bution to the physiology of the digestive glands; and should be read by every one. At least this volume of the series should be read by every physician.-SNEVE, St. Paul Medical Journal.

A Manual of Gynecology. By Henry T. Byford, M. D., Professor of Gynecology and Clinical Gynecology in the College of Physicians and Surgeons of Chicago; Professor of Gynecology in the Post Graduate Medical School of Chicago and in the ChiThird revised cago Clinical School, etc. edition, containing 363 illustrations, Philadelphia: many of them original.

P. Blakiston's Son & Co., 1902. Price, $3. In this, the third edition of the book, the author has recast the contents of the work and added much new matter. It is designed to be as complete and concise as possible and is excellently adapted for ready reference of those who do not desire to consult the more cumbersome and extensive works of its class. Marginal notes are employed to further simplify this means of reference and will be found of much assistance to the student, who will then be quickly enabled to find the text for which he may be looking. The work is excellently illustrated and special attention has been paid to treatment and surgical interference.

Text-Book of Histology. By Dr. Ladislaus Szymonowicz, Professor of Histology and Embryology in the University of Lemberg. Translated by John B. MacCallum, M. D., Johns Hopkins Medical School, Baltimore. Octavo, 437 pages, 277 illustrations, including 57 full-page plates in colors and monochrome. Cloth, $4.75, net. Lea Brothers & Co., Philadelphia and New York, 1902.

Histology underlies Anatomy, which is in turn the basis of Medicine and Surgery. The practical importance of the best books on Histology is accordingly paramount. This science has been especially developed in Germany, and the work of Szymonowicz there stands at the head. In selecting it for presentation in the English language, the publishers have been guided by the belief that its merits would be widely recognized. It is especially notable for

the beauty and instructiveness of its illustrations, in which colors have been used with great liberality. Dr. MacCallum has added to the text such points as were desirable to adapt it completely to the needs of American students, and while doing so has still further enriched its series of engravings and colored plates.

"Mary McLane shows too much egoism and introversion for buoyant mental health. Morbid egoism is often the beMary ginning on the way to insanity. McLane is apparently a little neurotic, probably troubled with a latent unrequited erotism, not yet having found its normal affinity. Congenial matrimony

often cures eroto-melancholia of ripening adolescence and places it in normal harmony with an otherwise inharmonious discordant world." So says Dr. Hughes, of St. Louis. But "congenial matrimony" is not absolutely necessary to a pure, devoted and useful womanhood, as the lives of thousands of immoral women testify. The use of matrimony as a cure for morbid sexual and psychic conditions is not desirable or justifiable.

By

A Text-Book of Bacteriology. George M. Sternberg, M. D., LL. D., Surgeon-General U. S. Army, Ex-President of the American Medical Association and of the American Public Health Association; Honorary Member of the Epidemiology Society of London, of the Royal Academy of Medicine of Rome, of the Academy of Medicine of Rio De Janeiro, of the Society Francaise D'Hygiene, etc., etc. Illustrated by Heliotype and Chromo-lithographic plates and 200 engravings. Second revised edition, New York, William Wood & Company, 1901, 672 pages and index.

This is the second and revised edition of Dr. Sternberg's notable work on bacteriology. This work has been a classic in its particular line and has been from the beginning a store-house of valuable information and the most complete work of reference of its kind. It is printed on excellent paper; is well bound and will no doubt be found a useful addition to the library of those physicians interested in bacteriology..

VOL. XXI.

No. 6.

cations.

A CASE OF BOWEL OBSTRUCTION FROM MECKEL'S DIVERTICULUM.*

BY J. C. SEXTON, M. D., RUSHVILLE, IND.

The writer reporting a failure will not be accused of using the time of your society for advertising purposes. Besides the study of an error either of judgment or undestanding often enables one to avoid a similar mistake. If then I intimate to your minds certain lines of thought by pointing out my own observations we may mutually benefit each other. As you have all heard the vermiform appendix has been called the devil's diverticulum to distinguish it from another diverticulum that occurs not infrequently and is situated upon the ileum some ten to twenty inches above the ileo-cecal valve. This pouch or diverticle was first described by Ruysch, but for some reason has received the name of Meckel's diverticulum, although Meckel's description of the anomaly appeared about a hundred years later.

A Meckel's diverticulum records an error in nature's efforts at tissue build

ing just as a hare-lip or an exstrophy of the bladder does, and to understand how it comes to be there at all it is necessary to review our embryology. Before and up to the seventh or eighth week of intrauterine life the tissues that are subscquently to be differentiated into the intestines and their glands receives their nourishment from the vitenus or yolk sac by a canal called the vitello-intestinal duct. When at the fourth or fifth week the abdominal plates close over, this duct is ab

*Read before the Shelby County Medical Society, and referred to the INDIANA MEDICAL JOURNAL for publication.

no trace of its previous existence, although the so-called vitelline remains or the omphalomesenteric remains can not infrequently be demonstrated upon the full term fetus. In a certain number of instances, however, the abdominal closure is not perfect. The duct may be only partially absorbed and remain open upon the intestinal side for a distance of several inches sometimes, terminating in a blind pouch which is not infrequently prolonged into a fibrous cord. This blind pouch formed in this manner from the incomplete absorption of the vitello-intestinal duct or canal is known as Meckel's diverticulum. It almost never has a mesentery. Its widest part is at the bowel opening, although the specimen I show you exhibits a slight narrowing at the neck giving it a somewhat polypoid appearance. It is located as a rule on the periphery of intestine, rather than upon the side or at the mesenteric border. Caused as it is by failure of perfect closure of the abdominal plates at the umbilicus the fibrous cord like termination is sometimes prolonged to the umbilicus or even the diverticle itself may be open at this point. Many cases

of persistence of embryological remains are associated with a history of umbilical hernia.

How often does a Meckel's diverticulum occur? Eighteen times in 1,446 cadavers studied by Kalynack, and as it was not the cause of death in any of these this pathologist attaches little importance to its presence, which by the way is not the experience of surgeons. In what propor

tion of cases of bowel obstruction is it the cause? Of fifty-four cases of intestinal obstruction acute and chronic observed by Fagge five were caused by a Meckel's diverticulum. In what proportion of cases of bowel obstruction by a diverticulum is

there a history of umbilical hernia associated? I can give no answer to this question that would have any scientific. support, but in the study of the causation the inquiry naturally suggests itself. When the end of the diverticulum is attached it is usually by a band of adhesion. to some neighboring loop of the ileum. The variations in size, shape, length, anatomical and pathological character, etiological hypotheses, etc., are points of very great scientific interest, but I do not care to take up your time with these for you can find them well worked out by Treves, Fitz, Senn, Socin, Gay, Fagge, Leichtenstern and other writers upon in

testinal obstruction, but would ask to report the following case:

A

He

On

A boy nine years old and delicate. thin, pale, undersized, poorly-muscled child. He had suffered greatly during his life from attacks of colic, indigestion and pains in the abdomen. He had an umbilical hernia of small size up to his eighth year when it was cured by strapping. was given a laxative on Thursday night, which moved his bowels on Friday. Saturday he was awakened at daylight by severe pain in the abdomen. This pain rapidly increased and his physician was summoned. He was given codia oneeighth grain every two hours. After the third dose the pain ceased. Upon cessation of the pain he was given sulphate of magnesia as a laxative, but began to vomit.