Recent Literature A Practical Text-book of the Diseases of Women . By Arthur H. N. Lewers, M.D. Lond., Obstetric Physician to the London Hospital, etc. Fifth edition, 526 pp., with 174 illustrations, four colored plates and 71 illustrative cases. Philadelphia: P. Blakiston, Son & Co. 1897
Boston Medical and Surgical Journal
It seems to me essential to investigate at least whether a bend of the septum producing a convexity of one side may not in some reflex way, perhaps from mutual interdependence of the turbinâtes of one side on those of the other, bring about an enlargement of the turbinâtes on the concave Bide of the septum. It would seem at least if we are to be deprived of the theory of respiratory influence we must look for it iu some nervous channel. I think the paper is extremely valuable because it has
... because it has made it necessary for us to alter our conception of the condition present, but we have not at present any definite substitute to offer for the old theory. Dr. Coolidue : The delicate physiological balance of the nose is well known. I want to draw attention to the delicate anatomical balance, tho change in the size of the turbinâtes themselves even involving the ethmoid cells as is seen in one of those skulls which are being passed around. Dr. Farlow spoke of judging of the patency of the nostrils by having patients breathe on a mirror. Hut we often find in a practically normal nose that at one time one nostril, and at another time the,other oiie, is admitting most of the air. I did not mean to take up the long subject of operations on the nasal septum. I merely mentioned that most of these operations involve problems in front of the nasal cavitieB proper. It seems to mo that one reason why so little harm is dono by many of the applications to the turbinated bodies is on account of tho great power of adaptation to different circumstances which these bodies possess. A turbinate can enlarge to such an extent that it will not be crippled by taking a little piece of from it or by putting some caustic ou it. I do not question the great benefit often obtained from chromic acid, for instance, but I do not believe that the result is due simply to the removal of tissue. Dr. Farlow has called attention to the over enlargement of the turbinâtes opposite a concavity, so that less than the normal amount of air can pass. I have noticed the same thing myself. 1 have tried to explain it by supposing that as the opposite side is obstructed by tho convexity of the septum, the concave side becomes equally narrow in order to keep tho air-carrying capacity of the two passages nearly equal. 1 am aware that when one nostril íb occluded by a bend of the cartilaginous septum opposite the nasal process of the maxillary bone the other or open nasal passage does not tend to close, but often furnishes sufficient space for comfortable nasal respiration. Where there has been nasal obstruction due to adenoid vegetations the turbinâtes are not small. The nasal cavities in these cases are often narrow and the turbinâtes consequently flattened. To go back to the question of the cause of the adjustment of the turbinâtes to the septum it seems to me to bo perfectly proper to doubt one explanation even if we have no substitute to offer. Many phenomena of growth in the body cannot be explainod by any mechanical process. Even to say that it is a trophic chango regulated by the nervous syBtem does not explain much. Septa are commonly nearly perpendicular iu early childhood. They become deformed gradually, and the turbinâtes change their shape to correspond, or possibly they all change together from some common cause, for the causes of the irregularities of septa deserve a better explanation than they have commonly received. Recent Literature. Physician to the London Hospital, etc. Fifth edition, 526 pp., with 174 illustrations, four colored plates and 71 illustrative cases. Philadelphia: P. Blakiston, Son & Co. 1897. This is the fifth edition, which brings the work to its ten thousandth copy ; and the most casual inspection of the book will at once show the reason for its having had a sale which is large for any book, phenomenally large for a technical work, and still more extreme for one devoted to a specialty. In the chapter devoted to the major operations one notes an absence of the more advanced technique which American operators now believe to be so essential to success. In the chapters devoted to tho minor operations of the subject, the author's free use of the uterine sound, his routine use of the cathoter, and his readiness to use tents in dilatation of the cervix, strike one as behind the times, but these are the only criticisms to be made upon the book. Its sensible, practical way of approaching the subject, its great attention to practical details, its thoroughness and clearness must make it of great value to any one, and of exceptional value to the inexperienced. It is a pleasure to review so praiseworthy a volume. The Medical Annual and Practitioner's Index. A Work of Reference for Medical Practitioners. Sixteenth year. Bristol: John Wright & Co. 1898. Those who are familiar with this handy annual and index will have learned to appreciate it. It is smaller than some of the more recent year-books, but its purpose is judiciously outlined and well executed. The publishers have in contemplation an index covering the last twelve issues.