Reviews and Notices of Books
He said that following the teaching of Martin this operation had ' I , been performed on patients at all ages during the childbearing period. In spite, however, of the results obtained ' , by Martin and Diihrssen, and their favourable reports of this I , operation in relation to childbirth, Mr. Scott Carmichael had ' , not felt justified in performing it under the age of 40 years in his later cases, and in his opinion the true facts as to the cause of difficulty during childbirth after this
... irth after this operation had not been worked out. From the results of 20 cases in which he had operated he believed that the procedure was of undoubted value in cases of retroversion, prolapse, and cystocele, where the patient would not submit to an abdominal operation and where treatment by pessaries had proved inefficacious. In fixed retroversion it was of value where the adnexa were not involved by the inflammatory processes. In cystocele and mild cases of prolapius uteri the symptoms could be entirely relieved by vagino-fixation. In following out the technique of Martin the uterus should be fixed to the anterior vaginal wall at a point 4.5 centimetres below the fundus, but if the patient had passed the menopause the point of fixation might be made nearer to the fundus. In the above class of cases next to the various methods for shortening the round ligaments vaginal fixation was to be preferred to ventro-fixation or ventro-suspension.-Dr. others discussed the paper. -Dr. J. W. Keay read a paper on a Simple Perineal Operation for Relaxed Vaginal Outlet. A commencement was made by raising a flap from the lower end of the vaginal wall ; into the right and left corners of the raw area Kocher's forceps were pushed through the fascial covering of the levator ani, and a portion of the muscle was grasped and pulled towards the median line and fixed there by strong catgut. By this means the vaginal outlet was narrowed and lifted up out of the axis in which the intra-abdominal pressure was directed downwards. The base of the flap was stitched to the fascial covering of the rectum, and the apex of the flap was stitched to the external wound, which was WE welcome the appearance of the last volume of this most excellent System of Surgery, for it completes a work which will for years maintain its place as containing the best general account of surgery in the English language. Nearly 70 writers have contributed toward the making of this great work and of these two died before the appearance of the last volume. When the work was first suggested it was intended that it should have filled some 4000 pages. In carrying out the idea which the editors had in mind they have found it necessary to employ nearly 5500 pages, representing an increase of over 25 per cent. We congratulate all concerned in it on the completion of this great work, but especially are our congratulations due to Professor Knee for the manner in which he has carried out so arduous a task. The contents of this volume are in no way less interesting than those in any of the preceding volumes. The Surgery of the Vascular System has been furnished by Dr. Rudolf Matas of New Orleans. This commences with an account of the surgery of the pericardium and of the heart. We cordially agree with the writer in his expression of opinion that incision of the pericardium for the purpose of letting out fluid, whether serum or pus, is far safer than aspiration or paracentesis, but Voinitch-Sianojentsky, whose work on the pericardium has been quoted, is one person and not two, as the writer apparently considers him to be. We do not think that the author lays sufficient stress on the compression of the great veins as they enter the heart and of the auricles as the essential part of the evil wrought by excessive intrapericardial tension. He speaks of the increase in the intrapericardial pressure interfering with the diastolic dilatation of the auricles and ventricles, but the effect on the auricles is vastly greater than that on the ventricles, because their walls are so much thinner. The fall in the general arterial pressure is entirely due to the interference with the supply of blood to the heart. A good description is given of the chief principles of the treatment of wounds of the heart. In the account of the surgery of the arteries we would especially commend the description of the rules for the tying of wounded arteries. The reasons of the methods employed are clearly given and the exceptions are explained. Arteriorrhaphy is of so modern an origin that it is only natural that we should seek with interest what a writer with so special a knowledge of the surgery of the arteries has said on the matter. The description is very full and is quite up to date. In speaking of the injection of saline solution, the author gives the temperature of the solution in the container as 120° F. We are certainly in favour of employing a higher temperature than that which is usually suggested, but we think that the temperature given here is a little above what is desirable. We are glad to see that the value of blood serum injections is recognised in the treatment of haemophilia. Dr. Matas a few years ago devised an ingenious operation for the treatment of aneurysm, and this method is usually called after his name, though it has a name of its own, endo-aneurysmorrhaphy. The method is of distinct value and it is becoming more widely used ; it is here described clearly. Altogether the surgery of the vascular system has been excellently treated. The next section deals with the Surgery of the Female Genito-urinary Organs and occupies more than 230 pages. It has been divided between three surgeons ; the first part, dealing with the methods of examination and with congenital malformations, has been entrusted to Dr. P. Brooke Bland of Philadelphia. The second portion, by Dr. John M. Fisher of Philadelphia, deals with the surgery of the vulva and the vagina. Both these sections are good, in particular the account of the treatment of ruptured perineum is very clear, and the illustrations representing the several stages of the operation are especially good. Dr. E. E. Montgomery of Philadelphia has written on the surgery of the uterus, broad ligaments, and Fallopian tubes. Dr. John H. Gibbon of Philadelphia has contributed the chapter on Surgical Technic. In this are described the various methods employed in modern aseptic surgery and the materials used. An interesting contrast is afforded by reprinting an illustration from Sir Watson Cheyne's " Antiseptic Surgery " published in 1882, and one of a modern operating room. The contrast is certainly very great, but it can hardly be said that there is an equally great contrast between the results obtained.