The subject of surgery is taken up by regions, each operation considered, discussed and preference indicated. The illustrations are good, together with the text, forming an admirable method of teaching surgery didactically. Of course, we all know that actual operating upon the cadaver is the prime condition of working out surgical technique. This work would serve well as a guide in performing this cadaver operating. At the same time it is a useful book to have in order to refresh the memory of the "occasional" surgeon, preparatory to invading the tissues. THE MEDICAL AND SURGICAL KNOWLEDGE OF WILLIAM SHAKESPERE.-With Explanatory Notes. By John W. Wainwright, M. D., New York. Published by the author, 1907. No works of pure literature have furnished more varied material to the student and commentator than the dramas of William Shakespere. They have been approached from all sides, and everyone who has delved into their treasures has brought to light something, the very existence of which had never been suspected. If Shakespere was actually possessed of all the qualities attributed to him, he must have partaken more of the nature of a divinity than of the attributes of a mortal. The lawyer has proved that his knowledge of law and of its essence was varied and extensive; the philosopher has been amazed by the profundity of his insight into the reality behind the apparent flux of phenomena; the moralist finds in him an understanding of the hidden springs of human action, and would elevate his maxims almost to the dignity of axioms; the statesman appeals to him in the heat of parliamentary debate, and clinches an argument by a sentence that seems made for the occasion. Dr. Wainwright has studied the works of the master from the point of view of the doctor of medicine. A man of broad culture, as well as a distinguished physician, he is eminently qualified for the task he has essayed. He has collocated numerous passages in which reference is made to disease and its cure, and in every instance elucidates the text by notes. For convenience, the matter is divided into sections, under the headings: Medicine, surgery, mental and nervous diseases, obstetrics and midwifery, therapeutics, pharmacy and toxicology, anatomy and physiology, hygiene and dietetics, ethics and medical jurisprudence. An interesting feature of the work is the frontispiece portrait of Shakespere, an engraved reproduction of the famous Droeshout portrait, painted when the poet was about fifty-five years old, and believed by competent authorities to be the only one in existence which was painted in his lifetime. The appearance of the book is artistic in the highest degree; the paper is handmade, deckel-edge; the margins are wide a desideratum in the eyes of those, who, like the reviewer, believe that a good book is one which produces copious stimulation in the jotting down of marginalia. The book should find a place in the library of every lover of the Swan of Avon. The edition is a limited one, and each copy bears the author's autograph signature. Price, $2.50. Published by Dietetic and Hygienic Gazette, 33 West 42d Street, New York City. OLOGY. THE PANCREAS, ITS SURGERY AND PATHBy A. W. Mayo Robson, D. Sc. (Leeds), F. R. C. S. (Eng.) of London, and P. J. Cammidge, M. D. (Eng.) D. P. H. (Camb.), of London. Octavo volume of 546 pages, fully illustrated. Philadelphia and London. W. B. Saunders Company, Philadelphia and London, 1907. Cloth, $5.00 net. Half Morocco. $6.50 net. This valuable work compiled by Robson and Cammidge, deserves a special niche in the hall of medical literature, because it definitely draws attention to the possibility of making a diagnosis of pancreatic disease during life a fact which has hitherto been overlooked in the standard works on internal medicine. It is a carefully written work upon what is usually considered an "organ of mystery." It opens up with a complete description of the anatomy and embryology of the pancreas, a sine qua non for a correct appreciation of the latter contents devoted to pathology and diagnosis. It is true that most of the information in the past relating to the function and diseases of the pancreas has been gleaned from the dissectingroom or autopsy table, but this work teaches what has been learned from surgical manipulation of the organ, from urinary examinations, from feces analyses. and from animal experiments (mostly vivisections). The attention of practitioners can be more particularly directed to the excellent chapter on diabetes, in which the meager pathology in the pancreas in Instructor in Radiography and Radiotherapy at Cornell University Medical College; Lecturer in [Written for the MEDICAL BRIEF.] Three conditions confront us in the use of any agent we wish to use therapeutically. First, it is well to understand the physical properties of the agent, for this usually leads to the second, or the physiological capabilities of the same; while a knowledge of the two will assist us in applying it to pathologic states. What is the X-ray? Its discovery is now history. To say that it is electricity in some form is simply begging the question. We must know, then, what electricity is before we can understand the physical properties of the X-ray. If we come right down to the last and final division of all that surrounds us, the world, the stars-in fact, the entire universe-we are compelled to recognize three, and no more than three entities. These three physical entities are: Matter, Ether and Energy. Each one of these three possesses special properties whereby they essentially differ from each other, yet each one is directly influenced by the presence of the other. Thus, all matter has weight and fills space. Ether is that elusive substance that seems to exist principally in a negative form, yet it is everywhere, and is absolutely essential. We can not see, hear, taste, smell, nor feel it; nevertheless, we can, by many experiments, prove its existence. Without the ether there could be no waves or radiations of light and heat from the sun. The ninety-three millions of miles from the sun to us must be filled with something; nature abhors a vacuum, and there is no such thing as emptiness. Energy is that power which changes the state of motion of all bodies. Just as there is no emptiness, so there is no such thing as rest. The very particles of a solid piece of steel are in a state of perpetual, unremitting quiver. This motion is vibration; the cause or the power that continues or changes this vibration is energy. * Read before the Medical Society of the Borough of Bronx, January 8, 1908. We started out to define electricity; shall we say electricity is matter? No, it does not possess weight, neither does it occupy space. Yet electricity can not manifest itself without matter, for something must be electrified. Is electricity ether? No, because electricity may be manifested to our senses, and is tangible; but electricity requires the ether, for it is only the ether that occupies all intermolecular space that conducts electricity. Ether, therefore, is not electricity, but essential to it. Is electricity energy? No, since energy is possessed by all bodies, and only under certain conditions is electricity manifested. We may have energy without electricity, but not electricity without energy. Matter, We have thus reduced the entire universe to three terms: Ether and Energy. It was shown that not one could, by itself, and without the other, exist. In reality these three entities are so closely interwoven with each other that they really become one, and this one, whatever that may be, is necessary for the existence and manifestation of a certain condition we call electricity. Electricity is essentially vibration; the rate and magnitude of this vibration is fixed by certain physical laws of which we are more or less conversant. Electricity, ordinarily, travels at the rate of two hundred and ninety thousand miles per second, with a certain range of wave length. When a current of a sufficiently high tension or pressure traverses a glass sphere from which all the air that can be removed, has been removed, the waves, or oscillations, become shorter, but increase in number enormously. The waves finally become so small that ordinary substances offer little or no resistance to the vibrations, and they are, therefore, capable of passing through various substances and becoming manifest again after such passage. This phase of an electric current, on account of its similarity to a ray of light, has been called X-ray. X-ray, because it acted like a ray of light, and yet would not obey the ordinary light rays. The X-ray can not be deflected, nor refracted, nor bent from its course by a magnet, but through many substances passes as light does through glass. The X-ray is invisible, the same as electricity; no human eye has ever seen the X-ray, but the effects of the X-ray may be studied in detail. So much, then, for the purely physical properties of the X-ray. The It has been said that all things are in a constant state of motion, or, rather, vibration. It naturally follows that the smaller the various particles of any substance, the greater should be its rate of vibration. ether, no doubt, possesses the smallest of all particles, and the vibration of the ether particles is electricity. If the string of a violin be caused to vibrate in a room where there is a piano, every string in the piano of the same pitch will vibrate in sympathy with the violin string. Not only that, but every string possessing octaves below and above it will also vibrate if the initial vibration is strong enough, and the piano strings in harmony with it. Again, if two or more rates of vibration exist at the same time, the stronger will destroy the weaker. In nature there is no such thing as discord; all and everything is harmony. Each and every manifestation of life depends upon certain rates of vibration. The cells composing the organs of Cortie in our ears respond or vibrate in sympathy with all rates between eighteen per second up to forty thousand per second. The cells of Cortie can not respond to vibrations, though they may be in harmony after the rate of forty thousand. The rods and cones of our eyes are capable of responding to vibrations when they reach four hundred thousand billion to seven hundred thousand per second. We recognize these rates as light and the various colors. see. There is much food for speculation in the thought that there exist sound-waves that no ear can hear, and color waves of light that no eye can The sum and substance of all this is that every single cell in our body is in a continuous state of vibration; more than that, it is harmonious vibration. The cell, as we know, is a complex arrangement of a cell membrane, protoplasm, nucleus and nucleolus. All these must be in harmony, and remain in harmony with each other and their neighboring cells. The very moment that discord or inharmony is caused to exist, that moment disease begins, and death of the part follows. The X-ray evidently possesses a rate of vibration far in excess of seven hundred thousand billions per second, because our optic mechanism is unable to respond to it. When the cells of our body are brought under the influence of X-ray vibrations, the cells either vibrate in sympathy, and so become actuated to a greater activity; hence we produce stimulation in the part, or the vibrations of component parts of a cell may be arrested, their vibration may cease, and so we cause inhibition. Should this arrested motion last too long discord would ensue, with the unavoidable alternative of death of the part. We have, then, three distinct effects from the X-ray, viz.: Stimulation, inhibition and destruction. These effects are not sharply defined; a large dose of stimulation by over-stimulation causes inhibition; a large dose of inhibitory effect would cause disintegration and death. It is not, then, the X-ray, but rather the way in which the various parts of the body respond to the X-ray that furnishes us with these varying results. It. therefore, depends entirely upon the state of the tissue at the time of exposure. This property of the X-ray to cause disintegration of tissue is due to the ionizing effect. So much, then, for the physiological properties of the X-ray. X-ray therapeutics, like all therapeutic measures, are only useful when applied to a pathological process. |