Operative Surgery

are performing operations on the cadaver." We are aware of the difficulties in carrying out this intention, but a perusal of the book leaves some dissatisfaction from both points of view. The illustrations number over 200, and are generally good and clear, but fig. 196 is anatomically incorrect in several particulars, and fig. 199 does not correspond with the description in the text. There are several grammatical and clerical errors, e.g., " jackanet," catgut in " 1 in 500 carbolic solution," the " innermost" of two white lines, "Parker Symes" (Syms), and " either . . . are" (p. 357). On page 10 the flexor carpi radialis is stated to be on the inner side of the front of the wrist.

She was readmitted on June 3, 1920, with a threatened miscarriage, bleeding, uterine pains and slight dilatation. After a week's rest she was discharged and was instructed to go to bed whenever pains reappeared. After several milder attacks she was readmitted on August 28, 1920, with a history of the waters having broken. A seven months' female child was born by a breech presentation. She was discharged with her child on September 24, 1920.
Case II.-Fixed Retroverted Uterus with Pyosalpingitls. N.N., aged 31 years, a multipara, was admitted on the recommendation of Dr. W. O. Doyle to Royal Prince Alfred Hospital on March 5, 1920, with pain in the abdomen, vomiting, leucorrhrea, frequency of micturition and amenorrhrea since January 25, 1920.
On examination it was found that the uterus was increased in size and fixed in a retroverted position. The tubes and ovaries were enlarged, bound down and tender.
Operation was performed on March 12, 1920, under ether aneesthesia. The abdomen was opened; the tubes were sealed to ovaries and contained pus. Adhesions fixing the uterus in retroverted position were severed. Both tubes were removed. The left ovary was cystic and infected and was therefore removed. The right ovary, being more normal, was conserved. Again the intramural portion of each tube was left in situ. The patient made an uninterrupted recovery and was discharged on April 8, 1920.

Subsequent History.
She wore a pessary until the fourth month, when it was removed. She was readmitted on October 5, 1920, for abdominal pains, but there were no signs of dilatation or other indications of labour. They were probably intestinal in origin and soon subsided. She was delivered of a fullterm male child on November 8, 1920, and had a normal puerperium, except that on the day after getting up (November 11, 1920) she had a rigor with temperature of 40 0 C., which came down next day. She was discharged on November 30, 1920.
Commentary. The foregoing two cases are of interest mainly as illustrating the effect of ovarian substance (whether corpus luteum or endocrine) on the control of the period of gestation. What starts the mechanism of labour and what factor determines the exact time at which the fretus is told that it is time to move on? Could these questions be answered, the explanation of many cases of over-gestation and prematurity would be possible and correction might be applied. In Case 1. the whole of the ovarian tissue was removed and the fretus several times attempted to break before the pistol, as it were, and eventually did finish before the appointed time. On the other hand, in Case II., in which one ovary had been conserved, the fretus displayed no hesitancy whatever about the correct time to start on its journey into the world. It would be interesting to hear the experiences of others in such operative cases. I regret that no note was made as to whether the. ovary left behind in Case II. contained a corpus luteum or not. operating surgeon. It is a book to which the surgeon may with confidence have recourse to when in trouble, because emphasis has been placed more on unusual rather than on common operations. The information is presented in the most concise manner possible and is so well illustrated that the most complicated procedures can be quickly mastered.
In this edition the chapter on tic douloureux has been brought up to date by the inclusion of an account with illustrations of Frazier's method of operating on the sensory root of the fifth nerve. This, no doubt, is the most ideal method of treatment available at present for the treatment of this most painful malady.
Many recent methods of bone grafting operations for replacing loss of bone substance in the lower jaw are given in great detail.
The chapter on thoracic surgery. has been practically rewritten. The modern methods of Cherrier or Berard for treating empyema are outlined and should be adopted by the practising surgeon. A new method of thoracoplasty is described. Much new matter has been added to the chapter on abdominal surgery. Many methods which cannot be recommended in the light of recent experience, have been deleted. The more modern tendency to deal with gastric ulcer by some form of resection or partial gastrectomy is emphasized and different methods of doing this are indicated.
Interesting reading will be found in the chapter on plastic surgery. Gillies's methods of transferring large areas of whole skin by the "tube pedicle" method and Dufourmental's ingenious operation for replacing the chin and lower jaw are given prominence. These methods have great application in civil practice. Altogether the work has been brought up to date and may be consulted with confidence by the surgeon, for whom it is intended.

• THE SPEOULUM.
"THE SPECULUM" has changed its shape, general appearance and secondary characteristics. The change represents a great improvement and the board of management, including the editor, MR. C. W. COURTNEY, and the sub-editor, MR. C. CRAIG, are to be congratulated on the work of reconstruction. From the cheerful skull and the bony title on the black cover to the record of the doings of "old boys" on the one hundred and seventeenth page there is evidence of budding as well as fully fledged talent. In common with the other journals of the medical students' societies, ineluding the former Speculum, its contents are a pot pourri of serious matter, of news items and of delightful nonsense of a pale pink shade, not scarlet. The serious part embraces a brief account of the new curriculum by Sir Harry Allen, a discourse on splints and the like by Mr. Fay Maclure, part of an article on aneesthettcs by Dr. C. P. W. Dyring and some reports of cases. The news items are contained in various notes from the several hospitals, notes of the first, second and third year students, sports notes and so on: This element of the publication also includes reports of the Melbourne Medical Students' Society's functions, such as the annual dinner and the annual ball and of the farewell dinner to the retiring lecturers in medicine and surgery. The lighter parts are witty, irresponsible and-spontaneous. At times the writers are not supremely original; but that is a minor matter. Each article is ruled off from the next by four small, dignified skulls. The other illustrations are a little crude, but the majority are cleverly drawn. Melbourne graduates should support their old school and its students' journal by subscribing the small sum of 5s. per' annum, for which sum they will receive two issues of a first-class and useful journal. The management asks all "old boys" to perform several minor services, such as to write letters about themselves, to contribute original articles, notes, jokes, sketches and the like, to advertise in the "Exchange Column," to report cases and to submit commentaries, send criticisms of The Speculum and so on. It is very little to ask and loyalty to the Medical School demands that they should respond. The management has determined to reduce the number of issues from three to two each year to meet the financial and other difficulties. A further reduction can be prevented only by a large response to the invitation addressed to all old Melbourne medical graduates.