AMERICAN ILLUSTRATED MEDICAL DICTIONARY. A New and Complete Dictionary of Terms Employed in Medicine, Surgery, Dentistry, Pharmacy, Chemistry, Veterinary Science, Nursing, Biology, and the kindred branches; with new and elaborate Tables. Ninth Edition, revised and enlarged. Edited by W. A. NEWMAN DORLAND, M.D. Large octavo of 1179 pages, with 331 illustrations, 119 in colors. Containing over 2000 new terms. Philadelphia and London: W. B. Saunders Company, 1917. Flexible leather, $5.00 net; thumb index, $5.50 net.

The construction of a dictionary calculated to fairly cover the vast field of modern medical terminology is an arduous task whose faithful accomplishment is worthy of grateful acknowledgment on the part of those whose daily queries it is found to solve; and the present-day lexicographer who in successive editions has to live up to an established reputation for "keeping abreast" has no sinecure. New ideas are ever springing up and new words describing them demand recognition. In the present edition of the American Illustrated Medical Dictionary it is understood that about 2000 entries make their bow to its professional clientèle.

Of itself, the demand for a ninth edition of a work emanating from the literary travail of Dr. W. A. Dorland and his associates and whose material soma issues from the W. B. Saunders Com

pany is a guarantee of excellence, which is confirmed by the general evidences of advancement in the path along which these sponsors have hitherto brought this important work.

A number of the newer terms have arisen in the course of the professional activities called forth by the present international conflict. Nor could it be otherwise in a faithful record in these

ance

stirring days, owing to the many beneficent advances in diagnostic and medicinal means and methods that are ever cropping forth, and the marvelous surgical improvements to which recourse is now available, and when even new pathologic entities are making their appear—all of which must be given a local habitation and a name in an up-to-date reference book. And we find here, e.g., such entries as ambrine, chlorazene, flavine, trypaflavine, javellization, Laclainché-Vallée serum: such pathological designations as "trench back," "trench foot," "trench fever," etc., and a score, perhaps, of "war abbreviations," as P. U. O., an English designation for the fever just named, the initials representing "Pyrexia of Unknown Origin." In which last phrase, by the way, occurs one of the extremely few typographic slips, giving the word as Pyreria. On page 863 we find an a for the middle vowel in a mention of the city of the famous shrine of the many-breasted image that "fell down from Jupiter," whose claims. when challenged the enthusiastic citizens overwhelmingly established by making the amphitheater ring for 120 minutes

by the clepsydra with "Great is Diana of the Ephesians!"

In the war abbreviations there is doubtless a present utilitarian value; in less hasty times, however, on the hopedfor re-establishment of a live-and-let-live international philosophy they may well be allowed to fall into "innocuous desuetude." With the necessarily multiplying abbreviations in the sciences, it would seem that the ministrants of healing need not add to them, but so far as possible abide content with those called for in prescription writing and other established uses. There is much liability to ambiguity, and this may be fraught with danger to life.

Of handsome exterior, with its red leather flexible covers, this "large Svo" book maintains a high typographical ideal, exhibiting experienced judgment and excellent workmanship. The body type is clear, notwithstanding its necessarily small size; the heavier type of the overhanging entries is harmonious with it, and the Greek derivations are given in an admirable Greek face, neither too bold nor too slim, and well adapted to accompany the English type. Judicious selection is evident in each feature, making the page inviting to the discerning eye; and thin but opaque paper combines with first-class presswork to give a clear impression and uniform "color" from beginning to end.

Speaking now of other general impressions, and first of the illustrations, it is welcome when referring, say, to the anatomic tabulations of arteries, veins, muscles or nerves, to find these pictured in colors on the pages immediately facing their mention. The illustrative material has been subject to considerable additions; there are, in fact, as many as 115 colored illustrations in this edition, and

of those in black and white over 300. As to tables, it would seem that about everything suited to tabular presentation is found here, including those of the exanthemata, of signs and symptoms, of serums, tests, reactions, staining and fixing methods; of operations; the various "procedures" known as such are given, the special technique being indicated. The posologic and therapeutic table at the end is a full one, occupying 50 pages. The brief biographies of the men whose names are specially connected with diseases, or methods of treatment, or operations, constitute an invaluable feature.

While for the province of dentistry a special wordbook is called for-and there are parturient symptoms of new dental nomenclature even at this moment-yet the dentist, it goes without saying, almost as much as the physician, must be familiar with innumerable matters that are constituents of this medical dictionary, while the feature of its recognition of dental terms has already, in the eighth edition, been commended in the DENTAL Cosmos. It may, however, be remarked in connection with the word Tooth (the words Tooth and Teeth take up about three-quarters of a page), that, after mention of the "root or fang," the latter word is unfortunately chosen in each of several subsequent mentions of the root. This is a blemish; the dental profession has abolished the "fang." Uncorrected, this is liable to cast an unjust reflection upon the other dental entries.

The DENTAL COSMOS has from time to time commended what is known as the "dictionary habit," and its application to the work before us could not but prove most fruitful of real interest and abundant profit. Whether this book be taken up from time to time with the purpose of recalling partly forgotten knowledge,

and of adding thereto, or to make references when perusing professional literature or contributing to it, or whether, again, in the exigencies of practice recourse may be had to its valuable epitomes of symptoms and methods-for these may be recalled instantly here, even

the quite recent ones-the practitioner of healing is furnished with a treasury of information for his own advancement in knowledge, for immediate aid and counsel in emergencies, and for the promotion in various ways of his usefulness to his patients.

Dichloramine-T is readily soluble in most organic solvents, with the exception of the paraffin hydrocarbons. The majority of these solutions are of no value for practical purposes, since the dichloramine-T contained in them is rapidly decomposed. Among the few solvents which give reasonably stable solutions many had to be rejected on account of their proving too irritating, so that it will be realized that the selection of a suitable solvent for dichloramine-T is a somewhat dif ficult problem.

The authors undertook a systematic survey of other possible solvents with the object of finding a cheaper and blander substitute for eucalyptol (the one hitherto most generally employed). This aim is believed to have been accomplished, at least in part.

It appeared, from extensive experiments, improbable that solvents containing oxygen were likely to prove successful, since they usually abstract chlorin from the dichloramine-T too readily. The choice then practially resolved itself into halogen derivatives other hydrocarbons of the aromatic, aliatic, and other series.

It was found that paraffin wax could be readily chlorinated under easily regulated conditions. The product when prepared as described below was an extremely bland, rather viscous oil, which readily dissolves dichloramine-T. The solution so prepared was stable over long periods, if kept under suitable conditions. The authors have provisionally chosen the name of "chlorcosane," for this solvent, since the systematic names of most of the hydrocarbons in paraffin wax end with the suffix "cosane."

Chlorcosane is prepared as follows: Paraffin wax, of a melting-point at 50° C. or higher, is placed in round-bottomed flasks and heated to about 120° C. Two flasks connected in series, each containing half a kilogram of the wax, may be conveniently used. A rapid current of chlorin from a cylinder of liquefied gas is then passed through the molten wax in the flasks, each of which is provided with a thermometer and the necessary glass tubes. The temperature should be controlled within the limits of 125° to 140° C. The first flask, in which the reaction is the more vigorous, will require but little heating. Chlorination is continued until the contents of the flasks have increased in weight 45 to 65 per cent. of the weight of the wax taken. It will be found convenient to complete the chlorination of the first flask and then remove it, and transfer the second to its place, putting a fresh flask of paraffin wax after it. In order to avoid undue discoloration of the product, a minimum amount of rubber tubing should be used

for passing the gases, and the ends of the delivery tubes are preferably blown into bulbs provided with a number of fine orifices to promote good contact between gas and oil. Hydrochloric acid is freely evolved during the reaction. After the requisite amount of chlorin has been absorbed, the oil, while still warm, is shaken vigorously with 5 per cent. of its weight of dry sodium carbonate, and then filtered through a dry fluted paper. The clear oil, which has a light yellow or sherry color, and is slightly heavier than water, is then ready for use. It possesses a viscosity

intermediate between that of olive oil and castor oil, has almost no odor, and is perfectly bland when sprayed up the nose or placed on skin or wounds.

The materials necessary for making this new solvent are all easily available at very small cost. It has no appreciable antiseptic action. At room temperature it can dissolve from 8.5 to 10 per cent. dichloramine-T. For wound treatment a 7.5 to 8 per cent. solution is strong enough. After heating the solvent, "chlorcosane," to 75° or 80° C., it will easily dissolve the necessary quantity of dichloramine-T. If necessary, filter, although with pure materials this is not required. The clear solution should be at once stored in small amber corked bottles, and not exposed to unnecessary heat.

Under ordinary conditions solutions which are protected from light by amber bottles and from contact with water or excessive heat may safely be used for two months, or possibly longer. The clinical results of dichloramine-T in this new solvent are similar to those already recorded by Lee. Sweet, and others.

[New York Medical Journal, January 12, 1918.] Oral Sepsis and the Anemias. BY M. L. GRAVES.

Anemia constitutes but one of the numerous clinical manifestations of sepsis or infection, whether it originates in the mouth or elsewhere. The author agrees with the belief of Wm. Hunter that pernicious or infective anemia should be ascribed to mouth infection.

One concrete case under Graves' personal observation illustrates this. Rigid examination failed to reveal any focus of infection save the mouth, which showed a bad glossitis

The article by Dieulafé is the more comprehensive of the two. The increased incidence of facial wounds in modern warfare increases the frequency of salivary fistulæ. In civil practice and also in war surgery the two varieties which vastly predominate are parenchymatous fistula of the parotid and fistula of Stenson's duct. For a fistula of the parenchyma of the parotid, at one time or another the following means have been advocated:

(1) Compression and excision of the fistulous tract. These have proved themselves insufficient.

(2) Cauterization, either with silver nitrate or thermo-cautery. This has given some good results. In mild cases Dieulafé always advises to commence treatment with one or the other of these methods. They are particularly adapted to fistulæ sequent to intraglandular suppurations.

(3) Injections of oil into the fistulous tract. In two cases where this was tried by Dieulafé the result was ephemeral.

(4) Creation of an intrabuccal opening by transfixation. The author tried this method in three cases, in one of which it did not succeed.

(5) Resection of the auriculo-temporal perve. On account of the complexity of the innervation of the parotid gland the author was not too sanguine of an absolute dryingup of the parotid secretion by resection alone

of this nerve. For this operation local anesthesia should be reserved for those cases where there is no inflammation or cicatricial tissues in the region where the nerve is to be sought. The secretion never stops immediately after the operation. Dieulafé practiced this method three times in healthy surroundings and twice in cicatrices. In all five cases the secretion was prolonged after the operation, then it disappeared. In two cases it was necessary, in order to complete a cure, to resort to cauterization, which had previously by itself failed. When everything is taken into consideration this operation leads to the desired therapeutic success.

Deupès has confined his attention in his report exclusively to this method of treatment, namely, resection of the auriculo-temporal nerve. In his experience salivary fistulæ, together with facial paralysis, are very frequent sequela to the cicatrization of extensive regional lacerations. His two cases are those of fistulæ from the parotid parenchyma. He summarizes his operative procedures as follows:

(1) Local anesthesia under novocainadrenalin.

(2) Vertical incision, about 3 cm. long, half above and half below the zygomatic arch. (3) Search for the nerve. The pulsations of the temporal artery have not served as a landmark. It was necessary to seek under the upper part of the incision for a peripheral filament of the nerve, and to follow this to the trunk.

(4) Dissection of the nerve in the sheath to the lower part of the incision, that is, to the glandular tissue.

(5) Gentle traction on the nerve with a hemostat, so as to obtain as great a length as possible until rupture. This step of the operation was always quite painful.

(6) Reunion of the cutaneous borders with the clasps of Michel.

On the next day, on removing the dressings, there was proof that this operation, benign, without blood, and rapid, had perfectly succeeded.

The remainder of Dieulafé's paper is concerned with the fistula of Stenson's duct. Among the war-wounded it is possible to recognize divers pathogenic groups: (1) A very limited traumatic injury to the cheek, by a shell splinter, directly involving Stenson's

duct, and creating a fistula as a result of a lateral section of this duct; (2) great lacerations of the cheek by shell splinters, followed by retractile cicatrices encircling the duct, obliterating its normal orifice and leaving open toward the skin the wound, which involved the duct; (3) traumatism, again by shell splinters having involved the bones and soft parts, resulting in inflammatory phenomena which open, abscess, and make a fistula out of Stenson's duct. The second variety is the most frequent; each of the others has been observed by Dieulafé but a single time.

In spite of the frequency of facial lesions among the war-wounded, of their seriousness, and of the vast lacerations which they produce, the author has gained the impression that the fistula of Stenson's duct is a rare complication. The following methods of treatment are mentioned, and some of them are briefly outlined: Compression of the gland or the duct, the injection of substances tending to promote atrophy, absolute immobilization of the jaws, cauterizations of the fistulous tracts (in one case by this method Dieulafé obtained a cure; the wound was completely limited to the buccinator region, and bordered directly upon the canal), simple occlusion of the fistula, suture of the fistula, suture of the two ends of the duct together, re-establishment of the permeability of the anterior (distal) end of the canal, the creation of an artificial passage toward the mouth (this method by transfixation has appeared to the author applicable to the generality of cases, whether they concerned wounds of Stenson's duct or the masserteric lobes of the parotid gland; the author employed this method four times, always with success), the transplantation of Stenson's duct (this procedure is contra-indicated where the tissues are cicatricial, but Dieulafé advocates it for all cases where there can be found an appreciable segment of the posterior, i.c. proximal, end of the duct, and where this can be fixed to a healthy mucosa, the author has had one failure, a civilian case, and two successes, military cases, by this method), the creation of an artificial duct at the expense of the mucosa, and finally, the suppression of the parotid secretion. The last method is not recommended personally by Dieulafé. However, to accomplish this the duct may be ligated.