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REVIEWS OF BOOKS. 


The Rules of Aseptic and Antiseptic Surgery. A practical 
Treatise for the Use of Students and the General Practitioner. By 
Arpad G. Gerster, M. D., Professor of Surgery at the New York 
Polyclinic; Visiting Surgeon to the Mount Sinai and German Hos¬ 
pitals ; pp. 332. With 248 photo-engravings and two chromo-litho- 
graphic plates. New York: D. Appleton Sr Co., 1888. 

The well known author of this book has prepared a manual of asep¬ 
tic and antiseptic technique which reflects upon himself the greatest 
credit, and which will do much to hasten the universal acceptance of 
the newer methods among those who do not adopt them on account 
either of ignorance or inability to comprehend them. 

It is not a complete manual of operative surgery, and is not intended 
to supplant any of the well known works on this subject. It is, how¬ 
ever, a complete exposition of so much of the theory and the prin¬ 
ciples of asepsis and antisepsis as is required for their proper observ¬ 
ance, and a complete description of all details by which success in 
such work is to be acheived. His thesis is that dictum now generally 
accepted that the surgeon's acts determine the fate of a fresh wound , and 
that its infection and sufpuration are due to his technical faults of 
omission and commission. 

As Cheyne has well shown modern wound treatment is based en¬ 
tirely on long accepted and well known principles of preservation of 
organic material, and these principles always must underlie the prac¬ 
tice ; the particular methods may change from time to time, as they 
have notably changed since Lister first showed us his early forms of 
dressings, but the facts never. For irrigation the author uses, of course, 
the mercuric chloride solution : for the instruments he advises carbolic 
acid. For the peritoneal cavity he recommends the boro-salicylic so¬ 
lution. For dry dressings he employs iodoform alone or with bismuth 
subnitrate. We do not find mention either of hydronaphthol, zinc 
oxide or naphthaline, all of which we have found both cheap and as re¬ 
liable as the others. The differences between aseptic and antiseptic 
work find frequent illustration throughout the book. Neuber’s bone 

( 47 =) 



ASEPTIC AND ANTISEPTIC SURGERY.— GERSTER. 473 

drainage tubes have been discarded by the author, who finds nothing so 
suitable as black rubber; but he still practices Neuber’s method of 
canalization without other drainage. Schede’s healing by means of a 
moist clot he both describes and re commends, though he does not 
give it a place of the greatest importance. 

Chapter v, he devotes to special applications of the aseptic method. 
This constitutes a pretty full discussion of regional surgery, less time 
being devoted to the instrumental technique than to the enforcement of 
aseptic practices, though the pages bristle with practical hints of great 
value. Of the features covered by this chapter we will stop only to 
notice what is said about radical cure of hemia, in which our author’s 
experience though not extensive has been very satisfactory. He follows, 
in the main, Czerny, whose method has always seemed to us the best, 
though we have for some time now substituted two or three silver su¬ 
tures for his shoe lace catgut suture of the external ring, with better 
satisfaction. We do not observe that he advises the application of the 
same method to the radical cure of large or small umbilical hemise, 
though an experience of several cases has taught us its advantages. 

For chapter vi, which deals with the natural history of idiopathic 
suppuration and its treatment we have a warm welcome, since now— 
perhaps for the first time—the student can find in English that which 
our text-books have been so slow to teach,—a summary of uur present 
knowledge of the bacterial origin of pus; in other words the parasitic 
causation of phlegmon. While this portion of the book seems to be 
rather the result of diligent study of the work of Koch and Rosen- 
bach, than the product of the author’s own research, it is none the less 
welcome since nothing better can be found. A number of Koch’s 
photographs are reproduced and three of Rosenbach’s colored plates 
are introduced by which the text is well elucidated. This part of the 
chapter is comparatively short; so short that we wish it might have 
been elaborated, since we consider it one of the greatest value at the 
present time. I he balance of it is given over to the diagnosis and 
tieatment of phlegmon, under which caption is included necrosis, acute 
and cold abscesses and fistula;. Here, as throughout the book, the 
most radical and hence the best methods are advised and illustrated. 
In not a few places reference to the surgical anatomy of the parts is 
made, by means of which the better antiseptic attack on their diseases 
is favored. One statement, which alone is a sufficient refutation of all 
argument against antiseptic methods, deserves to be quoted and em¬ 
phasized, that in ten years of extensive surgical practice, Dr. Gerster 
has had but four cases of erysipelas. 



474 


RE VIE IVS OR BOOR S. 


The third part of the book is devoted to tuberculosis, its aseptic 
and antiseptic treatment. If the author had seen fit to do as much for 
the profession at large in discussing the pathology of tuberculosis, as 
he did in considering that of suppuration, we should have been spared a 
certain feeling of disappointment; the more so, since we have been led 
to expect that this would constitute a considerable portion of the work. 
There is still the same necessity for widely diffusing clear notions on 
this topic that obtains with reference to the other. When eminent sur¬ 
geons and authors of treatises, or editors of cyclopedias are still to 
be numbered among the unbelievers, surely too much cannot be said 
by such men as Dr. Gerster. Still as he has seen fit to treat the subject 
rather in its practical relations, we can only express a hope that he will 
elaborate the chapter in a subsequent edition. Most of this chapter 
is devoted to the consideration of exsections with suitable dressings 
for the wounded parts. He gives an excellent description of Wladimi- 
roff-Mickulicz’ osteoplastic resection of the tarsus. 

Part iv takes up gonorrhea, and its antiseptic treatment, and part 
v syphilis,', aseptic and antiseptic treatment of external lesions. 

Their consideration is more apropos here than might at first appear: 
in the former he has a great deal of value to say about the endoscope 
and treatment of urethral lesions by its aid: the latter is brief, but 
thoroughly practical. 

A feature of the book is the introduction of a large number of illus¬ 
trative cases, which help to carry conviction as to the value of the 
methods according to which they are treated, and which make a valu¬ 
able record of the author’s work: nevertheless, it appears to us that 
some of them might have been omitted without detriment. 

But the most conspicuous feature which the work presents is consti¬ 
tuted by the illustrations, most of which are photo-reproductions from 
negatives taken by the author, or under his immediate direction, and are 
beautiful examples of the photo-engraver’s art. Exception can only 
be taken to a few of them which though attractive, yet, reveal nothing 
in any instructive detail; such, for instance, are figs, ioo, 114, 185, 
199, 214. But this is, perhaps, captious criticism, since they are simply 
superfluous. In the main, however, the illustrations do as much to 
convey valuable lessons as does the text, and .each vies with the other 
in value. 

The paper is, as befits such work, heavy and finely finished, and the 
typographical and artistic appearance of the book is so excellent that 
we consider it the finest medical book of its kind ever issued in Amer¬ 
ica. It is one of the greatest value to every one who aspires to do 



TEXTBOOK OF GENERAL SURGERY.—FISCHER. 475 


even a little surgery, since he should aim to do this little well, and au¬ 
thor and publisher should each be proud of their respective shares in 
its production. Roswell Park. 

Lehrbuch der Allgemeinen Chirurgie Nach dem Heutjgen 

Standpunkte der Wissenschaft. Bearbeitet von Prof. Dr. H. 

Fischer, (Breslau). Stuttgart, Ferd. Enke, 1887. New York, G. E. 

Stechert. 

Textbook of General Surgery, According to the Present State 

of Medical Science. 

In one large octavo volume of some 900 pages, the author has 
treated the entire subject of general surgery in such a manner, that 
the student or practitioner may readily find all that is important, and 
all that has of late been published in regard to any single question, or 
chapter in general surgery. 

The reader is supposed to possess a lair knowledge of general path¬ 
ology, but the special surgical pathology is, of course, everywhere 
given in detail. Where, in treating of any single subject, various con¬ 
flicting statements present themselves, they have all been admitted and 
given their due consideration, and where a want of special investiga¬ 
tion has made itself felt, this deficiency has been pointed out. For 21 
years the author, (as he tells us in the preface), made the contents of 
this book the subject of special study, and three entire years, he adds, 
it took him merely to write it out. 

From these data some idea of the amount of work contained in 
the book may be formed, and a glance at .the comparatively large 
amount of matter and historical learning contained in the fine print of 
the notes readily sustains them. 

The extensive use of numerals and letters to mark the divisions and 
subdivisions of the paragraphs, together with the printing of the head¬ 
ings in interspaced and capital types, gives the book an orderly ap¬ 
pearance, and facilitates the finding of any given subject, by reducing 
the confusion incident to the handling of large amounts of matter. 

An extended review of the various chapters cannot here be given; 
nor is it necessary to do so considering the objective manner in which 
the matter has been treated. Wherever the author deemed himself 
called upon to take sides in a question he has done so with the best 
judgment. 

Occasionally the reader is made aware of the difficulties presenting