some of the large volumes, with equally as much information. We recommend it to the profession.

GENERAL MEDICINE. Practical Medicine Series, 1913. Vol. VI. Billings and Salisbury.

This volume seems to be a good review of the year's work in medicine, and will be appreciated by the general practitioner. The specialist in other lines will be interested in the review thus offered because he can keep abreast of the new in medicine without extensive reading. This volume may be had singly or with the other volumes of the series.

A CLINICAL MANUAL OF MENTAL DISEASES. By Francis X. Dercum, M. D., Ph. D., professor of nervous and mental diseases, Jefferson Medical College, Philadelphia. Octavo of 425 pages. W. B. Saunders Company, Philadelphia and London, 1913. Cloth, $3 net.

A textbook of mental diseases most useful to the student perhaps, but especially valuable to the practitioner of general medicine. While perhaps most mental cases eventually become patients of the specialist, they all come first to the general practitioner, and he should be able to diagnose their condition early. Some of these mental cases could be relieved much more promptly if diagnosed early.

The book is written in a plain, readable style. The subjects are presented in as concise form as is practicable. The author does not indulge in longdrawn-out theories. The field is well coveredsome subjects perhaps briefly. We recommend this volume to the student or to the general practitioner. OBSTETRICS. A manual for students and practitioners. By W. P. Manton, M. D., professor of obstetrics and clinical gynecology, Detroit College of Medicine, Detroit, Mich. Second edition, revised and enlarged; including selected list of state board examination questions. 12mo., 292 pages, with 97 engravings. Cloth, $1 net. Lea & Febiger, publishers, Philadelphia and New York. 1913.

A handy little pocket volume, 292 pages, full of facts. Especially convenient to the student who wishes to refresh his memory. The questions appended to each chapter are particularly useful to those preparing for examinations.

The practitioner will often find it useful when lack of time forbids an extensive reading of a subject.

SEXUAL IMPOTENCE. A practical treatise on the causes, symtoms and treatment of sexual impotence and other sexual disorders in men and women. By William J. Robinson, M. D., chief of the department of genito-urinary diseases and dermatology, Bronx Hospital and Dispensary; editor The American Journal of Urology, Venereal and Sexual Diseases, etc. 1913. Critic and Guide Company, 12 Mt. Morris Park West, New York. $3. Perhaps no subject pertaining to human ills has been so neglected by medical teachers or medical textbooks as the subject discussed in this volume. While

legitimate medical literature was indiscreetly silent on sex teachings, the quack literature was teeming with misinformation, which, as the author intimates, did more real harm than did sexual ignorance or sex abuse.

The doctor will find this work instructive. It deals with the many causes of impotence and sterility and their treatment. It is rather profuse with case histories, shows frequently the results of false teachings. Withal it is a useful little volume and we recommend its reading.

From the government printing office at Washington comes the Hygienic Laboratory Bulletin No. 87. Digest of comments on the pharmacopeia of the United States of America (eighth decennial revision) and the National Formulary (third edition) for the calendar year ending December 31, 1911. By Murray Galt Motter and Martin I. Wilbert.

We have received a bound volume of the Bulletin of the State Board of Health of Kentucky. This volume is the biennial report of the state board of health, 1910-1911. It devotes thirty-seven of its pages to hookworm. Those interested in this disease should secure a copy of the report, as it is a thorough treatise on this condition and written by those having experience.

A TREATISE ON THE DISEASES OF WOMEN. For students and practitioners. By Palmer Findley, B. S., M. D., professor of gynecology, College of Medicine, State University of Nebraska; gynecologist to the Clarkson Memorial Hospital and Douglas County Hospital; fellow of the American Gynecological Society; fellow of the American Association of Obstetricians and Gynecologists; fellow of the Chicago Gynecological Society. Octavo, 954 pages, illustrated with 632 engravings in the text and 38 plates in colors and monochrome. Cloth, $6 net. Lea & Febiger, Philadelphia and New York. 1913. Another new work on "The Diseases of Women," by Palmer Findley, B. S., M. D., is from the press of Lea & Febiger. The work is somewhat larger than most works on the subject and is to be commended for several features. The volume is profusely illustrated. Many of the illustrations are excellent. There are in all 632 engravings and 38 plates, mostly color plates. These serve an admirable purpose in the chapters on examinations. There are three chapters on examination of patients, which can be read with profit by anyone practicing general medicine, gynecology or obstetrics.

Another feature to be commended is the discussion of various methods of treatment, aside from the surgical. For this the medical men should be grateful. Many patients must, of necessity, be treated otherwise than surgically, even though they may have surgical conditions, and this book tells us how to treat them, when possible, without the aid of surgery. Gynecologists have been prone to teach gynecologic surgery, but have taught much less gynecologic therapeutics.

The chapter on ectopic pregnancy is especially full and complete-a condition too frequently diagnosed incorrectly. The author writes quite fully on the pathology of the various diseases or conditions, and, of course, is generous in writing of gynecologic

surgery.

The print is plain and the mechanical construction of the volume is good. The reader will not be disappointed in the work.

MODERN OPHTHALMOLOGY. A practical treatise on the anatomy, physiology and diseases of the eye. By James Moores Ball, M. D., LL. D., dean and professor of ophthalmology, the American Medical College of St. Louis (medical department of National University of Arts and Sciences). Third edition, revised and enlarged, with 445 illustrations in the text and numerous figures on 24 colored plates. F. A. Davis Company, Philadelphia, 1913. Price $7.50 net.

The third edition of modern ophthalmology is an extensive work of 911 pages, presenting 445 illustrations and 24 full-page color plates. In addition to a careful revision of the earlier editions it has an entirely new chapter on the legal relations of ophthalmology and one new chapter each on elementary optics and normal ocular refraction.

The work includes chapters on embryology, anatomy and physiology, all of which subjects are treated fully and are splendidly illustrated.

The reader will not fail to note the large number of illustrations throughout the book, nor the very extra character of them.

The chapter on examinations covers 73 pages and seems to leave no portion undescribed. Again do the illustrations become an invaluable part of the chapter. Many instruments are described, illustrated and the method of their use clearly depicted.

Diseases of the eye with appropriate treatment, either medical or surgical, of course, fills the major portion of the book.

The author has the faculty of making one easily understand the subject matter and has produced a volume of equal value to student, practitioner and specialist.

The book is an extensive addition to medical literature and we recommend it to the profession. The author is to be congratulated on the production of such a work and also we must mention the good appearance and the excellent mechanical construction of the volume, which speak for the carefulness of the publisher.

THE DISEASES OF CHILDREN. By Henry Enos Tuley, M. D., late professor of obstetrics, University of Louisville, medical department; visiting physician, Masonic Widows' and Orphans' Home, Louisville, Ky.; secretary of the Mississippi Valley Medical Association; ex-secretary and ex-chairman of the section on diseases of children, American Medical Association; ex-president American Association Medical Milk Commissions, etc. With 106 engrav

ings and three colored plates. Second revised edition. C. V. Mosby Company, St. Louis, 1913. Price, $5.50.

From the publishing house of C. V. Mosby Company comes the second edition of "The Diseases of Children," by Tuley.

This book is a textbook written for students' use and for the aid of the general practitioner. It contains 684 pages with 106 engravings and three color plates. Special mention may be made of "Plate 1," showing the buccal exanthem in measles (Koplik's spots).

The work is extensive as regards the number of subjects. The practitioner might sometimes wish for a more exhaustive treatise, but the student especially will find this work valuable.

The subject of infant feeding gets a generous discussion of 64 pages. Especial attention is given to a chapter on production, care and certification of milk. Another excellent feature of the book is that it shows how to examine and treat the baby as well as what to do. This will be appreciated by the younger practitioner.

THE PRINCIPLES AND PRACTICE OF GYNECOLOGY FOR STUDENTS AND PRACTITIONERS. By E. C. Dudley, A. M., M. D., ex-president of the American Gynecological Society; professor of gynecology, Northwestern University Medical School; gynecologist to St. Luke's Hospital, Chicago; ex-president of the Chicago Gynecological Society; one of the founders of Congres Periodique International de Gynecologie et D'Obstetrique; fellow of the Royal Society of Medicine, England; surgeon in the Medical Reserve Corps, United States army. Sixth revised edition, with 439 illustrations and 24 full-page plates in colors and monochrome. Lea & Febiger, Philadelphia and New York. 1913.

Lea & Febiger have recently issued the sixth revised edition of this work. The necessity of the sixth edition proves the value of the book. The work contains nearly 800 pages, has 439 illustrations and 24 full-page color plates. These illustrations are practically all good and fulfill their purpose very well.

The introduction is from the author's presidential address delivered at the annual meeting of the American Gynecological Society, 1905, and is a plea for specialism in gynecology or for special gynecologic surgeons. One might think the specialty were not on a firm standing. Operative procedures are described in the author's brief, clear way and are so illustrated that the reader may not fail to understand them readily.

The book covers a large field and one is likely to fail in his search for a gynecologic subject not discussed. The medical treatment is not so complete as one might wish and other therapeutic measures are not given much space. It is essentially a surgical gynecology, but an excellent one, and the reader who is operating in the abdomen or vagina should

possess a copy.

VOL. XXIV

Original Articles

IS STERILIZATION DESTINED TO BE A
SOCIAL MENACE?*

G. FRANK LYDSTON, M. D.
CHICAGO, ILL.

It is hardly necessary for me to state that i am thoroughly in sympathy with the employment of sterilization in social therapeutics. I was one of the pioneers in promulgating the theory and practice of sterilization of the socially unfit, and have had no occasion to change my views as to its value.

It is a truism that any therapeutical resource which is beneficially potent is also capable of harm. This is quite as true in social therapeutics as in the ordinary kind. Social antiseptics and narcotics have in them the elements of danger.

It is the purpose of this paper not to attack sterilization, but to briefly suggest some of the possible evils of sterilization of the fit which, perhaps, may eventually affect its advantages.

STERILIZATION Α POSSIBLE

STATE.

MENACE ΤΟ THE

Through the publication of laws providing for the sterilization of the unfit, the laity is already becoming familiar with the technic, safety and effects of sterilization upon the sexual function. The consequence is that more often than the profession at large is aware, laymen who are not of the unfit are appealing to the surgeon for the prevention of the procreation of children, with its attendent cares, expense and responsibilities. That the surgeon will one day be still oftener appealed to is inevitable. The assumption of the responsibility of procreating and rearing children demands a certain degree of self-abnegation and self-sacrifice which many of both sexes gladly avoid. The fact that sterilization in

*Read before the Chicago Medical Society, Oct. 1, 1913.

No. 6

either sex does not impair sexual power is likely to appeal very strongly to the average layman. The desire to avoid the physiologic results of the sexual act is necessarily stronger out of wedlock than within it.

Not only will sterilization appeal to the male sex, but often also to the female, perhaps in some instances more strongly, because of the fact that the burden of responsibility and care of bearing and rearing children falls most heavily on the female.

THE ECONOMIC PHASE OF STERILIZATION.

The foregoing considerations are inextricably commingled with economic conditions. The increased cost of living, which means increased obstacles to matrimony, bears particularly on the expense of rearing a family. Economic conditions, which are already bad enough from the cost-of-living standpoint, are likely to grow worse instead of better, and the proportion of marriages will necessarily decrease. Sterilization obviously may be accepted by many as the answer to some of the problems which confront society in reference to the expense incidental to rearing a family.

A very important phase of the economic problem that confronts people of marriageable age is necessarily the probability of children. Under present conditions many wage-earners are compelled to remain celibates because of the disproportion between wages and the amount necessary to maintain a family. It is possible that increasing familiarity with sterilization may increase the proportion of marriages among wage

earners.

THE MORAL ASPECT OF STERILIZATION.

While it may be an open question whether sterilization of either the fit or the unfit will increase the proportion of marriages, there can hardly be any doubt as to the demoralizing effect

Under present conditions a rapidly increasing class of wage-earners is commanded by society to remain sex-neuters. This is especially true of the female wage-earner. The sex function alone of all the functions of the body is commanded by ethical considerations and moral law to remain dormant. As a matter of fact, however, it does not remain dormant. Society has not yet arrived at the stage of development which would enable it to openly face this issue. Society merely shuts its eyes and goes on mouthing legal, ethical and moral inhibitions of the biologic law.

If the practice of sterilization becomes at all general, society may be compelled to admit that inhibition of sexual immorality has depended as much upon the danger of paying the physiologic penalty, especially on the part of the female, as upon any moral or ethical influence per

se.

STERILIZATION AS A SUBSTITUTE FOR THE ABOR

TIONIST.

However much the fact may be deplored; however strenuously we may legislate and preach against abortion, the practitioner of this illegal operation is, under present moral and economic conditions, to be reckoned with as a social institution—indeed, he is a social demand. Aseptic safety and the substitution of the word "currettement" for the term "criminal operation" have merely served to conceal the fire and make the custom more wide-spread among supposedly decent physicians. Sterilization may prove to be a social factor which will greatly limit the practice of abortion.

STERILIZATION AND THE CHURCH.

The church, which has always exercised a supervision over the right of the human being to procreate or not to procreate, will soon, in my opinion, have a very important problem on its hands and will have to join with the state in the endeavor to regulate the practice of sterilization.

Whatever religious views one may hold upon the subject, and whatever social theories one may entertain, it must be admitted that the individual right to determine whether or not he or she shall have children, and when, and how many shall be procreated, is at least an open question.

The large family is an ideal proposition in the

ent economic conditions, there are those who believe that not to be born at all is better than a life of misery and degradation, and that a few children properly reared, should be the ideal of the family rather than a large number of children who can by no possibility be brought up as healthy and useful citizens. That woman should be sacrificed, as she often is, to the Rooseveltian idea of a large family has never been quite as clear to me as it seems to be to some.

RELATION OF STERILIZATION TO ILLEGITIMACY.

Should sterilization supplant the abortionist as a social factor it will be a saving factor for certain of the unborn. Society's attitude toward consistent as any social folly that could be menthe abortionist and his patrons is about as in

tioned.

The woman who bears an illegitimate child becomes a social pariah. She is downtrodden by man and despised by woman. Her child is branded as a bastard before it is born, and branded deeper directly afterwards. The State practically does nothing to save its life, preserve its health and morality and develop it into a useful citizen. If such children were the arbiters of their own destinies, they never would be born.

A demand is created by society itself for the abortionist, and then society penalizes the operation and rubs its hands in hypocritic and savage glee whenever a poor starveling who is caught in the act is convicted and sent to the penitentiary as punishment for his carelessness in getting caught and a sop to the Cerberus of ethics and morality. The fact that where one abortionist is punished thousands go unscathed does not weigh in the balance. There is more joy in the penitentiary over the one sinner who is caught than there is shame in society over the myriads who escape.

INDIVIDUAL RIGHTS VERSUS STATE RIGHTS.

I will concede, for the sake of argument, the right of the individual, male or female, to be sterilized, especially in view of the fact that, in the case of the male, sterilization may be only temporary. I will also still concede that sterilization is a valuable therapeutic resource in certain diseases, and a valuable prevention of the transmission of disease and degeneracy to the unborn. I will further concede that under proper regulations and the restriction of the opera

The regulation by the State of the surgeon's side of the practice of sterilization in private practice is an obvious corollary of regulation in general and will be the most direct method of attacking the evil of indiscriminate sterilization. How effective this would be is an open question. Judging by the failure of our laws for the suppression of criminal abortion, one would be justified in pessimism. The moral argument against sterilization can never be as strong as that against abortion. Sterilization is not child-murder, but is a preventive of childmurder.

The foregoing possibly will be considered by some as a prophecy by a social alarmist. I believe, however, that this paper comprehends merely the logical results that may be expected to accrue from the inevitable familiarity of the public with sterilization and its results. Possibly it may come with better grace from one who has always been a strenuous advocate of sterilization as a factor in social therapeutics, than from others who have not been quite so friendly to this particular method of social self-defence. 32 N. STATE ST.

THE TREATMENT OF HERNIA IN CHILDREN*

A. J. OCHSNER, M.D.

CHICAGO

ABSTRACT

The conclusions in this paper are based on the treatment of a large number of cases and a study of the literature. This study has been carried on for a period of twenty-six years and was originally begun as a result of the observation that in

* Read before the Chicago Medical Society, Jan. 29, 1913.

children which had suffered from strangulated hernia which had been reduced without operation permanent spontaneous cures resulted by simply keeping the children in bed with the foot of the bed elevated for a short time, at the same time overcoming the abnormal abdominal pressure by careful dieting and medication.

Similar results were observed in patients confined to bed following the operation of circumcision for the relief of phymosis. These observations seemed to indicate a greater tendency of hernia in children to heal spontaneously as soon as the exciting cause was removed than was generally supposed at the time these observations were begun. This led to a study of the literature.

The most important one of the older works studied was that of Malgaigne, which included all of the statistics of the French army for a number of years.

These statistics show that there is one hernia for every twenty-one children during the first year of life; that this proportion remains true up to the age of 6 years; that then there is a rapid decrease until there is but one hernia in seventy-seven children at the age of 13. During the years immediately following there is a constant and rapid increase of herniae in the male, so that at the time of recruiting the armies, which occurs at the ages of 20 and 21, there is one hernia in thirty-two males. In the female, there is no further increase until the beginning of the child-bearing period, when there is at once quite a sudden increase in the number. At the age of 28, there is one hernia for twenty-one persons; at the age of 30 to 35, one hernia for seventeen; at 35 to 40, one for nine; at 50, one for six; at 60 to 70, one for four, and at 75, one for three. From this stage on the patients suffering from hernia seem to die more rapidly than the remaining proportion of the population so that from the age of 80 to 85 there is but one hernia in fourteen persons; from 85 to 86 but one in twentythree, and among those whose age exceeds 86, but one in fifty-six. It is plain, however, that the only time at which we can be absolutely certain that the statistics are correct is at the age between 20 and 21 in the male, because at this time all the males are actually examined by competent surgeons.

According to these statistics if no new herniae were formed between the ages of 6 and 13, 73 per cent. of all hernia in children at 6 years of age would have healed spontaneously by the age of 13. But the percentage is much greater, because many of the children at the age of 13 have