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Hellerström, of Stockholm, first mentioned the possibility of cutaneous tuberculosis developing in abrasions from public swimming pools. He described six facial lesions, five of which followed abrasions sustained in the same pool.1 Water and sediment from the pool involved in the sixth case produced tuberculosis in a guinea pig. With material from the infected animal, tubercle bacilli were grown on a special medium. Hellerström's patients were males, aged 14 to 29 years, with no history of tuberculosis. In five pulmonary findings were normal, and in the sixth there were small hilar calcifications. In five the tuberculin reaction was negative before and positive after the injury. The clinical picture was strikingly uniform, with soft reddish-brown papules, pinhead to split pea in size and crusted and coalescent. The initial swimming pool abrasions became covered with epithelium but gave rise to granulomas without a period of perfect healing. Diascopy showed lupus vulgaris

Rabbit antipneumococcus serum was introduced in 1937 as a therapeutic agent in the specific treatment of lobar pneumonia by Horsfall, Goodner, MacLeod and Harris.1 They reported only one death in twenty-two cases of lobar pneumonia in which treatment was with this serum. Their series included patients with pneumonia caused by pneumococci of types I, II, VII and VIII.More recently they reported an additional series of cases, bringing the total to sixty-seven.2 Included in this report were cases of lobar pneumonia due to pneumococci of types I, II, III, V, VI, VII, VIII, XIV and XVIII in which treatment was with homologous rabbit antipneumococcus serum. The mortality rate for the entire series was 13.4 per cent. However, when thirteen cases of type III pneumococcus pneumonia, for which the mortality rate was 46 per cent, were excluded, the mortality for the remaining fifty-four cases was 3.7 per cent. They

Anesthetists have long recognized that cardiac arrhythmias were commonly encountered during surgical operations and this has led to the more extensive study of cardiac disturbances by graphic methods. A number of investigators have approached the problem from both experimental and clinical standpoints and have recorded electrocardiograms before, during and after operations under various anesthetics. The results indicate that arrhythmias, conduction disturbances and other electrocardiographic changes are of very common occurrence. Some workers have considered the results only as related to the depth and type of anesthesia, while others have endeavored to determine the effect of the operative procedure. In the present study an attempt was made to evaluate as far as possible the various factors concerned and to separate the effects due primarily to the anesthetic, and those due to operative manipulations. CASES STUDIED One hundred and nine patients were studied during one hundred and thirteen surgical operations, two of

Studies investigating fluid volume dynamics and albumin kinetics in patients undergoing major abdominal surgery indicate that during the operation, marked deficits develop in the total red blood cell volume, plasma volume, extracellular fluid volume, and the total exchangeable albumin pool. A disproportionate deficit in the plasma volume occurring in the course of the operation is believed to be secondary to a functional extracellular fluid volume deficit and abnormal losses of albumin from the intravascular compartment. Deficits in these compartments occurred during the operation in every patient studied. In some patients the plasma volume deficit immediately postoperatively amounted to close to 50% of the volume present when the patient went into the operating room. In the course of a regional node dissection in nine patients studied, a 29% deficit developed in the total body albumin pool.

In the past decade, impotence has been recognized as a sequela of a multitude of disease processes. I edited a monograph entitled The Management of Male Impotence in 1982, which emphasized the newer theories of erectile dysfunction, the newer diagnostic methods, and the surgical management of impotent men.Segraves and Schoenberg, a psychiatrist and a urologist, respectively, have organized a text, Diagnosis and Treatment of Erectile Disturbances, which emphasizes in great detail the medical and psychologic aspects of erectile impotence. The internist and family practitioner will find this book useful as a tool to sort out organic from psychogenic causes of impotence.The chapter on pharmacologic agents has a thorough bibliography and ably updates information in previously published material. The endocrine section is extensive and research oriented but unfortunately includes tables and graphs that are difficult to read because of their size and complexity.In the past five years, the

Current Operative Urology is a collection of articles from the late 1950s to the early 1970s. The "current" refers to commentaries by a variety of urologists at the end of each paper, bringing the particular subject up to date and adding an annotated bibliography to the original report. In this manner, Whitehead presents a historical review of the major urological advances over the past two decades. However, some of the papers are outdated and even with the additional material are not current in the sense of present practical methods and may be misleading in their emphasis.The paper by Emmett, published in 1963, advocates surgery for all renal masses, indicating that 2% to 3% of so-called cysts are found to be tumors. Current diagnostic techniques were not employed in the 1963 study. In the commentary, diagnostic ultrasound is not mentioned, a method that has aided in differentiating cyst from tumor.

The study of male infertility is a relatively new science. The editors of this book have brought together a group of international scientists who have all contributed to the field of andrology. Bain, in his introduction, alludes to the difficulty of defining the infertile male—the variations of count, morphology, and motility from one study to another—but does not have a chapter that specifically addresses this issue. With such a respected group of contributors, this book could have led the way in finally defining infertility. The reader is still left wondering whether 20 million sperm per cubic centimeter or 40 million sperm per cubic centimeter is the lower limit of normal. Today, in the United States, most physicians treating the infertile man have agreed that less than 20 million sperm per cubic centimeter in a couple trying for pregnancy for more than one year usually points to a male factor being

Eight years separate the second and third editions of Glenn's Urologic Surgery. Urologic surgery is continuously evolving and being refined, and this new edition has kept pace. The number of chapters has grown from 71 to 105, an increase of almost 150 pages.The chapter by Barbaric on "Percutaneous Nephrostomy" outlines the varied uses of this technique for diagnostic and therapeutic purposes. In the past year, however, a wave of enthusiasm has developed, along with newer instrumentation, for ultrasonic dissolution and subsequent percutaneous removal of kidney stones. It is unfortunate that this information was not available when the chapter was written. Brendler's chapter on transurethral surgery for benign bladder conditions does, however, detail the use of ultrasonic litholapaxy for bladder calculi. Peters' chapter on "Radical Retropubic Prostatectomy" is clear and well illustrated but was written before Walsh's description of a technique for avoiding injury to the pelvic plexus that innervates

This is a rather complete atlas for all students and practitioners of urology, but in his introduction the editor clearly admits that many alternative procedures have been omitted due to limitation of size.For the urologist practicing in America, only a few procedures of practical importance are lacking. Percutaneous nephrostomy using fluoroscopy or ultrasound can be extremely useful in alleviating obstruction without major surgery, especially in debilitated and critically ill patients. In the management of carcinoma of the prostate, little mention is made of bilateral pelvic lymphadenectomy with or without125I implantation as proposed by Whitmore. In the United States and Canada, more and more patients with stage B and C carcinoma of the prostate are being treated with radiation therapy, making staging lymphadenectomy important. Perhaps the omission of the description of the radical perineal prostatectomy bespeaks this trend in the management of prostatic carcinoma. The most commonly performed

When reviewing a major compendium such as Volume 2 of the fourth edition of Campbell's Urology, one first looks at any obvious deletions in the topics discussed. None are to be found! J. H. Harrison has gathered together an excellent group of contributors for this major revision of the classic textbook for urologists.The topics covered in Volume 2 are benign and malignant neoplasms, the neurogenic bladder, embryology and anomalies, pediatric urology, and a new section on the behavioral aspects of urology.The chapters on urological oncology are written by surgeons who are well recognized in the field. Newer diagnostic and therapeutic modalities are thoroughly covered. A new section on the cytopathology of the urinary tract by Tweeddale and Dee is well illustrated and emphasizes the usefulness of the cytologic examination in urology, especially in carcinoma in situ of the bladder. Although radiation therapy is discussed in each chapter, a

This monograph thoroughly updates the author's previous work on the same subject published in 1972, entitled Urinary Infections. Dr Stamey has devoted more than 25 years to a careful analysis of the causes and cures of urinary tract infections in both men and women, and his clinical experience and research as well as the important work of others are systematically expounded in this volume.I cannot argue with Dr Stamey for leaving chapter 3 intact as it is indeed an "in-depth" clinical-pathological study of pyelonephritis, which has no match.Dr Stamey develops the important concept that 20% of symptomatic patients will have fewer than 100,000 bacteria per milliliter in their bladder urine and that physicians should not withhold treatment because the culture results show fewer than the "standard" 100,000 bacteria per milliliter. In the chapter "Urinary Tract Infections in Women," he further emphasizes that pathogenic bacteria present in low counts

In the 15 years that I have been teaching urological surgery in medical school, I have been frustrated in not having a text that students on a two- to four-week clinical rotation could use for a complete embryologic, anatomic, physiological, and clinical correlation of our specialty. Clinical Urology Illustrated, authored by a well-known Australian urologist, presents urology in a clear, interestingly graphic manner combining line drawings, tables, management plans, pictures of specimens and equipment, and imaging modes, including ultrasound and computed axial tomography techniques.Clinical Urology Illustrated is composed of 20 chapters that touch on every aspect of urology, the common and the esoteric. A short yet pertinent bibliography follows each chapter.Certain chapters deserve special mention, as they are particularly good. "Embryology and Congenital Anomalies" clearly illustrates an often confusing subject, to be followed later in the text by the 40-page chapter, "Paediatric Urology," which gives the reader a

To the Editor.—The article, "Acute Urethritis in Male College Students" (226:37, 1973) by McChesney et al points to a real problem that many physicians are seeing in epidemic proportions. It is quite clear now that T-strain mycoplasmas must be implicated in some way in nonspecific urethritis.We studied a large group of patients with urethritis and found that the T-stain mycoplasmas can be isolated from the cervix in a great proportion of women who have recurrent urethritis. In some men, then, recurrent urethritis appears to be a venereal disease and treatment of both partners is necessary to eradicate the offending organism.1We have found tetracycline, 2 gm/day, for a ten-day period to be necessary to prevent recurrence, and in the female patients an antifungal vaginal tablet should be used to prevent the occurrence of Monilial vaginitis, which is so common in women who take large doses of tetracycline.

Unlike the first edition, this work is a compendium that has left few subjects in pediatric and adult urologiccal surgery unmentioned. Important points of technique are emphasized in all chapters, with a generous array of excellent illustrative material. Drs. Glenn and Boyce have called upon a panel of experts who give up-to-date accounts of time-tested procedures as well as many newer techniques, especially in pediatric and reconstructive urology. It is not possible in a review of this length to summarize the entire text, but certain sections are worthy of some comment.Although intersex conditions are not commonplace, Dr. Walsh's chapter gives a clear approach for the urologist who might be the first physician to handle these distressing problems that have such a great potential psychological impact on the patient and the family. Skinner's chapter on pelvic lymphadenectomy is well done and gives the background and rationale for this procedure, the

Fundamentals of Urology, edited by Jack Lapides and dedicated to Reed Nesbit, is a must for every medical student and should certainly have a place in the library of the surgical resident. All too often, urology is given a low priority in medical school curricula. In a few evenings of easy reading, Fundamentals of Urology can make the student feel comfortable and confident in his initial contact with the urological patient.Few subjects are left uncovered. The introductory chapters on the anatomy, physiology, and embryology of the genitourinary tract are excellent. In just 20 well-illustrated, concise chapters, the orderly discipline of genitourinary surgery is described. The workup of patients, whether it be for the more unusual diseases such as Cushing syndrome or more common disorders such as hematuria or urinary calculi, is clear and concise. A well-selected bibliography concludes each chapter so that the student may pursue a topic further

Haselton, Ohio, Dec. 19, 1894. TO THE EDITOR: —In answer to Dr. A. S. Caldwell, of Free-port, Ill., I should like to report my experience with Dr. Woodbridge's treatment of typhoid fever. I called him in consultation on October 27, last, to see the wife of a brother physician, who had been sick ten days with typhoid fever. The pulse was 120; her temperature was 1045; rose spots abundant, marked tenderness in right iliac fossa, with enormous tympanitic distension. Her nervous symptoms were very bad; in fact, it was a typical and severe case of typhoid fever, with a feeble breath and a pulse which became dicrotic. I heard Dr. Woodbridge say in answer to the husband's anxious inquiries that he did not consider her in as much danger as he would a well person, taking the ordinary risks of out-door life. Her temperature went to normal on the tenth

Mrs. H., æt. 35, multipara, was taken with convulsions at end of eighth month of pregnancy. At 4 o'clock in the morning of September 28 her husband was aroused from sleep by the convulsive action and labored breathing of his wife. I was called immediately and found patient in a comatose state; face and hands and, in fact, the whole body, ædematous to an uncommon extent. Being naturally plethoric, 16 ounces of blood were taken from the arm, followed by 10 grs. of calomel combined with ¼ gr. of elaterium. This procedure and treatment had a very happy effect in controlling the alarming symptoms. Elaterium was continued in 1/5 gr. doses administered every three hours, with 60 grs. of cream of tartar, until thorough watery stools were secured, which reduced the ædematous condition almost entirely.Believing that urea decomposing in the blood causes the phenomena of eclampsia, benzoic acid was