1763

Reviews and Notices of Books.A Treatise on Ðiagnostio Methods of Examination. By Pro-

fessor HERMANN SAHLI, Director of the Medical Clinic,University of Berne. Edited, with additions, by FRANCISP. KINNICUTT, M.D., Professor of Clinical Medicine atColumbia University (College of Physicians and Surgeons),New York; and N. BOWDITCH POTTER, M.D., VisitingPhysician to the City Hospital and to the French Hos-pital, New York. London and Philadelphia: W. B.Saunders and Co. 1905. Pp. 1008. Price 27s. 6d.

THE first edition of Professor Sahli’s treatise, ’’ Clinical

Methods of Investigation," was published in 1894 and wasrecognised as a most excellent work on the subject ofclinical diagnosis. A second edition appeared in 1899, athird in 1902, and a fourth during 1905. The presenttranslation of the last edition was undertaken to render

easily available to English-speaking students of medicine awork too little known in England and America. Professor

Sahli chose the title " Lehrbuch der Klinischen Unter-

suchungs-Methoden," a title which inadequately expressesthe large scope of the book. Not only are all methods ofexamination for the purpose of diagnosis exhaustively con-sidered but the explanation of clinical phenomena is dis-cussed from physiological as well as pathological points ofview. This task is carried out with a thoroughness whichhas not been exceeded in any work on the subject ofclinical examination which has appeared.

It is difficult to select from a work of this size any

particular points for review. The whole book is repletewith interest and from nearly every page something may belearned. The various methods of clinical investigation areadmirably described and the most recent aids to diagnosisreceive due attention. The section dealing with the arterialpulse contains descriptions of the latest modifications of thesphygmograph and sphygmomanometer. In reference to thefirst-named instrument modifications have now been intro-

duced by Professor Jarnet and by Professor Sahli whichcorrect the excessive vibration of the recording needle.This is a great improvement, as in the older instrumentserrors in recording the movements imparted by the pulsewere frequent. The sphygmomanometer is now being morefrequently used than formerly and is considered by somephysicians to yield a more accurate estimation of the arterialtension than can be gained by the use of the fingers only. ’,,The Riva-Rocci instrument, slightly modified, has claimedmost attention and is well described in this text-book.A large amount of space is devoted to the description of

the various tests which are employed in the examination ofthe contents of the stomach and the most modern methodsare described. For instance, Reissner’s improvement of theLutke-Martius method of determining the hydrochloric acidin the gastric juice is given, whereby the error introducedby the presence of ammonium chloride is obviated. Reissner’smethod of determining the chlorides for the early diagnosisof malignant disease of the stomach is also described.In the section devoted to the bacteriology of the sputum

the micrococcus catarrhalis is mentioned. This organism isalmost always found in the nasal secretion in rhinitis and isalso frequently observed in the sputum. It differs from the

ordinary staphylococci by its much larger size, by itsdecolourisation by Gram’s method, and by its position in thecells.The section on the examination of the blood is an

excellent one and contains the results of the most recent

investigations. Amongst the various forms of apparatusfor determining the amount of haemoglobin in the bloodattention is naturally directed to the description ofProfessor Sahli’s new hasmometer. In the instrumentswhich are most commonly employed the solution of blood

is compared with an artificially coloured substance-

i.e., either with a coloured wedge of glass or with a

solution of picrocarmine. To meet the demands of accurate

colorimetry, however, the coloured fluid to be examinedshould not be compared with a different substance similarin colour but with a solution of known strength of thesame colouring matter. The difficulty in applying this

colorimetric principle in the examination of the blood lies inthe fact that solutions of haemoglobin are not permanent. It

consequently follows that if in the interests of accuracy theemployment of artificial colours is avoided some permanenthaemoglobin derivative must be utilised in making thestandard solution. The solution of blood must then beconverted into a solution of the same derivative, whena comparison may be accurately made. After numerous

attempts Professor Sahli has succeeded in devising a

method by which the hæmoglobin of a solution ofblood may be transformed into a derivative by a

simple chemical reaction. The procedure consists simplyin diluting the blood with a known quantity and

strength of hydrochloric acid. After a few seconds thefluid becomes dark brown from the formation of minute

particles of hæmatin hydrochlorate. Although this sub-

stance is not held in true solution it has the appearanceof being so and when diluted with water forms a clear

brownish-yellow fluid, the pigment percentage of which

may be colorimetrically determined by comparison witha permanent standard solution of the same substance ; theexact details by which this method is carried out are fullyexplained in the book now before us.There are numerous other matters in this work to which

attention might be drawn did space permit. The sectionon the examination of the nervous system will well repaycareful study; here will be found a description of manyinteresting and important methods of examination whichhave not yet found their way into the general text-books butare scattered through special treatises on diseases of thenervous system or through the medical periodicals of differentcountries.The work is well printed and admirably illustrated. The

editors have performed their task in a most praise-worthy manner and deserve the thanks of the English-speaking members of the profession for having producedProfessor Sahli’s book in its present form. We can

cordially recommend this volume to the notice of our

readers.

LIBRARY TABLE.

The American National Association for the Study andPrevention of Ticberculosis. New York: Irving Press. 1906.

Pp. 448.-We have received a copy of the proceedingsof the first annual meeting of the above association whichwas held in Washington on May 18th and 19th, 1905,under the presidency of Dr. E. L. Trudeau. In preparingthe programme the executive committee had providedfor three sections-a sociological, a clinical and climato-

logical, and a pathological and bacteriological. Each ofthese sections held two sessions and, in addition, there

were two general meetings of the association. A largenumber of papers were read and some interesting dis-

cussions followed. Addresses were also delivered by thePresident and the two Vice-Presidents, Professor W. Oslerand Dr. Hermann M. Biggs. Professor Osler laid stress

on the "education of the public, the profession, and thepatients" in matters relative to the nature of pulmonarytuberculosis and the methods which might be adopted toprevent its spread. We have always insisted on the im-

portance of medical practitioners instructing their patientsin the proper dispcsal of the sputum and other measures ofdisinfection, this being, in our opinion, one of the most

1764

important factors in the general prophylaxis of the disease.Amongst the papers read at the meeting was one by Dr.David E. Twichell on the Vitality of Tubercle Bacilli in

Sputum. As a result of his experiments he found that theconditions most conducive to the prolonged life of thetubercle bacillus in sputum are darkness and moisture. Inone experiment the bacilli under these conditions were aliveat the end of five and a half months. Dryness hastenstheir destruction. A temperature of about 37° C. is lessfavourable for them than ordinary room temperature ; so is atemperature near the freezing point. The direct rays of thesun kill them in a few hours. These points should be im-pressed upon patients, more especially the effect of directsunlight. Two papers were read on the agglutination testfor tuberculosis-one by Dr. H. M. Kinghorn entitled " TheSerum Diagnosis of Tuberculosis," and the other by Dr. M. P.Ravenel and Dr. H. R. M. Landis, with the title, "Studies inAgglutination." The results closely corresponded-namely,that the agglutination test cannot be relied upon as a trust-worthy one and is therefore of no value in diagnosis ;that in far advanced cases the reaction is generally absent ;and that in cases under favourable conditions, as at a

sanatorium, the agglutinating power is distinctly increased.Amongst the other papers read at the meeting the followingmay be noticed: Infection in Transportation, by Dr. H. M.Bracken; the Progress of the Sanatorium Movement in

America, by Dr. W. H. Baldwin; the Examination of theBlood in Pulmonary Tuberculosis, with special reference toPrognosis, by Dr. J. T. Ullom and Dr. F. A. Craig ; Studiesin Mixed Infection in Tuberculosis, by Dr. M P. Ravenel andDr. J. W. Irwin ; and Results of the Open-air Treatment ofSurgical Tuberculosis, by Dr. W. J. Halsted.A First German Course for Science Students, comprising a

reader and Outline of Grammar, with Diagrams and

Vocabulary. By H. G. FIEDLER, Professor of German at

the University of Birmingham; and F. E. SANDBACH,Lecturer in German at the University of Birmingham.London : Alexander Moring, Limited. 1906. Pp. 99. Price2s. 6d. net.-The importance of a knowledge of the Germanlanguage to all scientific students is now generally recognisedbut there are many who have not opportunities of attend-ing a class of instruction in this subject. To such the bookbefore us should prove invaluable, affording as it does an

easy introduction to the language while at the same time

accustoming the reader to many of the technical words andphrases likely to be met with in lectures and text-books ofelementary science. It contains first a series of passages fortranslation into English, conversational in style, simple atfirst but of increasing difficulty, with references to the

principal rules of German grammar which are set out in thesecond part. At the end of the book is a vocabulary of thewords used in the exercises. The volume deals with ele-

mentary chemistry and physics and the text is illustratedwith a number of diagrams explanatory of the subjectmatter. We can imagine no better aid to a student whocontemplates going to Germany to attend a course of lecturesthan a study of this little work. Should it prove successfulfurther volumes dealing with other sciences will be issued.Nature and Health: a Popular Treatise on the Hygiene of

the Person and the Honae. By EDWARD OURTIS, 14T.D.Emeritus Professor of Materia Medica and Therapeutics,Columbia University, New York. New York : Henry Holtand Co. 1906. Pp. 313.-The author states that this bookhas been written in great part out-of-doors and thoughtout under the open sky and that the fragments have beencommitted to paper by the wayside, on the knee or on the flattops of fences. It is offered to the public not as learningbut as a lure-a lure for the wise living that shall gain fromgoddess fairer than Hera, than Athene, or than Aphroditeherself, that gift, all Hygieia’s own, the priceless boon of

health, happiness, and the usefulness of years." The bookis written in a pleasant vein. It tells what should beavoided and what should be done in order to live healthilyand long. The chapters are headed as follows, the titlesshowing the full scope of the volume: Breathing ; Eating ;Drinking ; Drugging for Delectation; Seeing ; Hearing ;Clothing ; Bathing; Disposing of Waste ; Disinfecting;Exercising Body and Mind; Sleeping and Waking ; Workingand Playing ; and Living and Dying. The text is brightlywritten and the book will be helpful, we think, to many.The chapter on Drugging for Delectation contains manynecessary warnings.

The Thompson Yates and Johnston Laboratories Report.Edited by RUBERT BOYCE and CHARLES S. SHERRINGTON,with H. E. ANNETT, BENJAMIN MOORE, RONALD Ross,E. W. HOPE, and Assistants. With illustrations and plates.Vol. VII. (New Series), Part I. February, 1906. Publishedfor the University Press of Liverpool by Williams and

Norgate. Pp. 87.-This issue contains the following con-tributions : (1) On a New Pathogenic Louse which acts asthe Intermediary Host of a New Hsemogregarine in theBlood of the Indian Field Rat, by S. B. Christophers, LM.S.,and R. Newstead, A.L.S. ; (2) Note on the Anatomy ofGastrodiscus Hominis, by J. W. W. Stephens, M.D. Cantab.;(3) A Revision of the Sarcopsyllidas, a Family of Siphon-aptera, by Karl Jordan, Ph.D., and the Hon. N. C. Roths-child ; and (4) The Maiotic Process in Mammalia, by J. E. S.Moore, F.L.S., and C. E. Walker, F.L.S. The fourth paperis beautifully illustrated with seven coloured plates.

Lectures 1lpon the Nursing of Infectious Diseases. By F. J.WOOLLACOTT, M.D., B.Ch. Oxon., Senior Assistant MedicalOfficer, Park Hospital, Metropolitan Asylums Board. London:Scientific Press, Limited. Pp. 147. Price 2s. 6d. net.-Thiswork is based on a series of lectures upon the nursing ofinfectious diseases originally published in the nursingsection of the Hospital. A description of the chief infectiousdiseases of this country is given and also of the measures,both preventive and curative, usually taken in dealing withthem. The rule that has been followed is to mention onlythose forms of treatment which are usually left to the nurseto carry out or for which she must make preparations. Wehave read this well-written little book with pleasure andit can be recommended to the notice of those for whosebenefit it is brought out. The teaching is both sound andpractical and the book will be a valuable one for reference intime of need.

The Ship Surgeon’s Handbook.-ByA. VAVASOUR ELDER,M.R.C.S. Eng., L.R.C.P. Lond. London : Bailliere, Tindall,and Cox. 1906. Pp. 167. Price 3s. 6d.-The treatment ofsickness or accidents on board ship is naturally much thesame as on shore but the differences of environment in thetwo cases are so great that some hints from an experiencedship surgeon can hardly fail to be useful to a novice. Wehave no hesitation in advising any young man who thinksof holding such an appointment to read Mr. Elder’s bookand to keep his injunctions in mind. A sufficient idea ofthe nature of the contents will be given by the headings ofsome of the chapters-namely, Choice of a Ship, Outfit andUniform, Drugs, Instruments and Appliances, Status andDuties on Board, Fees at Sea, and Medical and SurgicalPractice. Sea-sickness has a chapter of about 13 pages allto itself. The concluding chapter, which deals with Shipsas Convalescent Institutions, deserves the attention of

practitioners who are considering the question of sendinga patient on a voyage. We agree generally with the

suggestions given as to the class of patients who shouldnot be sent but the recommendation that invalid pas-sengers should carry with them musical instruments uponwhich they can play is surely open to question, just asmuch as is the vehement denunciation of ship’s fireme]3

1765

in another part of the book. Ship owners are not all

alike in their requirements with respect to what may be

called systematic visits made by the surgeon to the

portions occupied by passengers, whether first-, second-, orthird-class, and the spirit as well as the letter of the Boardof Trade regulations must be kept in view. It will be

remembered that the Australian contingents during theirreturn home from the South African campaign suffered

severely from sickness and in the inquiry which followedcomplaints were made that the medical officers "did not

sufficiently take charge." For this reason we should like tohave had a few additional details as to the round of inspec-tion mentioned on p. 34 ; as to the number, position, andconstant readiness of hospital cabins ; and as regards sickpassengers who either neglect or refuse to send for the

surgeon, thereby exposing him to the imputation of

negligence if he respects their privacy or of intrusivenessif he does not.

Varicocele in Relation to the Army. By FRANK HOWARD,M.D. St. And., Colonel, Army Medical Staff (R.P.). London :Rebman Limited. 1906. Pp. 3.-In our issue of Sept. 23rd,1905, p. 923, under the heading of " Varicocele-Whatof It? " we published a letter in which Colonel Howardraised several important questions relative to this con-

dition. In the first place, he emphatically expressedthe opinion that varicocele was not a disability whichshould entail the rejection of an otherwise suitable can- Ididate for a commission in the army. Furthermore, heis strongly opposed to the performance of any surgicaloperation for the relief of varicocele in these circum-

stances. In this he is not in full agreement with theofficial view, for the army medical regulations as to the exa-minations of candidates for commissions state that " a slightdefect [i.e., as regards the existence of varicocele] if success-fully cured bv operation is not a disqualification." In the

pamphlet now under consideration Colonel Howard discussesthe question of varicocele in recruits and points out that theobjection to enlisting soldiers in whom varicocele exists isnot so much a question of surgery as of military discipline,because such soldiers when they wish to evade certain dutiescomplain of disabling pain in the parts and there is no meansof controverting their statements. Varicocele is therefore

held to be a disqualification for a recruit (who, if enlisted,would be a private soldier) but in Colonel Howard’s opinionthere is no reason why it should be a disqualification for anofficer.

Reminiscences oj a Contry Politician. By JOHN A.BRIDGES, J.P., Worcestershire. With frontispiece portrait.London: T. Werner Laurie. 1906. Pp. 274. Price 8s. 6d.net.-These are the remembrances and thoughts of a

member of the old Tory party, of one who would like tohave Lord Curzon in command and sees in his the hand tosave the Tories from extinction. He finds in the tariff

reform agitation the cause which brought about the recentdefeat and in his final chapter he speaks of Mr. Chamber-lain’s utterances and policy with considerable scorn. The

title suggests that the book would deal with politics alonebut the author touches on many questions and in his chapterheaded "Parsons I have Known" he tells some amusingstories in a not unkindly manner. The book contains muchthat is clever and amusing and we can imagine that itsgeneral tone and its genial comment upon men and mannerswould recommend it to a large number of medical prac-titioners.

JOURNALS AND MAGAZINES.

Edinburgh Medical Journal.-In the June number theeditors announce that for the future this well-known journalwill be closely connected with the Edinburgh Medical School,its new proprietors being Edinburgh men whose na.m:s are I

distinguished in medicine and surgery. The editors remainthe same. The present number contains among its originalarticles an interesting paper by Dr. W. Murrell and Mr. H.Wilson Hake on Coloured Urine due to aniline dyes andother pigments. Dr. Hugh A. Stewart records a case ofAortic and Pulmonary Obstruction with Pericarditis, the

diagnosis not being, however, confirmed by post-mortemexamination as the patient recovered. Mr. J. Hogarth Pringlerecords notes of some cases of Hernia in which several loopsof bowel were strangulated in the same sac and points outsome important peculiarities met with in this condition.

Scottish Mediecal and Surgical Journal.-In the June

number, in an inaugural address delivered before the Sectionof Pathology at the recent Australasian Congress of Medicine,Professor D. A. Welsh deals with the views on Cancer andother Tumours which have been put forward as the resultof the work of Professor J. B. Farmer, Dr. E. F. Bashford,and others. Dr. H. G. Langwill records two cases of

Transitory Hemiplegia in which attacks exactly resemblingthe hemiplegia of cerebral haemorrhage occurred in elderlypersons and passed off as suddenly as they arose in the

space of a few minutes. Spasm of some vessel is

suggested as the underlying condition. Mr. E. W. ScottCarmichael pleads for Surgical Interference in Cases ofIntracranial Haemorrhage in the Newly Born which are

likely to lead to permanent paralysis and Mr. AlexanderDon discusses the Diagnostic Value of Radiography in

Fractures. Professor R. Jardine gives notes of two cases ofVesicular Mole in which there was not the rapid enlarge-ment of the uterus usually looked on as diagnostic of thecondition and remarks that he has never seen a case in

which the passage of vesicles in the discharges was notedbefore the uterus was actually emptying itself.Journal of Physiology. Edited by Sir MICHAEL FOSTER,

K.C.B., F.R.S., and J. N. LANGLEY, F.R.S. Vol. XXXIV.,No. 3. London : C. F. Clay. May 31st, 1906. Price 7.—The following articles are contained in this number of theJournal of Physiology. 1. On Some Physiological Actions ofErgot, by H. H. Dale. The nature of the active principle orprinciples of ergot has not in the author’s opinion been

quite satisfactorily determined. He finds that the physio-logical effects of preparations from ergot, such as cornutineand sphacelotoxin, fall into two groups : (1) stimulant effectson organs containing plain muscle, evidenced in contractionof the arteries, the uterus, and the sphincter iridis ; and (2) aspecific paralysis of the motor elements in the structuresassociated with sympathetic innervation which adrenalin

stimulates, the inhibitory elements retaining their normalfunction, as do also both motor and inhibitor autonomicnerve-supplies of cranial and sacral root origin. It is prob-able that these two’sets of effects are produced by differentactive principles of which the one responsible for the

peripheral paralysis appears also to be concerned in thecentral convulsant effects described by Kobert and others.Several incidental conclusions are arrived at and the articleis illustrated by many tracings. 2. The Action of Radium

Rays on Tyrosinase, by E. G. Willcock, Newnham College.The experiments showed that tyrosinase constituted an appa-rent exception to the general rule that radium rays are inju-rious to ferments. 3. The Regeneration of the Blood afterHoemorrhage, by C. Gordon Douglas, B.A. It appeared fromthe experiments (made on buck rabbits) that after bleedingto the extent of from one-fourth to one-third of the totalvolume of blood there was rapid restoration of the volume ofblood to its normal value followed by an increase above thatvalue. 4. On the Non-uniformity in the Rate of Dischargeof Impulses from Cells of the Spinal Cord Poisoned withStrychnine, by David Fraser Harris and William Moodie. Theauthors found the rate of discharge during the first second as

I hig h as 26 in the second, which they think may be explained