448

REVIEWS AND NOTICES OF BOOKS

TrachomaBy A. F. MACCALLAN, C.B.E., M.D., F.R.C.S.,Surgeon in Charge of Out-patients, WestminsterHospital, London; formerly Director of the

Egyptian Government Ophthalmic Hospitals.Embodying a Hunterian Lecture at the RoyalCollege of Surgeons of England, 1936. London :Butterworth and Co., Ltd. 1936. Pp. 225. 21s.

FIFTY years ago any worker at Moorfields EyeHospital would have been confronted with manycases of this disease, for most of the infected immi-grants into East London from the affected districtsof Europe at that time found their way there ; butto the younger generation of ophthalmologists inEngland the disease is practically unknown. Onlyamong those ophthalmic surgeons who have under-taken hospital duties in Egypt, Palestine, or theFar East are British " trachomatologists " now to befound.The natural evolution of trachoma was first

described by MacCallan in 1905, when he was workingin Egypt, as occurring in four stages. These stagesare now generally accepted and together with certainvarieties which occur in Stage II are well describedand illustrated with coloured plates in this book.The early diagnosis of the disease depends in difficultcases on the detection of pannus. This, which in theearly days was apt to be regarded as only a later com-plication -due to mechanical contagion from the

heavily infected upper lid to the cornea, is describedby MacCallan as a sign invariably present even in thefirst and second stages. Unfortunately its presenceor absence in early cases can only be verified by thecorneal loupe or the corneal microscope with slit-lamp in skilled hands ; this examination takes sometime, so that where mass infection has to be investi-gated the method is impracticable. It is, however,the only reliable criterion according to MacCallan,who attributes the infection of the cornea not todirect contagion but to slow and inevitable advancefrom the original site of infection in the conjunctivaof the upper lid. As to treatment, detailed instruc-tions are given, varying according to the stage andparticular variety of the disease. These display agreat advance over the days when the almostuniversal panacea was the drastic and cruel coppersulphate stick.As to the pathology of the disease, a vast amount

has of late years been published in support or incriticism of two theories of causation : one that it isto be found in the so-called Halberstadter ProwazekKörperchen (H.P.K.) structures found to be includedin the epithelial cells, the other and more recentone that it is due to an organism known as Bacteriumgranulosis discovered by the Japanese bacteriologistNoguchi. Neither of these theories has been foundto be capable of proof and knowledge of the aetiologyof the disease remains incomplete.

The latter half of this work is occupied with theepidemiology of the disease, its history, and a dis-cussion of the prophylactic measures best adoptedon the one hand for individuals living in infectedareas and on the other to the schools, &c., in areaswhere the disease has already or has always beenendemic. For a great part of the world the diseaseappears to be a universal scourge and there appearto be no natural conditions, either geographical orracial, which by themselves can render any areaimmune. At the same time no student of this bookcan regard the fight against trachoma as hopeless.

Great improvement has already followed from thesystematic prosecution of prophylaxis under scientificguidance in Egypt, and a victory on a smaller scaleis the elimination of the disease from our own poor-lawschools in England since segregation was adopted.

Pathological Physiology and ClinicalDescription of the AnaemiasBy WILLIAM BOSWORTH CASTLE, M.D., S.M.,Associate Professor of Medicine, Harvard Uni-versity ; and GEORGE RICHARDS MINOT, M.D.,S.D., F.R.C.P. Edin., Professor of Medicine, HarvardUniversity. Edited by HENRY A. CHRISTIAN,A.M., M.D., LL.D., Sc.D., Hersey Professor of theTheory and Practice of Physic, Harvard University.London: Humphrey Milford, Oxford UniversityPress. 1936. Pp. 205. 15s.

THE pioneer work of George R. Minot and WilliamB. Castle on Addisonian pernicious ansemia laid thefoundation for an entirely new conception of theaetiology of a wide group of conditions associated withabnormalities of the hsemopoietic system. It istherefore fitting that their review of the problem ofthe cause and treatment of the anaemias should bereprinted from the Oxford Loose-Leaf Medicine ina form easily available to workers in medicine andallied sciences. The short introductory chapter onthe physiology of the erythron contains a stimulatingaccount of the processes of blood production and blooddestruction. It illustrates well how much can belearnt of the processes of normal physiology by theexact quantitative study of pathological conditionsas seen in clinical practice. The hospital ward,in the hands of men like Minot and Castle, becomes aplace in which as exact a science is practised as inthe laboratory of the physicist or chemist. In this

monograph the authors give a concise descriptionof diagnostic technical methods and an analysis ofthe significance of the reticulocyte response, but

emphasise that " it is important to recognise clearlythat meticulous descriptions of the peripheral bloodin themselves often signify little without correlationwith clinical syndromes and in particular with thechronology of proceedings symptoms and therapy."The anaemias are classified on an setiological basis

as far as possible. Congenital anaemias of infants,Cooley’s erythroblastic anaemia, aplastic anaemia,the macrocytic an2emia of liver disease, and splenicanaemia are grouped together as idiopathic. Macrocyticanaemia associated with liver disease and achresticanaemia, they suggest, are not due to a derangementof the internal metabolism of the P.A. principle, asis usually believed, but are dependent upon some,at present unexplained, depression of erythropoiesis.Myelophthisic or leuco-erythroblastic anaemia is

regarded as due to mechanical interference with theblood-forming organs. The exposition of general prin-ciples of treatment is admirable in its clarity and thenecessity of making a correct diagnosis before theblood picture is obscured by indiscriminate therapyis emphasised. Specific treatment is discussed underthe headings blood transfusion, abolition of bloodloss and increased blood destruction, administrationof essential erythropoietic factors, elimination oftoxic agents, X ray and arsenic treatment, andsplenectomy. Apart from general principles notesare also given on the special treatment of certaintypes of anaemia. There is an excellent bibliographybut a fuller index would have been helpful, for it is

449REVIEWS AND NOTICES OF BOOKS

a book that will be used for constant reference aswell as read as a whole for the picture it gives ofthe principles underlying the modern diagnosisand treatment of the anaemias.

The 1936 Year Book of the Eye, Ear, Nose,and Throat

By E. V. L. BROwN, M.D., Professor; LoUIsBOTHMAN, M.D., Assistant Professor, of Ophthalmo-logy ; GEORGE E. SHAMBAUGH, M.D., ClinicalProfessor Emeritus ; ELMER W. HAGENS, M.D.,Assistant Clinical Professor; and GEORGE E.SHAMBAUGH, Jun., M.D., Clinical Instructor, inOtolaryngology, University of Chicago. Chicago :The Year Book Publishers; London: H. K.Lewis and Co., Ltd. Pp. 632. 10s. 6d.

Tiais issue consists of abstracts from the currentliterature excellently edited and well written by thesame authorities who have undertaken the task inrecent years. Editorial comment is not withheld,and critical attention is given to therapeutic claims.For example, the treatment of otosclerosis by localinjection of thyroxine is discussed in connexion withthe late Dr. Albert Gray’s original claim to haveobtained seven cases of improved hearing amongfourteen patients by the use of this method. Theeditors have tried the method " in a few cases,"using the audiometer to test the hearing, and havefound in no instance any significant alteration in thehearing. If the audiometer tests are made by atechnician, the results are comparatively free fromerrors which are almost bound to arise with the

whisper test. They say that with the slightestencouragement each patient would have declaredthat the hearing seemed improved, and they believethat it is this psychological element in deafness whichis responsible for the continued vogue of all kinds ofmethods in the treatment of otosclerosis. In this con-nexion they quote a report by H. C. Ballenger andB. A. Patterson, who treated 25 partially deaf patientswith an instrument similar to, but apparently notidentical with, that of Zund-Burguet, using the 2-Aaudiometer to follow the acuity of hearing. In onlyfive patients was there any improvement : in two ofthese it was so slight as to fall within the normal

range of variation ; in one treatment began threeweeks after an acute suppuration ; and the remainingtwo were cases of chronic catarrhal otitis in whichspontaneous improvement is more likely to occur

than in otosclerosis or nerve deafness. A numberof abstracts are given concerning petrositis, whichhas recently attracted much attention.Much interesting work has been published during

the year under review on diseases of the nose andthroat, including Henri Coutard’s recent report onthe results of treatment of cancers of the tonsil,pharynx, and larynx by X rays according to his ownmethod. The best five-year results, of 32 per cent.,were obtained in the tonsillar region; tumours ofthe larynx gave 25 per cent., and of the hypopharynx11 per cent. The editors point out that a new erahas been opened up by Coutard’s work ; five-yearcures are being obtained with gratifying frequencyin cases previously deemed hopeless ; the indica-tions for surgery are being narrowed to intrinsiccarcinomas of the larynx and to a few early lesionselsewhere.With regard to diseases of the eye, a useful collec-

tion of abstracts on glaucoma includes a long illus-trated article by C. Berens describing his operationof iridocorneosclerotomy for the relief of this

disease. In a study of optic nerve atrophy in relationto pituitary tumour, F. Fischer finds temporal pallorof the disc the most frequently observed alterationin the nerve-head; he also finds that this pallorremains unchanged, no matter how good are theresults of operation, an observation not in accordwith the findings of other authors. A number ofrare neoplasms of the choroid are described, andE. Hesse reports a favourable result in the treatmentof methyl-alcohol amblyopia by repeated lumbarpuncture ; as a result of prohibition this affectionwas far commoner a few years ago in the United Statesthan in England.The book is provided with a good index, and is

indispensable to those who want to keep track ofprogress in these specialties.

Chronic IndigestionBy C. J. TIDMARSH, M.A., M.D., F.R.C.P. (C.),Associate in Medicine, Royal Victoria Hospital,Montreal. London: Longmans, Green and Co.,Ltd. 1936. Pp. 143. 6s.

THIS small handbook is described on its yellow andred wrapper as " a layman’s handbook " ; abovethe title is written with a large question mark, " Areyou one of the 10 per cent.

" and beneath is thealarming announcement "ten per cent. of all peopleare affected by ulcers of the stomach." Whethersuch a statement is precisely accurate is of lessimportance than the effect such information mayproduce upon the reader. Books designed as thisone is for both patient and physician have the objectof helping the patient " to take an intelligent interestin his case," and thus to secure his cooperation, butthey tend as a whole rather to encourage a morbidpreoccupation with symptoms. Peptic ulcer is,however, one of the conditions in which the patient’scooperation is all-important, and where the physicianfeels the need of written instruction to supplementhis verbal ones. Dr. Tidmarsh’s little book, shornof its cover, should serve the purpose. His teachingis sound, and he gives useful advice as well as timelywarnings against incautious treatment. Physiciansmay themselves find a use for this book as a sum-mary of the problems of chronic indigestion. The

chapters on nervous indigestion and the unstable,colon are especially good.

Hay FeverWith Special Reference to Treatment by Intra-nasal Ionisation. By CLIVE SHIELDS, B.M:, B.Ch.Oxon., Clinical Assistant, Physiotherapy Depart.ment, St. George’s Hospital. London : HumphreyMilford, Oxford University Press. 1937. Pp. 57.7s. 6d.

IN this little book the author argues the superiorityof intranasal zinc ionisation over other methods inuse for the treatment of hay-fever. He does notdescribe the technique of desensitisation by pollenextracts, he does not mention the galvanocautery,and he condemns without reserve all kinds of palliativelocal applications. Records have been kept of theprevious treatment received by his patients, fromwhich Dr. Shields has drawn up a table showing that82 per cent. of those who had had desensitisinginjections, and 100 per cent. of those treated bycauterisation, had experienced no relief. It is notsurprising that a large proportion of his , patientsare people who had failed to get relief from othermethods ; the figures are of no value in assessing the

450 REVIEWS AND NOTICES OF BOOKS

results of these methods. The technique recom-

mended is similar to that used by other workers :three treatments of 8-10 mins. at weekly intervals,with a 2 per cent. solution of zinc sulphate, and amaximum current of 3 milliamperes for the firsttreatment, 7 milliamperes for the second, and 15

milliamperes for the third. Dr. Shields very properlylays stress on the importance of careful applicationof the zinc-moistened gauze to the upper and backpart of the nares, and on the avoidance of necrosisby the use of small doses of current. He says heobtains 90 to 100 per cent. of relief in 93 per cent.of cases, whereas other observers have been contentto claim 66 to 80 per cent. The method is a usefulone, and it is probable that those who have hadbad results from it have employed a faulty tech-nique or applied the packing unskilfully. But thevalue of this book is impaired by over-emphasis onthe merits of one.form of treatment to the exclusionof all others.

Synopsis of Diseases of the Heart andArteries

By GEORGE R. HERRMANN, M.D., Ph.D., Professor ofClinical Medicine, University of Texas. London :Henry Kimpton. 1936. Pp. 344. 17s. 6d.

THE systematic consideration of heart disease inthis book opens with a discussion of the study of apatient suspected of heart disease. This section,specially in its dealing with symptomatology, is oneof the best in the book, although the list of possiblefindings in examination is rather too exhaustive.In classifying morbid conditions of the heart theoutlines approved by the American Heart Associationhave been followed, and diagnosis is considered fromaetiological, structural, and functional standpoints inturn. When it is remembered that many patientsseeking advice for troubles apparently cardiac haveno disease but only a functional disturbance of theheart or its nervous mechanism, it is surprising thatmore systematic consideration is not given to this

group, which includes the very common left mam-

mary pain, nervous tachycardia, and suspirious as

well as the effort syndrome. Dr. Herrmann hascompressed a great deal of information into a rela-tively small space. Many useful diagrams and chartshave been included, together with good photographsof morbid anatomy and microphotographs. Muchattention to important detail has been given in thera-peutics and management in heart disease and failure.But the volume is hardly as comprehensive as the titlewould suggest because the discussion of peripheralvascular disease occupies only nine pages. The valueof future editions would be much enhanced by anelementary treatment of the symptoms and signsof the common forms of arterial disease ; a preciseaccount of the reactive hypersemia test, for example,is of far greater importance than a picture of theTycos Dermatherm.

Diseases of the Nails

By V. PARDOCASTELLO, M.D., formerly AssistantProfessor of Dermatology, University of Havana.London: Baillière, Tindall and Cox. 1936. Pp. 178.16s.

THERE will be no two opinions on the merits ofthis little volume, and few will read it without profitto themselves and a measure of gratitude to a pains-taking and able writer. The subject of this book,owing perhaps to the poverty of our therapeuticarmamentarium, has been neglected too long, and

even the trained dermatologist, " often at a loss tomake a diagnosis," as Howard Fox remarks in hisforeword, has been apt to underestimate its import-ance, both in his clinic and in the lecture room. Afurther obstacle to study is the involved nomen.clature, mainly Greek in its origin, and thereforeantagonistic to all but those of us who succeeded inreaching the " Vth form on the classical side." Dr.Pardo-Castello will be found to have made things veryeasy for the reader ; he has a lucid and most attrac-tive style. Two simple diagrams clarify in the ungualanatomy what has always appeared rather com-

plicated. These diagrams should be carefully studiedand memorised, or redrawn from memory, becauseconstant reference to the parts depicted-i.e., nail-bed, matrix, nail-root, lunula, and so forth-is madein the seven succeeding chapters. These deal withaffections peculiar to the nails, dystrophies, con-

genital affections, the effects of cutaneous and

systemic diseases, occupations, and poisons. Anextensive and carefully selected bibliography willstimulate the interested reader to further study orresearch, and the 94 clinical illustrations will befound invaluable. The treatment of nail diseasesby X rays is considered specially in a final chapter.A word of warning is appropriate here. The valueof radiotherapy is considerable, but in the hands ofthe inexpert it has inflicted irreparable damagein just this type of case.

A Textbook of PhysiologyFor Medical Students and Physicians. Thirteenthedition. By WILLIAM H. HOWELL, Ph.D., M.B.,Sc.D., LL.D., Emeritus Professor of Physiologyin the Johns Hopkins University, Baltimore.London and Philadelphia : W. B. Saunders andCo., Ltd. 1936. Pip. 1150. 30s.

THE general scope and character of this excellenttext-book were recalled in these columns when thetwelfth edition appeared in 1934. The thirteenthedition bears the brief legend " thoroughly revised,"and has a preface which does not enlarge upon thistext except in an impersonal way. The authordisdains to act as his own commercial traveller, orto display self-pity at the magnitude of his task,which has been conscientiously performed. The

changes which have taken place in our knowledge,for instance, of the vitamins, the hormones, theautonomic nervous system, and the cerebrum, allfind a place, and the sections describing them seemto fit naturally into the text. Less space is devotedto the properties of reflexes and a little more to theanatomy of the nervous system than is customary,and the chemistry of the foodstuffs needs supple-menting by reference to a biochemical text-book,but these can hardly be called defects. One of themain features of the book is its convenient size; no

part of the subject is neglected, and the balance hasbeen maintained with skill. The style is straight-forward and the exposition clear ; the size of thebook prohibits very detailed discussion, but accuracyis not sacrificed to clearness. It must be borne inmind by the student that the text-book comes fromthe other side of the Atlantic, and he may find theemphasis and arrangement unfamiliar in one or

two places. But it contains practically all he requiresin a small compass, and avoids many of the usualdefects of a short book. It is adequately but notprofusely illustrated, well indexed, and has a usefuldetailed table of contents showing the subdivisionsof the chapters and the pages on which they occur.