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12. Evans, F. A., and Happ, W. M. : Secondary Anæmias ofInfants, Bull. Johns Hopkins Hosp., January, 1922,xxxiii., 1.

13. Holt, L. E., and Howland, J. : The Diseases of Infancy andChildhood, Appleton and Co., 1919, p. 840.

14. Häusermann : Die Assimilation des Eisens, Zeitschr. f.Physiol. Chem., 1897, xxiii., 555.

15. Schmidt, M. B. : Uber die Organe des Eisenstoffwechselsund die Blutbildung bei Eisenmangel, Verhandl. derDeutsch. Pathol. Gesellsch., 1912, xv., 91.

16. Happ, W. M. : Occurrence of Anæmias in Rats on DeficientDiets, Bull. of Johns Hopkins Hosp., 1922, xxxiii.,163.

Reviews and Notices of Books.A TEXT-BoOK OF THERAPEUTICS.

Including the Essentials of Pharmacology andMateria Medica. Sixth edition. By A. A.

STEVENS, A.M., M.D., Professor of AppliedTherapeutics in the University of Pennsylvania,Philadelphia; Visiting Physician to the Universityand the Philadelphia General Hospitals. Londonand Philadelphia: W. B. Saunders Company. 1923.Pp. 793. 30s.Tms book is one which deserves to be better known

in this country amongst students who have attainedto house appointments and amongst all activelyengaged in the practice of medicine. Of the books on- treatment at present available which are at oncecomprehensive, up-to-date, and discriminating, it isone of the best we have met. It is divided into twoparts, of which the first deals with the various thera-peutic agents, their pharmacological action and methodof application ; the second part, occupying the last250 pages, is a compact survey of the treatment ofmost acute and chronic diseases. A prominent featureis the inclusion of numerous prescriptions and a

discussion of incompatible substances. In additionto the various pharmacopoeial preparations mentioned,useful attention is given to a consideration of thebetter known proprietary preparations. The chiefmerit of the book, however, lies in its exposition ofmodern methods. There is a good account ofC. Eggleston’s views on the value of administeringlarge doses of digitalis, and of the indications for andagainst the use of quinidine in heart disease ; ofSchleict’s method of infiltration anaesthesia withlocal anaesthetics ; of the Schick test and of Park’sresults with toxin-antitoxin mixtures in immunisa-tion against diphtheria ; of the treatment of amoebicdysentery with emetine-bismuth-iodide by the mouth ;of Chandler Walker’s method of treating bronchialasthma with specific proteins ; of the Allen treatmentof diabetes, which includes a table giving the protein,fat, and carbohydrate percentages in ordinary foods ;of the Sippy treatment of gastric ulcer. Chapters,written with judgment and restraint, are devoted toelectrical treatment, massage, the Nauheim treatmentfor chronic heart disease, X ray and radium therapyand the Finsen-light treatment. Turkish and Russianbaths, hot packs, hypodermoclysis and gastric lavageare discussed.A book of this kind should obviously be of great

value, presenting as it does within one volume acritical account of so many matters otherwise onlyavailable in scattered papers.

There is surprisingly little to which exception canbe taken. There is no mention of the treatment oftuberculosis by heliotherapy in climates where thehigh cooling power of the air makes prolonged exposureto sunlight possible; indeed, Prof. Stevens thinksthat sanatorium treatment has been shown to beequally successful in all climates. The work done inthis country during the war on the treatment of shockhas hardly received adequate attention. WhileBayliss’s gum-saline is described in the chapter oninfusion and hypodermoclysis, the author has nothingbetter to advise for shock than adrenalin and

pituitary extract. Unless A. Krogh’s recent work onthe frog is to be taken as such an indication, there is as Iyet no evidence whatever that pituitary extract is of

the slightest value in shock treatment; the defect is.one of the eapillary circulation which pituitaryextract does not influence. Perhaps a more seriouserror occurs in reference to the use of pituitary extractin labour. Prof. Stevens states that when the os isfully dilated, in cases of uterine inertia, 0-5 c.cm. ofpituitary extract may be given. It is not sufficientlyrealised how potent this remedy is, and text-bookstatements of this kind, if followed up, are bound taproduce the opinion that the extract is dangerous ;.for such a dose is two or three times too great. Doses.of from 0-1 c.cm. to 0-2 c.cm. of the ordinary 10 percent. extract are amply sufficient for administra-tion in the second or first stage ; ignorance ofthis important point has led many conscientious.obstetricians to neglect the valuable aid pituitaryextract can give.A dozen such criticisms, however, leave the main

excellence of the book unimpaired ; such points areinevitable when the net is cast so wide. The authoris to be congratulated on having on so many sides andwith so much judgment succeeded in presenting suchan excellent work in the limits of one volume.

MULTIPLE SCLEROSIS (DISSEMINATED SCLEROSIS).Being Vol. II. of the Series of Investigations andReports of the Association for Research in Nervousand Mental Diseases. New York: Paul B.Hoeber. 1922. Pp. 241.$3.75.

IF the report on disseminated sclerosis by numerousdistinguished American investigators does not yetsolve the problem of the disease, it brings us somewhatnearer that desirable end. The reader familiar withthe subject naturally turns to the sections dealingwith the nature and aetiology of the affection, onlyto find that the Commission declares it extremelydifficult to decide whether the disease is inflammatoryor degenerative ; in fact, they admit frankly theyhave not reached a conclusion on the question of theexistence of acute multiple sclerosis as distinct fromencephalitis or lues. They cannot regard the problem ofa possible micro-organismal origin as either confirmedor unsubstantiated on histological grounds. It mightappear as if we are farther off than ever from thesolution of a common and widespread organic nervousdisease. What is of value in this report, however,is the collation of an immense amount of data inreference to the geographical distribution, incidence,frequency, racial apportionment, and general setio-logical factors of multiple sclerosis ; the setting of theproblem, we may say, is rendered more distinctthereby. The chapter on general and specialsymptomatology apparently omits any reference tothe interesting group in which epilepsy is an early,sometimes the very first, symptom of the disease.There is an excellent bibliography, but the volume issorely in need of an index.

THE COMMON NEUROSES : THEIR TREATMENT BYPSYCHOTHERAPY.

By T. A. Ross, M.D., F.R.C.P.E:, Medical Director,Cassel Hospital for Functional Nervous Disorders.London : Edward Arnold and Co. 1923. Pp. 256.12s. 6d.

Dr. Ross opens by a survey of the many fashionsthat have come and gone in the theories and treat-ment of the neuroses-the exhaustion theory, withits rest cure, the

" reflex " theory with treatmentdirected to the uterus, to minor refractive errors, tonasal spurs and deflections or to

"

dropped kidneys,"and the still current toxic theory-and decides thatenthusiastic if short-lived belief was the agent thatremoved symptoms. Drawing almost entirely uponhis own experiences, of which 17 years were spentin general practice-a source of ample material for-the study of neuroses-he demonstrates the psycho-genic nature of these conditions and provides copiousillustrations of his methods of treating them. Herelies upon analysis, explanation, and persuasion.

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combined or as alternatives, and the frank accountsof his own difficulties and failures, together with arestrained tone throughout the book, are a welcomejontrast to those optimistic writings upon psycho-therapy which raise the suspicion that here, too, wemay have only another phase of enthusiastic belief.His attitude towards psycho-analysis is not well defined.In the preface he takes the view, scarcely justified bya retrospective glance, that ten years ago the spellof Freud was so potent that the writings of Dejerinewere unduly handicapped. Giving full credit toFreud’s work and making free use of his methods, heemploys the strange phrase, concerning the taking ofa history, that " there is no taint of psycho-analysisabout it " (p. 112). It is perhaps fear of this taintthat makes him skim lightly over difficult problems.Sexual impotence, for example, cannot always beremoved by reassurance, and the marriage of animpotent man, which he would allow (p. 110), is oftenfollowed by unhappy results; sexual frigidity inwomen, an equally potent source of unhappiness, orworse, is not mentioned. Dr. Ross’s handling of thecompulsion neurosis is weak, in both the treatmentand the symptomabology of this important and oftenunrecognised condition. He shares the view, whichpossibly had origin in a mis-translation in an Americanedition of Freud’s " Introductory Lectures," thatanalysis is contra-indicated in this neurosis, anddescribes his own failure in a patient of 49, who was" physically and psychologically a rather old man " ;few psycho-analysts would have attempted the taskin a patient of that age and type, but analysts claimmost satisfactory results in properly selected obses-sional cases, and Dr. Ross, in quoting Jelliffe, givesthe unfortunate impression that the gloomy prognosisis orthodox.

These weak points, however, detract but little fromthe usefulness of the book to the general practitioner,for whom it is written and to whom it may be cordiallyrecommended.

MEDICAL DIAGNOSIS.Fifth edition. By CHARLES LYMAN GREENE, M.D.,formerly Professor of Medicine, University ofMinnesota and Chief of Medical Clinic in theUniversity Hospitals. London : William Heine-mann. 1922. Pp. 1453. 63s.THE new edition of this work contains 75 new illus-

trations and an additional 150 pages. More than halfof the new matter is included in the section dealingwith disorders of the heart and blood-vessels to whichProf. Green devotes particular attention, the manyfacsimiles of electro-cardiograms being very valuable.We doubt whether all readers will agree with hisremarks on " drop heart," and feel that auricularflutter should be included in the classified list ofarrhythmias on p. 543, but otherwise we findthis section illuminating. The vast amount ofinformation in the book is made readily accessible bythe excellence of the indices as well as by the provisionon each page of a margin containing terse epitomes.The author’s descriptions of the latest tests and aidsto diagnosis, and his reasoned and moderate view oftheir individual value enhance the value of the workwhich, if too comprehensive for students, forms anexcellent text-book of diagnosis.

CYSTOSCOPY AND URETERIC CATHETERISATION.Traité pratique de eystoscopie et de catheter2.smeureteral. Second edition. By G. MARION, Pro-fesseur agrégé à la Faculté, Chirurgien de 1’HopitalLariboisiere (service civile) ; and M. HEITZ-BOYER, Professeur agrégé des voies urinaires a laFaculté, Chirurgien de 1’Hopital Saint-Louis.Paris : Masson et Cie. 1923. Pp. 480. Fr.100. ,IN the second edition of their book on Cystoscopy i

MM. Marion and Heitz-Boyer have not changed <the general arrangement of the work. They have, Ihowever, entirely rewritten the chapter dealing with i

the optical principles involved and with the inter- (

pretation of images ; and they have now given less.space to the discussion of direct and indirect (orreversed) images, for as they justly remark, urinarysurgeons should be equally conversant with bothmethods. One chapter is new and deals with urethro-cystoscopy as first described by Buerger. Manyadditions have been made in the chapters on

pyelography, the estimation of renal efficiency, andcystoscopic operations. It is of interest to note thatthese surgeons prefer the high-frequency spark tothe diathermy current as employed in this country,believing that the former is more exact and moreeasily controlled.The second edition should appeal to an. even larger

number of the profession than the first. It is admir-

ably written, and has the advantage of being basedon the personal experiences of two well-knowngenito-urinary surgeons. It contains in all 60 plates,mostly in colours, of cystoscopic findings, describedin no less than five languages.

SELECTED PAPERS AND ADDRESSES.

By WILLIAM WILLIAMS KEEN, M.D., LL.D.,Emeritus Professor of Surgery, Jefferson MedicalCollege of Philadelphia. Philadelphia : George W.’

Jacobs and Co. 1923. Pp. 340.Prof. Keen is well known on this side of the Atlantic as

the doyen of surgery in the United States, and his bookshows that he can write lucid and literary English withsomething of that indefinable quality which pervadesthe writing of John Brown of the " Horse Subsecivae."The papers and addresses were written at varioustimes and upon different occasions, and therefore, asProf. Keen implies in his preface, are not necessarilyto be taken as setting forth the present-day opinionsof their author. Some of them, however, deal withmatters which are as permanent as anything can bein this world of flux, as, for instance, the paper uponthe conditions of surgery before and after Lister; thatupon the benefits not only to human beings, but alsoto the lower animals derived from experiments uponanimals; and that entitled " Things Surgeons StandFor."

Other papers deal with the Service of Missions andwith the impossibility of a war between Great Britainand the United States. Altogether the collection isa satisfying one which should be read and ponderednot only by medical men, but by all who have thewelfare of humanity at heart.

GENERALISED PAIN.

Being Part II. of the Clinical Symptomatology ofInternal Diseases. By Prof. Dr. NORBERT ORTNER,Vienna. Authorised translation by FRANCIS J.REBMAN. With an introduction by THOMASWEBSTER EDGAR, M.D., New York. New York :Medical Art Agency. 1922. Pp. 596.To analyse and describe all the varieties and causes

of pain in the body generally, from scalp to toes, isan ambitious project ; to carry it out with any degreeof success is matter for congratulation. We thinkProf. Ortner has reason to pride himself on the attain-ment of his object, for only a physician with someknowledge of all the specialties can possibly hope toaccomplish the task in anything like an adequatefashion. Pain in the heart, back, neck, shoulder,chest, head, muscles, bones, joints, and extremitiesdemands for its investigation the erudition of a uni-versal specialist, if such there be. We have scannedthese pages with pleasure and profit, and are amazedat the range of clinical knowledge of their author.No one can quarry into this material without findingsomething with which he was not familiar. Wecan hardly compliment the translator on his style,though in an introduction the reader is assured thatclear and simple English has been chosen. Apartrrom a large number of misprints, misspellings, andmistakes (" a wattling gait," "plyocytosis," " par-)snia" and ‘’ pareugesia," " ischimia," "Bamberg’s

170

phenomenon in tabes," " motoric aphesia," &c.), we Iregret that the author’s meaning should thus sufferin careless translation : " diseases of the brainoccupy the area of the trigeminal nerve which is the ’original habitat of paraesthesias

"

(p. 281) ; " I do not Irefer to the sensible aura of epilepsy" (p. 330) ;’" bitemporal contraction of the face (hemianopsia) "(p 287),&c. The English rendering becomes ridiculouswtien we are told that varicose veins cause " edemaof the knuckle." Many unfamiliar expressions-" Wolhynian fever," " Sudek’s atrophy," " Pappatacifever," " malum Rustii," " Bruck’s disease," " Jack’sdisease " (can this be von Jaksch’s disease ?),"

pyrgocephalus," &c. occur. For those, however,to whom the original is not accessible even an

indifferent translation will be acceptable.

SURGICAL DIAGNOSIS.

Exploration clinique et diagnostic chirurgical.By FELix LEJARS, Professeur de CliniqueChirurgicale a, la Facult&eacute; de Medecine de Paris;Cbirurgien de 1’Hopital Saint-Antoine ; AncienPresident de la Soci&eacute;t&eacute; de Chirurgie. Paris :Masson et Cie. 1923. Pp. 778. Fr.60.

IT is a charge frequently levelled at the presentgeneration that its powers of diagnosis are, vastlyinferior to those of its forefathers. The charge can beeasily answered, but no one denies that there existsroom for improvement in this most difficult depart-ment of medical science. None will gainsay the i

existence of " clinical instinct," but this does notimply that diagnostic ability may not be acquired.How then may it be taught ? We believe that anexhaustive, exact, and intelligent examination of thepatient, combined with a judicial review of the history,will enable the student often to make accuratediagnoses, without having continual resort to multiplelaboratory tests. It is for this reason that wewelcome this book.

Prof. Lejars has set himself to describe a precisetechnique for the examination of every kind of

pathological condition in every part of the body.He has succeeded in so doing in a concise manner,and has been aided in making his meaning easilyunderstood by a very large number of illustrations.The style in which the book is written may not appealto some in this country, and the reproductions of theX ray photographs are in most cases poor, but therecan be no doubt that it is a book of great value andshould appeal to a wide circle.

THE EVOLUTION OF MAN.A Series of Lectures delivered before the YaleChapter of the Sigma Xi during the Academic Year1921-22. Edited bv GEORGE ALFRED BAITSELL.London: Humphry Milford, Oxford UniversityPress ; New Haven : Yale University Press. 1923.Pp. 202. 15s.THERE are six lectures included in this book, with

a bibliography and index. The subjects of the lecturesare the Antiquity of Man, the Natural History of Man,the Evolution of the Nervous System of Man, theEvolution of Intelligence, Societal Evolution, and theTrend of Evolution. The authoritative nature of thestatements made is assured from the names of thecollaborators, Profs. R. S. Lull, H. B. Ferris, G. H.Parker, A. G. Keller, E. G. Conklin, and President J. R.Angell. It is evident that the book is not intended forspecialists in the various departments with which itdeals, but rather for those’others who desire acquaint-ance with what is being thought and said in thebiological world and laboratories. We have read thebook with very great pleasure, for the lectures are notonly authoritative but are phrased in clear and simplelanguage. The earlier lectures are clearly illustrated.We can heartily recommend this work to the medicalman who has little time to spare but wishes to knowhow matters evolutionary stand to-day. The volumeis handy and well produced.

SURGICAL ANATOMY OF EMERGENCY OPERATIONS.’

Topographische Anatomie dringlicher Operationen.; Second edition. By J. TANDLER. Berlin : Julius: Springer. 1923. Pp. 118. 8s. 4d.

I IN this book the surgical anatomy of emergencyoperations is considered and the steps of each procedureset forth. The descriptions are clear and the many verybeautiful illustrations self-explanatory. In a, bookdevoted to anatomy only one naturallv looks for anaccount of variations in the typical relations of thestructures in the gastro-hepatic omentum, a subjectof great importance to the surgeon. But this does notappear, probably because the author is an anatomistand not a surgeon. The latter gets the impression atoperations that the cystic artery rather more commonlypasses behind than in front of the common bile-duct,as depicted on p. 67. By a printer’s error, thestructures shown in Fig. 54 have been wrongly labelled.The oblique lumbar incision for exposing the kidneyis described, but when, in an emergency, a bilateralnephrotomy or decapsulation has to be performed,the Mayo approach, which is not mentioned, is simplerand quicker.

VISCEROPTOSIS.Les d&eacute;sangl&eacute;s du ventre; ; 11([ aladies par relaehe-ment des parois et organes abdominaux. By Dr.CHAUVOIS. Paris: A. Maloine et Fils. 1923.Pp. 167.IN this little book Dr. Chauvois described the

varieties and results of atony of the abdominal wall,, with its effects on the abdominal viscera. The

illustrations are an important part of the work,being for the most part arranged in pairs to show

i the clinical types under discussion side by side with, types of healthy and well-built subjects. Full recog-

nition is given to the writings of Glenard, and the author has made no attempt to cover every aspect of his subject; technicalities are avoided, for Dr.

Chauvois appeals not only to medical men, but also: to lay people, and especially parents. With thisz object, in the chapters on treatment the greatest. prominence is given to the early stages of the dis-

; ability and to its prevention, particularly in child-hood. Methods of general hygiene, and the value

i of correct abdominal supports, fresh air, baths,athletics, and special breathing and gymnastic

’ exercises are described. In England we have been

L rather in advance of France in these matters, but’ abdominal atony is only too common, and this book

is of considerable educational value ; its mainpractical defect is that insufficient attention isdirected to the importance of looking for and eradi-cating any focus of sepsis, in children especially, for

) this is the primary cause of the lethargic habit inr very many cases.

SURGERY.Grundriss der gesamten Chirurgie. Second edition.

i By Prof. Dr. ERICH SONNTAG, Vorstand des

g Chirurgisch-poliklinischen Instituts der Universitat,Leipzig. Berlin : Julius Springer. 1923. Pp. 937.

l1s. 8d.e THIS book is written in the form of a synopsis ofe general surgery. It is well arranged and classifiede under suitable headings for the various systems, and. could be used by students as a "crammer" for.. revision before examinations, or by the practitionerr for reference in times of emergency. To literary stylet it makes no pretence, and it confines itself to the.- orthodox teaching of the day, without attempting toe present or to solve any of the numerous controversiese with which modern surgery abounds. The book includesIt a short chapter on operative surgery, which, whilee necessary for the completion of the work, is almost too1. short and sketchy to be of much practical value, mored especially as it lacks illustrations. The fact that aw second edition has appeared is sufficient evidence thate the book is in demand and fills a definite place in the

literature of its kind.