942

been done to the nerve centres.-Dr. T. R. Glynn remarkedupon the rarity of this disease in adults. In a long hospitalexperience he had met with but few examples. In one

typical case there was paralysis of the muscles of the neck aswell as of the extremities. This patient made a goodrecovery with the exception of some weakness of the anteriortibio-fibular group of muscles.-Dr. Warrington thought thatthe diagnosis in early cases was more difficult in childrenthan in adults ; in the latter some well-defined rules could beformulated for the distinction between anterior poliomyelitis,Landry’s paralysis, and polyneuritis of the very acute type.In children he thought that lumbar puncture investigationswould play an important part in the distinction betweenmeningitis and poliomyelitis.WINDSOR AND DISTRICT MEDICAL SOCIETY.-A

meeting of this society was held at the Guildhall, Windsor,on March 30th, Dr. E. S. Norris, the President, being in thechair.-The President read notes of a case of HasmorrhagicPancreatitis. The patient, who had recently died in KingEdward VII. Hospital, Windsor, was a woman, aged 53years, stout, and well nourished. For three days there hadbeen great abdominal pain and violent vomiting. She couldsit up in bed and move freely, but continuously keptshouting out in pain. The bowels did not act. The abdomenwas opened by Mr. J. 0. Skevington, but nothing abnormalwas seen at the operation. The necropsy revealed extensivefat cecrosis in the mesentery, while the omentum was

healthy. The gall-bladder contained one stone about aninch in diameter. The pancreas was swollen to about twiceits original size ; it was firm and hard. The head ofthe organ was yellowish and mottled with white,while the body and tail were red. Small haemorrhageswere visible in between the lobules in the body and tail, butin the region of the head the place of the haemorrhagesappeared to be taken by patches of fat necrosis.-Dr. W. F.Lloyd related the case of a young girl who journeyed bytrain and performed various acts in an apparently unconsciouscondition.-Mr. J. H. Tomlinson exhibited and demonstrateda model which he had constructed for the purpose of showinga curious colour effect due to simultaneous contrast.-Mr. R.Timberg, superintendent of the Physical Exercises Depart-ment, St. Thomas’s Hospital, London, read a paper entitled°‘ Spinal Curvatures and their Treatment by Physical Exer-cises." He divided spinal curvatures according to their

etiology into osseous and musculo-ligamentous. Among theformer the curvatures due to rickets, caries, and spondylitiswere differentiated, other rarer causes being merely referredto. In dealing with the second group of curvatures, where theprimary fault is to be found in the muscular and ligamentousstructures, an explanation was first given of the oiigin of thephysiological curves of the spinal column, and then of howthese curves can be abnormally increased, or how variouslateral curvatures can arise through any inequality of thesupport for the spinal column, or unequal distribution of theweight which it has to carry, or unilateral muscular actionupon it. A plausible theory was given of how the action ofthe spinal muscles tends to produce a rotation of the spinalcolumn when a lateral deviation exists, thus converting thisinto a true scoliosis. Various methods of treatment werereferred to, physical exercises being placed foremost in

importance and strongly advocated even in cases where nocure could be expected, and where artificial supports haveto be used Mr. Timberg then gave a practical demonstra-tion of a variety of exercises useful in these cases. He alsodemonstrated several appliances used in the treatment ofspinal curvatures, and instruments used for measuring theextent of the curves were also shown to the members.-Theproceedings closed with a vote of thanks to Mr. Timberg forhis interesting address.

A CORONATION CARAVAN MEET.-The CaravanClub of Great Britain and Ireland, iD which certain membersof the medical profession are interested, have decided to holda Coronation Meet at Coulsdon, Surrey, commencing onSaturday, June 17th, and continuing through the followingweek. It is thought that a considerable number of countrymembers will avail themselves of this opportunity to visitLondon, sleeping in their caravans at night and seeing thefestivities during the day. Particulars of the club can beobtained from the honorary general secretary, Mr. J. HarrisStone, 358, Strand, W.C.

Reviews and Notices of Books.A Monograph on Albinism in Man. By KARL PEnxsoe,.

F.H.S., E. NETTLESHip, F.R.C.S.Eng., and C. H. USHER;.M.B., B.C. Cantab. London: Dulau and Co. 1911.Text, Parr, I., pp. vii.-226. Atlas, Part I., photographic-plates A-Z and AA-ZZ. Price (to subscribers to whol&work) 35s.THESE two volumes are the first instalment of a compre-

hensive monograph on Albinism in Man. The text consists.of an introductory chapter and chapters on Early HistoricalNotices, the Geographical Distribution of Albinism, the

Albinotic Skin, Leucoderma, and Partial Albinism andPiebalds. Other aspects of the question will be dealt with inthe concluding section of the work, which the authors expectwill be issued during the present year. This section willcontain chapters on the Albinotic Eye in Man, on the-Albinotic Hair in Man, on the Albinotic Eye and Hairin Animals, on the Correlation between Albinism anclOther Defects, and on the Heredity and Statistics ofAlbinism.Albinism might be defined as the complete congenita)

absence of pigment from all parts of the body, but this.definition would lack practical utility as the complete-absence of pigment cannot be ascertained without the most,elaborate microscopic examination. It would also be in-

accurate, for in the majority of the few cases in which the eyes.of undoubted albinos have been investigated microscopically a.certain amount of pigmentation has been found. The hairalso of albinos with characteristic eyes and skin may show

tinges of straw, yellow, or red towards its terminals, and it.is probable that a certain amount of pigment is also usuallypresent in the skin. The authors therefore give the follow-ing definition of a complete albino for the purposes of the-monograph-namely, "one whose skin is of characteristicpallor or milky whiteness, whose hair is ’white,’ tingedpossibly with yellow or straw, and whose eyes have pink orred pupils, translucent irides, with the usual accompaniments.of defective vision, nystagmus, and ametropia."

Skin, hair, and eyes may severally show albinism, whichmay be perfect, or imperfect in that a sensible quantity ofpigment is discernible. Further, the albinism shown maybe complete for any of these three parts of the body in thatthe whole is affected, or partial in that part only is albinotic,while the remainder is normally pigmented. In describingor classifying an incomplete or imperfect albino it is there-fore necessary to state whether hair, skin, or eyes are-

deficient in pigment, and, for each affected part, whetherthe deficiency is complete or partial, perfect or imperfect.A simple system of notation is suggested by which thewhole of this information may be conveyed in three letters.

Complete albinism in one member of a family may be-

associated with an incomplete condition of the same defectin another member-a fac which is of some importance inrelation to theories of heredity.The occurrence of albinos has been recognised for many

centuries, and the existence of an albinotic race is a tradi-tion current in the writings of many authors from Plinyonwards. The most recent version of it appeared in the

Boston Sunday Herald of Dec. 15th, 1907, in which analbino colony inhabiting the Boxwood district of Lakeville is-described. Investigation has, however, failed to confirm this-story. The earlier versions-e.g., the Leucasthiopes of Pliny-may have been due to the discovery by travellers of branches-of comparatively fair races of Moors in Africa and of actualalbinos occurring sporadically in various places. In the

year 1667 Kjopirg described.a race which he calls Homo-sylvestris or Homo nocturnus, living in Tharnodo, one of the

943

Moluccas. These people were quite white mohair and skin ;they could not see during the daytime but only at night.’This race was included by Linnæus, in the twelfth edition of- the "Systema, Naturae" in 1766, in the same species withTroglodytes and the orang-outang seen by Bontius in Java;and described by him.The discussion on the geographical distribution of albinism

occupies more than half of the text of Part I. The material

available is not sufficient to render possible a really satis-factory account of the percentage of albinos present in

’different parts, even of the civilised world. For this purposeit is essential that there should be something in the nature of.a census, and no complete census of albinism has as yet beenmade in any part of the world. One of the most satis-

factory of the investigations into the prevalence of this

- condition is that pursued by Dr. V. Magnus in Norway,through the agency of the Distriktlaegen (the of6cial medicalman for the district). He was able to ascertain the exist-ence of 130 albinos, and to procure pedigrees of 100 of thesedistributed through 50 families. The returns are probably,more complete for the country districts than for the largetowns. In the three largest, Kristiania, Bergen, and

Trondhjem, the recorded cases of albinism occur ina proportion of under 1 in 20,000 of the population,whereas in the smaller towns and country districts theirincidence is approximately 1 in 7000. In contrast to

Norway, Sweden appears to have been almost unexplored,.only one case having been recorded, and that in the year1869, and information is also lacking from Denmark.Albinism seems to be exceedingly scarce among the Slavonic.population. Inquiries were instituted among the medicalmen of St. Petersburg and the clergy of Northern Russia, butnone had heard of any case. From Moscow three casesare recorded at the present day, while during the years1845-52 among 46,278 patients at the Ophthalmic Hospital4 were albinos. This would probably be equivalent to 1 in100,000 of the general population.From Germany Virchow’s report on the great pigmenta-

tion survey of school children gave promise of being a valu-able record, but as in this survey albinos were not entered ina special category it is impossible to estimate their numbers.accurately from the returns made. 400 of the childrenwere recorded as having white hair out of a total of

4,000,000, but of these only 23 had also red eyes, so

that if only these white-haired children with red eyes.are albinos the proportion among German children wouldbe 1 in 200,000. This is probably an under estimate,’since to judge from the number of published cases

the defect does not appear to be very rare in Germany.From Austria the data are even more inadequate ; from iSpain and Portugal there are no records at all; and inFrance, Holland, Belgium, and Switzerland only a few caseshave been brought together. If we consider next the British

Isles, albinism appears to be more frequent in Scotland. ’The new material collected consists of 172 cases, of which rbetween 100 and 150 were still living; as the districtscovered in the investigations contain not quite half the totalpopulation, it appears probable that the frequency is about1 to every 15,000-25,000 inhabitants of the country. From

England, also, a large number of cases have been collected.London furnishes 128, and almost every county contributesits share. The numbers from Ireland and Wales are compara-tively few. In Italy the question has been investigated moresystematically than in other countries. The Italian Anthro-

pological and Ethnological Society instituted a census by,issuing inquiry schedules to the parish priests. From the-results obtained in this way and reported on by Raseri it,.appears that about 1 person in 29,000 throughout all Italy’ as an albino. The authors of the monograph give reasons

for supposing that the frequency is in reality rather greaterthan this and estimate it at 1 in 23,000 to 1 in 24,000.

Albinism appears to be more common in Sicily than in

Italy. Arcoleo gives some particulars of 22 families contain-ing 34 male and 28 female albinos from Palermo. It is not

possible to calculate directly from these numbers the

prevalence of the abnormality in that town, but it may beset down as being probably 1 in 14,000 to 1 in 16,000persons.

- - - -

In the section dealing with the yellow- and red-skinnedraces-Asiatics, Polynesians, Australians, and Americans-anenormous quantity of evidence is presented. It would be

impossible to give at all a satisfactory account of this withinthe limits of the present article, but it would appear thatalbinism is not confined to any particu’ar part of the world,and it is improbable that it is completely absent from anycountry. Its relative commonness in the Fiji Islands is

worthy of note, where 30 living albinos are recorded among apopulation of 86,816.Among the black races albinism is not infrequent, and has

been recognised for several centuries. Xanthism also is

reported in a great number of cases. A xanthous negro

possesses a red or yellowish-red skin and hair that is usuallybrown ; the eyes are also brown of varying shades. Xanthousand albinotic negroes often occur in the same stock. The

pedigree of one, of the name of Jappe, is of especial interest.Jappe, of whom two excellent portraits are given on

Plate CO of the atlas, is "a well developed Myambaam ofabout 25 years of age ; of very light, almost white colour.His skin has more the healthy colour of a European some-what sunburnt, not the deadly white colour of a pure albino.The iris in this as in other cases was brown. The wool on

the head, slight moustache and beard, and pubic coveringwere of brown colour." His paternal grandfather, a normalblack, married an albino negress, the offspring was Jappe’sfather, a xanthous negro, who married a ’’ white Kaffir."

Jappe resulted from this union, and he himself marrying anormal black negress has two xanthous children.The chapter on the albinotic skin is full of interesting

matter. It begins with an historical account of the viewsheld as to the causes of albinism. One school looked on itas disease produced either by the intra-uterine influence ofthe mother or by external causes, such as a damp climate ora diet consisting too exclusively of fish. It is probable thatcongenital partial albinism was often confused with the

appearance of white patches on the body due to variousdiseases of the skin. Among the intra-uterine influences

"maternal impressions " figure largely. The statement thatalbinism is often found associated with cretinism gained aconsiderable currency, but it appears to rest on no evidence

whatsoever.

The latter part of the chapter is devoted to a discussion ofmodern microscopic and bio-chemical investigation into thenature of animal pigmentation. The many conflicting viewson this question are very clearly described, and the followingconclusions are arrived at : " (1) The presence of melanin isresponsible for skin pigmentation ; (2) melanin does not

appear to be a direct product of hæmoglobin ; (3) the supplyof pigment by way of the blood or otherwise (by means ofinjections) has not hitherto been successful in increasingexisting pigmentation or producing it where it was absent ;(4) it seems probable that pigment is created and storedin situ, and is due to a metabolic process not yet fullyunderstood; (5) the possibility of abnormal absence andabnormal presence of pigmentation being extremes of onenormal metabolic process is, perhaps, worthy of considera-tion ; (6) the production of pigment is very probably due tothe local action of a tyrosinase or ferment on tyrosin ; (7) ithas been suggested that the cause of albinism is the absence

944

of this ferment." As an alternative the authors suggest thatthe difference between a normally pigmented individual andan albino is one of cellular structure. Absence of the ferment

may be an explanation of complete albinism, but in partialalbinism the ferment must at any rate be present in the

pigmented parts. Anomalies of cell structure may, however,prevent it reaching some parts of the body, or may renderimpossible the storage of pigment even if formed.The remainder of the volume is occupied by a consideration

of leucoderma and partial albinism. Partial albinos may beeither piebalds or spotlings. The piebalds have the normalpigmentation variegated by comparatively large white areasof the body, while among the spotlings pigment is absent

only from comparatively small patches. The latter are far

more common. We have indicated in a general way thecontents of this volume, but it is almost impossible to give

any adequate picture of the very wide range from which theyhave been drawn. All the literature, ancient and modern,which could have any bearing on the subject appears to havebeen effectively searched, while countless individuals havecontributed fresh evidence. The manner in which all the

facts, theories, and fancies have been marshalled is worthyof the highest praise, and any part of the volume can beread with ease and interest. As in all the publicationsissuing from the Biometric Laboratory and Eugenics Labora-tory at University College, the print and paper are excellent,and the 52 plates of illustrations in the atlas have been

reproduced in a faultless way.

The Raoial Anatomy of the Philippine Islanders, introducingNew Methods of Anthropology and shnniny their Applica-

tion to the Filipi7tos, with a Classification of Human Earsand a Scheme for the Heredity of Anatomical Characters inMan. By ROBERT BENNETT BEAN, B.S., M.D., AssociateProfessor of Anatomy, the Tulane University of Louisiana,New Orleans, La. ; formerly Associate Professor of

Anatomy, Philippine Medical School, Manila, P.I. With19 illustrations from photographs and 7 figures in thetext. London and Philadelphia : The J. B. LippincottCompany. 1910. Pp. 236.MANY attempts have been made to sort out mankind and

to invent some system by which each individual so sorted outmay be labelled as the representative of some definite type.In the making of such systems most of the salient points ofthe body have been seized on, and all the human race hasbeen judged on the standard of the form, the size, and thespecial features of some particular portions of the humanframe. Universal success does not reward these systems, andtheir conspicuous failure is often more likely to be apparentto the observant lay traveller than to the professed anthropo-logist. It is a truth that the human heritage is so

mixed and so complex that individuals may not be satis-factorily labelled and set aside as representatives of certainchosen types, and even if the labelling and sorting is donewith the greatest care it will result only in the production ofgroups of individuals who resemble each other in some few

chosen points, but differ totally in a vastly greater numberof more important features. Dr. Bean has taken as his

standards such features as the total height of the body, thecephalic index, and the eye colour or ear form. Upon thesecriteria he has attempted to standardise as definite named

types a large number of individuals of the very mixed popu-lation of the Philippine Islands. He designates some ofthese types as "Iberian," some as "Primitive," "MixedPrimitive," or as " Australoid " ; others he labels Alpine, "" Blends," or the more cryptic I B. B. B. type. " Negrito,Malay, Hindu, Arab, Chinese, and Spaniard-these, andothers, have left their legacies of form and feature in theinhabitants of the group, and we are tempted to speculate ifthe author would not have derived more real knowledge of

the people he studied if, instead of measuring their ears, hehad asked them whence they came and what was their raceand parentage. Figures, and tables of figures, are but poorsubstitutes for observation and common’sense biologicalinsight in tabulating living man. To deal in this fashionwith a living race of known antecedents is to render the scienceof anthropology absurd to a degree which produces the un-fortunate result that its lack of utility and soundness is

apparent to every observant lay critic. Justified ridicule can

only accrue to a misused science which speculates upon theinfluences of " paleolithic man in the Philippmes," as arguedfrom the supposed existence of a race-" Homo Phiiippensis"-whose characters are established from the examination ofone solitary individual who presented himself at the dis.

pensary and " was treated for sexual neurasthenia." Of this

man the author knows absolutely nothing ; his parentage,his race, his home, and his family are all in the dark. He

is certainly a native of low type and of obscure antecedents;but these are not the qualifications for being regardedas a specimen of a race with close relationship to the

Neanderthal type."Orgmaic and Functional Nervous Daseases. By M. A. STARR,

M.D., LL.D., Ph.D., Professor of Neurology, ColumbiaUniversity. New York. Third edition, thoroughly re-

vised. With 300 illustrations. London: Baillière,Tindall, and Cox. 1910. Pp. 911. Price 25s. net.

THE third edition of this well-known text-book is largerthan the preceding ones, comformably to, the numerousadvances that are being made in the science of neurology.It has been brought up to date by the inclusion of new

material, more particularly in the chapters relating to

functional nervous disease. In its present form the bookcontains an immense amount of information based on the

experience of its author, and the utility of the volume isenhanced by numerous references to the literature on anyparticular matter that is provocative of discussion. Thus the

volume is characterised by an absence of dogmatism, and, onthe other hand, by a personal note, especially in the

paragraphs on therapeutics, which the reader will fullyappreciate. This being so, it is unfortunate that some of

the author’s statements do not appear to have undergone arequisite amount of revision. Such sentences as "the loss

of concepts has been termed apraxia ; the varieties of

apraxia-viz., psychical blindness, psychical deafness,amnesia, and astereognosis," are both misleading and

inaccurate. To say that the modern conception of hysteriais that elaborated by the French school and best portrayedby Babinski " would seem to imply that no other school hasa modern conception of hysteria, and that Babinski repre.sents the French school in its entirety, which is very far

indeed from being the case, as is pointed out in another

column in dealing with the current issue of Brain. To betold that "a very constant symptom of bulbar paralysis isan emotional state which leads to undue laughter, or moreoften to frequent crying without apparent cause: this mustbe regarded as a local symptom of pons disease," is doublyconfusing. Many of the illustrations are excellent, but anumber of printer’s errors in the text-e.g., "hypocampal" for" hippocampal "-bear witness to the hastiness of revision.

LIBRARY TABLE.

Manual ot Clinical Pathology for the General MedicalPraotitioner. By RICHARD WEISS, M.A., Ph.D., F.C.S.,in collaboration with GEORGE HERSCHELL, M.D. Lond.,and ANDREW CHARLES, F. R. C. S. Irel. London : J. and A.Churchill. Pp. 72. Price 2s. net.-This little bookis designed to afford the practitioner of medicine short

and practical directions for carrying out such of the