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REVIEWS AND NOTICES OF BOOKSInjuries and their TreatmentBy W. ELDON TUCKER, B.Chir. Camb., F.R.C.S.Eng., Surgeon to St. John’s Hospital, Lewisham ;Surgeon to the London Clinic for Injuries, Baker-street ; late Registrar, Royal National Ortho-

psedic Hospital. London: H. K. Lewis and Co.,Ltd. 1935. Pp. 174. 9s.

THE pathology and treatment of injuries to thesoft structures of the body is a subject which neverseems to arouse much interest among the juniorsin hospital circles. The student or resident who isbored with sprains and strains, and does not botherto learn much about their treatment, gets an un-pleasant shock when he finds how much importancehe is expected to attach to such injuries in generalpractice. Sir Humphry Rolleston notes in a prefaceto this volume that Mr. Eldon Tucker’s interest inhis subject and his knowledge have been acquiredin a very practical way-by treatment of injuries infellow athletes. Many text-books have been writtendealing with a special form of treatment, such asmassage, electrotherapeutics, or graduated muscularcontractions ; Mr. Eldon Tucker examines all themethods that he considers useful, and in a chapterat the beginning of his book compares the resultsto be obtained by each. He is then in a position toprescribe the suitable combination of methods foreach injury in turn. Particularly welcome are thedetails of joint manipulation with comments on anappreciation of its advantages and dangers at thevarious stages of repair after injury. Too prolongedrest is held by the author, as by many of his col-

leagues, to favour fibrosis of ligaments and muscles,whilst too active massage and movements in theacute stages may increase effusion into and aroundthe joint. The two aims of treatment are describedas the promotion of sound repair of the injuredstructures and the absorption of the traumaticeffusion as rapidly as possible; chronic affections of

joints and muscles are thus avoided.The chapters on osteo-arthritis and on fibrositis

are illuminating, and the comments on the successesand failures of the osteopath are of topical interest.In the sections dealing with particular joints weare especially glad to note the insistence on the

importance of the recovery of full quadriceps powerin knee-joint injuries ; the warning against the

dangers of manipulation and of all passive move-ments in injuries of the elbow-joint; and the descrip-tion of the exact type of manipulation to be practisedat the shoulder-joint, together with its contra-indication in sprain of the supraspinatus muscle.The subject matter of this volume should be familiarto every doctor, and thanks are due to the authorfor having presented it in such a readily accessibleform and in such small compass.

The Kidney in Health and DiseaseIn Contributions by Eminent Authorities. Editedby HILDING BERGLUND, M.D., and GRACE MEDES,Ph.D. With the collaboration of G. CARL HUBER,M.D., WARFIELD T. LONGCOPE, M.D., and ALFREDN. RICHARDS, Ph.D., M.D. London: HenryKimpton. 1935. Pp. 754. 45s.

THIS book is said to be an "outgrowth of a sym-posium on the structure and function of the kidneyin health and disease which took place in Minneapolisin the summer of 1930." The principal organizer

of this meeting was Dr. Hilding Berglund, at thattime professor of medicine in the university ofMinnesota. Of the 41 contributors 37 are Americanand a third of these at the time of the meeting heldposts in this university; s the somewhat parochialatmosphere of many of the papers .may be due tothis fact. The standard of the contributions israther uneven. That the bias is on the physiologicaland biochemical aspects of renal research is suggestedby the title, but other and more clinical topics arenot neglected ; of particular merit is a succinct andauthoritative account of the histological changes inBright’s disease by E. T. Bell. Interesting obser-vations and discussions of the different aspects ofproteinuria, including the phenomenon of Bence-Jonesproteinuria, and of oedema, with an account of thetechnique and effects of plasmaphaeresis, will alsobe found. The uses of renal function tests are fullydescribed. W. L. Longcope, J. Bordley, and F. D. W.Lukens adduce further evidence of the importantpart played by haemolytic streptococci in Bright’sdisease. On the clinical side a description of the retinalchanges in nephritis and hypertension by H. P.

Wagener is supplemented by an illuminating discussionof points in their pathology by J. S. Friedenwald.

F. Volhard contributes articles on hypertension,including both pale and red varieties, uraemia, andthe treatment of acute diffuse glomerulitis. Few

histologists would hesitate to challenge his statement(p. 249) that " the histological picture of kidneyinsufficiency, whether produced through subacuteor severe chronic nephritis, through malignantsclerosis or amyloid disease, or through drasticreduction of healthy renal tissue, is always thesame : an astonishing dilatation of the remainingtubules and a high-grade flattening of their epithelialcells. One can see at once from a kidney sectionwhether the patient died from renal insufficiencyor not." The morbid histology is unfortunately notas simple as that, and it is a pity that so renownedan authority on renal disease should utter such amisleading statement. There seems still to be a

gulf between the exponents of the clinical and thepathological aspects of nephritis, which will have tobe bridged before a symposium such as this is muchgood to the student. Senior workers, however, willfind stimulating material in its pages, making itworth their while to read it.

Eden and Lockyer’s GynaecologyFor Students and Practitioners. Fourth edition byH. BECKWITH WHITEHOUSE, M.B., F.R.C.S. Eng.,F.C.O.G., Professor of Midwifery and Diseases ofWomen, University of Birmingham. London :J. and A. Churchill Ltd. 1935. Pp. 964. 38s.

Eden and Lockyer’s " Gynaecology" has been

generally regarded as one of the best standard medicaltext-books ever produced in this country. Prof.Beckwith Whitehouse states that for this reason

he approached the task of the complete revision ofthe work for its fourth edition with some misgivings.It is due to him that we should record the opinion,which will certainly be shared by those who studythe outcome of his efforts, that he has succeeded inmaintaining the high standard previously set. Theadvances made during recent years in gynaecologyhave necessitated the addition of new subjectmatter and the rewriting of several sections. Thechapters dealing with the physiology and pathology

24

of menstruation contain a balanced account of the

knowledge at present available upon this intricateproblem. The sections concerned with diseases ofthe ovaries have also been largely re-cast, with theintroduction of new material under the title ofMorbid Conditions of the Graafian Follicle and

Corpus Luteum. Forty pages in Section 4 are allo-cated to the diagnosis of disease of the female pelvicorgans. The latter part of the book is devoted tothe operative side of treatment, and the descrip-tion of each operation is preceded by a clear

exposition of the indications for its performance.The careful account of post-operative treatment isinvaluable.We can offer no criticisms of any constructive

value. The trouble expended by the publishersover the reproduction of the 600 illustrations, ofwhich 36 are coloured, is the subject of well-deservedacknowledgment by the author.

Clinical Aspects of Visceral NeurologyBy W. K. LIPINGSTON, M.D., Clinical Associatein Surgery, University of Oregon Medical School.London: Bailliere, Tindall and Cox. 1935. Pp. 254.22s. 6d.

THE author states in the preface to this volumethat he intends to set forth his observations on the

pre- and post-operative condition of 300 patientswho have been treated by excision of some part oftheir sympathetic nervous system. Seeing that hisexperience has extended over a period of ten yearswe might expect the book to provide just that informa-tion which is most needed by those interested inthe problems of visceral neurology. Any such

expectation, however, is doomed to disappointment,for Dr. Livingston has occupied too much of his

space in repeating well-known anatomical and

physiological facts, and he has set down no clearstatement of the results of his own operations. Asa review of the more recent literature of the surgeryof the sympathetic system the book is of real value,but a surgeon with Dr. Livingston’s experience oughtto add to our knowledge more than can be obtainedfrom a bibliography.The book refers to all the conditions for which

sympathectomy has been performed, some of thereferences being of necessity brief, but special stresshas been laid upon the surgical treatment of vasculardiseases. The author’s opinion, "there is no dividingline between Raynaud’s disease and the Raynaud-like phenomena observed in the other clinical con-ditions such as thrombo-angiitis obliterans," is borneout by his records, for of 7 cases he quotes as examplesof Raynaud’s disease only 2 conform to the commonlyaccepted criteria. This unusual point of viewvitiates any arguments which he brings forwardregarding the nature of these vascular disorders.The number of charts of skin temperature testsbears witness to the importance of this method ofinvestigation, but it is strange that so little is saidabout the effect of cooling the limbs to be tested ;and since 17 out of the 22 tests used as illustrationswere carried out at room temperatures of over 20° C.,and in some cases at a temperature of nearly 30° C.,it is unlikely that the results of these tests are atall comparable with those performed under morecarefully controlled conditions. It is also remarkablethat with such a wealth of available material thereshould have been included as an example of theeffect of spinal an2esthesia the chart of a case in whichthe spinal anaesthetic failed to act. The chapter on

surgical technique includes some useful practicalsuggestions, but a study of the book as a whole leavesone with the impression that an authoritativeevaluation of the late results of sympathectomyhas yet to be made.

Forensic Medicine

By DouGLAS KERR, M.D., F.R.C.P.E., Lectureron Forensic Medicine in the School of Medicineof the Royal Colleges, Edinburgh. London :A. and C. Black Ltd. 1935. Pp. 311. 15s.

Dr. Douglas Kerr does not put this book forwardas an exhaustive work of reference. It is writtenfor medical students, but also contains guidancefor the practitioner. As police surgeon and medicalreferee to the city of Edinburgh he has wide experi-ence, and he has been able to include from his own

medico-legal practice several striking photographicillustrations. Expressed with the clarity which oneassociates with good lecturing, his chapters on

professional ethics and on the relation of crime andinsanity are excellent. The information on toxicologyand on such special matters as blood-groups is setout in brief but comprehensive fashion. The Scottish

legal procedure is as fully dealt with as the English.Such criticisms as we would offer are all trivial. It

might, for instance, have been stated on p. 124that for England the important Section 12 of theChildrenAct (on neglect) has been replaced by Section 1of the Act of 1933. A like amplification is wantedon p. 188 where the 1932 enactment has been replacedas respects England by Sections 50 and 53 of thelater statute. A careful study of Dr. Kerr’s competentpages, doubtless destined to grow more voluminousin future editions, will enable readers to face cross-examination with confidence either in the examinationroom or in the witness-box in a court of law.

Lungentuberculose und SchwangerschaftBy H. BRAEUNING, Chefarzt der Fursorgestellefiir Lungenkranke in Stettin. Leipzig : GeorgThieme. 1935. Pp. 275. M. 24.

THAT pregnancy is capable of lighting up a latenttuberculous lesion and aggravating an active onehas long been an accepted view ; Dr. Braeuning’sinvestigations have been directed towards the moreexact measurement of these risks in the various

types and stages of the disease. He concludes thatduring and after pregnancy severe and fatal relapseoccurs in about 6 per cent. of cases, transitory aggra-vation in 20 per cent. As relapse is frequent quiteapart from pregnancy these recurrencies must notbe attributed entirely to pregnancy. In 102 casesof therapeutic or spontaneous abortion there was

only one fatal relapse and three temporary setbacks.Relapse associated with pregnancy was found to berather less common in fibrotic forms of the diseasethan it was in the exudative ; but this again corre-sponds to experience in non-pregnant cases and itis therefore not justifiable to conclude that pregnancyhas a particularly unfavourable influence on theexudative type of disease.Twenty-four completed pregnancies in 22 women

with cavities were followed by three severe and fivetransitory relapses. In advanced tuberculosis theprognosis is already so bad that pregnancy does notappear to shorten life ; death before the end of thepregnancy is uncommon even when the disease issevere at its commencement. An unsuccessful

25

attempt was made to forecast the likelihood of relapseby means of the sedimentation test at the beginningof pregnancy.

Br. Braeuning finds little correlation between thedirection in which the disease is progressing whenthe pregnancy starts and the probability of relapse.He cites several cases of women who, although goingdownhill when they became pregnant, steadilyimproved during and after pregnancy; othersmaking good progress before becoming pregnant,suffered severe relapse, usually after delivery. Neitherthe original severity of the disease nor a tuberculousfamily history appear to have any influence on thelikelihood of relapse.The mortality during the first five years of life

of children born from tuberculous mothers was

found to be only 1 to 4 per cent. higher than theaverage. These figures are in striking contrast withthe high mortality figures usually cited for untreatedchildren by the advocates of B C G. The authoractually finds no increase in infant mortality whenthe mother is suffering from open tuberculosis ; a

fact which he attributes to the great care which thisgroup receives from the public health authorities.The main conclusion which may be drawn from this

important investigation is a negative one. Modernresearch has failed to make rore precise the know-ledge that the strain of pregnancy in tuberculouswomen increases the risk of relapse.

Beesley and Johnston’s Manual of SurgicalAnatomyFourth edition. Revised by JOHN BRUCE, M.B.,F.R.C.S.E., Tutor in Clinical Surgery, RoyalInfirmary, Edinburgh ; and ROBERT WALMSLEY,M.B., Ch.B., University Assistant and Demon-strator of Anatomy, Edinburgh University.London: Humphrey Milford, Oxford UniversityPress. 1935. Pp. 717. 20s.

THE original authors of this well-known work

being no longer able to cope with the responsibilitiesassociated with the issue of a new edition, Mr. JohnBruce and Mr. Robert Walmsley have taken up theburden of revision and reconstruction. They haveproduced a very good book, decidedly larger thanin the last edition, which will meet the requirementsof the present-day student. The anatomy is sound,and applied with judgment except in a few places.For example, even if one admits the possibility ofthe separation of the upper humeral, epiphysis, itseems likely that the muscles inserted into the

epiphysis have more to do with the injury than hasthe capsule. There is an excellent general accountof the autonomic system. The writers have resistedthe temptation to introduce such experimentaldetails as frequently confuse and irritate the reader,and have produced a clear and eminently under-standable account of the matter. The commoner

surgical procedures which have to do with this

system are shortly but well described from theanatomical side, but the few lines which deal withremoval of the right lumbar trunk might be improvedby some mention of the presence of the vena cavaand ureter. In a future edition, some of the develop-mental data given throughout the book should berevised. The work seems to meet well the purposeexpressed in the preface, the provision of a manualfor use by senior students in the dissecting room ;for such a purpose it can be heartily commended.It is well produced and clearly, if not too profusely,illustrated.

Electrokinetic Phenomena

And their .pplication to Biology and Medicine.By HAROLD A. ABRAMSON, M.D. American ChemicalSociety Monograph Series. No. 66. New York:Chemical Catalog Company, Inc.; London : ArthurF. Bird. 1934. Pp. 331. 33s. 6d.

THE American Chemical Society Monograph Seriescontains some most valuable works of referenceto isolated chemical problems, and this volume willadd to its reputation. In the space of some threehundred pages Dr. Abramson has provided a clearand comprehensive account of the application of

physical methods, such as electrodialysis to biologicaland medical problems. The first chapter is concernedwith historical development. Starting with an excel-lent photograph of Smoluchowski the author tracesthe development of the study of electrochemistryand gives in considerable detail the earlier work ofReuss, who, as he points out, was the true dis-coverer of electro-osmosis The way in which Dr.Abramson leads up to the conception of the electricdouble layer and its bearing on physico-chemicalphenomena deserves special praise. The text is

attractively illustrated by reproductions of the

early apparatus. Later chapters deal first with thetheoretical aspects of the subject and then with itspractical applications to various problems of bio-

chemistry and bacteriology. The summary of theliterature is judicious and contains a useful sectionon the patent literature.

The Theory of GymnasticsBy Prof. JOHANNES LINDHARD, M.D., Professor ofGymnastic Physiology, Laboratorium, University ofCopenhagen; Principal of State Institute of

Gymnastics, Copenhagen. London : Methuen andCo. 1934. Pp. 359. 12s. 6d.

THIS is a serious analysis of gymnastics, which willbe found stimulating by those interested in the variousschools of physical education and in the appliedtheory of movement. Prof. Lindhard is somewhatantagonistic to the accepted Swedish Ling school ofgymnastics. Many of his contentions, we feel, couldbe countered by a more understanding knowledge ofthe views of the best thinkers and not the averageworkers of this school. He discusses, in an originalway, the development of gymnastics and its modifica-tions. His critical allusions to modern system modifica-tions, as those of Bukh, Bjorksten, Knudsen andElin Falk, are not unjust. He deals at length with thevarious classifications of exercises, and comments onthe aim and application of gymnastics as evinced bythese groupings of movements. He has little use forthe orthodox conception of the fundamental standingposition, which in his view compares unfavourablywith the classical Greek form, and he analyses the" attention " position of any system as its keynote.

Prof. Lindhard lays emphasis, illustrated bydetailed anatomical facts, on the differences betweenthe sexes, and on the desirability of different move-ments for men and women. This thesis he seems to

pursue too far in proclaiming an arbitrary taboo oncertain movements for women on aesthetic grounds.The idea that the gymnast is endeavouring to

straighten the natural curves of the spine beyondNature’s intention rouses Prof. Lindhard to a briskattack. This zeal might be modified by the considera-tion that the whole of civilised daily life tends toincrease these curves, and the idea behind any butthe most unintelligently military system is simply

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a return to normal. His analysis of breathingexercises, however, provides a fresh and stimulatingoutlook, and his comments on the association ofrespiration with heart function are original andsuggestive. The section on marching is also ofpractical interest. Throughout the book Prof. Lind-hard appears to be reacting against a hypotheticalantagonist ; those who uphold traditional methods ofgymnastics would probably agree with many of hiscriticisms, and would yet find adequate reasons foradapting rather than scrapping the orthodox routine.

Medicine in Persia

By CYRIL ELGOOD, M.D., M.R.C.P. Clio MedicaSeries. New York : Paul Hoeber. 1934. Pp. 105.$1.50.THE attitude of the Persians to medicine seems to

have been chiefly receptive, the teaching of their ownZoroaster having been modified by Egyptian, Mesopo-tamian, and especially by Greek influences. Successivepolitical changes, and no doubt the artistic langour ofthe East, prevented their producing more than threegreat physicians-Rhazes, Avicenna, and Ismail. Ofthese, Rhazes (A.D. 850-932) is the best known for hisdifferentiation of both measles and small-pox, but healso introduced mercury ointment, and discoveredsulphuric acid amongst other things. Avicenna(A.D. 980-1037) was renowned for his celebrated" canon," founded largely on Galen and received withjoy by European physicians in the sixteenth century.Ismail, who died in A.D. 1136, described exophthalmosas an accompaniment of goitre and was thus, as

Dr. Elgood points out, the first to observe a signrediscovered by Dr. Parry in 1825. On the wholethe treatment of physicians by Persian monarchsappears to have been good, and it is clear fromDr. Elgood’s learned and instructive work that

hospitals and medical schools flourished in Persia andBagdad long before they were founded in Europeancountries. According to Dr. Elgood, the medicine ofthe New Testament shows evidence of the influence ofPersian medicine, and the term Magus is the oldPersian name for a Zoroastrian priest.

L’epauleAnatomie des Formes Extérieures, Anatomie Radio-graphique, Ohirurgie Operatoire. By ANTOINEBASSET, Professeur a,grege a la Faculte de Paris,Chirurgien de 1’Hopital Beaujon; and JACQUESMIALERET, Aide d’Anatomie a la Faculte. Paris :Masson et Cie. 1934. Pp. 292. Fr.65.THE authors have now produced two volumes in

their series dealing with the topographical anatomyand surgery of the large joints. That dealing with theknee-joint has already been reviewed in these columns ;the volume on the ankle-joint is being prepared. The

complete series will undoubtedly be an asset to anysurgical library. The standard set by the first volumewas high, and it has been well maintained. The

general scheme followed here is for the most partthe same as in the account of the knee-joint. Thefirst and smaller part of the work is devoted toanatomical descriptions, including surface anatomyand radiographical appearances, both of the normaljoint and of joints specially prepared by injections ofthe capsule and arteries. Reconstructions of themuscle relationships have been produced by drawingthe muscles over radiograms. Anatomical points ofsurgical importance are noted. This part of the bookis profusely and finely illustrated ; the illustrations,indeed, are descriptions in themselves.

Operative surgery is dealt with in the second part.The authors seem to have been at pains to includeevery operation and every incision that can possiblybe used to expose the shoulder-joint. This mass ofinformation tends to bring confusion in its wake, eventhough a résumé is given at the end of the chapter onincisional approach by the five routes which are con-sidered to be of value. In the section on injury theindications for operation are clearly presented. Threeprinciples are laid down : (1) in all injuries in the regionof a joint it is essential to make sure whether the jointitself is or is not involved ; (2) in all non-infectedarticular injuries closure without drainage is to beperformed ; and (3) all infected injuries of joints areto be treated by free drainage. Exploration by openincision, dividing layer by layer, of any woundsuspected of opening into the joint is recommended.The futility and danger of exploring by a probe isemphasised. Dislocation of the shoulder is discussedat length in as far as the injury may require openoperation.The consideration here devoted to the after-results

of the various surgical procedures will be welcomed.

Anatomy : The ThoraxFourth edition. Part V. (Catechism Series). ByC. R. WHITTAKER, F.R.C.S.E., F.R.S.E., Lectureron Anatomy, Surgeons’ Hall, Edinburgh. Edin-

burgh : E. and S. Livingstone. 1935. Pp. 69.Is. 6d.Tiais well-known series certainly helps those

students to whom all the institutes of medicine (aswell as that art itself) are simply exercises for theirmemories and hardly at all for their reasons. Forthese, books of this kind can be recommended, notas treatment of the condition but to relieve or hidethe symptom. This little book is full of accurateinformation, from cover to cover, but that is not tosay that it can teach thoracic anatomy to thosewho will not use their faculties properly. On theother hand, it may help those who have some know-ledge of the subject to get their information inorder.

REPORTS AND ANALYSES

MOUSSEC(MOUSSEC LTD., 175-6, PICCADILLY, W.1)

THIS is a sparkling wine of the champagne typeprepared from imported grape must and fermentedin this country by suitable selected champagne yeasts.The treatment of the wine during and after fermenta-tion is the same as carried out in the well-knownwine houses in France. When analysed the followingresults were obtained

Alcohol (by volume) ...... 12-0 per cent.

Equivalent to proof spirit.... 20-65 "

Total extractives...... 3-93 "

Consisting of-Invert sugar ...... 1-97 "

Cane sugar ...... 0.29 "

Fixed acidity (as tartaric acid) .. 0-51 "

Mineral matter, &c.... 1-16 "

Volatile acidity (as acetic acid) .. 0-06 "

The wine has the appearance, composition, andgeneral properties of an ordinary dry French cham-pagne. It is light and pleasant to the palate, andhas an agreeable aroma. The manufacturers wouldseem to have succeeded in making, in this country,an attractive and wholesome wine closely resemblingthe imported product.