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Reviews and Notices of Books.A MANUAL OF THE PARASITIC PROTOZOA OF MAN.

By CHARLES F. CRAIG, M.D., M.A. Hon., Lieut.-Colonel, Medical Corps, U.S. Army, D.S.M.London: J. B. Lippincott Company. 1926.Pp. 569. 35s.

THE rapid advances which have been made duringrecent years in our knowledge of the protozoanparasites of man and the diseases they cause haveled to a realisation of the fact that it is essential forevery medical practitioner, no matter whether he isdomiciled in the tropics, in temperate or even in coldclimates, to be able to diagnose with a fair degree ofcertainty each and every species inimical to humanwell-being. In our medical schools greater stress is

being laid on the teaching of this subject, but in thisboth teachers and students have been sadly handi-capped by the lack of up-to-date and reliable text-books. Since the war several excellent monographshave appeared, dealing, however, only with partsof the field, and also a few text-books ; the formerwere more in the nature of ’zoological treatises, whilethe latter contained much that was irrelevant and didnot emphasise the practical points so vital to themedical man.To produce a work for medical students and

practitioners, laboratory and research students, whichwould fill this want by adequately covering the salientfeatures of the morphology, life-history, relation todisease, and prophylaxis of these parasites was themain object of the author in compiling his text-book.His manner of approach is an excellent one, and mostmethodical. After a general consideration of eachgroup the individuals of that group are dealt with indetail. Thus a list of synonyms is given, subsequenthistory and nomenclature are discussed, and this isfollowed by a clear and lucid description of themorphological characters both as found in fresh andalso in stained preparations. The life-cycle, methodof reproduction, transmission, and mode of infectionof the vertebrate host are all clearly set forth, whilesuch points as the possibility of cultivating theorganism in question or of producing infectionsexperimentally in laboratory animals receive fullmention. A section is devoted to the relationshipwhich the parasite bears to the causation of symptomsof disease in man.

In startling contradistinction to the lucidity of thetext is the way in which the illustrations have beenprepared. The pictorial reproduction of the parasitesis surely as important, if not considerably more so,than the written word. That the student should beable at a glance to compare his microscopical findingswith an accurate drawing is, as must be obvious toall who have had either to learn or to teach thesubject, one of the first essentials, and from thisaspect the book falls sadly short of the necessarystandard of excellence. A wide use has been made ofphotomicrographs, the majority of which are splendidexamples of the photographer’s art as applied to themicroscope, but it must be remembered that thepossibilities are limited in this direction, that only.one focal plane containing, perhaps, a few of the mainfeatures can be registered, and even then the repro-duction cannot be so sharp as the visual image. Thus,for example, in some of the photographs of the amoebaethe nuclei are moderately sharp and clear, while thecytoplasm or body substance, after all as important asthe nuclear structure, is a meaningless shadow. Theinterpretation of a photomicrograph and its apprecia-tion are matters for those already expert and not forstudents. With a few exceptions the illustrations,other than photomicrographs, have been taken fromthe works of other observers. Some of these repro-ductions do not appear to be as clear as the originals,while the combining of drawings from two or moresources has resulted in fusion products, which alsodo not appear to do justice to the original pictures.

The value of a subsequent edition would be greatlyenhanced by the inclusion of original drawings ofmicroscopic appearances.Where it has been necessary in the text to indicate

that a certain matter is still sub judice, or that dis-agreement exists in the interpretation of certainphenomena, the author has endeavoured to stateboth sides of the question fairly and without bias.For example, he quotes the classifications of theamoebae in man according to Dobell and Stiles andBoeck, is in complete agreement with neither, andfinally gives a classification according to his ownviews. Indeed, it may be said that only in the caseof Craigia hominis, not yet accepted as a true parasiteof man by the majority of European, and moreparticularly British workers, does any suggestion ofpartisanship become evident, and, as this was describedin the first instance by Craig himself, has been acceptedby such authorities as Kofoid and Swezy, but hasbeen rejected by others on what Craig considers tobe inadequate evidence, his attitude on this question isonly natural. Generally speaking, the author’s teach-ing is in accord with the bulk of modern scientificopinion, and there are no large departures from theorthodox. We note, however, that he separates theparasite of eestivo-autumnal or malignant tertianmalaria into two subspecies, Plasmodium falciparumand P. falciparum quotidianum. Again, in thissection on malaria his use of certain expressionsmight conceivably give rise to confusion. The termspore should not be applied to the products of asexualmultiplication-the merozoites-nor should gameteand gametocyte be used interchangeably. Sporulation,too, although used for many years now to indicatethe final stages of the asexual cycle in man or schizo-gony, would be better applied to the formation of thesporozoites in the mosquito.At the end of each chapter the author has given a

list of references of the more important papers dealingwith the subjects covered in that section. This listis not intended to be a completevþiWi9raphy; itcontains more especially the receri’t, wor$:,-1Bp.d shouldbe regarded by the student as ;&nntrpduction to theliterature. Another most useful"feature is tti6 technicalappendix, in which is included the-’jnore- importantlaboratory methods of cultivating or - preparingpermanent stained preparations of the parasiticprotozoa. ... - -We have no hesitation in recommending this book

to the medical practitioner or the medical scientistas one of the best accounts of this important branchof medicine in English. One or two important addi-tions might be made with advantage. The absencein the present volume of coloured plates showing themalarial parasites at all stages of development, andof the trypanosomes and allied flagellates, is noticeable.The number of original diagrams illustrating life-cycles should be increased and those already includedshould be carefully revised. There would seem littledoubt that a demand for a second edition willgive the author early opportunity to make theseimprovements.

NUTRITION.Troubles des tchanges Nutritifs. By C. ACHARD,Professeur de Clinique Médicale à la Faculté deMedecine de Paris, Membre de 1’Academie deMedecine. Paris: Masson et Cie. 1926. Twovols. Pp. 1220. Fr.110.

IN these handsome volumes Prof. Achard hasadopted a new classification for the discussion ofdietetics and all those diseases which chiefly affectnutrition. Physiology is his basis, and he considersin sequence all methods by which the body can ingestgases, water, mineral matter, carbohydrates, fatsand lipoids, and lastly nitrogenous substances." L’esprit gaulois," says one of Meredith’s characters," sparkles with the clear crystal of common sense,"and in choosing this classification Prof. Achard hasnot only been able to display his facts in logicalsequence, but has succeeded in approaching nearer

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to a scientific classification than have the vast majorityof his predecessors. In subsections, each in itsappropriate place, he discusses the disturbancesattendant on the faulty elimination of the metabolicend-products, and hence his work embraces nearlyall the problems of disease amenable to dietetictreatment. It is clear that to be perfect his systemrequires an exact knowledge of the chemistry of allsubstances physiologically absorbed by the body, andthat knowledge is not yet wholly ours. Thus thediseases known collectively as " deficiency diseases "are due to an absence of food constituents still largelymysterious, and in consequence the author hasincluded very few words concerning scurvy or beri-beri and has not attempted any discussion of lesstangible forms of avitaminosis. Similarly, thedisturbances of health, such as chronic constipation,which are often the result merely of an ill-balanceddiet, find no place in these. volumes, as no upsetof " nutritional exchange" can be noted in their4case.

In a modest preface the author points out theimpossibility of including the latest advances in abook of this size, but it is so fully documented with-references to the work of foreign observers that wefeel that such an apology was superfluous. His bookwill be highly appreciated by physicians in every,country, and is worthy of the high traditions of FrenchTnedicine.

THE DIABETIC LIFE : ITS CONTROL BY DIET ANDINSULIN.

By R. D. LAWRENCE, M.A., M.D., ChemicalPathologist and Lecturer in Chemical Pathology,King’s College Hospital. London: J. and A.Churchill. 1926. Pp. 167. 7s.6d.

WITHIN a year of the publication of this usefulmanual a second edition has been called for. Dr.Lawrence points out that while no revolutionarydiscoveries have been made since the book waswritten, yet many new facts of practical importancehave been established and have been incorporated

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in this edition. The chief changes consist in a

rearrangement and further simplification of theline-ration scheme, and in the addition of some

detailed examples of diet and a table for emergencyuse in coma. We have already expressed admirationof the way in which Dr. Lawrence has reduced thismost complex and difficult subject to a level wheredoctor and patient can meet. There can be no betterpreparation for the tedious task of training a diabetichow to control his life than a study of this littlebook by his medical adviser, and no surer way ofacquiring the patient’s cooperation than the purchaseby him of another copy for his own use.

JOURNALS.

INDIAN JOURNAL OF MEDICAL RESEARCH. April,1926.-This journal contains some interesting papers.M. B. Soparkar, as the result of extensive experiments,concludes that Indian cattle as a whole are lesssusceptible to tuberculous infection than are Europeanvarieties.-J. W. Cornwall and W. A. Beer describesome peculiarities of B. typhosus in broth cultures.They also suggest a method of assessing the infectivityof rabies fixed virus, and, in a further paper, discussthe effect of injection of etherised normal brainsubstance in connexion with the treatment of thisdisease.-R. McCarrison gives an account of an eightmonths’ investigation into the effect of excessivelime consumption upon the thyroid gland, and hisconclusions on the connexion between lime andiodine ingestion have some bearing on the aetiologyof " colloid goitre."-From the Haffkine Institute,B. P. B. Naidu, R. H. Malone, and C. R. Avariwrite on the potency of Haffkine’s plague prophy-lactic. A. patfoni. a new species of anopheles found inShantung, is described.-J. A. Sinton publishes someinvestigations on subtertian crescents, and finds that

the number of crescent carriers after " quinine andalkali " treatment was less than after any other formof treatment tried.-H. E. Shortt, P. J. Barraud, andA. C. Craighead give methods for feeding and refeedingsandflies, and in another paper describe the life-history and morphology of Herpetomonas donovani inthe sandfly, P. argentipes.--As the outcome of a

commission appointed to investigate sandfly fever inthe Peshawar District, T. C. McCombie Young,A. E. Richmond, and G. R. Brendish publish theaccount of an extensive survey and give importantrecommendations aimed at the reduction of thesandfly.

BRITISH JOURNAL OF CHILDREN’S DISEASES.Vol. XXIII. April-June.-Dr. Bernard Myersfurnishes statistics concerning the height, weight, andother measurements of 1400 London school-childrenderived from his observations at the Children’s Clinic,Cosway-street, Marylebone-road. Tables are givenshowing the measurements of the head, chest,abdomen, intercristal diameter, height and weight forboth sexes ; comparisons of the height, head andchest measurements for both sexes at various ages ;and comparisons of these measurements with Green-wood’s figures for other English children and Baldwin’sstatistics for American children. Myers remarks thatinvaluable information would be obtained if similarmeasurements of males and females could be made inall parts of the British Empire.-In a paper onvaricella encephalitis and vaccinia encephalitis Dr.D. W. Winnicott and Dr. N. Gibbs have collected12 cases of varicella encephalitis including one undertheir own observation. The patient was a girlaged 2 years, who nine days after the onset ofvaricella developed symptoms of encephalitis, such asdifficulty in swallowing and articulation, squint,spasticity of the limbs, and mental dullness, whichlasted for about a month, after which completerecovery took place. The fact that the number ofdays between the onset of varicella and the onset ofnervous symptoms has been fairly constant in allthe cases, but one is a record suggesting that thereis more than a mere coincidence at work. Winnicottand Gibbs have also collected 44 cases of vacciniaencephalitis ; 35 of these were reported by Bastianseein Holland, and of the others one was a case of theirown of a male child aged 5 months, who six daysafter vaccination developed right facial paralysis,left ptosis, left internal strabismus, and convul-sions. Complete recovery took place within sixweeks.-In a paper entitled Further Observationson Acrodynia, Dr. A. E. Vipond summarises thecardinal signs of the disease as follows : the onsetappears to be a nasal catarrh, followed by a rash,which is often erythematous but may be papular orpustular. The hands and feet present a bluish-redappearance, as well as the tip of the nose, ears, andeyelids. The locomotor system is affected, the childbeing unable to walk. The sensory system is alsoinvolved, there being intense pain in the arms andlegs. All the superficial glands are enlarged, especiallythose in the axilla and inguinal region. Rapid lossof weight occurs. The duration of the disease isfrom four to six months. Vipond has obtained goodresults from the use of a vaccine prepared from anenlarged gland.-Dr. C. I. Wright reports an unusualcase of herpes recurrens. The patient was a girlaged 12, suffering from a moderate attack ofdiphtheria with an abundant eruption of herpesfacialis on both cheeks, remarkable for the presenceof several rounded tense unilocular bullse, the largestof which was half an inch in diameter. For the lastthree years the child had had recurrent attacks ofherpes on one or other cheek about three times a year,but in no previous attack had the lesions beenbilateral. The mother, who was subject to labialherpes, stated that at the age of 4 years the childhad had an attack of eczema which may really havebeen herpes.-The abstracts from current literatureare devoted to acute infectious diseases.