1149

ribs removed over a considerable area in order to give thegreatly hypertrophied heart more room. Since the operationthe patient had lost his cardiac pain and considered that hehad been greatly improved.WEST LONDON MEDICO-CHIRURGICAL SOCIETY,-

The opening meeting of the session was held on Oct. 2nd,when Colonel T. H. Hendley, the President, delivered anaddress on the Identity of Problems, Aims, and Interests ofthe Medical Man at Home and Abroad, with Special Referenceto India. As an old officer of the Indian Medical Service inboth its military and civil branches he drew attention to thevalue of some knowledge of tropical disease by the civilmembers of the profession at home and gave illustrations toshow how by such knowledge as well as by cooperation withthose engaged in similar work abroad they might do much toprevent the introduction and spread of dire diseases in thehome country. He referred to the use each section of the

profession might be to the other and gratefully acknowledgedwhat had been done in the past by the civil branch in supportof the services, especially in all matters for the improvementof the health of sailors and soldiers. Referring to thecolossal task of dealing with epidemic disease in Indiahe noted with pleasure the promise of the Indian Governmentto give further facilities for the study of tropical disease byestablishing a fully equipped bacteriological laboratory inthe neighbourhood of Simla, but he could not help feelingthat one great obstacle to progress in this direction was theconstant changes of stations of medical officers, which, in hisopinion, also gave rise to a good deal of the Indian "unrest," because mutual confidence and the power of doing good weredestroyed under such conditions. He held that the time was

approaching when the medical man would be more valuedfor his work in regard to the prevention of disease than forhis skill in treatment thereof, and laid much stress on theneed of general education in such questions for all medicalstudents, so that in future the general practitioner might takea larger share in the duties connected with preventive medi-cine-e.g., medical inspection of school children and thelike. He spoke with much misgiving as to the result of theseparation in India of the sanitary from the general medicaldepartment, because he believed that cooperation and un-divided control in dealing with disease in that country wereessential to success.

BRIGHTON AND SUSSEX MEDICO-CHIRURGICALSOCIETY.-A meeting of this society was held on Oct. lst,Mr. R. F. Jowers, the President, being in the chair.-Dr.A. W. Williams showed a girl with Tuberculous Onychia.Three finger nails had been practically destroyed and pus wasoozing from their beds, but great improvement had takenplace from tuberculin injections controlled by the opsonic

, index.-Mr. W. D. Calvert showed an Oxygen Gas Bag usedon the continent for measuring the quantity of gas given.-Mr. Joweis then read his Presidential Address on Cancer ofthe Intestines. He thought a time would soon come whensome substance would be found which inoculated would

help the tissues to destroy cancer, but at present earlyremoval was the only treatment. Cancer of theintestine was slow in disseminating itself and there-fore the prognosis was good after removal, but sym-

. ptoms were often almost absent until acute intestinalobstruction set in. The earlier symptoms were those ofdyspepsia, and later constipation or constipation alternatingwith diarrhoea. Loss of flesh was not an early symptom,and patients with obstruction from growth were oftenextremely fat. Peristalsis of the intestine might be seen andgurgling at a particular point might be felt, or rarely a

tumour which might be mobile and be difficult to diagnosefrom floating kidney. Bland-Sutton stated that 75 per cent.of growths occurred in the rectum, 23 per cent. in the largeintestine, and 2 per cent. in the small intestine. In doubtfulcases the abdomen should be examined under an anaestheticand the rectum by the sigmoidoscope. Bismuth given 48 Ihours before an x-ray examination might show the site ofstricture. Tuberculous disease of the colon and peri-sigmoiditis gave rise to difficulty in diagnosis. He thendescribed five cases in which he had operated successfully.He thought that when there was acute obstruction only acolotomy should be done, leaving resection or short-circuitingtill the patient was in better condition. He preferred afterresection to use two rows of sutures without bobbins or otherdevices.

Reviews and Notices of Books.The Pathology of the Eye. By J. HERBERT PARSONS, B.S.,

D.Sc. Lond., F.R.C.S.Eng., Assistant Ophthalmic Sur-

geon, University College Hospital ; Assistant Surgeon,Royal London (Moor fields) Ophthalmic Hospital; and

Ophthalmic Surgeon, Hospital for Sick Children, GreatOrmond-street. Vol. IV., General Pathology. Part II.London: Henry Frowde and Hodder and Stoughton. 1908.-Pp. 290. Price 15s.

, THE present volume completes Mr. Parsons’s treatise onthe pathology of the eye and forms the second part of thegeneral pathology of that organ. Like its three predecessorsit is beautifully illustrated and printed, whilst each sub-section has an appendix which supplies a full bibliography ofthe special subject under discussion, showing wide range ofreading combined with, so far as we have been able to testit, accuracy in the numerous references given. The subjectshere treated of are injuries of the eye, exophthalmos andenophthalmos, panophthalmitis, orbital cellulitis and throm-bosis, thrombosis of the cavernous sinus, sympatheticophthalmia, and the symptomatic diseases of the eye whichcover a large field, embracing amongst many others thediseases of the eye associated with affections of the

respiratory, circulatory, digestive, renal, and generativesystems, and infectious diseases. Lastly, a section is devotedto heredity in relation to the eye, a subject that has only oflate years attracted attention. Our knowledge of the con-ditions by which heredity is established and propagated fromone generation to another will receive, we trust, elucidationfrom the extensive series of observations now being made onalbinoism by Mr. E. Nettleship and Professor Karl Pearson.We turn to the chapter on sympathetic ophthalmia with

much interest, for in many cases great responsibility is

thrown upon the practitioner, especially in country districtswhere the advice of an expert cannot be obtained easily.The earliest reference to sympathetic ophthalmia is stated byMr. Parsons to be found in the oldest German text-book on

ophthalmology published by Bartisch in 1583, and subsequentnotices of the disease are to be found in the works of Le Dran,Demours, Wardrop, and Lawrence, but its true history com-menced with Mackenzie. His researches, which have beencorroborated by many subsequent observers, showed that

sympathetic ophthalmia is particularly liable to occur in thecourse of a few weeks after a punctured wound in the ciliaryregion. Such injuries are especially likely to occur inchildren engaged in untying knots with two-pronged forks orknives or scissors. Plastic irido-cyclitis in the injured orexciting eye usually precedes the outbreak of the ’attack.The pathogenesis of the disease, notwithstanding the vast’

amount of research that has been devoted to it, is still obscure.The theories of its mode of transmission from one eye to theother are classified by Schirmer under the following heads :pure nerve theories, which include the optic nerve theoryand the ciliary nerve theory ; pure bacterial theories, someholding that transmission takes place by metastasis, othersthat it results from reversed venous flow, and others, again,that transmission is effected through the lymph channels.Then Meyer and Schmidt-Rimpler hold that both the nervesand bacteria play a part in the process and, lastly, there isthe theory of toxins developed by the bacteria implicated. Mr.Parsons regards as the most probable of these various theoriesthat one which has been indicated as the bacterial metastatic

theory. According to this, the organism multiplies in theexciting eye ; if this be early removed infection does notoccur, but if organisms have escaped in quantity into thecirculation sympathetic ophthalmia may follow. The cases

where many months or years have elapsed before the

1150

secondary inflammation may be explained as being due tothe bacteria, after having been encapsuled, having been setfree by some blow or injury.Mr. Parsons has a very. excellently written section on

obstruction (embolism and thrombosis) of the central arteryof the retina in which all the cases that have been recordedare passed in review and critically examined. He seems to

doubt the existence of spasm of the arteries, but we

know :not howotherwise to explain such cases as those ofthe late Mr. Birkett who, when nearly 90 yearsof age, lost the vision of one eye for about a quarterof ’an hour on three or four occasions, recovering it com-

pletely without any apparent change in the diameter of theartery when examined ophthalmoscopically shortly after

recovery of vision. The loss of vision in one eye only, theabsence of faintness or of any general symptoms, the shortduration of the attack, and its termination in complete re-covery are all symptoms that seem to be suggestive of spasm.Much interest also attaches to arterio-venous aneurysm such

as may result from a punctured or from a gunshot wound,which does not appear to have come under the observation of

Mr. Parsons. In one case where the aneurysm burst into the

nostril and caused alarming haemorrhage a permanent curewas effected by ligature of the common carotid.The symptomatic diseases of the eye are discussed under

the heads of diseases of the respiratory tract; diseases of the’circulatory system, of the organs of digestion, of the urinaryand generative organs, and of the blood; infectious diseases ;.and diseases of the nervous system. Of these the most

interesting, as well perhaps as the most common, causes ofeye troubles are the diseases of the circulatory system, of thenervous system, and of the kidneys. Speaking of the

phenomena of pulsation in the intra-ocular vessels Mr.Parsons remarks that though we may be sure the

arterial pressure is far above the normal intra-ocular

pressure it would not be surprising if the pulse-wavewere transmitted to the central artery of the retina andcould be observed ophthalmoscopically, but, as a matter

of fact, this hardly ever occurs. He recognises two typesof arterial pulsation as visible under pathological conditions,a true pulse-wave accompanied by locomotion of the vessels,and an intermittent flow of blood or pressure pulse inwhich the arteries fill with blood only coincidently withthe heart beats, being empty between them; this formis only visible upon the disc. It is seen in the pulsation ofglaucoma and of syncope. The true arterial pulse occurs incases of aortic regurgitation or aneurysm and is not confinedto the disc. Capillary pulsation is seen only in aortic regurgi-tation. Venous pulsation occurs in three forms. The

normal negative venous pulse, which occurs in 70 or 80 percent. of persons, presents some difficulties which are thusmet by Mr. Parsons. It is diastolic-that is, the veins arenarrowed when the arteries are dilated, and it is thus

explained by Mr. Parsons. The intra-ocular effect of the

cardiac systole is constriction of the veins ; at the same

moment the blood is dammed back from the cavernous sinus.

It cannot flow back into the eye but the communication withthe facial and other veins tends to relieve the pressure.Soon after the diastole has commenced the pressure in the

orbital veins is still high and the blood is streaming throughthe intra-ocular capillaries and the veins dilate. The positivevenous pulse is presystolic-systolic and is due to tricuspidregurgitation, and lastly there is the transmitted centripetalvenous pulse.To write a sound and trustworthy treatise on the pathology

of a special organ such as the eye requires peculiar qualifica-tions in the author. He must, of course, possess a thoroughknowledge of its normal anatomy and physiology. He must

be familiar with the modern processes and methods of histo-

logical investigation, but above all he must have a wide field

for the prosecution of his researches. All these qualifica.tions meet in Mr. Parsons. The first volume he has publishedon I The Diseases of the Eye and his numerous contributionsto ophthalmic literature afford sufficient evidence that he iswell acquainted with the minute anatomy as well as withthe physiology of the eye, whilst his position as assistantsurgeon and curator of the museum at the Royal LondonOphthalmic Hospital has given him the opportunity of seeingclinically and subsequently making a microscopic examina.tion of an immense number and almost infinite variety of thediseases affecting the eye. That he has thoroughly utilisedhis unrivalled opportunities conclusive evidence is afforded

by his now completed treatise which embodies the results ofhis long labours. Whatever improvements may be effectedin microscopic technique and in our knowledge of pathologythis treatise will always constitute a book of reference

adequately representing the state of our knowledge in theserespects at the commencement of the twentieth century.

In conclusion we desire to congratulate Mr. Parsons onthe completion of his extremely valuable work which notonly stands alone in the English language but has no com-petitor in either French or German, and presents an extra-ordinary amount of original research as well as rare industryin the collection of cases and the accuracy with which theyare quoted.

Common Affections of the Liver. By W. HALE WHITE,M.D.Lond., F.R.C.P.Lond., Senior Physician to, andLecturer on Medicine at, Guy’s Hospital. London:James Nisbet and Co., Limited. 1908. Pp. 302.Price 4s. 6d.

-

IN his modest preface to this work Dr. Hale Whiteconsiders it necessary to apologise for and explain theappearance of this little book." After a perusal of the

volume we can assure the author that there is no occasion todo either. There was once a play which contained a

"leading West-end physician" as one of its characters.

That worthy exhorted his hearers not to malign the liver; atone time, he said, it was thought to serve some process inthe animal economy, but, he added, that was nonsense, "itwas designed by a munificei-it Providence for the sole benefit

of the medical profession." Undoubtedly, by the laity, theliver is often made the scapegoat for irregularities on thepart of the stomach, and it is naturally of importance thatstudents and practitioners should have a full comprehensionof the various morbid processes affecting the former organ.In the work now before us the more common affections of the

liver are considered fully, the rarer conditions are onlymentioned briefly, and the excessively unusual are omittedaltogether.

After a brief description of the anatomy of the liver, Dr.White proceeds to a consideration of the condition knownas hepatoptosis or wandering liver. He points out that mostpatients afflicted with a wandering liver have very weakabdominal muscles ; hence they suffer much from faintness,dyspnoea, palpitation, and exhaustion on exertion, but thesesymptoms pass away when the patient lies down. Manymistakes in diagnosis are probably made, usually becausethe possibility of hepatoptosis has been forgotten.Many persons when they over-eat and take insufficient

exercise feel out of health. They complain of lassitude,slight headache, loss of appetite, and irregularity or con-stipation of the bowels ; their urine is scanty, high-coloured,and often contains obvious lithates. There may be a feelingof fulness at the upper part of the abdomen. These

symptoms are sometimes ascribed to "congestion of theliver." We agree with Dr. White when he says that thereis no post-mortem or direct evidence that the liver is con-gested when such symptoms are present. Attention to diet

and the state of the bowels usually effects a cure. As the

1151

author points out, there are only two varieties of congestionof the liver generally recognised-that which follows back-ward pressure from disease of the heart or lungs and thatwhich is met with in the tropics and is usually called

tropical liver. He gives a good account of both of theseconditions.

Dr. White’s remarks on abscess of the liver and subphrenicabscess are well worthy of careful study. The causes of the

latter affection are carefully discussed. He estimates that

in this country about a quarter of the cases are due to

perforation of a gastric ulcer, one-fifth to hepatic abscess,between a sixth and a fifth to appendicitis, and duodenalulcer is the cause in almost 7 per cent. of the cases. The

other causes, though numerous, are each very rare. The

exact site of the abscess varies according to the cause, andthe observations on this point will be found interesting andinstructive. Leucocytosis is considered to be a valuable

diagnostic sign.The section on cirrhosis of the liver is one of the best in

the book. In regard to the alleged difference between

"hypertrophic" and "atrophic" " cirrhosis, Dr. White holdsthe view now adopted by the majority of observers-namely,that the cirrhotic liver is at first larger than normal, andthen, among those patients who survive, shrinks so as to

become of normal weight, and then, continuing to shrink,becomes of less weight than normal in those who still survive.The etiology of cirrhosis of the liver is fully discussed andthe conclusion is arrived at that alcohol is not solely - re-sponsible for the condition but that there are other factors ofwhich little is known.We can cordially recommend this volume to our readers.

It contains a large amount of useful and practical informa-tion on affections which are commonly met with but whichare not sufficiently dealt with in the ordinary text-books onmedicine. The remarks on treatment should be especiallynoted and the differential diagnosis of the various diseasesand those which simulate them is carefully considered.

Husband’s Practice of Medicine. Sixth edition. Rewrittenand Enlarged by ROBERT F. C. LEITH, M.A., M.B.,C.M. Edin., F.R.C.P.Edin., M.Sc.Birm., Professor of

Pathology and Bacteriology, University of Birmingham ;and ROBERT A. FLEMING, M.A., M.D. Edin., F.R.C.P.Edin., Lecturer on the Principles and Practice of Medicine,School of Medicine of the Royal Colleges, Edinburgh ;Assistant Physician, Royal Infirmary, Edinburgh. Edin-

burgh : E. and S. Livingstone. 1908. Pp. 1141. Price 12s.THIS work is designed for the use of students and

practitioners, and the authors have attempted to provide aconcise, trustworthy, and modern text-book sufficient for allpractical purposes. In the present edition the aim and scopeof the previous editions have been preserved, but in order tobring the book up to date a re-writing rather than revisionwas found to be necessary.We are not in favour of small text-books on medicine-

that is to say, books that are written with the idea of pro-viding students with sufficient knowledge to pass theirexaminations and nothing more. Although this manualcannot be said to come under such a beading, we do notthink that it can compete with the works usually used bystudents, at any rate in London. The sections on etiology,pathology, and symptomatology are for the most partaccurate, explicit, and brought up to modern scientificknowledge. The remarks on treatment, however, might withadvantage be amplified. For instance, the description givenof the more recent therapeutics of pulmonary tuberculosis islacking in detail and could not be satisfactorily followed inpractice.The classification of disease is not altogether in accord-

ance with the nomenclature adopted by the Royal College

of Physicians of London. Pneumonia finds a place under" Inflammations of the Lung," and rheumatic fever is con-sidered in the section devoted to "General Diseases of

Obscure Origin." We think that it would have been better ifthe authors had followed th.e plan now generally adopted ofplacing these two conditions under the heading of "InfectiveDiseases." For purposes of refreshing the memory this book may be

useful to students and practitioners. It is written in a stylewhich is easy to follow, and owing to a carefully compiledindex reference to any particular point can readily be made.

LIBRARY TABLE.Nouveau Traite de Médecine et de Therapeutique. Tome

XIII. : Cancer. Par P. MENETRIER, Professeur Agrege àla Faculté de Medecine de Paris; M6decin de 1’HopitalTenon. Avec 114 figures intercalees dans le texte. Paris:J. B. Baillière et Fils. 1908. Pp. 662. Price 12 francs.-This is one of the most interesting volumes of the valuabletreatise on medicine and surgery which is now beingpublished in Paris. Professor Menetrier has written this bookwith thoroughness and he has been careful to maintain a

judicial attitude on debateable points and in few otherdiseases do so many debateable points exist as in cancer. A

historical account commences the work and it appears to

contain all that is necessary, and this is followed by adescription of the cancerous processes and of the varieties ofcancer. The section on etiology is naturally of especialinterest and the whole subject is fully discussed. The main

conclusion at which the author arrives is that cancer is

associated with chronic irritation. In regard to the questionof the parasitic origin of cancer he maintains that all theappearances hitherto described as representing parasites aredue to internal cell changes or cellular inclusions, though hedoes not deny the possibility of the presence of a micro-

organism. The chapter on treatment is general and does notconsider individual organs, but in it are described most ofthe methods which have been employed for the cure or therelief of cancer. A large portion of the chapter deals withthe use of the x rays. The book contains a very good, thoughnot quite complete, account of our present knowledge ofmalignant disease. Like many other French books it has,unfortunately, no index.

The Praotwe of Obstetries. By American Authors. Edited

by CHARLES JEWETT, M.D., Professor of Obstetrics andGynaecology in the Long Island Hospital, New York. Third

edition, revised and enlarged. With 484 engravings, 46 ofwhich are in colours, and 36 coloured plates. London :

Henry Kimpton. 1907. Pp. 820. Price 21s. net.-Somefive years have elapsed since the second edition of this workappeared and the progress of obstetric medicine during thattime has necessitated a good deal of revision in the book.Several’of the chapters have been almost entirely rewritten ;amongst them are those on the Changes in the Maternal

Organism caused by Pregnancy, the Duration of Pregnancy,the Hygiene and Management of Pregnancy, the Anomaliesand Diseases of the Foetal Appendages, and the Diseases ofPregnancy. The revision, on the whole, has been well done ;the chapter on the Development of the Ovum, however, is stillmainly concerned with the facts as they relate to animalsand the author has not taken sufficient trouble to indicate how

far his conclusions differ from those ascertained up to the

present time with regard to the early human ovum. Thereis an interesting chapter on the Toxæmia of Pregnancy,and in the section on the changes which occur in the urineDr. W. S. Stone points out that while high percentages ofammonia nitrogen are usually associated with serious clinicalstates they are not found to correspond closely enough to thedifferent grades of the disease to use any definite percentage,

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