1701

A fibrous strand represented the cartilaginous meatus, themiddle ear was filled with embryonic gelatinous tissue, theEustachian tube was a cleft, the malleus was absent, but theauditory nerve was normal.-A fitted dressing bag was pre-sented, on behalf of the society, by Dr. B. G. Morison tothe President for his valuable services while secretary to thesociety.

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Reviews and Notices of Books.The Diseases of Children.Edited by Dr. M. PFAUNDLER and Dr. A. ScHLOSSMANN.English Translation edited by HENRY L. R. SHAW, M.D.,and LINNAEUS LA FÉTRA, M.D. In Five Volumes. Vol. II.

(second edition). London and Philadelphia: J. B. Lip-pincott Co. 1913. Pp. 652. Price E5 5s. for five vols.

THE table of contents of the second volume ofthe above text-book includes 19 separate chapterson the various infective disorders to which childrenare subject. It also includes four chapters onmetabolic diseases, two on blood diseases, one onthe diseases of the new-born, one on prematurityand congenital debility, and several miscellaneouschapters difficult to classify. It will be readilyunderstood from a perusal of this list of subjectsthat the volume under review not only containsmatter of the greatest importance, but also dealswith branches of medicine in which great progresshas been made since the publication of the previousedition (1908).Among the subjects dealt with in the chapter on

the diseases of the new-born, which is from thepen of Dr. W. Knopfelmacher, of Vienna, and istranslated by Dr. A. S. Maschke, of Cleveland, thereis an interesting account of the post-natal activityof the mammary gland and the causes of mastitis.Reasons are given for subscribing to the view thatmilk secretion in both mother and child is due tothe same cause, although proof is still wantingthat the cause of the secretion is the cessation ofthe action of some ferment or chalone elaborated

by the placenta. The prophylaxis against mastitisis summed up in the words "protection againsttrauma "; damage to the superficial epitheliumaffords a passage to micro-organisms, which wanderinto the glandular tissues, and these set up an

inflammatory reaction. "For this reason expressingthe contents of the gland is interdicted, and thesecreting gland should be protected from pressureby the application of sterile cotton buffers." In this

chapter also are described the other common pathsof septic infection in new-born infants, togetherwith the most practical means of prevention,especially in hospitals and institutions where anumber of infants may be segregated.The chapter on prematurity and congenital

debility is written by Dr. 0. Rommel, of Munich,also translated by Dr. Maschke. Full details aregiven of the physiology and pathology of the

premature infant, and a considerable number of

pages are occupied by a very full description ofvarious incubators, including one designed by theauthor himself. The disadvantages of incubators,especially those in which the head of the infantis imprisoned, are so great that we imagine thesomewhat elaborate and complicated apparatushere described will have little interest for Englishreaders. In this chapter Dr. Rommel emphasisesthe objections, frequently insisted upon in otherchapters of the volume, to the practice of artificiallycleaning the infant’s mouth owing to the extreme

vulnerability of the oral epithelium. Among thecauses of prematurity and debility in infants pre-natal toxaemias in the mother are only incidentallymentioned. Owing to the importance which theseconditions have recently assumed in the category ofpredisposing causes it is regrettable that the trans-lator did not take upon himself the responsibilityof adding a footnote or interpolated paragraphcalling attention to the work which has beenrecently published on the subject.In the chapter on blood diseases, by Dr. A. Japha,

of Berlin, translated by Dr. Edward F. Wood, of

Wilmington, N.C., a very excellent table is suppliedof the blood count, clinical picture, and anatomicalfindings in 15 different varieties of anaemia metwith in childhood. The differential diagnosisbetween acute lymphatic leukaemia, chroniclymphatic leukaemia, the pseudo-leukaamias, Banti’sdisease, and a number of other anaemias due tosplenic and marrow disturbances is admittedlydifficult ; and although the classification adopted byDr. Japha is not that which is most favoured in thiscountry, there can be no doubt that this painstakingtabular arrangement of the haematological andclinical distinctions will help many a student toarrive at a correct diagnosis.The chapter on infantile scurvy, written by Pro-

fessor W. von Starck, and translated by Dr. CharlesK. Winne, of Albany, N.Y., is, in view of the recentdiscovery of the vitamines, somewhat anachronistic,and further, in view of the considerable number ofcases which have been reported, especially inAmerican literature, of occurrences of the disease

among breast-fed infants, it is somewhat surprisingthat the translator or editor does not call attentionto the statement of the author that " the few casesof this kind reported in the literature are not freefrom criticism."A very interesting chapter is contributed by

Professor Pfaundler, of Munich, on the lymphaticconstitution, in which he recognises the difficultiesof the nomenclature of the complex of symptomswhich usually pass under this name, but which issometimes held to be identical with, and at othertimes distinct from, the arthritism of the Frenchpaediatrists, and the exudative diathesis of Czerny.He says: "The descriptions of different authors donot make it clear if the three names (quoted above)are really synonyms for the same disturbance, or ifwe have to assume different anomalies of this kindwhich have only some common symptoms."The chapters on the exanthemata are all from

well-known German authorities, and may be

regarded as authoritative and up-to-date accountsof these diseases. The chapter on malaria, whichis included among the specific infections, is anaddendum to the English translation. The inclusionof this disease in a text-book for English-speakingreaders was regarded as essential for completeness ;it has been contributed by Dr. Henry L. K. Shaw,of Albany, one of the editors of the translationunder review. Although quite a short chapter, it

brings out very clearly the characteristic featuresof the malarial infection as manifested in the:hild. The two chapters on syphilis and tuber-culosis, the first under the name of Professor C.

EIochsinger, of Vienna, and the second under that ofProfessor A. Schlossmann, of Dusseldorf, are thenost important in the volume. They are profuselyllustrated with both coloured and uncolouredelates, and they also contain a vast amount ofstatistical details which should prove of greatralue to the lecturer and investigator, but which

1702

are. clearly, outside the requirements of thepractitioner. 1Taken as a whole the second volume of this t

important text-book is, in spite of our rapidly I

growing knowledge of the subjects of which it 1treats, still the most complete and up-to-date work ravailable to the ordinary reader in a compact form. t

T&ercM-M Diagnosis and Treatment. By Dr. BANDELIER and Dr. RoEPKE. Second English tedition. Translated from the seventh revised and enlarged tGerman edition by WILFRED B. CHRISTOPHERSON. t

London: John Bale, Sons, and D,anielsson, Limited. (

1913. Pp. 307. Price 15s. ]

THE present (second) English edition of " Tuber-culin in Diagnosis and Treatment" is a translation 1from the seventh German edition of the " Lehrbuch

1der Spezifischen Diagnostik und Therapie der Tuber-culose." Apart from the addition of side-headings,the omission of a few notes unimportant to Englishreaders, and the conversion of doses from cubiccentimetres to cubic millimetres in accordance withother recent English text-books, the work has beentranslated literally.The new edition has been thorougly revised and

brought up to date, and the subject-matter has beenrearranged. This has necessitated an enlargementof the book, and in order to restrict this to definitelimits and not to hamper the clear description ofspecific diagnosis and treatment all matter relatingto theory, which was previously scattered throughthe various chapters, has now been collected into aspecial section, completed and condensed. It followsthe introduction, which describes the present con-dition of tuberculosis and the tuberculin question.The specific diagnosis of tuberculosis is again

divided into general and special sections. Theformer has been enlarged to include a more detaileddescription and a coloured illustration of the intra-cutaneous test, and to the latter has been added achapter on the specific diagnosis of tuberculosis ofthe digestive organs and some new charts to showtuberculin reactions. In discussing the specificdiagnosis of tuberculosis by means of the sub-cutaneous test, minute information is given as

regards the technique, and if the directions are

carefully followed no difficulty should be experi-enced in carrying out the process. We would drawspecial attention, however, to the remarks on theinterpretation of result. It is definitely statedthat reaction to one of the doses of tuberculinmentioned does not point with absolute certaintyto active tuberculosis requiring treatment. Thisstatement is in accord with the great majorityof observers who have studied the questionwith entirely unprejudiced judgment. Further,the authors say: " The subcutaneous tuberculinreaction, as such, tells us nothing certain as

to the activity or inactivity of the process.It only tells us whether the person tested is infectedwith tuberculosis, which may be latent and activeor latent and inactive. Whether the former or thelatter is the case must be decided by clinical obser-vation and by consideration of the history of thepatient." It is important that these words shouldbe borne in mind, otherwise a wrong interpretationof the tuberculin reaction is likely to arise.The section on the specific treatment of tuber-

culosis is admirably carried out. The differentvarieties of tuberculin which have been introducedare described at length, the methods of dilution, thesequence of doses, and the results which may beexpected being duly considered.

In the concluding section of the book an excel-snt summary is given of the results which haveeen obtained, both as regards diagnosis and treat-ment. Emphasis is laid on the necessity of com-bining tuberculin treatment with general measures.’he authors maintain that the combination of thewo modern factors-sanatorium and tuberculinreatment-is the most efficacious method of treat-ment for active pulmonary tuberculosis at presentavailable, especially when the disease has passedhe initial stage. We should go further and sayhat a combination of measures is essential through-out all the stages of the disease, for it is only bynaking use of all the therapeutic methods athe disposal of practitioners that success can beobtained. But in order to be able to give tuberculino the best advantage the greatest care and precau-ion are necessary, and before any practitionerattempts to adopt its use he should obtain practicalnstruction, preferably in the wards of a hospitalvhere the patients can be constantly watched.For general practical information on the employ-

nent of tuberculin we can cordially recommend thework we have been considering. Dr. Christophersonlas carried out the task of translation mostsatisfactorily.

FIandbook of Physiology.By W. D. HALLIBURTOJ1, M.D. Lond., F.R.C.P. Lond.,LL.D., F.R.S., Professor of Physiology, King’s College,London. Eleventh edition. With nearly 600 illustrationsin the text, many of which are coloured, and 3 colouredplates. London : John Murray. 1913. Pp. 923. Price15s. net.

A TEXT-BOOK which has reached its eleventhedition should hardly need any words save those ofapproval and commendation. We cordially con-

gratulate the author on the changes, excisions, andadditions he has seen fit to make in the presentedition. We think he has done wisely to call to hisaid the specific knowledge of Mr. Barcroft, F.R.S., onsaliva, respiration, and the kidney. The chapterson these subjects have been greatly improvedand brought abreast of all modern research.To Dr. A. F. Hertz, also, the author expresseshis indebtedness for useful hints, whereby hehas been enabled to bring the chapter on move-ments of the stomach and intestines up to date.A similar debt in relation to the sense organs is

acknowledged to Dr. C. S. Myers, and in regard tothe subject of reproduction to Dr. F. H. A. Marshall.The bulk of the volume has not been increased.We venture to offer a few suggestions for considera-

tion in further issues which may follow. It wouldsurely be well to introduce a few dates of epoch-marking discoveries in physiology. The youngreader hardly knows at what period Haller,Wharton Jones, Ludwig, Marey, and others lived,though the period of Erasistratus is given. Someresults obtained by means of the string galvano-meter are given, but there is no figure of theessential parts of the instrument itself, nor couldwe find a figure of the ergograph. In some of thecoloured illustrations, such as nerve cells, the bluesused in printing hardly strike us as well chosen,and at p. 215 the conventional colours used in adiagram of the circulation for venous and arterialblood have been widely departed from-perhapsintentionally. The colours chosen for red corpuscles(p. 455) and those for crystals of haemoglobin (pp. 462-463) do not strike us as correct. Funke’s atlas

I gives a far truer representation of the colour

of blood crystals. Diagrams of the position of the

1703

stomach derived from a study of X ray radiogramsare inserted, but there is no reproduction of anactual radiogram. And there is one notableomission that calls for rectification. We havelooked in vain for an adequate description of suchimportant acts as walking, running, and otherforms of progression. A few lines only are givenon p. 107, under the title " Lever Systems." Thesesubjects are not mentioned in the index. Havingregard to the variations and anomalies of progres-sion in various diseases, it would seem advisable-indeed, necessary-that the medical student atleast should be familiar with the normal physiologyof these movements.This handbook gives an all-round, very readable

account of the main features of histology and phy-siology, such as should be acquired by all medicalstudents as a basis for the further study of thesubject on which all practical and scientificmedicine must be based.

Stammering and Cograte Defects of Speech.By C. S. BLUEMEL. Two volumes. New York : G. E.Stechert and Co. 1913. Pp. 755. Price 20s. net.

THESE volumes are well worth careful study.The received traditions of the etiology of stammer-ing are admittedly not satisfactory. To state thatthis failing is due to spasm or to incoordination ofmuscles is only to bring up the question whatcauses the spasm or incoordination. The solutionof this question is the task the author has set him-self in his first volume. His thesis is that thestammerer’s difficulty is not one of phonation butthe result of transient auditory amnesia, whichproduces the secondary conditions of mental con-fusion and fear, these secondary conditions beingintensified in some cases by auto-suggestion. It istrue that the prime cause of the auditory amnesiamay be slight and limited to early life; it may evenlessen and disappear, while the secondary effectsremain as acquired habits.. Such cases are readilyamenable to elocutionary methods of treatment.The first volume is devoted to a full analysis of

the psychology of stammering as explained fromthis point of view. The author reviews the

physiology of verbal images and passes on to a con-sideration of the pathology of brain-centres pro-ducing failure or defect in speech, visual amnesia.aphasia, agraphia; in fact, the whole range betweenmental imagery and voluntary speech. Thereis nothing new in these chapters, but thematerial is culled from sound authorities, andwritten in well-balanced, simple English. The

chapter which carries least conviction is that onfear. A good deal of material is introduced whichhas no proper place,- especially the description ofGraves’s disease taken from Mr. Havelock Ellis andDr. Hector Mackenzie, which has no real connexionwith fear at all, except in so far as fear may causeacute distension of the thyroid, as noted by Dr.Leonard Guthrie. There is no doubt, however, thatfear does form a secondary factor in stammering,and increases the incoordination, whether that bepsychological or physiological.The second volume gives a review and criticism

of the various methods of training employed in thecure of stammering. These consist in variations ojspecial vocalisation and voice production. A largenumber of these methods consist essentially in

rhythmic practice of enunciation, the syllables beingspaced by a mechanical device, such as a metro.nome. The author’s sketch of the methods he haEselected is valuable, although his opinion of theirworth is not high. But in spite of his belief in th{

psychological origin of the disability, his estimateof its treatment by psychological methods is wobetter than that by purely phonetic methods. Onthe whole the treatment of stammering by

>

hypnotism has been a failure; and the result ofan attempt to apply the psychoanalytic processof Freud to stammering has been in most casesnegative.The volume ends with a

"

glossary" which isnothing short of ridiculous : it consists of 345 pagescontaining a list of words, some of which are

scientific, but many are the most ordinary terms.Who would start to read a book of this pretensionwho did not know what a "cent" means, or themeaning of "chorea," the " clavicle," or a " circularletter," to select one page at random? It would bepreferable to use the word

"

indisputable " ratherthan

"

apodictic," leaving the unfortunate reader tolook it up in the glossary. Further, it is quitedoubtful if "apodictic" does mean indisputable,though Kant appears to have employed it in thissense. Aristotle and Philo, who both used theword, appear to have meant "capable of demonstra-tion " or " explicable from evidence regularly setforth."

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.

A Guide to the llental Deficiency Act, 1913.By JOHN WORMALD, Solicitor, and SAMUEL WORMALD.With a Preface by T. EDMUND HARVEY, M.P. London:,P. S. King and Son. 1913. Pp. 155. Price 5s. net.

THIS book contains a legal and general exposi-tion of the Mental Deficiency Act, 1913, togetherwith suggestions on organisation for local autho-rities and others, by the authors, the senior ofwhom was for many years chairman of industrialschools and special schools, and the boarding-outand care committees for the mentally defective inLeeds. It should prove useful as an explana-tory volume for those desiring to obtain a

general idea of the objects of the Mental DeficiencyAct, and of the means which it provides for carry-ing them out. These will be found set out in

clearly written articles by the authors precedingthe full text of the measure. It is, however, to beregretted that the convenient method usual in legaltext-books of also annotating the various sectionsand appending to them the results of the authors’study in the form of explanatory notes should nothave been followed, even though in the case of a.new law these have to be more or less tentative incharacter. The index would then naturally havereferred the reader directly to the sectionscontaining that which he might desire to in-

vestigate. As it is, he will find himself onlyguided by the index to statements or expressionsof the authors’ opinion in their prefatory article.It would be more useful, for example, to a

justice of the peace or a medical practitionerseeking to ascertain his powers in particularcircumstances to be put in touch with them atonce, than for the former to find that " justice ofthe peace " is not a title in the index at all, or fora medical man to find no reference to the duties

imposed on his profession by the Act, but only to arecommendation of the authors as to the formingby a local authority of a panel of medical practi-tioners specially qualified to deal with mentaldiseases.

LIBRARY TABLE.The Illustrated Medical Dictionary. By W. A.

NEWMAN DORLAND, A.M., M.D. Seventh edition,.revised and enlarged. 1913. Pp. 1107. Price19s. net.-The Pocket Medical Dictionary. Edited