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GENERAL DISCUSSION.

Dr. KjOLSTAD, who was representing the NorwegianGovernment, said that the subject was one whichwas of great interest in Norway.

Dr. W. W. HERBERT said that in time he hopedthe biologist would be able to distinguish the carrierfrom the sound person. He considered that personsdischarged from asylums should be warned that theyought not to propagate, should be taught contra-ceptive methods, and offered sterilisation. Anofficial inquiry was only a way of putting off tillto-morrow what we ought to do to-day. The financial

question had been stressed, but not the great humansuffering to children born doomed to suicide or

insanity. -

Dr. W. A. POTTS was in favour of sterilisationunder proper safeguards, but pointed out the dangerinvolved by the fact that it was being advocated bybackward local authorities who hoped it would savethem their obvious duty of ascertainment andcolony provision. A proper inquiry was needed. IEven if sterilisation was only applicable to one-half iper cent. of cases, it should be used for them, forevery great social improvement began from a small ! Ibeginning. :The children of a defective mother would never li

be an asset to the community. Incautious sterilisa-tion of psychotic patients might prevent the con-tinuance of a valuable stock, for mental instabilitywas often closely allied to brilliance.

i Councillor Miss PATERSON, J.P., agreed with Dr.Blacker, Dr. Tredgold, and Dr. Potts, but suggestedthat we were losing valuable stock at present as a

result of the limitation of families made necessaryby expensive social services such as that of mentaldeficiency. There was only one real fundamental humanright and that was the right of every child to be bornwith a healthy body and a sound mind. She did not

want a Royal Commission; she wanted things done,because children were being born with their birthrighttaken away. THE CONGRESS DINNER.

’ On Wednesday, Nov. 19th, Sir Frederick Willispresided over a dinner to members of the Congressand a large assembly of guests, when a very interestingspeech was delivered by Sir Herbert Samuel in

proposing the toast of the Public Health Services.Sir Herbert reviewed briefly and clearly the responsi-bilities of the medical officers in the services,demonstrating clearly the debt which is owed to themby the country. The toast was responded to by SirArthur Robinson (secretary to the Ministry of Health),Mr. F. H. C. Wiltshire (town clerk of Birmingham),and Mr. E. S. W. Hart (clerk to the Middlesex CountyCouncil). The health of the Chairman was proposedin witty terms by Mr. Alderman A. R. Atkey, J.P.,late Lord Mayor of Nottingham. The dinner, whichmight fairly be styled a banquet, was a great success,and a very large company enjoyed some excellentspeaking.

REVIEWS AND NOTICES OF BOOKS

Text-book of the Surgical Dyspepsias.Second edition. By A. J. WALTON, M.S., M.B.,B.Se. Lond., F.R.C.S. Eng., Surgeon to the LondonHospital. London : Edward Arnold and Co.1930. Pp. 720. 42s.

WE welcome a new edition of this book. Itsmerits always lay in the fact that the author’s viewsare based upon a large experience carefully analysed.In this respect its value is further enhanced, since thenumber of cases reviewed is greater, and, indeed,assumes considerable proportions. The reader cannotbut attach importance to opinions founded on sucha firm basis, and, moreover, the consideration givento the writings of other workers in this field of surgeryand medicine shows that the author’s reading iswide.The new edition is thoroughly up to date, and its

scope is extensive. Of cholecysto-gastrostomy, whichhas been recently revived for the treatment of chronicgastric ulcer, Mr. Walton has had unfavourable

experience; his verdict will doubtless lessen thecurrent enthusiasm for an operation which seems tohave little to recommend it. For very large andadherent ulcers gastro-jejunostomy with perhapsa later excision of the ulcer is recommended. Wecould find no discussion on the place that should beaccorded to jejunostomy in such cases. The book isfull of statements of paramount interest to the

surgeon, but where some of these are not supportedby statistics they are open to criticism. For

example, it is affirmed that invagination of theduodenum will stop haemorrhage whether it comes froman ulcer on the anterior or pancreatic wall of thisviscus. That it is usually essential to perform a

gastro-jejunostomy when operating upon a perforatedduodenal ulcer will not be accepted by everybody,

but we welcome the warning against too early removalof the drainage-tube. A very valuable contributionis that dealing with reconstruction of the commonbile-duct.

This book ranks high in surgical literature. Thesustained effort, extending over many years, necessaryto its compilation, the careful correlation of personal

observations with the experiences of others is an

achievement which has put every practising surgeonin debt to the author.I

A Manual of Diseases of the Nose and

i Throat.

I Seventh edition. By CORNELIUS G. COAKLET, A.M.,M.D., F.A.C.S., Professor of Laryngology andOtology in the College of Physicians and Surgeons,Columbia University. London : J. and A. Churchill.1930. Pp. 672. 18s.

THE purpose of this book is primarily to providea compact manual on the nose and throat for theneeds of students and practitioners. It begins with ashort, perhaps too short, chapter on the anatomyof the region, a still shorter one on physiology, anda longer and far more thorough description of methodsof examination. The diseases of the nose, naso-

pharynx, pharynx, and larynx are discussed as

thoroughly as the conciseness of the style allows.For the treatment of chronic empyema of

the maxillary antrum, Prof. Coakley recommendsintranasal opening under local anesthesia with removalof the anterior half of the inferior turbinal, and findsa more radical operation rarely necessary. In the" radical operation, for which he does not give theindications, he opens the antrum through the caninefossa, and completely removes the mucous membrane

1187

from every nuok and coiner, stating that any smallshred of mucous membrane left will invariably resultin failure to secure healing ; he makes no openinginto the nose, but packs the cavity with iodoformgauze, renewed every four or five days for a month,and obtains complete obliteration in about three tosix months ; he does not give reasons for advocatingthis method, which entails prolonged and disagreeableafter-treatment and has long been abandoned bymost rhinologists. In the treatment of quinsy headvises that the abscess should be opened by meansof a stiff bent probe inserted into the supratonsillar ’,fossa, and does not mention the more usual methodof opening through the area of bulging in the palate.The operation for removal of tonsils by dissectionis well and carefully described, with a clear accountof the author’s own well-known slip-knot ligature ;for the removal of adenoids he prefers the La Forceadenotome. In the chapter on the larynx, the well-defined and important condition of multiple papillo-mata in children receives no mention; thoughsinger’s nodules are said to occur nearer to the

posterior than to the anterior portion of the vocalcords, the illustration shows the prominences on thevocal processes.

In the section upon malignant disease, intrinsicgrowths are classified as primary, and those involvingthe epiglottis and aryepiglottic folds as secondary toextension from the tongue and pharynx, a classifica-tion by no means always in accordance with the facts.In a manual of this size the operations for the removalof malignant laryngeal growths are rightly not

described, but, in view of the great importance ofearly recognition by the practitioner, the symptomsand diagnosis of the early stage of the disease mightwell be more carefully discussed ; thus, it is misleadingto mention pain as a symptom unless it is emphasisedthat it only occurs late in the disease. Again, impair-ment of mobility of the cord is given in more thanone place as a diagnostic sign, whereas it is wellknown nowadays that this sign implies such deepextension of the growth as to render the prospectof successful removal by laryngofissure very uncertain.Attention to the technique of the operation has soimproved the results of laryngectomy in recent yearsthat the statement that " few patients survive theoperation " is no longer true.These details, however, little impair the value of

the book, which is deservedly popular.

Investigations, mainly on the PhysiologicalActions of X-radiations.

Conducted for the Cancer Research Committeeof the University of Sydney.

Grenz Ray Therapy.By GuSTAv BucKy, M.D. New York: TheMacmillan Company. 1930. Pp. 170. 15s.

THE collection of papers from the Cancer ResearchCommittee of the University of Sydney shows -thata healthy state of activity and inquiry is the out-come of the effort made five years ago at the Universityto stimulate interest in the actions of radiations uponliving matter. The papers of most general interestin this collection are those upon the differential actionof X rays. This work has been attempted fromseveral sides, Dr. Moppett’s observations being thestarting-point for investigations of a physical andchemical character into the part played by certainchemical elements in the cells in this differential

action. The 17 original papers included in thisvolume are all genuine attempts at research in a.

difficult field.The book by Dr. Gustav Bucky includes contribu-

tions by Dr. Otto Glasser and Dr. Olga Becker-Manheimer. In the section written by Dr. Glasserwe learn that " Grenz rays are soft Roentgenrays having wave lengths of from 1 to 3 Angstromunits, and are produced in lithium glass X raytubes with voltages from 4 to 10 kilovolts." Theserays are very easily absorbed by all forms ofmatter; they have been given the name Grenz byDr. Bucky because he believes them to form a sortof boundary between ordinary X rays on the onehand, and ultra-violet rays on the other. We do notmuch care for the name. The terms soft X raysor long wave-length X rays have the advantage thatthey describe some characteristic of the rays, while theterm Grenz indicates a boundary that does not exist.These rays have been used by Dr. Bucky and othersin the treatment of a number of diseases, not onlydiseases of the skin. We gather that the developmentof this form of therapy has been somewhat chequered,for on page 109 the author says : " But even if a methodinvolves risks, a patient may be willing to take achance at times if he may thus be rid of a protracted,troublesome disease." He continues : " Thus, it isnot logical to dump the child out with the bathand arbitrarily to issue the fiat that a therapeuticmethod must be abandoned because of certain possibleaftermaths." The meaning of this is baffling.

Romance of the British Voluntary HospitalMovement.

By A. DELBERT EVANS and L. G. REDMONDHOWARD. London: Hutchinson and Co. 1930.

Pp. 360. 18s.

THE " Voluntary Hospital Movement " is a verymodern phrase, but the authors of this stout volume,to which Sir W. Arbuthnot Lane contributes anintroduction, carry it back to the monasteries regardedas hospitals for the sick, and to the refounding, afterthe Dissolution, of St. Bartholomew’s as solely acurative institution. This is a large field to cover, and,on the whole, the authors cover it adequately. Theyare naturally much indebted to the late Sir HenryBurdett’s monumental " History of Hospitals "; a bookof this kind intended for more or less popular use mustnecessarily be, in the main, a compilation. It will tellthe specialist little with which he is not alreadyacquainted, but it should be useful as a compendiousbook of reference.

There was room for a book which should bringtogether the facts and arguments relating to the

progress of the hospital movement in the modernsphere, and especially since the Great War, and muchspace is devoted to this side of the subject. Thus wehave a sketch of the rise of the specialist hospitals, ofthe work of the teaching hospitals, the creation ofscientific nursing, the place of the poor-law institutions,and a discussion of the technical problems affrontingthe voluntary hospitals, together with an accountof such new methods of support as the HospitalSaving Association and the various developments ofcontributory schemes. The facts and figures thus.

brought together afford an impressive view of manysides of a great subject, that which relates to

very recent legislation not being ignored. What.may be called the modern history side of thesubject is, indeed, the most useful part of the

1188

volume, which contains a very large number of smallillustrations.The index is full, but by no means complete. We

notice certain slips. "

Angelnoth," an Archbishop ofCanterbury who is supposed to have been flourishingin 1201, is a prelate unknown to history, and the houseof the Society of Apothecaries is not in Pilgrim-street.The statement that " the first cottage hospital " wasfounded at Cranleigh, in Surrey, in 1859 by Mr.Albert Napper, F.R.C.S., is inaccurate. The WarwickDispensary and Cottage Hospital was founded in1823; Frodingham Cottage Hospital, in Lincolnshire,goes back to 1844 ; that at Ripon to 1850, and that atNorth Ormesby to 1857. The name of the Founderof THE LANCET is mis-spelt more than once.

Modern Skin Therapy.By H. D. HALDIN-DAVIS, M.D., M.R.C.P., F.R.C.S.,Dermatologist, Royal Free Hospital; Lecturer onSkin Diseases, London School of Medicine forWomen. London : Jonathan Cape, Ltd. 1930.Pp. 128. 5s.

THERE is much to commend in this handy littlemanual. A lucid and fluent style and an engaging,if slightly cynical, outlook enliven its pages, and holdthe reader’s attention closely through all the ten

chapters. The selection of subjects has been madewith a view to meeting all the simpler requirementsof the general practitioner. With those requirements inmind it is unexpected to find a long chapter on lupus,which, as the author himself admits, "is in most casesbeyond the resources of any single medical man "(p. 59). The treatments of furunculosis intertrigo,carbuncle, scabies, pediculosis, and that ever-

_present and much maltreated disease-impetigo-are not entered upon, although they may tax theaverage therapeutic resources, and require expertadvice. All that is worthy of consideration in theagenesis and treatment of eczema has been describedin plain language, and there is a refreshing absence ofcomplicated formulae. The author’s exceptionalexperience in the application of X rays in the treat-ment of tinea tonsurans qualifies him to speak onthis subject with particular force, and makes his- carefully detailed descriptions of the technique he- employs of great value. His last chapter on minorsurgery includes an account of carbon dioxide freezingand its indications, electrolysis, and the technique forthe injection of varicose veins. It is satisfactory tonote that in common with nearly all other authorities,Dr. Haldin-Davis unhesitatingly condemns theX ray treatment of hypertrichosis, and reduces thefield and indications for ultra-violet therapy to oneof honest if diminished proportions. ,

iBacterial Metabolism.

By MARJORY STEPHENSON, M.A., Associate ofNewnham ’College, Cambridge; Member of theScientific Staff of the Medical Research Council.London: Longmans, Green and Co., Ltd. 1930.

Pp. 320. 18s.

AN outline of the essentials of bacterial metabolism- has been lacking in British bacteriological literature,and this volume supplies one. The general arrange-ment is good. The various chapters deal withfermentation, respiration, growth and nutrition,carbohydrate and protein breakdown, and nitrogennxation, while there is an extensive bibliography

..at the end of the book. There is, however, great

variation in the lucidity with which different subjectsare dealt. Many are excellent but a few, like thesections on oxidation, oxidation-reduction potentials,and anaerobiosis-these dealing particularly with thework of Miss Stephenson’s own school-are discussedin a confused manner. This is mainly due to undueprominence given to isolated and often unconfirmeddata. Happily the author, usually at the end,emerges from the haze with clearer conception, as,for example, in her concluding sentence on therespiration of anaerobes, "notwithstanding muchwork, however, the main problem of how strictanaerobes live remains unsolved." There are severalomissions, particularly of work done by Britishbacteriologists on anaerobes and haemophilic bacteria.This is doubtless due to the fact that the source ofmuch of the author’s information does not refer toBritish work. We could find no reference to thenature of toxins or their production. Apart fromthese defects, Miss Stephenson has succeeded inpreparing from a heterogeneous accumulation of

bacteriological data a volume which is a usefulsummary of the present-day knowledge of bacterialmetabolism.

’

I Del Ringiovanire Diatermico.By Dr. GAETANO ZUCCHI. Milano (132)-VialeRomagna N. 58. Soc. An. Istituto EditorialeI Scientifico. Pp. 240.THE author of this monograph holds the opinion

that the changes accompanying old age in men arecaused by deficiency in the internal secretions of thetesticles, and maintains that these changes can beprevented by applying diathermy to these glands.Believing, as he does, that there is no real kinshipbetween man and the anthropoid apes, Dr. Zucchibelieves that Voronoff’s transplantation is unscientific.He also criticises Doppler’s operation (sympathico-lysis of the spermatic artery) as dangerous. Hedescribes some work which he has conducted on theapplication of diathermy to bull’s testicles for the

purpose of ascertaining the conductivity of glandtissue of this kind and of devising a suitable technique.In the human testicle he has observed that the senilegland offers a lower resistance to electricity, and thatdiathermy increases it. He thinks that this increasemay serve as a prognostic index of clinical improve-ment. The benefits which are claimed for testicular

diathermy are great. They are said to appear, insome cases, after the first treatment, and in all casesafter six to eight applications. The asthenic, thenervous, the irascible and the depressed are saidto show best the effects of the treatment. Greaterelasticity is said to be observed in the arteries. Theauthor states that testicular diathermy has beensuccessfully combined with hepatic diathermy in

enlargement of the liver in immoderate drinkers;and that good results follow the former treatmentduring convalescence after influenza. In ageddiabetics the glycosuria is said sometimes to disappear.Apart from its use in cases of infection of the

contents of the scrotum, diathermy has not beensystematically applied in this country to the testiclesof those who are the subjects of disease-not, at anyrate, when the glands are clinically normal. Until theresults obtained by Dr. Zucchi have been confirmedby other workers it is likely that English workerswill remain sceptical. The electrodes used, which areprotected by patents, are described and illustrated.Their cost is stated, and those who subscribe to themonthly journal Le Indicazioni della Diatermiacan have them at a reduced price.