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:"3ymptoms. Up till the eighth and fifth days respectively1the only noticeable features were partial suppression- of urine and gradually increasing generalised oedema.The puerperium were afebrile in both. On the eighthand fifth days ursemic phenomena began to appear,but were slight in degree, and consisted, firstly, ofprogressive drowsiness, stupor, and ultimately coma;- secondly, of dyspnoea ; and thirdly, in the first case, of- uraemic vomiting. Both patients died without havingonvulsions. Treatment was on general lines-freeelimination, diaphoresis, and administration ofdiuretics-but without benefit. In both cases thekidneys showed the same characteristics-namely,,total necrosis of the outer two-thirds of the cortex,1the inner third being healthy, and slight congestionf the medullary portion. In neither case was therethrombosis of the renal vessels, nor was there anyevidence of previous nephritis. In the first case theliver presented areas of focal necrosis of the central:zone cells of the lobules.

Dr. JAMBS DAVIDSON showed specimens of kidneys!from three cases of bilateral cortical necrosis of thekidneys. One of these was from one of Dr. Turner’scases. The second showed the earliest changes ofTthis condition. Thrombosis of the afferent arteriolesof the glomeruli was well seen in microscopicalsections. The third case showed advanced stages ofnecrosis and was of interest because there was ante-mortem thrombus formation in both ovarian veins.He pointed out that there had been one case previouslydescribed in literature where naked-eye thrombosisllad occurred in both renal and ovarian veins. Dr.Davidson referred to a case which was reportedsome years ago of a man, aged 37, whose kidneysshowed a typical appearance of bilateral, corticalnecrosis.

Reviews and Notices of Books.AFFECTIONS OF THE EYE IN GENERAL PRACTICE.

’ R. LINDSAY REA, M.D., F.R.C.S., Surgeon to,the Western Ophthalmic Hospital ; Ophthalmic’Surgeon to West End Hospital for NervousDiseases. London : H. K. Lewis and Co., Ltd.1930. With 7 coloured plates and 33 other illus-’trations. Pp. 155. 10s. 6d.

.Mr. Rea dedicates his book to the general practi-tioner. The volume is in no sense a text-book of

ophthalmology, but is well calculated to help thepractitioners who have but a superficial knowledge of.eye diseases to overcome the difficulties which mayconfront him from time to time. Tli,- outcome, founded,,3n the experience of many years of clinical work at.a,a. ophthalmic hospital and at a hospital for nervousdiseases, is essentially practical; the teaching isbrightened by frequent reference to actual cases.

In the main the instruction is on orthodox lines anddoes not include reference to such recent develop-ments in ophthalmology as, for example, the newerpathology of glaucoma; but here and there are refer-ences to points not found in ordinary text-bo(,ks.The method of irrigating the eye by the hydr-ophthahnoscope of Rayner Batten is not nearly sowell known as it deserves to be ; an illustration inthis book shows how this instrument can be used.Some years ago Mr. Rea published a monograph oninterstitial keratitis in which he strongly advocatedspecific anti-syphilitic treatment in this disease, a

]point of view not held by many writers of text-books.His arguments are here reproduced and emphasised.According to him many of the cases of interstitialkemtitis with a negative Wassermann reaction whichwere formerly supposed to be tuberculous in originean be proved to be syphilitic if Lange’s colloidalgG>’d test is employed. The author gives a series ofintravenous injections of novarsenobillon to these

patients in graded doses, or to young children sulf-3I’scnol intermuscularly, the series being repeated if

necessary. Not one of 64 cases treated from theoutset in this way developed deafness, whereas inuntreated interstitial keratitis deafness is common.

In a book of this sort any description of the operativesurgery of the eye would be out of place, but thereare certain emergencies in which it is of the firstimportance for the general practitioner to knowwhat is the wrong, no less than what is the rightthing to be done. The onset of acute glaucoma isone of them. Another is the occurrence of a per-forating injury of the eye. In this, time may beall important, in order that septic infection may.if possible, be prevented. Mr. Rea gives details ofa method of covering the cornea with a conjunctivalflap which he demonstrated a few years ago at theRoyal Society of Medicine. The plate illustratingthe procedure should be of value to the ophthalmicspecialist. The book includes, as is fitting, a

chapter on the examination of the eye in nervousdiseases, one on the hygiene of the eyes; and a supple-ment with useful therapeutic formulae.The production and illustration of the book are

excellent, and the general practitioner to whom itis dedicated will find that it supplies his needs ingood measure.

COMMON IXFECTIONS OP FEMALE URETHRA ANDCERVIX.Second edition. By FRANK ]KIDD, M.A.,M.Ch. Cantab., F.R.C.S. Eng. ; and A. 1VIAL coL.SiMPsoN, B.A., M.B., D.P.H. Cantab. Withadditional chapters by GEORGE T. WESTERN, M.D.,and M. S. MAYOU, F.R.C.S. London : HumphreyMilford, Oxford University Press. 1929. Pp. 197.8s. 6d.

l3rnzT from an additional chapter on recentadvances in technique and a few minor alterationsthis book is, in its second edition, unchanged.Although other infections of the female urethraand cervix are mentioned, the book is essentiallyconcerned -with gonorrhoea in the female, andthe fact that no considerable alterations have beenfound necessary indicates that the authors’ methodsof diagnosis and treatment of gonorrhoea in the femalehave stood the test of time. The use of Brank Kidd’surethroscopes in the treatment of chronic urethritisby the application of local remedies to the urethraunder direct vision is explained ; the value of suchtreatment in resistant cases is now generally recognisedand is entitled to the prominence it receives. Cervic-itis is classified simply and the treatment applicable toeach type of cervicitis is discussed. The paragraphson chronic cervicitis are the best we have ever read onthis subject. The chronic cervicitis, type 2, heredescribed, in which the cervix is apparently healthywith no erosion. or in which there is " a pale erosionand a tear, but clear jelly-like mucus free from pus isseen issuing from the canal," is at once the mostfrequently missed and the most difficult to treat of allthe chronic gonococcal lesions. It is of interest tolearn how the authors treat such cases, and to learn theimportance which they attach to the diagnosticprocedures of tubal insufflation and of lipiodol injectionin the most resistant cases.For the rest, the chapter on prophylaxis is fearless

and sensible, and that on bacteriology contributed, asbefore, by Dr. George T. Western, describes lucidly thepitfalls which may be encountered in bacteriologicaldiagnosis. The warning against the use of the dia-thermy by all but the most expert, particularly in thetreatment of urethritis, is reiterated. Dr. RemingtonHobbs’s treatment (glycerin and iodine with glycerin)is given its proper place, being reserved for casesof acute or subacute endometritis and for cases ofresistant chronic cervicitis in which tubal infection issuspected. The authors are against the indiscriminateul-e of hii. or, indeed, of any one form of treatment.The excellent chapter on gonococcal arthritis inwomen enunciates the correct principles in the treat-ment of joint infection. Early and active movementsof the joints are essential, and the authors point out

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that " there are still too many cripples to be seen asthe result of the splint and plaster treatment."More space might perhaps have been found for a fulldiscussion of the importance played in gonorrhoea bythe secondary organisms.

In an easy, attractive style the needs of the practi-tioner are kept in mind throughout. The book shouldbe read by him, by the specialist, by the studentof medicine, and, most important of all, by the con-firmed pessimist. The last named is all too commonwhere gonorrhoea in the female is concerned. TheLondon Hospital deserves congratulation on itsDepartment for Venereal Diseases.

OTOLOGIC SURGERY.

Second edition. By SAMUEL J. KOPETZKY, M.D.,F.A.C.S., Professor of Otology, Polyclinic MedicalSchool and Hospital, New York. New York:Paul B. Hoeber. 1929. Pp. 553.$8.00.

’Tgzs book contains very much more than a

description of surgical operations on the ear and itsadnexa, for it is largely concerned with the diagnosisand clinical course of all forms of aural disease whichrequire surgical treatment, omitting only suchaffections as otosclerosis and the so-called catarrhalconditions which do not call for operative interference.A preliminary chapter is devoted to a discussionof inflammation of the middle ear and mastoid,cavities. The author lays stress, rightly we think,on the participation of the mastoid cells in all casesof acute purulent otitis, and states that radiologicalexamination substantiates this view. He dividesacute mastoiditis into two forms, the common

coalescent type and the haemorrhagic type ; the formermay reach the lateral sinus by continuity, when itshows a track of disease leading to the sinus groove ;but the latter infects the sinus by intravenousextension of thrombosis along the tributary veins,and may therefore show no evidence of disease ofthe bony walls. The author may not be justifiedin the conclusions he draws from the fact that he hasfound sterile pus in the mastoid process. It will beremembered that Mr. T. B. Layton, in the Journal ofLaryngology for January, 1930 (p. 25), has recentlyascribed this occurrence to the bactericidal actionof the admixture of blood on the swab, since in thesame cases he obtains positive results from directculture of a fragment of bone.

Prof. Kopetzky writes briefly on operations on theexternal auditory canal, incision of the membranatympani, and operations on the middle ear throughthe meatus. He holds that experience and timehave demonstrated the futility of ossiculectomy forthe cure of chronic suppuration, and that this pro-cedure has failed as a means of improving the hearingof patients with chronic non-suppurative otitis.The simple and the radical mastoid operations arevery thoroughly discussed, with a good descriptionof the necessary anatomy, indications, after-treat-ment, and results. One curious passage occurs inwhich the author states that " accidental opening ofthe sinus or tearing of the dura is often absolutelyunavoidable " ; exposure of the dura over sinus ormiddle fossa may be unavoidable if abnormallysituated, but injury to it can surely always be avoided.On the moot question of when to open the antrumin cases of acute suppuration which fail to clear up,in order to avoid chronicity, the author fixes theperiod at as long as two months, and stresses thevalue of the operation in the prevention of chronicotorrhoea. In dealing with the indications for theradical operation, emphasis is properly laid on thedistinction between the dangerous and non-dangeroustypes of chronic suppuration, the former with atticor marginal perforation, and the latter with a perfora-tion of the membrana tensa, which does not involvethe bony tympani ring. The author does not believethat the " modified " operation can heal necroticareas or restore a diseased ossicular chain, and thatdt offers no advantages over the simple mastoid

operation. Further chapters deal with the labyrinth,sinus thrombosis, meningitis and cerebral abscess,with a chapter on laboratory aids, and one consistingof reports on illustrative cases ; this chapter is oneof the most interesting and instructive parts of thebook. In pursuance of his design to confine thebook to surgery, the author is sometimes disappoint-ingly brief in his clinical descriptions. The illus-trations, especially of operative procedures, do notdo justice to the text, for they are insufficient bothin quantity and in quality.The book loses nothing by being written from a

personal standpoint, and gives evidence of the author’sextensive experience. It will be read with interestand profit by all otologists.

SHORT HISTORY OF THE ROYAL ARMY MEDICALCORPS.

By Colonel FRED SMITH, C.B., C.M.G., D.S.O.,R.A.M.C. (retired). Aldershot: Gale and Polden.1930. Pp. 111. 2s 6d.

IN this short book the history of the R.A.M.C. istraced through orders and warrants from the Penin-sula, a hundred years ago, to the present day, while theillustrations show the developments of uniform andof hairiness (there was clean shaving in 1805, tremen-dous whiskers appear in 1865). In the list of Directors-General, " James Jameson, 1893-1896," is alone inrecent years left without the K.C.B. An unusual honourwas given him, however-a notable dinner in London,attended by the Presidents of Colleges of Physiciansand Surgeons of England, Scotland, and Ireland, andheads of Universities and Medical Schools who felthe had merited the approval of the profession. Hisresignation took place during the South African War,in 1901. It is noteworthy that no Medical Director-General has since found it necessary to resign.

In preparing this book, Colonel F. Smith has donevery important work for the Corps, and his effortswill be welcomed by all those who are serving or haveserved in its ranks.

MANUAL OF PROCTOLOGY.

Third edition. By T. CHITTENDEN HILL, M.D.,F.A.C.S., Instructor in Proctology, HarvardGraduate School of Medicine. Philadelphia :Lea and Febiger. 1929. Pp. 272.$3.50.THE third edition of Dr. Chittenden Hill’s well-

known Manual of Proctology has now appeared ant..retains all the commendable features to which wereferred when reviewing the second edition. He haspresented a clear and practical description of procto-logical conditions and methods. His attitude ingeneral is a conservative one and ambulatory methodsare not over-emphasised. The evolution of the finalchapter on cancer of the rectum is of interest. Inthe first edition this chapter was written by Mr.Ernest Miles, and the one-stage abdomino-perinealexcision method was described. In the second editionCoffey’s two-stage modification was described andillustrated in much detail, while in this edition thechapter has been written by Dr. E. Parker Hayden.The principle of the abdomino-perineal excision isupheld with the reservation that often it is too severea procedure to be carried out in one stage, and whatis known as Jones’s two-stage modification is nowdescribed. No figures are given about operationmortality or recurrence rate. It is interesting tonote that Broders’s system of classification of malig-nancy has now been applied to carcinomata of therectum, and attention is drawn to work by Rankinand Broders showing that long-term cures afterradical operations occur almost entirely in patientswhose cancers were of low or medium malignancy.The author’s opinion of radiation is summarised inhalf a page ; he does not think that it is possible tocure an inoperable case by X rays or radium ; mostcan be accomplished by gold emanation seeds ; a

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growth just above the sphincter is not suitable forradium treatment on account of post-radiation dis-comfort. A large group of surgeons is likely toagree with these conclusions.

BOOKS FOR NURSES.

Elementary Materia Medica. Including Drugs andSolutions. By WALTER W. KRUEGER, Ph.B.,Instructor, The Grand Rapids Junior College.London: W. B. Saunders Co., Ltd. 1929. I!Pp. 278. 8s.

THE output from American sources of ’text-booksfor students of nursing is an indication of the attentionwhich the authorities are giving to the training ofnurses, but the books all suffer from the same defect;they contain far more information than a nurse intraining can possibly assimilate. Mr. Krueger’sbook is not exceptional in this respect, thoughin some ways it is an interesting production.In addition to the usual chapters dealing withthe elementary, and for the nurse important,aspects of materia medica, such as the administrationof medicines, the therapeutic classification of drugs,and the preparation of solutions, the author hasintroduced a chapter of general interest in the formof a sketch of the historical background of modernmateria medica. He recognises also that figures maynot come easily to a nurse, so he has added a simplechapter on numbers, fractions, and decimals. Thebook is readable and accurate. The elaboratebibliographies at the end of each chapter could quitewell be dispensed with. They indicate a want ofappreciation of the actual requirements of a nurse’straining.

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Nursing Care of Communicable Diseases. A Text-book of Prophylactic Technics for the Preventionand Control of Disease. By MARY ELIZABETHPILLSBURY, Instructor of Communicable DiseaseNursing, Yale University School of Nursing.1924-27. London : J. B. Lippincott Company.1929. Pp. 413. 12s. 6d.

MANY nurses come to the end of their hospitaltraining with but a scanty knowledge of communicablediseases, and in this American manual they may finda useful text-book. It is written in an interestingstyle and contains much information about theAmerican public health services, stressing the dutiesof the nurse as a teacher of the public in matters ofhealth. The second part of the book is devoted to thediscussion in separate chapters of the various better-known infectious diseases, each disease being viewedfrom the medical and nursing aspects. In connexionwith scarlet fever, while throat irrigation is mentioned,there is no reference to spraying of the throat, whichis usually found more effective for the relief of painboth in scarlet fever and diphtheria. The book isillustrated by photographs ; some of these are usefulin conjunction with the description of nursingtechnique ; the black and white attempts at repro-ducing the appearance of skin eruptions are notsuccessful. Blank pages for notes are provided at theend of the book ; in a later edition these might bemore conveniently placed in front of the index.

JOURNALS.EDINBURGH MEDICAL JouTtNAL.—The March issue

is a special Tuberculosis Number. The first articleby Dr. W. T. Munro, on Bovine-Type TubercleBacillus in Pulmonary Tuberculosis: Its R61e inPathogenesis, is annotated on p. 584. - or. D.Melville Dunlop writes on the Sedimentation Test inTuberculosis, and on the Leucocytic Reaction toTuberculosis, both in relation to their value in prog-nosis ; and also has a third paper on the Relationbetween Glandular and Pulmonary Tuberculosis.In the first he comes to the conclusion we believeto be now generally accepted that the sedimentation-

rate is an expression of the degree of activity of thedisease, but is by no means infallible, and shouldnever be taken alone as a prognostic index or asdefinite evidence of activity or inactivity. Hissecond article on the leucocytic reaction contains theresults of white cell counts from tuberculosis patientsin the Southfield Sanatorium Colony. Here henotices that in health the ratio between the neutro-philes and lymphocytes is less than the ratio betweenthe lymphocytes and monocytes. This picture isreversed in tuberculosis, and the more it deviatesfrom the normal the worse the prognosis. In histhird paper Dr. Dunlop reports that out of the last68 cases of pulmonary tuberculosis which have beentreated in the Colony, 13 have been associated witha history of disease of the cervical lymph glands,which represents a percentage of 18-9 as against1 per cent. quoted by other authorities.-Dr. R. S.Begbie contributes a short paper on Microbic Dissocia-tion, with special reference to Certain Acid-fastBacilli, in which, following the lines of the work ofPetroff, he has isolated rough and smooth coloniesfrom cultures of B C G, the smegma bacillus, andClegg’s lepra bacillus.-A short note on Inoculationof Calf with Human Tubercle Bacillus, by Sir RobertPhilip, Dr. J. C. Simpson, and Dr. Dunlop, recordsthe successful production of tuberculosis in a calf bythe ingestion of tubercle bacilli of human origin.-Two articles deal with social aspects of disease : oneon Education of the Public in Health Matters, withspecial reference to the Work of the National Associa-tion for the Prevention of Tuberculosis, by Dr.William Brand ; the other by Dr. A. Morrison McIntoshon Difficulties in Assessing the Capacity for Workof Ex-Sanatorium Patients.

New InventionsEXCRETA EXAMINATION DEVICE.

THE small device here illustrated facilitates theexamination of excreta, and is inexpensive. Itconsists of a pair of metal clips united by a hinge.Attached to the right clip is a small metal " stop "which pre-vents the test-tubes touchingeach other.Projectingforwards fromthe left clip isa 10-inch ro-

tating handleprovided witha ring at end.Ordinary test-tubes are fittedinto the clips.The advan-tages gainedby this deviceare as follows :1. The handsdo not touchthe test-tubesnuu 113L) ,L’e.lLl/:ULl ury lVI’ lIue reuoruiug m EtzULUZ5.

2. Burning and scalding accidents prevented when2. Burning and sca.lding accidents prevented whenpouring. 3. Spurting when mixing is checked, theejected fluid being received into the uppermost emptytest-tube. 4. Thorough mixing of liquids t4e tubesmay be shaken when horizontally opposed. 5. Theappliance stands on the table like a tripod untilreaction occurs. 6. The tubes are cleansed easily(together) under the tap and can be used singly ortogether. 7. The device hangs up when not in use.The makers of the appliance are Messrs. S. Murray andCo., Ltd., 11/13, Farringdon-road, London, E.C.

DAVID A. HERD, L.R.O.P., L.R.C.S. Edin.