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REVIEWS AND NOTICES OF BOOKS

Ions in Solution

By R. W. GURNEY, M.A., Ph.D., Research Asso-ciate in the University of Bristol. London:

Cambridge University Press. 1936. Pp. 203.10s. 6d.

THE development of the quantum mechanical

theory of the atom has led to important work on thenature and reactions of ions in solution. Dr. Gurneysummarises, in condensed yet intelligible form, thefruits of this work. If the book gives an impressionof being largely speculative, it must be rememberedthat the approach is comparatively new and thatexperimental research directly related to this approachis at present little developed. It is unfortunate,however, that the author has not taken more advan-tage of the frequent opportunities offered to relatehis point of view to more old-established if by nowmore barren ones. For example, the non-existencein solution of certain metals, such as calcium, in alower state of ionisation (Ca+) than the normal(Ca+ +), despite the predominance of the lowerstates in ionised vapours, is one of the interestingproblems here raised. Dr. Gurney’s explanation interms of the ionisation energies of the solvated ionsand of the solvent is no doubt sound, but it is notvery helpful to dismiss as

" irrelevant " the non-existence of salts in which calcium is monovalent.In nearly all cases where a metal exists in more thanone state of ionisation in solution, correspondingcrystalline salts are known, and rarely is a metalfound in a crystal (even an anhydrous crystal) in astate of ionisation which is not realisable in solution.On the other hand, the discussion of the Debye-Hückel theory, though so brief as to be not entirelyaccurate, is far better balanced than many muchfuller .discussions which extend the theory insome particular direction while leaving its basis

approximations unexamined.The biggest recent advance dealt with is in that

part of electrochemistry which thermodynamicscannot reach. The standard electrode potentialsand oxidation-reduction potentials of metals are

discussed in relation to thermionic work functionsand energies of solvation. To the worker in the

biological and medical sciences, whose interest inions is mainly in their permeability to membranes,and their influence on colloidal dispersion and onionisation of weak acid groups in complex molecules,the book is of no immediate practical value, becausequantum mechanics has as yet little to say on theseproblems.

Morphologische PathologieBy Prof. Dr. WERNER HUECK, Director of the

Pathological Institute of Leipzig University. Leip-zig : Georg Thieme. 1937. Pp. 818. R.M.52.

Prof. Hueck breaks away from tradition in thearrangement of subject matter. There have beentruants before among text-books in pathology ; forexample, MacCallum’s work is based on the idea thatall pathological changes are the result of some formof injury; this attitude brings with it a liabilityto teleological thinking. Prof. Hueck, being a strictcausalist, has taken the opposite point of view.He discusses the whole of general pathology on apurely morphological basis, and in fact the bookmay be regarded as a continuation of Oertel’s " Intro-duction to Pathology." It is interesting to find so

many problems approached from a logical standpointinstead of from one which elevates heuristic ideasto the level of final explanations.The book is in two parts : the first, on general

principles, gives an admirable account of the poten-tialities for differentiation of the mesenchyme andits relation to pathology, and excellent chapters onstone formation and tissue regeneration. The sectionon tumour formation is noteworthy for its com-

parison between the connective tissue tumours andnormal mesenchymal histogenesis ; the absence ofany adequate account of the systematised blasto-mata is disappointing. The second part of the bookdeals with " related morphological pathology," whichis almost the same thing as what is usually known as" special pathology " ; no attempt is made to men-tion lesions in every organ, but a few of the moreimportant disease processes are discussed in detail.For example, the account of pulmonary tuberculosisin its various forms, together with its complications-tuberculous enteritis, miliary tuberculosis, and amy-loidosis-is excellent ; other sections worthy ofcomment are those on disease of the heart andarteries, the stomach, and the liver. This lattersection reveals an interesting contrast between Ger-man and Anglo-American teaching. Prof. Hueckaccepts without question the evolution of a sub-acute hepatitis into a chronic stage, yet in nephritisthere is no suggestion that an acute nephritis maypass through a subacute cedematous stage before thefinal ursemic state ; " nephrosis " and nephritis arekept distinct, and focal nephritis is not mentioned.A new book of such a revolutionary nature--

perhaps revivalistic would describe better a returnto the best teachings of " cellular pathology "-isunlikely to maintain throughout a proper balance inthe allocation of space or to avoid omission of relevantfacts. Here endocarditis is merely classed as simple,verrucous, ulceropolypous, or fibrous with little con-sideration of setiological factors ; the account ofendocrine dysfunction in relation to constitutionalmorphology is too short, and the chapter on leukosisand anaemia is below the standard of the rest of this

stimulating book. We commend the instructivediagrams, drawings, and photographs, and the lavishuse of colour printing.

Venereal DiseasePractical Methods in Diagnosis and Treatment. Thirdedition. By DAVID LEES, D.S.O., M.B., D.P.H.,F.R.C.S., F.R.C.P. Edin., F.R.S.E. Edited andrevised by ROBERT LEES, M.B., F.R.C.P. Edin.,Assistant M.O. for V.D. to Edinburgh RoyalInfirmary and Edinburgh Corporation. Edin-burgh : E. and S. Livingstone. 1937. Pp. 608.15s.

THIS good text-book on venereal disease has nowbeen brought up to date without having been enlarged.The sections which deal with the clinical manifesta-tions of syphilis contain many excellent photographs,including some in colour, which are likely to be ofgreat value to those who seldom have access to thistype of clinical material. The views expressed ontreatment and on standards of cure are in the mainorthodox and are set out in a clear and practicalway. The detailed statement of recommendationsfor treatment in all stages of syphilis are especiallyto be commended. There are two unexpected omis.sions. The important condition of metastatic iritis

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secondary to gonococcal infection is barely men.

tioned, and we can find no reference to tricho-monas vaginitis in connexion with the differential

diagnosis of vaginal discharges of inflammatoryorigin. On most other subjects the information

given is full and complete.It is unfortunate that some of the methods of expres-

sion are slipshod and ungrammatical. More careful

proof-reading would have excluded such lesser sourcesof irritation as " prostrate gland." These faults shouldnot be allowed to obscure the value of this compre-hensive work in which sound theoretical knowledgeand wide practical experience are combined.

La vésicule biliaire et ses voies d’excretion

Second edition. By M. CHIRAY, Professeur agregeà la Faculte de Medecine de Paris ; and 1. PAVEL,Maitre de Conferences a la Faculte de Medecine deBucarest. Paris : Masson et Cie. 1936. Pp. 860.Frs.120.

IT is ten years since this standard text-book ondiseases of the gall-bladder appeared, and the secondedition necessarily contains important changes.These concern particularly the physiology of the gall-bladder and the mechanism of Oddi’s sphincter, thesetiology of gall-stones, the mechanism of hepaticcolic, and the bacteriology of cholecystitis. For thechapter dealing with the radiology of the gall-bladderDr. A. Lomon is responsible, and the reader will findtherein an excellent series of illustrations. A con-siderable bibliography enriches each chapter, and thereis a full index of authorities as well as of subjects.

Studies in Cardiovascular RegulationLane Medical Lectures. By G. V. ANREP, M.D.,D.Sc., F.R.S., Professor of Physiology, Medical

Faculty, Egyptian University, Cairo. London:Humphrey Milford, Oxford University Press.1936. Pp. 118. 10s. 6d.

IN this monograph Prof. Anrep clearly describesthe many important advances recently made inour knowledge of the way in which the heart exactlyadapts itself to the work demanded of it ; of the

respiratory influence on the heart-rate ; and of the

coronary blood flow. In a final chapter the bloodflow through skeletal and plain muscle is shown toundergo during muscular contraction changes similarto those in the coronary flow during the cardiac cycle.Far from being the master of the circulation, the heartis to-day regarded as its highly efficient servant, itsrate and output being dictated by a variety of reflexes,the receptors of which are situated in the walls of thecardiovascular system itself. Prof. Anrep gives aninteresting account of how, after much controversy,the carotid sinus was recognised as an importantagent in the control of blood pressure and heart-rate.With the aortic, and probably also the left ventricularwall and the carotid body, the carotid sinus formsthe chief vaso-sensory area on the arterial side.On the venous side, in the auricles and right ventricle,are receptors which are held to have exactly oppositeeffects. The complex effects of the impulses fromlung tissue and of central discharges from the respira-tory centre on the cardiac rhythm are discussedin detail. Their bearing on clinical problems isnot yet clear. The sections on the coronary bloodflow deal not only with matters of importance to thephysiologist, such as the effect of systole on

the flow, but also many which directly concern

the clinician and cardiologist ; for example the richdual innervation of the coronaries, the reflex constric-tion which occurs in them when the carotid sinus isstimulated, the effects of certain drugs and the atypicalreactions when they are sclerosed. Prof. Anrephas contributed largely to cardiovascular physiology.His Lane lectures are a record of his personalobservations, including those arising from importantexperiments which he has been able to carry out inEgypt on the human heart obtained soon after death.

1. Practical Physiological ChemistryFor Medical Students. By G. M. WISHART, D. P.CUTHBERTSON, and J. W. CHAMBERS. Glasgow:John Smith and Son, Ltd. (26, Gibson-street,Glasgow, W.2). 1936. Pp. 125. 3s. 6d.

2. Laboratory Experiments in PhysiologicalChemistryBy ARTHUR K. ANDERSON, Ph.D., Professor of

Physiological Chemistry, the Pennsylvania State

College. London : Chapman and Hall Ltd. 1936.

Pp. 234. 7s. 6d.

1. DESIGNED for use with a forty hours’ course inpractical biochemical work, this excellent little bookis eminently suitable for this purpose, being conciseand accurate. The omission of the estimations of

phosphate and sulphate in urine is regrettable, andsodium hydro sulphite is preferable to ammonium

sulphide as a reducing agent in the study of the bloodpigments. This is an outstanding little book.

2. This may be described as the text-book interro-gatory and local: interrogatory, because the reader,instead of being told what the result of an experimentshould be, is questioned by the author on that verypoint; local, because the reader is, for example,exhorted to " obtain from the instructor, in a dryflask, the sample of vinegar to be analysed " ; it ispossible that in other places than those familiar tothe author other customs may obtain, and theinstructor not be so well provided. In explanationof the sentence (p. 46) " by means of a clean graduateadd 240 c.c. of water to a beaker " it is a measuringcylinder, and not the instructor, which is to be putto use.

Physical DiagnosisBy RALPH H. MAJOR, M.D., Professor of Medicinein the University of Kansas. London: W. B.Saunders Co. 1937. Pp. 475. 21s.

THIS valuable text-book on physical diagnosisembodies fifteen years’ experience in teaching by anenthusiast for clinical medicine. Though the personalelement is essential for teaching at the bedside itcan be tiresome and pedantic in print, but Prof. Majoris not guilty in this way ; his tone is not didactic and hemakes use of all the recognised authorities and recentwork with frequent quotations and extensive listsof references. His admiration for the pioneers of

diagnosis leads him to quote their original des-criptions in many places, but the emphasis is

fortunately not on the past ; full credit is given tosuch valuable advances as the X ray, the electro-cardiogram, and the phonogram in explaining thesignificance and the physical basis of signs. Theviews expressed are on the whole in line with orthodoxBritish teaching, though as is natural where experi-ence depends on local observation material pointsof disagreement will be found; for example,

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pathological findings in this country do not suggestthat the diagnosis of aortic insufficiency with a Flintmurmur is more often correct than that of the com-bined lesion with mitral stenosis. The statementthat the wrist-drop in lead poisoning is due to a

paralysis of the ulnar nerve is of course merely acareless error.

Though there can be few practitioners who wouldnot find interest in this work, and no teachers ofmedicine who could not pick up a wrinkle or twofrom it, it has two disadvantages from the pointof view of the student for whom it is intended. First,it is too long; aspects of disease other than physicaldiagnosis might well have been left out, since theycould not be discussed adequately in the availablespace. The benefit derived from learning the signsnecessary for a diagnosis of aortic stenosis for

example is nullified if the student goes away withthe impression that it is caused equally commonly bysyphilis, arterio-sclerosis, and rheumatism. Secondly,it is important that the student should know whichphysical signs are nowadays regarded as significantand reliable ; this is not always made sufficientlyclear, and the historical emphasis may encourage theseeker after strange signs who may miss dilated and pul-sating veins in the neck when bending down in searchfor Broadbent’s sign. On the other hand the manyexcellent photographs, the helpful diagrams, and,above all, the impulse of Dr. Major’s enthusiasmmay transmit to the student the thrill which willsend him to the bedside, there to look, listen, and feelfor himself.

Physical Therapeutic Methods in Oto-laryngologyBy ABRAHAM R. HOLLENDER, M.D., F.A.C.S.,Associate in Laryngology, Rhinology, and Otology,University of Illinois College of Medicine. London :Henry Kimpton. 1937. Pp. 442. 21s.

. Dr. Hollender has had the help of ten collaborators,but is himself responsible for the larger part of thismassive work. A preliminary section deals with thephysical characteristics of the various agents underdiscussion and the apparatus used in their produc-tion ; the main part of the volume is concerned withthe numerous diseases of the nose, throat, and earin which these methods may be employed, and isfollowed by a few miscellaneous chapters. Amongthe latter is one by Chevalier L. Jackson on endo-scopy, and another on hearing-aids by Prof. HoraceNewhart which, although interesting, have little

bearing on the subject of physical therapy. Prof.Francis Lederer has contributed to this part of thebook two chapters on neoplasms; in general hefavours diathermy, or electrodissection, but givesno detailed description of the various forms of tumournor of the technique of their individual treatment.This criticism may also be applied to his referencesto treatment by radium and X rays, where detailsof application and dosage are not discussed ; of

laryngeal carcinoma he merely says that radium hasproved to be an ineffective therapeutic agent.

It is difficult to decide what methods should beincluded within the term of physical therapy. Fromthis book the galvano-cautery and all forms of spatreatment and inhalation therapy are omitted. Allthe methods here dealt with, except the use of radium,involve the use of electrical apparatus, and includesuch various procedures as ionisation, diathermyin all its forms, short-wave diathermy, infra-red andultra-violet irradiation, and X rays. These new

methods, as opposed to older forms of treatment,are advocated with a degree of enthusiasm whichsome will think exaggerated ; notably where short.wave radiation is hailed as " perhaps the most

important contribution since Roentgen’s epochaldiscovery," where diathermy is recommended for thereduction of the inferior turbinals, and the galvano-cautery is condemned because in unskilful hands itmay cause adhesions. A detailed table of contentsis provided, as well as a full index. The book containsuseful information on the treatment of a great varietyof diseases by these methods, and will be read withinterest by laryngologists.

Rural Health Practice

By HARRY S. MUSTARD, M.D., Associate Professorof Public Health Administration, Johns HopkinsUniversity. New York: The CommonwealthFund ; London: Humphrey Milford, OxfordUniversity Press. 1936. Pp. 603. 17s.

THE Local Government Act of 1929, by requiringall future appointments of medical officers of healthto be on a full-time basis, has inaugurated a new typeof expert in rural hygiene to whom Prof. Mustard’s.book will be most valuable. Such an expert shouldhave no difficulty in separating common ground fromthat which represents differences between Americanand British practices. In the United States alsopart-time public medical officers, often appointed forpolitical or charitable reasons, are now giving placeto full-time experts having some security of tenureof office and therefore the time and inclination tomake themselves expert in their particular branchof medicine. This is the justification for this work,which is compiled on original lines. Prof. Mustardis one of America’s foremost hygienists and is almostas well known in Europe as in the States as an

authority on rural hygiene-because he says hehas " already made most of the mistakes which it ispossible for a rural health officer to make." Thisbook is full of sound advice and is wittily expressed.

NEW INVENTIONS

A MODIFIED RECTAL BOUGIE

THE modified Wales’s rectal bougie here illustratedis designed for the purpose of dilating high stricturesof the rectum. It is not safe in such a situation asthe upper end of the rectum to use rigid metal dilators,or any form of dilator that cannot be passed through

the stricture under full sight. The bougie is made ofsoft rubber in gradually increasing sizes and can bepassed through a large rectal speculum or preferablyan operating sigmoidoscope. The difficulty of usingsoft rubber bougies in these circumstances is that theybuckle up, but this bougie has a hole reaching notquite to the end into which a stylet can be passed tostiffen it, and to make it possible to guide it in thedesired direction.The bougie has been made for me by Messrs. Down

Bros., Ltd., St. Thomas’s-street, London, S.E.

J. P. LOCKHART-MUMMERY, F.R.C.S. Eng.Emeritus Surgeon to St. Mark’s Hospital for

Diseases of the Rectum.