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holding in his breath. (b) A girl, aged 19, who had experi-enced in April, 1924, an attack of encephalitis characterised zby ocular paralysis, insomnia, and delirium. She nowsuffered from delusions about her food, which she thoughtwas poisoned. She also complained of the habit of yawningfrequently. At times during the yawn her mouth remainedopen and she was unable to finish the yawn until some timehad elapsed. Another habit developed was that of frequentlytaking deep breaths. Insomnia was present and towardsevening she showed restlessness of the left foot, which movedcontinuously during the night.

Dr. Abrahamson referred to the variation in theincidence of the sequel of encephalitis after thedifferent outbreaks. The Parkinsonian syndromeseemed to be much commoner after the last epidemicthan after previous epidemics. He pointed out thatin some cases the syndrome was whittled down toone or two symptoms. He discussed the changes incharacter noted in children, and referred to a childwho developed marked kleptomania. In his experiencesequels occurred in about 50 per cent. of patients.In a few cases recrudescences occurred indicating thatthe virus could remain in the system for long periods.

Dr. J. SpiEAP.E,,4 referred to the difficulty of diagnos-ing cases of encephalitis lethargica at first sight. Thedrug he had found most useful was luminal, startingwith gr. doses, and increasing to 2 gr. doses. Heasked if exophthalmos had ever been seen as a resultof the disease.

Dr. ALFRED R. PARSONS referred to the frequencyof restlessness in cases of sequelae of encephalitislethargica, both nocturnal and in the day-time.

Dr. T. G. MooRHBAD referred to a case which hehad recently seen, and which displayed in a strikingmanner the Frohlich syndrome.The patient, a girl, aged 23, employed at clerical work,

who had suffered from a mild attack of encephalitis lethargicain January last. Since then she had been mentally dull andlistless, and she now presented a typical Parkinsonian appear-ance. In addition, however, she showed an extraordinaryadiposity, affecting the entire body, but more especially themammary glands and the hips. There was complete amenor-rhcea, and an almost complete disappearance of pubic hair.The condition was most likely due to involvement of

the pituitary gland. He also referred to the possiblevalue of psychotherapy in the nocturnal restlessness ofchildren. Of the various drugs used for myoclonicspasm he had found hyoscine by far the most useful,but it was necessary to give it in fairly big doses.

Dr. NESBITT drew attention to the fact that theParkinsonian syndrome frequently occurred in theacute stage of encephalitis lethargica as well as in thelater stage, and to the frequency of mental deteriorationin these cases. In the case that he had shown thatevening he had given doses of influenza vaccine for aconsiderable time without much result.

Dr. V. M. SYNGE asked what dose of hyoscineshould be given. In one American journal recentlyhe had seen a statement by some observers who hadgot excellent results from the use of hyoscine ; somebad cases had got well enough to go back to workand others had shown a great improvement. The dosegiven was one-fiftieth of a grain four times daily, and insome cases one-hundredth of a grain four times daily.The PRESIDENT, in replying, said that he thought

the Parkinsonian syndrome occurred in 50 per cent. ofcases, and in nearly every case the face was affected.He had not found luminal of any use, and hyoscineeven in small doses had seemed to him to make thepatients delirious, and although he had found that incases of paralysis agitans it had stopped the tremorfor a time, he had not given it in cases of encephalitislethargica. He did not understand how exophthalmoscould arise as a sequela of the disease. The onset ofbulbar symptoms was not at all uncommon. Regardingadiposity, Duncan had mentioned the Frohlichsyndrome occurring in a boy aged about 14 who wasrecovering from encephalitis lethargica,. He wasof opinion that the Parkinsonian syndrome far morefrequently came on in the acute stage of encephalitislethargica than in the later stage.

Dr. F. S. BOURKE read a note on a case of picric aciddermatitis.

Reviews and Notices of Books.THE NERVOUS PATIENT.

By Mi-LLAis CuLPiN, M.D. Lond., F.R.C.S. Eng.,Lecturer on Psychoneuroses to the London Hos-pital Medical College. London: H. K. Lewis.1924. Pp. 305. 10s. 6d.THE practitioner who attempts to keep pace with

current developments in scientific research and moderntreatment is faced with peculiar, if not insuperable,difficulties when he tries to assimilate the materialdealing with that class of patient generally known as"neurotic." In the first place, the needs of theindividual who has failed to adapt himself to hisenvironment are so intimately bound up with religious,moral, and social considerations that the physicianwho would heal a disability of psychogenic originmust be both fitted and willing to take upon himselfsomething of the r6le of priest and pedagogue. More-over, the ingenuities of the neurotic’s attempts totwine himself around any prop that offers are sosubtle that the physician or friend who tries to helphim, unless especially qualified to do so, may run lessrisk of disaster for both by a refusal to face the realissue and hiding behind some simple physical theoryof causation.

Nevertheless, it is certain that the practitionerwith common sense and a real knowledge of things asthey are, is able to do an inestimable amount towardspreventing and curing the minor disabilities which lieat the root of so great a percentage of our physicaland social ill-health. It is now recognised that thesymptom which appears in the consulting-room doesnot result in a direct manner from a simple cause.Treatment on a "physical" theory of causationmay do no more than chop a leaf from the stem of aflowering weed, but an over-enthusiastic concentrationon the psychological factors may well result in anexcavation around the supposed site of the rootletswhich uproots wheat as well as weeds. Only apatient and highly skilled tracing of the fibres fromflower to stem and from stem to rootlets can everremove the weed completely, and this is scarcelywithin the compass of the practitioner. He mustusually be content with an attack at some level ofthe stem which will remove the flower temporarilyor permanently according to the shrewdness andcomprehension with which the blow is directed. Anunderstanding of the anatomy of the plant willindubitably help his aim. For the practitioner whohas little or no idea of the possible undergroundconnexions of common symptoms, Dr. Millais Culpin’sbook should come as a flood of light in a dark place.He has made a courageous attempt to meet a difficultposition. To convey to the non-specialist worker thegist of specialist work which is still in a tentative stageof development is always a delicate task ; Dr. Culpinhas succeeded in presenting, with a refreshing degreeof common sense and humour, a bird’s-eye view ofthe psychogenic possibilities behind the many physicalconditions that fill our waiting-rooms, as well assome helpful chapters on the " neurotic " condi-tions proper, which he prefers to term the minorpsychoses."He pursues the wise course of defining terms before

embarking on their usage, and has enhanced the valueof his book to the busy man by providing a copiousindex in chapter (1) entitled Classification andNomenclature. Other chapter headings are as follows :(2) The Position of Psycho-Analysis ; (3) Suppressionand Repression: Suggestion ; (4) Physical Relation-ships of the Minor Psychoses; (5) Hysteria ; (6)Bodily Symptoms commonly called Hysterical ;(7) Anxiety and Obsessional States; (8) GeneralPrinciples of Diagnosis; (9) The Examination of thePatient; (10) Asthma and Allied Conditions; (11)Exophthalmic Goitre : Stammer, Epilepsy, andHysterical Fits ; (12) Gynaecological Conditions ; x(13) Conditions Arising After Trauma or in Relation

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to Occupation: Head Injuries; (14) PosturalDeformities: Digestive Disturbances : The HeartNeurosis; (15) The Psychological Aspect of theEffort Syndrome. The panorama is completed bychapter (16) on " Eye Symptoms," by Mr.W. S. Inman,and chapter (17) on the " Major Psychoses " from thepoint of view of the practitioner, by Dr. StanfordRead, while the last two chapters deal directly and Iindirectly with treatment.The section on treatment is rather vague, but the

difficulties of the task which the author has sethimself in his comprehensive scheme are so greatthat we may congratulate him on the generalmeasure of success he has achieved. We advise allpractitioners to read this handy little book.

ARTIFICIAL SUNLIGHT AND ITS THERAPEUTIC USES.

By FRANCIS HOWARD HUMPHRIS, M.D. Brux.,F.R.C.P. Edin., D.M.R. & E. Camb., ConsultingX Ray Physician to the American Hospital inLondon. London : Oxford Medical Publications.1924. Pp. 164.THE use of natural sunlight in the treatment of

surgical tuberculosis and other diseases has obtainedresults so satisfactory as to stimulate a great deal ofresearch in actinotherapy, since it would obviouslybe of advantage to have an adequate supply of asynthetic substitute for those rays which Nature

supplies in so fitful and uncertain a manner, especiallyin climates such as that of the British Isles.

In the little volume under consideration Dr.Humphris covers the whole field of the history,production, and uses of artificial sunlight. His clear,concise description of the properties and productionof ultra-violet light demands from the reader onlya rudimentary knowledge of physics. A necessarywarning is given against the little high-frequencyelectrode machines which not infrequently masqueradeas

" ultra-violet ray apparatus " in hairdressers’

shops and elsewhere; ultra-violet rays will not passthrough glass, wherefore any effect these bulbsmay have will not be due to ultra-violet light. Dr.Humphris has done wisely in confining descriptionsof apparatus to the case of a few tried models. A briefreview of present knowledge concerning the modeof action of light is well up to date. Administrativetechnique is discussed in some detail. The dose ismeasured by the degree of erythema (1-4) produced ;for the removal of a naevus, for instance, one mustproduce an erythema of the fourth degree (that isto say, a blister), whereas in tuberculosis, especiallyof the pulmonary variety, much smaller doses areneeded. The number of diseases in which artificial

sunlight appears to have been applied with benefitis very great, the list including such dissimilarcomplaints as hay fever, alopecia areata, and enlargedprostate. In a final chapter Dr. Humphris discussesthe use of X rays as a complement to actinotherapy,and concludes that the two can safely be combined,and that in many cases the X rays definitely assistthe therapeutic action of ultra-violet light.

It is to be hoped that facilities for obtainingartificial sunlight treatment will increase rapidly,especially in centres where rickets and tubercleare rife. Any medical man wanting a brief butcomprehensive sketch of this subject could not dobetter than to make use of Dr. Humphris’s excellentlittle book.

A TEXT-BOOK OF HISTOLOGY.

Third edition. By HARVEY ERNEST JORDAN,A.M., Ph.D., Professor of Histology and Embry-ology, University of Virginia. London andPhiladelphia: D. Appleton and Co. 1924.Pp. 857. 25s.

THIS edition of Prof. Jordan’s popular text-bookdiffers little from previous ones. The book is peculiarlysuitable for medical students because of the large

number of illustrations it contains of preparationsmade from human tissue. It is disappointing, there-fore, to find that the pig’s liver still holds pride of placein the description of this organ, for it is difficult forthe student to gain from it any true idea of therelation between the structure of the liver and itsfunction. An even more serious blemish is theomission of any reference to Bj. Vimtrup’s corrobora-tion of Ch. Rouget’s important work on the structure ofcapillaries. There are a few new illustrations, amongthem one from the heart of the "Beef." The ugly,yellow-tinted figures have no advantages over

half-tones and might well be replaced.

INSULIN THERAPY.

Zur Einfi4hrung in die Insulintherapie des DiabetesMellitus. Von H. STAUB, First Assistant derMedizinischen Klinik, Basel. Berlin: JuliusSpringer. 1924. Pp. 106.ALTHOUGH the author desires that his work should

be considered as only an introduction to the use ofinsulin, and not as a monograph, the book is in someways the most complete which has been published.It is divided into three parts. Part I. consists solelyof an excellent account, with references, of all the workwhich had been done in the attempt to discoverinsulin, and will be of use to anyone who wishes torefer to the full story. Part II. contains a goodaccount of the discovery of insulin and of its proper-ties, but does not add fresh information. Part III.describes the different methods of using insulin, withreferences to innumerable papers. The ideals of theauthor are to keep the blood-sugar normal, as well asthe urine sugar-free, in order to allow the islands ofLangerhans to have a chance of recovering theirfunction. If no blood-sugar estimation can be made,he considers it safer to allow a little sugar to be presentin the urine. The changes which take place in thevarious mineral constituents of the blood of a patientwith diabetic coma after a large dose of insulin are veryinteresting. The inorganic phosphates are decreased,but the Na, K, Mg, and Ca all increased. The greatinfluence of various infections is emphasised. Theindex and references are very thoroughly and carefullyedited.

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A TEXT-BOOK OF PHYSIOLOGY.

By H. E. RoAF, M.D., D.Sc., M.R.C.S., Professor’ of Physiology at the London Hospital Medical’ College, University of London. London : Edward

Arnold and Co. 1924. Pp. 605. 25s.

THIS student’s text-book should prove a great boonto the serious-minded students of medicine, and willdoubtless become very popular among them. Physio-logy is treated in an original manner, and the studentis gradually introduced to the more difficult parts ofthe subject. The book is up-to-date, well arranged,splendidly illustrated, and altogether a work forcongratulation. A criticism might be made that thereis, perhaps, a little too much chemistry and physicalchemistry about it. But at a time when these subjectsare finding such extensive applications to medicalproblems, it is, perhaps, just as well to include thoseparts of them which bear some relation to physiology.We are glad to see that the author has included someaccount of histology.

INDIVIDUAL PSYCHOLOGY.

By ALFRED ADLBR (Vienna). Translated byP. RADIN, Ph.D., Associate Professor of Anthro-pology at California University. London : KeganPaul. 1924. Pp. 352. 18s.

Dr. Adler has claimed the title of " IndividualPsychology " for his well-known theory of disturbedmental processes, though it is unlikely that the law ofpriority would support his claim. The theory is

simple. Thwarted ambition or a sense of organic

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inferiority finds a spurious satisfaction through theneurotic symptom, and the " will to power," with itsvariant the " masculine protest " of the woman orweakly man, is made the basis of all the neuroses andsome at least of the psychoses. Most psycho-patho-logists agree that the neurotic symptom has not only acause but an aim, and that the explanation of the aimis to be found in the dispositions, infantile or other,of the patient, but it is doubtful whether this aim canbe usefully brought under an exclusive conception suchas Adler provides. Nervous insomnia, for example,is an " arrangement " by which the patients demandthat they be spared certain work and are able to forcetheir own will upon other people (p. 165). Suchsimplicity is attractive till we find the same pathologyapplied to melancholiacs, who by their behaviour" become the centre of attention of their limited circleand are able to induce those individuals who feelobligated to help them to increased activity, to note-worthy sacrifices on their behalf, and always to makeadvances to them " (p. 249). When we read, too,that " A cure will take place.... as soon as he[the melancholiac] has enjoyed the satisfaction ofhaving demonstrated his superiority" (p. 252), weseem to be in presence of a superficiality of observa-tion surprising in what is described on the wrapper as"the Classic of Individual Psychology." These dictaconcerning melancholia are not set out tentatively,but appear under the heading of

" Individual Psycho-logical Results obtained from a Study of Psychoses."They are in conformity with the general character ofthe book, which seems to have been written with animpetuosity indicated on p. 349,where the author says:" I am quite at sea as to what can be done in an ageof intensified demoralisation like ours. The correctand proper thing is clearly to act immediately."This, however, is the only glimpse the author givesof any doubts he may have ; the assertive mannerwhich begins in the preface and is continued throughoutwill be regretted by those who believe that Adler’stheory presents an aspect that exists in many neuroticdisorders and must be studied in conjunction withother aspects.

COLONIC THERAPY IN THE TREATMENT OF DISEASE.

By 0. BoTO SCHELLBERG. New York : AmericanInstitute of Medicine, Inc. 1923. Pp. 202.THE nature of this book is such as to induce caution

on the part of the reviewer. Its title-page gives no clueas to the qualifications of its author, its publishers arean

" Institute," which at first sight appears to beconnected with the more commercial aspects of our

Iprofession. At the same time, the volume is wellwritten, well illustrated, and supplied with a brief Ibut authoritative series of references. The book is aplea for the treatment of many diseases by a verythorough and complicated system of colonic irrigation,the results claimed being, if not extravagant, at leastsufficiently startling to make the sceptical readerdemand further proofs before accepting them. Theauthor, after quoting at great length from Dr. RobertHutchison’s masterly address on the ChronicAbdomen," claim.s that, in such cases, " had thecaecum been reached and treated as it should be,every symptom he describes with such exquisiteprecision would have disappeared." The book isinteresting, but we remain unconvinced.

THERAPEUTICS.Traité elementaire de clinique therapeutique. Eleventhedition. By Dr. GASTON LYON, Ancien Chef deClinique Médicale a, la Faculté de Medecine deParis. Paris: Masson et Cie. 1924. Pp. 1406.Fr.85.

THIS is a text-book of medicine with a strong leaningto treatment. What the writer has to say about thediseases themselves is generally in small print ; thetreatment is in more prominent type. It is thus easyfor the reader to determine whether he will study the

disease as a whole or will merely cull the treatment.This edition is, as the advertisement of the book says,entierement refo-ndue it is, as a matter of fact,well purged of old material, for it is some 400 pagesshorter than the last edition, but it is quite up to datein recent work. The use of bismuth in syphilis, ofinsulin in diabetes, both receive good notice. Thatfield of treatment to which anaphylaxis and theuse of colloids enter, a field of which the final value isstill so difficult to gauge, is well covered. The placingtogether in this section of treatment of shock andtreatment by shock provides an instance of the subtlecontrast which is so dear to the French mind. Thisbook maintains the position it has formerly gainedof being a first-class one for the practitioner whowants to keep level with the ever-advancing wave oftreatment.

DISLOCATIONS AND JOINT FRACTURES.

Second edition. By FREDERICK COTTON, A.M.,F.A.C.S., Visiting Surgeon to the Boston (Mass.,U.S.A.) City Hospital. London and Philadelphia :W. B. Saunders Company. 1924. Pp. 745. 50s.

THE first edition of this sound and original workappeared in 1910. It was to be expected that this after-war edition would bear evidence of the influence onpractice of the experience gained in military hospitals.It is somewhat surprising, therefore, to find how littlethat experience has affected civilian practice as it isrepresented by Dr. Cotton, who, however, takes careto tell us in his preface that his conclusions are basedalmost wholly on his own military hospital practice, yand not from " a re-hashing of the bewilderingprinted and rumoured war-time reports." He is notenthusiastic in favour of the use of Thomas’s splintsfor fractures, except as a temporary transportationmeasure, or combined with the Balkan frame. Hisexperience seems to have been unfortunate, for hespeaks of the occurrence of

" horrid perineal sloughs "due to the use (or abuse) of this splint. Speaking ofinjuries of the upper extremity, of " arm tractiondownward, Thomas splint," he says: " I see noexcuse for this arm traction thing." As regards theoperative treatment of fractures, he thinks that thetendency of to-day is to minimise the use of inlaygrafts, plates, and bands, and other " stunt " operativemeasures.

Evidently Dr. Cotton is a real master of his ownmethods, so that, perhaps, his results are not likelyto be improved by his adoption of other methods,based on different principles. Anyway, the treatiseis replete with information on the pathology andmechanism of fractures and dislocations, and withsound practical advice as to their treatment. Itcontains 91 pages and 192 illustrations more thanthe first edition.

JOURNALS.

JOURNAL OF PHYSIOLOGY. Edited by J. N. LANOLBY,Sc.D., LL.D., F.R.S. Vol. LIX., Nos. 2 and 3.Cambridge University Press. 1924. Pp. 99-258.13s.-The Effect of Cerebral Anaemia upon BloodPressure and Respiration, by Ff. Roberts. This com-munication deals in detail with the effects of anaemiaupon the medullary functions. The experiments wereall performed upon anaesthetised (urethane) rabbitsand cats, with exception of two upon dogs (morphia).It was found that both the vaso-motor and cardio-inhibitory centres are directly stimulated by a slightdiminution in their blood-supply. The resultinginhibition checks and sometimes annuls the rise ofpressure which vascular constriction tends to produce.The respiratory centre is totally insensitive to diminu-tion in its blood-supply until this diminution becomesextreme. Gasping is a modification of the nervousmechanism acting as a whole and is not due to theaction of a separate centre. When the medulla iscompletely or almost completely anaemic, injectionof lactic acid directly into a cerebral artery stimulates