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Reviews and Notices of Books.d Mamcal of Medicine. Edited by W. H. ALLCHIN, M.D.,

F.R C.P. Lond., F.R.S. Edin., Senior Physician andLecturer on Clinical Medicine, Westminster Hospital,Examiner in Medicine, Naval Medical Service. Vol. V.,Diseases of the Abdominal Organs. London : Macmillanand Co., Limited. 1903. Pp. 687. Price 10s.

Tms volume is a comprehensive one and contains articleson diseases of the digestive system and of the liver ; on

diseases of the peritoneum and of the vessels of the

abdomen ; on diseases of the kidneys ; and on diseases of theductless glands.

The digestive organs are first discussed. The generalanatomy and physiology of these organs are admirablydescribed by Dr. Allchin and then follows a well-written disquisition on Food and Diet by Dr. R.Hutchison. His remarks on the digestibility and absorb-ability of foods are worthy of close attention. He showsthat the physical form of a food has more influence uponthe eaEe with which it is digested than any other con-

sideration. Fineness of division greatly facilitates solutionin the stomach. On the other hand, all tough and hardarticles of diet are dissolved with difficulty, while the

presence of much fat in the interstices of a food militates

against rapid disintegration by preventing the readyingress of gastric juice. The quantity of any articleeaten has less influence on its digestibility than its con-sistence. Doubling the quantity, for instance, does notmean doubling the time required for digestion but onlyprolonging it by about one-half. Dr. Hutchison furtherdraws attention to the influence which certain accompani- iments of meals have upon the rate of digestion. Hestates that water is almost devoid of any influence unlessthe amount taken is excessive ; hot water even acceleratesdigestion. Tea and coffee delay it, both in the mouth andthe stomach, but alcoholic drinks have " astonishingly littleeffect" and, so far as the stomach at least is concerned,may even accelerate the process by promoting a flow ofgastric juice.

Equally interesting are the observations of Dr. W. S.

Lazarus-Barlow on the Bacteria of the Alimentary Tract. He

points out that the experiments of Schottelius tend to showthat the enzymes are incapable of exerting their full poweruntil aided by the bacteria which appear normally in theexcreta in thirty-six hours after birth ; therefore it wouldseem that the organisms found in the alimentary canal are ofservice to the economy of their host. Dr. Lazarus-Barlowconsiders that it is certain that the bacteria in manyinstances assist in the breaking down of proteid matter butwhether the less complex substances produced in this waycan be, and are, utilised by the body at large for its nutritionappears to be doubtful. It has, however, been shown that inlife under completely aseptic conditions the faeces do notcontain phenol, cresol, indol, skatol, or pyrocatechin, sub-stances found in the faeces of animals living under ordinaryconditions. Dr. Lazarus-Barlow sums up the whole questionby saying that "at the present time there is a tendency tobelieve that although the bacteria in the alimentary tractplay an extremely important part in inducing intestinal

putrefaction, they only act in this direction and do not pro-duce bodies which are utilised by the body to its advantage."

Diseases of the Mouth, Pharynx and (Esophagus are ablydealt with by Dr. Bertram L. Abrahams and this sectioncontains much information with regard to the diseaseswhich may affect those organs.The portions of the volume which are devoted to a con-

sideration of the Diseases of the Stomach and Intestineshave been written by Dr. Allchin. The observations on

etiology and pathology are full and complete, containingthe most modern views on those subjects. Then followsome extended remarks on the general symptomatology ofgastro.intestinal disease which will well repay perusal.The symptomatology and treatment of the individual dis-eases affecting these organs are considered seriatim. We

question whether it is a good plan to separate causationand pathology so entirely from the clinical aspect of diseaseas is entailed by the plan thus adopted. If, for instance,a reader wishes to obtain information on "gastric" or"peptic" ulcer he will have to search in three separatesections before he can attain his object. We are of opinionthat the old method of considering the various aspects ofeach malady (etiology, pathology, symptoms, and treatment)under the heading of that particular disease is to be pre-ferred. It is certainly more convenient for reference andless confusing to the student.The article on the Physical Examination of the Stomach

and Intestines and the Analysis of the Gastric Contents isby Dr. Bertrand Dawson and in it are described the modernmethods which are employed as aids to diagnosis in gastricand intestinal affections.The Diseases of the Liver are considered by Dr. R. G. Hebb

and Dr. Alexander Crombie. The article on Hepatic Abscessis a particularly interesting one and the etiology is discussedin a most instructive manner. It is shown that althoughthe maximum frequency of this disease corresponds to a zonecomprised within the isotherms of 75° and 80° F., yetheat has probably only an accessory influence and theessential cause of the greater seasonal prevalence is therelative prevalence of dysentery at the same seasons, forall hot countries are not equally noted for the occurrenceof hepatic abscess. Attention is also drawn to the influenceof race. A comparison of the returns of the army of Indiashows that the mortality from this affection is thirty-twotimes as great among European as it is among native troops,and this notwithstanding the greater prevalence of dysenteryamong native soldiers. The influence of age, sex, length ofresidence in the affected district, alcohol, and chill, and thecausal relationship of dysentery and other septic foci inthe intestines are also duly commented on.

Dr. W. Hale White writes on Diseases of the Perito-neum. In considering the treatment of tuberculous perito-nitis the question as to the performance of laparotomynaturally receives full attention. Dr. Hale White arrivesat the conclusion which is now generally held-namely,that the best results are obtained in those cases in whichthere is a large amount of ascitic fluid free in the peritonealcavity. It is true, as he points out, that these are just thecases which give the most favourable results when treatedwithout the intervention of the surgeon but on the otherhand they are the cases in which the operation is easiestand he therefore urges that as the mortality as a result ofthe operation is in all cases so low laparotomy should beperformed on such cases if circumstances prevent fresh andabundant food from being satisfactorily made use of or if,these having been tried, the progress is slow. We quiteagree with him that the cases in which operation is mostvaluable are those in which there are much ascites and some

j fibro-caseous change in the peritoneum but in which theadhesions are not numerous or dense enough to prevent theevacuation of the fluid.

Dr. J. H. Bryant contributes a short article on Diseases. of the Abdominal Vessels.

I Diseases of the Kidneys are considered by Dr. J. Rosei Bradford. His observations, though brief, are perhaps the

most interesting in the volume. In dealing with the. etiology of renal disease he draws attention to the factI that it has long been recognised that certain affections ofl the kidney, as for example some forms of Bright’s disease,

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have in many instances a toxic origin, but it is only recentlythat the view has gained ground that all forms of so-callednephritis and probably every variety of Bright’s diseasehave a similar origin. Dr. Bradford enters into a discussionas to the nature of these toxic substances and we can

recommend to our readers a careful study of his remarks.He is a strong supporter of the value of milk in the treat-ment of chronic Bright’s disease and recommends that whenuraemic symptoms are present or when dropsy occurs thepatient should be put to bed and kept on a rigid milk dietuntil the urgency of the symptoms has subsided.The description of the Diseases of the Ductless Glands

is divided between Dr. Sidney Coupland and Dr. Abrahamsbut, as the most important diseases in which these glandsare involved have been already dealt with in the earliervolumes of this manual, this article is a short one. It con-

tains, however, va’uable information on diseases of the

spleen, lymphadenitis, and tuberculosis of the lymphaticglands. Diseases of the thymus gland are also discussed.

Diseases of the Throat and Nose. By CHARLES HUNTOONKNIGHT, M.D., Professor of Laryngology, Cornell Uni-versitv Medical College ; Surgeon, Manhattan Eye andEar Hospital, Throat Department, &c. With 147 Illustrations. London : Rebman, Limited. 1903. Pp. 423. Price13s.

AFTER a careful perusal of this work we have no hesitationin congratulating Dr. Knight on the results of his labours,for the book is one which commends itself equally to thespecialist and to the general practitioner who wish to obtainsound information on the subjects of which it treats. Theauthor’s diction is easy and his style is simple and the variousconditions which are matter of dispute have the currenttheories relative to them clearly and lucidly explained.The anatomy and physiology of the nose are briefly butsum Gently dwelt upon and-rightly we think-the physio-logy of the nose is curtailed and reduced to such state-

ments as are necessary to guide the medical man in hisattempts to restore the nasal passages to an approximatelynormal conditions. Dr. Knight next deals with the methodsof exarnina5ion and the instruments necessary for this

purpose. This section is, perhaps, too brief and the

suggestion that sunlight should be utilised for examinationclearly shows that the author has never been subjectedto the inconvenience which results from the use of sucha powerful illuminant.The next chapter, which treats of Acute and Chronic

Rhinitis, is especially good from the clinical point of view.The pathological histology, however, is not so minutelydetailed as was to be expected in a book of this size anddescription. We next find an account of Atrophic,Membranous, Caseous, and Purulent Rhinitis. Atrophicrhinitis is described as a necessary corollary of pre existinginflammation, one of the few statements with which we

are inclined to disagree. If Dr. Knight had perused theadmirable paper by Professor Moure, read at the Inter-

national Congress of Medicine held at Madrid last year,

together with the other papers contributed on this sub-

ject, we think that he would have recognised that thereexist developmental errors in the nasal cavities which are

responsible for a proportion of cases of atrophic rhinitis.With this exception, and especially in the treatment of thisdisease, Dr. Knight’s recommendations are most happy. In

membranous rhinitis, which is very briefly considered, the

impression given is that the pseudo-diphtheritic bacillus isalmost invariably present. Caseous rhinitis has sufficientattention devoted to it, a point not usually observed in booksof this description. Diseases of the accessory sinuses

and their treatment are treated in a way to leave

but little room for adverse criticism, though we shouldhave liked to see some reference to the methods of opera-tion adopted by Killian. Especially valuable are the

remarks on me sources or error in transiiiummation. in

septal operations Asche’s method, where it is suitable, hasDr. Knight’s approbation. In nasal polypi we find the

pathological standpoint fully investigated. Neoplasms-benign and malignant-specific disorders, epistaxis, and.nasal hydrorrhoea receive adequate treatment. In the descrip-tion of hay fever we notice that Dr. Knight does not mentionthe serum treatment, which has within the last 12 monthsbeen prominently brought before the profession. In Diseasesof the Pharynx the adenoid operation is very fully described.There is an excellent, though brief, description of Yincent’sangina. The last section is devoted to the Larynx. In the-

chapter on Anatomy and Physiology the character of the-voice is said to be modified by the changes taking place inthe vocal cords, the varying size of the glottis being left oufrof consideration. The methods of examination and the

general therapeutics are again rather too briefly considered,for if instruction is needed that instruction should be full.In the account of acute laryngitis we are a little surprisedto see that the influence of nasal obstruction is not touched

upon. Chronic laryngitis in all its forms is grouped under one-heading. Neoplasms, especially benign, receive a very excel-lent description and here we find that the influence of nasalobstruction used in its widest sense-that is to say, includingpost-nasal adenoids-is fully recognised as an indirect cause-in their development. Malignant disease of the larynx isvery carefully described, the subject being brought fullyup to date ; and tuberculosis of the larynx receives an-amount of consideration which is amply justified by the-frequency and the importance of the disease. In his other-wise excellent account of the clinical appearances notedin this pathological condition Dr. Knight says that the surrounding parts of an ulcer are pale. This, however, is notusual. Under the heading of treatment it is recommendedthat the patient should be kept in a uniform temperature, a,suggestion which is not entirely borne out by those expe-rienced in the open-air treatment of consumption. In specific-disease of the larynx, while all other conditions receive fall’

recognition, stenosis is dealt with in one short sentence.

Neuroses, laryngismus stridulus, paralyses, and the presence-of foreign bodies receive attention.

This work, admirable in its production, will be of greatvalue to students and practitioners of general medicine andin directing their attention to it we have confidence that theywill find it most helpful and instructive.

A Narrative of Medioine in America. By JAMES GREGORY"MUMFORD, M.D., Assistant Visiting Surgeon to the-Massachusetts General Hospital and Instructor in

Surgery in the Harvard Medical School. London and

Philadelphia: J. B. Lippincott Company. 1903. Pp. 508..THIS book, wbich is dedicated to Professor William Osler, is

’

a narrative dealing with medicine and the medical profession,The author’s object has been to take some of the conspicuousAmerican physicians of each era in their proper sequence, to

. tell the story of their lives and their doings, and thus to illus-trate the whole history of medicine in America by a seriesof pictures. He hopes that the story will show the reader-something of the meaning of medicine and of the life of its

votaries. The narrative practically ends with the Civil. War or about the middle of the last century, as for obvious-

reasons it has seemed best not to bring it down to the

present day. Chapters are, however, added on Ether, on

s the Founding of the American Medical Association,s and on Some Tendencies in Modern Medicine. In thet introduction the author briefly glances at the contem-s porary conditions, political and scientific, in Great.s Britain, which the early immigrants called "home," to.

e see on what bases English and American medical men1 of the seventeenth and eighteenth centuries had to build.,- The age was not a great one for scientific progress, bute progress there was, and our profession struggled out of an

307

Egyptian darkness towards the present light. For the pu

purpose of the narrative the colonial days of America are bedivided into two eras which correspond roughly with two in,centuries : the seventeenth century, a time of colonisation, th

struggle, and privation ; and the eighteenth century when oh

towns were being built, when commerce was beginning to in

thrive, and schools and colleges were appearing in the land. thThe medical history of the one era is quite distinct from that giof the other. To the first belongs the practice, remote and th

inadequate, of Elizabethan England ; to the latter the wider mknowledge of American-born men and the early attempts to pacombine the wisdom and teaching of the Old World with the 01changed experience of the New. b(The book deals not only with the evolution of the medical qu

man but with the inception and development of American of

hospitals, schools, and universities. In the early history of de

American science great names are lacking and great events et

as well, yet in so far as the men of those days stirred up the gc

"Assembly " to pass laws regulating practice they were wise m

in their generation and did good service. The truth of what ei

Dr. J. S. Billings has said of his country is demonstrated in a

these pages. In " A Century of American Medicine " he r(

wrote : ’’ We have had, and still have, a very few men wholove science for its own sake, whose chief pleasure is in

original investigations, and to whom the practice of theirprofession is mainly, or only, of interest as furnishingmaterial for observation and comparison....... Of the S

highest grade of this class we have thus far produced no uspecimens : the John Hunter, or Virchow, of the United EStates has not yet given any sign of existence."

"

Many of the tlstories told in Dr. Mumford’s book are not new but the S

method of the telling is, we think, just and honest and ilthe author’s meaning is conveyed in a way which charms ’*-

the reader. t

Some 30 pages are devoted to the tale of the famous Mdiscovery of the anaesthetic properties of ether, America’s s

greatest contribution to medical science in the last century. vThe words of the venerable Jacob Bigelow uttered at the x"Semicentennial of Anaesthesia" bring this section of the Cbook to a most fitting conclusion. 1

Before finishing this retrospect the author notes the

gradual levelling up of the masses of the profession andremarks that the country districts are not being properlyfurnished with medical men ; whereas, on the other hand, vin the cities the supply of highly trained practitionersgreatly exceeds the demand. The available statistics showthat only about one-fifth of the men who have passedthrough the Harvard school during the years 1892-1901 are pure specialists and that in this conspicuous group of highly’trained men there appears no increasing tendency to

abandon "general practice." Among the "pleasures of the doctor’s life" the author writes of the fascination of

work and study, of the ever-present sense of somethingaccomplished, of the stimulation of great responsibility,and of the study of the strength and weakness of humanity-the latter an inexhaustible, fascinating, pathetic, sometimescontemptible, and often terrible field, which makes its

votaries either sneering sceptics or, more often we hope,great-hearted philosophers. The last chapter of the bookis one which will bring pleasure to any member of the

profession who peruses it. Dr. Mumford has given to us asolid contribution towards the history of the profession inthe New World.

Milk: its Production and Uses. By EDWARD F. WILLOUGHBY,M.D., D. P. H. Lond. London: Charles Griffin and Co.,Limited. 1903. Pp. 259. Price 6s.

THERE is no doubt that if every farmer and dairymanknew the ways and means by which milk may become avehicle or a factor in the spread of disease greater carewould be exercised in the clean production of milk and a

purer supply would be the outcome. This book aims at

being a manual by which information on the points concern-ing the relationship of milk and disease may be conveyed tothe cowkeeper and dairyman. That is a very excellent

object and the author has done well to emphasise hisintentions. The chapters on breeding, on the management ofthe cow, and on the construction of cowsheds and dairies

give evidence of the author’s practical acquaintance withthe subject but we think that the sections on milk analysismight have been well left out. It is quite a separate de-partment and one which has little concern for the breederor keeper. Besides there is a superabundance of handybooks on the composition and analysis of milk, on the

question of preserving milk, and on bacteriological methodsof examination. Chemical analysis has nothing whatever todo with the supply of milk free from disease-producingentities. The author is the inspector of the farms of, andgeneral scientific adviser to, a large dairy company supplyingmilk to the metropolis and certain suburbs, and the experi-ence which he gains in .this capacity must be valuableand should be helpful to those who are anxious to provide areally sanitary milk-supply.

LIBRARY TABLE.

The Causation and Prevention of Malarial Fevers: aStatement of the Results of Researches. Drawn up for the

use of Assistant Surgeons, Hospital Assistants, and Students.By Captain S. P. JAMES, M B. Lond., I.M.S. Issued under

the authority of the Director-General of the Indian MedicalService. Second edition. Calcutta: Office of the Super-intendent of Government Printing, India. 1903. Pp. 52.Price Ru. 1, or 1s. 6d.-The first edition of 5000 copies ofthis pamphlet was, the Director-General of the IndianMedical Service tells us, soon exhausted. In preparing asecond edition Captain James has enlarged the scope of thework so as to make it an easy introduction to the study ofmalaria. We have read this little publication, which is fullof pertinent information and excellently illustrated, withboth interest and profit and may congratulate CaptainJames on having performed a very useful wcrk. It is quitewhat it pretends to be and gives a clear, well-arranged,and capital resunae of the subject and may be accepted andused as a scientific and practical guide by those for whom itwas designed.Lehrbuch und Atlas der Zahnheilkunde nait Einschlu.ss der

Mundkrankheiten. (Manyual and Atlasnf Diseases of the Teethand Mouth.) By Dr. Med. GUSTAV PREISWERK. Munich :J. F. Lehmann. 1903. Pp. 352, with 152 Illustrations.Price 14 marks.-This volume includes those specialsections of anatomy, physiology, and pathology which havea direct bearing on dental surgery and the author has withinthe comparatively small space at his disposal succeeded inproducing a useful text.book. In the early chapters theanatomy of the teeth and of associated parts is described,the text being accompanied by serviceable illustrations. Inthe following chapters the various affections of the buccalmucous membrane and the more common tumours affectingthe jaws are considered and there is a short, even perhapstoo meagre an account of the bacteriology of the mouth.The author might with advantage have extended the accountgiven of abnormalities in position of the teeth and a recentlypublished book might have been expected to contain moreup-to-date methods of treatment. In dealing with the

pathology of the pulp the classification of Arkovy andRothmann is adopted. The different affections are clearlydescribed and some excellent illustrations are given.Throughout the book the technique of operative measuresis only briefly treated and in some instances the methodsadvocated are open to adverse criticism.

Précis d’Anatomie Dentaire. By J. CHOQUET. Paris