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Reviews and Notices of Books.SOME MEDICAL ASPECTS OF OLD AGE.

By Sir HUMPHRY ROLLESTON, K.C.B. London :Macmillan and Co. 1922. With nine plates.Pp. 170. 6s.

THIS expansion of the Linacre Lecture given inSt. John’s College in Cambridge in 1922 is just thescholarly fragment of pleasing erudition that we shouldexpect from the President of the Royal College ofPhysicians of London. Without attempting anythinglike a complete account of old age and its many prob-lems, he reviews some ancient and modern medicalaspects of the subject, ranging from an analysis ofthe twelfth chapter of Ecclesiastes to a considerationof last year’s work by Carrel and Brailsford Robertson.Like all good books, this small volume suggests asmany questions as it answers. One thing is constantlyin evidence-that the serious study of senescence hasreceived an extraordinarily small amount of attention,perhaps because the young, who have the capacity todo it, are not often interested and the old are likelyto think it not worth while. What can be achieved inour various retreats for the aged has recently beenshown in the valuable studies of Drs. R. J. C. Thompsonand R. E. Todd 1 among the pensioners in the RoyalHospital at Chelsea, and there is need of muchfurther work of this kind.The author accepts 100 as being about the time

when physiological old age, uncomplicated by patho-logical processes, may be expected to bring life to anend, and he attributes the considerable increase in themean expectation of life at birth which has occurredin the last 50 years to greater success in evadingdisease rather than to our having any greater inherentcapacity for life than our ancestors. It is, however,a little anthropocentric to call this the " natural "duration of life or to stress the epithet in " physio-logical " senescence. For each organism the naturalworld contains other organisms which are harmfuland destructive, and the " natural

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span of life ofany live thing depends on the balance between thewill to live and these opposing agencies. For manone may assume that natural life would generallycome to an end when his physical powers began everso little to fail and when the loss of elasticity in thelungs, the dying of the aorta, the onset of glomerularsclerosis in the kidneys and similar changes giveanatomical evidence of regression ; in other words, atabout 35. And it is the progressive achievement ofman that he has made himself more and moreunnatural in his dissociation from the economy ofthe live world in general. At present he has about doubled his natural life ; whether by further luck ormore cunning he will achieve a humorist’s ideal of300 remains to be seen ; probability seems muchagainst it. Another point of some moment arises in- connexion with the attempt to analyse the physicalchanges in old age and to correlate structural characterswith longevity. At first sight simple, the problem isreally difficult to get at since when we examine theaged we are dealing with a population which has beenselected by one of the factors which we are con-

sidering. If, for example, a number of old peopleare lighter or have larger hearts, either absolutely orrelatively to their body-weights, or are of more

cheerful spirits than a number of middle-aged persons,do they have these qualities because they are old orhave they survived to an unusual age because ofthese peculiarities? The question can be answeredonly by comparable data about those who, originallybelonging to the same series, failed to survive or,more practically, by the mass information of individualhistories of sick and healthy people which is one ofthe greatest needs for medical progress in manydirections. And if we have ’’ fresh air, meagre fare,freedom from care," we may live to see it satisfied.

1 THE LANCET, 1922, i., 874 ; ii., 503.

MEDICINE AND DENTISTRY.

Lehrbuch der Grenzgebiete der Medicin und Zahn-heilkunde. Second edition. Edited by DrJULIUS MISCH. Leipzig: F.C.W.Vogel. 1922. Intwo volumes. Vol. 1.: Pp. 671, 237 illustrations.Vol. II.: Pp. 672, 351 illustrations. M.1425.

THESE handsomely produced volumes deal withthe border-line between medicine and dentistry andcontain a large amount of interesting information.As may be judged from the size of the book, the term" border-line" is interpreted in a wide sense, the" line " including not only those diseases in whichdental conditions may stand in a causal relationship,but also all diseases in which there are oral symptoms.The plan of the book is ingenious. It is divided into

a series of sections on internal medicine, neurology,and diseases of children, written by experts in thosebranches. The subjects are dealt with from thegeneral aspect, but always with a clear idea of anydental significance which they may present. The-knowledge of dental conditions possessed by themedical contributors to the book is encouragingly full.To bring out the dental aspects of the various diseasesinto greater clearness, comments of varying lengthby the editor, Dr. Misch, are interspersed throughoutthe text, in such a way as to be easily distinguishablefrom the statements of the other writers. It willbe seen from this that these volumes have no counter-part in this country, though they might well be-imitated. Of their value to dentists there can be-no doubt, and it is equally certain that few doctorscould peruse these pages without profit. For thedentist to be able to extract the full value out of thework a considerable knowledge of general medicineis necessary, so that it is better adapted to the graduatethan to the undergraduate.The dental part, which is by Dr. Misch, is not limited

to well-ascertained facts but is a compendium of agreat number of views which have been put forwardby different writers, sometimes highly speculativeand still awaiting confirmation. It is stated that ininfluenza toothache is a frequent symptom ; thetooth pulp is often inflamed, and Pfeiffer’s bacillushas been isolated from it. Misch infers that thisdisease has a specific action on the pulp. A goodaccount of the dental stigmata of congenital syphilisis given, and the various views which have been putforward at different times to account for the presenceof " Hutchinson " teeth are fully quoted. Mischdoes not agree with Pasini that they are due to localaction of the syphilitic virus (the view also held byJonathan Hutchinson), and considers that they arethe result of a general trophic disturbance possiblyreinforced by local infection of a secondary character.The latest view of Kranz is also given, that these teethare caused by a syphilitic disturbance of the ductlessglands. The section on haemophilia and allied conditionsis good; according to Wrobel, the loss of teeth, eithernaturally or by extraction, is the commonest causeof death in haemophiliacs. Among various forms oftreatment, remedial or prophylactic, Misch recom-mends the local application of plugs dipped in 10 or20 per cent. of gelatin ; the subcutaneous injectionof hydrastinum, a preparation of Bayer, is said to beuseful in treating dental haemorrhage. As a prophy-lactic measure X ray applications to the spleen are-stated to be useful. The section on diseases of theductless glands and their possible relation to theteeth is treated with caution. The work of R.McCarrison on the thyroid is not mentioned. In theaccount of diabetes it is stated that stomatitis is anearly symptom ; indeed, Misch says that if a well-fitting denture suddenly begins to hurt without anyobvious cause, the possibility of diabetes should beconsidered and the urine tested. Stomatitis is alsosaid to occur as an early sign in leukaemia.The volumes are profusely illustrated and the

technical excellence of the drawings, both plain andcoloured, deserves especial praise. Dr. Misch and hiscollaborators have made a valuable contribution todental and medical literature.

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’CHEMISTRY OF PLANT PRODUCTS.

An Introduction to the Chemistry of Plant Products.Vol. II., Metabolic Processes. By PAUL HAAS,D.Sc., Ph.D., Reader in Plant Chemistry in theUniversity of London, University College; andT. G. HILL, A.R.C.S., F.L.S., Reader in VegetablePhysiology in the University of London, UniversityCollege. London: Longmans, Green and Co.1922. Pp. 140. 7 s. 6d.

THE subject, as indicated by the title, deals withthe chemistry of plants in relation to their physiology.’The chief problems dealt with are the synthesis inthe plant tissues of fats, carbohydrates, and proteins,respiration, and growth. Much of the subject-matteris of interest from the point of view of general bio-chemistry—e.g., the parts dealing with the synthesis- of fats and proteins, and especially those dealing withthe oxidative processes. Hormones and vitaminsalso play their parts in the plant economy, andfurther stress the resemblance between plant and- animal metabolism in certain of their aspects. Thebook is a welcome addition to the theoretical literatureof general biochemistry, and its convenient bulk will- make it useful to students reading for science degreeswith honours in botany, or for those taking biologicalchemistry as a subsidiary subject. It is so well-written and thoroughly digested that it will also:appeal to many who read widely on chemical lines,whether they are directly interested in biochemistryor not. We should be glad to have a volume dealing- with general plant physiology in as clear a manner as- this one deals with the biochemistry of plants.

PSYCHO-ANALYSIS.Fundamental Conceptions of Psych o-analysis. ByA. A. BRILL, Ph.B., M.D., Lecturer on Psycho-analysis and Abnormal Psychology, New YorkUniversity. London: George Allen and Unwin.1922. Pp. 344. 12s. 6d.

Dr. Brill, who is well known as a translator ofFreud’s works and an original writer on psycho-analysis, begins this book with a historical account ofthe development of psycho-analysis from the early’" cathartic method " of Breuer and Freud, and thendescribes the nature and function of the neuroticsymptom, the psychology of forgetting, and thepsycho-pathology of every-day life ; the last subjectis illustrated by examples from his own experienceand forms a most interesting chapter. Wit is analysedand explained as affording the opportunity of enjoyingthose primary pleasures, such as sexual exhibitionismor the hostile tendency, that civilisation and thehigher education have found inacceptable. Dreamsreceive lengthy notice on the usual analytical lines,and a short chapter on fairy-tales ends with a com-parison of ultra-modern art and the productions ofthe insane.The author occasionally offends by facile dogmatism,

as on p. 39, when lie says that the sufferer fromalcoholic insanity sees snakes " because of certainpoisons in the nerves of the retina"; and again onp. 50, where we read, " If one forgets in any realsense of the word he has some organic brain troublewhich can be diagnosed by a physician or a neuro-logist in about ten minutes." The explanation ofinsanity as the fulfilment of a wish may be correct,but its presentation on p. 38 makes the process seemfar more simple than experience with the insanewould teach ; the case described appears to be ahysterical outbreak and not a psychosis in the usualsense of the word. A later chapter on common formsof insanity is redundant, since no attempt is made tobring the different forms into relation with psycho-analytical theorv.The author does not go deeply into theory, but his

’book gives, within its limits, a good general accountof the subject. It holds a position half-way betweena popular and a technical exposition and is suitable- for those making a first acquaintance with the literaturedof psycho-analysis.

HUMAN PHYSIOLOGY.A Text-Book for High Schools and Colleges.Third edition. By PERCY GoLDTIIwAIT STILES,Assistant Professor of Physiology in’ HarvardUniversity. London and Philadelphia : W. B.Saunders Company. 1922. Pp. 425. 12s.TEACHERS of physiology in high schools, or for that

matter, in the universities and medical schools too,often feel the need for a small text-book which, whilesuited to the requirements of beginners, is yet nottoo childish in outlook. Dr. Stiles has struck theright note in this excellent little volume, making aplace for himself in the front rank of writers onphysiology. In language easy to follow, yet correct instyle, he deals with the very difficulties which everystudent new to the subject encounters, and in spite ofthe pains he takes to explain elementary points, itis surprising how much information the book holds.Anyone can, with diligence, produce an advancedtext-book of the compilation type, but it needs soundknowledge of the subject to write a convincingelementary book on a broad and philosophic plan,likely to stimulate the reader to wish for more. Wewish the author every success in future editions ofthis excellent manual.

TUBERCULIN TREATMENT.Recherches sur le " principe curateur" contenu dansla tuberculine. By Prof. J. GABRILOVITCH. Paris :Masson et Cie. 1922. Pp. 112. Fr.5.

Prof. Gabrilovitch’s book is a review of his ex-

periences with a tuberculin (T.P.G.) detoxicatedaccording to his methods, the principles of whichhe discusses. Considerable space is allotted to therecords of 30 cases treated by the author’s methods.The good results claimed would leave a more favour-able impression had not similar claims already beenmade, but not substantiated, by many other advocatesof special tuberculins. Possibly Prof. Gabrilovitch’stuberculin is superior to all the rest, but successivedisappointments have bred not only scepticism butalso impatience with the advocates of

" improved "tuberculins. Such impatience is, of course, deplorable,for almost every great discovery or invention has hadits forerunners whose failure to make good has barredthe way to progress. Prof. Gabrilovitch is handicappedby the ill-starred efforts of uncritical enthusiasts whosecapacity for auto-suggestion has been their undoing.Whether he deserves to be classed with his predecessorsin this field or not remains to be seen. He puts hiscase well, and time will prove how far it is a good one.

ELECTROLOGIE ET RADIOLOGIE.Third edition. By Dr. H. GUILLEMINOT, Professeura la Faculté de Médecine, Chef des Travaux dePhysique Biologique, Electro-Radiologiste des

Hôpiteaux (Hotel-Dieu). Paris : Masson et Cie.1922. Pp. 642. Fr.40.THE third edition of this book has been re-written

and greatly enlarged so as to be really a new work.It is divided into three parts. The first, whichoccupies 318 pages, deals with physics and electro-technics. Each kind of electric current is consideredin a separate chapter, each chapter being dividedinto sections dealing with the physics, mathematics,methods of production, application, and measurement.The indirect uses of electricity in medicine for thedriving of motors and converters, for the generationof ozone, for the production of heat, light, and ultra-violet light, are described in detail. About one-

third of the first part deals with the X rays in theirmathematical, physical, and electro-technical aspects.Radio-active bodies are described in a separate chapter.The second part, which contains 93 pages, is devotedto the description of the physiological action of thevarious physical agents considered in the first part.Under the headings of the constant and interruptedcurrents and condenser discharges are described thephysiological principles which underlie the determina-tion of the reactions of the excitable tissues, both in a

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qualitative and quantitative form. The laws of Weissare discussed and the measurement of the chronaxieis explained. The third part of the book (313 pages)deals with treatment by electricity, X rays, heat,light, ultra-violet rays, and ozone. This part contains16 chapters. Fourteen of these deal with the differentsystems of the body and the various diseases of eachsystem, suitable for treatment by the agents above-mentioned, are considered in order. The appropriatetreatment of each is described together with a noteon the clinical features of the disease and, whererelevant, the X ray examination or electrical test, as anaid to diagnosis. Diseases of the nervous system aretreated first and a section is devoted to the subjectof the testing of the electrical reactions of muscleand nerve. The other systems of the body are thenconsidered, while malignant diseases and the localisa-tion of foreign bodies are adequately dealt with.

This work is one of the most complete treatises onthe subject which has appeared. The first partcontains much that would be too advanced for themedical reader who is commencing his study ofelectrology and radiology. This applies more par-ticularly to those parts which deal with highermathematics. The elementary parts of physics areclearly described and are not inextricably interwovenwith mathematical calculations. The second partwill appeal particularly to the more scientific prac-titioner of medical electrology who wishes to explorenew territory and base his investigations on sure

ground obtained from knowledge of the effects ofelectricity on the normal body. The third part willinterest the largest number of readers. Treatment isclearly described, whether by electricity, X rays, orother physical agents, and the methods adopted bydifferent authorities are explained. Wherever X rayexamination is advisable the radiographic features ofthe disease are described and there are notes of theclinical features of most of the diseases.The book is well illustrated, well printed, and

indexed. Dr. Guilleminot, we regret to say. died onMarch 10th of this year.

BIBLIOGRAPHY OF HOOKWORM DISEASE.The Rockefeller Foundation, International HealthBoard, New York City. 1922. No. 11. Pp. 417.WORKERS in scientific helminthology will be grateful

to the Rockefeller Foundation for this useful publica-tion. It contains the most exhaustive and condensedaccount of ankylostomiasis in existence, havingover 5000 carefully tabulated references and a mostexhaustive author index as well as a list of periodicalsin alphabetical order. Emphasis has been laid on thesocial and economic aspects of the disease and theefforts to control it, rather than on the biology of theparasite. The cumulation of the literature has broughtout the interesting fact that four periods of activityin the production of literature in ankylostomiasis havetaken place ; the first in 1882, after the experience ofthe Saint Gothard tunnel; the second in 1003, whenits general extension in European mines was feared ;the third in 1910, culminating in the publication ofLooss’s monograph in 1911; and the fourth in 1917,when activity in combating the disease in many of thetropical and semi-tropical countries was at its height.

In the introduction to the volume references to thisdisease in the ancient literature are discussed. Thehistory of the discovery of the hookworm, the originof faecal diagnosis, the Saint Gothard epidemic, thedevelopment of vermifuges, and the discovery ofdermal infection are briefly set forth. Other sectionsdeal with the discovery of Necator americanus, thehistory of the campaign against hookworm in theUnited States, the extension of this work to manyparts of the world, the efforts to discover the idealanthelmintic, refinement in methods of diagnosis,the life of the hookworm larvae, especially their isola-tion from soil. The subject-matter is divided intoseveral sections containing concise and succinctaccounts which will henceforward be looked upon asclassical and correct statements.

AIDS TO TROPICAL HYGIENE.Second edition. By R. J. BLACKHAM, C.B., C.M.G.,C.LE., M.D., Colonel, A.M.S. London : Bailliere,Tindall and Cox. 1922. Pp. viii. + 240. 4s. 6d.

THIS little book has been considerably extended-indeed, practically re-written. It is designed to helpstudents for the D.T.M. and H., and those workingfor the promotion examination to the rank of majorin the R.A.M.C., and also to provide a handy pocket-book for practitioners in any part of the tropics.Since the war the science of tropical hygiene, as

apart from the treatment of tropical diseases, hasbecome so important that to deal with this subjectin a small volume is almost impossible. There arebound to be many omissions, but the essentialsappear to be present under every heading, and theresult is a useful book both from the point of viewof the student and from that of the medical officer.Possibly too much space is devoted to a descriptionof the various insects, arachnids, and animals thatare instrumental in spreading tropical diseases, atthe expense of more important subjects, such as-

sewage and refuse disposal and water purification.Anti-fly measures, which are of enormous importance-in hot countries, might have been dealt with more-fully. The only fly-trap mentioned is that designedby Dr. A. Balfour, which is much less efficaciousthan the roller-towel variety, making use of a

solution of arsenite of soda, treacle, and beer.On the whole the author is to be congratulated onthe way in which he has fulfilled a difficult task ofcompression.

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JOURNALS.BRITISH JOURNAL OF SURGERY.—In the October-

number of this journal Sir D’Arcy Power continueshis series of eponyms by discussing Paget’s disease.-The article on hydrocephalus by John Fraser andNorman M. Dott is an instructive survey. Theyintroduce a new and simple classification of theventricular and extra-ventricular types, and theydiscuss the aetiology, pathology, diagnosis includingventriculography, and treatment.-Zachary Copepresents a study of shoulder pain from the clinicalstandpoint.-E. A. Linnell contributes a note of acase of fibromyxoma of a nerve trunk.-J. B. Hume-discusses congenital diaphragmatic hernia.-J. S. B.Stopford reviews the results of 14 cases of resectionof nerves.-Two hundred and twenty-five operationsfor derangement of the knee are analysed by P. H.Mitchener, who amongst his conclusions states that" the full benefit of the operation is not to be expectedfor from two and a half to three years after its perform-ance."-G. P. Mills reports two cases of multiple polypiof the stomach.-R. E. Kelly publishes a case illus-trating the use of a wedged bridge graft in an ununitedfracture.-A. Piney brings forward strong argumentsto show that metastatic carcinoma in bones is due toan arterial or capillary embolus.-Lieut,.-C’ol. F. P.Connor considers some surgical aspects of filarial.disease.-A. P. Mitchell analyses 100 cases of operationin ununited fractures due to war injuries. Thefollowing rare and obscure cases are published :(1) metastatic melanoma of the scapula 18 years afterthe removal of the primary in the eye (F. D. Cairns) ;(2) gummatous pancreatitis resembling acute chole-cystitis (P. H. Mitchener) ; (3) a case of a calcifiedgland of unusual size, giving rise to dysphagia(G. P. G. Wakeley) ; (4) two unusual complications offemoral hernia ; in one there was an acutely inflamedappendix, and in the second an adherent Meckel’sdiverticulum (S. L. Ludbrook) ; (5) ulceration of therectum with perforation into the pelvic cavity andprolapse of the small intestine per anum (C. P. Cuff) ;(6) torsion of the gall-bladder (C. H. S. Frankau) ;(7) removal of a pin from the third part of theduodenum (E. E. Hughes) ; (8) pancreatic fibrosisobstructing both the common bile-duct and theduodenum (W. G. Spencer) ; (9) two cases of rupture-

i of the rectum, coxnmunicating with the pei--itonealcavity (W. G. Spencer).