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Reviews and Notices of Books.TREATMENT OF FRACTURES IN GENERAL PRACTICE.

By C. MAX PAGE, D.S.O., M.S. Lond., F.R.C.S., i

Senior Surgeon to Out-patients, St. Thomas’sHospital; and W. ROWLEY BRISTOW, M.B.,B.S. Lond., F.R.C.S., Surgeon to the OrthopaedicDepartment, St. Thomas’s Hospital. OxfordMedical Publications. London : Henry Frowdeand Hodder and Stoughton. 1923. With 142figures in the text. Pp. xi. +239. 12s. 6d.THE treatment of fractures until the late war had

fallen into rather a low estate, out of which the brilliantoperative treatment of Sir Arbuthnot Lane failedcompletely to rescue it. For the method of operationand plating was obviously inapplicable to the needsof general industrial practice, seeing that it couldonly be successful in a well-equipped hospital. Yetas the late Mr. Clinton Dent showed, the amount oftemporary or permanent disability after such a

comparatively minor injury as a Pott’s fractureof the fibula is very great and has a far worse effecton a workman’s earnings than many diseases, whichare cured by difficult and delicate operations. Forthese reasons we welcome this book. In it the simplestefficient methods of treating all the fractures that arelikely to be met with in general practice are described,not forgetting first-aid devices. The reader is notbewildered by being offered the choice of severalmethods, but generally he is told what proceedinghas given the authors most satisfactory results, andhe is shown how to carry it out. The diagrams,X ray pictures, and other illustrations_ are clear andsatisfactorily illustrate the text. A very importantquestion which is too often ignored in larger works onfractures is dealt with in this handbook. That is,how is the Scylla of the danger of permanent stiffnessor atrophy from too long fixation of joints and musclesto be avoided, without falling into the fatal Charybdisof recurrent deformity or faulty or deficient union ?We think that the advice given on these matters issound. The difficult region of the elbow-joint receivesspecial attention, and the way to avoid the awfuldisaster of ischaemic paralysis of the hand is plainlypointed out.The experience gained by one of these writers in

the Balkan war, and by both at the Special Hospitalat Shepherd’s Bush, has fully qualified them to writewith authority on the subject. It is to be hoped thatin the future it will occupy a much more importantposition in the training of students than it has donefor some years past in metropolitan schools of medicine.Many a young country practitioner’s reputation maybe made or marred by his manner of handling a caseof fractured femur in a locally important patient.Woe betide him if -he does not employ X rays in itsdiagnosis and treatment! In default of the propertraining, or in addition to it, the study of this bookwill not only prevent his making technical blundersand being cast in damages by a not too intelligentjury, but will ensure that his patients get the treat-ment best suited to their needs and circumstances.

L’HEMATOBLASTE, TROISIEME EL]TMENT DU SANG.Par GEORGES HAYEM, avec -avant-propos etannotations par le Dr. L. RIVET, Medecin desHopitaux. Paris : Les Presses Universitaires deFrance. 1923.- Pp. 254. Fr.25.THERE has always been an unfortunate tendency

among students of the formed elements of the blood toconfer upon them names indicative of their supposedplace in the haematological genealogical tree beforethat place had been properly determined. " 1-16mato-blaste " is one of these terms, coined by Prof. Hayemand by him applied to that element of the bloodknown in this country as the " platelet,"- with thepurpose of indicating the originator’s view that thesebodies represent incompletely developed red cells.It must always stand to Prof. Hayem’s .credit that,

while physiologists and pathologists in this and other’countries were denying their existence, he was

actively engaged in the study of the platelets ; at thesame time it must be admitted that his evidence asto their alleged relationship to the red cells, on thestrength of which he has bestowed upon them theGreek polysyllable, is of the scantiest; it mainlydepends on the observation, first made by himself, thatin states of regeneration after blood loss or destructionthe rise of the red-cell count is preceded by an initialincrease in the platelets in the circulating blood.Interesting as it is, all that this observation reallyindicates is a probability that both platelets and redcells derive from a common tissue system. The mostinteresting portions of the book are devoted to thecomparative anatomy of the platelets, a field intowhich Prof. Hayem was among the first to enter andwhich is still largely unexplored.

Dr. L. Rivet provides an introduction in which hegives histories of the growth of knowledge on thesubject of the platelets, and also of Prof. Hayem,both of considerable interest. He has also edited a

series of annotations, constituting Part II. of the book,in which, in the section on the therapeusis of theplatelets, he accomplishes a notable feat in describingthe procedure of blood transfusion without makingany reference to the blood groups. English readersshould note that when " anemie pernicieuse " isspoken of that condition of the blood known inthis country as

" aplastic " anaemia is apparentlyindicated.

There is still an opening for an up-to-date book onthe blood platelets.

THE INFANT AND YOUNG CHILD.

By JOHN LOVETT MORSE, A.M., M.D. ; EDWIN T.WYMAN, M.D. ; and LEWIS WEBB HILL, M.D.London and Philadelphia: W. B. SaundersCompany. 1923. Pp. 271. 8s. 6d.IN this book, which is addressed to mothers, the

writers have set themselves the task of anticipatingand answering the questions which mothers are in thehabit of asking about the many details of infant care.There are five main sections in the book,, dealingrespectively with antenatal preparations, feeding,growth and development, care and training, andlastly, diseases, emergencies, and medicines. The finalsection is designedly short and somewhat sketchy,as it is not intended in any way to take the place of aphysician when the child is ill. The range of topicsdiscussed is wide, since the book deals with the treat-ment of children up to the age of 6 years, but theauthors have observed throughout an excellentperspective, stress being laid rather on the principlesof treatment than on more or less trivial details.We do not, however, find _ ourselves altogether inagreement with them with regard to some of theirteaching. The list of contra-indications to suckling is-over-long, and includes a warning that really delicateand feeble women should not nurse their babies" because, as a rule, the milk is poor, and the strain ofnursing is too much for them." It is also consideredinadvisable for women who have some chronicdisease-other than syphilis-to suckle their babies :while even clinically inactive pulmonary tuberculosis.is a contra-indication unless the mother has beencured for a long time and is comparatively well.We fancy that most of the podiatrists in this countrywould qualify all these statements. The section onartificial feeding is good, but it is unfortunate that nomention is made of the principle of taking the weightof a baby rather than-or at any rate together with-its age as a guide in regulating the amount of foodneeded. In the chapter on mixed feeding it is saidthat where the supply of breast-milk is almost-sufficient, the baby may be given the artificial foodat one or two feedings in place of the breast-advicewhich we look upon as entirely wrong in principle.In the main, however, the teaching given is sound andhelpful, and the book should be useful to the sectionof- the public to whom it is addressed.

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How OUR BODIES ARE MADE.

By R. M. WILSON, M.B., Ch.B. London: HenryFrowde and Hodder and Stoughton. 1923.Pp. 246. 5s.CONVERSATIONS on the meaning of symptoms or

the reasons for disorders between patients and doctorsoften end in confusion-each party feeling embarrassedor contemptuous in the attempt to make himselfunderstood in a foreign tongue. This is largelybecause the doctor thinks in technical terms whichare unintelligible even when translated, since thefoundations of the lay conception of the structure and ’,functions of the human body have been neither well ’,nor truly laid. There is no common basis on whichto build, and those who attempt to find one are aptto be discouraged by the preliminary amount ofspade-work required. Often it is not until theclamour of questions arises from a younger generation,questions which can neither be hushed nor answered,that adults become aware how limited is their know-ledge of vital processes. If is for these reasons that thislittle book, which is intended for very young people, willbe read greedily and then be studied seriously, not onlyby children but by parents, to their mutual benefit.Not only has it a wealth of breezy martial imagerywhich cannot fail to stimulate the desire for moreknowledge and for active endeavour towards a sanemind in a fit body, but its valuable negative qualities,absence of patronage and sentimentality, deservepraise. It would be difficult to give an adequate idea ’,of the ingenuity of the analogies suggested and in manycases pictured. The chapter headings are admirably ’,chosen. They include The Hardest Worker in the ’,World, The Soldiers at the Gate, How People are Born,The Red Submarines and the White, When You CutYour Finger, The Hole in the Wall, Hitting and IHitting Back---to quote only a few. Throughout thebook aeroplanes, ships, engines, telephones, and scoutsact as prototypes, but never is an analogy strained toexplain the facts nor the facts distorted to complete ananalogy. The illustrations, with the sole exception-of the distorted figure on p. 145, are most suggestive.For example, a diagram of the action of a trap-doormakes that of the heart’s valves obvious to anyone.The movements of blood corpuscles are much moreentrancing when pictured as the activities of redsubmarines, taking a cargo of fresh air to the lung andremoving a cargo of used air, and it becomes of greatinterest to learn where these submarines are built andwhere broken up after a short but busy life. It is ahappy coincidence that this book should have beenpublished at the same Christmas season as Kipling’sappeal to Scouts and Guides: "Be fit-be fit! Inmind and body be fit!" Kipling has pointed out theideal, and Dr. Wilson shows boys and girls and parentshow to achieve it.

APPLIED PATHOLOGY IN DISEASES OF THE NOSE,THROAT, AND EAR.By JOSEPH C. BECK, M.D., F.A.C.S., Chief of Staff,Otolaryngology, North Chicago Hospital. London :Henry Kimpton. 1923. Pp. 280. 37s. 6d.Dr. Joseph Beck says, in his preface to this book,

that he has long felt the need for a text-book limitedto the pathology of nose, throat, and ear diseases ;he further states that he has decided to make thiswork one on applied pathology, and that it was hisdesire to limit it almost exclusively to his own personalexperiences. The effect of the first design is that theclinical aspect of the various affections, and thediscussion of their treatment, form by far the largerpart of the book, and that the pathology has beenrelegated to a very secondary place. From the second

part of the author’s plan it results that the patho-logical descriptions are extremely incomplete, andthat many interesting conditions are completelyomitted. Thus, although a place is given to diseasesof the oesophagus, the very interesting condition ofdilatation without stricture escapes all mention ; thepathology, also, of the commoner affections, such ascancer of the larynx, is very inadequately described,

and sarcoma of this region is not mentioned at all.Syphilitic labyrinthitis receives a scanty mentionfrom its clinical aspect, but no allusion to its pathology,and even the pathology of nasal polypus is but brieflydescribed. In fact, the book is not a systematic workon pathology, but resolves itself into a sketchygeneral description of some of the diseases of the nose,throat, and ear. It is very well printed, and some ofthe illustrations, which are numerous, are excellent.

DIGITALIS THERAPY.Die Digitalis und ihre therapeutische Anwendung.Authorised German translation (by Prof. Dr. P.NEUKIRCH) of a Monograph written by variousDutch authors. Berlin: Julius Springer. 1923.Pp. 119.$1.35.THE compliment we pay to this publication is

a high one : that we hope it will be translated intoEnglish, for it should be read widely. It is a well-balanced critical review of a subject which hasbecome difficult to understand, partly owing tochemical intricacy, partly owing to a plethora ofwriting, but still more largely by an incoordinationof terminology, itself based on international jealousyand business competition. In 1920 the DutchGovernment founded an imperial institute for phar-macological and therapeutical research to inquireinto suitable drugs and secret remedies. Oil ofchenopodium, salvarsan, and quinine and quinidinehave been reviewed in the way that digitalis is nowtreated. William Withering receives full credit for hispioneer work; his writings are quoted at some

length, always with approval. The writers considerhis remarks so concise and definite that no summaryof them is necessary, and compare his monographwith the later writings about digitalis. Modernliterature on the subject would fill volumes, butwould contain little of practical value that is notlaid down in the few pages of Withering’s account.After this acknowledgment digitalis is consideredfrom all sides-chemical, pharmaceutical, pharmaco-logical and therapeutical-and strophanthus is

included in the review. To trace the history and toassign a worth to the numerous preparations andsupposed constituents of a drug like digitalis is abig task, but it is a task here well done ; the subjectis treated in a manner that is full yet concise, andthe text is comprehensive though eminently read-able. The publication is a model of what a mono-graph should be, and is a credit to the Rijks-Instituut.

MEDICAL CLIMATOLOGY OF ENGLAND AND WALES.

By EDGAR HAWKINS, M.A. Oxf., M.D. Edin.London : H. K. Lewis and Co., Ltd. 1923. With149 Charts (144 in colours). Pp. xiv. + 302. 25s.

MEDICAL practitioners will find this creditable andhandy volume of much service when dealing withmedical climatic problems. The information hasbeen culled from the standard volumes on meteoro-logy and geology, as well as from works on spas,health resorts, pleasure resorts, and travel, and theauthor has rendered the subject-matter easily service-able by free use of excellent coloured charts. Thevarious meteorological factors for each district or

place are expressed in percentages either above or

below the normals for the whole of England andWales. In this way we may compare for differentplaces the annual mean values of temperature,sunshine, rainfall, daily range of temperature, cloud,relative humidity, relative frequency of the three mostprevalent winds, the average number of days of snow,hail, thunderstorm, fog, gale, and rain. Although detailsof many places are given, cost of printing has beenresponsible for omissions. While the work fulfilsthe functions of a general guide, a practitioner shouldhave some personal acquaintance with a place beforeexpecting to obtain any aid from climate. No claimcan be made that climate alone will cure disease.Nevertheless, climate may make life much easier andmay also act as an efficient assistant to nature and todrugs in very many conditions of ill-health. On the

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.other hand, an unsuitable place may do much to lretard recovery. Attention may well be given to the-effects of the place on the patient’s mind, and social- conditions cannot be left out of consideration.

Climates are divided into two main classes,. bracing.and sedative; these terms to be construed as

relative to the place in which a patient is residing.Brighton may he expected to be sedative to aninhabitant of Margate. Thus a place within a fewmiles may afford the desired change. The author isto be congratulated on producing a small volume,suitable for ready reference and containing detailstaken from many well-known fields ; nevertheless,many facts in the book will be recognised as old friends.What one misses is the freshness of new facts-that;is, some reference to the researches of the past 15 or20 years in England itself; full attention shouldhave been given at least to the work of Dr. LeonardHill, F.R.S., on the scientific side, and of Sir HenryGauvain on the clinical side. If we are to advance,new facts must be emphasised even in our small text-books.

The book is well arranged, and, for the practitioner,is probably the best of its kind now available. One ortwo maps might with advantage be included in afuture edition.

’THE OLD DOCTOR.

By FRANK G. LAYTON, M.R.C.S., L.R.C.P. Bir-mingham : Cornish Brothers, Ltd. 1923. Pp. 170. I4s. 6d.

Dr. Layton has already published a number ofplays and books. " The Old Doctor" " is a study ofmedical life in a Midland town before the days of theNational Insurance Act. It is written by a man ofinsight and feeling, keenly alive to the hardships ofthe general practitioner’s life in the back streets ofan industrial town, where calls were many but feesoften remained unpaid. These were the times ofthe penny clubs, when the sixpenny doctor-adviceand a bottle-flourished ; ten years is a long timein the recent history of medicine, and most of the"old doctor’s " idealistic schemes have since been- realised. The author has a Dickensian touch ; hischaracters are rather types than human beings-theyoung medical man fresh from the university, the:bluff, kind-hearted old practitioner, the unscrupulouscash-down "consultant," the High Church parson,.and the Labour leader-and certain inevitably sordidpictures are relieved by the grace of humour.

JOURNALS.

QUARTERLY JOURNAL OF EXPERIMENTAL PHYSIO-LOGY. Vol. XIII. Nos. 3 and 4. Pp. 199-404.London : Charles Griffm and Co., Ltd. November,1923. 20s.-The General Effects of Exposure toRadium on Metabolism and Tumour Growth in theRat and the Special Effects on Testis and Pituitary,:by J. C. Mottram and W. Cramer. This is a contribu-tion to the study of the effects of small doses of-radium. When small doses are applied over long-periods to young rats these animals put on weight:more rapidly than the controls and become very obese.The pituitary body shows changes in all three parts of- the gland, and on the testis the primary effect is the.atrophy of the seminiferous tubules, the resultingshrinkage of these tubules allowing the interstitial,cells to hypertrophy. Comparison with the effects of’castration shows that the elimination of the functional-activity of the seminal epithelium does not lead to- obesity. It only produces certain definite changes inthe anterior part of the pituitary body. The obesityis. in this condition, at any rate, the direct or indirectresult of the hypertrophy of the interstitial cells,which also produces changes in the intermediate andposterior portions of the pituitary. The observationsshow that the two component tissues of the testis, the;spermatogenic tissue and the interstitial tissue, haveawo distinct and independent effects on the organism,

and of these two effects that of the interstitial cells is themore profound. Even in the absence of the spermato-genic tissue the interstitial cells furnish an internalsecretion which produces definite changes in the inter-mediate and nervous portions of the pituitary, changeswhich, through the action of this gland and possiblyalso through the action of some other endocrine organs,affect the metabolism. These effects on endocrineorgans and metabolism represent probably the actualbasis of the general changes stated by Steinach tooccur after implantation of trabecular tissue, and wheninduced in a senile organism, described vaguely asrejuvenescence. Resection of the vasa deferentiaproduces no very obvious changes in either testis orpituitary, and does not produce obesity. Rats whichhave been rendered obese by exposure to radium aremore resistant to the growth of transplantable tumours.functions of the Pituitary and Thyroid Glands, byNorman M. Dott. This research includes the techniqueof experimental surgery of these glands and a summaryof the author’s results. Important both to the experi-mental physiologist and to the surgeon whose worklies in the domain of cerebral surgery is the very fulland copiously illustrated exposition of the techniquefor experimental operations, more especially on thepituitary gland. The experiments were made on dogsand cats. The experimental pituitary derangementsare considered and discussed, and the opinions foundedthereon are to be regarded as provisional. The generalconclusion arrived at is that the anterior lobe exerts

a powerful influence on the cell activities of the bodytissues generally and that it exerts a specific and vitalinfluence on tissues of an embryonic type, as repre-sented by the epiphyseal cartilages-X ray photo-graphs are given-and germinal epithelium. The parsnervosa is of less physiological significance, for its com-plete extirpation causes no physiological disturbance.A lesion of the thyroid, being a simple homogeneousgland, is more easy of interpretation. Total extirpationof the thyroid is compatible with indefinite survival.Complete removal-athyroidism-was followed bysubnormal temperature, adiposity, and lethargy-signswhich were interpreted as due to depression of themetabolic rate. A single injection of thyroid extractcaused a rise of temperature, beginning after 2-8 hour .and lasting for 20 hours. Injection of the anteriorlobe pituitary extract in the thyroidless animal causedsimilar results as regards temperature and liveliness.Histological examination showed that there was nodegeneration in the epiphyseal cartilages as in pituitarydeficiency, the bone and cartilage merely remainingin infantile condition. Thyroid injection restoresepiphyseal growth to normal as determined byaccurate X ray measurements. In hyperthyroidismthe generative organs share the general accelerationof maturation without deviation from the normalbeyond their more rapid development. Practicallyno changes were observed in the other endocrineglands, apart from those in the pituitary body, and,notably, the parathyroids were quite normal afterthyroidectomy. Thyroid feeding produced no obviouschanges in the thyroid. Athyroidism in young animalswas characterised by a state of persistent infantilism.In contrast to the thyroid, which appears to influencethe rate of tissue processes only, the pituitary bodyexerts, in addition, a special influence on the vitalityof the embryonic types of tissue.-R. K. S. Lim,Alister R. Matheson, and W. Schlapp contribute paperson " An Improved Method for Investigating theSecretory Function of the Stomach and Duodenum inthe Human Subject " and " Observations on theHuman Gastro-Duodenal Secretions, with SpecialReference to the Action of Histamine." Lim andSchlapp collaborate in a paper " On the Effect ofHistamine, Gastrin, and Secretin on the Gastro-duodenal Secretions in Animals." The " improvedmethod " is described and its technique figured andexplained; it consists essentially in applying con-

tinuous suction to these organs simultaneously by twoseparate tubes.-The other papers on Syneresis, orContraction of Blooã Clots, by J. W. Pickering andJ. A. Hewitt; Effect of Adrenaline on Left Auricular