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REVIEWS AND NOTICES OF BOOKS

1. Diseases of Infancy and ChildhoodBy WILFRID SHELDON, M.D., F.R.C.P. Lond.,Physician for Diseases of Children, King’s CollegeHospital; Physician to Out-patients, Hospitalfor Sick Children, Great Ormond-street ; ConsultingPaediatrician to the London County Council.London: J. and A. Churchill Ltd. 1936. Pp. 738.21s.

2. A Handbook on Diseases of ChildrenSecond edition. By BRUCE WILLIAMSON, M.D. Edin.,M.R.C.P. Lond., Physician to the Royal NorthernHospital, London ; Assistant Physician to thePrince of Wales Hospital, London. Edinburgh :E. and S. Livingstone. 1936. Pp. 329. 10s. 6d.

1. Now that paediatrics has received the officialbenediction of the Royal College of Physicians, inthe form of a diploma, one may hope for an increaseddemand for books on the subject. There is likely tobe a wider public especially for books supplying areliable survey of children’s diseases in reasonablysmall compass. Dr. Sheldon and his publishershave been singularly successful in this new venture.The book has none of the signs of prematurity,and indeed the author admits to a period of gestationof over nine years. The infant is of pleasing form,and the presentation satisfactory ; it is clearlybegotten of clinical experience. Dr. Sheldon hasin general followed the conventional plan of discussingthe diseases of the various systems seriatim, whichmakes the book easy of reference and useful in

providing an equipment with which to defeatexaminers. It is naturally less helpful to those whoare primarily concerned with the interpretation andsignificance of symptoms. Treatment, however, isconsidered as fully as is practicable in a book of thissize, and if there are signs of a lingering affectionfor lengthy formulae, more modern methods have a,prominent place. The 137 illustrations are, withthe possible exception of some of the radiograms,exceptionally good, and add greatly to the interestof the text. Dr. Sheldon has not hesitated to includerarities, but he is not likely to be accused of any falsesense of proportion. The book as a whole deserveswide popularity, particularly amongst undergraduatestudents. It is launched in true nautical mannerby Prof. Still.

2. Dr. Bruce Williamson’s book is smaller andcheaper. Whilst it contains little which can

justly be criticised, it appears slightly to havereduced a minimum, irreducible except by the

expedient of making the subject seem simpler thanit really is. It has clearly been found of value,and indeed it should serve a useful purpose as a

first introduction to the subject of children’s diseasesfor students doing their adult medical clerking.It would be regrettable if it were looked on as a text-book which in fact it does not claim to be. It isattractively bound and illustrated, and of convenientsize for the pocket.

A System of Clinical MedicineTenth edition. By T. D. SAVILL, M.D., edited byAGNES SAVILL, M.D., and E. C. WARNER, M.D.,F.R.C.P. London: Edward Arnold and Co.1936. Pp. 1061. 28s.

IN this well-known work symptoms rather thandisease entities are the primary material for discus-sion. After a description of the individual symptom,

the common causes are enumerated and elaborated,the symptoms being taken not in alphabetical orderbut arranged in chapters on the different systems ofthe body. In this edition all sections have been

thoroughly revised and much new matter has beenintroduced, though the size of the volume remainsunchanged. The editors have again had the assist-ance of seventeen collaborators, each of whom isresponsible for the revision of the section of the bookdealing with his special province, and an expertstandard is thus maintained throughout. Thespecial features of arrangement and the authoritativematerial which have made this book popular amonggenerations of students and practitioners are fullymaintained in this edition.

Medical DiagnosisSome Clinical Aspects. By S. LEVY SIMPSON, M.A.,M.D. Camb., M.R.C.P. Lond., Physician to theWillesden General Hospital; Assistant Physician,Princess Louise Kensington Hospital for Children.London : H. K. Lewis and Co., Ltd. GeneralPractice Series. 1937. Pp. 244. 10s. 6d.

TAKE the classified list of diseases from a text-book of medicine, omit the uncommon ones, and adda few common surgical and gynaecological conditions.Then under each heading write a succinct little para-graph indicating the nature of the disease, outliningits symptomatology, and mentioning a few points andpitfalls in differential diagnosis. Keep laboratoryaids in the background but show where their helpbecomes important. Such is Dr. Levy Simpson’srecipe. He has compounded his book very neatlyand shrewdly, with a good eye for the clinicalessentials, as becomes a pupil of Dr. Robert Hutchison.The busy practitioner, whose minutes for reading are

few, will find it both light and profitable.

Bright’s Disease and Arterial HypertensionBy WILLARD J. STONE, B.Sc., M.D., F.A.C.P.,Clinical Professor of Medicine, School of Medicine,University of Southern California, Los Angeles.London: W. B. Saunders Co. Ltd. 1936.

Pp. 352. 22s. 6d.

Prof. Stone has tried to supply the clinician witha concise description of the main features of Bright’sdisease-no easy task. In carrying it out he refersto many of the better known recent publications andis clearly up to date in his reading. His classifica-tion is a compromise with obvious affinities to that ofAddis ; thus he divides acute Bright’s disease intohaemorrhagic and degenerative types, the former

passing by recognisable stages to chronic Bright’sdisease with secondary hypertension (or secondarycontracted kidney). Under the heading of chronicBright’s disease he also describes the arterio-sclerotickidney with primary hypertension, subdividing thisinto the latent (or benign) and active (or malignant)types. In this classification the influence of theGerman school is apparent, but many will disagreewith the close association of these so-called benignand malignant types of hypertension. After a seriesof short chapters on various biochemical aspectsof the disease the various types of nephritis are

separately described with advice on treatment inwhich diets are given a prominent place. Thedietetic ingredients will not always be easilyinterpreted by those English readers who are

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unacquainted with the precise nature of Jell-O,graham crackers, and other transatlantic products.The work is in general sound and conforms to themore advanced lines of teaching, but is often marredby vague statements. For instance, p. 159 : "Etheranaesthesia has been believed to irritate the glomerularstructure of the kidneys, and is less frequently usedto-day for operative procedures in the presence ofinfection in children, than a decade ago." Suchcomment is worthless unless backed by referencesand only serves to harass the clinician over his choiceof anaesthetic. The author’s description (p. 121)of a simple and sensitive test for red blood-cells inurinary deposits which will enable the detectionof amounts down to 1300 per c.cm. of urine deservesthe attention of pathologists in view of the greatclinical importance of this finding.

Post-mortem AppearancesThird edition. By JOAN M. Ross, M.D., B.S. Lond.,M.R.C.S., L.R.C.P., Reader in Pathology, Univer-sity of London ; Morbid Anatomist to the RoyalFree Hospital; late Assistant Pathologist toSt. Mary’s Hospital. London : Humphrey Milford,Oxford University Press. 1937. Pp. 243. 7s. 6d.

THis little book has now established itself as a

student’s guide. Its special feature is the descriptionof typical cases as they appear in the post-mortemroom. Most of the larger text-books of pathologydeal with the changes in the different organs separately,leaving the student to learn from practical experiencehow these changes may be related. Dr. Ross describesbriefly the chief anatomical changes to be expectedin a person dying from any of the commoner diseasesand thus enables the student to judge how far thecases he sees at autopsy conform to type.The chief alteration made in preparing this new

edition is in the section on renal disease, which hasbeen entirely rewritten. The problem of the classi-fication of nephritis has been tackled in an effectiveway by preserving the utmost simplicity and byomitting the less important types. A useful sectionof the book is that dealing with death from causesother than disease ; here the characteristic featuresof cases of poisoning are briefly but clearly described.Appendices are included with tables of the normalaverage weights and measurements of the organs.The book is excellently adapted to its purpose, and itsarrangement and indexing make for quick and easyreference.

Bailey’s Textbook of HistologyNinth edition. By ELWYN and STRONG. Revisedand rewritten by the Anatomical Staff of the

College of Physicians and Surgeons, ColumbiaUniversity. London: Bailliere, Tindall and Cox.1936. Pp. 773. 27s.

THIS revision of the text-book by Adolf Elwyn andOliver Strong has been undertaken by five membersof the anatomy department of Columbia University.They have made alterations in nearly all parts,rewriting the four chapters on the cell, the blood andlymph, muscle, and the organs of special sense, andreplacing some of the old figures by new ones. Thesystem adopted is to explain structure as far as

possible in relation to function. Much physiologicalmatter is therefore included along with discussionson modern researches. An interesting chapter is :

that on the living cell, which describes amongst otherthings methods of tissue culture; and throughoutthe book there are frequent references to the study

of tissues in the living state. The result is a some-what lengthy work-perhaps more than the averagemedical student will be inclined to tackle at firstsight-but the reader will soon find compensationfor extra bulk in an easy and readable style. Sincethe text-book is intended for students and not as awork of reference no bibliography is included. Infor-mation on technique is confined to general terms,and no details are given on staining methods. The

subject matter is well balanced, and due considerationis given to the bearing of histological problems onthose of physiology and medicine. Thus the workforms a good coordinating link in the medicalcurriculum, and in this respect especially it can berecommended to medical students.

A Textbook of Bacteriology and itsApplicationsBy CURTIS M. HILLIARD, Professor of Biology andHealth, Simmons College. Revised edition.Boston : Ginn and Co. Pp. 339. 12s. 6d.

BACTERIOLOGY though it contains so much of

general interest is not easy to present in a popularform. This, however, is no reason why sincereefforts to this end should be discouraged. Prof.Hilliard’s little book certainly falls into the categoryof the sincere. Except that it does not cater for theneeds of any special technical group of bacteriologists,it is perhaps hardly fair to call it a popular work.The information provided appears to be reliable,and is set out in a scholarly way. One of the chapterscontains a very full synopsis of the classification ofbacteria according to Bergey; the professionalbacteriologist will pity the reader, say a dairymaid,a health visitor, or an "improver" in a canningfactory who struggles with detail upon which theaverage expert would not welcome examination.One of the best chapters is that on refrigeration andcanning. Here we read of a consignment of eggsput aside during two years’ iigitation, and subse-quently sold as " entirely sound and safe foodmaterial," with other interesting matter with whichEnglish readers are likely to be unfamiliar. A fewof the recurring solecisms of text-books are allowedto creep in, for example, Hofmann and Ziehl-Neelsenare misspelt, and there is some muddle in the descrip-tion of the unit of diphtheria antitoxin. To thosewho want a conspectus of general rather than medicalbacteriology, and who are not afraid to assimilatetheir knowledge in a concentrated form, this littlebook may be recommended.

Recent Advances in AllergyThird edition. By GEORGE W. BRAY, M.B., Ch.M.Sydney, M.R.C.P. Lond., Physician in Charge ofChildren’s Department, Prince of Wales Hospital;Assistant Physician, Princess Elizabeth of York

Hospital for Children; Consulting Allergist,Children’s Hospital, Hampstead. London: J. and A.Churchill Ltd. 1937. Pp. 517. 15s.

IN the days before allergy, asthma and urticariawere regarded as neuroses, and fell largely in theprovince of the neurologist. There are suggestionsthat the allergic hypothesis is losing much of itsmomentum-it has reached the dangerous age ofspecialised practitioners, journals, and societies-and with the swing of the pendulum the asthmaticis returning for help to the psychologist. One of themost interesting chapters in this third edition ofDr. Bray’s book deals with the nervous or psychicfactor. Psychologists and allergists at present adopt

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towards each other’ a sceptical or frankly hostileattitude, and until they exchange tactics of catch-as-catch-can for give-and-take the results will be moreamusing than instructive. As it is computed that30 per cent. of the population is psychoneurotic and25 per cent. is allergic, they must have a good dealof ground in common. In allergy proper the moststriking advances appear to have been the recognitionof the frequency with which moulds and fungi areresponsible for allergic symptoms and the study ofdrug sensitivity, of which two of the most strikingmanifestations are purpura haemorrhagica and agranu-locytosis. It is difficult sometimes to avoid the feelingthat allergists collect allergens as other men collectpostage stamps and old china, and until we solvethe central problem of the interplay of the soil andthe seed, of the nervous system or constitution andthe foreign protein, in these curious manifestationsof spasm and exudation, allergy will belong to theart of romantic detection rather than the science oftherapeutics.

This contribution to the " Recent Advances"series now contains more than 500 pages, and hasreally developed into a text-book on allergy. Con-sidered as such it is a very able production ; butmuch of the material presented is neither recent noradvantageous, and the book, like some others in theseries, would benefit from rigorous pruning. If indeedthe series is to live up to its title--and it is by sodoing that it will continue to earn the gratitude ofthe profession-the contributors should eschew anydesire to be encyclopsedical, and confine themselvesto critical reviews of recent work.

The ThyroidSurgery, Syndromes, Treatment. By E. P. SLOAN,M.D. Edited by Members of the Sloan Clinic.London: Bailliere, Tindall and Cox. 1936.Pp. 475. 45s.

WRITTEN by a surgeon who before he died in 1935had a vast experience of operations on the thyroidgland, this posthumous book deals with this glandmainly from the surgeon’s point of view. It purports,however, to cover the whole gamut of thyroid diseases,especially that of simple and toxic goitre, and includesalso chapters dealing briefly with the parathyroidsand thymus, particularly in their relation to thethyroid. Dr. Sloan gives an able and detailed accountof the surgical anatomy and of the various steps inoperative procedures on the thyroid gland ; thechoice of the an2esthetic and the pre-operativemanagement of the case are well discussed.The early chapters on the physiology of the thyroid

and on the aetiology and pathology of goitre, however,are disappointing. Due credit is given to Kendallfor the isolation of thyroxine, but no mention ismade of its synthesis by Harington. It is referred toas thyro-oxy-indol and given Kendall’s originalformula CllHo03N1, the fact that Harington hassince shown it to be a derivative of tyrosine and topossess the formula C15Hl104:N14 having been over-looked. The author supports the dysthyroidismhypothesis of toxic goitre, which is not accepted bymost authorities on the disease. " The secretoryproduct or products in thyroxine that complementiodine " he calls thyrom (presumably the same asHarington’s thyronine) ; he pictures it as " the activeprinciple contained in the thyroxine molecule thatdifferentiates thyroxine from iodine." Dr. Sloan’sthesis is that this unknown element has a great affinityfor, and combines with, the iodine in the colloid,producing

" wholesome " thyroxine and that, if

iodine is not present in the colloid of the follicle,true thyroxine is not formed and the unknownelement enters the circulation as a toxic substance.This suggestion, which can hardly be elevated to therank of an hypothesis, is refuted by the facts (1) thatthe iodine-free compound (which is not " an unknownelement " but has a definite formula) has been foundto be completely inactive, and (2) that in the earlystages of simple goitre, where there is marked hyper-plasia and little or no iodine present in the follicles,toxicity is absent.

Dr. Sloan still held to the view that the thyroid isthe seat of the primary disturbance in toxic goitre,against the experimental evidence of the last ten years.His frequent reference to toxic goitre as diffusehyperplastic goitre leads to confusion, especially inthe chapter on pathology, and in the first paragraphon p. 74 the suggestion that where a simple hyper-plasia involves the whole gland and continuesuninterruptedly it results in the symptoms of Graves’sdisease is not acceptable. Readers would be advisedto pay no serious attention to these early chapters.The rest of the book is a valuable contribution tothyroid surgery, and a word of praise is due to theillustrations, especially those of the surgical anatomyand operative technique.

History of Modern MoralsBy MAX HODANN. Translated by STELLA BROWNE.London: William Heinemann (Medical Books)Ltd. 1937. Pp. 338. 12s. 6d.

Tms book would seem to be written to prove thatsexual knowledge has still to wage constant battlewith something which the author regards as " Vic-torianism," and throughout the pages irritation isdisplayed wherever restraint is exercised against thedissemination of information upon sex matters in anyphase, development, or aberration. Is it Victorianism-a silly term which may imply a dozen things butwhich for Dr. Hodann would seem to mean hypocrisy-to point out that before knowledge is spread it isnecessary that the knowledge should be sound, andthat it is practically useful to ascertain that itsspread is made where the lessons can be understoodand are needed ? Y After a chapter entitled the " Secretof Generation," which resumes in a series of briefnotes the functions and mechanisms of sex, theauthor finds himself compelled to " pursue and dissectthe contradictions and cruelties which have grownout of the sexphobia of the nineteenth century."Accordingly we get forty pages dealing with sexualperversion, the case of Prince Eulenburg being givenin some detail, while that of Wilde is alluded to in away that reveals the author’s credulity.The chapters dealing with the fight against

venereal disease and the history of birth control arequite well done and here an extensive bibliographyis well selected, which cannot be said for other sectionsof the book. But it shows a want of all sense ofproportion to describe workers in the various fieldsof what the author calls "sexology" as "pioneerswho are in the uncomfortable position of urging acosmic evolution." This exaggeration of the effortand object fails to impress readers who know some-thing about the subject, and huge bibliographieswhich include publications of no importance side byside with really sound work give a wrong impression.Dr. Hodann has written an interesting book, but isdescribed on the wrapper as one who " knows theeconomic conditions of all Europe and the latestconclusions in medicine and psychology,"-and thatis a difficult description to live up to.