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78 Reviews and Notices of Books. A CONSULTING SURGEON IN THE NEAR EAST. By A. H. TUBBY, C.B., C.M.G., F.R.C.S.Eng. London: Christophers. 1920. Pp. 279. 15s. IN 1915 the Army Medical Department decided on the appointment of consulting medical officers to serve with the A.M.S., and Mr. Tubby was one of the surgeons to whom this important post was offered. He received the offer on June 12th, 1915, and on June 20th was on his way to Egypt via Malta, where two of his colleagues were to be landed. Mr. Tubby had a wide experience ; he served first in Alexandria, then at Imbros, Mudros, and the Gallipoli peninsula, then in Egypt again as consulting surgeon at Cairo; he was then sent back to Alexandria, visited Khartoum, and finally went to Palestine. In all these spheres he did varied and valuable work, and the book before us is a modest and unassuming record not only of his own labours, but incidentally of those of others. Like many another account of medical matters during the war the feature which strikes us most is the extraordinary powers of organisation and forethought which must be attributed to Sir Alfred Keogh, the Director-General, though it must not be forgotten that he was often served by excellent subordinates. Mr. Tubby’s account of the Gallipoli campaign is sad reading in so far as regards the sufferings of the troops, but it fills the reader with pride in his nationality. The camp at Cape Helles was anything but sanitary, despite all efforts to keep it so, and dust, flies, and lice-especially the lpst-tried the troops severely. Mr. Tubby quotes the simple remark of a captain, " Here am I, Lord and -, with one hundred and fifty thousand a year and ——lousy." After the heat, the cold. In November, 1915, a sudden storm of rain at Gallipoli was succeeded by two nights’ severe frost, and many .cases of frost-bite occurred, some leading to amputation, especially amongst the Ghurkas. Possibly the most interesting part of Mr. Tubby’s book is that dealing with the Palestine campaign-not that he ventures upon military details, but he gives various little touches which are very real. Thus he describes how when the railway from Egypt into Palestine was being made, the old road- the road that goes back to the ancient Kings of Egypt- was still employed. Progress was naturally slow and toilsome. Some unrecorded genius proposed laying down ordinary wire-netting on the sand to make a track, and this not only made marching easy, but afforded an excellent roadway for motors. The chapter called " The Consulting Surgeon in War " contains much valuable information and suggestion, and altogether the book is well worth reading. INTESTINAL AUTO-INTOXICATION. Contrib-itci6n ccd Estudio de la -411to-intoxicaci6n Intestinal. By C. J. DIAZ, Professor of Clinical Medicine, University of Madrid. Madrid : Hermanos Ruiz. 1920. Pp. 144. 3.50 ptas. THIS is a concise and excellent little work of its kind and, coming from the pen of a distinguished author, will be perused with the attention and interest it well deserves. It is partly a compilation from, and com- mentary upon, the researches of other workers in the field of intestinal auto-intoxication, and partly an expo- sition of the writer’s own views and experience of the subject, which are supported by clinical notes of nine cases under his observation. A large amount of con- temporary literature is introduced, with comments, especially that of Lane, Hurst, Herter, Cammidge, Wells, Mellanby, and others in this country, and Combe, Schmidt, and Strasburger on the continent. The author criticises the methods of research into the mechanism, physiological and pathological, of fermentation and putrefaction, the action of toxic products formed in abnormal intestinal processes, and the absorption of lipoids. He considers that there are two factors to be taken into account in eluci- dating the problems of intestinal auto-intoxication, the one corresponding to the chemical substances generated, the other following physical factors, and that the means which are at our disposal for coprological chemical analysis are sufficient to give a good general guide as to the processes which take place. The intestinal flora is as yet little understood, and the functions of certain micro-organisms are twofold, which detracts from the value of methods which rest exclusively on theiridentifica- tion. The author agrees with Oshima that the presence of dissolved albumin in the stools indicates lesion of the mucosa, and that intestinal putrefaction may occur without albumin in the dejecta, and he admits the existence of a dyspepsia, or rather a dystrypsia, from putrefaction in opposition to the "fermentative " of Schmidt and Strasburger. He considers that the fatty acids when absorbed are capable of producing symptoms of themselves, and not through withdrawal of alkali, and that, with the exception of indican, the exact quantity of sulpho-ethers in the urine has no significance. He conceives a "proteinsemic diathesis " which takes the place of the classical arthritism, and explains the transient hypertensions of the constipated by distension of the colon. There are several misprints, which do not, however, detract from the value of the book, such as animo-acids for amino-acids ; this occurs several times. A NATURALIST ON LAKE VICTORIA. With an Account of Sleeping Sickness and the Tsetse-fly. By G. D. HALE CARPENTER, D.M., B.Ch., Uganda Medical Service. London: T. Fisher Unwin. 1920. With 2 coloured plates, a map, charts, and 87 illustrations. Pp. 332. 28s. IN 1910 Dr. Hale Carpenter went to the north shore of Victoria Nyanja (not Nyanza as it is usually written; the author states that Nyanza "means nothirig "). His object was to investigate the bionomics of the tsetse-ny, Glossina palpalis. The book is an attempt, and we think a successful and interesting attempt, to give an account of the life on the islands of the Victoria Nyanja, and of that group of islands lying at the north-west of the lake just south of the Equator. The author is primarily an entomologist, so that the chief interest centres round his observations in regard to insects. There are extensive observations on coloration of insects, illus- trated by two coloured plates of model species of Planema with mimetic forms of PsE2edacrc e1.L1’ytlls. The chapters on mammals, birds, and reptiles are con- fessedly not so ample. In the short space of not quite three years the author accumulated a wonderful body of observations of island life, and as Professor Poulton remarks, the observations recorded " are both loving and accurate." Apart from the earlier chapters on the Natural History of Sleeping Sickness, the most important, according to Professor Poulton, are those which add to our knowledge of Papilio claerdan1l8, and the breeding experiments which brought final confirmation to the conclusions that the wonderful series of mimetic butter- flies are forms of a single species-Pselldacraea, eU1’ytuS. It appears that the Africanbutterflies include what are probably the two most remarkable examples of mimicry in the world-Papilio dardanus and Ps. euryt1.ts. To the purely medical reader the chapters which tell the story of sleeping sickness in tropical Africa will be the most attrac- tive. The author concludes that in order to exterminate sleeping sickness the animals must be kept from each other-the Situtunga antelope from which the fly obtains the trypanosome, and the fly which inoculates the Situtunga with the trypanosome. To the naturalist proper the careful and many new observations on the coloration of insects and allied subjects and the dis- cussion on mimicry will perhaps prove the most attractive part of the book ; nor must the entrancing account of the doings of the totally blind reddish ant, the Dorylus or "Safari Ant," that lives entirely by hunting live prey, be forgotten. Altogether, Dr. Carpenter’s sojourn on the islands of Lake Victoria has yielded interesting results for the naturalist, and his written record of his work, his voyages by canoe, and descriptions of the scenery make the printed account pleasant as well as profitable reading, even to one not deeply versed in zoological lore.
Transcript

78

Reviews and Notices of Books.A CONSULTING SURGEON IN THE NEAR EAST.

By A. H. TUBBY, C.B., C.M.G., F.R.C.S.Eng.London: Christophers. 1920. Pp. 279. 15s.

IN 1915 the Army Medical Department decided on theappointment of consulting medical officers to serve withthe A.M.S., and Mr. Tubby was one of the surgeons towhom this important post was offered. He receivedthe offer on June 12th, 1915, and on June 20th was onhis way to Egypt via Malta, where two of his colleagueswere to be landed. Mr. Tubby had a wide experience ;he served first in Alexandria, then at Imbros, Mudros,and the Gallipoli peninsula, then in Egypt again asconsulting surgeon at Cairo; he was then sent back toAlexandria, visited Khartoum, and finally went toPalestine. In all these spheres he did varied andvaluable work, and the book before us is a modestand unassuming record not only of his own labours,but incidentally of those of others. Like many anotheraccount of medical matters during the war the featurewhich strikes us most is the extraordinary powers oforganisation and forethought which must be attributedto Sir Alfred Keogh, the Director-General, though itmust not be forgotten that he was often served byexcellent subordinates.Mr. Tubby’s account of the Gallipoli campaign is sad

reading in so far as regards the sufferings of the troops,but it fills the reader with pride in his nationality. Thecamp at Cape Helles was anything but sanitary, despiteall efforts to keep it so, and dust, flies, and lice-especiallythe lpst-tried the troops severely. Mr. Tubby quotesthe simple remark of a captain, " Here am I, Lordand -, with one hundred and fifty thousand a year and——lousy." After the heat, the cold. In November, 1915,a sudden storm of rain at Gallipoli was succeeded by twonights’ severe frost, and many .cases of frost-biteoccurred, some leading to amputation, especiallyamongst the Ghurkas. Possibly the most interestingpart of Mr. Tubby’s book is that dealing with thePalestine campaign-not that he ventures upon militarydetails, but he gives various little touches which are veryreal. Thus he describes how when the railway fromEgypt into Palestine was being made, the old road-the road that goes back to the ancient Kings of Egypt-was still employed. Progress was naturally slow andtoilsome. Some unrecorded genius proposed layingdown ordinary wire-netting on the sand to make a track,and this not only made marching easy, but afforded anexcellent roadway for motors. The chapter called" The Consulting Surgeon in War " contains muchvaluable information and suggestion, and altogether thebook is well worth reading.

INTESTINAL AUTO-INTOXICATION.Contrib-itci6n ccd Estudio de la -411to-intoxicaci6nIntestinal. By C. J. DIAZ, Professor of ClinicalMedicine, University of Madrid. Madrid : HermanosRuiz. 1920. Pp. 144. 3.50 ptas.THIS is a concise and excellent little work of its kind

and, coming from the pen of a distinguished author,will be perused with the attention and interest it welldeserves. It is partly a compilation from, and com-mentary upon, the researches of other workers in thefield of intestinal auto-intoxication, and partly an expo-sition of the writer’s own views and experience of thesubject, which are supported by clinical notes of ninecases under his observation. A large amount of con-temporary literature is introduced, with comments,especially that of Lane, Hurst, Herter, Cammidge,Wells, Mellanby, and others in this country, andCombe, Schmidt, and Strasburger on the continent.The author criticises the methods of research intothe mechanism, physiological and pathological, offermentation and putrefaction, the action of toxicproducts formed in abnormal intestinal processes,and the absorption of lipoids. He considers that thereare two factors to be taken into account in eluci-dating the problems of intestinal auto-intoxication, the

one corresponding to the chemical substances generated,the other following physical factors, and that the meanswhich are at our disposal for coprological chemicalanalysis are sufficient to give a good general guide as tothe processes which take place. The intestinal flora isas yet little understood, and the functions of certainmicro-organisms are twofold, which detracts from thevalue of methods which rest exclusively on theiridentifica-tion. The author agrees with Oshima that the presenceof dissolved albumin in the stools indicates lesion of themucosa, and that intestinal putrefaction may occurwithout albumin in the dejecta, and he admits theexistence of a dyspepsia, or rather a dystrypsia, fromputrefaction in opposition to the "fermentative "of Schmidt and Strasburger. He considers that thefatty acids when absorbed are capable of producingsymptoms of themselves, and not through withdrawalof alkali, and that, with the exception of indican, theexact quantity of sulpho-ethers in the urine has no

significance. He conceives a "proteinsemic diathesis "which takes the place of the classical arthritism, andexplains the transient hypertensions of the constipatedby distension of the colon. There are several misprints,which do not, however, detract from the value of thebook, such as animo-acids for amino-acids ; this occursseveral times.

A NATURALIST ON LAKE VICTORIA.With an Account of Sleeping Sickness and theTsetse-fly. By G. D. HALE CARPENTER, D.M.,B.Ch., Uganda Medical Service. London: T. FisherUnwin. 1920. With 2 coloured plates, a map, charts,and 87 illustrations. Pp. 332. 28s.

IN 1910 Dr. Hale Carpenter went to the north shore ofVictoria Nyanja (not Nyanza as it is usually written;the author states that Nyanza "means nothirig "). Hisobject was to investigate the bionomics of the tsetse-ny,Glossina palpalis. The book is an attempt, and we thinka successful and interesting attempt, to give an accountof the life on the islands of the Victoria Nyanja, and ofthat group of islands lying at the north-west of the lakejust south of the Equator. The author is primarilyan entomologist, so that the chief interest centresround his observations in regard to insects. There areextensive observations on coloration of insects, illus-trated by two coloured plates of model species ofPlanema with mimetic forms of PsE2edacrc e1.L1’ytlls.The chapters on mammals, birds, and reptiles are con-fessedly not so ample. In the short space of not quitethree years the author accumulated a wonderful bodyof observations of island life, and as Professor Poultonremarks, the observations recorded " are both lovingand accurate." Apart from the earlier chapters on theNatural History of Sleeping Sickness, the most important,according to Professor Poulton, are those which add toour knowledge of Papilio claerdan1l8, and the breedingexperiments which brought final confirmation to theconclusions that the wonderful series of mimetic butter-flies are forms of a single species-Pselldacraea, eU1’ytuS.It appears that the Africanbutterflies include what areprobably the two most remarkable examples of mimicryin the world-Papilio dardanus and Ps. euryt1.ts. To thepurely medical reader the chapters which tell the story ofsleeping sickness in tropical Africa will be the most attrac-tive. The author concludes that in order to exterminatesleeping sickness the animals must be kept from eachother-the Situtunga antelope from which the flyobtains the trypanosome, and the fly which inoculatesthe Situtunga with the trypanosome. To the naturalistproper the careful and many new observations on thecoloration of insects and allied subjects and the dis-cussion on mimicry will perhaps prove the mostattractive part of the book ; nor must the entrancingaccount of the doings of the totally blind reddish ant,the Dorylus or "Safari Ant," that lives entirely byhunting live prey, be forgotten.

Altogether, Dr. Carpenter’s sojourn on the islands ofLake Victoria has yielded interesting results for thenaturalist, and his written record of his work, hisvoyages by canoe, and descriptions of the scenerymake the printed account pleasant as well as profitablereading, even to one not deeply versed in zoological lore.

79

DIABETES IN INDIA.

Being a Collection of Reprints from the IndianJOttrnal of Medical Research. By D. MCCAY, Major,I.M.S., Professor of Physiology, Medical College,Calcutta, and Others.

THE prevalence of diabetes mellitus in India is wellknown and presents a vast problem, which will requiremany years of detailed work before a solution isreached. The Imperial Indian Research Fund haswisely devoted funds for the purposes of the investiga-tions recorded in the papers, and the authors of this con-tribution are to be congratulated on the results of theexpenditure of much time and labour. A large numberof interesting facts have been revealed. The first paperdeals with the sugar in the blood and urine in theBengali. The sugar in the blood of the normal Bengaliis found to be 0’13 per cent., a much higher figurethan that obtained in the normal average European, andlargely explained by differences in the carbohydratecontent of the diet in the two races. This excess of sugarin the blood leads to the deposition of fat, andeventually to glycosuria. The sugar tolerance of suchindividuals becomes lower and lower as the percentageof sugar in the blood increases and with the rising body-weight. Each individual, however, possesses certainnarrow limits within which his blood-sugar concentrationvaries, as also the concentration of blood-sugar at whichthe kidneys begin to excrete sugar in abnormal amounts.It was found in examination of the urine of theBengali that the well-known tests often gave indefiniteresults, and this was especially true of Fehling’s test.This is not surprising when quantitative estimationsreveal the normal variations of sugar in the urine asbetween 0’Ola and 0’15 per cent. Further, there wasno parallelism between the sugar in the blood and thatin the urine in people of normal health, in those suffer-ing from a-glycosuric diabetes, in different individualssuffering from varying degrees of glycosuria, or even inthe same individual. The authors ’are of the opinionthat the predisposing cause of glycosuria is a gastro-duodenitis leading to an exhaustion or actual infiam-mation of the pancreas and a disturbance in theinternal secretion of that organ. The march ofevents leading to glycosuria as conceived by MajorMcCay is given in tabular form, and expresses veryclearly his main conclusions.The most interesting paper in the whole series

relates to the causation of death in diabetes mellitusas met with in India. There is no evidence of actualketosis, and the onset of diabetic coma (air-hunger) asmet with in England. On the contrary, the patientsalmost invariably die of ursemic coma. This uraemiccoma is the result of the functional derangement of thekidneys brought about by the continued passage of largequantities of sugar over a prolonged period. The onsetof this type of coma is not necessarily dependent upona definite pathological lesion of the kidneys. Thewhole of this work is unfortunately lacking in completeproof owing to the absence of post-mortem records-ah insurmountable difficulty in the present social andcaste conditions in India. However, numerous analysesof the blood are given to support this important con-,elusion. The last paper deals very thoroughly with thetreatment of diabetes in India. One is struck with theease in which a mere restricted dietary removes theglycosuria even in severe cases. This is partly explainedby the fact that diabetes mellitus in India is of amild type, and differs from the severe form as met within England, where death is due to true diabetic coma.Again, reduction of the carbohydrate in the diet doesnot lead to ketosis, and diacetic acid is rarely found. Asearly as 1913 the plan of inducing a raised glucose toler-ance by gradually increasing the carbohydrates wasadopted. This in essentials was the same plan of treat-ment as that devised by F. M. Allen, and worked outquite independently by McCay. The difference was thatstarvation as advocated by Allen was not ordered, simplybecause it was quite unnecessary in the treatment of themild type of case met with in India. The observationsrecorded in these papers are of great interest, and theauthors are to be congratulated on ctn excellent piece

of work. That difficulties were overcome and suchgood results obtained refiects great credit on MajorMcCay and his stimulating influence on those workingin his laboratory.

CHILDREN’S DREAMS.

By C. W. KIMMINS, M.A., D.Sc. London : LongmansGreen, and Co. 1920. Pp. 126. 5s.

As Dr. Kimmins points out, little attention has beenpaid to the dreams of normal people since the psycho-analysts first applied their methods to this subject.Freud’s l’raumdeut1tng is based mainly on the dreamsof his psycho-neurotic patients; and the graduallyrecognised importance of the study of dreams duringthe past six years has been due to their value in theexploration of the minds of those suffering from thepsychoneuroses of war. In Dr. Kimmins’s book wehave a collection of dreams obtained from nearly sixthousand children of various ages (from 5 to 16), in

elementary, central, and secondary schools, in industrialschools, and in schools for the blind and deaf. Theconclusions drawn from this important and fascinatingstudy throw a vivid light on the inner lives of children(e.g., the elder girls’ fear of strange people), on theirwaking desires as fulfilled in dreams (children inindustrial schools have more idealistic and excitingdreams than children whose lives are more fortunate),and on the changes in the dream content with differencesin age and sex, and with deafness and blindness. Thedreams of the children of eight years of age and overwere recorded by themselves, and it is interesting tonote that their power of graphic description of theirdreams " so far exceeds their ability in ordinary essaywriting on topics selected by the teacher ...... that itwould appear as if some fresh mental element hadcome into play." The matter is, as Dr. Kimminsobserves, worthy of further investigation.

DIRECTIONS FOR A PRACTICAL COURSE IN CHEMICALPHYSIOLOGY.

Fourth edition. By W. CRAMER. London: Longmans,Green, and Co. 1920. Pp. 138. 4s. 6d.

THIS excellent and concise handbook has now reachedits fourth edition-a sufficient recommendation of utility.The book is small and its scope is necessarily limited,but it embodies most of the recognised tests in generaluse, as also the practical demonstrations, and it is

specially designed for medical students possessing onlyan elementary knowledge of organic chemistry. The testsfor various substances in the blood, gastric contents,urine, &c., are clearly set out, and particular attentionis given to the small technical details which are soessential for the successful application of such tests.A pleasing feature of the book is the array of questionswhich accompany certain tests, as also the excellentnotes pointing out the fallacies of the tests. The authoris to be congratulated on the demonstration of coagu-lation of the blood, the description of which is clearlyand concisely put. The student is given a clear insightinto the phenomena of coagulation without the use of acumbersome and meaningless terminology.The importance of the maintenance of acid and base

equilibrium in the body is also dealt with in a separatechapter at the end of the book, and a difficult subject ismade quite clear by the presentation of several testsand demonstrations. The book should appeal to thegeneral practitioner, especially that part dealingwith pathological metabolism. The tests describedcan be carried out without the necessity of elaborateapparatus or a well-equipped laboratory. The descrip-tion of acetone bodies in the urine and the tests fortheir presence is well done and in accord with modernviews. The author introduces his own test for thedetection of sugar in normal urine, but omits allmention of Benedict’s test, which is far superior tosome of those described, and should be used in prefer.ence to that of Fehling. The book is of small size, andfrom its undoubted excellence, apart from its price, is tobe recommended as a laboratory manual.

80

MEDICAL EXAMINATION OF AIRMEN-. ’

By Dr. MAUBLANC and Dr. RATIE. Translated byNORMAN BALL, M.R.C.S., L.R.C.P. London: JohnBale, Sons, and Danielsson, Ltd. 1920. Pp. 88. 5s.

THIS little book in its original form was intended as apractical guide for use in the examination of membersof the French Air Service and its recruits. WingCommander Martin Flack contributes an introductionto the English translation without discussing Frenchmethods at any length. The authors state that their ’,methods were applied in systematic fashion to everyrecruit as well as to pilots who arrived from othersections and to applicants for rest-leave, but it is, iunfortunately, not very easy to glean from the textcomplete details of this systematic examination. Theyexpress the hope that the book will help the practitionerwho may, without previous experience, suddenly becalled upon to act as doctor to a flying squadron. In

England, at any rate, such a condition is not likely tooccur now that systematic courses of instruction andlectures are given to all medical officers charged withthe care of flying personnel. The book, indeed, givesthe impression of having been compiled during thestress of war and to take little notice of contemporarywork on medical aviation. No doubt the authors havethemselves moved forward since then in their methodsand practice, and we should like to see any set offorms now in use for the examination of pilots inflying, together with proper statistical tables of theresults.Dealing with the physical examination of candidates,

the authors advocate the anthropometric factor ofBouchard and do not mention the work of ProfessorGeorges Dreyer. They follow the physical measure-ment of a candidate with an inquiry into his familyhistory, and apparently recommend that if this isunsatisfactory on account of epilepsy, madness, para- !,lysis, or tabes he should be rejected. It seems awaste of time to go to the trouble of taking physicalmeasurements if the applicant is to be rejected onother grounds. The methods of examination of theheart are not described, and reference is made toinstruments unfamiliar to the practitioner in thiscountry. Here some explanatory notes with diagramsand instructions would have been useful. The all-too-short description of a special apparatus for measuringequilibrium is of interest. With these provisos thebook is one that can be recommended to Englishreaders for its conspectus of air medicine in France.

ADVANCED LESSONS IN PRACTICAL PHYSIOLOGY.

For Students of Medicine. By RUSSELL BURTON-OPITZ, S.M., M.D., Ph.D., Associate Professor ofPhysiology, Columbia University. Illustrated.London and Philadelphia: W. B. Saunders Company.1920. Pp. 238. 18s.

THIS excellent guide to experimental physiology isessentially on the plan of teaching practised in Englishschools of medicine. It is made up of 50 lessons, eachfor a practical class lasting three hours; 9 lessons areallotted to muscle and nerve, 3 to blood, 13 to heart andcirculation, 6 to respiration, 4 to nervous system, 7 tothe sense organs, 5 to digestion and absorption, and 3 toexcretion-a very judicious and well-balanced distribu-tion. The subject is presented in a practical manner-practical in the sense that many of the exercises leadup directly to the future clinical work of the student.Obviously in American schools of medicine the condi-tions under which a student is allowed to performexperiments-blood pressure, sections of nerves,fistulae, tracheotomy, ligature of vessels, &c., under

proper anaesthetic safeguards-are far differentfrom those allowed in this country. In the highergrade medical schools in the United States about300 hours are allotted to physiology-exclusiveof physiologic chemistry and clinical physiologyor experimental medicine-about 180 hours beingassigned to practical work and 120 to lectures and con-ferences. Each student must devote 10 hours per

week to physiology in an academic session of 30 weeks.At the end of the book a list is appended of over 30demonstrations given in connexion with the precedinglessons. These include demonstrations on Pfiuger’s law,electrical phenomena of muscle and nerve, galvano-meters, electro-cardiography, polygraph, decerebratepigeon and cat, lesions of cerebellum, semicircularcanals, removal of thyroid, parathyroid, and supra-renal glands, &c. The text is illustrated with 213 figures,some in colour. Perhaps Zollner, the astronomer ofLeipzig, would have preferred his name printed withumlaut instead of as on pp. 204 and 238. Any studentwho works carefully on the lines here laid down willfind that he has acquired an admirable training for hisfuture clinical work, and indeed for other subsequentsubjects of his medical career. This is a comprehensive,judicious, well-selected and admirably practical courseon experimental physiology-a meet companion to theauthor’s text-book (THE LANCET, July 24th, 1920,p. 190).

______________

THE PSYCHOLOGY OF PHANTASY.

Collected Papers. By CONSTANCE E. LONG. London: =Bailliere, Tindall, and Cox. 1920. Pp. 216. 10s. 6<

THIS book consists of a number of papers written byDr. Constance Long during the past four years, some ofwhich have already appeared in various journals. Dr.

Long is one of the leading exponents in this country ofthat " Analytical Psychology " which is associated withthe name of Dr. C. G. Jung, of Zurich, and in thesepapers she expounds in an elementary and popular waysome of the main tenets of the school to which sheadheres. Here, as in the school of Freud, great import-ance is ascribed to phantasy and dream, but each schoolputs its own interpretation on the real significance ofthese products of unconscious functioning. Dr. Longlays stress on the compensatory function of theunconscious and of the prospective or teleologicalcharacter of the unconscious thoughts and feelingswhich emerge in dreams and phantasies. The balancingor compensatory function of the unconscious impliesthat what is missing in the conscious will be foundin the unconscious, and that for the purpose of adapta-tion to life both the conscious and the unconsciousattitude towards any given situation should be takeninto account. Indeed, it would seem that Jung andhis followers are coming to lay more and more stresson the importance of the guidance in the actual conductof life which can be obtained from dreams and otherproducts of the unconscious. Dr. Long says that Jung,like Freud, attributes neurosis to repression, though hedoes not base its whole aetiology on sexual repression,but on a one-sided development of the various psycho-logical functions of thinking, feeling, sensation, andintuition. Whatever is repressed or under-expressedlinks itself up with unconscious elements, and from thepsychic tension produced between what is consciousand what is unconscious, the phantasies arise, repre-senting in symbolic form what is missing fromconscious consideration. But, according to this viek,what is missing from consciousness seems to be miss-ing mainly because it is

"

neglected." Neglect, how-ever, is a very different thing from repression. Thepredominating psychological function is said to be over-developed, the other functions being " relativelyrepressed," but it is hard to find any justification forusing the term " repression " to account for the presencein the unconscious of the relatively undeveloped orundifferentiated function.In a book of this kind, consisting of a number of

separate papers, it is inevitable that there should be aconsiderable amount of repetition, but for those towhom the subject is new this will be no drawback.The topics dealt with are by no means easy of compre-hension, and there is much to be said about them thatcould not readily find a place in these papers. Thosereaders who accept the doctrines of Freud will findlittle in this book to coincide with their beliefs, but forthe followers of Jung it will prove a useful and

interesting compendium of the views to which theysubscribe.

81

GEORGE MILLER STERNBERG. I

ABiography. By his Wife, MARTHA L. STERNBERG. IChicago: American Medical Association. 1920.

Pp. 331.$5.George Miller Sternberg was born in 1838 and died in

1915. He received his medical education at Buffalo andat the College of Physicians and Surgeons in New YorkCity, which body gave him the degree of M.D. in 1860.He proceeded to Elizabeth City, N.J., directly after-wards, where he practised until the .outbreak of theCivil War, when he was appointed assistant surgeon,U.S. Army, on May 28th, 1861. During the war he sawa good deal of service, and, amongst other experiences,was taken prisoner at the battle of Bull Run, but

managed to escape. After the war he served in variousplaces, mainly frontier posts. He had much experienceof Indian fighting, and in 1875 suffered from a severeattack of yellow fever, from which, however, herecovered. He was granted six months’ sick-leave andwent to Europe to recruit, returning to the States in1876. He served through the Nez Perces campaign of1877, and in 1879 was made a member of the firstHavana Yellow Fever Commission, which was the out-come of the widespread mortality from that diseaseduring 1878. Much good work was done by the Commis-sion, but the specific cause of the disease remained amystery.For the next ten years Sternberg did the bacteriolo-

gical work for which he is so justly well-known, and dis-covered in February, 1881, the pneumococcus, which had,however, been already described by Pasteur in Januaryof the same year. He had never lost his interest inyellow fever, and in 1887 he took up the subject againon behalf of the Government Commission which hadbeen appointed. In 1890 he published his conclusions,which were negative. In 1900 Sternberg, who hadbeen appointed Surgeon-General of the army in 1893,instituted the Yellow Fever Board, which in turnappointed a Commission, with Major Walter Reed asPresident. This Commission went to Havana in 1900,where Reed and his companions established the factthat yellow fever was transmitted by the bite of a

mosquito, even though the actual causative organismremained unidentified. In 1902 Sternberg retired fromthe army and was given the chair of PreventiveMedicine in George Washington University, and fromthis date until the time of his death he devoted him-self to the anti-tuberculosis campaign and matters ofpublic health.Mrs. Sternberg has written an interesting account of

a long and busy life. Sternberg’s researches are onemore instance of the fact, so well known in scientificwork, of how apparently unsuccessful toil leads to

great results. It was his patient research in elimi-nating the causes to which yellow fever is not due,which paved the way for the immortal work of Reed,Carrol, and Lazear, and enabled Gorgas to carry to asuccessful conclusion the Panama Canal.

JOURNALS.Journal of Neurology and Psychopathology. Vol. I., Nos. 2

and 3.-The second number of this new journal maintainsthe promise of its first. The chief article is one by Dr. R. M.Stewart, of Prestwich, on the Histopathology of CarbonMonoxide Poisoning, the case being that of a man who diedfrom the effects of gas-poisoning on the twenty-fourth day ofhis illness. Histological examination revealed the presenceof an intense and universal myelin degeneration, bilateralsoftening in the basal ganglia, and a widespread corticalsoftening strictly confined in a curious way to the deeperlayers of the grey matter. Dr. Stewart considers thatthis peculiar selective action of what must certainlyhave been a diffuse intoxication is to be explainedby certain anatomical peculiarities of the blood-vesselssupplying the central nervous system. It seemsclear that an anoxaemia alone could not have pro-duced the peculiar zones of softening and that carbonmonoxide must have a specific action of its own onthe parenchymatous elements of the nervous system.-Dr.William Brown, of London, contributes a brief paper on SomeFactors in Psychotherapy, emphasising the importance ofwhat he calls psychocatharsis, a process by which sup-pressed emotions are worked off, while at the same timereassociation of forgotten incidents takes place in the mind.He also describes the working of another therapeutic

process called by him autognosis, in which the patient isled backwards in memory and encouraged to discussemotional memories of the past, especially those wherehe failed to adapt himself adequately to his physical and3ocial environment.-A clinical paper on the Acute Con-fusional States in the Psychoneuroses is contributed byDr. W. Johnson, of Liverpool, based on his examinationof some thousands of military cases admitted to an armycentre for psychoneurosis. About 10 per cent. showeddefinite evidence of confusion. Three fairly distinct types.appeared-(1) simple type with short confusional period ofnot more, perhaps, than of 24 hours ; (2) severe type ofpronounced but temporary state of confusion; (3) typeassociated with definite mental disorder.-The Nature ofInsomnia in Cases of Psychoneurosis is discussed by Dr.R. G. Gordon, of Bath, who comes to the conclusion that theinsomnia is the result of the patient’s giving his attentionto keeping some unpleasant or insupportable idea out of his.mind, and trying to cut it off from all other associations.This effort of attention is the first step towards the forma-tion of a barrier which will repress the complex. Since, how-ever, in order to achieve normal sleep all effort of attentionmust be relaxed, the patient finds himself in a sort of impasse,.for if attention be relaxed, then the complex finds expressionin consciousness and disturbs the monotony necessary forsleep; on the other hand, to avoid this relaxation of atten-tion he becomes more alert than ever, and the more he triesto sleep the wider awake he seems to become.-Dr. M. A.Blandy, of London, describes in a brief clinical note a typicalcase of Torsion-spasm or Torsion-dystonia, apparently thefirst that has been recorded in England, and her articleis illustrated with excellent clinical photographs.-Dr.Aldren Turner, of London, publishes a critical review onModern Opinions in Regard to Epilepsy.In the November issue the first article is from the pen of

Professor C. Lloyd Morgan, of Bristol, and is concerned -

with the question of Psychology in the Medical Curriculum.The article is written in that delightful literary style ofwhich Professor Lloyd Morgan is a master, and constitutesa cogent plea for the instruction of all medical students ippsychology. Man is not only a complex physiologicalsystem, but an equally complex psychical system, and thetime has come to consider whether the psychologistshould not have a status on the staff of a medicalschool analogous to that of the physiologist.-A clinicalsymposium on Epidemic Encephalitis, for which SirThomas Horder supplies a brief introduction, is con-

tributed by a number of writers from Bristol and itsneighbourhood, where in the course of the summer andautumn a definite local epidemic has been raging. Theclinical descriptions of the various types of the diseasethen encountered constitute a useful contribution to a.

subject of great practical importance.-The Importance ofEducation in the Prevention of the Neuroses receivesconsideration in a paper by Dr. J. Ernest Nicole, ofManchester. Psychologists and others are coming to theconclusion that the normal and abnormal developments ofchild mentality exercise their influence on adult character,and that there is a great need for an individual andrational education which will help to close the wrongpaths and open up the right ones that are essential tohuman progress and development.-A remarkable series ofcases of Familial Tabes Dorsalis has been under the care ofDr. J. Le Fleming Burrow, of Leeds, who supplies thedetails in a short article. Briefly, of six surviving membersin a family of eight born of healthy parents, four acquiredundoubted syphilis from absolutely different sources, yetwith a resulting tabes dorsalis in all. The conclusion isjustified that tabes cannot be attributed to a special strainof spiroch&aelig;te introduced at the time of the initial infection,but is much more likely to be due to the spiroch&aelig;te actingupon tissues specially sensitised either by natural familialpeculiarity or by certain methods of treatment.-Dr. HenryDevine, of Portsmouth, writes a critical review on theNeuropathic Individual as a Social Unit, with special refer-ence to the recent illuminating work by Professor PierreJanet in this connexion.

The Journal ot Physiology. Edited by J. N. LANGLEY, Sc.D.,LL.D., F.R.S. Cambridge University Press. 1920. Vol. LIV.,No. 4. Pp. 203-318. Price 9s.-The Infiuence of VenousPressure upon the Heart-rate, by K. Sassa and H. Miyazaki.The authors confirm Bainbridge’s results as to reflex effectson vagus and accelerator tone. They find that the greater thevagus tone, the more effective is the rise of venous pressureupon the acceleration of the heart in different species ofanimals or different individuals of the same animal. In frogsand rabbits where the vagus tone does not normally exist,no appreciable accelerator effect was found, the sympatheticnerves alone being not sufficient to produce this effect.-Onthe Correlation of the Rate of Heart-beat, Breathing, BodilyMovement, and Sensory Stimuli, by Water M. Coleman.-Studies on Muscular Contraction. I., The Influence of

Temperature on the Mechanical Performance of Skeletaland Heart Muscle, by Yasukazu Doi.-On the Existence of


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