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compressing the diseased lobe with a minimum ofdanger and without complications. Even, however, ifthe lobe were too indurated to be compressed, the finalstage of lobectomy-once so feared-was not reallymuch more serious. When the plugs were removedthe lobe was found as a more or less pedicled structurein the closed pleural cavity around it, and it couldbe removed by slow elastic stricture of its root.This could be done in the ward without pain or

shock, the elastic tube being tightened daily untilthe lobe necrosed and fell off-usually in about twoweeks’ time. The cavity was then loosely pluggedwith gauze and became smaller and smaller until itclosed. Prof. Zaaijer showed photographs andradiograms of a number of cases, demonstrating thatthe patients recovered completely, with almostnormal use of the arm and normal function of the

remaining lobe of the lung.The PRESIDENT recalled the visit of the Dutch

admiral who had sailed up the Thames with a broomat his masthead, and the English admiral who hadretorted- by fastening a whip to his. Prof. Zaaijer,he said, had brought both broom and whip, sweepingaway many old notions of the dangers of intra-thoracic surgery and stimulating thought. Meetingssuch as this performed an international service inpreserving the friendship and increasing the mutualrespect of two nations.

Mr. J. E. H. ROBERTS, proposing a vote of thanks,remarked that a great deal of work on the surgeryof the oesophagus had been done in the north-westcorner of Europe without being heard of in thiscountry. The knowledge that surgeons could dealwith bronchiectasis was not adequately spreadthroughout the profession, and therefore surgeonsdid not see cases in the early, basal, unilateral stage,but only when the condition had become diffused.

Sir JAMES DUNDAS-GRANT, seconding the vote,said that Prof. Zaaijer’s demonstration had beenextraordinarily convincing, and mentioned the useof radium, to the possibilities of which surgeonsmust not shut their eyes.

DONATIONS AND BEQUESTS.-Mrs. Jane Parton, ofPercy House, Tunbridge Wells, left 222,500 for charity,including 22000 each to the Royal Blind Pension Society,Dr. Barnardo’s Homes, and the General Hospital, Maidstone ;21000 each to the Cancer Hospital, Brompton, the RoyalHospital for Incurables, Putney, and the General Hospital,Tunbridge Wells ; 2500 each to the Convalescent Home forChildren, Hawkenbury, Tunbridge Wells, and Dr. Barnardo’sCripples’ Home, Tunbridge Wells.-Dr. John CornwellRound, of Purbrook, Sydenham, left over jB15,000 upontrust for two persons and on the decease of the survivorwith remainder equally between the Royal National Life-boat Institution and the Samaritan Fund of St. Thomas’sHospital.-Lady James, of Springfort, Stoke Bishop,Bristol, left jE750 to Bristol General Hospital and 2250 toBristol Blind Asylum.-Sir George Sheppard Murray, ofCleveland House, St. James’s-square, and BarretstownCastle, Co. Kildare, left <131000 each to the Imperial CancerResearch Fund, the National Association for the Preventionof Consumption or Other Forms of Tuberculosis, and Dr.Barnardo’s Homes, as an addition to capital, and 2500 toPoplar Hospital for Accidents.-Mr. Edmund MurrayDalgety, of Magdalen Yard-road, Dundee, left 22800 to suchDundee charitable institution or institutions as the trusteesmay select ; 21000 each to the Dundee Royal Infirmary andthe Royal Victoria Hospital, Dundee ; and 2200 to theLittle Sisters of the Poor, Wellburn, Lochee.-Mr. EdwinWilliam Goodwin, of Didsbury, Manchester, left 2500 eachto Manchester Royal Infirmary, Ancoats Hospital, the Boys’and Girls’ Refuges and Homes, St. Dunstan’s Hospital forBlind Soldiers and Sailors, Manchester and Salford, theRoyal Schools for the Deaf and Dumb, Old Trafford,Manchester, the Crippled Children’s Help Society, and St.Mary’s Hospitals, Oxford-road, Manchester.-Mr. FrederickWilliam Archer, of Lansdowne-place, Hove, left 21000 tothe Leicester Royal Infirmary, 2500 to the Leicester Guildof the Crippled, 2200 each to the Leicester Infirmary for theBlind, 2100 each to the Leicester Wycliffe Society for theBlind and the Leicester Children’s Hospital.-Lord Glendynehas made a donation of 21000 towards the 35,000 requiredby the Royal Northern Hospital, Holloway, in order toobtain an anonymous gift of an equal sum.

Reviews and Notices of Books.ARTHRITIS.

Chronic (non-tuberculous) Arthritis. By A. G.TIMBRELL FI8HER, M.C., F.R.C.S. Eng., lateHunterian Professor, Royal College of Surgeons ofEngland ; Surgeon to the Seamen’s Hospital.London : H. K. Lewis and Co., Ltd. 1929.Pp. 232. 25s. -*

PROBABLY what is commonly known as rheumaticarthritis causes in this country as much or more

suffering and disability than all other chronic diseasesput together. Recognising this fact and realising thatthere is much still to be learnt about the physiologyof joints and the pathology and aetiology of chronicarthritis, Mr. Timbrell Fisher undertook the investiga-tions which are described in this book. Althoughgouty arthritis and joint diseases associated withchronic affections of the central nervous system areincluded, the really important subjects of this workare the two conditions which are described as

rheumatoid arthritis and osteo-arthritis. The authorfirst discusses the physiology and histology of the partsforming normal joints and then proceeds to describea number of experiments and investigations designedto advance our knowledge of the pathology of bothforms of chronic joint disease and of their treatment.Probably in this country no surgeon has had a morewidespread and enduring influence on the treatmentof inflamed and painful joints than John Hilton ofGuy’s Hospital, whose lectures on rest and pain havebeen accepted by several generations of students andsurgeons as a true gospel. Of late years it has beenrealised, however, that in certain cases rest is not thebest treatment for a chronic inflamed joint. As Mr.Fisher points out, complete rest and cessation offunction leads to atrophy of important joint elements,an atrophy comparable to the degeneration which isone of the characteristics of disease ; whereas inmany cases of chronic arthritis, movement favourscure and preserves function. The difficulty is thatonly experienced surgeons can decide in which casesto prescribe and insist on movement and in which toorder complete rest, with or without the intention ofprocuring healing by ankylosis.

Mr. Fisher gives due importance to orthopaedicmeasures of various kinds, but describes also theoperations of arthrotomy, cheilotomy, synovectomy,excision, and arthrodesis, including his own methodof approach to and exposure of the knee-joint.Rheumatism of joints is, however, as much in thedomain of medicine as of surgery, and Mr. Fisherrecognises medical treatment to be of the firstimportance.

This book is really interesting. New facts andoriginal observations are introduced and some knownfacts are brought to notice in a new light and freshinferences are drawn from them. All who have to dowith cases of chronic joint disease of so-calledrheumatic origin will find it worth while to study Mr.Fisher’s views.

____

Les Arthrites Gonococciques. By HENRI MONDOR,Professeur agrege de la Faculte de Medecine deParis ; Chirurgien des H&ocirc;pitaux. Paris : Massonet Cie. 1928. Pp. 528. Fr.70.

THE arthritic manifestations of gonorrhoea were firstrecognised in France by Swediaur, in Berlin byChristian Theophilus Selle, and in Great Britain byJohn Hunter, Sir Benjamin Brodie, and the surgeonwho in this book is called " Sir Astley Copper." It isprobable that gonorrhoeal arthritis is nowadays moreprevalent in France than with us, but whether itsincidence be frequent or relatively rare, its consequencesare disabling and its course prolonged. A large andserious work upon this important subject is thereforewelcome. Prof. Mondor protests against the use ofthe term rheumatism in this disease, which herightly describes as an infectious arthritis, in its early

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stages generally acute. He writes as a surgeon andis sceptical as to the value in gonococcal arthritis ofmedical treatment, such as serotherapy and vaccino-therapy or palliative measures. His conclusions arefounded on a vast knowledge of the pathology of thedisease ; many pages are devoted to discussion of

pathological anatomy, and Prof. Mondor illustrateshis study with coloured microphotographs and otherfigures of considerable interest. In the clinicalsection the classification is elaborate. and presentsthe various forms and sites of disease under 14headings. The scale of the work may be gauged bythe fact that under the general heading of " Formessegmentaires

" subsections deal separately with thedisease as it is manifested in each segment of thepatient’s frame ; for example, one is concerned solelywith gonorrheeal feet, such as flat-foot, pseudo-gout,bony spikes and outgrowths, and " picd-cloue." Cyto-logy, bacteriology, blood culture, serodiagnosis,vaccinodiagnosis, and fixation reactions of thedisorder are treated in sections headed LaboratoryResearch. Much space is devoted to descriptions ofcases and discussion of methods of treatment. At theoutset the original focus of the disease in the genito-urinary system must receive early and thorough treat-ment, including necessarily the seminal vesicles in themale and the uterus and tubes in the female. Forthe rest, Prof. Mondor disposes politely but firmly ofthe arguments of those physicians who claim to haveobtained results from serum and vaccine therapy.He has found no reliable evidence to justify suchclaims. Of the hyperbolical praise accorded to certainother methods he says : " cet amas d’adjectifs nesaurait cacher entierement le visage de la realite."In fact, the number of sovereign remedies advocatedin the past may be taken as an index of the ill-success of treatment in too many refractory cases.Immobilisation, compression, mobilisation, massage,puncture, hypersemia, electrotherapy, radium, auto-serotherapy, protein treatment, sero- and vaccino-therapy have also been vaunted. The authorconsiders that of these only vaccinotherapy withpuncture as a secondary measure are of much valueand that surgical intervention, especially arthrotomywith immediate suture if used very early in the courseof the disease, is the method of choice. His statisticsseem to us to bear out his conclusions.

This work should be studied bv all those who haveto treat gonorrhoeal arthritis. It contains a vastamount of information on the subject and abundantevidence is offered from which the reader may drawhis own conclusions. The mass of facts includedmakes the book bulky, but it has no redundantpassages, and compression would have diminished itsvalue. There is a bibliography of 47 pages, but noindex.

CARDIAC ARRHYTHMIAS.

By IRVING R. ROTH, M.D., Assistant in Medicine,Mount Sinai Hospital. New York: Paul B.Hoeber, Inc.; London : Humphrey Milford,Oxford University Press. Pp. 210. 36s.

TEN years ago there was a certain novelty aboutthe cardiac arrhythmias which rendered themextremely fashionable for examination purposesand as subjects for post-graduate lectures. Now thatnovelty has worn off, and the well-informed prac-titioner has a pretty good idea of what is meantrespectively by auricular fibrillation, sinus arrhythmia,and extrasystoles. He is unlikely to need a largetome on the subject, and his less enterprising col-leagues, who do not trouble their heads about suchmatters, will certainly not read one. We do nottherefore anticipate that there can be a big demandfor such a work as this, for it is quite an elementarytreatise and will not appeal to the specialist. Certainpeople, however, cannot digest condensed matterand prefer to take their mental nourishment in bulk.This work should appeal to them, for the text isclearly written and the diagrams are good, thoughin some cases unnecessarily elaborate. The printingand production generally are excellent.

WILLIAM HARVEY.Exercitatio Anatomica de Motu Cordis et Sanguinisin Animalibus. By WILLIAM HARVEY, M.D.With an English Translation and Annotationsby CHAUNCEY D. LEAKE, Professor of Pharma-cology, University of California. London : Bail-liere, Tindall and Cox. 1928. With five plates.Pp. xii. +228. 16s.

William Harvey. By ARCHIBALD MALLOCH, M.D.,M.R.C.P., Librarian, New York Academy ofMedicine. New York: Paul B. Hoeber, Inc.1929. With ten plates. Pp. xii. + 103.THE Harvey Tercentenary was celebrated on the

other side of the Atlantic as well as on this, and thesetwo volumes are some of the tangible results. Prof.Chauncey D. Leake has produced an interesting andcomprehensive memorial of Harvey’s work in hisbook, which would probably have found a widerpublic had it come while interest in the subjectwas at its height. The first part of the work con-sists of a facsimile reprint of the first edition of" De Motu Cordis " ; this includes the leaf of erratawhich was omitted from the facsimile issued by theRoyal College of Physicians of London. The text wasso inaccurately printed that this leaf is of someimportance. The second part is a new translationof the treatise, which Prof. Leake believes to be " thethird attempt to render Harvey’s classic into currentEnglish idiom." Actually it is the fourth, but thisfact in no way detracts from the value of Prof.Leake’s rendering, no attempt having been madesince 1847. In that year the Sydenham Societypublished Robert Willis’s stilted and unattractivetranslation, and this has held the field ever since asthe standard English text. The new text is a greatimprovement on the old. It is a sufficiently freetranslation to make easy reading, without departingfrom Harvey’s intention, and for this reason the bookshould be welcomed in England and America. Prof.Leake has added numerous useful and interestingannotations in footnotes. His illustrations increasethe value of the book, though his reproduction ofHarvey’s diagrams of the venous circulation in theforearm is hardly adequate.

Dr. Archibald Malloch’s smaller book, based on atercentenary address delivered in Boston, providesan admirable companion volume to the new transla-tion. In small compass he includes a study ofHarvey’s life and doctrines, in which all the importantfacts are attractively presented. It is difficult atthe present day to discover any new facts connectedwith Harvey, but Dr. Malloch, at any rate, contri-butes the observation that, in spite of his name,Wilhelm Fitzer, Harvey’s first publisher, was

probably an Englishman, who published also works byRobert Fludd and De Bry’s ’’ Voyages." We thus comenearer to an explanation of why Harvey chose Frankfortas his place of publication. Dr. Malloch was alsoresponsible for the verv useful Catalogue 1 of a HarveyExhibition held at the New York Academy of Medicine.

INCOMPATIBILITY IN PRESCRIPTIONS.

By SANTOSH KUMAR MUKHERJI, M.B. Calcutta :Rai Saheb B. N. Mukherji and Son. 1928. Pp. 135.THE excellent intentions of this book are not quite

borne out in the result. Possibly a less ambitioustreatment of the subject would have saved theauthor from committing himself to such singularitiesas the statements that calcium hydroxide is insolublein water, and that syrup of squill cannot be givenwith alkalis. Repetition is surely not inevitable in avolume of this size. For example, we read on pages 41,43 and 45 the statement that sodium bicarbonate isgiven in combination with diluted hydrocyanic acid.Prolixity, however, is not so serious a fault as in-exactitude. Compression under expert advice mayproduce a revised edition that can be welcomed.

1 Bulletin of the New York Academy of Medicine, 1928,lv., 906.

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EPIDEMIC ENCEPHALITIS WITH PREGNANCY, LABOUR,AND THE PUERPERIUM.

By FREDERICK RoQuES, M.A., M.D., M.Chir.Cantab., F.R.C.S. Eng. Manchester : Sherrat andHughes. 1929. With two appendices. Pp. 139. 15s.

STNCE 1917 when in the Wien. Klin. Wochenschriftvon Economo first described encephalitis lethargica,the literature on this disease has been extensive.It is, however, a curious fact that but little has beenwritten upon it, when complicated by pregnancy,labour, and the puerperium ; as far as we know thisis the first book that has been published on thesubject in any language, an omission doubtlessdue in the main to the fact that the complica-tion is admittedly uncommon. Nevertheless it wasquite time that the omission should be remedied,and Mr. Roques, towards this end, has dealtwith the material at his disposal most thoroughly.Starting with chapters on its aetiology and pathologyand on the clinical manifestations of epidemicencephalitis in the pregnant woman, the next fourchapters deal with the influence of pregnancy onacute epidemic encephalitis and the influence of thisdisease on pregnancy, labour, and the puerperium.Two chapters on the child are succeeded by two ondiagnosis and treatment, the last four chapters dealingwith pregnancy and Parkinsonism. The records are ’,given of 40 cases, which have not been publishedbefore, placed at the disposal of the author by col-leagues, but in order to make his survey more com-prehensive, the author has collected from suchliterature as was available 171 cases in which preg-nancy was complicated by acute lethargic encephalitisand 23 cases in which pregnancy was associated withthe Parkinsonian syndrome.From a consideration of the material at his disposal,

the author concludes that in the majority of cases

pregnancy generally proceeds to term without anyinterruption, that in cases of greater severity prema-ture labour often supervenes, while in the worstcases the patient dies before delivery. Labourdiffers in that it is painless, and the puerperium isnot affected. Other interesting points are, forinstance, that neither the age nor the parity of thepregnant woman increases the chance of infection,the mortality is greater when the infection occursearly in pregnancy, and that probably primigravidseare more frequently attacked than multiparae. Thetreatment of the complication is discussed fully andthe author is of the opinion that the artificial termina-tion of pregnancy is not indicated, that the secondstage of labour should be completed as soon as

possible with the aid of the forceps if necessary, andthat the mother should not nurse her child. He alsoissues a warning that the onset of labour should bevery carefully watched since, because of its painlessnature, the child may be lost. His conclusions onpregnancy and Parkinsonism are that if the onsetof Parkinsonism coincides with the onset of pregnancy,labour should be induced. Appendix I. contains fullnotes of the author’s 40 cases, and Appendix II.a list of the cases previously published in medicalliterature, as regards their age, parity, stage ofgestation, and results to the mother and child.There is a full bibliography consisting of 119 refer-ences.

Mr. Roques is to be congratulated on renderinga real service to obstetric medicine.

GOULD’S MEDCCAL DICTIONARY. J

By GEORGE M. GOULD, A.M., M.D. Second edition,revised and enlarged, by R. J. E. SCOTT, M.A.,B.C.L., M.D., Fellow of the New York Academyof Medicine. With illustrations and 170 tables.London : H. K. Lewis and Co., Ltd. 1928.Pp. 1522. 30s.

THIS book now contains over 83,000 defined words,many hundreds of which are new, and its size exceedsthat of the first edition by 125 pages. Dr. Scot

states that " the present issue may be said to be thesum of all of Gould’s Dictionaries." The parentvolume, which appeared in 1894 and was entitled"An Illustrated Dictionary of Medicine, Biology andAllied Sciences," has been familiar for 30 years to allwho value precision in medical and scientific nomen-clature. A new feature is the inclusion of portraits ofmedical men who have given their names to operationsor tests-a growing practice. This lays the burdenon the lexicographer of noting the date of their death,and the fact has been overlooked that Henry CharltonBastian died in 1915, George Huntington in 1916,Sir William Crookes in 1919, and Vladimir Bechterewon Christmas Day, 1927 ; while Dupuytren was bornnot in 1778, but on Oct. 6th, 1777. The eponym ofWilson’s disease is misspelt. Help is given in thepronunciation of these proper names : Gould wouldallow us to call Blaud " blawd," and Glauber" glowber," but Angstrom is to be read "

awng-strt-m," which we regard as a hardship. While thedictionary is not free from trifling inaccuracies, itcontains a wealth of accurate information, admirablydisplayed, which should make it as popular in itsrevised form as it was in the old.

THE SACK-’EM-UP MEN.

By JAMES MooRES BALL, M.D., LL.D. Londonand Edinburgh: Oliver and Boyd. 1928. Pp. 216.16s.

THE author of this book is an ophthalmic surgeonof St. Louis, whose text-book, entitled " ModernOphthalmology," is popular in other countries besideshis own. The historical bent of his mind has alreadybeen shown in his monograph on

" Andreas Vesaliusthe Reformer of Anatomy"; under a rather luridtitle he now gives a good account, drawn from manysources, of the doings of the body-snatchers or resurrec-tionists-" its very hard them kind of men won’tlet a body be." The book is far from being a merecompilation of extracts from the works of others ;it contains an excellent epitome of the history ofanatomy and the provisions for its teaching inEurope and the United States. As is well known,the legal provisions for anatomical teaching in thiscountry, before 1832, were meagre in the extreme.Even so late as 1830 the founder of one of the lastof the private schools of anatomy in England wroteof the difficulties of procuring subjects and thepersonal risk attached to the office of a teacher ofanatomy. Teachers on the Continent were betteroff in these respects. Naturally much space isdevoted to the West-Port murders in Edinburgh ahundred years ago, and to the murder of an Italianboy, in London, by Bishop and Williams, in 1831.Of course Burke and Hare and Bishop and Williamswere not " resurrectionists " in the proper sense ofthe word, but their ghastly trade was made possibleby the apathy of the Government in the matter ofmaking proper provision for the teaching of anatomyin this country, and no book on the subject would becomplete that did not include a full account of thesemurders. Warburton’s Anatomy Act of 1832, whichput an end to body-snatching and to " murder as afine art," is given in full. The book ends with ashort chapter on the teaching of anatomy in Americaand the New York anatomy riots, and alludes brieflyto certain cases of body-snatching which have beenperpetrated in the States within comparativelyrecent times. It is obvious that when describingevents which took place at so recent a date (only 50years ago), the author has to be guarded in hisstatements ; the time is not ripe for a completereview of the circumstances, but it is satisfactoryto learn that the officials of the medical collegethat received the body were exonerated from allresponsibility.A special feature of this book is the wealth of

illustrations ; the plates are well chosen and excellentlyreproduced. Some rare handbills, and the title pagesof some of the chap-books that flooded Edinburgh

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at the time of the Burke and Hare murders, are

included in the text and add greatly to its interestand value.

HEINE, THE STRANGE GUEST.

By HENRY BAERLEIN. London : Geoffrey Bles.1928. Pp. 310. 12s. 6d.

Mr. Henry Baerlein’s title has its origin in MatthewArnold’s lines :-

The spirit of the world d... let a sardonic smileFor one short moment wander o’er his lips.That smile was Heine !-for its earthly hourThe strange guest sparkled... ;

and certainly Heine’s life, literary, mental, andspiritual, did make of him a strange guest on earth.We have in this book a discursive story of him, fromthe cradle to the grave. Born at Dusseldorf in 1797,of Jewish parents, he became more French thanmany French of the period, through his venerationof Napoleon, with whose most brilliant period hisown youth coincided. He failed in Hamburg as abusiness man, was terribly bored at Gottingen as a,

scholar, was accepted while still young by the leadersof thought and letters in Berlin as poet and journalist,apostasised from the Jewish religion on practicalgrounds, visited England where he admired Canningand found Walter Scott wanting, and settled in Paristo make an imprudent love match which, while itlasted, brought great happiness, and supplied himwith an unboundedly affectionate attendant throughhis terribly protracted and fatal illness. This storyMr. Baerlein tells with great fullness of incident ina clear and pleasant way that should lead many whocan read German to enjoy the poet’s gay and seriousphases, his wit, his penetration, and his lovelyliterary gift.

JOURNALS.

BRITISH JOURNAL OF CHILDREN’S DISEASES, Vol.XXV., October-December.-Dr. C. C. Beatty con-tributes a paper on Congenital Stenosis of theoesophagus, in which he has collected and tabulated50 cases reported in the literature up to 1926, inaddition to five examples of the condition whichcame under his own observation. He distinguishesa membranous type in which there is a partial occlusionof the lumen by a fold of normal mucous membrane,and a non-membranous type in which there is a

localised reduction in the size of the oesophagus.The onset of symptoms is usually in infancy, themost characteristic symptom being regurgitationof food a few minutes after deglutition without eitherpain or nausea. Adult patients may be well developed,but some degree of infantilism is not uncommon inchildren and adolescents. The prognosis in themembranous type is good, and in the non-membranoustype is not unfavourable, as several patients havelived to old age. The best treatment in the mem-branous form is dilatation by bougies controlled byoesophagoscopy. In the non-membranous form a

few successful results have followed radical operation.-In a paper on the Rheumatic Child, based on hisstudy of 400 cases at the Downs Hospital, Sutton, andQueen Mary’s Hospital, Carshalton, Dr. N. Gray Hillshows that there are no physical characteristicspeculiar to rheumatic children, such as colour of thehair, colouring of the eye, or absence of cutaneouspigmentation, and maintains that the belief thatthere is a rheumatic type cannot be substantiated.He also brings forward evidence that there is verylittle, if any, connexion between the life and workat school and the onset of rheumatism or chorea.-Dr. F. Parkes Weber records a case of a "White"Naevus of the Conjunctiva in a Child and a Dark-blueNsevus of the Forehead.-In their paper on Erosionof the Neck Vessels in Scarlet Fever Dr. J. D.Rolleston and Dr. W. Gordon Sears report twofatal cases of this rare complication which they had

seen at the Western Fever Hospital in the courseof six months. The first was a male infant, aged11 months, who, in, the course of moderately severescarlet fever complicated by suppurative cervical

adenitis and otorrhoea, had profuse haemorrhagefrom the ear and died in a few minutes. The bleedingvessel was not identified post mortem, but probablyone of the veins in the neighbourhood of the cervicalabscess had been eroded. The second case was thatof a female infant, aged 2 years, with a septic attackof scarlet fever, also complicated by suppurativecervical adenitis. In this case the haemorrhagetook place from the wound in the neck where thecervical abscess had been opened, the source of thehaemorrhage being the internal jugular vein.-Theabstracts from current literature are devoted to

ophthalmology.

NORWEGIAN STUDIES IN SYPHILIS

CRITICISM OF THE RESULTS OF SPECIFIC TREATMENT.

THE late Dr. Caesar Boeck, professor of dermatologyat the University of Christiania (Oslo), has left atradition which was the subject of a long and inter-esting discussion at a meeting of the Norske MedisinskeSelskap last year. The paper which Dr. E.Bruusgaard read on this occasion is published inNorsk Magazin for Laegevidens7caben for December,1928, and the report of the discussion which followedit appears in the same journal for October.

Prof. Boeck used to arouse many protests amonghis colleagues on account of his teaching that theso-called specifics, potassium iodide, and mercury, aresymptomatic remedies which not only fail to eradicatethe disease, but also paralyse the body’s naturaldefences, with the result that the disease runs anatypical course, and inflicts serious injuries on certaininternal organs, particularly the central nervous

system. Only when the body failed to react satis-factorily, and the disease seemed to run its courseunchecked, did Boeck fall back on these two drugs.His colleagues, on the other hand, followed moreconventional lines. They taught that mercury mustbe given in every case, in such-and-such doses, andfor so many years. It was, therefore, natural thatthe generations of medical students brought up inthis controversial atmosphere should have beencurious to check such conflicting claims in the lightof subsequent events. Two of these men have, intheir turn, become leaders of the medical professionin Norway, one of them, Dr. Bruusgaard, havingsucceeded Boeck in the Chair of Dermatology, theother, Dr. S. Dahlstrom, being chief of the PsychiatricDepartment of the Ullevaal Communal Hospital inOslo.The task which Prof. Bruusgaard set himself was

the personal examination of the survivors of thesyphilitic patients who had attended Boeck’s clinicbetween Jan. 1st, 1891, and Dec. 30th, 1910. Of the2181 patients suffering from primary and secondarysyphilis in this period, 1388 were women and 793were men. Prof. Bruusgaard’s inquiries into theirsubsequent fates were begun in 1925 and provisionallyended in 1927. A small number of patients were alsoexamined who had contracted syphilis since 1910,and who had not received specific treatment. Onre-examination, the patients were subjected to a verycareful examination of the heart, two skiagramsbeing taken in different planes, and to a routineneurological examination. The cerebro-spinal fluidwas examined only in a few cases, but theWassermann reaction of the blood was carried outin most cases.

After grouping his material in several tables, thefirst showing the frequency of such complicationsas iritis and periostitis, the second showing thesubsequent careers of the patients whose infectiondated back three to four decades, and the followingtables showing what happened to the patients whose