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longer and more comfortably after their applicationSir Thomas Horder prophesied that these X ray:would play a conspicuous part in the elucidation o.-

the problems of malignant disease.

Prof. SIDNEY Russ read a paper entitled

Experimental Studies oyc the Lethal Doses of X Raysand .RcKMtMM on Aitiitial Tissues.

He defined a lethal dose as the dose which preventedproliferation of the malignant cells, not that whici:destroyed them. He described experiments which hEhad conducted on animals which were exposed tcradiation after grafting malignant tissues in them.After exposure the growth was transplanted intcanother animal and its proliferative powers noted.After exposure for 40 minutes it was found that60 per cent. of the growth proliferated. After exposurefor 55 to 60 minutes 1 per cent. only proliferated.The latter now required a much longer time oiexposure to prevent its proliferation. The part whichproliferated required a still longer exposure. Evenafter the latter a portion proliferated and requiredan even longer exposure. A stage was eventuallyreached in which proliferation could not be preventedby an exposure which was not sufficient to kill theanimal if given in toto.

Prof. Russ had conducted experiments whichshowed the relation between the doses of soft and hardrays which caused either epilation, blistering, or lethaleffects.

Epilation. Blistering. Lethal.Soft rays.... 21 .... 38 .... 56

Hard rays.... 126 .... 228 .... 146

He showed that the product of the time ofexposure to radium and the intensity of the irradiationgave no accurate idea of dosage. Even with verylong exposures it is doubtful whether the deep-lyingcells often receive a lethal dose. It had been shownthat the dividing cells require a shorter exposure thanthe growing cell for lethal action, but there was noknown method of making cells divide at an appreciablygreater rate by artificial means.

This change of vulnerability to radiation, accordingto the phase of the life-cycle, was perhaps of someimportance in radiotherapy, though there was noway by which the cells might artificially be broughtinto the dividing stage. Prof. Russ submitted that

under ordinary conditions the lethal dose that is ofimportance is the lethal dose for the growing and notfor the dividing cells.

Further experiments were described showing theeffects which X rays and radium have upon theresistance of the host. Whereas large doses might leadto the death of an animal, it had been shown thatrepeated small doses spread over considerable periodsincreased the body-weight and prevented suchvigorous growth of tumour transplantations as occursin the normal rat. Prof. Russ suggested that it mightbe well to supplement the thorough localised irradia-tion of a tumour by small generalised doses of radiationdesigned to increase the resistance to human growth.

MANCHESTER AND MATERNITY NURSING.—A newmaternity home for 18 beds is about to be opened in VictoriaPark by the Manchester and Salford District NursingInstitution, the intention being to make this a hospital forthose who are prepared to pay from three and a half to fiveguineas a week for accommodation and skilled nursing. Inaddition, the home will also be a midwifery training centrefor pupil midwives, and will assist institution nurses whowish to qualify for the C.M.B. certificate. Dr. Frances Ivens,of Liverpool, said that maternal mortality had not lessenedin the last 20 years. To bear a child should be a normalphysiological process, but it was often fatal and was oftenfollowed by terrible morbidity. The infant mortality-ratehad been halved, and they must do the same with thematernal mortality-rate. The annual report showed that57 nurses had been employed during the year and paid164,101 visits. Over 8000 new patients had been attended,and the patients themselves had contributed 92046 to thefunds.

Reviews and Notices of Books.PRACTICE OF MEDICINE.

An Introduction to the Practice of Medicine. ByWILLIAM BOXWELL, M.D. Dub., F.R.C.P.L, Pro-fessor of Pathology, Royal College of Surgeons,Ireland ; Physician to the Meath Hospital,Dublin ; and F. C. PURSER, M.D. Dub., F.R.C.P.I.,Professor of Medicine, Royal College of Surgeons,Ireland ; Physician to the Richmond, Whitworth,and Hardwicke Hospitals, Dublin. London:Bailliere, Tindall and Cox. Dublin : The TalbotPress, Ltd. 1924. Pp. 905.CONSIDERABLE courage is required to produce a

new text-book for the use of medical students duringtheir first years of clinical study. Established text-books have proved their worth, but, whilst theirsteady increase in size is a tribute to the progressof medicine, it has certainly rendered themdangerously bulky for the beginner.The writers have approached their task from a new

aspect. A brief account of general pathological andphysiological features is introduced before the descrip-tion of each disease or group of diseases, and it seemscertain that this method is one calculated to be usefulto the student, whose entry to the wards lies throughthe laboratories. We feel that high praise is due tothe authors for the boldness of their endeavour and,if in some details we disagree, the general scopeof their work must remain unchallenged. Thesection devoted to diseases of the nervous systemappears disproportionately long ; thus the account ofasphasia on p. 756 contains such detailed descriptionof the history of Broca’s discoveries that the subse-quent exposition of Marie’s views is overshadowed,while if phenomena such as apraxia require expositiona fuller description of them seems desirable. On theother hand, the description of the significance ofBabinski’s signs is better than is usually given andthe importance of these signs is well emphasised.The account of encephalitis lethargica on p. 628 willappear inadequate to readers in this country. Inthe section dealing with diseases of the ductlessglands, the authors include diabetes mellitus, a

classification justified by recent advances ; the bio-chemical pathology here described is clearly written,but the statement on p. 807 that an estimation ofblood-sugar should be made before and after theadministration of every dose of insulin is one calcu-lated to alarm both practitioner and patient and tobring disrepute upon an invaluable remedy. Futureeditions should receive e drastic revision of thesections devoted to chemical laboratory tests. Thepresent account of the tests for pancreatic insufficiencylays no stress on the importance of examining thefaeces; Fehling’s solution rather than Benedict’s isrecommended, and Rothera’s test for acetone is notgiven ; nor is mention made of the value of estimatingthe urea and non-protein nitrogen in the blood.The general conception of this book is excellent;

it keeps the pathological aspects of medicine clearlybefore the minds of its readers.

HERNIA.Its Anatomy, Etiology, Symptoms, Diagnosis,Differential Diagnosis, Prognosis, and OperativeTreatment. By LEIGH F. WATSON, M.D.,Associate in Surgery, Rush Medical College,Chicago, U.S.A. London : Henry Kimpton.1924. Pp. 660. 52s. 6d.

THE author has accomplished his aim at producinga complete treatise on hernia. He has written alarge but eminently readable volume, packed withinformation. Whether he is tracing the history ofhernia from ancient Egypt through Greece and Rome,or discussing the latest applications of local anaesthesia,he equally succeeds in infecting the reader with hisown enthusiasm for his subject. The attraction

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of the book largely depends upon the historical :setting in which it is framed. We feel that we arethe legitimate successors of Hippocrates and Celsus,of Pare and Lavater, and we gain a new conceptionof the continuity of our art and a new appreciationof the skill and insight of its founders. Every knownvariety of hernia receives full discussion, backedby ample statistical information and an elaboratebibliography.The author shows sound judgment in the views

and methods which he has selected for approval,and the value of the book is enhanced by an adequatedescription of those he would discard. Admirableillustrations are included.

UROLOGY.Lehrbuch der Urologie: By Prof. Dr. HANSWILDBOLZ, Berne. Berlin : Julius Springer. 1924. IPp. 546.$8.60.THIS is not only a text-book of urinary diseases,

it includes also affections of the male organs of genera-tion. Throughout we get the impression that theteaching is the outcome of personal experience andtherefore the book becomes more valuable. It isnot simply a compilation. Mostly the recommenda-tions conform to English practice, but here and thereappear notable differences. The author regardsperineal prostatectomy as preferable to the supra-pubic method. His own operation, in which hereconstitutes the prostatic urethra by suture, has amortality of between 5 and 10 per cent. with fewercomplications than the suprapubic method with amortality of 10-15 per cent. The method given onp. 70 for estimating the size of the kidney pelvis is

. not very good or accurate. Pyelography can be madeabsolutely safe by taking proper precautions. Forrefractory pyelitis an in-dwelling ureteric catheter isrecommended, a method of treatment scarcely everadopted in this country. A haematogenous originfor perinephric abscess is still put forward, but theauthor rightly says that the rupture of a small corticalkidney abscess cannot be laid aside as the possiblecause. The section on tuberculosis of the kidney isparticularly good. The pitfalls and difficulties indiagnosis are clearly set forth. Like most continentalsurgeons the author tays a good deal of stress uponthe indigo-carmine test and cryoscopy. Tumoursof the testicle are rather inadequately treated.Taken as a whole the work is a very good and

satisfactory text-book. The most careful -critic canonly point to minor blemishes. The book is illustratedby a number of informative coloured and monotoneplates which are beautifully reproduced.

HEARING.

By R. M. OGDEN, Professor of Education in CornellUniversity. London : Jonathan Cape. 1924.Pp. 351. 15s.IN this book Prof. Ogden deals with the psychological

aspect of hearing-that is, with the manner in whichsound affects the conscious mind-and he travelsthrough subjects many of which are of interest tomedical men in general and to otologists in particular.In the first two chapters are described briefly, butadequately, the physics of the sound-wave and theanatomy of the hearing organ. This is followed bya disquisition on the physiological theories of hearingfrom that of Helmholtz to that of Wrightson ; theauthor does not attempt to decide between theopposing " resonance " and "

telephone " theories

of audition.Every variety of sound can be classified into the

three groups of tones, vocables, and noises. A mostinteresting description of the attributes of tone isgiven, that of brightness is ascribed to variationof the wave-form whereby the pulsation is shortenedin comparison to the wave-length so that the troughbecomes longer than. the crest. There is a longdiscussion of vocables, or the characteristics ofvowel sounds, and of Hermann’s theory of "for-

mants " ; but surely the sound of " e," as in " fete,"is not a pure vowel, but a diphthong. A large partof the book is concerned with the character of soundsin relation to music, and interesting references areincluded to the musical scales of primitive races, ofancient Greeks, and of Oriental peoples. A chapter ofmore direct medical interest deals with the localisa-tion of sound. The physical conditions under whicha binaural sound is localised are primarily three :(1) the intensity ratio of the sound at the two ears,(2) the phase-difference of the sound-wave, and (3) the

relative time of arrival of the sound at the two ears.Interesting experiments are given as to the bearingof these three factors on localisation. A chapter onthe pathology of hearing is rather disappointing;it is not sufficiently full to be of real value, and isperhaps a little out of place in a book of this kind.Of the experiment with a tuning fork on the vertexit is said: " If one of the external canals is closed,the intensity of the sound in the closed ear is increasedby reason of the fact that the passage of the sound-waves outward is to some extent interfered with,so that the imprisoned column of air resonates " ;but is this a satisfactory explanation ? For it is certainthat the same phenomenon occurs when the meatusis solidly filled with cerumen or any other material.The paragraphs on the nature of auditory defects,deaf-mutism, and mechanical aids to hearing are

quite inadequate. The book ends with a criticism ofmusical education in America, and a plea for betteraural education in speech, which would also beapplicable to this country.

MINOR SURGERY AND BANDAGING.

Eighteenth edition. By GWYNNE WILLIAMS,F.R.C.S. London : J. and A. Churchill. 1924.Pp. 423. 10s. 6d.A VOLUME which started upon its career in 1861

and which has passed through 18 editions may beregarded as something more than a classic, it is almosta household friend. It would be interesting to comparethe last edition with the first and to see how muchremains of the original pages, but it is certain,anyhow, that Christopher Heath would be the firstto appreciate the sound common sense and the practicaloutlook of his grown-up child. In the preface theauthor expresses a modest hope that it may continueto be a guide to house-surgeons and students. Thereis scarcely a page from which the practising surgeonmay not pick up a useful - hint, from the tying ofa knot to the putting up of a fractured femur.Incidentally, the chapters on fractures are particularlygood and will repay careful study even by a surgeonof experience. We should like to recommend thebook to those who teach surgery. Minor surgery iswhat the student should know thoroughly if he is tobe efficient in any branch of his profession. He mayleave hospital full of the latest details of gastrectomyand bone-grafting, but entirely unable to treat a

dropped finger. A book like this would do much torestore in his teacher as well as in himself a truesense of proportion.

PHYSIOLOGY.Human Physiology : : A Practical Course. ByC. G. DouGLAS, C.M.G., M.C., D.M., F.R.S.,Fellow of St. John’s College, Oxford; and J. G.PRIESTLEY, M.C.,D.M., Christopher Welch Lecturerin Clinical Physiology, University of Oxford.Oxford : Clarendon Press. 1924. Pp. 232. 12s. 6d.FOR general utility as well as breadth, the course

given for the Final Honour School of Physiology inOxford must be admitted to come second to none.Local conditions are favourable, and such coursesare not given elsewhere, for various reasons. Teacherswho wish to imitate the Oxford course, which theymay well desire to do, have now fairly full accountsof the wide range of exercises comprised in the studiesat Oxford. The present book deserves nothing butpraise-the description of experiments is admirably

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clear and the selection of experiments is carefullymade. The book naturally deals in adequate detailwith those observations on respiration and /on theblood-gases for which the school is famous, and it issatisfactory to have a connected record of the methodsused. There are also chapters on the use of instru-ments for the investigation of the circulation, and onthe secretion of urine and the movements of thealimentary canal. A few chemical methods, such assome of the important ones for determination of blood- ’’,sugar and urea, are included. To teachers andadvanced students the book will be very useful, andit is regrettable that the equipment and techniqueinvolved preclude the carrying out of such exercisesby the ordinary medical student. To the clinical

research worker the book may, we think, show itselfindispensable. ____

Collected Papers, Institute of Physiology, UniversityCollege, London. Vol. XXI. Edited by ERNEST H.STARLING, C.M.G., M.D., Sc.D., F.R.S., Sir WM. M.BAYLISS, M.A., Sc.D., F.R.S., and J. C. DRUMMOND,D.Sc., F.I.C. 1923.THE 45 papers which comprise this closing volume

of a remarkable series, show the same high standardof excellence which has marked all the volumes ofcollected papers published during the time thatProf. Starling was the head of the University CollegeInstitute of Physiology. The papers fall roughlyinto three groups, corresponding to the direction ofinquiry followed by each of the three professors whoedit the collection. About half of the papers representwork on vitamins by Prof. Drummond and variouscollaborators, particularly Miss Katharine Cowardand Dr. S. S. Zilva ; these papers have contributedlargely towards giving the Biochemical Departmentof this College a high status. Original work breakingsome fresh ground is that by Drs. G. V. Anrepand R. K. Cannan on the metabolism of thesalivary glands, and on the effect of alteration ofblood reaction on the lactic acid concentrationof the blood. An interesting paper on active hyper-aemia is contributed by Dr. D. T. Harris. Prof.Starling and various collaborators contribute paperson the heart, and Sir William Bayliss, as usual, rangesover a wide field of subjects. This volume containstwo of his papers on the effects of haemorrhage.

Questions Actuelles de Biologie M édicale. ByG. H. ROGER, Doyen’de la Faculte de Medecine deParis ; Professeur de Pathologie Experimentaleet Comparee ; Membre de 1’Academie de Médecine.Paris : Masson et Cie. 1924. Pp. 194. Fr.16.

THE seven essays contained in this book representthe conclusions of some of the author’s researches,part of which have been already published as separatepapers. Among the subjects treated are the lipolyticand detoxifying action of the lungs, various effectsof injection of autolytic products of the lungs and ofother animal extracts, the functions of the suprarenalsespecially with regard to their relation to the hyper-tension of cerebral embolism, the action of the liveron toxic substances, various researches on enzymes,and a chapter on the functions of the bile. This lastis one of the most interesting in the book ; one of thehypotheses advanced is that the bile counteractsan enzyme mucino-coagulase, and so inhibits the <

coagulation of mucin. In muco-membranous colitis,for one reason or another, coagulation of mucus occurs.As a whole the book provides highly entertainingreading, and one leaves it with a feeling of admirationfor the author’s ingenuity. s

iDIET FOR CHILDREN. ;

By CECIL WEBB-JOHNSON, M.B., Ch.B., Major aR.A.M.C. (T.F.), late Civil Surgeon and O.C.Station Hospital, Dum-Dum. London : Mills andBoon. 1924. Pp. 128. 3s. 6d.IT is not necessary to agree with their contents in

entirety to find that Dr. Cecil Webb-Johnson’s

various works on diet contain much good commonsense, so that their appeal to the lay reader, forwhom they are intended, is justified. This is in manyways the best of his books ; it shows a balance anda tolerance of opinions current among authoritieson the scientific side of diet which have not alwaysmarked his previous works. He is still averse, thoughnot so bitterly, to the use of milk. Though it wouldbe easy to find fault with the scientific aspects of thebook, it is one which is capable of being understoodby those with no knowledge of science, and is likelyto do much more good than harm.

New Inventions.SPECIAL BOX FOR THE RADIANT HEATTREATMENT OF INFECTED FINGERS

AND HANDS.

THE use of radiant heat in treatment of infectedfingers and hands has been mentioned by severalauthors,! and Messrs. John Weiss and Son have madea special box to my design for the hot-air treatmentof such cases. The box is made of wood and is linedwith asbestos and measures 13 in. by 10 in. by 7 in.Four long cylindrical carbon filament lamps give theheat and they can be supplied at the desired voltage.They are shaded by strips of asbestos to prevent anypossibility of the lamp touching and so burning thehand. A tbermometer has been fixed into the top ofthe box, so that the reading may easily be checked.The illustration shows the arrangement, the two

halves of the box being equal in size, and the wholeapparatus is light and easy to use. The hand is

placed in the box, which is then shut and securelyfastened, and any gaps left around the wrist at theentrance to the box are closed with wool or a towel.The current is switched on and the temperatureallowed to reach 120&deg; F.-ivhich it does in five minutes-and it is then kept at that level for 20 minutes.The advantages of this box are that it provides asmall, light, portable heat-bath for the hand, that itcan be used anywhere where electric current isinstalled, and it provides a method which givesadmirable results in clearing up infections of the handand preventing adhesions of tendons and stiff hands.

R. M. HANDFIELD-JONES, F.R.C.S. Eng.,Assistant Director, Surgical Unit, St. Mary’s

Hospital, London, W.

1 See THE LANCET, 1924, i., 966.