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REVIEWS AND NOTICES OF BOOKS

The Endocrine Organs in Health and DiseaseBy Sir HUMPHRY DAVY ROLLESTON, Bart.,G.C.V.O., K.C.B., M.D., Hon. D.Sc., D.C.L., LL.D.,Emeritus Regius Professor of Physic and HonoraryFellow of St. John’s College, Cambridge ; some-

time President, Royal College of Physicians ofLondon. London: Humphrey Milford, OxfordUniversity Press. 1936. Pp. 521. 36s.THE progress of scientific knowledge is so rapid

that we seldom pause to reflect on the achievementsof our forefathers. The student of to-day has histime so fully occupied that he can scarcely affordto allow himself to digress from the main road of"examination medicine," and the fascinating studyof medical history is gradually becoming the hobbyof the medical dilettante rather than an essentialpart of the education of the cultured man of science.Medicine must fall into line with the general tendency,but some may feel that research has lost much ofits romance ; gone is the dreaming of future dis-coveries, gone the contemplation of past achieve-ments ; for the modern generation has little timeto pay respect to its contemporaries, and less tovenerate its predecessors. Gone also is much of themastery of words.

In the present volume we find combined the threeattributes whose loss we have just deplored ; it isthe romantic story of a subject still in the hands ofthe research worker told from the historical pointof view by an author whose eminence is not onlyuniversally recognised by his juniors but whoseexposition of medical subjects places him in the

company of Clifford Allbutt and Osler. The book isthe outcome of the delivery of the FitzPatrick lectureson the History of the Endocrine Organs at the RoyalCollege of Physicians in 1933 and 1934, a lectureshipwhich is devoted to the history of medicine ; and itis written from three points of view, as a biographyof the pioneers whose discoveries are milestones in theprogress of endocrinology, as a bibliography which isextensive and selective enough to be of real use tothose specialising in the subject, and as a review ofcontemporary knowledge. Sir Humphry Rollestonhas wisely refrained from a critical consideration ofthe evidence available, contenting himself with a

clear statement of the relevant facts and theories.A review of such a large and intricate subject is alaborious and ambitious task, which could be suc-cessfully accomplished only by a man of wide

learning. Its success is evident ; the author hassucceeded not only in producing a valuable work ofreference, but also a book which is interesting andpleasant to read. It is the most complete expositionof endocrinology so far written by an Englishman.

Stilling’s Pseudo-isochromatic PlatesFor Testing Colour Perception. Nineteenth edition.By Geheimrat Prof. Dr. E. HERTEL. Leipzig:Georg Thieme. English edition obtainable fromF. Bauermeister, 7, North Bank-street, Edinburgh.1936. With 32 diagrams. 22s. 6d.

Stilling’s test for colour-blindness, devised half acentury ago, takes the form of coloured plates cleverlycombined to differentiate degrees of abnormality.These plates have now reached a nineteenth edition.Most of them are designed to reveal red or greenblindness ; others will expose weakness in the blue-

yellow sensation. Several contain figures whichare hidden to the colour-blind but plain to the normal ;others contain only spots or dots of various sizes

in confusion colours. The examiner is supposed toindicate one of the spots and the subject is requiredto point out which others resemble it in colour.The test is certainly convenient; gross defects

of colour.vision are not difficult to discover. Partialdefects, which may cause difficulty in distinguishingcoloured lights in a mist, are not so easy to detect.For navigators the Board of Trade now insist on thelantern test of Edridge-Green. Now that traffic

lights are ubiquitous weakness of colour-visionbecomes a potential danger on the roads. It wouldbe interesting to ascertain in how many cases thishas been a factor in accidents. Certainly tests formotor-drivers should be as rigid as those now enforcedfor navigators and engine-drivers. The proportion ofthe male population affected with congenital colour-blindness is generally held to be from 3 to 4 per cent.

Alcoholism in General PracticeBy A. E. CARVER, M.A., M.D., D.P.M. Cantab.,Medical Director, Caldecote Hall ; THOMAS HUNT,B.A., D.M. Oxon., F.R.C.P. Lond., Physician to

Out-patients, St. Mary’s Hospital; and Sir WILLIAMWILLCOX, K.C.I.E., C.B., C.M.G., M.D., F.R.C.P.,Consulting Physician, St. Mary’s Hospital. London:Constable and Co., Ltd. 1936. Pp. 131. 7s. 6d.Dr. Carver begins by discussing the psychotherapy

of alcoholism, the use of drugs, and the generaltreatment, including the after-care of alcoholicswhom he classifies as intermittent, regular, and

paroxysmal. Treatment, he explains, may be

domiciliary, institutional, or carried out in a nursing-home. Of these, institutional treatment gives thebest results, but implies that the patient is anxiousto be cured and willing to cooperate. In the secondsection Dr. Hunt describes the general and physicaleffects of alcohol and their treatment. He holdsthat moderate drinking is probably harmless, butsets the upper limit of moderation for the normalperson at 1 pints of beer daily. In the final sectionSir William Willcox sets forth the medico-legalaspects of chronic alcoholism. The trio of authors,who have written independently, have avoided con-tradiction and overlapping to a remarkable degree.They provide the practitioner with all he is likelyto want to know about alcoholism.

William Budd, M.D. Edin., F.R.S.The Bristol Physician and Epidemiologist. By E. W.GOODALL, O.B.E., M.D. Lond. London: J. W.Arrowsmith Ltd. 1936. Pp. 159. 5s.

Dr. Goodall was moved to write this book becausehe feels that William Budd deserves a higher placein the history of British medicine than has hithertobeen accorded to him. This pioneer of modern

epidemiology was born at North Taunton, in Devon,in 1811, the sixth child of a family of ten, six of whomgraduated as doctors of medicine. Of the fivebrothers who went to Cambridge, all became wranglers.To stand out as the most brilliant in a family of thiskind implies ability of a high order. William Buddreceived his medical education in Paris (where healmost died of typhoid), at Edinburgh, and at theMiddlesex and Dreadnought Hospitals. He also hadaccess to clinical material at King’s College Hospitalwhere his brother George was physician. After

qualification he worked for a few years in Devonshirebut finally settled in Bristol, where he became, amongother things, physician to the Royal Infirmary. Despitea busy life he wrote extensively on such matters as

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contagion and on the absurdity of the current theoryof spontaneous generation. His interest in epidemicsled him to study epizootics which yielded him muchvaluable information. At a time when many doubtedit, he was a staunch upholder of the theory of thespecificity of infectious diseases, insisting that typhoidand typhus were two separate and distinct infections.Of the infectious nature of phthisis, also, he wasfirmly convinced. Some may prefer biography of a kindmore intimate than this, preferring to know more ofwhat manner of man the subject was rather than whathe did; but Dr. Goodall writes with accuracy andfairness, and has provided a most readable book.

Delafield and Prudden’s Text-book ofPathologySixteenth edition. Revised by FRANCIS CARTERWOOD, M.D., Director of the Pathological Depart-ment, St. Luke’s Hospital, New York. London :Bailliere, Tindall and Cox. 1936. Pp. 1406. 45s.

THIS well-known text-book, now more than 50 yearsold, covers practically every subject which is likelyto confront the student of pathology, even includingchapters on post-mortem technique and the possiblelesions in cases of sudden death. As in previouseditions the descriptions of the individual lesionsare admirable, and from the point of descriptivemorbid anatomy the work leaves little to be desired.Unfortunately the present edition is unevenlyrevised. In spite of many alterations, the bookas a whole is not completely up to date. For example,no attempt has been made to classify the anaemiasin accordance with modern teaching, whilst Price-Jones’s work on the size of cell and Castle’s workon pernicious anaemia are not even mentioned ; inthe section on nephritis no mention is made of

Dorothy Russell’s work. Under the heading arterio-sclerosis there is no clear differentiation betweenobliterating endarteritis and diffuse hyperplasticsclerosis; and, moreover, the use of such a termas chronic arteritis for all forms of arterio-sclerosisis misleading. These sections are a contrast to thoseon muscles, bones, joints, and the nervous systemin which the text has been thoroughly revised.

It would be unfair to recommend to students atext-book which however, good in many respects, is

likely to leave him out of touch with current teaching.As a work of reference it has value, though for thispurpose the bibliography could with advantagehave been revised. The bulk of the references are tothe early classical writers rather than to modern work.

English MessiahsStudies of Six English Beligious Pretenders, 1656-1927. By RONALD MATTHEWS. London : Methuenand Co., Ltd. 1936. Pp. 230. 108. 6d.FOR religious pretenders there would seem to be a

steady market and the craving for a messiah whowill liberate the oppressed has manifested itselffrequently in English history. Here is an interestingbook about six of these impostors, all patheticvictims of self-deception. First comes James Nayler,"the Quakers’ Jesus," who rode into Bristol in1656 with women strewing their garments beforehim and crying " Holy ! Holy ! " and who was

tried and cruelly punished by the CommonwealthParliament. Released from prison after three yearsand reconciled once more with George Fox, he made inBristol a public confession of his error which broughttears to the listeners’ eyes. Next we have JoannaSouthcott, "The Bride of the Lamb," that buxomcountry wench whose mysterious box was only to be

opened by 24 bishops ; and Richard Brothers, " GodAlmighty’s nephew," the ex-naval lieutenant who,during a brief nine months, captured the popularimagination, was then certified insane and imprisonedfor 11 years to die obscurely 18 years later. Nextcomes John Nichols Tom, " the peasants’ saviour,"son of a Cornish publican, who was killed in a pitchedbattle fought between his disciples and the military.Finally we have Henry James Prince (" Beloved ")and his successor, John Hugh Smyth-Piggott ofthe Agapemone, who died less than a decade ago.Mr. Matthews writes with sympathy and psycho-logical insight. He handles his subjects in no spiritof mockery but with a genuine desire for under-standing. In a convincing final chapter, he concludesthat all six were abnormal and not merely unusualpersons. At least five of them were true psychotics.Joanna Southcott, Brothers, and Tom " were all

escaping from hard reality into the dream happinessof imaginary worlds." James Nayler was a

cyclothymic and Prince a paranoiac with, perhaps," the terminal imbecility of dementia praecox."

The Eye and its DiseasesBy 82 International Authorities. Edited byCONRAD BERENS, M.D., Ophthalmic Surgeon,Pathologist and Director of Research, New YorkEye and Ear Infirmary. London and Philadelphia :W. B. Saunders Co., Ltd. 1936. Pp. 1254. 50s.

THIS is an encyclopaedic volume to which 82authors have contributed separate articles, some

brief, others very long. Most of the contributorsare American, but a dozen or so are British and afew are Swiss, German, or Dutch. Anatomy andphysiology take up about one-eighth of the book.

In Part III., which deals with methods of examiningthe eye, modern developments of perimetry are

explained by H. M. Traquair. The subject of slit-

lamp examination is given a chapter, but its diffi-culties can hardly be overcome without a course ofpractical training. Its importance is illustrated in along article by Basil Graves on diseases of the cornea,which is mainly devoted to slit-lamp diagnosis.Among other important articles we may mentionthose of Miss Ida Mann on the normal developmentof the human eye and on conditions due to abnormaldevelopment ; R. Affieck Greeves on the generalpathology of the eye; C. H. Usher on heredity ;S. Hanford McKee on diseases of the conjunctiva ;Karl Lindner on trachoma ; and Luther C. Peter onmotor anomalies of the eyes. In the section devotedto operative surgery the editor supplies the firstarticle on general considerations : he deals withpreliminary preparation, equipment, arrangementand preparation of the operating theatre, sterilisa.tion of instruments, and post-operative treatment.Description of the operations commonly performed isentrusted to various writers. It is, of course, impossibleto describe all the modifications that have foundfavour with different surgeons, but recent develop-ments are not lost sight of. After referring to currentprocedures for closing the hole in the operation fordetached retina, Marc Amsler wisely adds : " We areat present in a period of research and elaboration oftechnique. The exact indications for each method,especially in such varying cases of detachment of theretina, will best be determined in the light of experi-ence and newly acquired information." This is truein many other connexions included in the operativesurgery of the eye. However complete a work ofthis sort may appear to be it will certainly needfrequent revision.

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Quarterly Journal of MedicineTHE July issue (Vol. V., No. 19) contains the

following papers :-RESPIRATORY EFFICIENCY TESTS IN ASTHMA. By

James L. Livingstone and Marjorie Gillespie (King’sCollege Hospital). In asthmatics there are founddiminution of the reserve air, diminished chestexpansion, and predominantly costal breathing.Patients who, after treatment by breathing exercises,learn to breathe with their diaphragms, show clinicalimprovement; reserve air and chest expansionincrease. Measurements of other respiratory func-tions do not show parallel changes.A REVIEW OF RECENT WORK ON WHOOPING-

COUGH. By R. E. Smith (Rugby). The chief con-clusions are that Bordet’s bacillus appears to be thesole setiological agent; that vaccines made from freshorganisms grown on human blood give a fair measureof protection, but are of little use in treatment; andthat convalescent serum promises to beusefulinprophy-laxis and attenuation. A school epidemic is described.PULMONARY CONGESTION FOLLOWING ARTIFICIAL

PNEUMOTHORAX: ITS CLINICAL SIGNIFICANCE. ByRonald V. Christie (London Hospital). In spite ofabnormally large respiratory fluctuations in intra-pleural pressure, a partly collapsed lung takes in lesstidal air in inspiration than a normal one. Asdemonstrated in animals, and in a patient withbilateral pneumothorax, this observation is held toindicate decreased distensibility of the lung, whichis attributed to capillary engorgement. Similar con-gestion occurs in mitral stenosis and in people livingat high altitudes, and may therefore be an importantfactor in inhibiting tuberculous disease.

THE ROLE OF CALCIUM IN SPONTANEOUS OVER-BREATHING TETANY. Hy 0. <*. Barnes and R. 1. N.Greaves (St. Mary’s Hospital). In two cases a slightfall was observed during tetany in the cerebro-spinalfluid calcium content, which is regarded as an indexof the diffusible calcium of the blood.CHEMICAL AND CLINICAL FINDINGS IN BERI-BERI

WITH SPECIAL REFERENCE TO VITAMIN-Bi DEFICIENCY.By B. S. Platt and G. D. Lu (Shanghai). Severe andfulminating cases of beri-beri are shown to have anincrease in the amount of bisulphite-binding sub-stances in the blood, running roughly parallel to theseverity of the vitamin-B1 deficiency as judgedclinically. The increase is due largely to pyruvicacid which has been in some cases isolated from theblood. Increase of bisulphite-binding substances inthe blood, especially pyruvic acid, is a known featureof vitamin-B1 deficiency in pigeons.SECONDARY THRUSH OF THE BRONCHI. By J. F. D.

Shrewsbury (Birmingham). From a close examinationof published descriptions and cases of so-calledbronchomoniliasis the author fails to find adequategrounds for regarding monilia as a primary pathogenicagent. It is a variety of the common thrush fungus,and is frequently present in human sputum. Itsoccurrence occasionally in large quantities in thesputum, in the absence of oral thrush, is attributedto secondary thrush infection of bronchi already theseat of some inflammatory process. It. may con-tribute mechanically to the pulmonary embarrassment.Cases are reported in support of this contention.THE RAYNAUD PHENOMENA : A CRITICAL REVIEW.

By John H. Hunt (St. Bartholomew’s). This wasannotated in our columns last week.

NEW INVENTIONS

A DEVICE FOR INCREASING THE FIELD INGASTROSCOPY

ONE of the great disadvantages of working with theWolf-Schindler flexible gastroscope is that the upperpart of the lesser curvature and the adjacent part ofthe posterior wall are too close to the gastroscope toallow distinct vision. Since in this area gastriculcer and carcinoma are very common this dis-

advantage must be overcome by some device.

FIG. I.-Gastroscope with balloon deflated.

FIG. 12.-After inflation.

Fig. 1 and Fig. 2 show a rubber balloon built into thesheath of the gastroscope. If this balloon is inflated,as in Fig. 2, the mucosa in contact with it and withthe lens will be pushed away and the view will becomeclear. I have used this balloon on some 50 recentcases and have found it of great help in examiningthe upper part of the lesser curvature and the posteriorwall, where I have found a few lesions which I believewould have been missed without its help. A furtheruse of this balloon is in examining the stomata ofgastro-enterostomies which frequently lie on the

posterior wall so close to the instrument that onecannot see them. By inflating the balloon and movingthe gastroscope up and down the stoma can often

be held at a distance and’ a good view can beobtained. The radiograms reproduced in Fig. 3show the degree of displacement which inflation of theballoon produces. The increase of air space immediatelyproximal to the lens of the gastroscope is produced

FIG. 3.-Radiograms of the stomach during gastroscopy (lateraview), the lower showing the stomach wall raised by theballoon.

by the inflated balloon ; one was taken only a fewseconds after the other. The patient was in theleft lateral position and the fluid level towards thebottom is the pool of mucus which collects in the mostdependant part of the stomach.

This sheath has been made for me by the Genito.Urinary Company, London.

H. W. RoDGERS. F.R.C.S. Eng.,Chief Assistant to a Surgical Unit, St. Bartholomew’s

Hospital, London.

H. W. RODGERS, F.R.C.S. Eng.,Chief Assistant to a Surgical Unit, St. Bartholomew’s

Hospital, London.