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REVIEWS AND NOTICES OF BOOKS

Starling’s Principles of Human PhysiologySixth edition. Edited and revised by C. LOVATTEVANS, D.Sc., F.R.C.P., F.R.S., Jodrell Professorof Physiology, University College, London. The

chapters on the Central Nervous System and SenseOrgans revised by H. HARTRIDGE, M.A., M.D.,Sc.D., F.R.S., Professor of Physiology at St.Bartholomew’s Medical College. London : J. and A.

, Churchill. 1933. Pp. 1122. 24s.

PHYSIOLOGY is moving so fast that the last editionof Starling’s Physiology, only published three yearsago, needed very generous revision, and in some partsactual rewriting, to bring it up to date. The necessarychanges have been made with great skill by Prof.Lovatt Evans, and he deserves the thanks of teachersas well as students for the outcome of his labours.A feature of the new edition, which many must longhave desired in a text-book of this importance, is theaddition of references, both general and particular. "

Starling’s Physiology has become, over the course ofyears, a text-book for the more thoughtful student,who will appreciate a moderate number of carefullychosen references, to show him where further know-ledge may be obtained on special points. Wide reading,even at an early stage, is useful to mitigate a tendencyto acquire dogmatic views, and to bridge the gapbetween elementary and advanced reading. Afeature which will give satisfaction to all who lookat physiology in its broader aspect is the insertion ofa certain amount of historical matter. Some would

argue that it might be even greater in amount withoutdisadvantage, on the ground that the history of a scienceis an integral part of that science. The great physio-logists of a century, or two centuries, or three centuriesago made many lasting contributions to the subject,and their work should be honoured by succeedinggenerations. On the other hand, the curiosity of astudent keen to learn’the present state of knowledgeon, say, the functions of the liver or kidneys, maybe slightly damped by having to study previousdiscarded theories before coming to the modern view.The compromise between complete neglect of historyand the approach through a ladder of dates andobsolete work has been well planned.In the section dealing with the nervous system,

much recent work has been incorporated ; one wouldlike to see even more. Those interested in terminologywill regret that Sherrington’s carefully considerednomenclature is not more generally adopted-e.g.,"

sensory " should be changed to

" afferent " in manyplaces. The treatment of the autonomic nervous

system is still not the best possible, and one wouldhave hoped, from a physiologist’s point of view, thatProf. Hartridge would abandon the cranial nerves,which are not physiological entities, and substitutean orderly classification on embryological lines ofthe columns of nuclei, which are. This change is, inthe opinion of many, long overdue, for such a treat-ment of the central nervous system makes it muchmore intelligible to the student, who is, after all, theperson most concerned.These criticisms are, however, applicable to most

present text-books, and one would not care, byreference to small things, to leave an impression ofanything but high appreciation of this new editionof Starling’s Physiology. Prof. Lovatt Evans andProf. Hartridge deserve the thanks of students,and of those who teach them, for the vast amountof work in which they have been involved, and forthe excellence of this product of their labours.

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Handbuch der Rontgendiagnostik und

Therapie im KindersalterBy ST. ENGEL (Dortmund) and L. SCHALL (Hom-burg-Saar). Leipzig : Georg Thieme. 1933.Pp. 720. M.72.

RADIOLOGISTS who have made acquaintance withthe remarkable text-book of radiology by Baensch, .

Friedl, and Schinz, previously issued by the samepublishers, will welcome as a companion volume thisexcellent treatise on the radiology and radiotherapyof the diseases of children. It is a compilation,on the same general lines, of special articles byrecognised experts in various branches of radiology.The editors modestly describe even a work of thissize as a "beginning," having regard to the rapidadvances of radiology in recent years; but theyhave done their work so well that it takes rank asa standard work on the subject to-day.They have concentrated on those aspects of disease

peculiar to children, merely touching upon conditionscommon to children and adults. The section on

skeletal diseases is very brief, occupying less than60 pages, but the rather sketchy descriptions of

developmental and acquired disease are amplified byuseful bibliographies. The sections dealing withinternal disease, particularly of the chest, are handledwith great thoroughness and method. The section onthe chest contains 330 pages, very fully illustrated, andis introduced by a careful study of the developmentof the thorax, and of the changes and modificationsresulting from natural growth and from skeletaldisease. The importance of the lymphatic apparatusjustifies the inclusion of an excellent anatomicalstudy of the glands and of lymphatic drainage inrelation to chest disease. Interesting and informativearticles on the pneumonias of childhood are contri-buted by St. Engel and Samson, who emphasisethe variation of type with the age of the child, pointingout the frequency of paravertebral pneumonia in

infancy, of the lobular form in early childhood, andthe lobar during school age. No radiologist can

hope to understand the radiology of the lung andpleura without a clear understanding of anatomy,and Schonfield’s article on the pleura, on the anatomyof the interlobes, and on abnormalities of lobationis especially valuable. Recent German work on

tuberculosis of the lung, particularly the classificationof its varying forms, is of paramount importance ; .-and although we may not be prepared to accept alltheir conclusions, the pioneer work of German workersin this field already forms an accepted basis for seriousstudy. The contributions on primary tuberculosisand bronchial gland tuberculosis (Gottche), on

infiltrations (Priesel), on haematogenous disseminatetuberculosis (Redeker), and on phthisis (Simon) thusdeserve detailed attention. Very useful also is thesection on the mediastinum, in which especialattention is directed to thymic enlargement. The

opinion is expressed that the diagnosis of this enlarge-ment in the ordinary postero-anterior skiagramis virtually impossible. Simple elevation of the

diaphragm following a meal may, for example, producethe broadening of the mediastinal shadows describedin text-books as "characteristic" of thymic hyper-plasia. Another section of great interest is that onheart disease which contains the best summary ofcongenital heart lesions and their X ray appearanceswhich we have yet seen. In the section on thealimentary tract a somewhat fuller treatment ofpyloric obstruction would be desirable, and the’

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section on megacolon curiously omits all referenceto the role of the sympathetic. The section on

diseases of the skull and brain, and on encephalo-graphy is very good, and also that on radiotherapyby Holthuser and others. This contains usefuldiscussions upon the problems of radiosensitivityof children, on the risk of damage to the foetus byirradiation of the mother-a risk which is here foundto be by no means negligible-and on the routinetreatment of diseases of blood, ductless glands, andthe skin, and of tumours, especially brain tumours.

Altogether this book deserves high praise for matter,style of production, and quality of illustrations.

The Diagnosis and Treatment of DiabetesBy W. WILSON INGRAM, M.C., M.D. Aberd.,Honorary Physician and Physician in Charge ofthe Clinic for Diabetes Mellitus, and HonoraryDirector, Institute of Medical Research, RoyalNorth Shore Hospital, Sydney; and G. V. RUDD,M.Se. Melb., Research Biochemist to the Institute.London : Australian Book Co. 1933. Pp. 88. 5s.

IN this little book the problems of the errors ofmetabolism which occur in diabetes are discussed

,quite adequately in simple terms. The diagnosis bymeans of estimations of the blood-sugar and of sugar-tolerance tests is described more fully. The principles,of the diet suitable for the diabetics are set out, thehigh carbohydrate-low fat diet being adopted. The.diets selected seem rather inflexible, and the actual.amount of carbohydrate and fat contained in each.diet is omitted; although in some the calories andprotein content are given, but in most of them only-the calorie content is given. The food tables are setout in the old form of so many grammes of carbo-hydrate, protein, and fat in 1 oz. of the substance,instead of in the more convenient form which statesthat the substance contains 5 g. of each kind of food.This modern method enables the patient to changeone article of food for another without making anycalculations, and should be adopted in a subsequentedition. The chapter on the use of insulin and thetreatment of complications is short but clear.The manual is intended primarily for the use of

practitioners, and should be well received.

A Synopsis of Public HealthBy E. W. CARYL THOMAS, M.D., B.Sc.Lond.,D.P.H., Barrister-at-Law; Medical Officer of Health,Dagenham. Bristol: John Wright and Sons, Ltd. ;London : Simpkin Marshall, Ltd. Pp. 646. 21s.

THIS book is appropriately described as a synopsis.It provides also an index and summary of the practice,administration, and law of public health, and in:addition, summaries of the facts relating to thesciences upon which public health practice is based.The information is up to date and a very carefulscrutiny has failed to find any errors of fact.The book is one of a series prepared for students,

in this case for students working for the diplomain public health or a degree in State medicine or

sanitary science, and if a student must rely on onetext-book to cover the whole field this compilationof accurate information will appeal to him. In most

people, however, nothing could be more calculated tokill enthusiasm for a career in preventive medicinethan an approach limited to the study of one book,however excellent. We can with much more confi-dence recommend it to medical officers of health, whowill find in it facts which will be of great use in thepreparation of reports to their committees, and toteachers of public health. The very full biblio-

graphies at the end of each chapter redeem the workfrom pedestrianism and indicate the colossal amountof labour which its preparation has involved. Theindex is complete and altogether the book is a modelof its kind.

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Synopsis of GynecologyBy HARRY STURGEON CROSSEN, M.D., F.A.C.S.,Professor of Clinical Gynecology in the WashingtonUniversity, St. Louis ; and ROBERT JAMES CROSSEN,M.D. London: Henry Kimpton. Pp. 227. 15s.Ti-iis small book is one of the most satisfactory

gynaecological publications of recent years. Prof.Crossen points out that a large mass of facts accumu-lated in the various branches of medicine tends tothe production of expensive text-books which theaverage student has neither the funds to buy nor thetime to read. He suggests boldly that studentsshould be divided into those who intend to practisegynaecology as a specialty and those who are goingin for general practice. For the latter groupa wide knowledge of gynaecology is, he holds,unnecessary, and he has therefore prepared thissynopsis, which presents in short space a fairlycomprehensive survey of the subject. The resultis exceptionally satisfactory, for particular emphasisis placed upon the clinical side, and about a quarterof the book is devoted to methods of examination andthe elucidation of physical signs. Similarly theresume of the work on the endocrine glands is shortlyand accurately presented. In the operative sectionemphasis is placed on after-treatment and there islittle or no detail of the various surgical methods.

Prof. Crossen and his collaborator are to be

congratulated not only on the success with whichthey have stated their case, but also on the actionthey have taken in support of their views on medicaleducation. The book can be strongly commended tostudents starting their gynaecological studies.

Marriage, Children, and GodBy CLAUD MULLINS. London : George Allen andUnwin. 1933. Pp. 223. 6s.

Mr. Mullins’s book, which is supported by a prefaceby the Bishop of Southwark, seeks to reconcile thedeliberate limitation of families (by abstinence ifthis is possible ; if not, by contraception) with theprinciples of religion. The author is well knownas a London magistrate, and his plea is essentiallybased upon his experiences in courts of law, whereinhe has been convinced that much domestic strifecould be avoided by a rational sex education. Thevolume contains numerous quotations from ecclesi-astical authorities, and is primarily designed forthose who, on religious grounds, oppose the inclusionof advice on contraception in schemes of sex educationor of preparation for marriage. Careful considerationis given to the opinions of Jewish and Roman Catholicauthorities, and throughout the author writes as

one who is within the church and accepts its moralstandards. Emphasis is given to this standpoint bythe vigour with which Mr. Mullins dissociates himselffrom such writers as Lord Russell and Judge BenLindsey. As its title implies, the book containsno original observations of primarily medical interest,though it will prove helpful to many sincere peoplewho, on ethical grounds, find it difficult to acceptthe implications of contraception.

CORRIGENDUM.-The additional volume to thework on Operative Surgery by W. S. Bickham andC. M. Smyth, reviewed in our issue last week, wasVol. VII., and not Vol. III. as stated.

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THE LANCETLONDON: SATURDAY, OCTOBER 21, 1933

NOTIFICATION OF FOOD POISONINGWHILE we are getting to know something

about the causation of food poisoning, the numerousoutbreaks which still occur show how difficultit is proving to put this knowledge into practice.The suggestion has often been made that foodpoisoning should be added to the list of conditionsto be notified by the medical practitioner, andunder the provisions of the London County Council(General Powers) Act, 1932 (Section 7), medicalpractitioners are required to notify the boroughmedical officers of health of any persons who aresuffering or are suspected to be suffering fromfood poisoning. The Act became operative in

July, 1932, and in a recent report Sir FREDERICKMENZIES states that during the second half ofthat year particulars of 466 cases were received.There appears to have been no widespread infectionfrom any one source, except that 14 cases werereported amongst a wedding party in BethnalGreen, where the food suspected was choppedliver. The report unfortunately does not specifythe number of outbreaks in which more thanone person was affected, but in a great manyinstances there must have been only one sufferer.Single-person cases are particularly difficult to

elucidate, but in recent years there have beena good many such instances of definite food

poisoning where, with detailed investigation,the bacterial cause has been ascertained. In-a number of cases notified as. food poisoninginquiry showed that the practitioner had failedto distinguish between true food poisoning andpersonal idiosyncrasy or physiological reactions togross indiscretions of diet. Several boroughmedical officers, among them Dr. W. STOTT

Southwark) and Dr. G. C. TROTTER (Islington),have felt constrained to issue circulars drawingattention to the need for a clear conception as towhat constitutes food poisoning. Dr. TROTTER

points out that food poisoning is when the fooditself is poisoned either by bacteria or other poison,and the individual is poisoned by partaking ofthe same, and that it does not include faultydigestion or allergic cases. But the difficulty ofdefining food poisoning is a drawback to notifica-tion. The condition may be due to infection ofthe food with living bacilli and as such is difficultto distinguish by definition frQm dysentery or

typhoid fever infections. On the other hand,the cause may be some chemical substance eitheradded to the food directly or produced by bacterialactivity. Again, where but a single patient isaffected these two varieties of poisoning may behard to distinguish from those in which the main-factor is an abnormal reaction which would beharmless to other people. This point is emphasised,.since it implies that any system of notification

will result in the reporting of cases which are

not genuine food poisoning.Notification of itself is of but little help unless

it includes skilled investigation. The subject is

highly technical and requires, in many cases,

knowledge beyond that possessed by the ordinaryinspectorial staff. A routine inquiry, howeverconscientious, is likely to pass over much that

may be of value, although it may have its use inruling out what is trifling and manifestly notfood poisoning at all. For the residuum the

investigation should be in the hands of someone

acquainted with the distribution of food poisoningorganisms in nature, able to judge when (andwhen not) to take samples for bacteriological andc.hemical examination, and exactly what to sample.The elucidation of a genuine outbreak is a detectiveproblem which may sometimes demand a SherlockHolmes, but always requires extensive knowledgeof the subject. To explain fully any individual .

outbreak of food poisoning it is necessary to knowthe answer to four questions. What is the vehicleof infection ? What is the cause of the poisoning,bacterial or otherwise ? The third questionrelates mainly to bacterial infections-what isthe reservoir from which were derived the bacteriawhich infected the food ? Fourthly, what is thepath by which the bacteria were conveyed fromthe reservoir of infection to the vehicle ? Our

knowledge of the causative factors is extensive,the vehicle of infection is usually simple to ascertain,the reservoirs of the salmonella group of bacteriaand other strains responsible for food poisoningare gradually being brought to light, but knowledgelags in reply to the fourth question. As Dr. W. G.SAVAGE pointed out in his Sedgwick lecture lastyear,l the path of infection has not been discoveredin more than 10 per cent. of recent outbreaks.This lacuna in our knowledge can best be filled

by expert painstaking investigation.

WHERE RADIUM NOW STANDSFouR years have gone by since Lord LEE OF

FAREHAM was appointed the first chairman of theNational Radium Commission, and his statutoryretirement with five original members of theCommission has given an occasion to sum up thework of the Commission during its first quadrennialstage.2 The primary duty laid by Royal Charteron the Commission was to make arrangementsfor the proper custody, equitable distribution,and full use of the radium entrusted to them ;and in the execution of their national policy anetwork of 17 fully equipped radium centres hasbeen established throughout the country. Nine-teen grammes of radium have been purchasedby the Trust and rather over 17 grammes of thishave been loaned by the Commission to " national

"

1 Jour. Prev. Med., 1932, vi., 425.2 Fourth Annual Reports of the National Radium Trust and

Radium Commission, 1932 to 1933. H.M. Stationery Office.Cmd. 4427. Pages 31. Price 6d. The retiring members of theCommission are Prof. G. E. Gask, F.R.C.S. ; Mr. G. W. C. Kaye,D.Sc. ; Mr. W. E. Miles, F.R.C.S.; Prof. J. M. WoodburnMorison, M.D. ; and Dr. Canton Oldfield. Their places will betaken by Mr. J. J. M. Shaw, F.R.C.S. Edin. ; Dr. G. F. Stebbing ;Sir Cuthbert Wallace, F.R.C.S. ; Prof. Beckwith Whitehouse,F.R.C.S. ; and Sir Joseph Petavel, D.Sc., representing theDepartment of Scientific and Industrial Research.