1365REVIEWS AND NOTICES OF BOOKS

development of coma. On the fourth day, routinetreatment having failed to produce any improvementin the condition, inflation of both breasts with airwas carried out, and two hours later the patientbegan to improve.The other two cases were similar in that persistent

vomiting ended fatally, and that both were in thefirst pregnancy. Also anorexia was a conspicuoussymptom, and was a contributory cause of theexhaustion. One of these patients gave a history ofneurosis, and had severe vomiting until the sixteenthweek when this ceased, but 12 days later drowsinessfollowed by coma developed. In both cases theurine was negative for evidence of toxaemia, and inspite of treatment both patients died. Autopsyrevealed signs of mild toxaemia with some liver

damage in each case, but this was hardly sufficientto account for death. Prof. Oldfield considered thatthese three cases suggested that the conception oftoxaemia of pregnancy originating in the ovum isprobably erroneous.

Dr. C. G. PAINE (Sheffield) read a paper on ColonyVariation in Haemolytic Streptococci and its Import-ance in Puerperal Sepsis Immunity.-Prof. M. J.STEWART and Prof. CARLTON OLDFIELD showed a

specimen of diffuse endometriosis of the body ofthe uterus, secondary tuberculous infection, and oldbilateral tuberculous salpingitis, and also a specimenof liposarcoma of the broad ligament associated withspindle-celled sarcoma of the uterus.-Mr. A. GOUGHdescribed a case of Carcinoma of the FallopianTube.

REVIEWS AND NOTICES OF BOOKS

Handbook of Tropical FeversBy N. P. JEWELL, M.D., D.P.H., F.R.C.S.I.,European Hospital, Nairobi, Kenya; and W. H.KAUNTZE, M.D., D.P.H., Deputy Director ofLaboratory Services, Kenya. With a forewordby A. T. STANTON, C.M.G., M.D., F.R.C.P., ChiefMedical Adviser to the Secretary of State for theColonies. London : Bailliere, Tindall and Cox.1932. Pp. 485. 16s.

IN his foreword Dr. Stanton points out theclose cooperation between clinician and laboratoryworker which has characterised the study of tropicaldiseases. Manson himself combined in rare degreethe qualities of observer and experimenter, and hismethods have been diligently pursued by his disciples.This volume records the results of a combined studyof tropical fevers in Kenya. Most of the more

important fevers to be met with in the tropics aredescribed, even those which have happily not yetappeared in Kenya, for example, melioidosis and

Oroya fever, still far away, and yellow fever which isan imminent danger. The choice of matter cannothave been easy, because many fevers occur commonlyin temperate regions as well as in the tropics, and inother diseases more specifically tropical, pyrexia is

only an occasional, though possibly a well-marked,symptom. A chapter on the enteric group of feversin the tropics has been included, but none on pneu-monia and pulmonary tuberculosis, though the

prevalence and severity of these infections in thenatives of Kenya is recorded. Though they namethe various works on tropical diseases which havebeen consulted in preparing this volume, and especiallyrecord their indebtedness to Castellani, GordonThomson, Robertson, et al., for the many illustrationstaken from those authors’ works to embellish theirown, and to Dr. R. G. Cochrane for assistance in theexcellent chapter on leprosy, the authors have givenmore than a compilation, they have, in the 26 chapters,embodied the more important results of recentresearch and have treated their subject matter lucidlywith evident carefulness and in a practical manner.Where more than one method of diagnosis andtreatment is noted, that one is given at lengthwhich their own first-hand experience has taughtthem is the more suitable and more reliable. Theyhave produced a volume which may well servestudent and practitioner as a trustworthy introduc-tion to any intensive study of tropical fevers. The ibook is handy, well printed, well indexed, andwell illustrated, in so far as photomicrographs canever illustrate. -

A Text-book of EmbryologyBy MARY T. HARMAN, Ph.D., Professor of Zoologyin the Kansas State College of Agriculture andApplied Science. London: Henry Kimpton. 1932.

Pp. 476. 18s.

THIS book is at its best in the earlier chapters,dealing with more general questions and with theearly changes in the sex cells. After this it showsa tendency, common to nearly all books of its type,to cover the ground with too little attention to detail.The result is failure to provide an orderly consecutiveaccount of the subject ; a serious student would finddifficulty in acquiring coherent and satisfying ideas.about any regional or organic development from suchmaterial. On the other hand, there is evidently a.

demand for books on embryology which aim no higherthan the standard of ordinary examinations, andProf. Harman’s book is a complete and compact workwithin these limits. It is well produced and profuselyillustrated.

Asthma and Hay Fever in Theory andPracticeBy ARTHUR F. COCA, M.D., MATTHEW WALZER,M.D., and AUGUST A. TnoMMEN, M.D. London : mBailliere, Tindall and Cox. Pp. 851. 45s.

PUBLICATIONS on asthma and allergic diseasescontinue to appear in increasing number. Thisvolume offers a comprehensive review of our knowledgeof these conditions by three workers from Cornell Uni-versity and Bellevue Hospital, N.Y. The first part, byA. F. Coca, is devoted to hypersensitiveness, anaphy-laxis, and allergy. Much of it is taken up with theauthor’s own researches, but since he refers to morethan 370 articles from the literature he cannot be.accused of ignoring the work of others. The term"

atopy," here used to include asthma and hay-fever, is derived from the Greek atopia, a strange’disease ; the sensitising body present in the sera ofhypersensitive persons is named " atopic reagin,"’also a strange sound to English readers. The

terminology of "

allergic " disorders is alreadypuzzling, and the introduction of new names without,explanation or discussion will hardly dispel the’confusion of the general medical reader.

In the second and third parts of the book asthmaand hay-fever are considered separately in greatdetail, a wealth of experimental and clinical data being

‘

supplied. Nearly 100 pages are devoted to "

atopens.and other excitants " which are held to range fromanimal emanations such as rabbit, cat, and horse.hair, feathers, wool, and dust to almost every known

1366 REVIEWS AND NOTICES OF BOOKS

type of foodstuff, including meat, fish, eggs, milk,nuts, vegetables, spices, chocolate, alcoholic and evensoft drinks. The number of possible atopens is, infact, so vast as to discourage those who have beenhoping to get constant specific reactions to skintests in asthma and allied conditions. The greaterpart of the section on hay-fever deals with botanicalminutiae about plants and pollens concerned in thecausation of this condition. Over 1600 referencesare given in the bibliographies to Parts II. and III.This volume will take its place as a valuable work ’,of reference for specialists, but is hardly one to which ’,the physician will turn to refresh his knowledge ofgeneral principles.

Vision and Colour Vision

By R. A. HOUSTON, M.A., D.Se., Lecturer on

Physical Optics in the University of Glasgow.London : Longmans, Green and Co. 1932. Pp. 234.15s.THIS book is a physical and mathematical approach

to the complex problems of vision and colour vision ;it is valuable not only for its critical analysis of recentwork on the subject but also for the mass of originalwork it contains. The author questions suchentrenched views as the duplicity theory of vision,holding that it is accepted for the simple reason thatno other theory has been put forward-thoughEdridge-Green’s view is given. Weber’s law on thediscrimination of intensity is demolished by a mathe-matical analysis which proves that its results representJfiothing but a Gaussian curve of error. On colourvision the author is at one with all physicists in,decrying introspective analysis, but the Young-Helmholtz theory dear to physicists does not escape- unscathed. In fact, he advances cogent proof thatmathematically it is untenable. The classification.of the colour blind into deuteranopes and protoanopesas regarded as having descriptive value, but is seen

.as artificial when the colour blind are studiedatatistically. Houston’s own view of colour blindnessis that it is due to an irregularity in the working ofretinal synapses, though he admits that the modeof action he postulates is hypothetical.The book is a sound and provocative piece of

work. _____________

flat-foot’]Oy S. D. FAIRWEATHER, M.A., M.B., Ch.B.London : John Bale Sons, and Danielsson. 1932.

Pp. 76. 7s. 6d.

4jx this little book Dr. Fairweather launches a

severe attack upon the world in general for its stupidityin adding heels to its footwear. To this habit heattributes flat-foot and indeed almost all mechanicaldisabilities of the foot. He says that when heelsare worn the outer part of the foot is removed fromthe ground and the weight rests on the heels and fore-part only. He says also that the centre of gravity of;the body is thrown forward, and that to overcome thisthe muscles of the back, of the thigh, and of the legs,are in a state of more or less tonic contraction ; hence,in his view, come fatigue, often neurasthenia, and.&bgr;ometimes sciatica. A simple experiment devisedby Mr. P. B. Roth lends no support to the theory,that the centre of gravity is thrown forward by heels.He has shown that if a bare-footed woman standsoh two adjacent weighing machines with the heelson one and the fore-feet on the other, two-thirdsof her weight is found to fall on her heels, and one-third on her fore-feet ; if the experiment is repeatedwith a woman wearing ordinary heeled shoes the

Iproportion of her weight on either scale is unchanged. I

It is true that when cheap high-heeled shoes withweak shanks are worn the heels are raised and theweight rests only on the heels and the fore-part of thefoot, but a well-constructed shoe gives as much supportto the outer part of the foot as it would have if itwere nat on the ground. Dr. Fairweather’s argumentsare not convincing.

The Heart and Spleen in Health and DiseaseBy G. ARBOUR STEPHENS, M.D., B.S., B.Sc.Lond.,Consulting Cardiologist, King Edward VII. WelshNational Memorial Association ; ConsultingPhysician, Cardigan and District Hospital, and

Llandovery and Clydach Cottage Hospitals.London: H. K. Lewis and Co., Ltd. 1932.

Pp. 139. 7s. 6d.Dr. Arbour Stephens has for some years carried on

research work, more particularly in connexion withcalcium metabolism and disorders of the heart.In this book he brings together the main ideas under-lying all this work. The first chapter describeshis modified stethoscope, which he calls the " cardio-scope," and restates the author’s theory on theproduction of the heart sounds. The second chapterdeals with blood pressure, more particularly thediastolic pressure which is renamed the " basicpressure," and supplies a description of a new methodfor arriving at this figure. In subsequent chaptersreasons are given for associating the spleen closelywith the heart and the circulatory system, and

arguments are set out to prove that auricular fibrilla-tion, flutter, and tachycardia are not separate entities,but 3 out of 24 possible stages in the same type ofdisordered action. Considerable space is devoted toa discussion of predisposition, which is defined as

’a definite state of disordered action or disease. Thespleen is shown as the refitting shop for the corpusclesin connexion with the oxygenating function of thecirculatory system. In the chapter devoted to acuterheumatism and chorea, particular stress is laid onthe fact that these diseases occur in what is termed the

‘

" acid class." The author explains in detail why heconsiders that the wrong feeding of adults is responsiblefor much of the heart trouble arising in later life.He emphasises the importance of diagnosing heartdisease early, and has found that in every case ofacute inflammation of the tonsil examined the heartis disturbed, as shown by an alteration in the basicpressure. The teaching in the last chapter is describedby the author as "full of difficulties and highlydangerous, but that is no reason why it should notbe properly faced and studied," and this remark isnot wholly inapplicable to the whole book.

Anatomy of the Nervous SystemFourth edition. By STEPHEN WALTER RANSON,M.D., Ph.D., Professor of Neurology in North-western University Medical School, Chicago.London : W. B. Saunders Company. Pp. 478. 32s. 6d.Prof. Ranson writes throughout for students of

neurology working in laboratories and makes a

consecutive story out of his material while arrangingit to provide a work of reference of wide scope.We hope that in the next edition he will see his wayto a less cavalier treatment of the transversepeduncular tract and its endings, but otherwisethe information supplied is adequate. The presentissue has an excellent new feature in the shape of aseries of sections through the brain stem ; these arebeing added now to many neurological works comingfrom America. Altogether a sound and useful book.

1367THE UNAUTHORISED OPERATION-SEAMEN IN CARGO SHIPS

THE LANCET.

LONDON: SATURDAY, JUNE 25, 1932

THE UNAUTHORISED OPERATIONTHE litigation to which surgeons are exposed is

usually based on an allegation of negligence.A recent case is a reminder that they are alsoliable to be sued for trespass to the person if itcan be proved that, in performing an operation,they have exceeded the authority given by thepatient. Three statements may here be quotedfrom " The Conduct of Medical Practice." A patientwho consults a doctor gives implied consent thatthe doctor shall be entitled to do all such acts ashe considers reasonably necessary for dischargingthe duty of diagnosis, regard being had to thestate of medical knowledge and to his own personalexperience. A practitioner who proposes anydangerous or painful act or any act causing, ifunsuccessful, a permanent disability, should supplythe patient with the material information toenable him to give or withhold consent. Finally asurgeon, though circumstances may make itdifficult to attain the ideal of having patients’written consent to the operations performed, mayexpose himself to liability in damages for trespassto the person (a legal classification which includesassault and battery) if he exceeds his authority.

These general observations will serve as introduc-tion to an examination of the High Court actionbrought last week against the Royal Surrey CountyHospital and the surgeon in charge of its gynoeco-logical department. Damages were claimed on

the several grounds of negligence, breach of contract,and trespass to the person. The plaintiff complainedthat the surgeon, contrary to her instructions andwishes, performed on her at the hospital the

major operation of removing her uterus, thoughshe had consented only to the minor operation ofcurettage. As will be seen from the report on ip. 1377, the jury found that her complaint wasjustified. Her medical attendant had written aletter to the hospital conveying her refusal to

undergo the major operation. This letter, fromsome cause inadequately explained, reached thehospital but was not brought to the surgeon’snotice. There was thus an error of hospitaladministration which made it almost inevitablethat the plaintiff would succeed in her claim,though there was some evidence (strongly deniedby the plaintiff) that she was aware of the natureof the operation about to be performed and thatshe made no objection. Where a claim of thiskind succeeds, a jury may easily award substantialdamages. The facts of the case, however, werecapable of being interpreted as an occasion for

congratulation rather than of heavy compensation.For the patient suffered from epileptic fits whichhad become increasingly serious during recent

pregnancies.These proceedings were instructive both on the

question of a surgeon’s authority and on the

question of eugenics. It is essential to keep thesetwo points apart. An official inquiry into sterilisa-tion is proceeding but it will be a long time beforethe law is changed in the direction of compulsorysterilisation against the patient’s wish. The law,as Lord HEWART explained to the jury, does notenable a surgeon to say " If I had my way, Iwould sterilise the patient," and then to go on andperform the operation against the patient’s desire.It is one thing to say that, if the patient hadconsented, the operation would have been proper ;it is quite another thing to say that, in the absenceof her consent and in contradiction of her expressedwishes, the operation was proper. The case isalso important on the question of hospital adminis-tration ; a hospital cannot afford such oversightsas the loss of an important letter conveying thepatient’s precise wishes. In a proper case the

damages might have been heavy. We may note,too, Sir HENRY SIMSON’s answer (given duringcross-examination) that, if his attention were

drawn to a discrepancy in papers relating to apatient on whom he was about to operate, hewould report the matter to the hospital authoritiesand see that the patient was asked about it, or hewould ask the patient himself.

SEAMEN IN CARGO SHIPSTHE Shipping Federation, which is the chief

association of shipowners, decided in May, 1929,to set up a committee to work out a standardaccommodation suitable for seamen on cargosteamers, and chose for this purpose seven marinesuperintendents and two shipbuilders, who had theadvantage of calling on Dr. C. WHITE, M.O.H. ofthe Port of London, for advice in regard to ventila-tion and hygiene generally. In the report of thatcommittee, which has now been issued, the mainfeature is a definite proposal, with plan, for thecrew’s accommodation on a cargo steamer of 6000tons, taken as a type example, manned by 12sailors and 12 firemen. Two striking advancescatch the eye at once. The first is that the men areto be housed aft, in a deckhouse under the poop,where they will have better lighting and ventilation,less risk of injury in case of collision, less dangerand discomfort in heavy weather; also, with thegalley now more accessible, they will get their foodhotter and more reviving just when they want itscomfort most. The second, an even greaterimprovement, is the proposed increase of the

height between decks from the statutory 6 ft. to7 ft. 9 in., which will, as the committee remarks,facilitate ventilation, and, if we read the planaright, will give to each man in his sleeping quarters150 cubic feet instead of the 72 now the minimum

there, besides another 100 cubic feet with whichhe seems to be provided in the messroom. That

they have made this material advance is greatly tothe credit of the committee. A number of othersmall but useful proposals are evidence of the

increasing interest taken by marine superintendentsin the comfort of the men, now that attention has

1 From the Secretary of the Shipping Federation,52, Leadenhall-street, London, E.C.3.