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Reviews and Notices of Books.PULMONARY TUBERCULOSIS.

By Sir JANIES KINGSTON FOWLER, K.C.V.O.,C.M.G., M.D., F.R.C.P., Consulting Physician toMiddlesex Hospital, Hospital for Consumption andDiseases of the Chest (Brompton), King EdwardVII. Sanatorium, Midhurst. London : Macmillanand Co. 1921. With 52 illustrations. Pp. 284. 20s.MANY features distinguish this book from other

treatises. For example, Sir James Kingston Fowlerbreaks away from the beaten track in his historicalsurvey, giving prominence to two British workers-William Stark and William Budd-whose contributionsto the advancement of medical science have hithertobeen underrated. It is a pity that his appreciation ofthese and other British scientists should have as asetting a sweeping denunciation of German scientistsin a spirit reminiscent of war-time propaganda; thoughKoch and Walther do exceptionally receive praise.A short but most interesting chapter on the R61e ofHeredity ends with the rather unexpected conclusionthat the attempt to state with scientific precision theinfluence of heredity is doomed to failure. This isnot a satisfying verdict, but the author justifies itwith many cogent arguments proving the intricacyof the problem. In this, as in practically everychapter, he shows a first-rate and first-hand knowledgeof morbid anatomy.A characteristic and eupeptic feature of this book

is the author’s tendency to lapse into a conversationalstyle marked by quips and barbed digs at the foiblesof faddists, though some of his criticisms are ill-advised. His scepticism as to the very existence ofsuch a morbid entity as

" hilum tuberculosis " findsexpression in his definition of it as " a ’ shadow’ firstseen in a darkened room and not yet clearly recognisedin the daylight of the post-mortem room." To whichthe sponsors of " hilum tuberculosis " might feeltempted to retort by quoting the author’s opinionexpressed elsewhere in this volume that one does notfind a condition post mortem till one looks for it.Another and most valuable characteristic of the bookis the imposing quantity of clinical experience andsound advice it contains. In a few lines Sir JamesKingston Fowler tells more about hydrotherapy, theominous significance of the inverse type of fever, thecurability of tuberculous meningitis, the folly ofexploring for fluid with a fine needle, than mostwriters can condense into several pages. Here andthere his advice seems hardly up to date ; in discussingthe treatment of accidental pneumothorax he omitsall reference to oxygen or nitrogen replacement. Insome cases it may be advisable to exploit an accidentalpneumothorax and to maintain it as an artificialpneumothorax by injections of gas. His opinion ofmodern methods of diagnosis is seldom flattering.Force is given to a depreciatory discussion of X raysby a reference to the author’s own experience duringthe war at a military hospital, where, in collaborationwith the late Mr. C. R. Lyster, he was able tocheck this method with that of ordinary physicalexamination.The author is a caustic critic of the use of

tuberculin, and he suggests that " a tuberculosisdispensary that has become a ’ tuberculin ’ dispensaryhas become a very dangerous place." " Artificialpneumothorax," he says, " is the only advance in thetreatment of pulmonary tuberculosis since the intro-duction of sanatorium treatment as carried out atNordrach." He is a supporter of sanatorium treat-ment, but is rather difficult to follow in discussingthe vexed question of graduated exercise. On page220 he writes : " No exercise, except walking, for twoyears, i.e., after the arrest of the disease and dis-appearance of tubercle bacilli from the sputum ";while on page 232 he speaks with evident enthusiasmof the excavation by Frimley patients of 5000 tonsof earth wheeled 300 yards.

The dominant virtues of this book are its soundpathology and ripe clinical experience ; they are inevidence on almost every page. Its failing is thatof its limits. Instead of giving space to a full accountof such an epoch-making advance as, for example,the Pirquet test, the author often digresses toquote earlier writings and to show how viewsexpressed many years ago have now been provedcorrect. The book, therefore, is hardly suitable forthe student actuated by the single-hearted desire toplease examiners, but it is a work which both generalpractitioners and tuberculosis specialists will enjoyreading,

DIAGNOSIS AND TREATMENT OF VENEREAL DISEASESIN GENERAI, PRACTICE.

Third edition. By Brev.-Coi. L. W. HARRISON,D.S.O., M.B., Ch.B., M.R.C.P.E., Director ofVenereal Department, St. Thomas’s Hospital.With a chapter on the Medico-Legal Aspects. &c.,by F. G. CROOKSHANK, M.B., F.R.C.P. London:Henry Frowde and Hodder and Stouhton. 1921.Pp. 525. 25s.

THE first edition of this book, published in 1918,rapidly won its place as the authoritative Englishtext-book on the subject, and it is not surprisingthat a third edition has been called for so soon. It hascertain conspicuous merits. It is well arranged, coversthe ground adequately, is thoroughly up-to-date ; itis remarkably free from redundancies, and while itsteaching is dogmatic whenever necessary, on mattersas to which there is still considerable divergence ofopinion the author preserves balance. Further, hedeals with every aspect of the subject so systema-tically, and in such detail, that it is an invaluableguide for the tyro, while the expert will findmuch that is stimulating and suggestive in itspages.One slight shortcoming of the earlier editions has

been remedied : the treatment of gonorrhoea in thefemale is now dealt with in full detail. Further, avaluable section has been added on " proofs of cure "in gonorrhoea. This should be of great help to thosewho are anxious not to stop treatment too soon,and at the same time should serve to protect patientsfrom over-treatment. like manv other workersin the same field the author has found that successin the treatment of gonorrhoea with vaccines dependson (1) proper dosage, (2) the strain of gonococcusemployed, and (3) the method of preparation of thevaccine. iiis review of vaccine treatment, whichincludes observations on patients treated withdetoxicated vaccines, is concise but valuable, and hisconclusion, with which most workers will agree, isthat the case of gonorrhoea subjected to a rationalvaccine-therapy runs a milder course than that fromwhich vaccines are withheld.

In the section on the treatment of syphilis con-siderable modifications have been introduced sinceneo-salvarsan or one of its congeners is now generallyused in place of " 606." All the arsenical derivativesof use in the treatment of lues are passed underreview, including silver-salvarsan, and a useful seriesof tables, based on the routine courses of treatmentin use at St. Thomas’s Hospital, is inserted. In thesetables the equivalent doses of 914, 606, and silver-salvarsan are tabulated, and any patient treated uponthe lines there laid down will not suffer from inade-quacy of treatment. Colonel Harrison’s experiencehas led him to doubt the anti-syphilitic powers ofmercury, and lie emphasises .the need of combinedadministration of arsenic and mercury in the " con-tinuation treatment " of the disease. The chapter onthe prevention of venereal diseases gives much foodfor thought. After reviewing the subject, and givingstatistical tables based on the experience of theLT.S. Army in France, Colonel Harrison concludesthat " the greatest hope lies in the prompt treatmentof patients in the earliest stages of the disease, therebyensuring a maximum of cures and a minimum ofinfection carriers."

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An excellent chapter on the medico-legal aspectsof venereal disease is contributed by Dr. F. 0. Crook-shank. This should be carefully read by all medicalofficers in charge of V.D. clinics, in order that theymay have knowledge of some of the pitfalls thatsurround them in their work.Though the volume contains more pages it is less

bulky than the first edition. It is clearly printed ongood paper and copiously illustrated. Most of thepictures are excellent, but some of the coloured platesare too vivid to be true. Altogether the volume isdeserving of high praise. It is the conscientiousand sometimes brilliant work of one who has donemore than any other in this country, perhaps inthis generation, to systematise on a rational basisthe treatment of the venereal diseases.

SURGERY.A Pocket Surgery. By DUNCAN C. L. FITZ-wiLMAMS, C.M.G., M.D., Ch.M., F.R,.C.S. Edin.and Eng. London: Edward Arnold and Co.1921. Pp. 348. 10s. 6d.THE value of a pocket manual on a large subject

is always doubtful. It is impossible in a shortcompass to give a comprehensive description ofthe whole of surgery. There is hardly a conditionin which it is possible to state dogmatically that onedisease has one treatment, and in a text-book of thissize it is impossible to discuss adequately alternativetreatment. The student is therefore very prone togain erroneous ideas, probably from a misinterpreta-tion of the author’s statements. The only possibleway to condense such a subject as surgery is to reducethe matter as far as possible to tabular form.The difficulties of condensation are shown bv a few

examples taken at random from this text-book. Inthe treatment of exophthalmic goitre the student isrightly told that surgical treatment is more and morereplacing medical treatment ; but the impressiongiven-that the correct treatment is to remove bothlateral lobes in every case-is surely not intended.In the discussion of the diagnosis of gastric surgeryno mention whatever is made of the importance ofthe clinical history. The methods of examinationare briefly given. and percussion and gastroscopy,which might be safely omitted in most cases, standout with undue importance as diagnostic measures.We are told also that the symptoms of acute andchronic gastric ulcer are much the same, but are moreprolonged in the chronic form, and that hemorrhagein both forms may be excessive, but in the acuteform is rarely fatal ; as a matter of actual fact, moredeaths from haematemesis are due to acute thanto chronic ulcers. As to the treatment of thechronic variety, the advice is given to perform a

gastro-enterostomy, to free adhesions, and to examinethe appendix ; this form of treatment sounds simple,but will not be satisfactory in all cases. In discussingthe symptoms of a perforated gastric ulcer Mr.Fi-tzwilliams states that it is not always easy to dis-tinguish a ruptured ulcer from a ruptured ectopicpregnancy ; no attention is, however, directed tothe more difficult diagnosis from a perforated appendixor an acute pancreatitis. The acute ulcer is men-tioned among the causes of dilatation of the stomach,and in the paragraph devoted to treatment it issuggested that if daily lavage of the stomach doesnot bring about a cure a gastro-jejunostomy or

gastro-duodenostomy should be performed. Mr.Fitzwilliams states that this treatment has almostentirely superseded pyloroplasty; possibly this isso, but it must be remembered that it is a form oftreatment which in the acute variety of dilatation hasnearly 100 per cent. mortality. The list of methodsof examination for a carcinoma of the stomach isheaded by distension of the viscus with gas, surelymost dangerous advice.

These faults must be regarded not as peculiar toMr. Fitzwilliarns’s text-book, but as likely to exist inany form of pocket text-book. Under certain cir-cumstances the advice which can be given in a smallcompass may be correct, but it may prove very

dangerous. It is therefore difficult to see quite whatpurpose such a book serves. No student can beadvised to read it alone: it could only be recom-mended to one who has no time or inclination toread larger text-books, when it would assist him totake careful notes of his own cases.

Diaflktostische und TherapeuNsche Irrtümer undderen V erhiit ung. Chirurgie der Wirbelshule, desHnckenma,rks, der Bauchdecken, und des Beckens.Von Geh. Med.-’Ra.t Prof. G. LEDDERHOSE.Leipzig: OCOl’g Thieme. 1921. With 20 diagrams.Pp.lt60. M.45.Tms little book deals with diagnostic and thera-

peutic mistakes likely to be made in connexion withdiseases of the vertebral column, spinal cord,abdo-minal wall, and pelvis. It is really a small manualof diagnosis, and treatment, and forms one volumein a large series of books which have been or are tobe issued. The subjects dealt with in this book area somewhat strange mixture, but the substanceappears to be sound surgical doctrine.

In the differential diagnosis of tumours of theabdominal wall we could find no reference to phantom-tumour, which may certainly cause serious mistakesin diagnosis. In the section dealing with pelvic abscessno specific mention is made of diverticulitis, which isworthy of some reference. For the rest the book givesa clear account of the many pitfalls in diagnosis andtreatment. The diagrams are not very good.

THE ENGLISH PRISON SYSTEM.By Sir EvELYX RuGGLES-BRISE, K.C.B., Chairmanof. the Prison Commission for England and Wales;President of the International Prison Commission.London: Macmillan and Co., Ltd. 1921. Pp. 27.7.t. 6d.

Ix 1910 the International Prison Congress atWashington accepted the invitation of the BritishGovernment to hold the next quinquennial congress inLondon ; for the foreign visitors to this 1915 congressSir Evelyn Ruggles-Brise prepared a manual of thehistory and leading features of the English prisonsystem. The war prevented the realisation of allthe plans, and although the greater part of thisvolume was prepared in 1915, it was not publishedtill six years later, the statistics being brought up todate in most ways. The manual forms a complete andfascinating account of all the important changes thathave taken place in our prison system during thelast 100 years and contains interesting referencesto notable innovations during earlier periods in

English history. It is a book which should be in thehands of every student of criminology, while severalchapters, such. for example, as that on the History ofPenal Servitude would interest a far wider circle.

Sir Evelyn Ruggles-Brise gives not merely a recordof drastic changes with far-reaching effects, but a

philosophical discussion of each problem involved.Had the manual appeared in 1915, the writer mighthave been hailed as a great criminologist, as well as asuccessful, broad-minded, and humane reformer andadminstrator. But the war drove home the lessonthat conduct is essentially a reaction of mental life,and can only be understood by exploring the mind ofthe individual. This work contains no reference tothat magnum opus of modern criminology, ".TheIndividual Delinquent," by Dr. William Healy, firstpublished in 1914 ; it does not go beyond the investi-gations of the late Dr. Charles Goring, and it author,like Goring, belongs to the rationalist school. True themanual does not profess to be a text-book of crimino-logy, and, moreover, we may read between the linesthat Sir Evelyn Ruggles-Brise is appreciative of thenew ideas. He has obviously such a receptive andsympathetic mind that if the new psychologists hadbeen able to put their ease fairly before him he wouldsoon have appraised its essential features. Had thisbeen effected, and had he remained at the posthe has now relinquished, he would have becomea wise and inspiring leader. He is never deterred

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iby past failures ; witness the interesting chapters on ’,Female Offenders, Vagrancy, and Inebriety. Perhapshe is at his best in the chapter on the BorstalSystem, the development of which has evidently beenhis special care.A special chapter on the Medical Service describes

the numerous demands on the prison doctor. Wehope that all prison medical officers have the

ability attributed to them by Sir Evelyn Ruggles-Brise, but it is doubtful whether a doctor who hasto develop along so many different lines is alwaysqualified, even if he has served a term as officer in anasylum, to give the best opinion on insanity andmental defect. This manual is a valuable one whichcan be read with interest and profit by any intelligentcitizen ; for the specialist it is essential. There is anexcellent and correct index, and the whole productionforms a setting worthy of the subject matter.

A MANUAL OF PHYSICS.Second edition. By J. A. CROWTHBR, Sc.D.,F.Inst.P., Sometime Fellow of St. John’s College,Cambridge, Demonstrator in Physics in theCavendish Laboratory, Cambridge. London:Henry Frowde and Hodder and Stoughton. 1921.Pp. 537. 16s.THE appearance of a second edition of Dr. Crowther’s

-Manual of Physics so soon after the first is the surestevidence of the need for a work which gives, not toobriefly, the outlines of elementary physics.The book may well be popular among medical

students, for the subject-matter is well arranged, theexplanations of some of the more difficult parts of thesubject are quite adequate, and the whole of the letter-press is interspersed with diagrams which, on thewhole, leave little to be desired. In the section onPhotometry we should have liked to see includedJoly’s elegant and simple method of comparing theilluminating powers of two sources. The reader willhave some difficulty in seeing from diagram No. 125how the observer may directly view the twoilluminated surfaces. The diagram showing theminimum deviation (printed duration) is too sym-metrical, and might give the reader the impressionthat the angle of refraction was necessarily just one-half that of the angle of incidence. The diagramsillustrate a well-written and very useful book.

DISEASES OF CHILDREN.

By HERMAN B. SHEFFIELD, M.D., formerlyInstructor in Diseases of Children, New York ’,Post-Graduate Medical School and Hospital, &c.London: Henry Kimpton. 1921. Pp.798. 48s.

Dr. Sheffield’s book contains no salient advance on Ithe methods of diagnosis and treatment commonlyrecommended in this country, and will make no specialappeal to English readers. Even with regard to infantfeeding, the methods advocated resemble our ownsystem of percentage feeding, with its associateddisadvantage of the difficulty experienced by inexpertattendants in the preparation of the milk mixturesordered. With Dr. Sheffield’s prescriptions for dietafter seven months. and indeed up to five years, wecannot agree ; the diets appear complex, and insuffi-cient in many respects, containing an unnecessaryexcess of fruit juice and fruit pulp and not the necessaryvariety of proteins. A section on the Prevention andControl of Disease, however, contains much that is ofvalue ; the method of intravenous perfusion via theanterior fontanelle into the superior longitudinal sinusis advocated for infants, and the administration ofintraperitoneal saline solution in acute summer

diarrhoea-a method first practised in England-iscarefully described. The section devoted to thephysical examination of children seems elementaryand redundant. The difficult study of disease in child-hood should surely follow preliminary general instruc-tion in clinical methods, and a recapitulation ofphysical signs and surface markings is superfluous ina text-book devoted to this special subject.

The description on p. 268 of a case of acute intussus-ception in a young infant, which remained undetectedfor three days, reflects but little credit on thephysician. It is surprising, too, that the specialincidence of intussusception in breast-fed infantsshould have escaped the author’s notice. A morehopeless confusion than exists under the headingRheumatism and Rheumatic Fever would be difficultto imagine. This all-important disease of childhoodreceives scanty treatment ; the description of theearly physical signs of a heart damaged by rheumaticinfection and of its treatment is altogether unsatis-factory.The subject-matter of the book is, on the whole,

well arranged, and the plates, mostly from photo-graphs, are excellent, but the cumbersome use ofdog-latin equivalents in the nomenclature of diseasethroughout the book is unfortunate. The book isattractively produced, and the colour plates are

excellent.

JOURNALS.

JOURNAL OF PHYSIOLOGY. Edited by J. N.LANGLEY, Sc.D., LL.D., F.R.S. Vol. LV., Nos. 5 and 6.Cambridge University Press. 1921. Pp. 305-428.lls.-The Regulation of the Excretion of Waterby the Kidneys, by J. G. Priestley. The problemdiscussed is whether the diuresis following thedrinking of large amounts of water is related to anychanges in the blood comparable to the changes inhydrogen-ion concentration which regulate thebreathing. The excretion of urine can be increasedby drinking water from about 40 c.cm. per hourup to as much as 1200 c.cm. per hour, the specificgravity falling to less than 1001 ; the comparativeestimations of the amount of haemoglobin in the bloodbefore and after diuresis showed no appreciablechange. After water-drinking, the loss in weight ondrying blood; the chlorine content of the blood; theexcretion of water and chloride in the urine duringwater diuresis were estimated. It was proved thatthere were slight but definite changes in the composi-tion of the blood accompanying the diuresis provokedby drinking water. The excretion of water is largelybut not entirely in relation to the excretion of chlorides.Injection of pituitrin (1 c.cm. intramuscularlyimmediately or shortly after drinking two litres ofwater) delays the diuresis produced by water-drinkingfor 4-6 hours. Water diuresis then sets in and isaccompanied by an increased excretion of chlorides.These results, it is suggested, are compatible with theregulation of excretion of water by the kidneys of atwo-fold nature : (a) a main regulation dependent onthe diffusion pressure of water in the blood, and(b) a subsidiary modification of this regulationdependent on the inability of the kidney to hold backwater when the diffusion pressure of water in theurine is considerably below that of the blood.-TheIdentity of Haemoglobin in Human Beings, by G. S.Adair, J. Barcroft, and A. V. Bock. The differentaffinities for oxygen of various samples of humanblood may be due either (1) to differences in thehaemoglobin itself. or (2) to differences in the conditionsaffecting it-e.g., the salt and hydrogen-ion concentra-tion. It would seem that if samples of haemoglobinfrom different individuals be freed from the corpusclesin which they are held and be subsequently treated inexactly the same way, they give oxygen-dissociationcurves which are indistinguishable. On the other

hand, preparations prepared by slow dialysis of bloodagainst distilled water may simulate solutions in

appearance but still containing intact, though swollencorpuscles, give dissociation curves far different fromthose of true aqueous solutions of haemoglobin.-The Direct Measurement of the Partial Pressure ofOxygen in Human Blood, by J. Barcroft and M.Nagahashi. In principle the method used was towithdraw blood from a vessel, artery, or vein by directpuncture. To this blood is exposed a small bubbleof alveolar air at 37’ C. until an equilibrium is eqtab-lished between the blood and the bubble. The bubbleis then analysed in a suitable apparatus. The