1187REVIEWS AND NOTICES OF BOOKS.

Reviews and Notices of Books.THE COMMON DISEASES OF THE SKIN.

A Handbook for Students and Practitioners. ByR. CRANSTON Low, M.D., M.R.C.P., Lecturer onDiseases of the Skin, University of Edinburgh ; andPhysician to the Skin Department, Royal Infir-mary. London and Edinburgh: Oliver and Boyd.1927. Pp. 223. 14s.

THE scope and composition of this handbook, itsterse and dogmatic style which has by no meansrobbed it of a certain literary excellence, and, aboveall, a valuable and discreet selection of life-likeillustrations and textual figures and diagrams, havecombined to produce the most noteworthy contribu-tion of its kind in recent years. As might have beenexpected from the author of " Anaphylaxis andSensitisation," the chapters on eczema, urticaria, andthe eruptions in which sensitisation plays a part, areparticularly interesting, and even the expert willfind in them certain hints and explanations for whichhe will search many larger text-books in vain. Com-

mendable, too, are the sections on vesicular andbullous eruptions, and the attention of the casualreader will be held by such phrases as

" all pemphiguscases show bullse, but not all bullous eruptions arepemphigus." The relationships of herpes zoster andvaricella, and the aetiology of alopecia areata are

boldly discussed, some original suggestions beingput forward. If it should be argued that theory is outof place in a handbook, the reader will certainlybenefit from the occasional lapses that make forinterest and save the work from being a catalogue. ’The little diagrams showing the relative dermal andepidermal situations of cheloid and hypertrophicscars should help to prevent the common error ofconfusing these conditions.Treatment is modern in every section and will

make a general appeal on the score of simplicity.It was perhaps hardly necessary to describe thedetail of radiotherapy for ringworm of the scalp,and the bulk of dermatological opinion would notagree that

" if there is only one spot of disease whichis near the scalp margin then that spot and a widearea around it should be X rayed." If X rays aredecided upon, epilation should be total. Thalliumacetate treatment, which is not even mentioned byDr. Low, may eventually displace X ray epilationentirely. Syphilis and syphilitic eruptions, it shouldbe noted, are not dealt with, except in so far asdifferential diagnosis is concerned.The book contains 68 illustrations and 49 full-page

plates, eight of them in colour. These and theprinting itself are excellent, and the relatively lowcost should add considerably to the many attractionsof the book.

PHYSICAL SIGNS IN CLINICAL SURGERY.

By HAMILTON BAILEY, F.R.C.S. Eng., Surgeon,Dudley Road Hospital, Birmingham. Bristol:John Wright and Sons, Ltd. 1927. Pp.217. 21s.

MANY small books in surgery have been written forstudents beginning clinical work, but none of them isquite of the same character as this. It is a treatiseon examination of the patient by palpation, percussion,and other simple clinical ways on the same lines asProf. F. Lejars’s well-known book, only it is smallerand therefore better adapted for the use of juniorstudents. It was time a book of this nature wasavailable in English, and the author is to be con-gratulated upon the success with which he has carriedout his task. A feature of the book is the abundanceof illustrations, all of which, in addition to theexcellence of reproduction, are informative. Thetext is usually terse and to the point, and themnemonic for urinary complaints from " As YouLike It," on p. 153-which is simply ingeniouswithout being any aid to the memory-is the onlyblemish upon a very good and otherwise seriousaddition to English surgical literature.

THE NORMAL CHEST.The Normal Chest of the Adult and the Child. ByJ. A. MYERS, Associate Professor of Medicine,University of Minnesota. In collaboration withS. MARX WHITE, R. E. SCAMMON, A. T. RASMUSSEN,C. A. STEWART, and GEORGE E. FAHR. London :Bailliere, Tindall and Cox. 1927. Pp. 419. 22s. 6d.A COURSE of study of the normal chest at Minnesota

University, begun in 1921, forms the groundworkof this book. A brief account of the anatomy andphysiology of the normal chest precedes a reallyexcellent description of the physical examination,while Chapter 8 deals with the importance of system-’atic scrutiny of this sort. The author repeatedlyemphasises the necessity of studying the variousphysical, X ray, and other signs which maybe found in the normal chest, and his viewis reasonable that much time should be spent inlearning the normal breath-sounds, areas of dullness,and so forth, before the study of disease is undertaken.In the hospitals, students are apt to concentrate ondisease, and there is no doubt that the teaching of thenormal and the varieties of the normal is muchneglected. This book therefore supplies a real want,although for the student overmuch space is given todetail; the last three chapters, for example, dealin 150 pages with the innervation of the chest,developmental anatomy, and acoustics in a waythat can only be of interest for the specialist.Chapter 5, contributed by Dr. White, deals with theexamination of the heart and great vessels, andDr. Stewart describes the normal chest in infancyand childhood. Copious references are convenientlyarranged at the end of the chapters.We can thoroughly recommend this book, and shall

look forward to volumes dealing with the normal inother systems of the body.

Skinners, Worshipful Companyof ....

Sladden, Dr. A. F. S... ..Smith, Dr. F. B., M.C.Smith, Dr. J....Smith, Prof. J. Lorrain ..

Smyth, Mrs. .....Solly, Dr. R. V. ....

Sprigge, Sir Squire ..

Stevenson, Dr. W. D. H.Stewart, Prof. Matthew J... Stewart, W. R., Esq... ..

Surrey Branch of the BritishMedical Association ..

Susman, Dr. W.Symons, H. W., Esq.

Taylor, Dr. A. L. Teacher, Prof. J. H... ..Tetley, Mrs..... 1

Thistlethwaite Dr. W.Thompson, Mrs. ....Thomson, Sir StClair .

Thomson-Walker, Sir John,O.B.E.

Topley, Prof. W. W. C. ..Tudhope, Dr. G. R....Tulloch, Dr. W. J., O.B.E. ..Turnbull, Prof. H. M.

Veale, Dr. R. A.

Ward, the Executors of thelate Miss Ann ....11 f

Wardill, W. E. M., Esq.Wardle, Dr. G. Mary..Warnock, Dr. W.Watterson, Miss EleanorWatts, Miss M. A. ....Waugh. George E.. Esg. ..

Webb, Dr. R. A. .. ..

Westminster Hospital andMedical School, Consultingand Visiting Staffs of ..

Wheatley, Dr. Bertha . ,

White, Dr. Eva ....Whitfield, Dr. Arthur ..

Willcox, Sir William, K.C.I.E.,C.B., C.M.G. ....

Wills, Miss F. R. ....Wilson, G. E., Esq.Wilson, Dr. G. H. ....Wilson, Dr. H..... Wilson, Dr. W. J.Wolfe, Dr. H. .....Wormall, A., Esq. ....

Yelf, Dr. R. E. B.

....Young, Dr. C. J. ....Young, Dr. J. S.Young, Dr. M.

1188 REVIEWS AND NOTICES OF BOOKS.

THE ALPINE CLIMATE.Der heutige Stand der Physiologie des Höhenklimas.By Prof. Dr. LOEWY. Berlin : Julius Springer.Pp. 60.IN this short account of the present state of alpine

physiology the author correlates results obtainedby many investigators, among whom he occupies adistinguished place. The first part of the bookcontains observations on the special factors whichdistinguish the climate of mountains and high valleys ;the second part deals with their effects on physio-logical processes, especially circulation, respiration,and metabolism. Dr. Loewy analyses the actionof the various elements of the solar radiation andconfirms the value of natural sunlight as comparedwith artificial sources of light, although the morethe spectrum of the latter approaches that of thesun the greater the similarity of its action. He recallsthe work of Sonne, who showed that while a sourceof ultra-red rays (a heated metal plate) may raiserapidly the skin temperature and cause a sensation ofburning, though at a depth of 2 cm. the temperatureremains normal, exposure to the sun’s rays for halfan hour causes much less elevation of surface tem-perature but a marked rise in the deeper tissues.This he considers to be an important factor in raisingthe bactericidal power of the blood. The increase ofmetabolism caused by a sojourn in the mountainshe attributes to several factors, but chiefly to thestimulation of the skin by the air and solar rays.Alpine therapy has been well established on an

empirical basis, but Dr. Loewy’s concise and lucidstudy is a real contribution to scientific therapy.

Das Strahlungsklima von Arosa. By P. GOETZ.Berlin : Julius Springer. Pp. 110. M.8.70.

Tills monograph contains a mass of data and someinteresting speculations on the climate of the SwissAlps as observed at Arosa. The author refers to thewell-known fact that in the Alps the average tempera-ture in winter does not fall with increasing altitude asrapidly as would be expected. An important causeof this phenomenon is the collection of cold air andmist over the lower regions with upward reflection ofheat and light waves from the surface of the sea ofcloud thus formed. These favourable conditions areaccentuated at Arosa owing to its situation on a slopefacing south. This gives a higher average wintertemperature than would be found at the same

altitude at the bottom of a valley. After sunset theslope loses heat by radiation, but the cold air flowsdown to the bottom of the valley where it forms apool of very low temperature, its place being takenby a falling evening current of only moderatetemperature. Another point of general interestwhich Dr. Goetz brings out is the ratio of horizontalto vertical light. The former is defined as the amountof light falling on a vertical plane facing south-e.g.,a window. In winter the possible duration of sun-light per day is relatively short, but owing to thelow level of the sun the horizontal component ofit is so much increased that the actual amount ofsunshine entering a room is as great in winter as insummer. This surprising result is also due in partto the fact that clouds are more frequent in the summer months. Thus the ratio of overcast daysin January, as compared with July, is as 1 to 1-8.

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SOUTH AMERICA. By FRANKLIN H. MARTIN, C.M.G., D.Sc., M.D.,LL.D., F.A.C.S. London : Fleming H. RevellCompany. 1907. Pp. 435.

Dr. Franklin Martin, the well-known Director- <

General of the American College of Surgeons, has brought together in this book a valuable mass of information upon the Latin American countries. Thenotes were made or collected during visits to those’countries on behalf of the American College of (Surgeons, and they include experiences met withaboard the Ebro in a tour which included Jamaica, Panama, Peru, Chile, Argentina, Uruguay, Brazil, (

Ecuador, and Bolivia. Various sections are also.

contributed by Dr. A. J. Ochsner, who visited some.

of the larger cities of Mexico, and Dr. E. I. Salisbury,who records experiences in Nicaragua and Cuba.

e All the information is directed towards introducingto the medical profession of the rest of the world

aj the progressive course of their sciences in LatinAmerica. It is simply given, and profusely illustrated,while the rapid development of medicine in some of

. the countries visited, especially those most regardedf in Europe as backward States, will come as a surprise

to many readers. During Dr. Martin’s visits to SouthAmerica and Panama in 1921, 1923, and 1925, hepersonally interviewed the Presidents of Panama,Peru, Argentina, Uruguay, and Brazil in regard toestablishing, presumably in Panama, a memorial toWilliam Gorgas. This is to take the form of an

s Institute of Tropical and Preventive Medicine, and as. President Coolidge, the honorary president of themovement, is deeply interested in the scheme, practicaloutcome will not be delayed.

, MENTAL HANDICAPS IN ART.- By THEO. B. HYSLOP, M.D., C.M., F.R.S.E. With, a foreword by ARTHUR THOMSON, Professor of

Anatomy, Royal Academy. London : Bailliere,! Tindall and Cox. 1927. Pp. 98. 3s. 6d.

WITHIN less than 100 pages this little book conveysmuch aesthetic information, much useful criticism,

, and much sound philosophy. The exposition of thetrue aims and objects of art leads up to chapters

. dealing with the appropriate union of arts and industryand with the right appreciation and employment ofthe artistic faculty. Readers recognising in the

, author a well-known psychologist, as well as an

accomplished artist, will turn naturally to the con-, eluding sections on the influence of disease upon art: and the possible connexion of toxins with artistic: production. Dr. Hyslop suggests that many,

hysterical, hyperaesthetic, or supernorm sensoryanomalies are in reality merely reversions to remote

,

acquirements in evolution. He finds evidence that" what we have lost in instinct we have gained in

: reason," and appraises some of the most extra-, ordinary developments of the special senses as "in, reality not instances in advance of the evolution of: those special senses, but rather examples of reversion: to more primitive conditions of biological evolution."Not infrequently, he states, such abnormalities dis-appear when the balance of the internal secretionsbecomes readjusted. And on the often debatedquestion of how far genius and madness are akin

,

he finds that : "With the formidable array ofevidence of degeneration in those who are acknow-ledged to be geniuses in art, the theory of geniusbeing a disease of the nerves is apt to gain ground,but not when we take balance as the test of mentalhealth." He warns us that degeneracy is oftenproductive of bad art. A touch of madness mayserve in some instances to raise the individual abovemediocrity, and bad or offensive art is not invariablya symptom of degeneracy, for it may be the resultof defective education, failures in observation andtechnique, or of imposture. There is much that istimely in these words.

Messrs. J. and A. Churchill inform us that the priceof Rowlands and Turner’s " Operations of Surgery,"reviewed in THE LANCET of Sept. 17th (p. 610), is23 10s. for the two volumes.

COORDINATION OF BRISTOL HOSPITALS.-It has beendecided by the council of the Lord Mayor’s Hospital Fundand the local Voluntary Hospitals Committee to appoint aCommittee of Inquiry to consider the extension of accom-modation, and the best means of preventing overlappingand securing coordination. There are 15 hospitals inBristol with approximately 2100 beds, many of which aredoing precisely similar work. Three of them have recentlymade urgent appeals for help ; another is being financedto a substantial extent by the corporation, and two newones are about to be built.

1189EPSOM COLLEGE SANATORIUM.&mdash;BREAST CANCER.

THE LANCET.

LONDON: SATURDAY, DECEMBER 3, 1927.

EPSOM COLLEGE: THE NEW SANATORIUM.WE publish this week the results, as they at present

stand, of the efforts made by the Council of EpsomCollege for providing the institution with a new andadequate sanatorium. The intention of the Councilwas made known in these columns and in many otherjournals in December last, and the outcome of thatpreliminary notice has warranted the Council in

proceeding to definite plans in respect of site andconstruction. All who know anything of the cost perbed which has to be met in the founding of a modernmedical institution will see that the substantial sumalready subscribed bears small relation to the sumwhich will have actually to be spent, for thrice thatsum is needed to warrant a start, and a total far higherwill eventually be required ; but it will be rememberedthat so far the subscriptions have been made largelyin the dark, for, while the statement of the Councilthat the new structure was required has been

accepted, no one could have known until now exactlythe way in which it was proposed to spend the moneyobtained. We hope and believe that, with the detailedplans before them, which by the help of the accom-panying descriptions are easy to follow and appreciate,a large number of our readers will resolve not only totake a share in the good work, but to urge upon theirpatients and friends the righteousness of doing thesame. Epsom College possesses public as well as

professional claims, and the list of subscriptionspublished to-day shows that in many directions thesehave been finely acknowledged.The story of Epsom College is one of steady

development. There is no question of bolstering up an institution which is not justifying its existence ; rather, pecuniary support is asked because the workdone has been so progressive, and because that workhas never proved itself of greater public value thanto-day. Three-quarters of a century ago we find thatin an early reference to the foundation of the College,we prophesied its great future, and the steps in itsprogress, as they have been recorded regularly in ourcolumns, have been associated with expenditure bythe Council of large sums of money. Epsom has neverrested on its laurels, but always, as it obtained success,has prepared for still greater success. In the extensionof buildings, the provision of needed improvements forthe comfort of boys and staff, the erection of labora-tories, lecture rooms, common rooms, and chapeldefinite evidence has been supplied by the authoritiesof their sense of growing responsibilities. The neednow is one which should have a particular appeal tomedical men, for it is an anomaly that a great publicschool, definitely associated with medicine, should befound behindhand in any arrangements for the medicaltreatment of its charges. Now there is no doubt thatthe new sanatorium is urgently required. The numberof beds projected may seem large, but this will not bethe opinion of the school authorities, nor of any whohave realised the difficulties which epidemic diseaseentails upon residential institutions like great boardingschools. The provision for sickness in all our largepublic schools, if the tenets of modern medicine are

being observed, will always appear prodigal while thereis no particular reason for the occupation of the beds;alas, it may often be found too small if the schoolshould be unfortunately visited by an epidemic of anyextent or virulence. The Council of Epsom in placingthe figure of beds required at 50-30 general and20 isolation-for an estimated total of about 400 boys,have adopted the accepted view of experts.The cause of Epsom College has been pleaded so

often and so regularly in these columns that anythingsaid now will assuredly have been said before. Thisdoes not mean that it should not be said again. Theschool provides a first-class general training, withamenities for study and for sport that make it com-parable to any of its similars in the country. It alsosupplies a magnificent opportunity for giving theseadvantages to the children of medical men whose

expectations of educating their offspring suitably havebeen destroyed by death, sickness, or misfortune.The plea for money needs no further justification.It is to be hoped that the present appeal will enablethe authorities of the College to proceed at once todevelop their far-seeing scheme.

SURVIVAL AFTER OPERATION FORBREAST CANCER.

THE investigation of disease by a body such as, the Medical Society of London is not without pre-, cedent, although it is unusual for such a body toL overcome successfully the inertia in its make-up.. It is with genuine pleasure, therefore, that we welcome, the report presented to the Society on Monday last, upon the late results of operation for carcinoma of the breast The report is summarised on p. 1181,

along with a brief account of the discussion to whichit gave rise. To assess the value of an operation inrelation to the survival ratio after the lapse of aconsiderable number of years is never easy. Yet itis obviously of immense importance to find out whethercarcinoma of the breast is better treated by the

) simple operation of local removal or by the severe; and mutilating " radical " operation, or whether it

would be for the greatest good of the greatest numberif no operation were performed at all. Carcinoma

i of the breast is one of the commonest forms of cancer,t and, although it is anatomically one of the most,, accessible, the results of operation have not seemeds to be correspondingly good. If patients are to ber persuaded to present themselves for operation at an

early stage, an effort must at least be made to prover that operation really is efficacious. It must not be

i, merely a genial faith in the mind of the surgeon.By far the most extensive investigation of the

r problem that has ever been carried out was done by,- Dr. JANET LANE -CLAYPON, and was published by1 the Ministry of Health in 1924.i Probably it woulds be impossible for a voluntary society to gather any1 comparable mass of data. The committee of theo Medical Society of London have pointed out, however,c that all investigations hitherto published have, fore various good reasons, taken a three-year, or at most

a five-year, survival period as the evidence of curet after operation. The committee which drew up ther report have endeavoured to strike out in a new linee by restricting their investigations to those patientso who have survived operation for ten years or more,e and of these they have gathered 265 records.

1 Reports on Public Health and Medical Subjects, Nos. 28 and32. H.M. Stationery Office, 2s. 6d. and 3s. THE LANCET,1924, i., 1074.