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Reviews and Notices of Books.The Biobor and Treatment of Venereal Diseases

and the Biology of Inflammtion and its

Relationship to Malignant Disease.By J. E. R. McDONAGH, F.R.C.S. Eng., Surgeon to Out-patients, London Lock Hospital, &c. London: Harrisonand Sons. 1915. Pp. 625. Price £11Os.

THE biology and treatment of those diseaseswhich are classed as venereal have a vast import-ance for every medical man, for in one or otherform they are met with, not only in the work ofthe general practitioner, but in that of everysurgeon, physician, and specialist. This book iswritten by one who has done a large amount ofwork in endeavouring to unravel the problem ofthe nature of the organism causing syphilis, andis certain to arouse considerable interest.The time is not very far past when all venereal

diseases were supposed to be one in nature, thoughtheir manifestations greatly differed from one

another. As late as the fourth decade of the last

century it was customary in many of the hospitalsof London to treat gonorrhoea with mercury, withunsatisfactory results, as was acknowledged at thetime. The first step in advance was the separationof gonorrhoea from the other forms of venereal

disease, but many more years had to elapse beforeit was recognised by all that the soft chancre wasentirely distinct from the hard sore, thoughoccasionally a double infection might occur.The history of the search for the causa causans

of syphilis is full of interest, and Mr. McDonaghhas here presented it to us clearly. He describesthe discussion which is still going on as to the truenature of the spirochseta pallida ; is it a protozoonor is it a bacterium? If the spirochsete is the solecause of syphilis, Mr. McDonagh tells us that it isdifficult to explain why the incubation period is solong and why one or two injections of salvarsan donot always effect a cure. These difficulties areexplained by the author on the theory that thespirochaete is merely the male gamete of a proto-zoon, and that many other forms occur. He hasworked out the whole cycle of development, and inthe chapter devoted to this cycle are to be foundmany interesting photographs showing the variousstages. It is hardly necessary to mention that thisexplanation of the position of the spirochaete hasnot been accepted by everyone, though there isundoubtedly much to be said for it.

Interesting chapters are those on the Wasser-mann and the Abderhalden tests, and the difficultsubject of the true meaning and mode of action ofthese tests is fully discussed. The various types ofprimary sore are well illustrated by some colouredplates. The treatment of syphilis is given veryfully, and the author tells us that successful resultsmay be obtained with the use of many differentmethods of treatment, but he is inclined to beginthe treatment of nearly all cases with the injectionof neosalvarsan.The section dealing with the soft sore is good

and contains some excellent illustrations. Togonorrhoea some ninety pages are devoted. Theconclusions at which the author arrives are clearlystated. He regards the use of a vaccine as necessaryin many cases before a cure can be obtained, andthe most potent agent he considers to be a vaccinesensitised with a human antigonococcal serum. A

chapter is devoted to the minor venereal diseases.such as condyloma acuminatum and granuloma,inguinale. The eugenic aspect of venereal diseaseis of no little importance and it is fully discussed.Lastly, we have a section on the biology ofinflammation and its relation to malignant disease.,and though this is of great value it does not appearto be very germane to the main subject with whichthe book deals.To sum up, Mr. McDonagh has made a distinctly

valuable addition to the literature of the venerealdiseases, especially to that of syphilis, the mostimportant of them all. The work is excellentlyprinted and illustrated.

A Text-book of Surgery.By RICHARD WARREN, M.D., M.Ch. Oxon., F.R.C.S. Eng.,Assistant Surgeon to, and Teacher of Clinical Surgery at,the London Hospital. With 504 original illustrations.In two volumes. London : J. and A. Churchill. Pp. 1400.Price 25s. net.

THE advent of a new text-book by a new authoron a subject of such importance as general surgeryis always a matter of considerable interest toteachers, practitioners, and students. It is probablytrue that since the time of Erichsen there haubeen no great outstanding text-book on surgerywhich has held the field for any length of time,and this fact appears on consideration to be onlyright and proper seeing that advance in surgeryhas been so enormous and so rapid that in a shorl,space of time any text-book becomes out of dateand a new one is welcome. To a writer of text-books it must be a matter of great difficulty to,decide how much matter to put in and how muchto leave out; to insert all that a student is requiredto know means such an enormous tome that thereader of it grows weary and confused. Subsidiarybranches of the science also have grown and

require consideration. Taking, for instance, bac-teriology and pathology, a proper understandingof these subjects is essential to the modern surgeon;without them he cannot grasp the elements of hiswork, and hence their inclusion in works on surgery.But their position is now similar to that of anatomyin older text-books; it has been agreed that anatomyshould be taught separately, essential though it isto the surgeon, and it seems likely that bacteriologywill soon have to share a similar fate. In the bookbefore us Mr. Warren is to be congratulated onmaking a judicious compromise, incorporatingsufficient to instruct without bewildering.

Special features of the book are the sectionsdealing with subjects in which great advance hasbeen made in the last few years-namely, injuriesand affections of bones, blood-vessels, joints, theair-passages, abdomen, and urinary system. Thestudent is given a clear account of the bestmethods at present in use, and very helpfully theauthor directs attention particularly to those whichin his experience have proved sound and satis-factory. We note with gratitude that many ofthe more obsolete methods which have beenpreserved in other text-books by generations ofauthors, to the confusion of students, have beendropped. It can be stated at once that the bookis a good one, and if there is a criticism tomake it is that it is rather too long, the twovolumes together running into over 1400 pagesFrom the point of view of the student it might bedesirable that the subject should be presented in aslightly abridged form. The difficulty of doing so

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of course is great, but it might be possible withoutreducing efficiency.The work itself is produced in admirable style ;

the type is clear and the illustrations excellent.We believe that the book will take a good place inthe world of surgery.

Ji. Manual for Health Officers.By J. SCOTT MACNUTT, A.B., S.B., sometime Health

Officer of Orange, New Jersey, and Member of the Boardof Examiners of Health Officers and Sanitary Inspectors ofNew Jersey; Lecturer on Public Health Service in theMassachusetts Institute of Technology. With a Foreword

by WILLIAM T. SEDGWICK, Professor of Biology and Public Health in the Massachusetts Institute of

Technology. First edition. London: Chapman andHall, Limited ; New York: John Wiley and Sons. 1915.Pp. 650. Price 12s. 6d. net.

As the title indicates, the object of this volumeis to furnish a general guide for health officers andothers interested in public health work. The bookis divided into two parts, the first of which gives ageneral description of the organisation and powers<of health authorities, while the second deals withpublic health administration and has chaptersdevoted to communicable diseases, child hygiene,milk- and other food-supplies, water-supplies,housing and industrial hygiene, nuisances, sanitarylaw, and vital statistics. There are also a numberof appendices on various matters relating to publichealth. There are no illustrations.Most of the subjects are dealt with from the

American standpoint, and perhaps the chiefinterest of the book to the British reader lies in the

opportunity which it affords of comparing Americanmethods of public health administration with thosewhich obtain in this country. Thus it may comeas a surprise to many that the health officer inAmerica need not necessarily be a qualified medicalman. The author tells us that in the UnitedStates of America men hold office as healthofficers who have not been trained in medicine,but in biology or sanitary engineering. Execu-tive powers for dealing with public health mattersare conferred upon local boards of health, which,in greater or less degree, discharge the functions ofour sanitary authorities. The mode of election ofmembers to local boards of health is not madeclear. Mr. MacNutt states that such boards are notalways popularly elected bodies, but that the i

members may be appointed by the mayor. In the ]author’s opinion the board should be as small as 1

possible-not over five members, as experience has shown that larger boards are less likely to act harmoniously or to perform effective work. It is desirable that at least one member of the board (

should be a physician, particularly if the health iofficer be not a medical man. The board of health imust also have an official medical representative, i

sometimes called " medical inspector " or " board of thealth physician," whose chief duty lies in dia- t

gnosing doubtful or suspected cases of communi- tcable disease and in determining whether or not v

cases may with safety be released from quaran- e

tine. If the health officer is a medical man r

he generally undertakes such duties, but if not, r

a physician (who may or may not be a member of s

the board) is often designated for the purpose. c

Other members of the public health staff may include sanitary inspectors, public health nurses, a,and veterinarians, while a certain number of s

workmen may be employed in destroying mosquito Ibreeding places and the like. The services of a legal a-

adviser are also necessary, and this function maybe fulfilled by the city attorney, or the board mayappoint a counsel of their own. A laboratoryservice for the examination of morbid products toassist in the diagnosis of infectious diseases maylikewise be instituted. The activities of the boardof health are, of course, regulated and directed bythe powers conferred upon it by the State legislatureas expressed in the public health statutes. The

powers granted by these statutes are often statedin general terms, but the modern tendency is todefine the powers of health authorities more

exactly and to confine them within closerlimits.Just as local boards of health are entrusted with

the care of the public health of local communities,so the State health authorities exercise controlover those matters which are common to the com-munities throughout the State. State health depart-ments represent a later form of organisation thanthe local, having been called into existence by thenatural development of sanitary questions relatingto the State as a whole. We are told by Mr. MacNuttthat Massachusetts was the first State in America toform a State board of health, and a study of thestatute which created this board and defined itspowers shows that its functions were entirelyadvisory in character. Thus the board was to "makeinvestigations," " gather information for diffusionamong the people," and " make suggestions as tolegislative action." This is still perhaps the mostimportant function of State boards of health,but of recent years there have been added, as theneed for State-wide action became apparent, certainfunctions of an executive nature. These are

exemplified in supervision of foods and drugs, ofwater-supplies, and of sewage disposal, and in thecomprehensive registration of vital statistics. Statehealth authorities seldom interfere with purelylocal matters except when they have a State orinter-community bearing-i.e., when other districtsthan the one in question are injured or threatened.There is a tendency at the present time to limitthe degree of supervision of the State over localboards of health-in fact, the supervision exercisedis, in many instances, insufficient to maintainproper minimum standards by the local boards.What is known in America as "publicity" is

apparently regarded as one of the important func-tions of the State health authority. No phase ofpublic health work in recent years is more strikingbhan the movement for popular education inmatters of hygiene. All sanitary education has awofold object in view-the improvement ofpersonal hygiene and instruction in the aims andobjects of public hygiene. Such education, whichs attained by " publicity," is looked upon as thendispensable preliminary of legislation and thelecessary accompaniment of effective adminis-trative control. The newspaper press forms a

Iseful medium of public instruction, and many ofhe data collected by State authorities can bevorked up into readable and at the same timeiducative press material, which would otherwiseeceive limited attention if only issued in officialeports. Many State health departments, with aimilar object in view, issue popular bulletins,irculars, posters, and the like, while exhibits areometimes resorted to in connexion with campaignsgainst tuberculosis and for improvement of milk-applies.Mr. MacNutt’s description of the Federal health

uthorities and the position which they occupy in

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relation to the State authorities and the localboards is interesting and may be quoted.The Federal authorities bear somewhat the same relation-

ship to those of the States that the latter do to the localboards of health ; in other words, their functions are

properly either interstate or related to the Union of Statesas a whole and are not exercised except under conditionswhich cannot be effectively dealt with either by local or byState authorities. This is in accordance with the provisionof the Federal Constitution that powers not expresslydelegated by that instrument to the Federal Governmentare reserved by the individual States to themselves. Viewingthe national public health scheme as a whole, the bulk ofthe executive power is lodged with the local boards ofhealth ; less with the State boards of health, which are

therefore more advisory and less executive ; and still lesswith the Federal Government, which is most advisory andleast executive.

The United States has no unified department ofhealth, the activities of the Federal Governmentfor the furtherance of hygiene and sanitation beingcarried on by a number of separate bureaus. Themost important of these is the Public HealthService (formerly the Public Health and MarineHospital Service) which performs more of thefunctions of a national health department thanany of the other Federal bureaus. The servicehas charge of the administration of the nationalmaritime quarantine and of the national laws per-taining to medical inspection of immigrants. Itconducts investigations in the various States oninfectious diseases, maintaining a hygienic labora-tory to assist in the elucidation of such problems. Itis responsible for the purity and potency of vaccines,antitoxins and serums manufactured for sale ininter- State traffic, and it issues weekly public healthreports for circulation among health authorities,setting forth statistical and other data relatingto national quarantine, communicable diseases, andmortality throughout the country. Much excellentwork has been done by the Public Health Service,the publications of which are well known to thoseinterested in public health in Britain. The Bureauof Chemistry investigates the adulteration of foods,drugs, and liquors, and is responsible for theadministration of the Federal Pure Food Act. TheBureau of Animal Industry conducts sanitary andeconomic investigations in connexion with themilk industry and carries on inspection of meatentering into inter-State traffic, besides inspectingthe slaughter-houses in which animals for this tradeare slaughtered. The Bureau of the Census includesthe Division of Vital Statistics, which collects,analyses, and publishes statistics of population,births, and deaths for the country as a whole andfor its various cities, towns, and other civil divisions.The Children’s Bureau conducts investigations anddisseminates information concerning the protectionof child life, particularly as regards prevention ofinfant mortality.

Mr. MacNutt has succeeded in writing an instruc-tive book which should do much to stimulateinterest in public health problems in America.

Manual of EmbryoZogy.By A. MELVILLE PATERSON, M.D. Edin., F.R.C.S. Eng., IProfessor of Anatomy in the University of Liverpool. Withnumerous illustrations. London : Henry Frowde, Hodderand Stoughton. 1915. Pp. 391. Price 10s. 6d. net.

THE subject matter of this manual, the authortells us, is for the most part the amplified notesof lectures and demonstrations given to medicalstudents. In other instances we have noticedthat lecture notes, however excellent in them-selves, need extremely careful editing before being

published in book form. In the present case thelectures make their collective appearance in printso full of inaccuracies that it is impossible to regardthe work as a safe text-book. The illustrations areclear and diagrammatic, but unfortunately they, too.are in some cases so misleading that their veryclearness is a defect. The book needs abundantcorrection before it can be placed in the hands of a,medical student.

Lectures on Elemcntal’y Anatomy and Physio,-logy, including Short Sketches of f BiologyEmbryology, and Comparative Anatomy.

By H. CLIFFORD BARCLAY, M.D., Ch.B.N.Z., F.R.C.S.Edin., M.R.C.S., L.R.C.P. Lond., Major, Royal ArmyMedical Corps; Medical Superintendent, Waimate Hos-pital ; Examiner in Forensic Medicine, New Zealand

University. Second edition. Illustrated. London: Bailliere,Tindall, and Cox. 1915. Pp. xiv.-281. Price 6s. net.

A FLY-LEAF has been inserted in this work upon.which the author has appended the following post-scriptum :-

This work was set up in type by Japanese printers who,knew not one word of English. The outbreak of warnecessitated the departure of the author from Japan and theultimate completion of the book without his personal super-vision. The minor errors, he trusts, will, under the eircum--stances, be forgiven him.Even without such a warning the reviewer would.

be a ruthless person who had the heart to be over-critical in dealing with this volume. One is inclinedto forgive much in a book which bears on everypage the stamp of genuine, enthusiastic, first-handwork. The Japanese typesetters are to be con-gratulated. Trivial misprints abound in the book,as is but natural, but in the absence of any know-ledge of the language the performance is a greattriumph.As for the style of the book, we can only say

that it is a welcome relief. The writing is easy,almost conversational, and is stamped by the:author’s love of his subject. The present reviewer-has had frequent occasion to remark in thesecolumns upon the failure of authors to write eventolerable accounts of the structure and functionsof the human body for the use of nurses andthose not habitues of the laboratories of medicalschools. It is quite certain, however, that MajorBarclay can do this difficult thing. That his bookwill be useful and interesting to the " hospitalprobationers and teachers and students in highschools," for whom he specially writes, is perfectlycertain; and we would add that those who havegone far beyond this stage in the knowledge ofanatomy and physiology will be interested andinstructed too. With all its natural misprints andlittle slips, it is the best book of its kind we haveread.

MISCELLANEOUS VOLUMES.

WE have received several useful little books dealing-with questions of maternity and the up-bringing of children.Early in the year we noticed the first volume of a course oflectures delivered under the auspices of the National Asso-ciation for the Prevention of Infant Mortality at the RoyalSociety of Medicine and Charing Cross Hospital MedicalSchool in the winter of 1914. These lectures were continuedin February and May, 1915, and have now been issued underthe title of Mothercraft, Part II. (London : The NationalLeague for Physical Education and Improvement. 1915.Pp. 165. Price 3s. net). Antenatal and postnatal developmentof the child, feeding and nursing, cooking for infants andchildren under school age, first aid in emergencies, andinfectious diseases are among the subjects dealt with, and’the lecturers include Dr. Florence Willey, Dr. Eric Pritchard,

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Dr. Ronald Carter, Dr. Emily Mecredy, Dr. Herbert Cuff, andDr. Christine M. Murrell. Dr. Joseph Cates outlines a workingscheme in antenatal hygiene which has been in successfuloperation for a short time in the borough of St. Helens,Lancashire. In the coming years the need for the preserva-tion of child life will probably be forced more and more onpublic attention, and these lectures on mothercraft are avaluable contribution to the subject. The two series oflectures are bound together in one volume at the price of 4s.,but it is to be hoped that the authorities may see their wayto publish either a cheaper edition or an abridgmentof the information contained in them at a lower price,for a large amount of the teaching should form partof the education of every woman of marriageable age. IOne of a series of " Harvard Health Talks " (The Care and Feeding of Children. By JOHN LOVETT MORSE, M.D., IAssociate Professor of Paediatrics, Harvard Medical School.London : Humphry Milford, Oxford University Press.1914. Pp. 53. Price 2s. 6d.), among many wise aphorisms,includes in its 53 pages one which stands out branded withthe impress of sempiternal truth. It is this: "One of thegreatest obstacles to the proper feeding of children is the

opposition and interference of grandmothers."--The nextvolume (Mat,rnity Letters from Working Women. Collectedby the Women’s Cooperative Guild. London : G. Bell andSons. 1915. Pp. 211. Price 2;:. 6d.) consists of a largenumber of letters from working women giving accounts oftheir experiences during pregnancy and parturition. Thereis a preface by the Hon. Herbert Samuel, M.P. The objects ofthe guild are social and political, and the letters were collectedas evidence in favour of one of their movements. The bookcontains a recital of facts well known to every medical studentwho has done his maternity cases on a hospital I I district.

"

In A Compendium of Aids to Home Nursing, by N. CORBETFLETCHER, M.B., &c. (London : Bale, Sons, and Danielsson.1915. Pp. 100. Price 6d. net), which is a little pocketbook, four inches square, is contained a quantity of informa-tion as to all the matters a nurse need be acquainted with-physiology, the sick room, infection, disinfection, nursingdetails, and administration of food and medicine. The com-

pilation has been made with care, the facts are well arranged,and there is no padding. It is not a book to learn the art of

nursing from, but a useful vade mecum for the already trainednurse.

CURRENT GERMAN MEDICINE.

Medioine.-Professor Ehret (Strassburg i.E.) calls atten-tion to the frequent occurrence of aeeidenlccl heart murmursin soldiers at times of stress and agitation (MmW40 1).The murmur is generally systolic in rhythm, louder on deepinspiration, varying with the position of the body. He

regards murmurs of this character as I I pneumocardial inorigin, and having no diagnostic importance.

Dr. Fritz Levy, in charge of the bacteriological depart-ment of the war isolation hospital at Lugumkloster, found(MmW37) that attacks of pyrexia associated with hydrmiawere constantly associated with recurrens spirillum in theblood, even when typhus was also present. The conditiontended to become chronic and to persist for several monthsunless neosalvarsan was given, a single injection of 0’3-0’45grm. being sufficient to cure most cases. The oedema ofthe eyelids, feet, or scrotum was such as to suggest beri-beri or avitaminosis, but was really a symptom of recurrens.The diagnosis from malaria might be difficult, and thefollowing table is suggested as assisting differentialdiagnosis :-

* Middle generally yellowish and dry, edges cyanotic.

1 MmW = Munchener medizinische Wochenschrift. MK = Medizi-nische Klinik. WkW = Wiener klinische Wochenschrift.

The ready cure of recurrens by organic arsenic is confirmedby two other observers. Professor Reiche, of Hamburg’,finds (MmW40) a dose of salvarsan 03 grm. intravenouslysufficient to effect a regular cure. Professor Korczynski, ofSarajevo, gives (MK39) the preference to neosalvarsan in asingle dose of 0-9 grm., reduced to 0’45-0’6 in subjects ofsmall build.

Pharmaocology,-Dr. Marcovici and Dr. Pribram describe(WkW37) the remarkable protection to rabbits againstdysentery toxin afforded by a daily dose of 2 5 grm. of garlic,which is sufficient to prevent death after 10 times thenormal lethal dose has been administered. The drug is alsoactive against a culture of B. dysenterias given intravenously.An animal of 1-1-5 kilo. can tolerate 2-5-5 grm. daily.

Statistics,-The number of names on the medical registerin Germany for 1913 was given (MK40) as 34,136 males and195 females, being 51 to every 10,000 inhabitants, or 9-6in towns over 10,000 inhabitants and 3’8 in the countrv.Greater Berlin had 4151 names, being 11,1 per 10,000.According to the official reports to date, of these 473 werereported (MK39) wounded, 101 prisoners (18 of these have

returned), 118 missing (43 returned), 214 died of wounds, 95of disease, 1 of gas-poisoning.

Surgery. -Professor Sauerbruch, of Zurich, who has beenattached to a base hospital at Greifswald, has worked outthere in association with Herr Stodola, professor of mechanicsat the University of Zurich, a method of producing anartificial hand which can be voluntag-ily moved (MK41). A

proper bone-stump is essential and the existence of musclesand tendons which can give sufficient contraction. In thecase of a high amputation through the middle of the armflaps of skin and muscle are formed out of the flexors andextensors with the aid, if necessary, of a skin-graft from theabdominal wall. After healing is complete the edges of theflaps are refreshed and united so as to leave a transverse canallined by skin to contain a thin wooden stirrup to whichstrings are attached to move the hand. In another case the

flap was made out of the flexors alone, but the principle wasthe same. The method has the simplicity of genius, as

much of Sauerbruch’s surgical work, and may, when moredeveloped, do much to minimise the disability of a lost arm.

Prcfessor Kraske (rank of general) writes from Brusselsrecording his experiences in the early operation of abdominalshots (MmW39). Of the cases operated upon within thefirst 12 hours 7 out of 9 recovered ; in the second, 11 out of

21 ; in the third, 2 out of 8 ; in the fourth, none. He con-siders that the conclusion to be drawn is obvious.

THE NATIONAL INSURANCE ACT.

The Nem Regulations.THE new regulations making alterations in the terms of

service for medical men, to tate effect on Jan lst, 1916,have been introduced at an unfortunate time and in an un-fortunate manner. The medical practitioners on the panel,and now remaining in civil practice, are naturally hamperedin contesting points, which they feel that they have a rightto contest, by the consideration that nothing avoidableought to be initiated in the way of controversy until afterthe war. At the same time they had a right to expectthat during the period of the war nothing likely to arousecontroversy would be done by the Insurance Commissioners.This has hardly been the case.The new tariff of prices for drugs and scheduled appli-

ances supplied under the National Insurance Acts mayaffect mainly the druggists, but the explanatory notesissued with the tariff to elucidate the new system of pricingand paying for prescriptions must be studied by medicalmen in order fully to understand them, as must beMemo. 217/I.C., dealt with briefly in THE LANCET ofNov. 13th (p. 1102), for these relate to regulationsaffecting practitioners on the panels. The essentialfeatures of the regulations as to dispensing are : (1) anew tariff of prices, described as a commercial tariff, hasbeen issued, by which the cost of drugs is to be regu-lated in the pricing and paying for prescriptions dispensedunder the Act ; and (2) the price which the druggist willreceive will be calculated by the Insurance Committee whichpays him. The sum paid for each prescription will be made