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Reviews and Notices of BooksNOUVEAU TRAITE DE MEDECINE.

Edited by G. H. ROGER, F. WIDAL, and P. J. TEISSIER.Fasc. 1., Maladies Infectieuses. Paris : Masson etCie. 1920. Pp. 482. Fr.35.THE first volume of this treatise is a comprehensive

French work on systematic medicine on the lines of theEnglish work of Allbutt and Rolleston and the AmericanOsler and McCrae. It is published under the generaleditorship of Professors Roger, Widal, and Teissier,supported by an influential committee of more thanone hundred savants. Twenty-one volumes are contem-plated, and, as the editors state in the preface, the workis intended to replace the well-known treatise of Charcot,Bouchard, and Brissaud, published in 1891. The scopeof the work can be gauged, in general terms, bythe " plan " given at the beginning of Vol. I. Startingwith infective and parasitic diseases, an account ofwhich is designed to occupy the first five volumes,the plan gives summaries of the contents of volumesdealing successively with intoxications, vitamines,disorders of metabolism and of the endocrine glands,diseases of the cardio-vascular, respiratory, digestive,urinary, and nervous systems; and concludes with avolume on the muscles, bones, and joints. In somecases two or more volumes are to be devoted to onesection; for example, the diseases of the alimentarytract will occupy three volumes.In the first three paragraphs of the preface the

several editors have set before the readers high ideals.They point out that a great catastrophe has turnedthe world upside down and placed before the mindsof modern physicians all manner of new problems.They aim at utilising the lessons of war in learningthe further lessons of peace, and they appeal tothe nations to coordinate their efforts in a greatattempt to diminish human suffering. Professor Rogeropens the description of the infective diseases witha short historical introduction of the subjects of

infection, contagion, and auto-inoculation, sketchingthe progress which has taken place in the study ofthese problems, from the earliest times to the moderndays of Koch and Pasteur.The chapters of the first volume deal with

various diseases produced by the following organisms :streptococcus, pneumococcus, staphylococcus, Micro-coccus tetragenus, enterococcus, the influenza bacillusof Pfeiffer, the pneumobacillus of Friedlander,B.psittacosis, B. proteus, the organisms found associatedwith gas gangrene, meningococcus, and gonococcus.Brief bacteriological details, morbid histology, sym-ptoms, signs, and treatment are all clearly and con-cisely set forth. The section on pneumonia and thepneumococcus must, however, be singled out for specialnotice. This portion of the book shows all those

qualities of clear thinking and crisp, concise writingwhich are so characteristic a sign of the best Frenchmedical work, and Dr. P. Menetrier and Dr. H. Steveninare to be congratulated on this part of the work. The

chapter on the enterococcus should also prove valuableto English readers, as it is a subject on which ourEnglish text-books are distressingly vague and brief.The illustrations throughout the book are good, andsome of the coloured plates reach a very high standard.References are given in footnutes. They are too fewin number for a standard work of this kind, but as faras they go they are up to date and representative.

THE CARE OF HUMAN MACHINERY.

By R. M. WILSON, M.B., Ch.B. Oxford MedicalPublications. London : Henry Frowde and Hodderand Stoughton. 1921. Pp. 238. 10s. 6d.

THIS book is composed largely of material which

originally appeared in the Trade Supplement of theTimes, where the articles condensed in clear languagemuch that appeared during the past few years inGovernment publications. The author draws most ofhis facts from reports of the Health of Munition Workers

Committee, the Industrial Fatigue Research Board, theMedical Research Council, the National Service MedicalBoards, and the Factory Department, though he reliesupon a few other sources. Readers unacquainted withthese reports will be astonished to discover the leadwhich this country has taken up to the present inacquiring new knowledge, but, if they desire to readfurther on any subject, they will regret that the bookcontains no bibliography to guide them to the originalsources of the knowledge-an unfortunate oversight.An irrefutable case for factory medical officers is

made out in the interests of health and efficiency and ofa contented personnel and improved output. A worksdoctor, it is held, is a form of insurance that must soonbecome universal. Fatigue is discussed as the greatenemy of output, health, pleasure, and joy in life-an enemy that must be kept at bay by one who under-stands it. Its every move must be watched andstudied; but Dr. Wilson points out that so far theoptimum working time for industry in general has notbeen determined with a sufficient degree of accuracy,still less is this the case for particular processes andindividuals. Evidence is drawn from army recruitingdata to prove that work is to-day making many a fit manunfit because the worker and his work are not suited.The plea may be entered that each industry should

organise the health and efficiency of its workers, justas Sir Allan Smith has recently suggested that it shouldbe responsible for its own unemployment. Its interestlies that way, for the unfit worker becomes easilyfatigued and irritable ; he cannot give of his best.Industry must recognise that the skilled worker is

always of more value than a machine, and is worthtaking care of.

Lost time is discussed by Dr. Wilson as one of the’ diseases of industrial life, and its extent is laid bare.Labour turnover, or " lost workers," is presented asthe mortality of industry-a mortality as extensive asits cost is appalling. The need for determining both, soas to enable remedies to be applied, is adequately dealtwith. The chapter on Ventilation and Output is one ofthe best in the book; it is up-to-date and points outhow human activity is affected by " weather," which,within the workshop, can be controlled by ventilation.This matter, when our margin of safety in a health

sense is low, can hardly be over-estimated. Variety,however, is needed, since rhythmical changes of air aremore pleasant and stimulating than a steady, even flow.The claim is made that industrial management is inti-mately concerned with extra-factorial life, because "anemployee who comes from a clean and wholesomehouse, where his meals can be properly prepared, andwhere his leisure can be spent advantageously, is

manifestly a much better investment than one whosehome is situated in a slum, whose food is ill-cooked andworse served, and whose leisure belongs for the mostpart to the local public-house."Other matters, such as factory lighting, safety first,

first aid, noise, and industrial welfare, are also dis-

cussed ; but as the book is a summary and review ofwork done, it hardly lends itself to further condensa-tion. We recommend it to our readers as a first primerof interest in itself and one which may induce themto look further into subjects of the greatest economicimportance to all.

PRACTICAL MEDICINE SERIES.Vol. III. : Eye, Ear, Nose and Throat Series.Chicago: The Year-Book Publishers. 1920. Pp.382.$1.75.THIS is one of a series of eight volumes of abstracts

of medical and surgical literature. The third volumedeals with the eye, under the editorship of Dr. CaseyWood, while the sections on the ear and nose andthroat are edited respectively by Drs. A. H. Andrews andG. E. Shambaugh. The abstracts are mostly of articlespublished in American journals, but include a numberof English and a few continental publications. Thenumber of papers abstracted is very large ; indeed, asmaller number and a more ruthless selection wouldperhaps have been of advantage. Short editorial com-ments have been added here and there, sometimes of

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rather a pedagogic nature ; the labour of compilationmust have been great, but it has been well repaid bythe production of a volume of great interest and value,and we look forward to the regular appearance of thispublication in future years.

THE CEREBRO-SPINAL FLUID.Its Physiology and Pathology. By WILLIAM BOYD,Professor of Pathology, University of Manitoba ;Pathologist, Winnipeg General Hospital. London andNew York : Macmillan and Co. 1920. Pp. 176. 30s.

Professor Boyd prefaces a work which divides itselfnaturally into two parts, a purely scientific section andone which we may regard as clinical or empirical, withthese happily chosen words :-"Any means which will facilitate the difficult diagnosis of

diseases of the central nervous system is of value, and the cerebro-spinal fluid, which bathes its deepest recesses and washes the verynerve cells and fibres themselves, is in truth a mirror whichreflects every change taking place in that system."

It is impossible to view the controversial subject ofintrathecal therapy without taking into account thefact that there is a circulation of the cerebro-spinalfluid taking place in definite directions. As a result ofinjecting solutions containing easily visible particles ithas been shown that circulation takes place upwardsfrom the spinal sac to the lower cranial chamber, whilethe flow from the upper cranial chamber takes placein a downward direction. Further, there can be nodoubt, as the author points out, that the fluid is a definitesecretion of the choroid plexus or of the choroid gland,as Mott calls it. Not only is cerebro-spinal fluid a truesecretion, but it is also absorbed along definite channels,among which the arachnoid villi must be mentioned.As with other secretions, the flow of cerebro-spinalfluid can be increased considerably by the injection ofcertain substances, chief among which are extracts ofthe choroid plexus and brain tissue. It is suggestedthat the function of the fluid is not purely mechanical,for its composition points to a nutritive r6le.The clinical section of the book opens with a short

discussion of lumbar puncture and its occasionalharmful sequelae. The fact that general paralyticsnever suffer from any symptoms either during or afterlumbar puncture Professor Boyd explains by themarked excess of fluid present. It would, however,be more correct to attribute it to the general wastingof the brain, and possibly also to the dense duraladhesions which, as it were, suspend the brain fromthe cranial vault. He lays stress on the importance ofthe accurate determination of the fluid pressure, andrecommends the apparatus used by Cassidy and Pagefor clinical purposes. In the description of routine

laboratory tests no mention is made of the quanti-tative estimation of total protein, the dilution methodfor the rough estimation of protein excess, the cholintest, the Boveri test, or the Berlin blue reaction. Withregard to the Wassermann reaction, sufficient stress isnot laid upon the varieties of technique employed, noron the fallacies arising if fluid is kept at room tem-perature or becomes contaminated. It is, moreover,regrettable that the many chemical tests are not

critically discussed, and also that the practicaldifficulties encountered are not dealt with.In the section of the book devoted to a discussion of

the pathological fluid findings in diseases involving thecentral nervous system, Professor Boyd mentions thatthere may be a pleocytosis in cases of cerebral tumour,especially when the meninges are involved. The useof the sugar content is stated to be the chief differ-entiating point between acute anterior poliomyelitisand tuberculous meningitis; in the latter disease itis usually normal, while Professor Boyd states that inanterior poliomyelitis it is not reduced. Many willdisagree with the statement that only 30 per cent. ofcases of cerebro-spinal syphilis give a positive Wasser-mann reaction in the fluid, and that 70 per cent. oftabetics give a positive reaction in the blood. Pro-fessor Boyd is an enthusiast on intrathecal therapy.In the therapeutic section he states that infantileconvulsions may often be more quickly relieved bylumbar puncture than by any other treatment. Hequotes cases of cures of tuberculous meningitis by

intrathecal tuberculin injections and of pneumococcalmeningitis by ethylhydrocuprein. He gives in detailthe modern treatment of neurosyphilis.This book, taken as a whole, is a pleasantly written

summary of the more important aspects of our know-ledge of the cerebro-spinal fluid, which will appeal lessto the laboratory worker than to the general physician.

ON BONE FORMATION.Its Relation to Tension and Pressure. By Dr. MURKJANSEN, O.B.E., Lecturer on Orthopaedic Surgery inthe University of Leiden (Holland). Manchester:University Press. 1921. Pp. 114. 20s.

FOR more than half a century the views of Meyerand Culmann as to the effect of pressure and tension onformation of bone have been passively taken, and,within the last 30 years, what is known as Wolff’s law,which expresses the same belief in precise terms andwithin implied limits, has been accepted also withoutserious question by anatomists, who have in generallet it go, so to speak, by default. Yet objections havebeen raised from time to time to the acceptance of this"law," and these have come largely from orthopaedicclinicians who could not reconcile it with their findingsin practice. This book is the most recent declarationof the unsatisfied, for Dr. Murk Jansen holds stronglythat functional pressure is an important factor inbone formation, while tension has no power in thisdirection, and he considers it necessary to postulateother factors which-for want of a better word-may betermed "purposive." In developing his main thesis theauthor has, in our opinion, certainly demonstrated thattension can have little or nothing to do with boneformation. He illustrates his point with beautifulphotographs of very happy sections, not confining hisattention (as did Wolff) to the neck of the femur,although his demonstrations of the conditions in coxavara are among the most striking of his evidences.We cannot say that we think all his examples or allthe explanations advanced are of the same value-Albert’s " radiants " from the intercondylar fossa areextremely suggestive of crucial tension and call formore convincing treatment than Dr. Jansen’s if theeffect of tension is to be eliminated. Again, the readerof his exposition of pressures in joints may have anoccasional feeling that the author’s enthusiasm leadshim to make less of the points on the other side thanthey really deserve. But, notwithstanding these weakspots, we cannot help feeling that Dr. Jansen has pre-sented an excellent and almost convincing argumentfor his side of the question, and those who are not to beconvinced will at any rate derive much interest andinformation from his clearly written pages. The

printing is large and clear, and the get-up of the bookas a whole reflects credit on its producers, as well as onits author, who is to be congratulated on a courageousattempt to reform loosely-held beliefs.

ORGANIC MEDICINAL CHEMICALS, SYNTHETIC ANDNATURAL.

By M. BARROWCLIFF, M.B.E., F.I.C., and FRANCISH. CARR, C.B.E., F.I.C. London : Bailliere, Tindall,and Cox. 1921. Pp. xii. + 331. 15s.

THIS is one of a series of handbooks, edited by Dr. S.Rideal, each of which is intended to give a com-prehensive survey of some branch of industrialchemistry. The preparation of the volume before ushas been entrusted to two chemists who are able tospeak authoritatively on both the industrial and labora-tory aspects of their subject, although the former

naturally takes the more prominent place. Practicaldetails are given for the preparation of all the moreimportant medicinal organic chemicals, some accountof the underlying theory being added where necessary.Numerous illustrations of chemical plant are includedand the citation of literature is very complete. TheBritish fine chemical industry earned the thanks of thenation for the manner in which it succeeded in

supplying all essential synthetic chemicals during thewar. The quality of these products is excellent, butthe manufactures in many cases have not yet beenestablished on a commercial basis as regards maximum

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yields and minimum costs of production generally.These are matters of great national importance and, asthe authors point out, perfection can only be attainedby zealous work on the part of those with knowledge.University-trained men are handicapped in chemicalworks, as a rule, by their lack of information on currentindustrial conditions; this book should be cordiallywelcomed as helping to bridge the gap between college and factory.

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EINFACHES PHARMAKOLOGISCHES PRAKTIKUM FURMEDIZINER.

Von R. MAGNUS, Professor der Pharmakologie in IUtrecht. Berlin: Verlag von Julius Springer. 1921.Mit 14 Abbildungen. Pp. 51. M.17. ]

THIS little book should be found useful by those whohave to arrange courses of laboratory instruction inpharmacology. Directions are given for 20 sessions ;14 of these are devoted to practical exercises to be carried out by the students themselves, consisting chiefly of work on the frog and experiments illustratingsome of the chemical aspects of the subject. The

remaining six sessions take the form of demonstrationsselected to illustrate experimental methods as appliedto warm-blooded animals. The use of complicatedappliances is avoided as far as possible, and the workis planned so as to make the best use of the time avail- able. Details of all the apparatus and reagents neededare given, and the interleaving with blank pages addsto the use of the work.

PATHOLOGY.A Text-book of Pathology. Second edition. ByW. G. MCCALLUM, Professor of Pathology andBacteriology, Johns Hopkins University, Baltimore.London and Philadelphia: W. B. Saunders

Company. 1920. Pp. 1155. 45s.

Aids to Pathology. Fourth edition. By HARRYCAMPBELL, M.D., B.S., F.R.C.P. London : Bailliere,Tindall, and Cox. 1920. Pp. 248. 4s. 6d.

CONSIDERED only as a student’s manual, ProfessorMcCallum’s text-book has obvious disadvantages. Itmakes no claim to being a complete work of reference ;many important conditions are omitted altogether, andthere is a certain lack of balance in the space allottedto several of the commoner pathological processes.Moreover, the arrangement of the subjects is uncon-ventional, and the student who wishes to read up thepathology of any individual organ may find the infor-mation he desires scattered through the book in half adozen different chapters. Nevertheless, the success ofthe work was immediate. It has been reprintedseveral times, and now, four years after publication,we have the second edition. The explanation, of

course, is not far to seek. Professor McCallum holdsdefinite views which he elaborates in a logical andconvincing manner. The result is a work which bearson every page the stamp of the author’s individuality.We feel that he is teaching from his personal experi-ence, and the suggestion of a compilation which is sooften discernible in text-books of this size is altogetherlacking. In this edition certain sections have beenrevised or rewritten in the light of the progress of thelast few years, and several new illustrations have beenadded, but the plan of the work remains the same.

Dr. Harry Campbell’s little book would seem to havean established vogue in student circles, and we canimagine that it is a useful aid to a qualifying examina-tion. Indeed, the very fact that it is written by aclinician enhances its value as a guide in preparationfor those ordeals which are conducted without the assist-ance of a professional pathologist. This edition hasbeen slightly increased in size and has been brought upto date, though here and there an old-world flavour isstill discernible. It is stated, for example, that the" hobnails " of the cirrhotic liver are portions of liversubstance which have been thrust out by the contrac-tion of fibrous tissue. And the information, on page 87,that at the growing border of a sarcoma there is a greatexcess of small round cells which advance in all direc-tions, absorbing the normal tissues (histolysis) in theimmediate vicinity, leaves us plunged in thought.

JOURNALS.British Journal of Ophthalmology. October to December,

.920.-The October number is occupied by the papers readt the Oxford Ophthalmological Congress last summer onPerimetric Methods and the discussion that followed. Thesubject has received a great impetus since the importance)f small scotomata adjacent to the blind spot in theliagnosis of incipient glaucoma has been realised, and theelative advantages of various different instruments werelet forth. The same subject overflows into the Novemberlumber but cannot be regarded yet as closed. At least twoiew instruments for the purpose have been submitted to thenembers of the Section of Ophthalmology of the RoyalSociety of Medicine during the last few months.-Thesubject of Colour Vision is dealt with in the Novemberssue by Dr. F. W. Edridge-Green, who returns to the chargesn his controversy with Mr. J. H. Parsons, and in the nextssue Sir George Berry criticises the Young-Helmholtz theoryrom an independent standpoint.-These numbers alsoJontain articles by Dr. A. W. Stirling, who maintains thatthe axis of aRtigmatism tends to shift with advancing age;)y Dr. J. A. Wilson on the subject of Cinematograph EyeLrritation; by Mr. M. S. Mayou and Mr. H. Neame on theinjuries to the eyes of fishes by the tar-pollution of rivers;tnd by Mr. H. Herbert, who describes his latest operation’or glaucoma, which he terms the " small flap sclerotomy."Journal of Laryngology and Otology. February, 1921.Vol. XXXVI., No. 2.-This number contains the second andinal part of a review, by Mr. Irwin Moore, of all the recordedjases, 73 in number, of angeioma of the larynx. Spontaneoushæmorrhage occurred in 12 cases, but was never fatal; of 32ases on which intralaryngeal operations were performedbleeding was considerable or severe in 25, but was unimpor-tant in the 7 cases treated by thyro-fissure. An article byS. H. Mygind, of Copenhagen, deals with the occurrence ofhead-nystagmus in human beings; this symptom, a commonresult of vestibular irritation in birds and some mammals,is of the greatest rarity in man, but Mygind obtained thephenomenon in 78 per cent. of infants between the ages ofone and eight months, and considers that it disappears at alater age as a result of a reflex tendency to fixation of thehead originating in the cerebellum. The new editors of thisJournal are Dr. Logan Turner and Dr. J. S. Fraser, ofEdinburgh, and it is now published by Messrs. Oliver andBoyd, Edinburgh.Journal of the Royal Army illedacal Corps.-In the issue for

January there is an article on Anoxeamia in Acute GasPoisoning by J. Barcroft, C.B.E., F.R.S., in which it ispointed out that the pathological condition is a more or lesscomplete oxygen-starvation of the tissues and organs, andthat this may develop in three forms-the anoxic type,where, though there is plenty of haemoglobin, the oxygenpressure is low ; the anaemic type, where there is too littleeffective hadmoglobin, perhaps because too much has beenchanged into methæmoglobin or carboxyhæmoglobin; andthe stagnant type, in which the blood, indeed, maybe normal, but too little is delivered to the tissues.His experiments were made on goats, which endurehaving blood taken by aspiration from either ventricle asrequired for chemical examination. The arterial bloodof a goat is generally oxygenated up to 90 or 100 percent. of saturation, while the venous blood contains onlyhalf as much. The goats were given phosgene to breathe,and became " gassed." Oxygen may be used to cure them ;there is one sign, cyanosis, that calls for oxygen, and thereis one clinical rule, oxygen being always valuable, and inwar precious-Do not use oxygen in gas-poisoning unless thepatient is cyanosed. When the oxygen pressure in theblood falls below 90 per cent., headache occurs, visionis impaired, sleep is difficult, work is impossible, andvoluntary movement may kill the patient, especiallysudden movement. Thus an officer, gassed, died at oncewhen, being unexpectedly shelled, he jumped for theshelter of a dug-out. The condition to begin with is anoxicanoxaemia, but death follows by failure of the circula-tion, vagus stimulation, lack of vaso-motor tone, perhapsbrain failure. A goat which fought hard against anoxaemiabreathed more rapidly for hours, doubling thus its pulmo-nary ventilation, and its venous blood became more

oxygenated and redder, the circulation also becoming morerapid. This all put so much strain on the goat that after20 hours it became exhausted, its respiration and circulationfailed, its blood became black, and a condition of stagnantanoxaemia was established. The cyanosis of the early stageis plum-coloured while the systems can react ; when thecirculation has failed the cyanosis is grey. In either of theseconditions oxygen may yet restore function. The treatmentfor anoxaemia is, in the first place, rest and warmth;secondly, oxygen; and, thirdly, intravenous injection ofsaline solution, which replaces the liquid lost in developingoedema of the lungs and re-establishes blood pressure ;bleeding may also be required to reduce pressure raised onthe right side of the heart.