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.drugs under proprietary designation to the cheaperform of the same under its scientific or non-patentedname. A certain number of prescriptions in thispart will help the beginner, and practical notes ontreatment are given. Prof. C. BACHEM, of Bonn,treats the subject rather differently. This bookdirects the doctor who has some knowledge oftheoretical pharmacology to use the right drug in theright place and in the right manner. Experimentalpharmacology has in the past been separated andtreated too far apart from practical medicine, and theauthor’s aim is to bridge the gap for the practitionerby treating of different diseases and functions of thebody and by bringing together and describing thedrugs used for them. This therapeutic arrangemententails the duplicating of some drugs and a consider-able amount of cross reference. The drugs are well andclearly described. Proprietary preparations naturallyoccupy a large portion of the book, and many of thosedescribed are little used in English-speaking countries,but this adds to the value of the book, for thosecommonly used in this country can easily be found inEnglish books. The index of the firm which manufac-ture the drugs, unobtrusively placed in the book, maybe of great use. The author believes that as proprie-tary preparations abound, there is a demand forinformation about their composition and contents ;for in the battle against quackery and swindling thedoctor must possess and impart information on theirnature and value in the interests of the public andthe manufacturers alike.

Annotations.

MEDICAL HISTORY OF THE WAR.

"Ne quid nimis."

WE reviewed last week four large and carefullyedited volumes on the Medical Services of the War inthe domain of pathology and hygiene, together withthe second volume on Diseases of the War. Adetailed estimate of the many and varied fields whichsuch work covers cannot possibly be made in thespace at our disposal. Taking it as a whole, thesevolumes make most interesting and informatoryreading, and in compiling an official document of thegrowth of medical science in the forcing house of war,the editors are to be congratulated on accomplishing:a great and laborious task. These records have been.evidently designed to be read as a comprehensive,and consecutive study rather than as a series ofmonographs, and in this the system adopted ofgrouping the contributions with the contributors inan index at the beginning of each volume, while leavingindividual chapters unsigned, helps very considerably.The reader feels that he is getting a connected story(in many parts one might almost say " romance ")bearing the stamp of editorial authority in its balanceand general treatment of the subject, and which isat the same time scientifically accurate in details.This sense of editorial responsibility in the reader’smind greatly enhances the value of the work as anauthentic history. Also in many places this historymust become a valuable work of reference, and forsuch a purpose it is equally well constructed. Thestudent in any particular section can refer to theauthor of it merely by consulting the list at the headof the volume, while a full bibliography appended toeach chapter furnishes a comprehensive. reference tothe bulk of the medical literature of the war.

In a general survey of medical experience there areperhaps two facts which claim attention as beingessentially lessons of the war. The first is the discoveryof the inadequacy of accepted theories of antisepsisin dealing with wounds under war conditions. Itwas found that the control of sepsis under civil

3 Arzneitherapie des praktischen Arztes. Third edition. ByProf. C. Bachem, of Bonn. Berlin and Vienna : Urban andSchwarzenberg. Pp. 296.

conditions was a very different problem from theprevention of suppuration in wounds where satis-factory primary treatment was often delayed fordays. Sir Alfred Keogh makes the striking statementthat at the beginning of the war we went straightback into all the septic infections of the Middle Ages."In recognising the part played by the body fluids,as apart from antiseptics, in overcoming infection,and in devising means to facilitate this action,pathology, chiefly through the investigations of SirAlmroth Wright and his fellow-workers made a

great step forwards. The other outstanding factbrought home by the modern conditions of war-

fare is the paramount importance of hygiene inconserving life and promoting efficiency. It wasrealised from the first that in a campaign involvingmillions of men the way to success lay in sanitation.The results of the work done in maintaining the generalhealth and efficiency of the fighting forces and of thecivil population under the severest conditions willremain as a benefit to humanity ; in a fuller apprecia-tion of the meaning of economy and in the widespreadawakening of a " sanitary consciousness " we learneda lesson in the war which can well be adapted to timesof peace. As a military text-book, the Medical Historyof the War will occupy a prominent place, and willform, in the unfortunate event of some future warfarein any part of the world, the basis of sound medicaladministration. The books are well printed and onthe whole the illustrations are good, but the bindingis at the best fair. Volumes intended largely forreference should at least be strongly backed, whichthese are not. The tooling is poor, and their appearancein a library-for they should be on every medicalman’s top bookshelf-can hardly be called handsome.

THE BLOOD IN SMALL-POX.Prof. W. H. Hoffmann, of Habana in Cuba, where

an epidemic has been prevalent for three years, hasexamined the blood in 300 cases of small-pox, andhas come to the following conclusions. (1) The totalnumber of leucocytes is subnormal during the firstthree days, amounting only to 4-6000. It rapidlyrises after the fourth day, and between the ninthand fourteenth days shows an average count of17,000, in some cases as much as 30-40,000. In thethird week there is an average leucocytosis of10-12,000, and occasionally 24,000. During the nextthree weeks the number of leucocytes gradually falls,but still remains fairly high-viz., 9-12,000. Prof.Hoffmann was unable to pursue his observationsbeyond the sixth week, by which time the leucocytecount had not yet become normal. (2) The differentialcount shows considerable variations from the normal.The number of polymorphonuclears is diminished inthe first week, being on the average 20-30 per cent.,and in some cases only 12 per cent. Subsequentlythe polymorphonuclears remain at about 40 per cent.until the end of the sixth week. There is a consider-able increase in the eosinophils, which in the firstthree weeks number 3-10 per cent. on the average.After the eighteenth day they rise to 15-20 per cent.,and sometimes to 30 per cent. Corresponding to thediminution of the polymorphonuclears there is a

well-marked increase of lymphocytes. During thefirst week they are 45 per cent., in the third week65 per cent., and later they are still 40-50 per cent.Readings of 60-75 per cent. are not unusual. Thelarge mononuclears are also increased, especiallyin the first two weeks, being on the average 4-8 percent., and not infrequently 20 per cent. Speciallycharacteristic of small-pox is the appearance of

pathological cells in the blood in the form of myelocyteswhich are hardly ever absent. In the first three weeksthey amount to 1-3 per cent., and often number4-5 per cent., and even 10-12 per cent. Later theybecome somewhat, less numerous. A similar bloodpicture is only to be found in varicella, in which,however, the total number of leucocytes is generallyrather diminished with an occasional slight rise about

1 Münchener medizinische Wochenschrift, August 10th, 1923.

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the eighth to tenth day of disease (10-12,000). Prof.Hoffmann thinks that in suspected cases examinationof the blood may be of diagnostic value. (3) Nostriking changes were observed in the. number of redcorpuscles and haemoglobin content, nor did the redcorpuscles show any pronounced degenerative changes.

MEDICAL RESEARCH IN JAPAN.

WE have lately received a number of publications Ifrom Japan which testify to the activity with wliichmedical research on modern lines is pursued’in thatcountry. In the first place there are several bulkynumbers of the twenty-ninth and thirtieth volumesof the well-known journal Mitteilnngen aus der111edizinischen 1! akultat der Kaiserlichen Universitätzu Tokyo, with many solid papers on a great varietyof subjects-lymphoma leukaemia and allied condi-tions, mathematical hydrodynamics of cerebro-spinalfluid, the culture of rabies virus in vitro, and so

forth. Next there are three parts of a new journalissued by the National Research Council of Japan asthe Japanese Journal of Medical Scienees : Abstraets,which gives abstracts (in some cases titles only) inGerman or English of the papers published in theJapanese periodicals. In some of these the papersappear in a European language, and would be easilyavailable to those who were in the habit of con-

sulting the journals in question. But many ofthem are originally in Japanese, and this new pub-lication certainly gives a surprising revelation of thebulk and quality of medical research which is printedin a form which makes it quite inaccessible to mostpeople who might be interested. The topics and theway in which they are dealt with are quite Westernin character, and it is interesting to compare thenumber of abstracts appearing under each headwith their representation in European and Americanwork. Part 1. includes pathology (260 items) ;Part II. physiology (25), pharmacology (53), bio-chemistry (144), serology (41), forensic medicine (6),protozoology (3), bacteriology (138), hygiene (36),and anatomy (95) ; Part III. internal medicine (13),surger (9), gynaecology and tocology (95), dermato-logy (321), urology (120), ophthalmology (106),pediatrics (106), oto-rhino-laryngology (77), and

psychiatry and neurology (45). Thus pathology inour own wide sense accounts for 442 and clinical 1

subjects for 872 ; to which it should be added thatmany of the abstracts in Part III. deal with purelylaboratory investigations-e.g., comparisons of the

Sachs-Georgi and Wassermann reactions are under

dermatology, not serology. From all of which wemay surmise that in Japan, as in this country," medical " research tends to desert the wards for theallied field of the laboratory. The third publicationto notice is the first volume of Scientific Reports fromthe Government Institute for Infertious Diseases, ofwhich Prof. M. Nagayo is the director. This con-tains complete reprints of most of the papers pub-lished from the institute during 1922, translated intoa

" foreign language " under the editorship of Dr. Y.Miyagawa. The non-Japanese language is Englishin 34 papers, German in nine, and, which will pleaseProf. F. G. Donnan, in three Esperanto.A cursory survey of these publications shows that

a very large amount of active research work haslately been done in Japan. We can only hope thattoo much damage to personnel and material has notbeen done by the disastrous earthquake. Progress inrecent years has been vigorous and determined, andthe set-back, which must at the best be substantial,is surely a sad disappointment to those who havestriven to build up higher education in Japan andbring their results to the notice of workers elsewhere.And it is entirely in a friendly spirit that we wouldremark that the imitation of Western medical researchis so complete that under that name is included agood deal of work which, invaluable as post-graduateeducation, does not really add to knowledge, andthat the free publication of these exercises increasesstill more the already impossible task of anyone who

tries to keep abreast of advances in any but somevery small corner. will the Japanese be the firstto take the step which must follow the presentincoherence sooner or later, and bring up groups ofscholars whose business it will be to forswear the funof investigation and live faborious days in syntheticanalysis of the data which have been already accumu-lated ? It is a great opportunity which lies open toany school; what the world wants is discoveries notresearches. ————

ON THE PATHOGENESIS OF DEFICIENCYDISEASE.

IN the current number of the Indian Joitrnal ofMedical Research Dr. R. McCarrison has published hisexperimental researches undertaken during the lastyear upon the relationship between food-metabolism,iodine intake, and thyroidal activity, as well as uponthe effect of insanitary conditions upon the thyroidhyperplasia. For this purpose tadpoles and pigeonswere employed. Paying very particular attentionto the technique of administering fat and iodine tothese creatures, he has concluded that excess of fatsin the food of tadpoles causes retardation in theirrate of growth, and that this can be controlled bythe administration of iodine in amounts of 0-5 to1 mg. of food mixture. The effect induced bylinseed oil and cod-liver. oil cannot, however, becontrolled in this manner. On the other hand,abnormal metamorphoses can be induced by a highiodine intake, and can be hastened by administeringat the same time a higher proportion of butter.His former experiments with pigeons have shownthat an excess of butter in the diet favours thedevelopment of thyroid hyperplasia similar to thatin Graves’s disease ; but more recently he concludesthat the confinement of these birds in cages whichhave become grossly contaminated by excreta isalso a potent cause of thyroid enlargement, and thatthis pathological condition is not due to lack ofexercise but to actual contamination of food and waterby the birds’ own excreta. This can be preventedby scrupulous cleanliness and by the administrationof chlorine to the water. It may be that the effects .

of fat excess upon thyroid hyperplasia are insome way related to bacterial contamination of thedigestive tract. It is curious to note that the adminis-tration of cod-liver oil affords complete protectionagainst goitre induced by the insanitary conditionsalready referred to. -

’

X RAY DIAGNOSIS OF PREGNANCY: ITSMEDICO-LEGAL VALUE.

AN echo of Faffaire d’Evreux, which created muchinterest and not a little consternation in France andBelgium some time ago, is to be found in Paris 11;[édicalfor Sept. 8th. It will be remembered that a certainDr. Vallet was sued by the relatives of a lady, Mme.Jouenne, on whom he had operated on the assumptionthat she was suffering from a fibroid tumour. Thisunfortunate operation ended in a Caesarean sectionand the death of the patient, whose parents broughtan action for malpractice against Dr. Vallet. Theaction ended in favour of the plaintiffs, and in passingjudgment on the surgeon, who had set out to removea fibroid, and who had found a viable infant in itsplace, the legal authorities appeared to have beenlargely influenced by Dr. Vallet’s omission to employthe X rays as an aid to diagnosis before operation.The author of the paper in Paris Medical, AdrienPeytel, Advocate of the Court of Appeal, points outthat the judges seem to have convinced themselvesthat from the fifth month of pregnancy onwards itis increasingly easy to demonstrate the presence ofa foetus, by the X rays. In his defence, Dr. Valletmaintained that the evidence of the X rays in suchcases is not always reliable, and that the risk to themother and infant are not negligible. This defencewas not accepted. Was it sound ? Mr. Peytel hasinquired into this matter, soliciting the opinion of anexpert radiologist, whose views are recorded in somedetail. It would appear from the opinion of this