903

35 years ago, and his treatment consisted of a 90 days’course of mercury pills. Eleven years ago there wasa decrease of muscular power, with some wasting inthe arms and legs. In 1916 he had three injections of" 606," after which his walking improved. Three yearslater he again had three injections of

" 606," but nosubsequent treatment of any kind. The conditionwas apparently stationary until a year ago, when hehad occipital headaches and experienced a warm patchbetween the scapulae, and he has now lost all powerin both thumbs. Deep reflexes are exaggerated, theplantar response is flexor, but sensation is normal andthere is no sphincter disturbance.

DERBY MEDICAL SOCIETY.

A MEETING of this Society was held on April 10th,Mr. J. E. KILVERT, the President, in the chair, when

. a paper was read by Dr. JOHN A. WATT onIntrathoracic Tuberculosis in Children.

Dr. Watt said it was now generally accepted thattuberculosis in adults developed from an infection inchildhood, and that all efforts at prevention shouldbegin in early years. Investigations by the RoyalCommission and others showed that human tuberclebacilli were almost constantly present in pulmonaryand bronchial gland tuberculosis, indicating thatinfection occurred from human sources. The clinicalfeatures of intrathoracic tuberculosis were dealt within three main forms-viz., (1) general or infantile,(2) hilum or juvenile, (3) adult types. Tuberculosis ininfancy showed a strong tendency to generalisationand was most fatal at this age. The bronchial glandswere invariably involved and were usually the chiefcentres of the disease. Progressive caseation occurred,then dissemination, and miliary tuberculosis or

meningitis was the termination. The typical form ininfants was acute miliary tuberculosis; other varietieswere tuberculous bronchitis and caseous pneumonia.When school age began the disease passed into morelatent and chronic forms with a low death-rate. Thecommon form was a benign and latent glandular Iinfection contracted in infancy. The primary lung i

focus gave rise to secondary infection of the thoracicglands, but the disease might spread out into theparenchyma of the lungs. This condition was knownas hilus tuberculosis, and by the French as

"

glandulo-pulmonaire." The physical signs of hilus diseasewere discussed and most importance was attached topara-vertebral dullness, altered breath sounds, andD’Espine’s whisper sign. Radiography was invaluable,and the presence of tubercle bacilli clinched thediagnosis. A case of open tuberculosis in a householdhad a sinister influence on young life. Investigationsshowed that in such nearly all infants were infectedin the first four years of life. Hilus tuberculosis wasusually a mild disease and nearly all cases recovered.It might smoulder on for years often unrecognised,and there was weighty evidence accumulating thathilus tuberculosis in children might develop atadolescence into the adult type as we knew it. Adulttypes, apical, basal, or lobar, were not common beforethe age of 12 but increasingly frequent afterwards.They were easily diagnosed, tubercle bacilli were

usually present, and a radiograph showed- the extentof the disease.

Dr. Watt tabulated 165 cases of intrathoracictuberculosis admitted to the County Sanatoriumduring the last four years. There were 117 cases ofhilus tuberculosis with one death, and 48 cases ofadult forms with 18 deaths after an average period ofthree years. Fifty per cent. of the hilus cases hadtubercle bacilli present and nearly 80 per cent. of theadult cases, examination being made by the Ellerman-Erlandsen method. Lantern slides were shown ofradiographs illustrating the main types.A discussion followed, in which there took part

Drs. S. BARWISE, NIVEN ROBERTSON, H. BARBER,M. PARRY-JONES, F. G. LESCHER, and P. HEFFERNAN.

Reviews and Notices of Books.MEDICINE, MAGIC, AND RELIGION.

By W. H. R. RIVERS, M.D., D.Sc., F.R.S. Prefaceby G. ELLIOT SMITH, F.R.S. London : KeganPaul, Trench, Trubner and Co., Ltd.; New York :Harcourt Brace and Co., Inc. 1924. Pp. 147.10s. 6d.How great was the loss sustained by psychological

medicine through the untimely death of Prof. Riversis proved by the publication in book form of hisFitzPatrick Lectures by the International Library ofPsychology, Philosophy, and Scientific Method. Thelectures were delivered before the Royal College ofPhysicians of London in 1915-16, and were reported infull in THE LANCET, where they were seen to displayin a simple manner the intimate relations betweenprimitive medicine and magic and religion. The authortakes the widest possible survey of the ways andthoughts of primitive medicine-men, and while inmany places the deductions are distinctly original, thecopious references to other authorities show how wellProf. Rivers was documented. Nowhere is the volumepadded out by quotations ; for example, he does notconsider the kind of magic usually known as sympa-thetic magic in any detail at all, but refers the readerto the magic art of Sir James Fraser and his owngreat monograph on the history of MelanesianSociety. The work of A. B. Ellis, E. im Thurn,C. G. Seligman, and J. Roscoe comes in for similarallusive treatment.

Prof. Elliot Smith points out that in the last yearsof Rivers’s life his views were undergoing a change inthe direction of a fuller recognition of the part playedby the diffusion of culture in the development ofcustom and belief. The first two chapters of the book,which represent the first two lectures, were writtenafter Rivers’s valuable work at the Maghull MilitarvHospital, where for a considerable period he investigatedthe mental effects on soldiers of trench warfare. Hethen found a remarkable analogy between the methodsemployed in the hospital for the diagnosis of psychicaldisabilities and those which he had used himself inMelanesia when investigating the social and religiouspractices of primitive peoples ; and in the secondchapter the section treating of the attribution ofdisease to infraction of taboo, quoted from a bookby Mr. A. M. Hocart and himself recording theirstudies in Mandegusu, indicate how keenly Rivers wasinterested in the effects of cultural diffusion upon thepsychology of races. The last chapter of the book,entitled " Mind and Medicine," considers at lengthan important principle of psychological medicine-namely, psychical determinism-and contains theauthor’s views of the work of Freud, of whom hesays that more than any other investigator he hasemphasised the mental factor in disease. The earlyrelationships between man and medicine are shown inbhis chapter to be bound up with the process by whichmedicine grew out of magic and religion. This closingssay formed the subject of an address delivered inL919 at the John Rylands Library in Manchester,Mid makes a valuable round-off of the whole subject,.ndicating well Rivers’s own development of outlook.

SURGICAL EMERGENCIES.

By RUSSELL HOWARD, C.B.E., M.S., F.R.C.S. Eng.Surgeon, London Hospital ; Senior Surgeon,Poplar Hospital. London : Edward Arnold andCo. 1924. Pp. 216. 7s. 6d.

" Emergency surgery has therefore become decen-tralised and the general practitioner ... is now calledupon to perform operations which a short time agowere in the hands of the surgeons of the greathospitals." The truth of this statement in the author’spreface cannot be denied, though we may disagreewith the reasons he assigns therefor. If operativetreatment at local small hospitals is to be of a high