1129REVIEWS AND NOTICES OF BOOKS.

speak with some authority. He greatly prefers theintra-capsular to the extra-capsular method of opera-ting, but has rejected Colonel H. Smith’s operationon account of the frequency with which vitreous is lost.His own operation consists in rupturing the suspensoryligament, not during the actual extraction, as inSmith’s operation, but prior to it. This he does bymeans of a blunt hook specially devised by himself.This method of employing it, and the reasons by whichhe justifies his own operation as against the ordinaryegtra-capsular one on the one hand and Smith’sintra-capsular one on the other, are fully set out, andwill be of interest to ophthalmic surgeons. Thismethod was first published in the -Indian MedicalGazette in 1909, but we do not know that it has beenadopted in this country to any extent. Now that itsauthor has returned from the East, it seems likely,that more will be heard of it.The chapters on cataract are the most important

part of the book, but the rest of it is by no meansdevoid of original suggestions, as in the author’smethods of treatment for trachoma, his suggestion totrephine for progressive myopia, and his employmentof subconjunctival injections of phenolaine for cornealopacities. His methods of dealing with such ordinarydiseases as corneal ulceration, and the various formsof conjunctivitis well repay perusal. Perhaps theleast satisfactory part of the book is that dealing withglaucoma. Here, too, there is evidence of originalthought, but the whole subject of the chronic form ofthe disease, as we know it in this country, is ignored.In the description of the operation for trephining,Major Nesfield’s advice to drop in eserin immediatelyafter the operation needs justification, as it iscontrary to that of Colonel R. H. Elliot and mostauthorities. Among minor blemishes in the book, itmight be mentioned that in the treatment of lacrymalobstruction no mention of syringing is found ; andspelling of the word " pterygium " is too phonetic.We recommend the book as the outcome of an

obviously original mind presenting knowledge andideas in a pleasing form.

MATERIA MEDICA FOR DENTISTS.Fifth edition. By FRANK COLEMAN, M.C.,L.R.C.P., M.R.C.S., L.D.S., Assistant DentalSurgeon, St. Bartholomew’s Hospital; DentalSurgeon and Lecturer in Materia Medica, RoyalDental Hospital. Oxford Medical Publications.London: Henry Frowde and Hodder andStoughton. 1922. Pp. 308. 10s. 6d.PRACTICALLY a fresh book has emerged in this

- edition, based on a well-known volume, for whichMessrs. D. P. Gabell and H. Austen were responsible.It is in every respect an admirable production andshould prove of value to practitioner and student.’The drugs are classified according to their pharmaco-logical action, and though this inevitably leads to acertain amount of repetition, the advantage to thestudent is undoubted. Some might cavil at theliberal way in which Mr. Coleman interprets hissubject, for he describes a large number of drugs which:have no place in dentistry. We think he is justified inso doing, for the student who acquires a good ideaof general pharmacology will be more fitted to useintelligently those drugs which are commonly used bydentists. On the dental side the book is remarkablycomplete. A few minor errors have crept in. Onp. 34 a prescription for ulcerative stomatitis is given,as follows :-

Vini ipecac .. .. .. 31 1Glycerin. .... 31 1Liq. arsen....... ad 31 1

This would baffle any chemist and should, doubtless,read vini ipecac. ss. The statement is made thatsolutions of cocaine can be boiled with impunity’without decomposition. Under certain conditions this- is true, but not to state these conditions is to make theinformation dangerously misleading. In receptacles ofabsolute neutrality, such as cast silica, cocaine solu-tions are not affected by a- temperature of 120° C.

But in ordinary glass vessels, which are alkaline,decomposition on boiling readily occurs. A usefulfeature of the book is the large number of prescriptionswhich are given. The addition of a few blank pagesat the end for additional prescriptions and formulaemight prove useful in future issues.The book is well produced and is a valuable addition

to dental literature.

DISEASES OF THE STOMACH AND UPPER ALIMENTARYTRACT.Fifth edition. By ANTHONY BASSLER, M.D.,F.A.C.P., Professor of Gastro-Enterology, NewYork Polyclinic Medical School and Hospital andthe late Fordham University Medical College;Visiting Physician, New York Polyclinic Hospital.Philadelphia: F. A. Davis Company. 1922.Pp. 975.$8.THE new edition of Prof. Bassler’s well-known book

will attract many readers. Recent advances such asfractional gastric analysis and duodenal tubage arefully described, and the technique of such procedures asgastroscopy is dealt with. The reader might appreciatefuller reference to the comparative appearances of,and findings from, the normal, but doubtless theauthor has been restrained by limits of space. Itcontains more than 250 illustrations, many of whichare admirable. Thus, following p. 134 will be found35 full-page reproductions of radiograms illustratingall the common appearances of the normal and patho-logical stomach.

It is unfortunate that the reader’s pleasure isdiminished by the clumsy and sometimes ungram-matical language employed ; such phrases as that onp. 85, in which the writer states that " It is surprisinghow little more time it takes to make records of caseswhen one habituates himself to it in steady practice,"mar what is in many respects a remarkable volume.

JOURNALS.

QUARTERLY JOURNAL OF MEDICINE.-The Octobernumber contains articles by the following authors :S. C. Dyke : A Preliminary Report on some Casesof Contracted Kidney. An account is given ofthe renal function, as judged by the blood andurine urea content, and the urea-concentrationtest in nine cases of nephritis, in eight of whicha contracted kidney was found post-mortem. Themacroscopic and microscopic appearances of theorgans are also recorded. In seven of the cases

the arterioles of the kidney showed inflammatorychanges together with " diffuse hyperplastic sclerosis,"and before death renal inefficiency was observed. Theauthor suggests that these changes are the result ofone toxic agent and that a true cardio-vascularlycontracted kidney belongs to the senile arterio-sclerotic type.-G. B. Fleming: The RespiratoryExchange in Cretinism and Mongolian Idiocy. Basalmetabolic observations on children are liable togreater errors than in the case of adults, owing tothe difficulty of ensuring complete muscular reposeduring the tests. The author graphically recordedthe movements of the child in these experiments andapplied a corresponding correction to the resultsobtained. In two cases of cretinism it was found thatthe metabolic rate was low before thyroid administration, but after treatment it rose to the normal valueor became slightly in excess. In six mongols the meta-bolic rate as compared with that of a child of the sameweight was normal, although somewhat lower than thatof a healthy child of the same age. Thyroid treatment,however, did not influence their metabolism. Theseappear to be the first observations on the basalmetabolic rate in mongols.-Arthur J. Hall and J. S. C.Douglas : On Relapsing Pyrexia in Lymphadenoma,with an Account of a Case. A description is given ofa case of the " cryptic " type of lymphadenoma withrelapsing pyrexia. Very slight changes were foundpost-mortem in the lymphatic glands, but the livercontained lymphadenomatous deposits and was con-siderably enlarged, and there was also some swelling

1130 N]4,’W JNVENTK)N8.

of the spleen. The diagnosis remained in doubt up t<the time of the microscopical examination of th<organs. Records of cases of this type probablenumber less than 50, but the authors, by a study of th(temperature charts of some of these, point out thaithe " span " of pyrexia is usually from 15 to 25 daysand is fairly constant in each case. The pyrexifsuggests that the disease may be due to a protozoainfection. - Geoffrey Evans : Arterio-sclerosis irChildren. Four cases of chronic nephritis in childrerwhich terminated fatally were observed together wittthe pathological findings. From the histologicastudy of the affected organs it is concluded that diffus{hyperplastic sclerosis is a similar condition both irchildren and in adults. The actual cause of th(vascular changes still remains undetermined.-S. V,Telfer: Studies on Calcium and Phosphorus Meta-bolism. Part 1.: The Excretion of Calcium andPhosphorus. Observations were carried out uponinfants placed in a " metabolism " bed, and fed withcow’s milk. It was shown that the amount 01calcium and phosphorus excreted varies with thequantity ingested, and no evidence was obtained iufavour of these elements having to any appreciabledegree an endogenous source. Only a small amountof the calcium excretion occurs by the kidneys.whereas 40 per cent. of the phosphorus eliminationtakes place by this route. Calcium soaps play a partin determining the bulk of the fseces. When fattyderivatives are in excess in the stools phosphates arcdeviated from the intestines to the urine for excretion.Part II. : The Metabolism of Calcium and Phosphorusin Rickets. The mineral matter in the dried limbbones of rachitic pups may be as low as 17’7 per cent.,the normal average being 44’9 per cent., but therelative amount of calcium and phosphorus is notaltered. The softening of rachitic bone must, there-fore, imply an alteration in phosphorus metabolismof no less importance than that of calcium. Findlay,Noel Paton, and Sharpe, in a previous contribution tothis Journal (1921, xiv., 353), brought forwardevidence to show that the bony softening was not dueto decalcification, but they could not determinedefinitely whether or not there was a deficient supplyof calcium to the bone. Only cases of active ricketswere studied in the present investigation, and eachexperiment was continued for at least five days. Inthese cases of rickets a diminished retention of CaOand P 20 was observed, but in no instance was therea negative retention of these substances. The con-clusion arrived at is that no support was obtained forthe theory that excessive decalcification is the causeof bony softening, and that defective absorption ofcalcium from the intestines cannot be excluded as afactor in the bony changes in rickets.

BRAIN. Vol. XLV., Part l.-Joshua Rosett, M.D. :A Study of Thomsen’s Disease, based on Eight Casesin a Family Exhibiting Remarkable InheritanceFeatures in Three Generations. In some membersof the three generations of a family described myotoniawas found, always associated with a large muscula-ture, while in the other members psychoses of variouskinds were present. The condition of myotonia wasinherited as an independent factor from the firstfemale ; it became dominant, that is to say, becamemanifest as a muscle abnormality, in those cases

where the offspring inherited a large musculature.After full consideration of the facts, however, theauthor comes to the provisional conclusion thatmyotonia congenita is caused primarily not by aninherited abnormality of muscular structure or

function, but by an inherited sublethal factor whichexerts an injurious action upon the neuro-muscularsystem.-Violet H. Keiller : A Contribution to theAnatomy of Spina Bifida. A very careful examina-tion of seven cases of different types of spina bifidaundertaken in order to emphasise certain features inthe minute structure of these cases which have adirect bearing on details of operative procedure andon prognosis. The conclusion is that except in casesof spina bifida occulta with pressure symptoms, andin a small number of meningoceles in which there is I

adherence or traction of the nerve roots but nolesion of the cord, no improvement in function is tobe expected as the result of operation. What maybe hoped, for is that the function of segments abovethe lesion will not be subjected to further impair-ment.---F. R. Miller and F. G. Banting : Observationson Cerebellar Stimulations. The authors considerthat the cerebellar cortex is excitable. The reactionchosen as a test was the inhibition of decerebraterigidity evocable by stimulation of the surface of thecerebellum. Excitation of the anterior surface of thevermis occasionally elicits walking movements of thefore legs and walking or running movements of thehind legs.-Charles N. Armstrong: Three Cases ofSupra-Pituitary Tumour Presenting Frohlich’s Syn-drome. None of these tumours started in or infil-trated the pituitary body.-J. F. Barrington: TheNervous Control of the Urinary Bladder in Amphi-bians. Paralysis of the bladder did not occur as aresult of the destruction of any part of the brain infront of the posterior half of the mid-brain. Byexperiments in section of the nerve roots the authorconcludes that the impulses from the posterior partof the mid-brain which normally prevent over-

distension of the bladder must pass out through bothanterior and posterior spinal roots;

New Inventions.A COMBINED GAG AND TONGUE RETRACTOR.THE gag shown by the accompanying illustration

is a copy of one designed by Dr. Davis and wasbrought back by me from America. It combines gag

and tongue retractor. The gag is constructed on theprinciple of the hanging laryngoscopy apparatus andhas five spatulse of different sizes, so that it can be usedfor adults and children. It gives a more perfect viewof the tonsils than can be obtained with many othergags, and further, by gently raising the lever the airway is kept perfectly clear. On the right of the patient’smouth there is a tube for sucking out the blood, andon the left of the spatula, as will be seen from theillustration, is the anaesthetic tube. By using this gagin conjunction with a suction apparatus and etherblower, I can get better results than with any othergag that I have hitherto used. The suction apparatusprevents blood from entering the larynx and oesophagusand minimises the amount of sponging, so that thereis less after-sickness and sore throat than when theolder methods are used. A little care must be exer-cised when inserting the gag lest the posterior wall ofthe pharynx be bruised.The apparatus has been made for me by Messrs.

Mayer and Phelps, Chiron House, New Cavendish-street. London.W.1.

H. EDMUND G. BOYLE, O.B.E., M.R.C.S., L.R.C.P.Upper Wimpolc-street, W.