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in the third section on dietetic therapy detailed dietsheets are given for diabetes and oxaluria ; section fouron hydrotherapy contains numberless photographs anddiagrams of baths, douches, and packs ; and so on

throughout the book. The result is a completeness intrivialities that rather obscures the solid worth of newand exact technique in many specialties. The book iswithout parallel in any other tongue. H. A. Hare’s" Modern Treatment" and A. S. Morrow’s " Diagnosticand Therapeutic Technic " are the nearest approach tosuch a book in the English language. It may alsodeserve attention from the British or American studentas affording a ready method of becoming familiar withGerman medical terms.

FROM CLOUD’ TO SUNSHINE : ALGIERS AND ALGERIA. ITenth edition. By ALFRED S. GUBB, M.D. Paris, IM.R.C.S. Eng., D.P.H. London : Bailliere, Tindall,and Cox. 1921. Pp. 109. 3s. 6d. Dr. Gubb has already published several books, in

French and English, on various aspects of Algeria. Thevolume under review, which is called the tenth edition,but is in many respects a new work, deals with thecountry as a winter health resort; the new edition isprofusely illustrated, and the climate and topographyreceive careful attention with reference to numerousdiseases. Concerning chronic affections of the respira-tory tract, we read that physicians of remote antiquity,Celsus (25 A.D.) among them, were accustomed to sendtheir chest patients to North Africa ; and Sir HermannWeber is quoted to the effect that early chroniccases of phthisis benefit by a winter season in

Algiers if high altitudes are not well borne bythem, and if Egypt and the Riviera are too dry.Freedom from sudden changes of temperature rendersthe country very suitable for asthmatic persons. Dr.Gubb passes on to mention the climatic advantages forthose suffering from kidney and heart diseases, circu-latory disturbances, arterio-sclerosis, rheumatism,neuritis, gout, and debility. The therapeutic aspectof Algeria does not, however, occupy the entire book;interspersed with pages on prevailing winds andmineral springs are interesting details concerning thecustoms and appearance of the inhabitants of the

country and the life of the French and native quartersof the city of Algiers, together with notes on the manyplaces of historical and artistic interest which mayattract the traveller. Means of transport, hotel accom -modation, and useful hints as to selection of a housefor temporary or permanent residence, all find a placein an attractive little volume.

JOURNALS.Journal of Physiology. Edited by J. N. LANGLEY, Sc.D.,

LL.D., F.R.S. Vol. LIV., Nos. 5 and 6. 1921. CambridgeUniversity Press. Pp. 319-414. 9s.-The Metabolism of theSalivary Glands. I. The Relation of the Chorda Tympanito the Nitrogen Metabolism of the Submaxillary Gland, byG. V. Anrep. In 1851 Ludwig found that in protractedsecretion the submaxillary gland is gradually exhausted andthat in consequence the percentage of organic solidssecreted in the saliva diminishes as the secretion goes on.Heidenhain in 1868 showed that in the dog the mucin in thesaliva arose from a clear substance in the cells, that duringsecretion the gland lost weight and that the percentage ofsolids in it is decreased. Dr. Anrep’s experiments weredirected to the problem of nitrogen metabolism in thesecretory process. Having established by the comparativeestimation of the nitrogen content and weight of the sub-maxillary glands of the dog that the two glands showcomplete concordancy, the determinations justified theassumption that the submaxillary glands on both sidescontain practically the same amount of nitrogen. Theeffect of chorda stimulation on the total nitrogenmetabolism of the gland was first determined, then thesecretion of mucin nitrogen and non-mucin nitrogen, andsubsequently the relation of mucin nitrogen and non-mucinnitrogen to the nitrogen output and intake. Dr. Anrepconfirms the old statement that during secretion producedby stimulation of the chorda tympani the output of nitrogenby this gland is greater than the loss by the gland. Theexcess of the nitrogen output over the loss by the glandincreases with increase of output. The output of mucinnitrogen, which, as is known, decreases during secretion,ceases altogether after a time, and is equal to the loss of

nitrogen by the gland. The output of the non-mucin nitrogencontinues after the output of the mucin nitrogen has ceased,proceeding at the same level throughout the secretion, andis equal to the excess of output over the loss. Its meanpercentage in the chorda saliva is 0’018 per cent. The resultsshow that within the limits of experimental error the mucinof the saliva comes entirely from the mucin or mucinogenpre-stored in the gland, that the non-mucin nitrogen isderived from the body fluid, and that no formation of mucinor increase of nitrogenous cell substance takes place duringchorda stimulation.The Temperature Coefficient of the Velocity of a Nervous

Impulse, by A. V. Hill. The phenomena of a nervous

impulse have been compared with those of a chemicalsystem, such as a train of gunpowder, and Keith Lucas hasshown that the velocity of a nervous impulse is increased1-79 times by a rise of temperature of 100 C. It has beenargued that this is a sign of the chemical nature of thechanges underlying the propagated disturbance in a nerve.Professor Hill points out that the nervous impulse consistsof two separate things : the change at a given point and thetransmission of that change to a neighbouring point. Atpresent, however, we are ignorant of the relative import-ance of the two phases. The temperature coefficient foundby Keith Lucas for the velocity of propagation is higherthan that of most physical changes. We cannot conclude,however, that the reactions underlying the nervous impulseare chemical in nature, but only that a chemical changeinterposes sOl1wlche/’e in process, occupying a large part ofthe time of propagation, which may be an important ora relatively unimportant link in the chain of actionsconstituting the propagated disturbance.Studies on Muscular Contraction. II. The Relation

Between the Maximal Work and the Tension Developed ina Muscle Twitch, and the Effects of Temperature andExtension, by Yasukazu Doi. At a constant temperaturethe maximal work done by a muscle excited by a singleshock has a maximum value with a moderate initialextension of the muscle. Before this optimum extension isreached the absolute maximum work increases, and beyondthis optimum it decreases with increasing extension. Theabsolute maximum work done in a twitch at the sameextension of a single muscle is greater at a lower tempera-ture than at a higher. The optimum extension is shorter ata lower temperature than at a higher.Variations in Alveolar Carbon Dioxide Pressure in Rela-

tion to Meals, by E. C. Dodds. All the samples werecollected and analysed by the Haldane methods from threehealthy men and from a man from whom the greater part ofthe stomach had been removed. In normal persons thealveolar carbon dioxide pressure showed the following

. changes after a meal: (1) a rise of from 2 to 6 mm. withinthe first half or three-quarters of an hour ; (2) a subsequentfall of about the same amount (2-6 mm.) below the originallevel; (3) a return to this level. In the man operated on therise after a meal was very small in amount (04-0-8 mm.),while the subsequent changes were similar to those seen ina normal person. To Dr. Dodds it seems probable that therise is associated with the secretion of gastric juice, and the.suosequenli iaii wnn line later processes oi digestion.On the Supposed Identity of the Water-soluble Vitamin B

and Secretin, by G. V. Anrep and J. C. Drummond. In1919 Voegtlin and Myers put out the theory that the anti-neuritic vitamin and secretin are possibly one and thesame substance, basing their view on certain observations.Dr. Aurep and Dr. Drummond find that this suggestion isnot supported by experimental evidence-e.g., extractsprepared from yeast which show marked growth-promotingand antineuritic properties have no specific action onpancreatic secretion, differing in this respect from secretin.The pancreas of a cat showing typical symptoms induced bya diet deficient in the vitamin B responds in a normalmanner to secretin. Secretin can be extracted from themucous membrane of the intestines of cats, showing theso-called polyneuritic condition to a very marked degree.The Action of Ions upon the Frog’s Heart, by I. de Burgh

Daly and A. J. Clark. The authors’ experiments weredirected to analyse the effect upon the mechanical andelectrical responses of the frog’s heart of changes in theconcentration of the kations, which are normally presentin Ringer’s fluid. The effects produced ’by the variouschanges of ionic content are obviously of very greatcomplexity. Alterations of the concentrations of theions, if sufficiently extensive, impair all the functionsof all parts of the heart, but a moderate degree ofchange affects the different regions of the heart to anunequal extent, and also acts with different intensity uponthe different functions of the ventricle. Alterations of thepotassium content produce a greater impairment of theconduction of the electrical variation, both from auricle toventricle and within the ventricle than any other ionicchange studied. Reduction of the calcium content haslittle effect upon the conduction of the electrical variation.Potassium and calcium are true antagonists as regards

866

their effect upon the muscular response, but they act asantagonists only to a very limited extent as regards theiraction on the conduction of the electrical variation. Lackof sodium shows a striking resemblance to the effect ofstrophanthin. Lack of potassium or sodium and excess ofcalcium all produce increase of systotic tone in the heartand produce rather similar variations in the electricresponse; increased alkalinity, which produces increasedsystolic tone, produces different effects upon the electricalresponse.The Immediate Action of Volatile Substances, by W. E.

Dixon and Fred Ransom. The object of this paper is thedemonstration that the immediate physiological effects pro-duced by certain volatile substances are most readily ’iexplained by their physical properties. Two types of experi-ment were performed : (a) on the bronchioles and (b) per- Ifusion of isolated organs. The bronchiolar experiments Iwere made on pithed cats, artificial respiration being per-formed and the blood pressure recorded from the left carotidartery and the condition of the bronchioles gauged bymeasuring the volume of the middle lobe of the right lung.A great many irritant substances, when inspired in very smallquantities, cause broncho-constriction-e.g., ammonia gas,chlorine and bromine vapour; the principal feature of thisaction is the long latent period, generally 15 to 30 seconds.Chloroform, volatile and possessing little irritant propertiesand relatively non-poisonous, causes an immediate suddenconstriction of the bronchioles lasting 10 to 12 seconds. Thefirst action of alcohol, chloroform, ether, amyl nitrite, petro-leum ether, and many other volatile substances adminis-tered by inhalation, is to cause broncho-constriction lastingabout 30 seconds. The same substances injected intothe perfusing fluids of surviving organs of the catand dog, artificially perfused, cause vaso-constrictionlasting about 30 seconds. Professor Dixon and ProfessorRansom state their reasons for believing that this action isdue to physical processes.

Studies in the Regeneration of Denervated MammalianMuscle. IV. Effects of Massage and Electrical Treatmentin Secondary Sutures, by F. A. Hartman and W. E.Blafz. The tibial nerves in rabbits at the primaryoperation were severed under aseptic conditions, the cutends being separated by various procedures ia order tocheck regeneration of the proximal end until the desiredtime-varying from 1 to 7 months. The denervated legs Iwere. carefully protected. When desired the two ends of ’,the nerves were freshened and brought together by suture.The power of the gastrocnemii groups of the two sides wastested by galvanic stimulation immediately after denerva-tion, and at frequent intervals until the conclusion ofthe experiment. The gastrocnemius group of the right sidewas treated almost daily by either a slow surging galvaniccurrent or by massage. Of 125 rabbits started in thisresearch. 60’8 per cent. possessed stronger muscles on theright side (gastrocnemius group), the remainder beingstronger on the left. Neither massage nor electrical treat-ment appeared to benefit the denervated muscle.On the Fibrillation of the Heart, by S. de Boer. If a

bloodless heart of a frog is taken, a single electrical stimulusis capable of causing fibrillation of the ventricle. A badmetabolic condition of the heart favours fibrilla-tion. Essential factors in fibrillation are decreasein the rate of conduction and in the duration ofthe refractory period, so that a circulating excita-tion can be set up. A single stimulus, in orderto produce fibrillation in the bloodless heart, mustbe applied directly after the refractory period. Atthis time the excitability of the muscle is slight,and a slowly-travelling contraction with a briefrefractory period is produced, so that when thecontraction completes its circuit the muscle isagain excitable and the contraction can spreadagain and again round the heart. The stimulus, ifapplied later, gives rise to a complete coordinatedextra-systole. Dr. de Boer concludes, from thedeflections recorded in the electrogram and sus-

pension curves of heart peristalsis after poisoningwnn digitans ana oi noriiiatiion oi snorij duration, matin fibrillation the excitation wave passes round theheart in a series of stages, each being marked bya deflection, and that the local circulating excitationassumed by the observers Mines and Garrey does not exist.According to Dr. de Boer’s theory fibrillation of the ventricleconsists of a linking together of fractionated ventricularsystoles.On Recurring Extra-Systoles and their Relation to Fibril-

lation, by S. de Boer. When a stimulus is applied to theventricle of a bloodless frog’s heart, a short time after theend of the refractory period, a series of extra-systoles mayOccur. But when the same stimulus is applied at a longerinterval after the end of the refractory period to a heartcapable of giving a series of extra-systoles, one extra-systoleonly is produced. It appears, therefore, that the phenomenon

of recurring extra-systoles (Haufung d. Syst.) only occurswhen the heart has not recovered its metabolic state.In this state the excitation wave is conducted muchmore slowly, the refractory period is shorter, and theexcitation is able to pass round and round the ventricle-i.e., a circulating contraction is set up. Conduction throughthe muscle is slowed both in recurring extra-systoles and infibrillation ; the difference between the conditions beingthat in the former conduction takes place evenly, and in thelatter it takes place in stages. The intimate connexion ofthe two phenomena is shown by the fact that each may passinto the other.

New Inventions.IMPROVED STERILISABLE URETHRAL SYRINGE.THE illustration shows a syringe shaped to plug

the meatus

efficientlywithout

causingpain or in-jury to aninflamedmucous membrane. It is verysimple to use and to keep clean,it can be boiled, is not easilybroken, and cannot get out oforder. The glass barrel of thesyringe, which holds half an

ounce, can be filled without

drawing any fluid into the rubber bulb. The syringe ismade by the Holborn Surgical Instrument Company,of Thavies Inn. London. E.C. 1.

FREDERICK H. PICKIN, M.R.C.S., L.R.C.P. Lond.

CONTINUOUS GAS AND OXYGEN APPARATUS.

THE special features about this apparatus, whichhas been in use for more than two years are (1) its

simplicity (it consists of no more than the essentials),(2) the re-designing of each important part with a viewto efficiency, and (3) the formation in conjunction withthe warm ether " bomb " (described by Dr. S. R. Wilsonand myself in THE LANCET of Feb. 12th), of a completeoutfit applicable to generalsurgery. The wide-bore face-piece has a small tap in theside (which cannot be seen inthe illustration) for the attach-ment of the tubing from the

‘‘ bomb." The oxygen cylinder valve is the outcome ofconsiderable experiment, differing entirely from othermakes. A clip for the ends of the cylinders keepsthem rigidly locked together and there are no high-pressure connexions. The design of the stand is for ahorizontal position of the cylinders, which are controlledby foot-keys, the gases being admitted in puffs, as

desired. An upright stand with hand-control can,however, be supplied. The former method leaves bothhands free and is quite satisfactory.

Full particulars can be obtained from the makers,the Condensed Gas Co., Ltd., 59 and 63, Grosvenor-street, All Saints, Manchester.

K. B. PINSON, M.B., CH.B.Birm., M.R.C.S.