1025

LIVERPOOL MEDICAL INSTITUTION.

THE last ordinary meeting of the session was held on IApril 28th, Dr. J. E. GEMMELL, the President, in the chair. IDr. FRANK H. BARENDT read a note on the Antiquity

of Syphilis.Dr. ISAAC HARRIS read a paper on the

Value of the Electro-cardiograph in Diagnosis andProgno8Í8.

Whilst the electro-cardiograph had its limitations, therewere, he said, a great number of affections of the myo-cardium which could only be diagnosed by means of it.The practical significance was indicated of an inverted T inthe second lead, of abnormal Q.R.S. complexes and othercardiographic aberrations. A case of auricular fibrillationcomplicated by degeneration of the heart muscle was givenas an illustration of the value of electro-cardiography asguide in treatment. Digitalis was to be avoided in such acase which could not be diagnosed without the cardiograph.In regard to the Adams-Stokes syndrome, Dr. Harris pointedout that in his experience heart-block, partial or complete,uncomplicated by degeneration of heart muscle, never gaverise to the syndrome, while whenever it appeared degenera-tion of the muscle was found. Hence Mackenzie’s con-tention that the svndrome was due to a sudden transitionfrom normal to ventricular rhythm was considereduntenable. The prognosis of these cases was, as a matter offact, much worse than that of ordinary block.Dr. JOHN HAY said that it was essential to understand

what an electro-cardiogram represented. It gave in graphicform the variation in electric potential associated with eachsystole of the heart and nothing more. If for any cause anyportion of the heart beats abnormally there was a change inthe curve. Fibrillation, flutter, extrasystoles, heart-block,relative hypertrophy of either ventricle all presented theircharacteristic electro-cardiogram because some portion ofthe heart was contracting in an abnormal manner. A

recognition of these variations made diagnosis certain,and brought some accuracy into prognosis. Variationsin the ventricular complex were significant of myo-cardial damage-i.e., arborisation-block. Data were beingcollected of patients presenting bizarre forms of Q.R.S.complex. At the Royal Infirmary cases of auricular fibrilla-tion in which this unusual form of electro-cardiogram waspresent were being observed in regard to the course ofthe disease. In patients suffering from fibrillation therewas a small percentage in whom ectopic beats occurred;the prognostic import of this abnormality was not yetsettyed, though it was considered to indicate a seriousoutlook.

. Mr. FRANK JEANS read a note on the Uses and Limita-tions of the Cystoscope, with special reference to con-

ditions in which the cystoscope was the sole method ofdiagnosis.Mr. G. P. NEWBOLT described a case of Cyst of the Brain

occurring in a youth aged 17. ICorrection.-In a report of a paper read by Dr. Jane

Walker before the London Association of the MedicalWomen’s Federation on Tuberculosis in Children of SchoolAge, which appeared in THE LANCET of April 23rd (p. 862),the following sentence occurs: " From 1914 to 1919 at theEast Anglian Sanatorium 62 per cent. of the 807 childrenhad T.B. in the sputum and of these 56-4 per cent. died."This should read : "From 1914 to 1919 at the East AnglianSanatorium 68, or 6" per cent., had T.B. in the sputum andof these 35, or 56’4 per cent., died."

’i’HE SOUTHERN UNIVERSITIES OF IRELAND AND THEELECTIONS.—Our Dublin Correspondent writes : "It issymptomatic of the lack of interest shown by the Irishpublic in the elections to the Southern Ireland Parliamentthat, writing only a few days before the nominations, onecannot discern with any certainty what candidates arelikely to present themselves in the two university con-stituencies. Dublin University and the National Uni-versity are each entitled to elect four members. Inregard to the former, three or four names havebeen mentioned in the press, of whom some at leastcould hardly be regarded as serious candidates if theelection were a serious affair. Among them no medicalname occurs, nor have I heard of any medical man con-templating candidature. In the National University it isunderstood that Professor John McNeill, the presentmember for the University, will be a candidate, but it is notknown who his colleagues will be, or whether there will bea contest. The likelihood of a contest is much diminishedby the decision of Mr. Dillon not to encourage Nationaliststo seek election at present, but there may be someindependent candidates."

Reviews and Notices of Books.DISEASES OF THE SKIN.

By J. M. H. MACLEOD, M.D., F.R.C.P. London’:H. K. Lewis and Co., Ltd. 1920. Pp. 1307. f:310s.

Dr. MacLeod has dedicated his book to his colleaguesin dermatology, and the appreciation with which itwill surely be received by them should compensatehim for the infinite pains he has bestowed upon it.We think it may rank among the most authoritativetext-books of dermatology that has yet appeared inthe English language ; it is certainly the most readableEnglish modern work. It is unlikely that the charmand the vivid word-pictures which characterise Darier’s" Precis de Dermatologie" will ever be reproduced; thisstands alone and hardly admits of comparison. But Dr.MacLeod’s book resembles the Precis in this respect-while:his descriptions are admirably succinct, theyare not written in the text-book style which makesconsecutive reading almost an impossibility. Theauthor admits that he has been compelled to omita good deal of the historical side of the subject, andto restrict the bibliographies; at the same time he hasgiven us an excellent short account of the history ofleprosy. The bibliographies, if not complete, are at

any rate very useful, and, as a rule, the most importantreferences to the literature of the various diseases aregiven. Curiously enough, soft sore is not dealt with

except in the discussion on the diagnosis of genitalchancres, but this is not a very serious omission.No text-book can be quite up to date, but this volume

can be little criticised in this respect. A few importantsections might have been modernised. For example,in that dealing with oriental sore the treatmentis said to be "unsatisfactory," and, while Low’smethod of applying an ointment of tartar emeticis given, administration of antimony by intravenousinjection is not mentioned, although Ferra, of Brazil,used this method successfully several years ago.Again, in the description of xanthoma, which isincluded in the chapter on "Pseudo-neoplasms ofthe Skin," no reference is made to the work ofPinkus and Pick, and of Chauffard and his assistantson cholesterinæmia, nor is the fact mentioned thatin xanthoma multiplex, at any rate, the amountof cholesterin in the blood is greatly in excess.

Describing herpes zoster, Dr. MacLeod says : " Shouldsuppuration occur, the neighbouring lymphatic glandsgenerally become enlarged-a feature which has beennoted even in cases in which the lesions were un-contaminated by pyogenic micro-organisms;" and Dr.Henry Head, in a classical article on zoster, states that" in most cases the contents of the clear vesicles becometurbid. Possibly it is in connection with this pusformation that the lymphatic glands that drain theaffected tract of skin are in the majority of cases

enlarged." It is curious that these two accurateobservers should apparently not have noticed that theadenitis associated with herpes is such an earlysymptom that it certainly sometimes, if not always,precedes the appearance of the eruption.We are surprised, too, to find in the section on pruritus

ani that Murray’s view that the actual pruritus is due toinfection of the skin with the Streptococcias fœcaliswhereas local disorders of the rectum, threadworms,&c., are only predisposing factors, is summarily dis-missed as untenable, and treatment by vaccines asunreasonable. Bassler entirely supports Murray’swork, and considers that autogenous vaccine treatmentis the most valuable method in cases in which thepruritus persists after any local abnormality has beencorrected by operation or otherwise, and, according tohim, failure with vaccines is usually due to ignoranceof the technique and of the dosage required. The lastchapter is devoted to tropical diseases of the skin, uponwhich the author is a recognised authority, and it isto be noted that, in discussing the aetiology of pellagra,he seems rather to favour the views of Sambon, which,in the light of Boyd’s work among Turkish prisoners of