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299REVIEWS AND NOTICES OF BOOKS.
He urged the necessity of seeing that the nurses engaged inasylums, both male and female, should be able to lookforward to a provision in old age at least equal to that ofthe policeman.-On the motion of Dr. G. F. BLANDFORD,seconded by Dr. R. PERCY SMITH, the President was heartilythanked for his address.
Dr. JOSEPH S. BOLTON read a paper entitled " The Pre-frontal Cortex Cerebri," illustrated by lantern slides. Dr.Bolton exhibited a series of most successful sections to showthat the prefrontal area of the brain was of extremely com-plex structure, as complex as, though of finer architecturethan, any other part of the brain. These observations weredistinctly at issue with those recently published by Dr. A. W.Campbell to the effect that the prefrontal cortex was a verylow structure, of poor d( velopment, and that it containedpractically no fibres, except a few of the finest calibre. Itwas for the purpose of giving ocular proof of his owncontention that Dr. Bolton made the contribution. The
paper was diecussed by the PRESIDENT, Dr. C. C. EASTER-BROOK, Dr. P. W. McDoNALD, and Dr. A. WILSON.
In the evening the members dined together in the GeorgianHall of the New Gaiety Restaurant, the President being inthecbair, He was supported by about 70 persons, amongthe guests being the Bishop of St. Albans, Lord Monkswell,Canon Swallow, Sir William J. Collins, M P., Sir OwenRoberts, Sir Ralph Knox, K.C B., Sir W. S. Church,K.C.B., Sir Edwin Cornwall, M.P , Dr. G. H. Savage, SirLauder Brunton, F.R.S , Mr. Justice Walton, Dr. F. Need-ham, Dr. E. Marriott Cooke, Mr. John Tweedy, Mr. HenryMorris (President of the Royal College of Surgeons ofEngland), and Sir Richard Douglas Powell (President ofthe Royal College of Physicians of London).-Lord MONKSWELL replied to the toast of the Legislature proposedby Dr. SAVAGE.-Sir EDWIN CORNWALL, M.P., repliedto the toast of the "London County Council," proposed byMr. H. F. HAYES NEWINGTON. Sir WILLIAM J. COLLIKS,M.P., in an eloquent speech proposed the toast of the
evening, "Prosperity to the Medico-Psychological Associa-tion," in the course of which he emphasised the value ofscientific investigation and pathological research in rtla-tion to insanity. The toast was replied to by the PRESIDENT,Dr, D. YELLOWLEES, and Mr. CONOLLY NORMAN. The toastof "The Visitors," proposed by Dr. CHARLES A. MERCIER,was responded to by Sir RICHARD DOUGLAS PowELL, andDr. T, OUTTERSON WOOD proposed "The Chairman."On July 27th an elaborate and striking paper was read by
Dr. F. W. MOTT, F.R.S., entitled "The Effects of Alcohol inHospital and Asylum Practice." He compared the results onthe mind and body of those who drank to excess in the
pursuit of pleasure with those who drank because they wereworried or had some great trouble or aflliction. He hadfound that the people admitted to asylums through drink haddrunk because they were worried and that they were personsof a nervous temperament ; perhaps previously they wereepileptic ’or degenerate or feeble-minded. Excessivedrinkers who had not such a bad history were found usuallynot to suffer in mind but in body, and to manifest the effectsin cirrhosis of the liver with ascites.-The paper was dis-cussed by the PRESIDENT, Mr. CONOLLY NORMAN, Dr.JAMES STEWART, Dr. R. C. HOLT, Dr. J. CARSWELL, Dr.C. HUBERT BOND, and Dr. T. W. McDOWALL.Dr, HELEN BoyL E read a paper entitled The History of
an Unusual Case of Murder," a woman having murdered heryoung child in a fit of religious exaltation following upon avisit to a famous mission.-The paper was fully discussed.
Dr. W. F. MENZIES read a paper entitled " TuberculinDiagnosis," in which he gave his reason for holding but littlefaith in tuberculin as a certain diagnostic. In the discussionwhich followed considerable emphasis was laid on the
necessity of adhering to the old methods of diagnosingpulmonary tuberculosis.
Dr. E. S. PASSMORE described a Diagrammatic Method ofRecording Family Histories, which was applicable to generalmedical practice.
Dr. ROBERT PuGII sent a contribution entitled, " TheRelation of Goitre to Insanity," which was read by Dr.WILSON.A paper by Dr. M. J. NOLAN, entitled "On the Possibility
of the Limitation of Lunacy by Legislation " and one byDr. EDWARD N. BRUSH, Maryland, U.S.A., entitled" Descrip-tion of the Method of Admission and Treatment in theHospital, also of the Founding and Organisation of the
Hospital (with Plans of Extension) " were taken as read.The meeting concluded with a cordial vote of congratula-
tion to the PRESIDENT.
Reviews and Notices of Books.Collected Studies on Immunity. By PAUL EHRLICH, Privy
Councillor and Director of the R yal Institute for
Experimental Therapy, Frankfurt, Germany, and by hisCollaborators ; with several new contributions, includinga chapter written expressly for this edition. Translatedby Dr. CHARLES BOLDUAN, Professor of Bacteriologyand Hygiene in Fordham University, New Yoik, &c.New York : John Wiley and Sons. London : Chapmanand Hall. 1906. Pp. 586. Price 25s. 6d. net.
Professor Ehrlich’s " side-chain " hypothesis as to theinteraction of living cells and chemical bodies in the lymphsurrounding them has now established itself as the most
acceptable explanation of many, if not of all, the phe-nomena at present known to occur in the field of immunity,and if the essential characteristics of a valid hypothesisare that it should apply to the known facts and suggestfurther lines of research the results of which are alsoin accord with it, then this must be ranked among themost valuable generalisations recently propounded in
biology. In the book before us we find a collection of the
writings of Ehrlich and his collaborators in which we cantrace to some extent the building up of the theory of
immunity and can realise the successive steps in the process.It is true that we have to assume some of the pioneer workin this field, such as the well-known experiment of Pfeifferand the original observations of Belfanti and Carbone onthe properties of the serum of one species of animal wheninjected with blood corpuscles from another species, but theexplanation of these phenomena on Ehrlich’s theory and thefurther experiments undertaken to prove the correctness ofthis explanation are here given in considerable detail.The first three chapters are by Ehrlich and Morgenroth and
deal with hæmolysis—destruction of blood corpuscles withinthe animal body and in the test-tube by the action of serum.We are introduced to the two substances which take part in
this process, the immune body and the complement; we findthat there are several different complements present in theserum of an animal and that some, contrary to the usualrule, are capable of withstanding a considerable degree ofheat. We learn also that though an animal is able
to form substances capable of dissolving the corpusclesof other members of its own species (isolysins), it never
develops the property of so acting on its own cells (autolysis).The bearing of this discovery on theories of auto-intoxicationis pointed out. Chapters IV. and V., by von Dungern, dealwith the quantitative relations of immune body and comple-ment and with the formaticn of cytotoxins-substanceswhich act on cells other than blood corpuscles. Chapters VI.,VII., and VIII. are again by Ehrlich and Morgenroth anddeal with the plurality of both immune bodies and comple-ments, with Bordet’s view that the immune body acts byrendering the cell susceptible to the action of the alexine(complement), and with the differences between immunebodies formed in different species of animal. The inferenceis drawn that a bactericidal serum for curative purposesmust either be derived from n animal nearly related to manor be formed by mixing the serums obtained from a numberof different species. In Chapter IX., by Neisser, it is
shown that excess of immune body may act detrimentally bycausing "deflection" of complement, thus preventing itfrom combining with the organisms which are the object ofattack, and Chapter X., by Lipstein, enforces the same
point. In Chapters XI., XII., and XIII., written by Rehns,Neisser, and Sachs respectively, the effects of injectingmixtures of antagonistic bodies are investigated-toxin alongwith an excess of antitoxin, blood corpuscles treated withhoemolytic immune body, and bacilli saturated with
300 REVIEWS AND NOTICES OF BOOKS.
Very interesting are the researches which have been con-ducted as to the nature of the poisons formed by manyspecies of animals-snakes, spiders, and toads (Chapters XV.,XVI., XXVII., and XXXV.). All of these animals secretesubstances having a hasmolytic action. Snake venom, for
example, is found to contain a substance acting as an im-mune body and capable of anchoring a complement to theblood corpuscles. The complement in this case is containedin the stromata of the corpuscles themselves and is identifiedas lecithin. This is apparently the only instance in which acomplement has been isolated as a definite chemical bodyand the discovery is of great interest.Limits of space forbid us to deal in detail with the contents
of all the 41 chapters of the book : allusion can only bemade to a few more of the subjects dealt with. As toxins arefound to diminish in virulence in course of time and as hasmo-
lytic serums are rendered inert by heat, it was necessaryto study the properties of such inactive fluids. It appearsthat as the toxin on the one hand, and the complement onthe other, are each made up of two groups of molecules, one serving to unite with the cell or with the immune body, the I
other to effect a toxic or hssmolytic action, it is possible forthe latter group to disappear, while the combining (hapto-phore) group remains. Thus are formed in the one case
toxoids, in the other complementoids - inactive bodies
capable of preventing the action of toxins and of hæmolyticcomplements respectively, but also of giving rise to anti-toxins and anti-complements when injected into animals
(Chapters XIX. and XXXVIII.). Similarly by heating anagglutinating serum substances known as pro-agglutinoidsare formed, able to prevent the action of an agglutinatingserum, but themselves inert.
The reader who is but little acquainted already with theresults of recent researches in immunity such as are hererecorded will probably be wise to read first Chapter XXXII.,in which Ehrlich gives a general account of his theory andits application. He will also appreciate those chapters(XXIX. and XXX.) in which the technique of the variousprocedures is described. Take it as we will, the book is any-thing but light reading. To advanced students it should
prove highly useful, especially since it has the advantageover the original German edition of containing a specialchapter written by Professor Ehrlich, bringing the subjectup to date. A fatal blot, however, is the absence of an
index, a defect which is calculated to cause acute exaspera-tion in the reader, especially in the case of a collection ofscattered writings such as is here presented. The compara-tively small amount of trouble involved in compiling anindex would have doubled or trebled the value of the work.
We have said that the" side-chain" " hypothesis is now
firmly established and on this account we are inclined toregret the attitude adopted by its author towards those whodiffer from him. Science advances by criticism of prevailingopinions and serious criticism should be met cheerfully,indeed welcomed, by scientific writers. Merely carpingobjections may safely be ignored. Hence the polemical andin places querulous tone of the preface and of some of thearticles in the collection before us is much to be regretted.Perhaps the least satisfactory point about the theory of
immunity is its terminology, at least as it is presented in anEnglish or American dress. Such an expression as a
"hasmolytic ciliated epithelial immune body" seems anexample of torturing the English language beyondendurance when we reflect that the chemical " body "
in question is not itself immune to anything butconfers immunity on a living animal ; that it isnot epithelial in nature, and that it is certainly notciliated. The term "immune body" is itself clumsy, notonly for the reason just stated, that it confers rather thanpossesses immunity, but also in that it employs-two words for
one thing. " Amboceptor," again, 6eems defective in that weare specially taught that these bodies are capable of anchor-.ing more than one substance at the same time to a cell andhence the component I I ambo " (both of two) is wrongly used.We can only hope that the leading authorities on this subject-who on Socratic principles should, as knowing most aboutthe matter, be also best able to describe it-will devote alittle attention to its terminology and endeavour to simplifywhat is at present a serious difficulty in the path of the
Studies from the Institute for Mediaal Research, FederatedMalay States. Vol. IV. Part 1: Observations in theFederated Malay States on Beri-beri. By C. W. DANIELS.hederated Malay States on Beri-beri. By C. W. DANIELS,M.B. Cantab., late Director of the Institute for MedicalResearch, Kuala Lumpor, Federated Malay States.London: E. G. Berryman and Sons. 1906. Pp. 105.Price 3s. 6d.
BERI-BERI, which is responsible for so much sickness intropical and sub-tropical countries, the mortality rangingfrom 1 in 40 to 1 in 2 in different epidemics, has of lateyears received considerable attention at the hands of variouswriters who have had experience of the disease. Thus Dr.Hamilton K. Wright, Dr. Travers, and Dr. H. Dangerfield,to mention only some of the names, have given us theirviews of the affection. In the volume under review we find
succinctly and clearly expounded by Dr. Daniels the variousconflicting theories, together with the opinions formed bythe author, who was for some time director of the Institutefor Medical Research at Kuala Lumpor and who hasembodied here the conclusions at which he has arrived fromthe facilities of observation afforded him of the disease in
Malay.Dr. Daniels, in discussing the etiology, points out that
the primary cause of the lesions is as yet unknown. The
symptoms known clinically as beri-beri are a secondaryresult. The main hypotheses which have been suggested canbe grouped into two classes-namely, (1) that the disease issecondary to a lesion or disease occurring in the same man(in this class would be included the views of Wright andDurham); and (2) that the disease is secondary to the
absorption by man of a poison generated or existing outsidethe human body : in this are included the views of thosewho are of opinion that the disease is due to infected
ground, poisoning by food, or substances known to induceperipheral neuritis.The author first gives us an account of the disease as
it occurrs in prisons, in the Taiping gaol, Batu Gajah gaol,Pahang prison, Singapore gaol, Penang gaol, and the oldand new gaols at Kuala Lumpor. The conclusions arrivedat from a consideration of the matters of fact at Kuala
Lumpor are that the disease there was independent of thewater-supply, and of the consumption of fish, fresh or salted,and that changes of diet to a more liberal scale and thoroughcooking of the food had but a slight effect. He shows thatthe one constant factor in beri-beri in prisons was the admis-sion of cases in the early stage of the disease which, whenonce introduced, usually spread widely. Those introducingthe disease were mainly prisoners under a short sentence
and therefore it is recommended that such prisoners shouldbe confined in a separate block ; that the confinement in anassociation ward for the first night of all prisoners shouldbe discontinued ; that the cells should be daily cleansed;that all vermin should be destroyed; that any cell inwhich a case of the disease has developed should be
thoroughly disinfected before it is again occupied; andthat all blankets should be thoroughly disinfected after useand again sterilised and washed at regular intervals.The occurrence of the disease in mining and other com-
munities is next considered and then its relation to otherdiseases. The period of exposure required to produce definite
301REVIEWS AND NOTICES OF BOOKS.
signs of the affection has been found difficult to determine, F
some patients complaining of symptoms and showing definite (
signs only after they have been ill for some days ; in others 1the period is longer. !
With regard to the theories advanced that the diseaseis secondary to the absorption by man of a poisonoriginating or existing outside the human body, there cer-tainly have been cases reported to support this view which, moreover, is fortified by the good effect alleged to have ]
followed removal from an infected locality. But in con-
sidering this factor we must not lose sight of the fact thatthe locality to which the patients were removed was usuallya healthy one; also that in the new locality there was noconstant influx from outside of cases in the early stage ofthe disease; and again, that in transferring the patient acertain amount of selection was unconsciously made, theseverest cases not being transferred, and thus the death-ratewas not so high as it would have been had these cases beentransferred.
Dr. Daniels next enters upon the question of the causationof the disease by the ingesta ; arsenic, alcohol, and oxalicacid are first considered in this relation and then the theoryof nitrogen starvation is discussed. He states that in the
Japanese navy an increase in the nitrogenous food wasfollowed by a great reduction in the amount of beri-beri butthat this was one only of many changes made in that navy,and hence that the improvement in the nitrogenous elementcannot account for the lessening of the disease. But will
this criticism apply to every case? We think not. Surgeon.Major L. L. Seaman, U.S.V.C., has shown how in 1883 theoutbreak in the Japanese war vessel Ryujo caused the
question of the causation of beri-beri to become acute.This vessel voyaged 271 days to New Zealand and SouthAmerica and there developed over 100 cases of the disease,there being less than 350 persons on board. Baron
Takaki, F.R.C S. Eng., the head of the Naval Service,therefore sent another ship over precisely the same courseand zcnder the same conditions, so far as they could beduplicated, and at the same season of the year, the sameports being visited with a similar number of days’ stay ateach port. The difference was remarkable : the first shiphad 160 cases altogether, the second 16 only, but the latterhad been sent out under a new diet scale, avoiding theexcessive use of rice. Acting on this experience during thewar with Russia the Japanese navy was entirely free fromthe disease.There are many other valuable points noticed in this report
which lack of space forbids us entering upon. Dr. Danielsconcludes that beri-beri is an infectious disease ; that thereis no definite proof that an intermediate host is required ;that there is some proof that for a short period only afteroccupation of small spaces the poison may remain ; that foodis not the causative agent; and that if any intermediate hostis required for the unknown parasite it must be either acimex or a pediculus. The report must have been compiledwith immense labour and is a most valuable renunzc of our
present knowledge of the disease.
Report on Epidemic Cerebro-Spinal Meningitis in India.By Captain C. J. ROBERTSON-MILNE, M.B. Aberd., I M.S.Issued under the authority of the Government of India bythe Sanitary Commissioner with the Government of India,Simla. Calcutta : Office of the Superintendent of Govern-ment Printing, India. 1906. Pp. 67. Price Rs.1 or ls. 6d.-In this report Captain Robertson-Milne divides his subjectmatter into three sections-(1) a Historical Survey ; (2) aClinical Description ; and (3) a Bacteriological Examina-tion. The treatment is dismissed in less than a page, for, asthe author says, "no drug occupies the position of be:ng a
specific for the disease and treatment must therefore beerected towards the relief of symptoms." He mentions thelocal application of ice bags to the head, the neck, and the3pine as of value and the use of the prolonged hot bath asadvocated by Netter. He says opinion is divided as to thevalue of lumbar puncture as a therapeutic measure. In IndiaE. Harold Brown has employed it in four cases with con-siderable relief to the patients and Captain Robertson-Milnehas noticed an amelioration of the symptoms following theoperation when he has employed it. Constant careful
nursing and light nutritious food are essential. He has
attempted to prepare a serum from goats ; it seemed to besatisfactory so far as laboratory experiments went, buthe has not had other opportunity of testing its efficacy.The lack of pathogenicity, which the meningococcusexhibits, greatly deters research in this direction. CaptainRobertson-Milne says that the following conclusions may bedrawn from this study of the disease :-1. Epidemic cerebro-spinal meningitis or cerebro-spinal fever in both its epidemicand its sporadic forms is a well-known disease in India: therecords of the disease show that it is clinically, bacterio-
logically, and epidemiologically identical with the malacyas it has been observed in other countries. 2. In India ithas been an ailment which has most frequently attackedprisoners in gaols ; in some of these institutions the diseasehas continued to prevail irregularly for prolonged periods.No explanation of this is at present possible. A completelocal bacteriological and epidemiological study of a severe e
outbreak, such as has occurred in past years at the gaols (f fBbagalpur and Mung Rasul, might be productive of usefuldata in this connexion.
McDou,gall’s Health Reader. London and Edinburgh:McDougall’s Educational Company, Limited. Pp. 96. Price6d, net.-This is a useful little book; it conforms exactlyto the syllabus of the Board of Education. The intro-
duction treats of Health and Ill-health. The body of
the book is divided into four parts which consider re-
spectively the Home; the Person; Eating and Drinking;and Illness. In the fourth part the final section is headed,"When to Send for a Doctor"; the advice here is quitesound and if followed will save much suffeiing and insurea freedom from grave respon.,ibility. The book is interestingas well as useful, it is sufficiently illustrated, and it is
printed in good, bold type.Textbook of Diseases of the Ear, Nose, and Pharynx. By
B. ST. JOHN RoosA, M.D., LL.D., Professor of Diseases
of the Eye and Ear in the Post Graduate Medical Collegeand Hospital, New York, Consulting Surgeon to the BrooklynEje and Ear Hospital, formerly President of the New YorkAcademy of Medicine, &c. ; and BEAMAN DouGLAgs. M.D.,Professor of Diseases of the Nose and Throat in the NewYoi k Post-Graduate Medical College ard Hospital; Fellow ofthe New York Academy of Medicine, &c. With 108 illustra-tions in the text. London and New York: Macmillan and
Co., Limited. 1905. Pp. 621. Price 12s. 6d. net.- This workis intended for the use of students and practitioners and willbe of assistance to those who are in search of a book whichdeals not too deeply with the subjects The fault whichwe have before had to lament in other works of he same
calibre-namely, that the differential diagnosis between thenon-suppurative conditions of the ear is extremely vague-also detracts from the value of the book before us. Fre-
quently also the text is misleading. For instance, it is stagedthat the C2 tuning fork is generally known as C. Speakinggenerally, some of the sliphter disorders have an undue pro-minence. ’J his work scarcely reaches that standard whichstudents and practitioners now demand.
Oliver IVendell Holmes and the Contagiousness of Puer-
peral Fever. By CHARLES J. CULLINGWORTH, M.D. Durh.,, F,R C P. Lend. With Portrait. London : Henry J. Glaisher