1413

REVIEWS AND NOTICES OF BOOKS

Diagnosis and Treatment of Brain Tumours.By ERNEST SACHS, A.B., M.D., Professor of I

Clinical Neurological Surgery, Washington Uni- Iversity School of Medicine, Saint Louis. London :

Henry Kimpton. 1931. Pp. 396. 42s.

THIS is the first surgical text-book of importanceon intracranial tumours by a modern neurologicalsurgeon, and it would have been difficult to find

anyone more fitted to write it than Dr. Ernest Sachs.A pupil of Horsley and of Halstead, he was trainedin two schools which have probably contributed morethan any others to the foundation of neurologicalsurgery. The book supplies an up-to-date accountof the rapidly advancing knowledge on intracranialtumours, and at the same time sets out the stepswhich led to the development of current beliefs andpractice. In the first chapter on anatomy the authorbreaks away from the older descriptions of cerebro-cranial topography, and describes just those anato-mical points that will be of use to the surgeon, suchas the surface markings of the ventricles. These areillustrated with an admirable coloured drawing whichshows the relation of ventricles, convolutions, blood-vessels, skull, and face. The second chapter on

methods of examination, contains a valuable and

profusely illustrated account of X ray diagnosis andventriculography. The scheme for case-taking is tooelaborate, and the 20 different methods recom-

mended for testing sensation are surely too many forroutine use. The importance of examination of thevisual fields is rightly stressed ; the claim that theterm " hemianopia " refers to the part of the retinaaffected, while " hemianopsia " refers to the part Iof the visual field affected, is not likely to be accept- Iable in this country where the terms are held to be I

synonymous. In explaining homonymous hemianopiain tumours of the temporal lobe, Dr. Sachs does notmention the work of Traquair, which shows that thesymptom is often due to pressure on the optic tractrather than to involvement of Meyer’s loop.

In the section on pathology Dr. Sachs follows the IIwork of Bailey and Cushing on gliomas, and ofPenfield on meningeal tumours. The general symp-toms of raised intracranial pressure are well described.The account of papillcedema and of the effect on itof removal of tumours shows the author’s ripe experi-ence and sound judgment to great advantage. Thefocal symptoms of intracranial tumours in variousregions are dealt with in sections which should bevaluable both to surgeons and neurologists, for eachimportant point is illustrated by detailed case-

reports from the author’s own series, and these containa wealth of information and hints of a practical nature.There is a useful chapter on differential diagnosis.The section on operative treatment and post-

operative care provides an admirably clear accountof modern methods and the principles that underliethem, and this is followed by a short description ofthe more common operations for tumour in variousparts of the brain. Dr. Sachs has been wise in resist-

ing the temptation to go into greater detail in thissection, for in the past text-books of brain surgerywere hopelessly overbalanced by lengthy descriptionsof untried operations and mechanical devices for

opening the skull, and gave no indication of theimportant need that the surgeon should investigatehis cases at the bedside before operation. Dr. Sachspreaches that need from every page of his book. He

has succeeded in giving an essentially practicalaccount of neurological surgery in clear and simplelanguage, and the book is to be commended to allwho are interested in brain tumours. Although thework is short it covers a vast field, and through itsbibliography, which refers to most of the importantpapers and monographs on intracranial tumours

published during the last 30 years, it will act as asource of information hitherto inaccessible to students.No neurological surgeon of experience can afford toneglect the book because he has progressed beyondthe stage of interest in text-books, since Dr. Sachshas been able to find room for important unpub-lished work of his own, for example, on the treatmentof racemose angiomas.

The Commoner Nervous Diseases.

By FREDERICK J. NATTRASS, M.D., F.R.C.P.,Assistant Physician, Royal Victoria Infirmary,Newcastle-on-Tyne. London : Humphrey Milford,Oxford University Press. 1931. Pp. 218. 12s. 6d.

THE requirements of the student and practitionerare well catered for by Dr. Nattrass’s compendiousyet succinct descriptions of the commoner nervousdiseases. Commencing with disseminated sclerosisand neurosyphilis, he takes up seriatim the affectionslikely to be met in everyday clinical work, and dealsfaithfully with their outstanding features and withtheir treatment. Rarities are omitted and contro-versial aspects eschewed. Certain symptoms suchas vertigo receive separate consideration. The studentis not burdened with excessive detail, nor is muchsaid of the neuropathological side of the diseases.But however simple the exposition, it is clear thatDr. Nattrass is familiar with neurology of a moreelaborate kind than is here sketched ; the soundnessof his doctrine and the width of his conceptionsare made evident to the trained neurologist at manypoints in the pages. A few illustrative clinicalinstances are inserted at intervals to bring greateractuality into the descriptions. So far as we haveobserved there is little indeed to criticise ; within thelimits assigned the author has accomplished satis-

factorily a difficult task, steering successfully betweenbaldness of narration on the one hand and diffusenesson the other.

Psychiatrie.By ANDR BARB. Medecin alieniste desHôpitaux de Paris. Paris : Masson et Cie. Pp. 195.Fr.16.

THIS is one of a series of introductory manualsintended for the medical student and practitioner.In such a work it is proper that more than half thebook should be devoted to methods of examination.In the difficult task of investigating a patient’smental state, the tiro will find the detailed instructionshere given most helpful ; the advice as to examinationof physical and metabolic changes is briefer, andsomewhat superficial, though that is scarcely a faultin an elementary manual of this kind. The sectionson examination are the valuable part of the book;the rest is humdrum, careless, and old-fashioned ;there is no consideration of prognosis or treatment,and only gross psychosis is described. This is likelyto give the beginner a false impression and may fostercurrent misconceptions as to distinctions between

1414 REVIEWS AND NOTICES OF BOOKS.

psychosis and neurosis, psychotherapy and psychiatry.The section on syphilis of the central nervous systemis not helpful.

It is curious that the admirable section on examina.tion of the patient is not accompanied by one onthe collecting of an anamnesis ; the student is noteven recommended to pursue inquiries into suchimportant matters as the family history and theprevious life and personality of the patient, muchless told how to proceed to elicit reliable information.

TheThomsenHoemagglutination Phenomenon.By V. FRIEDENREICH. Copenhagen : Levin andMinksgaard. 1931. Pp. 138.Olaf Thomsen in 1927 described a transmissible

agent which had the power of changing humancorpuscles, in vitro, so that they became agglutinableby their own serum and by the sera of all four bloodgroups. The discovery was apparently accidental,and some corpuscles which were grouped on oneoccasion and found to be inagglutinable with thetest sera were re-examined on the following day withthe opposite result. Thus in the course of 24 hoursthe corpuscles had become panagglutinable. Thepractical importance of this matter is obvious and alarge number of careful experiments have beencarried out by Dr. V. Friedenreich in order to ascertainthe mechanism of the reaction. The alteration in the

corpuscles is apparently brought about by a filtrableproduct of bacterial contamination. The activeprinciple is regarded as being an enzyme and thespecific hsemagglutination is accompanied by haemo-lysis. The relation between this type of haemolysisand that of paroxysmal haemoglobinuria is herediscussed. Two kinds of contaminating bacilli whichhave this power of transforming the corpuscles are

described, and it is interesting to note that theiroptimum temperature of growth is 20° C. Various

pathogenic organisms were tested and of these theVibrio cholerce and other vibrios were found to havesimilar action.A final chapter notes the practical importance

of the matter in relation to blood-grouping. Theavoidance of error in this respect is of such vitalimportance that this monograph (which is printed inEnglish) should be studied by all those who are

engaged in work on blood transfusion.

Nucleic Acids.

By P. A. LEVENE, Rockefeller Institute for MedicalResearch ; and LAWRENCE W. BASS, MellonInstitute of Industrial Research. New York:Chemical Catalog Company Inc. 1931. Pp. 337.$4.50.THE title hardly does justice to the contents

of this very valuable book ; actually rather less thanone-third of the volume is devoted to the nucleicacids-as such-while the remainder deals with thecomponent parts from which these substances are

built up. Accepting the definition of nucleic acidsas esters of phosphoric acid with an organic radiclecomposed of a sugar residue and a nitrogenous cyclicderivative of urea, it is clear that the proper approachto the study of such highly complex substances is

by way of the examination of the various constituentswhich go to make the whole. The book is dividedinto two parts composed of seven and four chaptersrespectively. Part I. contains reviews of the

chemistry of the sugars and the pyrimidines and

purines extending over five chapters. The chapteron the sugars is the shortest since, as the author

points out, sugar chemistry has been reviewed indetail in several monographs, The sugars occurringin the nucleic acids are, however, in some waysthe most interesting of all their constituents sincethree of them d-ribose, d-ribodesose and methylthio-ketopentose are not known to occur anywhere elsein nature. In the isolation and identification of thefirst two of these the senior author has played aleading part. The two remaining chapters of Part 1.are devoted to the nucleosides and nucleotides

respectively, and contain full accounts of the methodsof preparation and properties of these substancesas well as descriptions of the methods by which theirconstitutions have been established.The second part opens with an historic account

of the development of our present-day knowledgeconcerning these substances, and it is pointed out thatthis development falls under three headings : thefirst in which these acids were discovered by Mieseber,,the second in which their components were studiedby Kossel, and the third in which their structurewas elucidated, chiefly by American workers ; thesecond part contains also an account of the physio-chemical properties and colloidal behaviour of thesesubstances and a chapter on nucleases.The book is a very valuable contribution to

the chemistry of these fundamentally importantsubstances. In a future edition a more freeuse of hyphens to split up such awkward words asdesoxyribonucleotides would be helpful.

Medical Emergencies.By CHARLES NEWMAN, M.D., M.R.C.P., Junior

, Physician, King’s College Hospital. London e’ J. and A. Churchill. 1931. Pp. 128. 8s. 6d.

THIS small volume is designed as a companionvolume to " Surgical Emergencies in Practice "recently published. Its 120 odd pages contain muchuseful information, some of which is not very readilyobtainable in the standard text-books, as for instance.the chapter on procedure when confronted withsudden insanity. The book includes chapters on

poisoning, coma, convulsions, circulatory failure,haemorrhage, asphyxia, and " the colics." Briefpoints in diagnosis and essential lines of immediatetreatment are indicated. The author has set himself to

provide definite practical assistance in an emergency,and has therefore given simple and admittedlydogmatic advice, without alternative measures.

Not every reader will agree with all that he willfind in this volume ; for example, that all diabeticsshould be given an overdose of insulin deliberately ;that iodine should not be given to cases of toxicadenoma of the thyroid; or that cutaneous hyper-sesthesia is a very good sign of an actively advancinggastric ulcer. It must be rare for true mucous colitisto cause " the most terrific passing of bright redblood from the bowel." It is not, as is here implied,very safe to give strophanthin subcutaneously.Direct blood transfusion with a 5 c.cm. syringe involvesa difficult technique, but it is described more fullythan the simpler citrate method. A detailed accountof blood-grouping would be a useful addition sinceeven in an emergency there is often time to send for asuitable donor if the patients group is determined.These minor criticisms are set out because the bookshould prove a most helpful addition to the practi-tioners library, and a guide on which he is likely taplace great reliance.

1415TONSILLECTOMY AND DIPHTHERIA CARRIERS.—EPSOM COLLEGE.

TONSILLECTOMY AND DIPHTHERIACARRIERS.

THE LANCET.

LONDON : SATURDAY, DECEMBER 26, 1931.

ELSEWHERE in our present issue Surgeon-Captain S. F. DUDLEY reports that at GreenwichHospital School the diphtheria carrier-rate amongboys whose tonsils have been removed is onlyhalf the rate among those whose tonsils are aboutto be removed-the figures being 10 per cent.and 20 per cent. respectively. In each of his

groups there were over a hundred boys, and thedifference is therefore statistically significant(about three and a half times its probableerror). Further he finds reason to think that

among the carriers the " average intensityof infection " is substantially less where thetonsils have been taken out ; in other words,besides being scarcer diphtheria carriers withouttonsils may be a less dangerous source of infectionto others. The numbers in his sub-groups are

admittedly small but they suggest that the lowertotal carrier-rate of the tonsillectomised is onlydue to a lower incidence of avirulent infection,and that there is no difference between the carrierrates for virulent bacilli, a conclusion which agreeswith the findings of J. A. DouLL and W. T.FALES in 1923. In relation to Schick immunity IProf. DUDLEY’S observations confirm those of IB. SCHICK and A. TOPPER (1929) to the effectthat tonsillectomy in some way stimulates thethe development of diphtheria antitoxic immunity.On the other hand WHEELER, DOULL, and FROST 1have found no significant differences betweenthe proportions of Schick negatives amongchildren with tonsils removed, those with normaltonsils, and those with pathological tonsils. These

investigators reached the same result with testsmade on a series of medical students. A similarlack of differences in Schick reaction among thosewho lost their tonsils and those who did not is

reported by K. B. GEDDIE (1930) and by Dr. BURTONand Dr. BALMAIN at p. 1401. Of these two studiesit must be noted that the former comprised childrenliving in a rural area, while in the latter theywere drawn from a non-rural but residential and

non-congested area.The varying conclusions reached by the several

investigators are not necessarily as contradictoryas they appear at first sight. There is no proof,as Prof. DUDLEY points out,

" that tonsillectomy, inthe absence of subsequent contact with diphtheriabacilli, can act as a ’non-specific antigen’ in theproduction of diphtheria antitoxin." It is morethan probable that after their tonsils were removed

1 Amer. Jour. Hyg., November, 1931, p. 555.

the Greenwich Hospital School boys and theNew York children tested by TOPPER and ScHicKwere exposed to diphtheria bacilli in the ordinarycourse of their life. On the other hand in ruraland in non-congested areas the likelihood of exposureto the bacillus would be appreciably less. Similarlyin the normal conditions of student life there isevidence that the risk of infection with diphtheriabacilli is low. These negative results may thereforebe evidence in favour of Prof. DUDLEY’S hypothesis" that the presence of diphtheria bacilli is an

essential adjunct to the production of Schickimmunity after tonsillectomy." Accepting thesevarying conclusions as complementary it stillremains to be explained exactly how the removalof the tonsils favours the development of Schickimmunity. Prof. DUDLEY suggests that such

development " may actually be caused by the

injury of one of the natural immunity mechanisms,which the Schick susceptible (in contrast to theSchick immune who has acquired antitoxic im-

munity) uses to destroy or modify the toxigenicityor antigenicity of the diphtheria bacillus."

This series of papers, taken in conjunction withone another, is of considerable value in the elucida-tion of a peculiar phenomenon.

EPSOM COLLEGE.

WITHIN a few days Epsom College will reachthe seventy-seventh year of its life, having beenestablished as a public school with a Royal founda-tion in 1855. The principal facts in connexionwith the Foundation may be found in an advertise-ment received this week from the College, and asthe terms of that advertisement are accurateand the claims of the institution clearly advancedtherein, we will ask readers to consult what theCollege has to say about itself. We can summarisethe story by saying that a life of more than threequarters of a century has formed a record ofusefulness, making pertinent the question to ourreaders-Why not subscribe to the support of aninstitution whose activities are so practical andwhose design is so good ?The progress of the College has been well

illustrated, since a year ago we brought its claimsbefore the profession, by two interesting departures :the first in connexion with the amenities and thesecond in connexion with the principles of theFoundation. First, then, Epsom College has,during the year just closing, entered into possessionof the finest public school sanatorium in the country.Sixty years ago few public schools made anyorganised provision for dealing with epidemicdisease among their charges. There would beaccommodation for accidents, and, where the

separate house system existed, the house master,and whoever might act as matron, took uponthemselves the responsibility of caring for the sicksubjects in their particular unit. The publicschools were, as a whole, much smaller in numbers,and many features of modern life which conduceto the spread of infection were less pronounced until