1371REVIEWS AND NOTICES OF BOOKS.

the coroner in such inquests-and as a rule he would direct oneto be made-a competent and unbiassed pathologist shouldbe employed to dissect the body. It was the province of thejudge to define what might be negligence ; the jury decidedwhether negligence had been exhibited in any particular case.That was, in sum, the legal position, for the whole matterwas one of fact rather than of law.

Mr. C. R. SALISBURY said that quite recently he had seen aman who had an almost fatal attack of syncope, induced bythe opening of a small stye, evidently due to fear. He alsonoticed that Jews, who were a very nervous race, often gaverise to anxiety during the preliminary stages of anaesthesiaowing to their extreme nervousness. Other cases which often

gave rise to anxiety occurred in children suffering from"spastic paraplegia," who were under treatment for theirdeformities, during the operation of wrenching. He hadnever had a death under an anaesthetic but had recently avery near escape from that accident. The patient was a youngman, aged 20 years, and the operation was stretching thesphincter ani."

" Chloroform was being given, and before thepatient was completely under the anaesthetic the surgeoncommenced to stretch the sphincter. This was immediatelyfollowed by stoppage of the heart and respiration, and it wasonly after 20 minutes of artificial respiration, &c., that the

patient recovered. This Mr. SalisDury thought was due toshock causing a sudden lowering of the blood pressure. Thiscase was corroborated by one in which he saw a patient havea very severe attack of syncope during the administration ofan enema. He believed that syncope occurring during theearly stages of the administration was more serious than thatin the later stages because its onset was more sudden. Hethought that the respirations were the greatest guide as toits impending danger, and seldom felt the pulse unless therespiratory functions showed signs of failing.The PRESIDENT, Dr. W. LANGDON BROWN, Mr. M.

CURSHAM CORNER, Dr. ERNST MICHELS, and Mr. H. LETTcontinued the discussion.

Dr. PROBYN-WILLIAMS replied.

BRITISH BALNEOLOGICAL AND CLIMATOLOGICALSOCIETY.-A meeting of this society was held on Oct. 29th,Dr. W. J. Tyson (Folkestone), the President, being in the chair.-After the balance-sheet had been presented the new Presi-dent, Mr. E. Solly (Harrogate) took the chair and spoke a fewwords of welcome in the French language to a party ofFrench medical men representing the Societe d’Hydrologiede Paris who had been invited to attend the meeting.-In the absence of Sir Dyce Duckworth, who was un-

able to be present, Dr. Leonard Williams gave an

address of welcome to the French medical men.-ThePresident then delivered his address on the MunicipalManagement of Health Resorts.-Dr. Schlemmer (MontDore), President of the Société d’Hydrologie de Paris,proposed, Mr. A. G. S. Mahomed (Bournemouth) seconded,and Dr. R. Fortescue Fox supported, a vote of thanks tothe President for his address.--Mr. Solly replied.ROYAL MEDICAL SOCIETY OF EDINBURGH.-A

meeting of this society was held on Oct. 30th.-Dr. Mark S.Fraser delivered his Presidential address. The subjectchosen was "The Career and Life-work of Edward Jenner." "

Dr. Fraser received a hearty vote of thanks at the close of amost interesting and instructive address.-Dr. Scott broughtbefore the notice of the society a man suffering from Ele-phantiasis of the left arm, the nature and causation of whichwere obscure.-An interesting discussion followed, in whichmany members took part.

ROYAL SANITARY INSTITUTE.- A provincialsessional meeting of the institute will be held at the TownHall, Durham, on Saturday, Nov. 14th, at 11 A.M., when adiscussion will take place on the Health Visitor and SchoolNurse in Relation to Sanitary Administration. The dis-cussion will be opened by Dr. H. Renney, medical officer ofhealth, Sunderland. The chair will be taken at 11 A.M. byColonel J. Lane Notter, R.A.M.C., deputy chairman of thecouncil of the Institute. Tickets for admission of visitorsmay be had on application to Dr. T. Eustace Hill, ShireHall, Durham, who is acting as the local honorary secretaryof the meeting, and from Mr. E. White Wallis, secretary,Parkes Museum, Margaret-street, London, W.

Reviews and Notices of Books.Pulmonary Tuberculosis and its Complications, nith special

reference to Diagnosis and Treatment, for General Prae-

titioners and Students. By SHERMAN G. BONNEY, A.M.,M.D., Professor of Medicine, Denver and Gross College ofMedicine. With 189 original illustrations, including 20in colours and 60 x ray photographs. Philadelphia andLondon: W. B. Saunders Company. 1908. Pp. 778.Price 30s. net.

THE author states in his preface that it was his desire thatthis book should be devoted essentially to the clinical aspectsof pulmonary tuberculosis and he has therefore endeavouredto emphasise practical considerations. He further intimatesthat the work is not designed for the benefit of specialists inthe treatment of pulmonary affections but that it is

intended for the use of general practitioners whose oppor-tunities for clinical study may have been somewhat limited.

Part I. is devoted to a consideration of the etiology andpathology of pulmonary tuberculosis ; Part II. to the sym-

ptomatology, course, varieties, and termination of the disease ;Part III. contains a description of the general physical signs;and Part IV. is devoted to a consideration of diagnosis andprognosis. The complications are described in Part V. andprophylaxis and general and specific treatment in Part VI.A good account is given of the morphological characters

of the tubercle bacillus and of the various types met with.Dr. Bonney concludes that recognised differences do exist in

the morphological and cultural attributes of the human and

bovine bacilli, but that these are not of such a nature as toestablish a fundamental divergence in character. He adoptsthe opinion generally held that the lack of perfect identity

in these separate varieties of the same bacterial organism isoccasioned by essential modifications of the host. His most

important practical dictum, however, is that the dangers ofinfection from the bacillus of cattle are sufficiently real tojustify no abatement of legislative, municipal, and individualmeasures to suppress the disease among domestic animalsand to afford protection to the human race.The remarks on the methods of infection are worthy of

attention, although the author’s conclusions do not altogethercoincide with those held by the majority of observers ; on theother hand, he has the support of some recognised autho-rities. Infection through the respiratory tract is held bymost investigators to be the usual method by which thedisease is contracted. Dr. Bonney, however, is of opinionthat’’ while it does not appear rational to deny the prob-ability of the occasional transmission of tuberculosis through

.

the process of inhalation, a careful review of the evidencefails to substantiate, in a perfectly satisfactory manner, a

belief in the respiratory tract as the prinoipal route ofi bacillary invasion." Again, in speaking of infection throughthe digestive tract he says : "It appears almost impossible

to form a definite estimate concerning the relative fre-

quency of inhalation and deglutition tuberculosis. Althoughthe available data are insufficient to warrant even approxi-mate conclusions as to the usual route followed by tubercle

bacilli in their entrance into the body, it may be assumedthat admission is permitted through the respiratory tract less

often than has been supposed, and that ingress by means ofthe digestive canal is correspondingly more frequent."The description of physical signs which are characteristic

of pulmonary tuberculosis is particularly clear and well’ expressed. A study of Dr. Bonney’s method of examination

will be found valuable both by students and practitioners.: Stress is rightly laid on the differences which exist in the

various regions of the normal chest ; unless these variationsare remembered errors in diagnosis will be sure to arise, The

1372 REVIEWS AND NOTICES OF BOOKS.

complications which may arise in the course of the disease areconsidered at great length and the portion of the volumedevoted to tuberculosis of other organs than the lungs forms aprominent feature of the work, rendering it very useful for

purposes of reference. The treatment of the various complica-tions is also fully discussed. In the remarks on the treatmentof tuberculosis of the larynx there is a strange omission. The

great value of local rest by abstention from speech is notmentioned. On the other hand, importance is rightlyattached to the necessity of a general management of thecase by attention to climatic, hygienic, and constitutionaltreatment. The description of sanatorium treatment is givenin satisfactory detail. The directions in regard to rest and

exercise are perfectly explicit and may be confidently followedin actual practice.We have perused this volume with considerable pleasure.

It is evidently written by a physician who has had a largepractical experience in the management of cases of pul-monary tuberculosis and who has thoroughly studied the

numerous details in regard to diagnosis and treatment. The

book is a large one but a full index renders reference easy.The numerous illustrations are beautifully executed and addto the interest of the work.

Third Annual Report of the Henry Phipps Institute for theStudy, Treatment,-and Prevention of Tuberculosis. Edited

by JOSEPH WALSH, A.M., M.D. Philadelphia: HenryPhipps Institute. 1907. Pp. 410.THIS excellent report deals with the work of the Henry

Phipps Institute from Feb. 1st, 1905, to Feb. 1st, 1906.It indicates the large amount of investigation which wascarried out during that year and yields information of

great interest in connexion with tuberculosis. A statistical

study of the influence of the institute upon the death-rate from tuberculosis in Philadelphia was conducted

by Dr. Irvin E. Bennett and Dr. Lawrence F. Flick.A map of Philadelphia is reproduced giving the outlines ofthe wards into which the city is divided and some care-

fully drawn-up tables show the reduction in the death-rate from tuberculosis topographically and chronologicallyin the three years during which the institute has carriedon its work. An attempt is made to determine the relation-ship between this work and the change in the death-ratefrom tuberculosis in the city. It is not claimed, of course,that the change in the death-rate is entirely due to theinfluence exerted by the institute, but Dr. Bennett and Dr.Flick believe, and probably quite rightly so, that some

effect has been produced by the instructions given to the

patients and by the general work of those connectedwith the institute. Various other institutions in Philadelphiaalso treat tuberculosis and assist in the attempt to reducethe incidence of tuberculosis, and one fact which stands outprominently in the topographical study in the death-ratefrom tuberculosis in this city is that every ward in which aninstitution for the treatment of tuberculosis exists has had a

reduction in the death-rate from the disease, while some ofthe adjoining wards have had an increase. Dr. Bennett and

Dr. Flick point out that this fact is especially noteworthy inview of the opposition which exists to the establishment of

institutions for the treatment of tuberculosis on the score of

danger to those dwelling in the neighbourhood. An interest-ing article on the Kidneys in Tuberculosis is contributed byDr. Joseph Walsh. After a comparison of 101 kidneysfrom cases of tuberculosis of the lungs with 44 kidneysobtained from the bodies of patients who had diedfrom other diseases he arrives at the conclusion that,apart from the presence of tubercles, no particular patho-logical condition is found in the kidneys in connexion withtuberculosis. Every form of nephritis is found excepthæmorrhagic nephritis and glomerulo.nephritis, The most

common form is chronic focal interstitial nephritis. Thiscondition is found in association with other diseases than

tuberculosis. It appears to be the result of a local

infection and Dr. Walsh believes that in cases of tuber-

culosis it may possibly be due to the tubercle bacillus.

’Chronic general interstitial nephritis is not only uncommonin association with tuberculosis of the lungs but there is

evidence that tuberculosis is antagonistic to its development.Chronic parenchymatous nephritis (usually of mild grade)was found in 34 per cent. of cases of tuberculosis, butwhether this condition is dependent upon tuberculosis or notDr. Walsh is uncertain. He suggests, however, that the

long-continued action of a toxin such as would be producedin tuberculosis might be the cause. Dr. Flick, in a con.

tribution on Serum Treatment in Tuberculosis, gives an

account of the cases in the institution which were treated byProfessor Maragliano’s serum. The results generally wereunfavourable to the serum. Further trials of the remedywill, however, be made.

This volume contains much that is interesting in con-nexion with tuberculosis. The collective work accomplishedby those connected with the institution should prove mostuseful and for purposes of reference these reports are ofconsiderable value.

S2trgical Diagnosis. By DANIEL N. EISENDRATH, A.B.,M.D., Adjunct Professor of Surgery in the MedicalDepartment of the University of Illinois (College ofPhysicians and Surgeons) ; Attending Surgeon to theMichael Reese and Cook County Hospitals, Chicago.With 482 original illustrations, 15 of them in colours.London and Philadelphia: W. B. Saunders Company.1907. Pp. 776. Price 28s. net.

BOOKS cannot teach diagnosis but books can give much helpin diagnosis by drawing attention to those points which areof importance and pointing out the relative value of the

several signs and symptoms. A work on diagnosis shouldalways view the subject from the clinical standpoint andDr. Eisendrath’s book is excellent in this respect. For

instance, in considering affections of the abdomen he dividesthem into three classes-namely, acute abdominal affections,abdominal tumours, and other abdominal conditions. It

may be urged that this is an unscientific classification but it

is essentiallv a clinical division. The acute abdominal con-

ditions he divides into those with early signs of suppura-tion, those in which pain is a prominent early symptom,those where there are early signs of intestinal obstruc-tion, and those with early signs of intestinal haemorrhage.Then the conditions giving rise to each of these groups ofsymptoms are referred to in detail and the differential

diagnosis is given. There is but little to which we can objectbut in a few points we would - suggest alterations. Themethod of palpating a tumour of the breast figured on p. 223is certainly not the best, and equally certainly it is not the

method that should be taught to a student. The figurerepresents the breast tumour held between the thumb andforefinger. This is the method in which the student by thelight of nature examines a breast and it frequently leads tothe diagnosis of a tumour which does not exist. The breastshould be examined with the flat hand. The oedema of thearm which follows carcinoma of the breast is said to be dueto compression of the axillary veins ; if this were so the armwould be dark-bluish in colour, whereas it is almost alwayspale. The oedema is certainly due to obstruction of the

lymphatics, as Mr. W. Sampson Handley has conclusivelyproved. In speaking of leukoplakia the author also calls itpsoriasis linguae, a name which can only cause confusion.We have formed a very favourable opinion of the book and

we think that no better work could be placed in the handsof a student anxious to improve his powers of diagnosis.

1373REVIEWS AND NOTICES OF BOOKS.

The illustrations are numerous and they nearly all show justwhat they are intended to show ; they are all original.

LIBRARY TABLE.

Eighteenth Annual Report of the Asylums Committee as tothe London County Asylums, for the Year end’ing March 31st,1907. London : P. S. King and Son. Price 2s.-The AsylumsCommittee is of opinion that the increase in the lunacystatistics for London, which was apparent for some years, isnot due to a real increase in the incidence of the disease but

rather to more comprehensive registration and accumulationand that the increase will not persist. Indeed, there has beena recent steady decline in the rate of increase and, as ahappy result, it has become doubtful whether it will be

necessary to take any steps for the provision of an eleventhasylum. The total number of cases admitted during the yearunder consideration was 3895, of which only 468 were notfirst admissions. The total number of cases under care

during the year was 20,835. There were 1319 recoveries,671 persons were relieved, 268 were discharged not improved,and 1519 died. The average number resident during the yearwas 17,062. Dr. F. W. Mott, in his report to the PathologistSubcommittee, states that it appears from the tuberculosisreturns from all the London county asylums that relativelyfew of the cases acquire the disease after admission to theasylums and that in a large number there is a recrudescence ofthe disease coincident with the lowered vitality of the tissues.It is remarkable that the incidence of tuberculosis at the

different asylums shows a great variation. At one of them,for example, there were four times as many cases as at

another and ten times as many deaths in which the subjectsat necropsy showed active tuberculous lesions. Dr. Mott is

of opinion that the difference may be explained in part bythe fact that some asylums more than others remove casesfrom the tuberculosis list as the symptoms pass away, butto a greater extent by the situation of the asylum, the typeof its inhabitants, and the personal equation of the medicalofficers in charge. Melancholia appears to figure largely asthe mental disease in tuberculous cases, general nutritionaldeficiency being particularly marked among patients so

suffering. Dr. J. P. Candler has been devoting his attentionin the laboratory to a continuance of the work of Eyre andFlashman relating to the incidence of diphtheroid organismsin general paralysis, and his observations on the blood andcerebro.spinal fluid confirm that work and do not support theconclusions of Dr. W. Ford Robertson.

The Sexual Disabilities of Man and their Treatment. ByARTHUR COOPER. London: H. K. Lewis. 1908. Pp. 184.Price 4s.-Mr. Cooper has written a book for which a largenumber of practitioners, puzzled and harassed by a class ofcases of extreme difficulty, may well be grateful. After

defining the loosely used terms I I sterility " and impotence" "

as they apply to the male, he describes the scientific methodof the recognition of these conditions and then passes on toreview the various causes which may lie behind them. The

last section of his work is devoted to a consideration oftheir treatment, and indicates the conditions which in

the author’s opinion are remediable and the various methodswhich may be of service in dealing with them. Wecan find nothing to criticise in this chapter, which doescredit to its author’s perspicacity. The success of thebook is due largely to the just balance which Mr.

Cooper holds between the physical and psychical aspectsof his subject, both as regards causation and treat-

ment, and we may add that without sacrificing any essentialdetail he handles it with a delicacy of restraint that renderssupererogatory the apt apologia from Montaigne which

prefaces the book and affords a pleasant comparison withcertain turbid continental outpourings. Mr. Cooper does

; well to insist that in sterile marriages the fertilityof the husband should be investigated before the wife

is asked to submit to a troublesome and often distressingexamination. Some of his indications for treatment are veryvaluable, as, for instance, this negative one. I I To send a

nervous youth addicted to masturbation or a sexual hypo-chondriac alone on a long voyage is to place him in circum-stances most unlikely to be beneficial ; for the monotony,

: idleness, and over-feeding incidental to such a voyage are; just the things to be avoided by the class of patients in

question.Round the Fire Stories. By ARTHUR CONAN DOYLE.

, With a Frontispiece by A. CASTAIGNE. London: Smith, Elder,, and Co. Price 6s.-The new volume of stories issued by

Sir A. Conan Doyle is, we gather from his preface, intended,

to make our flesh creep. Most of them, if not all, have, we, fancy, already appeared in the pages of sundry magazines,

but with the exception of one story we do not think that SirA. Conan Doyle has succeeded in giving that atmosphere ofsomething uncanny which was so marked a feature of hisI Hound of the Baskervilles." " The story about the unicorn

, does, however, possess the quality of indefinable horror, butafter all no story of this kind can rank with those master-

pieces of Sheridan Lefanu-namely, " Green Tea " and "TheFamiliar "-or with that amazing invention of FitzjamesO’Brien, What is It?" " However, we are always gratefulto Sir A. Conan Doyle for supplying us with stories which areeasy to read and within the reach of all.

From an Easy Chair. By Sir E. RAY LANKESTER, K.C.B.,F.R.S. London: Archibald Constable and Co. 1908.

Pp. 144. Price Is. net.

The world is so full of a number of things,I am sure we should all be as happy as kings,"

quotes this Professor of the Easy Chair and proceeds to tellhis readers a number of interesting facts about an amazingdiversity of things. They include absorbing accounts of howin former days he discovered (in St. James’s Park) by theexperimental method that you cannot catch ducks by pour-ing even pounds of salt on their tails, and how (in the Zoo)a giraffe sought to devour his new Leghorn straw hat,with its ornamental bunch of Egyptian wheat and broadpink ribbon," an episode which deserves the attention ofMr. E. T. Reed who, as we remember, has already immor-talised Sir E. Ray Lankester in the pages of Punch. But hetells also of the making of diamonds, of the sea serpent, ofextinct monsters, of Sir Norman Lockyer’s fascinating workof the astronomical orientation of ancient temples, of thejigger flea, of luminous owls; he touches on votes for

women (a section which, we fear, will endanger the sanctityof his door-knocker), on the heredity of acquired characters,on glaciers, on tobacco, on Lord Kelvin-a delightful chapter-and on many other things too numerous to mention. The

author scotches certain vulgar errors." Many people, forinstance, will learn with surprise that English mistletoe"occurs on nearly all our trees but is very rare on the oak."

He tells us that mistletoe was held sacred by the Druidsonly when they found it on the oak, a sacred tree.

But to start quoting from the book would lead to

transcribing the greater part of it. We welcome

it especially because it affords a valuable aid to the

work of the Research Defence Society. The story of the

conquest of malaria, yellow fever, Malta fever, and othertriumphs of preventive medicine are told in plain language,and the last chapter on " Cruelty, Pain, and Knowledge" isa notable vindication of scientific methods of research. SirE. Ray Lankester talks very plain truth on the subject ofrank newspaper absurdities which do duty for scientific andmedical "news." The book is, of course, very disjointedbut it avoids the common pitfall of compressed popular