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Reviews and Notices of Books.Allgemeine Physiologie : Ein Grundriss der Lehre vom Leben.

(General Physiology : An Outline of the S‘cience of Life.)Von Professor MAX VERWORN, Universität Gbttingen.Fifth edition, with 319 figures. Jena: Gustav Fischer.1909. Pp. 742. Price 16 marks ; bound, 18 marks.

PUBLISHED first in 1894, this work is now in its fifth edition.It is one of the best works on General Physiology extant, andwe hope that in its greatly enlarged form it will soon be trans-lated into English, as was the case with one of the earlier

editions. So much progress has been made in nearly alldepartments of general physiology since the fourth editionwas published in 1903 that almost every chapter has had tobe overhauled and brought up to date. The great advancesin physics, chemistry, and in physical chemistry, not to

speak of our rapidly advancing knowledge in regard to thephenomena of life, of stimulation, the relation between

asphyxia, fatigue, and narcosis, in our knowledge of thenervous system, and, in fact, in every department of

physiology, have caused the author not only to recast thetext where necessary, but he has added nearly 80 pages ofnew matter and 19 additional woodcuts.The book is so well known as a standard work both for

study and reference that it seems almost unnecessary to

attempt to review it, but we do so to justify the view thatthe translation ought soon to arrive. The name of Professor

Verworn is itself a guarantee of the masterly quality andaccuracy of the work. Naturally, from one who has made sucha profound study of the protozoa as Professor Verworn-withhis pupils-has done, the chapter on ’’ the Living Substance

"

is one of peculiar interest-a subject ever old and ever new.The elementary manifestations of life are discussed, as in

previous editions, under the three heads of Metabolism,Form and Shape, and Transformation of Energy. As to

the general conditions for life, they are discussed from

several points of view ; first, the conditions at presentprevailing on the earth, then the origin of life on the earth,and lastly the story of death.The fifth chapter is devoted to Stimuli and their mode of

action. The various forms of stimuli and their actions oncell life are treated very fully. " Tropisms " are dealt with,and very full accounts are given of chemotaxis, barotaxis,phototaxis, thermotaxis, and galvanotaxis. Nor are the

actions of the Roentgen rays and the Becquerel rays omitted.In the long section devoted to the Mechanism of Life

we have one of the most interesting and important chaptersin the book. Rightly, the author regards the" investigationof the mechanism of life as the very kernel of the whole of

physiology," and while he is loth to confess that our know-ledge of the metabolism of living matter is still very imper-fect, he sees that this imperfection can only be remedied by athorough investigation of the processes going on in the cell,for it is the seat of those processes on which the phenomenaof life depend. At death everything goes to show that

- certain changes take place in the living substance, so that inthe living cell substances exist which are not to be found in’the dead cell-substances which have a very unstable con.stitution. Life itself depends directly on the existence of,this labile complex of atoms, represented by certain proteinbodies. For "living proteins," as is known, the author

suggests the word "biogen," the word meaning not a singleprotein, but a group of chemical compounds. The authoradmits that the "biogen" stands on a completely hypo-thetical basis, and all that he claims for it is its-uncommon instability, which gives it a certain resemblanceto explosive bodies. Indeed, similar hypotheses were pro-mulgated by Pfliiger, Hermann, Detmar, and others. The

author sets forth his view of these " biogens " in large type,

and then he gives an elaborate account of the role of oxygenin metabolism, leading up to a consideration of the sub-stances which produce asphyxia and fatigue.The work should be in the hands not only of every

physiologist but also of every zoologist. It gives by far thebest account we know of the phenomena of life itself andof the conditions on which life depends, and also of thefactors, natural and artificial, which modify its phenomenaand manifestations. It also contains valuable and suggestivehypotheses to explain or at least illumine some of the

mysteries of the mechanism of life. The introductorychapter on the Aim and Objects of Physiological Investi-

gation deals with the problems of physiology, the historyof physiological discovery, and the methods of physio-logical investigations. The subjects of I I Vitalismus " and"Materialism" " are duly discussed, and their history tracedfrom Hippocrates and the Alexandrian School to the presentday. The book, it will be seen, is as comprehensive as it issuggestive.

Action de la Contraction Tltcrzne sur l’Œuf Humaín: Pkg-nmènes Patssifs de ta G7-ossesse et du Travail. Par leDocteur BouQUET, Mcdecin de la Maternit6 de Brest.Un vol. in 8 grand jésus de 180 pages, un tableau synop-tique et 45 planches hors texte. Paris: G. Steinheil.1909. Prix 10 francs.

Dr. Bouquet maintains that the commonly accepted view,that the bag of membranes usually begins to form when

dilatation of the internal os has commenced, is erroneous,and as a result of his investigations puts forward some novelhypotheses on the formation of the fluid wedge of membranes.If, he says, the membranes attached to the lower uterine seg,ment are not so extensible as the tissues of the lower uterine

segment themselves, then, as a result of painless uterine con-tractions occurring during pregnancy, separation of the mem-branes round the region of the internal os takes place and apotential bag of membranes is formed before the onset oflabour. We must confess that we cannot follow his line of

argument. It appears to be this: that the uterine con-

tractions, while they make the lower pole of the bagof membranes, when they are inextensible or less ex-

tensible than they should be, less convex, render alsoat the same time the lower pole of the uterus-viz.,the lower uterine segment in the neighbourhood of the

internal os-more convex, and thus cause a separationof the two structures from one another. If the uterine con-

tractions continue to act on this potential bag of membranesbefore labour sets in, it becomes more and more developed,further and further separation of the membranes from thelower uterine segment takes place, the pressure upon the

separated area, according to the author, becomes increased,and premature rupture of the membranes occurs.We know of no proof of the assumption the author starts

-with, that in these cases-admitting for the moment thatseparation of the membranes takes place in the manner hedescribes-the membranes are less extensible than the lower

uterine segment. This, as he says, is a sine quâ non for hisargument, but the assumed inextensibility of the membranesin such cases is pure hypothesis, and admits of no proof.By this action of the intermittent uterine contractions of

pregnancy, and the consequent separation of the membranesand the prævial portion of the placenta, he explains theoccurrence of hæmorrhage in cases of placenta prasvia beforethe onset of labour.

The author further maintains that such a condition occursabout three times in every eight cases of labour, and pointsout certain physical signs by which he considers that such abag of membranes, that is to say, one formed before the onsetof labour, can be recognised. It is said to interfere with the

866

descent of the presenting part, the dilatation of the certakes place slowly, the cervix is often rigid, and the preseing bag of membranes tends to be flattened and continuoutense. Dr. Bouquet does not agree with the sayingMadame Lachapelle, who said: " Qu’elle ne craignait paseaux plates, qu’elles 6taient toujours d’un prognosfavorable. "

Since the author believes that the bag of membrarformed in the manner he describes recedes during a cctraction of the uterus, he lays great stress on the positionthe patient during the period of dilatation of the cerv:The best position he considers to be one in which the verticaxis of the patient’s body makes an angle of 30 degrewith the horizon. In such a posture, so long as the membranare extensible, the bag of waters is formed in the normmanner, and when the membranes have ruptured the weigof the foetus is able to come into play and so to assistthe dilatation of the cervix. When the membranes, ho’ever, are inextensible and the bag of waters is formed in t]unfavourable manner described by the author, the weightthe foetus cannot, according to him, be of any avail.

we have said, the truth of the whole hypothesis depen(upon the accuracy of the author’s assumptions, and the;

appear to us to be very doubtful.

Areltives of the Middlesex Hospital. Clinical Series, No. I(being the Sixteenth Volume of the Archives). Edite(being the Sixteenth Volume of the Archives). Edite

by W. SAMPSON HANDLEY and VICTOR BONNE1London : Macmillan and Co. July, 1909. Pp. 58.THIS number contains : 1. A drawing of a case of Gunshc

Wound of the Hand, by the late Mr. T. W. Nunn. 2. case for Diagnosis, possibly an Undescribed Manifestation othe Rheumatic Poison, with a short account of a case oRheumatic Thrombosis of Systemic Veins, by Dr. WPasteur. 3. A case in which an Enlarged Prostate wa;

Removed through an Inguinal Cystocele, by Mr. J. BlandSutton. The patient had an enlarged prostate and a larglscrotal swelling, which proved to be a sausage-shapectumour of the spermatic cord, together with a cystocele ancan epiplocele. During the operation the bladder was acci.dentally opened, and the opening thus made was utilised foithe removal of the prostate. 4. The Treatment of Ascites

by Continuous Drainage into the Tissues, by Dr. W. EssexWynter. This interesting paper gives details of seven casestreated by the ingenious method suggested by Dr. Wynter ofdraining the ascitic fluid into the patient’s subcutaneoustissues. He finds that the procedure is of decided benefit tothe patient provided accumulation of fluid is the leadingfeature of the case, but that the presence of marked jaundiceor other indication of serious organic change in importantorgans offers a bar to its performance. The site originallychosen of drainage through the femoral ring affords thegreatest advantage as regards drainage. 5. The Rationaleand Technique of Infusion, by Dr. W. S. Lazarus-Barlow.Evidence is brought forward to show that the ordinarymethod of infusion often fails because too little fluid is

given. Dr. Lazarus-Barlow recommends repeated infusionor continuous infusion extending over several hours, as muchas seven or eight pints being given in all. He also recom-

mends the use of sugar solution instead of saline, suggesting a2 per cent. solution of glucose. 6. A case in which a Cyst ofthe Broad Ligament became Infected by the Bacillus

Typhosus, by Mr. T. H. Kellock. 7. Clinical Notes onDiseases of the Nervous System, by Dr. H. CampbellThomson. 8. Some Effects of Erupting and Diseased Teethon the Lymphatic Glands, by Mr. W. S. Nowell. 9. Cæsarean

Section, To-day and Yesterday, by Dr. Comyns Berkeley.This paper contains an interesting study of the history ofand indications for this operation. 10. On the Nature and

rvix Structure of De Morgan’s Spots (Senile Telangiectases), byent- Mr. W. Sampson Handley. He finds that the skin in which

usly they occur shows atrophic change, and that they representof an invasion of the epithelial layer by connective tissue-the

: les newly formed capillaries in which undergo ectasis owing tostic the lack of support.

,nes Graphic Methods in Heart Diseases. By JOHN HAY, M.D.:on- Vict. and Liverp., M.R.C.P. Lond., Assistant Physician,i of Liverpool Royal Infirmary. With an Introduction

by JAMES MACKENZIE, M.D. Edin., M.R.C.P. Lond.

cal London : Henry Frowde, Oxford University Press ;’ees ,

Hodder and Stoughton. 1909. Pp. 184. Price 7s. 6d.

nes MAINLY owing to the enthusiasm and excellent work of

nal Dr. James Mackenzie the graphic methods of investigatingYht

the disorders and diseases of the heart have recently received

Din considerable attention. Numerous avenues of research havebeen opened up and many interesting results have been

the recorded, and when care is taken to avoid errors due to

of defective apparatus the tracing of any movement of the

As circulation obtained by instrumental means remains as a true

Lds and permanent record of an actual event. Further, when

se sufficient experience has been gained in order to correctlyinterpret the tracings, valuable information is therebyobtained. Considerable difficulty is at first encounteredin obtaining satisfactory records, and it is in order to aidthose who wish to adopt the "graphic methods" that

ed this book has been written. Dr. Hay gives a goodaccount of two of the many instruments which havebeen devised for recording the movements of the heart

ot and the pulsations in the arteries and veins-namely,

(1) a modification of the Dudgeon sphygmograph, namedof the "clinical polygraph"; and (2) the" ink-writing poly-graph." The deductions to be drawn from the tracings

are given in detail. The normal records are first discussed,and the records obtained from the radial artery at the wrist,from the apex beat, and from the jugular vein are minutely’e described and analysed. To read a " phlebogram

" correctlyrequires much care and practice, but when the necessarytechnical skill is acquired and the cardinal principles under-stood a large field of study is opened to the investigatorwhich will well repay the time and trouble expended. For

those who wish to enter upon this field of study we cancordially recommend the work now before us.

f

s Allbutt’s System of Medicine. Second Edition. Vol. IV.,) Part 2: Nose, Throat, and Ear. London: Macmillan

and Company. 1908. Pp. 566. Price 25s. net.

THE first portion of this volume is devoted to Diseases ofthe Nose. The section on the more simple pathologicalchanges, which are dealt with in the first 36 pages, chiefly; by Dr. Greville Macdonald, presents no striking novelties,

but we are interested to see that Dr. Macdonald considersthat so-called croupous rhinitis is not by any means

necessarily a consequence of the presence of the Klebs-: Löffier bacillus. Dr. Ernest B. Waggett follows with descrip-

tions of Malformations and Diseases of the Septum, and Dr.Herbert Tilley with articles on Rhinoscleroma, Glanders, andForeign Bodies in the Nose. The next sub-section on NasalNeurosis, by Sir Felix Semon and Dr. P. Watson Williams,is somewhat vague. The article on Diseases of the AccessoryCavities by Dr. Tilley is ably and clearly written. Hyper--trophy of the Pharyngeal Tonsil, by Sir Felix Semon andDr. Watson Williams, concludes this section.The account of Diseases of the Pharynx, which forms the

second portion of the book, is also by Sir Felix Semon andDr. Watson Williams ; it is beautifully illustrated with

lithographs, and we would especially draw attention to

the extremely interesting plates, coloured and otherwise, of

867

rhinoscleroma, a condition but rarely seen in the British

islands, and one, therefore, of which it is particularlynecessary to possess such an admirable description as is

here given. Section III., on Diseases of the Larynx, is bythe same authors as the last section, and this part also is

beautifully and profusely illustrated, chiefly by drawingsfrom Dr. Watson Williams’s brush. This section fully comesup to the standard which was to be expected. Next are

articles on the Pharynx and Larynx in Acute SpecificFevers and Direct Laryngoccopy, the former by Dr. WatsonWilliams and the latter by Dr. Waggett. This portion ofthe book concludes with an article on Foreign Bodies in theUpper Air and Food Passages and Diseases of the Trachea.The last part of this volume is devoted to Diseases of theEar. Dr. Thomas Barr details the Methods of Examination

and General Semeiology, and Dr. W. G. Porter discussesGeneral Therapeutics. This is followed by articles on

Diseases of the External Ear and Tympanic Membrane, byMr. Hunter Tod ; on Acute Inflammation of the Middle Ear,by Dr. J. Dundas Grant; on Chronic Suppuration of the

Middle Ear, by Dr. W. Milligan ; on Intracranial and Intra-venous Affections Complicating Ear Disease, by Mr. CharlesA. Ballance ; on Eustachian Obstruction and Chronic Middle-ear Catarrh, by Dr. E. C. Baber ; on Otosclerosis, by Dr.Albert A. Gray ; on Affections of the Auditory Nerve andLabyrinth, by Dr. P. McBride; and on Deaf Mutism, byDr. J. Kerr Love.

This is an extremely creditable volume, every part of

which, with no noteworthy exception, is well done, but wedo not think that it is all of equal value as a book of refer-ence, and this refers, perhaps, more especially to the lastsection-that on Diseases of the Ear. But as part of ageneral system of medicine it fulfils its object and is wellup to the high standard set by the rest of the work.

LIBRARY TABLE.

Infant Feeding : A Practical Guide to the Artificial Feedingof Infants. By J. S. FOWLER, M.D. Edin., F. R. C. P. Edin.,Physician to the Royal Hospital for Sick Children, Edin-burgh, &c. London: Henry Frowde and Hodder and

Stoughton. 1909. Pp. 230. Price 5s. net.-It is doubtlessa fact that greater attention has been paid in recent yearsthan previously to the subject of feeding infants, and of theimportance of the study there can be no two opinions.Nevertheless, we cannot but marvel at the number of bookson this very limited subject which cortinually appear. The

one before us is a reprint of lectures delivered in connexionwith the class of diseases of children in the University ofEdinburgh and to members of the post-graduate coursesthere. It has the merits of brevity and lucidity. The

methods advocated are simple and practical. There are a

good many illustrations, chiefly of apparatus and of thecurds obtained from different modifications of milk. On the

principle that "Segnius irritant animos demissa per aurem,Quam quae sunt oculis subjecta fidelibus," these may perhapsbe of use to readers. The type and get-up of the book aregood, but we feel that the material might have been com-pressed into rather less space without loss, while the utilityof the work would be increased if it could be sold at a lower

figure.Hose-Drainage, Sewerage, and Sewage Disposal in Relation

to Health. By Louis C. PARKES, M.D., D.P.H. Lond.,Consulting Sanitary Adviser to H.M. Office of Works, &c.

London: H. K. Lewis. 1909. Pp. viii.-142. Price 2s. net.-This little book contains a series of lectures delivered at the

University of London under the trust created by the will ofthe late Sir Edwin Chadwick, K.C.B., of whose life a shortaccount is given in the introductory section. The lectures

deal first with the causation of disease by excretal refuse-the conveyance of infection by dust, air, flies, water, and soforth-then with the various methods of removal of excretal

matter, both the so-called conservancy methods and themodern arrangements for drainage and sewerage, and lastlywith the disposal of sewage by means of precipitating tanks,land treatment, and artificial bacterial beds. The wholeforms a very complete account of the subject dealt with,written in a clear and interesting style and showing a know-ledge of recent developments as well as of established

principles. The book may be commended to candidatesfor the D.P.H., as well as to others who are in search of

practical guidance in this important subject.The "Nauheim" Treatment of Diseases of the Heart and

Circulation. By LESLIE THORNE THORNE, M.D., B.S.Durh. Third edition. London: Bailliere, Tindall, and

Cox. 1909. Pp. 82. Price 3s. 6d.-The third edition of awork requires but little explanation from the reviewer. That

a course of baths and gymnastics, as carried out at Nauheimor elsewhere, may be followed by considerable improvementin certain cases of cardiac disorder is undoubted, althoughthe mechanism and explanation of the action of these

measures are much disputed. In this volume the methods of

administering the " Nauheim" " treatment are well described,so that any practitioner wishing to carry out the treatmentin the patient’s own house will find in the pages of Dr.

Thorne’s book all the information that is required. The

selection of cases suitable for treatment is discussed and

examples of the results which may follow are recorded. In

this edition the chapters on the preparation of the baths andthe administration of the exercises have been revised andthe classification of cases suitable for treatment has beensomewhat altered.

Synoptic Chart of Cardiac Examination. London : John

Bale, Sons, and Danielsson. Price 2s. 6d. net.-This consistsof a chart representing the front of the chest with openingscut over the valvular areas and along the borders of the

right and left margins of the area of cardiac dulness. Bymeans of an ingenious device the principal physical signs ofthe various forms of cardiac disease are indicated by symbolswhich can be made to appear at these openings, so that thestudent can see at a glance the conditions which are foundin connexion with valvular affections and other morbidstates of the heart. The chart has been arranged by Dr.J. D. Comrie, assistant pathologist, Royal Infirmary of

Edinburgh. A small pamphlet on the symptoms and

physical signs of cardiac disease accompanies the chart.

JOURNALS AND MAGAZINES.

Ophthalmology. Edited by H. V. WÜRDEMANN, M.D.,and a large Editorial Staff. Vol. V., No. 4. July, 1909.Seattle : Metropolitan Press. Price 6s. 6d.--The originalarticles in this number are 12, and there are numerous

abstracts from English and continental works as well as

reviews of books. Amongst the more important originalarticles are: 1. Amblyopia or Anopsia, its Nature and

Treatment, by A. Alison Bradburne of Southport. 2. The

Restoration of Vision in Strabismus, by the same writer.This latter is an interesting subject, and the author

gives some valuable suggestions. 3. Metastatic Carcinomaof the Choroid, a Critical Study with Case Report,by George F. Sukers, M.D., and Lorenzo N. Grosvenor,M.D., Chicago. The chief points noticed are that it

usually occurs between the ages of 30 and 40 years, is

commonly bilateral and proves rapidly fatal, that the blood-vessels are frequently involved, that the tension is not

uncommonly minus, that the retina is frequently extensivelydetached, and that the tumour cells rarely invade the retina