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Mr. S, Maynard Smith, and Mr. C. I. Graham.-Mr. T. CrispEnglish showed the following specimens: (1) A Fibro-adenoma of the Breast of great size, which was removed froma patient who was five and a half months pregnant; (2) aMalignant Growth of’ the Prostate Gland removed by himfrom a patient aged 70 years ; and (3) a Twisted CalcifiedFibroid of the Uterus of great size, which had caused sym-ptoms of intestinal obstruction. The tumour was removed byoperation.SOUTH-WEST LONDON MEDICAL SOCIETY.-The

first meeting of the winter session of this society washeld on Oct. 14th, when an address was given by Dr.L. S. McManus, the President, on General Practitionersin Relation to Each Other, to the British Medical

Association, and to the General Medical Council. A briefsketch was given of the relationship of medical mento one another in the past, illustrating by examples culledfrom history, art, and literature, how our predecessorssuffered like medical men of to-day from evils arising out ofprofessional rivalries and jealousies and misconceptions onthe part of the public ; it was pointed out how the formationof societies such as the South-West London and on a largerscale of the British Medical Association had ushered in an eraof greater kindly feeling and cooperation in which much goodwork had been done. Owing to the failure of the BritishMedical Association to fulfil the objects for which it hadbeen founded, of late years it had been found necessary torevolutionise it and to place it on a broad democratic basiswith many and varied functions designed for the advantageof every individual member as well as of the profession asa body. The General Medical Council was instituted for the

protection of the public, and its main function, which hadbeen adequately performed, was the supervision of the mentalequipment of every student. The Council, however,lamentably failed to afford any protection to the prac-titioner when once qualified, a failure due to the insufficientrepresentation of the general practitioners. In conclusion,the President urged on all practitioners the necessity ofcombination if the profession were to maintain its rightfulposition.

Reviews and Notices of Books.Applied Physiology: A Handbook for St1ldents of Medicine.By ROBERT HUTCHISON, M.D. Edin., F.R.C.P. Lond.By ROBERT HUTCHISON, M.D. Edin., F.R.C.P. Lond.

London : Edward Arnold. 1908. Pp. 298. Price7s. 6d. net.

THIS is an attempt, and a successful attempt, to apply phy-siology to medicine in the same way as anatomy has long beenapplied to surgery. It is intended to be a companion to, andnot a substitute for, physiological text-books. An account ofmethod is omitted : the chief emphasis is laid upon facts

which have a direct bearing upon clinical work. There is

no chapter on muscle, nerves, or the special senses. What is

included is physiology as applied to metabolism (pp. 48),body heat (pp. 22), blood and hmmopoietic organs (pp. 34),heart and circulation (pp. 72), respiration (pp. 48), digestion(pp. 53), and excretion (pp. 20).

In connexion with the question of the metabolism of pro-teins, Chittenden’s estimate of 60 grammes per day insteadof 118 is mentioned and the author remarks, I I it would bewell for the physician to be cautious in applying theseresults in practice." Experience has shown the value of aliberal meat diet in tuberculosis, while the Japanese have found Ithat a liberal meat diet given to their sailors is a prophylactic ’,against beri-beri. A person cannot be made strong by aliberal protein diet, exercise must be taken at the same time.Massage has no appreciable influence on metabolism and istherefore in no real sense a substitute for exercise. Meta-bolism is treated from the quantitative point of view,expenditure and income of energy, storage of surplus energy,and then is set forth the influence of age, sex, build of the

body, work and rest, season, period of day and weather,nervous system, internal secretions, and personal peculiarity

on metabolism., Qualitative metabolism is then dealt witb,including proteins, fats, and carbohydrates, which leads upto the consideration of diabetes and the metabolism of uric

acid. Sometimes the temperature is given in degrees Fahren-

heit, sometimes in degrees Centigrade. The blood itselfis considered not only as a medium of exchange and.as a tissue, but also as a means of defence, and hencethe importance of its antitoxic and bactericidal pro-

perties ; and for this reason " hæmatology " has assumeda very important place in latter-day medicine. The term

" apex beat " is retained for cardiac impulse. The nervousmechanism of the heart apparatus is carefully considered inrelation to disease, while a general account of the chieffacts of the circulation on which physiologists are agreedis supplemented by clinical facts. The capillary pressure isstated, on the authority of Hill, as being often above 100 milli-metres of Hg. I I Cold contracts the peripheral arteries andraises the blood pressure, so that the first onset of cold

weather in winter is apt to be attended by a crop of apoplexies "

(p. 165). The splanchnic nervous system is the ’’ resistance

box " of the circulation. Ludwig long ago pointed out theimportance of the portal system in the regulation of the

arterial blood pressure.Special emphasis is laid on nose-breathing and the whole

treatment of the respiratory processes is eminently scientificas well as practical. The treatment of certain conditions byinhalation of oxygen has justified itself in practice (p. 213),and the author quotes French writers on the effects of

decompression in "caisson disease," when they say " pay-ment is only made on coming out." Deep breathing is nosubstitute for exercise, this alone can really increase theoxidation processes in the body. The researches of Pawlow,of Cannon, and Hertz are woven into the story of the

digestive processes and their practical applications are fullystated.

We feel sure that this work will prove useful not only tothe student beginning his clinical work but also to the prac-titioner who has long since "walked the hospitals." It is

written in a style at once simple and attractive which makesthe assimilation of the facts both easy and effective. The

salient facts of physiology find their appropriate applicationin the study of the phenomena of disease.

Atlas Chirurgisch-pathologischer Röntgenbilder. Mit 240

autotypischen, 105 photographischen Bildern, 66 Skizzenund erlauternden Text. (Atlas of Radiograrris of SacmgictctDiscases. With 240 autotype and 105 photographic figuresand 66 sketches and explanatory text.) By Dr. RUDOLFGRASHEY, Assistenzarzt der K. chirurgischen Klinik zuMunchen. Lehmann’s Medizinische Atlanten, Band vi.Munich: J. F. Lehmann. 1908. Pp. 152. PriceM.22.THE above work, as the title infers, is confined solely to

the consideration of surgical diseases. It is divided intotwo parts. The first consists of 49 pages devoted to a shortconsideration of the following subjects: foreign bodies,concretions, diseases of bone, diseases of joints, deformities,tumours, pathological changes in the soft parts, dislocations,and fractures. The chapters on the location of foreign bodiesand on the diseases of bone are by far the best; the othersare a little disappointing, especially the scanty notice givento renal calculi.

The second part consists of numerous reproductions oftypical radiograms with very full descriptions of each plate.Here there can be nothing but praise for the excellent repro-ductions of the prints. The difficult problem of bringingout the minute texture of the bones in book prints seems tohave been solved most satisfactorily. In fact, the re-

productions are as good as successful positives. In the

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diagnosis of bone disease radiograms are useless unless thistexture can be properly studied. Past books on the subjecthave usually erred in this respect and have therefore been oflittle use to the practitioner who is unable to study a seriesof radiograms first-hand. We can therefore confidentlyrecommend this book to those who wish to study the subjectof differential diagnosis of diseases of bone by means of thex rays, a subject which has so far been comparatively neglected.With a knowledge of the subject such as this book confers ’,it is comparatively easy to say whether osteitis is tubercu- Ilous, syphilitic, or due to the other more virulent pyogenicorganisms, and to differentiate inflammatory swellings fromtumours of bone, a boon which no other method of examina-tion confers with half the same certainty. We recommend it

specially to those who have to deal with large numbers ofobscure cases of diseases of bones and joints in the out-patientdepartments of the large hospitals.The book is worth buying as the plates are accurate

records of typical pathological conditions and can thereforenot get out of date. Nor is modern printing likely to

reproduce such plates any more accurately in the future.

The plates could hardly be better done.

Essentials of Physiology for Veterinary Stttdents. By D.NOEL PATON, M.D., B.Sc. Edin., F.R.C.P. Edin. Secondedition. Profusely illustrated. London and Edinburgh :William Green and Sons. 1908. Pp. 464. Price 12s. net.

IN setting himself the task of writing a book on veterinaryphysiology Dr. Noel Paton has well earned the thanks of .theveterinary community, both of students and practitioners.Realising the pressing need for a work of this nature he hasbrought to bear on the subject not only his knowledge asa professor of physiology but also the experience whichhe gained as examiner in the same subject appointed by theRoyal College of Veterinary Surgeons. In this capacity hehad from time to time before him the students for whose

assistance he has now compiled the volume under review.Careful reading of Dr. Paton’s book conveys the impres-

sion that the author writes from the point of view of

the scientific theorist. The trained veterinary practitionerwhose life’s work lies amongst the animals of the farm

will disagree with some of the statements made. Thus we

can find no mention of the fact that the horse possesses no

gall-bladder. In speaking of this organ Dr. Paton would seemto give the impression that it is possessed by all animals, yet , it is a fact which is of great clinical importance that theequine bile-duct has no diverticulum and consequently thebile dribbles continuously in small quantities into the bowel.We have only to consider this fact, associated as it is withsmall capacity of the stomach in this animal, to appreciatethe necessity for feeding the horse frequently, and withsmall quantities each time, if we would keep it in health ;

recollecting, too, that it adapts itself to these incon-

veniences in the natural state by being a continuous feeder.General physiology is fundamentally the same in both

man and animals, and animal protoplasm is exactly the sameas human. The circulatory system is the same in both, andthe human nervous system only differs from the animal inbeing more highly developed. But in the alimentary tractwe find great differences of structure and variations in the

composition of the digestive juices. For the most part theauthor deals with this complex subject in a manner which

leaves little to be desired. He states briefly the nature andcomparative value of the various food-stuffs ; he points outclearly the differences in value between the foods of the car-nivora and the herbivora ; and he describes the relationbetween the foods and the nature of the tract through whichthey pass. He demonstrates clearly in the text and by meansof some excellent diagrams the anatomical peculiarities to be

found in each animal. He describes the different processes

through which the foods pass after being eaten, discussingtheir digestibility and energy value, the part which they playin the metabolic processes, and their ultimate fate in thetissues. All these matters are dealt with exhaustively yetwithout superfluity. Reproduction, the bugbear of the

student, is rendered admirably clear and simple in the con-cluding pages of the work, the value of which would havebeen enhanced, however, if greater emphasis had been laidon the differences to be found in the placentation in thedifferent animals.

Taking the book as a whole we feel sure that the informa-tion contained in it will be welcomed by the present-dayveterinary student, and we venture to express a hope thatwhen it comes to a third edition the wants in this direction

of the veterinary practitioner may also be more fully dealtwith especially in reference to the everyday occurrences

which are met with in daily practice ; in fact, if we may souse the term, we should like to see the book named a" clinical" " veterinary physiology.

LIBRARY TABLE.

Diseases of the Genito- Urinary Organs and the Kidney.By ROBERT HOLMES GREENE, A.M., M.D., Professor of

Genito-urinary Surgery, Medical Department of Fordham

University ; Genito-urinary Surgeon to the City and to theFrench Hospitals, New York City; and HARLow BROOKS,M.D., Assistant Professor of Pathologic Anatomy, Universityand Bellevue Hospital Medical School ; Visiting Physician tothe City Hospital, New York City. With 292 illustrations.London and Philadelphia: W. B. Saunders Company. 1907. ’Pp. 536. Price 21s. net.-In this work we have for the first

time, so far as we are aware, a treatise on the genito-urinarysystem which has been written jointly by a surgeon and by aphysician. Nearly the whole of the literature of this

important department of therapeutics has been written froma surgical point of view, therefore it is well sometimes tohave combined with this the medical aspect of the subject.We are also pleased to see that the urinary part ofthe genito-urinary system has received its due share

of notice, for in many works on the subject sexual dis-

orders have usurped more attention than they deserve.A good account is given of the instruments employedin the examination of the urinary organs, and we are

inclined to agree with the authors that urinary segregatorswill give way to ureteral catheterisation. With the latter

method the results are much more certain, though it is

probable that less skill and experience are required in theemployment of a urinary segregator. The authors speakfavourably of massage of the kidney and ureter as an aid indiagnosis of suppurative nephritis. The method was intro-duced by Giordano of Venice and it deserves attention, butthe cases in which it is likely to be useful are probably fewin number. A very brief account is given of litholapaxyHid the authors are mistaken in saying that Bigelow wasthe inventor of the evacuator, though he should certainlyhave the credit of extending its use greatly. The histology)f hypertrophy of the prostate has been fully investigatedby the authors and their conclusions are that the conditions certainly inflammatory, and they are inclined to attributet in most cases to a posterior urethritis, usually of gonor-hœal origin. A good description is given of the perineal)peration for enlarged prostate, but the account ofhe suprapubic operation is inadequate. We should likeo know the evidence that the authors have for saying thathe ordinary radical operation for hydrocele affects theunction of the testis. They say : " By removing the tunicahe natural covering of the testicle is destroyed, and it wouldeem to follow, as a matter of course, that the adhesion with