REVIEWS AND NOTICES O F BOOKS 587 The author points out in the opening sentence of his book that z rays, if applied in sufficient

intensity, induce destructive changes upon all cellular tissues. He then refers to the work of Scitx and Wintz in regard to the dosage required to induce changes of a favourable kind in the treat- ment of various conditions. He is not in agreement with the very definite statements made in their work on the action upon cancer and other forms of tumours. As a basis for calculation the doses mentioned may be useful, but like many other workers he cannot accept without reservation the statement that 110 per cent of the erythema dose is the lethal dose for cancer.

He calls attention to the theory put forward by Regaud and Nogier of the specific biologic action of different wave lengths, and quotes the evidence in support of this theory. He contrasts it with the views expressed in Fredrich and Krong’s well-known work. These workers maintain that the extremity of the biologic action would appear to be independent of the wave lengths of t,he incident rays. For the same dose absorbed in the mass of tissue the biologic action is the same for filtered and for unfiltered rays. The writer inclines to the latter view, but says no definite statement can yet, be made.

The very important matter of the tube used in deep therapy is entered into : several types are described. The boiling-water tube so much used until recently in Germany is discussed. The Lilienfeld tube is very favourably commented upon ; there is no doubt that t.his tube possesses certain advantages over the others.

The physics of radiation therapy has been exhaustively dealt with by the author ; the absorp- tion of the rays by the filter, and the value in relation to a standard, such as water, are described. Water is then taken as a standard of comparison with the human tissues, and though the relation is not absolute, i t is yet sufficiently near to enable the author to give useful indications for the calculation of the depth dose.

The very important matter of the divergence of the rays in the medium used is dealt with in a very lucid manner. The scattering of the rays in the tissues furnishes a very important factor in deep x-ray therapy. These are entirely useful to the x-ray therapist.

Multiplication of the ports of entry or cross fire has been engaging the attention of workers for years ; this is briefly explained. Various methods for determining the coefficient of radio are described and their value indicated.

Those dcsigned in various centres are det,ailed, and a full explanation given of t,he intricate structure of the most popular types. The latest developments of the French technicians are referred to, and their advantages clearly put forth. The apparatus shown on page 47 gives an illustration of a complete installation. This indicates the great developments which have been made in this direction.

The important question of the measnrement of the radiations is admirably dealt with, the various methods are outlined, and an excellent description is givcn of the ionization method. The ionometer designed by the author is fully described in the test, and the description is made easy by the inclusion of a number of good diagrams.

Valuable tables of absorption values are given.

An important technical point is discussed in a lucid manner.

The apparatus used in deep therapy is fully described.

Prophdeutique et Technique Urologiques. By DR. G. WEINEK, Bruxelles. Large 8vo. Pp.

TIIIS book is devoted entirely to desrriptions of the various methods employed in the investigation of cases of diseases affecting the genital and the urinary tract.

Two chapters are devoted to descriptions of all the usual and unusual examinations of urine and genital secretions in health and disease. The nest chapter deals in detail with cystoscopes, urethroscopes, bougies, and other instruments used by the urologist. After a description of the special methods of anaesthesia which may usefully be employed, and the indications for their employment, there follow chapters on the examination of each of the individual organs of the genito- nrinary system. These are the most valuable part of the book, for the many variations met with in disease are well described, and many useful points in technique are given which simplify the investigation of difficult cases and aid in forming a corrert diagnosis.

The earlier part of the book is equally well written, but does not contain much that will help the surgeon who specializcs in this branch of surgery, and seems hardly likely t o be read by others. Therc are some useful diagrams.

492, with 153 illustrations. 1922. Paris : Masson et Cie. SO fr.

The Thyroid Gland. Clinics of GEORGE W. CRILE and ASSOCIATES. Edited by AMY P. ROWLAND. Yp. 288. with 10G illustrations. 1922. Philadelphia and London : W. 13. Saunders Co. 24s. net.

A SERIES of papers on various problems connected with the surgery of the thyroid gland is gathered together in this volume. Each contribution is by an expert in his own line of work, and the collection contains much information of interest to every medical man, though it will be found of particular value to those who operate upon the thyroid gland.

588 THE BRITISH JOURNAL O F SURGERY The opening chapters. by G. W. Crile, are of a highly theoretical nature. as, for instance, that

on the rBle of the adrenals in exophthalmic goitre, and the ideas contained in them are not always easy to follow. But their author disarms criticism by explaining in the introduction that the volume is an ephemeral work, and only represents the views held in the Crile clinic a t the moment of publication. The opinions expressed will be subject to revision, or may even be reversed. The pathology of the thyroid gland is well presented, and there is a good account of laryngeal function in relation to the thyroid gland, attention being directed to the frequent occurrence of pre-operative abductor paralysis. Intrathoracic goitre, the value of observations on the basal metabolic rate, and the possibility of preventing the development of colloid goitre are all well diwussed.

Most readers, perhaps, will find the chief interest of the book to lie in the account that is given of the pre- and post-operative care of patient7 with exophthalmic goitre. Great attention is given to the subject of anaesthesia, and the importance of this is not exaggerated. Stress is also laid on the prevention of operative shock, method: now well known in association with the name of Crile being described.

In the Crile clinic this is brought to a state of efficiency such as can only be attained where large numbers of similar cases are constantly being operated upon, though it may surely scrve as a useful object lesson wherever surgery i s practised. Every surgeon has his own preferences in the details of operative technique, and will probably find something that is not to his mind in the methods used by others ; but he cannot fail to be interested in those practised by surgeons so expert as Crile and his associates ; beyond this, technical procedures and their results must be seen t o be properly appreciated OF criticized.

As already mentioned, the claims made for this volume are modest ; yet most surgeons will regard it as a valuable addition to their libraries, and those who have enjoyed the friendship of G. W. Crile will think, as they read his words, that they can almost hear again the genial tones of his voice and feel the influence of his inspiriting presence.

Many subsequent chapters, however, arc eminently practical and instructive.

Some account is given of the organization of the work done in the operating theatre.

The N e w Physiology in Surgical and General Practice. By A. RENDLE SHORT, BLD., B.Sc., F.R.C.S. Fifth edition. Crown 8v0, revised and enlarged. Pp. 330. 3922. Bristol: John Wright & Sons Ltd.

IT is difficult to find fault with a book which, in spite of the years of the war, has run to a fifth edition since first published in 1911. Its popularity is equally great among medical practitioners and among students reading for higher degrees in medicine and surgery.

In the present edition three new chapters appear, devoted to the physiology of muscular exercise, the functions of the kidney, and the dietetic factor in the causation of appendicitis. The last-named subject depends largely on the work in which the author himself has been especially interested, and hence is more fully dealt with than is perhaps quite justifiable in the present state of our knowledge. Most of the systems of the body arc included under the various chapter head- ings ; but although the new work on the heart is adequately reviewed by Dr. C. E. K. Herapath, the lungs do not come in for special mention. The newer methods of oxygen administration, t o mention one item only, would certainly be of interest to medical practitioners, few of whom have learned to get the full value from such treatment.

The references which appear a t the end of every chapter are useful to those who may wish to go further into the subject discussed. After the section on tests for renal function, mention might have been made of Professor Hugh Maclean’s little book, which gives a particularly clear and concise account of the subject.

A very few errors have been noticed in perusing the book, an amusing one being the conferring of a titlc (no doubt well-deserved !) on a well-known neurologist who has written on aphasia.

The style in which the book is written is really excellent, and the reader’s interest never flags. We agree that for medical men who are keenly interested in their work, this book must be as interesting as any novel.

9s. 6d. net.

Mistakes and Accidents of Surgery. By HAROLD BURROWS, C.B.E., M.B., B.S. (Lond.), F.R.C.S. Demy 8vo. Pp. 470 + viii. 1923. London: Baillike, Tindall & Cox. 10s. Od. net.

As we know t,he reputation both of the author and of the publishers, we can readily believe the latter’s disclaimer that publicity in the lay press was not sought by either ; but the pity is that such a disclaimer should be necessary. As we glanced through the volume-and it was purposely done far more carefully than usual-the thought ‘‘ What on earth was this book written for ? ” constantly recurred to the mind. It is impossible to regard it as a “ serious scientific work” as claimed by the publishers, for if it is to be judged by this standard, the verdict can only be that i t is trivial and cursory. Mr. Burrows cannot have written this book for his peers, or even for those beginning the practice of surgery in the orthodox way a t a large hospital. If so, i t

Then again, For whom was i t written ?

Is i t for the type of would-be operator with no surgical training?