Book reviews

CURRENT SCIENCE, VOL. 102, NO. 6, 25 MARCH 2012 924 sequences of the genome, the phenotypes associated with them and their possible role in disease causation. The recent developments in understanding the genetic basis of human genetic diseases have resulted in medical genetics moving from bench to bedside. Four chapters in the book deal with the practical implications of the new knowledge being generated regarding the genetics of atrial fibrillation, Parkinsonism, speech and language disorders and schizophrenia. Xiao et al. discuss the genetic mechanisms underlying atrial fibrillation and how the integration of this genetic information into clinical practice may aid in the early identification of at-risk patients. Further, the knowledge of the molecular pathways involved may help in identifying potential therapeutic targets. Gejman et al. present a detailed description of the molecular genetics of schizophrenia, the role of genotyping arrays and next-generation sequencing in the elucidation of the genetic basis of the condition, the genetic variations associated with it, and its genetic overlap with other psychiatric disorders. The chapter by Kang et al. throws new light on the genetic basis of speech and language disorders such as aphasia, stuttering, articulation disorders, verbal dyspraxia and dyslexia, and the utility of linkage studies and the candidate gene approach in exploring the genetic mechanisms underlying such

100 pages) deals with the various methods of examination of the abdomen in general and the stomach in particular, while several chapters are devoted to chemical, microscopic, and other tests of the digestive apparatus. Diseases of the stomach are considered in two sections which deal with organic and functional diseases respectively, while diseases of other organs which present stomach symptoms are dealt with in the last section of the book.
The book will serve a very useful purpose in so far as it treats the subject a little more fully than most of the ordinary manuals on medicine, and without the superfluity of detail which is common in a book written for specialists. If there is any fault in the book it is that too many alternative tests have been incorporated, and we think that the practitioner and student alike would have been more content with the minimum of tests, particularly when, as even in the author's opinion, some of the tests would be better to be abandoned.
There are several typographical errors, which could have been avoided by more careful proof-reading, but no doubt these will not appear in future editions. We can recommend the book to any who wish to  If the Great War was responsible for much evil it gave also opportunities for much careful observation of, and inquiry into, surgical problems. The resulting gain to surgery forms no inconsiderable part of the bright side of the picture, and perhaps in no department has this shown itself more than in that of the surgical lesions of the peripheral nerves. On this account the volume now before us will be carefully scrutinised, and none the less because of its modest size?less than 200 pages. The authors of the present treatise may therefore rest assured that their work will be read with attention by all practising surgeons. The foundation for the work is the experience gained by the authors, in the Edinburgh War Hospital, in the observation and treatment of exceptionally abundant material.
The text is arranged in three parts, of which the first deals with anatomical considerations in which the origins of the nerves from spinal roots and from the plexuses are fully gone into. The various sections are conveniently and systematically arranged for reference, and are furnished with diagrammatic aids. Diagnosis next comes under review, with its general principles and special difficulties. This section is extremely well done, and gives the reader an excellent idea of how to set about examining a case. A good illustration of the authors' methods occurs in the section on " substitution" in the limbs (p. 32), whereby the action of paralysed or impaired muscles is taken on by healthy neighbours, and "trick" movements produced. A brief description of the types of lesions found at operations is followed by the indications for operation. The authors' rule is to explore the nerve in cases where steady improvement is not going on at the end of three months after wound healing. As regards the type of operation, this depends to some extent on the function of the nerve in question. For example, the sensibility of the finger-tips is of great importance.
Hence, in median injuries every effort should be made to restore sensation, while motor losses may be compensated for by tendon-transplantations from the extensors. The methods of dealing with complete lesions are enumerated, and the different ways of overcoming a given gap in various nerves are described. Then follows a consideration of partial lesions.
Prognosis and after-treatment conclude this part of the work.
Part II deals with the operative treatment of war injuries of the nerves, and opens with valuable "General considerations." These are very evidently based on the authors' experience of actual operative work, and as such merit the reader's careful consideration. The use of a tourniquet to a limb is deprecated because of subsequent oozing. Dissection should be too extensive rather than too limited, and should be carried along the trunk, and also laterally to free muscles and tendons, from cicatricial tissue.
Longitudinal incision into injured portion of nerve is advised in doubtful cases as giving the surgeon valuable information as to the presence or absence of bundles of fibres.
When in doubt on this point exsection is favoured, provided the stumps can be afterwards brought into apposition without tension. As regards permitting extension of the united nerve, pain is a useful indication of how far we can safely go in this direction. Latent sepsis should be tested for by heavy massage as soon as the original wound of injury has healed. As regards operative procedures, special attention is drawn to the "twostage slow-stretching" operation. In addition to operative points, anatomical generalisations will be found, e.g.y the closeness of origin from the parent trunk of branches to muscles of one group. Following on these general considerations we find individual nerves taken up in detail, this part of the work being furnished with numerous coloured figures which indicate clearly the anatomy of the parts concerned in the text. These illustrations are from drawings made by one of the authors at time of operation.
In Part III special attention is given to tendon-transplantations, and details are furnished of some special operations. We have indicated above the general outline and scope of this work, and it only remains to say that the subject is admirably worked out. The attention with which we began the perusal qf the volume deepened into interest, and that again into an appreciation of our indebtedness to the authors for placing before us a treatise whose value it would be difficult to overestimate. The publishers on their part have not been behind the authors, and the result is a well-favoured practical book which we have both pleasure and confidence in recommending to our surgical confreres. There has been for a long time a crying need for some authoritative work in English dealing with the relationships of ophthalmology and general medicine. It cannot be said that the hiatus is quite filled by this book, but it is at least a very welcome contribution to British ophthalmological literature.
Although it has evidently been far from the author's intention to compile a book which would form a complete survey of the subject of medical ophthalmology, he may perhaps be induced, by the success which the present work is sure to achieve, to aim at something in that direction. The need is evident, and material is easy of access. It would, of course, be impossible to give even a good synopsis of the subject within the compass of three hundred pages, but it is perhaps not unfair criticism to suggest that more room might have been found for the fuller consideration of the more important topics by the omission of paragraphs dealing with such subjects as jaw blinking, snow and eclipse blindness, electric amblyopia, oyster shuckers' keratitis, and factitious conjunctivitis, which seem out of place in a work on medical ophthalmology. Again, there is some lack of system in the arrangement of subjects, and sectional headings refer now to some general disease, now to some ocular symptom, often seemingly unrelated. The lack of proportion and of plan, which is the superficial defect of Foster Moore's book, arises no doubt from the fact that the author throws the chief emphasis on those snbjects which have absorbed his interest during nine years of work in the medical wards of a general hospital, and the value of the book lies mainly in those pages which embody the results of his own investigations and the expression of his personal tfo. 4. S Vol. XCVIII.
opinions. These will be found especially in the chapters devoted to retinal vascular changes, renal retinitis, and the ocular complications of diabetes. In describing the retinal changes associated with arterio-sclerosis, the author writes of these as " arterio-sclerotic retinitis," a local disease " quite distinct from renal retinitis." Although it will be generally agreed that there are cases of retinitis, embracing vascular changes, haemorrhages, white spots, &c., in which albuminuria is absent or slight and intermittent, and that in these cases the prognosis is very much better than in similar cases with urinary evidence of renal disease, we would submit that it is impossible, on ophthalmoscopic grounds alone, to distinguish sharply between renal and arterio-sclerotic retinitis. The diagnosis and prognosis can only be established when the retinal changes are considered in conjunction with the results of physical and urinary examinations. Although there is much in this work to arouse criticism, it is one which should find a place on the shelves of all who are interested in the subject of medical ophthalmology. The publishers have produced the book well, and at a moderate price; paper, print, and illustrations are good, and misprints and errors are few. (12s. 6d. net.) As Colonel Kirkpatrick remarks, the subject of cataract possesses a peculiar fascination for the ophthalmic specialist. With a better understanding of the pathogenesis of cataract a day may come when its prevention and cure will be a medical, rather than a surgical, problem; but that day has not yet dawned, and the successful operative treatment of cataract remains the supreme test of the skill of the ophthalmic surgeon. Whether cataract is more prevalent in India than in European countries is an undecided question, but it is well-known that the civil surgeon in India passes an enormous number of cataract patients through his hands, and consequently acquires a familiarity with cataract in many of its forms, and ha? opportunities of working out his operative technique in a way scarcely possible to the ophthalmic surgeon in this country.
Colonel Kirkpatrick, out of his Indian experience, has given us this useful handbook, which covers the whole subject of cataract, not exhaustively, but much more fully that it can be dealt with in a general text-book of ophthalmology. This applies especially to the operative treatment, which occupies two-thirds of the 196 pages, The earlier chapters deal in an interesting way with the development, anatomy, and nutrition of the lens; the histological, physical, and chemical changes in the cataractous lens; the etiology, varieties, and diagnosis of cataract, and its non-operative treatment. The chapters dealing with the nutrition of the lens, and the physical and chemical changes associated with cataract, are especially welcome, as this aspect of the subject receives little attention in the average text-book; and the short chapter on the non-operative treatment of cataract will be generally regarded as an adequate and fair statement of the present-day position. The section on the differential diagnosis of cataract might have been elaborated to some extent, and the illustrations of persistent remains of the foetal pupillary membrane would be better omitted, as they give this anomaly an importance which it does not possess in this connection. It is unnecessary to follow the author through his chapters on the operative treatment of cataract. Suffice it to say, that very little is omitted that the ophthalmic surgeon will expect to find with reference to the preparation of the patient, the choice of operation, the technique of the different procedures, aftertreatment, and the treatment of complications. A reasonable amount of space is devoted to such variants as the conjunctival flap and conjunctival bridge operations, and two pages are, given to Barraquer's phakoeresis operation. Some pages, notably those dealing with the intra-capsular extraction, would have been more easily understood if it had been possible to include a few illustrations.
The author does not express his opinion as to the relative value of this procedure, but, on the whole, it would appear that his preference lies with the older operations which include a capsulotomy. The reader will find, scattered through these pages, much of that valuable advice which can only come from wide experience and careful observation. The book is well printed and illustrated. There is a remarkable freedom from typographical and other errors (we note only the occurrence of " meridia" as the plural of " meridian"), and the author's style is clear and readable, although it is occasionally marred by a too liberal use of commas.
We can cordially recommend Colonel Kirkpatrick's book to those interested in the subject. This book can be recommended to the medical practitioner who is in search of a simple treatise on that common disorder?nerve exhaustion?the effects of which are so widespread throughout the body. One is so accustomed nowadays to the term "neurasthenia" as applied to the above symptom-complex, that it is of considerable interest to find that in this volume the author avoids the term altogether. One is left in some doubt as to whether he regards nerve exhaustion and neurasthenia as synonymous terms.
The problem of the prevention of such exhaustion receives particular attention. In this connection the author lays special stress on "hypersensitivity," due either to an inherent constitutional defect or to some exceptional strain to which the individual has been subjected. He holds that it is this hypersensitivity which in varying degrees brings about the ultimate collapse of the nervous system, and pleads for earlier recognition of the signs of this condition, so that timeous steps may be taken to prevent the development of the later and more serious symptoms.
The chapter on causation is short and explicit, and is followed by a full account of the symptomatology of the condition.
A special section is devoted to the consideration of sleeplessness and its treatment, and this will be found to contain much useful information to aid the physician in dealing with this familiar and troublesome symptom. One may reasonably remark, even in a work of this size, on the small space allotted to the question of diagnosis and prognosis, particularly when a diagnosis of pure nerve exhaustion can only be arrived at when by elimination everything else has been ruled out. It Reviews.

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is impossible in such cases to over-emphasise the need for careful examination for organic diseases of the nervous system at its earliest stages. The question of treatment is dealt with generally and specially, and particularly is one glad to find that drug treatment, apart from narcotics, is regarded as of secondary importance. The book is well printed in a nice clear type, which renders reading easy. During recent years the advance of physiology has been in many directions, and not least in that path by which it has made direct use of the recent developments of applied physics.
So much has this been the case that we have witnessed the evolution of a new division of the science of life, biophysics. This new point of view obtained by the application of physics to the study of vital phenomena, is gradually making itself felt in clinical work. It is becoming more and more essential for the clinician to have at least an elementary idea of biophysical and biochemical phenomena in order properly to understand the true significance of pathological manifestations. Unfortunately, but unavoidably, the subject of biophysics involves a knowledge of the latest advances in the physical sciences, and a consideration of physical laws which are none too easy of comprehension by those who are not acquainted with higher mathematics. The presentation of the subject in a simple non-technical manner is therefore not an easy task. It has, however, been accomplished by Professor Burns. The volume commences with a consideration of the laws of energy, and, among other things, considers very fully the subject of calorimetry. We would commend this chapter specially as giving a clear and lucid explanation of the fundamentals of this important subject. Physico-chemical processes are then explained, and the ideas derived from them applied to the study of cell-life. Thereafter the various systems of the body are considered from the physico-chemical point of view, and, lastly, the organism is studied as a whole. Part two consists of the description of illustrative experiments which should be of use to teachers in general. The illustrations?many of them original?are excellent, as is the general get-up of the volume. We would heartily recommend this volume to all who desire to enlarge their knowledge of the fundamentals of vital phenomena. Each lecture is complete in itself, and is written in such a style that the reader's interest is always maintained; the person, however, who is not conversant with chemistry will find it difficult, if not impossible, to understand certain passages, but those who have some knowledge, even though it should be elementary, of the subject will gain much in breadth of outlook by a study of this book. It is a happy blend of the history of famous chemists and physicists, chemical theory, and the application of chemistry to agriculture, the arts and sciences, and especially to war-like purposes. The last occupies a large portion of the book, for the Great War forced the scientific chemist to extend his investigations in many unexpected directions, the results of which, as in the fixation of nitrogen, will persist when war is forgotten. As in Part I the text is printed from two different founts, the descriptions of the structures being in smaller type than that in which the directions for dissection appear.
The volume opens with the order of dissection, the number of days required being indicated for each region. A total of 50 is regarded as suitable for this part of the body. Beginning with the perinseum, the dissectors are allowed three days in which to display and study the contents of the rectal and uro-genital triangles. Thereafter they have an opportunity of examining the lumbar region during its dissection by the dissectors of the arm and of the head and neck. The Manual directs them here to the posterior relations of the kidney, and later to the arrangement of the lumbar fascia. The dissection of the anterior parietes comes next, and the directions and description, which occupy upwards of 30 pages, are very comprehensive, a considerable amount of attention being given to the details of the inguinal canal and its contained structures. The abdominal cavity and viscera are carefully described, and the dissectors then proceed to the thorax and thoracic viscera, the posterior thoracico-abdominal wall, and, lastly, the pelvis. The present volume of the work fully maintains the high level attained by its predecessor. It gives the student an accurate and interestingly written account of the anatomy of the thorax and abdomen, which he will fully appreciate when he comes in his later curriculum to the clinical application of the knowledge so gained The text is illustrated by upwards of 80 excellent figures. These two volumes present an elaborate study of the pathological changes found in two outbreaks of broncho-pneumonia in the United States Army?the former occurring for the most part after measles, and the latter after influenza. In the 1917-18 epidemic the organism causing the disease was, a hemolytic streptococcus, which produced a peculiar form of bronchopneumonia, and although most of the patients had suffered from measles, the streptococcus apparently acquired sufficient infectivity to spread among those who had suffered no predisposing disease.
Severe cases were characterised clinically by early appearance of fluid in the pleural cavities, severe dyspnoea and often cyanosis: and post-mortem in such cases there were generally found patchy collapse of the lung, engorgement of blood-vessels, and areas of haemorrhage and great changes in the walls of the bronchi.
In the second epidemic described, pneumonia occurred as a complication of influenza. Here various organisms were found to bring on the pneumonic attack, and the author's special aim has been to point out the typical . reaction in such lungs to the invasion of particular bacteria. Upon the question of the prime cause of influenza there is still no general agreement, but there is agreement that it reduces the resistence of the body to infection, and so allows secondary invaders to grow unchecked.
Professor MacCallum vigorously upholds the view that the Pfeiffer bacillus is merely one of these secondary organisms. He emphasises the local geographical distribution of some of the organisms, a fact which is probably insufficiently recognised by those who have found bacillus influenzae regularly in their cases. The volumes are valuable for their description of special varieties of broncho-pneumonia, and should be consulted by all who work on the subject. Hormone Therapy by Sera, Vaccines, and Drugs. By D.
He believes that all defence is physiological, and is at least potentially present before infection. The lymphatics produce antibodies, from which comes the specific resistance obtained by the hypodermic injection of sera. Given orally the antibodies are neutralised, and therefore ineffective. The blood serum, however, contains all the hormones required by the body, and these are not lessened in therapeutic value when taken orally. The conception of the production of hormones to meet pathological conditions affecting the tissues, and the use of sera containing them, so that any one or all of them may be passively transferred to the patient is, as the author states in his preface, quite a new departure. He employs chiefly normal serum under a trade name, and antidiphtheria serum of low potency, both orally. He also uses vaccines and certain drugs, e.g., cantharidin and emetine, for the active production of " different hormone balances." Much of the author's theory is difficult to follow and accept. As to his results, he states dogmatically that they are facts, and his statements are supported in an introduction written by his partner. None of his cases are fully detailed, but a few examples may be given. Fifteen cases of alcoholism, many of them "hopeless" cases, were treated successfully by J-grain of emetine hypodermically every second day. Appendicitis, acute and chronic, is treated by oral administration of serum, with the reservation that if there be definite appendicular tenderness on palpation after seven days' treatment, operation is advised. Good results are obtained in asthma by the use of streptococcus vaccine, and any form of iodine orally. Three " severe cases of ruptured duodenal ulcer " were successfully treated without operation ! Results are also good in lobar pneumonia, bronchopneumonia, acute rheumatism, hay fever, synovitis, &c. The author is evidently an enthusiastic believer in his methods, but the medical profession of this country will require much more definite and detailed evidence before giving them full acceptance.
Hygiene of Women and Children. By Janet E. Lane-Claypon, M.D., D.Sc.Lond. London: Henry Frowde and Hodder & Stoughton. 1921. (15s. net.) This book is primarily intended by the author for the use of nurses and health visitors in connection with child welfare, but there is much useful information in its pages which cannot fail to be of service to a wider clientele. So much has already been accomplished along the lines of communal hygiene that the present generation is apt to take the communal aspect for granted, but it is to the hygiene of the individual and the home that this book is specially directed. The author has succeeded in including a great amount of up-to-date information which hitherto has not been readily accessible. This has been accomplished in a clear and readable manner, though it may be said that the treatment of some of the subjects dealt with is of a more advanced nature than is necessary for the readers to whom the book is specially addressed. For instance, part of the sections on "Food and feeding," "Bacteria in milk," and can unhesitatingly recommend it to everyone who is seriously interested in the subject. Of the valuable surgical experiences which have been acquired during the war that of injuries to the peripheral nerves has proved of greater use than most. Where re-establishment of function is so long delayed after operations on nerves, it has naturally taken a long time to arrive at a just estimation of the ultimate results. Such an estimation Mr. Platt has provided in his Hunterian lectures, in which he makes a wide survey of this field of surgery. All those who are interested in surgery of the nerves will find these lectures full of information. There are too many points of interest to be referred to here, but, of the period of delay between the original injury and the performance of the operation, he considers the influence of the time factor has been definitely proved. "As a general rule, sutures performed within a period of eighteen months show little appreciable differences in the time of the onset of recovery or the rate and ultimate completeness of the recovery; after a delay of two years, recovery is often seen to be tardy, incomplete, or in some cases fails completely." Submucous Resection of the Nasal Septum. By W. Meddaugh Dunning, M.D. New York : Surgical Publishing Co. ($1*50.) This is a very comprehensive book, giving a detailed description of the etiology of septal deflections and of the technique of the operation. It is a carefully thought-out work, and reflects a very considerable experience of the subject. The physiology of the nose is dealt with, and the opinions arrived at regarding the etiology of septal deflections are formulated. The technique of the operation, as practised by the author, is described, and the modifications thereof in different types of deflections and spurs. It is of interest to note that the author constantly makes use of an L-shaped incision, and that he always makes heviews.
the original incision on the left side of the septum. Of the advantage of this proceeding, operators will form their own opinions. A curious omission?which may, of course, be voluntary?is that no mention is made of the turbinal disturbance which constantly accompanies septal deflection. Almost invariably, there is turbinal hypertrophy on the side of the septal concavity, and the hypertrophy of the posterior ends following the operation, is a matter of common knowledge. The chapter on " typical case-histories and their significance" is particularly welcome. Its subject-matter could not be included in the ordinary text-book of rhinology, but its addition to the work under review constitutes one of the virtues of a volume which is a valuable addition to the bibliography of the subject. The book is well written, and its freedom from the lapses of diction, which characterise many American text-books, must evoke approval. The only error in the letterpress is in the first line of the second paragraph of page 62, where the word