reviews and notices of books

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Reviews and Notices of Books.’THE ART OF SURGERY.

By H. S. SOUTTAR, D.M., M.Ch. Oxf., F.R.C.S. Eng.,Surgeon, London Hospital. London: WilliamHeinemann (Medical Books) Ltd. 1929. Pp. 624.30s.

THIS book is written with the avowed object oflightening the student’s labour by omitting what is-not essential and by describing very fully what isfundamental. It bears little resemblance to the.conventional text-book, though the general arrange-ment of the contents follows the usual pattern,.commencing with inflammation, suppuration, tuber-culosis, syphilis, gangrene, tumours, hoemorrhage, andother general surgical subjects, and proceeding toregional surgery. Apart from its arrangement thetext does not resemble that of any ordinary text-book ; there is a greater continuity in the method ofwriting, which makes for pleasant reading and theredoes not seem to be such a large and forbidding’collection of facts to be absorbed by the reader. This,effect has not been obtained by the omission of anymaterial facts, but partly by the skill of the writer andpartly by his resolve to avoid too much detail. Manytext-books consist of a blend of the author’s personal’experience of surgery with facts obtained from othertext-books or original writings, and the younger theauthor the more do the latter tend to predominate.Mr. Souttar has relied entirely on his own knowledgeand the fruits of his wide experience. Results havejustified this method ; those facts which have seemedto Mr. Souttar to be of great importance are

undoubtedly those which should first be absorbed bythe student, who can later supplement this funda-mental knowledge from the study of more advancedworks or special monographs. A possible danger in- a text-book by one author is the statement of only’one point of view on a controversial subject, but onthe whole this pitfall has been avoided by Mr. Souttarwith excellent judgment. An exception is in thesection on paralytic ileus and peritonitis, where Mr.’Souttar omits to mention that there is a definite schoolof thought favouring absolute rest to the intestines.He describes only the vigorous treatment pursued bythe opposing school. Similarly, his enthusiasm forgastro-enterostomy in the treatment of chronic gastriculcer is not universally shared, while his assumptionthat the hopes formerly held as to the value of medicaltreatment have now been abandoned is certainlynot in accordance with modern views.

It is difficult to select any chapter for special- comment since the book is remarkably uniform in.aim and value. Even to those subjects in whichhis previous contributions to surgical literatureshow him to be specially interested, Mr. Souttargives only their just proportion of space. The.section on fractures is typical. The writer of a

surgical text-book is always hampered by traditionwhen he writes on this subject since he feels it to behis duty to deal minutely with fractures which rarelyif ever occur and splints and appliances which are ofhistorical interest only. Mr. Souttar has broken-away from the traditional method, for he discussesonly those fractures of each bone which are common,giving the physical signs and the points specially tobe noticed. He then describes a method of treatmentwhich has given good results in his hands and should;give equally good results if proper care is taken in allcases. The number of splints recommended is small,but most surgeons will agree that it is possible totreat most fractures with those mentioned, and it isindisputable that it is better for the student tounderstand thoroughly the way to apply a smallnumber of splints than to have a fragmentary know-ledge of many. There is certainly no ground here forthe common complaint that the chapter on fracturesis the most boring part in a surgical text-book.As would be expected, the chapters on injuries to

serves, cerebral injuries and tumours, and diseases

of the oesophagus are all excellent. Especially in thesurgery of the nervous system it is difficult to separatethe essentials necessary for the student from therefinements required by the expert, and Mr. Souttarhas drawn the dividing line with skill. Althoughhe is well known as an inventor of ingenious surgicalinstruments, he makes no more than a modest passingreference to some of his inventions, in accordancewith his determination to avoid any details of operativesurgery. He has thereby preserved the balance of hisbook, but we should have liked to see an illustrationof his craniotome, an instrument of the greatestmechanical beauty and precision. There should alsohave been some reference to the useful metal framedevised by him for the support of splints used infractures of the lower limb. This frame is much lesscumbersome than the Balkan frame. The last chapteris devoted to a short but excellent description of localand spinal anaesthesia. The general principles arestated clearly and their application in severalsituations fully explained. As the author points out,this method of anaesthesia is limited only by the skilland anatomical knowledge of any surgeon who hasthoroughly grasped the general principles. There aretwo useful appendices, one concerned with the measure-ments of the lower limb and the mechanics of apparent.lengthening and shortening, always a confusingsubject, and the other with the use of radium.The book is most attractively produced. It is a

moderately large and pleasant volume which is nottoo heavy to hold for a long period ; it stays openeasily and the pages lie flat ; the paper is good andnot highly glazed, and the printing is from a soundtype and easy to read. A conspicuous feature isthe very wide margin on the outer side of each page;this has not only a decorative effect, but it has alsothe more important function of providing space forsub-titles and illustrations which look casual, but areoriginal in style and peculiarly apposite to the text.They are reproduced from drawings which are admir-ably chosen. No explanatory legends are required,for each drawing is accurately placed next to theparagraph which it illuminates. Mr. Souttar’s idealwas to provide a thumb-nail sketch for each para-graph capable of being illustrated. He has alreadygone far towards reaching this end and we look forwardin each succeeding edition to seeing interestingsketches in the still empty margins. We have nodoubts as to the success of this production.

BACTERIOLOGY.Recent Advances in Bacteriology and the Study ofthe Infections. By J. HENRY DIBLE, M.B. Glasg.,M.R.C.P., Professor of Pathology and Bacteriologyin the Welsh National School of Medicine ; lateProfessor of Pathology in the University ofLondon. London : J. and A. Churchill. 1929.Pp. 363. 12s. 6d.

IT is the misfortune of bacteriology that it has beenchiefly studied by medical men in its relation todiseases, especially those of human beings. It hasthus been very much an applied science and hassuffered in consequence. In recent years, however,there has been a greater tendency to study theorganism for its own sake and not merely for itseffects upon a host; bacteriology has, in fact,developed a definitely academic side. This in itself issatisfactory, but it does not lighten the work of themedical student, who has not only to keep himselfabreast of the increasing knowledge of the influenceof bacteria in disease, but is also expected to have someidea of the highly complicated problems of purebacteriology. And who is to tell him how much ofthis academic knowledge it is necessary for him toacquire :’ Prof. Dible has attacked the problem withsuccess, and has written a book which should have awide appeal not only to students and medical practi-tioners who are not especially versed in bacteriology,but also to those whose knowledge is more intimate.The book is divided into 27 chapters dealing withdifferent aspects of the subject. Some of these are

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related to one another, but the arrangement seemsmore or less haphazard ; the pneumococci, forexample, are sandwiched between measles andtularaemia and the spirochaetal infections. Smoothprogression from chapter to chapter is, of course,impossible in a work of this kind.One of the earlier chapters, that on the streptococcus

problem, is probably the best in the book ; it dealsin the most comprehensive way with this importantsubject. The author can scarcely be blamed if thenext chapter on bacterial variations is not quite soclear and good ; he has done all that is possible in thepresent confused state of roughs and smooths, andO’s and H’s. An excellent chapter on the bacterio-phage is followed by two others, we rejoice to see,on experimental epidemiology, and Calmette andB.C.G. The next three chapters are devoted tofilterable viruses, and the most important examples ofthese are well surveyed, though perhaps the treatmentof the infective theory of malignant disease leavesomething to be desired. Other chapters deal withRickettsia bodies, measles, pneumococci, spirochsetalinfections, local immunity, diphtheria, and anaerobicorganisms. The book is well printed and produced,but the table on pages 2 and 3 is far from easy to read.To write single-handed a review of recent work on

bacteriology is no easy task, but Prof. Dible hassucceeded admirably. He has surveyed the groundwith thoroughness, and has exercised excellent judg-ment in the presentation of conflicting views. Hisbook will not be the least popular member of thisexcellent series.

THE MOTOR MECHANISM OF PLANTS.

By Sir J. C. BOSE. London : Longmans, Greenand Co., Ltd. 1928. Pp. 429. With 242 text-figures. 21s.THE veteran founder of the Bose Research Institute

in Calcutta gives in this volume a further series of hisingenious researches, showing that all plants respondto stimulation by movements of various kinds,similar in kind to, though less in degree than, thoseof the special " sensitive " kinds. He also deals withthe existence of a mechanism for pumping sap whichis subject to peristaltic movements akin to those ofthe mammalian bowel. Those people, especially whoin their youth learnt botany and zoology as separatesubjects and not as part of a considered scheme oftraining in biology, will be stirred by this account ofthe resemblances between the animal and thevegetable kingdom.

ELEMENTARY HSMATOLOGY.

By W. E. CooEE, M.D., Director of the PathologicalDepartment, Royal Infirmary, Wigan. London :Charles Griffin and Co., Ltd. 1928. Pp. 100.7s. 6d.As its name implies this book is concerned with the

elementary facts of hsematology, which are set out ina most satisfactory way; the language is lucid andthe illustrations, most of which are from microphoto-graphs, are clear and instructive. The descriptionsof the various blood " diseases are short but fullenough to give a distinct picture ; the section on thepurpuras is remarkably good, and may be recom-mended to students of the blood who have passedthe elementary stage. The book should provepopular with students and with practitioners who wishto keep at least within hailing distance of modernwork.

GREEK THOUGHT.

By LEON ROBIN. London : Kegan Paul, Trench,Triibner and Co. 1928. Pp. 409. 20s.

Prof. Leon Robin, Professor at the Faculty ofLetters of the University of Paris, contributes thelatest volume to the History of Civilisation, edited byMr. C. K. Ogden, of which some 50 volumes are nowin circulation. The volume has been translated froma revised and corrected French edition by Mr. M. R.Dobie.

From the medical point of view the evolution ofthe scientific spirit, as developed by the Greeks andexposed by Prof. Robin, has no very direct connexionwith medicine, and when we say that in this long and.closely written book the allusions to Hippocrates arebut two or three in number and that those are briefand indirect, it will be seen that the work must notbe confused with any history of the actual practice ofmedicine and surgery, as it existed in the four or-

five centuries preceding the Christian era or in the.-

subsequent Roman period. Prof. Robin’s learned

pages, however, supply a general background to sucha history, for he details the story of the great schools ofGreek thought, and gives pictures of the philosophersconnected with them, showing the connexion of theirteaching with the external circumstances of the time.An interesting foreword is supplied by Mr. Henri

Berr, in which he points out that, although Prof,Robin presents philosophy and science in their constantrelationship, he draws a distinction between the-history of the one and that of the other which it isnot easy to recognise. This reflection is founded upon,Prof. Robin’s statement that the history of philosophyis philosophy, and has for the philosopher an ever-living interest, while the history of science is notscience, but only the dead part of scientific efforttowards truth, the effort being forgotten when the endhas been reached. This would imply that the historyof science can only satisfy the curiosity of the erudite-and not, like the history of philosophy, the generaland deep needs of society. This view Mr. Berrcontroverts, for he finds that the history of sciencenot only shows the mind adapting itself to things ancf-man taking possession of his environment, but it makes.us follow the constitution of a method intended tosolve the problems which the mind sets itself, and whichit formerly tried to decide first in religion and then inmetaphysics. Every medical man will take this.

view, which, in other words, finds science to be aninstrument for solving philosophic problems ; and the-science of medicine in its modern manifestations isincreasingly being shaped in this direction, in spite ofthe apparent divorce of the special sciences fromphilosophy.The book forms a valuable section in this important

historic series, but it makes quite difficult readingIn many places readers, save those specially equipped,will find a Greek lexicon necessary in spite of the-occasional translation of terms and quotations,although familiarity with the original texts quotedfrom is not necessary for the comprehension of the-arguments, and could not be expected from any save-accomplished classical scholars.

DISEASE OF THE LOCOMOTOR SYSTEM.

Differentialdiagnostik der Inneren Krankheiten desBewegungsapparates. By Dr. ERNST FREUND.Privat Dozent in the University of Vienna; andDr. ALBERT SIMO, Bad Schallerbach (O.-O.).Dresden and Leipzig : Theodor Steinkopff. 1929-Pp. 58. M.4.50.THIS fasciculus of a larger work (" Praktische-

Differential-Diagnostik fiir Arzte und Studierende "treats of the differential diagnosis of internal diseases.of the mechanisms of movement. In the intro-duction it is stated that the local manifestations ofgeneral diseases such as those of the nervous system.of the metabolic system. and the endocrine glands,are often to be observed in the organs of movement-The subject matter is considered under three head--ings : (1) the general diseases of the apparatus ofmovement such as acute polyarthritis, pains, andpolyarthritis without fever ; (2) the spinal columnand various pains and their significance and occupa--tion neuroses ; and (3) in the lower extremity, limping-swelling of the knee-joint, and pains in various regions

It will thus be seen that this booklet is an illustratedguide to the significance of various symptoms whichappear in the limbs and particularly of the diagnostic’value of painful sensations. It should be useful tothe student and practitioner.