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engrossed with his bodily pabulum, and in caringfor the needs of the body he neglects the needsof the mind. If the " brown study" were moreoften cultivated many people would be liappier andmore clear thinking would be done.

TEETHING AS A CAUSE OF SYMPTOMS ININFANTS.

THE problem of dentition in infants in one shapeor another reappears from time to time in medicalliterature all the world over, and mothers andnurses appear to be, as a correspondent of THELANCET points out this week, in entire agree-ment that teething is the fons et origo of thatmiscellany of ailments to which infants duringthe period of dentition are peculiarly prone.It may further be asserted with some confidencethat the majority of family practitioners are ofthe same opinion in a somewhat restricted sense.The dissentients from this view are mainly to befound in the ranks of hospital physicians andspecialists, but even among paadiatric physiciansof the first rank there are diversities of opinion onthis thorny question. To give a few instances only,Dr. A. Jacobi, of New York, a pronounced scepticand the Nestor of paediatrics, caustically remarksin his "

Therapeutics of Infancy and Childhood" "

(p. 315): " There are, fortunately, practitioners whoprefer making a diagnosis of the real condition ofthe ailing baby, and that and its improvement orcure comprise the main treatment I recommend for’difficult dentition.’" Dr. Leonard Guthrie, whoseopinion both as a neurologist and as a specialistin the diseases of children deserves the most

respectful hearing, devotes in his " FunctionalNervous Disorders in Childhood " an entire

chapter to the disturbances associated with

primary dentition. He discharges whole broadsidesof good-natured chaff at the expense of thosewho believe that the physiological process ofdentition has pathological consequences. He sayson p. 173: "I believe, therefore, that the ordinaryphenomena of painful dentition are dependent onalimentary disturbances associated with a ’ commoncold,’ and that dentition is painful because the

gums become unhealthy." Dr. G. F. Still, in awholly admirable article on the same subject inhis "Common Disorders and Diseases of Child-hood," gives a long list of the symptoms which heascribes to the process of teething, and concludeswith the words: " I am inclined rather to

enlarge than to restrict my own conceptions of therole of dentition in producing disturbances ofvarious kinds in infancy." Sir James Goodhart, inhis "Diseases of Children " (seventh edition), says:"Increased activity of all the physiological pro-cesses at work necessarily implies greater risks offriction between one organ and another, or even ofregular breakdown. Excessive energy, if not

properly regulated or adequately expended, is liableto lead to an explosion of some sort or another."With such divergences of opinion between ex-

perts of unquestioned authority, how shall lessermen decide 2 It may, however, be remarked thatthe majority of authorities who write, at any rateauthoritatively, on this problem and who as teachershave great influence in formulating opinion amongpractitioners, acquire the larger proportion of theirknowledge from so-called pathological experiences,for the greater number of children and infantswhom they see are either sick or ailing. On theother hand, it is interesting to note that the opinion

of that now considerable number of medical men andwomen who act as officers to Infant Welfare Centresis almost unanimously in favour of the belief thatteething is a common cause of disturbance tohealth ; this fact is instructive, because at

" Infant

Consultations " the vast majority of the infants arerelatively healthy.l It has been claimed thatdentition is a physiological process, and that sinceno physiological process should be accompanied bypain, dentition itself cannot be the cause of patho-logical phenomena. This syllogism is unsound inits major premise, in its minor premise, and in itsgeneral conclusion. There is no true distinctionbetween a physiological and a pathological process;both are designed to preserve life in the mannerbest suited to meet the existing conditions of theenvironment. If they should happen to be accom-panied by pain or other disturbance of bodilyharmony so much the worse for the individual.Pain is one of the most efficient means of protectingthe body against existing dangers, and is in essencephysiological. Parturition is a physiological processand a distinctly painful one, especially in the caseof the contracted pelvis ; and so also may be theprocess of dentition in the contracted jaw ofcivilisation, as many can avow from personalmemories of the cutting of the wisdom teeth.

During the period of dentition many symptomsdevelop either as a consequence of, or coincidentwith, the eruption of each tooth which must give thecareful observer much food for reflection. The almostinvariable flush on the cheek of the healthy child,the running of the nose or the lacrymation in thoseless fit, the pharyngeal cough, the bronchitis or thediarrhoea in those of still poorer condition arebest capable of explanation as the misdirectedincidence of nervous energies, whether reflexly orby irradiation engendered by the eruption of thetooth, taking effect in organs or in situations ofleast resistance. This may possibly explain whywhen any particular function has previously beendisturbed there is apt to be a recurrence of theevent during the period of dentition-why, in otherwords, the child always cuts its teeth " withbronchitis or diarrhoea," as mothers and nurses arewont to believe.

____

ARTIFICIAL PNEUMOTHORAX IN THE TREATMENT

OF PULMONARY TUBERCULOSIS.

THE treatment of pulmonary tuberculosis byinduction of pneumothorax was introduced byForlanini, of Pavia, in 1882, and was later, butquite independently, advocated by Murphy, of

Chicago, who in his address on the Surgery of theLung at the annual meeting of the AmericanMedical Association in 1898 reported 5 cases. Themethod became popular on the continent, where alarge amount of clinical and experimental workwas done, of which the most important was theuse of the water manometer by Saugman, ofChristiania, to measure the intrapleural pressure.In this country the method was neglected for manyyears, but recently has come into vogue. In theJoui-nal of the Amel’ican Medical Association ofNov. 27th, 1915, Dr. T. B. Sachs has published animportant paper on the results obtained by 24American observers in 1145 cases. The stage ofthe disease is reported in 1028 cases. Of these,88’7 per cent. were " far advanced," 10’6 "moderately

1 An instructive chart showing the Influence of dentition on curvesof weight in six cases is given (Chart 7, p. 59) in the Report for 1914 bythe Chief Medical Officer to the Infants’ Department of the BradfordHealth Committee.

92

advanced," and 0’7 "incipient." 77 per cent. werebilateral and 23 unilateral. Cavities were present in53 per cent. In 23 per cent. there were complications,such as laryngeal or intestinal tuberculosis, pleuraleffusion, or empyema. In about half of the casesno improvement was obtained, in 29’2 per cent. tem-porary improvement followed, and in 21’7 per cent.arrest or cure. The large proportion of advancedcases must be taken into consideration in judgingthe results. Sufficient data do not yet exist toshow the ultimate results, as the method has beenextensively practised only in the last few years.So far it seems that permanent arrest is obtainedin about 12 per cent., and a palliative effect ofvariable duration in about twice that number. Butit must be remembered that these figures areobtained from all the cases in which the methodhas been tried, and include cases in whichobliteration of the pleural cavity by adhesionsprevented, partially or completely, the induc-tion of pneumothorax. In cases in which themethod is specially indicated the results are

much better. Thus the disease was arrestedin about half of the unilateral cases. Further, itmust be remembered that the method is generallyresorted to when all other treatment has failed.The best results are obtained before the formationof extensive pleural adhesions, and before there ismarked affection of the opposite lung or irrepar-able loss of health. With gradual improvement ofthe technique and more careful selection of cases.accidents during the production of pneumothoraxhave diminished. The nitrogen should never beallowed to enter until the manometer shows, bysustained negative pressure and free oscillations,connexion with the pleural cavity. Pleural effusionis the most frequent complication of the operation.It occurred in 113 of the cases. There is a con-siderable difference of opinion as to its effect onthe progress of the case. Pleural shock occurredin 26 cases, but in no instance was fatal. Its sym-ptoms vary from slight faintness to severe nervousdisturbances, and fatal cases have been described.- Gas embolism occurred in 3 cases, but this cata-

strophe should be almost impossible if the mano-meter readings before the admission of the nitrogenindicate that the orifice of the needle is in the

pleural cavity. Dr. Sachs concludes that pneumo-thorax should be induced in all progressive cases ofpulmonary tuberculosis which fail to respond to:sanatorium treatment, regardless of the stage.

A LOST LIBRARY.

THE library of the old Corporation of EnglishSurgeons, so rudely dispersed in 1751, had beenin process of formation ever since the daysof Vicary or earlier. In 1562, Thomas Vicary,serjeant-surgeon to Queen Elizabeth, left by willto the Barbers’ Company " one booke calledGuido and ii billes, ii bowes, ii shefes ofarrowes," &c. The Guido was a work by Guidode Cauliaco or Guy de Chauliac, whose "Cyrurgia" "and other works were text-books of that age.In 1591 another serjeant-surgeon, Robert Balthrop,wills his Guido to his servant, but leaves to"

the companie of the Ba-rbors and Chirurgeonsof the Cittie of London the Chirurgery of thatmost excellent writer, John Tagaultius, the lattinbooke and also the English translation that Ihave made thereof." This alludes to the " DeInstitutione Chirurgica" of Jean Tagault, pub- ’,lished in Paris in 1543. He likewise leaves them i

"the Chirurgerie of the expert and perfect prac-titioner Ambrose Parey." Both these works he has"

written into English for the love which I owe mybrethren practising Chirurgerie and not understand-ing the Latin Tounge, and given them into theHall for their daily use and reading both in Latinand English, and desiring that they may be kept fairand clean for my sake." These English translationshave vanished as completely as the lost books of

Livy, though Tagault’s work was in its time so

popular that it was translated into Flemish, Italian,and French, besides running through several Latineditions. Not only are books mislaid, but they arequaintly misnamed in the sixteenth century.Thus, another serjeant-surgeon " unto the Queen’s 8Majesty, sick of body "-namely, Richard Ferris,whose portrait appears on the extreme left ofthe kneeling surgeons in Holbein’s well-knownpicture-wills to the Company

" a grete Pandack and

another booke called a verroyce." This is probablythe allusion of an unlettered practical man to the"Liber Pandectarum Medicinae " of Silvaticus,published at Venice in 1474, a gothic letter work, orto the same author’s " Liber Cibalis et MedicinalisPandectarum " (Naples, 1474), and to the " Medicina"of Averroes, published in Venice in 1482. Thelatter work begins with the words "Incipit liberde medicina Aueroys." Hence

"

verroyce." Wehave more certain information as to the " Tablesof Morus," which Mr. Deputy Caldwell, in 1604,"freely gave to this Company to be distributedamongst the professors of chirurgery, freemen."Some 500 copies were distributed, but the professorsseem to have despised them. They were thin foliosof 32 pages, containing Latin tables and lists, andwere probably treated as such gifts are wontto be even at the present time. One copy of the" Tabulae universam Chirurgiam complectentes, exeruditioribus Medicis collectae," fol., London, 1584,still exists in the library of the Royal College ofSurgeons of England. It is from the Pitt Collection,but the absence of names and graffiti on the fly-leaves bears witness to original neglect. During theseventeenth century a certain number of volumes,of which the titles are on record in the books of theBarber-Surgeons’ Company, were added to "the newlibrary." In 1638-39, 64 volumes were chained,which would account for the 130 yards of chainbought at this time. A chained book is given atether measuring a trifle over two feet in length.At the end of the century the Company possessedGerard’s

’’

Herbal," Stow’s "Survey of London,"Dr. Gwyn’s MSS., Arris’s five books on Surgery,the Anatomy of Cafferius Placentius, besidesother works. In the next 45 years we can

imagine the Company adding to its collection alarge number of books, for books were then

beginning to be published at frequent intervals.These would include in time Cheselden’s classical"Osteographia," the famous plates of Albinus, andthe works of Heister. It is curious to note thatHamilton, in 1794, describing an army surgeon’snecessary library, which was to travel in bulk withthe regimental baggage, mentions very few booksprinted prior to 1750. Modern medicine andsurgery began only to make their appearance in

print in the latter half of the eighteenth century,when the Hunters, Cullens, Monros, Pringles, andother famous men rendered their professionillustrious. But the lost library none the less

probably contained many classics, such, for instance,as some 30 or so early printed books now rarelyseen. Curiosities also must have abounded on its