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An Atlas of the Primary and Cutaneous Lesions of Acquired S} philis in the Male. By Charles F. White, O.B.E., M.B., Major, Royal Army Medical Corps, Lecturer on Venereal Disease and Officer in charge Rochester Row Military Hospital; and W. Herbert Brown, M.D., Physician for Diseases of the Skin, Victoria Infirmary, Glasgow, late Captain, Royal Army Medical Corps (T.F.). London: J. Bale, Sons, and Danielsson, Ltd., 1920.

AT the present time, in view of the increased frequency of venereal diseases and the immense importance of their early and accurate diagnosis, the present work is calculated to be of great service to medical practitioners. The names of the authors already give some guarantee with regard to the value of the work, but it may be noted as further evidence of their com­petence to deal with the subject that the Atlas is the outcome of a photographic record of cases made at a large venereal hospital in which some 19,000 cases of syphilis came under observation.

The work contains four coloured plates, the first of which comprises seven figures and reproduces the lesions of primary syphilis, the second, with six figures, depicts the appearance of soft sores, and the remaining two show respectively the lesions of secondary and tertiary cutaneous syphilides.

The uncoloured photographs number seventy-nine, and with a few exceptions they reproduce syphilitic lesions on various parts of the body. A few show cases of psoriasis and other cutaneous lesions that are not infrequently mistaken for syphilis.

The Atlas is made more valuable by the inclusion of over thirty pages of text devoted to a concise and lucid description of the primary sores and of the secondary and tertiary skin lesions in syphilis.

Les Tuberculoses Animales. By H. Vallee, Directeur de l'Ecole Veterinaire d' Alfort, and L. Panisset, Professeur a l'Ecole Veterinaire de Lyon. Paris: Octave Doin et Fils, 1920.

TUBERCULOSIS is now, and for many years is likely to remain, one of the most important diseases of animals in Europe, not only because of the number of species which it affects and the economic loss which it inflicts on agriculture, but also because of its proved connection with the dl'sease of the same name in man. A thorough up-to-date knowledge with regard to it is therefore essential both for the veterinary student and the veterinary practitioner, and to both of these the present work by the two distinguished French authors can be strongly recommended.

The matter is well arranged, the information is presented in language that is at once concise and clear, and no point of importance in connection with the disease has escaped consideration. There are a number of good plates in which some of the more important lesions are reproduced in colour.

The opening chapter deals briefly with the history of tuberculosis, and the second is devoted to the species affected and its incidence among the domesticated animals in different European countries. In the following chapter symptoms are dealt with, and one has to note as an omission that

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stiffness of the neck or other part of the spine IS not mentioned as an indication of infection with tuberculosis in the horse.

In the following chapter an excellent account is given of the morbid anatomy of the lesions in tuberculosis. In referring to the use of the terms "localised" and "generalised" the authors express the opinion that the attempt to classify all cases under these two heads ought to be abandoned. They observe that the lesions of tuberculosis may spread more or less rapidly to various parts of the body, and that the bacilli which are con­cerned in this may be disseminated by way of the lymphatics or the blood vessels. In general what are called localised lesions have resulted from the lymphatic method of dissemination, and since in spite of this method of origin the lesions may be very extensive and widespread the term localised is often inappropriate. On the other hand, when the bacillli are carried throughout the body in the blood of the greater circulation the case becomes one of generalised tuberculosis, but the lesions from such a blood dissemina­tion may be confined to a single organ. The theoretical possibility of such an occurrence cannot be denied, but in actual practice indubitable cases of the kind are exceedingly rare. It would appear to be better not to abandon the use of the term generalised, but to limit its use to cases in which multiple small tubercles, apparently of the same age, are unifOlmly disseminated in the lungs and other internal organs.

The authors include among tuberculous lesions those well-defined tumour­like growths which are occasionally found in cattle under the skin or in the depth of the muscular masses of the body. These tumours are described as being homogeneous, yellowish-white, containing centres that are caseous or calcified, and distinctly marked off from the neighbouring tissue. As a rule, the nearest lymphatic glands show no evidence of disease, and the authors quote Perard and Ramon to the effect that these subcutaneous and muscular tumours always co-exist with visceral lesions. It is also stated that" histological study shows in this atypical form of tuberculosis all the elements of the classical tubercle," and that" this subcutaneous tuberculosis probably represents in cattle as in man an attenuated form of bacillary invasion." Inasmuch, however, as no one has yet succeeded in demon­strating tubercle bacilli in these lesions or shown by experimental inoculation that tubercle bacilli are present in them, it would appear to be better to admit that their etiology is still quite undetermined, than to adopt the view of Perard and Ramon that bacilli are present but very few in number or very slightly virulent, or perhaps even dead. Exception may also be taken to a statement which would appear to imply that histologically these peculi:u growths are identical with the ordinary tuberculous lesions found in cattle. The fact is that the growths here referred to have a quite peculiar histology, and one which presents many points of difference when compared with that of a genuine tubercle. In particular, it may be noted that while giant cells are very seldom absent from any save the most recent tubercles they are usually absent from these subcutaneous and intramuscular tumours.

In the chapter which deals with bacteriology, the characters presented by cultures of tubercle bacilli on different media are very accurately described, but Dorset's egg medium is not even mentioned, although by almost general consent it is now given the first place among the media most suitable for the growth of primary cultures.

One of the most interesting chapters is the one in which the authors dis­cuss the variability of tubercle bacilli. They point out that between the well·characterised human and bovine types there are numerous intermediate types which differ from these in respect of morphology, method of develop­ment, or pathogenic effect; and after reviewing the evidence they come to the conclusion that even the avian type ought to be considered as a simple

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variety of Koch's bacillus, and that its special characters have been developed by a long series of passages in the organism of the fowl. "Mammalian and avain tuberculosis is caused by one and the same microbe, the bacillus of Koch." It must be admitted, however, that, although the variability of these different types within certain limits IS now generally admitted, there is by no means general agreement as to the extent to which the characters of any of the types may, by what may be called natural passage, be changed within any moderate period of time.

In discussing the channels by which infection occurs in bovine tuberculosis the authors state that in animals of any age infection follows with certainty if the virulent material is given by means of a sound, so as to ensure its direct entrance to the fourth stomach, and they consider it absolutely established that tubercle bacilli may pass through an intact epithelial barrier, traverse a group of lymphatic glands without provoking the development of macroscopic lesions, and finally by way of the lymphatics or by the blood stream give origin to a lesion in some distant part of the body.

A valuable critical view is made by the authors of the different methods of immunising cattle against tuberculosis which have been recommended in recent years, and they sum up by observing that, although vaccination confers an increased power of resisting natural or experimental infection, the vaccinated animal has not the power of resorbing living bacilli when these are afterwards injected into it in order to test its immunity. When the bacilli are thus inoculated subcutaneously they are partly expelled directly from the lesions when these burst outwardly. If the test bacilli are injected into the veins some of them are eliminated by the liver, while others are retained in the lymphatic glands, and especially in those attached to the lungs. If one regards as the true test of immunity the power of destroying the pathogenic organisms throughout the body it would therefore appear to be improper to use the word immunisation in connection with tuherculosis. Nevertheless it has been demonstrated that by appropriate methods one can certainly confer on cattle a useful power of resistance, and the suggestion is thrown out that, instead of endeavouring to obtain for purposes of vaccination strains of bacilli that are slightly virulent, investigators should in future try to discover a vaccine which, while being non-dangerous, would be only slowly resorbed within the body.

Touching the question of human infection from bovine sources the opinion is expressed that the existence of the disease in cattle constitutes a con­siderable danger to the human species, since it appears probable that in more than 25 per cent. of the cases of tuberculosis in children the infecting bacilli have been derived from cattle. No doubt this estimate mainly refers to cases of human tuberculosis in which manifest abdominal lesions are present in the abdomen, but the authors apparently consider that cases of human tuberculosis with what appear to be primary lesions in the lungs may also have had their origin in ingested bacilli that have passed through the intestinal wall and the mesenteric glands without creating any macroscopic lesions.

Lymphangite Epizootique des Solidi pedes. By A. Boquet and L. Negre. Paris: Masson et Cie., 1920.

THIS work is one of the most original and important contributions to equine pathology that have appeared in recent times. It gives a very complete account of the etiology, pathology, symptoms, diagnosis, and treatment of epizootic lymphangitis,· and it records recently made observations and