3 mm. of aluminium and a folded bath-towel. Resultimprovement. (b) J. N., female, aged 22, ten doses-improvement. (c) A. H., female, aged 60, five doses-improvement. (d) I. S., female, aged 32, five treatments-pulse rate fell from 120 to 92 per minute. Dr G. H. S. Millen showed case of Graves' disease cured by X-rays. W. H., male. Complete cure of a very severe case after eighteen months' treatment. Pulse now normal. Gain in weight of three stone. Dr A. D. Yule showed (1) a patient with multiple adenomata of the colon, and (2) a patient with deformity of the foot. Dr J. E. G. Thomson showed (1) two patients with duodenal ulcer: (a) Man, aged 48. Previous health good, except for a complaint of having felt tired for some weeks. No symptoms of indigestion. He was suddenly seized with severe pain while cycling home from work. Operation was done at 9.30 p.m., assisted by Dr Gilruth. There was extravasation of stomach contents into the peritoneum. A small punched-out ulcer was found in the first part of the duodenum. The peritoneum was dry-swabbed, the ulcer inverted by a purse-string and covered over by a layer of Lemberts. Drainage. Recovery uneventful, followed by good health. (b) Man, aged 34. After a meal of stewed steak, bread and tea at 5 p.m., he was seized with pain shortly after II p.m. Next morning, at 10.30, the abdomen was rigid. Pulse 120. Operation at 2.30. Purulent fluid in the right iliac fossa. Appendix and cæcum were normal. There was also much extravasation of stomach contents. Through a second incision in the upper part of the right rectus perforation of the first part of the duodenum was found, the surrounding tissue being of cartilaginous hardness. The part was infolded with catgut sutures and covered over with sutures of fine silk. Drains were inserted to the site and to the recto-vesical pouch. There was offensive discharge from both wounds, which yielded to Carrel-Dakin irrigation. Recovery ensued, complicated by a left-sided pleural effusion, and followed by good health. enterostomy has not been recommended in either case. was no dental caries. Gastro There (2) A case of Brodie's abscess, in the lower end of the diaphysis of the left tibia, in a boy of 13. There was tender swelling just above the left ankle. An X-ray photograph by Dr Laing showed an abscess cavity. Pus was evacuated after trephining the bone, and the lining of the cavity scraped. Professor Tulloch reported on the pus that only organism present was the staphyloccus p. aureus. There is now 4-in. increase in the circumference of the left leg at the level of the abscess, and the leg is used freely in playing football, etc. Dr P. Bellwood Farrar showed a specimen of an abnormal fœtus. Delivery of a woman of 40, required a general anæsthetic and strong traction on the left leg which presented. The foetus showed a gap in the anterior abdominal wall with protrusion of organs. The tip of a finger could be passed between the halves of the pelvis behind, owing to a deficiency in the spinal column. There was no sign of external genitals. The legs could not be brought together. The placenta was healthy. The cord was, throughout its whole extent, adherent to it. NEW BOOKS Operative Surgery. By WARREN STONE BICKHAM, M.D., F.A.C.S. per volume. The first two volumes of this exhaustive treatise, the unaided work of the author, is now before us. As the sub-title indicates, the work covers "The Operative Technic involved in the Operations of General and Special Surgery." It is with general surgical procedures and with the operations on skull, brain, and spine, that volumes I. and II. deal. Considerable space is devoted to the study of lotions, dressings, methods of drainage and anesthesia. Outlines of surgical anatomy involved in the different organs precede the description of the operative technic and the pre-operative and post-operative procedures are also fully discussed. The author is not content to describe one operation for a condition, but gives a choice of several, and quotes authorities both in this country and in his own. Chapters on cineplastic amputations, artificial limbs, and the transplantation of tissues and organs appear, and their mention indicates the scope of this part of the work. In volume II. the description of the operations on the skull and brain are particularly clear, thanks in no small part to the illustrations. Perhaps the most striking feature of these volumes is the number and excellence of the illustrations. Each step of the operation as well as a large number of the instruments used are shown. In addition to the usual index at the end of each volume there is a classified index of each subject at the beginning of each chapter. The author is to be congratulated on a successful start in his laborious task. Insulin in General Practice. By A. CLARKE BEGG, O.B.E., M.D. Pp. 130, with 4 illustrations. London: Heinemann. 1924. Price 5s. net. Dr Begg has set out to produce a small volume which will give the practitioner all the information he requires to treat diabetic patients with insulin. In this he has succeeded admirably, and the result is a thoroughly practical clinical guide. Theoretical considerations are reduced to a minimum, and only the simplest chemical methods have been introduced. Short chapters describe the principles of insulin treatment, dietetics, and dietetic treatment. The discussion is liberally illustrated by reference to case histories. The author's plan of treatment is simple. It consists of putting the patient on a standard diet yielding about 2300 calories. For some patients this alone may be sufficient to make them sugar-free, others require insulin. The method of using insulin, the spacing of the doses, the quantities to be given, etc., are discussed in considerable detail. Our only criticism is that the author is content to leave a faint trace of sugar in the urine instead of endeavouring to keep the patient sugar-free. This plan, of course, will avoid the risk of attacks of hypoglycemia but, theoretically at least, is not good practice. The treatment of the major complications of diabetes is also described. Dr Begg is to be congratulated on his production, which we have no hesitation in describing as the most useful book of its kind at present on the market. A Descriptive Atlas of Radiographs of the Bones and Joints. By A. P. BERTWISTLE, M.B., Ch. B. Leeds. Pp. viii+198, with 299 illustrations. Bristol: John Wright & Sons, Ltd. 1924. Price 17s. 6d. Some time ago, the author introduced the "Silhouette Radiograph,” which while giving good bony definition also makes plain the contour of the limb or other soft parts. This method, which is described, has been adopted throughout the book with satisfactory results. The arrangement of the volume is excellent, the first part of the atlas is devoted to plates of normal bones and epiphyses. These appear on the left side of the volume to allow the student to compare them with the plates of pathological conditions which later appear on the righthand pages. A comprehensive series of X-ray plates is shown, including a number which show congenital deformities, and others of foreign bodies in various situations. Opposite each plate a short description of the X-ray appearances, and in many cases clinical notes, are given. The volume concludes with a serviceable index. The reproduction of the radiographs is excellent, and the author is to be congratulated on producing a volume which will prove of value to all who have to interpret X-rays. Human Physiology. By C. G. DOUGLAS and J. G. PRIESTLEY. Pp. 232+ix, with 30 illustrations. Oxford University Press: Humphrey Milford. 1924. Price 12s. 6d. This book gives an account of the practical course in human physiology given at Oxford University. As the authors point out, it is now recognised that the earliest symptoms of disease which can be detected are manifestations of change in the normal balance of physiological processes. It has, therefore, become a matter of real importance that the student should gain by practical experience a knowledge of some of the experimental methods which are applicable to man. The book does not include the physiology of the nervous system and the sense organs, but deals fully with the other systems. A large portion of it is concerned with respiration and the blood gases. Chapters are also devoted to the circulatory system, the kidneys, the blood, and the alimentary canal. Descriptions of methods are written in clear and detailed fashion so that they can be easily followed. The more theoretical aspects of the subject are also discussed, so that the volume may be regarded as a small text-book rather than a mere laboratory guide. Clinicians will welcome a book of this sort, which helps to bridge the gulf that has formed between the science of physiology and the practice of medicine. The introduction of a practical course of this nature in the medical curriculum would be of enormous benefit to the student. Organic Substances, Sera, and Vaccines. By D. W. CARMALT JONES. Pp. 393+ viii. London: Wm. Heinemann. 1924. Price 15s. The modern physician's armamentarium has been enriched by numerous substances formerly unthought of, and notably by bacterial products. Some of these are of great importance and value, while similar preparations in the case of other diseases are entirely worthless. The author's aim has been to give his personal opinion of the value of the substances dealt with, so that the practitioner may be warned off experiments in treatment which a hundred others have unsuccessfully tried. The book is divided into two parts-(1) organotherapy, (2) vaccineand serum-therapy. Short accounts are given of the lesions caused by the various forms of endocrine imbalance, and of the various uses to which the gland extracts may be put. The field of serological and vaccine treatment has been covered in more detail. Immunity and specific bacterial diagnosis are described at some length as an introduction to this part. All the commoner bacterial diseases are dealt with, and the value of vaccines or sera in them is critically discussed. The sections on the tuberculins and on non-specific serum therapy may be specially mentioned. The subject is one which is insufficiently treated in books on bacteriology and on medicine, and we have no doubt that the volume will be of great service to the up-to-date clinician. Epidemic Encephalitis (Encephalitis Lethargica). By ARTHUR J. HALL, M.A., M.D. Camb., F.R.C.P. Lond. Pp. 229, with 17 illustrations. Bristol: John Wright & Sons, Ltd. 1924. Price 12s. This book is an expansion of the Lumleian Lectures delivered by Prof. Hall in 1923. It presents a very complete study of the disease in its various aspects-historical, epidemiological, pathological and |