NA TURE 



2 41 



THURSDAY, JANUARY 13, 1898. 



A SYSTEM OF MEDICINE. 

 A System of Medicine. By many Writers Edited by 

 Thos. Clifford Allbutt, M.A., M.D., F.R.C.P., &c., 

 Regius Professor of Physic in the University of 

 Cambridge. Vol. iii. Pp. xi + iooi. Illustrations 23. 

 Charts iv. Plate i. Vol. iv. Pp. xii + 880. Illus- 

 trations 31. Plate i. (London : Macmillan and Co., 

 Ltd., 1897.) 



THE works before us are the third and fourth volumes 

 of Prof. Allbutt's " System of Medicme," the first 

 and second volumes of which have been already reviewed 

 in these columns. 



Vol. iii. begins with a consideration of the General 

 Diseases of Obscure Causation. The subject is introduced 

 by an article on Acute Rheumitisin, or Rheumatic Fever, 

 which is contributed by Dr. Church. This article con- 

 tains a mass of clinical information drawn from a rich 

 bibliography, and supplemented by the author's own 

 ample experience at St. Bartholomew's ; as an instance 

 of the latter, we may mention a chart of 1998 cases of 

 rheumatic lever arranged in months according to the time 

 of onset of the disease. Acute Rheumatism in children 

 is dealt with by Dr. Cheadle, and forms a valuable ad- 

 dition to the above article. The very various manifesta- 

 tions of acute rheumatism in children are described, and 

 the relative sudsidiary importance of the arthritic phe- 

 nomena is emphasised. Rest and full alkaline treatment 

 are, according to the author, the most valuable thera- 

 peutic measures in diminishing the frequency of the 

 occurrence of cardiac inflammation. 



The articles on Chronic Rheumatism, Gonorrh(jt;al 

 Rheumatism, and Muscular Rheumatism are from the pen 

 of Dr. A. E. Garrod. The essay on Rheumatoid Arthritis 

 is contributed by Dr. Kent Spender, of the Royal 

 Mineral Water Hospital, Bath ; unfortunately, before its 

 completion he had to relinquish the task. The revision, 

 however, fell into fortunate hands, and was undertaken 

 by Dr. A. E. Garrod, who entirely contributes the section 

 on treatment. Rheumatoid arthritis in children forms 

 the subject of a special essay by Dr. Still. The mono- 

 graph on Rickets is written by Dr. Cheadle, and includes 

 a full description of the disease, an account of its path- 

 ology and treatment, and of its modifications and con- 

 current disorders. Mr. Bowlby contributes three suc- 

 cinct articles on Mollities Ossium, Acromegaly, and 

 Hypertrophic Pulmonary Osteoarthropathy. 



All will agree that the essay on Gout could not have 

 fallen into better hands, coming as it does from the pen 

 of Sir William Roberts. The author expresses the views 

 so clearly enunciated by him in the Croonian Lectures 

 for 1892, with regard to the existence and decomposition 

 of the so-called quadri-urates. The relative merits of the 

 mechanical and chemical theories of the production of 

 the symptoms of gout are carefully examined. The 

 monograph concludes with a consideration of the general 

 and local treatment of gout. Dr. Saunby contributes 

 the article on Diabetes Mellitus ; the late Dr. Ralfe the 

 one on Diabetes Insipidus. This part of the volume 

 concludes with an essay on Lardaceous Disease by Dr. 

 Howship Dickinson. 



NO. 1472, VOL. 57] 



The second division of the work is devoted to diseases 

 of Alimentation and Excretion. Two essays on the 

 general pathology of Digestion and Secretion introduce 

 the subject. In the former, Drs. Ralfe and Soltau Fen- 

 wick give an account of what may perhaps not in- 

 appropriately be termed the clinical chemistry of diges- 

 tion, and describe the more recent methods for the 

 qualitative and quantitative determination of the various 

 constituents — normal and pathological — of the digestive 

 juices, more especially, of course, of the gastric juice. 

 It is to be wished that the value of exact chemical 

 examination of the gastric contents after test meals 

 should be more recognised in this country. The general 

 Pathology of Secretion is the subject of a short essay by 

 Dr. Rose Bradford. The pathological modifications, both 

 in quality and quantity, of external and internal secre- 

 tions are considered. Shock and Collapse is treated in an 

 original manner by Dr. Cobbet ; Diseases of the Mouth 

 by Dr. Wills, and Diseases of the CEsophagus by Dr. 

 Rolleslon. 



The Diseases of the Stomach are treated by several 

 authors. Among the monographs composing this sub- 

 section of the work may be mentioned the essays on 

 Dyspepsia and Gastritis, by Dr. Lauder Brunton. These 

 articles contain a mass of valuable clinical information, 

 and many useful hints for the treatment of these dis- 

 orders. They are written in that clear and lucid style 

 which is characteristic of their author. Dr. Stocker 

 contributes a short account of Sea-sickness. He divides 

 the treatment of this most unpleasant disorder into 

 preventive and remedial. Under the former head he 

 advises light diet and purgation before start mg. He 

 regards the beneficial action of the bromides as most 

 probably due to the anaesthetic action which they e.xert 

 on the pharynx and larynx, and suggests that they would 

 probably be as efficacious if given as gargles. The 

 Editor writes an account of Mountain-Sickness. He 

 adopts the view that the symptoms are due to the 

 diminished oxygen tension obtaining at high altitudes. 

 Prof. Allbutt further contributes the essays on Neuroses 

 of the Stomach and Gastrectasis. In the former article 

 the author gives an account of the recent researches of 

 Pawlow upon the nervous mechanisms influencing gastric 

 secretion. He then passes to the symptoms of the many 

 varieties of gastric neuroses. Motor Disorders of the 

 stomach are dealt with, and the article concludes with an 

 account of the neuroses of the other abdominal viscera. 

 The article on Gastrectasis comprises a discussion of 

 the aetiology, varieties, diagnosis and treatment of this 

 disease. 



The essay on Ulcer of the Stomach is written by Dr. 

 Dreschfield. The author first gives a brief account of 

 the history of this affection, he then passes on to the 

 aetiology, considering the role played in its production 

 by sex, age, race, climate, occupation, &c. The discus- 

 sion of symptomatology is very full, and includes a 

 mention of Acetonuria and Diaceturia. The complica- 

 tions and sequekt are fully considered, as is the diagnosis, 

 prognosis and treatment. Duodenal Ulcer forms the 

 subject of a short appendix to the above article. An 

 able monograph on Tumours of the Stomach is from the 

 pen of Dr. Hale White. Short accounts of Subphrenic 

 Abscess and Diaphragmatic Hernia are given by Dr. Lee 



iM 



