April 17, 1919] 



NATURE 



123 



Oliver-Sharpey lectures, delivered before the 

 Royal College of Physicians in 1918. 



The subject of "shock " was one which offered 

 little attraction, under normal conditions, to the 

 laboratory worker, with his habit of precision in 

 nomenclature and his love of the clearly defined 

 problem. To the surgeon the problem was a 

 sufficiently definite and urgent one, but there was 

 always the suspicion, not even yet dispelled, that 

 the term covered any condition in which the vital 

 functions suffered rapid depression, and that the 

 common factor was obscurity of causation. The 

 same applied to "wound shock" in the earlier 

 stages of the war, but Prof. Bayliss shows how 

 the co-ordinated efforts of physiologists working 

 at home and surgeons working in the clearing 

 stations succeeded in reducing the complexity of 

 the problem. He shows that the question of 

 causation has by no means yet received a final 

 answer; it is still obvious that the contributory 

 factors are numerous, and that their relative im- 

 portance varies widely from case to case. The 

 central feature of the condition, however, is con- 

 stant — a deficient volume of the blood in effective 

 circulation. In the large majority of cases the 

 loss has a twofold origin ; blood has been lost 

 from the system by actual haimorrhage, and of 

 what remains part is rendered ineffective for the 

 needs of the body by the tendency to stagnation 

 in the peripheral vessels. In the production of 

 this latter phenomenon a central importance is 

 attributed to the absorption from injured tissues 

 of the toxic products of autolytic changes. Fat- 

 embolism receives brief mention, but might with 

 advantage be given fuller consideration in a future 

 edition. Probably too general a significance has 

 been attributed to it by some American writers, 

 but its occurrence may possibly throw light on 

 the appearance of "shock" in certain cases 

 with no obvious destruction of the tissues, and on 

 the complete failure in such cases of efforts to 

 restore the blood volume. 



A large part of the book is devoted, as its title 

 indicates, to the treatment of shock by intra- 

 venous injections. The theoretical considerations 

 and experimental findings leading to the intro- 

 duction of gum-acacia solution, as a substitute 

 for the deficient blood, receive full treatment. The 

 importance which, in certain passages, is attri- 

 buted to deficient oxygenation of the blood seems 

 scarcely consistent with what is said elsewhere as 

 to the relatively small importance of oxygen- 

 carrying power, in comparison with the volume 

 and the rate of circulation of the fluid in the 

 vessels. There seems as yet to be no evidence 

 which would enable us to estimate the relative 

 importance, as factors in the bad effects of a 

 retarded circulation, o'f the reduced supply of 

 oxygen on one hand, or of the defect of the me- 

 chanical flushing of the tissues on the other, by 

 which toxic metabolites are normally swept away, 

 possibly to be destroyed in the liver or eliminated 

 by the kidneys. The effect on the function of the 

 kidney of replacing blood by gum solution is 

 not here recorded, and seems worth investigation. 

 NO. 2581, VOL. 1031 



Prof. Bayliss does not deal specifically with the 

 application of conclusions, drawn from the study 

 of "wound shock," to the "surgical shock" of 

 civilian practice. It is to be hoped that the effi- 

 ciency of his gum solution, which has done such 

 splendid service during the war as a substitute 

 for lost blood, will be further tested under the 

 more rigid observation which peaceful conditions 

 will make possible. H. H. D. 



INTRODUCTORY METEOROLOGY. 



Introductory Meteorology. Prepared and Issued 

 under the Auspices of the Division of Geology 

 and Geography, National Research Council. 

 Pp. xii + 150. (New Haven: Yale University 

 Press, 1918.) Price 45. 6d. net. 



"T N the United States meteorology is included 

 ^ in the course of study outlined by the Com- 

 mittee on Education and Special Training of the 

 War Department for Students' Army Training 

 Units. The plan involves an intensive study of 

 the elements of the subject in order to familiarise 

 prospective Army officers with its chief con- 

 clusions and methods." It is to meet this require- 

 ment that "Introductory Meteorology," a work 

 of a hundred and fifty octavo pages, including 

 seventy excellent illustrations, has been prepared 

 by members of the staff of the United States 

 Weather Bureau, including W. J. Humphreys, 

 S. P. Fergusson, W. R. Gregg, J. Warren 

 Smith, A. J. Henry, and C. F. Talman, who are 

 all recognised as experts in the special subjects 

 assigned to them. 



In this country no committee on education 

 and special training of the War Department 

 has as yet included meteorology in the course 

 of study for Army officers, but the experience 

 of the war has impressed upon us the necessity 

 for setting out the elements of the subject, and 

 the Meteorological Oflfice has endeavoured to 

 satisfy the requirement provisionally by the issue 

 of the "Weather Map and Glossary" and a 

 number of other publications. It is interesting 

 to compare notes about these endeavours to meet 

 a common necessity. 



Though it sets out a considerable number of 

 well-selected facts and illustrations, many of them 

 quite novel, "Introductory Meteorology " is, from 

 the nature of the case, little more than an en- 

 larged prospectus of the whole scope of meteoro- 

 logy, including climatology and forecasting. The 

 primary difficulty of such an enterprise meets us 

 on almost every page, and that is to decide how 

 much preliminary knowledge of physics and mathe- 

 matics on the part of the reader is to be assumed 

 by the author. The most effective chapter is one 

 on ".Atmospheric Optics," in which the author, 

 with an obvious command of the subject, boldly 

 tells the reader what he may see and what may 

 be explained without entering into the details of 

 explanation. There is no attempt to define re- 

 fraction or diffraction. In other chapters less 

 assurance is shown, and the author hesitates 

 between assuming and expounding the experience 



