502 



NATURE 



[August 28, 19 19 



L'hermitte, and others in France, and Hurst in 

 this country, SoUier declares that the " re- 

 flex" or " physiopathic " cases described by 

 Babinski and Froment are easily curable by 

 mobilisation and psychotherapy. The muscular 

 and vaso-motor changes, etc., are believed to be 

 entirely due to immobility, and clear up as soon 

 as the use of the affected limb is restored. A 

 return to Charcot's conception of hysteria is pre- 

 dicted by SoUier as the result of war experiences. 

 Careful distinction is made between true reflex 

 contractures associated with pain, and those 

 called "reflex " by Babinski and Froment. All 

 varieties of functional disorder, including- those 

 of the special senses, are described. Treatment 

 by mobilisation and isolation is recommended, 

 while the exclusion of splints, massage, electro- 

 therapy, etc., is urged. 



The section which deals with re-education is 

 instructive. The organisation of the re-education 

 treatment seems to have been excellent. The 

 early individual treatment by the physician is suc- 

 ceeded by exercises under a masseur, who is him- 

 self carefully supervised by the physician. The 

 next stage is that of gymnastic drill under 

 medical supervision, in which chosen N.C.O. 's 

 and patients assist. Finally, uncontrolled military 

 drill completes the "hardening process " to fit the 

 soldier for military duty. The use of carefully 

 supervised physical work, as in our own "cura- 

 tive workshops," and of games, also forms part 

 of the routine. 



The value of mechano-therapy is - contrasted 

 with that of motor re-education, to the great 

 advantage of the latter, which is found to be an 

 active, living mode of treatment when crowned by 

 curative work. 



(2) The authors publish in this volume the 

 results of their careful studies of tissues damaged 

 by war wounds. They have been able to make 

 parallel observations upon the tissue cells and the 

 bacterial flora of wounds, so that much useful 

 information is available. The deductions that 

 they have drawn from the various changes found 

 are clearly expressed, and a fearless criticism of, 

 the recent antiseptic methods of wound treatment 

 is made. 



The opening section is devoted to a description 

 of the lesions, emphasis being laid upon the 

 important part played by damaged muscle as a 

 culture medium for bacteria. The process of 

 myolysis by ferments is described, and stress is 

 laid upon the fact that the simple protein bodies 

 resulting from the process, viz. peptones and 

 amino-acids, favour bacterial growth to a greater 

 degree than do the albumins. During the first 

 four to twelve hours after the trauma the infection 

 is little marked, and at this period such a 

 wound might be capable of transformation into 

 a surgical wound with union by first intention. 



In the nature of the infection an important 



place is given to the anaerobes. The bacillus of 



malignant oedema (vibrion septique), bacillus 



aerogenes capsulatus {B. welchii), with the whole 



NO.- 2600, VOL. 103] 



series of anaerobes, obtain the expected recogni- 

 tion in the description of the infection. The 

 aerobic organisms appear in wounds after the 

 anaerobic series has been observed for some 

 hours previously. The streptococcus is found to 

 be the most dangerous of the aerobic series, espe-J 

 cially in the usual state of mixed infection, when 

 proteolytic changes greatly favour its growth. 

 The defence in all its aspects is fully and clearly 

 discussed. 



Leucocytic changes as seen by vital stain- 

 ing methods, serum reactions, antitoxins, and 

 ferment actions are all included in the study of 

 the defence mechanism. The changes which 

 result in the breakdown of the defence, and the 

 production of gas gangrene, are fully dealt with, 

 and emphasis is laid upon the fact that the nature 

 of the infection rather than bacterial quantity is 

 the important factor with which the tissue cells 

 have to .deal. 



The section on therapeutics mentions every 

 known means of meeting infection, and each 

 measure is fully criticised. As a result of their 

 wide researches, especially those directed to the 

 study of infected excised tissues, the authors urge 

 that the best treatment for war wounds is the 

 early excision of all damaged tissue, followed by 

 primary suture. The authors insist upon the early 

 work of Gaudier in October, 191 5, in connection 

 with wound incision, and they claim that, as 85 

 per cent, of the wounds can be safely excised 

 and sutured, other treatment, such as irrigation 

 with antiseptics, is superfluous. 



The action of chemical agents is carefully 

 analysed until their futility is obvious. The 

 Carrel-Dakin technique is severely handled by the 

 authors, the solution itself being characterised as 

 a "chemical bistoury which acts by proteolysis of 

 mortified tissue." The general therapeutic con- 

 clusions are that damaged tissues and their m-. 

 fection play the most important part in war 

 wounds. Excision of lacerated muscle, etc., and 

 the conversion of the wound into an ordinary 

 surgical wound, are the greatest advances in 

 wound treatment. Local treatment is most im- 

 portant, although general measures, such as vac- 

 cines and sera, may help in selected cases. 



J. LE Fleming Burrow. 



THE FACE OF THE EARTH. 

 La Face de la Terre {Das Antlitz der Erde). Par 

 Prof. Ed. Suess. Traduit de I'Allemand avec 

 I'Autorisation de I'Auteur et Annote sous la 

 Direction de Emm. de Margerie. Tome iii.> 

 4« Partie. (Fin.) Avec un Epilogue par P. 

 Termier. Pp. xvi+ 1361-1724. Tables 

 Centrales de I'Ouvrage. Tomes i., ii., iii. 

 (i^e, 2^ 3^ et 4« Parties.) (Paris : Librairie 

 Armand Colin, 1918.) Price 25 francs. 



THIS is a noble ending to a noble work. On 

 the merits of the original it is scarcely 

 necessary to enlarge ; since they were first recog- 

 nised in these pages they have become familiar 



