NATURE 



389 



THURSDAY, AUGUST 25, 1892. 



BR AM WELLS CLINICAL ATLAS. 

 Atlas of Clinical Medicine. By Byrom Bramwell, M.D. 

 Vol. I. (Edinburgh : Constable, 1892.) 



THIS large and handsome volume is highly creditable 

 to the author and to the Extramural School of 

 Edinburgh, in which he is a lecturer. It consists of a 

 series of thirty admirably coloured plates, mostly portraits 

 of patients, with about an equal number of woodcuts, and 

 descriptive letterpress. The account of the several 

 diseases illustrated is so full and good that it almost 

 makes the work a collection of illustrated monographs. 



The diseases described and portrayed in this first 

 volume are myxoedema and sporadic cretinism, Addison's 

 disease, Hodgkin's disease, unilateral atrophy of the face, 

 bulbar paralysis, Ophthalmoplegia externa, MoUuscum 

 fibrosum, Kaposi's disease, variola, melancholia, and 

 mania. 



There are alsa reports of cases of Friedreich's disease 

 and of a few other rare morbid conditions. 



The plan adopted by the author is to give a detailed 

 account of the case or cases illustrated, and then a dis- 

 cussion of the disease under the heads of anatomy, 

 diagnosis, and treatment, concluding with minute hints 

 (such as one would give to intelligent ward-clerks) as to 

 the points of cUnical investigation. No order is observed 

 in the sequence of subjects, and as the work is without a 

 preface (though not, we are glad to say, without an index), 

 it is not clear whether the author has formed any other 

 plan than publishing interesting cases as they may come 

 under his notice. The words " Volume I." on the title- 

 page encourage the hope that Dr. Bramwell contemplates 

 an additional series, and in that case it might be desirable 

 to arrange the completed work in alphabetical or some 

 other convenient order. 



To take the first subject treated — Myxoedema — as a 

 specimen. 



There is first a brief notice of the first patient whose 

 portrait is given ; then an account of the original descrip- 

 tion of this remarkable disease by Sir William Gull in 

 1873 ; i^ext a discussion of its geographical distribution 

 and incidence on sex and age ; the symptoms and patho- 

 logy follow, and the author agrees with the conclusion of 

 most who have studied the question, that this peculiar 

 condition is in some way dependent on atrophy of the 

 thyroid body ; finally, the treatment is discussed, and 

 the method of transplantation or grafting of a portion 

 of the healthy thyroid of an animal into the patient's 

 body is mentioned, with the results so far obtained by 

 Bircher and Kocher. 



Three portraits of patients afflicted with myxoedema 

 follow, each with a full clinical history of the case. They 

 are all three excellent, the colouring as well as the 

 design being as good as chro mo-lithography can 

 produce. 



This monograph is followed by one on sporadic 

 cretinism, which Dr. Bramwell regards as "infantile 

 myxoedema," another way of stating the true relation 

 which Gull's remarkable insight led him to detect when 

 he called the disease he discovered " a cretinoid condition 

 NO. 1 191, VOL. 46] 



in the adult." The paper is illustrated by seven uncoloured 

 lithographs. 



The two plates which belong to Addison's disease are 

 the most artistic in the book ; the difficulties are, of course, 

 much less than in the case of myxoedema. Some of the 

 other portraits are reproductions of photographs, very 

 good in their way, but with the defects inseparable from 

 this mode of illustration. 



The three coloured plates of the singular affection 

 described by Kaposi under the ill-chosen title of xeroderma 

 pigmentosum are again excellent, particularly No. xviii. 

 The illustrations of mental disease, although they display 

 considerable power in draughtsmanship, are perhaps open 

 to the objection of showing such fully developed and ex- 

 treme aspects of the several states delineated, that they 

 do not much help the recognition of less marked and 

 typical examples. 



We should, indeed, advise Dr. Bramwell, if, as we hope, 

 he is encouraged to continue this valuable series of plates, 

 to choose for illustration rather such infrequent morbid 

 conditions as the diseases associated with the names of 

 Graves, Addison, Raynaud, and Friedreich than the more 

 familiar maladies which can be always studied at first 

 hand. 



It would also be well, perhaps, if in a scientific work 

 of importance like this the catechetical method of instruc- 

 tion were omitted, which here and there interrupts the 

 course of a paper. For instance, the following conver- 

 sation, though no doubt an excellent paradigm of one 

 method of class teaching, seems out of place where it 

 stands (p. 30). 



Dr. B. (to the students). The case, gentlemen, is 

 exactly what I suspected. It is, in fact, an absolutely 

 typical example of the disease. . . . Such are the leading 

 facts ; I shall now be glad to hear any suggestions you 

 may have to make as to the diagnosis. 



A Student. Tumour of the cerebellum. 



Dr. B. No, it is not a case of tumour of the cerebellum. 



And so on. 



Here and there an inelegant word or sentence strikes 

 the eye. Thus Dr. Bramwell pertinently remarks that 

 Addison's discovery was not merely " a happy hit," but 

 spoils the phrase by adding " it was no mere fluke." A 

 more important error of omission is, that in quoting the 

 interesting quotation which follows from Addison's 

 original work. Dr. Bramwell makes no clear distinc- 

 tion between the graphic and marvellously accurate 

 account of idiopathic Anaemia, and the description of 

 Melasma suprarenale, as the discoverer named it, 

 which begins : " It was while seeking in vain to throw 

 some additional light upon this form of anaemia that 

 I stumbled upon the curious facts which it is my more 

 immediate object to make known to the profession.'' 

 The fact is that Addison, in a few pages, made known 

 the existence and clinical features of two rare and re- 

 markable diseases— idiopathic (since called grave or 

 pernicious) anaemia and Melasma suprarenale (since called 

 Morbus Addisonii). Dr. Bramwell is well aware of these 

 facts, but it would have been useful if he had fully stated 

 them, particularly as so much confusion on the subject 

 still prevails both in this country and in Germany. 



In conclusion, we must repeat that the present volume 

 is most creditable to the author, to his artist, and to the 



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