August 8, 1901] 



NA rURE 



347 



of these chapters contains an account of the authors' 

 experience of enteric fever and simple continued fever 

 in South Africa. But most of the scientific interest 

 attached to this subject has already been exhausted in a 

 paper by Dr. Tooth which was read and discussed quite 

 recently before the Clinical .Society of London, and the 

 chapter is more or less a repetition of that paper. Some 

 interest, however, will be felt in the attitude of the authors 

 towards "simple continued fever,'' which they express in 

 the statement that a diagnosis of simple continued fever 

 " is little more than a confession of ignorance," but " must 

 be tolerated in the absence of more exact knowledge.'' 

 In their experience, all such cases were cases of exhaus- 

 tion, diarrhoea, dysentery, insolation or true enteric fever, 

 and they consider that a medical officer assumes a rather 

 dangerous position in diagnosing a case as "simple con- 

 tinued fever" simply because he does not know what the 

 fever is and does not think it is enteric. All thoughtful 

 physicians will readily acknowledge that there is a general 

 lack of exact knowledge regarding fevers of this 

 kind. In military medical practice these fevers are ex- 

 tremely numerous and seldom fatal, and the term 

 " fcbricula" which was included in former editions of 

 the " Noinenclature of Diseases," issued by the Royal 

 College of Physicians, best indicated the type of fever 

 described and was a less confusing term to use for what 

 was, after all, a symptom rather than a definite disease 

 and for what must necessarily be a provisional rather 

 than a positive diagnosis. It is evident, however, that, 

 in the authors' e.xperience, a large number of these cases 

 were considered to be mild forms of enteric fever. The 

 Board of Medical Officers appointed to inquire into the 

 outbreak of enteric fever in the camps of the United 

 States Army in iSgS came to a similar conclusion ; and, 

 if it becomes the fashion to record this type of fever as 

 enteric fever instead of as simple continued fever, we 

 must be prepared for some remarkable variations, 

 statistically, in the incidence and case mortality of the 

 former disease. 



The second chapter on medical subjects deals with 

 diarrhcea, dysentery, sunstroke, diseases due to exposure, 

 functional diseases and mental disturbances as ex- 

 perienced in war. It will repay perusal, but can scarcely 

 be described as important. The facts are commonly 

 known and have frequently been described in the medical 

 histories of campaigns. It may, however, be interesting 

 to note that the authors consider diarrhoea and dysentery 

 to be synonymous. " Dysentery," they say, " is diarrhcea 

 writ large,' or, in other words, the two have a common 

 origin." Their reasons for adopting this opinion are 

 not convincing. In fact, no reasons are given other 

 than some vague theories and speculations regarding 

 the probable cause of the well-known diarrhoea of 

 campaigns. 



The best feature of the volume from a scien- 

 tific standpoint is the record of surgical work ; 

 and the chapters on this subject, to which nearly 

 one-half of the book is devoted, will cause it to 

 take a high and important place in the literature of 

 military surgery. They are written by Mr. Bowlby and 

 Mr. Cuthbert Wallace, and are characterised, pre- 

 eminently, by thoughtful and careful observation of fact. 

 NO. 165S, VOL. 64] 



Hitherto our scientific knowledge of the effects of modern 

 fire-arms has been dependent on experiments, notably 

 those of Prof. Bruns of Tiibingen. Mr. Bowlby and Mr. 

 Wallace have at once lifted us from the sphere of experi- 

 ment into that of actual facts by a series ot observations 

 the accuracy and completeness of which are forcibly im- 

 pressed upon the reader. Briefly, their facts may be 

 regarded as confirming the observations and conclusions 

 of the experimentalists. They had opportunities of 

 observing side by side wounds made by the Mauser and 

 old Martini rifles, both of which were used by the Boers. 

 The modern " perfect " bullet, the bullet with hard mantle 

 and small calibre, causes less shock, both local and 

 general, than the old bullet, and the risk of sepsis is 

 diminished. But the high velocity of the former at short 

 ranges is disastrous and is the cause of the so-called 

 " explosive" effect. The authors' explanation of this is 

 that the energy of the bullet is transmitted to the tissues, 

 and they base this explanation on the symptoms and 

 after-effects of wounds observed by them in which the 

 injury was not confined to the immediate track of the 

 bullet. The tissues beyond were found to be profoundly 

 injured, and these widelyrspread effects were largely in 

 proportion to the velocity of the projectile. Thus, in the 

 brain the passage of a bullet at close range is found to 

 result in the disintegration of almost all the cerebral 

 mass, while a certain proportion of patients shot through 

 the brain at extreme ranges made satisfactory recoveries. 

 In bones, too', the effect of high velocity at short ranges 

 is to produce very extensive splintering and pulverisation, 

 whilst at long ranges cancellous bone may be simply 

 perforated and compact bone fractured with but little 

 comminution. These observations completely confirm 

 Bruns' experiments, and they will be quoted as essential 

 facts in future text-books on military surgery. 



As regards another well-known phenomenon, fragmen- 

 tation and alteration in the shape of bullets, the authors' 

 observations lead them to believe that this does not 

 occur, in the case of hard mantled bullets, except as a 

 result of ricochet and impact with hard substances out- 

 side the body, a probable explanation which has been 

 overlooked in some recent continental works on the 

 effect of modern fire-arms. Another important observ- 

 ation is that soft-nosed or " sporting " bullets do not " set 

 up " on impact with soft tissues, and only when they hit 

 hard bone. Sportsmen will be inclined to disagree with 

 this, but the authors point out that the hide of big game 

 is compact enough to cause " setting up " of a soft-nosed 

 bullet, whereas the human skin is not. 



These are only a few of many interesting and im- 

 portant observations made in the chapters on the surgical 

 work of the hospital. In pages devoted to bullet 

 wounds of blood-vessels, nerves, joints, head and 

 abdomen there are points of special interest and value, 

 which throw a flood of light on many questions con- 

 nected with the surgical work of modern wars, and which 

 every surgeon, certainly every military surgeon, should 

 study. 



The volume is profusely illustrated by photographs, 

 including some skiagraphs, which add greatly to the 

 interest and value of the book. It also contains a useful 

 index. W. G. M. 



