NATURE 



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THURSDAY, AUC.l'ST 20, iS 



A SYSTEM OF MEDICINE. 

 A System of Medicine. By many Writers. Edited by 

 Thos. Clifford Allbutt, M.A., M.D., F.R.S., Regius 

 Professor of Physic in the University of Cambridge, 

 &c. Vol. i. Demy 8vo, pp. 1008, 38 illustrations, 13 

 charts, i coloured plate. (London : Macmillan and 

 Co., Ltd., 1896.) 



IT is almost e.xactly thirty years ago since the first 

 volume of the " System of Medicine," edited by Sir 

 Russell Reynolds, was published ; and the dedication of 

 the present work to him is a touching acknowledgment, 

 on tlie part of the editor, of the service rendered to 

 medicine by the late lamented President of the College 

 of Physicians, and his band of collaborators. Thirty 

 years has produced not only great changes in medicine 

 itself, but also great changes in the methods of attack- 

 ing medical problems. The intimate relation in which 

 medicine to-day stands to what may, perhaps, collectively 

 best be termed experimental pathology, has rendered 

 necessary in the present System, the collaboration of a 

 band of authors whose names are better known as 

 physiologists, pathologists, or bacteriologists than phy- 

 sicians, and their contributions lend a very special value 

 to the work. The book begins with an academic intro- 

 duction by the editor, who at once rightly denies any 

 corporeal fi.xity to the term ".System of Medicine," and 

 defines it as " a setting forth of the whole of our know- 

 ledge, as immediate convenience and the exigencies of 

 contemporary learning may dictate." A few brief but 

 pregnant remarks upon classification, nomenclature, dia- 

 gnosis and prognosis, lead us to Division i. of the System, 

 which has received the name of prolegomena. Each 

 of the articles, twenty in number, contained in this part 

 of the work is complete in itself, and may be regarded 

 as representing the present state of our knowledge upon 

 the subject of which it treats. 



Medical Statistics are dealt with by Dr. Billings in a 

 most able and exhaustive manner ; .\nthropology and 

 Medicine by Dr. Beddoe. Dr. Rivers, in a short essay 

 on Temperament, points out that a valuable classification 

 of temperaments may be expected from a study of this 

 subject on the lines of Gallon and Kraepelin. Mr. 

 Hutchinson, in a few^ pages, discusses " The Laws of 

 Inheritance in Disease." Dr. Haviland tells us succinctly 

 what is known w'ith regard to the relations of the physical 

 geography of this country to heart disease, cancer and 

 phthisis. 



One of the most difficult tasks in the book has fallen 

 to the lot of Prof .-Vdami, who contributes the monograph 

 on Inflammation. The article is divided into three parts. 

 Part i. is devoted to the comparative pathology of inflam- 

 mation ; chapter i. is introductory ; chapter ii. contains 

 an account of the researches of Metschnikoff, Kruken- 

 berg, Reinke, and others, on the effects of irritants on the 

 protozoa and lower metazoa ; chapter iii. describes the 

 main forms of the process of acute inflammation in the 

 higher animals, in which the experimental production of 

 suppurative inflammation finds a place. Here the author 

 considers at length the work of Cohnheim, Grawitz, and 

 NO. 1399, VOL. 54] 



De Barry, Councilman, and others. Part ii. is devoted 

 to the factors in the inflammatory process considered in 

 detail, and first and foremost the part played by the 

 leucocytes. The author here gives, with a table, a classi- 

 fication of leucocytes according to the different authori- 

 ties. The rival theories of " phagocytosis " and " extra 

 cellular action " are discussed at length. Dr. Adami 

 inclines to the view that although different bacterial pro- 

 ducts may give rise to positive chemiotaxis of varying 

 intensity, the possession by these products of actual 

 negative chemiotactic properties is very doubtful. The 

 author concludes by saying that however important phago- 

 cytosis may be to the organism, the extra-cellular action 

 of active and disintegrating leucocytes may under certain 

 conditions be even more so. The question of the inflam- 

 matory exudation, the part played by the vascular and 

 nervous systems, the diapedesis of the leucocytes, which 

 the author regards as active, and caused by the positive 

 chemiotactic properties of the irritant, are each con- 

 sidered. Of the role played by the cells of the tissues, 

 and of the origm of the " fibroblasts," a full account is. 

 given ; and this part of the subject concludes with an 

 exhaustive chapter on the varieties of fibrous hyperplasia 

 and their relation to inflammation. Part iii. is devoted 

 to classification and the systemic changes consequent 

 upon inflammation. The author, in conclusion, defines 

 inflammation as " the local attempt at repair of actual or 

 referred injury." In the article just considered, Prof. 

 Adami has certainly accomplished the task he set before 

 himself, viz. " to bring into order the very numerous- 

 recent researches upon the inflannnatory process, and to 

 show whither they appear to tend." 



The Doctrine of Fever is dealt with by Dr. Burdon 

 Sanderson, and divided into two parts. Part i. is a 

 historical retrospect which deals chiefly with the views 

 of Cohnheim, Senator, Traube, Pfluger, and Leyden. 

 Part ii. gives an account of the researches bearing on 

 this subject since 1883. The relation between the 

 increased proteid disintegration in fever and in inanition 

 is discussed, as is the production of " fever," so called, by 

 cerebral puncture and the mode of action of antipyrine 

 and other antipyritics. 



An article on the General Pathology of Nutrition is 

 contributed by Dr. F. W. Mott. Dr. Mott first describes 

 the physiology of nutrition, and discusses the influence of 

 the quality of the blood, the internal secretions of the 

 organs, the nervous system, and the inherited specific 

 properties of the blood, upon the maintenanceof a normal 

 state of nutrition. Necrosis, atrophy and fibrosis, the 

 degenerations, and hypertrophy are fully dealt with. The 

 author holds the view that in the fatty degeneration of 

 myelin, lecithin is the source of the fat, and suggests that 

 extensive degeneration of this kind may produce an auto- 

 intoxication. The article is well illustrated. A mono- 

 graph on the General Pathology of New Growths is 

 communicated by Messrs. Shattock and Ballance. The 

 chief interest of this article lies in the full description 

 and searching criticism of the parasitic theory of car- 

 cinoma. The authors have spared neither time nor 

 trouble to put this theory to scientific tests. .=^11 attempts 

 to cultivate the hypothetical parasite of carcinoma, either 

 directly in various media or through the intervention of 

 lower forms of life, were negative. The treatment of 



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