row * reacts quite promptly to infections. In laboratory animals dying of an infection I have often noticed a marked engorgement of the marrow; so often that I have come to regard it as a pathogenic sign of an infection." The theory of the purely passive rôle of bone tissue itself is not by any means generally accepted, but the author points out many facts which have led him to believe that it is so. His observations, for instance, have led him to regard periostitis as an inflammation of the subjacent bone marrow-quite a departure from the standard teaching. He explains the frequency of the occurrence of infections of the bone marrow in the young by the fact that the marrow at this stage of life is essentially a lymphoid tissue. It is well known that if pus germs of sufficient virulence are carried in the blood stream to a lymph node, the lymph node suppurates and breaks down; if they are carried to the bone marrow, the bone marrow does the same. Trauma appears not to have the importance in this connection which is usually attached to it. All through the volume the reader will find similar modifications of long accepted facts which have been brought about by the author's researches. APPLIED PHARMACOLOGY by A. J. Clark, B A., M. D., F. R. C. P., professor of pharmacology in the University of London. P. Blakiston's Son & Co., Philadelphia, 1923. The writer has endeavored in this book to give an account of the direct scientific evidence for the therapeutic action of the more important drugs which is available at the present time, and to demonstrate the importance of this knowledge in the clinical use of these drugs. The subject matter is arranged according to the therapeutic application of drugs, and so we find chapters on disinfectants, the action of mercury, arsenic, and antimony as internal disinfectants, the action of quinine in malaria, the action of emetine and the salieylates, the anthelminthics, alcohol, anæsthetics, depressants of the central nervous system, the pharmacology of the alimentary canal, the heart, circulation, respiration, kidneys, and uterus. There are chapters on the pharmacology of temperature regulation and of the endocrine glands; chapters on the pharmacological action of radiations and of the products of protein breakdown: chapters on the vitamines and immunity reactions and on the physiological standardization of drugs. The drugs treated are those which have been studied by means of animal experimentation and as far as possible the author illustrates the action of these drugs by observations made upon patients; hence the physician who desires to practice scientific medicine will find much to assist him in his thera peutic endeavors in this book. The work is sufficiently up to date to mention Bayer" 205" and the ethyl esters of chalmoogra oil; but one looks in vain for a discussion of the action of the bismuth salts which are now being recommended in the treatment of syphilis. Mercurochrome "220" is not mentioned in the chapter devoted to the use of disinfectants for special purposes, and carbon tetrachloride, which has been found so effective in the treatment of ankylostomiasis, is not included in the discussion of the anthelminthics. The author's failure to consider these therapeutic factors is not a fault; it merely illustrates the rapid growth of that branch of medical science with which he deals. A REFERENCE HANDBOOK OF THE MEDICAL SCIENCES EMBRACING THE ENTIRE RANGE OF SCIENTIFIC AND PRACTICAL MEDICINE AND ALLIED SCIENCE, by various writers. Fourth edition. Edited by Thomas Lathrop Stedman, A. M., M. D. Complete in eight volumes. William Wood & Co., New York, 1923. The Reference Handbook of the Medical Sciences has served two generations of medical men. It was first published in 1884 under the supervision of a medical editor of note, Dr. Albert H. Buck. The publication of the third edition was completed in 1917. The World War, however, brought about so many changes in medical and surgical practice that the publishers felt that an extensive revision of some of the articles and the addition of many new ones were urgently called for. It is pleasing to note that the new articles which appear in the fourth edition treat not only of subjects coming to notice for the first time during the war but also of new knowledge acquired in the natural course of medical progress since the appearance of the third edition. The list of contributors contains the names of men who stand at the head of their respective specialties, hence the information contained in the various articles is singularly authoritative and up to date. STATE BOARD QUESTIONS AND ANSWERS, by R. Max Goepp, M. D., professor of elinical medicine at the Philadelphia Polyclinic; assistant professor of clinical medicine, Jefferson Medical College. Fifth edition. W. B. Saunders Co., Philadelphia, Pa., 1923. The purpose of this book is to provide a convenient compend for the use of those who wish to prepare themselves for State board examinations. In compiling the volume the author has adopted a convenient order in the arrangement of the questions, and a few simple and obvious questions have been interpolated here and there in order to maintain the continuity of the subject. In the preparation of this edition the author has included only such new material as has been generally accepted and is no longer in the controversial stage. One finds that the most essential developments of the last few years and those which may be expected to furnish new questions in the course of the next year or two have been included. The subjects of physics, chemistry, anatomy, physiology, pathology, bacteriology, materia medica and therapeutics, medicine, surgery, obstetrics, gynecology, and hygiene are covered. DENTAL SURGERY, by Wesley Barritt, O. B. E., L. D. S. (Eng.), and Alfred T. Barritt, L. D. S. (Eng.). Henry Kimpton, 263 High Holborn, W. C. 1, London, 1922. This is a small volume on dental surgery arranged in the questionand-answer form, prepared by the authors apparently not with the idea of assisting the dental student to pass examinations but with the view of supplying him with a handy outline of the essentials of the subject. SPECTACLES AND EYEGLASSES, by R. J. Phillips, M. D., ophthalmologist, Presbyterian Orphanage. Fifth edition. P. Blakiston's Son & Co., Philadelphia, 1923. This book gives a clear and concise description of the method of measuring, fitting, and adjusting spectacles and eyeglasses. In the first part a general description is given of the principles of placing lens before the eye and the name of the parts of eyeglasses and spectacles with the part that are adjustable emphasized. The methods of checking the lens after the prescription has been filled is last described. The proper centering of the lenses, measuring for prisms, spheres, and cylinders is clearly shown. The book would make a good addition to the library of the naval ophthalmologist. DIGEST OF DECISIONS. Suicide among the personnel of the Navy and Marine Corps is not infrequent, yet the conditions attending suicide are varied and the question of line of duty and misconduct must be determined upon the facts set forth in the records or the events. Injustice may easily be done in the case of men who commit suicide under similar circumstances and even by similar means. One man's act is declared in line of duty, as, it appears, some one has said or the man himself has displayed evidence that he was "peculiar," perhaps mentally deranged. Another man, however, has exhibited no such evidence, and therefore his act is adjudged misconduct and not in line of duty; nevertheless, he may have been just as deranged as the former. In order that there might be fairness to all and a consistent policy established to govern such cases, the Secretary of the Navy requested that the question of suicide and its probable background be briefly outlined. The following memorandum has therefore been furnished: DEPARTMENT OF THE NAVY, Subject: Suicide. MEMORANDUM FOR THE SECRETARY OF THE NAVY. 1. For the purposes of the Navy, suicides may be divided into two groups: The adult deviates. The insane. 2. Conscious reasons for suicidal acts have no finality. However, many conscious formulations have in them vague distortions and projections from the unconscious which make them worthy of notation if not for dependence in suicide motive. The position taken by some authorities is that only by fathoming the unconscious can we get at the true motivatism to the suicidal act. There is no standard for mental soundness. 3. Many of the bravest and most reckless deeds have had a suicide component in that premeditated self-destruction is accomplished by placing oneself in a position of extreme danger and leaving the rest to chance, the real intent being concealed by what appears to be extraordinary bravery or by the sentiment that it is sweet to die for one's country--" Dulce et decorum est pro patria mori." 4. In antiquity the church came to frown upon suicide and placed drastic penalties, thus changing public sentiment and opinion, and for this reason even in our day religion is strongly inhibitive of suicidal thought and act in those communities or countries genuinely pious and devoted to dogmas of the church, and also in those isolated individuals who have suicidal tendencies but whose religious scruples are of sufficient reactive force to restrain from the act. Re ligion both checks and punishes. Where there is a laxity of community and religious sentiment (as in cities) suicide increases as the inhibiting influence of society is removed and the forces of present-day civilization are more pressing in their reaction upon the human nervous system. Here, too, enters the influence of suggestion and example not only as to the deed but also as to the means as set forth in the daily newspaper. 5. That suicide is essentially pathological seems true, although there are adherents to the belief that the existence of nonpathological suicide has never has proved. Such a view must involve the belief that a man of sound mind has the instinct of self-preservation so strongly that self-destruction is im possible. Before suicide can be committed there must be a severe mental conflict due to the cross pull of the instinct of self-preservation and the desire for extinction. 6. That suicide is one of the outcomes of insanity has always been recognized, and since insanity is shown to be on the increase the number of potential suicides must also increase in proportion. Stearns analyzed 167 self-inflicted deaths, during a period of five months, of which 65 persons were frankly insane, 8 were psychoneurotic, 6 were psychopathic (abnormal personality), and 9 were alcohol or drug addicts. In other words, 88, or somewhat more than half, were presumably mentally unsound, 25 were victims of physical disease, 15 were considered as delinquents, and 9 were senile. 7. To say that the suicide is a neurotic, a constitutional inferior, is not proper. A motive must be sought in the relations of the present day. According to Stelgner, the common factor is a contraction of mental capabilities and inability by means of the will, reason, or imagination to escape from an untenable position. Werther said, "Nature finds no way out of the labyrinth of confused and conflicting thoughts, and the man must die." There is an overvaluation of circumstances, conditions, events, or deeds, a fear of fear, a balancing of desire by an equally strong fear of the objective. The early environment seems to be strongly influential in individuals with an hereditary predisposition. 8. It is evident that suicide must be studied in groups only. It is held that suicide in the insane psychoneurotic criminal, drug addict, invalid, etc., can throw no light on suicide in those who apparently are sound and have everything to live for. Furthermore, from the Navy standpoint, the poorly adjusted period of adolescence is that period of the young man's life during which he enlists or enters the service and is a time when he is exceptionally susceptible to impressions and emotions. Daily occurrences, circumstances, deeds of accomplishment or failure, etc., set up constantly new motives to renounce life which soon become so numerous and pressing as to be adequate to unbalance the controlling factors. It is not known what may be behind a so-called philosophical suicide. 9. It has long been known that no neurotic ever feels suicidal unless he has first wished the death of others and that in such a case his impulse to murder is turned back upon himself. One must say there are probably good instances of sane self-destruction but not normal self-destruction, i. e., if one believes that the fundamental normal desire is for an enduring continuity of the life process. Apparently the sane suicides have the same psychology as the psychotics though the full and conscious motivation to the act may not be analyzed so specifically, veiled perhaps by the milder states of mental alteration and deviation from the normal. |