its cause in an associated disturbance of pancreatic function. In two cases hypoglycemia was found, without apparent explanation. The ordinary clinical tests for hepatic insufficiency, Widal's, etc., gave no data of clinical value.

As to the associated liver pathology this organ was found grossly enlarged in about 50 per cent of the cases examined. Microscopically, the more chronic cases showed the most marked changes in the form of a diffuse fibrosis of the periportal tissues, with new formation of bile ducts, leucocytic and lymphocytic infiltrations, degenerative conditions in the liver cells, rarely hyperplasia of the blood capillaries and an increase in the reticulo-endothelial cells. The authors regard this type of hepatitis as distinct and definite, and unlike Laennec's cirrhosis. In a few cases changes typical of the latter condition were found. No definite parallelism between the gross and qualitative liver changes, and the pathologic condition of the associated abdominal conditions was observed. Insofar as disease of the gall bladder was concerned the presence or absence of calculi seemed to make no difference. The changes in the liver in such cases were most intense in the neighborhood of the gall bladder, and the quality of the change varied inversely with the distance from the gall bladder.

In

these cases the microscopic examination showed lymphocytic infiltrations beneath the capsule and extending into the trabeculae.

Material for critical comment upon the work outlined above is furnished in the photomicrographic illustrations accompanying it. These represent a class of pathologic conditions of mild degree that are very common in the

livers of people over 40 years of age, whether coincident or not with other abdominal inflammatory conditions. It is very difficult to evaluate the significance of such findings. Particularly is this true with the periportal lymphocytic infiltrations and fibrosis, inasmuch as they are also particularly associated with the pathologic lesions of latent syphilis in other organs. The lymphocytic collections in the periportal tissues are in the majority of cases only hyperplastic primitive lymph nodes, and may be only a part of a constitutional anomaly, the thymico-lymphatic constitution, and not necessarily to be interpreted as inflammatory in character. It is reasonable enough to believe that some of these changes are the result of chronic abdominal inflammations; they are what we would expect to find in the liver as the result of such conditions; but the mere coincidence of liver changes and inflammation of pancreas, appendix or gall-bladder does not prove an etiologic relationship. case is much clearer as far as the localized hepatic changes associated with gall bladder disease are concerned, but an approximately accurate estimation of the frequency of association between diffuse hepatic changes and abdominal inflammations can be arrived at only through the study of an enormous amount of autopsy material of all kinds, and not restricted to cases in

The

which intra-abdominal inflammations are present. If we confine ourselves to the latter we are struck by the fact that the associated liver pathology is relatively slight, and we are impressed by the apparent great defensive powers possessed by this organ. This is a point which the authors themselves emphasize.

Untersuchungen über die pathogenese des Morbus Basedowii (der Thyreosen). By JOHAN HOLST, Stockholm, 1923. Acta Chirurgica Scandinavica, Supplementum IV.

In an elaborate monograph upon Basedow's disease Holst discusses the various conceptions and theories as to the nature of this affection that have arisen in sequence since the original description given of it by Karl von Basedow in 1840. This introduction is followed by an extensive study of the pathological changes in the thyroid and other organs in the various forms of the thyreoses, primary and secondary Basedow's. From this study Holst concludes that all forms of Basedow-struma (“hyperthyreosis") are associated with the presence of epithelial neoplastic tissue in the struma, and the pathologic-anatomic processes constituting the different types of Basedowstruma are essentially similar. He, therefore, would class all of the pathologic conditions appearing under the names of primary or secondary Basedow's, hyperthyreosis and thyreotoxicosis as constituting a pathogenic unity: "They are all primary thyreoses, caused by epithelial neoplasms of the thyroid." Holst believes that epithelial neoplasm-tissue of the thyroid is the "primus motor" of the circulus vitiosus which forms the pathogenetic foundation of all forms of Morbus Basedowii. With this definite conception of pathogenetic unity he replaces the old elastic and scarcely definable clinical conception of Basedow's disease. Not that this conception of the disease makes its clinical diagnosis any easier, but it does, he thinks, make clear the essential nature of the process. Holst believes further that the conception of the different forms of Basedow-struma as an expression of an epithelial neoplasm explains the most striking characteristics of these forms in so far as their apparent autonomy, and mixture of excess and deficiency shown in their growth are

concerned. The bizarre functions of the Basedow-strumas are to be explained as the expression of the qualities which these strumas possess as tumors (neoplasms).

In his histologic studies of cases presenting Basedowian symptoms he found the following pathologic forms: (1) Primary diffuse Basedow struma; (2) secondary Basedow in the form of adenoma with hyperthyroidism; (3) diffuse colloid struma with Basedow symptoms; (4) cancer of the thyroid with Basedow symptoms, and (5) one case of strumitis with Basedow symptoms. The primary diffuse exophthalmic goiters are to be regarded as Basedowadenomas; the adenomas of the adenomatous goiters with hyperthyroidism are epithelial tumors of the same kind; and the diffuse colloid strumas with Basedow symptoms are explained as containing microscopic adenomas which are responsible for the symptoms; while in the cases of cancer of the thyroid with Basedow symptoms the latter are due to the tumor tissue itself. The one case of strumitis with Basedow symptoms he disregards because no microscopic examination was made of the thyroid, but an abscess only was evacuated, hence no certain knowledge of the kind of epithelial changes in this case was available; but he favors his argument with the statement that in strumitis the inflammatory process is usually in an adenoma. In all other cases of primary and secondary Basedow's he finds local excesses of growth of an autonomous character justifying their interpretation as epithelial tumors. He also notes a parallel between Basedow-cachexia and tumor-cachexia.

As a practical application of his theory the successful therapy of all the different forms of Morbus Basedowii must consist in a complete destruction of all of the epithelial tumor-tissue in the thyroid, either by operation, ligature, irradiation, or by a combination of all three methods. If, after

operative treatment, there is a recurrence of Basedow symptoms, this event is to be explained by the presence of multiple tumors which were not microscopically visible and hence not removed. He explains the apparent spontaneous healing of Basedow's disease as due to regressive changes in the Basedow-adenoma bringing its growth to a stand-still, while there is still sufficient normal thyroid tissue left to carry on the normal function of the organ. The causes for the different forms of Basedow types are to be sought partly in the struma itself, partly in the constitution of the patient, and partly in other exogenous and endogenous factors acting during the course of the disease. The degenerative changes in Basedow-strumas play an important rôle, leading to a more or less marked destruction of the parenchyma. As the result of such destruction of the normal epithelium of the thyroid symptoms of myxedema may follow those of Basedow's disease, and the final picture may be that of myxedema. The majority of cases of Base

dow's are not the expression of a pure hyperthyroidism, but rather of a dysthyroidism. He does not think that there is any positive proof that the Basedowstruma produces any especial poisonous substance of other character than that contained in the normal gland secretion. The constitutional anomalies seen in Basedow patients Holst regards as secondary and thyreogenic, and not the cause of Morbus Basedowii. Likewise, he regards the neuroses, especially the sympathetic neuroses, as secondary and thyreogenic. He finds no foundation for the belief that the thyroid changes in Basedow's disease are the result of a normal reaction on the part of the thyroid to infection or to the influence of other organs on the thyroid. He further opposes the view that Basedow's is an expression of a congenital degenerative anlage. He concludes his work with a reiteration of his belief that the cellproliferations in the Basedow-strumas are autonomous new-growths, neoplasms.

International Clinics, Volume III, Thirtyfourth Series, 1924. J. B. Lippincott Company, Philadelphia and London. 304 pages, 2 colored plates, and 59 figures, charts, plans and tables. Cloth.

The third volume of International Clinics for 1924 contains six articles on Public Health and Hygiene, seven in Diagnosis and Treatment, four on Medicine, one on Pediatrics and two on Surgery. All of these articles are by well-known writers and are on timely and interesting subjects. Of especial importance is Zingher's paper on "The Dick Test and Active Immunization with Scarlet Fever Toxin," illustrated by two colored plates as frontispiece, showing various stages of the positive Dick reaction in a normal child and in a case of scarlet fever. The practical applications of the Dick test are discussed, and a valuable summing-up of our present knowledge of scarlet-fever is given with a bibliography of the most important recent work on scarlet-fever investigations. Other papers of interest in this volume deal with Malaria, Peptic Ulcer, Evolution in the Treatment of Syphilis, Treatment of Tics, and Parkinsonian Syndrome.

Basal Metabolism in Health and Disease. By EUGENE F. DuBois, M.D., Medical Director, Russell Sage Institute of Pathology; Associate Professor of Medicine, Cornell University Medical College. Illustrated with 79 engravings. 372 pages. Lea and Febiger, Philadelphia and New York, 1924. Cloth. Price $4.75. To the internist the subject of basal metabolism has become a matter of much interest during the last several years. A very large amount of literature has appeared upon the subject, but this has been chiefly from the standpoint of research work in pure physiology, and no book has hitherto appeared which has attempted to present the subject from the standpoint of

clinical medicine. This the present book aims to do; it is written for those engaged in the practice of medicine and surgery, for medical students, physiologists and dieticians. The underlying principles of technic are fully discussed. Part I is concerned with metabolism in health, eight chapters being given to this. Part II, consisting of eleven chapters deals with metabolism in disease under the headings undernutrition, over nutrition and obesity, basal metabolism in diabetes, diseases of the thyroid, adrenal, pituitary and sex glands, diseases of the blood, heart and kidneys, fever, water metabolism, influence of diseases of the central nervous system in basal metabolism, and the effects of drugs upon the basal metabolism. This book is a very important compilation of our present state of knowledge upon these subjects and should be in the hands of every medical student and practitioner of medicine. The information herein contained is not elsewhere available in this compact form. It is well put together, the style is agreeable, and the bookmaking well done.

Pathogenic Microorganisms, A Practical Manual for Students, Physicians and Health Officers. By WILLIAM HALLOCK Park, M.D., Professor of Bacteriology and Hygiene, University and Bellevue Hospital Medical College, and Director of the Bureau of Laboratories of the Department of Health, New York City; and ANNA WESSELS WILLIAMS, M.D., Assistant Director of the Bureau of Laboratories of the Department of Health; and CHARLES KRUMWIEDE, M.D., Assistant Director of the Bureau of Laboratories; Associate Professor of Bacteriology and Hygiene in the University and Bellevue Hospital Medical College, New York City. Eighth Edition, Enlarged and Thoroughly Revised, with 811 pages, 211 engravings, and 9 full-page plates.

Lea and Febiger, Philadelphia and New York, 1924, Cloth. Price $6.50.

The eighth edition of this deservedly popular text-book of bacteriology has been thoroughly revised, to make the grouping of different microorganisms conform more closely to the classification adopted by the Society of American Bacteriologists, and the new terminology suggested by this Society has also been added. Many parts of the book have been completely rewritten. The sections on immunity have been enlarged, and the authors' experiences to date with active immunization against diphtheria are given. New matter as to the probable value of certain serums and vaccines has been added. The chapters on pyogenic cocci, paratyphoid bacilli, dysentery bacilli and on the higher bacteria have been rewritten. The newer knowledge on the pathogenic anaerobes has been added, as has also the recent additions to our knowledge of scarlet fever, measles, typhus fever, Rocky Mountain fever, tularemia, etc. The chapters on milk and water have been revised and the descriptions of Standard Methods brought up to date. The chapter on complement fixation has also been revised, and details of the newer precipitin tests have been added. Well brought up to date, this book is a standard text-book on bacteriology, and thoroughly supports its reputation for popularity among medical students and laboratory workers.

Modern Methods in the Diagnosis and Treatment of Renal Disease. By HUGH MCLEAN, M.D., D.Sc., Professor of Medicine, University of London, and Director of the Medical Clinic, St. Thomas's Hospital; Honorary Consulting Physician to the Ministry of Pensions; Consulting Chemical Pathologist to St. Thomas's

Hospital. Second edition, revised and enlarged. With four coloured plates. Lea and Febiger, Philadelphia and New York. 1924. 110 pages, 4 figures, 2 charts and 4 coloured plates. Cloth. Price $2.50.

The first edition of this book appeared in 1921, and there were reprintings in 1922 and 1923. It is intended for the general practitioner, and presents a short practical account of some of the newer methods employed in investigating the renal function. Only those tests have been included which an extensive experience with renal patients has shown to be of practical clinical value and which are easily carried out. Allusions to theoretical points are brief, and no references to the literature are given. The author emphasizes the importance of a thorough study of the clinical manifestations in correlation with the results of the laboratory tests. In the main this new edition remains in the form of the first one. Although much has been written upon renal disease since that appeared, not much of clinical value has been added to our knowledge. A fuller discussion of the indications afforded by high blood urea concentration is given. The nine chapters treat of the chief functions of the kidneys, the kidneys in disease, the significance of albuminuria and casts, blood examinations in renal disease, tests for investigating renal function, the relation of nephritis to blood pressure and cardiovascular changes, the examination of patients for renal efficiency, the importance of ascertaining the state of the kidneys in certain surgical conditions, and observations on the dietetic treatment of nephritis. The book is well-written, in a clear and pleasant style. It is a valuable practical monograph for the general practitioner, and for the medical student.