lymphoid leukaemia. The tumors may be large or small, miliary, discrete or confluent; they may be so numerous as to be universal. On the face, which is the site of election, they may produce a leonine expression resembling that of leprosy. They are usually of a livid red color. Pruritus is very common; and the resulting scratching may give rise to pruriginous papules. The leukaemic tumors may last for some years. They may be present with either the aleukaemic or leukaemic phases of the disease, but Rolleston objects to the use of the term leukaemic tumor when the blood does not show a leukaemic condition. The other cutaneous manifestations of chronic lymphoid leukaemia are numerous and polymorphic: erythrodermia, bronzing, urticaria, vesicles, pemphigoid eruptions, etc. The pigmentation may be the result of arsenical administration, but may occur in the absence of such treatment.

Chloroma: The cutaneous lesions associated with this form of leukaemia may appear in the form of definite green nodules in the skin, but these are rare, only seven cases having been reported. Chloroma is only very rarely associated with cutaneous tumors. Purpura, however, is common, as in acute leukaemia; and haemorrhages into the orbits, eye-lids, subcutaneous and peritoneal tissues are common. These may suggest scurvy.

Multiple myeloma: As in chloroma tumors may occur in the subcutaneous tissues, and metastatic deposits of calcium may develop, especially in superficial bursae. Two cases of probable multiple myeloma with respectively pruritus and erythrodermia (Spiethoff), and a papular crusty eruption (Block) have been reported.

Hodgkin's disease: In an analysis of 70 cases K. Ziegler estimated that a quarter of the cases presented cutaneous manifestations at some time in their course; in 33 previously unpublished cases H. N. Cole found cutaneous manifestations in 39.3 per cent. The occurrence of Hodgkin's nodules in the skin is very rare; Colrat accepted only 3 cases from the literature; Rolleston could collect 12 cases only. There may be either small pin-head-sized nodules in the dermis, or of various sizes, large and flattened, or somewhat diffuse plaques. The face and

course.

scalp are more often affected than the trunk, and a leonine appearance like that in nodular leprosy may result. The tumors grow slowly, seldom undergo involution or disappear, and very rarely ulcerate spontaneously; in Langley's and Cole's cases, one of a number of cutaneous growths ulcerated. As a rule the tumors are not associated with pruritus. Pruritus is, however, much the most common cutaneous manifestation in Hodgkin's disease, and is responsible for the next more frequent-prurigo. Pruritus may be the initial symptom, and may appear before any obvious glandular enlargement. It has been compared with the premycotic manifestations of mycosis fungoides. Rolleston has the impression that the cases with initial pruritus run a rapid In other cases pruritus may not appear until late in the disease. The itching may be continuous or intermittent, and appear to correspond with exacerbations of the disease. With the pruritus there may be a coincident eosinophilia, but the two conditions are not necessarily associated. The cause of the pruritus is not yet known, although many theories have been advanced in explanation of it. It appears to be capricious, and to be determined possibly by anaphylactic or individual idiosyncrasy. Prurigo follows the scratching; the lesions are purely inflammatory, there being no evidence of lymphadenomatous growth. Lichenification and pyogenic infection are also sequelae of scratching. Pigmentation may result from the scratching, use of arsenic or x-rays; but it may also arise from the irritation to the sympathetic by enlarged glands surrounding the solar plexus, or to adrenal insufficiency due to pressure on the adrenal veins. Icterus may also occur. Urticaria, erythema nodosum, subcutaneous haemorrhages, morbilliform eruptions, bullous or pemphigoid eruptions, exfoliative dermatitis, erythrodermia, etc., have all been reported in association with Hodgkin's disease, but are of rare occurrence.

Mycosis fungoides: This disease shows much more definitely than the previously mentioned conditions the association of the two groups of cutaneous manifestations. In the premycotic stage pruritus and polymorphic rashes appear for relatively long

periods, even ten years. During this period lesions due to scratching, such as papules, pyogenic infection, lichenification, etc., may complicate the erythrodermia, eczematous, erythematous, macular and urticarial changes. The site of the later tumor formations appears to be largely determined by the earlier eruptions, although the tumors may arise without any premycotic manifestations. The tumor

formations are the essential part of mycosis fungoides, and thus contrast with the incidence of cutaneous growths in leukaemia and Hodgkin's. The nature of the disease has been much debated; it has been regarded as the cutaneous form of lymphadenoma and as an alymphaemic lymphomatosis. Transition forms exist between Hodgkin's, alymphaemic lymphoblastoma and lymphatic leukaemia.

Infection, Immunity and Inflammation. A Study of the Phenomena of Hypersensitiveness and Tolerance, and Their Relationship to the Clinical Study, Prophylaxis and Treatment of Disease. By FRASER B. GURD. B.A., M.D., C.M., F.A.C.S., Montreal. Lecturer in applied Immunology and in Surgery, McGill University. Associate Surgeon, Montreal General Hospital. Surgeon Western Pavilion, Montreal General Hospital. Consultant in Surgery and Surgeon in Charge St. Anne's Hospital, Department of Soldier's Civil Reestablishment. The C. V. Mosby Company, St. Louis, 1924. 329 pages. Cloth. Price $5.00. This work is made up of twenty-six chapters dealing with the defensive and offensive reaction of the body against irritants; infection and infectious agents; immunity and immunization; general principles of acquired immunity as exemplified by toxin-antitoxin reaction; anaphylaxis-hypersensitiveness; the fundamental phenomena characterizing hypersensitiveness, desensitization and tolerance in the guinea pig; detailed description of the phenomena of anaphylaxis in the guinea pig and other animals; physiology of anaphylactic shock; transferred anaphylaxis; desensitization; antisensitization; nature of anaphylactic antigen; anaphylactoid phenomena; site of the reaction between antigen and anaphylactic antibody; nature of this reaction; allergic reaction; function of the leucocytes in immunologic processes; protein-lysin immunity, alexin and sensitizing substance; agglutinins and precipitins; relationship of anaphylactin to other immune bodies; hemocellular reaction; focal vascular and cellular reaction to irritants, inflammation; classification of inflammatory reactions; anaphylaxis in man; application of immunity principles to the prevention and treatment of disease; and the therapeutic guidance of the acute inflammatory reaction.

Written by a practicing surgeon who has made the study of infection and the

reaction of the tissues to irritants his chief interest and hobby for many years the object of the author has been to present to the practicing physician and surgeon a more general knowledge of the facts of tissue hypersensitiveness and tolerance. He believes that the immunologic process as it applies to the tissue reaction against colloidal proteins is an exhibition of digestive activity on the part of the tissue cells. Anaphylaxis is the first stage in the immunologic reaction, and, although, under very exceptional circumstances, it may constitute a danger to the life of the animal or individual, it serves a useful purpose, in that, in consequence of hypersensitiveness of the tissues to the complex protein molecules which constitute bacteria, the bacterial cell bodies are immediately recognized by the tissue, as irritants. The normal response of the tissues to the presence of small particles of irritant substances is focal hyperemia, accumulation of leucocytes and phagocytosis of the irritant particles. Through the proper appreciation of the allergic phenomenon and its relationship to anaphylaxis and tolerance the prevention and treatment of infection by means of bacterial or other protein preparations is placed upon a rational basis. The volume consists of an elaboration of this point of view in the form of well-digested critical abstracts of published investigations bearing upon the subject, and their interpretation from the author's standpoint. It is a convenient condensation of an enormous amount of research literature.

The Effects of Inanition and Malnutrition upon Growth and Structure. By C. M. JACKSON, M.S., M.D., L.L.D., Professor and Director of the Department of Anatomy, University of Minnesota. 616 pages, 117 illustrations. P. Blakiston's Son & Co., Philadelphia, Pennsylvania, 1925. Cloth. Price $8.00.

The increasing importance of conditions of malnutrition and deficiency diseases

throughout the world, even in the more fortunate countries, and the occurrence of famines in the less fortunate nations have since 1914 drawn an increasing amount of scientific attention to the questions of total and partial inanition. While the importance of inanition and malnutrition has long been recognized in connection with the diseases of infancy, their significance for adults is just coming to be understood. Among the outstanding problems of experimental and clinical medicine today are the nature and relationships of the deficiency diseases. These problems concern the zoologist and botanist, the physiologist, biochemist and the pathologist as well as the clinical therapeutist, since the facts of normal and pathological nutrition underlie normal morphology and physiology and pathology. The present volume is concerned with a systematic review of the widely scattered data in the literature concerning the morphological effects of inanition in all living organisms and includes both published and unpublished work by the author and his coworkers of a decade of research in this field. pecial care has been taken to make the bibliography as complete and accurate as possible. The contents consist of three parts: Part I dealing with the effects of inanition on plants, protozoa and the higher invertebrates; Part II dealing with the effects upon vertebrates of total and partial inanition affecting the body as a whole and the individual organs and tissues; Part III consisting of conclusions, tables and bibliography. This is an important and valuable survey of the whole subject; and the resume of the bibliography alone makes it an indispensable volume to the biologist and physician. The facts marshalled here in systematic order form the foundation stone for any rational conceptions of the problems of nutrition and for the treatment of nutritional disorders.

Es

Rejuvenation: The Work of Steinach, Voronoff, and Others. By NORMAN HAIRE, CH.M., M.B., London, England. The Macmillan Company, New York, 1925. 223 pages, 4 figures. Cloth. 12 mo. Price $2.75.

The avowed purpose of this book is to

make out a case for the methods of socalled rejuvenation advocated by Steinach and Voronoff, in a manner intelligible to the educated layman and devoid of sensationalism. The unfortunate and misleading use of the term rejuvenation is pointed out, as is also the fact that other terms suggested in its place, such as, revivification, reactivation, regeneration, etc., are no more satisfactory. The writer has evidently been much impressed by the improvement in general health resulting from, or at least following, the Steinach operation of unilateral vasectomy and vasoligature. In some cases this general improvement has been accompanied by an improvement of sexual health, in others by little or no sexual regeneration. The argument is for an improvement in the general health, rather than for the sexual rejuvenation popularly supposed to be the aim and result of the Steinach operation. No claim is made for a restoration of youth or complete health; the removal of some of the ravages of age or the postponement of oncoming senility are alone to be hoped for. As to the prolongation of human life by rejuvenation operations no positive answer can be given at this time. The author has operated and observed twenty-five cases of his own. No claim for permanence of the results of the operation are advanced. The only very positive claim made is that from the evidence available from investigators in almost every country of the world Steinach's operation is usually followed by a considerable improvement in the patient's general health. A bibliography, by no means complete, is included. The therapeutic application of glandular therapy to eunuchism, eunochoidism, homosexuality and various abnormal mental and psychical conditions is also included.

Serum Diagnosis of Syphilis by Precipitation. By R. L. KAHN, SC.D., Immunologist to the Bureau of Laboratories, Michigan Department of Health, Lansing, Michigan. The Williams & Wilkins Company, Baltimore, 1925. 237 pages, 55 tables, 5 plates and 1 chart. Cloth, gold stamped, 6 x 9. Price $3.00. This volume describes the governing principles, the procedure, and the clinical

interpretation of the Kahn precipitation test, based upon the experimental studies carried out by the author during the last three years. The development, standardization and clinical application of his test are discussed in full in twenty-eight chapters. A bibliography is appended. The theory and technical details of precipitation tests are clearly and fully given. The style is simple and concise, and the manner of presentation clear and logical. The claims for the advantages of the precipitation test are modestly made and not too dogmatically stated. When checked up in a large number of clinical tests, the Kahn precipitation test appears to be somewhat more sensitive in primary syphilis than either of two different Wassermann systems, one highly sensitive, the other more conservative in character. In secondary syphilis there appears to be general agreement with all methods. In tertiary syphilis including cerebrospinal, the author's test appears to be considerably more sensitive than either of the two Wassermann tests. In syphilis of the viscera the precipitation test compares in sensitiveness with that of the two Wassermann tests. In diffuse cerebrospinal syphilis and in general paresis the author's test is comparable in sensitiveness with the prolonged fixation Wassermann test. In tabes dorsalis this Wassermann test appears to be the more sensitive. In latent syphilis the sensitiveness of the author's test compares favorably with the prolonged fixation Wassermann test. The comparative value of the precipitation and Wasserman tests can be finally determined only through accumulated clinical experience, and this volume will be of the greatest service in making such comparative studies possible. It is an indispensable aid to the serologist and clinician engaged in the practical diagnosis of syphilis. The Internal Secretions of the Sex Glands. The Problem of the Puberty Gland. By ALEXANDER LIPSCHÜTZ, M.D., Professor of Physiology in Dorpat University. With a Preface by F. H. A. Marshall, F.R.S. 514 pages, 142 illustrations. American edition published by The Williams & Wilkins Company, Baltimore, 1924. Cloth. Price $6.00.

This book was first published at Berne in 1919 with the title "Die Pubertätsdrüse und ihre Wirkungen." To the present edition which contains much new matter the author has given the title "The Internal Secretions of the Sex Glands" as indicating more accurately and completely the contents and character of the book. The manuscript was written by the author in English, and the work of the editor was confined in making such alterations as seemed to render the former's meaning more clearly. In twelve chapters the author gives a systematic and comparative account of the endocrine functions of the gonads, so far as these are known, in all groups of multicellular animals. Concise and critical analyses of all experimental work that has been carried out along this line, as well as of clinical observations, make the book of great value and interest to biologists and medical men. The full bibliography and the critical abstracts of the same make it especially helpful to the students of this branch of endocrinology. On a first reading it seemed to the reviewer to be the most sane and scientific book upon this subject that has yet appeared. The author believes that one conclusion stands beyond the reach of controversy and that is that the testicle and ovary are organs of internal secretion, and that their hormones are sex specific; but that the seat of hormone production in the testicle is not definitely settled. The effects of transplantation or ligature should not be confused with the question as to the seat of hormone production. It is possible that some of the effects of ligature are not necessarily of an hormonic order at all. It still remains to be settled whether the effect of ligaturing the vas is the result of an intensified hormone-production of the interstitial cells, as Steinach supposes, or is due to the resorption of disintegration products of the seminal cells. So many of the books written upon this subject show a distinct tendency; this one is free from such. It, therefore, can be recommended to medical students and physicians as a scientific collection and presentation of the known facts in the

case.