Reviews and Notices of Books
224 an opinion of its merits.-Mr. Heath showed: 1. A case of Aural Suppuration of 40 years' duration in one ear and 38 in the other, with an interval of two years between the operations. There had been complete recovery, with excellent hearing on each side, after conservative mastoid operations by the method devised by the exhibitor of the case. 2. A case of Chronic Aural Suppuration of two years' duration with cholesteatoma in both ears (specimen shown), with perfect restoration of structure
... d function in each ear after conservative mastoid operation by the exhibitor's method.-Dr. Spicer congratulated Mr. Heath upon Case 1, and said the ears of this patient were the most satisfactory results of mastoid operations he had ever seen. With regard to Case 2, the result of operation showed how much advance there had recently been in the treatment of chronic aural suppuration ; not long ago a patient such as this would have undergone the radical operation.-Dr. Pullin drew attention to the cosmetic effects of these two cases of double mastoid operations, and congratulated Mr. Heath upon the results.-Mr. Heath, in reply, said, with regard to the case of 40 years' duration, she was referred to him by Dr. Meggison, who did not anticipate that hearing could be restored, but in the hope that arrest of aural suppuration by mastoid operation might put an end to the severe headaches which had marred the whole life of the patient, whereas the result was that hearing had been restored to 20/50ths and 14/50ths, which was really excellent hearing; the headaches, too, had abated. With regard to the double cholesteatoma case, prior to the introduction of the conservative mastoid operation in 1906, Mr. Heath, too, would under such conditions-as Dr. Spicer had statedhave performed radical operations, and this patient would now be more or less deaf, whereas at present her hearing was more acute than the average girl of her age.-Mr. Walker Wood showed a Set of New Instruments used in conjunction with the Naso-pharyngoscope for the direct treatment of the Eustachian tubes.-Mr. Heath also exhibited several and Stoughton. 1913. Pp. 395. Illustrated. Price 10s. 6d. net. THE rise of clinical pathology has been one of the outstanding phenomena of the progress of medicine since the opening of the twentieth century. , The exact status of those who practise it and the exact relation of this new science to pre-existing specialties are still not finally settled, in spite of serious debate upon these topics by several of those who delight in looking into the future of medical evolution and in seeking to direct the lines along which advance shall take place. The most philosophical and original section of Dr. Bernstein's book is the first chapter, wherein he expounds his own views on these points, about which he has evidently done some hard thinking. To begin with, he sees quite clearly that clinical pathology is, and will almost certainly remain, an adjunct to clinical medicine, not a substitute for it. No clinician is likely to dispute this view, and, indeed, it is only the youngest of bacteriologists who are apt to overlook it. He proceeds to express the belief that laboratory technique can be, and ought to be, handed over mainly to the skilled laboratory assistant, and to protest against the view that the trained and qualified clinical pathologist should spend his time cutting sections and counting leucocytes. Here, again, we think he is right, though a good many physicians may not agree. He is thus led to anticipate the day when the general practitioner will call into consultation not the present-day type of consulting physician, but a new breed of " physician-pathologist." Certainly a transitional period is being passed through just at present. The general practitioner hears much of this "reaction " and that, of vaccines, hormones, and many other applications of organo-therapy. For the great majority of patients these aids to diagnosis and treatment are out of the question on the score of expense, unless, that is, the patient is in such circumstances as to be a legitimate candidate for a voluntary hospital. Apart from that, it is extraordinarily difficult for a man in general practice to sift the permanently valuable from the ephemeral of these complicated processes. He ends, sometimes, by distrusting them all ; or, if his patients are willing, by adopting in turn each new fad, and neither course is right. The author of this book seeks to do the conscientious practitioner, who has not time or training to enable him to discriminate for himself on matters of bacteriology, the service of summarising for him the value, the meaning, and the limitations of all the various investigations which the clinical laboratory now undertakes. He does not enter at all into the questions of technique, rightly judging that this want is well supplied already, and that the information would be useless to the readers for whom the book is designed. The task thus set is carried out in a very thorough and painstaking way. Throughout it is obvious that the author draws upon extensive personal experience, and is not content merely to echo the opinions of others. A tinge of the dogmatic is thus introduced, which in the circumstances is both necessary and advantageous. The whole tone of the book is practical, and as a summary of up-to-date knowledge in this branch is thoroughly trustworthy. There are, it is true, small points upon which clinicians would oppose the author's views. To give an instance, the hourly blood-count recommended in appendicitis is neither practicable nor sound in our personal judgment. Many observers, we fancy, would object to the distinction drawn between physiological glycosuria " and the graver forms of disturbed carbohydrate metabolism. But these are minor details which scarcely detract from the high opinion we have formed of the book as a whole. There are far too many misprints, however ; the most glaring is that which directs the intravenous injection of salvarsan in 300 ounces of solution. The Rationale of Punishment.