Studies in Neurology

These two books cause one to reflect on the needs of the reader of the textbook on infectious diseases. Some will want a work which devotes special care to the description of all aspects of the infections, a book to which reference can be made when the unusual is encountered and which will reflect the breadth of the writer's experience. Such is the clinician's book, and after the detail of the clinical description the reader is satisfied with less in the way of bacteriology, pathology, epidemiology, or even specific therapy. This is the classical approach, and the original texts of books like Ker's Infectious Diseases and Ricketts's monograph on smallpox still remain as up to date as when they were written because of the mastery they display in their clinical observation. Others, however, will be content if the clinical descriptions are less detailed, provided there is adequate discussion of the most recent knowledge of, for example, bacteriology or therapy. Naturally, this type of book tends to " date " more quickly, especially in these days, when treatment may change so rapidly. Either of the present books may be recommended to both groups of readers, though each has its emphasis towards one or other aspect of its subject. The French work tends towards the classical form. The present volume is the first of a series of seventeen which will clearly supply a comprehensive review of modern French medicine. The infectious diseases described comprise most of the notifiable diseases common to this country. A detailed clinical description is supplied; and, as one would expect in a Continental textbook, each disease is carefully subdivided into every possible clinical type. There is no doubt that the book excels in painting the clinical picture, and though the British reader will not agree with all the interpretations he will enjoy the reading. The section on typhoid fever (which occupies 164 pages) may be used to exemplify the style. The bacteriological description is impoverished by an absence of reference to recent advances, and the importance of phage typing is not mentioned. This naturally weakens the section on epidemiology. The discussion of pathogenesis is excellent; so is the detailed description of the clinical course of the disease and its treatment. Here, as elsewhere, the fine subdivision into different clinical types rather engenders the view that " the disease is everything." One would welcome an extended discussion on the host-parasite relationship and a more obvious appreciation that the form of the infection is not merely a question of the causative organism. Scarlet fever is excluded from the section on streptococcal diseases and is described as a specific malady, the writer agreeing with the Dicks on the specificity of the scarlet fever streptococcus. There is thus no concept of scarlet fever as but part of the whole range of streptococcal disease. The role of reinfection as a causative factor in many of the complications is not stressed, and the possible connexion between scarlet fever and rheumatic fever is overlooked. Finally, one notes that the use of laboratory methods in the diagnosis of smallpox is not well discussed and the place of egg-culture not mentioned. But these deficiencies, viewed from the classic approach, are secondary to the excellence displayed in the description of the disease. Dowling's book, as one would expect, is a praiseworthy survey of the "new look" in fevers. Here the author turns away from the strictly clinical or pathological approach, and, because of the importance of the aetiological agent in dictating treatment, groups the diseases on a bacteriological basis. There is thus particular emphasis on the place of laboratory aids in obtaining a precise diagnosis. Having decided on the most rapid and certain methods to be used, the author discusses specific therapy and the effects which may be expected from its correct application. In the first part of the book are four chapters dealing with serum therapy, sulphonamides, penicillin, and streptomycin. These present a clear review of the subjects and should be particularly valuable to the person who is not dealing with these substances daily in infectious diseases, for they are essentially practical. Throughout the book there is a profusion of practical diagrams and individual case records, permitting the reader to see how his case ought to respond to the treatment advised. Though it is somewhat expensive for the student, there can be no doubt that the practical tone of the book and its ready appeal to the visual memory make it a useful volume for the undergraduate. The graduate can be assured of finding in it a fund of ripe experience. T. ANDERSON.