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although impeded by their inherent modesty. Theseveral biographies are interesting in themselves ;they have been put together with skill and there isconsiderable charm in the author’s extreme simplicityof style. To the inexpert, approaching the historyof tropical medicine for the first time, he recommendsthe reading of biographies in the following order-viz., Leeuwenhoek, Jenner, Meigen, Pollender,Griesinger, Bilharz, Obermeier, Koch, Laveran, Baelz,Pasteur, Metchnikoff, Manson, Ross, Reed, Gorgas,Carroll, Ehrlich-a list which does credit as much tohis sense of proportion as to his freedom from nationalprejudice. Having been a medical missionaryhimself he has allowed himself to go strong in

recounting missionary endeavour, and here againthe reader will be grateful for his indication of sevenbiographies which deserve study. Happily in thiscase there are some survivors. To the biographythere is in many cases a bibliography attached, andthe author takes credit for giving the present addressof these who are still alive. The production of thebook is as distinguished as its authorship. The papercover is attractive in design, the typesetting beyondcriticism, and the index a model for other effort.The book is indispensable in any medical library.

PHOTOTHERAPY OF THE EYE

A DEPARTMENT for ultra-violet treatment was

established at Moornelds Hospital in 1925, underSir Stewart Duke-Elder, who summarise his work inreports issued in 1926 and 1928. In the book before us 1

his successor, Mr. F. W. Law, considers all the caseswho had a full course of such treatment, general orlocal, in the clinic last year, and some of those treatedin the three years preceding. To help towards

assessing the permanence of results a letter was sentout to the patients or their parents as to their presentcondition. The effect of general phototherapy mustbe read in the light of the fact that the patientswere attending hospital three times a week for along period, and therefore received also other treat-ment in an unusually thorough way. This resultedin a high standard of cleanliness, for the undressingof a child three times a week before a nurse has itseducative value on the mother. With these provisosMr. Law endorses the favourable opinions expressedby other writers of the ultra-violet treatment of

blepharitis, phlyctenular disease, and conjunctivitisin children. Most forms of keratitis derive somebenefit ; this applies, in Mr. Law’s experience, evento interstitial keratitis. Syphilitic iridocyclitis andtuberculous disease failed to react, and, on the whole,his results do not reach the high level of some otherworkers. General phototherapy is, in fact, no morethan an adjunct in treatment. Local irradiation inits own sphere has more to offer. Mr. Law reports51 cases, nearly all of them corneal ulcers or differentforms of keratitis, treated by focusing the raysexactly on the spot. Although he has himself neverseen a cataract remotely connected with ultra-violettherapy, the application calls for continual care.

Preferably the pupil should be small, although this isnot always feasible. The usual initial dose is one of2 to 2i minutes, but if the duration of the beamhas to be as oblique as 45° the time of exposuremay be increased by one-half; if to 60° it may

1 Ultra-violet Therapy in Eye Disease, with a review of otherforms of Radiant Energy. By Frank W. Law, M.A., M.D.,B.Chir. Camb., F.R.C.S., Assistant Surgeon, Central LondonOphthalmic Hospital ; Pathologist and Curator, and MedicalOfficer in charge of the physico-therapeutic department, RoyalLondon Ophthalmic Hospital (Moorfields). With foreword bySir Stewart Duke-Elder, M.D., F.R.C.S. Published for theMiddlesex Hospital by John Murray. 1934. Pp. 78. 5s.

be doubled. Although corneal ulcers undoubtedlyheal more quickly when irradiated there is notsufficient evidence that the density of the sub-

sequent scar is less, nor is there any effect on

established nebulae. In tuberculous iritis there isoften a suggestion of improvement, but the dosageneeds careful watching. Throughout the monographMr. Law maintains a severely critical attitude towardshis own results. In using radium and X rays foreye diseases the danger of inducing cataract must,he says, always be taken into account. Infra-red

rays play no part as a therapeutic agent in diseasesof the eye ; they are a source of possible injury tocornea, lens, and retina--e.g., eclipse blindness.

THE ENGLISH TONGUE

THE history of the English language is not a matterfor philologists ; all persons with claims to education,in the countries where English is spoken, should havesome acquaintance with the origin and developmentof their own tongue. In the United States of latethis feeling has certainly been active, and a shortarticle on the subject in the Medical Record for July 4this worth attention. The writer says that few personsknow the origin of " the King’s English," evidentlythinking that fuller appreciation of the lineage of

language would minimise its frequent abuse. His

pithy sketch of the Saxon invasion and the settlementsof parts of England at different epochs gives reasonsfor the gradual evolution of English to its presentstandard. According to him it was not until 1385that the language of the English-speaking peoplesstepped out of its dialect petticoats to become anadult tongue, since when it has taken its place as themost universal means of intercommunication. Onthe cover page of the same issue of the Medical Becordthere is a picture of Dr. Thomas L. Stedman, formany years the editor of the journal, and this is

opportune, for Stedman is a master of English, aswell as a versatile linguist. Largely through this facthe has made a reputation as a lexicographer, wherean accurate knowledge alike of the subject in handand of languages is essential.

EPIDEMIC MYALGIA IN SWEDEN

IN a note presented to the permanent committeeof the Office International d’Hygiene publique,Dr. R. Huss outlines the salient features of the

epidemic of myalgia which, in the summer and autumnof 1931, claimed many victims in the southern coastalareas of Sweden and in Denmark.2 Though not asingle case was fatal, the manifestations of the disease,when it was of the abdominal type, led occasionallyto an exploratory laparotomy which proved nothingbut the mistake in making it. There was also a

thoracic type with bilateral symptoms referable tothe lower chest. The most common complicationswere orchitis (some 50 cases) and dry pleurisy (about ascore). Catarrhal symptoms referable to the respira-tory tract were rare. Some cases were characterisedby euphoria and flushing of the face. It seems

that the epidemic had had its forerunners in 1927,1929, and 1930. The outbreak of 1931 began in themiddle of June in the seaport of Marstrand, at whichtwo Swedish warships were stationed from June 18thto 26th. The sickness-rate on these ships a few daysafter they had left Marstrand was such that about athird of the crews was involved. Between the agesof 14 and 17 there were 190 persons, 72 of whom fellill. Between the ages of 20 and 30 there were only

1 Bull. de l’Off. Internat. d’hyg. pub., June, 1934, p. 1083.2 See THE LANCET, 1933, i., 709.

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12 patients out of a possible 44, and none of the 14members of the crews who were over the age of 30

developed the disease. Apparently, therefore, it hasa predilection for adolescents. As for the mode of

propagation, Huss is inclined to defer final judgmenttill more tangible evidence is available. In favourof a contact infection was the behaviour of the epidemicon board the two warships ; but the theory of acontact infection was not supported by the tendencyof the disease to flare up in certain well-defined areason the seaboard, and to leave whole communities hereand there in the same area untouched. The occurrenceof the outbreak in the hottest months of the yearwas suggestive of an insect-borne disease, and its

explosive character on certain occasions gave supportto the theory that it was conveyed by water.

EXHIBITS AT THE COLLEGE OF SURGEONS

THE Royal College of Surgeons of England hasreceived an important addition to the historical sectionof its museum by a gift from Miss K. R. Image ofover 300 surgical instruments belonging to her fatherand grandfather. The collection, which was formerlyin the possession of the faculty of medicine at

Cambridge, was made by William Edmund Image,an honorary fellow of the College, and his son,Francis Edward Image, M.B. They practised at

Bury St. Edmunds between 1830 and 1913, and theinstruments may be said to represent the completearmamentarium of a country general practitioner ofthe last century. They are now on view and includemore than 40 varieties of scalpels, bistouries, anddressing instruments, together with knives for amputa-tion and lithotomy. The gynaecological and obstetricinstruments comprise several types of vaginal specula,from the old bladed patterns to Fergusson’s silveredglass instrument, the midwifery forceps of Robertson,Waller, and Simpson, and cephalotribes and forcepsin great variety. Lithotomy instruments are alsowell represented and include the lithotrites of

Fergusson, Thompson, and Weiss, as well as stone-crushers, gorgets, and the lithotomy knives devisedby Liston and Thompson. There is a comprehensivecollection of ophthalmic, aural, and nasal instrumentswhich illustrate the period of development between1830-70, and the instruments for amputation includeListon’s and Lisfranc’s knives, saws, and several typesof bone-forceps.Among the earlier exhibits are a number of dry-

cupping sets, scarifactors, and glasses complete withspirit lamp ; cauteries, stethometers, otoscopes, andone of the earliest types of Dudgeon’s sphygmograph.There is also a pair of the long clinical thermometers,introduced by Prof. William Aitken of Netley, used inhospitals in 1866. Another gift to the College, whichis of special interest in this connexion, is a thermo-meter that originally belonged to Dr. John Aikin,of Warrington, the medical biographer, who wasborn in 1747 and died in 1823. It is 64 in. in lengthand is bent at a right angle of 25° at one end term-inating in the mercury bulb. The index is of ivorywhich is clipped on to the stem and is graduated inhalf inches from 1 to 12, and is divided into tenths.It is marked " Cary. London," and is enclosed in avelvet-lined leather case. It was probably used beforethe end of the eighteenth century, and is similar toone described as having been used by Sir AstleyCooper in 1802, which also had an ivory scale. Thisauthentic specimen is probably the earliest type ofclinical thermometer known, and descended in directline from Dr. Aikin to Mr. C. W. Brodribb, whopresented it to the museum.

Instruments of more recent date now on exhibition

at the College are represented by the original modelof Kocher’s artery forceps made for the inventor andpresented by his son, Dr. Albert Kocher ; also a setof four instruments devised and used by Prof.Trendelenburg for performing embolectomy,l whichwere given to and presented by Sir Charles Ballance.Objects of more general interest include a mummifiedhand said to have been that of Dick Turpin, thehighwayman, who was hanged at York in 1739, andsome relics of the Roman occupation discoveredlast year near the Poultry and presented by Dr.Mervyn Gordon, F.R.S. They consist of two spoon-sounds, two ear-scoops, a pair of forceps with earscoop, and a long needle, all in an excellent state ofpreservation. They are believed to date from thefirst century.

INJECTIONS OF CARBON

SOME observations by Gaudier and D6mareZ 2

on the treatment of infections by means of injectionsof animal carbon arise out of an earlier communica-tion to the French Academy of Medicine by Saint-Jacques, of Montreal.3 They have given this treat.ment to 25 patients suffering from various infections,surgical, medical, and obstetric. Each dose consistsof 2-5 c.cm. of a suspension of animal carbon inisotonic glucose serum, containing from 1 to 3 percent. of carbon, and the injections were given everyor every other day or at longer intervals, themaximum total dosage being 42 c.cm. of a 2 per cent.solution. The injections were painless even whensome of the solution was deposited outside a vein,and there was no violent reaction at the time such as

pallor, flushing, shivering, dyspnoea, or any changein the pulse and blood pressure. There was noteven a febrile reaction, and the treatment could not,therefore, be considered as a variety of shock treat-ment. Gaudier and Demarez believe that as a rulethe injection was followed by a fall in temperatureof at least 0 - 5’ C.-a fall which in the favourablecases was maintained and even continued in associa-tion with clinical improvement which was sometimesstartling. The carbon did not seem to have a direct

antipyretic action, and it was ineffective when

escape was not provided for collections of pus. Thebest results were achieved in diffuse, inflammatoryprocesses, when the reaction of the organism to theinfection hung fire, or when it ran an acute and seriouscourse without free suppuration. It is said that

pneumonia and acute articular rheumatism also

responded satisfactorily to the remedy, but its modeof action remains obscure.

CANCER OF THE LARYNX

Dr. J. H. Douglas Webster reports 4 two cases oflaryngeal cancer in which the patients have beenwell for nearly 12 months after treatment withX rays, according to the protracted fractional methoddescribed by Dr. Coutard, of Paris, in our issue ofJuly 7th. Dr. Webster’s previous study of 42 casesof cancer of the larynx shows clearly that the diseasecan rarely be controlled by the methods of X radia-tion which have been successful in other situations.All methods he has employed have ultimately led tofailure, except occasionally in post-operative "pro-phylactic

"

cases, in which it is not known whetherany malignant cells have been left in the tissues.Exact clinical details of the two cases now reportedare not given, but it is stated that the first had a

1 See THE LANCET, 1912, i., 139.2 Bull. de l’Acad. de Méd., 1934, cxii., 45.

3 See THE LANCET, 1934, i., 418.’Jour. Laryng. and Otol., July, 1934.