Fatty Liver Disease in Infants in the British West Indies

200 this book is ks easy smooth-flowing readable style. T h e physiology of respiration is lucidly outlined and well illustrated by a multiplicity of diagrams. Moreover, readers of the earlier edition will welcome the revision in the nomenclature of the anatomy of the bronchial tree which now brings this work into line with the recent papers of Foster Carter, Hoyle and Brock. Other chapters which deserve special mention are those dealing with bronchial carcinoma, where the author has taken great pains to give a most comprehensive picture of this condition. Too many phthisiologists and physicians have been duped too often by the diversity of presenting symptoms and the variety of radiological appearances of malignant pulmonary disease. Special praise must also be made of the author's outstanding chapter on pulmonary tuberculosis. This appears to have been partially rewritten with an eye to recent developments in rehabilitation and after c a r e . It is no overstatement to say that the discussion on the management of the phthisical patient is one of the sanest and most balanced in the literature. It is therefore to be regretted that there appears to be no extensive reference, in the section on therapy, to Monaldi drainage as a supplementary measure in the treatment of the " g i a n t " cavity. Unfortunately publication of this edition has preceded the recent work on streptomycin and para-amino-salicylic acid therapy, though most assuredly these will receive a place in subsequent editions. T h e description of the radiological appearances of pulmonary hydatid disease omit a number of important diagnostic features, v i z . , perivesicular pneumocyst, " double arc " and " water lily " signs mentioned by Barrett in his recent paper. Criticism might also be directed to the author's description of the treatment of bronchial adenomata by bronchoscopy, forceps removal and radon seeds. Part of these growths are undoubtedly intramural and recurrences, bronchiectasis and pulmonary suppuration will in some cases follow such piecemeal removal. Lobectomy would be considered by most thoracic surgeons the treatment of choice. Dr. Coope has not produced a reference book of encyclopaedic detail but has rather furnished his readers with a fund of readily assimilable principles gleaned from his own wealth of experience. This volume already enjoys a wide reputation and its popularity and increasing circulation are assured. My Life in General Practice. By H. W. PeeLER, M.B. (Pp. x i i ÷ 194. 6 plates and 12 illustrations. Price 15s. net.) L o n d o n : Christopher Johnson (Publishers), Ltd. T h e author of this work was born in Wellington, salop, in 1866, and began the study of medicine at the age of 17 years as a pupil with his uncle. He was entered as a student at Queen's College, Birmingham some 18 months later and became qualified at 23 years. His recollections extend over the period of the last 60 years, an era in which the practice of medicine has made great strides. Dr. Peeler tells the story of the parts he has played in this development in simple and fascinating style. He has indeed played many parts--as an apprentice to his uncle, a medical student, a resident medical officer, a whole-time district medical officer and public vaccinator under a Board of Guardians, a part-time child welfare officer and, most important of all, as a general practitioner. A mere recital of the medical work on which he has been engaged gives little indication of his catholic interests and pioneering spirit. Perhaps it was while in practice at Ashted and when he became a member of the Birmingham City Council that he made his greatest contribution to medicine. In these days members were not elected on a party ticket and every member did his best to promote the interests of his town--party politics being eschewed at council meetings. Dr. John Robertson (afterwards Sir John) was the medical officer of health to the city at that time and on his advice Dr. Peeler set himself out to establish child welfare. Birmingham perhaps was not the first city in this country to undertake this work but under the influence of these two men it soon forged ahead and it may be fairly claimed for it to-day that it leads the way in this field of medicine. During his period as a city councillor Dr. Peeler had a number of opportunities of visiting the Continent as an envoy of a great municipality in connection with housing and town planning and child welfare. These experiences are carefully and pleasantly recorded in his life story. After his fall from grace at the next city council election, Dr. Peeler threw himself whole-heartedly into the work of the British Medical Association of which he has been a pillar for many years and recently received the rare honour of election as an Honorary Vice-President of that body. T h e author describes the changes in medical practice.brought about by the National Insurance Act 1911 and subsequent developments up to the present time. No one can read this autobiography without realising that all the activities of Dr. Peeler have been labours of love. It is indeed the case that the words of R. L. Stevenson can be applied to him : " If a man love the labour apart from any question of success or fame, the gods have called him."

PUBLIC HEALTH, July, 1948

Fatty Liver Disease in InIants in the British West Indies. By J. C. WATERLOW, IVLD., B.CH. Medical Research Council Special Report Series No. 263. (Price 2s. ) H.M. Stationery Office. Interest to-day eentres around the liver diseases, such as cirrhosis and fatty degeneration, and the part played in their aetiology by choline and methionine deficiency. Professor Himsworth and others have demonstrated the importance of these two substances in the transport of fat from the liver. Choline is the chief agent and the amino acid methionine is important because it can be converted to choline in the body. T h e r e is a difference of opinion as to whether choline is a member of the vitamin B group or is itself an amino-acid ; it is needed in larger amounts than is the case of vitamins. So far as the evidence now goes there is certainly a strong connection between protein deficiency and the n0n-infective types of cirrhosis, and the ~cute yellow atrophies such as occur in pregnancy, presumably due to the distention of the liver cells with fat which should have been removed elsewhere. It is therefore of more than ordinary interest to read in the Medical Research Council Special Report No. 263 of the study by Dr. Wateflow of the " sugar babies " in Trinidad, British Guiana and Jamaica. " Fatty Liver Disease in Infants in the British West Indies " is a timely contribution to this fascinating dietetic problem. T h e preface to the report says " T h e disease has been clearly different'ated from infantile marasmus and kindred conditions. T h e most important feature observed was fatty infiltration of the liver, which appeared to determine the clinical course and severity, and was used as a diagnostic criterion. T h i s was accompanied by oedema and muscular wasting without total loss of subcutaneous fat. In the West Indies mucosal and cutaneous signs of vitamin-B-complex deficiency, which in o t h e r parts of the world may dominate the clinical picture, were slight or non-existent. There was no response to treatment with pure tipotropie substances, but considerable improvement occurred on a high intake of milk. An attempt was made to determine the natural history of the disease in both its early and later stages, and evidence was obtained that it may be the precursor of portal cirrhosis developing in c h i l d h o o d - a condition that is not uncommon in the tropics." • In the result it is disappointing to learn that Dr. Waterlow found that choline, methionine and inositol had no beneficial effects in treatment. On the other hand there was ample evidence of protein deficiency and protein depletion, and improvement occurred on a high intake of milk. T h e report is particularly interesting in its study of cirrhosis present in children in the West Indies as early as 26 months, which it finds to occur as a terminal result of fatty infiltration, " an example of true dietary cirrhosis in man." T h e whole report is worthy of study. Bacterial and Virus Diseases : Antisera, Toxoids, Vaccines and Tubereulins in Prophylaxis and Treatment. By H. J. PARISH, M.D., F.mC.P.E., D.e.H. (Pp. 168. Price 7s. 6d.) Edinburgh : E. & S. Livingstone, Ltd. 1948. This admirable little book by the Clinical Research Director of the Wellcome Foundation presents clear and authoritative descriptions of the essential principles of immunology and their practical app.lication in human medicine. T h e matter is divided into three sections. T h e first deals succinctly and in practical fashion with immunity and immunisation in general, the methods of administration of antlsera and antigens, with special reference to the technique of the sterilisation of syringes and the routes of injection, serum reactions and their prevention. T h e n follow sections on particular antisera for passive immunisation whether for prophylaxis or therapy and on serological products for conferring active immunity (toxins, toxoids and vaccines) and descriptions of some diagnostic reagents for ascertaining, by intradermal tests, immunity or sensitivity as the case may be. Where all is so excellent it is hard to discriminate, but probably the accounts of active immunisation against diphtheria, vaccination against smallpox (including the multiple pressure method), and of tuberculins and B.C.G. vaccine will make the widest appeal to those in the public health service. T h e book is well illustrated in half-tone and colour and there is an adequate index. T h e production is first rate and the price modest. In short, this is one of the books for which a place mast be found on the shelves of all those engaged in the control of communicable bacterial or virus diseases by specific means. The Registrar-G~neral's Statistical Review ior England and Wales, 1943. Tables. Part I, Medical. (Price 5s. 6d. net, 5s. 10d. post free.) It.M. Stationery Office. 1948. T h e publication of the Registrar-General's Statistical Reviews was greatly delayed during the war. While priority is being given to more recent material, it is intended to publish the volumes for the intervening years as rapidly as possible and Part I for I943 has now been issued. T h e total number of deaths registered in England and Wales in