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The normal chest
26
THE
BRITISH
JOURNAL
OF
TUBERCULOSIS
NOTICES OF BOOKS. THE
NORMAL
CHEST.
A Tt-mROUCH u n d e r s t a n d i n g of the n o r m a l chest should precede all considerations of disease involving i n t r a t h o r a c i c structures. An eIaborate guide to such a s t u d y is now available in the h a n d s o m e and effectively illustrated volume provided by P r o f e s s o r M y e r s and his colleagues of the U n i v e r s i t y of Minnesota. 1 T h e w o r k is the outcome of a course of lectures and d e m o n s t r a t i o n s on the n o r m a l chest carried t h r o u g h in 192i , and was s t i m u l a t e d b y papers a n d discussions on education in tuberculosis presented before the S e v e n t e e n t h A n n u a l Meeting of the A m e r i c a n N a t i o n a l T u b e r c u l o s i s Association in N e w York City. W e e a r n e s t l y c o m m e n d th~ volume which lies before us to the notice of all medical advisers interested in affections of the chest, and p a r t i c u l a r l y to tuberculosis officers a n d medical superintendents of s a n a t o r i a ; it is a -work which no one of t h e m can afford to neglect. T h e main facts so far as a s c e r t a i n e d in r e g a r d to one part of the h u m a n machine are here g a t h e r e d t o g e t h e r and presented in system a t i c array, a d m i r a b l y illustrated by diagrams, drawings, charts, and roentgenograms. T h e r e are a dozen c h a p t e r s dealing respectively with P r a c t i c a l Considerations of the A n a t o m y of the Chest, the Surface of the Chest, P r a c t i c a l Considerations of the P h y s i o l o g y of the c h e s t , P h y s i c a l E x a m i n a t i o n of the N o r m a l Chest, the E x a m i n a t i o n of the N o r m a l H e a r t and G r e a t Vessels, the X-ray E x a m i n a t i o n of the N o r m a l Chest, the B o d y W e i g h t and Chest M e a s u r e m e n t s , including the Vital C a p a c i t y of the L u n g s of the N o r m a l A d u l t , the I m p o r t a n c e of S y s t e m a t i c E x a m i n a t i o n s , the E x a m i n a t i o n of the N o r m a l Chest in I n f a n c y and Childhood, the I n n e r v a t i o n of the Chest, the D e v e l o p mental A n a t o m y of the Chest and the T h o r a c i c Organs, and the Acoustics of P e r c u s s i o n and Auscultation. Such a brief enumeration of titles will be sufficient to i n d i c a t e the c o m p r e h e n s i v e n e s s and thoroughness of this unique composite volume. A t the end of each c h a p t e r is a serviceable select bibliography. A word of praise m u s t be allowed to p r i n t e r s and publishers for the g e n e r a l g e t - u p of the work and for the a d m i r a b l e i!lustrations. D e a n E . P. L y o n in his comm e n d a t o r y introduction says of this w o r t h y enterprise : " I t is set forth as f o r e r u n n e r of a day, still no doubt distant, when the facts of biology can be resolved into m a t h e m a t i c a l principles, and when medical diagnosis and t r e a t m e n t can proceed with the assurance of exact knowledge 1 ,, TtSe Normal Chest of the Adult and the Child, including Applied Anatomy, Applied Physiology, X-Ray and Physical Findings." By J. A. Myers, Associate Professor of Preventive Me:licine, Medical and Graduate Schools, University of Minnesota, in collaboration with S. Marx White, Professor of Medicine ; R. E Scammon, Professor of Anatomy; A. T. Rasmussen, Professor of Neurologyo; C. A. Stewart, Assistant Professor of Pediatrics ; and George E. Fahr, Associate Professor of Medicine, all of the University of Minnesota. With an Introduction by Elias P. Lyon, Head of the Department of Physiology, and Dean of the School of Medicine, University of Minnesota. Pp. xv+419, with I4I figtlres. London: Bailli~re, Tindall and Cox. 1927. Price 22s. 6d.
NOTICES
~7
OF BOOKS
leading to predictable consequences . . . . W e believe that the human body operates, in health and disease, in accord with immutable laws. W h e n these l a w s are k n o w n , whe n the factors concerned can be measured, then medicine will be a science." T h e Medical School of the University of Minnesota has rendered medical science a real service by the publication of this very complete exposition of our present-day knowledge regarding the normal chest. " T. N. KELYNACI% M.D., M . R . C . P .
TUBERCULOUS
MIDDLE-EAR
DISEASE.
Professor Cemach, of Vienna, has written a monograph on middleear tuberculosis which will be of interest to aural surgeons and to serious students of tuberculosis. 1 T h e work is divided up and set forth in the usual order, and, atthough no index is provided, it is preceded by a careful contents list, and it concludes with a useful bibliography. Tuberculosis of the middle ear is, of course, no separate entity, but merely a local manifestation of a general infection. Our knowledge of the condition is unsatisfactory and elementary, and this is chiefly due to the fact that no one investigator has had any extensive experience of it. The author claims, as his justification for this thesis, the considerable experience he had during the Great W a r in the tuberculosis department of various hospitals, when some 3,0oo soldiers passed through his hands. These patients were suspected or definitely proved to be tuberculous in various stages. As is well known, cases of puL monary tuberculosis are conveniently arranged in three groups in accordance with the Turban-Gerhardt classification. (This is also the classification employed at Midhurst.) Group I. includes early cases ; Group If., fairly advanced cases ; and G r o u p I I I . , well advanced cases. In Group I., in 7 1 6 cases, the author found tuberculous middle-ear disease in seven ears--i.e., about i per cent. in Group II., in I,x52 cases, twenty-five ears--i.e., about 2'i per cent. i n Group I i I . , in 474 cases, twenty-four ears--i.e., about 2 5 per cent. These patients were all adu!ts. To determine the incidence according to age Cemach took another series of i5o cases, which showed that the disease is most commonly met with in the third decade of life (this, of course, because pulmonary tuberculosis is more c o m m o n then than in any other decennium). It is :not, as is sometimes thought; particularly a children's disease. T h e route by which the ear is infected from the primary focus m a y be by the blood or lymph channels. Infection by direct conveyance: of bacilli via the Eustachian tube must be very rare. T h e description of the clinical appearances is not very definite. It includes nodulatione.and gradual destruction of the membrana, caries, tenderness, caseation of mastoid cells, fistula, mastoid, painless and progressive destruction of the membrane, and granulations. Confirmatory evidence is found by the discovery of pulmonary disease, tuberculosis of the peri-auricular glands, inoculation reaction, histological examination, and animal research. Prognosis, as regards life, the author coni ,, Das Problem der Mittelohrtuberkulose," yon Dr. A. I. Cemach,. Fachart f~ir Hals-, Nasen- und Ohrenkrankheiten in Wien. Pp. 224, mit 5 Abbildungen im Text. ]Berlin: Urban und $chwarzenberg. Friedrichstrasse Io56. I926. Price M. 9.
THE
BRITISH
JOURNAL
OF
TUBERCULOSIS
NOTICES OF BOOKS. THE
NORMAL
CHEST.
A Tt-mROUCH u n d e r s t a n d i n g of the n o r m a l chest should precede all considerations of disease involving i n t r a t h o r a c i c structures. An eIaborate guide to such a s t u d y is now available in the h a n d s o m e and effectively illustrated volume provided by P r o f e s s o r M y e r s and his colleagues of the U n i v e r s i t y of Minnesota. 1 T h e w o r k is the outcome of a course of lectures and d e m o n s t r a t i o n s on the n o r m a l chest carried t h r o u g h in 192i , and was s t i m u l a t e d b y papers a n d discussions on education in tuberculosis presented before the S e v e n t e e n t h A n n u a l Meeting of the A m e r i c a n N a t i o n a l T u b e r c u l o s i s Association in N e w York City. W e e a r n e s t l y c o m m e n d th~ volume which lies before us to the notice of all medical advisers interested in affections of the chest, and p a r t i c u l a r l y to tuberculosis officers a n d medical superintendents of s a n a t o r i a ; it is a -work which no one of t h e m can afford to neglect. T h e main facts so far as a s c e r t a i n e d in r e g a r d to one part of the h u m a n machine are here g a t h e r e d t o g e t h e r and presented in system a t i c array, a d m i r a b l y illustrated by diagrams, drawings, charts, and roentgenograms. T h e r e are a dozen c h a p t e r s dealing respectively with P r a c t i c a l Considerations of the A n a t o m y of the Chest, the Surface of the Chest, P r a c t i c a l Considerations of the P h y s i o l o g y of the c h e s t , P h y s i c a l E x a m i n a t i o n of the N o r m a l Chest, the E x a m i n a t i o n of the N o r m a l H e a r t and G r e a t Vessels, the X-ray E x a m i n a t i o n of the N o r m a l Chest, the B o d y W e i g h t and Chest M e a s u r e m e n t s , including the Vital C a p a c i t y of the L u n g s of the N o r m a l A d u l t , the I m p o r t a n c e of S y s t e m a t i c E x a m i n a t i o n s , the E x a m i n a t i o n of the N o r m a l Chest in I n f a n c y and Childhood, the I n n e r v a t i o n of the Chest, the D e v e l o p mental A n a t o m y of the Chest and the T h o r a c i c Organs, and the Acoustics of P e r c u s s i o n and Auscultation. Such a brief enumeration of titles will be sufficient to i n d i c a t e the c o m p r e h e n s i v e n e s s and thoroughness of this unique composite volume. A t the end of each c h a p t e r is a serviceable select bibliography. A word of praise m u s t be allowed to p r i n t e r s and publishers for the g e n e r a l g e t - u p of the work and for the a d m i r a b l e i!lustrations. D e a n E . P. L y o n in his comm e n d a t o r y introduction says of this w o r t h y enterprise : " I t is set forth as f o r e r u n n e r of a day, still no doubt distant, when the facts of biology can be resolved into m a t h e m a t i c a l principles, and when medical diagnosis and t r e a t m e n t can proceed with the assurance of exact knowledge 1 ,, TtSe Normal Chest of the Adult and the Child, including Applied Anatomy, Applied Physiology, X-Ray and Physical Findings." By J. A. Myers, Associate Professor of Preventive Me:licine, Medical and Graduate Schools, University of Minnesota, in collaboration with S. Marx White, Professor of Medicine ; R. E Scammon, Professor of Anatomy; A. T. Rasmussen, Professor of Neurologyo; C. A. Stewart, Assistant Professor of Pediatrics ; and George E. Fahr, Associate Professor of Medicine, all of the University of Minnesota. With an Introduction by Elias P. Lyon, Head of the Department of Physiology, and Dean of the School of Medicine, University of Minnesota. Pp. xv+419, with I4I figtlres. London: Bailli~re, Tindall and Cox. 1927. Price 22s. 6d.
NOTICES
~7
OF BOOKS
leading to predictable consequences . . . . W e believe that the human body operates, in health and disease, in accord with immutable laws. W h e n these l a w s are k n o w n , whe n the factors concerned can be measured, then medicine will be a science." T h e Medical School of the University of Minnesota has rendered medical science a real service by the publication of this very complete exposition of our present-day knowledge regarding the normal chest. " T. N. KELYNACI% M.D., M . R . C . P .
TUBERCULOUS
MIDDLE-EAR
DISEASE.
Professor Cemach, of Vienna, has written a monograph on middleear tuberculosis which will be of interest to aural surgeons and to serious students of tuberculosis. 1 T h e work is divided up and set forth in the usual order, and, atthough no index is provided, it is preceded by a careful contents list, and it concludes with a useful bibliography. Tuberculosis of the middle ear is, of course, no separate entity, but merely a local manifestation of a general infection. Our knowledge of the condition is unsatisfactory and elementary, and this is chiefly due to the fact that no one investigator has had any extensive experience of it. The author claims, as his justification for this thesis, the considerable experience he had during the Great W a r in the tuberculosis department of various hospitals, when some 3,0oo soldiers passed through his hands. These patients were suspected or definitely proved to be tuberculous in various stages. As is well known, cases of puL monary tuberculosis are conveniently arranged in three groups in accordance with the Turban-Gerhardt classification. (This is also the classification employed at Midhurst.) Group I. includes early cases ; Group If., fairly advanced cases ; and G r o u p I I I . , well advanced cases. In Group I., in 7 1 6 cases, the author found tuberculous middle-ear disease in seven ears--i.e., about i per cent. in Group II., in I,x52 cases, twenty-five ears--i.e., about 2'i per cent. i n Group I i I . , in 474 cases, twenty-four ears--i.e., about 2 5 per cent. These patients were all adu!ts. To determine the incidence according to age Cemach took another series of i5o cases, which showed that the disease is most commonly met with in the third decade of life (this, of course, because pulmonary tuberculosis is more c o m m o n then than in any other decennium). It is :not, as is sometimes thought; particularly a children's disease. T h e route by which the ear is infected from the primary focus m a y be by the blood or lymph channels. Infection by direct conveyance: of bacilli via the Eustachian tube must be very rare. T h e description of the clinical appearances is not very definite. It includes nodulatione.and gradual destruction of the membrana, caries, tenderness, caseation of mastoid cells, fistula, mastoid, painless and progressive destruction of the membrane, and granulations. Confirmatory evidence is found by the discovery of pulmonary disease, tuberculosis of the peri-auricular glands, inoculation reaction, histological examination, and animal research. Prognosis, as regards life, the author coni ,, Das Problem der Mittelohrtuberkulose," yon Dr. A. I. Cemach,. Fachart f~ir Hals-, Nasen- und Ohrenkrankheiten in Wien. Pp. 224, mit 5 Abbildungen im Text. ]Berlin: Urban und $chwarzenberg. Friedrichstrasse Io56. I926. Price M. 9.