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Rebiews and Notices of Books.IMMUNITY IN HEALTH.

By KENELM H. DIGBY, M.B., B.S., F.R.C.S.,Ho Tung Professor of Clinical Surgery and ProfessorOf Anatomy in the University of Hong-Kong.London : Henry Frowde and Hodder and Stoughton.1919. Pp. 130. 8s. 6d:.

THE functions of the tonsils and other subepitheliallymphatic glands in the bodily economy are dealt withby Professor Digby in a novel and arresting manner inthe handy little volume bearing the above title. If thetitle is a little too comprehensive and the micro-

diagrams a little crude, these minor deficiencies areamply compensated for by the clarity of the author’sarguments. Charles Darwin, amongst others, is saddledwith the responsibility of teaching that the tonsils,adenoids, and vermiform appendix are dangerous relicsof a past usefulness. Professor Digby holds that theseorgans, which with the solitary follicles and otherlymph nodes of the gut are collectively termed thesubepithelial lymphatic glands, constitute a veryvaluable antibacterial mechanism and are the primefactors in the development of individual immunity.Large numbers of bacteria pass into the subepitheliallymphatic glands and are attenuated by the lympho-cytes, and this process of attenuation is completed inthe red marrow. The cells of the glands are of twokinds-the small lymphocytes and the endothelial cells.The former, Professor Digby assures us, are bothmotile and phagocytic, and the latter ingest the formerwhen these return to the glands laden with bacteria.The small lymphocyte in the blood is also probablymotile and phagocytic. This much would appear to beconfirmed by the fact that an increase of small

lymphocytes accompanies infective granulomata andalso malaria, measles, mumps, and whooping-cough. If

lymphocytosis were not purposeful why should it occurat all ? The glands in question protect against measles,cerebro-spinal fever, and influenza ; also against theinroads of the alimentary bacteria. They are anato-

. mically and chronologically situate at the point ofmaximum aggregation and minimum protection againstbacterial infiuence. There is a gradual atrophy whenwith age individual immunity is secured. Appendicitisbegins as a lymphadenitis, and is followed by ulcera-tion, which progresses or cicatrises according to theresisting powers. Subepithelial lymphadenitis is thebeginning of sore-throats, peptic ulcers, typhoid fever,and appendicitis. As the author points out,

" an occa-

sional attack of tonsilitis is a cheap ransom to pay forimmunity from general infections of far greater fre-quency and severity," and, indeed, it is clearly proventhat diminished bacterial resistance may eventuatefrom indiscriminate removal of tonsils and adenoids.Professor Digby advises greater moderation in these

matters, and we are inclined to agree with him thatNature is not so foolish as to have planted these organsfor the mere benefit of surgical handicraft. At thesame time the author in nowise denies that undermodern civilised conditions, particularly in England,these organs frequently become grossly pathological,and that then their removal becomes an urgent neces-sity. "Suaviter in modo, sed fortiter in re

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exactly iftritely’epitomises the attitude which Professor Digbysets forth in this connexion.

THE ART OF ANÆSTHESIA.By P. J. FLAGG. Second edition. With numerous

plates and charts. London and Philadelphia :Lippincott and Co. 1919. Pp. 367. 18s.

LITTLE time has elapsed since the first edition ofthis book appeared, and the present issue is thereforenot widely different from its predecessor. The chapterdealing with ether is a good deal extended, and a newchapter treats of the choice of anaesthetic. The author’spreference, generally speaking, is for gas and oxygenwith ether. He treats his subject in a broad-minded way,and the book, with its large print and capital illustra-tions, can be read with pleasure.

JOURNALS.Tubercle. A Monthly Journal Devoted to all Aspects

of Tuberculosis. Vol. 1.. No. 3. December, 1919.-Thecurrent number opens with an article on Syphilis andTuberculosis-the work of Emile Sergent, by Dr.A. Mirande of Paris, who claims that Sergent hasbrought order out of chaos. The subject is summarisedunder the heads of Etiology-the Influence of" Soil," the Interaction of the Two Diseases in theSame Individual, and thirdly, Diagnosis, Prognosis, andTherapy. "Mercury is the remedy to be used for allcombined lesions; it cures the syphilis and helps tocure the tuberculosis." The question of the relationsbetween the two great granulomata is one whoseimportance is becoming increasingly realised.-Dr.Clive Riviere’s lecture on artificial pneumothorax,recently delivered at the Royal Institute of PublicHealth, gives an excellent account by an acknow-

ledged authority of the practical side of this methodof treatment. The value of X rays as an aidto’ realising the physical conditions of the chestis insisted on, and it is to be regretted that some

sanatoriums still lack this essential equipment.-Aseries of abstracts deals with institutional treatment,and in the course of critical remarks apropos of thePapworth scheme, the suggestion is made that partof the unemployment problem might be solvedby providing the type of employment used insuch a colony as Papworth within reach of thehomes of the patients. If this means the estab- ’lishment of factories, &c., in urban or semi-urban

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districts, surely it is a plan well worth trying and likelyto benefit a much larger number of patients than anycolony.-Another set of abstracts is devoted to therelation of alcohol to tuberculosis.-A critical reviewdiscusses the sociological aspect of tuberculosis, espe-cially as affecting the metropolis ; while an article onpreventive medicine stresses the view that this israther a political and economic than a medicalproblem.-The number closes with reports on theCannes Conference and on meetings of various societies.A Review of the Foreign Press.-During the war the

intelligence service of the War Office, at first a smallpress-reading section of the department, developed bythe end of 1917 into an essentially civilian organisationwhich supplied the Government, the Army and Navy,and the Civil Servants of the Crown with all the informa-tion of importance-political, economic, technical, andmedical-which could be obtained from the newspapersand printed publications of foreign countries. A" Review of the Foreign Press" was thus instituted,and we are glad to learn that this important nationalwork is to be continued and the results published in twojournals known as the Pobiticat Review and the EconomicReview, now issued in weekly numbers. The collaboratorson the staff have been chosen from among those whocarried on the same work for the Government. Havingthe latter paper before us, we heartily join in theearnest hope of the editor and of his distinguishedadvisory council that all those who realise the paramountimportance of accurate information to the commercialand industrial existence of the nation, and who see theurgent need for an accurately informed public opinionin our relations with other nations, will give their

support to the undertaking. The first numbers we havereceived (Nov. 12th and 19th) furnish abundant evidenceof the value of the information collected, the contentscovering the following subjects : I., Economic and SocialConditions; II., Industry and Commerce; III., Transportand Communication-Shipping, Shipbuilding, Railways ;IV., Foreign Trade, Treaties, &c. ; V., Trade Propaganda;VI., Banking, Money Market, Insurance ; VII., PublicFinance, Financial Policy, Taxation ; VIII., Colonies,Colonial Policy, Migration ; IX., Social and EconomicPolicy, Education ; X., Labour Conditions and Organisa-tions ; XI., National Insurance, Savings Banks, Coöpera-tion, &c. ; and XII., Agriculture, Food Supplies. Medicine,of course, is bound up with many of these questions, andwe hope will soon make a more conspicuous appearancein the journal, for the Economic Review should appeal toa very wide class of readers and render excellent serviceto the nation.