The Problem of Lupus Vulgaris

subject and it is also a fitting testimony to the wellconsidered authoritative and pleasing style ot the author. The general plan is the same as in previous editions. Part I contains chapters on etiological and anatomical factors in diagnosis. Part II is devoted to details of the more common diseases. Outstanding among these are the development of the speech function and aphasia, epilepsy and cervical rib. But it is difficult to discriminate. The last-named subject, together with the sections on peripheral nerve lesions, Herpes Zoster, sciatica, and protrusion of the intervertebral disc, have been recast, but so discreet has been the choice of new material and so refined is its presentation that the whole book (including illustrations) dies not exceed 350 pages. Here and there throughout Dr. Walshe does not hesitate to express his own personal opinion, albeit this is sometimes scathing, and those familiar with his teaching and views will delight in such passages as the following: "The easy opportunities which the nose and its accessory sinuses present to the determined seeker after irrelevant bacteria need not be emphasized. It should be borne in mind that with the increasing range of diagnostic procedures, biochemical, bacteriological, radiological and the like, few indeed of us even when we enjoy complete health could hope to escape without the discovery of some imperfection were we so unwise as to submit ourselves to inquisition on these lines. That the subject of an anxiety neurosis has teeth that show signs of wear and tear, nasal catarrh or large tonsils is not necessarily evidence that these blemishes stand in any relation to his symptoms, and to assume that they must do so is a travesty of reasoning that should not have survived the discipline of a scientific education." The only criticism indeed that one might level against this work is that too little .space is devoted to the "psychoneuroses." Anxiety states, hysterical reactions and other kindred ailments are at least as common in practice as the other nervous diseases which are described in some detail. Dr. Walshe refers to the concept of psychosomatic illness, and says: "We know that psychological factors may set in train disturbances of bodily function, that in their turn may issue in structural lesions and symptoms arising therefrom." Clearly he is still sceptic, but it might be an advantage to include here more discussion on the relative importance of psychosematic relationships in such conditions as chronic rheumatism. The scheme given for examination of the nervous system would also be improved by intr,ducing more detailed directions for assessing the mental and emotional state of patients. R. S. A.