440 AMERICAN JOURNAL OF DIGESTIVE DISEASES AND NUTRITION

cences occur on a basis similar to the appearance of the initial ,peptic" lesion. Thus, it follows, that in extent, persistance, severity and clinical attributes (hemor- rhage, obstruction, deformity, perforation) the lesion is more or less "self limited."

In the walls of stomachs and duodenums where the proteolytic process has not involved the mucous mem- brane and,.hence, no ulcer has occurred, usually can be demonstrated by histo-pathologic changes at micro- scopy and grossly by sight, palpation and transillumi- nation, areas of congestion, tissue-lysis, scar produc- tion, deformity, in all respects resembling what occurs in true peptic ulcer, with the exception, however, that mucosal destruction has not developed and given rise to so-called "peptic" ulcer. The mural affection has healed and has been confined wholly to the wall. The older the individual, usually the greater is the number of these mural les ions--"scars"--which can be ob-

served. However, age is not a requisite for the ap- pearance of such changes: in infancy, childhood and youth where local circulatory, neural, muscular or intra-mural localized infections or t raumata have oc- curred, similar tissue defects can be demonstrated; at times they include the mucosa and are the fore-run- ners of peptic ulcer.

Seriously and broadly considered, peptic ulcer is not a disease, sui generis. It is a complication of a prior mural defect due to many agents acting to produce arterial, circulatory defects. Whether or not these de- fects involve the mucosa and then are followed by the ulcer complication is accidental. Evidence is avail- able which proves that the large majori ty of the human family experiences these mural defects but that such never include the mucosa and, hence, the large major- ity of the human family never develops peptic ulcer.

Frank Smithies.

SECTION IX--Book Reviews (This section is open to contributions from any medical reader, whether a member of the Editorial Council or not).

The Patient and the Weather, Vol. 2, Autonomic Dysintegration, by William F. Petersen, M.D., with the assistance of Margaret E. Milliken, S.M. Pub- lished by Edwards Brothers, Inc., Ann Arbor, Mich- igan, 1934. 530 pages, 8~x111A, price $6.50.

F OR many reasons, this is a very interesting volume. In the first place, it is the most beautiful example

we have seen of the new method of reproducing a type- written manuscript. The result is so satisfactory that it is to be hoped that in the future more books will be produced in this economical way. It would make pos- sible the publication of many highly technical mono- graphs which for economic reasons cannot now be printed in the usual way.

This is the second of a series of four volumes. The writer 's thesis is that most diseases of the body are influenced by the weather. Wisely he admits, on the first page, that "other interpretations are possible and indeed probable. Seldom is one environmental factor alone responsible in a mechanism so complex as the human body. We deal with a constellation of events-- but in this constellation of events the meteorological environment is probably the most important."

Dr. Petersen frequently uses the term "autonomic dysintegration" whick may perhaps prove useful in the future. I t may be an apt way of describing what takes place in many now poorly understood diseases. There is much evidence also in favor of the idea that many distressing upsets in health appear when they do be- cause the patient is passing through a certain phase of one of many cycles which normally take place in the body chemistry. These cycles seem to be much more marked in females than in males. It is an impressive thing to go into a laboratory such as Slonaker's at Stanford or Richter's at Johns Hopkins where the movements of scores of white rats are being recorded every hour of the day and to see the remarkable peri-

odic variations in the activity of the females. Similar cycles of various kinds have been found in women, and it does seem reasonable to suppose that an attack of migraine or paroxysmal tachycardia or an epileptic seizure should coincide with some phase of one of these cycles of metabolism.

I t has been known for ages and it has been shown scientificMly by Rowntree and others that in some persons painful attacks of arthri t is come with certain changes in weather, and it seems reasonable to sup- pose that careful study would show that other diseases are similarly influenced. Most openminded physicians are likely to feel receptive to such a thesis, and they would be interested to see what could be done in the way of proving it. Unfortunately, it has not been easy in the past to correlate arthritic pains with any partic- ular meteorologic change. The impression the reviewer has had is that the body answers to some change in its surroundings which are not yet being detected or measured by any meteorologic instrument.

Even a cursory inspection of the volume before us will show that Dr. Petersen has attacked his problem with tremendous energy and perseverance. He has gathered and graphed an enormous mass of data, and one wonders how any one man could have read so widely and done so much research in so many fields. The cost also of the blood chemical work done must have been tremendous. For instance, on page 462, one finds 17 curves plotted one above the other, besides six meteorological records. The experiment was car- ried on daily from the 20th of April until the 15th of July on a patient with arthritis. Anyone who has ever attempted to carry out such a study knows what a time-consuming and costly job it is, and how large a force of laboratory helpers it requires.

Unfortunately, we fear the reader will feel rather appalled at the plethora of material. Certainly the re- viewer feels that it would be impossible for him to ap-

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praise the value of the volume or to form a safe opinion of the correctness of the author 's theorizing unless he could spend several weeks analyzing the .curves and studying the text. The reviewer's feeling is that the author would have created a much better impression and would have had many more readers and much more examination and discussion of his views if he had not offered so much material and had not claimed so much for so many diseases. It seems also as if he should have, in each case, briefly pointed out what the graphs show or prove. The reviewer fears also that in many cases the experiment was too short to prove much. Dr. Petersen presents scores of short charts showing that an attack of this or that occurred coincidentally with some meteorological event, but the reader must wonder if it would do this several times running, and would it fail to do so with the opposite type of weather?

We all tend to remember our hits and to forget the misses, and nowhere is this tendency more dangerous than in a work like this.

Another thing that throws doubt on the value of the book and makes it less easily read is the inclusion of many subjects which one does not expect to find here. For instance, it is hard to see what eclampsia and premature delivery have to do with weather. It is possible, as Dr. Petersen says, on page 204, that the weather precipitates attacks when the individual is conditioned by certain meteorological conditions, but i t seems to the reviewer that a wise man would not dilute his best arguments by including a lot of weak and unlikely and unconfirmed theories. He who ex- pects to have his writings read, especially in these busy days, must be brief, and must leave out every- thing that is not pertinent to his subject.

The reviewer has the feeling that Dr. Petersen's book is a wonderful quarry in which one might profitably dig. A better salesman would have taken out of this quarry his most beautiful bits of marble and placed them in logical order and clearly labelled in a small booth by the wayside where every passerby could see them with ease. It is one of the tragedies of this world that some of the hardest workers in science, men sometimes with unusual and original minds, and an enormous knowledge of the literature, fail to get a hearing or to influence the work of their fellows, simply because they write up their results so poorly or so unsystem- atically, or so vaguely, or so verbosely, or with such an ~dmixture of chaff that other men throw up their hands in despair and say, "He is doubtless a genius and there is probably much in his writings which is of value, but I haven't the time now to search through his papers to see what is there." Such a man ought to stop every little while and get a trained editor to sit down with him for a week or two to put his writ- ings into easily understandable form. He should get some one to show him where he is leaving out large gaps in his descriptions of work done, or gaps in his reasoning, to interpret him to the public, and to keep him from filling his papers with material which, al- though of interest and perhaps well enough written, does not belong where it is, and only brings confusion and boredom to the reader.

In spite of anything unfavorable that may be said of the plethora of data in this book, this reviewer has been sufficiently interested by it to hope that Dr. Peter- son will supplement it with a shorter essay, based on his great work, and having as its purpose evaluation and interpretation.

Walter Alvarez, Rochester, Minn.

Preview of Dr. B. B. Vincent Lyon's "Atlas"

I N the Scientific Exhibit at the recent meeting of the the American Medical Association we saw one dem-

onstration which should be brought to the attention of our readers who are interested in the very difficult field of microscopy--and its interpretat ion--of ma- terial recovered by duodenal drainage of the biliary tract. We learned that from that exhibit soon there will be available an "Atlas" compiled by no less an au- thori ty than Dr. B. B. Vincent Lyon, himself.

This "Atlas" will be purely clinical in motive and scope. Over many years, Dr. Lyon, carefully and as- siduously has made photomicrographs of characteristic and unusual cellular, crystalline, infectious, parasitic, etc., sediments and has correllated them with clinical and pathologic data. The scope of the work is tremen- dous. Practically every known gall-bladder and biliary tract condition has been covered. Most faithful photo- micrography has been done. The advance sheets of this work reveal a series of actual photographs of the greatest interest and value. The accompanying de- scriptive text has been written by Dr. Lyon from the data in his own and others' archives; it presents a mass of really authoritative information compressed into an extremely brief space.

According to the schedule now set, Dr. Lyon's "Atlas" will not be available for distribution for about three months because of the immense amount of work required to make and mount the microphotographs (each is an "original") and to group and bind them in logical clinical sequence. What such a "different" Atlas can be sold for, of course, is problematical. In any event, the number of Atlases issued of necessity will have to be limited, since each volume is almost en-

4

tirely hand-work. It is to be hoped that the cost per volume can be kept as low as twenty-five dollars: cer- tainly, at such low price, it is our opinion that the books which become available, eagerly will be spoken for by clinicians who wish to do biliary tract drain- ages scientifically and purposefully. Even at double the mentioned price (no profit can accrue to the Author at such charge) the proposed Atlas will pay the pur- chaser big dividends on the investment.

Our profession could benefit greatly from the type of publication proposed by Dr. Lyon: what all of us need is not text-heavy books, largely constructed as "compilations" and illustrated by pictures as familiar to us as are those in the "Jack-and-Jill" books of our childhood. We need before us those facts, observations and data upon which important clinicians actually de- pend in their day-by-day diagnostic and therapeutic efforts.

Frank Smithies, Chicago.