866 REVIEWS AND NOTICES OF BOOKS

position for four days. Accurate localisation anddelicacy of technique are essential and the operationis not without risk, since the optimum needed to killthe growth cells is very near the exposure which willstart degenerative changes in the lens and normalretina. The address was certainly an outstandingcontribution to the subject of radium therapy.The president’s address was followed by a dis-

cussion on diseases of the blood and their ophthal-mological complications, opened by an ophthalmicsurgeon (Sir Arnold Lawson), a physician (Dr. LethebyTidy), a biochemist (Prof. E. C. Dodds), and a hsema-tologist (Dr. P. N. Panton). The relationship ofretinal haemorrhages and exudates to the blood count,coagulation time, calcium content, and other bloodchanges was discussed from the various points of view.The afternoon was devoted to contributions by theguests, notably a paper on the localisation of retinal

holes in detachment, by Dr. Marc Amsler (Lausanne),and on the treatment of the condition by a modifieddiathermy current by Dr. Leon Coppez (Belgium).The following sessions were occupied by a variety

of papers of interest. Mr. Tudor Thomas gave adetailed account of the microscopic appearances oftwo successful corneal grafts in man, the first availablerecord on the subject. Mr. Cardell read a suggestivepaper on the possible uses of polarised light inophthalmoscopy and retinoscopy. By incorporatinga double Nichol prism in the ophthalmoscope it waspossible to abolish the corneal reflex and so toexamine the macula easily through the undilated

pupil, a procedure often of great value. Miss IdaMann read a paper on an embryological theory ofoxycephaly, which indicated that the possible primaryaberration of growth lay in the visceral mesodermof the maxillary process.

REVIEWS AND NOTICES OF BOOKS

Recent Advances in Sex and ReproductivePhysiologyBy J. M. ROBSON, M.D., B.Sc., F.R.S.E., BeitMemorial Fellow, Institute of Animal Genetics,University of Edinburgh. London: J. and A.Churchill Ltd. 1934. Pp. 249. 12s. 6d.

THERE are probably few physiological problemswhich have been subjected to more active investiga-tion in the last ten years than that of reproduction.As the literature gains in volume and the terminologygrows in complexity, so does the need arise for aperiodical survey by an authority who, while familiarwith intricacies, can yet direct our attention to itssalient and well-established facts. In a preface,Dr. Robson explains that his treatment has beenselective. He has been compelled to discuss verybriefly, or even to dismiss altogether, much datawhich appear to have no permanent bearing on theproblems which, for him, are important. Such a

handling of the subject is clearly necessary, but

equally clearly it will evoke criticisms from thosewhose work has been cursorily dealt with or over-looked. Making allowances for this and for the factthat it is probably now impossible to write a book onreproductive physiology which will please everybody,Dr. Robson’s work may be regarded as fulfillingits primary purpose.The book falls naturally into two parts. In the

first, consisting of five chapters, are described thenature of the sex cycle in different animals, cyclicalalterations in uterine endometrium and muscle, andthe functions of oestrin and lutein. This part thusfurnishes an anatomical and physiological introductionto the complex processes described in the six laterchapters. These deal with the relation of the pituitarygland to ovarian activities, ovulation and fertilityin primates, hormone production and excretion,pregnancy and parturition, and the mammaryfunctions. The book concludes with a chapter onclinical applications which will be of special interestto those " clinicians who seek to incorporate intotheir practice recent advances in science," for whom,Prof. F. A. E. Crew explains in an introduction, thisbook has been primarily written. Clinical applicationsof our present knowledge are (1) diagnostic, (2)therapeutic. " In the field of diagnosis," says theauthor, " important and even spectacular progresshas been made, whereas the therapeutic applicationof hormones yielded apparently meagre and dis-

appointing results." The diagnostic functions are

clearly described : the Aschheim-Zondek test in itsvarious applications, the Friedman test, and theBrouha test. Indeed, details of technique are

included which would be of interest to the laboratoryworker rather than to the clinician. The therapeuticapplications are less clearly set forth. It is suggestedthat oestrin may have therapeutic uses in curingamenorrhcea and sterility, in terminating pregnancy,in relieving symptoms of the menopause, and in

treating haemophilia. The therapeutic use of corpusluteum hormones is, we are told, not yet feasible.The gonadotropic hormones of the pituitary havebeen administered for amenorrhoea, spasmodic dys-menorrhoea, the prevention of abortion, ovarian

bleeding, and for certain pelvic inflammatory con-

ditions. Though definite instructions as to the

therapeutic uses of these hormones are as yetimpossible, the clinician might have been gratefulfor clearer guidance as to their possibilities. Thebook is somewhat indifferently illustrated with

diagrams, photographs, and microphotographs whichare not always very clear or well explained. In

parts it is carelessly written. Thus the textualdescription on page 9 does not correspond to thediagram on the opposite page and there are severalexamples of loose phrasing (such as the use of theword " menstruation " for the term " menstrualcycle " on pages 94 and 95) which have confusingeffects. On the whole, however, the medical readeris deftly guided into and through the obscurities of adifficult subject.

Biochemistry of the EyeBy ARLINGTON C. KRAUSE, M.A., Ph.D., M.D.,F.A.I.C., Instructor in Ophthalmology, the JohnsHopkins Medical School. Baltimore: Johns

Hopkins Press; London: Humphrey Milford,Oxford University Press. 1934. Pp. 264. 15s.

IN this monograph, No. 2 of the series issuedby the Johns Hopkins Hospital and University,Dr. Krause has attempted to review briefly theinvestigations which have been carried out on thechemistry of the eye. The work is divided into eightchapters, which deal in order with the chemistryof the external secretion and conjunctiva, the sclera,the cornea, the uveal tract, the retina, the aqueoushumour, the vitreous humour, and the lens. A veryfull bibliography is given at the end of each chapter,and the various conclusions reached by different

867

workers are summarised and critically discussed.Forty-nine pages throughout the book are devoted toa study of the chemistry of the lens, and this formsthe largest chapter in the work. We would have likedto hear more of the author’s views on the theories ofthe formation of the aqueous humour, and it seemsa pity that the soft, low-tension eye of diabetic comareceives no mention.The monograph will doubtless prove of great value

as a work of reference both to ophthalmologists andbiochemists; some ophthalmologists who consult it

may be dismayed to find that Dr. Krause presupposesa knowledge of general biochemistry and its relatedsubjects in his readers. It would, however, have beenimpossible to keep the book within reasonable compassif this assumption had not been made, and for thosewho possess the equipment to appreciate it this workprovides a valuable addition to the literature of thechemical side of ophthalmology.

Psychology and Health

By H. BANISTER, M.Sc., Ph.D., Director of Psycho-logical Studies, St. John’s College, Cambridge ;Lecturer in Experimental Psychology in theUniversity. London : Cambridge University Press.1935. Pp. 256. 7.9. 6d.

THIS is a very fair exposition of modern psychologicalmedical problems by a trained psychologist who is apractising psychotherapist to the Papworth VillageSettlement. Dr. Banister is not only experienced in thepsychopathic problems of childien and adults, buthis training is catholic and methodical, and hiscomments demand respectful understanding. After apreliminary chapter on psychology and the physician,in which he urges the general practitioner to equiphimself to undertake some measure of psychologicaltreatment, at least of the child, Dr. Banister proceedsto a useful consideration of the senses in which heintends to use some of the common psychologicalterms, whose meaning in any article tends to varywith the author’s school of thought. Successivechapters deal with mental defect; the problem child ;infantile sexuality ; further development ; the annoy-ances and troubles of the healthy ; effects of ill-health ;the invalid ; suggestion ; hypnosis; the unconsciousand dissociation ; conversion hysteria ; anxietystates; and compulsion and obsession. Thereafterthe outstanding theories of Freud, Jung, Adler, andJanet are discussed each to a critical exposition,and the final chapters are concerned with methodsof treatment.Dr. Banister raises an interesting distinction between

dissociation, according to Janet, and conversionhysteria, according to Freud. His account of childproblems is sound and unprovocative, inclining toenvironmental interpretations rather than to the

anxiety theories of the Freudians, which account forchild neurosis on the basis of instinct frustration,particularly of infantile sexuality. This knottyproblem, which forms the basis of psycho-analyticplay technique, is made the subject of a specialchapter. Dr. Banister rejects the psycho-analyticinsistence on infantile sexuality, and suggests alterna-tive interpretations which will appeal to all but strictFreudians. According to him, curiosity rather thanactual sexual desire is the keynote of the child’sinterest in procreation and physical functions.

Dr. Banister is by no means an opponent of Freud ;his work shows him to be a critical adherent of thewider principles. The zealots will hold that his doubts

about infantile sexuality puts him definitely outsidethe pale; whereas those to whom not only psycho-analysis but any of its derivatives are anathema willfind him far too sympathetic to the many variants ofmodern theory and practice, which he discusses withobvious understanding. It seems likely that hiswork will appeal to those for whom he writes-medicalstudents and practitioners who need to understandsomething of the working of the human mind in order" to direct to favourable ends the psychologicalprocesses which inevitably influence the course ofevery life."

Physiology in Modern MedicineSeventh edition. By J. J. R. MACLEOD, M.B.,LL.D., D.Sc., F.R.C.P., F.R.S., Regius Professor ofPhysiology in the University of Aberdeen. Assistedby PHILIP BARD, Professor of Physiology, JohnsHopkins University School of Medicine ; EDWARD P.CARTER, Adjunct Professor of Medicine, JohnsHopkins University; J. M. D. OLMSTED, Professorof Physiology, University of California; J. M.PETERSON, Lecturer in Experimental Physiology,University of Aberdeen ; and N. B. TAYLOR,Professor of Physiology, University of Toronto.London: Henry Kimpton. 1935. Pip. 1154. 36s.

Prof. J. J. R. Macleod, whose death we had torecord a few weeks ago, set his hand 17 years ago tothe task of helping to bridge the gap between

physiology and medicine. He was distressed, as somany others have been, at the contrast between thescientific and experimental atmosphere of the labora-tory and the empiricism that dominates a great dealof clinical medicine ; so he offered to the clinicianshis now well-known book on " Physiology and

Biochemistry in Modern Medicine." The book wasintended to provide a basis of physiology out of whichthe inquiring clinician might begin to construct hisown functional pathology. It was to deal with thoseparts of its subject whose bearing on medicine isclosest, and to treat them as far as possible from thehuman, as distinct from the general mammalian,standpoint. The book has been of great value. Inthis last revision the collaborators have been increasedto five-four physiologists and one physician; manychapters have been rewritten, and much new anduseful material has been incorporated.

This is not to say that the gap which led to theoriginal production of the book has yet been success-fully bridged. The clinical end of the bridge is notso firmly grounded as the physiological end.The authors sometimes seem to have overlookedthe very point at which the physician is unableto make progress. For example, a physiologist’scritique of the various forms of test-meal wouldhave been welcome; the statement that gastric HCIis " decreased " in pernicious anaemia, and the assertionthat dystrophia adiposo-genitalis is undoubtedly dueto a lesion involving the anterior pituitary, suggesta lack of familiarity with ascertained clinical and

pathological fact. Even in his own field of carbo-

hydrate metabolism Prof. Macleod has omitted todiscuss the mysterious effect of the composition of thediet, on the efficiency with which the body deals withingested sugar, an effect which has been known foryears, and which no doubt underlies the success of themodern high carbohydrate diabetic diet.

Perhaps it is too much to expect the interdigitationof physiologist and physician over the whole range ofmedicine. and both may be better served bycollaboration in restricted fields.

868 NEW INVENTIONS

Synopsis of PediatricsBy JOHN ZAHORSKY, A.B., M.D., F.A.C.P., Professorof Pediatrics and Director of the Department ofPediatrics, St. Louis University Medical School.Assisted by T. S. ZAHORSKY, B.S., M.D., Assistantin Pediatrics, St. Louis University Medical School.London: Henry Kimpton. 1935. Pp. 359.17s. 6d.

THE word " synopsis " has come to have such a

specialised connotation in this country that it usuallysuggests a cram-book on the lines of the old " Paley’sGhost" of the Little-go. This volume is not that sortof synopsis, but is, rather, a short text-book of

paediatrics; it is well illustrated with 77 photographsand diagrams and 6 coloured plates, and should serveas a useful introduction to the subject as well as amanual for rapid revision. It has been reduced toits very modest size by the use of type that is

unpleasantly small for prolonged study, but it containsa vast amount of material at a most reasonable price.It is marred by a few definite misstatements andomissions which could easily have been avoided.Gaucher’s disease, for instance, is described as

" a chronic enlargement of the spleen caused by adeposit of large endothelial cells." Banti’s disease.twice referred to, is said to be extremely rare inchildhood, but is not described or defined. It is a

pity that radiograms of the chest have not been

consistently reproduced as either positives or nega-tives. These defects, however, are not serious

enough to make the book unsuitable for its pur-pose, and students who want a concise review of

psediatrics, without entering deeply into controversialmatters, will be well advised to procure it.

Groedel’s Roentgendiagnostik in der InnerenMedizin

Lief. 1. Fifth edition. Edited by HEiNZ LossEN.Munich: J. F. Lehmann. 1934. Pp. 186.RM.24.

THIS book forms the first part of the fifth edition ofDr. F. M. Groedel’s text-book and atlas of X raydiagnosis, which is being produced in six parts bymany authors. Groedel and H. Lossen contribute avery full description of technique, including hat ofkymography and cinematography. The same authorsdiscuss the legal aspects of radiology, while Groedeland K. Saller deal with physical constitution. Fromthe pen -of the late Prof. G. Holzknecht comes a

description of his technique for the localisation andmeasurement of internal organs. 0. Schnaudigelprovides a short chapter on the eye.To the general radiologist the most interesting

chapter is that by H. Wintz on the changes foundin disturbances of the internal secretions. It is a

mine of information on a little-known subject.H. Peiper’s account of the investigation of the nervoussystem is invaluable to those radiologists who haveopportunities of carrying out such work. We notethe author’s admonition that encephalography andventriculography are not to be undertaken light-heartedly by the inexperienced.

- A word must be said about the format of this work.Its 41 plates are among the best we have seen. The

letterpress is rendered clear by the skilful use ofdifferent types. It is a puzzling fact that only inGermany do text-books on radiology seem to be

produced in the grand manner. There is evidentlya market for them such as does not exist in coun-

tries which consider themselves more prosperous. Theeditor, authors, and publishers alike are to be

congratulated on their work.

British Journal of Children’s Diseases

IN the January-March issue (Vol. XXXIII.), ina paper entitled Some Observations on Rheumatismin Childhood, Dr. T. Warwick Preston reviews thework of the past four years at the Elizabeth Bullock,Putney, and Downham Supervisory Centres, hisconclusions being as follows : (1) pains of the " grow-ing pain " type occasionally prove to be an insidiousform of rheumatism which may attack the heart;(2) many pains which may appear to be rheumaticare caused by minor orthopaedic conditions and generaldebility ; (3) a certain number of children continueto complain for a prolonged period of aching limbsfor which no adequate explanation is forthcoming;(4) cases of insidious carditis are usually the resultof a definite subacute attack of rheumatism ; (5) " grow-ing pains " are uncommon in children definitelyknown to have had acute rheumatism ; (6) amongchildren with serious rheumatic carditis the generalcondition is remarkably good and complaints of allkinds are rare ; (7) there is evidence that the heredityfactor is a real one.-In continuation of his Analysisof Over Four Thousand Cases of Educational Deafness,Mr. Macleod Yearsley deals with cases of acquireddeafness due to congenital syphilis and chronic middlesuppuration (for which in the great majority of casesno cause could be found), chronic middle-ear catarrh,otosclerosis, and injuries of the ear.—Dr.P. H. Newmanreports a Case of Double Riga’s Disease in a maleinfant of 6 months, in whom an ulcer first appearedon the frenulum and under surface of the tongueand four months later on the dorsum. The conditionhealed rapidly on each occasion after removal of theincisor teeth.-Dr. V. Kolew of Satanow, U.S.S.R.,reports a case of Premature Greyness of the Hairin a girl aged 1Z, whose hair had begun to grow greyon both temples two years previously, since whencanities had spread all over the head with the excep-tion of the eyebrows and eyelashes. The child wasotherwise normal, and there were no similar cases inthe family. Kolew attributes the condition to thefact that both the parents were elderly at the timeof the child’s conception.-The abstracts from currentliterature are devoted to tuberculosis.

NEW INVENTIONS

A NEW LOBECTOMY CLAMP

THE clamp here illustrated has been designedby us for holding and crushing the bronchusand pedicle of the lobe during the operationof lobectomy. The ordinary snare occasionallycomes off the pedicle at the critical moment,but this clamp will give a firm hold and not

slip, as it has

great crushingpower, while 1the longi-tudinal serra-

tions of theblades renderit possible tocut the lobe away absolutely flush with the clampwith safety. The upturned end renders the tying ofligatures or stitches round the pedicle easy. Theclamp is made in two sizes for adults or children,and is now manufactured by the Medical SupplyAssociation Ltd., 167, Gray’s Inn-road, London,W.C.1, and is available for general medical supply.

W. H. C. ROMANIS, M.Chir., F.R.C.S.,T. HOLMES SELLORS, F.R.C.S.