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REVIEWS AND NOTICES OF BOOKS

Physiological Basis of Medical PracticeBy C. H. BEST, M.A., M.D., D.Sc.Lond., F.R.S.Canada, F.R.C.P. Canada, Professor and Head ofDepartment of Physiology, Associate Director of theConnaught Laboratories, Research Associate in theBanting-Best Department of Medical Research,University of Toronto ; and N. B. TAYLOR, M.D.,F.R.S. Canada, F.R.C.S. Edin., F.R.C.P. Canada,Professor of Physiology, University of Toronto.London: Bailliere, Tindall and Cox. 1937.

Pp. 1684. 45s.As the authors of this book point out, there is

now a growing conviction that "’ morbid physiology "has been neglected in the past in favour of morbidanatomy, though the neglect has been due to lackof knowledge rather than lack of interest. A book

by Krehl, published thirty or forty years ago, whichran into several editions (the last appearing in 1916),dealt with the more physiological aspects of pathoslogy, stressing their importance but hampered through-out by a paucity of known facts. Those who attemptto-day to correlate physiology and medicine are

embarrassed by such a wealth of more (or less)scientific information, that protagonists of thisresearch are pleading for a fresh start at the other end,digging back channels to receive and direct the

oncoming flood. This book by Best and Tayloris essentially a text-book of physiology which does notstop at a description of the normal, but displaysfully the consequences of functional derangement.It is large and comprehensive enough to do justiceto the scientific method, and the result is impressive.After all, the essence of physiological research isnot mere observation but experiment, and experi-ment involves the study of a tissue, organ, or systemunder artificially controlled conditions. It is inevit-able that investigation should progress from theisolated tissue to the whole organism, and fromthe lower animal types to the higher, and that theartificial environment should gradually proceed fromthe purely physical to the physiological. An artificialphysiological environment is a pathological condition,and the modern physiologist finds himself more andmore often coming into contact with such conditions.It is, of course, impossible and undesirable to lay downany law of progress ; many important discoverieshave been evolved in precisely the reverse direction,but the paths of the clinical and scientific investigatorintersect at a point which is moving steadily andever more rapidly in one direction. It is increasinglyimportant, therefore, that we should periodicallybe presented with a bird’s-eye view of the situation,and this has been skilfully provided in this work whichis written primarily for students. The style is clear,direct, and logical. The seeker after sensation will be

disappointed, and also those who delight in subtleargument. There is no space in the seventeenhundred pages for anything but the transfer ofinformation from authors to reader ; and it is a

merit that it has been made readily assimilable.Most of the work is straightforward physiology

and biochemistry, as the title suggests, and it is

quite up to date. There is, however, a commendableabsence of tag ends of recently acquired informationwhich would tend to break the continuity of thetext. Indeed, this might be open to the criticism ofbeing a little dogmatic, if it were not for two featureswhich enormously increase the scope of the book.One is an excellent system of cross references, and theother the list of original papers and monographs which

are arranged under chapter headings and occupy thelast hundred pages. The full titles of these are givenand the authors are not always speciflcally referredto in the text, which is not overburdened with names,and is moreover unrestricted by any obligation inthe way of exact quotation. The reader is given aninterpretation which he can readily understand andcan easily check by using the bibliography. Abrief account of structure is introduced wherenecessary, and free use is made of small print in

describing experimental methods and in presentingthe background. The keynote of the book is compre-hensiveness in relation to the subject as a whole,without the confusion which is apt to result from amere catalogue of detail.

Diseases of the Colon and Rectum

Diagnosis and Non-Operative Treatment. ByGOTTWALD SCHWARZ, M.D., Professor, Universityof Vienna ; JACQUES GOLDBERGER, M.D., Consult.ing Physician, Carlsbad; and CHARLES CROCKER,M.D. London : H. K. Lewis and Co. 1937. Pp. 540.40s.

A professor of radiology and two consultingphysicians, working in collaboration, have much ofinterest to say about diseases of the colon and rectum.Nearly 250 of their pages are devoted to diagnosis,including an account of the physiology and move-ments of the large intestine. They describe a newtype of " deplicoptic " proctosigmoidoscope whichhas an optical arrangement, something like that of acystoscope, giving an exceptionally clear and enlargedfield of view. It is a long instrument (35 cm.) andof a diameter no larger than that of the ordinarychild’s sigmoidoscope (13.5 mm.). They claim thatit is passed more easily than the usual adult sigmoido-scope ; air inflation can be used, but more commonlya continuous stream of warm watr keeps the boweldistended and the field clear. Certain of the coloured

plates (notably V and VI) suggest that the view of arectosigmoid carcinoma given by this instrument is

very different from that to which we are accustomedin the air-inflated sigmoidoscopes. It seems to us

a moot point whether in endoscopy of the rectum andthe pelvic colon a greatly magnified view is an

advantage to the person with normal vision, and wequestion also whether water inflation is likely to givea true and easily recognisable picture of the mucousmembrane of a viscus which is normally in a relativelydry state. Chapter V is devoted to laboratoryexamination of the faeces, and includes an excellentaccount of the protozoa which may be found in the estools. In Chapter VI we find a full account of

diagnosis by X rays, and are introduced to the term"

irrigoscopy" for the barium enema controlled byfluoroscopy. A large series of radiograms illustratethis chapter, and the radiographic appearances of thecolon in such conditions as- ulcerative colitis,megacolon, diverticulitis, carcinoma, and polyposisare exhaustively discussed. General methods oftreatment by diet, massage, and hydrotherapy, bothexternal and internal, are described, including variousforms of electrical treatment. The medical treat-ment of the large number of diseases of the colon isgiven in great detail, particularly of the dysenteriesand the various forms of colitis, megacolon, anddiverticulitis. The authors have written helpfulsections on diarrhoea, muco-membranous colitis,constipation, and visceroptosis. The final short

chapter on diseases of the anus and rectum deals with

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some conditions which scarcely come within the

province of a physician, such as fissure, fistula, andabscess.A few words and phrases are curious : for instance,

"tuberculotic" " is used as an adjective (p. 494), andin the final paragraph of the book we read " Theapplication of the enterocleaner in cases of dyschezia... " In the main the authors have kept very fairlyto their medical viewpoint and have indicated theconditions for which surgery is advisable. Since thediseases discussed include many, such as diverticulitis,colitis, and proctitis, which come under the survey ofboth surgeons and physicians, all clinicians willread it with profit.

Die Prophylaxe der SchlafstorungVon Dr. med. habil. PAUL VoGLER, Dozent an

der Universitat, Berlin. Leipzig : Georg Thieme.1937. Pp. 130. R.M.5.80.

Tms little manual is devoted to non-medicinaland non-psychological measures for combatinginsomnia. A brief review of the physiology and thetheories of sleep-with a disapproving note aboutthe psycho-analytic theory-precedes a section on

prophylaxis in which the influence of bedroom, bed,bedclothes, and habits upon sound sleep, and theimportance of diet and sunshine, are elaborated.The duration and periodicity of sleep and other

problems such as the possibility of educating a childto have good sleep habits are briefly examined. Inthe final section on the treatment of insomnia by" exactly performed prophylaxis," the only methodsdescribed are those of hydrotherapy ; a brief passageabout drugs and another about psychotherapy serveto emphasise the author’s preference for water

externally in one form or another. The success whichhe has attained with his " nature cure methods,"and the cases he reports, suggest that he has nothad much experience of the intractable forms of

sleep disturbance sometimes met with in psychiatricpractice.

1. Aids to the Treatment of Diseases ofChildrenSeventh edition. By F. M. B. ALLEN, M.D.,M.R.C.P. Lond., Lecturer in Infant Hygiene andDiseases of Children, Queen’s University, Belfast ;Assistant Physician, Belfast Hospital for SickChildren. London: Bailliere, Tindall and Cox.1937. Pp. 329. 4s. 6d.

2. Synopsis of PediatricsSecond edition. By JOHN ZAHORSKY, A.B., M.D.,F.A.C.P., Professor of Pediatrics and Director ofthe Department of Pediatrics, St. Louis UniversitySchool of Medicine, and Pediatrician-in-Chief tothe St. Mary’s Group of Hospitals. Assisted byT. S. ZAHORSKY, B.S., M.D., Instructor in Pediatricsat the School, and Assistant Pediatrician to theGroup. London : Henry Kimpton. 1937. Pp. 367.17s. 6d.1. Whatever view may be taken of keys, " ghosts,"

and synopses by the fully fledged physician, theyform an important part of the armamentarium of theaverage student who still has to break through theshell of his examinations. There must be few indeedwho have never used one or other of the famous"Aids" series, of which Dr. Allen has supplied oneof the more popular volumes. The title is somewhatof a misnomer, as the author considers each diseaseunder the headings of aetiology, symptoms, anddiagnosis as well as treatment. In the seventh edition

there has been considerable revision of the sectionsdealing with infant feeding, prematurity, and thespecific fevers, whilst asthma and pink disease areincluded for the first time. The little book is clearlyand sensibly written, and despite the wide field coveredand the modest size and price of the resulting volume,the author has succeeded in avoiding most of thefaults of manner and matter common in books ofthis kind.

2. Dr. Zahorsky’s work, though it contains muchuseful information and little to which exceptioncould be taken, is not equally successful. By the useof small print he has produced a small, illustratedtext-book of paediatrics which is hardly adequateas a student’s primary source of information onpaediatrics, and, on the other hand, is not speciallysuitable for purposes of rapid revision. The secondedition has been extensively revised, a chapter ondiseases of the eyes and ears has been added, andseveral good coloured plates are now included.

Muir’s Bacteriological AtlasSecond edition. Atlas enlarged and text rewrittenby C. E. VAN ROOYEN, M.D. Edin., Halley StewartResearch Fellow and Lecturer in Bacteriologyin the University of Edinburgh. Edinburgh:E. and S. Livingstone. 1937. Pp. 90. 15s.

THE late Richard Muir’s book has for some

years been the only bacteriological atlas in commonuse in this country. Muir’s fame as a technician

naturally spread far beyond the walls of the

University of Edinburgh where his work was done.He was also an artist in his way and his coloured

plates present an almost ideal representation ofmicro-organisms. Dr. van Rooyen’s additional platesare in every way up to Muir’s standard and indeed,in places, surpass it. The colour reproduction of the83 plates is of high quality and considering the costof such things the price of the book is very reasonable.

The Low Voltage Cathode Ray Tubeand its Applications. By G. PARR, Radio Director,Edison Swan Electric Company. London : Chapmanand Hall. 1937. Pp. 177. 10s. 6d.

THE cathode ray tube is a form of oscillographwhich has proved a valuable instrument in the

analysis of rapidly altering electrical potentials andcurrents. It consists essentially of a beam of electronsejected from a heated filament, concentrated into afine jet by an electrical field and allowed to fallon a fluorescent screen. The impact produces aluminous spot. The whole instrument is enclosed inan evacuated tube. The pencil of electrons forms asensitive pointer which can be deflected by electricaland magnetic forces, and, since its inertia is practicallyzero, the deflections follo N perfectly any variationsin these forces however rapid they may be.

Mr. Parr divides the cathode ray tubes into threetypes according to the voltages applied to them-high, medium, and low. The first class, employingsome 60 kv. is not dealt with here, but a detailedand practical description is given of the other instru-ments which work under various potentials up to3000 volts. The use of these tubes is rapidly increas-ing as new applications are continually being found.Any varying quantity, such as sound waves, can

be converted into the corresponding electrical varia-tion and analysed on a cathode ray tube, and theseinstruments have for some time been used in this sideof physiological research. Owing to its application

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in one method of television, the recent developmentof the cathode ray tube has been very rapid. Theearlier chapters give a very useful and detailed accountof how to handle the apparatus-the focusing of therecording spot and its deflection for various purposes.

Our only criticism of this book is that the titleis misleading. It suggests a handbook dealing withsome particular tube, whereas the subject mattercovers all the instruments which are likely to be metwith to-day in normal research work.

Manual of Practical AnatomyBy J. ERNEST FRAZER, D.Sc., F.R.C.S., Professorof Anatomy in the University of London ; andREGINALD H. ROBBINS, M.A., M.D., AssistantLecturer and Senior Demonstrator of Anatomy,St. Mary’s Hospital Medical School. London:Bailliere, Tindall and Cox. 1937. Vol. I, pp. 526 ;Vol. II, pp. 442. 10s. 6d. per volume.

THE dissecting-room in a British school of anatomyis traditionally a sort of club where the student

spends a good deal of time acquiring conversationalarts and incidentally perhaps hoping to acquiretechnical knowledge by a kind of osmosis. When thepreclinical sciences had not much else to offer than acourse in dissection of the human body, and physio-logy, now become so rich and extensive, was forced toeke out its scanty store by teaching histology, it wasinevitable that the student should live in the " rooms."Practical manuals of anatomy which fitted into thisscheme were used as text-books as well as practicalguides. It has now become impossible to continuein this traditional way, and practical anatomy hasto be taught by schedules arranged according to afixed time-table. In most departments special instruc-tions for dissection are issued week by week to itsstudents. Much time is gained by this method, andit is possible to use the time so saved for the study ofother aspects of the structure of the body than thoseof position and topography-aspects even more

important, conveying some understanding how thebody is made and how it works. In a sense the

practical manual in book form belongs to an epochthat is over. But there are still students who findworks of this kind do provide them with the necessaryamount of information in a period of time that isneither too long nor too short. In this one thetext is full and accurate, thus fulfilling the chiefcriteria of the dissecting manual. The illustrationsare not perhaps quite up to the standard of thetext, but they show clearly enough what must belooked for at each stage of the work. The longteaching experience of the authors is sufficient

guarantee that they have anticipated the difficultiesof the average student.

A Textbook of Embryology {

Third edition. By HARVEY ERNEST JORDAN, A.M.,Ph.D., Professor of Histology and Embryology, Uni-versity of Virginia ; and JAMES ERNEST KINDRED,M.A., Ph.D., Associate Professor of Histology andEmbryology at the University. London: D.Appleton-Century Company. 1937. Pp. 613. 25s.

THIS text-book is an excellent example of the

teaching manual. The text is clear, the illustrationsare abundant, the order and logic of its arrangementare manifest, and nothing appropriate to the purposeseems to have been omitted. The usefulness of thework is increased by the inclusion of a laboratoryguide and this has been put into a convenient form.

It begins with a list of laboratory exercises so arrangedthat to work through them would entail a completeexploration of the anatomy of the embryo. Inaddition an illustrated guide is provided to enablethe student to find his way through serial sections ofthe usual laboratory types. Every aspect of embryo-logy is covered, and chapters are included on therecapitulation theory, prenatal and postnatal growth,teratology, and eugenics. Both authors are

distinguished biologists, though neither of them

belongs to the medical profession. This perhaps mayexplain the only slip that we have noticed-namely,the use of the term " lochia " in the same sense as" afterbirth."There is, however, one thing that is lacking in

this book. Embryology has now become a greatscience. Nothing is so dramatic and impressive asthe formation of a new organism from a fertilisedovum. The sequence of events by which this isachieved is fundamentally the same for all organisms,and is always the same in the same organism.Since this sequence is so invariable the conclusioncannot be escaped that there must be a causalmechanism behind it. This manual is descriptivein its outlook and does not convey to the student anyvivid sense of the dynamic aspect of embryology.

Physiologie de l’innervation renaleBy JEAN HAMBURGER. Paris: e Masson et Cie.Pp. 180. Fr.30.

THE kidney has a rich nerve-supply whose functionis still in doubt. The different lines of approach ofvarious research workers to this problem are herereviewed and their conclusions criticised. Britishreaders will be astonished to find no reference in thebook to the recent work of E. B. Verney, and thoseinterested in special aspects of the subject will findother less obvious omissions. It must be conceded,however, that the various points of view are fairlyrepresented, and the neglect of certain individualsdoes not impair the main purpose of the book. Theauthor’s own experiments are of particular interest.A series of beautiful X ray photographs depict thevascular system of the kidney after injection withThorotrast, and vasodilatation after nerve sectionis demonstrated by this means, which is free frommany of the objections attending other methods.Briefly, the more complete the denervation, and thenearer to the kidney, the greater the dilatation.There is a suggestion, however, that the nerves inthe hilum itself may have the opposite effect. Withregard to diuresis, the conclusions of others thatdenervation has no permanent effect are confirmed,but stimulation of the nerves causes oliguria andalbuminuria. The author is unwilling, on the evidenceavailable, to say whether this is a pure vasomotoreffect or whether secretory nerves play a part. Perhapsthe most interesting experiments deal with ortho-static albuminuria, which can be readily produced inanimals. The presence of albuminuria in associationwith certain nervous lesions is discussed, and experi-ments are cited which show that denervation of thekidneys prevents the appearance of orthostaticalbuminuria in animals which previously exhibitedthe phenomenon quite readily. The author wiselyrefrains from drawing any far-reaching conclusions,but stresses the frequent coincidence of vasoconstric-tion and functional albuminuria. The book is roundedoff by a survey of other functional renal troublesmet with in clinical practice. It is stimulating, easyto read, and foreshadows results of medical importance