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Reviews of Books

Chemical Prevention of Cardiac NecrosesHANS SELYE, M.D., PH.D., D.SC., professor and director of theInstitute of Experimental Medicine and Surgery, Universityof Montreal. New York: Ronald Press. 1958. Pp. 235.7.50.

THE chemical prevention of cardiac necroses is the latest

development of Selye’s hypothesis of the " diseases of adapta-tion ". It is perhaps the most exciting and certainly the bestsupported of the many outgrowths of this fertile concept.The dominant theme of this book is that " electrolytes, steroidsand stress all play important conditioning roles in the develop-ment of cardiopathies elicited by the most diverse agents ".The diversity of these agents is reflected in the list of headingsunder which they are considered-namely, electrolytes,hormones, vitamins, cardiac glycosides, chemical compoundsand food constituents, physical agents, psychic and nervousstimuli, microbes and their toxins, hypersensitivity, spon-taneous diseases, and " various and other factors ".

Since the views advanced embrace the most important partof cardiac pathology it is reassuring to find that they are basedon sound animal experimentation, as well as a phenomenalacquaintance with world literature. Despite the overwhelmingmass of facts derived from these two sources, the book is easyto read, and its implications both fascinating and stimulating.It should be read by every practising cardiologist, and sincecardiac necrosis is probably the commonest cause of death inman we hope that many others will read it too.

Family Influences and Psychosoir atic IllnessE. M. GOLDBERG, of the social medicine research unit of theMedical Research Council. London: Tavistock Publications.1958. Pp. 308. 38s.

THIS investigation of the family background of 32 youngmen with duodenal ulcer is based on the hypothesis thatpsychological and social factors may have contributed to theincreased incidence of duodenal ulcer, and that these factorsare associated with changes in the composition of the family, inrelationships within the family, and in the methods of bringingup children.The material for the study consisted of 32 men with duodenal

ulcer, aged 16-25, attending two East London hospitals whowere matched for age with a control series of 32 men from the

register of a general practitioner. A psychiatrist, a psychologist,and Miss Goldberg, a psychiatric social worker, investigatedthe subjects and their families. The most important findingsconcerned the roles of the parents of the patients with duodenalulcer, especially the mothers, who were characteristicallyobsessional and striving, themselves prone to psychosomaticillnesses, and with tendencies to overprotect, to restrict, andto overindulge their children. Typically, the fathers were

quiet and mild, more attentive to their sons when young butas the sons grew up figuring less as models than as " pals ".The fathers often had themselves suffered from dyspepsiaor ulcers. The patients had been gentle and unaggressiveboys with especially close ties to their mothers. The parentalhomes had been stable and the family bonds close, themother playing a dominant role as organiser and authorityfigure.Most striking, perhaps, were the similarities between the

family background of the ulcer group and the controls, whichsuggest that the changing roles of men and women in themodern urban family may be universal and only intensified inthose families that breed sons with duodenal ulcers. As Miss

Goldberg remarks, the increasing authority of the mothermay lead to considerable problems of identification in thegrowing son, and the incompatibility of his strong tie to hismother with the demands that the outside world makes uponhim may cause severe conflict in the young man. The researchwas undertaken by the social medicine research unit of theMedical Research Council, and in a later volume it is hopedto relate these familial and childhood factors to the emergenceand functioning of the adult personality.

Staphylococcal InfectionsIAN MACLEAN SMITH, M.D., F.R.F.P.S., assistant professor ofmedicine, State University of Iowa. Chicago: Year Book Pub-lishers. London : Interscience Publishers. 1958. Pp. 180..32s.

MANY papers, conference reports, leaders, and annotationsscattered throughout the medical journals discuss the epi-demiology, prophylaxis, diagnosis, and treatment of staphy-lococcal infection as it occurs today. This short textbook is anattempt to give the gist of this information in an easily acces-sible form. It is thoroughly up to date (the useful section onantibiotics includes even ristocetin and kanamycin) and

although a small book of this kind cannot probe very deeply,selected British and American references with each chaptershould help the reader to fill in detail.

Calcium Requirement and Adaptation in Adult MenOLE J. MALM, Johan Throne Holst Institute for NutritionalResearch. Oslo: Oslo University Press. 1958. Pp. 290.

FOR many years Professor Nicolaysen and his associates inOslo have been pioneers in the study of calcium metabolism;one of their major contributions has been the new concept thatpeople can adapt to a low intake of calcium by an increase intheir ability to absorb calcium from the gut. In this volume

(published also as a supplement to the Scandinavian Journal ofClinical and Laboratory Investigation) Dr. Malm has broughttogether much of the work on which this theory is based. Thebalance studies which were made on volunteers from the State

prison are exceptionally valuable because they extended overmany months; and they may provide a new basis for estimatingthe calcium requirements of normal adult males.An aspect of the work of special interest to the clinician

concerns the relation of the intake of calcium to the productionof senile osteoporosis. This condition is usually thought to bethe result of diminished osteoblastic activity, but it seems thata simple lack of calcium without deficiency of vitamin D canaccount for some instances of senile osteoporosis, presumablyin people who have lost their ability to adapt to low intakes.The book contains an extensive bibliography complete withthe titles of papers.

Reversicon : A Medical Word Finder

J. E. ScHMIDT, PH.B.S., M.D., LITT.D., president, The AmericanSociety of Grammatolators; chairman, National Association onStandard Medical Vocabulary. Springfield, Ill.: Charles C.Thomas. Oxford: Blackwell Scientific Publications. 1958.

Pp. 440. 57s. 6d.

Humpty Dumpty and the Red Queen must have thoughtup between them this looking-glass dictionary;, in whichone searches for unknown words, each vox supplying thereciprocal of a definition-just the thing for a writer at lossfor a word. The non-technical writer could, of course, turnto Roget’s Thesaurus, and even then he would not be sure offinding exactly the right word. This work is not confined tomedicine but embraces, among other things, nursing, pharmacyand pharmacology, chemistry, botany, and zoology. Americanusage is followed, which means not only that some things arecalled by different names and some spelt differently fromEnglish but also that many of the listed words do not existin this country.

It’s Healthy to be Human (London: British MedicalAssociation. 1958. Pp. 160. lOs.6d.).- The slightly ambiguoustitle of this Family Doctor book does not mean that homosapiens has a special endowment of health but that it makesfor health to recognise and be kind to our instincts. Thisthesis Dr. F. R. C. Casson expounds persuasively, with

knowledge, tolerance, insight, and humour, supporting andillustrating it with well-chosen examples. Normal psycho-logical development is sketched from babyhood to age, and thenature, power, manifestations, and modifications of the sexualand the self-assertive instincts are the book’s main theme.That man cannot live by bread alone is implicit throughoutthe book; whether he can live a life worth living without a

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Credo or scheme of values is not considered, and mention orrecognition of the " herd instinct ", as expounded by WilfredTrotter, is so conspicuously absent that the hunting in packsof dogs " in the wild state " is ascribed to intelligence subduinginstinct. A chapter on Are Doctors Human ? is disappointing,at least to a doctor; but the book can be warmly recommendedas a provoker of thought and fund of good advice to the"

ordinary reader ", for whom it is intended, especially if he isyoung and a parent.

Modern Treatment Year Book 1959 (25th ed. London:

Bailliere, Tindall, & Cox, for The Medical Press. 1958. Pp. 312.30s.).-Twenty-five editions and acclamation from all overthe world seem adequate comment on this book, edited bySir Cecil Wakeley. Yet the preface says that it is intended tohelp the general practitioner, and readers of the 1959 volumemay wonder whether some articles will do that. There areexcellent articles-the one on carcinoma of the rectum and colonis outstanding-and there are topics very relevant to a generalpractitioner’s work (chronic bronchitis and painful feet, for

example). But there is much that is beyond a family doctor’s(and many specialists’) scope. Is the management of spinabifida cystica and hydrocephalus or technical details of thetreatment of endocrine crises a necessary part of a generalpractitioner’s knowledge ?

New Inventions

AN INCUBATOR BALANCE

H. H. NIXONM.A., M.B. Cantab., F.R.C.S.

R. H. WILKINSONM.A., M.D. Cantab.

The Hospital for Sick Children,Great Ormond Street,

London, W.C.1

THE spring balance shown in the accompanying figure is

designed to weigh an infant up to 6000 g. with an accuracy of:2-5 g. while it is being nursed in an incubator. Rapid andfrequent weighings are possible.

POSTOPERATIVE WEIGHT AND FLUID RECORD: HUMIDITY 98% (RECORDEDON INSTRUMENT IN INCUBATOR TEMP. 80oF IN INCUBATOR

’ALEVAIR’ MIST; NO FLUIDS BY MOUTH

A spring balance has been chosen because it is simple toread, is accurate, and has a very stable zero in conditions ofrough treatment, heat, and moisture. It is not expensive.The makers have adapted a standard model 1 so that each revolu-

tion of the pointer records 2000 g. in 5 g. divisions to a maximum ofthree revolutions. The second and third revolutions are shown onthe bottom slide. A long hook connects the balance with the infant’ssling through a 1 in. hole in the ’ Perspex ’ top of the incubator. Thebalance is adjusted by the manufacturer to read zero with the hookand sling attached. The incubator we use 2 has an infant-weighingsling provided (this is easily sterilised). The perspex ice box isomitted. The hospital engineers made the stand. This has three legsof ample length for stability. The 6-foot tubular upright is adjustablefor height and carries a horizontal arm supporting the balance abovethe incubator.

Tubing for transfusion, drainage, ,and feeding extends from thebaby through holes in the incubator walls. This tubing does notaffect serial weighings if the loops of tubing are not altered greatly inlength. The same splint is used all the time for the limb into whicha transfusion is being given.The movements of infants cause far less oscillation of the

pointer than was expected. Gently swinging the infant in itssling often puts it to sleep. If movements are excessive, thereis always a period when the infant is still; and, as the needlesteadies immediately, a reading can be taken. For serial

weighings at short intervals, the infant is left lying on the sling(which is merely a sheet of plastic).To weigh an infant, the balance is lowered so that the hook

extends through the lid of the incubator far enough for therings on the sling to be attached. The balance is raised tillthe infant is suspended freely. Readings can be made with theminimum of disturbance to the infant and may be started

immediately after an operation is completed. Two-hourlyweighings of an infant in the incubator at 81°F and 98%humidity (recorded by the instrument in the incubator),receiving nothing by mouth, were 3345, 3330, 3305, and 3295 g.No urine or stools were passed during this time. The weightsshow the water-loss clearly over six hours. The accompanyingtable shows part of a postoperative record of weighings.Weight stayed constant while operative losses were restored;then intravenous fluids exceeded requirements for a few

hours; and this was followed by satisfactory balance as thePYCPS6 ftniii XX73Q l()<Bt

With this balance the weight changes of infants can befollowed accurately under practically any conditions. Themethod should prove useful in the management of fluidtherapy.

It is a pleasure to thank Messrs. Salters of West Bromwich andOxygenaire of Wembley for their cooperation, and in particularMr. Harold Bright, B.SC., for his advice and help; Sister J. A. Barnes-Marsh for her enthusiastic help; the research committee of theHospital for Sick Children, Great Ormond Street, London, for aresearch grant; and the photographic department of the hospitalfor the i)h]Rtrat)nnR-

1. No. 236T. George Salter & Co. Ltd., West Bromwich, England.2. Series IIIA. Oxygenaire Ltd., Wembley, England.