25

secondary to hiatus herniation. In a few people therewas a wide hiatus, due to late descent of the stomach inembryological life. True congenital short oesophaguswas present in only about 5% of cases. Paroesophagealhernia without shortening of the oesophagus did notproduce peptic ulceration. Secondary strictures formedif hyperchlorhydria was present, and associated juxta-pyloric ulcers were common.Carcinoma involving the sphincter was more commonly

adenocarcinoma than squamous-cell, and the area

5 mm. each side of the oesophagogastric mucosal junctionwas very prone to malignant disease. Mr. Edwardsdescribed three cases of adenocarcinoma arising in

intraoesophageal gastric mucous membrane. In everycase the lymph-glands around the cceliac axis wereinvolved early. It was necessary to remove the lesseromentum, greater omentum, cceliac nodes, mediastinalnodes, and suprapancreatic nodes. Adenocarcinomacalled for removal of the lower end of the oesophagus,two-thirds of the pancreas, spleen, and related nodesin continuity, and for an oesophagojejunal anastomosis.For a squamous-cell carcinoma a subtotal gastrectomymight be performed, and cesophagogastric anastomosiscompleted the operation ; but it was necessary to

perform extensive nodal resection similar to that in theprevious operation.The treatment of cardiospasm, if simple measures

failed, was by Heller’s operation of oesophagocardio-

myotomy, which should be done early, preferably throughthe abdomen ; the incision down to the mucosa mustbe at least 2 in. long. In 15 cases this procedure hadbeen uniformly ’successful. Other operations were notrecommended.The treatment of well-established peptic ulceration

was difficult ; repeated dilatations, alkalis, and sleepingin the erect position would help. If the condition wasfound early, cure might result from restoring the normalanatomy. Excision of stricture with oesophagogastricanastomosis after two-thirds resection of stomach hadbeen recommended, but the experience was not greatenough to evaluate this procedure. -With regard to carcinoma of the stomach, Mr. Edwards

made a plea for more radical treatment, in view of thepoor long-term results. The postoperative course mightbe difficult owing to hypoproteingemia and vitamin

deficiency, and before operation care must be taken tomake good these deficiencies. Of 21 cases in which ceso-phagogastric resection had been performed, 2 had diedafter operation-one from bronchopneumonia three

days afterwards, and one from hypoproteinsemia nineweeks afterwards. The patients, 4 of whom were overseventy years of age, tolerated these operations very well.Follow-up showed that of 5 patients operated on atleast two years ago, 4 survived. The main mortalitywas from metastases in the 40-50 age-group ; the older

age-groups did well.

Reviews of Books

Darmbrand : Enteritis Necroticans- K. HANSEN and others from the Städtische Kranken-

anstaten of Lubeck. Stuttgart: Thieme. 1949. Pp.212.D.M. 25.

FROM their study of cases -seen in Germany in 1946and 1947 the authors of this monograph bring forwardevidence that Darmbrand is a distinct and recognisabledisorder, of epidemic type, not previously separatedfrom other diseases. These cases occurred for the mostpart in the North -German coastal areas in explosiveoutbreaks in the summer and autumn months of 1946-47.The condition may affect any part of the intestinaltract, and its essential characteristic is a colourednecrosis resembling that of burnt tissue. This necrosismay lead to death from early perforation, to stenosiswith perhaps subsequent perforation, and of course toulceration and bleeding in the acute stage. Of 364cases recorded 22 % were fatal, most of the deaths beingin people over fifty years of age. The disease wascommonest in August and September, and was notedespecially in Lubeck, Hamburg, and Kiel. The authorsdescribe their cases with careful detail and record thepathology, the diagnosis and complications, and inseveral cases the results of surgical treatment by gutresection. Their monograph, which is illustrated bynumerous X-ray photographs and some coloured illustra-tions, deserves study by those interested in gastro-enterology. A satisfactory English version of theGerman title has not yet been suggested. Germancases were described in our columns last spring (1949,i, 519) under the name of necrotic jejunitis.

Visual DevelopmentVol. i. J. H. PRINCE, F.R,.M.s. Edinburgh : E. & S.

Livingstone. Pp. 418. 50s.

Mr. Prince’s book. apart from discursive accounts ofthe anatomy and physiology of the visual apparatusproperly speaking, is packed with icems of curiousinformation about many matters indirectly related tovision ; and its entertainment value is enhanced by anabundance of photographic and coloured illustrations.As Prof. Hamilton Hartridge points out in an introduc-tion, it is full of information and raises many problemsof the greatest interest which call for solution. But itis uneven in its treatment of the many subjects withwhich it deals, and here and there occur rather startling

statements which arrest the reader’s attention some-what abruptly (as, for instance, the remark that"

primitive man’s remains have been found in conditionswhich suggest that he may have been well advancedas much as eighteen million years ago "). The lackof adequate references makes it difficult to distinguishthe author’s own observations from those he quotesfrom the work ’of others. He says in the preface thatvolume m (in- preparation) will be concerned with" attempts at proving points and presenting newtheories."

Die PsychohygieneEditor : Dr. MARIA PFISTER-AJ.Bo1M:ENDE, Zurich. Berne :Huber. 1949. Pp. 423. Sw. fr. 28.

MENTAL hygiene on a world-wide scale has lately beenpropagated as a panacea against many troubles of ourtimes. Its theoretical aims are rather vague, butpractical mental welfare work can claim results in

many fields. This is the impression one gains from thisSwiss publication in which over 40 writers do homage toDr. H. Meng, of Basle, holder of the only professorialchair of mental hygiene in Europe, on the occasion of his60th birthday. Contributions from Switzerland reflectthe high standard of mental health services and of

psychiatric personalities outside and inside hospitals.By far the most interesting articles deal with welfarework among the 300,000 refugees from all parts ofEurope, prisoners-of-war, displaced persons, and deprivedchildren received by the Swiss authorities since April,1940. Organisation, selection and training of welfareworkers, and special difficulties with certain nationalgroups and their psychological problems are describedin some detail ; but this must be only a fraction of thelarge and unique Swiss experience in practical mentalhygiene, from which other peoples could greatly profit.That mental hygiene as a movement and practice has

not made the same progress in many countries is obviousenough from the reports in this book from Britain.the United States, France, Hungary, Denmark, andBerlin-in spite of some rosy articles suited to the festiveoccasion for which it was compiled. It is not a compre-hensive picture, for some of the best-known work in thefield of social and preventive psychiatry-that of theChildren’s Police in Holland, and the mental-aftercareorganisations in Amsterdam and X ew York State, andpreventive work directed against crime and other formsof asocial behaviour in the Scandinavian countries-has not been included. It is difficult to gather from thebook a clear idea of Dr. Meng’s own teaching on the

26

principles of mental hygiene; he evidently lays emphasison the collaboration of educational psychologist, socialscientist, and psychiatrist, on the importance to thecommunity of borderline cases of mental abnormality,and on the prevention where possible of the more severeforms of mental illness by the use of psycho-analyticprinciples-all too familiar ground to readers in English-speaking countries. After perusing the 400 beautifullyprinted pages they will turn again reflectively to thequotation from Groethe’s Wilhelm Meister in the preface :" If one once knows all the essentials, one ceases to betalkative."

Streptomycin and Dihydrostreptomycin in Tuber-culosis

"’"

Reports of research incl-zzding studies sponsond by theAmerican Prudeau Society (Medical Section, NationalTuberculosis Association). Editors : H. TvIcLEOD RIGGINS,M.D.; H. CoBwiN HiNSHAW, M.D. New York : NationalTuberculosis Association. 1949. Pp. 554.$7.50.

THis volume is of historic interest, for it gatherstogether the most important papers on streptomycinpublished in the LTnited States since the first account ofits discovery by Schatz and Waksman in 1944. The

early experimental and clinical studies by Feldman andHinshaw, the clinical reports by McDermott and hisco-workers, the 1948 report of the Veterans Administra-tion Streptomycin Committee, and the first reports ondihydrostreptomycin, are all reprinted here. Specialarticles on the bacteriological problems have been writtenfor this volume by Steenken and Youmans, on thepathology by Baggenstoss and Medlar, and on toxicityby Fowler and others.

’...

In the Trudeau Society investigations, which form thenucleus of the book, a main finding was that large dailydoses (1-5—3-0 g.) gave better therapeutic results thansmaller doses ; but the treatment groups differed somuch from one another at the outset, and so manyresults appear as

" not stated," that the findings mustbe hedged with reservations, and cannot be held toinvalidate the opposite findings by the VeteransAdministration. At the same time, clinical reports bythe individual investigators offer much enlightened-comment on the problems of streptomycin therapy.The book is handsomely produced, and is a valuable

addition to the literature on the chemotherapy oftuberculosis.

The Infancy of Speech and the Speech of InfancyLEOPOLD STEIN, --NI.D., F.R.A.i., physician in charge ofspeech therapy, Tavistock Clinic. London : Methuen.1949. Pp. 209. 21s.

STUDY of the origin and early evolution of language isfundamental for the study of the evolutionary develop-ment of the human family ; but it is difficult of approach.Dr. Stein’s book on the evolution of speech is bestregarded as a speculative essay, for (as the prospectivereader is informed on the cover)

" where direct evidenceis lacking he has resorted boldly to analogy and fantasy."The fact is that we have no direct evidence of the lin-guistic capacity of palaeolithic man, and the questionnaturally arises how far the author is justified in theuse which he makes of analogies and fantasies. This isa matter, perhaps, for the individual reader to decidefor himself, and in any case Dr. Stein may be commendedfor his strenuous effort to align all the indirect evidence-provided by comparative philology, by the study of thedevelopment of speech in the modern human infant,and by broad psychological principles-with what isknown of the evolution of man and of human culture.To those unfamiliar with the notations used for expressingelementary voice sounds, the book is by no means easyto read. At the first mention of lists of phonetic symbolsthe reader is referred to the index, but unfortunatelyfinds nothing there to help him. Much of the book isa popular account of the development of man and hisculture in palaeolithic times, and this draws largely onprevious popular accounts (rather than specialist studies)for its factual data. Opinions are thus attributed tocertain authors which they have really quoted fromothers. There are not a few inaccuracies of prehistorywhich are bound to affect the value of the book asa whole. Nevertheless, Dr. Stein’s essay has been well

worth while, for he demonstrates quite candidly thelimitations of the sort of evidence on which he is boundto rely, and at the same time indicates the utmost limitto which it is possible to go, on the evidence at presentavailable, in any attempt to elucidate the origin oflanguage.

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A Textbook of Bacteriology (6th ed. London: Heine-mann. 1949. Pp.484. 20s.).-In this edition of Dr. R. W. Fair-brother’s book the sections on milk, the viruses, and theRh factor have been revised, but otherwise there is littlechange. Subjects which have only technical interest are

wisely omitted, but space is given to the relation of bacterio-logy to clinical medicine. The book covers the course inreasonable space, but it could be made shorter and better,though medical students, for whom it was written, seemto like it. It has a few useful illustrations but no

references.

Proceedings of the Ninth International Congresson Industrial Medicine, London, 1948 (Bristol: John

Wright & Sons. 1949. Pp. 1090. 60s.).-Those who attendedthe industrial medicine congress last year will be glad to havethis stout memento of an interesting occasion. The book,however, is more than this, for many of the papers reproducedhere will be valuable references for many years to come.

Photographs, drawings, and diagrams shown at the sessionsare well reproduced, and English synopses of foreign papersare provided.The Filterable Viruses (Supplement no. 2, Bergey’s

Manual of Determinative Bacteriology. 6th ed. London :Bailliere, Tindall; and Cox. 1948. Pp. 172. 20s.).-Thissupplement, by Francis 0. Holmes, which was included inthe last edition of " Bergey," classifies and names the viruseswhich cause disease in man, animals, plants, and bacteria,and gives valuable references and information about most ofthem. We shall miss the pleasant descriptive names of someof the plant viruses-those causing wilts, crinkles, and curls-and it is small consolation to know that mumps and herpessimplex viruses take the latinised names of a pettifogger anda rascal. Children with measles and chickenpox may sharethe taxonomist’s fun when they learn that the generic nameof both viruses is Briareus, the hundred-armed giant.

Law Relating to Hospitals (2nd ed. London : H. K.Lewis. 1949. Pp. 587. :S2 2s.).-The start of the NationalHealth Service has obliged Mr. S. R. Speller, LL.B., to rewritemuch of his useful book and to put in a good deal of newmatter, not only about the National Health Service Actitself but about the Penicillin Act, 1947, and the RadioactiveSubstances Act, 1948. Moreover he has taken the bold andhelpful course of putting in a chapter on the mental hospitals.Doctors will again find that part 11 and part ill contain muchto interest them, and nurses will find their position andobligations defined in part iv. Part v deals entirely with theoperation of the Act. As a barrister, as former editor ofThe Hospital, and as secretary of the Institute of HospitalAdministrators, Mr. Speller is in a good position to knowhis subject both in theory and practice, and his survey shouldbe of great use to our profession.What is Man ? (London : C. A. Watt. 1949. Pp. 2Q4.

10s. 6d.).-The concept of man as a being who carries hisevolutionary past as a fixed if inconvenient corollary of hispresent belongs more to the last than to the present century.It is this approach which may limit the value of Mr. AlfredMachin’s essays-or rather aphorisms-for modern biologicalor sociological readers. He traces the very broad outlinesof the conflicts between evolutionary survivals, in the formof instinct and conduct-pattern, and human aspirations ;but he adds very little to the pattern of evolutionary ration-alism which was far more comprehensively and accuratelystated by T. H. Huxley nearly a century ago. It is hard,for example, for a 20th-century reader to come to termswith an author for whom " men hate work... (and) haveno social instinct," or for whom " sex is one of the aberrantinstincts of mankind " because it fails to coincide withcivilised institutions. It is difficult to imagine that such asequence of dogmatic inaccuracies could have been writtenby anyone familiar with the work of Mead or Unwin on sexualand social patterns, or of any of the more recent workerson the social behaviour of animals. The book is an interestingstatement of an obsolete position-more cannot be claimedfor it.

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