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improved survival in patients who are gravely ill with

myocardial infarction.We are indebted to Messrs. Glaxo Ltd., who made available supplies

of bydrocortisone hemisuccinate (’ Efcortelan ’) for the trial.

J. L. C. DALLM.D. Glasg., M.R.C.P. Glasg.

A. A. F. PEELM.A., D.M. Oxon., F.R.C.P. Glasg.

Department of Cardiology,Victoria Infirmary,

Glasgow

Reviews of Books

Sir John SimonROYSTON LAMBERT. London: MacGibbon & Kee. 1963.

Pp. 669. 63s.

MUCH has been written about the life and achievementsof John Simon, for nothing can efface his work. This scholarlybook presents a fascinating account of his extraordinary career,as pathologist, surgeon, and medical administrator: his eminentand satisfying work at St. Thomas’s Hospital; his spectacularsuccess as medical officer to the City of London, where,seizing the challenge of the environmental squalor of themid-nineteenth century, he clearly established the value of theservices that could be rendered to preventive medicine by adedicated M.o.H.; the years between 1855 and 1876, when hewas medical officer to the Government-years, in retrospect,of progress which none the less were for Simon largely years offrustration.One of the interesting aspects of the book is, indeed, the

light which it sheds on the lot of the professional man incentral Government during these pioneering years. Simon

enjoyed a very high professional reputation and could generallycount upon solid support from the Press, professional and layalike. From his earliest days he used his official annual reportsnot merely to describe conditions as they were but to point outremedies. This method worked well in the City but was not sosuccessful when he went into the Government service. Hehad no qualms at all about identifying himself with overtpressure groups, so long as he could harness them to shapesocial policy. His reports, understandably enough, became asource of annoyance to his official masters, and in 1872 and1873 Simon was not allowed to publish them; when the rightto do so was restored to him in 1874, he took the occasion todisavow the policies of his masters and to propound his ownalternative schemes. The Treasury regarded him with

suspicion. Disraeli, when Chancellor of the Exchequer,minuted that "’ Mr. Simon is energetic but requires super-vision ". Experience taught him to bypass Parliament so far aspossible, trusting to make more rapid progress by administra-tive penetration. He had increasing difficulty in preserving hisright of access to the Minister; as The Lancet said in 1875," Mr. Simon has been relegated to some Departmental limbo ".Things came to a head when, in the following year, Simonthreatened to resign unless the President of the Local Govern-ment Board met his demands for right of access and initiation,control of the Board’s sanitary administration, and increase ofmedical staff. His demands were not met and Simon left the

public service in 1876, at the age of 59. The undoubted pioneerof State medicine in Britain, he had had a long and, as he sawit, fruitless struggle to build up a medical department. Simonlived until 1904, but the later years of his life brought him scanthappiness, despite the honours that were showered upon him.He was conscious less of the success of his work than its failure.

John Simon had great virtues-a passionate humanism,restless creative endeavour, breadth of imagination, intenseconviction; and he had a flair for sensing the potentialities ofyoung men and for persuading men already of repute to workwith him. But all this was apparently not enough, and it isscarcely surprising that towards the end of his official careerhis self-control broke down under the strain of long frustrationand his language sometimes became " outspoken to the point

of offensiveness ". The Establishment did not regret his going,though there was deep professional shock and wide publicregret at the downfall of State medicine.

Dr. Royston Lambert presents a fitting portrait of a greatman and a revealing picture of Government and sociology in aformative era.

An Introduction to Medical Genetics3rd ed. J. A. FRASER ROBERTS, M.D., D.SC., F.R.C.P., F.R.S.,director, Clinical Genetics Research Unit, Medical ResearchCouncil. London: Oxford University Press. 1963. Pp. 283. 35s.

Dr. Fraser Roberts’ first edition appeared in 1940, sincewhen the face of genetics, and especially human genetics, hasvery greatly altered. Biochemical genetics and chromosomalanomalies have almost swamped the older aspects of the subject.It is at once the strength and weakness of this book that Dr.Roberts has resisted this swamping: D.N.A. and the geneticcode appear only briefly in small print on page 2; chromosomalanomalies have one late chapter; and biochemical geneticsonly a part of a later one. There is very little mathematics, andno mention of the infra-structure of the gene.The modern school of geneticists may ask for more; but,

within its limits, this is an admirable book that can be readand enjoyed by those completely ignorant of the subject. Atthe end they will understand most of the genetics that is at

the moment of any practical use in medicine.Medical geneticists able to speak with equal authority among

both pure geneticists and consultant physicians are, not

unexpectedly, as rare as astronomers who can navigate a liner.We have very largely to make do either with geneticists who arenot medically qualified or with doctors who know some

genetics. Both are necessary, but there is a certain professionalrivalry between them and they are a little inclined to over-

emphasise the difference between them. Good as it is, thisbook would have been even more valuable if Dr. FraserRoberts had been more concerned to show how much at homehe is in both camps.

Comparative EndocrinologyVol. I. Glandular Hormones. Editors: U. S. vorr EULER andH. HELLER. New York and London: Academic Press. 1963.

Pp. 543. 143s.

THIS, the first of two volumes, deals with glandular hormonesof the vertebrates (the second will cover invertebrate hormonesand tissue hormones). The names of the contributors are

household words in endocrinology. The first chapter, byFortier, is concerned with the hypothalamic control of theanterior pituitary, and it surveys somewhat briefly the ana-tomical connections and the neurohumoral agents concerned.The next two deal with the neurohypophyseal hormones andthe hormones affecting the chromatophores. Remarkable

progress has been made in the comparative biochemistry ofthese substances and in understanding their physiologicalactions in different species, and they are well reviewed byHeller and by Karkun and Landgrebe. Chapters on the femaleand the male sex steroids, by Velle and by van Oordt, follow.Each ;ncludes about 300 references, but the subject is vast andthese only skim the surface. The adrenocortical hormones areably discussed by Phillips and Bellamy, and the chromaffin-cell hormones by von Euler. Then follow chapters on thethyroid (Gorbman), the parathyroids (Greep), insulin (Young),and glucagon (Berthet). The comparative biochemistry of allthe anterior pituitary trophic hormones is described by Li andtheir physiological action by Knobil and Sandler.The chapters are well written and uniform, a credit to both

authors and editors, but one is left wondering what a book ofthis size should achieve. The many subjects it covers are

changing so rapidly that they need to be reviewed often andfully. It aims at bringing together a series of such reviews in asingle volume; but this imposes restrictions and it is doubtfulwhether the chapters are sufficiently comprehensive or whethernew editions will appear often enough to satisfy the specialist,while the pure clinician may find the book has too little to sayabout the human animal.

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A History of the Royal College of Physicians of Ireland1654-1963

J. D. H. WIDDESS, M.A., L.R.C.P.I., professor of biology, andlibrarian, Royal College of Surgeons of Ireland. Edinburgh:E. & S. Livingstone. 1963. Pp. 255. 40s.

THE Irish College dates back to 1654 when John Stearnefounded the Fraternity of Physicians, which, in 1667, wasgranted a Royal Charter by Charles II because it was " aninstrument under God for reforming the practice of physic inthe Kingdom ". But this happy state of affairs was ended alltoo soon by disturbances arising in 1688 from the pursuit ofJames II, which abruptly cut short intellectual work in Dublinuntil more settled conditions returned after the victory ofWilliam III at the Boyne.The reconstituted college under a new Charter granted by

William and Mary in 1692 decided to perpetuate the gloriousmemory of the sovereign, who had triumphed over the Jacobites,in their title of the King and Queen’s College of Physicians inIreland. Under its second Charter the college was a smallexclusive body, the number of whose fellows was limited tofourteen, who had to be Protestants. It was further handicappedfor over a century by the lack of a building. Its licence, which,according to the Charter, had to be taken by all who desired topractise physic in Dublin and its neighbourhood, was not con-sidered necessary by the large number who had qualified out-side Ireland and were unwilling to pay the high fee required.And the college was unable to compel them.Revolutionary changes ushered in the modern era in the

early 1860s, with the opening of the fellowship in 1862 to allcandidates approved by the college, and the increase in thenumber of licentiates caused by recognition of the need forgeneral practitioners. About the same time, too, through theefforts of Corrigan, the college acquired for the first time anadequate and dignified hall; and this year it celebrates its

centenary.This, in brief, is the story here told with engaging and often

delightful detail. Professor Widdess is to be congratulated athaving produced so good and readable a source book.

Atlas of Vascular SurgeryFALLS B. HERSHEY, M.D., F.A.C.S., associate professor of clinicalsurgery; CARL H. CALMAN, M.D., F.A.C.S., assistant in clinicalsurgery, Washington University School of Medicine, St. Louis.St. Louis: C. V. Mosby. London: Henry Kimpton. 1963.

Pp. 307. 135s.

OPERATIVE technique is a highly personal matter to eachsurgeon, and the working methods of the craft are not easilyconveyed in a book. If the reader already knows a good dealhe is easily irritated, and if he knows less he is easily con-fused. In this imposing new guide to blood-vessel surgery,the authors have tried to help both types of reader; for theybegin with elementary advice and statements of first principles,and, not forgetting the ways and means of angiography, they goon to deal with such matters as the reconstruction of the

vertebral, mesenteric, and renal arteries.Useful clinical data precede each operation; and the brevity

of these is no handicap, for the authors know so much that theircondensed comments are very salutary. The illustrations are

mainly very good, though some curious ones have found a

place, and some, supposed to show points of exposure oractual technique, are confusing, even to a vascular surgeon.Not many operators of experience would rely on rotating theiliac anastomoses of an aortic bifurcation graft in order tocomplete the underside: suturing within the lumen is far lesscumbersome. Neither would many of them release one side ofthe graft while still working on the other distal anastomosis. Afull nephrectomy incision is out of date for lumbar sympathec-tomy, and the exposure shown for internal carotid endarterec-tomy is three times as long as necessary. Distal clamping of theembolised artery as is shown can result in the breaking up of thesoft clot beyond the embolus: this clamp need not and shouldnot be applied until retrograde bleeding has appeared.Amputations are well depicted but the now-popular Gritti-Stokes operation is not included.

Perhaps the book is truly intended for the occasionalvascular operator or the surgical apprentice, for everywherethe emphasis is on safe simple methods and the application ofgood basic principles. If this is so, the authors have certainlysucceeded, and this elegant volume may find a place in manyoutlying hospital libraries, to provide wise guidance when mostneeded.

Morbidity and Mortality from Malignant Neoplasms inthe U.S.S.R.

Editors: A. M. MERKOVA, G. F. TSERKOVNOGO, B. D. KAUFMAN.Translated by K. SYERS, M.A. English edition edited by J. G.DEAN, M.D., M.R.C.P. London: Pitman Medical Publishing Co.1963. Pp. 37. 7s.6d.

SEPARATE returns for recording cases of cancer were intro-duced in the U.S.S.R. in 1939, when they were required forall towns with cancer institutes. In 1953 the system wasextended to cover the urban areas of the whole country. The

present translation makes available to non-readers of Russianinformation about cancer morbidity based on the records ofgeneral and specialised therapeutic and prophylactic institu-tions and about cancer mortality based on death-certificatedata kept by the civil records authorities. It is claimed that the

growth of a specialised service providing skilled medicalassistance for cancer patients will improve the statistics of thedisease in the years to come. The U.S.S.R. is composed of anumber of republics, and it is not surprising that great variationsin morbidity and mortality rates are evident between one

republic and another. Regional differences depend on the num-ber of oncological establishments in each republic and on howwell they are technically equipped to establish and verify diag-noses, on the level of qualification of the doctors working inthem, and on how well their work is organised. At the end ofthe book comparisons are made with cancer mortality-rates in18 other countries.This information will become more valuable as time passes

and comparisons can be made with the figures for ensuingyears, based on a health service which must by now be reachingstability. The book is well arranged and translated, and, withinthe limits of the material on which the figures are based, it is avaluable addition to the study of the geographical distributionof cancer.

Photographic Illustration for Medical WritingDONALD J. CURRIE, M.D., M.SC., F.R.C.S.E., F.R.C.S.(C-), attendingstaff surgeon, department of surgery, and consultant, departmentof photography, St. Michael’s Hospital, Toronto; ARTHURSMIALOWSKI, F.R.P.S., director, department of photography,St. Michael’s Hospital, Toronto. Springfield, Ill.: Charles C.Thomas. 1962. Pp. 116. 7.50.

DEPARTMENTS of medical illustration, most of which startedas essentially clinical services, are becoming increasinglyoccupied with improving the standard of published work. In

recognition of this, the Lancet trophy is awarded annually bythe Royal Photographic Society for the best photographsreproduced in the medical press during the preceding year, andthis year the authors of this book received the trophy for theirwork in the field covered by this admirable little manual. Acopy should be available in every illustration department,whence it should often be out on loan to clinicians and others

preparing papers.The authors are a surgical teacher and a medical photographer

and emphasis throughout is on joint planning: there is littleactual photographic technique. This is as it should be, forthere are adequate textbooks of medical photography, and itwould be churlish to quarrel with a few oversimplifications andminutix which may strike the British reader as odd. Thereseems to be rather too much insistence on cost: while economymay well be achieved in such ways as grouping pictures forengraving to a common scale, a line block should not be pre-ferred to a half-tone because it is cheaper, but because it is thebetter medium for the particular job. The chapter on releasesand permission to publish is not based on English law, underwhich no written consent of a patient to be photographed isnecessary (though it is courteous to obtain it verbally). On the

1100

other hand, the paragraphs on obtaining consent to use otherpeople’s material might well be put more strongly. Un-authorised and unacknowledged use of illustrations is prevalent,and, at the least, it is bad manners (it is also usually unnecessary,for clinicians, medical illustrators, and publishers will neverwithhold consent unreasonably).

Dr. Currie and Mr. Smialowski have done a considerableservice to medical writing and publishing, and their bookdeserves success. It is copiously illustrated, which accounts forits price-but it is worth it.

Gastroenterology2nd ed. Vol. I. HENRY L. BocKUS, M.D., emeritus professorof medicine, University of Pennsylvania Graduate School ofMedicine. Philadelphia and London: W. B. Saunders. 1963.

Pp. 958. 175s.

TWENTY years ago Professor Bockus produced the firstedition of this book in three volumes and it made a great impacton gastroenterology throughout the world. A very long timehas elapsed before the second edition, but the timing cannot becriticised. In the interval there has been a rapid advance in thisspecialty and a number of single-volume books have beenwritten. This edition brings the whole subject up to date notonly in the broad outline but also in the minutiae. This first of thethree new volumes covers the oesophagus and stomach in40 chapters. Space has been no problem for the contributors,but, even so, reasonable conciseness has been achieved. This isnot really a second edition but a completely new book, sinceeach section has been rewritten, and few references from theoriginal book persist. Dr. Bockus is to be congratulated on hiscontinued energy in editing his book and ensuring the uni-formity of its presentation. He has been helped by the fact thatthe book is a product of the Pennsylvania Graduate School ofMedicine, written by his colleagues and former pupils. Buttheir outlook has been a wide one, and they have kept in goodtouch with ideas and work in other countries. All physiciansand surgeons particularly concerned with gastroenterology willwish to have this book.

Clean CateringA Handbook on Hygiene in Catering Establishments. Ministry ofHealth. London: H.M. Stationery Office. 1963. Pp. 89. 6s. 6d.

FROM time to time we have noticed handbooks and brochuresfrom official and other sources designed to raise the hygienicstandards of the catering trade. Observation suggests that thesehave done good. The Ministry of Health has now published amore comprehensive book which covers the subject from end toend. The design of premises and their equipment, the engage-ment and training of staff, and the day-to-day running of thebusiness are all discussed in detail. Bound with this is a copy ofthe Food Hygiene (General) Regulations, 1960. It is not easy tofind any serious omission, and the suggestions we make forimprovement are limited to the methods of propagatingsound doctrine. There are too many long paragraphs whichsubmerge essentials. Subheadings are few and not in well-differentiated type. The table of contents is not a substitute foran index and it is not easy to turn up any detail in a hurry.There might be more quantitative information. It must be wellknown how much storage and refrigerator space is necessary,within fairly wide limits, but the architect who follows this bookwill have to guess. The diagrams are good, but there should bemany more of them at the expense of the photographicillustrations which will tell most readers nothing new.

This book should be on the shelves of every medical officer ofhealth and public health inspector-and, far more important,those of every caterer in the country.

History of ScienceVol. Il. Editors: A. C. CROMBIE and M. A. HOSKIN, lecturers inthe history of science at Oxford and Cambridge Universitiesrespectively. Cambridge W, Heffer. 1963. Pp 177. 30s. (paper-back 21s.)

As an annual volume intended in the first place to be aninstrument of research and criticism, History of Science aims ata filnrtinn nnt- <:v<:tfmatifHv nPrfnrmarl hv anv of thp fvmtitio-

journals. It is intended not to compete with these older journalsin publishing original historical articles but to complementthem by providing critical reviews of problems and materialsfor research and of recent publications. These reviews are to beboth critical and constructive, to draw together contributionsthat may appear in widely scattered places, and to directattention to original source materials as well as outstandinghistorical problems.

This interesting volume contains five articles on: MertonRevisited, or science and society in the 17th century; earlyastronomical and mathematical instruments; new light onLavoisier; histories of scientific societies; and a sixth-form coursein the history and philosophy of science. There follow ten longessay reviews, two of which have medical interest-O’Malley,Poynter, and Russell’s translations of Harvey’s PraelectionesAnatomiae (by Walter Pagel) and Sigerist’s History of Medicine(volume 2) (by F. N. S. Poynter). Finally come a group ofshorter reviews by Sir Geoffrey Keynes, Sir John Cockcroft,and Dr. Cuthbert Dukes. The quality of writing and of interestare throughout very well sustained.

We Met at Bart’sGEOFFREY BouxrrE, M.D., F.R.C.P. London: Frederick Muller.1963. Pp. 288. 25s.

Percivall Pott, of immaculate dress and immaculate literarystyle; John Abernethy, renowned for dramatic lectures andterse advice; James Paget, with his discerning eye for minuteclinical detail: St. Bartholomew’s Hospital has never lackedcolourful personalities, or grateful biographers for them. Butthe past sixty years have been particularly momentous for thehospital, and Dr. Bourne was concerned lest that era, andthose who graced it, might go unchronicled. His reminiscencesdescribe how he was taught by and later worked with, suchmen as Horder and Drysdale, Langdon Brown and Spilsbury.They incidentally provide an account of the arduous process bywhich, in the days before the war, a consultant achieved hisstatus and built his practice (Dr. Bourne is emphatic about thelessons to be learned from private practice and is convincedthat its decline can only be to the detriment of medicine as awhole).The volume is, of course, full of anecdotes and there are

many excellent photographs, including one of Barts’ first car,the property of C. B. Lockwood (Dr. Bourne may not haveheard this vehicle called " The Gumma ", because, as GreyTurner recounted, " it had a pronounced tendency to breakdown".)

Pott used to say that he had worked for Barts " man andboy for half a century". Geoffrey Bourne can claim a

period of devoted service that is just as long. Now he hasadded to the debt the hospital owes him by producing thisenjoyable account of an important phase in its evolution.

Cell Proliferation (Gumness symposium. Oxford: Black-well Scientific Publications. 1963. Pp. 241. 42s.).-This well-produced book, edited by Dr. L. F. Lamerton and Dr. R. J. M.Fry, reviews personal and related work by many of theauthorities investigating cellular proliferation by autoradio-graphic methods. It deals with such topics as the analysisof cell population kinetics, the use of radiation to inhibitcellular proliferation, the question of exchange or turnover ofD.N.A., the production of the white and red blood-cells, andthe interpretation of data obtained in growing tumours. Thereviews are clearly and simply written, and the book is a goodintroduction to the extensive literature. It is up to date, and forthe expert provides some interesting new ideas on the inter-pretation of existing data. A paper of particular interest is thatof Cronkite and his associates on the application of lymph-duct drainage and extracorporeal irradiation of the blood inthe study of lymphopoiesis. Their extensive investigationsillustrate the problems which will have to be solved if thisapproach is to be used in the treatment of leukaemias. Several

papers deal with the mathematical interpretation of data ongrain counts. These papers illustrate the dilemma in this workof having information about single cells but of using it tomtrTrft O’rCl1’ln nttvitia nniv