329

The treatment is simple and appears to be safe. Itcan easily be carried out at home. The only drawbackis that it is expensive. I understand that the retail

price of aureomycin in Malta would work out at 5s.a capsule, and that a complete treatment would cost;E24. Against this must be set an average of three months’stay in hospital and another three months’ invalidism.Considered from this point of view the cost does not

appear to be excessive, and one hopes that, as in thecase of penicillin and streptomycin, large-scale productionand improved technique will soon lower the cost andincrease the supply.My thanks are due to the Lederle Laboratories for supplying

me with 2000 capsules of aureomycin free of charge, and to’

the C.G.M.O. Malta, who handed me his quota of the drugand has given me permission to publish this paper. Mostof the bacteriological work was carried out at the PublicHealth Laboratory, and I wish to thank Prof. V. Mifsud andDr. E. Agius for their help and cooperation.

REFERENCES

Duggar, B. M. (1948) Paper read to New York Academy of Science,Section of Biology, July 21, 1948.

Spink, W. W., Braude, A. I., Ruiz Castaneda, M., Sylva Goytia, R.(1948) J. Amer. med. Ass. 138, 1145.

Reviews of Books

Bronchiogenic Carcinoma and AdenomaB. M. FRIED, M.D., associate attending physician,Montefiore Hospital, New York., London: Bailliere,Tindall, and Cox. 1948. Pp. 306. 33s.

’

.

THIS well-produced and freely illustrated work is ofparticular interest at the present time, when an alarmingincrease in the incidence of pulmonary cancer is beingrecognised. Dr. Fried feels that the increase is moreapparent than real, and is due to such factors as

improved diagnostic methods, public-health facilities,and "awareness."

Classification of bronchial carcinoma is by no meanseasy ; but it can follow anatomical or microscopicalcharacters, and conveniently enough these almostcoincide. Assessment of aetiological factors, too, isdifficult: radon in cobalt mines (Schneeberg) andchromium are now under suspicion, while the oldfavourites—tobacco, tar products, silicosis, and viruses-are more or less exonerated for the moment. Theclinical aspect and course occupy several chapters andDr. Fried describes fully hypertrophic osteo-arthropathyin relation to pulmonary cancer. In a good accountof superior-sulcus tumours (Pancoast) he admits thatWhile most are bronchial carcinomas wedged in theapex, some are derived from bronchial rests. The valuein diagnosis of bronchoscopy and sputum-examinationfor cells is stressed and the dangers of aspiration biopsyindicated.

Dr. Fried notes that radiotherapy rarely givesgood results. and advocates radical surgery whereverpossible. The chapter on bronchial adenomas indicatesthat he regards these, on the whole, as benigntumours arising from the basal cells of the bronchialmucous membrane or from the mucous glands. Abrief concluding section on mediastinal tumours includesdescriptions of dermoids, neurogenic tumours, and otherrarer entities.

’

The 118 illustrations are well produced, the photo-micrographs being particularly satisfactory. A numberof illustrative case-reports in each section help to coveraspects not fully dealt with in the discussion. Thewhole forms an authoritative work on a subject that isdemanding increasing attention.

Les metrites du col

(2nd ed.) P.1 DUREL, H6pital Saint-Lazare. Paris :Masson. 1948. Pp. 334. 650 Fr.

IN this monograph Dr. Durel gives full descrip-tions of the pathological anatomy, bacteriology, andtreatment of the infected cervix. Relatively little issaid of symptoms. There is an excellent chapter on

the interaction of the diseased cervix and pregnancy.The greater part of the book, however, deals withgonorrhoeal infection, and for the gynaecologist whorarely sees overt gonorrhoea its value is correspondinglylimited.

Under pathological anatomy the English reader will findmuch with which he is familiar ; but Dr. Durel expands thestandard pathological descriptions into an ingenious, thoughpossibly over-elaborate, classification of types. The colpo-scope diagrams are well thought out, though somewhat crudein execution ; indeed, many of the drawn illustrations wouldbe better replaced by photographs, and photomicrographs.The full chapters on bacteriology contain much detail on themorphology, staining, and cultural characteristics of the

organisms concerned.Therapeutic measures are discussed in great detail, and the

chapters on the use of antibiotic and chemotherapeutic drugsgive full details of the physical and chemical characteristicsof the different preparations. A section on the use of hor-mones develops into a discussion of their use in any gynæco-logical condition fortuitously associated with cervical lesions.Other therapeutic measures described range from the

commonly accepted tampons, pessaries, and douches, througliintracervical pencils (which are condemned) to methodsto which the British reader may not be accustomed—e.g.,cervical massage, artificial pyrexia, thermal baths, radio-active waters, and dietetic regimes. There are good chapterson the use of high-frequency currents, including diathermyand coagulation ; and here, with his passion for thoroughness,Dr. Durel even includes circuit-wiring diagrams. Conisation

by cutting wire is not discussed at all, and the actual cauteryand electrocautery receive scant mention. Hysterectomy isonly discussed in so far as it is necessary for chronic adnexaldisease.

If Dr. Durel intended to cover all current knowledgeon appearances, bacteriology, and methods of treatmentof cervicitis he has achieved his object ; but his chaptersare apt to be watertight, and fail to link up appearances,aetiology, and treatment. Only very rarely does heexpress a clearcut personal opinion on the value of thevarious treatments.

Child Psychiatry(2nd ed.) LEO KANNER, M.D., associate professor ofpsychiatry and of pediatrics, director, children’s

psychiatry service, Johns Hopkins University and

Hospital, Baltimore. Springfield, 111. : C. C. Thomas.Oxford : Blackwell Scientific Publications. 1948.

Pp. 752. 458.

THE second edition of one of the earliest attempts topresent child psychiatry systematically is an importantevent, the more so as the psychobiological school atJohns Hopkins has seemed to many to provide the most"sensible" approach to this controversial subject. Inhis effort to be comprehensive, even at the expense ofdepth, Professor Kanner summarily dismisses psycho-analysis, thus (some will feel) discarding any seriousexamination of the dynamics of the situations he describes.While he gives a balanced account of the influence ofheredity, he interprets the psychological disorders ofchildhood in terms of crude environmental influences, andthe profit motive in the child. Even with such a self-imposed limitation, his choice of a purely symptomaticclassification is hard to understand, being at odds withthe psychobiological appeal, made early in the book,for a holistic approach to the physical, emotional,intellectual, and environmental problems of childhood. .

It is difficult to preserve the holistic perspective when, ina section entitled Problems of Behaviour, children aresorted out according to symptoms, under the headingsof anger, fear, anxiety attacks, and hypochondriasis.In strong contrast to his appeal for unification are hisreferences to the child psychiatrist’s natural allies-parents, school-teachers, hospitals, and juvenile courts-which, on the whole, are unfriendly and even sarcastic ;while the work of the psychiatric social worker isdismissed in two pages of vague description.

Professor Kanner’s critical qualities, ably displayedin comparative studies of the contributions of others,seem to vanish before deeper psychological phenomena.Since his book will inevitably be in demand among

H 3

330

students, psychiatrists in training, and paediatricians,they should be aware that the superficial " commonsense

"

approach may mask an underlying poverty ofinquiry into causation. We still cannot predict con-fidently that a particular type of reaction will be shownby a known child in a given set of circumstances ; nor

do we know why a certain child falls ill in one way whileanother child of comparable antecedents, subject tosimilar environmental influences, will react differently.The elucidation of these mysteries is a task ofparamount importance to child psychiatrists of allschools.Where there is little inquiry below the surface, treat-

ment methods must rely on manipulation of the environ-ment alone. This book, painstaking and thoroughlyreadable though it is, leaves too many questions open ;and induces a mood of disappointment.

Sex in Social LifeEditor : SYBIL NEVILLE-ROLFE, o.B.E. London : Allen& Unwin. 1949. Pp. 506. 21s.

THIS symposium on the sociology of sex was ready forthe press at the outbreak of war, and now appears in arevised form. Of the experts who contribute, those whoseconcern is with the scientific background are most attheir ease, Dr. C. H. Waddington on sexual biology andDr. M. Fortes on comparative anthropology being out-standing. In the sections dealing with hygiene and ethics,one occasionally longs for the horse-sense of certainother works. There are passages in which insufficientcitation of evidence and confusion of fact with opiniondiminish the authority of the writers, but in general thestandard is high, though not equal to that of at least one- recent American symposium. In books of this kind, theintended audience must at all costs be kept in mind ;and to describe Trep. pallidum, for instance, as " a worm-like organism," or to state that venereal diseases arecommonly contracted without promiscuity, though safeenough in the presence of a trained audience, is to courtdefinite risks in public hygiene teaching. It would,however, be ungenerous to carp at a book which manywill find informative and helpful, and which representsa sincere attempt to state the scientific background of arational sexual ethic.

Progress in Allergy °

Vol. 11. Editor : PAUL KALLOS. Basle: Karger. 1949.

Pp. 356. Sw. fr. 36.

THE first volume of this work appeared before thewar under the editorship of Paul Kallos. The secondvolume resembles the first in having many -contributors,but differs from it in being mainly in English insteadof German. Since the editor has allowed each authorto express his own views, there is not always absoluteagreement. They discuss the immunological, chemical,and therapeutic aspects of recent advances inallergy, using the term in the sense given it by vonPirquet-

-

,

G. L. Waldbott surveys the setiologieal causes of urticaria.He points out how difficult it is to determine the cause in

many cases, especially when it is the residue of a long-persisting serum-sickness in which there are none of theusual landinarks of allergic disease. Drug sensitivity (e.g.,aspirin) is common in the non-reactor group ; but not everyonewill agree with his assertion that pollen is as important asfood as a cause of urticaria. -

F. A. Simon’s experimental evidence of the sensitivity ofpatients to human dander may throw light on the problempresented by the infarit with eczema or seborrhcea. It isdifficult to know where experimental findirigs can fit in withthe clinical picture, for it was shown that a patient could havepositive skin-reactions and circulating reagins for an allergenpresent in the epidermis of her thigh and her own scalp.Even a newborn infant has allergens in the epidermis.Scratching may therefore be harmful not only becauseit causes trauma, but also because it favours auto-

inoculation.Professor Haxthausen, too, suggests that the exacerbations

of eczema may not be due primarily to antigen-antibodyreactions-but may be secondary to irritation and scratching.Positive skin-tests of urticarial ’type are often found ineczematous patients ; yet it is urticaria or asthma and not

eczema that results from an overdose of the antigen. The, difficulty is that there are many causes, known and unknown,specific and non-specific, which influence an allergic condition.Animals may be sensitised to bacterial antigens of the

tuberculin type or show an immediate response to bacterialproducts like brucella polysaccharide. Dogs, like humans,can as easily be sensitised to ascaris antigen ; but F. W. Wittich,who reviews the subject of allergic diseases in animals, wasthe first to demonstrate spontaneous allergy (atopy) in a

-dog which had seasonal hay-fever.. Foster Kennedy postulates that the demyelinatingdiseases, including disseminated sclerosis, have in commonan antigen-antibody upset. Many cases of transient paralysis,retrobulbar neuritis, peripheral-nerve involvement, chronicheadache, and migraine, and some cases of epilepsy, originatewith symptoms of an oversensitiveness to protein.

E. A. Kabat epitomises the recent advances in immuno.chemistry ; and aerosol, bronchoscopic, and anti-hiataminetherapy are well summarised.One small criticism of this valuable work seems

justified. The publishers have not allowed a new linefor each reference, and it is most difficult to followthe non-alphabetical jumble which appears at the endof most articles.

Kayne, Pagel, and O’Shaughnessy’s PulmonaryTuberculosis

(2nd ed.) Editors : WALTER PAGEL, M.D. ; F. A. H.SiMMONDS, M.D. ; ; N. MA-EDONALD, M.B.; ; L. FATTI,F.R.C.S. London : Oxford University Press. 1948.Pp. 720. 63s.

,

THE new edition of this textbook is inscribed to thememory of two of the original authors, Dr. GregoryKayne and Mr. Laurence O’Shaughnessy, who havedied since the first edition appeared ten years ago. Inrevising it, Dr. Pagel has been assisted by Dr.Simmonds, Dr. MacDonald, and Mr. Fatti.

Recent work has made it necessarv to alter the textconsiderably, and the book is 160 pages longer than itspredecessor. It is a sound account of modern thoughtand practice, and carries a good bibliography. Thearrangement remains the same, under the headings ofpathology, diagnosis, prognosis, management (includingall aspects of treatment), and epidemiology and preven-tion. Two appendices cover classification and the

present state of knowledge of streptomycin and otherchemotherapeutic agents. The section on pathology,which includes -the evolution of tuberculosis in man,occupies considerably more space than any other section but the account is so detailed, well documented, andbeautifully illustrated that the lack of balance is at onceforgiven. Modern methods of diagnosis are welldescribed, though the statement that inspection " willreveal a pronounced emphysematous chest " shouldnot have been made without qualification. The variousforms of collapse therapy occupy many pages, andaccounts of immunisation with B.C.G. and the vole bacillusform an important part of the section on prevention.The authors urge the need for a clean milk-supply inrural areas but claim that the building up of tuberculin-negative herds on a large scale is impracticable. InDenmark and the United States, however, it has alreadybeen accomplished.

An Introduction to Medical PsychologyL. ERWIN WEXBERG, M.D., director, bureau of mentalhygiene, District of Columbia. London : HeinemannMedical Books. 1948. Pp. 171. 17s. 6d.

THE eclipse of Alfred Adler’s " individual psychology "

seems to have prolonged itself sufficiently to be regardedas extinction. Dr. Wexberg, however, shows in thisseries of lectures delivered to medical students thatAdler’s theory of dynamic psychology can be weldedinto a body of teaching which takes account of otherpoints of view and more recent studies. The bookcontains six chapters-ranging from Individual andCommunity to Methods and Techniques of ClinicalPsychology-and will commend itself to those who

dislike psycho-analysis but want something separatefrom psychology which they can call medical psychology:inevitably they get something respectable but old-fashioned.