New Inventions

R. W. A. BOTTOMSM.B. Lond.

A DRIP ALARMBECAUSE of the shortage of nurses and the pressure

which devolves upon the limited numbers in a smallgeneral hospital, it has proved not uncommon for adrip-transfusion bottle to become empty and remain sofor some time before being -noticed. A simple form ofalarm to sound just before the bottle becomes empty

was designed, andhas succeeded in itsobjects of savingdiscomfort for thepatient and prevent-ing recriminationamong doctors andnurses.

The device consistsof a weight-operatedspring switch

(fig. 1) which energises a relay on closure. The lattermakes connections which illuminate a red light andsound a buzzer at the same time as extinguishing agreen pilot light. The general lay-out of the apparatusmay be seen in fig. 2. A remote buzzer may be operatedaway from the patient by using the ’’ extension buzzer "plug. Although normally worked from the main 240 VA.C. supply (using a transformer with a 6 V output)the device could easily be adapted for use with drybatteries.

The system is simple to use, is safe, and has proveduseful and popular with nurses.

I am indebted to Mr. George White, of Commercial CableCo., for technical assistance with the apparatus, and I thankthe consultants of Hounslow Hospital for allowing its use inthe treatment of their patients. ’

,

’

, R. W. A. BOTTOMS

West Wickham, Kent M.B. Lond.

Reviews of Books

Manual of UrologyALEC W. BADENOCH, M.A., M.D., CH.M. Aberd., F.R.C.S.,

surgeon, St. Peter’s Hospital for Stone and other Genito-urinary Diseases. London : Heinemann Medical Books.1953. Pp. 555. 1058.

UROLOGY is one of the newest but at the same timeone of the oldest branches of surgery. In its longhistory it has accumulated not only a corpus of lore buta heap of lumber, from which it is now shaking itselffree and emerging gleaming and streamlined. Mr.Badenoch has set out to provide the essentials of

symptomatology, pathology, investigation, diagnosis,and treatment in the specialty. His book is plannedon orthodox lines, starting with development, anatomy,and physiology, and the examination and investigationof a urological patient, and then dealing with the variousdiseases of the genito-urinary system, arranged for themost part regionally. An unusual feature is a separatechapter at the end of the book on operative urology.The approach is practical and the viewpoint that of theBritish school. He avoids dogmatism and discussesother views, but -at the same time gives definiteopinions. In all important respects his book is good.It is clear, concise, consistent, and covers much besidesthe mere essentials. The metabolic aspects of renaldisease are perhaps given less space than they deserve ;and there is a good case for introducing, in a moderntextbook, the milli-equivalent notation for electrolyteconcentration, if only as alternative, since it has certainlycome to stay and is gaining ground. In so practical abook it is disappointing to find hardly anything aboutthe varieties, qualities, use, and care of ureteric catheters,especially as a good deal of attention is given to otherurological instruments. Omissions, however, are inevit-able in a book of moderate length. The illustrationsare good and plentiful, and this book is a pleasureto handle.

Retinal Circulation in Man and AnimalsI. C. MICHAELSON, PH.D. Glasg., F.R.F.P.S., D.O.M.S..

advisor in ophthalmology to the Government of Israel.Springfield, Ill. : Charles C. Thomas. Oxford : Black-well Scientific Publications. 1954. Pp. 146. 50s.

THE extensive studies recorded here on the developingvascular system of the retina were carried out on differentvertebrates, special attention being paid to representativespecies like the eel, frog, pigeon, and some mammals.They amplify the rather sparse knowledge on thechoroidal circulation and the vascular system of thevitreous in nourishing the retina. In addition, Michaelsonbrings forward much new and detailed work on theuneven rate of vascularisation of the retina duringdevelopment, and on the uneven vascular developmentin different parts of the retina-work which leads himto the assumption that there is a local factor in the retinawhich influences vascular development and is capableof affecting growth of new vessels. This small book isprofusely illustrated and clearly documented.

Atlas of Pelvic Operations -

LANGDON PARSONS, M.D., professor of gynecology,Boston ’University School of Medicine ; HOWARD

ULFELDER, M.D., assistant clinical professor ofgynecology,Harvard Medical School. Philadelphia’ and London :W. B. Saunders. 1953. Pp. 231. £4 10s.

Tms substantial volume weighs 4 lb. 13 oz. Itspurpose is to teach by means of illustrations the technicaldetails of pelvic surgical procedures, as practised andtried in the Harvard and Boston schools of medicine.The format is designed to permit a surgeon to follow adetailed description of the -operation by word as well asby drawings, or to combine the two if he chooses. Thereare 197 plates, each of which contains from 3 to 13 separatedrawings, and each drawing illustrates a definite stepin an operation. All the ordinary gynaecological opera-tions are described, as well as many of the more unusualones (e.g., the Marshall-Marchetti operation for stress

incontinence). Some operations not strictly gynaeco-

1168

logical-such as large-bowel resection and anastomosisand excision of rectum-are also described and illustrated.The modern extensive operations for malignant diseaseof cervix and vulva are fully shown. The atlas is carefullywritten and beautifully illustrated : its careful studyshould certainly improve a surgeon’s skill and on

occasion enable him to carry out safely a procedure withwhich he may not be very familiar. Therein lies a danger :the atlas makes pelvic surgery look almost too simple.

Peripheral Circulation in Man ‘

A Ciba Foundation Symposium. Editors for the CibaFoundation : G. E. W. WOLSTENHOLME, O.B.E., M.A., M.B.;JESSIE S. FREEMAN, M.B., D.P.H., assisted by JOANETHERINGTON. London: J. & A. Churchill. 1954.

Pp. 219. 25s.

ON the first page of the first number of the BritishJournal of Experimental Pathology-which saw the lightin February, 1920-the late W. M. Bayliss, then probablythe most outstanding British physiologist, posed thequestion " Is hæmolysed blood toxic ? " In giving anegative answer-which certainly delayed our knowledgeof the renal effects of haemolysed blood-he was carefulto point out that the results obtained in the rabbit werenot, for reasons special to that animal, to be applied toother species. Generalisations from findings in animals,under conditions of experiment in the physiologicallaboratory, are more guarded today ; yet ProfessorEdholm, in opening the Ciba symposium on the peripheralcirculation, was constrained to say:

" Human physiologyis still regarded with some suspicion by a number ofphvsiologists ... it is harder to work on man than onisolated pieces of tissue." A remark which is at once awarning and a stimulus.

_

The cogency of this warning was well borne out by theopening paper in which Prof. A. C. Burton surveyedthe methods of measuring human peripheral blood-flow.Indeed he made the difficulties seem so formidable thatsome of the audience may well have wondered, at thisstage, whether a conference held upon such shifting sandswas worth pursuing. Pace these philosophic doubts, itseems to have been generally accepted that venous-

occlusion plethysmography is a reliable method; even ifone is left wondering whether the rate of filling anartificially emptied blood system may not be a differentthing from the rate of flow under normal physiologicaland psychological conditions-if such exist.Though much of this symposium was concerned with

the measurement of blood-flow and is for the expertphysiologist and physicist to evaluate, the report containsmuch good biological reading-including, for example,work on the observation of living tissues, the physiologyof adrenaline, the nervous control of blood-vessels,afferent effects by sympathetic trunks, reaction and

adaptation to cold, reversed blood-flow in arteries, andvarious aspects of the pathology of the peripheralcirculation, contributed by some thirty scientists drawnfrom eight nations.The Ciba Foundation deserves credit for its notable

example of the beneficent activity of free enterprise inthe world of medical science. In the choice of thesubjects for its conferences, in the rigorous limitations insize, in the careful selection of the participants, and in theexcellence of the organisation, it shows an element ofbenign autocracy which makes a refreshing contrast tothe compromises of committees. The matter does notend with the closing of the foundation’s doors on thelast departing participant, but goes on to the productionof a monograph such as the one we are reviewing, whichbears witness to the efficient though unostentatiousrecording done during the conference and the admirableediting by the foundation’s director and his staff.

Hospital Accounts and Financial Administration3rd ed. Capt. J. E. STONE, C.B.E., M.C., F.S.A.A., F.H.A.London: Faber & Faber. 1954. Pp. 866. 6 guineas.

ALL concerned with the financial side of hospital lifewill welcome the publication of this entirely new andenlarged edition of a well-known standard work.The first part is a section on general accounting ; the second

part discusses the financial control of hospitals ; and othersections include a detailed study of the National Health Service

Act and the problems of departmental accounting. The

appendices reproduce important statutory instruments andmany valuable forms. The publication is remarkable for itscompleteness and contains extracts from all circulars pub-lished by the Ministry of Health relating to accounts andcosting. There is a useful summary of law cases relating tolegacies, and this is to be kept up to date by the issue ofsupplements. One section of the book sets out a summaryof the system in Scotland, and for those working in Englandthe differences can be instructive. Occasionally the authorappears to be just a little out of touch with common practice.Thus, he says that the practice of signing for wages is almostobsolete, but we understand that it is in fact still quitecommon. He recommends the use of an official invoiceform provided by the hospital, but this is not in general useand indeed was the basis of one of the well-known fraudsin local government. Continuous stocktaking throughoutthe year is recommended, and this is indeed a very goodpractice ; but unfortunately the financial regulations requirestocktaking of everything at the end of the year.

Despite the high price of the publication, it is onethat every hospital management group should possess.

Narcotics and Narcotic AddictionProf. DAVID W. MAURER, PH.D., lecturer on narcoticaddiction and criminal argots, Southern Police Institute,Louisville, Kentucky ; VICTOR H. VOGEL, M.D., medicalofficer in charge, European Activities, U.S. Public HealthService, Paris. Springfield, 111. : Charles C. Thomas.Oxford : Blackwell Scientific Publications. 1954. Pp.303. 54s.

ACCORDING to Osler, man is a medicine-taking animal;and this book on drug-addiction is welcome. The authorshave not limited themselves to narcotics, as the titlesuggests. The commonest form of addiction in Americais the use of marihuana ; but " more dangerous," theysay, are " recent products of medical and pharmaco-logical research," and they emphasise that " any drugwhich will substitute smoothly for an addicting drug isequally as addicting as the primary drug." The authorsstress the high incidence of barbiturate addiction-ofteninduced by medical treatment-alone or in combinationwith amphetamine, alcohol, morphine, or other drugs.That " more deaths are caused by barbiturates, eitheraccidentally or deliberately ingested, than by any otherpoison " applies to this country as well as to America :and it is sobering to read that even heroin, dihydro-morphinone, cocaine, and recently pethidine were con-

sidered free from dangerous addicting properties whenfirst introduced. In this way " addicts were literallymade by the millions."

Dr. Vogel finds that drug-addicts need to be segregatedfor a minimum of 41/2 months, preferably in special institu-tions ; and even then results are poor in thoroughly establishedcases. The recognition of addicts is discussed in a specialsection, because the authors have found that even responsiblepersons have " fantastic ideas of what the symptoms ofaddiction are." Stress is rightly laid on difficulties of diag-nosis : in most cases it has to be made on withdrawal symp-toms rather than from symptoms of intoxication. Many addicts,go undetected for a long time while supplies are unfailing,and the many different symptoms with which they presentoften deceive their physicians.A chapter on legal controls for drugs of addiction refers

mainly to American law. The last part, devoted to the

argot of narcotic addicts, gives an interesting if horrifyingglossary of terms used in the American underworld, intendedfor the guidance of " Government Officials and LawEnforcement Officers," to whom this book is primarilyaddressed.

The Yearbook of the Universities of the Common-wealth 1954 (London : Association of Universities of theBritish Commonwealth. 1954. Pp. 1916. £3 3s.).-The 31st’edition contains only one new institution, the Nova Scotia

’ Agricultural College. News came too late for the inclusion ofthe University of Rajshahi in East Pakistan and of RhodesiaUniversity College at Salisbury. A new feature is a statement

, of the numbers of foreign students attending each university. -. Perhaps the most useful item is the index containing about

30,000 names of " staff and officials."