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his cases to us; and to the medical illustration department of MakerereUniversity College Medical School for the figure. This work was

supported in part by the U.S. Army Medical Research and Develop-ment Command, Department of the Army, under research grantno. DA-MD-49-193-63-6101, and the Leverhulme Trust.

D. A. M. GEBBIEM.B. Glasg., M.R.C.O.G.

P. J. S. HAMILTONB.A., M.B. Edin., D.T.M. & H.

M. S. R. HUTTM.D. Lond., M.R.C.P., M.C.PATH.

P. D. MARSDENM.B. Lond., M.R.C.P., D.T.M. & H.

A. VOLLERPH.D. Lond.

N. E. WILKSPH.D. Tulane

Departments of Medicine,Obstetrics, Pathology, and

Microbiology,Medical School, MakerereUniversity College, Kampala,Uganda, and the LondonSchool of Hygiene and

Tropical Medicine

New Inventions

CHRISTOPHER J. DEWHURSTM.B. Mane., F.R.C.S.E., M.R.C.O.G.

City General Hospital,Sheffield, 5

VAGINAL SPECULUM FOR CHILDREN

INSPECTION of the vagina in children is seldom easy. Happilyit is seldom necessary, but there are a few occasions, such aswhen a foreign body or a vaginal ectopic ureter is suspected ora rectovaginal fistula exists, when careful vaginal inspectionmay be essential. The children’s vaginal specula which I haveused have not been completely satisfactory; I have foundthe Kelly cystoscope the most useful, but illumination andinstrumentation can be difficult.On the suggestion of my anaathetist colleague, Dr. C. J.

Levy, I tried a Magill’s infant laryngoscope, which was easy tointroduce and gave excellent illumination and permitted smallinstruments to be inserted without difficulty alongside the blade.Two disadvantages of the laryngoscope were that the largehandle which contained the battery was heavy to hold, makinggentle manipulation more difficult, and that the blade had anunnecessarily long tip.The instrument (see figure) has been modified for vaginal

use by removing the standard handle and substituting a tubularone, 9 cm. by 1 cm. in diameter, the free end of which is sealed.The lighting system has been provided with leads which can

Vaginal speculum.

be fitted into a battery box or diathermy low-voltage lightingcircuit. The blade has been shortened by removing 5 mm. fromthe beak. The instrument can be sterilised by immersion in 1in 2000 chlorhexidine (’Hibitane’) for twenty to thirty minutes.These modifications permit the speculum to be inserted

easily and to be held gently in the vagina for quite long periodsif necessary. The view obtained and the instrumentationpossible make the speculum a decided improvement.The manufacturers are Medical and Industrial Equipment Ltd.,T B!7 1

Reviews of Books

A Synopsis of Surgical PathologyWILFRED KARK, M.B., F.R.C.S., assistant surgeon, JohannesburgHospital, and lecturer in clinical surgery and surgical pathology,University of Witwatersrand. Bristol: John Wright. 1964.

Pp. 426. 45s.

IF one is prepared to accept that pathology can be dividedinto medical and surgical halves, one has gone halfway towardsapproving this book. But it is a division many find questionable.Methods of treatment change from year to year, and no youngdoctor can afford to be one-sided in his approach to patients;and thoughtful appreciation of the growing edges of anysubject depends more on general principles than on localdetails which are dominant in this book and in much surgicalteaching. The handling of tuberculosis in this volume is anexample: isolated short paragraphs deal with the infection inbone, kidney, and lymph-nodes; pulmonary tuberculosis(though surgery is part of its treatment) is dealt with in a page;tuberculous empyema is mentioned, but the tuberculous

pleural effusion is not; and the general changes in tuberculousimmunity which are the background to the infection are

ignored. Other serious omissions are autoimmunity and graftreactions, of great and growing importance. There is a curiouslystatic feel about the description of many conditions-transientmoments of structural change rather than a moving stream ofprocesses.The book is arranged in systems, starting with the skin

and its tumours and covering all organs in the thirty-sevenchapters. These are of unequal detail and treatment, thebalance probably representing the author’s interests. Some arevery good indeed-notably that on the peripheral vasculartree, and most of the ten chapters on the abdomen. The

chapter on neurosurgical pathology could be expanded, and avaluable addition would be more exact and detailed surgicalbacteriology (or is this a separate volume ?). For example, inthe chapter on burns, a discussion of the sources and effects ofthe type of infection would be informative; the structuralchanges do not make sense without this. Some chaptersmerely list uncommon conditions (who has seen a neuro-sarcoma of the spleen ?), and without strong guidance from theauthor the student could get the emphasis on these conditionsquite out of proportion.The author has packed a great deal of information into a

relatively small space by the fullest use of tabulation, heavytype, and good paragraphing; so the book is easy to read.An excellent index and a guide to further reading-all too oftenabsent from " practical " books-are particularly praise-worthy. Perhaps some statements are superficial and un-critical (" Many benign moles have a dominant trait "), and thebreakdown of classification is sometimes over-elaborate (most ofthe subheadings of the complex of cystic mastitis can be foundin one case). There are small points of detail with which wewould not agree (the relative frequency of small-intestinaltumours in this country seems the reverse of that in SouthAfrica); but the virtues of this book are many. Those approach-ing an examination in pathology conducted by surgeons willfind that this work provides a real insight into the examiner’smind and a fine volume of exact detail on which to baseanswers. It is a book which carries little excess weight, and, asa clear, concise, and economical guide to the greater part of asurgeon’s practical work, it will be widely appreciated.

Our Most Interesting DiseasesHAROLD BURN, M.D., F.R.S., emeritus professor of pharmacology,University of Oxford. London: Allen & Unwin. 1964.

Pp. 180. 25s.

THE title of this excellent book is perhaps unfortunate." Growing points of medical science " would more nearlydescribe its contents and would baulk the question: " What is,and what is not, an interesting disease ? " But there is littleelse to criticise.

Addressing himself to the layman, Professor Burn is mainly

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concerned to expound the state of knowledge and the nature ofunanswered questions concerning his chosen subjects, withhints of possible solutions and here and there some practicaldeductions. He excels at depicting the slow steps by whichknowledge is acquired and the interlockings of research. Hedescribes the relation of breast cancer to the endocrines and oflung cancer to the cigarette, comparing the relative immunityof the young smoker with the susceptibility of those whopersist. He applies common sense to " high blood-pressure "and coronary occlusion, emphasising the virtues of exerciseand of restraint in drinking, eating, and smoking. He has anadmirable chapter on the researches proceeding from hiberna-tion to low-temperature cardiac surgery, and another on thecomplex xtiology of peptic ulcer, again with apposite practicaladvice. Nothing is dramatised and all deductions are reason-able and restrained. In a last chapter, on keeping age at bay,he suggests that doctors fail to inspire the young with a

conception of enduring health and fitness purchasable byappropriate exertions and abstentions in youth and middle age.

Chemistry and Prevention of Congenital AnomaliesHIDEO NISHIMURA, M.D., DR. MED. sci., professor of anatomy,Kyoto University, Japan. Springfield, Ill.: Charles C. Thomas.1964. Pp. 119.$5.75.

WIDENING interest in congenital anomalies has created theneed for a compact reference book summarising existing know-ledge of the pathogenesis of human malformations. ProfessorNishimura’s book fills this need. The title is a little mislead-

ing, since the book covers a far wider field than chemistry. Theteratogenic effects of radiation and infections are reviewed,together with social, geographical, nutritional, and patholo-gical factors which have been linked with malformations atone time or another.

Throughout the book the emphasis is on human anomalies,but reference is made to animal work where this seems relevant.A remarkable amount of ground is covered in short space, andthe reader who has had his fill of thalidomide and rubella canturn to Minamata disease and learn what happens to alpinelambs in Idaho if their mothers eat Veratrum californieum.

This useful book is pleasantly presented and the illustrationsare good (except for the snapshots of thalidomide babies). Afew errors have crept into the 600 references, but these canbe corrected in the next edition.

Atlas of the Fundus of the EyeHANS-WALTHER LARSEN, M.D., department of ophthalmology,Copenhagen University Hospital, Denmark. Oxford: BlackwellScientific Publications. 1964. Pp. 271. 168s.

ILLUSTRATIONS of fundus abnormalities have - played an

important part in the interpretation of their pathology. Theinvention of the Nordenson camera a generation ago greatlyextended the usefulness of such records, and further advanceshave been made through developments in photographictechnique and illumination.

In these circumstances, an atlas on fundus photographs fromthe Danish school is of particular interest. Its lavish illustration

by excellent colour photographs exemplifies the high standardoriginally set by them and now maintained with the newtechniques. The chief problem of selection has been admirablysolved by the inclusion only of conditions in which the ophthal-moscopic picture is of serious diagnostic value. The book willthus prove a most useful guide, not only to the young ophthal-mologist but also to the general physician and neurologist.

A Practical Introduction to PsychiatryC. M. B. PARE, M.D., M.R.C.P., D.P.M., physician, department ofpsychological medicine, St. Bartholomew’s Hospital, London.London: J. & A. Churchill. 1964. Pp. 181. 25s.

Up to a year ago the British medical student had a relativelylimited choice of books of psychiatry to consult, but in theinterval six new textbooks have appeared, together with neweditions of three established works. The latest to be added tothis array is in every way the shortest introduction (with the

possible exception of the staccato lecture notes issued fromGlasgow). Dr. Pare’s special knowledge of psychotropic drugsensures that this topic is well covered. The demands of com-pression have perhaps dictated the very summary treatmentof the more complex problems of psychopathology, butthe emphasis on genetic and organic factors in aetiology andthe simplified version of psychotherapy seem to be personalto the author.

A Manual of Cardio-pulmonary TechnologyLAURENCE W. PILLER, principal technician, cardiac clinic,Groote Schuur Hospital, Cape Town. London: Staples Press.1964. Pp. 287. 63s.

CARDIOGRAPHERS have been familiar figures in the largerhospitals for many years now, but cardiological technicians arerelative newcomers. The development and the application toclinical problems of physiological techniques for studying thecirculation has taken place almost entirely since the secondworld war. The complexity of these techniques and theintricacy of much of the modern equipment they use hasnecessitated a technical staff to assist the medical workers andto operate and maintain the equipment. These techniciansare a growing body who are only just receiving properrecognition.One of the difficulties facing such a group is how to secure

adequate training. The rapid growth and change in the know-ledge they require and their relatively small numbers scatteredthroughout the country have conspired to make the provisionof training courses very inadequate. Added to this has been thelack of any textbook covering their unique interests. Thisbook by the principal technician of the famous cardiac unit inCape Town, who trained at the Institute of Cardiology inLondon, is an attempt to meet this need.The first three chapters are devoted to the basic anatomy and

physiology of the heart, lungs, and blood. The next chapterdiscusses the major diagnostic techniques, including electro-cardiography, and is based largely (perhaps too much so) onthe author’s own experience. The technique of blood and gasanalysis and operating-theatre techniques (including resuscita-tion methods) are dealt with in another two chapters. Brief

descriptions of the commoner heart-diseases and some accountof abnormal electrocardiographic patterns follow. The book iscompleted by a chapter on elementary electronics and physics.Despite the title, no account is given of the techniques of therespiratory function tests.The required ground is fairly well covered, but many topics

(for example, the behaviour of fluid-filled manometer systems)could profitably have been dealt with in more detail. The

writing is sometimes hard to follow and many students mightfind themselves confused at some points. There are a numberof errors of fact and terminology (e.g., " oxidised " for

" oxygenated " on p. 36 to describe arterial blood).Being without rivals, this book will undoubtedly prove

useful to technicians; but they will need to be careful aboutaccepting every statement it contains.

American Drug Index 1964. (Philadelphia: J. B. Lippin-cott. London: Pitman Medical Publishing Co. Pp. 772. 55s.).-This Index, compiled by Prof. Charles 0. Wilson and Dr.Tony Everett, appears annually and lists all the pharmaceuti-cal preparations available in the United States. At a roughestimate there are well over 6000, far more than can be justifiedon medical grounds. The book gives for each preparation itscomposition, dosage forms, pack sizes, manufacturer’s name,and intended use. No distinction is made between preparationsadvertised only to doctors and those advertised to the public.All preparations are listed both under the proprietary name andunder the generic name of each constituent. Official " U.S.

adopted names ", corresponding to (and usually with) our" approved names ", are indicated by an asterisk. Theaddresses of over 600 manufacturers are given at the end ofthe book. Anyone who has to deal with American drugs willfind this a very useful reference book.