422 REVIEWS OF BOOKS

Reviews of Books

Chemotherapy and Serum Therapy of PneumoniaBy F. T. LORD. M.D., clinical professor of medicine,emeritus, Harvard Medical School; E. S. ROBINSON, M.D.,Ph.D., director, division of biologic laboratories, Massa-chusetts Department of Public Health ; and R. HEFFRON,M.D., medical associate, the Commonwealth Fund. London :Humphrey Milford, Oxford University Press. Pp. 174. 6s.WITH the approach of the pneumonia season this is a

handbook which every interested physician ought to buyand study. The title of the book-the third in a seriesfirst published as Lobar Pneumonia and Serum Therapyand then as Pneumonia and Serum Therapy when therange of therapeutic sera was extended to the pneumo-coccus types which cause bronchopneumonia-indicatesthe latest advance in the treatment of the pneumonias.It is a compact store-house of useful information on allaspects of pneumonia, and has the advantage over itspredecessors of containing data and analyses fromHeffron’s fine work on pneumonia published in 1939(see Lancet, 1940, 1, 551). Sulphapyridine was not givena very good reception in America, so that the consideredstatement of the authors that it is " not only a mostuseful remedy but also one which is on the whole moreefficacious than serum " is praise indeed. The dosageand action of the drug and the results obtained arecarefully considered and analysed. Perhaps too muchemphasis is given to its possible toxic effects ; forexample, the authors recommend complete blood-examinations before treatment is begun and each daythereafter, and they disadvise continuance of the drugbeyond the fourth day unless the blood-concentration isbeing estimated daily. Results from therapeutic rabbitantiserum are contrasted with those obtained with horseserum (combined figures show little difference betweenthe two) the relative merits of and indications for serumor chemotherapy are discussed, and a plea is made forcombined treatment under such circumstances as whenthe patient is first seen late in the disease, is over 50 yearsof age, has a positive blood-culture, is pregnant or doesnot improve with one or other treatment alone.

Rose & Carless’s Manual of Surgery(16th ed.) By CECIL P. G. WAKELEY, F.R.C.S., and JOHNB. HUNTER, F.R.C.S. London : Bailliere, Tindall and Cox.Pp. 1708. 2 vols. 30s.

THE successive authors of this excellent textbookhave had the happy knack of giving the undergraduateexactly what he wants. This has necessitated consider-able changes which are particularly notable in the presentedition. The first eight chapters on general pathologyhave been simplified and shortened ; a very welcomerevision. Simplification and clarification have also beenobtained by combining the chapters on shock andhaemorrhage and those on gangrene and ulceration. Asection on the treatment of war wounds has also beenadded. There have been so many advances or altera-tions in the management of fractures, diseases of thecentral nervous system and chest conditions that exten-sive revision had to be carried out, and no less than 300illustrations appear in the text for the first time. Thescope of the book is wide enough to supply the practi-tioner with a trustworthy guide to all branches ofsurgery.

Biochemistry of DiseaseBy MEYER BoDANsxy, Ph.D., M.D., director of the JohnSealy memorial laboratory and professor of pathologicalchemistry, University of Texas school of medicine ; andOscAR BOD AN SKY, Ph.D., M.D., lecturer in biochemistry,graduate division, Brooklyn College. London : Macmillanand Co. Pp. 684. 30s.

Tms book embraces the whole field of clinical bio-chemistry. Several such textbooks already exist, butthe unusual presentation of the Bodanskys’ work givesit an exceptional value. General presentation of carbo-hydrate, fat, protein and mineral metabolism, anddescriptions of chemical methods are avoided. Thesubject matter is arranged according to clinical entities,and thus there is a systematic presentation of thebiochemical aspects of the various diseases. A mass ofbiochemical information is in this way made readily

available to clinicians who do not require to read throughtechnical methods b2fore obtaining the necessaryinformation. Useful information is given on pro-thrombin and vitamin K, diseases of the endocrineglands, and on the neglected subjects of biochemistry inobstetrics and gynaecology and the biochemical aspectsof neurological and psychiatric disorders. Each chaptercontains a full list of references. Practitioners, studentsand clinicians will find the book of outstanding valuefor reference and as a review of recent work.

Pharmacology and Therapeutics of the Materia Medica(16th ed.) By WALTER J. DiLLiNCt, M.B. London : Casselland Co. Pp. 580. 12s.

THE recent alteration in format has made this usefulmanual much more readable. In a book of this type it isnot possible to deal exhaustively with many subjects,but more than two pages might have been spared for thesulphonamide compounds. The new preparations ofvitamins A and D which became official in June, 1940,with the publication of the Second Addendum to theBritish Pharmacopoeia 1932 are included, and an

indication of the international upheaval is seen in theofficial pharmacopaeial names now adopted for drugspreviously known under trade names.

Handbook of RadiographyBy JOHN A. Ross, M.A. Camb., M.R.C.S., D.M.R.E.,radiologist to the Warrington Infirmary. London : H. K.Lewis and Co. Pp. 126. 7s. 6d.

A HANDBOOK for medical technicians must always bedogmatic if it is to avoid confusion. For this reason atextbook intended for the student pharmacist is of littlevalue to the student of pharmacology. The same

applies to the radiologist and the radiographer-on theone hand the training is scientific, on the other technical.Dr. Ross writes for students of both radiology and radio-graphy, and therein lies a weakness. However, as hepoints out, there is undoubtedly a place for a handbookon radiography like this, illustrated with simple linedrawings. The book has the advantage of being easilyportable, and blank pages for notes are an excellentidea. Some form of tabulation for each technique wouldbe useful, giving specific figures for such factors as kV,mA, time, distance, size of diaphragm or cone, size offilm, screens, grid, angulation of tube, position of centralray, method of immobilisation of part, and stereoscopy.The radiographer could then modify each factor accord-ing to the requirements of each individual apparatus andradiologist and enter them up on the opposite blank page.Sufficient stress is not laid on the necessity for taking atleast two right-angled views in most branches of radio-graphy. For example, only one projection is describedfor the shoulder. Here stereoscopy is recommended,but it will never be a satisfactory substitute for anotherview at right angles. Stereoscopy should always beregarded as an ancillary method of examination. In thechapter on the skull the special projections, such as arerequired for the petrous bone, are scarcely mentioned,and these are some of the most difficult views that aradiographer is called on to produce. There are one ortwo other omissions, such as arthrography and the out-lining of the pancreas by filling the stomach with gas,but otherwise the radiographic field is well covered.

Principles of Animal Biology(2nd ed.) By LANCELOT HOGBEN, F.R.S. London:George Allen and Unwin. Pp. 415. 7s. 6d.

WHEN first published in 1930 Professor Hogben’sbook was an innovation, and probably for that reasonnever became popular with teachers. While insistingon the need for a knowledge of sound established facts,and giving many useful hints as to how they can belearnt, his chief aim is to give the student an insight intothe biological problems of today. In the successfulcombination of these two aims this book is unsurpassed.It would be difficult to find a better elementary introduc-tion to modern genetics than chapter VIII, with itsadmirable series of problems to be solved. The newedition has been extensively revised and has been illus-trated afresh by J. F. Horrabin. Professor Hogben’sreputation has increased since 1930, and it is certain thatthis edition will enjoy a much wider circulation, which wehope will include members of the schools and universities.

423CASUALTIES IN LONDON

CASUALTIES IN LONDON

THE LANCETLONDON : : SATURDAY, OCTOBER 5, 1940

Now that the Philistines are upon us we can judgethe quality of our own foresight. With air-raid-casualties, as with any other wounded people, theaim must be to ensure that urgent cases are treatedfirst. Early expert classification would make thispossible, but it cannot be achieved in the peace-timehospitals of London; they are not laid out for it,they are dangerous, and they are in the wrongplaces. Their vulnerability has been amply demon-strated lately, and it was not unforeseen. We drewattention to it in an annotation last year,1 and inthe same issue CROME, FISHER and SHIRLAW 2

advocated casualty clearing stations in the base-ments of steel-framed buildings-buildings to bechosen not for their traditional associations withhealing but because they were safe, and close tomain lines, underground railways or arterial roadsby which patients fit for transport could be evacu-ated. They pointed out that the London hospitals,besides being old and collapsible and badly placedfor transport, were so well known in their own

neighbourhoods that in any large disaster they wouldbe overwhelmed by patients hurrying to an accus-tomed refuge. They also urged the vital importanceof skilled classification, which cannot be left to first-aid workers, however willing. These can, as theysaid, divide patients roughly into " those who canbe sent home, to the surgeon or to the mortuary,"but they are totally unqualified to say which needpriority of treatment or which are able to support ajourney out of London by train or ambulance. Thatis a task for an experienced surgeon; it calls forconcentration and cannot be carried out with pre-cision in premises in the front line shaking underthe impact of neighbouring explosions. Moreover,some of the patients need immediate operation tosave their lives or limbs, and the operating surgeoncan do his best for them only if he is protected whilehe works.Fortunately we are told that casualties in London

have so far been fewer than the authorities expected,but that hardly excuses the inadequacy of existingarrangements, especially since an effective alterna-tive can be put into action with little trouble or cost.In every dangerous area it would be possible, as

SHIRLA w says in his book,3 to set aside for the

reception of casualties a capacious basement-thereare many available among the steel-framed factories,warehouses, garages, hotels and office blocks ofLondon-close to a railway or main road or both.This would be subdivided into four departments.In one the patients would be at once classified bythe receiving surgeon as suitable to be sent home,transferred by ambulance or train to an outlying

1. Lancet, 1939, 1, 650.2. Crome, L., Fisher, R. E. W. and Shirlaw, G. B. Ibid, p. 655.3. Casualty Training and Organisation, London, 1940; see Lancet

Aug. 24, 1940, p. 231.

hospital in the sector, operated on without delay, orgiven restorative treatment to fit them for operationin an hour or two. Those suitable for transferwould be taken at once to the evacuating depart-ment and sent off. Those requiring restorativemeasures would be taken to the resuscitation depart-ment to be put to bed by the nursing staff. Casesfor operation would go to the fourth departmentand receive the care their injuries required. Wherea single basement of sufficient size was not availablethe various departments would be in separate build-ings, as close to each other as possible. Gravelyinjured patients would receive treatment accordingto their needs, surgeons and -nurses would work pro-tected from anything short of a direct hit, and casesfor transfer would be sent off quickly enough toavoid congestion. A large number of beds wouldnot be required, but those that there were would beplaced in sufficient safety to give patients the senseof security for which they crave.SHIRLAW gives the name classification evacua-

tion points (C.E.P.) to these centres. His plan isdoubtless imperfect, as all improvised plans mustbe, but it has obvious advantages over the existingsystem. The bombardment of London may last a

long time and if we have put off making proper pro-vision before the event nothing justifies delay nowthat we know what to expect. I

CHRONIC MASTITISTHE dependence of mammary growth and function

on hormones has been amply demonstrated byexperiment. The gonadal hormones, and artificialcompounds with similar biological properties, are

readily available and by their means the physiologicalactivities of the mamma can be largely controlled.Clinicians have hoped, not unreasonably, that someof the pathological activities might be controlled bythe same means. Changes closely resembling thoseof chronic mastitis in women can be, produced inanimals by aestrogens.l In women the exacerba-tion of pain and lumpiness in the mamma aboutthe time of ovulation-that is to say when the out-put of oestrogen is at a maximum-leaves littledoubt, when considered with knowledge derivedfrom experiments on animals, that so-called chronicmastitis in women is attributable to a relativeexcess of aestrogen. One method of diminishing theoutput of oestrogen by the ovary is to supply testo-sterone, which reduces the output of gonadotrophinfrom the pituitary. Unfortunately androgens givenin amounts sufficient to relieve mammary discomfortmay have other effects which are undesirable.On another page ATKINS gives in detail the results

of treating 34 patients with testosterone propionategiven by injection in doses usually exceeding 400mg. during four weeks. Among these 34 patients 25were benefited by the treatment so far as the breastcondition was concerned, but hairiness, amenorrhoeaand deepening of the voice were noted in 8 andmenstruation was upset in others. In the goat andrabbit oestrogens have been found to be most effectivewhen applied directly to the mamma.2 MACBRYDE 3

1. Goormaghtigh, N. and Amerlinck, A. Bull. Cancer, 1930, 19,527 ; Lacassagne, A. C.R. Acad. Sci. Paris, 1932, 195, 630 ;Burrows, H. Brit. J. Surg. 1935, 23, 191.

2. de Fremery, P. J. Physiol. 1936, 87, 50 P. Lyons, W. R. andSako, Y. Proc. Soc. exp. Biol. 1940, 47, 398.

3. MacBryde, C. M. J. Amer. med. Ass. 1939, 112, 1045.