1193

De Filippis, V., Iannaccone, A. (1951) Rif. med. 65, 893.Fisher, R. A. (1948) Statistical Methods for Research Workers.

London.Kekwiok, R. A. (1940) Biochem. J. 34, 1248.Lerman, J. (1944) Amer. J. med. Sci. 207, 354.Lowell, F. C. (1944a) J. clin. Invest. 23, 225.- (1944b) Ibid, p. 233.- (1947) Ibid, 26, 57.

Thomson, D. L. (1942) In American Medical Association, GlandularPhysiology and Therapy. Chicago ; p. 56.

New Inventions

OPERATING-SPECTACLES FOR AURAL SURGERY

THESE spectacles have been designed and constructedto fulfil a number of requirements found to be of practicalimportance in certain aural operations which call for amoderate degree of magnification. Glasses of this kindhave been in use for many years, and one variety, theZeiss-Gullstrand, is particularly well known. In this, useis made of small Galilean-type telescopes carried in front

of the eyes in metalspectacle frameswith rather com-plex screw adjust-ments for inter-pupillary distance,convergence, &c.Such spectacles,however, are

fragile and difficultto adjust andclean, and therigidity of theirattachment to thehead falls far belowthat attainablewith a well-fittedpair of spectacles.This seriouslyimpairs their effec-tive use as opticalinstruments. More-over, it is neces-

sary for the

operator to re-

move them when

operating on partswhich do not needmagnification, andfor this reason

they may need tobe put on andtaken off by anwa..u

assistant several times in the course of an operation. Thisis time-consuming and may be very irritating, particu-larly when some manipulation is needed which calls fora prompt change to magnified vision.The operating-spectacles described here are designed

to overcome these difficulties. They have as their basis

Fig. I-Spectacles in use.

.

Fig. 2-spectacles showing bar for carrying telescopes.

a pair of accurately fitted spectacles carrying flat lenseswhich give any correction required for working at 10inches. The Galilean telescopes are mounted upon a

small light metal bar accurately constructed to provide-the interpupillary distance and convergence to 10 inchesneeded by the individual user. The bar is carried upontwo rigidly connected metal posts projecting forwardsfrom the nasal portions of the lens frames. It is accuratelysited upon these posts and rigidly fixed thereto with twosmall thumbscrews. The bar with the telescopes can bevery speedily detached for cleaning and reaffixed withease and precision. -

-

The size and conical form of the telescopes are such asto provide a minimum of obstruction to the visual field.By directing the gaze downwards by a matter of a fewdegrees a wide view of the’ unmagnified operation.field isobtained through the spectacle lenses alone, withoutchange of the working distance of 10 inches. This changeof view necessitates, of course, a slight change in directionof the head-light which is usually worn. This can easilybe achieved by the surgeon himself, who can thus, at anymoment of the operation, switch to or from magnificationwithout any delay or dependence on an assistant.The optical quality of the telescopes is good ; coated

lenses are used, and light loss is thus minimised. Magnifi-cation is X 2 with a field diameter of 11/4 inches.The spectacles are manufactured by Keeler Optical Products

Ltd., 39, Wigmore St., London, W.1, who have solved severaldifficult problems of design and construction, in particularthe fixation of the telescopes to the spectacle frame in amanner which combines comfort, rigidity, accurate position-ing, and ease of removal for cleaning.

Otological Research Unit, Medical ResearchCouncil, National Hospital, Queen Square, C S HALLPIgE’and Aural Departments, National Hospital — ’— ALLPIKE’and University College Hospital, London F.R.C.P.

C. S. HALLPIKEF.R.C.S., F.R.C.P.

Otological Research Unit, Medical ResearchCouncil, National Hospital, Queen Square,and Aural Departments, National Hospitaland University College Hospital, London

Reviews of Books

Malignant Disease and its Treatment by RadiumVol. 4. 2nd ed. Sir STANFORD CADE, F.R.C.S., surgeon,Westminster Hospital, London. Bristol : John Wright& Sons. 1952. Pp. 544. 63s.

THE fourth volume of this second edition has beenalmost entirely rewritten and becomes an up-to-date andauthoritative description of the groups of tumour withwhich it deals. The first section describes the varioustypes of cancer of the skin and of their treatment withradium. The illustrations are a reminder of the advancedlesions which are still sometimes seen, although now,with spread of knowledge and modern therapy, they arebecoming rare. A photograph of a radium mould made ofplastic material, such as are now in general use, mighthave been included. A chapter on malignant diseaseof the kidney, testis, and prostate follows and maintainsthe high standard. It is, however, in the chapters onbone sarcoma and on sarcomas of soft parts that SirStanford Cade’s ability and experience are best shown.The amount of material available, the balanced outlookbrought to the problems of treatment, and the -detailedrecords of cases must all be helpful to those who have tomake decisions about patients who are mostly young andwhose disease calls for prompt action.A new section on the pathology of tumours of lymphoid

tissue has been added by Dr. George Lumb, who gives a clearclassification which can be accepted, though with somereservation. The difficulty encountered is where to placeHodgkin’s disease. Dr. Lumb recognises three separatetypes of lesion : (1) lymphoreticular lymphoma, of which hesays " some of the cases which have been called early Hodgkin’sand Hodgkin’s-like probably belong to this group " ; (2)Hodgkin’s disease ; (3) Hodgkin’s sarcoma, which he regardsas the anaplastic variety of the mixed-cell neoplasm of normalHodgkin’s type. The first and second types are sometimesfound in the same patients, and so are the second and third,though admittedly some acute cases seem to be sarcomatousfrom the beginning. Surely all three are manifestations ofthe same condition, -and a parallel is found in the reticulosisusually called Brill-Symmers disease, which also has threeforms. It would also have been helpful had more emphasisbeen laid on the difficulty of differentiating the anaplasticsarcomas from certain anaplastic carcinomas-a point of

great clinical importance.The chapter on the leukaemias, by Prof. B. W. Windeyer

and Dr. J. W. Stewart, gives a thoroughly competent account

1194

of the pathology of the many varieties, with good illustrations.Due weight is given to the different methods of treatmentnow available, and the great importance of maintaining theerythroblastic function of the marrow is recognised. Therewill be wide agreement that irradiation of the spleen is stillthe method of choice for the ordinary chronic case.The last chapter, on intracranial tumours, includes sections

on pathology by Dr. D. Williams, on surgery by Mr. WylieMcKissock, and on radiotherapy by Mr. J. Jackson Richmond.The satisfactory results recorded, together with some cases oflong survival in patients treated with radium at the -West-minster Hospital, show how much can be done for thesetumours by a first-class team.Now that the fourth volume of this textbook is

available it becomes more than ever apparent that thewhole is a work of great scope and interest. The firstedition was outstanding, but the additions to the secondhave enhanced its merit. Nothing but praise can

be found for the clinical descriptions, from which astudent of cancer may build a sound knowledge of thedisease. The knowledge, judgment, and enthusiasmwhich have gone to the production of four volumes, allon this high level, call for warm congratulations to theauthor and his collaborators.

Traitement des nephrites aigues anuriques par lesmethodes d’epuration extra-renale

A. TZANCK ; M. DEROT ; J. J. BERNIER ; M. BESSIS ;J. DATJSSET ; M. LEGRAIN ; P. MILLIEZ ; L. MOREAU ;P. PIGNARD ; P. TANRET. Paris: Masson. 1952. Pp. 176.Fr. 1200.

WE now recognise that anurias resulting from mis-matched transfusion, septic abortion, and shockinginjuries tend to spontaneous recovery in two or threeweeks if the patient can be kept alive. The effort tomaintain life during this critical period received a newimpetus from Kolff’s development of his artificial kidney.The French authors describe exsanguino-transfusionas the simplest way to avert progressive ursemia. Support-ing methods are intestinal dialysis, peritoneal dialysis,or the driving of arterial blood through still anothermodel of artificial kidney. The successful dietetic methodof Bull, Joekes, and Lowe is described as a solutiondraconienne. The more sanguinary methods of theFrench authors are none the less successful and thevobtained recovery in 58 out of 96 cases.

Despite its French bias, this book gives a reasonablygood account of the literature. It contains a greatdeal of useful practical information on the specialisedtechniques involved.

Health EducationA guide to principles and practice. CYRIL BIB13Y, M.A.,M.SC., F.L.S. London: Heinemann. 1951. Pp. 222. 17s. 6d.

GRANDMOTHERS’ tales die hard, and the generalpublic is still ill informed on how to keep healthy. Butwould-be educators need to know what to teach, andhow, and when. Mr. Bibby, who has had long experiencein health education, shows excellent judgment and muchcommon sense in the helpful book which he has writtenfor teachers, parents, doctors and nurses. It isthoroughly readable and it will be easily understood byeducated laymen and yet not bore those with technicalor medical knowledge.

In his analysis of the methods and media of health educa-tion, Mr. Bibby describes five principles : the build-up ofassumptions via environment; inculcating habits by training ;imparting biological information; fostering attitudes to

create a healthy outlook on life ; and inspiring appreciationsand ideals. He elaborates these through the different stagesof development from the baby to the parent, and accordingto the type of educator. The appendix contains an onto-genetic scheme in tabular form, information on methods ofintroducing health teaching into the curriculum, on planningformal health education, and on the use of media, togetherwith a list of films and filmstrips, a directory of healtheducation organisations, and an annotated bibliography.Another section deals with health statistics, and Mr. Bibbyrightly deprecates that mortality statistics have to be usedin the absence of satisfactory information on morbidity ;for they do not give a

"

picture of the degree of health andvigour of a community."

In considering personal health habits in relation to the

attainment of a full and happy life, Mr. Bibby suggeststhat we should drop the idea of " keeping clean" and

replace it by "

getting clean on appropriate occasions."He regards the parent as the prime health educator,with teachers coming a close second. He treats schooland college education in some detail, and he advocatesspecial periods for health education. He also urgesthat the environment in schools and colleges shouldbe up to the level of their health teaching.

Cardiac PainSEYMOUR H. RiNZLKR, M.D., F.A.C.P., adjunct in medicineand cardiovascular research unit, Beth Israel Hospital,New York. Springfield, 111. : Charles C. Thomas. Oxford:Blackwell Scientific Publications. 1952. Pp. 139. 27s. 6d.

THis acceptable monograph from the AmericanLecture Series should interest the clinician. It containsa useful bibliography of 335 references, and covers infair but well-chosen detail the history of the syndromeof angina pectoris, the anatomy of the nerve pathwaysof the heart, and the mechanism, differential diagnosis,and treatment, of cardiac pain. Of the 12 plates 10 arefull-page sketches illustrating trigger-areas in chestmuscles and techniques of local block therapy used inattempts to anaesthetise the somatic components ofcardiac pain. Dr. Rinzler’s own contributions to thesubject have led him to give undue prominence to thismethod, but in other respects he has preserved a

restrained balance.

BacteriaK. A. BissET, D.SC., lecturer in bacteriology, Universityof Birmingham ; assisted by F. W. Moore, J3.se,

Edinburgh : E. & S. Livingstone. 1952. Pp. 122. 20s.

Dr. Bisset describes this book as a " natural history ofbacteria." This it is not, since the attention given tobacteria in their native haunts is incidental. It is rathera system of bacteriology based essentially upon morpho-logy. It applies to bacteria rules of determination andclassification such as were devised by Linnaeus for largerplants. It is not the first venture in this line, but it isclear and dogmatic and it may profitably be read atleast once by all who have a professional interest inbacteria. The medical bacteriologist, because like arisesfrom like, wishes to label bacteria so that he may knowthem at a later meeting. To this end he uses hisknowledge of their habits, natural and acquired, theirantigenic make-up, and their biochemical parlour-tricks,in a practical but disorderly way, and he is content tolabel them with numbers or antigenic formulae. To thesystematist this appeals as little as the keeper at the Zoowho replaces the Linnaean system by such useful labelsas

"

harmless," "

dangerous," or "

smelly."Dr. Bisset’s emphasis on morphology is in the classical

tradition, but his line drawings are clearer than what isusually seen under the microscope. In his introductionhe says " simplicity is characteristic of truth." He hasin fact so simplified his account of the habits andproperties of living bacteria that he has been forced backonly too often on

" rather " and " almost " in place ofquantitative statement. We do not often ask for alarger book, but we hope that a second edition will beexpanded in this direction, and, in view of the author’sexperience, an appendix on cytological methods would bevaluable. It is interesting to see that there is no referenceto work earlier than 1941.

The World of Learning (London : Europa Publications.1952. Pp. 964. 80s.).-The fourth edition contains 83 morepages and costs’20s. more than the third edition did in 1950.As usual there is an index of institutions, but an " Index ofNames " (presumably personal) is promised for separatepublication in August, and it is intended that such an indexwill be included in future editions. Several countries havechanged their places or disguised, themselves under newnames : Salvador has moved about 300 pages nearer the frontas El Salvador ; Iran has moved in the opposite direction asPersia ; Eire has disappeared as such and reappears as IrishRepublic ; South Africa is now Union of South Africa;Netherlands Overseas Territories is split into Indonesia andNetherlands West Indies (which strangely consists of Curacaoand Dutch Guiana) ; and Saar is a newcomer.