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453 Reviews of Books Psychiatry in the British Army in the Second World War Rosrxr H. AHRENTELDT, formerly deputy assistant director of Army Psychiatry, Army Medical Directorate, War Office. London: Roudedge & Kegan Paul. 1958. Pp. 312. 35s. Dr. Ahrenfeldt states that his book has three main purposes: to record the work of Army psychiatrists in the care and treatment of the psychiatric Service patient, their contribution to solving problems of personnel-selection and proper use of manpower, and how their efforts resulted in a clearei apprecia- tion of the importance of preventive psychiatry. His critical and explanatory account, not an official history bur based on official documents, makes absorbing reading; for we are told not only how Army psychiatry developed but why the succes- sive stages in its development took place. The scope of the problems to which Army psychiatry was applied is indicated by the chapter titles: personnel selection; officer selection; mental defect and dullness; disciplinary problems; treatment and disposal of psychiatric cases; forward psychiatry; problems of training and morale; and rehabilitation and civil resettlement of repatriated prisoners-of-war. Not only had great numbers to be dealt with, but the leading Army psychiatrists had to devise new administrative methods and to secure cooperation from the Army authorities, often in the face of considerable prejudice even among their medical colleagues. This readable book amply fulfils its author’s purposes. The Management of Emergencies in Thoracic Surgery JOHN BORRIB, M.B.E., CH.M., F.R.C.S., F.R.A.C.S., thoracic surgeon, Dunedin Hospital, New Zealand. New York: Appleton-Century Crofts. 1958. Pp.340. Tms book reviews usefully the pathology, clinical features, and treatment of many thoracic surgical emergencies. These include injuries to the chest wall and pleura, empyema and lung abscess, postoperative complications, inhaled or swallowed foreign bodies, oesophageal fistula and rupture, strangulated diaphragmatic hernia, and cardiac wounds and arrest. Thoracic surgeons may disagree here and there with Mr. Borrie’s views: for example, surgical drainage of lung abscesses has long been abandoned by most; and the photograph of how to fix an empyema tube shows weU enough how not to do it. Neverthe- less the book covers competently a field outside the scope of most surgical textbooks, and it should prove valuable both to general surgeons and to the junior staff of thoracic surgical units. Leukemia WILLIAM DAMESHEK, M.D., professor of medicine, Tufts Univer- sity School of Medicine, Boston, Mass. ; FREDERICK GuNz, M.D., PH.D., haematologist, Christchurch Hospital, Christchurch, New Zealand. New York and London: Grune & Stratton. 1958. Pp. 420. E5 11s. THIS book begins with a most interesting chapter on the growth of knowledge about leukaemia and the development of terminology and classification. The authors’ own classification is sensible; they decry the currently fashionable use of " lymphoma ", but are not very satisfied about the blanket use of " reticulosis ". Information on the increasing prevalence of leukaemia and the work on aaiology are well reviewed; some if not all forms of leukemia are essentially neoplastic ", they think, and they are unimpressed by virus " propaganda The " pathology of the leukemic cell " is being studied not only morphologically but also by histochemistry, which they thmk very promising. A chapter on the " course and special pathology as related to symptomatology " covers features common to most types of leukxmia, and then a separate chapter describes the features of the recognised forms of leukaemia induding " myelomonocytic " (the so-called Naegeli form of monocytic leukaemia), Di Guglielmo’s erythræmia, and multiple myeloma. The chapters on diagnosis properly emphasise that laboratory investigations have the last word, but the authors agree with those who think that newer methods such as phase-contrast and electron microscopy have done brike to help differential diagnosis. They do not mount their own hobby-horses, and even myeloproliferative disorders are not given undue prominence. As regards therapy: " The evidence is by now overwhelming that present-day treatment of acute leukemia is capable not only of producing remissions and thus leading to prolonged periods of normal health, but actually to extend the total survival time ". This book is always balanced in its discussions---and there are real discussions, not just lists of other people’s views. It is at the same time notably complete, taking account of all significant American papers and quite a lot of British and other European ones too. The illustrations are not excessive and are always apt to the text; a few colour plates show fields prepared from paintings. This work is a worthy successor to Forkner’s classical text. The Waking Brain H. W. MAGOUN, PH.D., University of California School of Medicine, Los Angeles. Springfield, Ill.: Charles C. Thomas. Oxford: Blackwell Scientific Publications. 1958. Pp. 138. 36s. AT present the reticular system is much to the fore in neuro- logical work, and this book is an account of some of the work done by Dr. Magoun and his colleagues in Los Angeles. The reticular system is thought to be a major and non-specific mechanism, lying centrally in the brain, which is able by its many interconnections to affect the function of all other parts of the central nervous system, and so of the body as a whole. It is thought, also, that the reticular system can raise or diminish the activity of other centres, and integrate their several activities. If this idea is correct the importance of the reticular system is obvious. After a historical introduction, Dr. Magoun considers in turn the influence of the reticular system on the spinal cord, on reception of, and response to, sensory impulses, on neuroendocrine and visceral activity, on wakefulness and atten- tion, and on cerebral cortical activity. From his own and his col- leagues’ work Dr. Magoun concludes that the reticular system grades the activity of other parts of the brain. Its influence is widespread, and it appears to be divisible into a more tonically operating lower part and a more cephalic component with the capacity for fractionated shifting influence upon focal regions of the brain. It seems that the reticular system is even involved in conditioned learning. This small, excellently produced, but expensive book will interest all neurologists. Young Children in Hospital (London: Tavistock Publica- tions. 1958. Pp. 103. 4s. 6d.).-This book by James Robertson is published as an accompaniment to the second of his films. Mr. Robertson has done much to encourage hospitals to humanise the care of child patients; but unfortunately his conclusions are presented here in a way which can lead to misapprehensions. Firstly, awareness of the possible dangers of separating mothers and young children should not be allowed to bring about a failure to put first things first: in acute illness the appropriate physical treatment must take precedence, for when life is in danger the primary psycho- logical and physical needs coincide; and the behaviour which Mr. Robertson depicts and describes as typical of the young child in hospital may not be true of the acutely ill child. There is a widespread feeling that the psychological reaction to a stay in hospital on account of severe illness may differ from that of a well child separated from its mother. There is great need for research on this--as also on the psycho- logical effect of physical illness in children who are cared for by their mothers. Illness has its psychological meaning for the child, whether or not the mother is present. This leads to the other potentially harmful implication-that " continuous " care by the mother can relieve the child of all anxiety, whether he be well or ill. Such a standard of care is beyond human attainment; yet, if this aim is set, mothers will try to reach it and will suffer correspondingly from a sense of guilt at their own failure. These criticisms do not amount to a plea against endeavours to relieve young children of anxiety by preserving the essential link with their mothers, but they do reflect the need not to underestimate the complexity of psychological reactions in sickness or in health.
