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Reviews of Books

Clinical Radiology of the Ear, Nose, and ThroatERIC SAMUEL, M.D., F.R.C.S., F.F.R., D.M.R.E., late hon.

radiologist, Middlesex Hospital, London. London :H. K. Lewis. 1952. Pp. 339. 70s.

UNTIL the appearance of this book there had been nopublication in this country wholly devoted to the

.radiology of the ear, nose, and throat. Dr. Samuel hasbrought together the best recent writings on the subject,which have hitherto not been easy of reference, and hehas also kept the anatomical and clinical aspects well tothe fore. For each region there are chapters on theradiological techniques employed, and on the develop-ment and anatomy of the structures. These are followedby chapters on the normal and abnormal radiologicalappearances and the clinical features connected withthem. This arrangement has resulted in some repetition,especially of anatomical material. The style, moreover,is not easy and there are some errors which would nothave escaped more careful editing. The illustrationsare numerous but their quality is varied. On theother hand, the full references, and the indexing, bothof authors and subjects, suffice in themselves to makethe book valuable.

Kielland’s ForcepsE. PARRY JoNES, M.B., M.R.C.O.G., consultant obstetricianand gynaecologist, St. Asaph General and MaternityHospitals. London: Butterworth. 1952. Pp. 212. 35s.

ABOUT half this book concerns forceps in general: theremainder describes the Kielland instrument, its designand manufacture, the indications for its use, the techniqueof application, the dangers, and the results that may beexpected. Mr. Parry Jones has used the instrument on60 occasions, and from careful personal observation anda full review of the literature he gives a detailed and usefulaccount of the place he thinks the instrument should holdin modern obstetric practice. There is a translation inan appendix of the original article by Christian Kiellandin which his forceps and his special method of insertionare described. The book is beautifully illustrated andeasily read ; it will certainly revive interest in an obstetricforceps which has never achieved the popularity in thiscountry which it holds in Scandinavia. The instrumentdiffers considerably from the more usual forceps, andmany useful and important technical details are describedby Mr. Parry Jones, which will undoubtedly help othersto use the instrument with judgment and skill. On theother hand, some of the statistical tables and many ofthe illustrations (especially of other types of forceps andof those who have designed them) might have been leftout. They make the book much more costly than itneed have been.

Cancer Cytology of the UterusJ. ERNEST AYRE, M.D., director, Dade County CancerInstitute, Miami, Florida. New York: Grune & Stratton.London : J. & A. Churchill. 1952. Pp. 407. 105s.

To the few in this country who practise cytologicaldiagnosis of uterine carcinoma by smears this new bookwill be of interest. It is an atlas of 362 figures accom-panied by full, though often discursive, descriptivelegends, and a text of some 53 pages interspersed withpages of figures. Based on 150,000 preparations-vaginalsmears, cervical cell smears, and cervical cell scrapings-from over 22,000 women, the work is a cytomorphologicalstudy chiefly of epidermoid carcinoma of the cervix.Cytological findings in cancer of other sites in the femalegenital tract, in certain benign conditions, and in normalsmears are also given. Such topics as the organisationof the service, the technique of taking and preparingspecimens, and the method of reporting on smears areincluded.There is much in " gynecytology " and in this book

which is disputable and open to serious criticism.Particularly is this true of what Dr. Ayre calls nearo-carcinoma " (" the precancer cell complex " : incom-pletely developed carcinoma cells "), which lies at theheart of the problem and on which the chief value ofsmear diagnosis depends. To quote the author, " when

adequate scientific data are available to prove thespecific character of the anaplastic precancer cell of thecervix, a significant advance in knowledge of carcino-genesis will have been achieved." Adequate scientificdata have yet to be provided.

Congenital Dysplasia of the Hip Joint and SequelaeVERNON L. HART, M.D., F.A.c.s., assistant professor of

’

surgery, University of Minnesota. Springfield, Ill. :Charles C. Thomas. Oxford: Blackwell ScientificPublications. 1952. Pp. 187. 36s.

IN this small book Dr. Hart makes an appeal for theearlier recognition and treatment of the dysplastic hip-joint ; the pleasant style and beautiful production makeit well worth reading. Although few cases of frankcongenital dislocation escape skilled orthopaedic care inthis country nowadays, there is still a vast amount ofavoidable disability in the form of subluxation and osteo-arthritis secondary to lesser degrees of unrecogniseddysplasia. Because simple abduction treatment in theinfant can prevent all this, early recognition is of cardinalimportance; and Dr. Hart clearly describes the separateclinical and radiographic signs, all minor in themselvesbut adding up to a convincing total picture, which mustbe looked for.

Comparative Biochemistry of the Carotenoids -

T. W. GOODWIN, D.SC., F.R.I.C., senior lecturer in thedepartment of biochemistry, University of Liverpool.London : Chapman & Hall. 1952. Pp. 356. 50s.

THE carotenoid pigments are widely distributed inplants and animals, and are sometimes present in micro-organisms. Except when they are concealed by otherpigments, such as chlorophyll, their intense yellow colouralways makes their presence obvious. Research on theirphysiological importance has resulted in prolific studiesof the function of carotene as provitamin A, but littleelse has been clearly established. We have no adequateexplanation, for example, of the tendency of carotenoidsto be concentrated in the reproductive organs of animalsand plants.

In writing.this comprehensive account of the distributionof carotenoids in all forms of living tissues, Dr. Goodwinhas not only worked hard to collect information, but hasspent much time in constructive thinking. Information froma wide field has been cleverly condensed, often into tables.The two main parts of the book deal with carotenoids inplants and animals, and attention is focused on currenttheories which give hopes of explaining their biologicalfunctions and on possible lines of future research. Thoughthe book as a whole has been written primarily for biologistsand biochemists, parts of it are of considerable medical

interest-especially those on the distribution of carotenoidsin the tissues and blood in health and disease, and on thefactors controlling the conversion of carotene to vitamin A.

Three Vesalian EssaysSAMUEL W. LAMBERT, WILLY WIEGAND, and WILLIAMIviNS, jun. New York: Macmillan. 1952. Pp. 128.$6.00.

MosT of the wood blocks used to illustrate the originaleditions of Vesalius’s De Fabrica and Epitome were foundin 1932, in the library of the University of Munich ;unfortunately they perished during the late war. Inconnection with their discovery these three importantessays were written.

Dr. Lambert describes and reproduces the drawings usedfor the initial letters of the first two editions of De Fabrica.These show anatomical and surgical subjects in which theacting parts are taken by young children, a conceit whichheightens their artistic merit. Dr. Wiegand, of Munich, givesan account of the discovery and history of the blocks, andalso some interesting points about the title page of De Fabricaand the continuous landscape which forms the backgroundto the twelve muscle men in that book. The charm of the bookvanishes with the third essay, by an art-expert who admitshe has no knowledge of anatomy or Latin. Smooth reading islost by the inclusion in the text of bibliographic details andlengthy bracketed material which should have been printedas footnotes. In the main the essay is a sustained attack, notalways in good taste, on the Vesalian writings of Dr. CharlesSinger-which are described as careless, lacking in exactness,

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and carping in criticism. " Dr. Singer’s comments are queru-lous and niggling " and are described" as talk of the kind oneexpects to hear in club corners." Mr. Ivins bases his essay ona study of the original woodcuts, and of books and articlesdealing with Vesalius. He concludes that the illustrations weredrawn by John Stephen of Calcar without help from Vesalius,who merely wrote a commentary on them. Stephen thereforeis the hero of De Fabrica.

This essay will arouse vigorous discussion amonghistorians, who will find the book of great interest evenif parts are infuriating.Visceral Circulation

A Ciba Foundation Symposium. Editor : G. E. W.WOLSTENHOLME, o.B.E., -Ai.i3., assisted by M. P. CAMERON,M.A., and J. S. FREEMAN, M.B. London: J. & A. Churchill.1952. Pp. 278. 30s.

IN the recent symposium on the visceral circulation,held in London by the Ciba Foundation, 49 guests tookpart, comprising anatomists, physiologists, biologists,biophysicists, biochemists, pharmacologists, and clini-cians in medicine, surgery, and anaesthetics. This admir-able book of the proceedings contains summaries ofpapers presented by each of the 25 speakers, and of thediscussions which followed. There are contributions onvisceral vascular structure, vascular patterns in thealimentary canal, vascular architecture of the kidney,the laws of physics and the flow in blood-vessels, sym-pathin production and excretion, visceral blood-vesselsas pain perceptors, afferent paths of cardiovascularreflexes, aortic and coronary flow, determinants inhepatic hsemodynamics, vasoconstriction and vasodilata-tion in the normal and failing circulation, physiologicalchanges during fainting, and many other subjects oftopical and permanent interest.

The Knee and Related Structures

Injuries—Deformities—Diseases—Disabilities. PHILIPLEWIN, M.D., F.A.C.S., professor of bone and joint surgery,Northwestern University Medical School. London :Henry Kimpton. 1952. Pp. 914. 120s.

IT is difficult to see to just which section of Britishmedicine this massive book will prove attractive. As amonument to the industry of the author it is comparableto his previous volume on the foot ; any subject with anyconceivable connection with the knee has been included.It is too vast a book for the student, while insufficientlyeclectic and perhaps too " popular " in style to be likelyto appeal to orthopaedic surgeons in this country. Butit has at least collected an immense amount of materialunder one cover. One cannot but admire the hardwork that has gone into this volume, but the resultremains very indigestible.

Lumbar Disc Lesions

Patitogenesis and Treatment of Low Becck Pain and Sciatica.J. R. ARMSTRONG, M.D., M.CH., F.R.C.S., orthopaedicsurgeon to the Metropolitan, Lambeth, and Manor HouseHospitals. Edinburgh : E. & S. Livingstone. 1952.

Pp. 228. 42s.

Mr. Armstrong’s extensive experience of lumbar discsurgery qualifies him to write a more engaging clinicalaccount of the subject than he offers us here. The styleis somewhat dry and didactic, and, though diagrams andarguments about lumbar mechanics abound, case-

histories and radiographs would have been more refresh-ing. It is not made clear that senescence and degenerationof the discs is a universal and indeed normal process ;nuclear pathology is emphasised at the expense of annuluslesions : and nothing is said on the newer developmentsin discography and the electron-microscope study of

ground structure. In the clinical section Mr. Armstrongunderestimates, we think, the value of the plaster-jacket,which, efficiently applied and renewed as necessary,makes bed rest or other fixation unnecessary for the greatmajority of acute cases. Manipulation, epidural anal-gesia, and the local anaesthesia of sites of referred tender-ness are all decried, on largely theoretical grounds,though experience shows that, used judiciously, theymay greatly ease those patients, often decrepit or elderly,who are unfit for plaster or laminectomy and who wouldbe rotted by bed rest. Lest these criticisms seem

ungrateful, we should add the important fact that thisbook succeeds in presenting every fact relevant to thediagnosis, differential diagnosis, and treatment of lumbardisc lesions, including the indications for operation andthe technique of laminectomy and spinal fusion.

Intracranial AneurysmsWALLACE B. HAMBY, M.D., professor of neurologicalsurgery, University of Buffalo School of Medicine andDentistry, Buffalo General Hospital. Springfield, Ill.:Charles C. Thomas. Oxford : Blackwell Scientific Pub-lications. 1952. Pp. 564. E5 2s. 6d.

INTEREST in intracranial aneurysms has much increasedduring the past ten years with the development ofpercutaneous angiography and more radical surgicalmethods of treatment. A monograph on the subject wasneeded, and this book, besides giving a clear account ofthe clinical syndromes caused by intracranial aneurysmsin various situations and the possible methods of treat-ment, also describes arteriovenous malformations. Thestyle is informative rather than inspiring, and the textis broken by a series of case-histories. The clinical andpathological illustrations are good, but the definitionof the angiograms varies greatly and in some it isdifficult to see the vessels clearly. There is a usefulbibliography.

Human Milk .

Yield, Proximate Prin,ciples and Inorganic Constituents.S. D. MORRISON, B.so., Institute of Physiology, GlasgowUniversity. Farnham Royal : Commonwealth Agricul-tural Bureaux. 1952. Pp. 91. 10s. 6d.

IN this book is collected much of the information inthe literature on the yield and chemical compositionof human milk. Besides the three major constituentsand related compounds (nitrogenous-mainly protein-materials, lipids, and carbohydrates), it deals only withminerals. No consideration was given to the vitamincontent because this aspect of the subject has recentlybeen comprehensively covered by Kon and Mawson(Medical Research Council Special Report Series no. 269,1950). Mr. Morrison not only brings together manyinteresting data from papers published in a wide varietyof journals, some of them not readily available, butpresents them critically, sometimes recalculating statis-tics so as to make comparison easier. He is often on lesssure ground when he theorises, as he does here and there,on the biochemistry of milk formation.

Forensic Medicine (2nd ed. London : Edward Arnold.1952. Pp. 344. 21s.).-Dr. Keith Simpson’s textbook,as attractive and lucid as his lectures, is now brought intoline with the last year or two’s forensic progress. It is

encouraging to see that the chapter on war gases has givenway to one on poisonous plants and fungi. The new chapterusefully sums up their lethal properties, and it will be all themore welcome now that the trifling monograph on this subjectby a Baker Street toxicologist is out of print.Muscle Relaxation as an Aid to Psychotherapy (London:

Actinic Press. 1952. Pp. 65. 5s. 6d.).-This little book iswritten primarily for physiotherapists, to enable them to giveeffective relaxation exercises to certain types of psychiatricpatients. The author, Dr. Gerald Garmany of the WestminsterHospital, points out that the use of relaxation in psychiatryis limited, and that it cannot by itself effect cure in cases ofmuscular tension due primarily to emotional disturbances. Inabolishing tension and in teaching the anxious patient how torelax properly, the techniques described may, however, bringabout a better all-round adjustment to the stresses of life.The ways in which emotional disturbance can affect bodilyfunctions and muscle tension are clearly described ; the

James-Lange theory and the work of Jacobson are discussed,and the part that bodily feelings play in emotional states isnot overstressed. The need for cooperation and a workingknowledge of the technique used by the other partner in thisjoint enterprise of psychotherapist and physiotherapist is

constantly borne in mind. There is a chapter on indications forthe treatment and its difficulties, and another on the types ofconcurrent psychotherapy. The book is very well written,concise without being dry, and authoritative without

being dogmatic.