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early it responded well to treatment. In the antenatal

cardiac clinic the almoner played a most important part.It was now known that in the last few weeks of

pregnancy blood-volume and cardiac output diminished,and that the strain on the heart was correspondinglyreduced. There was therefore no justification, in this

respect, for anticipating normal delivery by inducingpremature labour or by csesarean section. All recentwork showed that in patients with heart-failure cæsareansection carried a heavier mortality than normal delivery.

New Inventions

R. P. ARONSONM.B. Lond., M.B.C.P.

Senior Pædiatric Registrar,Farnborough Hospital, Kent

A TECHNIQUE FOR SAVING THE VEINFOR administering continuous intravenous fluids to

children it is usual to cut down on a vein and tie it off.The method described here is designed to preserve thepatency of the vein for subsequent intravenous therapy.It is based on the assumption that after a few hours’intravenous therapy little bleeding will take place,because of spasm and sometimes thrombosis of the vein.As an alternative, it has been suggested that after a vein

has been dissected out, it may simply be needled withouttying; but I have found this unsatisfactory because ofbleeding round the needle at the point of puncture.The usual cutting-down apparatus is required, and also

a piece of Polythene ’ tube. The polythene is cut intofour lengths, two of 1 in. and two of 1/4 in. The size ofthe polythene tubing is not important, but no. 3 is ,quitesatisfactory.The vein having been exposed, two catgut sutures are

placed round it in the normal way. The ends of thesesutures are threaded loosely through the long pieces ofpolythene (see figure), and artery forceps are applied to the

polythene. A snick is made in the vein and the cannulais introduced. The two sutures are now drawn tightthrough the polythene, one being placed round thecannula and one distal to it (the artery forceps havingbeen removed). One end of each suture is threadedthrough the smaller piece of polythene, and the sutureis secured with a surgeon’s knot. It will be seen thatthis is a modification of the Bowden-wire principle.When the transfusion is finished, the cannula is

extracted and an attempt is made to suture the veinwall. Then the sutures are cut and removed. Evenif it is impossible to suture the cut in the vein,bleeding can be easily controlled by skin sutures and apressure bandage.The method has been applied successfully in the

treatment of infants with gastro-enteritis who haverequired intravenous therapy. The- long saphenous veinhas been used. At the conclusion of the transfusion ithas always been found possible to remove all the sutureswithout untoward effects, and there has been no leakingfrom the vein during the infusion. The method was alsoused in giving blood to a boy with acute leukaemia whohad a hæmorrhagic tendency shown by widespreadecchymoses and purpuric spots. There was slightbleeding from the vein at the conclusion, but it soonstopped when a tight bandage was applied at the siteof the incision.

I have had an opportunity of using this method for asecond time on the same vein. A child, aged 1, wastransfused during the treatment of an ulceratinghsemangioma affecting both legs. A second transfusionwas needed three months later, and I cut down on thesame vein. There was no real difficulty in introducing

the cannula and though the lumen of the vein seemed alittle narrower the transfusion was entirely satisfactory.

This method might appeal to those who have to giverepeated transfusions to the same patient over severalyears-e.g., in congenital hypoplastic anaemia.

Reviews of Books

PrinCiples and Practice of MedicineA Textbook for Students and Doctors. L. S. P. DAVIDSON,M.D., F.R.C.P.E., professor of medicine and clinicalmedicine, University of Edinburgh. Edinburgh: E. & S.Livingstone. 1952. Pp. 919. 32s. 6d.

Professor Davidson, with the staff of the medicaldepartment and clinical units at Edinburgh, has compileda textbook embodying the teaching of this school overthe past twenty years. This volume is clearly producedand simply designed. A similar descriptive pattern isused for each disease, giving concise aetiology, pathology,clinical manifestations, diagnosis, and treatment. Aswould be expected from this group of teachers, thephysiological background is well covered and specialemphasis has been laid upon treatment: it is indeedpleasant to find this aspect so well handled. The selectionof material is admirable, and the student will findenough about rare diseases to serve him for his finalexaminations.The printing and production is first-class. Some

readers may wish for more illustrations, but they mustremember that the price is remarkably low for all thisvolume provides. Davidson’s textbook will assuredlytake its place as a real contribution to British medicalteaching.

Oestrogens and NeoplasiaHAROLD BURROWS, C.B.E., PH.D. Lond., F.R.C.S., formerlyexperimental pathologist, Chester Beatty ResearchInstitute, The Royal Cancer Hospital, London; E. S.HoRNING, M.A. Oxfd, D.se. Melb., reader in experi-mental pathology, University of London, at the institute.Oxford : Blackwell Scientific Publications. 1952.

Pp. 189. 30s.

IN addition to its main theme this volume includesan account of the chemistry of oestrogens by C. W.Shoppee and a brief summary of experimental tumourchemotherapy by W. C. J. Ross. A preliminary chaptersets out the natural sources of oestrogen from plantsand animals, as well as factors controlling its supply inthe body and influence in stimulating mitosis, hyper-plasia, and benign and malignant growths. Fromobservation of human and experimental conditions,the authors support the view that continuous secretionof, or exposure to, cestrogen rather than intermittentexcessive output or application is the effective hormonalfactor causing spontaneous or induced neoplasia. Amongother special conditions cited are species and organvariation in sensitivity and response and, within thesame species, differences depending on heredity andinbreeding. In the case of heritable mammary tumoursof mice the effective cause is infection with the milkfactor aided by oestrogen. Subsequent chapters sum-marise systematically knowledge of the neoplasticinfluence of oestrogen on its target organs. A shortaccount of oestrogen-producing tumours is included.Numerous subheadings and cross-references help thereader to extract and to trace to source any specialinformation required. There is a bibliography of957 references.

Surgery of the ŒsophagusR. H. FRANKLIN, M.B., F.R.C.S., senior lecturer and surgeon,Postgraduate Medical School of London. London :Edward Arnold. 1952. Pp. 222. 42s.

IN this work Mr. Franklin has considered the oesophagusas a whole, and he has used his experience to draw intoreasonable perspective the work in this field of theear, nose, and throat surgeon, the thoracic surgeon, andthe abdominal surgeon.

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He writes with authority on the operative treatment ofcongenital atresia, and it is interesting to note that he hasnow a preference for the transpleural as opposed to theextrapleural approach. In his brief but clear discussion ofthe technique of oesophagoscopy he emphasises its potentialdangers in incautious hands. Apart from diagnosis, endoscopyplays an important part in the removal of foreign bodies, butthere are some complications which require the use of opensurgery. He considers the syndrome of reflux oesophagitis,resulting from a shortened cesophagus with herniation of thestomach, in the light of recent work, and illustrates thedifficulties of treatment. In the description of the operativetreatment of carcinoma of the cervical and thoracic oesophagus,the absence of many figures and results make it difficultto determine the appropriate technique for each case.The illustrations are well selected. All interested in

the cesophagus should read the book, for it is a valuablecontribution to a subject which is rapidly developing.

Psychology, the Nurse, and the PatientDORIS M. ODJLTJM, M.A. Oxfd, B.A. Lond., M.R.C.S., D.P.M.,senior psychiatrist, Elizabeth Garrett Anderson Hospital,and consultant psychotherapist, West End Hospital forNervous Diseases, London. London : Nursing MirrorPublications. 1952. Pp. 114. 7s.6d.

Tms pocket-size book should be of real help to studentnurses, for it covers the syllabus in psychology for thepreliminary examination for State-registered nurses. Itcould also be read with advantage by medical studentsand their seniors. After a brief outline of modern psycho-logical theories the nurse is shown how this can be appliedto the whole gamut of the patient’s experience of illnessand hospital life ; so that she is led step by step to arealisation of how psychology can be of real use inunderstanding and ministering to her patients. Thechapter on Some Special Problems is particularly goodand deals with the surgical case, preparation for opera-tion, anaesthetics, the care of the patient after operation,alleviation of pain, getting up, the use of sedatives andhypnotics, patients’ questions about dying, the long-stay case, the elderly patient, and relatives and visitors.There is also a good chapter devoted to the nursing ofchildren ; the need for avoiding unnecessary separationof the young child from its mother is emphasised, thoughnot, perhaps, forcibly enough. Some account of thegood results obtained in children’s wards where the motheris encouraged to visit daily and assist with settling thechild down for the night might well have 4i been included.The whole book is written around the patient (a fact

which is not suggested by the phrasing of the title) andthis is specially commendable.

Nutrition and Climatic StressH. H. MITCHELL, professor of animal nutrition, Universityof Illinois ; MARJORIE EDMAN, instructor in animalnutrition, in the university. Springfield, 111. : Charles C.Thomas. Oxford : Blackwell Scientific Publications.1951. Pp. 234. 50s.

THIS monograph was originally written for the UnitedStates Armed Forces, to summarise what is known ofthe influence of’ nutrition on the ability of men toendure climatic stress. The subject has an obviousbearing on the proper rationing of troops ; but, as theauthors point out, it has much wider implications thanthat. They have studied and summarised a great dealof work, published before October, 1949, on diet in acold environment, a hot environment, and at altitude.Each section begins with the physiological effects of theform of stress under consideration, and then gives anaccount of what is known of the effects of this stress onnutrient requirements in animals and man. The verylarge bibliography refers mainly to American work, butsome other sources are quoted. At the end of eachsection the authors have weighed up the evidenceavailable at the time, and have offered some practicalconclusions-such as that carbohydrate, especially whenbacked up by fat, is more effective than ’protein inkeeping out the cold, that there is no statistical evidenceto show that men voluntarily eat less protein in hotclimates, that vitamin supplements seem to make littledifference to tolerance of either heat or cold, and that

’

for those going up to 15,000-17,000 feet carbohydratesare the thing, though perhaps inclined to cause troublefrom flatus. A table occupying 16 pages summarisesthe effects recorded of treatments other than nutritionalon altitude tolerance, noting the subject (whetheranimal or human) used, and the results. This shows ata glance which measures look promising and which mayas well be given up. It also bears out the authors’contention that animal experiments do not offer a satis-factory guide to human nutritional requirements.Human Nature

- - Its Development,. Variations and Assessment. JOHN C.RAVEN, M.sc. London : H. K. Lewis. 1952. Pp. 226.12s. 6d.

IN this book Mr. Raven, the author of the well-knownProgressive Matrices test, gives a good introductoryaccount of the development of human personality frombirth to maturity and old age. His style is leisurely andreflective, and much of what -he says will stimulate the.reader to fresh thought on well-worn topics, withoutever shocking the most devout disciple of William Jamesor McDougall. The section on mental testing in itsvarious forms, with the assessment of their value, isauthoritative. An appendix deals with the statisticaltechniques used in psychology, but even this is palatablyadministered. The book includes references to furtherreading at the end of each section, and a useful glossaryand index.

Fitness and Injury in Sport (London : Skeffington.1952. Pp. 189. 16s.).-During the last few years a number ofbooks have appeared on the subject of athletic trainingwritten by men who must have had considerable practicalexperience in the preparation of athletes and in the preventionand treatment of injuries. Their aim, they invariably say,is to convey to athletic trainers in simple language the essentialscientific principles and their application. That is a praise-worthy ideal, but in their anxiety to emphasise

’’ the scientific

approach " they usually include details of anatomy, physiology,and pathology out of all proportion to the requirements ofpotential readers. The difficulty is that moderate knowledgeof a subject like physiology does not equip anyone to write asimple treatise for a layman, for this is one of the most difficultof all scientific literary achievements, and demands the

profound knowledge of a professor.There are so many flowery bypaths into which a writer can

stray, and Mr. S. S. Knight, who is general secretary of thePhysiotherapists’ Association, unfortunately strays a gooddeal. Thus in the chapter on Food and the Athlete he beginsby saying that " there is no known or certain way of improvingathletic performance by means of food," and ends 14 pageslater with the remark : " it is my experience that it is whatyou like in food that does you good providing there is enoughof it." This being so, he might as well have omitted theintervening account of food analyses and calorie values. Nordoes he make up for this waste of space in the section on

prevention of injuries, for practical details here are’scarce.He gives a brief but good summary of modern ideas onphysical fitness. His proposed course for athletic trainerswould occupy four to five terms, each of 12 weeks’ full-timestudy. It seems a lot.

Proceedings of the Third International Congress ofthe International Society of Hematology (London :Heinemann Medical Books. 1951. Pp. 593. ;E3 10s.).-Thisis the English edition of the proceedings. It does not differat all from the American edition, edited by Dr. Carl V. Moore,reviewed in The Lancet, 1951, ii, 868.Interrogation (Springfield, Ill. : Charles C. Thomas.

Oxford : Blackwell Scientific Publications. 1951. Pp. 164.35s.).-Captain Harold Mulbar is a senior officer of theMichigan State Police who has had much experience of gettingat the truth by interrogating reluctant people. He has written"in admirably direct style, a well-informed guide to the

practice of this art. Besides describing the procedures andartifices of ordinary questioning within the American policesystem, he gives much sensible information about the useof the polygraph, in Chicago and elsewhere, for "lie detection."His book is eminently practical, full of wrinkles and warnings,and assumes throughout that the investigator will- have toproduce his evidence for an American court. He is outspokenin condemning third-degree methods, which, it seems, might.better be called torture and brutality.