519 a young Indian vagrant who was operated on for ileo- ceecal intussusception which recurred after twenty- four hours. Conservative measures were adopted, and the patient passed the intussusception. A subsequent barium enema showed the appearances of an ileo- transverse anastomosis. Mr. K. 0. Parsons reported a case of intussusception of the pelvic colon in a patient who presented with gangrenous bowel protruding from the anus. He had been previously diagnosed elsewhere as a case of prolapse. The patient passed the intussusception five weeks later. A barium enema showed no signs of the anastomotic level. Mr. Wilfred Mills reported that he had been called to a patient in a mental hospital who was said to be " pass- ing his uterus through his rectum." There was some reason for this description because the prolapsed bowel closely resembled a patulous cervix. Again this intussusception sloughed away, leaving a normally functioning bowel. In children with intussusception, initial shock is well known, and recognised by quietness and pallor. In the present case in an adult, shock was disproportionate to the pathological condition present. An extreme degree of shock is not commonly seen in acute intestinal obstruction caused by strangulated hernia, or even by impaction of large gall-stones. Acute intestinal obstruc- tion appears in this case not to have been complete until after the separation of the intussusception, when one would have expected recovery. It is possible that complete obstruction was caused by rapid cicatrisation at the site of separation, and was delayed by the presence of the bulky gangrenous mass. One wonders if diagnosis could have been made in the early stages by barium contrast filling and X rays, but it is doubtful if operation would have been strongly urged even in the presence of an accurate diagnosis, because of the absence of complete obstruction. The total absence of blood from the stools at all times is noteworthy. Reviews of Books Eugenics : Galton and After C. P. BLACKER, M.C., G.M., M.A., M.D., F.R.C.P., general secretary, Eugenics Society. London : Duckworth. 1952. Pp. 349. 25s. Dr. Blacker has combined a biography of Sir Francis Galton with a review of the development, after Galton’s death in 1911, of the " science, practice and religion " of eugenics. In his description of the person and work of this remarkable cousin of Darwin, Dr. Blacker follows closely Karl Pearson’s biography, and the first third of the book is a reliable account of the many interests of a highly gifted and well-connected Victorian gentleman. His account of developments since 1911 gives a better view of what Galton accomplished than can be found anywhere else, and sets it in a framework of modern views about genetics and eugenics. It would be a mistake, however, to regard the book as a detached and academic survey. It is written from a personal standpoint which many do not share. Since eugenics (and even genetics) offer such controversial themes this was inevitable, and the reader must allow for it. In addition, a fair amount of the controversy in this country on national intelligence and kindred issues is reported, and there are informative accounts of the demography of the peoples of the earth, of some recent general developments in genetics (but not in human genet.ics), and of methods of ascertainment. The Scientific Paper 2nd ed. SAM F. TRELEASE, Columbia University. London : Bailliere, Tindall, & Cox. 1951. Pp. 163. 20s. AUTHORS who worry about their manuscripts, and would gladly make them less of a burden to editors and more of a joy to readers, will be much helped by this little book. It deals with every aspect of collecting and presenting the results of scientific work : the use of the library, treatment of data, reliability and significance of measurements, the actual writing and the choice of headings, logical presentation, how to maintain interest, revision, typescript, correction, the estimation of length, good usages, tables, illustrations, the ways of editors, and proof-reading. Experienced writers will not find anything unfamiliar, but few books cover the problem so completely as this one. The introduction, Mr. Trelease says. should state the problem, describe its condition at the beginning of the study, tell the reasons for investigating it, and give the purpose, scope, and general rrn-thod of the investigation. He also thinks it should state clearly and definitely the most significant result or the investigation : for this not only enables the reader to distinguish essential from non-essential evidence, but makes the writer face squarely at the outset what it is that he really wants to say-whether, indeed, he has anything to say. Like other advisers on scientific writing, he emphasises the need for numerous revisions. It is true that a revised manuscript is likely to be better than one which is " dashed off " and dispatched without revision, but there is a limit to the number of useful revisions : some much-revised papers show that their writers have grown sick of the sight of them and are no longer interested in correcting their faults. Before he begins to write, an author should plan his paper so that it conforms to the layout of the journal of his choice. He should then write with a two-inch margin and three spaces between the lines. He can do a great deal of correction on such a script without rendering it illegible to an intelligent typist. Two candid friends of good critical ability, knowledge of the subject, and experience of publishing papers should independently edit and freely comment on copies of the draft ; and the author should weigh their observations, think his own second thoughts, and transfer the result to his correction copy. This should be retyped and sent to the editor. If writers would observe these sensible rules it is probable that the editorial staff of scientific journals would live much longer and look much younger than is usual for persons of this kind. Atlas of Tumor Pathology Fascicle 9. RUPERT A. WILLIS, M.D., F.B.c.p., professor of pathology, University of Leeds. Pp. 58. 50 cents. Fascicle 16. PHILIP M. LE COMPTE, M.D., pathologist, Faulkner Hospital, Boston, Mass. Pp. 40. 45 cents. Fascicle 18. HANS G. SCHLUMBERGER, M.D., professor of pathology, Ohio State University. Pp. 88. 75 cents. Fascicle 29. HOWARD T. KARSNER, M.D., medical research adviser, Bureau of Medicine and Surgery, United States Navy. Pp. 60.$1.00. Fascicle 34. FRED W. STEWART, M.D. Pp. 114.$1.10. Washington: Armed Forces Institute of Pathology. 1950 and 1951. THESE helpful monographs are published at a reasonable price by the Armed Forces Institute of Pathology, under the auspices of the National Research Council, and are sponsored by various bodies, including the American Cancer Society and the rational Cancer Institute of the United States Public Health Service. They form part of an atlas of tumour pathology, and the illustrations are very good though the subject matter is brief. They contain a surprising amount of information nevertheless, and contrive to survey prognosis and treatment into the bargain. The fascicle by Prof. R. A. «-illis is on teratomas, which he defines as neoplasms composed of multiple tissues foreign to the part in which they arise. He believes that they may represent areas of tissue which, during early embryonic development, escaped from the action of the primary organiser, and adduces evidence against the popular view that they are embryomas or distorted fœtuses, derived either from included twins of the bearers or from panhogenetic proliferation of the host’s own germ cells. Dr. Philip M. Le Compte writes on tumours of the carotid body and related structures. Since most carotid-body tumours are both clinically and histologically benign, he
Transcript
519
a young Indian vagrant who was operated on for ileo-ceecal intussusception which recurred after twenty-four hours. Conservative measures were adopted, andthe patient passed the intussusception. A subsequentbarium enema showed the appearances of an ileo-transverse anastomosis.
Mr. K. 0. Parsons reported a case of intussusceptionof the pelvic colon in a patient who presented withgangrenous bowel protruding from the anus. He hadbeen previously diagnosed elsewhere as a case of prolapse.The patient passed the intussusception five weeks later.A barium enema showed no signs of the anastomoticlevel.
Mr. Wilfred Mills reported that he had been called toa patient in a mental hospital who was said to be
"
pass-ing his uterus through his rectum." There was somereason for this description because the prolapsed bowelclosely resembled a patulous cervix. Again thisintussusception sloughed away, leaving a normallyfunctioning bowel.
In children with intussusception, initial shock iswell known, and recognised by quietness and pallor.In the present case in an adult, shock was disproportionateto the pathological condition present. An extreme
degree of shock is not commonly seen in acute intestinalobstruction caused by strangulated hernia, or even byimpaction of large gall-stones. Acute intestinal obstruc-tion appears in this case not to have been complete untilafter the separation of the intussusception, when onewould have expected recovery. It is possible that
complete obstruction was caused by rapid cicatrisationat the site of separation, and was delayed by the presenceof the bulky gangrenous mass.One wonders if diagnosis could have been made in the
early stages by barium contrast filling and X rays, butit is doubtful if operation would have been stronglyurged even in the presence of an accurate diagnosis,because of the absence of complete obstruction. Thetotal absence of blood from the stools at all times is
noteworthy.
Reviews of Books
Eugenics : Galton and AfterC. P. BLACKER, M.C., G.M., M.A., M.D., F.R.C.P., generalsecretary, Eugenics Society. London : Duckworth.1952. Pp. 349. 25s.
Dr. Blacker has combined a biography of Sir FrancisGalton with a review of the development, after Galton’sdeath in 1911, of the " science, practice and religion "of eugenics. In his description of the person and workof this remarkable cousin of Darwin, Dr. Blacker followsclosely Karl Pearson’s biography, and the first thirdof the book is a reliable account of the many interestsof a highly gifted and well-connected Victorian gentleman.His account of developments since 1911 gives a betterview of what Galton accomplished than can be foundanywhere else, and sets it in a framework of modernviews about genetics and eugenics. It would be a
mistake, however, to regard the book as a detachedand academic survey. It is written from a personalstandpoint which many do not share. Since eugenics(and even genetics) offer such controversial themesthis was inevitable, and the reader must allow for it.In addition, a fair amount of the controversy in thiscountry on national intelligence and kindred issues isreported, and there are informative accounts of thedemography of the peoples of the earth, of some recentgeneral developments in genetics (but not in human
genet.ics), and of methods of ascertainment.
The Scientific Paper2nd ed. SAM F. TRELEASE, Columbia University.London : Bailliere, Tindall, & Cox. 1951. Pp. 163. 20s.
AUTHORS who worry about their manuscripts, andwould gladly make them less of a burden to editors andmore of a joy to readers, will be much helped by thislittle book. It deals with every aspect of collecting andpresenting the results of scientific work : the use of thelibrary, treatment of data, reliability and significance ofmeasurements, the actual writing and the choice ofheadings, logical presentation, how to maintain interest,revision, typescript, correction, the estimation of length,good usages, tables, illustrations, the ways of editors,and proof-reading. Experienced writers will not findanything unfamiliar, but few books cover the problemso completely as this one. The introduction, Mr. Treleasesays. should state the problem, describe its conditionat the beginning of the study, tell the reasons forinvestigating it, and give the purpose, scope, and generalrrn-thod of the investigation. He also thinks it shouldstate clearly and definitely the most significant resultor the investigation : for this not only enables thereader to distinguish essential from non-essential evidence,but makes the writer face squarely at the outset whatit is that he really wants to say-whether, indeed, hehas anything to say. Like other advisers on scientificwriting, he emphasises the need for numerous revisions.
It is true that a revised manuscript is likely to be betterthan one which is " dashed off " and dispatched withoutrevision, but there is a limit to the number of usefulrevisions : some much-revised papers show that theirwriters have grown sick of the sight of them and are nolonger interested in correcting their faults. Before hebegins to write, an author should plan his paper so thatit conforms to the layout of the journal of his choice.He should then write with a two-inch margin and threespaces between the lines. He can do a great deal ofcorrection on such a script without rendering it illegibleto an intelligent typist. Two candid friends of goodcritical ability, knowledge of the subject, and experienceof publishing papers should independently edit and freelycomment on copies of the draft ; and the author shouldweigh their observations, think his own second thoughts,and transfer the result to his correction copy. Thisshould be retyped and sent to the editor. If writerswould observe these sensible rules it is probable that the
editorial staff of scientific journals would live muchlonger and look much younger than is usual for personsof this kind.
Atlas of Tumor PathologyFascicle 9. RUPERT A. WILLIS, M.D., F.B.c.p., professorof pathology, University of Leeds. Pp. 58. 50 cents.Fascicle 16. PHILIP M. LE COMPTE, M.D., pathologist,Faulkner Hospital, Boston, Mass. Pp. 40. 45 cents.Fascicle 18. HANS G. SCHLUMBERGER, M.D., professorof pathology, Ohio State University. Pp. 88. 75 cents.Fascicle 29. HOWARD T. KARSNER, M.D., medical researchadviser, Bureau of Medicine and Surgery, United StatesNavy. Pp. 60.$1.00. Fascicle 34. FRED W. STEWART,M.D. Pp. 114.$1.10. Washington: Armed ForcesInstitute of Pathology. 1950 and 1951.
THESE helpful monographs are published at a reasonableprice by the Armed Forces Institute of Pathology,under the auspices of the National Research Council,and are sponsored by various bodies, including theAmerican Cancer Society and the rational CancerInstitute of the United States Public Health Service.They form part of an atlas of tumour pathology, and theillustrations are very good though the subject matteris brief. They contain a surprising amount of informationnevertheless, and contrive to survey prognosis andtreatment into the bargain.The fascicle by Prof. R. A. «-illis is on teratomas, which he
defines as neoplasms composed of multiple tissues foreign to thepart in which they arise. He believes that they may representareas of tissue which, during early embryonic development,escaped from the action of the primary organiser, and adducesevidence against the popular view that they are embryomasor distorted fœtuses, derived either from included twins ofthe bearers or from panhogenetic proliferation of the host’sown germ cells.
Dr. Philip M. Le Compte writes on tumours of the carotidbody and related structures. Since most carotid-bodytumours are both clinically and histologically benign, he
520
favours a diagnostic biopsy only. The surgeon who decidesto operate should realise that
" he has one chance in threeof killing his patient and if the patient survives, about eightchances in ten of leaving him with some kind of temporaryor permanent neurological disturbance." For tumours of theglomus jugulare, Le Compte recommends radical ty-mpano-mastoidectomy when the diagnosis is established. He also
gives brief accounts of tumours of the aortic bodies, andtumours arising in the ganglion nodosum of the vagus, andbelieves that there are probably two unverified instances ofneoplasms arising in the paraganglion ciliare. Tumours ofthe chemoreceptor system are in general radio-resistant.
In his account of tumours of the mediastinum, Dr. Hans G.Schlumberger does not include an account of tumoursof the thymus, oesophagus, heart, or pericardium ; but hediscusses the histogenesis of the many others met with inthis situation, including those arising from misplaced organs.Every mediastinal tumour not known to be metastatic, hesays, should be submitted to biopsy before it is irradiated ;for this not only establishes the diagnosis but makes it
possible to avoid those post-irradiational tissue changeswhich often increase the difficulty of surgical removal.
Dr. Howard T. Karsner, writing on tumours of the adrenal,includes an account of the tumour-like myelolipoma. Heholds that a diagnosis of phaeochromocytoma is not validwithout a positive chromaffin reaction, because polygonalcells may be numerous in cortical adenoma while cells whichresemble those of the cortex occur in phaeochromocytoma.The excellent section on tumours of the breast is written
by Dr. Fred W. Stewart. Primary mammary cancer canoccur, he says, in any postpubertal breast: in fact, withincreasing experience a pathologist may employ the term"
pre-cancerous " less and less. The youngest patient he
had seen was twenty ; the oldest were identical female twinsover ninety years of age. Gross anatomy and the extentof disease, he holds, far outweigh in importance microscopicalclassification, although confirmation of the two may yieldsignificant information. With involvement of the basal
axillary group of nodes only, Dr. Stewart has found a 65%survival-rate at 5 years. If the midgroup are involved thesurvival-rate falls to 45%, while if the apical axillary nodesare affected the survival-rate is only 28%. The so-called
medullary type of carcinoma with a lymphoid stroma has abetter survival-rate than the average scirrhous cancer : in5 years only 11-5% had died of their disease in the formergroup, as against 56% in the latter group.
Management of the NewbornARTHUR HAWLEY PARMELEE, M.D., professor of pedia-trics, University of Southern California. Chicago :Yearbook Publishers. 1952. Pp. 358.$7.
THIS excellent book on the newborn infant will be awelcome addition to the shelves of paediatricians andobstetricians. Professor Parmelee has had intensiveexperience of the newborn for many years, and hisapproach is physiological and clinical. He is a keenand accurate observer, and he has produced a
"
story ofthe newborn " which is a pleasure to read. Fully halfof the book deals with the normal infant, and theremainder is a comprehensive account of abnormalitiesand diseases of the newborn. The 83 illustrations aregood, but such a valuable book is worthy of many more.It is a pity that American books are now so expensivein this country, but no-one who has regular care of thenewborn can afford to be without this one.
Connective TissuesTransactions of the Second Conference, May 24 and 25,1951. Editor: CHARLES RAGAN. New York: JosiahMacy, Jr., Foundation. 1952. Pp. 190. S3.50.
THE second Josiah Macy conference on connectivetissues has produced a volume even more interestingthan the first ; but when experts confer, new words andunfamiliar concepts, likely to be above the heads ofsome of us. are often taken for granted. Some smalleditorial explanatory notes in the present volume aretherefore helpful, and more of them would be welcomein later books of the series.
Of the five main topics pain mechanisms in connectivetissues, discussed by Travell, is the only one which representsthe clinical approach. The other four are of more fundamentalnature. Porter’s valuable contribution on repair processes
in connective tissue is illustrated by a series of beautifulelectron micrographs showing the stages of collagen-fibreformation in relation to the cell-surfaces of chick embryofibroblasts in tissue culture. Morrione deals with the regressionof scar-tissue as seen in recovery from experimental cirrhosisof the liver, and advances several ideas which may bear onrestoration of the normal state after fibrous-tissue healingin various other maladies, such as rheumatic heart-diseaseand nephrosclerosis. In discussing the chemical morphologyof elastic fibres, Lansing is concerned with the chemistry of theindividual fibres and the reasons for their spiral structure,which can be seen under both the light and electron micro-scopes. Gersh treats mainly of alterations in the appearanceand staining reactions of ground substance in relation to theaction of hormones or the mechanism of allergy, and alsodiscusses its origin and fate.
Disease in Old AgeROBERT T. MONROE, M.D. From the Medical Clinicof the Peter Brent Brigham Hospital and department ofmedicine, Harvard Medical School, Boston, Massa.chusetts. Boston : Harvard University Press. London :Oxford University Press. 1951. Pp. 407. 32s. 6d.
Dr. Monroe has made an elaborate analysis of themedical records of 7941 patients over the age of 61 whowere admitted to hospital during the years 1913-43.The wealth of the clinical material he describes isimpressive ; though it would have been more usefulif he had compared the incidence of disease in hispatients and in those of lower age-groups. He pointsout that hospital management and practice must nowa-days be adjusted to patients in the higher age-groups;for whereas, in 1913, 1 in every 16 patients admitted tohospital was over the age of 61, in 1943, 1 in every 5patients admitted was of this age-an increase of 200 %in 30 years. To those who hold that continued usefulemployment assists in the maintenance of physical andmental health, Dr. Monroe’s figures are depressing,for 92 % of men between the ages of 61 and 65 were inemployment during the first decade under review,compared with 66 % during the last. These figures helpto confirm the trend which has been observed in surveyscarried out both in this country and in the U.S.A.Dr. Monroe’s views on the management of elderly patientsare refreshingly humane, and he puts forward a sensiblescheme for a comprehensive service for elderly persons,organised by the community, which would ensure anadequate supply of beds of various categories, linkedwith a central hospital. He emphasises the value of thegeriatric clinic, and ends with a plea for an
"
age centre."This would include a supply of one- and two-roomedflats for about 400 people, where adequate medical andsocial services would be available.
Hospital Organisation and Management (4th ed.London : Faber & Faber. 1952. Pp. 1782. £8 8s.).—Thisstandard work, first published in 1927, is now very portly.Captain J. E. Stone has amplified the facts and data gatheredduring many years of active work in the hospital field withnumerous references to American experience, and to the
changes brought about by the National Health Service Act.This has not been offset by sufficient compression andpruning. The appendices, too, which take up as much as300 pages, could be shortened. Nevertheless this is a verygood account of the development of the British hospitalsystem, and of methods of hospital management. Alldepartments of hospital organisation are covered, and thechapters on the law relating to hospitals could not be improved.Applied Physiology (9th ed. London : Oxford University
Press. 1952. Pp. 1190. 50s.).-The appearance of the newedition is as startling as that of an old friend who returnsfrom a holiday with an unexpected moustache ; but there canbe no misgivings about Prof. Samson Wright’s book. With theaid of Prof. Montague Maizels and Mr. J. B. Jepson, D.PHIL-he has rewritten more than half the text, and rearranged thepresentation in drastic fashion. Though past readers maytake time to find their way about again, they will readilyagree that the new sequence of subjects is an improvement.starting as it does from
" the outstanding generalization ofphysiology "-the constancy of the internal environment,Some 200 new illustrations have been added. What is virtuallya new book will enjoy an even greater popularity.
