675

The final follow-up in these cases includes 29 cases ofeach series, two patients having failed to report in spiteof repeated requests, and one patient having been

accidentally killed before the end of the six-month

period. The table shows the results obtained in the58 cases successfully followed for six months.

RESULTS OF TREATMENT

* The criteria of clinical relapse include the history of a rigor and atertian periodicity of symptoms.

The factors which may have influenced the resultshave been briefly compared in the two series.

(1) The average intervals between the date of arrival inthe U.K. and the date of admission to hospital were forquinine-paludrine 4-8 months, and for quinine-pamaquin4-1 months.

(2) The probable areas of infection were as follows :.

z

India- Far East OtherBurma (P. 0. TV.) areas

Quinine-paludrine .. 24 .. 4 .. 1

Quinine-pamaquin.. 20 .. 4 .. 5

The fact that each series contains equal numbers of patientswho had been in captivity in the Far East obviates anypossible bias due to the higher relapse-rate that is to be

expected in that group.(3) The average intervals between treatment and further

relapse were for quinine-paludrine 3-6 months, and for

quinine-pamaquin 3-7 months.It was previously thought that paludrine possibly gave a

longer period of freedom from relapse than did the combinedpamaquin-quinine treatment (Johnstone 1946a). This sug-gestion is not borne out by the present investigation, in spiteof the fact that the dosage of paludrine was larger than inthe previous investigation.

(4) As would be expected, no difference was noted in therapidity with which the temperature fell to normal in thetwo series, since both received equally large doses of quinine.

CONCLUSIONS

This series is too small for conclusions to be drawn

regarding an exact relapse-rate, but the results indicatethat paludrine with quinine is not so effective as

pamaquin with quinine for controlling further relapsesof benign tertian malaria.The possibility that paludrine may have a synergistic

action similar to that of pamaquin has not beenconfirmed.The results obtained in the quinine-pamaquin series

closely approximate to those previously reported (John-stone 1946a and b, Malaria Committee 1945), and thequinine-paludrine results are very similar to those foundwith paludrine alone (Johnstone 1946a), mepacrine(Malaria Committee 1945), and 4430’ (Johnstone1946b). ,

I wish to thank Major-General Sir. Alexander Biggam forpermission to publish this paper ; and many members of thestaff of the Colchester Military Hospital for their help. Iam indebted to Imperial Chemical (Pharmaceuticals) Ltd.for the supplies of paludrine.

REFERENCES

Johnstone, R. D. C. (1946a) Lancet, ii, 825.- (1946b) Ann. trop. Med. Parasit. 40, 330.

Malaria Committee of Medical Research Council (1945) reportM.L.E. 30.

Reviews of Books

Renal DiseasesE. T. BELL, M.D., professor of pathology, University ofMinnesota. London : H. Kimpton. 1946. Pp. 434. 35s.

Professor Bell’s renown as a morbid anatomist andhis special interest in the kidney are well known; his

monograph, besides surveying the literature of bothmedical and surgical diseases of the kidney, contains adetailed analysis of renal cases in a series of 32,360autopsies, with statistics and numerous case-records.It is primarily an exposition of pathological findingsand their interpretations, and it is well illustrated with117 photographs and 4 colour plates, all original, wellchosen, and germane. The section on tubular diseaseis disproportionately short, perhaps because Dr. Bell isinterested mainly in the glomerular basement-mem-brane (as his good account of the diabetic kidney shows).He hopes, he says, to encourage cloger cooperationbetween pathologist and clinician.; and if pointing outthe gaps and contradictions in our knowledge of functionwill help to fill and resolve them, the book should fulfilits purpose. At present we know little of the functionalaspects of renal disease, except in essential hypertension,and it is inevitable that the chapters on function andfunctional disturbances (" extrarenal azotsemia ") shouldbe less satisfactory than the rest. Clinicians will regretthe absence of clinical charts or diagrams, and the scantyreference to the grosser biochemical disturbances ; and

English readers will be surprised to find no mention ofthe work on nephritis of Ellis, Evans, and Wilson.Despite these minor criticisms the book is a stimulatingachievement.

Ranson’s Anatomy of the Nervous System(8th ed.) Revised by SAM LILLARD CLARE, M.D., PH.D.,professor of anatomy, Vanderbilt University, Nashville.Philadelphia and London : W. B. Saunders. 1947.

Pp. 532. 32s. 6d.

IT is a difficult task to take over the revision of anestablished textbook which is stamped with the indi-viduality of its creator. In the 8th edition of

" Ranson "Dr. Clark has succeeded in revising and even improvinga good book while preserving its distinctive approachto the subject. The matter has been to some extentrearranged, and gross descriptive anatomy is now col-lected into one section. A new set of illustrations madefrom parasagittal sections makes it possible for the readerto picture the structures of the brain-stem in threedimensions. The whole book has been revised to includethe results of recent research. It is doubtful whetherthe addition of a chapter of clinical illustrations wasworth the space, for the comments are necessarilysketchy and there are already plenty of books dealingwith the applied anatomy and physiology of the nervoussystem. The statement that the posterior columns ofthe spinal cord conduct sensory impulses serving tactilediscrimination and localisation is based on Head’sviews ; but, as Walshe has pointed out, these activitiesare not forms of sensibility but judgments, and cannotbe assigned to tracts in the spinal cord.

Heparin in the Treatment of ThrombosisAn account of its chemistry, physiology and applicationin medicine. (2nd ed.) J. ERIK JORPES, M.D., reader inbiochemistry, Caroline -Institute, Stockholm ; foreword

by Prof. J. R. LEARMONTH, CH.M. London : Oxford

University Press. 1947. Pp. 260. 18s.

JUST before and during the war, interest in the possibletreatment of thrombosis by anticoagulants was stimu-lated by the production of heparin on a commercialscale in Canada and Sweden. Venous thrombosis, longknown as a cause of surgical tragedies, is now recognisedas being just as common an agent of sudden death inthe medical wards. It is among the dangers of takingto one’s bed for any illness ; and is responsible, too, formuch disability from swollen legs, and for pleural painand breathlessness. Even when emboli appear it -may notbe easy to locate their source ; the process begins inthe deep veins of the calf in almost every instance, andemboli have usually appeared before the leg begins to

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swell. Tenderness in the calf is taken to be an earlysign, especially when accompanied by mild fever.

This book gives an excellent account of the greatadvances made in Sweden on the study of the chemistry,mode of action, and clinical use of heparin. There islittle doubt that heparin shortens the course anddiminishes the incidence of complications of venousthrombosis. Jorpes states that, on the average, rest inbed is reduced from 5 weeks to 9 days, and duration offever from 3 weeks to 7’ days, and that further pulmonaryemboli rarely occur in patients treated with heparin.His monograph is fully documented and should becarefully considered in Britain, where we have had littleopportunity to do much in the way of active treatmentfor thrombosis along these lines. The amounts of heparinrequired may cost up to 220 or more per patient, but theSwedish results, if substantiated, would certainly suggestthe expense is justified. The cheaper method of usingdicoumarol is much more risky and seems to be lesssatisfactory.

A Descriptive Atlas of Radiographs .

(6th ed.) A. P. BERTWISTLE, M.B., F.1t.O.S.E. London :H. Kimpton. 1946. Pp. 606. 45s.

THE author states that this atlas is primarily designedfor the clinician, to whom knowledge is presumablydenied by a number of " vociferous radiologists whowish to keep radiology as a closed art, a mystic rite."There are 947 illustrations, most of which are accom-panied by a short text. Some of the illustrations are good,some are indifferent, and a regrettable number are ofsuch ancient vintage that text and picture cannot becorrelated even by a radiologist. The text is scrappy andmakes no attempt at differential diagnosis. Unfor-tunately some pictures are open to an interpretationdifferent from the author’s ; accompanying a normal chestpicture is the alarming mis-statement that the " olderview that the lung markings were due to the pulmonaryvessels can be discountenanced definitely." An atlasof X-ray pictures could be very helpful to both studentand general practitioner, but this one requires morecritical revision.

Buchanan’s Manual of Anatomy(7th ed.) Editor : F. WOOD JoNES, D.SC., F.R.C.S.,.B..s., professor of anatomy, Royal College of Surgeonsof England. London : Bailliere. 1946. Pp. 1616. 45s.

THE student, as we have remarked,l can make useof three kinds of anatomy textbook-a small concisedissecting manual which can be thrown away whendirty and done with, a larger book giving a coherentaccount of the systems rather than the regions of thebody, and a big work of reference which both he andhis teachers can consult at need. " Buchanan’s Ana-tomy

" falls into the class of the reference work.After an interval of nine years a new edition appears

under the editorship of Professor Wood Jones, therevision of the various sections having been deputed tomembers of the department of anatomy at ManchesterUniversity. As hitherto, the book deals mainly withtopographical anatomy on a regional basis, but thereare innovations. Some, such as a series of radiographicillustrations, will certainly be approved ; but others

may disappoint those acquainted with previous editions.The introductory section on embryology and the descrip-tive accounts of organogenesis have been almost elimi-nated, and histology has been greatly reduced-sometimesinconsistently, as when the minute structure of thecerebellar cortex, but not the cerebral, is described.Nearly all the original drawings of Buchanan’s Anatomyhave been restored, supplemented by almost 200 newdiagrams ; but the removal of all colour (on the groundthat colour is unnecessary and sometimes misleading)has made some of the diagrams less effective. The textstill contains much of the sort of topographical detailwhich many anatomists feel might with advantage nowbe discarded in a reference work used chiefly by students.Certainly there are few items of anatomical topographyof which a knowledge may not be of some value atsome time to the practising clinician ; but if our physio-logical colleagues adopted the same principle in planning

1. Lancet, 1944, i, 569.

their curriculum, the medical student would face a

textbook of physiology about the size of the EncyclopcediaBritannica. In any case the medical student is unlikelyto make much practical use of such things as the chordaobliqua posterior, the external petrosal nerve (which isstated to be " of doubtful existence "), or the transversusnuchse muscle.More eponyms have led to multiplication of terms,

which some will feel imposes an unnecessary strain onmemory ; but the perverse fact is that an eponym oftenstrikes into the mind better than a more logical name.Miss Dobson’s biographical notes, at the end of the book,refresh their interest, though perhaps there are rathertoo many of them.

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Textbook on the Nursing and Diseases of SickChildren (4th ed. London : H. K. Lewis, 1947. Pp. 744.308.).-The new edition of the textbook for nurses, edited byProf. Alan Moncrieff, has just appeared. It will be welcomedby sister-tutors and student nurses, in orthopaedic as well aschildren’s hospitals.

Syndrome cortico-pleural : son etude clinique et

experirnentale (Paris : Masson, 1946. Pp. 140. Fr. 160).-The German occupation of France in 1940 postponed publica.tion of this monograph written in French by Prof. J. Skladal,of Prague. An English translation was published by theCambridge University Press in 1942 (Lancet, 1942, ii, 281).

A Short Handbook of Practical Anaesthetics (Bristol:J. Wright, 1946. Pp. 120. 12s. 6d.).-Surgeon CommanderHoel Parry Price writes a breezy, friendly little book, coveringa wide range. Mistakes are acknowledged, and advice basedon a wide practical experience is given freely. The chatty stylemakes easy reading at the end of the day’s work, but some ofthe advice should not be taken too literally by the beginner.Incidentally, the statement that carbon-dioxide absorption" was first used by Snow in about 1887 " is only a roughapproximation, since Snow died in 1858.

Diseases of the Skin (3rd ed. Philadelphia and London:W. B. Saunders, 1946. Pp. 937. 50s.).-Prof. George ClintonAndrews, of Columbia University, New York, deals fully withthe commoner skin diseases, and gives enough informationabout the rarities to stimulate the reader’s interest. The

chapter bibliographies, omitted from the second edition,have happily returned. The work has been brought right upto date, new illustrations have been added, and redundantmatter has been ruthlessly cut. It is a pity that ProfessorAndrews’s just enthusiasm for penicillin has caused him torate it so highly in the treatment of early syphilis. Many casesof clinical and serological relapses in patients treated solelywith penicillin are now reporting at the clinics.

Haematological Technique (3rd ed. Calcutta : U. N. Dhur,1945. Pp. 128. Rs. 8).-Prof. L. Everard Napier and Dr. C. R.Das Gupta describe the standard haematological methodsfollowed at the Calcutta School of Tropical Medicine; theyare all well-established methods, and no original ones areincluded. They also give an account of bilirubin estimationand gastric analysis. The blood-transfusion section is some-what limited and does not mention the Rh factor. The colour

plates are unfortunately poor ; it would be very difficult toidentify the different erythroblasts from these reproductions,and the leucocytes have fared little better. All the same, thefull detail will undoubtedly secure a wide local circulation forthis book, which is particularly useful for less experiencedworkers or for training technicians.

Diagnostic electrocardiographique (Paris: Masson,1946. Pp. 362. Fr. 860).-In this new addition to Frenchtextbooks Dr. A. Jouve and Dr. J. Senez provide the beginnerwith a clear account of the principles and methods of cardio-graphy. The normal tracing and the borderline patternsbetween normal and pathological are fully described. Thearrhythmias receive relatively more attention than conditionsof greater clinical importance such as disease of the coronaryarteries, pulmonary lesions, and pericarditis. English readerswill find this book a sound introduction to the interpretationof- electrocardiograms, though they will notice that theold technique is used for chest leads and will encounter afew unfamiliar terms (such as auricular’ tremulation).The illustrations are good, and the book ’is a notableachievement under difficult conditions.