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in the equipment of any mobile surgical or emergencytransfusion unit. It is obtainable from Messrs. MedicalPneumatics Ltd., 28, Thayer Street, London, W.l.

A. H. GALLEYM.B. Lond., F.F.A.R.C.S.

King’s College Hospital,London

1. See Lancet, 1953, ii, 1185.

PLASTIC SPUTUM FLASKS

W. HARTSTONM.D. Lond., D.P.H., D.T.M.&H.

THE ambulant or bedfast patient who coughs up muchsputum may find embarrassing difficulty in its convenientcollection and hygienic disposal. If the accumulatedsputum is likely to be infective or must be disposed ofby a nurse, the use of a satisfactory and acceptablecontainer becomes essential.There is need for a sputum flask which will be con-

venient to the hand, mouth, pocket, and bedside ;unobtrusive and unbreakable ; easy to empty and wash orboil; leakproof and made of a material unaffected byacids, alkalis, hypochlorites, detergents, or other strongantiseptics. To allow the volume of its contents to bemeasured, this container should be translucent andgraduated in half-ounces. To this end, with the manu-facturer’s help, I have designed the flask illustrated. Itis made of buff-coloured pliant Polythene ’ in twosizes-a 4-oz. flask for the pocket and an 8-oz. flask forthe bedside. Its wide neck makes spitting into it comfort-able. The polythene screw-on cap has a knurled outer

rim to facilitate tight closure and easy opening, and aspecially devised leakproof tapered internal seating.

This flask satisfactorily meets all the criteria men-tioned above. Half an ounce of lysol, ’Milsol,’ (nowcalled Miltherex’) or other suitable antiseptic is put intothe flask before use and renewed after each sputumdisposal.These containers are made by Fibrenyle Ltd., 157, Dukes

Road, Western Avenue, London, W.3.

Reviews of Books

Standard Edition of the Complete Psychological Worksof Sigmund Freud

Translated under the general editorship of JAMESSTRACHEY. Vols. 4 and 5. The Interpretation ofDreams and On Dreams. London : Hogarth Press andthe Institute of Psycho-Analysis. 1953. Pp. 338 and723. E36 (set of 24 volumes).

THIS is the first outcome of a notable and welcomeundertaking. Most of Freud’s writings have been trans-lated at one time or another into English ; but the workhas been done by various hands, some of them unskilled,and it has been difficult to assemble the scattered publica-tions. The first volumes to be issued of this editionshow the high standard of fidelity and clarity, annotationand precision achieved. Mr. James Strachey hasestablished a merited pre-eminence in translating Freud :in his hands there can be no doubt that the executionof the whole work will be scholarly and the Englishflowing and natural.

It would be appropriate on this occasion to review theposition Freud holds in contemporary thought, and thegrandeur of his accomplishment. But any such estimatemust still express a partial judgment : there is notyet that consensus which comes sooner, and is surer,for the scientist than for the artist, and which is com-pounded of the informed assessment of experts and thegeneral opinion of educated men. Between the acclaimthat sets Freud alongside Galileo, Newton, and Darwin,and the suspended judgment which cannot separatetruth from ambiguous error in his theory of dynamicforces and mental development, there is a wide gulf.Few, however, will question that he was a discovererof genius who opened strange ways of thought, full ofpower to change our understanding of ourselves. It isfortunate that all his writings on these potent themesare to be accessible to the English-speaking reader.

Shoulder Lesions

(2nd ed.) H. F. MOSELEY, D.M., F.R.c.s., F.A.C.S., assistantprofessor of surgery, McGill University, Montreal.Toronto and London : Cassell. 1953. Pp. 329. 90s.

Mr. Moseley has not attempted a comprehensiveaccount of diseases of the shoulder-he omits, forexample, inflammatory disorders such as rheumatoidarthritis and tuberculosis-but he covers all the commoninjuries and disorders peculiar to the shoulder in the? lightof his own vast experience and of his painstaking- study’of the work of others. Since the book first appeared in1945 he has visited London as a Hunterian professor, andin this second edition he gives special emphasis toruptures of the short cuff muscles, the subject of hislecture at the Royal College of Surgeons in 1950.

Other lesions considered in detail include calcified deposits’within the supraspinatus, biceps tendonitis, fractures in theregion of the shoulder, and dislocations of the shoulder.There are also chapters on the acromio-clavicular joint andthe sternoclavicular joint. Dr. C. B. Peirce and Dr. J.

Bouchard, of Montreal, have contributed a useful section onX-ray diagnosis and treatment; and Dr. Francis L.

McNaughton a valuable account of the neurological aspectsof shoulder and upper-limb symptoms.

Mr. Moseley is a sound guide to surgeons and generalpractitioners who wish* to keep abreast of modern ideason shoulder disorders. But those who seek easy solutions

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to the many problems of shoulder surgery will be dis-appointed, for’he has nothing startlingly new to report.He is still unable to tell us how to ensure success in therepair of ruptures of the cuff muscles-though his resultsare better than most previously published-or what is thepathogenesis of those baffling conditions, " frozenshoulder " and the shoulder-hand syndrome. There area great many excellent coloured illustrations, but theseare not always sufficiently described ; and though wellproduced, the book would gain by more ruthless editingand more concise writing.Gastro-intestinal X-ray Diagnosis

M. RITVO, M.D., assistant professor of radiology ; L. A.SxaLFFER,, M.D., instructor in radiology, Harvard

- Medical School. London: Henry Kimpton. 1952.

Pp. 838. Y7 10s. -

AT least a-dozen books on this subject have appearedsince the end of the war. All of them follow the con-ventional pattern of description-beginning with the

oesophagus and ending with the rectum-and most ofthem, like this one, also include the liver, gall-bladder,spleen, and pancreas. Although no spectacular advanceshave lately been made in the radiology of the abdomen-excluding aortography-improved techniques todayenable the radiologist to recognise many more

abnormalities at an earlier stage and with greateraccuracy. For example, fifteen years ago few radio-logists looked for hiatus hernia or gastro-oesophagealreflux, but these procedures are now routine. Dr. Ritvoand Dr. Schauffer have made good use of this advantage,and they describe in great detail the rare as well as thecommon abnormalities. Full descriptions of endo-metriosis of the colon and irradiation damage to thecolon are good examples of their work. Their book iswell written and well illustrated and can be confidentlyrecommended for the radiologist’s reference shelf.i oxaemias ot pregnancy

JOHN SOPHIAN, M.D., F.R.C.S., M.R.C.P., M.R.C.O.G.,gynaecological surgeon, St. Mary’s Hospital for Women,Plaistow London : Butterworth. 1953. Pp. 231. 25s.

Tms book propounds the theory that the toxaemias ofpregnancy are due to a

" Trueta shunt " in the kidney,and that this is mediated by a " uterorenal reflex "resulting from increased uterine tension. The argumentis based mainly on a synthesis and integration of theliterature on a wide variety of topics. The authorexamines very critically any evidence which does notaccord with his theory. On the other hand, when he hasevidence or interpretations which appear to support histheory, he usually accepts them without question. Theconclusions drawn in this way are always interesting butnot necessarily valid. Experts, because they have

practical experience as well as theoretical knowledge, willbe capable of assessing the deductions which are madeon their own particular subject. But to those who-arenot so versed, the book could be misleading, the more sobecause those parts of the evidence which are in fact theleast acceptable will probably appear the most clear andconvincing to the non-specialist.

Mr. Sophian gives a critical analysis of modern viewson renal physiology, and on renal function in thetoxaemias of pregnancy. He discusses the aetiology ofœdema, hypertension, and albuminuria, and maintainsthat the Trueta mechanism can satisfy theoretically theproduction of these three conditions. He believes thatthere is mounting evidence that the syndrome of toxæmiaof pregnancy can be ascribed to, and stems from, thephysiological uterorenal reflex, and that the thesis of thereflex as the paramount setiological factor in eclampsiacan under no head be shown to be inapplicable. Indiscussing eclampsia and its treatment by Hingson’s

’ method, he makes the rather sweeping assertion thatrecovery by the use of conduction anaesthesia is invariablydramatic and certain. The last chapter of the book dealswith anuria which, he maintains, is completely explainedby the Trueta mechanism.- He also describes his own work on the subject. He hasfound in rabbits and sometimes in cats that the surface of the

kidney becomes pale at once if the uterus is distended by theinjection of fluid, and regains its colour when the distension isreleased. He observed a slower but much more prolonged

blanching when an cestrogen dissolved in sesame oil was

sprinkled into the peritoneal cavity of rabbits. In furtherwork on rabbits he found that the intravenous injection ofminimal lethal doses of dioxan also produced the blanching ofthe kidney. If, however, the kidney was denervated, muchlarger doses of dioxan were required for this effect. (It shouldbe noted that, in the rabbit kidney, dioxan does not produceany necrosis, though it causes a hydropic change in thetubular epithelium.) He also found that electrical stimulationof the renal nerves causes renal ischaemia and eventuallycortical necrosis, with casts and hyaline material in the

secondary convoluted tubules. Unfortunately fig. 30, whichis intended to illustrate these results, is not good enough- toshow any recognisable lesions. The other photographs in thebook are excellent.

L’oesophage en cardiologieMARCEL SEGERS, charge de cours a 1’Universite deBruxelles ; MARCEL BROMBART, chef du service de

radiodiagnostic a la Clinique C. De Paepe. Paris:Masson. 1953. Pp. 202. Fr. 1248.

THIS is a comprehensive study of the relation of theoesophagus to the heart and great vessels in health anddisease, as seen by radiography. The main value of dis-playing cardiovascular-oesophageal relationship is todemonstrate deviations due to enlargement of the leftauricle or abnormalities of the aorta. The first part ofthis book deals with the normal anatomy, the second withthe left auricle, the third with acquired aortic lesions,and the fourth with congenital malformations of the greatvessels. The sections on the left auricle and congenitalanomalies of the aorta are very detailed ; in fact thesection on aortic anomalies, which is of increasingimportance for the cardiac surgeon, is probably the mostcomplete survey of this subject yet written. There are135 excellent illustrations.

Regional BlockDANIEL C. MOORE, M.D., director, Department of Anes-thesiology, Mason Clinic, chief of anesthesia, VirginiaMason Hospital, Seattle, Washington. Springfield, Ill. :Charles, C. Thomas. Oxford : Blackwell ScientificPublications. 1953. Pp.373. 80s.

IN this handbook for beginners regional block isdescribed with the aid of diagrams and simple instructions.The diagrams are useful, but for some readers detailand repetition will make the text seem rather dull.There is much to be said for the author’s reminder thatconcentration on, and practice with, a single techniquefor a particular nerve increases the proportion of successfulresults, but he is perhaps over-careful when he repeats,with the description of every block, that the sterilisercontrol must be checked to be sure the equipment hasbeen sterilised..

Pharmacology (4th ed. London: Oxford UniversityPress. 1953. Pp. 562. 35’s.).-Placed in the middle of thecurriculum, pharmacology is a sort of medical; entrepot,receiving raw materials from the. hinterland of physiologyand .organic chemistry, and transmitting finished products toclinician, --hygienist, and veterinarian. This concept, isrealised once again in .the fourth edition of Prof. J., H.Gaddum’s well-known text. The stolider student will notfirid here-a methodical arrangement of the properties, -prepara-tions, and doses of drugs, designed for last-minute revision orrapid reference;_ but the more contemplative student windelight in,the book’s wide horizon’s,, its incursions. into medicalhistory and etymology, itsr. well-selected ieferences to’originalpharmacological literature. The appendix on chemical namesis helpful, and there is a long and relaxing chapter on generalprinciples of pharmacology, placed at the end of the booklike diastole following -systole.

Ophtalrnologie (Paris Flammarion. 1954. Pp. 1262).—Dr. Louis Guiltaumat’s addition to French loose-leaftextbooks is a comprehensive treatise on medical ophthal-mology, = though_ _ surgical indications ’are discussed andsurgical -procedures are briefly -described. Valuable separatesections on ocular therapeutics and medicolegal -problems areincluded.-- The publication is- designed, primarily for the busyFrench practitioner and the arinual review- by means* of

, up-to-date page editions will be welcome to those -who wishto keep painlessly abreast of current advances.