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The hood can be removed from the respirator in a fewseconds.Four months after his introduction to the hood the

patient had recovered sufficiently to be transferred to acuirass respirator, but subsequently he developed a

secondary infection from which he died. At necropsy hislungs showed no abnormal changes attributable tointermittent positive-pressure breathing.

SPLIT FRONT

A divided head-piece or "

split front" (figs. 3 and 4)is a great advantage in cabinet respirators from thepoint of view both of patient and staff ; such a divided

head-piece can be used with or without the hood. Smith

(1953) has described an excellent split front ; the onlyadvantage we claim for our head-piece is that it can bemade for a few shillings in any hospital workshop. The

existing front of the cabinet is removed, and a new splitone is substituted. Both divisions are made from stout

plywood. The sides of the detachable upper section movein metal runners extending upwards from the sides ofthe lower section to which they are fixed. The meetingedges of the upper and lower sections are tongued andgrooved so that they interlock when they are broughttogether.

This split front is still a sloping front, and it remainsdifficult to nurse a patient in the prone position. We aretesting a further simple modification which we hopewill overcome this difficulty.

SUMMARY

A positive-pressure hood for use with the cabinet typeof respirator is described.

This hood is a much more convenient method ofventilating patients than the positive-pressure mask. Itwas designed to ventilate the patient during nursingprocedures, but we found that it could be used for muchlonger periods.

Ventilation with either alternative or combinedpositive and negative pressure can be provided easily,and we suggest that these methods should be furtherinvestigated.A simple method of splitting the front of the Both

respirator is described.We are most grateful to the staff of the Fazakerley Group

of Hospitals maintenance departments for their enthusiasticcoöperation in this work and for their technical skill. -

REFERENCES

Russell, W. R. (1952) Poliomyelitis. London.Smith, R. E. (1953) Lancet, i, 674.

New Inventions

DEREK FREETHM.D. Lond., M.R.C.O.G.

Crewe and South CheshireHospitals

IMPROVED PELVIC STAND FOR DOYEN’SRETRACTOR

THIS stand is designed for placing between the patient’sthighs and holds a Doyen’s retractor firmly in placewhen exposure is needed for pelvic and bladder operations.This support does away with the cumbersome chainand weights previously employed and has severaladvantages over a similar type used in Birmingham.The illustrated design is smaller than the Birminghampattern, is more easily sterilised, and has the advantagethat the height of the jaws can be adjusted before

insertion between the thighs, thus avoiding possiblecontamination from the skin in operations on fat women.The stand is usually wrapped in a sterile towel before

being placed between the thighs, to protect the vulvafrom any chance of bruising.The original stands were kindly made for me by Messrs.

Rolls Royce and I am indebted to Miss C. Jenner for theillustration. The instrument is now manufactured byMessrs. Chas. Thackray, of Leeds.

Reviews of Books

The Birmingham Hospitals CentreSTANLEY BABNES, M.D. Birm., F.R.C.P., LL.D., chairman ofthe executive board of the hospitals centre. Birmingham aStanford & Mann. 1952. Pp. 144. 15s.

THIS is the story of the building of the centre now thepride of Birmingham and the envy of medical professorsin this and other countries. Beginning with the originof the scheme Professor Barnes describes the troublesmet and overcome, the amalgamation of the Generaland the Queen’s Hospitals, and the formation of alimited company to organise the finance, control theexpenditure, and supervise the building. He tells ofthe completion of the great modern hospital now called" the Queen Elizabeth," of the Nuffield Nurses’ Home,and of the Medical School, and of their baptism of firein the second world war.

Among many generous donors and helpers three menstand pre-eminent in ability, devotion, and unwearying effort- the late Sir Charles Grant Robertson, then vice-chancellorof the university, Sir Harry Vincent, and Professor Barneshimself. It is regrettable that the scheme for a big hospitalcentre has in the last few years been in part spoilt. Land

presented to the city for the purpose of hospital developmenthas been used for the erection of some two hundred houses.Much of the detail makes fascinating reading and could havebeen expanded without loss of interest-the care taken toeliminate noise, the designing of a unit of 60 beds, the relativemerits of a many-storeyed building in contrast to one builton the pavilion system. The book is a wonderful tributeto a great scheme triumphantly carried through and wouldhave been a classic on the subject df hospital construction ifmore details had been given.

Human Blood Coagulation and its DisordersROSEMARY BIGGS, PH.D., M.D., graduate assistant,department of pathology ; R. G. MACFARLANE, M.A.,M.D., clinical pathologist, Radcliffe Infirmary, Oxford.Oxford : Blackwell Scientific Publications. 1953. Pp.406. 32s. 6d.

A FULL-LENGTH monograph on this subject is timely.Dr. Biggs and Dr. Macfarlane justly point out that thesubject and its complications can no longer be regardedwith tolerant detachment by the ordinary doctor." Blood coagulation research," they say,

" has led to thediscovery of a new vitamin, the recognition and treat-ment of a whole range of newly defined hæmorrhagicdiatheses ; it has raised problems in genetics andeugenics, introduced with all their attendant problemsanticoagulant drugs for the treatment of thrombosis,and has been concerned with many subsidiary develop-

1030

ments, such as synthetic resins and water repellentsurfaces." But existing published work on this subjectis bewildering :

" The number of aliases, false clues,conflicting statements and fallacious deductions to befound there would arouse the envy of the most prolificwriter of detective novels." The object of the authorsis " to reduce this profusion to the smallest possibleresidue of useful and sober facts ; to sort out the differentnames which really belong to the same thing, the differentthings which have the same name, the things whichprobably do exist from the things which probably do not,.and to present what is known about the probable waysin which the things which remain react together to

produce a clot," and it takes some 400 pages to presentthis residuum. Nevertheless we have nowhere seen itbetter or more clearly done. The book is divided intotwo parts : the first deals with the physiology of blood-clotting and some allied problems, the second withthe disorders of blood coagulation. Both sections aredivided into chapters at the end of which are most usefuloutline summaries. The first of three valuable appendicespresents a scheme for differential diagnosis of coagulationdefects, the starting-point being the determination ofthe " thromboplastin time " (old style prothrombin-time) ; the second gives properly detailed informationabout the preparation of reagents, and the third fulldescriptions of the techniques employed.

This book presents all schools fairly, glosses over nogaps, and gives the most readable and balanced accountof the subject available today.Les vomissements du nourrisson

EMILIO ROVIRALTA, head of the service of psediatricsurgery, Barcelona. Paris : Flammarion. 1952. Pp. 236.Fr. 1800.

- THIS monograph does not, as its title might suggest,deal comprehensively with all the causes of vomiting ininfancy, but only with those likely to be encountered bythe psediatric surgeon. The author places much value onradiography in the differential diagnosis of the variousconditions, and the book is well illustrated with repre-sentative radiographs. Pyloric stenosis naturally receivesa good deal of space, and the author has observed astriking coincidence of pyloric stenosis with partialintrathoracic stomach, to which he gives the name" syndrome phreno-pylorique." He favours medicaltreatment for hiatus herniae, with cesophageal dilatationif stenosis is severe. Among other conditions describedare volvulus of the stomach, oesophageal atresia, mal-rotations, and other congenital malformations of thegastro-intestinal tract. Most of the book is devoted todiagnosis, and it will be useful to physicians as well assurgeons who have to deal with babies.

National Health ServiceA Guide for Practitioners. Editor: MAX SORSBY,L.M.S.S.A., vice-chairman. Local Medical Committee,London. Edinburgh: E. & S. Livingstone. 1953. Pp.262. 12s. 6d.

EVEN after five years, many doctors in the N.H.S.have only a hazy idea of the administrative side, regardingit as a necessary evil, to be placated rather than under-stood. This book leaves little excuse for such an attitude.Those creatures of myth, the statutory bodies, here cometo life and are seen to be composed of a great manypublic-spirited men and women, both inside and outsidethe profession, who devote much time and trouble to thethankless task of administering the service. Not all willagree, however, with Dr. Sorsby’s somewhat gloomypicture of the decline of the status of the general practi-tioner, and he might have added a reminder that generalpractice is still very largely what the practitioner makes it.An account of the General Medical Services Cornmitteeand the British Medical Association is followed bv asection on the Special Services, which, as Sir Allen Daleynotes in his foreword, reminds doctors of how servicesneeded by their patients, but which they cannot providethemselves, can be obtained. Dr. Sorsby lists someremediable deficiencies and argues forcibly for relievingthe general practitioner from the responsibility forgetting acute cases into hospital. Such an extensiveorganisation as ours should surely be able to shoulderthis important part of the service, leaving the familydoctor freer to do his proper work.

Dr. Horace Joules, looking forward, suggests decentral-isation, with integration of all health and social welfareorganisations in all-purpose local health authorities, eachhandling a population of about a quarter of a million.Students, he says, should be taught along lines which willfit them more closely for their future work. He believesthat a salaried service will develop, and argues that alist of 3500 will preclude most doctors from giving morethan the minimum diagnostic and therapeutic services.Both these points are debatable.

Human Parasites and Parasitic DiseasesK. D. CHATTERJEE, M.D. Calcutta, visiting physicianR. G. Kar Medical College, Belgachia, Calcutta. 1952.Obtainable from Das Gupta and Co., 54, College Street,Calcutta, 12. Pp. 766. ;E6.

THE human parasites of the title are the protozoa andworms which are responsible for disease in man, and afew, like Endolimax nana, which are not, but which areimportant for differential diagnosis. The author describestheir structure and biology fully, and the clinical featuresof the diseases they cause, including treatment, in somedetail. He does not seriously discuss prevention andcontrol, except drug prophylaxis, and the sections ontransmission by arthropods are not always as compre-hensive as one would wish.Two other features are obvious to the reader. One is

that the author’s first love is for the protozoa., which aretreated and discussed more fully and effectively than theworms ; they get 469 pages and the worms 284. The otheris that parasites not found in India are not so well doneas those which the author obviously knows at first hand.The accounts of the trypanosomes, the schistosomes, andOnchocerea volvulus, for instance, fall far short of theexcellent studies on the amœbæ, leishmanise, and malariaparasites. With these reservations, however, the book isvery good. It is not the terse, dogmatic textbook ’soappealing to the undergraduate, but rather the compre-hensive treatise, the reference book, in which one mayfind accounts of the theories and movements of research,and descriptions of experiments. The long lists of refer-ences enhance the value of this book to research-workers.The writing is lucid and the subjects are set out anddiscussed in a clear and orderly manner. The illustrationsvary ; the photographs are in general excellent, but someof the coloured drawings (for instance that of Glossinapalpalis) are less successful. The production and printingare superb.

This is a major work which parasitologists will needand should have. For the next edition Dr. Chatterjeemight with advantage ask the collaboration ofauthors who have met the non-Indian conditions atfirst hand..

Society and the HomosexualGORDON WESTWOOD. London : Gollancz. 1952. Pp. 191.9s. 6d.

THE general tenor of this book is reminiscent ofHavelock Ellis : cool, descriptive, unprofessional, sociallyresponsible. The author is well read in the clinical andlegal literature of the subject, and has had -advice andguidance from Dr. Edward Glover. He makes a sustainedplea for more sympathy from the public and moreleniency from the law. Most impartial readers willagree with the author that, as things are, a prisonsentence is much more likely to do harm than good tohomosexual men.

Materia Medica, Pharmacology and Therapeutics(29th ed. London: J. & A. Churchill. 1952. Pp. 512. 208.).-Dr. A. H. Douthwaite took over this popular veteran from theoriginal author, Sir William Hale-White, in 1931 ; and he hasagain smartened up his charge. For example, news of theantibiotics, anti-histamines, A.C.T.H.’,- cortisone, and the methonium compounds has been deftly introduced as part ofthe revision. Some (they will not be students) may mournthe almost complete elimination of pharmacognosy; for theemphasis is now on pharmacology and therapeutics, with anice tribute to Sir William and a less bustling age in theretention of Materia Medica in the title. The regularity witliwhich a new edition has been called for through the yearsdemonstrates the trust of generations.