66

REVIEWS OF NEW BOOKS. A Hiatory of Medicine. B y DOUGLAS G~rTHItIE, Nelson. 30/- ne t t .

T h a t br i l l iant , but bru ta l i n s t i t u t i on , Mr. George B e r n a r d Shaw, greeted the a p p e a r a n c e of Dr . Guthr ie ' e excel lent e p i t o m e of me~Aieal h i s to ry w i th a p l ay fu l sp l a sh of his wel l -known odium ~ d i c u m . F r o m t h e v a n t a g e - p o i n t of vene rab le age, he b u o y a n t l y descr ibes h imse l f as "" f loored b y t h e e x t r a o r d i n a r y d i s c r epancy b e t w e e n his h i s t o r y a n d m y knowledge ." Mr. S h a w ' s lm, owledge of m e d i c i n e - - a s d sp l ayed in a t h r e e - c o l u m n review sc in t i l la t ing w i t h a succession of S h a v l a n pe rve r s l~ms- - l s of such n a t u r e as to call to m i n d t h e g o o d - n a t u r e d g r u m b l e of t h e A m e r i c a n edi tor who " d i d n ' t m i n d a cor respondent be ing p l u m b ignoran t ; t h e real t roub le he h a d was wi th t h e g u y who knew a lot o f t h i n g s t h a t w e r e n ' t so ."

The n u m b e r o f medical fac ts t h a t w e r e n ' t so which Mr. Shaw b l a n d l y passes on to a n a d m i r i n g publ ic even m o r e i n n o c e n t of medica l h i s to ry t h a n h imse l f is indeed amaz ing . H e wri tes wi th obvious rel ish o f t h e doctor ' s d i l emmas , b u t no s u c h d i l emmas beset his m a n i f e s t de t e rmina t ion to t ickle t h e groundl ings , nor does he scruple to i m p a r t d e m o n s t r a b l y false i n fo rma t ion so long as t h e agreeable t i t i l la t ion m a y cont inue . W e who are o n t h e Regis te r k n o w t h a t t h e (so-called) Genera l Medical Council is n o t a T r a d e s U n i o n , a n d m a y let i t p a s s a t t h a t . B u t to describe L i s te r as " b l u n d e r i n g into an t i sep t ic s u r g e r y " is to be t r ay , n o t Lis ter , b u t his cri t ic as " a sha l low reasone r a n d a m a l a d r o i t opera tor " of t h e E n g l i s h language. E v e r y science h a s benef i ted in the p a s t f r o m h a p p y accident , b u t sure ly l~Ir. Shaw of all m e n shou ld k n o w t h a t n o t h i n g of consequence h a s ever been t h u s easi ly accompl ished . L i s te r ' s f o rmidab l e a n t a g o n i s t , L a w s o n Ta i l , Mr. Shaw a d m i t s he n e v e r know, b u t he " k n e w a f r i end of his who ta lked a good deal a b o u t h i m , " u p o n w h i c h impregnab le rock o f a u t h o r i t y he bui lds his c o n t e m p t for L i s te r ' s °' b e d e v i l m e n t " of surgery , p roceed ing t h e r e f r o m wi th superb a s s u r a n c e to hail W r i g h t ' s " p ipe -wate r wi th t en per cent . o f sa l t in it " as t h e s t a n d a r d i s e d t r e a t m e n t of w o u n d s t o - d a y in Eng land . A n d so on , for th ree co lumns as full o f puck i sh pervers ion of ascer ta inab le fac t as ever were u t t e r e d by a T u d o r Cour t jes ter . P r e t t y ~ a n n y ' s first w a y doub t less d i d t ickle, b u t s u c h m e n o p a u s a l a rchness , one is free to consider, l a te r p r o v e d t i resome to t he l ady ' s con tempora r ies . A n d t h e r e p e a t e d gibe of " overpower ing pecun ia ry in t e res t "" a~ad "" profess iona l economic b ias " comes wi th par t i cu la r grace f r o m the cri t ic whose tr~v/a ca r ry t he p e n n y - g r u b b i n g subsc r ip t ion in i talics (World Copyright). The lowly med ica l reviewer c a n n o t res is t t h e t e m p t a t i o n to p a r a p h r a s e Ches te r ton : " Chuck it , P ' S h a w ! "

I n one respect , Mr. Shaw is n o t whol ly in error. Dr. Guthr ie h a s n o t wr i t t en a history of medicine , no t , a t least , in t h e sense in wh ich a Gur l t or a N c u b u r g e r would h a v e used t h e t e r m . B u t - - ~ a c e Mr. S h a w - - t h e prac t ice of medic ine is s o m e t h i n g more t h a n a luc ra t ive t echn ica l accompl i shmen t , a n d m o d e r n medic ine h a s a long a n d honourab le historical b a c k g r o u n d . Our Univers i t i es do n o t inc lude t he s y s t e m a t i c t each ing o f medical h i s t o r y in t h e s t u d e n t ' s heav i ly loaded cur r i cu lum, b u t Dr . Gu th r i e has here p rov ided for t h o s e incl ined to s t u d y i ts evo lu t ion a n eas i ly r e ad a n d s t i m u l a t i n g out l ine o f t h e m a j o r p h a s e s o f i t s d e v e l o p m e n t a n d of t h e m e n whose spade work bui l t u p i ts success ive s tages. The s t u d e n t or prac t i t ioner who is so f o r t u n a t e as to s t a r t w i t h Dr . G u t h r i e ' s accoun t will f ind h h n s e l f s t i m u l a t e d to f u r t he r enqu i ry , a n d h is reading will be accura te ly gu ided b y t h e well-chosen b ib l iography se t fo r th a t t h e conclus ion o f each chapter . B r i t i s h - - a n d I r i s h - - m e n of science h a v e in t he p a s t c o n t r i b u t e d the i r q u o t a of pioneers to t h e progress o f our a r t , a n d all o b t a i n here due a n d h o n o u r a b l e men t ion . Dr. Gu th r i e ' s book is a n ideal gif t for a n y pup i l or col league who h a s an h is tor ica l b e n t a n d would k n o w t h e s to ry of his craft , W,D .

Ar~alysi, s a.ud l~terpretatio~ of Symptoms. Ed. b y C. M. I~ACBRYDE- Lipp ineo t t . 25[-. This u n u s u a l h o o k consis ts o f e leven c h a p t e r s b y different a u t h o r s on special ly

selected s y m p t o m s . T h e objec t of t h e edi tor is to discuss t he c o m m o n e s t s y m p t o m s which b r ing p a t i e n t s to a doctor, so t h a t t h e app roach to inves t iga t iou shou ld be based on a p roper i n t e rp re t a t i on of t h e h is tory .

T h e idea is excel lent , b u t i t s express ion in t h e f o r m of a t e x t b o o k is n o t easy. I t is essent ia l ly a n a t t e m p t to learn different ial diagnosis quickly a n d painlessly, b u t differential d iagnos is is t h e m o s t difficult s tep for s t uden t s in med ica l educa t ion a n d m a n y g r a d u a t e s do n o t consider t h e y achieve a n y faci l i ty in i t u n t i l s o m e yea r s a f te r qualif ication.

T h e ind iv idua l chap te r s v a r y a good deal in the i r excellence, a s s o m e o f t h e sub jec t s chosen do n o t l end themse lves to th i s approach . F a t i gue a n d ner~.ousness are ideal types , as t h e y a r e c o m m o n compla in t s wh ich recewe cu r t a t t e n t m n m tex tbooks . " F e v e r , " " j aund ice " or " obes i ty " a re less easi ly t r ea ted , a n d m o s t of t he mate r ia l in these c h a p t e r s is readi ly ob ta inable in a s t a n d a r d t ex tbook of medicine . I t is sig- nif icant t h a t t h e ~ections of m o s t in te res t a re those con ta in ing m u c h appl ied a n a t o m y a n d phys io logy.

REVIEWS OF NEW BOOKS 67

I t is not likely tha t this work will be used extensively by s tudents , bu t clinical teachers will be both interested and repaid by even glancing through it. Each chapter represents a common topic for a clinic, pu t in an at tract ive form, while a useful biblio- graphy is appended. Possibly it presages a new type of textbook much larger in scope than this which would deal with the symptomatology of disease along scientific lines. We are a long way from this, as the majori ty of our symptoms still defy an accurate analysis in terms of morbid ana tomy or physiology. D.K.O'D.

Essentials of Allergy. By L. H. CRIm'. Lippincott. 30/-. This small but highly condensed book contains a good deal more than the essentials.

The author preserves a sane and orthodox outlook throughout and his book is easily one of the best of its type available. For an Irish reader some of the elimination diets are positively exotic, and certainly could not be produced under the present emergency conditions. While paper space is economised in the mos t rigid fashion, it is surprising tha t some diets are repe~ted three t imes in full in one chapter. A futile photograph of removal of blood from a vein is also included.

The author wisely condemns the use of morphine in allergic as thma, the use of which is still relied upon by some Irish practitioners. He also rationally assesses the use of nasal surgery and sulpha drugs in as thma. The dose of adrenalin recommended is amazingly small, being 0"2 to 0-5 c.c. of 1 in 1,000 solution, and he ignores the Hurs t technique of repeated injections with the needle in situ.

By present s tandards the book is very reasonably priced and can be safely recom- mended to graduates rea~ling for higher degrees or general practitioners interested in a subject of increasing significance to their patients. D.K.O'D.

Demonstrations of Operative Surgery for Nurses. By H. BAILEY. Livingstone. 21l-. Mr. Bailey is a strong believer in the t ru th of the Chinese proverb tha t "' one picture

is worth a thousand words." His use of the vivid picture coupled with a m i n i mu m of explanatory text is now familiar to m a n y hmldreds of s tudents and house officers ; in this book he has performed a similar service for the theatre sister with graphic illustrations of theatre technique. Not all his colleagues will agree with his choice of operations for description---outstanding omissions are the techniques of spinal analgesia and of the insertion of the Smith-Petorsen pin, and others could be men t ioned- -bu t , apar t from this minor criticism his latest volume will gain h im the grat i tude of m a n y nurses whose special work is in our operating theatres. As usual , his publishers have served him excellently well in every detail. W.D.

Aviation Neuro.Psychiatry. By IRO~rSlDE AlqD BATCHELOR. Livingstone. 8]6. Aviators, even mil i tant ones, suffer from similar menta l and neurological complaint~

to terrestrians, and there are no particular " acre-neuroses." In this very readable and practical book the authors have omphasisod t h a t exposure to danger is the mos t impor tan t of all environmental stresses in the production of neurosis ; physical causal factors are infrequently of first importance, bu t m a y provide a period for reflection, when fear m a y grow to neurotic proportions. The development of psychosis during a flying career is a rare occurrence; a schizophrenic reaction is the least uncommon.

The writer 's t rea tment appears to have boon a groat deal simpler than in civilian cases, h u t it had to be severely practical. Permanent grounding is recommended in practically every case, though " certain conscientious but nem~otic persons with great flying ap t i tude and experience are able to continue rout ine flying for m a n y years, doubtless protected by their excessive caution."

There are interesting chapters on neurotic visual disorders and migraine which deserve a wider audience. Wri t ten on wartime experience and for air force personnel, th is book is a valuable record and guide, bu t it will require considerable modification for peace-time aviators and is probably out-of-date for atomic aerial warfare.

H.J .E.

The Premature Baby. By V. MARY CROSSE. Churchill. 10/6. A hospital uni t for the care of premature babies was opened by the Public Hea l th

Authorit ies in Bi rmingham in 1931, and Doctor Mary Crosse was put in charge. She set out to evolve a sys tem which would reduce the mortal i ty amongst premature infants. This book is a record of the almost unprecedented success which she has a t ta ined a n d of the methods which she used. The keynote of these methods is simplicity. They are equally applicable to the homo and to the hospital.

The book contains a wealth of detail. Each stop, f rom the commencement of labour until the infant m a y be regarded as " n o r m a l , " is described with thoroughness and clarity. The sections on feeding, nee-natal infections and birth injuries are very well done and apply equally to the full te rm baby. Erythroblastosis fcetalis is described in an up-to-date manner and the fact (not usual ly found in s tandard text-books) tha t R h agglutinins are secreted in the breast milk, is noted.

68 IRISH JOURNAL OF MEDICAL SCIENCE

The work concludes with an appendix, which is in fact a statistical report of 14 years ' work of the Premature Baby Uni t of the Bi rmingham City Maternity Home. These statistics will convince even the most sceptical t h a t Dr. Crosse's methods are worthy of trial. The book can be recommended with confidence to all interested in the care of the premature infant. T.M.K.

Transactions of ~/~e Amer'can Gynecological Society. Volume 68, 1944. C . V . Mosby & Co., St. Louis,

This volume is compiled in the customary fashion, and the paper, printing, binding and general production is of the usual high standard. I t contains some 20 communica- tions which are mainly of a clinical, as distinct from a scientific, nature.

.The President (G. W. Kosmak} chose for his address an abstract and coutreversial subject which he entitled " W o m a n in This Changing World." He handles this volatile subject with such tac t and unders tanding tha t he will receive little advorso criticism, while all should agree with h im tha t " it wotfld prove a dull, drab and weary world if she no longer mainta ined tha t position of love and respect and admirat ion which is her due."

Two lJapers dealing with the t rea tment of eclampsia are well worth s tudying. They contrast greatly in m a n y ways and display conflicting views in the approach to the whole sub jec t - - the interpretat ion of symptoms and the line of t reatment . However for tunate Dr. Arnell m a y have been in his series of cases, he is to be mos t heartily congratulated on his results.

There are two papers on an te -par tum h~emorrhage, one on accidental h~emorrhage and one on placenta pr~evia. They review series of cases and discuss mainly the treat- ment . Cervical cancer receives a t tent ion from two authors. One deals with a pathological s tudy of 26 cases associated with pregnancy, the other discusses the earliest possible diagnosis of the lesion and" goes on to discuss t reatment .

The distribution and metabol ism of glycogen in the reproductive t ract . is describe4 and discussed in a very interesting paper by E. G. Hughes. He demonstra tes the cyclical changes tha t take place in the glycogen content of the endometr inm, and

i t s effects on sterility and abortion. He further discusses the interrelaoion between the ovarian hormones and glycogen metabolism in this location. He has made an impor tan t contribution to research into the causes of sterility and abortion.

The remaining papers are of the usual high s tandard and will provide interesting and instrnctive reading. J.F.C.

Surgery of the Ha~wl. By S T E R i l e BUNN~LL. Lii~pincott. 72/-. The author of this mono~oTaph presents a comprehensive account of the hand in

heal th and disease. A complete description is given of the embryological and phylo- genetic development of the hand, followed by an analysis of the normal movements and mechanics of the hand and upper arm. He gives an excellent account of the reconstructive surgery of the injured t issues--skin, tendons, nerves, etc. : also of the effects on the hand of injuries to the arm and forearm. There are chapters on injuries and infections of the hand, followed by an interesting section on congenital deformities, with a discussion of their ~etiolegy. This handbook is excellently produced, and very clearly illustrated with photographs and diagrams. The diagrams of operative technique will be found very helpful. Dr. Bmanell's accounts of his results in tendon sutur ing are remarkable. For this he is using stainless wire sutures .

This book is a valuable additicJu to the already extensive literature on the hand, and will be read with great benefit by surgeons interested in this subject. F.D.

A Class Book of Practical Embryology. B y P. N. B. ODaE~S. Oxford Medical Publications. 7/6.

The book consists of a series of rough il lustrations of sections of 6ram. and 10mm. pig embryos with a key to each diagram on the opposite page. Twenty-seven sections are used, twelve of the 6mm. stage, and the remaining fifteen of the 10ram. stage. The sections have been selected to cover the salient features of the entire embyres. The drawings are mere outline wi thout any a t t e m p t being made to represent the actual appearance of a n y part icular structure.

FQr the beginner the book migh t be of some value as a first step, bu t one wonders whether it was worth the trouble the author pu t into its preparation. In a more extended form such a work would be of use to s tudents of embryology. E.K.