BOOK REVIEWS

Anaesthesia for Infants and Children. By ROBERT M. SMITH. The C. V. Mosby Co., St. Louis, $13"50.

The first edition of this book appeared in 1959, the author being head of the anaesthesi- elegy service of the Children's Medical Centre, Boston, Mass., with wide experience in the field of paediatric anaesthesia. At tha t time most information and articles on the subject of paediatric anaesthesia, were scattered through the various textbooks and journals, consequently publication of this book filled a long felt want in the literature.

The second edition appeared four years later. During tha t t ime there have been many changes and advances in the subject. These have been described and noted in a thoroughly revised and re-edited edition. Topics such as profound hypothermia, improved methods of resuscitation, methodsof prolonged ventilation, are discussed. Theory is not neglected and one of the most valuable chapters in the book is that on respiratory physiology by Dr. Charles Cook, which also has been revised and recent findings added.

Halothane has received much a t tent ion in this edition. I t would appear to have replaced ether as anaesthetic agent of choice on many occasions. I t does appear to be a valuable agent, but whether in view of its reported liver toxicity, it will maintain its popularity, remains to be seen. I t is interesting to note that the sequence of thiopentone relaxant, gas/oxygen, controlled respiration, so commonly used in Britain, is less often used in the States, where the emphasis seems to be more on spontaneous breathing, with agents such as ether, eyelopropane, and halothane.

This book is beautifully pr inted and bound, and contains many fine illustrations and photographs. EVELYN GALLAOHER.

An Outline of Pulmonary Function and Pulmonary Emphysema. By E. ROSEI~MA~, M . D . C . C . Thomas, Illinois. $6.50.

The author has a t tempted to: summarise, in this small book, all~ the relevant infor- mat ion on pulmonary function tests for the past fifteen years, ending with the diagnosis and t rea tment of emphysema. As a result the reader is presented with a series of facts which would be rather bewildering to the uninitiated. For those who have already some knowledge of the subject, this book presents a useful outline of the possible physiological findings and t reatment of emphysema. I t ends with a summary of the already con- densed material which could be called " Instant pulmonary function ". A few more diagrams would make the book more readable.

I t should be of help to clinicians with some knowledge of the subject, to place pul- monary function reports in their proper perspective. T . T . CHAPMAN.

Pulmonary Function in Clinical Medicine. By B. H. BASS, M . D . C . C . Thomas, Illinois. $4.75.

This book is designed to give physicians a clear concept of the nature of modern pulmonary function tests and their application to clinical medicine. I t is beautifully concise and manages, in about 60 pages, to give the reader a balanced picture of the subject while avoiding the pitfalls of physiological speculation.

This well illustrated and clearly wri t ten little book is, in my opinion, the best book available for the clinician who wishes to acquire enough knowledge of the subject to t reat his pat ient on physiological principles. T . T . CH~-PMAN,

Neurologic Manifestation~ of General Diseases. By Prof. J. A. AITA. Charles C. Thomas, Illinois. 1964. $24.50.

Human pathology, like the map of the world, has changed bewilderingly : syphilis is no longer an empire, nor poliomyelitis a kingdom ; bronchitis and bronchial neo- plasms occupy terri tory where the pneumonias held sway and the lat ter have retired to an archipelago where navigation is infinitely difficult. Fur ther re-grouping has occurred within the sub-speclalities of medicine, surgery and obstetr ics: Wilson's disease is known to be a disorder of metabolism ; the clue to an orthopaedic problem may be a renal tubular defect ; surgeons and cardiac-physiologists dominate hitherto incurable heart condit ions; cervical spondylosis established as a disease enti ty by neurologists, remains, as far as management is concerned, an area of dispute.

As old frontiers are re-drawn the artificiality of every boundary is apparent. A World State in pathology as in politics is the ultimate answer. But citizens of a World State will not despise local government and some virtues must be conceded to both nationalism and specialism. To the later considerable accretions of knowledge are due.

The conventional terrain of neurology has been extended to include nervous derange- ment occurring in the course of, or heralding, general diseases. The related literature is now so prolific that Prof. Aita 's book is timely.

I t is a large, expensive, scholarly book and years of work must have gone to its compilation. Out of respect for such a book and its author a reviewer should neither shower unlimited praise upon it, nor find fault uneonstructively. At the outset, in fairness, it should be asked : What has the author set out to do and has he done it ?

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102 IRISH JOURNAL OF MEDICAL SCIENCE

Prof. Aita 's book " represents an a t t empt to gather, to catalogue, and to describe briefly the neurological manifestations of general, medical, surgical and other speciality diseases . . . . "

He has been unprecedentally industrious in his gathering, exhaustive in his catalogu- ing and sometimes all too brief in his clinical descriptions. I f one ventures to suggest that the value of the book might be enhanced by less extensive cataloguing.and greater neurological detail, one does so with the feeling that it will become a major work-of- reference and that the necessity for further editions may permit such alteration.

The fashion of piling reference upon reference---for surely i t is a fashion--is com- paratively recent. Gowers gave few references avd Osler fewer in their famous text- books. Sooner or later the pendulum will swing back, but meanwhile by increasing the size and cost of books the present otherwise harmless custom is in many cases a dis- service.

In a book of the type under review the space allotted to bibliography must, of course, be generous, but when it is found tha t some chapters contain nearly as many pages of references as of tex t the question of proportion must be raised. Parkinson's law is no t without relevance to medical bibliography. A short selective list of references would suffice for every article consulted will supply an additional bibliography.

Vastly more important in making or marring the book is the space allotted by the author to clinical details. One seems to look in vain for the information one would wish to find. The facts given regarding encephalitis in sarcoidosis, for instance, are so brief as to be unhelpful. Panereatitis, to cite another example, occasionally presents with cerebral symptoms predominating, but this is merely stated and the clinician is afforded no constructive suggestions as to how to anticipate a post-mortem diagnosis. Three-quarters of a page is allotted to the general features of Sjoegren's syndrome ; two lines to its neural complications.

As a text-book of general medicine for neurologists it is excellent, but because many excellent text-books of general medicine already exist one may wonder if the author 's admirable conception would not be bet ter served by high-lighting the features of nervous derangement (by the inclusion of case records if necessary), instead of obscuring them by elaborate descriptions of the primary diseases.

A minor criticism directed to the publishers is that throughout an entire chapter, presumably to facilitate their type-setters and suit the length of a page-heading, they have used a heading which is ugly if not meaningless, viz., Neurologic Manifestations of Hematologic.

Prof. Aim waives any claim to have reported " a l l of the neurologic manifestations of a/1 of the diseases which beset the human organism," and solicits comments and suggestions concerning what has been overlooked. One rar i ty which is not included is the association of tendon, xanthoma and nervous disease which was described by Van Bogaert and his celleagues in 1937. A similar case was recorded in the Journal of the It/s/, Med/ca/ Assoa-'~atbm in 1955. J . B . LYoNs.

The Temiooromand/bu/ar Jo/~$. Second Edition. Edi ted by BERNARD G. SARNAT, M.D. Illinois : Charles C. Thomas. Price $12.5.

This book eonsists of ten chapters contributed by nine specialists and each chapter is complete in itself.

The book is especially directed to maxillofacial surgeons and orthodontists, but the less speclalised surgeon will find much to interest him especially the chapters on x-ray technique of the temporomandibular joint and the mandibular movement as an aid in diagnosis.

The chapter on surgery of the joint is both concise and informative, but it seems to the reviewer a pi ty that the writer of the most important section has not developed in greater detail and with more clarity the possible approaches to expose s~iequately this joint encumbered as it is by the facial nerve and the parotid gland.

This will surely be the standard book of reference relating to this structure. As is inevitable the price for readers on this side of the Atlantic ocean is not cheap.

J. C. CHERRY.

A Practical Manual for the Treatn~nt of B u ~ . By ELI RUSH ChEws, M.D., M.S. Charles C. Thomas, Springfield, Illinois, U.S.A. $6.75.

This essentially practical book covers, in little over 100 pages, the important aspects of the modern management of burns.

Having specialised in the t reatment of burns for many years the author speaks with lucidity on every aspect of the problem from first aid onwards.

As one would expect the problem of fluid, colloid and electrolyte replacement is dealt with in detail. In this respect the author illustrates a " Metabolism Chart " for use in serious burns ; this allows an easy check on input, output, vital signs and haematoorit from hour to hour.

The views expressed regarding the local t reatment of the burnt area are the same as practised in this country, exposure being in general the commonest treatment, except

BOOK REVIEWS 103

for t he h a n d a n d some c i r cumfe ren t i a l l imb bu rns . I t is i n t e r e s t i ng to no t e t h a t e n z y m e d e b r i d e m e n t h a s been o f no prac t ica l va l ue in c l ean ing u p a n a rea pr ior to graf t ing .

The p r o b l e m of n u t r i t i o n is dea l t wi th , pa r t i cu la r ly in t h e la te r s t ages of t he b u r n w h e n t he i m m e d i a t e h a z a r d s o f f luid r e p l a c e m e n t have b e e n rep laced b y t he u s u a l n e g a t i v e n i t r o g e n ba lance .

The u se o f h y p n o s i s in e n c o u r a g i n g t he pa t i en t to ea t m i g h t well become of real va lue in a m o d e r n b u r n s un i t .

The book ends w i t h a sec t ion devo t ed to the n u r s i n g care o f b u r n s in wh ich al l t h e e s s en t i a l p rob l ems are c lear ly exp la ined , inc lud ing such a spec t s as t r a c h e o s t o m y m a n a g e m e n t .

The book can be r e c o m m e n d e d w i t h confidence to t he i n t e r n invo lved wi th b u r n s m a n a g e m e n t , or to those i n t e r e s t e d in the p l a n n i n g o f a b u r n s un i t .

D. MAYlgE.

Accident Injuries of the Conjoined .Femur. B y JACOB KULOWSKI, M.D., F.A.C.S. 1964, I l l inois : Char les C. T h o m a s . $12.50.

Th i s l i t t le book is based on the a u t h o r ' s exper ience over the per iod 1947-1960. The pr inc ipa l ma t e r i a l cons i s t ed of 352 medica l case records o f in ju r ies o f the conjo ined f emur . Mr. Ku lowsk i u s e s t he t e r m " conjo ined f e m u r " to ind ica te the t r i ad con- f igura t ion o f the f em ur a n d i t s r e s t r a in ing a r t i cu la t ions a t the h ip a n d knee. He d i s cus se s in ju r i e s to th i s region f rom b o t h t he medica l a n d eng inee r ing a s p e c t s : m e t h o d s o f t r e a t m e n t a re mere ly out l ined, t he m a i n purpose o f t he book be ing to correlate i n j u r y p a t t e r n s w i t h p r e s e n t d a y m o t o r acc iden ts . The a u t h o r se t s o u t to p roduce a work o f va lue to cl inicians, engineers , and medico- legal assessors . I n th i s he v e r y nea r ly succeeds. Pe r sona l l y I found the va r i ous eng inee r ing pr inciples r a t he r difficult to follow a n d feel t h a t the n o n - m e d i c a l readers wou l d h a v e s imi la r t roub le w i t h t he or thopaedic m e t h o d s descr ibed .

The v a r i o u s p h o t o g r a p h s a n d i l l u s t r a t ions were well se lec ted a n d beau t i fu l ly r e p r o d u c e d a n d all t he references h a v e been ve ry sens ib ly classif ied a n d l is ted a t the end o f t he book.

On t he whole, th i s is a use fu l book, which can be r e c o m m e n d e d pa r t i cu la r ly to all i n t e r e s t ed in acc iden t p r even t ion .

PATRICK M.AcAULEY.

Thrombophlebitis. B y J. EARLE ESTES, I~r M.D. I l l inois : Char les C. T h o m a s . $4.50. I n the preface, the a u t h o r m a k e s clear t h a t t h i s l i t t le book of 64 pages , is a m o n o g r a p h

o f h i s pe r sona l c o m p r e h e n s i o n of t he p rob lem of t h romboph leb i t i s . I t is wr i t t en for t he benef i t o f s t u d e n t s a n d p h y s i c i a n s conf ron ted b y the cha l lenge o f t h romboph leb i t i s . The m o n o g r a p h is based on t he pe r sona l exper ience o f t he a u t h o r ob ta ined over a per iod o f e igh teen years .

The to ta l absence o f a b ib l i og raphy a n d the lack o f d i a g r a m s a n d i l lus t ra t ions r a the r t ake a w a y f rom th i s book on a sub jec t t h a t l ends i t se l f a d m i r a b l y to such s u p p o r t i n g ev idence . However , the five t ab les dea l ing w i t h blood c lo t t i ng m e c h a n i s m s are ve ry c lear a n d unde r s t andab l e . The re is a concise a c c o u n t o f the bas ic concep t s a n d cl inical s y n d r o m e s o f t h romboph leb i t i s . The re is a ra t iona l modus operandi proposed for t r ea t - m e n t a n d a ba lanced a p p r o a c h to a n t i c o a g u l a n t t he r apy . However , w i th the p roposed " goa l s o f t h e r a p y to be prac t ica l , safe a n d economica l " one wonde r s w h y he h a s n o t t r i ed s imple compress ion a n d a m b u l a t i o n as advoca t ed b y some, i n s t ead of d i sca rd ing i t as ineffect ive a p p a r e n t l y w i t h o u t t r y i n g it.

I n conc lus ion th i s book is w r i t t e n in a n ea sy a n d readab le s ty le a n d dea ls a d e q u a t e l y w i t h a m u c h d i scussed p rob lem.

DERMOT E. FITZGEI~ALD.

A Synopsis of Cardiology. B y I). WEITZ~AN, M.D. J o h n W r i g h t & Sons Ltd . , Br is to l . 30s.

Th i s m o n o g r a p h is der ived f rom t he sec t ion on h e a r t d i sease in T i d y ' s Synopsis of Medicine. I t h a s been b r o u g h t u p to da t e and now fo rms a h a n d y a n d rel iable source o f re ference for the prac t i t ioner . B e c a u s e the whole sub jec t h a s been comprehens ive ly a n d r ecen t l y covered, i t is n a t u r a l t h a t the m o n o g r a p h shou ld have a r a the r te rse a n d i m p e r s o n a l s ty le . I t therefore m a k e s dul l reading , b u t t h i s d i s a d v a n t a g e seems to be difficult to avo id when such a wide sub j ec t is so brief ly a n d y e t so efficiently covered. Dr . W e i t z m a n ' s m o n o g r a p h m a k e s a use fu l add i t i on to W r i g h t ' s Synops i s Series.

RISTEARD MULCA~[Y.

Chemistry and Treatment of Adrenocortical Diseases. B y F. T. J . PRU~TY. C. C. T h o m a s . P r ice $14.00.

Th i s m o n o g r a p h in the ser ies o f A m e r i c a n L ec t u r e s in L iv ing C h e m i s t r y is a m i x t u r e o f t he phys io logy a n d b i o c h e m i s t r y o f the ad rena l s w i th cl inical medic ine . The cl inical f ea tu res are n o t e m p h a s i s e d a n d th i s is wise because l i t t le h a s been added on t he se

104 m~sH JOURNAL OF MEDICAL SCIENCE

lines in recent years. Prof. P run ty makes an excellent effort to assist the clinician to find his way through the maze of modern steroid chemistry and is perhaps more successful than any recent author. The title may inhibit clinicians handling this book and i t is therefore only reasonable to emphasise tha t the final objective throughout is the definition of the progress of medicine. Thus the reader will be rewarded with the best available survey of the diagnosis and t reatment of Cushing's Syndrome. There are no flamboyant coloured plates of plethoric facies nor startling pictures of the patient before and after treatment. These welcome omissions may explain why a book of almost 400 pages and 1,100 references, published in America, is nevertheless marketed for such a reasonable price.

The book has one other pleasant feature in tha t being devoted to fundamental problems i t is less likely to become quickly out-dated. The list of references covers all the post-war development and extends up to late in 1962. An hiatus of two years or even more is a necessary but endurable evil in a subject such as this.

The reviewer differs from the author in some of the guiding principles of therapy which are advised. Few will agree tha t monthly injections of deoxycorticosterone t r imethyl acetate are necessary or advisable for long-term t rea tment of Addison's disease. Nor will every author agree that routine est imations of serum sodium and p o t a ~ u m are necessary except in special circumstances. However, such differences of custom are almost inherent in the practice of medicine. This book is considered a necessity for physicians interested in endocrine disease, i t is advised for all clinicians and teachers of medical physiology would benefit by reading it.

D. K. O'DosovA~.

Narcotics and Narcotic Antagonists. F. F. Foldes, M. Swerdlow and E. S. Siker. Ct~rles C. Thomas. 1964. $11.75.

The bibliography contains 1575 references and the index ("which holds the eel of science by the tail") contains nearly 3,000. The authors have included almost every known narcotic drug and their 280 pages contain a good deal of sound sense. No doubt the cost of making blocks for the chemical formulae was high, but all the same the price seems rather high for a book of about 80,000 words.

R. H. Mmxs.

Teztboolr of Obstet/rics. By Jomr F. CUN~I~CG~A~. Fourth Edition. William Heinemarm, London, 60/-.

Th~ ed/bion of Professor Cunningham's textbook is basically similar to its successful ~ r e , with the additional benefits of a complete revision by the author 's eolI~Suesl~t . t l~ N~tiomd M~ternity Hospital.

Im~ludlng, as i t does, ~I1 the information required for the final examination and pre~nted in a~t easily a~mimilable, concise manner, it will surely retain the popularity exhibited byea~lier editions, espeoially amongst the undergraduate students for whom it is mn, inly intended,

IVlZCHAEL SOLO~ONS.

Acc~s and E~r A b d o m ~ Buryery. By HUGH A. F. DUDLEY and PETER F. JO~ES. Lloyd--Luke Medical Books Ltd. 25/-.

The making and elosttre of mbdominal incisions have always been of paramount importance to the trainee smegeon ~md registrars in hospitals, and as access and exposure is the key to successful surgery, this unique little book (140 pages) will fill a very important role in this domain.

The first part deals with general principles of abdominal incisions, their closure and heal ing--par t two with the minutiae and par t three with the choice of incisions.

While one may not agree wi th some of the procedures advocated, this book is never- theless stimulating and instructive and worthy of inclusion in the library, especially of the younger surgeon. The illustrations are outstanding and at 25 shillings it is excellent value.

HAROLD H. BROWI~TE.

Human Foetal and NeonaSal Circula$1on. By LI~D, S~RN & WEGE~US. C. C. Thomas. $5.75.

The work of many physiologists has contributed to the present knowledge of the mammalian foetal circulation and its adaptat ion to the requirements of independent existence at birth. Barcroft and Davies have been particularly active in this field and the study of animal physiology has been speculatively applied to the human foetus. Lind and his colleagues now produce direct experimental evidence concerning cardio- respiratory problems in the human foetus. The principal technique used is that of cine-angiography, outlining the course of the circulation by the injection of radio- opaque dye.

The publication is a slim book but the tex t is mainly a description of the findings

BOOK REVIEWS 105

on 78 x-ray frames illustrating the path of the circulation in the foetus and in the neonate. Those from the age of 12 weeks were s tudiedand striking confirmation was obtained of traditional teaching concerning the course of the circulation. In particular the authors confirm the division of the inferior vena caval flow into independent right and left streams, the latter being the most highly oxygenated as it has been shunted directly from the umbilical vein into the inferior vena eava through the ductus venosus. The diversion of the oxygenated left half of the inferior vena caval blood through the foramen ovals into the left atrium, ventricle and ultimately into the cerebral circulation is elegantly shown.

This book will be the standard reference work on the subject and it should be studied by every teacher of physiology, embryology, obstetrics and neonatal paediatrics.

CONOR WA~D.

Post.Lumber Puncture Headaches. By W. W. TOURTELLOTTE, A. F. HAERER, G. L. I~ELLER and J. E. SOMERS. Pp. 120. Thomas, 1964. No price given.

In the first section of this book 188 publications on post-lumbar puncture headaches are reviewed. The general incidence in diagnostic puncture is 33 per cent. The incidence in spinal anaesthesia is 10--18 per cent. The difference is unexplained. Further sections report observations on diagnostic puncture in volunteers, various neurological cases in pat ients with multiple sclerosis. In all of these the incidence was about 30 per cent.

No new facts emerge. The authors recommend "perhaps a strictly recumbent regime for 24 hours" despite their findings that bed rest did not affect the incidence or severity of headaches. They found that a smaller needle results in less severe headache, but not a smaller incidence. I~ydration was not investigated, but the literature suggests it is helpful. Elevation of the foot of the bed is not mentioned. The view that the headache is clue to C.S.F. leakage from the dural hole with consequent low spinal pressure, sagging of the brain in the upright position and transaction on pain sensitive structures is supported.

'["nis is a useful review. The text is very repetitive. EDWARD A. MARTIIq.

Infectious Diseases of Children. By KRUG~AN and WARD. 3rd Ed. Mosby. $15.75. Since the first edit ionappeared in 1958, dramatic changes have occurred in the infec-

tious diseases, and these have been fully discussed in the edition underreview. While the authors say with justification tha t the availability of poliomyelitis and measles vaccines could if properly distributed wipe these diseases from the face of the earth, this is unlikely to happen in the near future and so a book of this nature will be required reading for the g~neral practitioner and medical student. This book is comprehensive, well-presented and readable. The schematic drawings and colour plates are very helpful to a complete grasp of the subject. The new chapters on the aetiology and symptoms of acute respiratory diseases are concise and worth close study.

~V[. POWELL.

A Synopsis of Biology. (Second Edition). By DR. W. B. CRow, M.Sc. Price 52/6. John Wright and Sons have produced a Second Edit ion of Dr. Crow's Synopsis of

Biology four years after the publication of the first. As did the previous edition, this contains a prodigious amount of detailed information in a highly condensed, but logically arrauged form. The last chapters contain descriptions of techniques and instruments used in the various branches of biology which will be valuable to the enquiring student.

The index, which contains some 12,000 entries, was, as far as your reviewer could discover, not only a monument to human perseverance, but both useful and accurate.

DOUGLAS E. MELLON.

The Chemistry and Therapy of Disorders of Voluntary Muscles. By E. G. MURPHY. Springfield, III. , Thomas. $6.50

The specialist of the future will need to be a hybrid, part-clinician, part-chemlst or physicist. Present-day internists, meanwhile, find it difficult to assimilate advances in their own specialities because of the inevitable meagreness of their knowledge of parallel advances within the basic sciences.

The American Lecture Series in Living Chemistry is specifically designed to facilitate digestion, absorption and hence assimilation, and comprehension of biochemical advances. Dr. C. B. Murphy, a Toronto pediatrician, surveys new applications of chemistry in the disorders of voluntary muscles. His short monograph has the merit of simplicity. I t may be recommended both to recent graduates studying for higher degrees and to those of their more mature colleagues who are discouraged, but yet not daunted, by the avalanche of medical literature.

J. B. LYo~s.

106 IRISH JOURNAL OF MEDICAL SCIENCE

Collected Papers in Medicine from the Mayo Clinic I963-1964. Vol. 55. Philadelphia & London, Saunders.

From t ime to time The Guardian, The Observer and other newspapers publish collections of articles which have appeared in their pages. These delightful books are usually extremely instructive and entertaining. When regular readers of the papers from which they are gathered dip in to them, skimming from one article to another, they exclaim, "How did I miss that, and that , and that?"

The Mayo Clinic's Collected Papers in Medicine evokes a similar feeling of surprise. Vol. 55 contains re-published papers of great variety and interest. Subjects range from perennial problems like the painful shoulder, diabetes, and t inni tus to such sophistic- ations as the diagnostic applications of closed-circuit televisionin neuroroentgenology. As a bedside book it will certainly be found to be less soporific than many detective stories. Pausing to reflect on what singular quality makes all these papers so attractive one cannot escape the conclusion that they have been improved by condensation and abridgement. Medical editors please note.

J. B. LYo~s.

Disorders of Voluntary Muscle. Edited by JOHN N. WALTON. London, Churchill. 100/- The reaction aroused by the diagnosis of muscular dystrophy, in the average clinician,

is a sense of helplessness. The gloom surrounding the therapy of this group of diseases tn~aeY have contributed to the surprising lack of general interest in diseases of muscle in

past. Recent developments, however, have brought an awareness of the diverse pathology which may under]y virtually identical clinical pictures. New syndromes have boon described; improved diagnostic methods are available; t rea tment of a number of dis~blL~g ailments gives satisfactory results. The management of muscle disease no longer is the prerogative of pediatricians and neurologists for in the guise of thyrotoxic myopathy, polymyositis, or myasthenia gravis respectively, the ailment may present in the consulting rooms of endocrinologists, rheumatologists, or obstetricians.

Under the editorship of Dr. J. N. Walton twenty-six contributors have written a detailed book which will more than adequately satisfy the needs of those seeking an authoritative account of the disorders of voluntary muscle. The clinical section is preceded by chapters on the anatomy of the motor unit and its ul t ra-s tructure-- the latter from the pen of Prof. J. W. Harman of University CoUege Dubl in- -by a discussion o f i t s physiology and pharmacology in health and disease and by a description of pathological changes.

The o]inleal problems are considerec[, comprehensively and if one singles out the chapters o~ polymyositis and myasthenm gravis as especially valuable it is because the o n e r much that is comparatively new and the other deals with a condition of great ~ e r a ~ u t i c importance, The diagnosis of myasthenia gravis, as Dr. J. A. Simpson shOwS, iB comparatively simple (but it may be confused with cases of polymyositis respol~i~ag p~i~ially to prostignaine); its management is sometimes fraught with dififieulty, Because of this one would welcome greater detail about the management of pregnancy arid p~rturition in m y a s ~ n i a gravls. Clinical features of neonatal myasthcnia are helpfully described by Dr. J. P. M. Tizard.

J. B. LYo~s.

HypnoMs Throuylmu~the World. By F. L. MARCUS--., Ph.D. Illinois : Charles C. Thomas. $11.

I t has been said that a useful concept will be rediscovered approximately every fifty years. This is particularly'true of hypnosis and is well illustrated by the present volume which outlines the developments in hpynosis in many different countries. Professor Marcuse has managed to visit personally most of the countries and authors mentioned in the book and the contributors are well known authorities in the field of hypnosis.

I t is fascinating to read hew in chapter after chapter and country after country the evolution of hypnosis has been so similar. To quote an example, A. C. de Moraes Passes, writing of hypnosis in Brazil, s tates tha t there was " suspicion and curiosity during the first half and scientific interest in the last half of the nineteenth century. Since then there has been a loss of interest, with the almost complete disappearance of scientific hypnotism . . . Scientific hypnosis reappeared and was extensively practised for clinical purposes starting in 1956 and at the same time its use for purposes of entertain- ment was finally prohibited by a Federal Decree in July, 1961 ".

Anyone hoping to find in this book a description of the practical aspects of hypnosis, techniques of induction and so on, will be disappointed. But for those with a general interest in the subject, i ts history and development, the book will be valuable. The chapter on the position of hypnosis in the U.S.S.R. is particularly useful as until recent years so little has been known of developments in medicine in that country. I t is of interest to note that in the U.S.S.R. hypnosis did not suffer the eclipse in the early years of this century which, as mentioned already, was characteristic of most western countries. Rather i t has undergone a steady development and its use is now widespread, not only

BOOK REVIEWS 107

in psychiatry, but also among obstetricians, dentists and general physicians. I t seems likely that the main reason for this difference has been that Russian medicine remained virtually unaffected by the Freudian movement which in other countries such as the U.S.A. created quite an unwarranted prejudice against hypnosis. Instead Russian medicine tended to follow the more physiologically based theories of Pevlov.

The only criticisms to be made of this book is that it is rather loosely strung together and that some of the chapters are lacking in clarity, probably as the result of translation, while others are quite superficial, depicting the undeveloped state of hypnosis in those countries. IVOR W. BROWSE.

Management of Oral Emergencies. By DArCEIL M. LAsxIrr Charles C. Thomas, Illinois. $5.50.

This small volume is all tha t i ts foreword claims it to be, a concise yet complete monograph of interest to all those who work in the oral cavity. Oral and systemic emergencies are described, together wi th their management. The text is good, the illustrations clear and the book is very well cross-referenced.

In addition to minor dental and jaw injuries, the t rea tment of oro-antral l~stula and splinting of loosened or avulsed teeth is well set out. Particular note has been taken of chapters dealing with emergencies associated with the use of local anaesthesia, treacheo- tomy, elosea chest cardiac massage and mouth to mouth resuscitation.

The final section tabulates the various drugs used in emergency t reatment and these are of broad interest. Only one small error on page 60 has been noted ; " perforated " should be substituted for " performed ".

Altogether this is an admirable small volume, which has something for each of the various specialists who share this cavity. W. DOYLE-KELLY.

Fibrinolysis. British Medical Bulletin, Volume 20. Number 3, September, 1964. British Medical Council Price s 10s. 0d.

The study of fibrinolysis has been the cinderella of haematological investigation and knowledge of this subject is very often confined to literature from pharmaceutical firms advertising their wares. The September edition of the British Medical Bulletin provides an opportunity of remedying this state of affairs.

Fibrinolysis is still ill-understood and for this reason few dogmatic statements are made. Some of the many interesting points discussed are the linking of the fibrinolytic with the coagulation mechanism through the Hageman Factor (Factor XII) and the possible physiological balance between fibrin deposition and fibrinolysis. One line of investigation which catches the imagination is the investigation of proteolytie activity in connective tissue and the persistence of fibrin in auto-immunity. The hard cIinieal facts associated with pathological fibrinolysis are dealt with in the latter portion of the edit ion and a sensible line of therapy included. There is also a balanced report on the efficacy of thrombolytie therapy.

There are comprehensive lists of references and the editor has obviously taken pains to ensure a continuous line of thought by correlating the individual articles. This Bulletin is a review of fibrinolysis and is recommended to those who wish to further their knowledge of the subject. IA~r J. TEMPERLEY.

The Physican's Handbook. Oxford. Blackwell Scientific Publications. $4.50. The .Phys~ian's Handbook, now in its thir teenth edition, comes from the Medical

School of California and is that valuable mixture, part textbook of general medicine part laboratory guide, part therapeutic index specially compiled for the use of hospital doctors, registrars and housemen.

I t s range is wide and the large part which is taken up by biochemical investigation includes the most up to date of tests. There are chapters dealing with the examination and t reatment of the medical emergency. The minor techniques of ward practice are described in detail. The chapters dealing with pre-and post-operative care, fluid and electrolyte balance and the technique and indications for blood transfusion contain the essentials of good treatment.

E.C.G. interpretation gives an introduction to the subject with examples of the commoner abnormalities. Drugs are well presented, but surprisingly "Megamid" is omit ted from the t reatment of barbiturate intoxication.

The good things of this volume far outweigh its deficiencies, but in a book so detailed in its other aspects, the section on history taking is insufficiently developed to give a full view of the patient 's disability. The neurological, gynaeeological and psychiatric examinations are complete, but other specialities do not get the same emphasis. One thought that the manual was not geared to the t reatment of cor pulmonale in the chapter on oxygen therapy, perhaps an unconscious tribute to the climate of California.

When one accepts that the I-Landbook is neither an Encyclopaedia nor a substitute for the usual textbooks, its l imitations are appreciated. 1NTeither is it a ready reckoner, despite the tables of normal values and of conversion factors, but the information contained between its covers makes it an invaluable pocket guide.

P. J. BLANEY.

108 IRISH JOURNAL OF MEDICAL SCIENCE

Care of Children in Day CenSres. By F. I)AWDSON, B. GORNICKI, S. LEBOVICI, ]~REN]~ LEZlNE, JULIUS B. RICHMOND, EVA SCHMIDT-KOLME]R, STIG SJOLIN. W.H.O. Public Health Papers No. 24. 1964.

These Papers are revised versions of those submitted to an Exper t Committee on the Care of Children in day-care centres and institutions, held in Geneva, late 1962, under the joint auspices of the United Nations and the World Health Organisation. They deal with maintenance and promotion of heal th--mental , physical and emotional - - a n d with the development of those young children, who cannot be cared for in their own homes during the day. The sections comprising these groups of papers are brilliant, detailed, careful studies carried out by paediatricians, psychiatrists and trained Child Health personnel, all eminent in the field of child health and revealing the excellence of team-work, ably directed.

The special needs of children who are being eared for in the absence of their parents during a substantial part of the day have been studied and the outcomes of the investig- at ions and observations are the subjects of these papers. The results of competent, thorough enquiries and research, ranging over the years since 1947 are given and the findings, facttml and statistical, are set out. The wide field covered and the international character of the contributions comprising this book, are evidence of the excellence of the studies undertaken in the U.S.A., Poland, Sweden, Germany and France. There is a special section concerned with the report of Child Care Services of the International Labour Office. This latter report on Child Care Services in relation to the needs of working mothers and the employment of married women, deals with various countries in Europe, as well as Asia, Africa, Australia and New Zealand and the Americas. I t refers specially to these countries which lmve recently acquired their political independence. The I.L.C. Statement of particular significance is tha t "this tendency towards a high and increasing level of employment of llmrried women will continue and gain strength. Whatever its causes it seems to be a social fact, which has to be regarded as such and i ts implications examined seriously. In Greece, in Ireland and in the Netherlands, only a mamll percentage of all nmrried women are employed outside the home, though the numbers so employed are said to be increasing."

The Papers contributed by the paedlatriciaus, psychiatrists and Child Health teams on the growth, speech development, education and care of children in day centres are of the utmost importance. The effect of deprivation and associated retardation of devotopment~ the influences affecting your children---environmental and personal, the offsets of movement, independence and protection are all carefully examined. The problem of continuity of personal care and encouragement is stressed. The importance of nouri~tlng food and a pleasant meal-time atmosphere is set out. The deleterious effeot8 of repression, coldness, unnecessary correction of young children, those are some of the many" aspects of child e~re wi th which these contributors deal. Infection in children mad their safe-gtmrding by immunisation, the incidence of illness and morbidity in children who are eared for away from their own homes,--a l l these factors have been carefully exa~mled by the contributors and there is an extensive list of references a t the end of each Section.

The financing and lay-out of clay eentres is described including the equipment and furnishings. Qualification and training of the day centres' personnel is emphasised and the numbers of s~ f f required to mainta in the work in these day centres is specially seb out.

This is a book to be read and studied by all those concerned in providing an adequate supplement to family c~re, either in creches, clay nurseries, nursery schools or kinder- gardens. I t deals with an aspect of life today ~nd as such is of vital importance. The Papers are well-produced and the contents are excellent.

C. M. O'BRIEN.

The Temperature G'uidefor Women. By O. S A c ~ G~LLER. London: Burns Oats. 10/6. In this book Dr. Geller gives a clear and concise account of his work done on the

relationship between fertility and the menstrual cycle. I t will prove of great value, not only to m~rried people who wish to use this method to regulate their family, but of even greater value to doctors who wish to mivise such patients.

The book is in two parts. The first part describes the reproductive cycle in women. He emphasises the necessity of keeping accurate d~tes. He explains clearly how the safe period may be calculated, but points out in an equally clear way the pitfalls o f such a method. He stresses the reliability of es t in~ tmg the safe period by the tem- perature method.

The second part describes the method of temperature taking, This is well illustrated by charts showing the different ways in which the temperature may rise. I t explains how the ~afe period may be determined and how to deal witkfluctuation in temperature.

The book is simply written, easy to follow and should be of great help to married couples and to all those who are interested in family planning.

BRENDAN J. MURPHY.