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REVIEWS AND NOTICES OF BOOKS

1. A Synopsis of MedicineSixth edition. By H. LETHEBY TIDY, M.D.,F.R.C.P., Physician to St. Thomas’s Hospital.Bristol: John Wright and Sons, Ltd. 1934.

Pp. 1112. 21s.

2. Synopsis of Surgical AnatomySecond edition. By ALEXANDER LEE McGREGOR,M.Ch. Edin., F.R.C.S. Eng., Assistant Surgeon,Johannesburg General Hospital. Same publishers.1934. Pp. 644. 17s. 6d.

IT has been a fashion to decry the " synopsissystem, and declare that every student should makehis own summaries of his reading ; but there can be

very few who are not grateful for the help providedby this book. Notes are for revision, and to refreshknowledge stored in the head, not on paper; and a

printed synopsis at least checks the error, commonamong students, of relying on notes rather thannotice, and forgetting that it is what they rememberrather than what they have once set down that willhelp them first to pass examinations and later to

diagnose and treat patients.1. Tidy’s synopsis is much more than a series of

revision notes. It is essentially a large text-bookof medicine excellently condensed and tabulated.This new edition has over 1000 pages and hardly anunnecessary word. It includes a large number ofnew articles, and several sections, notably those onnephritis, ansemia, and the endocrine glands, havebeen almost entirely rewritten. As in previouseditions symptomatology has been emphasised, butmany of the. summaries of treatment are remarkablyfull and self-sufficient, and notes on pathology,aetiology, diagnosis, complications, and prognosisare given for every important condition. Tidy’ssynopsis holds a deservedly high place, not as a

short cut to practice or a medical degree, andstill less as a substitute for text-books or bedside

teaching, but as an almost indispensable aid toboth.

2. A second edition of this excellent work will bewelcomed alike by students and surgeons. The

originality with which it was conceived and writtenmade it an immediate success, and the additionsnow made should enhance its reputation.

There are of course a few omissions and someinstances where accounts, more especially of opera-tions, are not quite adequate ; but these are rare.We do not find described the anterior approach tothe Gasserian ganglion for alcohol injections, and theoperations for ganglionectomy in the abdomen andin the front of the neck might be given in moredetail; and this applies also to the method of remov-ing the posterior end of the internal semilunar carti-lage. On the other hand, it would be difficult tofind elsewhere such convenient and concise informa-tion on so many subjects of importance in surgery.The book can be cordially recommended.

Le barbiturisme aiguPar G. CARRIRE, CLAUDE HURIEZ, et P.WILLOQUET. Lille: Imp. A. Durant. 1934.

Pp. 164. Fr.30.

IN this monograph the authors have been at painsto summarise an extensive literature and have addedmany interesting experimental and clinical observa-tions of their own. The morbid anatomy and

histology of barbiturate intoxication are fullydescribed and the clinical manifestations accuratelyand clearly conveyed. The chief interest attachingto this work is the advocacy by Prof. Carriere and hisassociates of alcohol as an antid ote for the barbiturates.Its use was suggested by the chance observation towhich we referred a few months ago 1 of a youngwoman who attempted suicide by taking 5-0 g.of veronal together with 100 c.cm. of 95 per cent.alcohol and who appeared to recover very muchmore quickly than would be expected. Workingwith laboratory animals they injected 1 c.cm. perkilogramme of body-weight of 30 per cent. alcoholhourly and found it very effective. They claim thatalcohol is superior to coramine and strychnine as

an antidote. Their clinical trial of alcohol waslimited to one case of mild barbiturate poisoning towhom was administered 80 c.cm. of 30 per cent.alcohol divided into hourly doses of 20 c.cm. Thepatient awoke after the fourth injection and theauthors feel satisfied that this was due to the alcohol.It must be noted, however, that the total amountadministered during the entire four hours was

slight to produce any very definite effect, beingequivalent only to the alcohol contained in a pintof ordinary beer or two glasses of sherry. Injectionof 20 c.cm. of 30 per cent. alcohol would producefor a few minutes a concentration in the neighbourhoodof 1 part per 1000 in the circulation which is thelevel at which, as Widmark has shown, the influenceof alcohol becomes just apparent in ordinary consciouspersons. It may be that Carriere, Huriez, and

Willoquet have stumbled, as they believe, upon a.

specific pharmacodynamic antagonism, and thatalcohol will become a standard form of treatmentfor barbiturate poisoning. It may be, too, that sincethe publication of this book they have satisfiedthemselves of its efficacy by further clinical trial,but at the moment there is not enough evidence todisplace the more established antidotes, strychnineand coramine, in favour of alcohol.

The Physiology of Human PerspirationBy YAS KuNo, Professor of Physiology, ManchuriaMedical College, Mukden. London: J. and A.Churchill. 1934. Pp. 269. 12s. 6d.

A GLANCE at the exhaustive bibliography at theend of this book shows that most of the work doneon perspiration has been published in Japanese,German, or French, and it is fortunate for English-speaking people interested in the subject that Prof.Kuno has chosen our language for his monograph.Not only does it provide a review of pre-existingknowledge, but it embodies the important results of15 years’ work by the author and his colleagues.They have done much to synthesise available informa-tion on different aspects of the subject, and bycarefully controlled experiments to make clear its

significance. Difficulties and failures are franklydiscussed, and the general tone of the book suggeststhat where interpretations are necessary, these havebeen made without bias. A judicial approach some-times means an absence of useful conclusions, buthere certain fundamental principles emerge from amass of detail, because Prof. Kuno has himselfdevised and patiently carried out crucial, thoughmostly simple, experiments upon human subjects.

1 THE LANCET, 1934, i., 1243.

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The idea that sweat is purely concerned with heatregulation is exploded ; the soles and palms andaxillae are shown to perspire under totally differentconditions from those determining sweating of the

general body surface, and interesting conclusions aredrawn about the functional significance of thesedifferences. There seems no doubt of the importanceof the skin as an excretory organ, particularly withregard to lactic acid. The monograph abounds withlittle-known facts about the skin and sweat glands;after reading it we are inclined to agree with theauthor that if the privilege enjoyed by the humanrace of inhabiting the whole earth has partly beenacquired by intelligence, its spread over the torridzone has only succeeded through the high developmentof its sweat glands.

High Blood PressureThird edition. By J. F. IlALLS DALLY, M.A.,M.D. Camb., 11Z.R.C.P. Lond., Senior Physician tothe Mount Vernon Hospital. London: W. Heine-mann Ltd. 1934. Pp. 281. 15s.

ABOUT one-third of the text of this book, withabout 30 illustrations (some of which are redundant),is still devoted to methods of estimating bloodpressure. The remainder includes a useful discussionof average normal pressures, of the causation of highblood pressure, treatment, and a helpful chapterupon arterial pressure in relation to life assurance.In the matter of treatment the author still emphasisesthe importance of purgation and elimination of bowelintoxication, and avoids all extremes in dietaryrestrictions. In the discussion of pathology thereare some contradictions and in places the reader isleft confused. The classifications of hyperpietic,arterio-sclerotic, and nephro-sclerotic groups are inthe main those generallv accepted, and the indicationsfor treatment are explained in full detail. This is auseful handbook with a number of references to moreextensive studies of this difficult subject.

Who Shall Survive?

By J. L. MORENO, M.D. Washington, D.C : Nervousand Mental Disease Publishing Company. 1934.

Pp. 438.A FOREWORD to this book, written by W. A. White,

opens with the following sentence: "A crude conceptof structure thinks of it as composed of parts after thefashion of a Mosaic." This is not an inspiring begin-ning, whether viewed as grammar or sense. Nor arethe words with which Dr. Moreno opens his firstchapter much more encouraging ; a true therapeuticprocedure cannot have less an objective than thewhole of mankind." Dr. Moreno’s book resembles,in fact, a badly made sandwich. It consists of aninteresting and original middle part wedged betweenunusually inept introductory and closing chapters.The following sentence from one of the last pages ofthe book is typical: " In consequence our emphasisupon any particular problem in Hudson, as racialtension, sex, or runaways, needs to be understood asarising from a penetration into the underlying factorswhich are uncovered when we examine beneath thesurface of a community’s psychological structure oforganisation, whether this community be now Hudsonor any other."

Essentially the book describes a method of analysingthe psychology of groups of children and adolescents,

the most important component of which is the so-calledsociomotric test. This consists of ascertaining thepreferences of each member of a group for the othermembers. The emotional attitude-whether of anger,fear, sympathy, or dominance--is recorded in answersto certain set questions put to the whole class or groupinvestigated ; and it is expressed in " spontaneity

"

tests in the course of which each child is asked to actcertain emotions towards other children. The methodsounds simple, though perhaps somewhat unprac-ticable with shy or inhibited children ; yet the amountof interesting information forthcoming from the totalmaterial which finally becomes available is surprising.Light is thrown on such general questions as theattitude to each other of children of different colourand racial groupings-Jews, Italians, Germans, &c.,upon the psychology of sexual attraction, of leader-ship, and of group organisation. The method of

investigation is time-consuming and it presupposesthat the subjects do not lie in recording their attitudesand that they do not falsify their emotions in thespontaneity tests. The inquiries here described makeno attempt to answer the question of who shallsurvive, which is posed in the title of the book, thougha suggestion is made in the last chapter, a chef d’oeuvreof muddled thinking and writing, that those personsshould survive who have " spontaneability."

Year Book of Radiology, 1934Edited by CHARLES A. VTERS, M.D., Associatein Roentgenology, Johns Hopkins University;Assistant Visiting Roentgenologist, Johns HopkinsHospital ; and IRA I. KAPLAN, B.Sc., M.D.,Director, Division of Cancer, Department ofHospitals, City of New York ; Visiting RadiationTherapist, Bellevue Hospital; Clinical Professorof Surgery, New York University and BellevueMedical College. Chicago : Year Book Publishers,Inc. 1934. Pp. 512. 19s.

Tms year book should be in the hands of everyradiologist. The extensive and scattered literaturethat has appeared during the year is reviewedand presented in compact form. The selectionof the material is, as in the previous volumes,judicious and the book is therefore a valuable precisof important current contributions to diagnosticand therapeutic radiology. For reasons of economythe number of pages has been reduced but, on theother hand, the paper used is of a finer quality thanin the previous issues, and the 454 illustrationsthat accompany the text are not only adequate butdefinitely good.

British Journal of SurgeryTHE January issue (vol. xxii.) includes the follow-

ing papers. The letiology of the Vascular Symptomsof Cervical Rib, by D. M. Blair, F. Davis, and W.McKissock (London). Evidence has been obtainedof inflammatory changes in the first dorsal nerve andin the inferior part of the lower trunk of the brachialplexus. The gray rami are affected, and to thisfact the vascular symptoms are traced.-DiffuseIntraduct Carcinoma of the Breast, by E. H. Lepperand A. H. Baker (London). The clinical history"andprogress of 11 cases is described. Owing to thediffuseness of the malignant change the action of ahormonic stimulus is postulated. The relation toPaget’s disease is discussed.-Serial RadiographicAppearance of a Neuropathic Shoulder-joint, byJ. F. Brailsford (Birmingham). Examination overtwo and a half years showed progression throughstages typical of hydro-arthritic, atrophic, and hyper-

214

trophic disease.-Renal-adrenal Adherence, by T. 13.Davie (Liverpool). The author has met six cases in1500 autopsies, and points out that the conditionmay be of serious import in nephrectomy.-CollectiveInquiry, by the Fellows of the Association of Surgeonsinto Gastrojejunal Ulceration, by Garnett Wright(Manchester). A complete statistical and clinical surveyof 176 cases following 2051 operations for duodenalulceration and of 62 cases following 1382 gastric opera-tions. The incidence, pathology, symptoms, radio-logical findings and treatment are reviewed.-Chronic Interstitial Mastitis, by Frank d’Abreu(Birmingham). Cyst-formation is regarded as a

further stage of mazoplasia, and both are said to

depend on defective endocrine activity. A stage isrecognised which is possibly premalignant.-Inter-stitial Radium Treatment of Carcinoma of theBreast: Description of a Radical Technique, byR. G. Hutchinson (Manchester). It is claimed thatthis technique approaches more nearly than anyother to the radical operation, and that there is anoptimum dose of radium that will produce completeresolution of the primary and secondary growth.The results in 23 cases are recorded.-DiaphragmaticHernia, by Sir Thomas Dunhill (London). Clinicalrecords of the various types of diaphragmatic hernia,correlated with a short introduction on the develop-ment and anatomy of the diaphragm (Arris and Galelecture).-Congenital Hernia through the RightDome of the Diaphragm, by Frank Forty (Birming-ham). The clinical history, operative findings, andpost-mortem appearances in a case.-Hernia througha Mesenteric Hiatus, by E. S. J. King (Melbourne).On the basis of two cases observed at operation, aninflammatory origin is suggested for mesenteric

defects.—Dyschondroplasia, (Ollier’s Disease), withReport of a Case, by Donald Hunter and PhilipWiles (London). 1 ncludes careful discussion ofdifferential diagnosis, and an account of radio-logical appearances, course, and treatment.—Colos-tomy, by W. 13. Gabriel and O. V.Lloyd-Davies(London). A statistical and clinical account of500 cases of palliative colostomy in carcinoma of therectum.-Adenoma,ta of the Pituitary, with specialreference to Pituitary Basophilia of Cushing, byWilliam Susman (Manchester). It is concluded thatadenomata are comparatively common, and are of nospecial significance. Also that the basophilic cellsdo not produce a sex hormone, and that their hyper-secretion does not give rise to a special syndrome.-Perforation of Carcinoma of the Stomach into theGeneral Peritoneal Cavity, by Ian Aird (Edinburgh).Two clinical types are described : in one the perfora-tion symptoms are typical and acute ; in the otherthey are

" silent." The operative mortalityapproaches 60 per cent.-Bilateral Bipartite Patellae,by Ruggles George (Toronto). A case is recorded.The condition is said to follow non-fusion of multiplecentres of ossification.-Osteitis Fibrosa : an Experi-mental Study, by Hermon Taylor (London). Theeffect and fate of injected phosphatase are recorded.Changes typical of osteitis fibrosa have been pro-duced in rabbits by injection of parathormone, com-bined with a high calcium diet.—Etiology of Trau-matic Shock, by Laurence O’Shaughnessy and DavidSlome (London). From experiments in cats theauthors conclude that the factors of importance arelocal fluid loss, and the discharge of nociceptiveimpulses. The theory of a tnxapmic cause theyreject

NEW INVENTIONS

A NEW TONSIL GUILLOTINE

THE guillotine is still extensively used for theenucleation of tonsils in children. When this is doneunder a prolonged general anaesthesia, the expert willsucceed in removing the whole tonsil, conservingboth anterior and posterior pillars, no matter whattype of guillotine is used. Unfortunately tonsillec-tomies are still performed by the short-ansestheticmethod, owing to circumstances beyond the surgeon’scontrol. He is then called upon to perform theacrobatic feat of enucleating both tonsils and adenoidsin a fraction of a minute and to leave both anteriorand posterior pillars intact and unblemished. It isthen that the type of guillotine used plays an import-ant part in the efficient removal of the tonsils. The

guillotine illustrated here has been used by me forsome considerable time, and it is claimed that itovercomes the difficulties mentioned. The featuresof the guillotine are :-

1. The fenestra is oval and is of sufficient lengthto permit the longitudinal diameter of the tonsil tobe engaged without undue squeezing (any pressurerequired is produced by the transverse diameter ofthe ring, with or without adjustment of the blade).This fact makes it very difficult for the upper or lowerpoles to escape from the ring the moment the bladeis pushed home, a not uncommon occurrence whensmall sized guillotines are used, particularly whenenucleating flat or non-pedunculated tonsils.

2. The size of the fenestra A can be regulated by theaction of the screw B. This does away with thenecessity of employing different blades. The appear-ance of the tonsil on simple inspection is deceivingand its actual size is often only appreciated after itsdislocation from its bed ; it is obviously an advantageto be able to adjust the size of the fenestra with theguillotine actually in the patient’s mouth.

3. The bevelled edge of the blade prevents theanterior pillar from being drawn into the slot of thehead when the blade is driven home. It is a common

experience (except when using the reversed guillotine)to find the anterior pillar damaged in spite of a correctapplication of the guillotine, particularly when

dealing with flat or non-

pedunculated tonsils.This is in my opinion dueto the anterior pillarbeing dragged towards orinto the slot of the headwhere the actual damage often takes place. Thebevelled blade peels the anterior pillar off the tonsil,folding the former, as it were, on itself.

4. The action of the guillotine is particularlysmooth as all the joints are of the ball-and-sockettype. It is easily taken to pieces for cleaningpurposes.

Messrs. Mayer and Phelps of New Cavendish-street,W.l, are the makers of this instrument.

London, W. ARTHUR MILLER, F.R.C.S.