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Reviews of Books
1
372 Mr. R. C. BROCK could not think it safe to divide adhesions in the presence of tubercles ; it was hard to assess the age of adhesions. A French surgeon had told him recently that he was doing one hundred cases of extrapleural pneumothorax a week ; but perhaps the cases at the Brompton were not as favourable for this operation as those in sanatoria on the Continent. It was a dangerous operation, and he was not sure that the results on the Continent were better than in Britain. The disadvantage of replacing thoracoplasty by extra- pleural pneumothorax was that a thoracoplasty had often to be done afterwards. If the patients were carefully looked after the deformity from thoracoplasty was usually negligible ; in any case it was better to be deformed than dead. The dictum that delay in thoraco- plasty is always desirable was " horrifying." In his view the critical phase in the life of the patient with chronic pulmonary tuberculosis was when he left the sanatorium for the first time : unless his disease was completely controlled by a perfect pneumothorax he was unsafe ; and if surgeons would only step in with thoracoplasty much better results would be obtained. As for pneumonectomy, he was feeling his way gingerly, and the few cases he had done had been very carefully selected. In reply, Dr. MARSHALL said that in the treatment of bilateral cavitation thoracoplasty was a dangerous remedy ; but this was a dangerous disease. A thoraco- plasty on one side and an artificial pneumothorax on the other was much less dangerous and was often highly successful. Mr. PRICE THOMAS said that about half the patients he operated on had bilateral disease. On the subject of pneumonectomy he was as cautious as Mr. Brock. Reviews of Books An Approach to Social Medicine JOHN D. KERSHAW, M.D. Lond., D.F.u., medical officer of health, Accrington. London : Baillière. Pp. 329. 15s. THIS book seeks " not to teach the reader social medicine but to show him where it lies and how it may be sought." The first half could well stand by itself as a description of the origin and purposes of our social fabric ; in the second half Dr. Kershaw indicates the place he would give to medicine in this larger framework. Since medicine entered late into the scientific field, doctors followed the lead of their colleagues in the physical sciences, and adopted a mechanistic outlook- to the neglect, he suggests, of philosophy. Yet we must not forget that it was the sharp reaction from earlier unfounded theorising which gave us the hard facts on which we build today. This thoughtful book gives the casual reader a good idea of medicine’s widening functions in a changing world ; for those who wish to make a serious study of social medicine there could be no more encouraging introduction. The Psycho-analytic Theory of the Neuroses OTTO FENICIIEL, M.D. London : Kegan Paul. Pp. 703. 35s.. THE author of Outlines of Clinical Psycho-analysis, published in 1934, rather than produce a second edition, has completely altered his previous book, and added a general introduction, a bibliography of over 1QOO references, and an index of 40 pages. His facility in writing, which survived translation in the former book, is preserved now in his -own English. His useful book not only covers many points of Freudian theory but illustrates the divergences of the psycho-analytic dis- cipline from formal psychiatry. Thus "traumata" are never " physical," they are associated with castration and implied insecurity, and the intellectual and physical factors which form so important a part of Meyer’s " psychobiology " are hardly mentioned. The index has only three references to the climacteric, three to " physical" matters, seventeen to the ’ ’ body," and twenty to " organic " conditions ; " neurology " is not indexed at all, and the thalamic centres and the sympathetic nervous system not even mentioned. The title of the book may justify this dichotomy, but the rift between neurology and psycho-analysis has not been bridged by Dr. Fenichel, able writer though he is ; and we could wish lie had written.the book of a dweller in both worlds, like Stanley Cobb’s Foundations of Nc1tropsychiatry. He is notably frank in discussing contra-indications to treatment and trial analyses, but offers no suggestions for shortening psycho-analytic treatment. He emphasises the emotional character of " shock," but later admits that insulin and leptazol act best on different disorders, thus implying that the word " shock " itself may have other connotations. Similar and more serious difficulties may be found in formulations about the origin of the ego ; but, open to dispute as these may be, his clarity in general and his careful documentation make the volume essential for the psycho-analyst, and to others a valuable book of reference. Gray’s Anatomy Descriptive and Applied. (29th ed.) Editors: T. B. JOHNSTON, C.B.E., M.D. ; J. WBJULIS, M.-D., M.S. London : Longmans, Green. Pp. 1597. 70s. THE basic facts of topographical anatomy have not altered since Gray wrote his first edition in 1858, yet his book has now reached its 29th edition-roughly a new edition- every three years. " Gray," containing as it does sections on histology, embryology, and neurology, all subjects which are rapidly progressing, is more than a reference book of topographical anatomy ; and it is largely because these sections must be kept up to date that new editions are needed frequently. Though there are advantages in having all branches of anatomy col- lected together in one reference work, few medical students rely on " Gray " for their histology, embryology, and neurology : but if these sections are to be included it is important that they should be factual and accurate, without too much discussion of controversial subjects or unlikely theories. In this edition, for example, perhaps too much space is devoted to Carey’s theory of muscle structure, which is far from being generally accepted; but Sha,rpey-Schafer’s classical diagram of the sarcomere has at last been omitted. The picture of a spermatozoon is drawn at a magnification well beyond the resolution of any ordinary microscope and is therefore misleading. In future editions electron microscope pictures should replace such diagrams. It is impossible for the authors to please everyone, but a discussion of blood-groups, and especially of the Rh factor, seems out of place in an anatomy book. Much new matter has been added. including sections on the work of Holmes and Young on nerve regeneration, of Weddell and Woollard on cutaneous innervation, and of Brock on the bronchial tree. Apart from drawbacks due to poor paper, most of the illustrations are first-class, and many new ones have been added. The X-ray plates too are good, and we could do with many more. Entstehurig und Friiherfassung des Portiokarzinoms Dr. med. HANSJAKOB Wjssrr, Chefarzt der geburtshilflich- gynakologischen Abteilung am Krankenhaus Frauenfeld. Basle : Benno Schwabe. Pp. 91. Sw. fr. 11. THIS book is concerned with the early diagnosis of cancer of the uterine cervix by means of the Hinsehizann colposcope. The author, who has charge of the gynaeco- logical clinic of the University of Zurich, has for seven years been using this method, together with the Schiller iodine test, to establish the diagnosis in early and difficult cases. The colposcopic picture and the histology of the normal and pathological cervix are carefully described, and the various types of white leucoplakia, red erosion, and irregular surfaces which may be seen are usefully discussed. Case-records show the care which is taken in the examination of every patient whose condition gives rise to suspicion of early neoplasia, and illustrate the possibility of distinguishing between certain early cancers and simple inflammatory conditions. The numbers of patients with cancer of the uterine cervix who can be treated early and with success are increased when routine colposcopic examinations are made. Such close observation is only possible. however, , where facilities such as those offered by his clinic are available ; and gynaecologists in Switzerland seem to be fortunate in seeing many of their cases at a stage when the diagnosis is still in doubt.
Transcript of Reviews of Books
372
Mr. R. C. BROCK could not think it safe to divideadhesions in the presence of tubercles ; it was hard toassess the age of adhesions. A French surgeon had toldhim recently that he was doing one hundred cases ofextrapleural pneumothorax a week ; but perhaps thecases at the Brompton were not as favourable for thisoperation as those in sanatoria on the Continent. It wasa dangerous operation, and he was not sure that theresults on the Continent were better than in Britain.The disadvantage of replacing thoracoplasty by extra-pleural pneumothorax was that a thoracoplasty had oftento be done afterwards. If the patients were carefullylooked after the deformity from thoracoplasty was
usually negligible ; in any case it was better to bedeformed than dead. The dictum that delay in thoraco-plasty is always desirable was " horrifying." In hisview the critical phase in the life of the patient withchronic pulmonary tuberculosis was when he left thesanatorium for the first time : unless his disease wascompletely controlled by a perfect pneumothorax hewas unsafe ; and if surgeons would only step in withthoracoplasty much better results would be obtained.As for pneumonectomy, he was feeling his way gingerly,and the few cases he had done had been very carefullyselected.
In reply, Dr. MARSHALL said that in the treatmentof bilateral cavitation thoracoplasty was a dangerousremedy ; but this was a dangerous disease. A thoraco-plasty on one side and an artificial pneumothorax onthe other was much less dangerous and was often highlysuccessful. Mr. PRICE THOMAS said that about half thepatients he operated on had bilateral disease. On thesubject of pneumonectomy he was as cautious as
Mr. Brock.
Reviews of Books
An Approach to Social MedicineJOHN D. KERSHAW, M.D. Lond., D.F.u., medical officerof health, Accrington. London : Baillière. Pp. 329. 15s.
THIS book seeks " not to teach the reader socialmedicine but to show him where it lies and how it maybe sought." The first half could well stand by itself asa description of the origin and purposes of our socialfabric ; in the second half Dr. Kershaw indicates theplace he would give to medicine in this larger framework.Since medicine entered late into the scientific field,doctors followed the lead of their colleagues in thephysical sciences, and adopted a mechanistic outlook-to the neglect, he suggests, of philosophy. Yet we mustnot forget that it was the sharp reaction from earlierunfounded theorising which gave us the hard facts onwhich we build today. This thoughtful book gives thecasual reader a good idea of medicine’s widening functionsin a changing world ; for those who wish to make aserious study of social medicine there could be no moreencouraging introduction.
The Psycho-analytic Theory of the NeurosesOTTO FENICIIEL, M.D. London : Kegan Paul. Pp. 703.35s..
THE author of Outlines of Clinical Psycho-analysis,published in 1934, rather than produce a second edition,has completely altered his previous book, and added ageneral introduction, a bibliography of over 1QOOreferences, and an index of 40 pages. His facility inwriting, which survived translation in the former book,is preserved now in his -own English. His useful booknot only covers many points of Freudian theory butillustrates the divergences of the psycho-analytic dis-cipline from formal psychiatry. Thus "traumata" arenever " physical," they are associated with castrationand implied insecurity, and the intellectual and physicalfactors which form so important a part of Meyer’s" psychobiology " are hardly mentioned. The indexhas only three references to the climacteric, three to" physical" matters, seventeen to the ’ ’ body," and twentyto " organic " conditions ;
"
neurology " is not indexedat all, and the thalamic centres and the sympatheticnervous system not even mentioned. The title of thebook may justify this dichotomy, but the rift between
neurology and psycho-analysis has not been bridged byDr. Fenichel, able writer though he is ; and we couldwish lie had written.the book of a dweller in both worlds,like Stanley Cobb’s Foundations of Nc1tropsychiatry.He is notably frank in discussing contra-indications to
treatment and trial analyses, but offers no suggestionsfor shortening psycho-analytic treatment. He emphasisesthe emotional character of " shock," but later admitsthat insulin and leptazol act best on different disorders,thus implying that the word
" shock " itself may haveother connotations. Similar and more serious difficultiesmay be found in formulations about the origin of theego ; but, open to dispute as these may be, his clarity ingeneral and his careful documentation make the volumeessential for the psycho-analyst, and to others a valuablebook of reference.
Gray’s AnatomyDescriptive and Applied. (29th ed.) Editors: T. B.JOHNSTON, C.B.E., M.D. ; J. WBJULIS, M.-D., M.S. London :Longmans, Green. Pp. 1597. 70s. ’
THE basic facts of topographical anatomy have notaltered since Gray wrote his first edition in 1858, yet hisbook has now reached its 29th edition-roughly a newedition- every three years. " Gray," containing as itdoes sections on histology, embryology, and neurology,all subjects which are rapidly progressing, is more thana reference book of topographical anatomy ; and it islargely because these sections must be kept up to datethat new editions are needed frequently. Though thereare advantages in having all branches of anatomy col-lected together in one reference work, few medicalstudents rely on " Gray " for their histology, embryology,and neurology : but if these sections are to be includedit is important that they should be factual and accurate,without too much discussion of controversial subjectsor unlikely theories. In this edition, for example, perhapstoo much space is devoted to Carey’s theory of musclestructure, which is far from being generally accepted;but Sha,rpey-Schafer’s classical diagram of the sarcomerehas at last been omitted. The picture of a spermatozoonis drawn at a magnification well beyond the resolutionof any ordinary microscope and is therefore misleading.In future editions electron microscope pictures shouldreplace such diagrams. It is impossible for the authorsto please everyone, but a discussion of blood-groups,and especially of the Rh factor, seems out of place inan anatomy book. Much new matter has been added.including sections on the work of Holmes and Youngon nerve regeneration, of Weddell and Woollard oncutaneous innervation, and of Brock on the bronchialtree. Apart from drawbacks due to poor paper, most ofthe illustrations are first-class, and many new ones havebeen added. The X-ray plates too are good, and we coulddo with many more.
Entstehurig und Friiherfassung des PortiokarzinomsDr. med. HANSJAKOB Wjssrr, Chefarzt der geburtshilflich-gynakologischen Abteilung am Krankenhaus Frauenfeld.Basle : Benno Schwabe. Pp. 91. Sw. fr. 11.
THIS book is concerned with the early diagnosis ofcancer of the uterine cervix by means of the Hinsehizanncolposcope. The author, who has charge of the gynaeco-logical clinic of the University of Zurich, has for sevenyears been using this method, together with the Schilleriodine test, to establish the diagnosis in early anddifficult cases. The colposcopic picture and the histologyof the normal and pathological cervix are carefullydescribed, and the various types of white leucoplakia,red erosion, and irregular surfaces which may be seenare usefully discussed. Case-records show the care whichis taken in the examination of every patient whosecondition gives rise to suspicion of early neoplasia, andillustrate the possibility of distinguishing between certainearly cancers and simple inflammatory conditions. Thenumbers of patients with cancer of the uterine cervixwho can be treated early and with success are increasedwhen routine colposcopic examinations are made. Suchclose observation is only possible. however, , wherefacilities such as those offered by his clinic are available ;and gynaecologists in Switzerland seem to be fortunatein seeing many of their cases at a stage when the diagnosisis still in doubt.
