Reviews of Books
2
729 laryngoscopy, and who need not have any experience in bronchoscopy. The extractor is passed via either the larynx or a tracheostomy stoma. The procedure can be performed quickly and easily. The instrument is simple in design and operation and is not traumatic to the tissues. The extractor consists of a malleable rod ensheathed in an endotracheal tube. There is a handle and spring at the posterior part and a specially designed wire " basket " anteriorly. To use the instrument, the vocal chords are dis- played by direct laryngoscopy and the ensheathed instrument introduced into the trachea. The basket is then unsheathed by depressing the handle against the spring (see diagram) and the instrument advanced smoothly down the trachea as far as the carina, ensnaring the foreign body in its path. The spring is now released, the basket retracts, securing the foreign body, and the instrument is withdrawn. Should the instrument fail to extract the foreign body and life is immediately threatened, it may be used ensheathed in an attempt to impact the foreign body in one of the main bronchi, from where it may be later removed via a bronchoscope. The extractor is intended for use only in urgent cases, where the alternative is death, immediate bronchoscopy being clearly out of the question-the instrument is in no way an alternative to bronchoscopy, it is merely a complement to it. I thank Prof. E. Steen, Makerere Medical School, Kampala, Uganda, for his constructive criticism and helpful advice in preparing this paper, Dr. Brenda Vaughan, Makerere Medical School, for useful data, Mr. Wassanyi Serunkenyi, head of the motor vehicle section, Masaka Technical School, Uganda, who manufactured the prototype, and the Chief Medical Officer, Ministry of Health, Uganda, for permission to publish this paper. The extractor may be obtained from Messrs. Chas. F. Thackray Ltd., P.O. Box 171, Park Street, Leeds. I. P. CROWLEY M.B. N.U.I., F.R.C.S.E. Masaka Hospital, P.O. Box 18, Masaka, Uganda REDUCING STRANGULATED HÆMORRHOIDS WITH ETHYL CHLORIDE A COMMON complication of haemorrhoids is strangulation when one or more of the internal haemorrhoids prolapse and become gripped by the external sphincter. Further congestion follows because the venous return is impeded. Strangulation is accompanied by considerable pain, and is often spoken of by the patient as an " acute attack of piles ". Unless the internal haemorrhoids can be reduced within an hour or two, strangula- tion is followed by thrombosis. The thrombosed strangulated haemorrhoids may then become ulcerated or gangrenous. Cold compresses and elevation of the foot of the bed aug- mented by manual pressure are normally used to reduce strangulated haemorrhoids; but often the procedure is difficult for the surgeon and painful to the patient. The manoeuvre has a high recurrence-rate due to further prolapse. By spraying the hxmorrhoids directly with ethyl chloride they become reduced in size, due to cooling, and less sensitive since some of the ethyl chloride is absorbed through the mucous membrane. The hxmorrhoids can then be easily reduced, and on inspection the next day they will be found to have a healthy appearance. The procedure should be explained to the patient, and a pre- medication with pethidine is advised especially if the patient is nervous or apprehensive. The spraying is performed with the patient lying in the left lateral position, after absorbent gauze has been placed on the buttocks to prevent spread of the ethyl chloride. The spray should be applied continuously with the bottle held 6-8 in. (15-20 cm.) from the haemorrhoids until a " frosted " appearance is produced. I have found that this method avoids unnecessary bed occupancy by permitting earlier hxmorrhoidectomy to be performed. This paper was awarded a research prize by the South West Metropolitan Regional Hospital Board. C. P. BROAD M.B. Lond., F.R.C.S. St. Peter’s Hospital, Chertsey, Surrey Reviews of Books Principles of X-Ray Diagnosis DAVID H. TRAPNELL, M.A., M.D., M.R.C.P., F.F.R., D.M.R.D., consultant radiologist, Westminster Hospital, London. London: Butterworth. 1967. Pp. 291. E6lox. THIS book is intended primarily for trainees who have embarked on a full-time course in radiology. An account of the physical basis of the production of X radiation and the factors which influence the quality of the radiograph is followed by chapters on the principles of observation and deduction by which lesions in various systems may be diagnosed. The radiographic techniques for investigating lesions in the various systems are briefly described. Individual diseases are not dealt with in detail, although a wide range of disorders is illustrated by the 368 reproductions of radiographs, most of which are excellent. Throughout the book, basic principles and the logical approach to interpretation of radiological problems are set out and stressed in a concise and very readable text. Much fundamental radiological knowledge is clearly presented, and the trainee who studies this book will have made a good start. Candidates for the M.R.C.P. and F.R.C.S. would also find the book helpful. It is strongly recommended. Principles of Nuclear Medicine Editor: HENRY N. WAGNER, Jr., M.D., professor of radiology and radiological science, associate professor of medicine, The Johns Hopkins medical institutions. London, Philadelphia, and Toronto: W. B. Saunders. 1968. Pp. 896. Cll 14s.;$27.50; $29.70 (Canada). THE wide availability of artificially produced radionuclides has led to striking developments in nuclear medicine. Nuclear methods have been widely applied in both the investigation and the treatment of disease, and the use of radiopharmaceuticals has considerably increased our knowledge of drug metabolism. The first part of this book is an introduction to the basic history of nuclear physics followed by a brief review of diag- nostic taxonomy and the mathematical and statistical techniques used in nuclear medicine. The essential parts of nuclear physics are presented in an interesting way, and the measurement of radioactivity, including the principles of whole-body counting and neutron activation in vivo, is comprehensibly described. Unfortunately, radiation dosimetry and radiological protection have been relegated to the end of the book ; they could usefully have been dealt with in this first section. The main part of the book deals comprehensively with the application of isotopes to the investigation of various systems of the body, and this section is of a high standard. This volume can be recommended as a standard text for those entering this new specialty and will for a considerable time be a good work of reference for those who have to use isotopes in their clinical or research work. The standard of production and presentation is high throughout. Handbook of Fractures EDGAR LEE RALSTON, B.A., M.D., F.A.C.S., professor of ortho- pedic surgery, School of Medicine, University of Pennsylvania, Philadelphia; in collaboration with ALFRED RIVES SHANDS, Jr., B.A., M.D., F.A.c.s., visiting professor of orthopedic surgery, School of Medicine, University of Pennsylvania; HERNDON BRIGGS LEHR, B.C.E., M.D., F.A.C.S., assistant professor of surgery, School of Medicine, University of Pennsylvania; FREDERICK WILLIAM PITTS, B.A., M.D., F.A.C.S., associate professor of neurosurgery, School of Medicine, University of Southern California, Los Angeles. London: Henry Kimpton. St. Louis: C. V. Mosby Co. 1967. Pp. 299. 97s.;$10.75. How, asks the author in his preface, can the publication of yet another book about fractures be justified ? He goes on to explain that the importance of accident surgery is increasing at a rate out of proportion to the time allocated to the subject in the medical curriculum; and he emphasises that the treat- ment of fractures must be taught in terms of the physiological responses involved, and of the basic processes of repair-not just as a list of various types, with one or two methods of reducing and splinting each. This is convincing, and promis- ing. Unfortunately the chapters which follow adhere faith-
Transcript of Reviews of Books
729
laryngoscopy, and who need not have any experience in
bronchoscopy. The extractor is passed via either the larynx ora tracheostomy stoma. The procedure can be performedquickly and easily. The instrument is simple in design andoperation and is not traumatic to the tissues.The extractor consists of a malleable rod ensheathed in an
endotracheal tube. There is a handle and spring at the
posterior part and a specially designed wire " basket "
anteriorly. To use the instrument, the vocal chords are dis-played by direct laryngoscopy and the ensheathed instrumentintroduced into the trachea. The basket is then unsheathed bydepressing the handle against the spring (see diagram) and theinstrument advanced smoothly down the trachea as far as thecarina, ensnaring the foreign body in its path. The spring isnow released, the basket retracts, securing the foreign body,and the instrument is withdrawn. Should the instrument failto extract the foreign body and life is immediately threatened,it may be used ensheathed in an attempt to impact the foreignbody in one of the main bronchi, from where it may be laterremoved via a bronchoscope.The extractor is intended for use only in urgent cases, where
the alternative is death, immediate bronchoscopy being clearlyout of the question-the instrument is in no way an alternativeto bronchoscopy, it is merely a complement to it.
I thank Prof. E. Steen, Makerere Medical School, Kampala,Uganda, for his constructive criticism and helpful advice in preparingthis paper, Dr. Brenda Vaughan, Makerere Medical School, for usefuldata, Mr. Wassanyi Serunkenyi, head of the motor vehicle section,Masaka Technical School, Uganda, who manufactured the prototype,and the Chief Medical Officer, Ministry of Health, Uganda, forpermission to publish this paper.The extractor may be obtained from Messrs. Chas. F. Thackray
Ltd., P.O. Box 171, Park Street, Leeds.
I. P. CROWLEYM.B. N.U.I., F.R.C.S.E.
Masaka Hospital,P.O. Box 18,
Masaka, Uganda
REDUCING STRANGULATED HÆMORRHOIDSWITH ETHYL CHLORIDE
A COMMON complication of haemorrhoids is strangulationwhen one or more of the internal haemorrhoids prolapse andbecome gripped by the external sphincter. Further congestionfollows because the venous return is impeded. Strangulationis accompanied by considerable pain, and is often spoken of bythe patient as an
" acute attack of piles ". Unless the internal
haemorrhoids can be reduced within an hour or two, strangula-tion is followed by thrombosis. The thrombosed strangulatedhaemorrhoids may then become ulcerated or gangrenous.Cold compresses and elevation of the foot of the bed aug-
mented by manual pressure are normally used to reduce
strangulated haemorrhoids; but often the procedure is difficultfor the surgeon and painful to the patient. The manoeuvre hasa high recurrence-rate due to further prolapse.By spraying the hxmorrhoids directly with ethyl chloride
they become reduced in size, due to cooling, and less sensitivesince some of the ethyl chloride is absorbed through the mucousmembrane. The hxmorrhoids can then be easily reduced, andon inspection the next day they will be found to have a healthyappearance.The procedure should be explained to the patient, and a pre-
medication with pethidine is advised especially if the patient isnervous or apprehensive. The spraying is performed with thepatient lying in the left lateral position, after absorbent gauzehas been placed on the buttocks to prevent spread of the ethylchloride. The spray should be applied continuously with thebottle held 6-8 in. (15-20 cm.) from the haemorrhoids until a" frosted " appearance is produced.
I have found that this method avoids unnecessary bed
occupancy by permitting earlier hxmorrhoidectomy to be
performed.This paper was awarded a research prize by the South West
Metropolitan Regional Hospital Board.C. P. BROAD
M.B. Lond., F.R.C.S.St. Peter’s Hospital,Chertsey, Surrey
Reviews of Books
Principles of X-Ray DiagnosisDAVID H. TRAPNELL, M.A., M.D., M.R.C.P., F.F.R., D.M.R.D.,consultant radiologist, Westminster Hospital, London. London:Butterworth. 1967. Pp. 291. E6 lox.
THIS book is intended primarily for trainees who haveembarked on a full-time course in radiology. An account ofthe physical basis of the production of X radiation and thefactors which influence the quality of the radiograph is followedby chapters on the principles of observation and deduction bywhich lesions in various systems may be diagnosed. The
radiographic techniques for investigating lesions in the varioussystems are briefly described. Individual diseases are not dealtwith in detail, although a wide range of disorders is illustratedby the 368 reproductions of radiographs, most of which areexcellent. Throughout the book, basic principles and thelogical approach to interpretation of radiological problems areset out and stressed in a concise and very readable text. Muchfundamental radiological knowledge is clearly presented, andthe trainee who studies this book will have made a good start.Candidates for the M.R.C.P. and F.R.C.S. would also find the book
helpful. It is strongly recommended.
Principles of Nuclear MedicineEditor: HENRY N. WAGNER, Jr., M.D., professor of radiology andradiological science, associate professor of medicine, The JohnsHopkins medical institutions. London, Philadelphia, andToronto: W. B. Saunders. 1968. Pp. 896. Cll 14s.;$27.50;$29.70 (Canada).
THE wide availability of artificially produced radionuclideshas led to striking developments in nuclear medicine. Nuclearmethods have been widely applied in both the investigationand the treatment of disease, and the use of radiopharmaceuticalshas considerably increased our knowledge of drug metabolism.The first part of this book is an introduction to the basichistory of nuclear physics followed by a brief review of diag-nostic taxonomy and the mathematical and statistical techniquesused in nuclear medicine. The essential parts of nuclear physicsare presented in an interesting way, and the measurement ofradioactivity, including the principles of whole-body countingand neutron activation in vivo, is comprehensibly described.Unfortunately, radiation dosimetry and radiological protectionhave been relegated to the end of the book ; they could usefullyhave been dealt with in this first section. The main part of thebook deals comprehensively with the application of isotopes tothe investigation of various systems of the body, and thissection is of a high standard. This volume can be recommendedas a standard text for those entering this new specialty and willfor a considerable time be a good work of reference for thosewho have to use isotopes in their clinical or research work. Thestandard of production and presentation is high throughout.
Handbook of Fractures
EDGAR LEE RALSTON, B.A., M.D., F.A.C.S., professor of ortho-pedic surgery, School of Medicine, University of Pennsylvania,Philadelphia; in collaboration with ALFRED RIVES SHANDS, Jr.,B.A., M.D., F.A.c.s., visiting professor of orthopedic surgery,School of Medicine, University of Pennsylvania; HERNDONBRIGGS LEHR, B.C.E., M.D., F.A.C.S., assistant professor of surgery,School of Medicine, University of Pennsylvania; FREDERICKWILLIAM PITTS, B.A., M.D., F.A.C.S., associate professor of
neurosurgery, School of Medicine, University of SouthernCalifornia, Los Angeles. London: Henry Kimpton. St. Louis:C. V. Mosby Co. 1967. Pp. 299. 97s.;$10.75.
How, asks the author in his preface, can the publication ofyet another book about fractures be justified ? He goes on toexplain that the importance of accident surgery is increasingat a rate out of proportion to the time allocated to the subjectin the medical curriculum; and he emphasises that the treat-ment of fractures must be taught in terms of the physiologicalresponses involved, and of the basic processes of repair-notjust as a list of various types, with one or two methods ofreducing and splinting each. This is convincing, and promis-ing. Unfortunately the chapters which follow adhere faith-
730
fully to the traditional pattern. There are forty pages onfractures in general, but five times as many on individuallesions. The style is lucid, and the radiographs are unusuallyclear. But the volume is not detailed enough for a registrar,whilst its price is rather high for the undergraduate.
Nerve Excitation
A Macromolecular Approach. Icaih TASAKI, M.D., laboratory ofneurobiology, National Instirute of Mental Health, Bethesda,Maryland. Springfield, Illinois: Charles C. Thomas, 1968.
Pp.201.$14.75.THE interpretation of the mechanisms of nervous transmission
proposed in this monograph is very different from that whichwas previously proposed by Hodgkin and Huxley; for since1952 many physicists have been occupied with the propertiesof membranes. Dr. Tasaki shows an amazing ability to makenew and difficult concepts of membrane theory understandable.This book is essential reading for physiologists, biochemists,and physical chemists interested in the physics of biologicalprocesses; it is rewarding reading for anyone interested inneurology, since the changes when nerve-fibres conduct
impulses are the basis of neurology, psychology, and psychiatry.
Health Manpower in a Developing EconomyTaiwan, A Case Study in Planning. TIMOTHY D. BAKER andMARK PERLMAN. London: Oxford University Press. Baltimore:
Johns Hopkins Press. 1967. Pp. 203. 62s.;$6.50.IN economic and human resources Taiwan is comparatively
fortunate: with a per caput income of 150 U.S. dollars relativelyequably distributed, a 5% annual rise in real national income,and one physician per 2100 people, the country might well bethe envy of some others. Yet, as this lucid and readable bookmakes clear, it has problems in the future supply of manpowerfor its health services: the authors predict a shortage of
physicians and a surfeit of nurses. Taiwan has adopted familyplanning on a national scale with considerable success; andthis is one of the main planks of the country’s developmentprogramme. The book ends on the optimistic note that,though it is difficult to initiate change, Taiwan has done so,and the results are revealed in robust economic growth and thesuccessful planned population programme.
The Encyclopaedia of General PracticeService Volume. Editors: G. F. ABERCROMBIE, V.R.D., M.A., M.D.,past-president, Royal College of General Practitioners; R. M. S.MCCONAGHEY, o.B.E., M.D., editor, Journal of the Royal Collegeof General Practitioners. London: Butterworth. 1967. Pp. 199.50s. (standard volume); 57s. 6d. (de luxe version).
THIS book consists of two parts-new articles and a cumula-tive supplement. Autoimmunity is explained lucidly, andexamples are given of autoimmune disease. There is a longsection on diagnostic techniques which will remind the prac-titioner of past skills and also inform him of new methods andequipment for investigating disease. Other subjects’ includechronic bronchitis and pyelonephritis, and there is an especiallysuccinct article on pre-diabetes. The cumulative supplementcontains fresh information on drugs and poisons legislation,leprosy, and tetanus.
Methods in Cancer ResearchVol. III. Editor: HARRIS BuscH, department of pharmacology,Baylor University College of Medicine, Houston, Texas.New York and London: Academic Press. 1967. Pp. 755.
$33; E15 8s.THE third volume in Dr. Busch’s ambitious treatise is devoted
to two main subjects-molecular biology and anti-tumour
agents. The first (and larger) section covers aspects of D.N.A.,D.N.A. polymerase, R.N.A., and nucleotide metabolism. Mostof the accounts emphasise the problems of isolation and puri-fication of these substances-problems which must be solvedbefore significant differences between nucleoproteins in normaland malignant tissues can be fully assessed. The interactionof nucleoproteins and carcinogens is briefly mentioned, and itseems likely that important advances in our knowledge of themode of action of some of the polycyclic hydrocarbons may
emerge from studies of this kind. Anti-tumour agents arediscussed in the remaining two chapters. These include avaluable account of the various modes of action by whichanti-cancer agents affect malignant cells, and the discussion ofthe forces which bind these agents to their target cells is likelyto be of considerable relevance to those interested in the
parallel field of carcinogenesis. The formidable task of evolvingdrugs with a selective action on cancer cells is analysed, andthe book ends with a discussion of the anti-tumour activity ofnatural materials such as the Vinca rosea alkaloids. The variousaccounts are well documented, although some of them areheavy going (particularly for readers whose knowledge of pro-tein chemistry is fitful); and the book is appallingly expensive.
Cardiopulmonary Laboratory Basic Methods andCalculationsA Manual of Cardiopulmonary Technology. N. BALFOUR SLONIM,M.D., PH.D., director, pulmonary function laboratory, GeneralRose Memorial Hospital, Denver, Colorado; BETTYE P.BELL, B.s., senior cardiopulmonary technologist, SHERRYL E.CHRISTENSEN, cardiopulmonary technologist, General RoseMemorial Hospital. Springfield, Illinois. Charles C. Thomas.1967. Pp.265.$15.75.
THIS book is both more and less than the title suggests:more, because it gives the views and habits besides the tech-niques of one unit; less, because there are some remarkableomissions-for example, there is no mention of the Haldanegas analysers or the Seldinger technique for arterial catheterisa-tion. The accounts of technique are good and there are manyuseful tables, but on the whole the book falls between toomany stools.
Diseases in AntiquityA Survey of the Diseases, Injuries and Surgery of Early Popula-tions. Compiled and edited by: DON BROTHWELL, BritishMuseum (Natural History), London; A. T. SANDISON, path-ology department, University of Glasgow, Western Infirmary,Glasgow. Springfield, Illinois: Charles C. Thomas. 1967.Pp. 766.$39.75.
IN the past few years the study of disease in ancient manhas received increasing attention. This book is therefore par-ticularly welcome. It not only includes accounts of recentadvances but also has reprints of 8 classic contributions to thesubject. A host of diseases is represented here, and it is ofgreat interest to find that so much evidence of them has beenbrought to light. The accounts of primitive treatments suchas trephining the skull, which is still carried out in East Africatoday, are of equal fascination. Many of the diseases we see,including cancer and arteriosclerosis, existed in much thesame form thousands of years ago, and in some instances in
prehistoric animals that preceded man-the basic disease pro-cesses found in the bones of the dinosaur still afflict modernman. This volume, sumptuously prepared, will become thestandard work on palxopathology. It can be recommendedwithout reservation.
_____ ____
New Editions
Drugs of Choice 1968-1969.-Edited by Walter Modell. London:Henry Kimpton. St. Louis: C. V. Mosby Co. 1967. Pp. 907. E8.$17.75.
Essentials of Cardiology-2nd ed. By S. G. Owen, T. B. Stretton,and J. Vallance-Owen. London: Lloyd-Luke. 1968. Pp. 226. 30s.
Veterinary Parasitology.-2nd ed. By Geoffrey Lapage. Edin-
burgh and London: Oliver & Boyd. 1968. Pp. 1182. E8 8s.
Bailey & Love’s Short Practice of Surgery.-14th ed. Revised byA. J. Harding Rains and W. Melville Capper. London: H. K. Lewis.1968. Pp. 1270. 84s.
Essentials of Fluid Balance.-4th ed. By D. A. K. Black. Oxfordand Edinburgh: Blackwell Scientific Publications. 1967. Pp. 182.30s.
Diseases of Children.-2nd ed. By Hugh Jolly. Oxford and Edin-burgh : Blackwell Scientific Publications. 1968. Pp. 752. 63s.
