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BOOK REVIEWS. t"ri~ciples of Medical Statistics. By '~_. BRADFOICI) HILL. The Lancet. 6/-. To r e g u l a r readers of t h e Laucet, in which j o u r n a l t h e c o n t e n t of this b o o k a p p e a r e d in serial form, t h e ability of Dr. B r a d f o r d Hill to p r e s e n t s t a t i s t i c a l m e t h o d in its most p a l a t a b l e form need n o t be stated. H e is a s t a t i s t i c i a n of well-recognised m e r i t , b u t t h i s work reveals t h e fact t h a t h e is also extremely g i f t e d in t h e a r t of p r e s e n t i n g t h e complexities of s t a t i s t i c a l analysis in l a n g u a g e readily u n d e r s t o o d by t h e average reader. This book of less t h a n 200 pages p r e s e n t s t h e p r o p e r m a n n e r of a p p r o a c h to t h e q u a n t i t a t i v e analysis of a g r e a t v a r i e t y of medical a n d public h e a l t h problems. I t progresses from t h e simple c a l c u l a t i o n of s t a t i s t i c a l c o n s t a n t s to a very full t r e a t m e n t of t h e problems of s a m p l i n g a n d an e x c e l l e n t discussion of t h e ehi-square test. The c h a p t e r s on c o r r e l a t i o n a n d life-tables are also good, a n d i t is to be hoped t h a t in t h e f u t u r e , as t h e r e s u l t of this book's a p p e a r a n c e , t h e s u r v i v o r s h i p t a b l e will be more widely used in assessing t h e values of different forms of medical t r e a t m e n t . T h e r e are t h r e e i n t e r e s t i n g c h a p t e r s devoted to t h e discussion of fallacies which should do m u c h to remedy t h e pseudo-logic so f r e q u e n t l y e~ncountered in c o n t r i b u t i o n s to t h e medical journals. Medical workers who equip themselves w i t h t h e knowledge c o n t a i n e d i n t h i s slender volume will p l a n t h e i r i n v e s t i g a t i o n s so t h a t t h e conclus i o n s a r r i v e d a t shall h a v e p e r m a n e n t value. They may, or m a y not, come to know t h e d e l i g h t of l e a r n i n g these m e t h o d s of precision t h r o u g h e x a m p l e s d r a w n from medical experience. Those o t h e r medical workers who h a d to l e a r n w h a t t h e y know of t h e s t a t i s t i c a l m e t h o d from s t o u t t e x t b o o k s i n which t h e examples were i n v a r i a b l y d r a w n from t h e d a t a ~ f commerce will h a v e no d o u b t a b o u t it. The book has u n d o u b t e d l y r e n d e r e d a g r e a t service to medical i n v e s t i g a t o r s a n d will prove no less v a l u a b l e to c a n d i d a t e s for t h e D . P . H . W. P. O'C.

Kirschner's Lessons in Surgery. Volume I l i : The Ear, Air Passages and Neck. By MARTIN KI~SC~NEa, w i t h t h e collaboration of A. LAUTENSCHLA~R a n d O. KLEINSCHI~IDT. A u t h o r i s e d t r a n s l a t i o n by I. S. RAVDIN a n d M. COATES. L i p p i n c o t t . 50]-. This is t h e t h i r d volume of K i r s c h n e r ' s Lessons in Surgery. I t is t h e f i r s t volume which was n o t w r i t t e n by Professor K i r s c h n e r himself, b u t i t w o r t h i l y upholds t h e t r a d i t i o n he established i n t h e first two volumes. T h e r e is a t p r e s e n t no o t h e r single work we know of, which covers q u i t e t h e same field as this, which deals w i t h t h e s u r g e r y of t h e head a n d neck (exclusive of t h e b r a i n ) a n d c e r t a i n aspects of t h e s u r g e r y of t h e face. T h e i l l u s t r a t i o n s are a f e a t u r e of t h e book; t h e y are p a r t i c u l a r l y good, large-scale a n d detailed, a n d coloured in t h e m a j o r i t y of cases. The t e x t m i g h t , p e r h a p s , in places, be fuller, b u t it is very clear a n d concise: T h e book is p e r h a p s p r i m a r i l y of i n t e r e s t to t h e ear, nose a n d t h r o a t s u r g e o n , b u t i t should be of v a l u e to t h e g e n e r a l s u r g e o n also. F o r t h e m o s t p a r t i t p r e s e n t s t h e t e a c h i n g of t h e G e r m a n schools, as m i g h t be expected. One is s u r p r i s e d to find t h e old B r i i n i n g ' s cesophagoscope a d v o c a t e d r a t h e r t h a n t h e i n s t r u m e n t designed by H a s l i n g e r , which has replaced i t in most c o n t i n e n t a l c e n t r e s by v i r t u e of t h e b e t t e r illuminat i o n a n d g r e a t e r ease of m a n i p u l a t i o n which i t allows. W e h a v e no d o u b t t h a t t h e A m e r i c a n editors will be a m p l y r e p a i d for t h e i r labours i n t r a n s l a t i n g t h i s volume. They h a v e n o t confined t h e m selves to simply t r a n s l a t i n g from t h e G e r m a n , b u t h a v e added to i t in places, p a r t i c u l a r l y when t h e C o n t i n e n t a l a n d A m e r i c a n schools differ i n t h e i r practice. These a d d i t i o n s can only be criticised because of t h e i r b r e v i t y . This no d o u b t results from a consciousness of t h e difference b e t w e e n a n a u t h o r a n d a t r a n s l a t o r , b u t n e v e r t h e l e s s one feels a t times, n o t a b l y in t h e description of t h e Ballance-Duel t e c h n i q u e of facial n e r v e g r a f t i n g , t h a t a fuller d e s c r i p t i o n of t h e p r o c e d u r e would n o t h a v e been ~)ut of place. T. G. W.

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Modern Psychology in~ Practice. By W. NEUSTATTER. Churchill. 10]6. I n Modern Psychology in Practice we have a t last found a book of reasonable dimensions which deals a d e q u a t e l y w i t h t h e neuroses, t h e psychoses a n d c h i l d r e n ' s disorders from t h e p o i n t of view of b o t h t h e student and the practitioner. T h e e n t i r e compass of t h e book is j u s t s h o r t of 300 pages, a n d i t obviously was n o t i n t e n d e d to be a n e x h a u s t i v e work on such a wide field. Y e t i t proves to be a v e r y ample source of i n f o r m a t i o n a n d i t is w r i t t e n in a style t h a t m a k e s very p l e a s a n t r e a d i n g , no small measure of t h i s a c h i e v e m e n t b e i n g due to t h e a u t h o r ' s facility for c i t i n g a c t u a l casehistories from his wide experience. The book is m a d e up of five sections, Section I b e i n g devoted to a n i n t r o d u c t i o n to t h e t e r m i n o l o g y of t h e psychopathologist a n d some s h o r t d e s c r i p t i v e sketches of t h e t h e o r i e s on which t h e F r e u d , Adler, J u n g a n d S t e k e l schools operate. S e v e n c h a p t e r s in Section 2 deal w i t h t h e disorders of childhood, r a n g i n g f r o m simple a n x i e t y s t a t e s a n d b e h a v i o u r problems to physical disorders a n d m e n t a l defect. The m o d e r n t r e a t m e n t is g i v e n i n considerable detail. A n u n e x p e c t e d confusion of t h e t e r m s " sleepy " a n d " sleeping '" sickness occurs on p. 41, a n d a g a i n on p. 49. Section 3 is devoted to t h e neuroses a n d psychoses as seen i n adults. The two c h a p t e r s on sex difficulties should prove very valuable t o t h e g e n e r a l p r a c t i t i o n e r who e n c o u n t e r s these not u n c o m m o n cases. ,Section 4 deals w i t h m e t h o d s of t r e a t m e n t a n d clearly sets o u t t h e t e c h n i q u e of t h e psycho-analyst. This valuable book concludes w i t h some o b s e r v a t i o n on t h e c a u s a t i o n a n d p r e v e n t i o n of m e n t a l illness a n d a c h a p t e r on t h e law i n r e l a t i o n t ~ m e n t a l t r e a t m e n t as p r a c t i s e d i n E n g l a n d . The t e x t will prove t h e solution to t h e problem of t h e medical s t u d e n t p r e p a r i n g for his final e x a m i n a t i o n with n o t too m u c h t i m e a t his disposal for t h e s t u d y of special subjects. I t will be equally welcomed b y t h e busy p r a c t i t i o n e r , a n d i t has also a claim on t h e a t t e n t i o n of t h e i n t e l l i g e n t lay public. W. P. O'C. ~'he Thyroid and its Diseases. By J . H. MEANS. L i p p i n c o t t . 25[-. I n t h e p a s t couple of decades a n a v a l a n c h e of l i t e r a t u r e has a p p e a r e d c o n c e r n i n g t h e t h y r o i d a n d its diseases. I n t o t h e s p a t e of p a p e r s t h e a u t h o r s of t h i s work h a v e waded deeply a n d t h e y h a v e produced a f a s c i n a t i n g book. They modestly s t a t e t h a t a t h o r o u g h r e v i e w of t h e l i t e r a t u r e h a s n o t been a t t e m p t e d , b u t t h e y r a t h e r wish to a d d t h e i r own considerable experience to t h e e x i s t i n g c o n t r i b u t i o n s . A n a m a z i n g a m o u n t of i n f o r m a t i o n a n d discussion is provided, which m a k e s this volume one of t h e most valuable c o n t r i b u t i o n s to t h e l i t e r a t u r e of t h e t h y r o i d g l a n d t h a t h a s y e t a p p e a r e d . Dr. M e a n s has t h e g i f t of p r e s e n t i n g his subject i n t h e most lucid a n d r e a d a b l e fashion. I n no place is h e d o g m a t i c ; ~ h e gives t h e reasons for his p r e s e n t beliefs, a n d w h e n he disagrees i t is b y i n f e r e n c e r a t h e r t h a n denial. H e infers t h a t P l u m m e r s ' disease is G r a v e s ' disease w i t h o u t t h e " Oop-eye " a n d carries conviction w i t h his a r g u m e n t . The question of residual a n d r e c u r r e n t thyrotoxicosis is fully discussed. Some surgeons are u n w i l l i n g t o a d m i t t h a t t h i s c o n d i t i o n is common, v e t i n a series of 190 carefully followed cases t h e r e were 19.5 p e r cent. w i t h p e r s i s t i n g toxicosis. This book, w r i t t e n by a p h y s i c i a n w i t h a biochemicaI t r a i n i n g , .contains t h e most r a t i o n a l account of t h e o p e r a t i v e a p p r o a c h to t h e t h y r o i d problem t h a t we h a v e yet e n c o u n t e r e d . I t should be r e a d by all surgeons, if only to tell t h e m t h a t in dealing w i t h t h y r o i d disease t h e s u r g e o n is focussing on a n e x t r e m e l y b r i e f t h o u g h v i t a l single e v e n t a n d t h a t t h e last word in t h e t r e a t m e n t of toxic goitre h a s n o t yet been said. A useful f e a t u r e is t h e s u m m a r y a t t h e conclusion of each c h a p t e r , followed by a bibliography. The final c h a p t e r s t r e a t of t h y r o i d a d m i n i s t r a t i o n as a d r u g i n c o n t r a s t to its use in s u b s t i t u t i o n t h e r a p y , t h e rSle of t o t a l t h y r o i d e c t o m y i n h e a r t disease, diabetes a n d leuksemia, a n d " F a c t a n d F a n c y i n M a t t e r s Thyroid." This a d m i r a b l e volume, r e p r e s e n t i n g t h e personal experiences of a g r o u p of worl:crs in t h e Thyroid Clinic of t h e M a s s a c h u s e t t s G e n e r a l t t o s p i t a l , should be studied b y ' a l l i n t e r e s t e d in t h e t r e a t m e n t of disorders of t h e t h y r o i d gland. F. J . M.

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and its Diseases. By CHEVALIER JACKSON a n d C. L. JACKSON. S a u n d e r s . 35/-. F r o m t h e accepted m a s t e r s of bronchoscopy a n d cesophagoscopy we e x p e c t a really i n t e r e s t i n g book on t h e larynx, n o r are we d i s a p p o i n t e d . The book is in every sense complete; i t deals w i t h e v e r y d a y l a r y n g e a l troubles, a n d a t g r e a t l e n g t h w i t h all t h e r a r e r conditions which one m a y see i n a l i f e t i m e devoted to t h e speciality. The r a r e r l a r y n g e a l conditions a r e d e a l t w i t h from t h e p o i n t of personal o b s e r v a t i o n , i n diag-nosis, prognosis a n d t r e a t m e n t ; t h e r e is no slavish following of o t h e r a u t h o r i t i e s ; h e r e we h a v e t h e v i e w p o i n t t h r o u g h o u t of C h e v a l i e r J a c k s o n . F o r t h i s r e a s o n t h e references (which are numerous) are t a k e n i n g r e a t m e a s u r e f r o m t h e publications of t h e a u t h o r s themselves. T h r o u g h o u t t h e book t h e r e is a n insistence on a few c a r d i n a l principles, e.g. (i) n o l a r y n g e a l e x a m i n a t i o n can claim to be complete if i t does n o t include direc4 laryngoscopy; (ii) t r a c h e o t o m y is a v e r y v a l u a b l e o p e r a t i o n , b u t i t m u s t be done early a n d low. I n d i r e c t laryngoscopy for i n t r a l a r y n g e a l o p e r a t i v e work is scarcely a c k n o w l e d g e d This book is essentially one for t h e specialist r a t h e r t h a n for t h e g e n e r a l p h y s i c i a n or surgeon, b u t t h e a u t h o r s h a v e very clear views as to when a case should be h a n d e d over to one or t h e other. T h e i l l u s t r a t i o n s t h r o u g h o u t t h e work are really w o n d e r f u l ; t h e p a p e r p r i n t a n d general t u r n - o u t is of t h a t u n f a i l i n g h i g h s t a n d a r d one associates w i t h Messrs. S a u n d e r s ' productions. P. J . K. The Larynx

ProtoformotI~erapy. By N. E. ISCttLONDSKY. K i m p t o n . 2 1 / - . " P r o t o f o r m o t h e r a p y is n o t merely a method of t r e a t m e n t , as could be

concluded from its d e n o m i n a t i o n , b u t also, a n d even m a i n l y , a basic conception, t h e most c h a r a c t e r i s t i c f e a t u r e of which is t h e widest a p p l i c a t i o n of s y n t h e s i s in t h e i n t e r p r e t a t i o n of morbid p h e n o m e n a . " T h e a u t h o r has devised a " system " of t r e a t m e n t , based a p p a r e n t l y on his experiences with t h e use of e x t r a c t s of e m b r y o n i c tissue. W e c a n n o t a t t e m p t to criticise t h e results claimed for his t r e a t m e n t , for t h e p r e p a r a t i o n s employed h a v e n o t been sufficiently fully described e i t h e r i n respect of t h e i r composition or in respect of t h e i r action i n v i v o u n d e r controlled conditions, b u t we m u s t censure h i m for his a t t e m p t to r e v i v e t h e vogue of " systems " of t h e r a p y . I t was one of t h e g r e a t e s t claims to immort a l i t y of t h e F r e n c h p h y s i c i a n Louis t h a t he i n s i s t e d t h a t methods of t r e a t m e n t should all be t e s t e d by s t a t i s t i c a l methods, a n d we h a d hoped t h a t his t e a c h i n g was now accepted as axiomatic. B u t a p p a r e n t l y i t is n o t so, a n d t h e r e are still m e n who believe t h e y c a n conquer all t h e problems of medicine by t h i n k i n g a b o u t t h e m . John Hunter said: " Don't think; try the experiment "! We do n o t wish to discourage o r i g i n a l t h o u g h t , b u t we do u r g e t h a t u n t i l t h e t h o u g h t h a s proved f r u i t ful i t should not be used as t h e f o u n d a t i o n - s t o n e for a " system " R. H'. M. o] S o m e C h r o n i c a ~ d " I n c u r a b l e " D ~ s e a s e s . B y A. T. T o n n . W r i g h t & Sons. 10/-. Dr. Todd wishes to emphasise t h e p o i n t t h a t in c h r o n i c diseases n o t one b u t m a n y systems are a t f a u l t , a n d t h e r e f o r e to t r e a t effectively t h e bodily s t r u c t u r e as a whole m u s t be examined. I t is a sound view, a n d we hope t h a t he will m a k e m a n y :converts to it. W i t h m u l t i p l e i n v o l v e m e n t as his s t a r t i n g p o i n t , he proceeds to analyse t h e s y m p t o m - p a t h o l o g y of t h e more common a i l m e n t s such as Graves' disease, diabetes, a s t h m a , epilepsy, constipation, r h e u m a t i s m a n d chorea, etc., t r a c i n g back each sign a n d s y m p t o m to its o r i g i n a l cause, so as to p r e s e n t a clear p i c t u r e of t h e m a i n ]~athological s t r e a m a n d its no less i m p o r t a n t t r i b u t a r i e s . Thus h e u r g e s us not to be satisfied merely by observin_~ a n d p a l p a t i n g , useful as t h e y m a y be, b u t to r e a s o n a n d cleduce as well.~ H i s advice is timely, for t h e r e is much t h a t is slip-shod in o u r methods of r o u t i n e e x a m i n a t i o n . I n a c h a p t e r dealing w i t h w h a t he calls " false h e a r t disease " he offers a lucid e x p l a n a t i o n of t h e m e c h a n i s m by which t h e venous r e t u r n is effected, e m p h a s i s i n ~ t h e p a r t played by t h e r e s p i r a t o r y Dump. " More t h a n 50 p e r cent. of p a t i e n t s p r e s e n t i n g f r a n k c a r d i a c illnesses will b e f o u n d on e x a m i n a t i o n to be suffering from d y s f u n c t i o n of t h i s m e c h a n i s m . " H e also draws a t t e n t i o n to t h e condition of d u o d e n i t i s a n d h e p a t i c defect, showing how closely i t m a y s i m u l a t e d u o d e n a l ulceration, a n d w a r n s us to be careful of t h i s very common clinical pitfall. I n t h e final Treatment

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c h a p t e r a valuable review is given of the excellent e x p e r i m e n t a l work done in t h e R e s e a r c h D e p a r t m e n t of t h e Bristol Royal I n f i r m a r y on t h e mtiology a n d t r e a t m e n t of cancer. Those who o b t a i n this book will find in i t m u c h tha~ is new a n d i n t e r e s t i n g . D. M.

1'he Endocrines in Theory and Practice. P a p e r s collected from t h e British Medical Journal. Lewis. 9/-. If endocrine t h e r a p y h a s fallen into disuse of r e c e n t years t h e f a u l t lies n o t in t h e p r i n c i p l e of g l a n d u l a r t r e a t m e n t b u t r a t h e r t h e abuse of i t by i n d i s c r i m i n a t e p r e s c r i b i n g , t r y i n g " a shot i n t h e d a r k " when o t h e r m e t h o d s m a y h a v e failed us. I t is o p p o r t u n e , t h e r e f o r e , t h a t we should h a v e some a u t h o r i t a t i v e work to i n s t r u c t a n d g u i d e us, to let us know w h a t these unseen h o r m o n e s m i g h t be reasonably expected to accomplish, a n d t h e i n d i c a t i o n for t h e i r s u i t a b l e e m p l o y m e n t , i n t h i s small volume 24 skilled c o n t r i b u t o r s offer us t h e i r advice a n d experience in a most r e a d a b l e form, a n d if t h e i r advice is i n t e l l i g e n t l y followed m u c h benefit m a y ensue for o u r p a t i e n t s . No e x t r a v a g a n t claims are m a d e in t h i s v o l u m e ; on t h e contrary~ i t is a n a t t e m p t to r e i n s t a t e e n d o c r i n e t h e r a p y to its f o r m e r sound a n d scientific basis. D.M. NEW

EDITIONS.

Applied Phar~nacology.

By A. J . C ~ m c . 6 t h Ed. Churchill. 18/-. I t is h a r d to u n d e r s t a n d why this t e x t b o o k h a s n o t a n even more e x t e n s i v e sale t h a n it has, even t h o u g h t h e p r e s e n t e d i t i o n is t h e sixth. I t is indispensable to t h e t e a c h i n g physician s for i t s u m m a r i s e s in a m a s t e r l y way t h e m o s t r e c e n t available knowledge on t h e subject of all t h e useful drugs, o m i t t i n g a t t h e same t i m e d i s t r a c t i n g references to t h e n u m e r o u s shams which fill t h e pages ~of all n a t i o n a l pharmacopoeias. The p r e s e n t edition is t h o r o u g h l y u p t o date, a n d t h e a d d i t i o n s m a d e h a v e e n t a i l e d considerable revision. W e find i t h a r d to express fully e n o u g h o u r a d m i r a t i o n for t h e i n d u s t r y of t h e a u t h o r who, a t t h e same t i m e as h e was engaged in r e v i s i n g his Applied Pharmacology, finished a n d saw t h r o u g h t h e press a colossal volume on General Pharmacology for t h e s u p p l e m e n t a r y volume of H e f f t e r ' s Handbuch der experimentellen Phar~acologie. Professor C l a r k h a s placed all t e a c h e r s u n d e r a very deep d e b t of g r a t i t u d e to h i m as i n t e r p r e t e r of t h e m y s t e r i e s of p h a r m a c o l o g y ; we would n o t p e r h a p s receive his i n t e r p r e t a t i o n s w i t h such respect if we did n o t knew t h a t h e himself is a scientist of E u r o p e a n d i s t i n c t i o n . T h e r e is n o t h i n g to criticise in this book, unless i t be t h e r a t h e r artificial d i s t i n c t i o n of narcotics i n t o " anmsthetics " a n d " d e p r e s s a n t s , " or t h e a u t h o r ' s occasional a c c e p t a n c e of u n p r o v e d beliefs, such as t h e belief t h a t " chronic c o n s t i p a t i o n is usually associated w i t h ill-health, which is probably caused by a b s o r p t i o n of toxic p r o d u c t s from t h e aliment a r y c a n a l . " Clark's Applied Pharmacology r e m a i n s , as i t h a s been for f o u r t e e n years, t h e most useful book on t h e a c t i o n a n d use of d r u g s w r i t t e n in t h e E n g l i s h l a n g u a g e . R. H . M.

Materia Medica for N.urses.

By A. MUZR CRAWFORD. 4 t h Ed. Lewis. The reviewer has j u s t h a d t h e p l e a s u r e of r e a d i n g t h i s l i t t l e book for t h e first time. I t is excellently, one m i g h t almost w r i t e perfectly, s u i t e d to its purpose, which is p r e s u m a b l y to serve as a c o m p a n i o n to ward-sisters or t u t o r - s i s t e r s engaged i n c o a c h i n g nurses for a n e x a m i n a t i o n . I t is s h o r t a n d t h e m a t t e r is e x t r e m e l y well presented. The m e r i t s of t h i s l i t t l e book are so h i g h t h a t t h e reviewer feels t h e a u t h o r will be g r a t e f u l to h i m for p o i n t i n g o u t a few defects. A m i d o p y r i n e (" P y r a m i d o n " ) is n o t even m e n t i o n e d by n a m e ; n e i t h e r is a famous p r o p r i e t a r y m i x t u r e of b a r b i t o n e a n d a m i d o p y r i n e . The list of b a r b i t u r a t e s is too short, cons i d e r i n g t h e p r e s e n t e d i t i o n is d a t e d 1937. No m e n t i o n is m a d e of a n y p r e p a r a t i o n of insulin o t h e r t h a n t h e solution. The section on liver e x t r a c t s suggests t h a t t h e only liquid e x t r a c t in use is t h e B . P . liquid e x t r a c t of liver, whereas t h e f a c t is t h a t p r o p r i e t a r y c o n c e n t r a t e s are almos~ universally employed. T h e note o n t h y r o i d m a k e s no m e n t i o n of t h e a l t e r a t i o n made by t h e 1932 Pharmacopoeia, a f a c t w i t h which every