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Reviews of Books

Essentials of Forensic MedicineC. J. POLSON, F.R.C.P., professor of forensic medicine,University of Leeds. London : English UniversitiesPress. 1955. Pp. 561. 30s.

TEXTBOOKS on the specialties of medicine fall into twocategories, the " shorter " and the " much longer." Theformer guide the student and refresh the practitioner ;the latter are books of reference for the expert-and, inlegal medicine, for those who want to test the expert’sknowledge. To expect both in one volume is asking toomuch, and Professor Polson has plainly set out to enjoywriting at length on a subject he evidently revels in,exploring the literature and collecting what Montaignewould have called un amas de fleurs etrangeres. It is

superbly done, for he writes well, lucidly, and sanely,weaving the vivid and the more mundane chapters offorensic medicine, medical ethics, law and insanity intoa comprehensive whole that is both informative andreadable. The book is no short guide to the subject forthe student, but it will delight the specialist who cannotsummon Professor Polson’s enthusiasm for research intothe literature. The absence of pictures is a break withtradition, made deliberately, so as to " focus attention onthe text." A toxicology on similar lines is to follow.

The Clinical Approach in Medical PracticeG. E. BEAUMONT, D.M., F.R.C.P., honorary consultantphysician, Middlesex Hospital. London : J. & A.Churchill. 1956. Pp. 469. 45s.

THIS is a sequel to Dr. Beaumont’s Applied Medicine,and it follows similar lines. The emphasis throughout ison practical clinical matters, and both this book and itspredecessor show clearly how a skilled and intelligentphysician’s mind works when he is faced with a difficultdiagnostic problem.In one section he describes some interesting cases he has

met, and in another he and a group of pupils discuss, by themethod of question and answer, the differential diagnosis ofother cases. In the case-descriptions Dr. Beaumont amplyproves how repaying is care in history-taking and bedsideexamination. In the question-and-answer demonstrations heexplodes with wit and erudition (some of his pupils are

remarkably well informed, too) and the joint result is bothinstructive and diverting. There are two new features : a

section describing in detail the psychological reactions of sometuberculous patients to their disease, and a short philosophicexcursion into the ethics of prolonging life in advanced heart-disease. Dr. Beaumont seems less at home with such emotionalmatters, and this part of the book is rather dull ; but the restis more entertaining than many a novel.

Splenin A in Rheumatic FeverThe testing of splenin A as an anti-inflammatory agent.ALVIN F. COBURN, M.D., LUCILE V. MOORE, M.D., JUDITHWooD, M.D., MARY ROBERTS, R.N., Rheumatic FeverResearch Institute, Northwestern University MedicalSchool, Chicago, Ill. Springfield, Ill. : Charles C.Thomas. Oxford: Blackwell Scientific Publications.1955. Pp. 86. 27s. 6d.

IN the modern therapeutic arena a favourite battlewith the crowd involves Allergy, and particularly thechimera Rheumatic Allergy. Here comes a dark horsein the trampled wake of the giants Corticotrophin andCortisone, challenging perhaps the most elusive championof all, Rheumatic Fever. Is Splenin A a worthy opponent?On its form it will do. As Ungar described it, splenin Ais a product of the spleen which decreases capillarypermeability, increases capillary resistance, and shortensbleeding-time. Like corticotrophin and cortisone itincreases the antifibrinolytic activity of guineapig serum,but unlike these hormones has a similar action in splenec-tomised animals. Moreover, it inhibits anaphylacticarthritis in the guineapig-and is not hypersensitivityits opponents’ Achilles heel ?How will the issue be judged ? Not by therapeutic

trial; the challenger, unfortunately, is as yet too meagreof substance. By clinical impression then, and a con-sensus of opinion about anti-inflammatory effect. Theskirmishing begins ; the contestants are hidden in clouds

of dust. The challenger sometimes seems to be on top,but alas ! when the air clears, the champion looks thefitter of the two, and the laurels are still firmly on his.brow. What does the crowd think ? It has been offeredpoor material for judgment; so it very sensibly keeps itsthumb in its fist, and refuses to consider its verdict.

A Hundred Years of NursingSir ZACHARY CoPE London: Heinemann Medical Books.1955. Pp. 144. 10s. 6d.

THE main part of Sir Zachary Cope’s interesting bookdescribes the history of nursing at St. Mary’s Hospital,Paddington, since it was opened in 1851, but in a firstchapter he gives a short account of the general historyof nursing during the same period, which shows thestriking changes which have taken place.

In 1860 the matron asked if a gratuity might be givento a sister who was leaving after seven years’ service. Theboard recommended that she be given £3 to pay her travellingexpenses. The matron herself was dealt with rather shabbily.Her salary remained at £50 per annum for twelve years,after which an increase of £10 a year was granted. Andout of her meagre salary £12 had to be spent on washing.

James Parkinson 1755-1824Editor : MACDONALD CRITCHLEY, M.D., F.R.C.P. London :Macmillan. 1955. Pp. 268. 15s.

To mark the bicentenary of Parkinson’s birth fourpapers dealing with Parkinson’s disease have been attrac-tively published. The book includes the original Essayon the Shaking Palsy. There is also an introduction bythe editor, a biographical essay by Dr. W. H. McMenemey,an account of the pathology of Parkinson’s disease byDr. J. G. Greenfield, and a clinical analysis of theparalysis-agitans syndrome by Sir Francis Walshe.

Parkinson led an exciting life. He was something of apolitical revolutionary but escaped the fate of transportationand imprisonment which befell several of his associates. Twoof his tracts were entitled Revolution without Bloodshed orReformation preferable to Revolt (1794), and Whilst theHonest Poor are Wanting Bread (1795). His papers onmedical subjects included Hints for the Improvement ofTrusses (1802), Some Accounts of the Effects of Lightning(1789), and one of the earliest descriptions of a Case ofDiseased Appendix Vermiformis (1816). He emerges as a

competent and keenly observant surburban practitioner, andan eccentric. But for all that he was an engaging and likeablecharacter, modest, unassuming, and warm-hearted. Hisfamous essay is a great rarity, but it is very profitable reading.How effective are the words with which Parkinson opened :" Involuntary tremulous motion, with lessened muscular

power, in parts not in action and even when supported ; witha propensity to bend the trunk forwards, and to pass from awalking to a running pace ; the senses and intellects beinguninjured."The editor and his collaborators have done well in

republishing and adorning this classical piece of medicalwriting.

Airborne Contagion and Air HygieneWILLIAM FIRTH WELLS, PH.D., laboratory for the study ofairborne infection, University of Pennsylvania School ofMedicine. Cambridge, Mass. : Harvard University Press.London : Oxford University Press. 1955. Pp. 423. 48s.

FOR more than twenty years Dr. Wells has beenengaged on the problems of airborne infection. Muchof his published work has been highly technical, and itwas therefore encouraging to read in the preface to thisbook that " much of the original work had .... to berevalued, and significance, only implicit in publishedpapers, made explicit in the book." But he has notentirely succeeded in this last purpose.In the first part, Dr. Wells describes, in physical and

mathematical terms, the formation and behaviour of respira-tory droplets. He examines the merits of various devicesused for the bacteriological analysis of air and describes theinfluence of ventilation and ultraviolet irradiation on airborneorganisms. The first part of the book ends with a considera.tion of the factors influencing penetration of infected particlesinto the lung.

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The work described up to this point in the book includesDr. Wells’s more important contributions to the understandingof airborne infection ; and a clear account and interpretationwould have been valuable. Unfortunately much of thediscussion is hard to follow and there are long and unnecessarilydetailed descriptions of laboratory apparatus. Most air

bacteriologists in this country have found the slit-sampler tobe the most satisfactory instrument for sampling air. Dr.Wells apparently prefers the air-centrifuge in spite of itsinferior performance with small particles.

Dr. Wells then goes on to describe, in the second part ofthe book, his efforts to prevent airborne infections by meansof " sanitary ventilation." For this purpose he prefersultraviolet irradiation to ventilation in its generally acceptedsense, and he records bacteriological and epidemiologicalexperiments to support his claims for the efficacy of themethod. Some epidemiologists may not be satisfied with the

statistical methods. During one experiment infections occur.ring in an irradiated room were excluded from the resultsbecause the ultraviolet tubes had not been dusted.The chapter on dust-borne infection is the best in the book.

Another useful feature is the comprehensive bibliography.In spite of these several criticisms, the book will be

useful to the bacteriologist working on air hygiene becauseit provides, in one place, a record of Dr. Wells’s notablecontributions to the subject.

Poliomyelitis (Philadelphia : J. B. Lippincott. London:Pitman Medical Publishing Co. 1956. Pp. 567. 60s.).-Thepapers and discussions at the 3rd International PoliomyelitisConference, held in Rome in 1954, have now been published.The official delegates from the United Kingdom were Dr.W. H. Bradley and Mr. H. J. Seddon.

New Inventions

"STITCH-GUN" FOR SUTURING ATRIAL

SEPTAL DEFECTS

M. G. WILSONM.B. Leeds, F.R.C.S.

Royal Infirmary,Bristol

OF the various closed methods of repairing atrialseptal defects the most versatile is the atrial well, firstdescribed by Gross et al.,l but placing sutures underblood by means of a needle-holder is difficult.

I have devised an instrument to overcome thisdifficulty ; it has been used in closing experimentallycreated atrial septal defects in animals, and suturingthe margins has proved rapid and easy.The instrument consists of a head and a barrel housing

a removable needle, mounted on a pistol grip (figs. 1 and2). At the pointed end of the needle is an open eye ;at the other end is a thumb-plate and spring. The springprevents the needle from projecting beyond the barreluntil the thumb-plate is pressed, and when the thumb-plate is released the needle automatically returns tothe barrel. On the pistol grip near the barrel are twospring catches to hold the thread.The suture is threaded into the grooves on the head

(fig. 3A), and the two long ends are secured in the spring

1. Gross, R. E., Watkins, E., Pomeranz, A. A., Goldsmith, E. I.Surg. Gynec. Obstet. 1953, 96, 1.

catches. The edge of the defect is palpated through thewell with the left index finger, while the right handholds the gun and places it so that the edge of the defectis in the U on the head of the gun (fig. 4A). The thumb-plate is then pressed and released ; one end of the threadis held (fig. 2), and the other is allowed to slide throughthe spring catch. The needle passes through the septumat the margin of the defect, catches the thread in itseye and then pulls it back through the septal margin

(figs. 3B and c). With the left hand the needle isthen pulled right out of the barrel, drawing with it theloose end of the thread, which now occupies the barrel(figs. 4B and 3D). The fixed end of the thread isthen released and the instrument removed from theheart.The stitch-gun may also be used for placing stitches

elsewhere in the heart, or in other parts of the bodywhere visibility or room to manoeuvre are lacking.

I should like to thank Mr. A. E. Christmas who made theprototype for me. The instrument has been made- for-meby Messrs. Down Bros. and Mayer & Phelps, 92, BoroughHigh Street, London, S.E.I.

Fig. I-The stitch-gun.

Fig. 3-Action of needle on thread.

Fig. 4-Stages in stitch.

Fig. 2-The stitch-gun, with needle in position.