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Reviews of Books

Modern Trends in Gastro-EnterologyEditor : F. AVERY JONAS, M.D., F.R.C.P., physician,Central Middlesex Hospital. London : Butterworth.1952. Pp. 831. E5 5s.

LIKE the preceding volumes in the " Modern Trend "series which have been appearing under the generaleditorship of Lord Horder, this book aims at reviewingmodern advances in a special subject against a back-ground of established knowledge. Dr. Avery Jones, whoedits it, has spread his net widely, and included manyrelated fields of work, whether physiological, surgical,or medical. He makes no apology for including muchthat is essentially of. research interest rather than ofimmediate clinical importance, and he offers a criticalappreciation of recent progress. He has wisely refusedto include some subjects on which little new knowledgehas come to light, and in general his selection is excellent.Many of the 45 authors who have collaborated in thisvolume belong to the younger school, actively engagedin original investigations ; others are more senior.On the whole the balance has been well kept betweenreally important aspects of progress and the lesssignificant pieces of individual research. This balancecalls for skilled judgment ; for a book such as this isoften marred by undue emphasis on minor advances.Many of the chapters are outstandingly good ; all are

competent and readable. Much that is included hereis not easy to find clearly elsewhere-for example, theexcellent account of hiatus herniae, based chiefly on thework of P. R. Allison, and the general review of progressin peptic ulcer by several authors. Both in its scientificand in its literary qualities this book is a fine example ofBritish authorship. There are numerous good illustra-tions and full bibliographies throughout. The wholeproduction is first-rate.

Der Diinndarm im RontgenbildProf. F. KuHLMANN. Berlin : Urban and Schwarzenberg.1951. Pp. 110. D.M. 11.80.

IN recent years more and more attention has been paidto apparent abnormalities in the X-ray appearances ofthe small intestine. The gross lesions of regional ileitisand tuberculosis were, of course, always comparativelyeasy to recognise, but disturbances of motility andalterations in the mucosal pattern were long either over-looked or ignored. Some of these abnormalities werefound to be associated with deficiency diseases, allergy,and the presence of intestinal parasites, and accurateradiological diagnosis of such conditions is now a reason-able possibility. Like other workers in this field, however,Professor Kuhlmann is careful to point out that muchhas still to be learnt. Special techniques for small-bowelexamination and the normal and abnormal appearancesare very well illustrated. The German text is surprisinglyclear and easy to read.

Gestation et cytologie vaginaleJ. PAUL PUNDEL and FRED VAN MEENSEL. From theresearch laboratory of the University gynaecological andobstetric service, Hopital Brugmann, Brussels. Paris :Masson. 1951. Pp. 210. Fr. 2250.

SINCE the classical demonstration of cyclic changes inthe vaginal cytology of rodents by Stockard andPapanicoloau in 1917, increasing use has been made ofthe fact that the epithelial cells removed from thevagina reflect, in a remarkably faithful manner, thechanging levels of ovarian hormones. Much has beenwritten on the clinical application of this technique toproblems of menstrual dysfunction, and more recentlyto the early detection of uterine and cervical carcinoma.Little has been published on vaginal smears in pregnancy,however, so the present volume fills a real need. More-over, it does far more than merely review published work ;it surveys a wide range of obstetrical problems, discussessome of the more obscure endocrinological aspects ofpregnancy, carries a valuable bibliography, and containsa great deal of original work by the authors. Duringthe first three months of gestation the vaginal smearpresents varying pictures, without great diagnosticsignificance, but from then on, as they show, a constant

appearance is the rule in normal pregnancy. Morpho-logy of the cells, they say, is only one of the criteriato be considered ; equally important are the " eosino-philic and pyknotic indices." The former requirescorrect staining technique with Shorr’s stain and Harris’shaematoxylin. When these indices are used some of themore important complications of pregnancy-particularlythreatened abortion and premature labour-can bepredicted from the vaginal smear. The need for, andlikelihood of success from, hormonal therapy in threatenedabortion can also be decided by examination of smears.The book also contributes to our understanding of the

hormonology of the postpartum and lactation periods,The possibility of diagnosing hydatidiform mole (byfinding syncytial elements) has importance for thepractical obstetrician, as well as for the endocrinologistand biologist.

Management of the Hopeless" CaseC. J. GAVEY, M.D., F.R.C.P., physician, WestminsterHospital, London. London: H. K. Lewis. 1952.

Pp. 41. 9s.

THIS was the winning essay for the Buckston Browneprize of the Harveian Society of London in 1950, thesubject being the choice of the president and council,It deals mainly with the treatment, in the widest sense,of the patient suffering or deemed to be suffering froma mortal disease, and with the doctor’s attitude to deathvictorious or in the ascendant. It consists partly ofquoted observations gathered from many sources,medical and other, and partly of Dr. Gavey’s own opinionsand practical advice " based on experience of cases

duly recorded with this problem in view." Bothconstituents are admirable in themselves, though perhapsnot freely miscible. There are some illuminatingquotations, notably one from H. Sainsbury’s PrincipiaTherapeutica, a story of Osler inducing a child to greetDeath as a friend, and helpful and detailed suggestionsconcerning drugs and operations for smoothing the wayout. Dr. Gavey does not fail to point out that the fieldof the " hopeless " malady is constantly contractingas our therapeutic armament grows, and that " it isthe hardest stone one can throw a man to remove allhope." The essay is described as " written for thestudent," and a thoughtful and discerning studentcould assuredly react it with profit. But practitioners,sadly familiar with the problems with which it is con-cerned, can scarcely fail to find something onnspirationand help in its pages.

Metabolic Interrelations -

Transactions of the Third Conference, January 8-9,1951. Editor: EDWARD C. REIFENSTEIN. New York:Josiah Macy, Jr.,_ Foundation. 1952. Pp. 294.$4.00.

THis report of the Josiah Macy, Jr., Foundation’sdiscussion group on metabolic interrelations reallyconcerns itself with bone.

The subjects discussed are : resorption of bone; histo-chemical observations on the development of membranebone ; the effect of alteration in the concentration of calciumin circulating fluids on the mobilisation of calcium; osteo-

genesis ; osteogenetic potency, and osteogenetic inductorsubstances of periosteum, bone-marrow, bone-grafts, fracturecallus, and hyaline cartilage transferred to the anteriorchamber of the eye ; the effects of beryllium salts on in-vitrocalcification of cartilage ; inhibition of endochondral calci.

- fication in vitro by beryllium and L-histidine; effects of: pituitary factors and of thyroxine on skeletal morphogenesis

in the rat ; the nature of bone and phosphate rock; the

L solubility of calcium phosphate ; the role of phosphatase:r

the effect of age and low-phosphorus rickets on calcificationand the deposition of certain radioactive metals in bone:

’

retention and turnover of radiocalcium by the skeleton of: large rats ; and electron micrography of bone.; Some of these specialised aspects of bone metabolic; are outside the sphere of interest of most physiciansf or even orthopsedic surgeons, but Baird Hastings’s; observations, made about 20 years ago, on the rate at

which calcium may be mobilised from the skeleton tor replace an induced deficiency in the serum, are most3 impressive. Only 2 out of the 25 participants at thet conference came from centres outside the United states.