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evaluated by comparing tremor before and after administrationand assessing against a placebo. The apparatus can be usedfor short experiments as well as for recording over longperiods and gives objective data useful in the study of

parkinsonian tremor.T. K. COWELL

B.SC. (Eng.), A.M.I.E.E.C. D. MARSDEN

M.SC. Lond., M.R.C.P.D. A. L. OWENM.A., M.B. Cantab.

Medical Electronics Department,Departments of Medicine and Neurology,St. Thomas’s Hospital, London, S.E.1

Reviews of Books

Congenital Heart DiseaseCorrelation of Pathologic Anatomy and Angiocardiography.JESSE E. EDWARDS, M.D., director of laboratories, Charles T.Miller Hospital, St. Paul, Minnesota; LEWIS S. CAREY, M.D.,director, cardiovascular diagnostic unit, department of radiology,St. Joseph’s Hospital, St. Paul, Minnesota; HENRY N. NEUFELD,M.D., chief, heart institute, Tel-Hashomer Government Hospital,Israel; RicHnitn G. LESTER, M.D., chairman, department ofradiology, Medical College of Virginia, Richmond, Virginia.Philadelphia and London: W. B. Saunders. 1965. Pp. 890 (in2 vols.). E15 15s.

THE classification of congenital heart-disease has been attemp-ted in many different ways-usually reflecting the author’smain interests (such as clinical features, pathology, or embry-ology). None of the classifications has found general acceptance,and that indicates the difficulties. The authors of this bookhave clearly been much concerned about classification, for theybegin with a short section on it in which they expound andjustify their choice. Rather surprisingly, in view of the subtitle,they adopt one based on plain radiographic assessment of thevascularity of the lungs, coupled with the clinical assessment ofcyanosis: thus their group I is defined as

" Increased pulmonaryarterial vasculature; cyanosis absent (a) Extracardiac left-to-right shunts, (b) Intracardiac left-to-right shunts ". Group IIis similar but with cyanosis present. In view of the difficultiesin distinguishing the state of the pulmonary vasculature inborderline cases, or in assessing patients with only slightlylowered arterial-oxygen saturation, it is debatable whethersuch a classification is satisfactory for any purpose. It is hardto believe that it was the best for an exposition of pathologicalanatomy, for it means that identical anatomical conditions aresometimes considered in two different sections according towhether it presents with or without cyanosis.

Despite criticism of the arrangement of the book, the materialitself and all the other aspects of its presentation are admirable.The work of Professor Edwards and his colleagues in unravellingand delineating the many variants of the basic abnormalities rof congenital heart-disease is well known and widely acknow-ledged to be of outstanding value. Into the book has beendistilled much of this work, revised and refined to extract thebest.The book is really an atlas, with 1118 figures, nearly all

photographs of specimens and radiographs from the same orsimilar cases. The text is brief (spread around the figures,it often fills only part of a page); but this has not preventedthe inclusion of remarkably accurate thumbnail sketches of theclinical features of each condition. The clinical cardiologist,the cardiovascular radiologist, and the cardiac surgeon will findexamples, amply illustrated, of the commonplace and the rare,with authoritative accounts of the pathology and how this maybe displayed by radiographic techniques. This is not a bookfor the student, but it will be an invaluable work of referencefor the interested specialist.The publishers deserve special praise for the quality of

production and for the high standard of the illustrations.

Considering the amount of material in the book and the carewhich has been taken in its presentation, the price, though high,is not surprising.

Depression and its TreatmentJOHN POLLITT, M.D., M.R.C.P., D.P.M., physician in psycholo-gical medicine, St. Thomas’s Hospital, London. London:Heinemann Medical Books. 1965. Pp. 114. 24s.

Dr. Pollitt believes that " much of current terminology isoutdated, there is no satisfactory classification, and existingtheories do not cover the breadth of knowledge which hasrecently accumulated ". He therefore presents a new classifi-cation of the illness and suggests a physiological basis for thephysical symptoms (based on changes in the hypothalamus)and possible mechanisms which might produce the psycholo-gical features of depression. Broadly, the condition is dividedinto psychological depression (type J) and physiologicaldepression (type S). The first is related to adverse externalcircumstances, while the second is characterised by bodilychanges, referred to as the " functional shift". These are theones usually regarded as characterising endogenous depression,so that in fact the new classification does not seem to be verydifferent from the old. But a more serious criticism is that Dr.Pollitt’s whole edifice rests on certain assumptions. In due

course, they may all be established as true, but hardly anysuggestion of present doubt appears in the text. For instance," Depression is more common among those brought up toassume responsibility early than in irresponsible individuals ";how is this established ? Again, " gross weight loss affects theprognosis adversely "; have cause and effect been carefullydistinguished here ? And another important influence is saidto be the " increasing frustration of modern life ".

For the psychiatrist or postgraduate student, this is a stimu-lating work which can be balanced against other points ofview. But the introduction indicates that it is intended largelyfor general practitioners and physicians, and it would beunfortunate if they gained the impression that all the materialhere was based on clearly established fact. Also, the discussionof " atypical depression " suggests that treatment is rathersimpler than it usually turns out to be.

The Craft of SurgeryEditor: PHILIP COOPER, M.D., professor of clinical surgery,Albert Einstein College of Medicine, New York. London:

J. & A. Churchill. 1965. Pp. 1510. 05.THE most conscientious reviewer can give only a limited

appraisal of a widely ranging compendium such as this. Mostof the contributors to the two volumes are American, butRussian, Italian, Japanese, and British surgeons have writtensections. The emphasis throughout is on refinements in

technique. Preoperative and postoperative care is not dis-

cussed, and most surgeons will agree that this was wise.

Abdominal, cardiovascular, and pasdiatric operations are amplycovered, but gynxcologists and orthopaedic surgeons maygrumble at the small space allocated to their specialties. Allin all, this is a handsome and praiseworthy production.Surgeons who are looking for some tangible way of rewardingthe work of their assistants could do worse than present themwith these two volumes.

Evolution of AnaesthesiaM. H. ARMSTRONG DAVISON, M.B.E., T.D., M.D., F.F.A. R.C.S.,lecturer in anaesthetics and in the history of medicine, Universityof Newcastle upon Tyne. Altrincham: John Sherratt & Son.1965. Pp. 236. 35s.

Dr. Armstrong Davison considers the background to thehistory of anaesthesia so important that about half of this bookis concerned with events before Morton’s classic administrationof ether in 1846 in the Massachusetts General Hospital. Theremainder deals fully with the development of ether andnitrous-oxide anxsthesia, the rise, decline, and fall of chloro-form, endotracheal intubation, muscle relaxants, and the

history of premedication and local analgesia.He gives a full account of the discovery and use of oxygen,

both by the quacks of the early 19th century and by those whoemployed it rationally for the treatment of disease, and he addsa short section on helium. The history of blood-transfusion istraced from the mythical story of how Medea did an exchangetransfusion to rejuvenate the ageing Aeson, to modern methods

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of extracorporeal circulation. The many variants of intravenousanxsthesia during the years are also described.The first of three entertaining appendices tells the story of

diethyl ether from the time of Harun-ar-Raschid up to its

presentation by C. T. Jackson to Morton. The second concernsthe trial of a celebrated Scottish witch, Eufame MacCalzean,who is reputed to have been executed for claiming to be ableto relieve the pains of labour. One gathers that this was by farthe least of her crimes; in fact, she was sentenced for trying toencompass the death of the sovereign by witchcraft in the fullknowledge of what she was attempting. The last appendixharks back to a prize essay on the resuscitation of the apparentlydead submitted to the Humane Society in 1787 by Dr. CharlesKite of Gravesend. It describes the treatment of the drowned;and much of it, with its appreciation of the importance oflaryngeal spasm and death before the entry of fluid to thelungs, and the emphasis on artificial restoration of respiratorymovements and the value of oxygen and endotracheal intuba-tion and tracheostomy, has a very modern ring.This book should be read not just by every anxsthetist, but

by anyone who has a serious interest in the history of medicine.Grant’s Method of Anatomy

7th ed. J. C. BOILEAU GRANT, M.C., M.B., HON. D.SC., F.R.C.S.E.,professor emeritus of anatomy in the University of Toronto andcurator of the anatomy museum; J. V. BASMAJIAN, M.D., pro-fessor and head of the department of anatomy, Queen’s Uni-versity, Kingston, Ontario, Canada. Edinburgh: E. & S.

Livingstone. 1965. Pp. 777. 108s.

WHEN Professor Grant wrote the preface to the first editionof this now well-known work, he said that his aim was tolead the student to approach anatomy in a way that wouldmake sense of the subject. He did this by emphasising rela-tionships, enabling students to grasp the raison d’etre and theprinciples involved. In 1937 he could claim that this approachwas a departure from tradition, and since then this rationalapproach has been widely adopted.The new edition has an improved format, and the 27 chap-

ters of the previous edition have been broken down into 50.The terminology has been revised to conform to the NominaAnatomica (Paris 1961), and 38 new illustrations have beenadded. The authors are to be congratulated on reducing thenumber of pages by nearly 100 and rejuvenating an alreadyvaluable aid to anatomy. The one defect is that insufficientattention is paid in some sections to the embryological basis ofadult structure-for example, the accounts of the skull and theinnervation of the limbs would make better sense to thestudent if more attention were paid to the embryologicalapproach. The simple line drawings are all lucid and helpful,and some are novel and arresting.Elizabeth Garrett Anderson

Jo MANTON. London: Methuen. 1965. Pp. 382. 42s.

TODAY the Medical Register includes the names of some18,400 women doctors. A century ago it contained only one:and, since the responsible authorities were about to revise thecondition which allowed Elizabeth Blackwell to register anAmerican qualification, it seemed unlikely that it would evercontain another. Then Elizabeth Garrett, the daughter of asuccessful business man, London born but Suffolk bred, pre-sented herself before the only examining body in this countrywhich would consent to test her. Very few aspirants to thelicence of the Society of Apothecaries can have been morethoroughly prepared. Miss Garrett had received personaltuition from a fellow of the Royal Society, a regius professor,three fellows of the Royal College of Physicians of London, andone fellow of the Royal College of Surgeons of England. MissManton’s book happily commemorates the fact that in Septem-ber, 1865, Miss Garrett acquitted herself better than any othercandidate and became the first woman doctor to be both trainedand registered in Great Britain.The story of her life falls naturally into two parts. Her

career before qualification was often frustrated and disappoint-ing. An attempt to join the Middlesex Hospital Medical Schoolby way of the nursing profession failed, and she fared no better

at the London Hospital. St. Andrew’s University refused toadmit her, and London University had already rejected a pre-vious petition from a Miss Jessie White. Of all the authoritiesrecognised by the General Medical Council, only the Apothe-caries agreed to examine her: they were furthermore (and thiswas an issue almost as critical) prepared to acknowledge certifi-cates of instruction furnished by competent lecturers, even if notissued from the schools of medicine where they normally taught.The years after 1865 were as successful as those before had

been vexatious. Dr. Garrett earned the M.D. of Paris by herdistinguished performance at an examination which included apublic viva voce in a foreign tongue. Aged 29 when she quali-fied, within four years she had become a successful consultantand a competent surgeon. Soon afterwards she married a giftedAberdonian, James Skelton Anderson, and bore three children.This biography makes it plain that marriage in no way curtailedDr. Garrett Anderson’s enthusiasm and medical work, for shehelped to found the New Hospital for Women (now the Eliza-beth Garrett Anderson Hospital) and the London School ofMedicine for Women. Miss Manton is to be congratulated onhaving chronicled a life so full of professional and public achieve-ments without obscuring the personality that lay behind them.

Drugs of HallucinationSIDNEY COHEN, M.D. London: Secker & Warburg. 1965.

Pp. 268. 30s.

LYSERGic acid diethylamide (L.s.D.-25) has been widely usedover the past decade as an effective adjunct in psychotherapy.It enables unconscious material to be reached more quicklythan with classical analytical techniques, and in a condition ofclear consciousness rather than as dream memories. L.S.D. hasalso been misused, however, particularly in the United States.Two professors were expelled from Harvard for giving hallucino-genic drugs to students in an allegedly unethical manner; andthere is now a movement in the United States (particularly insouthern California) that uses L.S.D. deliberately for what canonly be described as brain-washing. The drug is supposed togive a new insight into the universe, and the experiencequalifies for membership of a select group of initiates whoadumbrate the new chemical Utopia. Another cause for alarmin the United States is the use of L.S.D. by students. ApparentlyL.S.D. is taken in doses as large as 400 pg., and without adequatesupervision, for purposes of

" instant zen ". Several serious

accidents have ensued.Dr. Cohen gives an admirably well-balanced and sensible

review of " the uses and misuses " of L.S.D., indicating howpowerful it is in moulding behaviour-for good or ill. Thebook is meant for a wide general audience, and it does not

pretend to be a manual for the specialist use of L.S.D. in psycho-therapy. Dr. Cohen is. concerned with all aspects of the

problem, which he covers briefly but adequately. He includes agraphic account of what the use of L.S.D. as an agent of chemicalwarfare might really be like (certain military opinions havehoped that it would merely be incapacitating rather than

lethal), but Cohen says " it is evident that the so-called

incapacitating agents are neither non-lethal nor humane ".

Obstetrics (13th ed. Philadelphia and London: W. B.Saunders. 1965. Pp. 1246. 140s.).-For fifty years this

textbook, edited first by Dr. DeLee and latterly by Dr. J. P.Greenhill, has enjoyed an international reputation. For thenew edition the entire book has been rewritten, many oldillustrations removed, and over 400 new ones added. As in theprevious edition, Dr. Greenhill has enlisted the help of world-renowned authorities to bring the text up to date. A feature ofthe book is the careful and detailed assessment of medical dis-orders which may complicate pregnancy. Again the extendedsection on the newborn infant, normal and abnormal, reflectsthe growing importance of neonatal paediatrics. Each chapterhas a selective bibliography to guide the student to key articlesin the literature.

Disease in Infancy and Childhood (5th ed. Edinburgh:E. & S. Livingstone. 1965. Pp. 712. 70s.)-We regret that inour review of this book (Dec. 4) the price was given incorrectly.