811

benign cases by filling the uterus with indigo-carminesolution before total hysterectomy ; there has neverbeen any escape of fluid.In the accompanying figure, the clamp unit (A)

consists of sharp toothed upper and lower jaws, sup-ported by strong arms converging at a hinge 1½ in.

distant; the opening and closing of the jaws is con-trolled by a rachet mechanism (B) neatly located in thehinge..The control lever (C) of the rachet lies parallelto the arm of the lower jaw, where it may be disengagedreadily by a simple device (D) on the carrier forceps(E) when the clamp is approaching the cervix in thevagina. This allows the clamp to be introduced inthe closed position through the narrow introitus of thenulliparous patient, and then to be opened when theroomier vagina is reached so that it can grip and compressthe cervix. Immediately before the final compressionof the cervix, the rachet on the clamp is allowed to comeinto action merely by operating the disengaging lever (D)

on the carrier forceps. Full compression is thus securelymaintained. The carrier forceps are then easily slippedoff the clamp by a slight opening movement of thehandles.The clamp, which is made in two sizes (standard and

large), takes up very little room in the vault and in noway interferes with the hysterectomy. In fact it acts asa very convenient landmark which identifies the base ofthe portio vaginalis. The clamp and carrier forceps areeasily dismantled for cleaning.

This clamp should be capable of modification to suittemporary occlusive procedures in other operative fields.The instrument may be obtained from Heaton Grogan

Co. Ltd., 21, Bowling Green Lane, Clerkenwell, London,E.C.1, to whom much credit is due for its finalproduction.

ROBERT PERCIVALF.R.C.S., M.R C.O.G.

Department of Obstetricsand Gynæcology,

The London Hospital, London, E.1

Reviews of Books

Non-Pulmonary Tuberculosis of Bovine Origin inGreat Britain and Northern IrelandGRAHAM SELBY WILSON, M.D., F.R.C.P., D.P.H., director,public health laboratory service, Medical ResearchCouncil ; J. W. S. BLACKLOCK, M.D., F.R.F.P.S., professorin pathology, St. Bartholomew’s Hospital Medical

College, London; LILIAN VIOLET REILLY, B.SC., M.D.,D.P.H., bacteriologist, Northern Ireland TuberculosisAuthority. London : National Association for thePrevention of Tuberculosis. 1952. Pp. 108. 16s.

IN this volume three papers dealing with findings forEngland and Wales, Scotland, and Northern Irelandhave been brought together, and a general discussion ofthe English and Welsh and the Scottish reports has beenadded. The distribution of human and bovine bacilliis analysed in detail according to types of disease, ageof patient, contact history, milk-drinking history, andregion of domicile of patient. The calculation that inGreat Britain as a whole in 1944 there were 1600 deathsfrom non-pulmonary tuberculosis due to bovine-typebacilli has already had the full publicity it deserves.This volume contains the evidence needed to demandthat all milk for human consumption should be madesafe by efficient heat treatment, unless it is known tobe derived solely from a herd of non-reactors to tuber-culin. The evidence that the number of such herdsshould be increased as rapidly as possible is equally strong.

The Metabolic Response to SurgeryFRANCIS D. MOORE, M.D., Moseley professor of surgery,Harvard Medical School, Boston, Mass., and MARGARETR. BALL, A.B. Metabolic diagrams by MILDRED B.CODDING, A.B., M.A. Springfield, 111. : Charles C. Thomas.Oxford: Blackwell Scientific Publications. 1952. Pp. 156.55s.

To show how the human body responds to injury,Professor Moore and his team have arranged the resultsof some of the metabolic balance studies they have madeduring the last six years. The effects of surgical opera-tions of varying severity in different types of patient,and of starvation, immobilisation, and changes inendocrine secretion, on nitrogen, sodium, and potassiummetabolism, are discussed and evaluated.The writers illustrate the disturbances associated with

multiple operations and with large extrarenal losses of

body-fluids accompanying intestinal fistulae, and the changesassociated with burns and bilateral adrenalectomy. They alsodiscuss how much the normal effects of injury can, or should,be disturbed by treatment, giving case-histories (which arean important part of the book) and describing the value ofprotein supplements such as albumin, whole plasma, andsolutions containing amino-acids or protein hydrolysates. The

importance of adequate provision of calories with amino-acidand hydrolysate preparations, and the slow rate of turnover ofalbumin and whole plasma, are emphasised. They mentionthe difficulty of interpreting metabolic balance studies inwhich materials are pooled for periods of three, four, or evenseven days. Difficulty also arises when the preoperativeperiod of study is too short for the existing plane of meta-

bolism of the patient to be assessed. The last chapter sum-marises the evidence and recommendations, and a useful

appendix gives the detailed composition of diets and intra-venous infusions suitable for the various stages of treatment.Here is described in detail the stuff the sick are made

of. The essential normality of the metabolic changesafter injury is emphasised and enthusiastic claims tohave reversed such reactions, by overwhelming the ureaammonia mechanism with hydrolysed protein, are dis-armingly discounted. This book should have a profoundeffect on the postoperative treatment of all patients andespecially those whose convalescence is complicated byinfection, wound disruption, or leakage from fistulee.

Understanding Heredity -

An Introduction to Genetics. R. B. GOLDSCHMIDT,professor emeritus of zoology, University of California.New York : John Wiley. London : Chapman & Hall.1952. Pp. 228. 30s.

ENCOURAGED by the public interest in the Lysenkocontroversy, Professor Goldschmidt has written a booksetting out clearly and simply the principles of genetics.He does not directly refute Lysenko’s views ; but heshows that the main outline of mendelian segregationfits so well with the observed behaviour of the chromo-somes that the reader will be convinced that the chromo-somes are the main bearers of heredity. The later chapters,covering more difficult topics-gene collaboration, multi-factorial inheritance, multiple alleles, and physiologicaland biochemical genetics--are well written but lessconvincing. Here the reader without special knowledgeof genetics must take Professor Goldschmidt on trustas a reliable guide. Medical practitioners will be pleasedto note his full account of mutations ; many doctorsfind it difficult to appreciate that where a conditionseriously affects health, even though it is determined bya single dominant hereditary factor, most patients willhave a " negative family history."Isotopes in Biochemistry

Ciba Foundation Conference. Consulting editors : J. N.DAVIDSON, M.D., L. H. GRAY, PH.D., A. S. McFARLANE,M.B., A. NEUBERGER, M.D., F.R.S., G. POPJAK, M.D., andC. RIMINGTON, PH.D. Editor for the Ciba Foundation :G. E. W. WOLSTENHOLME, M.B. London : J. & A.Churchill. 1951. Pp. 288. 27s. 6d.

AN informal international meeting of workers withisotopes in the biochemical field was held in London inMarch, 1951, under the auspices of the Ciba Foundation.The proceedings, consisting in communications followedby discussions, are published with a foreword by SirCharles Harington, F.R.s. The speakers were concernedon the whole less with technique than with the resultsobtained with isotopes in various branches of bio-chemistry, but the extent to which procedures such aschromatography, ionophoresis, and infra-red spectro-metry are being used in isotope work clearly emerges.Six fields were covered : steroids ; haemoglobin andmetabolic derivatives ; the use of tracers in the studyof biological effects of radiation ; nucleic acids ; ’proteinsand amino-acids ; and carbohydrate and fatty acidmetabolism. All the subjects discussed had an indirect,and some also a direct, reference to medicine.

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C. P. Leblond emphasised the excretion of steroids in thebile, and K. Bernhard, after studying a spleen of highcholesterol content in a case of splenic tumour, suggested thatcholesterol is synthesised by this organ. A. Neuberger pointedto discrepancies between the isotopic and agglutinationmethods of measuring the life span of the human red cell ;the haemoglobin may not be so completely locked up in thecell as was thought. A. Hollaender, G. E. Stapleton, andW. T. Burnett reported that Bacterium coli is protected fromX-ray damage by a variety of compounds, especially thiolsand carboxylic acids. E. Hammersten’s findings indicatethat synthesis of nucleoproteins precedes, and is necessary for,synthesis of proteins. From studies of fatty acid synthesis inthe mammary gland, G. Popjak concluded that it proceeds bystepwise addition of two-carbon units, and suggested thatthe glycerol supply may sometimes be rate-limiting in fatsynthesis. In the discussion S. Gurin stressed pituitary-pancreas antagonism in fat synthesis from acetate.

Sodium Metabolism in Health and DiseaseDouGLAS A. K. BLACK, M.D., F.R.C.P., lecturer in medi-cine, University of Manchester. Oxford : Blackwell

,Scientific Publications. 1952. Pp. 79. 9s. 6d.

OuR knowledge of the physiology and the functionalpathology of the electrolytes in man is advancing sorapidly that few who are not working in this field cankeep pace. Many of the published reviews consist largelyof diagrams and are difficult to follow or digest. Thissmall monograph, which was awarded the Rogers prizeof the University of London in 1951, reviews the highlycomplex problems of sodium metabolism, covering workpublished up to eighteen months ago. In a surprisinglysmall space Dr. Black covers such diverse subjects asthe excretion of sodium, its distribution in the body, itsmetabolism in the infant, the clinical effects and treat-ment of sodium depletion and retention, and the rôleof the adrenal cortex. This is a really readable introduc-tion to a difficult subject. A companion volume onpotassium would be equally welcome.Clinical Pathology of the Eye

BERNARD SAMUELS, M.D., emeritus clinical professor ofophthalmology, Cornell University Medical College ;ADALBERT FucHs, M.D., E.o. professor of ophthalmology,University of Vienna. London: Cassell. 1952. Pp. 420.f,7. 7s.

THE opening chapter of this work deals with thegeneral pathology of the eye, and the 7 succeedingchapters with the different ocular structures. The last6 chapters cover myopia, tuberculosis, syphilis, post-operative pathological findings, injuries, and tumours.Unfortunately the text as a whole deals more withmorbid histology than with the wider aspect of pathology,and thus fails to live up to its title. The illustrationsleave nothing to be desired; but the supporting text isuneven, the technical revolution through which histologyis passing at present is overlooked, the descriptions tendto be confined to individual entities, and the teaching isnot always up to date. The significant work of Callendarand Wilder on the histology of choroidal melanomata isignored in favour of a rather obsolete interpretation, andthe pathology of phlyctenular ophthalmia is discussedin almost meaningless terms. Sympathetic ophthalmiais firmly, and perhaps rightly, ascribed to virus infection.The great experience of the authors in the morbidhistology of the eye lends authority to many specialisedaccounts scattered throughout the text, but this cannotbe regarded as an adequate presentation of the currentteaching in ophthalmic pathology.The Human Blood-groups

P. H. ANDRESEN, M.D., chief, municipal blood bank,Bispebjerg Hospital, Copenhagen. Springfield, 111. :Charles C. Thomas. Oxford : Blackwell ScientificPublications. 1952. Pp. 114. 25s. 6d.

Tms book deals mainly with the medicolegal appli-cations of blood-grouping. It gives adequate detailabout the distribution and heredity of the blood-groupsand the application of this information in cases of disputedpaternity ; it also deals with the use of blood-groupmethods for the identification of blood stains, semen,and saliva. Actual techniques of blood-grouping arehardly mentioned at all, and the author seems satisfiedwith the slide method. A former chief of the serological

department in the Copenhagen University Institute ofLegal Medicine, Dr. Andresen has had more experienceof this kind of work than anyone in Europe ; in fact,only A. S. Wiener in New York has had comparablenumbers to deal with. In Denma,rk the courts can makecompulsory orders for blood-group tests in suitablecases, and at present about 2000 disputed paternitycases are settled annually. The courts, moreover, canhave these tests done at the University Institute, whichis not run by the police and accepts no fee from theplaintiff. Apparently the Danish Medicolegal Councilstill relies on the use of the ABO, AA2, and MN systems.Dr. Andresen consequently gives most space to these;but he does deal quite adequately with the Rh systemand the " secretor " phenomenon, and he mentionsbriefly the other blood factors such as P, S, and theLewis groups. He does not commit himself on thequestion of the Rh group nomenclature, and it is unfortu-nate that apostrophes have often been substituted fordashes in the symbols of Wiener’s nomenclature (e.g.,Rh’ for Rh’). This book, however, fills a gap in theliterature and Dr. Andresen’s wide experience allows himto point out the difficulties and limitations, as well asthe possibilities, of blood-group techniques.Mind : A Social Phenomenon

Illustrated by the Growth of Medical Knowledge. F. S. A.DORAN, M.A., M.D., F.R.C.S., clinical demonstrator in

anatomy, University of Manchester. London: Watts.1952. Pp. 182. 10s. 6d.

To say anything new about the mind-body problemcalls for genius : even to restate the issues arrestinglydemands exceptional freshness of outlook. Dr. Doranis a painstaking and thoughtful man who writes clearly,but does not manage to grapple with the complexitiesof his theme or the stronger arguments of the dualist.As a simple statement of the view that mind is anexpression of brain function, and a rapid resume of thehistory of medical thought, the book is interesting andwould give a useful turn to a medical student’s reflections.Meconnaissances et hallucinations corporelles

Integration et désintégration de la somatognosie. H. HÉCAENand J. nE AJURIAGUERRA. Paris : Masson. 1952. Pp. 382.Fr. 2300.

THis interesting monograph from the Paris school ofneurology deals with problems common to neurologyand psychiatry which have recently attracted renewedinterest. The theme of the book is disturbances of thebody-irnage; and phantom limbs, anosognosia, construc-tive apraxia, the Gerstmann syndrome, " hallucinationsof the self," and other aspects are discussed in detail.The authors give many personal case-records with, insome cases, detailed pathological reports ; and theseare correlated with previous work on the subject. Theproduction of the book is good, but the price seems highfor a paper-bound volume.

Architectural Principles in Arthrodesis (2nd. ed.E. & S. Livingstone. 1952. Pp. 196. 42s.).-The secondedition of Mr. H. A. Brittain’s well-known monograph hasbeen largely rewritten, and expanded in various ways. It is acraftsman’s manual, not pretending to any wide discussionof the indications for arthrodesis as opposed to any otherprocedure in a given case, and it has the advantages and dis-advantages of this type of book. He is a persuasive advocateof the operations he describes, many of them the result ofhis own original thoughts and methods. The principles heexpounds so clearly are those essential for the embodimentof the graft, which he considers the mainstay of all arthrodeses.He does not attempt any wide description of other methodsof arthrodesis, and the book is therefore of greater value to thesurgeon of some experience than to the student.

Brittain’s ischiofemoral arthrodesis has come to stay;over the last ten years the experience of surgeons in manyparts of the world has proved the soundness of this procedure.He- now adds a description of his more recently designedV-arthrodesis of the hip. Whether this will become equallypopular remains to be seen : an incidence of nearly 10% offractures of the femur as a complication of its early stages israther disquieting. In view of the present surge of feelingtowards arthroplasty, it is perhaps healthy to be remindedof the advantages of arthrodesis by someone as expert andenthusiastic as Mr. Brittain.