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creased pressure never demonstrated patterns similarto the waves described above. Similarly, prolongedrecordings in ten patients with increased l.c.p. to levelsof 40-60 mm. Hg without pressure waves revealedno I.C.P. wave patterns.The source of these changes in echo magnitude is

uncertain. de Vlieger and Ridder 7 suggested thatchanges in the magnitude of the midline echo arecaused by distortion of the third ventricle. Changes inblood volume, such as those described by Risberget al.,8 during plateau waves could cause sufficientventricular distortion to produce the observed changesin echo magnitude.

CONCLUSION

If the change in height of the midline echo isrecorded during l.c.p. waves, distinctive wave patternsare produced. These patterns are easily recognised andcorrelate well with the I.C.P. waves. The equipmentand technique used to obtain these tracings is notelaborate and can be used on critically ill patientswithout interfering with nursing care.

Similar wave patterns have not been seen in theabsence of l.c.p. waves in patients without intra-

cranial lesions or in patients with increased I.C.P. butwithout pressure waves. Some patients with i.c.p.waves have been difficult to study because of restless-ness. With perseverance, however, adequate tracingswere obtained which always verified the presence of theI.C.P. waves.

This technique will complement existing methodsfor continuously monitoring iC.P., since it can selectthose patients who have I.C.P. waves. These indivi-duals are at risk of sudden clinical deterioration andwould benefit from continuous i.c.p. monitoring. 1

We thank the Cancer Research Campaign for a grant, ourneurosurgical colleagues for permission to study their cases,and Miss J. Beattie for technical assistance.

Requests for reprints should be addressed to A. R.

REFERENCES

1. Richardson, A., Hide, T. A. H., Eversden, I. D. Lancet, 1970,ii, 687.

2. Eversden, I. D. Med. biol. Engng, 1970, 8, 159.3. Jeppsson, S. Acta chir. scand. 1964, 128, 218.4. ter Braak, J. W. A., de Vlieger, M. Acta neurochir. (Wien), 1965,

12, 678.5. Campbell, J. K., Clark, J. M., White, D. N., Jenkins, C. O. Acta

neurol. scand. 1970, 46, suppl. 45.6. Lundberg, N. Acta psychiat. neurol. scand. 1960, 36, suppl. 149.7. de Vlieger, M., Ridder, H. J. Neurology, Minneap. 1966, 16, 1033.8. Risberg, J., Lundberg, N., Ingvar, D. H. J. Neurosurg. 1969, 31,

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Reviews of Books

Diagnosis and Treatment of Abdominal AbscessesEdited by IRVING M. ARIEL, M.D., F.A.c.S., associate clinicalprofessor of surgery; and KIRK K. KAZARIAN, M.D., assistantprofessor of surgery, New York Medical College. Baltimore:Williams & Wilkins. Edinburgh: Churchill-Livingstone.1971. Pp. 322.$17.50; E8.

GOOD in parts, but this curate’s egg lacks much of the

yolk. There is a very useful chapter on gram-negativeshock alongside chapters on aetiology, bacteriology, andradiology. It is interesting to learn about combined lung-liver scanning in a report of its successful use in 32 cases(only 3 incorrect diagnoses), but not very useful, for, thoughthe author regards the investigation as simple, it would bebeyond the compass of most centres. It is odd that a bookon abdominal abscess, which includes liver abscess, hydatidcyst, anorectal fistula, and a somewhat anecdotal chapter onthe role of urinary infection, fails to give more than passingreference to perinephric, psoas, and appendix abscesses.Psoas abscess has connotations other than tuberculosis ofthe spine and can occur in association with Crohn’s diseaseand appendicitis. Surely appendix abscess warrants at leasta chapter ? Pelvic abscess is seen from a gynxcologicalstandpoint. To the gynaecologist, pelvic abscess is secondaryto a septic tube lying in the area; it comes as no surprise,therefore, that an aggressive approach with early surgery isadvocated, in a section in which the difference between apelvic and a tubo-ovarian abscess becomes progressivelyill-defined. The admission that injury to the intestinal tractis a major complication of this regimen raises more than asuspicion that it is, in fact, important to distinguish betweentubo-ovarian abscess and pelvic abscess, especially sincethe injuries are stated to be minor with no statementabout fistula. The book suffers from inadequate editorialplanning. As a collection of contributions by 24 differentauthors it is not without value, but two opening chapters-one historical and the other a classical topographicaldescription of the disposition of the peritoneum and how itcomes about embryologically-are irrelevant. Pus is where

you find it, and nobody would stop for a moment to recallthe topography of the peritoneum before releasing the pus.

Outline of RadiologyLouis KREEL, M.D., M.R.c.P., F.F.R., head of radiology,Clinical Research Centre, Northwick Park, and radiologistin administrative charge, Northwick Park Hospital, Harrow.London: William Heinemann Medical Books. 1971. Pp. 377.E6.

Dr. Kreel has provided a comprehensive collection ofstaccato notes, covering the radiology of all systems of thebody in less than 400 pages. An account of the radiologicalanatomy of each system is followed by a summary of theradiological investigations and techniques used and by theinterpretation of the X-ray appearances. The points madein the notes are illustrated by simple line drawings. Theprecis method of presentation used is useful for pre-exami-nation cramming or for ready reference, and it is to these twopurposes that the book is directed. The reader who attemptsto read it as a book will require exceptional powers of con-centration. Interest cannot be long sustained by suchundiluted matter. Within its limits this book is never-theless a useful teaching contribution, and, since it containsno radiographs, it is cheap as radiological books go.

Biochemistry of Antimicrobial ActionT. J. FRANKLIN and G. A. SNOW, Imperial ChemicalIndustries Ltd., Alderley Park, Macclesfield, Cheshire.New York and London: Academic Press. 1971. Pp. 163.$7; S2.25.

BIOLOGY undergraduates, medical students, doctors, andothers will find in this book a readable and easily under-standable account of the mode of action of the principalantibiotics, sulphonamides, and related drugs. The

history of chemotherapy is an exciting one, and, althoughthe opening chapter of this book is too short to capture thefascination of the subject, it is an interesting and usefulintroduction. The chapter on those antibiotics which affectthe bacterial cell wall is likely to be of the most generalinterest, not simply because of the penicillins but also

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because many later research developments havebeen in this area. The chapter gives an excellent account ofthe complex processes of mucopeptide synthesis and themechanism of the inhibitory effects which make penicillinsand related antibiotics such effective growth inhibitors.There is also a welcome account of the development of thesemisynthetic penicillins. With the synthesis of these andsimilar compounds has come the hope that the syntheticapproach to chemotherapy may now be more fruitful. Thesynthesis of compounds related to known antibiotics or thechemical alteration of known antibiotics may, as with thesemisynthetic penicillins, give rise to agents with a widerantibacterial spectrum or which are unaffected by theenzymes mediating resistance to the parent antibiotic.Secondly, with increasing knowledge of the mechanisms ofmicrobial enzyme reactions, and the ways in which anti-biotics inhibit them, it may be possible to extend thesynthetic approach and to design successful antimicrobialagents. Franklin and Snow emphasise that several success-ful antibiotics not only are similar in structure to somereactant of the inhibited enzyme, but also have rigidstructures with the key groups evidently held in the mostfavourable position for binding to the enzyme; this know-ledge may prove useful in designing synthetic agents. Thelater chapters are also well written and provide a usefulsummary of the effects of the other major antibiotics. Thechapter on drug resistance is a very worth-while addition tothe book, although the genetic aspects are given rather scantattention. The provision of fuller reference lists would

probably increase the value to the interested reader. In

summary, therefore, although this book could be improvedin a few small ways, it is one that can be heartily recom-mended.

Mode of Action

Antibiotics and Chemotherapy : vol. XVII. Edited byH. SCHONFELD and A. DE WECK. Basle, London, and NewYork: S. Karger. 1971. Pp. 170. S5.50,$12.50.

THIS is a book of variable quality. The choice of drugsfor review is certainly very strange. Why include a fewsuperficial comments on obscure substances such as

ostreogrycin B3 while omitting all mention of chlor-

amphenicol, the j3-lactam antibiotics, the rifamycins, andthe antifolate drugs ? The treatment of the chosen topicsvaries from the competent (tetracyclines, streptomycin,actinomycin, nalidixic acid) to the downright slipshod(cycloserine, azaserine, macrolide antibiotics). The modeof action of fusidic acid, which is of some interest tomolecular biologists, is dismissed in 3 lines, and the latestreference given on this agent is dated 1967. Instead we areinformed of daily dosages, trade names, and manufac-turers. Several of the chapters are written in very poorEnglish: an English-speaking editor would have eliminatedthe more dreadful passages of literal translation from theGerman. Although the better chapters provide usefulsummaries of the mode of action of a number of drugs,the publication fails as an integrated work: it cannot berecommended.

Environmental Health

Edited by P. WALTON PuRDOM, director, Center for UrbanResearch and Environmental Studies, Drexel University,Philadelphia. New York and London: Academic Press.1971. Pp. 584.$19.50; S9.10.

THIS new textbook will interest many who are concernedwith the effects of the environment on health and well-being. This book was written for postgraduate students ofthe environmental sciences in the United States, and thusmost references to statutory requirements are to Federal or

State law. It will, however, interest a much wider audience,since the problems it covers are causing increasing concernin all communities. Ten authors contribute chapters, andthe editor has written a general introduction and a mostuseful final chapter on the planning and evaluation ofenvironmental control programmes. Each chapter can beread by itself and is followed by a comprehensive list ofreferences; many line drawings illustrate the text, althougha few are insufficiently explained; the index is adequate.Since the book is not directed at specialists, the chapters oninsects and other vectors of disease, occupational toxicology,radiation, and accident prevention may not entirely satisfysome medical readers. Others on food, including refer-ence to preservation and contamination, on the pollutionof air and of water, and on the safe disposal of solid wastes,are clear and instructive, whilst the chapter on housing andnew-town planning is of particular interest since it discussespsychosocial as well as physical problems. The price issomewhat high, but the volume will be a useful addition forthose whose reference book on public health may be outof date. Perhaps the next edition could include morediscussion on the environmental problems created by trafficand by modern farming techniques.

The Comparative Pathology of Tumors of BoneSHELDON A. JACOBSON, M.D., associate professor of pathologyand director of the Bone Tumor Registry, University ofOregon Medical School. Springfield, Illinois: Charles C.Thomas. 1971. Pp. 467.$27.75.

Dr. Jacobson succeeds in two of his objectives-thedescription of bone tumours and allied lesions in animalsand their comparison with those of man. The third aim-indicating the value of non-human material for therapeuticresearch-is not so well accomplished, except, perhaps, forcanine osteosarcoma. In all species, man included, primaryskeletal neoplasia is rare, and two important varieties-giant-cell tumour and Ewing’s sarcoma-are probably con-fined to man. Although claiming priority of authorship ofa comprehensive treatise on bone tumours for the veteri-narian, Dr. Jacobson has been forestalled by the concisebut informative monograph by L. N. Owen (1969). Never-theless, Jacobson’s is a wider and more detailed study andincludes only tumours of spontaneous origin. This bookis on the whole well produced, although several of theillustrations seem poorly printed. Three radiographicreproductions are incorrectly oriented. There is wide

coverage of the radiological appearances, sometimes supple-mented by tracings which are rather difficult to interpret.There are many photographs of specimens and the photo-micrographs are representative and widely selected, thougha few are marred by inadequate magnification. An extensivebibliography of 535 references is arranged at the end of thebook together with an author and subject index. Un-

fortunately, there are a number of errors in the cross-references between the lists of authors and publicationscited. Naturally, the space devoted to human conditionsis limited, and in some instances tumour definitions areimprecise. Nevertheless, Jacobson deals shrewdly with themajor diagnostic problems of malignancy in cartilage andthe round-cell tumours. Several new tumour names areintroduced-e.g., " polyhistioma " (alias mesenchymalchondrosarcoma), the justification for which is not fullyconvincing. It is in the extensive section of osteosarcomathat comparison of animal and human tumours has itsmost valid and useful application. Bone-forming, cartila-genous, and fibroblastic tumours are well described. Thesections on lesions of vascular, neural, fatty, and non-neoplastic tissues are shorter, but adequate and informative.With Dr. Jacobson’s wide experience of human oncologythis book should prove a sound reference volume for theresearch-worker and veterinarian.