BOOK REVIEWS

The Biochemistry of the Cells of Blood and 'Bone Marrow by Joseph F. Seitz. Springfield, Illinois. Chas. C. Thomas. $18.75.

Written by an eminent Russian haematologist, this book sets out to summarize and explain the chemical nature and metabolic workings of the haemopoEetic cells. The result is definitive, concise without being tabular and surprisingly readable.

The four major sections, erythrocytes, leucocytes, thrombocytes and bone marrow, are each analysed with regard to const:tuents, their chemical measurement and respective roles in the overall cell metabolism, w;th regard to respiratory and other metabolic pro- cesses and how various enzyme systems interact with substrates. Finally the biochemistry is related to the overall body metabolism.

The section on leucocytes is particularly comprehensive. A metabolic classification is emphasized, namely those which utilize aerobic glycolysis (granulocytes), and those which do not (lymphocytes) and the various metabolic derangements which can occur in the leukemias are discussed.

There is an extensive bibliography to each section, with many references to German and Soviet literature.

The book fills an important role as adjunct to the classical descriptive pathology type of haematology textbook, wh!ch rarely concerns itself with dynamic biochemistry such as is expounded here. It is to be recommended to the haematologist or interested general phy- sician, who should, however, have a knowledge of basic biochemistry and laboratory techniques.

DAVID POWELL.

O bstelrics and Gynaecology, Combined for Students by Elliott E. Philipp. London. H. K. Lewis. 2nd ed. s

The author points out that this book has been written for students working in hospital and those preparing for their final examination. It admirably achieves this aim.

The subjects of obstetrics, gynaecology and paediatrics are nicely interwoven in order to provide the reader with a smooth and coherent account of the three subjects, which, to a certain extent, overlap both in curriculum and practice.

The text is divided into nine sections, the sequence of which is rather unusual, but which, on reflection, is both orderly and reasonable.

The writer is obviously a man of kindness and humanity and takes every opportunity of reminding the reader of the importance of these virtues in dealing with patients. It is heartwarming nowadays to read a chapter on "Kindness to Patients". No worthwhile review gives unstinted praise to a scientific work of this nature, but the faults noted are minor. The chapter on diabetes, in our opinion, does not give sufficient attention to the latent diabetic state, and to the indications for the glucose tolerance test in the pregnant woman. There is a great need of uniformity in the designation and classification of disturbed car- bohydrate metabolism. The chapters on the other medical complications are, however, very good indeed.

In a short review such as this, it is difficult to make the point that one book is better than another. It is a pleasure, therefore, to be able sincerely to express the opinion that the student, the practitioner and the specialist will enjoy reading this book and learn much from it.

J. K. FEENEY.

143

144 IRISH JOURNAL OF MEDICAL SCIENCE

A Student's Guide to Geriatrics by T. H. Howell. London. Staples Press. Second Edition. s

Trevor Howell has modestly called his latest book "A Student's Guide to Geriatrics" but, the student who has mastered its contents would have little to fear from his examiners not alone for the token geriatric question but in general medicine too, for this concise "guide" is a mine of valuable and practical information for student and graduate alike.

"Practical" is the key word and throughout emphasis is placed on the importance of clinical examination and the interpretation of clinical findings confirmed as indicated by pathological or radiological studies.

Occasionally the author may appear unduly dogmatic but this is the dogmatism of one who knows and can teach his chosen speciality.

The approach to the aged sick is dynamic and stress is rightly laid on the importance of active treatment and relief of distress in those for whom true cure may not be possible.

"Normal" ageing is defined and described as well as can be done with this nebulous concept and there is an excellent chapter on the multiple, often asymptomatic pathology of old age.

There is rather a large number of minor misprints and spelling errors but these are very minor blemishes in a book which can be thoroughly recommended for the student, general practit ioner or specialist in another field who must cope with a geriatric problem.

J. FLEETWOOD

Diseases of the Chesl by H. C. Hinshaw. Philadelphia and London. W. B. Saunders Co. Third Edition. s189

The first edition of this volume was completed in 1956, and the second in 1963 under joint authorship with the late Dr. L. H. Garland. The author fittingly dedicates this new edition to his former col league and calls on Charles T. Carman, M.D., Professor of Medi- cine, University of California Medical Centre; Douglas A. Young, M.D., and Horton C. Hinshaw Jr., M.D., both of San Francisco, to write chapters 6 and 37.

It is written primari ly for medical students and physicians who are not chest medicine specialists and in that context it is a comprehensive study of nearly 800 pages with a useful list of references at the end of each chapter. It is unlikely to attract our medical students though it would be a useful l ibrary reference for them to work up a special project. The paper, typing and reproductions are excellent. The chapter on physiological function tests is sound though brief. It is up to date in its preliminary optimistic reference to Rifampicin in the treatment of pulmonary tuberculosis and mentions Ethambutol as a drug of great promise, both of these predictions are being fulfilled. Bronchial asthma is given a poor showing with only 20 pages compared with 118 pages for tuberculosis. Disodium Cromoglycate (Intal) is not mentioned, this reflects the slow progress of new drugs (though useful) through the Food and Drugs Administration's processing. The changes in blood gas tens:ons with bronchodi lator drugs is not mentioned though paragraphs are given to ad- renaline inhaler aerosols (relatively ineffective), potassium iodide and antihistamines. Most drugs used in the treatment of asthma in the past 20 years are mentioned without balance; some of these might be relegated to a historical review. A sentence on neurosis is worth quoting, "Some asthmatic persons develop psychoneurotic symptoms because they have asthma, they do not have asthma because they are psychoneurotic", this view has been borne out by recent studies and is certainly the reviewer's experience.

The text reflects the aetiological factors additional to ours in American medicine which are mainly fungal and what we could consider tropical diseases. The predominance of complex industrial processes also makes exposure to various dusts or chemicals of more importance in the United States. The emphasis on Tuberculosis probably partly reflects the author's age, though this comment may not be fair, and it might be truer to say the author's wisdom, and also the large pool of infection still remaining in the Negro, Immi- grant and Skid Row populations.

I would recommend this text-book to all physicians needing a personal and reason- ably comprehensive review of chest diseases. It is well written, produced and up to date.

W. D. LINEHAN.

BOOK REVIEWS 145

The Physiological Mechanisms of Cerebral Blood Circulation by A. I. Naumenko and N. N. Benua. Translated by J. Brozek and E. Simpson. 1970. Illinois. Chas. C. Thomas, $8.75.

The tranquil air of effortless superiority that goes with a knowledge (mastery is not essential) of the English language deludes even the scientists into the curious notion that nothing of value is to be found expressed in 'barbaric' tongues. The brill iant application of the Fick principle by Kety and Schmidt has given so much information about total cere- bral blood flow that regional studies have been neglected and it is to this field that the Russian authors of this little monogram have turned their attention. To study neural and humeral control and autoregulation they employ impedance plethysmography which pro- vides qualitative rather than quantitative information. In this concise review they relate their work to Western knowledge, and, indeed, one third of the 409 references detail work done outside the U.S.S.R. The translators are to be thanked for making available infor- mation not otherwise readily obtainable to those of us who cannot read Russian.

C. S. BREATHNACH.

Histology by Thomas S. Leeson and C. Roland Leeson. 2nd Edit;on. Philadelphia and Lon- don. W. B. Saunders Company Ltd. s189

The collaboration of Professor T. S. Leeson, Professor of Anatomy, Faculty of Medicine, University of Alberta, and his brother, Professor C. Roland Leeson, Professor of Anatomy, University of Missouri, School of Medicine, have presented to pre-clinical students of medicine and dentistry in this their second edition of Histology, a useful volume thus fulfilling an essential need for simple texts acquainting the student at this level, with not only a basic knowledge of microscopical anatomy as related to functional specializations of the human tissues and organs, but also to some of the relevant advances and fields of current interests and investigations.

The microscopic anatomy of cells and tissues evolving from electron microscopy is rapidly gaining independent status and is superseding much of the older information derived from light microscopy. The influence of this emphasis on this volume is stimulating. How- ever, the chapter introducing established basic microscopical instrumentation and tech- nique and the advances currently achievable with modern instrumentation, does not combine at the elementary level, simplification with sufficient information to enable the student to comprehend the relevant limits of the dimensions of fine structure. With the extension of magnification beyond the limits of microscopical resolution, these dimensions approach those of molecules, and in this sense structure and chemical composition become synonymous.

The scientific contributions of Professor H. E. Huxley to the knowledge of the physiol- ogy and ultra-structure of striated muscle are remarkable. Some of these included in the chapter describing the structure and function of muscle, illustrated by means of high magnification electron micrographs are at magnification of x 145,000. (See page 165, figure 9-11). However for the pre-clinical student of histology, these would certainly involve special pleading to relate observable effects to general concept.

Greater relevancy would be achieved by more emphasis on the use of the electron scanning microscope photographs for the teaching of histology to the pre-clinical student. The use of magnifications of x 536 to x 13,000, would enhance understanding of the relations of three dimensions to microscopical anatomy. (See page 135, figure 8-1 and page 305, figure 14-31).

Textbooks written in the second fifty years of this century must necessarily differ from those written during the first fifty years. Accompanying this volume is the additional aid of two supplementary 35 ram. colour filmstrips of one hundred colour photomicrographs keyed to the black and white photomicrographs of the text. These are available for the student's home viewer.

From the reading of this votume, the student will without doubt acqu!re an understand- ing of the primary tissues and organs of the human body, and their specialisations, even if he lacks comprehension of morphological structure at high electron magnification.

PATRICIA F. STEVENS.

146 IRISH 'JOURNAL OF MEDICAL SCIENCE

General Pathology. Edited by Lord Florey. London. Lloyd-Luke & Co. s

The fourth edition of this standard textbook was completed after the death of the editor and remains as a testament to his interest and knowledge. The format of the book has not altered since its first edition in 1954, but the topics under discussion have changed greatly, in keeping with the change of research interests and with the advances in know- ledge brought about by these. Accordingly a chapter by Gowans on lymphocytes and chapters on immunology underline the modern emphasis in this book. Despite the con- centration on recent advances, topics such as oedema, chapters on fever and on degener- ative changes provide a traditional foundation for the later flights to more sophisticated subjects.

The editor's interest in mucus and its secretion results in a single chapter on this subject, and the reactions of the blood and circulatory system to injury retain their emphasis in this edition. The book is beautifully produced with a liberal use of electron photomicrographs, but the balance is preserved so that one can learn from the range of the ultra-structure of the circulating blood cells to the naked eye appearances of healing wounds and fractures.

The editor has chosen a distinguished list of contributors, most of whom have con- tributed original research on their subjects, and while the academic pursuit of knowledge sometimes obscures the practical significance of the changes under discussion, the detailed and long text (1,223 pages) results in an exhaustive treatment of most of the topics under discussion. A majority of the authors are drawn from the late editor's own university and one might regret that more transatlantic contributors were not invited. The result of this however is that the book retains an overall balance between its parts, and reflects much of the best in British pathology.

One might find it difficult to recommend this as a standard textbook to undergraduates, but it is undoubtedly a most learned reference book for teachers of pathology, and for occasional use by undergraduates. It is not written for examination purposes, thereby contrasting markedly with other textbooks of general pathology, and those seeking rapid precise guidance for fellowship and other examinations would be well advised to seek a less discursive text. On the other hand one can heartily recommend this to any person genuinely seeking enlightenment in areas of pathology.

In conclusion one can say it is a most valuable and genuine textbook on general pathology, carefully avoiding the detailed examples of general principles which so com- monly occupy at least half of other textbooks on this subject and treating most of its topics to an analysis in depth.

To be brief this is the best book on this subject, although rather heavy going.

D. O'B. HOURIHANE.

Epilepsy by W. Pryse-Phillips. Bristol. John Wright and Sons. 90p.

Ellis's classification of nephritis into Types I and II helped to clarify a complex subject and Dr. Pryse-Phillips, a registrar in the department of neurology at the Royal Free Hos- pital, may have had this in mind when, ignoring the endeavour of the International League against Epilepsy to prepare an international-acceptable classification, he classifies the disorders into Types I and II. For practical purposes there is much to be said for his approach. His clinical descriptions and therapeutic advice are written with commendable clarity and his book can be recommended to those requiring an up-to-date account of epilepsy not overburdened with detail.

The chapter on social management will make Irish readers more than ever aware of the lamentable inadequaci6s in our country. Incidentally, the address of the Irish Epilepsy Association is incorrect (having changed since the book was wr i t ten) : i f is now 30 Leeson Park, Dublin 6.

J. B. LYONS.

Illustrated Dictionary of Eponymlc Syndromes and Diseases by S. Jablonski. Philadelphia and London. W. B. Saunders. s189

Eponyms exist. Like warfare in this age they excite the public disapproval of those in office yet their use continues with all devastating effect, whether in the lunch-time skirmish between peers, or on the one-sided conflagration of higher examinations. Bin- swinger's Disease, Hanot-MacMahon-Thannhauser syndrome and the Curse of Oudine must

BOOK REVIEWS 147

be as emotive and pulse quickening to those who know what they are, as ever will be the thought of Austerlitz or Marengo to those who were not there.

There is an interesting and enjoyable volume, a monument to the confusion in medical terminology. One of the stated aims of the author is that he reduce in some measure this confusion. His success may be judged from the following extract: "Clay Schvellers syn- drome. A misspelling of Clay Shovellers syndrome, occasionally found in the literature. See Schmitrs Disease".

Throughout, the work is admirably cross referenced and contains many useful and unforgettable illustrations of rare syndromes. The dictionary will be considered complete by all save those who feel that their names warranted inclusion.

M. P. BUCKLEY.

Symposium on the Spine by American Academy of Orthopaedic Surgeons. St. Louis. The C. V. Mosby Company. $19.50.

The material from this monograph has been taken from the course on the spine or- ganised and presented by the Committee on Injuries, American Academy of Orthopaedic Surgeons, which was given in Cleveland, Ohio, in November, 1967.

There are sixteen chapters, covering six topics, as follows, one each on the bio- mechanics of the spine, spondylolisthesis, and osteoporosis, two chapters on cervical spine injuries, five chapters on disc lesions, and six chapters on scoliosis. Inevitably there is fairly considerable repetition in the contributions on disc lesions and scoliosis. This apart, I found these essays most informative, and indeed stimulating.

The chapter on fractures and fracture dislocation of the cervical spine, by J. Neil Garber, is mainly concerned with the classification and mechanism of these injuries. Whilst appreciating this author's personal preference for posterior cervical fusion, I think an essay on this subject should contain more than three and a half lines on anterior cervical fusion.

The chapter on osteoporosis is based on the classification of AIbright and Reifenstein, and the subject is dealt with purely as a metabolic disorder. This reviewer feels that men- tion might have been given to the importance of "osteoporosis" as an early warning of hitherto unsuspected malignancy.

Of the six chapters on scoliosis, Blount's contribution on the place of the Milwaukee Brace treatment, and Moe's chapter on classification and treatment, are really excellent. I fully endorse the former's statement and we must avoid conservative treatment that is no more than standing by and watching the curve deteriorate over the years. Similarly I agree with Professor Moe when he states "that in scoliosis there is no dependable pattern of behaviour and that prognosis can only be based on probabilities and experience--which latter can best be obtained by the establishment of a scoliosis service in a teaching insti- tution".

Whilst all the chapters on disc and associated lesions are interesting and informative, the outstanding chapter in this section and in fact in the whole monograph is that by Coventry and Stauffer on "The multiply operated Back". Their emphasis on careful selec- tion for operation cannot be overstated.

Having reviewed and described the various methods of lumbo-sacral fusion, they recommend postero-lateral fusion on the transverse process and in the lateral gutters of the laminae as being the method of choice.

Lastly, one must congratulate the publishers on the excellent radiographic reproduc- tions.

PATRICK MacAULEY.

Functional Pathology of the Human Adrenal Gland by Thomas Symington. Edinburgh and London. E. & S. Livingstone Ltd. s

Prof. Tom Symington's department has been the focal point of a group of prolific workers on the various aspects of adrenal gland disorders in various departments of the the University of Glasgow. It has been obvious that a comprehensive compendium on the subject could be produced from this group but nobody could have anticipated the completeness of the work as it has now appeared.

148 IRISH JOURNAL OF MEDICAL SCIENCE

An unusual feature of the work is the evidence, which its treatment of the subject man- ages to convey, that the author has been concerned more with the reader and less with his own ideas. Nothing is assumed about the reader's lack of surfeit of prior knowledge-- the whole wide range of the subject is unfolded skilfully.

Let no endocrinologist fear that this is a book about morbid anatomy alone. It is much more- - i t is a copious review of knowledge on the chemistry and chemical pathology of the gland with the morbid structures and functions inevitably at the centre.

There is a very high standard--characterist ic, one must say of many Livingstone works - - i n black and white illustrations. This includes gross pictures, photomicrographs, line and camera lucida drawings. But the supplement of 80 electron--micrographs of abnormal adrenal glands is unbelievably good and probably perfect.

The Chromaffin and Chemoreceptor systems have close affinities and therefore it was logical to include a chapter on the latter system, although only the Carotid and Cardio- Pulmonary bodies have as yet been shown to have a functional role. The two main divisions of the book are of course devoted to the cortex and the medulla. There is how- ever a section on changes in other tissues, mediated by the adrenals in response to shock and injury. There is a section on chemical and histological techniques. In fact for many years to come there can be little that will be found lacking on the human adrenal in this book.

There is no section on comparative pathology which may be a fault but as is well-known a good animal model for adrenal experimentation has not been found. I looked for a long time in the index for cytomegaly of the cortex which is adequately covered in the text. I finally found it h idden-- rather presumptuously--under 'Congenital Hypoplasia'. These are mere carpings.

If you have any doubts about buying this book I advise you to just examine it and if your field is endocrinology or pathology then you will succumb and never regret it.

S. F. CAHALANE.

'Pain Analysis: A Gu|de to Diagnosis. Edited by Rudolph Janzen. 1970. Bristol. John Wright and Sons. s

Despite its containing a useful, sound and appealing account of clinical diagnosis of pain syndromes, this book, which has been translated from the German edition, cannot be recommended. The poor standard of English makes it a struggle to read and occasional sentences are incomprehensible. Some of the mis-phrasing or misuse of words might be misleading to the inexperienced. The use of unfamiliar eponymous titles is an additional defect.

Some unusual procedures are described such as palpation of the abdomen with the patient in a warm bath.

EDWARD A. MARTIN.

Modern Trends in Neurology. Volume 5. Edited by Denis Williams. London. Butterworths. s

This is a further excellent volume in the Modern Trends series. Its general context will have a broad appeal to neurologists and neurosurgeons. Some of the chapters are relevant to the work of the general physician and psychiatrist. There is a uniformly high standard throughout and the reviewer may best serve possible purchasers by listing the authors and their subjects : - - Bender on Perceptual Interactions, Geschwind on Discon- nection Syndromes, Nathan on Spasticity and its Amelioration, Gilman on Cerebellar Dys. synergia, Poirier on Tremor and its Treatment, Thomas Smith on the Pa!hology of Organic Dementias, Hankinson on the Surgery of Syringomyelia, Cavanagh on Neurological Cell Injury, Brierley on the Neurological Complications of Hypotension, R. W. Ross Russell on Cerebral Emboli, Dubowitz on the Histochemistry of Muscle, Henson on Neuropathy in Malignant Disease, Meadows on Visual Failure, Matthews on the H Reflex, Corsellis on the Pathology of T.L.E., Reynolds on latrogenic Complications of Epilepsy and the distinguished editor on "The Propagation of Epileptic Events".

EDWARD A. MARTIN.