282

BOOK REVIEWS

I n t r o d u c t i o n to G e n e r a l P r a c t i c e . By D. C~)~DDOCX. Lewis. 42/-. " Books still accomplish mirac les : they persuade men " (Carlyle). The perusal

of this tex t will convince those sceptics who say tha t the general pract i t ioner has only a minor pa r t to play in the practice of medicine today.

This book has been wr i t ten for general pract i t ioners by one who is a general practi t ioner. I t s appearance is oppor tune , for the " G.P." is now becoming aware tha t he was being gradual]y pushed into the background, and tha t his sphere of ac t iv i ty was being narrowed and controlled on every side. I-Ie was losing caste.

Dr. Craddock's tex t will do much to correct th is impression. I n an admirable in t roduct ion he gives a broad outline of general practice, its financial prospects, its advantages and disadvantages. Ide tells how to deal wi th the pa t ien t in the doctor ' s surgery and in the pa t ien t ' s home. He gives sound advice on the doctor-pat ient relat ionship as well as on professional contacts w i th colleagues and consultants . I f expanded, this chapter would form an excellent guide to the young doctor on the day he graduates f rom medical school.

Dr. Craddock surveys in outl ine the work and compass of general practice. An extensive bibl iography is appended to each chapter. Every phase of general practice is adequately covered.

Sir Heneage Ogi]vie has some per t inent things to say in the F o r e w o r d : " I t is becoming increasingly evident to those who th ink, and eventual ly will become more evident to those who plan tha t the whole basis of n~edical education, and of the examina t ions which set the seal on successful education, m u s t be re-orientated wi th a view to teaching the common and impor t an t ra ther t han the rare and the bizarre, wi th a view to prepar ing s tudents in the first place for general practice, the stock f rom which specialist practice m u s t s tem."

This book is sincerely recommended to all in general practice, and those who teach will find in it much for thought .

SEAN McCAN~.

M e c h a n i s m s o f U r o l o g i c D i s e a s e . By D. M. DAvis. Saunders. 22/6. This book presents the mechanisms of urologic disease in a condensed, crisp, ye t

surprisingly inclusive manner . Emphas i s has been placed on basic pathological aspects and disturbances of the conductive funct ion of the genite-urinary tract , especially obstruct ive lesions. The a r rangement of the text in a pathologic series ra ther t han in the usual topographic or anatomical sequence is admirable to demonst ra te any one or more of the eight types of pathologic change present in practically every case of urologic disease.

Apar t f rom some excellent cys tomet rograms i l lustrat ing neurogenic disorders of the bladder, no i l lustrat ions grace th i s well-writ ten text .

Occasional s t a t ements in th is volume run somewhat cont rary to the accepted tenets of urologic practice :

On p. 34 : " Organisms of tuberculosis and of the mycoses are ext remely res is tant to all drugs known at the present t ime." As this s t a tement is contradicted in later pages, proof-reading migh t obviate its recurrence in a later edition.

On p. 39 : " The results after nephrec tomy for unilateral renal tuberculosis are . . . females about 70 per cent, males about 35 per cent well a t the end of 5 years ." Recent assessments of mor ta l i ty and prognosis differ great ly f rom the above s ta tement par t icular ly when pat ients have had adequate s t rep tomycin therapy.

On p. 45 : The reviewer cannot subscribe to the opinion tha t abor t ion is ever justified in urologic disease.

On p. 58: " Wilms ' t u m o u r . . . is not really a k idney t u m o u r . " This s t a tement is a t variance wi th the opinions of mos t author i t ies on the subject. Gross s ta tes (1953) tha t the t umour always arises wi th in the substance of the kidney and as it grows, the kidney capsule is expanded a round the neoplasm and tha t postoperat ive i rradiat ion is of t r emendous value in rais ing cure rates.

On p. 65 : " Cancer is present in about 25 per cent. of all men seeking t r ea tmen t for prostat ic obs t ruc t ion ' " This as tounding s t a tement does not tally wi th one's ord inary experience of a large series of cases of pros ta t ic obs t ruc t ion nor wi th the publ ished figures of incidence from reliable urological clinics. Like the repor t on Mark Twain ' s death, the results of perineal excision of the prosta t ic t u m o u r are "' grossly exaggera ted ." American l i terature still t eems wi th repor ts from urological clinics in which an undue bias in favour of the perineal approach has clouded a proper assessment of the value of this now much out-dated manoeuvre . I n a discussion on the value of the different approaches to a prostat ic tumour , the perineal angle is clearly favoured. Millin's re t ropubic approach is allowed a mere five lines while t ransure thra l resection and the perineal " p ros ta tec tomy " are promoted to a posit ion of unmer i ted eminence.

BOOK R E V I E W S 283

I t is interesbing to note while journeying thro ' American clinics, the declining pre- occupat ion wi th the two lat ter approaches and the gradually increasing use of the Mitlin approach in the last five years, part icular ly a t a t ime when nearly 90 per cent. of " pros ta tec tomies " were done in I re land by this excellent method, since i ts intro- duct ion here in 1946. This reviewer does not agree tha t the theoretical advantages of the frozen section obtained by perineal biopsy outweigh the m a n y complicat ions which so f requent ly follow the perineal approach.

On p. 91 : " In rup tu re of the u r e t h r a . . , balloon catheter pulls bladder and prosta te down into normal posi t ion." Long experience wi th war injuries of th is region has well proved tha t the balloon catheter will seldom hold these s t ruc tures in posit ion bu t will bu r s t or slide out of posi t ion and allow the bladder to become retroposed in the pelvis and a large gap to appear between the rup tu red ends of the urethra.

I n spite of these var ia t ions of opinion, this book should be considered suitable for house surgeons and pract i t ioners wi th surgical interests and it will serve as an excellent guide in their urologic studies.

M. V. SHEEHAN,

Introduction to Funct ional Histology. By G. BOURNE. Churchill. 25/-. Histology. By A. W. HAM. Lippincott . 2nd Ed. 80/-.

These books inake an interes t ing study. Bo th are excellent, well produced and cover much the same course, yet they are as alike as chalk and cheese. Such diversi ty invi tes scrutiny.

Perhaps it results from a differing outlook on teaching. Dr. H a m ' s work shows his supreme belief in teach ing- -every th ing is p u t in. Two quar to pages are devoted to diagrams of vary ing sections of cut t u b i n g ; another set is given to diagrams of glands, and the whole abracadabra of junior b iochemis t ry is detailed. :Not tha t the book is element:ary in tone or outline, for it gives a very full course of m a m m a l i a n histology up to a very high s tandard , yet it would be difficult to pu t in more detail w i thou t unbalance. The au thor jus t believes in leaving noth ing unexplained. The least imaginat ive or wor thy of s tudents get t ing this book migh t plod through f rom cover to cover and emerge at the far end a safe histologist. Too safe : for he migh t take it l,hat all h is quest ions are answered in the tex t (as, indeed, they are) bu t he migh t never have been warned tha t t r u t h is of m a n y facets. Dr. Bourne hardly believes in teaching at all : it would seem tha t his s tudents m u s t learn. The course covered is, as already stated, the same, bu t there are no explanations. The wri t ing is clear, the Engl ish crisp. I f the groping s tudent cannot find his way there is a beacon, bu t it is too far off to be a street lamp and remains, as all good beacons should, a challenge and a warning. I t is an ent rancing book : no Honours s tudent should leave it unread for it is curiously st imulating.

Pe rhaps the contras t expresses the academic circumstances of the authors . I t m a y be t ha t Dr. Bourne ' s s tudents come to h im already ma tu re enough to appreciate and discount the obvious. I t m a y be tha t they are filtered th rough a fair course of the basic sciences and tha t it is unnecessary to contemplate the possibil i ty of a raw student. I t may be tha t he jus t wrote the book for his own en joyment - -cer ta in ly it reads tha t way. :No similar gaiety exists in the other book and it might well be misplaced if so many poin ts m u s t be carefully registered. S tudents are curiously liable to get fixed and irrat ional ideas in their early s tudies and such irrat ionali t ies remain. Bi t by bi t Dr. H a m clears the ground, fixes the foundat ions and hesi tates to add even an ext ra course till the earlier mor t a r has set. The s t ruc ture should be enduring.

Pe rhaps the difference is one of tradit ion. London can take its place in the great histological t radi t ion of Europe. B u t t radi t ion is no t entirely an asse t : too often it has resulted in too ready acceptance of doubtful dogma. Be{bre the last war text- books were still being wr i t ten wi th directions which could only be excused as ins t ruct ions for the use of oil lamps in microscopy. Even today perfectionists eschew reason when designing or selling substage condensers. Such sweeping lines of technical advance as the electron microscope have forced a reconsideration of basic ideas and the low available level of useful visual magnificat ion is now bet ter realised. I t is to be expected t ha t the resu l tan t revaluat ion of fundamenta ls will have less obs t ruc t ion the fur ther the th inker is f rom the older eentres of thought . The detailed par t ieular ism of the Canadian au thor m a y express his cultural freedom to examine the foundat ions of his discipline. His in t roduct ion is, for example, a serious considerat ion of the technique of teaching and another example m a y be seen in his i l luminat ing chapter on hair. /ndeed almost any of the chapters might be taken to show the value of this a t t i tude in s t imula t ing both expert and neophyte.

Professor H a m ' s book is excellently produced, the i l lustrat ions are good and well chosen, the pr int ing is of an ext remely high s tandard and only one minor typographical error was noticed. The price may seem high for a s tuden t ' s book, bu t every l ibrary cater ing for bie'logical s tudents m u s t have a copy.

F. KA~E.

284 I R I S H J O U R N A L OF M E D I C A L S C I E N C E

Clinical Electrocardiography. By SC~ERF and BOYD. Heinemann . 4th Ed. 42/-. This edition, which has been completely revised, cont inues to be based on the old

establ ished empirical me thod of electrocardiography, which is no t so ou tmoded as some author i t ies would appear to think.

As in previous editions, the au thors ' a im has been to produce a practical handbook ; hence the physical and physiological basis of the electrocardiogram is not discussed in too much detail, nor overburdened wi th theoretical considerations. Among new features we note tha t the chapter on bundle branch block and hype r t rophy have been completely rewrit ten. New sections on auricular infarct ion and on infarct ion of the subendothelial muscula r layers are included. Other addi t ions relate to the electro- eard;ographic pa t t e rns in hyper- and hypo-kalemia.

There is a full discussion on the mechanism of auricular f lut ter and fibrillation which subs tan t i a tes the view tha t the circus theory is no longer tenable. Pr inzmeta l ' s recent work on fibrillation appears to have been omit ted, a l though his name is listed in t he bibliography.

I n the discussion of the therapy of a r r h y t h m i a s only those measm'es are ment ioned which have been found to be effective. The admin is t ra t ion of procaine amide is dis- cussed in detail. The au thors stress the impropr ie ty of mak ing anatomical diagnoses from the electrocardiogram alone ; for while the EC.G. great ly assists in the detect ion of abnormal loci in the myoca rd ium it can say little or no th ing about these ibci. Great care mus t also be exercised in drawing conclusions f rom the E.C.G. alone. To quote the a u t h o r s : " :Not every inverted T wave has the same meaning ."

The final chapter on vector cardiography will be s tudied wi th much interest , for some author i t ies believe tha t the electrical ac t iv i ty of the hear t can be recorded more rat ionally by direct spatial vector cardiography t h a n by the old classical me thod of mul t ip le leads.

This book deserves a wide popular i ty . I t contains a mass of practical informat ion which, though somet imes difficult to sort out, nevertheless gives the reader a reasoned view of the practical ut i l i ty of the electrocardiogram in modern medicine.

P. T. O'FARRELL.

Modern Clinical Psychiatry. By A. P. ~OYE$. Saunders. 4th Ed. 35/-. Dur ing the five years t ha t have elapsed since the previous edi t ion there have been

m a n y advances in psychia t ry , and all are embodied in the text . The classification of psychiatr ic disorders, prepared by its commit tee in 1952 and officially adopted by the American Psychia t r ix Association, is used th roughou t and has m a n y advantages. Ins tead of the water t igh t compar tmen t s of disease enti t ies, broader groupings based on clinical differences are utilised. Chapter 5 (causes and na ture of menta l disorder) incorporates recent work on genetics, as well as summar ies of the cont r ibu t ions of Kraepel in , Mayer, Masserman, Freud, Adler, J u n g and Janet . There are excellent chapters on alcoholism, wi th a critical survey of recent t rea tments , on psychotherapy, and on child psychiatry.

This is a well balanced presentat ion, a clinical t ex t book tha t can be fully recom- mended as a s t andard for s tudents and D.P.M. candidates. Controversial quest ions such as insulin or electrical t r ea tmen t in schizophrenia, the value of newer neurosurgical procedm'es, t r ea tmen t of p sychopa ths and sexual offenders, are presented fairly, and the au thor ' s own views would be accepted by any psychia t r i s t in th is country.

J. P. MALOI~'E.

Peripheral Nerve Injuries. By HAYMAKER and WOODH~LL. Saunders. 35/-. The second edit ion of th is t ex tbook makes very pleasant reading. I t should find a

place on the bookshelves of every physic ian and surgeon interested in nerve injuries. The book is divided into four sections dealing wi th the analysis of the segmental

and peripheral nerve supply of the skin, muscles and skeleton, the examina t ion of the peripheral nervous system, the classification of the causes and symptomato logy of peripheral nerve injuries, injuries of the plexuses and peripheral nerves.

This a r rangement leads to a certain a m o u n t of repeti t ion, bu t this adds to the value of the book and, f rom the s tudent ' s poin t of view, makes it more instructive.

There is a high degree of anatomical accuracy th roughou t the text , which is well i l lustrated by pho tographs and diagrams.

The danger associated wi th the use of plas ter casts, splints, bandages and tourn ique ts is adequately dealt wi th and will act as a gentle reminder to the reader in these

.litigious days. JOHN LANIGAN'.