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direction and uniform in thickness, soft, mobile, pliable,and easily deformed and obliterated by pressure. Thechanges which can be recognised radiographically induodenitis consist of variations in the stickiness of themucosal surface for the opaque medium ; changes in thecalibre and number of the folds ; alterations in themucosal pattern ; and changes in the consistency of thefolds. The normal mucosa appears radiographicallyto be a dry surface to which the opaque medium adheresuniformly. In duodenitis the degree of stickinessdepends on the fibrinous content of the inflammatoryexudate. The stickiness is diminished in the morerecent forms of the disease and increased in the older andmore chronic ones. The inflammatory exudate oftencauses a veiling of the mucosal surface. One of the mostcharacteristic findings is a broadening and swelling of themucosal folds, usually accompanied by a diminution intheir number. Broadening and swelling of the folds isnot characteristic of duodenitis unless accompanied bychanges in their consistency. The folds show diminishedmobility and are stiffened so that they are less easilydeformed by pressure. In very chronic cases the foldsappear to be quite rigid structures. A common findingis the presence of irregular, swollen and stiffened trans-verse folds which seem to push apart the main folds.The variations in the mucosal pattern in duodenitis arenumerous but these abnormal patterns are not met within a,symptomatic and presumably healthy subjects.

Reviews of Books

Gynaecological OperationsBy J. LYLE CAMEBo, M.D. Manitoba, F.R.C.S., F.A.C.S.,M.R.C.O.G., senior gynecological surgeon, Royal WaterlooHospital, London. London : Humphrey Milford, OxfordUniversity Press. Pp. 200. 21s.

IT is always difficult to write a theoretical guide topractical procedures, but this book gives clear instruc-tions to the inexperienced gynaecological surgeon. Mr.Lyle Cameron is necessarily dogmatic, but when thestudent of this book has gained confidence, using themethods described, he will no doubt vary the techniques,and eventually evolve methods of his own like everyother senior surgeon. Most gynaecological operations arenot urgent, and a timely warning is given, on the firstpage, that the patient should be kept in bed for 24 hoursbefore operation, while the general health is investigated.A paragraph on dressings and after-treatment followsthe account of each procedure. The dangers of differentoperations are noted and the methods for avoiding them,or for dealing with them if they arise. Indications foroperation are given in some cases ; here the youngsurgeon does not need clear-cut instructions so urgentlyas he does on points of technique, and variations inopinion might well have been included. Much attentionis given to operations on the cervix and uterus under-taken by the vaginal route. Gynaecological operationsare probably performed more often than any otherabdominal operation with the exception of appendicec-tomy, as the author points out, and they have played animportant part in the development of abdominal surgery-,since section for large ovarian cyst was among theearliest of all operations in pre-anaesthetic and pre-antiseptic days. With the development of antisepsis andasepsis, access to the abdominal cavity per vaginam fellinto disfavour,.as being both restricted and necessarilyinfected. Now, however, the use of the vaginal approachin certain cases is again being recognised, and five edifferent operations for the removal of uterus andadnexa are described in this book.

Textbook of Gynaecology(3rd ed.) By VILFRED SHAW, M.D. Camb., F.R.C.S.,F.R.C.O.G. London: J. and A. Churchill. Pp. 610. 21s.

THis is now one of the most popular textbooks ofgynaecology used by medical students up for their finals ;a third edition has given Mr. Wilfred Shaw an oppor-tunity to rewrite the text and bring it up to date by theintroduction of chapters on endocrine treatment ingynaecology and on the new chemotherapy. The openingchapters on the anatomy and physiology of the femalegenitalia are examples of lucid writing, and first-class

illustrations and diagrams drive home the main points.But the book excels in pathology, notably that of theovaries, and for this reason will appeal to others besidesthe students for whom it was written. There is quiteenough in the book to pilot an intelligent reader throughthe M.R.C.O.G-. examination and even through the M.D.Practitioners will find it useful for reference, and toregistrars and first assistants, on whom much of thetask of instructing the students falls, it will be a lessonin teaching. The text is in large print, easily read atnight.

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Experimental Physiology for Medical Students

(3rd ed.) By D. T. HARRIS, M.D. Mane., D.Sc. Lond.,F.Inst.P. London : J. and A. Churchill. Pp. 292. 15s.

MosT laboratories in this country have a programmeof exercises in physiology to which they adhere, andwhich they sometimes publish with illustrations, inbook form. Professor Harris’s book has a wider scope,and samples of at least two practical courses which arebased on it are given in the introduction. Representa-tives of various schools have contributed experimentsso as to increase the ground covered. The book iscopiously illustrated with line drawings, tracings andpictures of apparatus, and is therefore immenselyvaluable to the student for use in conjunction with histheoretical textbook, whether or not the laboratory inwhich he works has its own independent set of exercises.Many methods and pieces of apparatus are illustratedwhich the student has no opportunity of seeing, and it isimportant to him to have some idea of how such thingswork, whether he is able to use them himself or not. Aset of exercises in pharmacology is included.

Modern Treatment Year Book 1941

Edited by CECIL P. G. WAKELEY, D.Sc., F.R.C.S. London :Bailliere, Tindall and Cox. Pp. 326. 12s. 6d.

IN the wide range of subjects, the suitable choice ofcontributors, and the conviction and reasoning of itsadvice, this annual of diagnosis and treatment maintainsthe high standard of usefulness for the practitioner whichit attained before the war. Now, as the editor pointsout, it should be of greater value, because so many of ourprofession are cut off from the normal contacts that caterfor mutual discussion and medical refreshment. Twelveadditional articles on war-time surgery and medicine areincluded; at present, accounts of acute conditions maybe more appreciated by civil doctors in bombed areas,while doctors in the forces will find that the more

homely articles on constipation and fiat feet meet theirdaily needs. But there is something for all.

Orthopaedic Surgery for Nursesand Orthopcedac X1tf8ing Care. (3rd ed.) By PHILIPLEWi, M.D., F.A.C.S. London : W. B. SaundersCompany. Pp. 433. 7s. 6d.

THE third edition of this book is even more entertainingand readable than its predecessors. Dr. Lewin still has atendency to regard his audience as senior medicalstudents or even junior house surgeons ; and some of theinformation given-such as the table of differentialdiagnosis of tuberculous disease, syphilis and osteo-myelitis, and the even more heavy classification ofchronic arthritis-have no place in a book for nurses.But these are faults that may be corrected by anyintelligent teacher recommending a book which, on thewhole, is probably the best work of its kind in English.It has a special value now when there is great demandfor nurses with experience in the treatment of orthopaedicconditions. When a fourth edition is being consideredthe author might well do some drastic pruning. Hementions too many authorities whose doings are of noimportance to the orthopaedic nurse, and includes toomany little sections on rare conditions. After all, inmost hospitals there are plenty of books of referenceavailable for girls who want to know something abouteverything.

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Messrs. HENRY KIMPTON (26, Bloomsbury Way,London, W.C.l) ask us to say that they are publishingSnell’s Medicolegal Ophthalmology in this country.The book was reviewed in our issue of June 7 (p. 724).