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Reviews of Books

Basic Practical SurgeryC. BARRIE WILLIAMS, M.D., F.R.C.S., senior surgical registrarto the United Bristol Hospitals. Bristol: John Wright andSons. 1971. Pp. 171. E1.75.

As Mr. Williams notes, individual operative techniquesmay differ, but competence in surgery depends upon athorough knowledge of basic principles. His intention isto present these principles in such a way that the inexperi-enced " surgical apprentice ", having grasped the essen-tials of operative surgery, may be better placed tolearn by subsequent observation in the operating-theatre.What are these basic essentials of surgery ? They centrearound such topics as ligatures and sutures, surgical instru-ments, wound drainage, infection, hxmostasis, and woundhealing. At least one chapter is devoted to each topic.Some chapters are profusely illustrated-especially theone on surgical instruments. It is impossible to find faultwith the idea behind this book, since most textbooks ofoperative surgery cover the subject in great detail but areprohibitively expensive. Yet the result is strangely old-fashioned in a number of ways. For example, the historyof catheters, drains, and hsemostasis is interesting, but in avolume of this nature one might prefer to see discussionof topics such as fluid balance and the metabolic responseto trauma, both of which receive scant attention. Also,the book is somewhat uneven, and gives the impressionthat the last few chapters have been tacked on to theend in something of a rush. This is doubly unfortunate,since the opening chapters make interesting reading.The student contemplating a surgical career would cer-tainly add to his enjoyment and interest in the operating-theatre by reading through the first half of the book.

Cardiac HypertrophyNORMAN R. ALPERT. New York and London: AcademicPress. 1971. Pp. 641.$25, E11.65.

THIS book by 97 American contributors has seven parts.The first four deal with the way in which cardiac hyper-trophy occurs both naturally and under stress, the influenceof hormones (hypophyseal, thyroxine, corticosteroids)on the process, and the increase of protein synthesis. Thelast three parts cover the altered mechanics, metabolism,and electrical activity of the hypertrophied heart. Up toa certain size of muscle-fibre (about 14 !.t diameter), hyper-trophy is adaptive; beyond this it becomes pathologicalbecause there is no mitotic addition of myocardial cellsafter the age of 6 months; moreover, the cells are mono-nucleate and so cannot expand their cytoplasm. Increaseof D.N.A. supports the increase in cytoplasmic proteinsynthesis. Other changes are widening and irregularityof Z-bands, an increase of connective tissue and of theratio of membrane-bound to free ribosomes, and altera-tions in myocardial enzymes similar to those of the failingheart. Indeed, the cardinal feature of the hypertrophiedheart is a fall of contractility, which may eventually resultin failure. In coronary-artery disease, this reduced con-tractility may lead to dilatation and hypertrophy of theleft ventricle and to mitral regurgitation. The two sidesof the heart may enlarge individually or together. At birthboth ventricles are about equal, but the immediate relativefall of pulmonary to systemic pressure leads to normal leftventricular enlargement. In later life, systemic hyper-tension or aortic obstruction increases this growth. Rightventricular hypertrophy results from obstruction to

pulmonary flow, hypoxia, or polycythasmia, and whole-

heart hypertrophy from prolonged strenuous exercise,anaemia, hyperthyroidism, or various experimentalprocedures such as androgen or isoprenaline adminis-tration. Experimental cardiac hypertrophy soon starts

to regress once the stress is relieved; in man such

regression is protracted and often incomplete. The bookis finely produced; the illustrations are excellent andinclude numerous high-quality electron-micrographs. It is

packed with information. It is not expensive, consideringthe comprehensive coverage of American research now madeavailable under the scholarly editorship of Dr. Alpert.

Diseases of the Ear, Nose and Throat4 Books: the Nose, the Ear, the Throat, and Basic Sciences.3rd ed. Edited by JOHN BALLANTYNE, F.R.C.S., D.L.O., andJOHN GROVES, M.B., F.R.C.S., consultant ear, nose, and throatsurgeons, Royal Free Hospital, London. London: Butter-worths. 1971. The Nose, pp. 379, E7.25; The Ear, pp. 670,E10.50, The Throat, pp. 610, E10, Basic Sciences, pp. 450,E8.25.

ALTHOUGH it is only six years since the second edition,Mr. W. G. Scott-Brown’s former co-editors have seen toit that the new model is not just a souped-up version ofthe old. It is truly new in that it appears in fourvolumes, brought right up to date by experienced-indeedoften distinguished-practitioners. New chapters havebeen added on acoustic neuroma and noise and deafness-both subjects of increasing concern to the otologist. Thevolume on basic sciences is the bible for any candidatefor the primary F.R.C.S. or the first part of the D.L.O., andit is no exaggeration to say that the clinical section is nowthe standard textbook of E.N.T. in the English language.The books provide a balanced Anglo-Saxon approach tothe specialty. Perhaps the next edition will do for otorhino-laryngology what Sir Stewart Duke-Elder has done forophthalmology, but if it is to become the standard refer-ence book as well as the standard textbook the index willhave to be enlarged to make quick reference easier for thebusy surgeon. For example, it is no doubt very correct toindex elongated styloid process "process elongated styloid",but surgeons are likely to look for sphenoid, styloid, orglossopharyngeal neuralgia.

Adams & Maegraith Clinical Tropical Diseases (5thed. Oxford: Blackwell Scientific Publications. 1971. Pp.578. E5).-This standard textbook from Liverpool is nowfirmly established, and postgraduates who have read andretained its contents will certainly pass their examinations.The thirty-six chapters range alphabetically from Amce-biasis to Yaws. The book’s style is somewhat pedestrian,but it is well produced and the photographs and index areexcellent. Even well-established books have their faults,and many workers would dispute such statements as:" Homozygous sicklers seldom live beyond the early yearsof life " and, of kwashiorkor, "Even the worst cases have agood chance of survival".

Samson Wright’s Applied Physiology (12th ed.London: Oxford University Press. 1971. Pp. 576. E5 5hardback, E3.50 paperback).-" Samson Wright " has lostan inch in height but gained the equivalent in pages. Theresult is as good as ever. C. A. Keele and Eric Neil haverevised many sections extensively-notably those on theheart and circulation and respiration. There is a new

section on chemical senses and pain. Some may regretthe change to a matt paper: reflected light from burningmidnight oil may no longer disturb the concentration, butthe printing of this trusted companion seems a good dealless sharp than formerly.