545

ibrium must be maintained by a balance of advantagesand disadvantages. He recalled the work of Aird andhis colleagues, who in 1953 had shown that there was anassociation between carcinoma of the stomach and blood-

group A. In the following year the same workers hadnoted that peptic ulcer was associated with a markedexcess of group 0.Dr. Clarke gave the results of a similar investigation

in Liverpool. From three hospitals 1497 cases of ulcerhad been analysed and it had been found that whereasthe distribution of the blood-groups in gastric ulcer wasnormal, in duodenal ulcer there was a distinct swing to0 from A ; 59-6% of the cases were 0 and only 29% A,the corresponding control figures being 49-1% 0 and40.9% A.The control series had been obtained from two sources :

(1) the over-all blood-group distribution of the three hospitals,excluding ulcers, in 1948-54 ; and (2) blood-donors obtainedfrom the Nuffield Blood Group Centre. As no significantdifference had been found between these two sets of controls,that from the hospitals had been used because it was muchbigger (15,377 cases).Dr. Clarke considered whether the association between

blood-group 0 and duodenal ulcer might be due to

miscegenation rather than to causal relation. Ananalysis of duodenal ulcer within families was helping tosolve this problem. The number of sibships so far

investigated was only 53 ; this was not nearly enoughto allow of any definite conclusion, but the current datadid give a hint that the association was present withinthe families.Because of the reciprocal relation between group 0

and group A in respect of duodenal ulcer and cancer ofthe stomach, it was worth investigating other diseasesin which the secretion of hydrochloric acid was abnormal.Buchanan and Higley 2 had shown that in 457 cases ofpernicious anaemia there was a higher incidence of group Aat the expense of 0 than in the general population.Dr. Clarke thought that this finding supported his ideathat the ABO locus might contain one genetic factorresponsible for the amount of hydrochloric acid secreted,0 in the direction of hyperchlorhydria and A in thedirection of hypochlorhydria.Turning next to diabetes mellitus, in which duodenal

ulcer is rare and achlorhydria rather common, Dr. Clarkedescribed an analysis by R. B. McConnell on the

blood-group distribution of 815 diabetics from thediabetic clinic at the David Lewis Northern Hospital,Liverpool.3 This showed that in the under-30 age-group(131 cases), mainly consisting of patients (predominantlymale) who were non-obese and who required insulin,there was a swing of 12% from group 0 to group Acompared with the controls (&khgr;2 = 8.21). In the older

age-group, usually associated with obesity and insulininsensitivity, the blood-group distribution was normal.He believed that the finding in the younger age-groupmight support his hypothesis, and the next step was tofind out the age-incidence and blood-group distributionof achlorhydria in diabetics.Dr. Clarke showed how the ABO blood-groups were of

use as marker genes. He described a linkage betweenthe ABO locus and hereditary onycho-osteo-dystrophy(nail-patella syndrome), recently discovered by Renwickand Lawler 4 at the Galton Laboratory.

In the third part of the paper he described howtesticular biopsies obtained from fertility clinics providedexcellent material for human chromosome studies. Theidea had come from Mr. J. H. Burnett, D.PHIL., of thedepartment of botany, and emphasised the value ofcooperation between university departments.2. Buchanan, J. A., Higley, F. T. Brit. J. exp. Path. 1921, 2, 247.3. McConnell, R. B. Proc. R. Soc. Med. (in the press).4. Renwick, J. H., Lawler, S. D. Paper read to Genetical Society,

Nov. 20, 1954.

Reviews of Books

Artificial RespirationWith Special Emphasis on the Holger-Nielsen Method.T. 0. GARLAND, M.A., M.D., D.P.H. London : Faber &Faber. 1955. Pp. 60. 6s. 6d.

Tms short book will be useful to all concerned inteaching and practising resuscitation. It is practical,giving enough theory only to make it clear why somemanoeuvres produce better results than others.The emphasis is mainly on the now officially recommended

Holger-Nielsen method, and secondarily on the Silvester andEve rocking methods. Other and older manoeuvres are brieflydescribed. An interesting account is given of the observationsoriginally made by Pask in Oxford-courageous observations,all too rarely mentioned, which were the forerunners of theintensive and important work done later in the U.S.A. A fewtables show clearly the large ventilation induced by theHolger-Nielsen method as compared with others, particularlythe Schafer method. The photographs are clear ; and onesubtly emphasises that the Holger-Nielsen method does notneed muscular strength by showing a young girl applying itto a man.The author points out that efficient first-aiders should

know more methods than one, since no one method is suitedto all circumstances. He describes how artificial respirationmay be applied with the patient in a sitting position whereit is not possible for him to be laid down, as in a small boat,or in pole-top rescue after electrocution when speed of treat-ment is even more desirable than usual. He also describeshow the rocking method may be applied for short periodsand immediately in rescue to both children and adults. Herecommends (what is now agreed) that oxygen rather than ainixture of oxygen and carbon dioxide should be usedfor resuscitation.

The book takes very little time to read, and deservesthe attention of doctors, some of whom know less thanlaymen about resuscitation methods.

Radio-isotope Conference, 1954Vol. i. Editor : J. E. JOHNSTON. 1954. Pp. 418. 65s.

Radiobiology Symposium, 1954Editors : Z. M. BACQ and PETER ALEXANDER. 1955.

Pp. 362. 60s.London : Butterworth Scientific Publications.

THE fashion of the scientific 1950s of printing theproceedings of international conferences is valuable onlyif publication is rapid. In both these instances thepublishers and the editors are to be congratulated onissuing reports within six months.The work recorded at the radio-isotope conference held

at Oxford last July was in no sense revolutionary. In thesessions on therapy, diagnosis, animal physiology and patho-logy, biochemistry, and plant nutrition there is nothing thatwill rank in history as outstanding, but there is much soundeffort. As might be expected, radioactive isotopes still havetheir most useful role in physiological experiments on animalsor in the glassware of the biochemist-now often vastly morecomplex than the test-tube. Thus the three sessions each on

physiology and biochemistry are much better value than thetwo clinical sections ; but the clinician may dip into themwith advantage : for on the physiology of today, as illustratedhere, next year’s diagnostic tests may be founded.At the radiobiology symposium held at Liege last August,

physical chemists described the effects of radiation on modelchemical agents such as lipids. An oxidising effect is usuallypredominant and the peroxides found in vivo in mice aresought. Desoxyribose nucleic acid (D.N.A.) is also of course asubstance for study, and so less obviously to the biologistis polymethylmethacrylate. Oxidation is of interest not onlyto the chemist. Bacteria, bacteriophage, and mice are thesubjects for experimentation with anoxia and oxygen-accept-ing substances. Some of these last-mentioned, like cysteamine,are being widely used in investigation, since they give measur-able prophylaxis against radiation. Spleen and bone-marrowinjections on the other hand are equally in the news sincethey are effective as therapy in reducing mortality. Reversely,radiosensitisers are of value in clinical radiotherapy. Takingthe cell to bits after it has been irradiated is another method

546

of approach. The biochemists look at such processes as

phosphorylation of mitochondria and D.N.A. synthesis : the

cytologists look at disordered chromosomes.

Color Atlas of PathologyVol. 11. Prepared under auspices of the U.S. NavalMedical School, National Medical Center, Bethesda.

Philadelphia and London : J. B. Lippincott. 1954.

Pp. 450. f.7.

THIS admirable and well-produced book will be readwith profit not only by students and postgraduates butalso by pathologists in need of an interesting refreshercourse.

The subjects covered include the endocrine glands, the

reproductive organs, the breast, and skin. The illustrations,some of which are clinical, are nearly all excellent, and theyare all helpful and carefully selected. Each section is intro-duced by a few pages of text ; then follows the photographs,three to a page, with full and lucid captions outlining thecase-histories and the pathological findings.

Rear-Admiral Lamont Pugh, the surgeon-general, inhis foreword pays a well-earned tribute to the team ofauthors, photographers, and lithographers who havecontributed to the work. Inevitably, in a book of thiskind, the price is too high for most of us ; for this reasonit is to be hoped that it will be included in medical-schoollibraries.

PorphyrinsTheir Biological and Chemical Importance. A. VANNOTTI,University professor and director of the UniversityMedical Polyclinic, Lausanne. Translated by C. RIMING-TON, D.sc., F.R.s., professor of chemical pathology,University of London. London : Hilger & Watts. 1954.Pp. 258. 50s.

THE original German edition of Professor Vannotti’smonograph, Porphyrine und Porphyrinkrankheiten, wasrightly regarded as a classic ; hence the new Englishedition, translated and revised by Professor Rimington,and containing new material, is especially welcome. Itis a pity, however, that, at a time when there have beenmajor advances in this field, there has been so long a delaybetween preparation of the manuscript and publication.Thus there is but a scanty account of the incorporationof labelled glycine and acetate into porphyrins andrelated compounds ; there is no mention at all of thebrilliant work of Shemin in elucidating the source of eachcarbon atom in the porphyrin structure ; and only afootnote refers to the identification of porphobilinogen,the colourless precursor of porphyrin, excreted in acuteporphyria. At no point is it made clear that, accordingto modern views of porphyrin biosynthesis, protoporphy-rin is formed (even though via an indirect pathway) bydecarboxylation and dehydrogenation of uroporphyrin.On the contrary, some emphasis is made regarding thedemonstration by van den Bergh that protoporphyrinwas converted to coproporphyrin by perfusion throughthe liver-an observation which has not been confirmedand upon which doubt has been cast. The very recentwork on 8-ammo-laevulinic acid could perhaps scarcelyhave been included.The chapter on physicochemical aspects of porphyrins

has a number of valuable tables presenting the wave-lengths and extinction coefficients of the absorption bandsof the various porphyrins and-even more useful-theirfluorescence spectra. The short chapter on methods ofextraction and qualitative and quantitative determinationof porphyrins is little more than a catalogue of the variousmethods proposed, and does not discuss them critically.A brief but useful account of porphyrins in Nature, inwhich previous work on the porphyrins of bacteria andof yeast is particularly well reviewed, is followed by twochapters dealing with the physiology and pathology ofporphyrins in man. Professor Vannotti discusses, fromhis wide clinical experience, numerous conditions in whichporphyrin excretion is increased or abnormal, and

presents some interesting data on the time relationsbetween porphyrin excretion and such pathologicaldisturbances as haemorrhage, anæmia, and cardiac insuffi-ciency. One of the best sections deals with the evidencethat in lead poisoning there is an inhibition of the utilisa-

tion of iron in the synthesis of haemoglobin in the erythro-blast, and consequent elimination of type-I porphyrins.A 56-page chapter on porphyria is one of the best accountsof the clinical aspects in English. It is a pity that theauthor does not emphasise more the great diagnosticimportance attached to the finding of porphobilinogenin the urine. A final chapter, on treatment, probablygives too much weight to the relations between vitaminsand the porphyrias. Treatment of this disease is still

symptomatic and palliative, and spontaneous remissionshave too often been attributed without foundation tosome specific treatment.

In spite of the lamentable delay in publication andthe consequent absence of the recent advances in thisfield, this book is a valuable contribution to the literatureof porphyrins and porphyria and can usefully be readby clinicians likely to encounter the condition as well asby laboratory workers attempting to elucidate thefunction of these pigments and the mechanism of theporphyrias.

Rheumatic Fever .

" Disease-a-Month " S’eries, no. 1. LowELL A. RANTZ,associate professor of medicine, Stanford UniversitySchool of Medicine. Chicago : Year Book Publishers.London: Interscience Publishers. 1955. Pp.35. Twelvemonthly issues, 65s.

THE publishers of this new series are convinced that" the busy physician ... unable to maintain a routineschedule of comprehensive reading... will eagerly findtime to read regularly a single and original 30 to 40 pagemonthly presentation of high authority." The first issue,by Dr. Rantz, of Stanford Unive.rsity Medical School, isan authoritative, balanced, and practical summary ofmodern views on the pathology, prophylaxis, andmanagement of rheumatic fever which fully justifies thepublishers’ description. It is possible to feel a nigglingdoubt about this sort of thing. There is no real substitutefor the eclectic approach, however laborious. If oursifting is done for us, can we distinguish fact fromopinion and experience from prejudice ? Neverthelessthis series will be welcomed as useful and convenientsummaries. It is, after all, intended as no more.

Psychometric Methods (2nd ed. New York and London:McGraw-Hill. 1954. Pp. 597. 61s.).-Prof. J. P. Guildfordrecognises that the problems of psychometrics are not so muchproblems of pure mathematics as practical problems of

collecting, comparing, classifying, and inter-correlatingpsychological data. From a concise account of the valueof measurement itself, and the mathematical concepts involved,he proceeds to discuss methods of conducting the simplestto the most advanced statistical operations required to

determine the central trend, dispersion, correlation, andfactor content of different kinds of psychological measure-ments. Quite justifiably he gives precedence to his own nowlargely orthodox procedures, but he describes the contribu-tions of other workers in this field in a way which brings hissubject into historical perspective and makes the book enjoy-able. Copious references are given at the end of each chapter,and are clearly indexed at the end of the book. Even in 600

pages he has had to limit his discussion of this subject, whichis at present almost a major psychological industry. Tomake room for the enormous amount of new material it hasbeen necessary to eliminate most of the statistical treatmentsgiven in his first edition, and to refer readers to his Funda-mental Statistics in Psychology and Education. In psycho-metrics we are notoriously apt to destroy the qualities ofhuman behaviour which will not submit to measurement, orfrom their very originality cannot be classified and counted;but Guildford conveys a vitality behind his techniques and agenerous outlook which renders his exposition free from eitherdefensive dogmatism or aggressive objectivity.La rate et ses maladies (Paris : Masson. 1954. Pp. 299.

Fr. 2200).-This monograph is a fair summary of present-day ideas on diseases of the spleen, but contains little that isnot already well known to anyone who follows the literature.The only unusual sections-on splenomegaly due to para-sitic diseases and on splenomegaly due to tuberculosis-

reflect Dr. Gabriel Gelin’s special experience in NorthAfrica.