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Reviews of Books

Antibiotics

A Survey of Their Properties and Uses. 2nd ed. Con-tributors : S. J. EDWARDS, D.SC., A. KEEWICK, F.R.C.P.,F. A. ROBINSON, M.SC., G. SYKES, M.SC., B. J. THOMAS,M.r.S. Published by direction of the Council of thePharmaceutical Society of Great Britain. London :Pharmaceutical Press. 1952. Pp. 274. 25s.

THE number and uses of antibiotics have been increasingso rapidly that it has been virtually impossible for anyoneto keep himself fully conversant with the latest develop-ments. This book is therefore welcome, since it providesa relatively short and concise, yet remarkably complete,account of the uses and abuses of these drugs. The bookis intended primarily for general practitioners, veterinarysurgeons, and pharmacists, whose requirements are

admirably met. It is perhaps rather overloaded withlaboratory details ; some of those relating to chemicalanalysis and biological assay methods might well havebeen omitted.

Genes and MutationsCold Spring Harbor Symposia on Quantitative Biology.Vol. 16. Cold Spring Harbor, New York : Long IslandBiological Association.. 1952. Pp. 521.$9.

THE science of genetics seems forbiddingly formalisticto many who are not in any way enemies of Mendelism,like the followers of Lysenko. The subject is sometimesthought to be less a branch of experimental biology than aplayground for mathematical statisticians. There couldhardly be a better corrective to this belief than thecontributions to a recent symposium on genes andmutations, organised, like its predecessors, by ProfessorDemerec and held at Cold Spring Harbor.In his introductory paper Goldschmidt points out that the

idea of correlating one enzyme with each gene, though logical,may require revision. Mutations in neurospora and Bacteriumcoli have repeatedly been shown to produce metabolicalterations or defects which are attributable, according to thework of Horowitz and Leupold, to changes in single enzymes.On the other hand, the " position effect " phenomenon,investigated profoundly by McClintock, especially in maize,points to genes having actions which vary according to thenature of their genic neighbours.The causes of gene mutation are multiple ; and, as Auerbach

shows, radiation produces immediate effects whereas those ofnitrogen mustards and formalin are often delayed. There isstill no known common factor among mutagens. Westergaardand others point out that it is difficult to prove that anysubstance is not mutagenic, because changes produced maybe very slight. A criterion of the difference between true

gene mutation and chromosome damage might be the abilityto produce back-mutation-a return to the original state.Stadler takes the matter even further, and, on the basis of hisexperiments, doubts whether there is any way of distinguishingabsolutely between gene mutations and other processes, suchas crossing-over at very closely adjacent loci.Thus the ground is prepared for the reception of the idea of

pseudoallelism " as propounded by Lewis. Pseudo allelesare complex genes, of which the rhesus types in man areprobably examples, and they are thought to arise in the firstplace by duplication of one gene, followed by divergentfunctioning of one of the pair as a result of a

"

position "

effect. Justification for Goldschmidt’s assertion that there isno fundamental distinction between chromosome breakages,rearrangements, and point mutations thus becomes evident.The facts about the genetics of bacteria, as set out by the

Lederbergs, may seem incredible enough ; but the reader maybe pardoned if he gasps with astonishment when Luria describesexperiments on mutant genes in the phage infecting Bact. coli,and when Hershey and Chase demonstrate recombination,proving that the genes in phage T2H are arranged in linearorder. Then again, there is the follow-up, by Hotchkiss, ofthe work of Avery and McCarty in which he transformedpneumococci into a penicillin-resistant type by adding a

desoxyribonucleate prepared from resistant strains.Of more direct interest to human genetics by analogy is the

exact measurement of mutation-rate at specified loci in themouse. This was found by Hussell to average 25 X 10-8 perr6ntgen-a higher rate than that formerly established for droso-

phila. Aspects of the influence of cytoplasm on heredity arediscussed by Ephrussi and by L’Heritier, and the interactionof cytoplasm and nuclear components in chlamydomonas andparamcecium is explained by Sonneborn.

Altogether there are over thirty papers, every one ofwhich is of first-rate interest. An attractive featurethroughout is absence of complacency ; ideas are chang-ing, and a vast field of investigation into fundamentalbiological processes is being rapidly developed. It isbecoming clear that, as a small sacrifice to facilitate theseadvances, many current concepts of the gene and itsfunctions will have to be modified considerably.

Injury of the Xiphoid .

MICHAEL BURMAN, M.D., SAMUEL E. SINBERG, M.D. NewYork: Columbia University Press. London: OxfordUniversity Press. 1952. Pp. 92. 228. 6d.

IT seems hard to believe that the xiphoid should besufficiently important to justify a monograph, but theauthors’ experience of nearly 100 cases of serious injuryshows that it deserves attention. Direct injury, leadingto dislocation of the cartilage from its normal site, resultsfrom sudden blows in the solar plexus, or when thedriver of a car is thrown forward against the lower edgeof the steering-wheel in an accident. The surgeon cannotbe exonerated from being the cause of a xiphoid fracturewhen an enthusiastic assistant during a laparotomyexerts unduly vigorous retraction at the upper end ofthe abdomen. Like the coccyx, the xiphoid may becomehypersensitive as a result of injury, and in many suchcases the authors recommend its excision. Though themain concentration is on the xiphoid itself, this mono-graph touches on a slightly wider field than its titlewould suggest.

‘‘

Primer on Alcoholism

MARTY MAN, chairman and executive director, NationalCommittee on Alcoholism in America. London : Gollanoz.1952. Pp. 160. 8s. 6d.

ALL doctors should be adequately informed aboutalcoholism ; and this book, though written by anAmerican expert primarily for her fellow-countrymen,contains much that the British doctor should know.Mrs. Mann was herself an alcoholic, and has been cured.She has become a recognised expert on alcoholism, andhas held her present post for seven years, so she is wellqualified to speak on the subject. Throughout her bookshe emphasises that alcoholism is a disease, and thereforeshould be treated as objectively as pneumonia or diabetes.If this were more generally recognised a great deal ofthe guilt and shame from which the alcoholic invariablysuffers, and in which his family and friends share, might bealleviated and treatment might be more readily accepted.

Mrs. Mann gives a good general description of thecourse of alcoholism and its effects both on the patientand his family ; and she discusses in practical detailwhat can be done about it. Medical and psychiatrictreatment, both at home and in institutions, is outlinedand the work of Alcoholics Anonymous is particularlywell described. This valuable organisation is already wellestablished in Great Britain, with twenty groups inLondon, Liverpool, and other cities (headquarters addressBM/AAL, London, W.C.1). The work of the Society forthe Study of Addiction and the recently formed AdvisoryCouncil on Alcoholism is also sympathetically mentioned.There are two brief appendices by British doctorsdescribing the treatment of alcoholism by apomorphineand Antabuse.’ .

Adrenal CortexTransactions the Third Conference, Nov. 15-16, 1951.Editor : ELAINE P. RALLI, department of medicine,College of Medicine, New York. New York : Josiah

Macy, Jr., Foundation. 1952. Pp. 204.$3.25.WHEN such workers as Astwood, Ingle, Kendall, and

Pincus (to mention only 4 out of 25) are brought togethera verbatim report of their discussion, quickly published,is really up to date. Much of the material in this

volume has not yet appeared elsewhere : some of itindeed is still in the stage of pure speculation. Thisconference dealt with the effects of adrenal corticalhormones on renal function, the r6le of the hypothalamus

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in regulating A.C.T.H. secretion, the estimation of bloodsteroids, the biogenesis of the adrenal cortical steroids,and the clinical use of adrenal cortical hormones andA.C.T.H. The discussion has been illustrated with graphs,tables, and photographs.Anaesthesia for Thoracic Surgery

HENRY K. BEECHER, M.D., professor of research inanesthesia, Harvard University. Springfield, 111. : CharlesC. Thomas. Oxford : Blackwell Scientific Publications.1952. Pp. 65. 18s.

THE methods advocated here are those of the author,and the book is therefore neither a review of present-day

. techniques nor in any way a critical analysis of them. Avaluable account is nevertheless presented of thoracicanaesthesia as practised at the Massachusetts GeneralHospital.

Professor Beecher is a strong exponent of ether for thoracicanaesthesia. His advocacy of assisted respiration rather thancontrolled respiration may well be associated with his use ofether, the difficulty of controlling respiration with this anaes-thetic being well known. Many of the ideas and practicesdescribed are clearly more in accord with surgical conditionsin the United States than in this country. One exampleindicative of the gulf between Beecher’s methods and thoseused here is the brief mention and somewhat offhand dismissalof the use of curare or other relaxants in thoracic anaesthesia.

Anaesthetists will read the book with interest.

Monographs on Surgery 1952Editor : B. ROLAND CARTER, M.D., PH.D., professor ofsurgery, University of Cincinnati. 1952. Pp. 430. 95s.

THE policy of publishing annual volumes of monographson surgery seems to be amply justified by this volume,the third in the series. Among the subjects reviewed arethe radical surgery of pancreatico-duodenal cancer, stressincontinence in the female, arthroplasty, and currentviews about the internal fixation of fractures. All thearticles are detailed and written by authorities on theirsubjects. The reader is thus spared the labour of wadingthrough irrelevant and useless papers : the selection hasalready been made for him by reliable people. Mono-graphs of this kind are of real help to busy surgeons.Normal Blood-Pressure and Hypertension

New definitions. ARTHUR M. MASTER, M.D., cardiologist,Mount Sinai Hospital, New York, and associate clinicalprofessor 6f medicine, Columbia University, New York ;CHARLES I. GARFIELD, M.D., research assistant in

cardiology, Mount Sinai Hospital, New York; MAx B.WALTERS, M.D., F.R.C.P. Can., member, heart station,Vancouver General Hospital, Canada, formerly researchassistant in cardiology, Mount Sinai Hospital, New York.London : Henry Kimpton. 1952. Pp. 144. 30s.

THE correct interpretation of blood-pressure readingsis earnestly to be desired ; but opinions vary widelyabout the range of normal.

During the last thirty years there has been a tendency toaccept 140-150 mm. systolic and 90-95 mm. diastolic as theupper limit of the normal, irrespective of age and sex. Theseauthors contend that such limits are too rigid, and set toolow ; moreover, they are largely based on life-insurancestatistics, which are in any case unsound because the materialis highly selected, and relates to more men than women ;moreover, most of the subjects are young, and the analysisis based on group-mortality. Dr. Master and his colleaguesdiscuss the influence of age, sex, emotion, and other factors,and criticise the value of " basal " readings, concludingthat it is more important to find the range of

" casual "

readings, since these reflect the subject’s ordinary life.They also consider local factors. Thus the relationship

between the size of the arm and the width of the cuff greatlyinfluences the accuracy of the pressure reading. It is note-

worthy that arterial disease does not affect the reading; butspasm does, producing a false elevation of pressure whichcan be eliminated by repeated inflation of the cuff. Recom-mendations for cuff-size, design, and technique are given indetail.

Race, country, altitude, pregnancy, exercise, meals, andstarvation do not exert an appreciable effect on the blood-pressure. Height has no influence ; but weight is important,and reduction in weight is followed by a lowering of blood-

pressure. The blood-pressure normally increases significantlywith age, and this rise is more rapid and greater in femalesthan in males after the age of 40.The authors studied 74,000 unselected subjects representing

the average working population between the ages of 16 and 65,and have tabulated their results in detail ; and they havesummarised their conclusions about normal and hypertensivelimits in a final table. They discuss the interpretation andclinical application of the new blood-pressure limits, pointingout that the precise level of the blood-pressure is not so

important as the presence or absence of underlying cardio-vascular disease. There is no correlation between the heightof the blood-pressure and symptoms, rate of progress, or

development of complications ; and the most importantfactors in prognosis are cardiac enlargement, albuminuria,changes in the retina, and the electrocardiographic findings.

There is a wide field of application of this new range ofpressures in the practice of medicine and in clinicalresearch ; and the final table, a spare copy of which can beremoved for mounting, should be on every doctor’s desk.

Anglo-Saxon Magic and MedicineJ. H. G. GRATTAN and CHARLES SINGER. London:Oxford University Press. 1952.- Pp. 234. 28s.

THE essential part of this important work is an editionof the definitive text of Laenunga, an Anglo-Saxon bookof prescriptions, incantations, and methods of treatmentin various diseases. The text was last published in 1866by Cockayne and is now’very rare.The present edition, which has been issued by the Wellcome

Historical Medical Museum, is preceded by a detailed intro-duction by Professor Singer dealing with the whole subject ofAnglo-Saxon medicine and enlivened by a choice and unusualcollection of reproductions of contemporary illustrations.The second part of the book consists of the text, some of itin facsimile, of Lacnunga, and Professor Grattan’s translation,notes, and commentaries.

Barbarian man had no mechanism for recordingexperience. His views on the nature of disease remaineddisjointed ; but-since he knew well that he couldsustain injury at his own hands or those of others-hecommonly conceived that his symptoms were due toinjuries inflicted by beings like himself, and that hissufferings were produced by weapons or agents identicalwith those that he himself employed. Elves were oftenregarded as the cause of disease, but as Christianitypenetrated into the country God became pictured as theavenger in their place. The Anglo-Saxon leechdoms area mass of folly and credulity. This is hardly surprisingwhen it is remembered that there was no proper theoryof disease and in consequence no rational remedies couldbe applied. The writer of Lacnunga dwells in the bar-barian world of magic and hardly ever emerges. Hereis an example of his text :

" If there be a pock in the eye take marrow soap andhind’s milk ; mix and beat together ; let stand until it beclear. Then take the clear fluid ; put into the eyes. WithGod’s help the pock shall away.... If a man be swollen withinso that he cannot swallow the liquid, sing into his mouth."

This book will be welcomed as a treasure by students ofAnglo-Saxon and medical historians interested in thatperiod. The authors have garnished their scholarshipwith charm and humour.

Progress in Neurology and Psychiatry (Vol. 7. NewYork : Grune & Stratton. 1952. Pp. 604.$10).-Swellingyear by year, this review, edited by Prof. E. A. Spiegel,seems to be approaching the awkward stage at which itmust choose between blowziness and austere self-discipline.The book cannot cover everything written within its widerange, and a severely selective policy will save those who useit from the exasperation of looking up articles which turnout worthless. On the whole the neurological section remainsthe more satisfactory, as well as the more detailed : withthe sections on neurosurgery and on the anatomy, physiology,and pharmacology of the nervous system, it takes up nearlytwo-thirds of the book. In the section on psychiatry thecontributors seem unduly numerous, an extreme instance

being the chapter of six and a half pages on the neuroses,prepared by no less than twelve doctors and a librarian.The value of the review would be increased by the inclusionof an index of names.