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Reviews of Books

An Introduction to Chest SurgeryGEOFFREY FLAVELL, F.R.C.S., M.R.C.P., thoracic surgeon, TheLondon Hospital. London: Oxford University Press. 1957.

Pp. 354. 30s.

THE rapid advance of chest surgery has made many bookson this subject out of date before they are published, and it ishard to find one which can give the student and practitioner(as distinct from the expert) an accurate picture of currentpractice.Mr. Flavell and his publisher are to be congratulated on

providing in this book the maximum information at theminimum cost. The approach is practical, and after shortintroductory sections the author embarks straightway on how tolook at a chest X ray, bronchoscopy, and pulmonary resections.The various conditions which may call for surgery are

concisely discussed, and a number of short case-histories areadded, to show how errors in diagnosis and treatment can ariseand how they should have been avoided. In the discussion onthe diagnosis of bronchial carcinoma Mr. Flavell pointsto an important fact: even as recently as 1954 there was anaverage delay of over eight months between the first symptomsand surgical removal of the growth; and only one to twomonths’ delay could be attributed to the patient. Apart fromdiseases of the lung, there are adequate sections on the aeso-phagus and heart which discuss those conditions that can betreated surgically. The final chapter, on mitral stenosis, is anadmirable description of the disease and its possible remedy.Clear line drawings and several pages of small but goodX-ray reproductions illuminate the text.

Here and there are matters about which other thoracic

surgeons might disagree; but the balance of the book and itseasy style should make it very acceptable to the general reader.It gives an excellent picture of the scope of surgery in thoracicdisease and provides much information that is not readilyfound in general medical and surgical textbooks.

The Dynamics of Anxiety and HysteriaH. J. EYSENCK, PH.D., professor of psychology, University ofLondon. London: Routledge & Kegan Paul. 1957. Pp. 312. 32s.

FROM time to time Professor Eysenck summarises in a bookthe work of his group at the Institute of Psychiatry (MaudsleyHospital). His latest instalment begins with a recapitulationof earlier work seeking to show that psychotic patients can bedistinguished from those who are neurotic by their scores in abattery of objective tests, and that by further tests neuroticpatients can be subdivided not only by their measurable degreeof neuroticism or emotionality but also by their degree of intro-version or extroversion. Thus, hysterical patients are moreextroverted than persons with anxiety states. Professor Eysenckthen passes on to a detailed analysis of the observed differencesin learning, perception, socialisation, and response to drugsshown by the different personalities he has defined. He meas-ures the ease of acquisition or extinction of conditioned reflexesinvolving eye blinking, the rate of dark adaptation, attitudes todivorce and the death penalty, and nonsense-syllable learningwhile under the influence of amylobarbitone or dexampheta-mine ; and he interprets the results in terms of a neo-pavloviantheory of cerebral excitation and inhibition.

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The book is not easy reading. Its chief value lies in its dis-cussion of the experimental methods used, and the referencesto the fuller published papers of the Eysenck school. The

theory it proposes is still evolving, and unfortunately it appearsso far to be moving along a different dimension from clinical

psychiatry. The author himself admits that it seems over-

simple to explain the phenomena of hysteria and anxiety. Itmust be added that the results on which it is based are statis-tical correlations between items of behaviour of groups of

people. Measurement of items of behaviour of an individual,with quantitative prediction of his further responses, is whatinterests the clinician, and general statements of probabilitiesin groups are of little use. Professor Eysenck’s ideas, however,

have already stimulated a good deal of experimental work, andwill provoke more; and that is sufficient justification for ascientific hypothesis. If they could be applied longitudinallyinstead of cross-sectionally (that is, if the measurements wererepeated at different times in the life of the same individual)they might come to have practical relevance.

Bone Tumours

DAVID C. DAHLIN, M.D., consultant, section of surgical pathology,Mayo Clinic, Rochester, Minnesota. Springfield, Ill.: Charles C.Thomas. Oxford: Blackwell Scientific Publications. 1957.

Pp. 224. 87s. 6d.

THIS is a study of 2276 consecutive bone tumours seen at theMayo Clinic: and no praise could be higher than that Dr.Dahlin has done justice to such a rich source of material.

Anybody writing on bone neoplasms must come to terms withseveral problems to which there are as yet no satisfactorysolutions. Perhaps because there is often little correlationbetween the clinical course, histological structure, and radio-logical appearance of these growths, clinicians, pathologists,and radiologists have not yet agreed on a mutually acceptablenomenclature: and without a common language it is hardlysurprising that they have evolved no satisfactory classification.Dr. Dahlin bases his on a system suggested by Liechtenstein:this has many features in common with Thompson andTurner-Warwick’s classification and will be acceptable to mostpathologists in this country. The cell type is used as the chiefcriterion in assigning a tumour to its group: this makes for

histological accuracy, but it does not always favour cleardistinction between what is clinically innocent and what is

malignant.Tumours arising from marrow elements have been included

in the survey: malignant myelomas are, in fact, the largestsingle group. The scope of the investigation can be judged bythe fact that no less than 88 chordomas have been examinedand analysed. The lay-out and presentation of this vast

material is impeccable: and the illustrations have been judici-ously selected and beautifully reproduced. Dr. Dahlin reachesno startling conclusions; but as a basis for further study hisbook will prove invaluable.

Gastro-intestinal Obstruction

MEYER 0. CANTOR, M.D., M.S., F.A.C.S., assistant attendingsurgeon; ROLAND P. REYNOLDS, M.D., F.A.C.S., chief of surgery,Grace Hospital, Detroit. Baltimore: Williams & Wilkins.London: Bailliere, Tindall & Cox. 1957. Pp. 565. 144s.

EVERY conceivable aspect of intestinal obstruction is herecovered in a monograph by expert authors. In a sapient prefacethey observe that, despite advances in the control of blood-chemistry by infusion and of infection by antibiotics, the

mortality of obstruction can be reduced only by earlier

operation.Starting at the oesophagus, they discuss obstruction at

various levels of the alimentary tract. Chapters follow onobstruction in special circumstances-in pregnancy, in infancy,and in the aged, for example-and then on procedures diag-nostic, therapeutic, and operative. The work would have beenmore effective if it had been more concise. Emphasis issometimes lacking, and it is hard at times to hold the thread.Nevertheless as a source of information, with nearly 40 pages ofbibliography (and over 40 references on each page), it excels.

Air Pollution (London: Butterworth. 1957. Pp. 248.

42s.).-As Sir Hugh Beaver says in his foreword, " The ques-tion of Air Sanitation is one that affects the country from thesocial, medical and economic points of view; but it is essentialthat its consideration should be put on to a technical andscientific basis rather than an emotional one ". A conferenceheld at Sheffield University in September, 1956, sought to dothis; and the papers (here edited by Prof. M. W. Thring) dis-cussed the nature, measurement, sources, course, consequences,and elimination of air pollution. Dr. John Pemberton gives anaccount of the ill effects of air pollution on health and vege-tation.