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common, and thrombi are found in the small arteriesand glomeruli. These changes indicate that damagemay be caused by the vascular dilatation as well as thepreceding spasm.With " lower-nephron nephrosis" the early changes

are similar. After four days casts may be found in almostevery tubule ; but their number then diminishes, andthe tubules show evidence of rapid repair. Ballooningof the glomerular capsule is pronounced, and there arevarying degrees of glomerular thrombosis and damage.These lesions differ only in degree from those found incortical necrosis, and Dr. Govan feels that both syndromeshave the same aetiology. In addition, the earlier phasesof both 11 lower-nephron nephrosis" and symmetricalcortical necrosis can be seen in toxaemic cases of shock.Dr. IAN MACGILLIVRAY spoke on the clinical aspects

of renal dysfunction in obstetric shock. In all cases

of shock there is an immediate rise of blood-urea. Wherethis is not great there is usually only transient renaldysfunction ; but the group in which there is a greaterrise and a persistently low urine-urea are almost allcases with a combination of concealed accidentalhsemorrhage and toxaemia, and the shock lasts longerand oliguria persists even after recovery from the shockedstate. Oliguria of more than three days’ duration is ofgrave prognosis.Dr. MacGillivray went on to discuss ,the clinical

aspects of Dr. Govan’s cases of "lower-nephronnephrosis" and cortical necrosis. He suggested thatthe stimuli conducive to renal cortical necrosis in

pregnancy are pre-eclamptic toxaemia or sepsis, associatedwith shock. The same factors occurred in the cases of"lower-nephron nephrosis "; but toxaemia alone caninduce this condition, and those cases in which toxaemiaand shock were present did not have both factors to asevere extent. Of 4 non-toxaemic cases with " lower-

nephron nephrosis," 3 had sepsis and shock, and the4th had had an intra-uterine injection of posterior-pituitary extract while in the shocked state. All the casesof cortical necrosis had a well-marked rise of temperatureon the second or third day, unassociated with sepsis.This fever was not present in the " lower-nephronnephrosis" cases, except for 1 in which some degree ofthrombosis of the renal cortical arterioles was found

post mortem. Dr. MacGillivray suggested that the riseof temperature may be associated with massive thrombosisin the renal cortex. He did not think hæmaturia reliableas a diagnostic criterion of cortical necrosis, because thiswas present also in his cases of "

lower-nephronnephrosis." He advised four-hourly temperature chart-ing, since the fever of cortical necrosis may be transient.Any shocked patient, especially with associated pre-

eclampsia, may develop a severe renal lesion, and theblood-urea is a better prognostic guide than the amountof urine passed. Fatal renal lesions may be avoided bypreventing shock, or treating it early, and oliguriapersisting for more than three days is probably besttreated with limitation of fluids and a protein-free diet.

SPINAL ANESTHESIA AND THE KIDNEY

Dr. A. H. GALLEY recalled that chloroform lowers thesystemic blood-pressure and reduces the glomerular-filtration rate, and that ether stimulates the neuro-

hypophysis. Soda lime, as used in closed-circuit anæs-

thesia, is not a completely efficient carbon dioxideabsorbent. In the presence of reduced pulmonaryventilation, during closed-circuit anaesthesia, enoughcarbon dioxide might accumulate to cause diversion ofblood from the periphery of the renal cortex. Thisdanger can be overcome by intermittently squeezingthe anaesthetic bag.In view of some recent work by Professor Franklin

and his colleagues, Dr. Galley felt that spinal anæs-

thesia might influence renal function by abolishing

the effects of stimulation of the chemoreceptor centresin the spinal cord which are responsible for the renalcirculatory responses to hypoxia and hypercapnia. In addition, the hypotension and hypoventilation whichresult from spinal anesthesia are disadvantageous fromthe point of view of their possibly adverse effects onrenal function.

Therapeutically, spinal analgesia is a supplementarymeasure in the treatment of a number of conditions,including hypertensive encephalopathy in pregnancy.Dr. Galley concluded with a plea for its application assoon as possible after the decision has been made toenlist the help of the anæsthetist.

Reviews of Books

Insects and HygieneJAMES R. BUSVINE, PH.D., D.sc., Department of Ento-mology, London School of Hygiene and Tropical Medicine.London : Methuen. 1951. Pp. 482. 30s.

INSECTS do not play the overwhelming part in publichealth in this country which they do in tropical lands ;nor is the visible destruction in the home as spectacularas that achieved by termites, for instance, in warmerclimates. But the fact remains that we have a verylarge number of insect pests of greater or less importanceto medicine, commerce, and domestic life. At one timeor another they force themselves upon the notice of themedical officer of health, the sanitary inspector, andevery applied entomologist who has to do with ware-houses or private homes or the many trade processesvulnerable to insects. Dr. Busvine sets out to provide acomplete compendium of the information required tocope with these pests, starting with a straightforwardaccount of the structure and classification of insects.their anatomy and physiology, and the general principlesof their ecology. Chapters follow dealing with the generalprinciples of insect control and its organisation, and thetheory and uses of insecticides. The insects themselvesare dealt with on a practical ecological basis : house-flies and blowflies, the blood-sucking flies, the arthropodparasites of the human body, pests of foodstuffs, refuseand sewage, clothes moths and carpet beetles, wood-boring beetles, stinging and biting insects, and variousnuisances. Technical appendices include keys to mostof the insects, and information about the more importantinsecticides, and references and a good index complete abook that is both comprehensive and practical.

James Lind : Founder of Nautical MedicineLoTjis H. RODDIS, captain, Medical Corps, U.S. Navy.New York. Henry Schuman. 1950. Pp. 177.$3.

THE reading of biographies of certain naval heroes- admirals all-tends to become a weariness of the flesh.It is a pleasant change, therefore, to turn to the bio-graphy of a naval surgeon and to find there a better-balanced picture of old-time sea life, where battles wereonly occasional and sickness unfortunately occurred everyday of the week. The battle against disease at sea in the18th century was particularly hard, and since peopleare always ready to read of a good fight, Captain Roddishas told again the story of James Lind, M.D., ofEdinburgh, who took such a prominent part in it.Lind went to sea in 1739, remaining there until 1748 when

he returned to Edinburgh. In 1753 he published his Treatiseon the Scurvy and four years afterwards An Essay on Preservingthe Health of Seamen in the Royal Navy. These two books

helped him to the appointment of physician in charge of thenew Royal Naval Hospital, Haslar, in 1758. Here he wrotehis third book, Essay on Diseases Incidental to Europeans inHot Clinaates. His Treatise on the Scurvy added to the longrecord of the experiences of seamen and earlier surgeons anote of his experiments in the Salisbury, 50 guns, in 1748,which led him to conclude that lemon or orange juice was arapid, sure, and simple cure for the disease, and a preventive.Captain Cook, as we all know, put Lind’s ideas into practice,with splendid results.

It is perhaps worth noting that though Henry VIII did muchfor the Navy, he did not build its first ship in 1488 (his acces-

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sion was in 1509) ; and that though Charles I built some fineships, he was absent-minded about their crews : more thanhalf starved, they mostly died of scurvy. The book. is agraceful tribute by a naval surgeon of today to a naval surgeonof long ago who was always honest both with himself andothers.

The Order of the Court

J. DUDLEY PANK. London: Hodder & Stoughton.1951. Pp. 191. 8s. 6d.

Mr. Pank has a long experience of approved schools,and his thesis is that the delinquent boys in such schools" could be the salt of the earth if the iron hand weresubstituted for the kid glove." In spite of this ratherforbidding manifesto, the author appears as a likeableand sensible person, whom the psychologist would bevery willing to admit as a good influence in his ownright and regardless of his theoretical approach. Mr.Pank’s contact with his charges seems on his ownshowing to have been intuitively sound, and it is unfor-tunate that he seems to limit his theoretical deductionsto his own experience, and even there to documentthem thinly: in demanding the restoration of thebirch he adduces no evidence whatever to rebut thevery large body of contrary evidence, while his call tothe ’’ cranks who are in favour of abolishing punishment ’’ to " themselves try to control over a hundred youthssuch as ours with no other methods than persuasion "could be met very fully from the records of work suchas the Hawkspur Experiment alone. It is unfortunateto see a born teacher with an obvious sympathy andunderstanding for his charges so poorly informed of thework and methods which others advocate, and of thesuccesses they have obtained.

Steroid Hormones and TumorsA. LIPSCHUTZ, M.D., director of the department of experi-mental medicine, National Health Service of Chile.Baltimore : Williams & Wilkins. London: Baillière,Tindall, & Cox. 1950. Pp. 309. 46s. 6d.

THIS monograph presents in condensed form and logicalsequence the results of 15 years of experimental work bythe author and his numerous associates. Much of thework is already well known from previous publicationson the subject of tumorigenesis and antitumorigenesiswith steroid hormones. It deals with the induction ofthose curious fibromatous and fibromyomatous tumoursof the abdominal cavity of the domestic guineapig bycontinuous dosage with œstrogens, their prevention bycombined dosage with luteinising hormone, and theirdisappearance on withdrawal of the originating stimulus.Some unpublished data are included. The quantitative,timing aspects, and general implications of the experi-ments are discussed as also are the precise origin and classi-fication of these atypical yet reversible growths. Thelatter discussion is highly valuable.

Experimental work dealing with the induction oftumours directly or indirectly by oestrogenic hormoneboth in his own and in other laboratories is described witha full bibliography. The author is always careful to make adistinction between evidence that provides proof ofautonomous growth (metastasis, transplantability) andthat which does not, at the same time stressing thegradations in response from reversible hyperplasia tofull autonomy. Contributions and opinions of others areaccorded impartial consideration and there is a list of900 references. The whole monograph is illustratedlavishly and well.

The Esophagus and Pharynx in ActionA Study of Structure in Reflation to Function. WILLIAMLERCHE, M.D., F.A.C.S., Associate Professor of Surgery,University of Minnesota, Minneapolis, Minnesota. Spring-field, Ill. : Charles C. Thomas. Oxford : BlackwellScientific Publications. 1950. Pp. 229. 40s.

SURGICAL literature badly needs a book about theoesophagus and pharynx in action. As soon as surgicaltechnique loses touch with the knowledge of functionand the causes of dysfunction patients suffer in vain.It therefore seems a pity that a book with so attractivea title should consist of anatomical description of thenot only dead but embalmed oesophagus served up withmuch conjecture.

Under the title " rumination " Dr. Lerche will describea detailed dissection of an oesophagus, and then say : " Sinceno clinical history was available my belief that the conditionwas due to rumination could not be confirmed." He seemsto have lost sight of the normal action of the oesophagus inpassing food down to the stomach, and he concentrates onhow it behaves with fluid and wind coming upwards. Fromthe’ arrangement of a few muscle-fibres examined monthsafter death, he deduces that the body was in the process ofbelching as the spirit fled ; he can even assert that half thebelch reached the lower segment of the oesophagus while someof the wind frittered away in the upper segments.The author may have spent much time in microscopic

dissection of muscle-bundles ; but, if so, it is all the moredisappointing that he has obscured his anatomical workby untenable hypotheses, poor illustrations, and a

somewhat misleading title.

Poisons Guide : Volume I (London : Chemist and Druggist.1951. Pp.89. 20s.).-Thiswork, the previous edition of whichappeared in 1944, has been revised by Mr. W. A. Whatmoughin the light of changes in the poisons regulations, and is nowset out in a more easily read form. Together with volume n,which is being prepared, the book is claimed to form an"

encyclopaedia of poisons law."

Zoogeography of the Land and Inland Waters {London:Sidgwick & Jackson. J951. Pp. 208. 30s.).-The- world isdivided into eight natural geographical regions, and the faunaof each is described here both as it is now and as it -waspreviously according to the geological record. Prof. L. F.de Beaufort has successfully compressed his vast materialinto a small book with a good bibliography and index.The account is clear and concise ; and the trackingof the fauna that colonised the British Isles is as enthrallingas a good detective story.

Dible and Davie’s Pathology (3rd ed. London : J. & A.Churchill. 1950. Pp. 963. 54s.).-Dible and Davie’s Patho-logy .first appeared in 1939 and proved its worth as a standardtextbook. This edition is brought up to date by Prof. J. HenryDible, the senior author, whose wide experience and outlook,both in pathology and bacteriology, have allowed him tointroduce much recent work without asking too much of hisreaders. Indeed, the book is a pleasure to read from theintroductory homily to the final page. The more importantand dramatic historical facts are well presented, and the wholesubject of pathology is made lucid and stimulating.

Emergencies of Childhood (London : James Nisbet.1950. Pp. 64. 6s.).—This good short book on first-aid, byDr. R. Gamlin, is marred by inflated language. " Synopsis ofgeneral procedure in haemorrhage control " is not a better, buta much worse, way of saying " what to do for bleeding."The advice is in the main sound, but though it is true that theburned child " should be conveyed to hospital as rapidlyas possible," it is a pity that Dr. Gamlin recommends hisreaders to apply " strips of gauze soaked in sodium bicarbo-nate." It is now generally agreed that only a clean towel ordry dressing should be put on burns. Moreover it would bewise to mention that tannic acid or gentian-violet shouldnever be applied to burns or scalds which entirely or partlyencircle the finger. The illustrations are helpful, and it wasa good idea to include Dr. Breen’s pictures of fever rashes.

Freud : Dictionary of Psychoanalysis (New York:Philosophical Library. 1950. Pp. 208.$3.7).-This is a

glossary, edited by Nandor Fodor and Frank Gaynor, of themore important psycho-analytical terms, arranged inalphabetical order, illustrated by brief extracts from the

writings of Sigmund Freud himself. Reference is made,alongside each extract, to the work in which it occurs, and thereis a key at the beginning of the book to the various writings.A chapter and page reference might usefully have beenincluded with each extract for those interested in tracingeach definition to its source and studying it in its relevantcontext. There are some surprising omissions, such as theterms abreaction, anaclitic, economic, metapsychology,omnipotence, organ pleasure, and reaction formation, spacefor which might well be found in a further edition by pruningsome of the terms which Freud does not use in any but theordinarily accepted sense—such as beauty, phantasy, andintoxication.