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Reviews of Books

Non-infective Disease in Africa

H. C. TROWELL, O.B.E., M.D., F.R.C.P., consultant physician,Mulago Hospital; Uganda Medical Department and Depart-ment of Medicine, Makerere College Medical School, Kampala.London: Edward Arnold. 1960. Pp. 481. 70s.

THIS carefully reasoned and detailed study occupied Dr.Trowell exclusively for a year, and he brought to it twenty-nineyears’ experience as a physician in East Africa. The com-

prehensiveness of the sections, the full documentation, the carewith which evidence is weighed and personal opinions givenare outstandingly evident. The range includes the diseases ofthe special systems, and the endocrine organs, nutrition, anddisturbances of electrolytes; and there is a final chapter on theAfrican milieu interieur and the incidence of disease. Differ-ences between biological values in Bantus and Europeans arediscussed, and it is postulated that in these differences may liethe clue to some-but only some-of the anomalies of acquirednon-infective disease in Africans.With this stimulating and thought-provoking book Dr.

Trowell intends to say goodbye to Africa: if this is indeed afinal curtain he deserves enough applause to evoke severalencores.

Pioneer Microbiologists of AmericaPAUL F. CLARK, emeritus professor of microbiology, Universityof Wisconsin. Madison: University of Wisconsin Press. 1961.

Pp. 369.$6.HIGH on the facade of the London School of Tropical

Medicine and Hygiene are engraved the names of the twenty-three men who have contributed most to our knowledge ofthose subjects. The notable part that the United States has

played is reflected in the six American names which thus rankwith those of Jenner, Pasteur, and Koch. Yet, whereas mostlaymen are familiar with the work of those men, even somedoctors would be hard put to it to explain why Biggs andShattuck, Gorgas and Reed, richly deserve to share their

place.The biographies of these four, and a great many more, will

be found in this book, which surveys microbiology in NorthAmerica from the days of Oliver Wendell Holmes and AustinFlint to the years of the first world war. Professor Clarkhas not confined himself to the pathological aspects of thesubject: and he is widely travelled and senior enough to haveknown personally many of those on whom he writes. His

text, therefore, is never in danger of degenerating into a merecatalogue. For instance, when describing Theobald Smith,the pioneer in the laboratory study of tuberculosis, he relateshow the great bacteriologist led such a meticulously orderedand economical life that every night he laboriously wound hiscar up on four ordinary jacks simply to take the weight off itstyres.The only criticism this excellent volume is likely to encounter

will be that its chapters are arranged geographically. Such a

plan has some undoubted advantages (as when considering theteam which worked at Johns Hopkins under Welch) but hasrelatively little significance for readers beyond the UnitedStates. And it is certain that the book will be widely readoutside its country of origin.

Clinical HaematologyROBERT DUNCAN EASTHAM, M.D., D.C.P., D.PATH., consultant

pathologist to the Frenchay/Cossham hospitals group, Bristol.Bristol: John Wright. 1961. Pp. 158. 15s. 6d.

THIS compendium of facts and figures about the subjectsthat make up clinical haematology is written in abbreviatedgrammatical language, supported by lists and the occasionaltable. It is surprisingly comprehensive, and there must be fewsubjects that have been missed; even recent work (such asOwren’s thrombotest, conditions in which glucose-6-phosphatedehydrogenase is deficient in red cells, and alkaline-phosphatase

in leucocytes) are adequately described. The many laboratorytests of clinical haematology are briefly described and theirsignificance discussed, usually in list form. There is a goodtable presenting the results of the acid serum haemolysis testin various haemolytic syndromes, and another on the identifica-tion of the now numerous clotting defects by use of thethromboplastin generation test; it includes the rarer deficiencies,such as Hageman-factor deficiency.The lists, even when quite long, preserve a fair balance

between the reasonably common and the exceptionally rare.Most clinical pathologists and physicians will find this a

handy book for quick reference, and it can be stronglyrecommended.

The Story of Hospital AlmonersThe Birth of a Profession. E. MOBERLY BELL. London: Faber

& Faber. 1961. Pp. 146. 13s. 6d.

THE author has set out to record the history of the birth andestablishment of a profession of which too many are still

ignorant. It is not unusual to be asked what almoners find todo now there is no money to collect and little to bestow.

Others, even in the profession, think that medical social workis the discovery or invention of the National Health Act. Aquick look at this book will dispel that misconception.The word " almoner " dates from the fourteenth century

when it concerned those who distributed alms among the poor.But latterly it came to be associated in the public mind withcollecting money from patients rather than with their socialwelfare. The word " lady " was added to " almoner " in anattempt to overcome this. Mary Stewart, the first lady almoner,was appointed to the Royal Free Hospital in 1895. Others soonfollowed at St. George’s, Westminster, and St. Thomas’s. AnneCummings, the first lady almoner at St. Thomas’s, wasone of the ablest of these pioneers, and she strove to demon-strate the great need for hospital almoners and to establishthem as a professional body. Her abilities were successfullydevoted to dealing with patients’ social conditions, which, ifthey remained unchanged, often turned purely medical treat-ment into a mockery.The book follows the development of the profession to the

beginning of the National Health Service. Although the firstwhitepaper on the National Health Bill did not mention thealmoner, this was repaired in December, 1947, by a circulardealing exclusively with her function. In it the Ministryaffirmed that the almoner was a colleague of the doctor and,with him, responsible for the health of the patient. It alsoindicated that almoners would be expected to play an increas-ingly important part in the training of medical students insocial medicine and in cooperating with the medical professionin research.

Although there have been important developments in thepast thirteen years, the book ends here, at the coming tomaturity of the profession with this official recognition of itsstatus and function.

Enzymes in Clinical MedicineIRVING INNERFIELD, M.D., associate attending physician, depart-ment of medicine, Kings County Medical Center; researchprofessor, Graduate School, department of biology, LongIsland University, New York. New York and London: McGrawHill. 1960. Pp. 334. 89s.

IN a preface the author says " the chief justification for thisbook lies in the opportunity it affords to present a comprehen-sive review of the historical, experimental, and clinical evidencefor the rational use of enzymes as therapeutic and diagnosticagents "; but he has not fully succeeded in his aim.The first chapter (on proteolytic enzymes) and the second (on

inflammation and enzymes of clot lysis) are much concernedwith animal experiments, and their presentation is involved.To follow the argument the reader must be so familiar with the

subject that he may get little help from the book. The writingis inclined to be loose-for example, " at optimal activity thepH of plasmin is 7-4..." (p. 50)-is the sort of remark thatmakes a biochemist’s blood run cold. Chapter 3 (on methods

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of administration of enzymes) and chapter 4 (on the clinicalindications for enzyme therapy) are more satisfactory and givethe author an opportunity to present his vast experience in thissubject. The main theme that fibrin is the " bogey man " ofinflammation is often repeated, but some readers may wonderwhether this statement is completely proven. The authoradmits that surgical drainage and antibiotic therapy are stillnecessary. In relation to respiratory-tract infection, there is

hardly any reference to the use of pancreatic deoxyribonuclease.Chapter 5 discusses rather briefly enzyme inhibitors and theirclinical applications. And chapter 6, one of the two largest inthe book, is concerned with the use of enzymes in diagnosticproblems: although a lot of information is set out, muchrelevant material is omitted. The subject matter of the finalchapter might have been distributed through earlier parts ofthe book.

Maurice NicollA Portrait. BERYL PoGSON. London: Vincent Stuart. 1961.

Pp. 288. 35s.

Dr. Maurice Nicoll was established as a neurologist when ameeting with Ouspensky in 1921 changed the direction of hislife. After a year’s training in France under Ouspensky’steacher, Gurdjieff, he returned to London with permission toteach the system which he did until his death in 1953. This

biography written by his secretary is intended primarily forthose who knew him and read his published work-The NewMan, The Mark, Psychological Commentaries on the Teachingof Gurdjieff and Ouspensky (in five volumes). It is not easy foran uninitiated reader to find out what exactly was the system,its secrecy being stressed. The essential point seems to havebeen:" the breaking up of mechanicalness, and the making of new associa-tions for the purpose of shifting the basis of oneself, with an insistenceon individuality, which was impossible without sincerity" The system aims at an all-round and harmonious development ofMan. It is a place where every one can be an artist, or an artisan, andhis own mental, emotional and instinctive energies are the materialswith which he works. As most of the energy of modern life flows intomental activity, much physical activity is needed, and many acuteemotional conflicts are required to divert this energy into instinctiveand emotional channels."

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At one conference it was discovered that if you threw a new-laid egg over a three-storey house it would not break providedit was new laid and fell on grass.

Re-Educative Treatment of Suppression AmblyopiaAn abridged English version of Jean Sedan’s Post Cure DeL’Amblyope Rééduqué. T. KEITH LYLE, M.D., M.CH., M.R.C.P.,F.R.C.S., CYNTHIA DOUTHWAITE, D.B.O., JILL WILKINSON, D.B.O.,Orthoptic Department, Moorfields Eye Hospital, London.Edinburgh: E. & S. Livingstone. 1960. Pp. 135. 25s.

RE-EDUcATION of a squinting eye in which temporary visualneglect and suppression may lead to the more permanentcondition of amblyopia is often successfully achieved byocclusion of the fixing eye. Attention to visual detail improvesduring this process and the object of this primer is to stimulateattention by presenting a text with manifest errors, detectionof which by the child are believed to assist in the re-educationof the neglecting eye.

This text, in type of diminishing sizey plus a section ofpuzzle pictures, comprises the volume which will be usefulto orthoptists and the parents of squinting children in

supervising the use of the squinting eye.

The Case Reports and Autopsy Records of AmbroisePare

Compiler and editor: WALLACE B. HAMBY, M.D., F.A.C.S.,department of neurological surgery, Cleveland Clinic, Cleveland,Ohio. Springfield, Ill.: Charles C. Thomas. Oxford: BlackwellScientific Publications. 1960. Pp. 214. 52s.

WHEN a scenario writer chances on the name of AmbroisePare, his most serious obstacle, in producing an epic film, willbe that the public may demur at the plot. For a story in which

the hero alternates between palace and battlefield; operates onkings and beggars alike; narrowly escapes poisoning at thehands of his enemies; is carried through the streets by hisgrateful patients; and is spared death in a bloody massacre bya royal decree, may seem too fanciful.To the medical historian, of course, Pare has always been a

figure of great interest, and not only because all these thingsreally happened to him. His life almost exactly spanned themomentous sixteenth century during which medicine emergedfrom the Dark Ages, and he both chronicled and shaped thesurgical practice of his times. ·

An English translation of his works has been available since1634: but in their complete form they are too discursive, andtoo highly coloured with speculation based on medievaltheories of pathology, to hold much interest for a moderndoctor. His case-histories, written in terse, objective style, areanother matter, and Dr. Hamby has now selected some 200 ofthese from Malgaigne’s edition. Amongst them are thosedescribing the introduction of ligatures for amputations; thefirst removal of a loose body from the knee; the wound whichkilled Henri II; and the misadventure which befell Charles IXduring a phlebotomy. One of the most remarkable, althoughnot the best known, relates how two men were revived afterhaving been found, apparently dead, in a room where a char-coal stove was burning. This is one of the earliest reports ofcarbon-monoxide intoxication, although Pare had obviouslymet the condition before, since he deduced the presence of thebrazier before it was found.Such records can be read as historical documents, as clinical

papers, or even, and by those with no claim to medical know-ledge, for their inherent interest. In whatever light it isexamined, this is a fascinating book.

Antenatal and Postnatal Care (9th ed. London: J. & A.Churchill. 1960. Pp. 435. 45s.).-This familiar work byProf. F. J. Browne and Prof. J. C. McClure Browne haschanged to a larger size, the text has been revised, one or twochapters have been completely rewritten, and others have beenadded. Seldom less than authoritative, the book will retain itsvalue for senior students and postgraduates. Occasionally,however, some readers may feel the need for more up-to-dateor critical guidance. In the chapter on placenta praevia threeof the fifteen references are earlier than 1905, seven are morethan ten years old, and only one comes from the past five years.Placentography is not discussed in this chapter, but a latersection on radiology in obstetrics has something to say aboutthe various techniques used. In their consideration of contrac-ted pelvis and disproportion the authors quote extensively fromthe work of Caldwell and Moloy and accept their opinion that theandroid type of pelvis is common in women and that the malepelvic inlet is typically heart-shaped. But it has been shown 1 2

that men of good stature have pelvic brims whose shapeis identical with those of healthy women. The next editionmight usefully include a frank discussion of the medicolegalissues associated with termination of pregnancy and sterilisa-tion. The final chapter of ten pages is given to postnatal care,and there is not space enough to consider the wider aspectsof this subject. For example, nothing is said of the emotionalproblems which may trouble the woman at this time, of thedifficulties which may be associated with the return to normalmarital relations, or of future pregnancies and familyplanning.

Modern Trends in Endocrinology (Second series. London:Butterworths. 1961. Pp. 349. 75s.).-Dr. H. Gardiner-Hillisto be congratulated on producing a second series of theseModem Trends. A distinguished group of authors have con-tributed 19 articles on a wide range of topics in endocrinologyand metabolism; and this book, with its predecessor, providesa pleasant means of finding out what is happening in one of themost active branches of medical research.

1. Bernard, R. M. Transactions of the Edinburgh Obstetric Society, p. 1, inEdinb. med. J. February, 1952.

2. Thoms, H., Greulich, W. W. Amer. J. Obstet. Gynec. 1940, 39, 56.