1374 Nov.
24, 1962 REVIEWS
Reviews
STUDENTS' TEXTBOOK OF MEDICINE
A Short Textbook of Medicine. By J. C. Houston, M.D.,
F.R.C.P.. C. L. Joiner, M.D., M.R.C.P., and J. R. Trounce,
M.D., M.R.C.P. (Pp. 564+x. 25s. paper; 35s. boards.)
London: English Universities Press. 1962.
The teaching of physics at university level is constantly
being revised and rewritten in terms of the latest ideas
about the atom and the universe. It is not quite so
easy to deal in the same way with the teaching of
medicine, because medicine includes so much factual
detail, but both the incidence and the treatment of
disease are changing so rapidly that medical textbooks
quickly fall out of date. There is therefore a good case
for regarding them as expendable and producing them
as inexpensively as possible. This new textbook of
medicine is one of the most interesting reviewed here
in recent years, not only because it is produced in
paperback form but also because the authors have
successfully tried to deal with the medicine of to-day
and to cut out.the dead wood which encumbers so
many books written for medical students. The arrange-
ment of the text is unorthodox in that genetics, psychi-
atry, and alimentary diseases come first, and infectious
diseases are left till near the end. The sections on the
different systems are usually preceded by a discussion
of the mechanism of symptoms and the methods of
examination. The short accounts of heart sounds and
respiratory function tests are excellent. Most diseases
are considered under the headings of clinical features,
diagnosis, and treatment without much formal definition
or pathology. There is no attempt to be encyclopaedic,
but references are given for further reading.
In a first edition, not unnaturally, there are a few
points to cavil at. Lupus erythematosus is consistently
misspelt. More space is devoted to osteopetrosis, which
a medical man may never see, than to myelomatosis,
which killed fifteen people per million in this country
in 1960. (Incidentally, cyclophosphamide and melphalan
have superseded corticosteroids in the treatment of
myelomatosis.) Myelofibrosis is not mentioned, though
many-haematologists regard it as just as common as
chronic myeloid leukaemia. However, these are minor
points.' What really matters is the favourable impres-
sion created by the book as a whole. It is clearly written
and readable, and contains just about as much and no
more medicine than the student should know on quali-
fication. It may well prove a serious challenger for the
title of the most popular student textbook of medicine.
L. J. WwIrs.
CURRENT PHARMACOLOGICAL ADVANCES
Recent Aavances in Pharmacology. By J. M. Robson, M.D.,
D.Sc., F.R.S E., and R. S. Stacey, M.A., M.D. Third
edition. (Pp. 406+ x: illustrated. 54s.) London: J. and
A. Churchill Ltd. 1962.
The assembling of a book of this kind becomes
increasingly difficult with the rise in the number of
preparations in clinical use, and certain sections (such as
that on bacterial chemotherapy) are not much more
palatable than " New and Non-official Remedies." Then
the account of drugs acting on the central nervous
sy-stem is likewise unsatisfactory, resembling the pieces
of a jigsaw puzzle which cannot be made into a picture.
JBoRff
There are, however, chapters which are both interesting
and well presented. Among these are the chapters on
catechol amines, on hypoglycaemic agents and diabetes,
and on new drugs in the treatment of tropical diseases.
The last of these is specially noteworthy.
The discovery that piperazine was effective against
roundworms was made by a pharmacist in Rouen,
M. Boismare, who recommended a Dr. Fayard to try it,
and gave him a preparation of piperazine hydrate in
apple syrup. Its effects were described in Fayard's thesis
submitted to the University of Paris in 1949.
Much more is now known of the mode of action of
drugs used in tropical diseases. Thus trivalent antimony
kills schistosomes because it inhibits the enzyme
phosphofructokinase; the action point of antimony is
known as accurately as that. Primaquine is an anti-
malarial agent closcly related to pamaquin. Some people
are sensitive to primaquine and suffer from intravascular
haemolysis. The sensitivity occurs in those whose red
cells are deficient in the enzyme glucose 6-phosphate
dehydrogenase; the deficiency is hereditary and leads
to a lack of reduced glutathione in the red cell.
Glutathione has a protective function in the red cell.
Sulphonamides are active antimalarial substances, and
they increase the action of pyrimethamine. These
substances block different points along the same
metabolic pathway to folinic acid, and their joint action
is more powerful than could be expected from the
sum of their separate effects. This is observed both in
experimental and in human malaria.
These examples indicate the great increase in our
understanding of the biochemical changes produced by
drugs used in tropical diseases. They furnish perhaps
the best index of current pharmacological advance.
J. H. BuRN.
AIR HYGIENE
Airborne Infection. Transmission and Control. By Richard
L. Riley, M.D., and Francis O'Grady, M.D M.Sc. (Pp. 180
+xv; illustrated. 68s.) New York and London: The
Macmillan Company. 1962.
This book is dedicated to W. F. Wells, the discoverer
nearly 30 years ago of the droplet nucleus, the first
advance on Flugge's work on droplet infection at the
beginning of the century. Riley collaborated in much
of Wells's earlier work at Baltimnore, and O'Grady in
a recent study of the air-borne transmission of
tuberculosis.
A droplet nucleus is formed by the drying in the air
of a particle of secretion expelled from the mouth which
is too small to reach the ground before evaporation.
For the same reason it tends to remain suspended in
the air, and its capacity to transmit infection also owes
much to the fact that the smaller the particle inhaled
the more deeply it will penetrate the respiratory tract:
it is established that a very few organisms reaching an
alveolus will cause infection whereas many more
deposited in the nose or bronchi may not.
These authors adduce what seems incontestable
evidence that the droplet nucleus is the vehicle of trans-
mission of two diseases, pulmonary tuberculosis and
measles. Moreover, their work is impressively quanti-
tative: calculations are made of the volume of air
containing one infective unit, and, in connexion with
the spread of measles, an equation is proposed relating
the number of new cases to be expected in a single
enclosed atmosphere, such as a classroom, to various
factors, including the ventilation rate. It is strongly
 Nov. 24, 1962 REVIEWS
contended that ultra-violet irradiation, which kills
micro-organisms in droplet nuclei though not in dust
particles, can hinder the aerial spread of infection,
whether used as a barrier or for the whole upper
atmosphere of a room. The circumstances of measles
epidemics, several in the U.S.A. and one in London,
are analysed: the attack rate was greatly reduced in
irradiated class rooms at one of the schools, and in
those where the process failed reasons are given for
believing that transmission was occurring mainly else-
where-at one school in buses.
It is emphasized that dust-borne infection is a totally
different problem, calling for different measures. It
is also admitted regretfully that sanitary engineering,
so far as it concerns the provision of pathogen-free air,
is in its infancy; most of those who have to design and
test installations still have almost everything to learn.
The facts and arguments in this book demand the
closest consideration by anyone concerned with air
hygiene. As an epitome of the work initiated by a
great pioneer in this subject it may well attain the rank
of a classic.
L. P. GARROD.
USING ADRENAL STEROIDS
Clinical Uses of Adrenal Steroids. Edited by Josiah Brown,
M.D., and Carl M. Pearson, M.D. (Pp. 447+xvi; Ilus-
trated. 85s. 6d.) New York, Toronto, London: Blakiston
Division, McGraw-Hill Book Company. 1962.
This book is the report of a two-day symposium held
in 1959 in Los Angeles under the auspices of the
University of California (L.A.). We have on several
occasions in these columns expressed doubts about the
desirability of publishing so many symposium pro-
ceedings, and the point has been raised recently by Sir
Lindor Brown, Secretary of the Royal Society, in Nature
(February 24, 1962, p. 724). But the present volume
undoubtedly serves a useful purpose, though it has the
common failing of so many such reports in that it shows
a good deal of overlap, a number of gaps, and variations
in standard between the various contributors.
On the whole the book is very good. It adopts a
commendably cautious attitude to steroid usage and
warns against undue enthusiasm. It gives very useful
summaries of the place of steroids in the handling of a
wide variety of medical disorders. At the end of each
section there is a very generous list of references to the
relevant literature and due representation is given to
British contributors. The ophthalmological, dermato-
logical, and gasteroenterological uses, for instance, are
backed by about 100 references each. The section on
eye diseases is in particular a very comprehensive and
thorough one, but not all the sections are equally so.
The very important subject of bronchial asthma is
discussed under allergic disorders. It is stated (p. 158)
that the aim of steroid therapy in asthma is the complete
clearing of the pulmonary disease. No warning is given
of the grave dangers of steroid addiction, which would
result from such an aim in many asthmatics. The
possibly life-saving use of intravenous steroids or
corticotrophin in severe status asthmaticus is not
recognized. Seven of the eight references quoted on the
steroid treatment of asthma refer to steroid inhalations.
But most of the sections are good and well balanced,
and reflect a mature judgment of the place of steroids
in the therapeutic armamentarium. The section on the
controversial question of the use of long-term steroids
in the nephrotic syndrome is a particularly good
MEDICAL JOURNAL 1375
example of this, for it backs its conclusions with a
complete analysis of all the published series available
in the world literature, a total of nearly 600 cases.
Clinicians in many fields will find much of value in
this volume about modern attitudes to these valuable
but controversial drugs.
C. L. COPE.
GERMAN TEXTBOOK OF GYNAECOLOGY
Lehrbuch der Gyndkologie. By Heinrich Martius. Seventh
edition. (Pp. 459+xv; illustrated. DM. 58.) Stuttgart:
Georg Thieme Verlag. 1962.
The popularity of this Textbook of Gynaecology on the
Continent is demonstrated by the fact that this is the
seventh revised edition to appear since it was first
published in 1946; in addition it has been translated
into Italian and Spanish. Its success must be attributed
to the precise and authoritative manner in which
the author presents the essentials of gynaecological
anatomy, physiology, and pathology. The style of the
German text is easy and clear, but a considerable know-
ledge of the language is needed if the book is to impart
all the information that it contains.
Functional disorders of the female genital tract are
described according to the symptoms with which they
present, whereas tumours and inflammatory conditions
are dealt with systematically according to the organs
involved. The book concludes with three useful
chapters on gynaecological urology, orthopaedics, and
the technique of clinical examination of the pelvic
organs. The importance of clinical diagnosis is
emphasized by numerous helpful schematic illustrations
of the physical signs associated with pelvic disease. The
loyalty of the author to his talented illustrator, Miss
Droysen, is, however, sometimes misplaced. The
appearance of patients and the macroscopical and
microscopical details of gynaecological pathology would
surely be better conveyed by photographs.
Besides presenting a complete textbook for under-
graduates, the author aims to supply practising doctors
with a reference book. It is because of the rapid
advances in gyanecological treatment, particularly in the
use of hormones, that repeated revision of the text has
been necessary. An earlier criticism of this work-
namely, the use of proprietary names-has been over-
come by the inclusion of an appendix which lists the
hormone preparations available under their proper
names. Many of the details of medical treatment-
spa therapy, dietetic regimes, the widespread use of
radiotherapy in the treatment of benign gynaecological
conditions, and so on, will be unacceptable to British
readers. The details of operative technique are not
discussed, but the pros and cons of medical versus
surgical treatment and the indications for the various
types of operation are dealt with. Continental students
and practitioners of gynaecology must all be grateful
for the admirable energy of Professor Martius.
P. J. HUNTINGFORD.
THE SKELETON IN FORENSIC MEDICINE
The Human Skeleton in Forensic Medicine. By Wilton
Marion Krogman, Ph.D., LL.D.(h.c.). (Pp. 337+xxvi;
illustrated. 5 12s.) Springfield, Ill.: Charles C. Thomas.
Oxford: Blackwell Scientific Publications. 1962.
Wilton Krogman is a remarkable man with a repute in
the field of anthropometry that ranks him foremost
among the few scattered world experts in this brancb
of anatomy. His authority is unchallenged, and when