Reviews of Books

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increase susceptibility to corrosion at or near welded areas.The filler metal used for welding is ER308L. The interiorsurface of the steriliser chamber can be constructed of eithernickel-clad metal or stainless steel. All those parts of thechamber door which come into contact with the steam inthe steriliser chamber are of stainless steel, because suchclad material is unsuitable for the machining required inthe construction of the door’s locking mechanism.The first of these sterilisers has now been inspected and

evaluated after four years of operation. The temperatureand pressure attained in the steriliser’s 16 x 16 x 24 in.

il (40 x 40 x 60 cm.) chamber meets the standards required forlaboratory steam sterilisers. The 25-litre generator can beheated from room temperature in 8 minutes so as to

deliver and maintain chamber steam at the required 121 °C,and can then provide twenty 30-minute sterilisation cycles.During its 4 years of operation the generator and its coilsreceived no corrosion-preventive maintenance, in order to

I encourage maximum corrosion under operational con-

ditions. At the end of this period the front end of theI generator was removed to permit inspection of the coils’ and internal surfaces of the generator. All surfaces wereI free of residue and corrosion except for one small region of

the generator and one small area of a weld. The damagedregion of the generator contained approximately one dozencircular areas of corrosion, the largest of which measured1 mm. in diameter. The corroded area of the weld coveredless than a 1 x 3 mm. area, while the combined, undamagedsurface areas of the many weldings totalled approximately195 sq.cm. All these areas of corrosion were easily removedby abrading with clean emery cloth and were then treatedwith dilute nitric acid to prevent recurrence of corrosion.The materials and method of construction make this

generator extremely corrosion-resistant, permitting the useof distilled water and thus essentially eliminating the mainsources of chemical contamination without sacrificing thesterilising efficiency of a standard autoclave. Our experienceindicates that with periodic inspections of the generatorand attendant removal and passivation of incipient areas ofcorrosion, the extent of corrosion could be further reduced.We thank Dr. Melvin R. Meyerson, of the U.S. National

Bureau of Standards, for advice on metallurgy and for evaluatingthe metal components and their construction.

Requests for reprints should be addressed to J. H. R., Building10, Room 12N238, National Institutes of Health, Bethesda,Maryland 20014, U.S.A.

Reviews of Books

Clinical Chemistry in Diagnosis and TreatmentJOAN F. ZILVA, M.D., B.SC., F.R.C.P., M.R.C.PATH., seniorlecturer in chemical pathology, Westminster MedicalSchool, London; and P. R. PANNALL, M.B., F.F.PATH.(S.A.),M.R.C.PATH., senior lecturer in chemical pathology, Uni-versity of the Orange Free State Medical School. London:Lloyd-Luke. 1971. Pp. 430. E2.50.

THIS is an important new book for teachers of clinicalchemistry and for those learning about it (medical studentsprincipally, but also junior doctors, biochemists, and

laboratory technicians). It is written by an experiencedteacher of chemical pathology and a former departmentalregistrar, in a lucid style outlining the principles underlyingthe various changes measured in clinical chemistry. Becauseof the importance attached by the authors to getting thestudent to understand the sequence of events leading tosuch measurable changes, the book is longer but morehelpful than many others written for this class of reader.One device used to avoid back-referral in the text is thereproduction of a figure on a number of pages. The lasttwo chapters, on Chemical Pathology and the Clinician andInterpreting Results, should be taken to heart by all

hospital doctors. An up-to-date note is maintained byinclusion of short chapters on the clinical chemistry ofpregnancy and oral-contraceptive therapy and on theendocrine effects of tumours. Thus this is basically anexcellent book for students. It contains very few errors, andit will rapidly become an accepted and widely read text.There are, nevertheless, two criticisms that can be levelledagainst it. First, to keep the text short or to avoid con-troversy, the authors do not commit themselves to valuesfor normal ranges or for typical findings in disease states-e.g., one can read here an excellent account of primary,secondary, and tertiary hyperparathyroidism without everbeing told what hypercalcaemia is. It is not easy to giveacceptable figures for substances whose concentration mayvary with technique, age, time of day, and so on, but ifchemical pathologists refuse to offer detailed guidance onsuch matters in a textbook of chemical pathology, whowill ? Secondly, general biochemistry as a whole, includingthe vitamins, is sketchily dealt with. If clinical biochemistrywere clearly a different subject to clinical chemistry theremight be some justification for omitting descriptions of the

underlying biochemical functions of various substancesmeasured in chemical pathology. There must be some

dividing line in a student’s book between excessive bio-chemical detail and ordinary chemical pathology, but theauthors could have said, for example, that vitamin B12 canbe measured by radiochemical techniques but that a

description of its biochemical functions is beyond the

scope of the book. This approach would be less irri-

tating than statements such as " the exact mechanism ofketosis is obscure " or the remark that the biochemicalfunctions of vitamin B12 are less clearly understood thanthose of folate. Moreover, a slightly fuller account of thecoenzymes, for instance, would make it clear to the studentwhy erythrocyte-transketolase determination may be a

better approach for detecting thiamine deficiency thanolder tests. A compromise might be to improve the use ofspace by giving certain biochemical reactions more fully-e.g., in tryptophan metabolism or galactosaemia, wherethere is confusion between reversible hexose-I-phosphatedependent and u.T.p.-dependent galactose-1-phosphateuridylyl transferase.

ColposcopyA Scientific and Practical Approach to the Cervix in Healthand Disease. MALCOLM COPPLESON, M.D., F.R.C.O.G., KingGeorge V Memorial Hospital, Royal Prince Alfred Hospital,Sydney; ELLis PIXLEY, M.B., M.R.C.O.G., King EdwardMemorial Hospital, Perth; and BEVAN REID, M.D., B.V.SC.,Queen Elizabeth II Research Institute for Mothers andInfants, University of Sydney. Springfield, Illinois:Charles C. Thomas. 1971. Pp. 346.$21.50.

FEW clinics in the United Kingdom use colposcopy as anaid to the diagnosis of early cancer of the uterine cervix;reliance is mostly placed upon exfoliative cytology. Dr.

Coppleson and his co-authors do not deny the value ofcervical smears and biopsy in the diagnosis of preinvasiveand microinvasive cervical cancer, but they do argue that thesediagnostic procedures are of greater value when combinedwith direct examination of the cervix at those intermediatemagnifications provided by the colposcope. They presentcolposcopy as an investigative tool capable, in conjunctionwith cytology and microscopy, of helping to solve some ofthe most difficult problems of cervical pathology. Theauthors have had an extensive experience of colposcopy-nearly 20,000 cases, including fetal and prepubertal females,virgin and promiscuous adolescents, and women in preg-

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nancy and in the reproductive years and after the meno-pause. Over the past few years they have written manyauthoritative articles on colposcopy, and their views carryconsiderable weight. The case for colposcopy is stronglyargued, and the criticisms commonly levelled against thetechnique-that it is too complex and expensive; that theinstrument cannot see into the cervical canal; that col-poscopy is concerned with superficial appearances anddoes not give information on deeper tissues; and that thetechnique adds nothing to what is gleaned from cytologyand tissue biopsy-are carefully examined and refuted. Forthe most part the arguments are convincing, but inevitably,in some cases, the earliest cellular changes indicative ofmalignancy occur deep in the cervix either in the glandularelement (adenocarcinoma) or in squamous epitheliumwhich has burrowed deeply down into the cervical glands,and it is difficult to imagine how these changes can be spottedby colposcopy. But this is a minor criticism of a generallywell-argued case. From their own experience in the

King George V Ho3pital, Sydney, the authors confirmreports from the clinics of E. Navratil and H. Limburg thatcolposcopy and exfoliative cytology, used singly, have anaccuracy of some 92% in the diagnosis of preclinicalcervical cancer, but when combined the accuracy is raised to98%. The technique is well described and beautifullyillustrated, and the literature is extensively reviewed. Thisbook may well stimulate a number of British gynaecologiststo review their attitude to colposcopy.

The Manufacture of MadnessA Comparative Study of the Inquisition and the MentalHealth Movement. THOMAS S. SzASZ, M.D. London:Routledge & Kegan Paul. 1971. Pp. 383. E3.50.

IN this book Dr. Szasz pursues the theme of The Mythof Mental Illness by tracing the role of the " disturbed "or " mentally sick " individual and the functions whichthe construct of " madness " serves in society as a channelfor acting-out by the " sane "-including physicians andpsychiatrists. His analogy to the social uses of the idea ofwitchcraft is acute, though he does not discuss how far theexperiences now described by psychiatrists as schizo-

phrenic have served a constructive function which may havepreserved their biological bases: the shaman has been an

important constructive force in human evolution, and it

may well be his successors whom we now confine as

insane. The record of interlocking superstition and theabuse of well-intentioned psychiatry to express aggressionand the abnormalities of the sane is a chastening one-thepolitical abuse of " madness " as a label for unconven-tionality or dissent has lately been still further revealedin the certification of Soviet dissidents. What is, however,consistently lacking from Dr. Szasz’s argument is an

evaluation of the phenomena on which the superstructure ofprejudice and fear has been erected. As the phenomena ofwitchcraft depended not only on society’s attitudes but onobjective causes such as ergotism and spontaneous delu-sions, objective psychosis remains to be explained, whetherits causes are genetic, experiential, biochemical, or all three.It seems to be true that the " schizophrenic " is for somereason in a different posture to cope with external eventsfrom the unlabelled citizen-the depressed or manic

subject likewise. Society in its ignorance or cruelty canmake " mad " people " madder ", and determine andexacerbate the underlying disability, but few intelligentconvalescents from a schizophrenic or a depressive illnesswould regard the experience as either illusory or whollyproduced by the expectation of others. A fuller under-

standing of cerebral biochemistry could very well makemany of these arguments obsolete, though it would notweaken the thrust of Dr. Szasz’s denunciation of the way

society has reacted to unusual mental states. In borderlinecases-" psychopaths ", the anomic old, the compulsivevagrant-administrative convenience and plain inhumanitystill act to justify a great deal he has written.

General Anaesthesia

Vol. I, Basic Sciences; vol. II, Clinical Practice. 3rd ed,Edited by T. CECIL GRAY, M.D., F.R.C.S., F.F.A. R.C.S.,dean of the faculty of medicine, and professor of anxs-thesia, University of Liverpool; and J. F. NUNN, M.D.,PH.D., F.F.A. R.c.s., director of anxsthesia, Clinical ResearchCentre, Northwick Park Hospital, Harrow, Middlesex.London: Butterworths. 1971. Vol. i, pp. 736, E16; vol. n,pp. 773, E16.

Professor Gray and Dr. Nunn have enlisted the help of42 contributors to provide an up-to-date account of theprinciples of modern anaesthesia. These collections of

monographs will disappoint the student who is looking forgeneral guidance in his studies. The price is prohibitive.A serious criticism of vol. i is that some chapters (e.g., thoseon mechanical ventilation, cerebral circulation, and pharma-cokinetics) appear basically unchanged in Scientific Founda-tions of Anesthesia also published this year (see Lancet,1971, i, 786). That book also has a long list of authors, butis better produced and costs less than half the price ofvol. i of General Ancesthesia to which it corresponds.Vol. 11 is a well-balanced discussion of clinical practice,which is not confined to the operating-theatre: it seems tobe one of the best general accounts available and is recom-mended to both experienced and aspiring anaesthetists.Each volume is independent of the other and can bepurchased separately.

Atlas of Human Histology and UltrastructureJ. L. MATTHEWS, PH.D., professor and chairman, depart-ment of anatomy, Baylor University; and J. H. MARTIN,PH.D., departments of anatomy and pathology, BaylorUniversity Medical Center, Dallas, Texas. Philadelphia:Lea and Febiger. London: Henry Kimpton. 1971. Pp. 382.$12.50; E5.60.

THIS book contains 150 plates composed of photomicro-graphs and electron micrographs of sections of humantissues. Each plate occupies a full page, with descriptivetext facing it. Most plates contain three or four figures,usually a combination of black-and-white photomicro-graphs of a stained paraffin section and a stained plastic-embedded section, together with an electron-micrographof the same tissue. Thus the transition from histology toultrastructure is made easier. The quality of the photo-graphs is uniformly high, and is matched by the quality ofthe sections. The legends to each plate are brief, butsufficient. All the main tissues and organs of the humanbody are represented. A general account of the cell precedesillustrations of the basic tissues-epithelium, connectivetissue (including blood and haemopoiesis), muscle, andnervous tissue. These are followed by sections on thecirculatory and lymphoid systems, endocrines, the repro-ductive systems, digestive tract, respiratory and urinarysystems, special senses, skin, and teeth. Finally, a list ofselected references is provided. Criticisms are minor.The letters used to label the figures are sometimes in-conspicuous ; and there are no illustrations of the fine struc-ture of the posterior lobe of the pituitary, of a dorsal-rootganglion, or of the conducting system of the heart. The

price is reasonable for an atlas of this size and quality.The combination of histology and ultrastructure is sensibleand useful, and the book is recommended to students andestablished workers in anatomy, physiology, and pathology.