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Reviews of Books

Medical History of the Second World WarThe Royal Air Force Medical Services. Vol. 1 : Administra-tion. Editor : Squadron-Leader S. C. REXFORD-WELCH,M.A., M.R.c.s. H.M. Stationery Office. 1954. Pp. 611.70s.

THE exact date of the birth of the Medical Branch ofthe R.A.F. seems uncertain, but its growth can hardlybe said to have begun until after the end of the firstworld war, and it faced its first big test in 1939 unen-cumbered by too much experience. To this absence ofrigidity can be ascribed the successful development ofactivities which had not been foreseen. Rehabilitationunits and special departments for treating burns andfacial injuries are examples of clinical work, fostered bya sympathetic administration to meet an immediatewar-time need, which later diffused through the wholeof medical practice. Planning for the unknown is dis-appointing work, only made tolerable if a good deal ofvariation is allowed for. It is in a way symbolic thatof the general hospitals constructed by the R.A.F. earlyin the war, the hutted buildings were found to be moreeasily altered to meet changing needs.Among the specified aims of this history is the definition

of mistakes in the light of after-knowledge, and Squadron-Leader Rexford-Welch has recorded faithfully both successand failure. His difficulty in selecting material musthave been great, and the interest of the sections have avarying appeal. The struggles and difficulties of organisingthe air transport service for the sick and injured arewell described ; and the description should be widelyread, for there was much criticism at the time. Thestory of the final achievement during the invasion ofFrance is dramatically exciting. Another chapter ofgeneral importance is that on medical man-power. Thefighting Services are usually held to be greedy in theirdemands for doctors : here are set down the argumentsand increases for all to see.Much of the volume, though of domestic interest to

those who served in the R.A.F., carries no wider lessons.Something shorter than three volumes at 70s. each wouldprobably be more welcome to outsiders.

The Casualty DepartmentT. G. LOWDEN, M.A., B.M., F.R.c.s., consultant surgeon,Sunderland Royal Infirmary. Edinburgh and London :E. & S. Livingstone. 1955. Pp. 278. 37s. 6d.

THE casualty department is the shop window of a busygeneral hospital, yet it is sometimes neglected by thesenior members of the staff. Mr. Lowden sets the workof the casualty department in proper perspective. Hisbook will be of value to everyone, from house-officerto consultant, who has anything to do with surgery ;-and it should be read by the medical student in hisfinal year. He combines good sense with clear expositionand excellent illustrations, and he deals with conditionsthat are common and of economic importance.

Mr. Lowden sees the problem of casualty work in thesetting of our times. He does not merely repeat descrip-tions of septic conditions and injury, and their treatment;he guides the reader in the inanagement of the case andthe situation. The patient’s financial and temperamentalbackground occupies one chapter, sound advice on legalresponsibilities another, and legal protection the next; inAnother the implications of industrial injury and disable-ment benefit are considered. His appendices show thevalue of simple investigations conducted despite thehurly-burly of such a department. This is a valuable book.

The Graphomotor Projection TechniqueClinical Use and Standardisation. SAMUEL B. KUTASH,PH.D., chief, clinical psychology section, Veterans Admini-stration Hospital, East Organge, New Jersey ; RAYMONDH. GEHL, M.D., psychiatric consultant, Newark regionaloffice, mental hygiene clinic, Veterans Administration.Springfield, Ill. : Charles C. Thomas. Oxford : BlackwellScientific Publications. 1954. Pp. 133. 27s. 6d.

FOR assessing personality, drawings have the advantagethat they provide permanent records of self-expression.

The difficulty is to know what they represent, and tocompare them one with another. Some people thinkthey have only to look at a drawing to interpret it

correctly ; but the authors of this book hold that skillin classifying records can be developed only throughpractice and experience under the supervision of an" indoctrinated and trained " examiner.

The subject has no model to follow. He is blindfolded

during the entire graphomotor performance, and the " funda-mental rule " is to ask him to move his pencil freely over thepaper provided, and " to try not to make anything definite."The aim is to elicit free expression from inner promptings,and to note the character of such movements. Each subjectis later asked what he was thinking about while he was drawing,and, finally, whether he is able to recognise parts of what hedrew. The authors claim that this association part of theirtest is unique, being " loaded " by the subject himself, inthe sense that he creates the material out of which contentis first delineated, and then used as the stimulus for association.

Normative data consist of " 200 well-substantiatedschizophrenic patients " and a control group of " 200apparently normal persons." Since only these two groupsare compared, the test’s practical value cannot be assessed,however much we may admire its theoretical principles.

Analgesic obstetricale .

B. JAMAIN, gynecologue-accoucheur de 1’Hopital Tenon;R. GIRAUD, assistant en obstetrique des Hopitaux deParis. Paris : Masson. 1954. Pp. 156. Fr. 900.

THIS is a fairly comprehensive work on the clinicalaspects of obstetrical analgesia Pain in labour, itsmechanism, and the practical in’plications of analgesiain terms of foetal physiology are discussed ; but thegreater part of the text consists of descriptions of thedrugs and techniques for relieving pain.

Perfect analgesia in childbirth is still an elusive ideal;and Dr. Jamain and Dr. Giraud rightly emphasise theneed for clinicians to keep an open mind and select themethod suited to the particular patient and obstetricalproblem. Their own views are similar to those widely heldin this country, and they show a preference for generalrather than local methods of analgesia.

Hospital Planning RequirementsGY ALDIS, 1.R.LB.A. London : Pitman. 1954. Pp.257.858.

Mr. Aldis is the architect to the East Anglian RegionalHospital Board, and his book is primarily for architects;but it will also be useful to the many doctors who arelikely to be concerned with hospital reconstruction inthe coming years.He does not attempt to impose a standard design for

future hospitals, but he sets out the basic needs forindividual departments, and indicates the importance ofcorrect lines of traffic and the needs of patients as

well as of medical and nursing staff. In short detailednotes supplemented by over 400 diagrams he covers

the clinical service of a hospital-the casualty depart-ment,’ outpatient department, different ward units,operating-theatre, X-ray department, pathology depart-meTM.. and mortuary block. In a later book he hopesto deal with the administrative and service departments.

Diseases of the Skin (4th ed. Philadelphia and London:W. B. Saunders. 1954. Pp. 877. 65s.).-Dr. G. C. Andrewshas brought the new edition of his popular textbook right upto the minute and has at the same time reduced the totalnumber of pages by 60-good evidence that out-of-date matterhas been ruthlessly cut. Though this is a book for specialists,it is not unsuited to the practitioners and students, beinglucidly written and telling the reader in fair detail what todo by way of treatment. Possibly the dangers of treatingtuberculosis of the skin with vitamin D are over-emphasised.The chapter on syphilis has rightly been retained ; but Dr.Andrews seems to pin all his faith on penicillin, and statesthat " supplementary treatment with arsenic and bismuthdoes not increase the good results and is of no value." Thisdoes not conform with current British ideas or practice.Nevertheless, this is a good book, well presented, with plentyof good illustrations and adequate references.