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Reviews of Books

Recent Advances in Clinical Pathology2nd ed. Editor : S. C. DYKE, D.M., F.R.c.p. London :J. & A. Churchill. 1951. Pp. 575. 40s.

THE second edition of this valuable work appearsafter only four years. Yet so great have been theadvances in laboratory medicine that the book has hadto be entirely recast. Occasional chapters have beenrewritten but most are new, so that it would be morecorrect and perhaps fairer to call this volume the secondof a series rather than a second edition. The editors,in fact, point out that it is meant to supplement thefirst edition and " what at first sight seems to be a rathercurt dismissal of the work of the previous authors isactually a tribute to its quality, because the contribu-tions made by them in 1947 are still, for practicalpurposes, valid to-day." The 30 contributors are

acknowledged authorities ; their essays are full ofup-to-date information ; and we can be sure of seeingthis edition, like its predessor, on the " practical " book-shelf of pathological laboratories throughout the world.

Treasury of Human InheritanceEditor : L. S. PENROosE, M.D. Vol. 5. On HereditaryDigital Anomalies. Part I. On Brachydactyly and

Symphalangism. JLU,IA BELL, M.A., F.R.C.P. London :

Cambridge University Press. 1951. Pp. 31. 12s. 6d.

MINOR malformations of the hands and feet earlyattracted the notice of geneticists. They are easilystudied by naked-eye and X-ray examination. Theyhave little effect on fitness, so that where dominantgenes are responsible some impressive pedigrees havebeen collected with affected members in six or more

generations. Dr. Julia Bell’s account of these mal-formations follows the traditional pattern of the Treasury.She gives a detailed account of all the published families,together with an analysis of the variations that occurin the form of the malformations within the same familyand between different families. The anomalies fallinto about seven main groups, and within the samefamily the affected members usually all belong to thesame group. All the pedigrees suggest dominantinheritance ; in some of the groups it is probable thatall those carrying the gene are affected, but in othersoccasional skips occur.A genetic studv based on recorded families has its

limitations. It tells us nothing about the frequencyof the condition nor the proportion of instances in whichthe anomaly occurs in only one member of a familywith no suggestion of genetic determination. Butwithin these limitations the monograph could hardlybe bettered.

Adrenal CortexTransactions of the Second Conference, Nov. 16, 1950,New York. Editor : ELAINE P. RALLI. New York :Josiah Macy Jr. Foundation. 1951. Pp. 209.$3.

Proceedings of the Second Clinical A.C.T.H. ConferenceEditor : J. R. MoTE, M.D. London : J. & A. Churchill.1951. Vol T ; pp. 531. Vol 11 ; pp. 716. 60s. each.

BOTH these books are verbatim reports of what hasbeen said by experts in conference. It is a pity that,as reports from the front line of medical research, theyhave taken so long in transit.The smaller book deals mainly with the theoretical

background of adrenal chemistry and physiology.There are five main topics : the chemistry of A.C.T.H.

(led by H. Li) ; the regulation of pituitary adrenocortico-tropic activity (led by G. Sayers) ; the relation of the adrenalcortical hormones to the hypersensitive state (led by T. F.Dougherty) ; hyaluronidase and the adrenal cortical hormones(led by J. Opsahl) ; and further clinical studies with A.C.T.H.and adrenal cortical hormones (led by G. W. Thorn).The text is presented rather like the script of a play,making it easy to picture the speakers at the conference.Hobby-horses are ridden across these pages, and arestalked by the other experts. The reader can conjureup a vivid impression of the scene when Li has, by meansof a patient, learned, and logical exposition, built upa theory of the chemistry of " small molecular " A.C.T.H.,

only to have it rudely upset by Astwood’s pronounce-ment that the starting material Li had used was probablyat least 99 % impure. Opsahl’s review of the ratherconfusing relation between hyaluronidase and theadrenal cortex, and Sayer’s exposition of the physio-logical mechanisms governing corticotropin releaseand allied questions are to be particularly commended.However, the book is by no means confined to the topicslisted, for the discussions roamed over many relatedsubjects. Many small errors are probably due to hastyediting and proof-reading.The two large volumes which contain the proceedings

of the Second Clinical A.C.T.H. Conference testify to theenormous amount of research that has gone on sincetherapeutic adrenal stixnulation for diseases other thanthose of the pituitary became possible on a large scale.A year ago, at the first conference, it seemed that mostaspects of A.C.T.H. therapy had been touched on. Nowwe see specialties appearing within specialties, andin addition interesting newcomers take the stage-such as " Black Widow spider bite," " North Americanblastomycosis," and " liunner ulcer." The two volumesare subtitled, rather hopefully, " Research " and " Thera-peutics." But allocation of subjects is often unpredict-able. He who seeks information on the effect of A.C.T.H.on liver disease, for example, must not be dismayedif he cannot find this under " Infectious Disease andLiver Disease " ; he has only to turn to " Adrenal Glandand Hemopoietic System " to find three papers on hissubject. But this is a minor failing in a book of greatvalue to all those who seek to keep up with the greattide of research that the mass-production of adrenalcortical hormones has liberated.Much of the research into the therapeutic uses of

A.C.T.H. has outstripped knowledge of its pharmacology,and particularly of the factors which influence the

response of the patient ; for it is clear that, on theone hand, batches of A.C.T.H.. identical on animal assay,may provoke different degrees of response in man;while, on the other hand, the same patient’s responseto repeated doses of the same batch of hormone willitself vary from week to week. These limitations makesome of the quantitative studies of qualitative value only.

Fractures and Joint InjuriesVol. 1. 4th ed. Sir REGINALD WATSON-JONES, M.CH.

ORTH. LPOOL, F.R.C.S. Edinburgh : E. & S. Livingstone.1952. Pp. 443. jE6 (with Vol II, when published).

EVIDENTLY it is possible to gild the lily. In this newedition, appearing nine years after the last, the texthas been extensively rewritten and many fresh illustra-tions have been added. New material, dealing withwound shock, the adaptation syndrome, chemotherapy,bone-grafting, and Iriedullary nailing, almost doublesthe space allotted in the first edition to the - generalprinciples of fracture treatment. The section on patho-logical fractures gives an exhaustive review of local andsystemic disease of the skeleton. If the slightly polemicalflavour of this edition and its increasing emphasis ona personal view makes it rather less valuable as a guidefor the newly qualified, it is more valuable than ever tothe young orthopaedic surgeon who is forming his ownopinions. Thus the chapter on the reaction of bone tometal is a vigorous attack on the accepted view thatcontact-compression is an important and desirablefactor in promoting union. The sections on openfractures, joint wounds, and bone-grafting are magnificentand magnificently illustrated with colour photographs,though it is a pity that Phemister’s method of simpleonlay grafting without disturbance of the fracture sitefor non-union of the tibia is not specifically mentioned.Volume 11, on the management of individual fractures,is to appear later in the year.

Anemias (Madrid : Manuales Ibys. 1950. Pp. 393.).-This is interesting as an example of a Spanish textbook.It describes the ansemias very thoroughly. Sometimes thesyndromes are split into more subdivisions than are customavin this country, but the teaching is sound and conforms withAnglo-American views. The notably representative biblio-graphy shows that Dr. Valentine de la Loma is well acquaintedwith modern English, American, and European work. The12 colour plates, however, are poor.