Reviews of Books Lectures J. H.
MEANS, M.D., Jackson professor of clinical medicine emeritus, Harvard University. Cambridge : Harvard
University 1954. Pp.
Press. London : 113. 24s.
FOR 37 years Dr. Means directed the thyroid clinic at the Massachusetts General Hospital with such success that it is generally recognised as the finest of its kind in the world. His notable textbook on the thyroid has passed through two editions, the last being published in 1948. This book of lectures is a postscript to his textbook and represents his most recent views. He surveys the place of the thyroid within the endocrine system, delves into the mysteries which surround its hormone as it passes into the tissues, discusses the clinical management of thyroid patients, speculates on the causes of Graves’s disease, and describes the findings of the recent expedition his hospital sent to investigate endemic goitre in the Argentine. Hence the group of five lectures represents an authoritative statement of the present position in thyroid research. Being in lecture form, the book is sometimes rather diffuse ; but the reader is helped along by the easy, almost conversational, style we have come to associate with Dr. Means. Practical Obstetrics 2nd ed. BRUCE T. MAYES, M.B. Sydney, r.R.c.s.E., professor of obstetrics, University of Sydney. Sydney 1954. and London: Angus & Robertson. Pp. 497. 878. 6d.
Prof. Bruce Mayes, as the Sims-Black professor of the Royal College of Obstetricians and Gynaecologists, has recently made a lecture tour of the British Isles, when many of his colleagues in this country were charmed by his sincerity and devotion to obstetrics, and many students were delighted by his teaching. All will read his latest book with interest even though some will disagree with his opinions. It is based on a series of bulletins in obstetrics that Professor Mayes wrote for doctors in the Services in 1939-46. It is apparently addressed to those practitioners in Australia, and perhaps elsewhere, who may find themselves having to do midwifery without recent training or much experience, or seemingly much surgical knowledge ; for very full details are sometimes given, even to the extent of how the rectus sheath and the peritoneum should be opened in caesarean section. Much of the teaching will be acceptable, but some may not. For babies born of diabetic mothers the use of an oxygen tent with " continuous oxygen " is recommended despite the relation between retrolental fibroplasia and oxygen administration.Pituitrin’ in 1 ml. (presumably 10-unit) doses is advocated without reservation, both to prevent and treat postpartum haemorrhage. But what of pituitary shock ? The first case described in the chapter on postpartum heemor-
may illustrate this condition, though no mention is of it. Three preparations containing respectively ergotamine tartrate, ergometrine, and ergotoxine, tyramine, and ergamine are all given equal weights as oxytocics-a view which is difficult to reconcile with the oxytocic properties of the ergot alkaloids, so fully worked out about twenty years ago. Treatment of brow presentation is said to be cæsarean section, without mention of any alternative : this, too, is contrary to published experience. Ingerslev,l for instance, states that though caesarean section may often be necessary some 40% of these cases can be delivered spontaneously without difficulty, while others allow of easy forceps delivery after correction to face or vertex presentation.
It is easy to see how popular Professor Mayes’s war-time bulletins must have been : there is a refreshing sincerity and homeliness about his style. But it is doubtful if this book will have as much appeal, except to isolated pra,ctitioners overseas. Those practising obstetrics in Britain will find much wisdom in its pages ; but it will be less useful to them because the conditions of obstetric practice in this country are so different. 1. Ingerslev, M.
Acta obstet. gynec. scand. 1951, 30, 278.
Malnutrition in African Mothers, Infants and Young Children Report of the Second Inter-African (C.C.T.A.) Conference on Nutrition, H.M. Stationery Office. Gambia 1952. 1954. Pp. 398. 25s.
THE conference held in 1952 at the Medical Research Council’s field research laboratory, Fajara, Gambia, under the presidency of Prof. B. S. Platt, was attended by over fifty people, representing nearly all African countries. The meeting contributed much to our understanding of the importance of nutrition in the welfare of African mothers and children. This verbatim report of the proceedings describes the epidemiology, clinical features, morbid anatomy, biochemistry, dietetics, and public aspects of the subject. It is certainly the most comprehensive record of kwashiorkor at present available. During the eighteen months between the conference and the appearance of the report, however, all the important new contributions presented by the delegates have been published elsewhere ;-, and the many repetitions and irrelevances (inevitable in a verbatim report) are irksome. Nevertheless, though untidy, the volume will be appreciated for the mass of valuable information it contains.
Patterns of Defeat
The Effective Readjustrraent of the Sick Personality. RICHARD L. JENKINS, M.D., chief of psychiatric research, Psychiatry and Neurology Service, Veterans Administration, Washington, D.C. Philadelphia and London: J. B. Lippincott. 1954. Pp. 270. 55s.
To grow up, live, work, and grow old in fair harmony with kith and kin, friends, society, and self is a hard task. Failure is common, and its causes and course are often sadly familiar to the informed and experienced observer. Causes can sometimes be removed, courses sometimes changed. " Patterns of defeat " is perhaps an acceptable collective term for the diverse troubles of the " sick personality " with which this book deals. Its declared intention is to broaden and humanise the outlook of the narrowly specialised workers in psychiatric clinics. Patterns " named are those of the rejected child, anxious over-control, internal conflict, withdrawal, excessive rivalry, and the paranoid pattern. Other chapter-headings mention room to grow, parenthood, and integration of sex with love and life. The book is more concerned to illustrate accepted classifications and methods of treatment than to propound new ones. Diagrams illustrate the emotional dynamics of various situations ; case-histories, not numerous but detailed and often lengthy, show the evolution of the patterns and sometimes their resolution. The author writes illuminatingly of Western guilt and shame pairing with Eastern " loss of face," and with warmth of the neglected personality problems of age. "
It must strike the British reader that
patterns partake of the universal social scene, the actors in it, their behaviour and outlook, and the therapeutic aid they seek and receive, belong to a Western civilisation quite different from his own. The family doctor who, one would think, should play a part in keeping patients in tune and resolving their discords is conspicuously absent from this stage. The Anatomy of the Bronchial Tree (2nd ed. London: Oxford University Press. 1954. Pp. 243. Russell Brock’s splendid book has been widely accepted as the standard work on the subject, and in this new edition he has largely recast it so as to relate the pathological applications more closely to the anatomy of the bronchopulmonary segments. At the same time the terminology has been modified to conform with the newly introduced international standard nomenclature. The first edition was based on a series of previously published articles, so there was some uuovenness in structure which has now been remedied to make a very clear and authoritative book. The many illustrations are excellent, and it is difficult to irnagino how this complex subject could be presented more