BOOK REVIEWS

Practical Clinical Biochemistry. By HAROLD VARLEY, M.Sc., F.I~.I.C. Third Edition. Published by William Heinemann, Medical Books Ltd., London, and Interscienee Books, Inc., New York. Price 50 shillings. l~ow in its third edition (the second appeared four years ago) Varley's book maintains

its very high standard as an extremely complete and competent handbook on bio- chemical procedures as applied to clinical laboratory investigations and determinations. An extraordinary amount of information is packed into the book's 652 pages and after each of its 29 chapters there appears a useful list of references.

Apart from full descriptions of all routine tests, many others are at a much more advanced level to meet the requirements of research workers and those working in the larger clinical laboratories where a wide range of equipment is available.

Broadly speaking, each chapter is arranged along the following lines : (1) An introduction concerning the nature of the biochemical substance to be

investigated or determined. (2) A choice of methods which may be used in carrying out such determinations,

in which full details concerning reagents, technique and calculations axe given. (3) An interpretation of results obtained. Much new material has been incorporated into this edition. For example, in the

chapter on hormones (already rewritten in the 2nd edition) methods are now described for determining the methylated derivatives of adrenaline and noradrenaline and also a technique for estimating urinary pregnanetriol.

The chapter on acid-base balance has been rewritten and brought up to date by including the Astrup techniques and the methods of Campbell and Howell.

An entirely new chapter on enzymes has been added and as the author says in his preface, this is a chapter which is likely to grow considerably in future. I t deals with the determination of those enzymes which show marked fluctuations in the serum in certain clinical conditions usually associated with tissue t rauma or disease. Tests for serum trsnsaminases, lactic dehydrogenase, aldolase, and pseudocholinesterase are all fully described.

The printing, paper and binding are all good and the book is of convenient size. I t is indeed a publication to be highly recommended and all clinical laboratory workers should have a " Vaxley " handy. I do not think it is likely to let them down.

T. BRADSHAW.

The Collected Papers in Medicine from The Mayo Clinic. Volume 53. 1961-1962. This Collection of Papers ranges over the whole field of internal medicine, so that it

is almost impossible for one person to review it adequately. Some of the Papers are full length ; others are abstracts and at the end of each

division there is a list of Papers published without having abstracts printed. The book is beautifully produced, well indexed and as far as I could find, entirely

lacking in misprints. The only thing lacking was a bibliography attached to the individual Papers.

There are two interesting Papers on infections of the urinary tract and one on the association of Cushings' Syndrome and neoplastic disease ; an excellent long Paper on primary hyperpaxathyroidism ; that most controversial subject, long-term anti- coagulant therapy, gets a most useful annotation, though the Paper was published before the present tendency to abandon this form of treatment.

There is a long section on the diseases of the heaxb--21 Papers- -as well as a long llst of references.

This volume, of course, like its predecessors, is an essential one for any medical library. BREI~D AI~ O 'BRIEI~.

The Management of Impaired Fertility. By MARGARET MOORE WItlTE and V. B. GREE~-ARMYTAGE. pp. 320. (4 eoloured plates and 184 half-tone). 63/-. London. Oxford University Press. 1962. This is an excellent book. The emerging science of fertility investigation has long

needed an authoritative book on treatment and management. This book by Margaret Moore V]hite and the late V. B. Green-Armytago is the answer to the problem. The causes, investigation and t reatment of sub-fertility are presented as simply and as completely as possible.

Par t 1 d-als with the development, anatomy and function of the reproductive system, Part 2 deals with the causes of sterility or impaired fertility, Par t 3, with investigation of impaired fertility and part 4, with medical and surgical t reatment of impaired fertility including a magnificent chapter on tubal implantation. Five appendices deal with a scheme for the investigation of impaired fertility, method of extraction of pregnanediol, a cornification index, instructions for taking measurements for Loewenstein's coitus training apparatus, and instructions to patients for the collection of semen. This book is didactic, objective, comprehensive, scientific and practical, is delightful to read and

145

146 IRIStI JOURNAL OF MEDICAL SCIENCE

can be fu l ly r e c o m m e n d e d as t he ideal book for those who f ind t h e m s e l v e s compe l l ed to k n o w s o m e t h i n g a b o u t t he t r e a t m e n t of sub- fe r t i l i ty a n d pa r t i cu l a r ly for t hose who are des i rous o f specia l i s ing in t h e m a n a g e m e n t of i mpa i r ed fer t i l i ty .

RAYMOND G. CROSS.

Gray's Anatomy: Descriptive and Applied. 33rd ed i t ion . Eds . I:). V. DAVIES a n d F. DAVIES. L o n g m a n s , Green & Co. L td . 150/-.

R e v i e w e r s o f Gray ' s A n a t o m y m u s t long ago h a v e e x h a u s t e d the i r ab i l i t y to m a k e o r ig ina l c o m m e n t on i ts mer i t s . T he m o s t cr i t ical rev iewer m u s t acknowledge t h e m - - a c lear a c c u r a t e desc r ip t ive t e x t a n d generous i l l u s t r a t ions whose qua l i t y in th i s 33rd ed i t i on is, i f possible, h i g h e r t h a n in earl ier ed i t ions . B u t in c r i t i c i sm i t m u s t be sa id t h a t i t s e e m s to c o m b i n e t h e defec t s o f a t e x t w i t h t oo m a n y de ta i l s for t h e s t u d e n t ' s s t u d y o f a n a t o m y a n d w i t h too few de ta i l s for t he p o s t g r a d u a t e who consu l t s i t for reference, or as a guide; i t c a n n o t be c o m p a r e d to t he large G e r m a n a n d F r e n c h re fe rence v o l u m e s on n o r m a l a n a t o m y . P e r h a p s i f it, were sho r t e r a n d m o r e f u n c t i o n a l in a p p r o a c h it w o u l d be m o r e su i t ab le for t h e m o d e r n s t uden t . T he p r e s e n t ed i t i on h a s been r ev i s ed a n d t h e to t a l n u m b e r of f igures r educed ; howeve r s o m e 70 o f t h e i l l u s t r a t i ons are new. The i r qua l i t y a n d t he f r e e d o m f rom error in b o t h t e x t a n d f igures are t r i bu t e s to t h e care a n d skil l o f t he p r e sen t ed i tors .

C. A. ERSKINE.

Histopathology. B y ROBERTSON F. OGILVIE. E d i n b u r g h : L iv ings tone . s 15s. T h e t e a c h i n g of n o r m a l a n d pa tho log ica l h i s t o l o g y m a k e s h e a v y d e m a n d s on t h e

t u t o r i a l s y s t e m . I f eve ry s t u d e n t could have h i s own i n s t r u c t o r t he s i t u a t i o n wou ld be ideal , b u t in m o s t t e a c h i n g d e p a r t m e n t s he f inds h i m s e l f a m e m b e r o f a s izeable g roup d e p e n d e n t on a b r ie f l e c tu re - - -demons t r a t i on , occas iona l a s s i s t ance f rom a pe r i pa t e t i c d e m o n s t r a t o r a n d h i s own necessa r i ly l i m i t ed resources . H e du t i fu l l y scans h i s ha l f -dozen sec t ions a t each sess ion of prac t ica l work a n d s o m e t i m e s mis ses m u c h of w h a t he m i g h t h a v e learned. T h e s t u d e n t who wishes to b e c o m e c o m p e t e n t m u s t supple - m e n t h i s c lass work, a n d in t h i s he wil l f ind Dr. Ogi lv ie ' s b o o k a n i n f o r m a t i v e c o m p a n i o n . Here is a col lec t ion of 400 r ep re sen t a t i ve sec t ions cover ing t h e m a i n topics in genera l a n d reg iona l pa tho logy s u p e r b l y p h o t o g r a p h e d a n d r ep roduced in eolour.

T h e b o o k is a long e s t ab l i shed f avou r i t e w h i c h sca rce ly needs t he a t t e n t i o n o f rev iewers excep t pe rhaps to s igna l t h e appea rance o f a n e w edi t ion . The p r e sen t s i x t h ed i t i on r ep resen t s t he e i g h t h p r i n t i n g s ince 1940. A n y o n e whose exper ience ha s s h o w n h i m t h e cos t o f i l l u s t r a t i ng even a v e r y m o d e s t pape r w i t h good qua l i t y p i c tu re s in co lour wil l apprec ia te t h a t a b o o k w h i c h e m p l o y s 400 eo lour blocks of t he h i g h e s t q u a l i t y a n d wh ich can be b o u g h t for seven ty - f ive sh i l l ings m u s t a l r eady be s o m e t h i n g o f a n i n s t i t u t i on . The new ed i t i on will enhance a n e s t ab l i shed r epu ta t ion .

W h i l e t he book is i n t e n d e d for use as a guide to prac t ica l h i s topa tho logy , t he t e x t offers m u c h more t h a n a ba ld desc r ip t ion o f t h e se lec ted sec t ions . The b a c k g r o u n d is a d e q u a t e l y drawn. There are p e r h a p s occas ional i nd i ca t i ons o f u n e v e n revis ion. F e w people will n o w accept t h a t c a r c i n o m a of t he ce rv ix a c c o u n t s for 90 per cent . o f u t e r i n e c a r c i n o m a seen in E u r o p e a n p rac t i ce a n d t he a n n o t a t i o n on e ry th ropo ie s i s m i g h t p e r h a p s now be rewri t ten . On page 299 sept ic ab so rp t i on is m e n t i o n e d in t he course o f a dis- cu s s ion o f rena l t u b u l a r necros i s where t he c o n t e x t sugges t s t h a t sept ic a b o r t i o n was i n t e n d e d b y t he au tho r .

The p ic tu res are superb . T h e i r q u a l i t y is a t r i bu t e to t h e a u t h o r ' s se lec t ion of mate r i a l , to t he t e chn i c i ans respons ib le for t he sec t ions a n d to t he s u p r e m e skil l of Mr. T. C. :[:)odds in t h e t e c h n i q u e of p h o t o m i c r o g r a p h y in colour. R e a d e r s who are fami l ia r w i th ear l ier ed i t ions will apprec ia te t h e f a s h i o n in wh i ch a c r a f t s m a n of Mr. ]:)odds' cal ibre h a s been able to exp lo i t t he m a n y a d v a n c e s in a p p a r a t u s a n d sens i t ive m a t e r i a l s w h i c h h a v e been m a d e s ince t he book was first pub l i shed . E v e n in such good c o m p a n y t h e PAS p r e p a r a t i o n s i l lus t r a t ing t h e les ion of d iabe t i c g l o m e r u l o p a t h y (page 308) s eem to call for special c o m m e n t . To a n expe r t in colour p h o t o m i c r o g r a p h y t he p ic tor ia l resu l t s ach ieved w i t h t r i c h r o m e s t a i n s are pe rpe t ua l l y a cha l lenge a n d a t e m p t a t i o n . T h e a u t h o r a n d Mr. ]:)odds, consc ious of t he fac t t h a t n e a r l y all t h e s l ides i s sued in t h e course o f u n d e r g r a d u a t e t e a c h i n g will be h a e m a t o x y l i n a n d eos in p repa ra t ions , h a v e e m p l o y e d o the r s t a in s on l y whe re t h e y are essen t ia l to t h e d e m o n s t r a t i o n of t he les ion a n d t h e m e t h o d s u sed are t h o s e w h i c h are l ike ly to be r ep re sen t ed in t he s t u d e n t ' s own col lect ion. A l t h o u g h t h e i l lus t r a to r m u s t feel t h a t t h e r eade r is p e r m i t t e d on ly a n occas iona l g l impse of h is real capabi l i t i es , t he po l i cy referred to is one of t he real m e r i t s of t h e book. The e m p h a s i s in t h i s r ev iew has been la id on t h e va lue of Dr . Ogi lv ie ' s book to t he u n d e r g r a d u a t e s t u d e n t o f pa tho logy , b u t p o s t g r a d u a t e work l ead ing to h ighe r qual i f ica t ions in t h e c l inical sc iences u sua l l y m e a n s a r e t u r n to t he mic roscope a n d here t h e book will be equa l ly welcome.

E d i n b u r g h t ake s pr ide in i ts t e a c h i n g t r ad i t i on in m o r b i d h is to logy . The r e p u t a t i o n o f i t s p r i n t i n g houses is n o t less s o u n d l y based. Dr . Ogi lv ie ' s book represen t s a w o r t h y c o m b i n a t i o n o f these d iverse skil ls a n d a t t he pr ice o f seven ty - f ive shi l l ings Messrs . L i v i n g s t o n e are offering a ba rga in . FRANK GEOGHEGAI~.

BOOK REVIEWS 147

Surgery of the Chest. E d i t e d b y J . H . GIBBON, JR., M . D . W . B . Saunde r s Co. s 9s. One o f t h e d i s m a y i n g obs tac les for t he t ra inee in tho rac ic s u r g e r y ha s been t he lack

of a c o m p r e h e n s i v e t e x t - b o o k to p rov ide a base- l ine f rom wh ich to assess the v o l u m i n o u s l i t e r a tu r e p roduced b y t h i s young , b u t r o b u s t a n d l u s t y a d d i t i o n to t h e f ami ly o f special t ies . D ' A b r e u nea r l y a ch i eved t h e imposs ib le in h is " P rac t i ce o f Thorac ic Su rge ry " (Arnold 1953), b u t t he sub jec t was a l r eady too b ig for one m a n to cope w h h a n d t h i s exce l len t book was, l ike a m o d e r n ba t t l e sh ip , obsole te before going in to service.

Here n o w is a t e x t - b o o k w h i c h p a m p e r s t he t ra inee , excep t p e r h a p s in the m a t t e r of cost . Th i r ty - f ive con t r ibu to r s , N o r t h A m e r i c a n w i t h t he no tab le excep t ion o f All isou o f Oxford , h a v e covered t he who le field of thorac ic s u r g e r y w i t h prec is ion a n d c lar i ty . T h e balarme, a v o i d a n c e o f r epe t i t ion , a n d u n i f o r m i t y o f s ty le , are a t r ibu te to the dis- c i p l i n a r y powers of t h e edi tor , Dr . Gibbon . There is no padd ing .

Mos t o f t h e sec t ions inc lude usefu l h is tor ica l , embryo log ica l a n d a n a t o m i c a l notes , a n d conc lude w i th an impress ive b ib l iog raphy . The s ty le is m a i n l y d idac t ic and con- t r o v e r s y is avoided , a l t h o u g h due p lace is g iven to accep ted a l t e rna t i ve procedure . A n o u t s t a n d i n g fea tu re is t he t i m e l i n e s s ; t h e r e is no obv ious r ea son for an i m m e d i a t e n e w edi t ion, a l t h o u g h i t is ce r t a in t h a t f u r t h e r ed i t ions will appear .

N o n - A m e r i c a n s m a y de t ec t a ce r t a in c h a u v i n i s m in t h e t e x t a n d b ib l iog raphy . A n o t a b l e e x a m p l e o f t h i s is t h e credi t accorded to Gerbode o f San F ranc i sco for t h e t r a n s v e n t r i c u l a r ope ra t i on for m i t r a l s tenos ls , one of t he g r ea t a d v a n c e s in cardiac s u r g e r y ir~ r ecen t years . T h i s o p e r a t i o n was first p e r f o r m e d b y L o g a n of E d i n b u r g h , a n d popu la r i zed b y T u b b s o f L o n d o n .

Th i s t e x t - b o o k will be cons idered ind i spensab le by a n y p r ac t i t i one r in t e re s t ed in t ho rac i c su rgery . K . M . SHAW.

Principles of Chest X-ray Diagnosis. GEORGE SIMOn. Second ed i t ion . B u t t e r w o r t h . 50/- I t is h a r d to real ise t h a t t he first ed i t i on of th i s exce l l en t b o o k a p p e a r e d as long as

s ix yea r s ago. Much new m a t e r i a l h a s n o w been a d d e d a n d t h e i l l u s t r a t i ons c lar i fy t h e t e x t in a m o s t s a t i s f ac to ry mamuer . T h e y are all b e a u t i f u l l y r ep roduced . The rev iewer h a s f o u n d i t m o s t useful in e x p l a i n i n g to co l leagues a n d s t u d e n t s t h e o c c a s i o n a l " woo l ly" repor t . Careful r ead ing o f t h e I n t r o d u c t i o n is m o s t r ewa rd ing a n d t he pr inc ip les la id d o w n the r e in set a s t a n d a r d for all Rad io log i s t s . I t is a g a i n s t r ong ly r e c o m m e n d e d to al l s t u d e n t s o f R a d i o l o g y a n d can be r ead w i t h profi t b y all .

I t is b e a u t i f u l l y p r o d u c e d a n d b y m o d e r n s t a n d a r d s t h e pr ice is no t un reasonab le . SYLVESTER J . ]~OL&~D.

Acquired Surgical Lesions of the Oesophagus. B y CLIFFORI) F . STO~EY, M.D. Char les C. T h o m a s , I l l inois . P r ice $19.00.

T h i s v o l u m e in t h e m a i n is w r i t t e n b y Clifford F. Storey, w i t h a chap t e r on cancer o f t h e o e s o p h a g u s b y E u g e n e G. Lafore t , J o h n W. S t r ieder a n d J o s e p h P . L y n c h . The b o o k is well la id ou t in s i x t een chap te r s . T he paper , p r i n t a n d i l l u s t r a t ions are excel lent .

I f t h i s b o o k leads to an inc reas ing awarenes s o f les ions o f t h e oe sophagus wh ich a r e su rg ica l ly correctable , i f it c o n t r i b u t e s to a n earlier, or m o r e accu ra t e d iagnos i s o f oe sophagea l disease, i f it exc i tes i n t e r e s t in t he poss ibi l i t ies o f cu ra t ive defini t ive su rge ry as opposed to conse rva t ive pa l l i a t ive m e t h o d s , i t will h a v e se rved i ts purpose . These ob jec t s h a v e been ve ry la rge ly fulfilled.

Cardiospasm : I n t he c h a p t e r on aeha l a s i a t he theor ies on c a u s a t i o n are in te res t ing , b u t su re ly in v iew of r ecen t l i t e r a tu re t h e y are ou t o f da te . A m o n g t he s igns a n d s y m p t o m s i t s t a t e s w h a t h a s been for yea r s accepted , i.e., " s o m e t i m e s solid food is be t t e r swal lowed t h a n l iqu ids ". T h i s I have no t f o u n d in m y cases. I n t h i s sec t ion t he a u t h o r s t a t e s t ha t , "Frank m a l i g n a n c y p r o b a b l y occurs m u c h m o r e f r e q u e n t l y in p a t i e n t s w i t h a cha l a s i a t h a ~ in t h e genera l p o p u l a t i o n " . T h i s s t a t e m e n t m a y be correct , b u t needs f u r t h e r e luc ida t ion . I t is s t a t ed in t h e t e x t t h a t l eucop lak ia a n d u l ce ra t i on are o f t en found on oesophagoscop ic e x a m i n a t i o n in ca rd iospasm. I h a v e n o t f o u n d such to be t h e case, a t y p e o f oesophag i t i s m a y be seen, b u t n o t u l ce ra t i on or l eueop lak ia .

I n t h e sec t ion on t r e a t m e n t o f a eha l a s i a t he u s u a l p rocedure s are adop ted , b u t t h e fol lowing sec t ion wh ich s t a t e s : " A successful d i l a t a t i on (ac tual pa r t i a l d i s rup t ion ) is i nd i ca t ed b y a sma l l a m o u n t o f b lood on t h e d i s ta l end of t he d i la to r w h e n it is w i t h d r a w n . Th i s p rocedure is n o t w i t h o u t r i sk . " Th i s is t h e second t i m e I h a v e

seen t h i s s t a t e m e n t in p r in t . I do n o t agree w i t h t h e s t a t e m e n t as be ing a n i nd i ca t i on of good t r e a t m e n t . I t m a y be a n i nd i ca t i on o f successful d i l a t a t ion , b u t t he r i sk o f r u p t u r e w h e n b lood is p roduced f rom t h e s t r e t ch i ng is no t jus t i f ied w h e n the re is a n o t h e r m o s t s a t i s f a c t o r y t r e a t m e n t , i.e., He l l e r ' s opera t ion . However , i t is on ly fair to p o i n t ou t t h a t t h e a u t h o r does n o t s eem to f a v o u r d i l a t a t ion . The ope ra t i on a d v o c a t e d for t h i s l es ion is a modi f ied HeIler ' s . T h e modi f i ca t ion is a pas sage o f a B l a k e m o r e - S e n g s t a k e n t u b e b y t h e a n a e s t h e t i s t a n d t h e oesophagea l ba l loon d i l a ted . The gu l le t is d iv ided on t h i s ba l loon a t t he opera t ion , or t h e "gas t r i c c a rd i a " is o p e n e d a n d a f inger is i n se r t ed in to t h e gul le t . These modi f i ca t ions I c a n n o t agree wi th . I t is u n n e c e s s a r y to open t he m u c o u s m e m b r a n e , indeed i t s hou l d be t he a i m of t h e ope ra to r to avo id open ing i t .

148 IRISH JOURNAL OF MEDICAL SCIENCE

The sect ion on divert icula is well documented and carries the usual teaching about these lesions. The lesion is divided into pulsioix and t rac t ion diverticula. Some would no t agree wi th this classification. The reviewer feels tha t the mid-oesophageal di la tat ions are no t t ract ion, bu t puls ion diverticula. Be tha t as it m a y this section of the book is excellent.

I n the section on h ia tus hernia, congenital ly shor t oesophagus is ment ioned and like m o s t surgeons the au t ho r is doubt fu l concerning the occurrence of the enti ty. I1~ the s y m p t o m a t o l o g y he does no t seem to differentiate be tween the " sliding herni'~ " and the para-oesophageal . This sect ion carries the usual descr ipt ion well documented, bu t the au tho r s tates t ha t one of the com m on compl ica t ions of h ia tus hernia is haemorrhage . This has no t been a c o m m o n compla in t in m y cases, unless there is ~ gastr ic ulcer in the hernia ted s tomach.

H i s technique for opera t ion on th is lesion is more or less s tandard, bu t the su tures inser ted f rom the oesophagus to the erus on the thoracic side do no t seem to me to b~. necessary and m a y indeed injure the muscula ture of this s t ructure . I t is also s tated t h a t a radial incision is made in the d iaphragm. This incision, I think, is likely to injur~ the poster ior of the phrenic nerve, therefore, I believe the incision should be made parallel wi th the nerve in the t end inous port ion.

The sect ion on oesophagit is is ins t ruct ive bu t has added very li t t le to the present day kv~owledge of th is lesion. Most would agree wi th the a u tho r t ha t hiatal hernia is the c oIn-E~on cause.

A special section of the book is given over to ulcers of the gullet, main ly wha t the au tho r t e rms " peptic ulcers ". This concept of a peptic ulcer of the gullet is no t agreed to b y mos t authors . A peptic ulcer can arise above the d iaphragm, bu t when it does it occurs in the hernia ted p a r t of the s tomach. The ulcer t ha t occurs as the result of oesophagi t is is superficial and m a y no t indeed have to do wi th hydrochloric acid, it m a y be due to pers is tent regurg i ta t ion of pepsin. Also in th i s section there is a mos t t ime ly reminder of acute ulcerat ion of the oesophagus complicat ing intracranial lesions and cran io tomy.

I n the section on str ictures the classification regarding the cause is mos t complete. b u t no a t t e m p t is made to describe the different types. I believe tha t these she,aid also be classified into oedematous and fibrous str ictures---a mos t impor t an t del ineat ior , as t h e y require different t r ea tment .

There is a section on " spon taneous rup ture of the oesophagus ". This follow~ t l , usual lines, bu t like other au thors he describes predisposing causes which ; u r e a : i t are, I think, the actuM causes of the lesion. I n m y opinion th is t e rm " spon taneou . oesophageal rup tu re " should be removed f rom the nomencla ture of oesophageal lesions

I n the section on acquired benign oesophago-tracheo-bronehial fistula it is state.: t h a t mos t cases are due to mal ignancy. This I believe is accepted by all. This section is mos t l y a resum4 of the l i terature, b u t it is a mos t useful reminder, especially as tbe lesion m a y have a benign cause.

Oesophageal replacement is described and covers f rom the " skin tubes " to " col(at replacement ".

I n the section on " r ings and webs " the reviewer can offer very little cerumen;. The subject ma t t e r is very controvers ia l and the au thor has no t made it any less confused. However , he does speak abou t webs associated wi th P lummer -Vinson Syndrome. This is a compara t ive ly com m on finding and should, I believe, be looked on as a fur ther stage' of the disease.

Benign t umour s are ap t ly described. The au thor s ta tes t ha t these tumours usual ly produce no symptoms . I t h i n k t h a t mos t au thors agree t h a t benign t umour s of the gullet m a y no t cause symptoms . The t r ea tmen t of these t u m o u r s is well described.

The sect ion on oesophageal variees is well wr i t t en and informative. I t gives a clear- cut descr ipt ion of m o d e m t r ea tmen t s of th is lesion.

Very interest ing and informat ive is the ti t le " Displacement and Compressions '" This chap te r has grouped the lesions which compress and displace the gullet. I have n,,t seen these lesions grouped toge ther in any other book.

I n the section on " Cancer " the opening lines are as follows : " To state t ha t the current t he rapy is unsa t i s fac to ry is a plat i tude of m o n u m e n t a l proport ion, t)roml) ' diagnosis is infrequent, ext i rpat ive surgery is all too uncommon , palliative resec~.:ion is formidable, and overall salvage is slim. Notwi ths tand ing these present inadequacies- - or pe rhaps because of t h e m - - t h e managemen t of the pa t i en t wi th th is disease is o n ~ of the mos t challenging tasks in medicine and one of its m o s t unrewarding ". This indeed sums up the problem. However , in the pre-opera t ive t r ea tmen t the au thor does advocate a gas t ros tomy and s ta tes t ha t he does no t find tha t the gas t ros tomy interferes ve ry much wi th the mobi l i sa t ion of the s tomach at the elective operat ion. Many will disagree wi th this.

I n the operat ion for cancer of the lower oesophagus it is s ta ted tha t a r abdomina l incision is no t necessary. This is now accepted by mos t surgeons in this field. I t is interest ing to note t h a t in the operat ive technique, a py lo ro tomy is not performed. I have never performed a pylorotomy.

This book has mos t useful in format ion for those interested in lesions of the gullet and it should find a place in mos t reference libraries. C . K . ]=~YR~ES.