AN IMPROVEMENT TO THE CROSBY PERORAL INTESTINAL BIOPSY CAPSULE

894 Coats’ Disease Prof. ALAN WOODS (Baltimore) said that this condition was a definite entity, which in adults appeared to be associated with hypercholesterolaemia and uveitis. Localisation of Lesions in Visual Pathways Discussing the anatomy of the afferent visual pathways, Mr. K. C. WYBAR stressed the importance of correctly distinguishing the different groups of visual fibres, each of which maintained a constant relative position. He was inclined to ascribe macular " sparing " mainly to the extensive area representing the macula in the occipital cortex. Dr. REGINALD KELLY, discussing lesions around the optic chiasma, stressed the importance of careful visual-field examination, particularly in the central area. The surgical methods of localisation were described by Mr. VALENTINE LoGUE, who showed examples of the value of arteriography and air studies. The resiliency of the brain substance might allow considerable distortion over small expanding neoplasms, often with little change in the visual fields, and a small field defect might be the only sign of a

relatively enormous

tumour.

New Inventions A TROLLEY FOR RADIOTHERAPY TREATMENT couches designed for use with apparatus for deep X-ray therapy have become complex, heavy, and expensive. As the majority of small telecurie and deep X-ray machines are provided with very manoeuvrable heads, the need for adjustable couches is reduced. In this department we have, therefore, designed a simple unit which is easily moved, yet has complete four-wheel braking, and to which minor longitudinal adjustments can be made after the brakes have been applied. It has been welcomed by all who have used it.

The basic trolley is lightly constructed of tubular steel, and all the other parts are of light alloy. The brakes can be firmly

Endocrine Exophthalmos Lord BRAIN, in a Bowman lecture, said that endocrine in general presented no real difficulty in differentiation from a space-occupying lesion of the orbit. Associated myopathies were found from time to time as part of the general endocrine disturbance, and in thyrotoxic myopathy temporary relief was sometimes to be had from the administration of neostigmine. Exophthalmic ophthalmoplegia was probably related to an abnormal pituitary hormone, which might be in excess only in the early stages; thus treatment aimed at reducing pituitary function should preferably be applied early. Follow-up showed that the prognosis was often good, especially with regard to recovery from ophthalmo-

exophthalmos

plegia. Cyanide Poisoning and Optic Neuritis Dr. J. M. HEATON suggested that tobacco amblyopia was the result of increased intake of cyanide aggravated by a low serum-level of vitamin B12. Parenteral administration of vitamin B12 and increased animal protein in the diet was likely to be the most effective treatment. Chronic

The cost of the complete couch is E125, and the manufacturers, who have been most helpful and cooperative, are Capecraft Ltd., The Cape, Warwick.

Department of Radiotherapy, Coventry and Warwickshire Hospital, Coventry

T. W. BACKHOUSE M.A., M.B. Cantab., D.M.R.T., F.F.R. Consultant Radiotherapist

AN IMPROVEMENT TO THE CROSBY PERORAL INTESTINAL BIOPSY CAPSULE THE Crosby capsule is the most convenient apparatus for routine intestinal biopsy because it is simple, and lengthy radiological screening of the patient is not required. There are certain disadvantages, however, in the existing design, notably the frequency with which the cap is dislodged from the rest of the apparatus. This can happen during the injection of radio-opaque dye used for the localisation of the capsule, but the cap may be dislodged spontaneously. Even if the apparatus is very carefully assembled, the simple friction fit of the cap is often insufficient to withstand the churning movements of the gut. Dislodgement is inconvenient for the patient because the whole procedure must then be repeated; furthermore, the search for the cap in the patient’s fasces is unpleasant. The patient may have to be kept in hospital while the search is made. We know of one case where the cap of the apparatus was retained in the crater of a duodenal ulcer for several months.

and easily applied by foot pressure on a bar at the end of the trolley, and they operate on all four castors. The release handle is readily operated. The table top, which is of aluminium, has a ledge to prevent the rubber-foam mattress from moving. It can be adjusted longitudinally by a coarse-pitch lead-screw handle at the foot of the couch. This movement is very light. A back rest of the rack type is built in I not

at

the head of the couch.

surprised to find that a trolley with these basic points is available elsewhere, because obviously it could have many

am

other

applications.

Fig. 1.

895

the original design, is trapped between the cap A and the body of the capsule D, and it is vented by a hole drilled longitudinally through the screw B. This ensures that the rubber membrane moves freely when suction is applied to the capsule. The firing mechanism, therefore, is the same as in the original design. We have used the modified apparatus 12 times, and the cap has always remained in place and adequate biopsy has been obtained. The new cap now withstands even inexperienced, and therefore often vigorous, injection of the radio-opaque dye. We also think that the modified apparatus consistently obtains a larger piece of jejunal mucosa, thus permitting several Fig. 2.

We have redesigned the cap using the principle of the expanding collet, but the rest of the instrument remains as originally described by Crosby and Kuller.1 Fig. 1 shows the three components of the redesigned cap and a cross-section of it assembled; and fig. 2 compares it with the original cap. The lower part of the cap (A) has a thin wall and is slit axially to give four flexible segments. When the screw B is tightened, the tapered plug C is drawn into the mating part of cap A, expanding the flexible segments radially to grip the inside of the body of the capsule at D. The rubber diaphragm E, as in 1.

Crosby, W. H., Kuller,

H. W. Amer.

J. dig. Dis. 1957, 2,

236.

Reviews of Books Clinical Methods in

Tropical Medicine

BRIAN

MAEGRAITH, M.B., D.PHIL., F.R.C.P.; C. S. LEITHEAD, M.B., Liverpool School of Tropical Medicine, Liverpool. London: Cassell. 1962. Pp. 545. 30s. IN this country, it is usual for the bird sitting on the tree to be a sparrow: in the tropics it may be a sparrow or a canary or a particular type of sunbird; and several different birds may sit on the same tree at the same time. Does the practitioner in the tropics have to consider every possibility ? Or can he restrict himself to the conditions found in the continent or even in the part of the continent in which he is working ? He certainly needs a thorough grounding in clinical methods. If he is fortunate, he will have studied as an undergraduate in the country in which he is going to work. Here the authors have decided that a wider approach is necessary, and they have produced a book that will be useful everywhere-to the practitioner of tropical medicine in a temperate country, who may see patients from all parts of the world, as well as to the man in the tropics working in a more restricted area. It will also be helpful to the graduate seeking additional training in tropical medicine and wishing to revise his knowledge of clinical methods. The book does much more than merely describe the special methods required for tropical practice. It covers the whole range of clinical medicine-history-taking, examination, and techniques in the clinical sideroom. Its tropical bias is applied by concentrating on examples from tropical medicine and by giving a full description of tropical parasites. The standard is very high and criticism can only be of emphasis, which is often a matter of personal preference. A difficulty facing most doctors in parts where a language is spoken over only a small area is the use of the interpreter; this subject is mentioned, but no practical advice is given. In many countries shortage of medical man-power means that outpatients will have to be filtered through unqualified assistants for many years to come. Advice on the principles to be adopted would be of value to many clinicians. The section on laboratory methods has been kept to a reasonable length by referring the reader to other textbooks for details of the more difficult procedures; this practice might have been carried further. It is useful to have a description of the tapping of a hydrocele or an abdomen, though these procedures are usually described more fully in books of minor surgery; and anyone who can recall an embarrassing situation during a funeral in an African village may look in vain for

procedures to be performed on one piece. The complete instrument will be manufactured under the auspices of the National Research Development Corporation, 1, Tilney Street, London, W. 1,

to

whom

inquiries should be

addressed.

A. E. READ M.D.

Lond.,

M.R.C.P.

K. R. GOUGH M.D.

Brist.,

M.R.C.P.

J. A. BONES B.SC.

Departments of Medicine and Mechanical Engineering, University of Bristol

Brist.

C. F. MCCARTHY M.D.

N.U.I.,

M.R.C.P.

advice on how to make a viscerotome work. The index is good. The book succeeds in covering a lot of ground succinctly and at reasonable cost. A convenient size, it can be carried easily for help in time of trouble in the tropics or for selfimprovement in public transport in this country.

The

Physiology

of Emotions

Editor: ALEXANDER SIMON, M.D., professor and chairman, department of psychiatry, University of California School of Medicine. Springfield, Ill. : Charles C. Thomas. Oxford: Blackwell Scientific Publications. 1961. Pp. 248. 52s.

THERE is no adequate textbook on this subject: indeed, so is its growth, and so large its literature, that much of such a book would be outdated at once. One method of overcoming the difficulty is to invite leading scientists to meet and talk, and then put their papers and discussions in a book like this. The difficulty here is that there are many such symposia, particularly in the U.S.A., and the same people seem to spend much of their working lives going from one to another; so there is bound to be redundancy. Nevertheless, this volume is a good example of its species and contains some excellent reviews and discussions, presented coherently with a central theme and progressing from evidence to sane conclusion. Hoagland and Goldstein describe endocrine stress responses in man. The efficacy of Hoagland’s contribution depends partly on the massive detail of experimental work at the Worcester Foundation: and of Goldstein’s on his insight into the way that the effects of adrenocortical and vitamin insufficiencies depend on the particular activity of the nervous system, especially the sympathetic nervous system. Kety gives a short and pithy review of the relation of stress to the catecholamines, and Beach a factual analysis of the physiological basis of mating behaviour of mammals. A more sparkling brew is provided by Elkes, in which he gives close attention to experimental work, mostly the excellent work of the Birmingham school of neuropharmacology on the mode of action of hallucinogenic drugs on the electrical activity of the brain. He also proposes a complex and elegant hypothesis about how regional and local neuropharmacological events and shifts of equilibrium can determine which pattern in which complex neural lattices will dominate for the moment the outflow of the stereotyped yet " highly organised patterns of activity which we know as affective behaviour ". Thus it becomes apparent that the mere level of substance X (e.g., adrenaline) in blood or a particular part of the brain is of little significance without knowledge of concentration gradients, rates, or turnover, and without relating it to the activity of other agents, such as the adrenocortical hormones or

rapid

acetylcholine.