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Congenital malformations
599 he recommended to the In closing his comments woman’s spinal canal! Rh factor are reviewed; The section on’gynecology function by cytological is amply covered. The operative techniques in
general practitioner for the treatment of the toxemias of pregnancy. on anesthesia, the editor vividly expresses his respect for the parturient Early ambulation receives considerable attention. Many articles on many also, on the use of penicillin as a prophylactic in ophthalmia. has many references to the diagnosis of cancer and genital dysmethods and the literature of the various modes of treatment of cancer abstracts of the considerable literature on stress incontinence, and general are well illustrated. PHILIP F. WILLIAMS.
The return to civilian life from the military service by many English physicians is the occasion of this small book, Obstetrics and Gynaecology, by C. Scott Russell.3 The concise text is intended not only to freshen their existing knowledge of the subjects but to explain the advances that were made during the war years. The discussion of prenatal hygiene, particularly nutrition, is excellent. A conservative attitude is advocated for labor, and analgesics are briefly discussed. The abnormalities of pregnancy are divided according to those which occur in the first six and the last three mouths. Ceearean section is the first choice in placenta previa. The author suggests early termination of pregnancy in the toxemic woman, and recommends x-ray study in primigravida to a larger degree than it is presently used. The author feels that the place of penicillin in the treatment of syphilis in pregnancy has not yet been settled. His advice on abnormal labor is conservative, and the discussion should do much to help the returned soldier doctor in the difficulties of abnormal Isbor. The various disorders of the newborn are discussed briefly but well. There is a short section on the common gynecological complaints. The section begins with vaginitis of childhood and sex education, and proceeds with sterility, infections, and new growths in a very logical manner, with a short and pithy text. There is an ample discussion of therapy for these conditions. This small manual should do much to orient the physician recently separated from the service, or, indeed, any general practitioner, with corn. monly met problems of reproduction and the genital tract. PHILIP F. WILLIAMS.
In the second edition of Congenital Malformations,4 Dr. Murphy discusses He considers the congenital genetic and environmental causes of maldevelopment.
both basis
the of such situations in regard to their frequency and the relationship to both the reproductive and The ratio between white persons and negroes as to nonreproductive factors of the parents. congenital malformations is in the order of 57 to 32, and such children are born to older mothers much more frequently than to’young ones. The author points out that prematurity is excessive in malformed offspring, and that miscarriages, stillbirths, and premature births are much more frequent in the preceding and succeeding pregnancies after those which have resulted in the development of a malformed child.
A study of factors in the pregnancy which produced a defective child showed an obvious nutritional deficiency in the mother in many instances, with anemia commonly present. Abnormal motility of the deformed child seems to have been one of the most frequent subjective symptoms. Dr. Murphy did not note an unusual association with placenta previa in these situations. The deformities in the series of cases which he studied showed defects of the central nervous systems to be more numerous, with hydrocephalus the most frequent. Pyloric stenosis, harelip, and cleft palate were present in a fair percentage. Similar defects appear to be common in their nature, both in the immediate family and in distant relatives where defects were present. These frequent defects in brothers, sisters, and relatives appear to be the most single convincing piece of evidence in favor of heredity, and would make it ap-
600 pear
E’&ANK that
t,he malformations
arose
from
factors
inherent
in the germ
cells
prior
to fertilizatiou,
The
author discusses maternal pelvic irradiation and maternal rubella as environmental factors, and he is convinced that pelvic radiation during pregnancy is harmful to the fetu,. i& utero, whether given early or whether given late, hut considers radiation of the ovarie> or the nonpregnant uterus to bc a minimal factor in producing structural defects in children horn after such preconceptive radiation. .\s to rubella, the prerent literature is rcvirwed, with Darticular stress on the crit,icisrn regarding the diagnosis of the disease and the treatment of the present pregnancy when ;: pregnant woman has been afflicted with rubella in the first trimester. The author apparenrly feels that the uterus should be emptied. He notes in this section that measles, mumps, and r*hirken pox in early pregnancy have been followed by both congenital cataracts and con genital heart disease in the infant, and infers that possibly any infe&ous disease of the mother in early pregnancy might be capable of producing the defects common after rubella. The monograph is a comprehensive study of congenital defects from the point of view ul origin. PHILIP F. &‘ILLIAMS. The third edition of Robson’s Recent Advances in Sex and Reproductive Physiology: has appeared after seven years. In size and general appearance it differs little from the previous edition, but it has been brought thoroughly up to date, including the bibliography. This is a very useful book for those who want a quick, impartial survey which has been controlle~l and arranged by an experienced and distinguished investigator in the field. On the whole, little of comparatively new or startling nature has developed in this field since the second edition was published. R. T. Ftmlu~. The thirteen contributions on the various phases of the Hh factor which formed the proceedings of the International Hematology and Rh Conference held at Dallas, Texas, November, 1946, under the auspices of the Baylor University Hospital, now appear as a special issue under the title The Rh Factor in the Clinic and L&boratQ~.s These contributions were made by investigators from Canada, England, Mexico, and the United States. Levine opened the conference with a survey of the significance of the Bh factor, bringing out the history and development of the subject, and discussing the genetics of the Rh, HI He has fully considered the practical aspects system, as well as the present terminologies. and the specific therapy of the affected infant. In discussing a public health program, Levine recommends a comprehensive program of Rh testing, and suggests that this procedure eventu, ally be included as a state compulsory premarital or prenatal test, since the morbid effects in. cidental to isoimmunization are observed more frequently than those resulting from syphilis. Race, of London, discusses the Rh genotypes and Fisher’s theory. He considers that the antigenie allelomorphisms revealed by Fisher are fundamental to an understanding of the Rh blood groups, and that Fisher’s ideas have brought order and simpIieity to a confused mass of apparently arbitrary facts about Rh antigens and antibodies. The text continues with the study of hemolytic mechanism by Dameshek, and the nucleolar content by Guzman, of Mexico City. Witebsky discusses the relationships between the Rh system and the A Ii system, citing two illustrative cases, referring to the iso-antibodies, anti-A and anti-B, Thcb possibility of a third order of antibodies, hemolytic Rh immune globulins, is described by Hill and his associates. The
lower nephron nephroses are discussed by Muirhead of acute renal insufficiency.
fusions, subject
‘The
causes, particularly incompatible There is an excellent paper Hospital series, factors other
blood transon the general than hemolysis
and Reproductive Physiology. By J. M. Rohson. M.D., D.Sc. Pharmacology, Guy’s Hospital Medical School, University of by Professor F. A. E. Crew, M.D.. D.&z, F.R. S. Third Edition, The Blakiston Company, Philad&,hia-Toronto. 1947. Rh Fsctor in the OUnieaad the Labrbow#oty, B h Jlwh M. Hill, M.D., and William M.D., 190 pages, GREne & Stratton, New Yor ,
6R%Cent
Advanres
in
(Leeds), F.R.S.E., Reader London. With Introduction 336 pages, 65 illustrations. Dameshek,
from various and others. In the Baylor
Sex
in
general practitioner for the treatment of the toxemias of pregnancy. on anesthesia, the editor vividly expresses his respect for the parturient Early ambulation receives considerable attention. Many articles on many also, on the use of penicillin as a prophylactic in ophthalmia. has many references to the diagnosis of cancer and genital dysmethods and the literature of the various modes of treatment of cancer abstracts of the considerable literature on stress incontinence, and general are well illustrated. PHILIP F. WILLIAMS.
The return to civilian life from the military service by many English physicians is the occasion of this small book, Obstetrics and Gynaecology, by C. Scott Russell.3 The concise text is intended not only to freshen their existing knowledge of the subjects but to explain the advances that were made during the war years. The discussion of prenatal hygiene, particularly nutrition, is excellent. A conservative attitude is advocated for labor, and analgesics are briefly discussed. The abnormalities of pregnancy are divided according to those which occur in the first six and the last three mouths. Ceearean section is the first choice in placenta previa. The author suggests early termination of pregnancy in the toxemic woman, and recommends x-ray study in primigravida to a larger degree than it is presently used. The author feels that the place of penicillin in the treatment of syphilis in pregnancy has not yet been settled. His advice on abnormal labor is conservative, and the discussion should do much to help the returned soldier doctor in the difficulties of abnormal Isbor. The various disorders of the newborn are discussed briefly but well. There is a short section on the common gynecological complaints. The section begins with vaginitis of childhood and sex education, and proceeds with sterility, infections, and new growths in a very logical manner, with a short and pithy text. There is an ample discussion of therapy for these conditions. This small manual should do much to orient the physician recently separated from the service, or, indeed, any general practitioner, with corn. monly met problems of reproduction and the genital tract. PHILIP F. WILLIAMS.
In the second edition of Congenital Malformations,4 Dr. Murphy discusses He considers the congenital genetic and environmental causes of maldevelopment.
both basis
the of such situations in regard to their frequency and the relationship to both the reproductive and The ratio between white persons and negroes as to nonreproductive factors of the parents. congenital malformations is in the order of 57 to 32, and such children are born to older mothers much more frequently than to’young ones. The author points out that prematurity is excessive in malformed offspring, and that miscarriages, stillbirths, and premature births are much more frequent in the preceding and succeeding pregnancies after those which have resulted in the development of a malformed child.
A study of factors in the pregnancy which produced a defective child showed an obvious nutritional deficiency in the mother in many instances, with anemia commonly present. Abnormal motility of the deformed child seems to have been one of the most frequent subjective symptoms. Dr. Murphy did not note an unusual association with placenta previa in these situations. The deformities in the series of cases which he studied showed defects of the central nervous systems to be more numerous, with hydrocephalus the most frequent. Pyloric stenosis, harelip, and cleft palate were present in a fair percentage. Similar defects appear to be common in their nature, both in the immediate family and in distant relatives where defects were present. These frequent defects in brothers, sisters, and relatives appear to be the most single convincing piece of evidence in favor of heredity, and would make it ap-
600 pear
E’&ANK that
t,he malformations
arose
from
factors
inherent
in the germ
cells
prior
to fertilizatiou,
The
author discusses maternal pelvic irradiation and maternal rubella as environmental factors, and he is convinced that pelvic radiation during pregnancy is harmful to the fetu,. i& utero, whether given early or whether given late, hut considers radiation of the ovarie> or the nonpregnant uterus to bc a minimal factor in producing structural defects in children horn after such preconceptive radiation. .\s to rubella, the prerent literature is rcvirwed, with Darticular stress on the crit,icisrn regarding the diagnosis of the disease and the treatment of the present pregnancy when ;: pregnant woman has been afflicted with rubella in the first trimester. The author apparenrly feels that the uterus should be emptied. He notes in this section that measles, mumps, and r*hirken pox in early pregnancy have been followed by both congenital cataracts and con genital heart disease in the infant, and infers that possibly any infe&ous disease of the mother in early pregnancy might be capable of producing the defects common after rubella. The monograph is a comprehensive study of congenital defects from the point of view ul origin. PHILIP F. &‘ILLIAMS. The third edition of Robson’s Recent Advances in Sex and Reproductive Physiology: has appeared after seven years. In size and general appearance it differs little from the previous edition, but it has been brought thoroughly up to date, including the bibliography. This is a very useful book for those who want a quick, impartial survey which has been controlle~l and arranged by an experienced and distinguished investigator in the field. On the whole, little of comparatively new or startling nature has developed in this field since the second edition was published. R. T. Ftmlu~. The thirteen contributions on the various phases of the Hh factor which formed the proceedings of the International Hematology and Rh Conference held at Dallas, Texas, November, 1946, under the auspices of the Baylor University Hospital, now appear as a special issue under the title The Rh Factor in the Clinic and L&boratQ~.s These contributions were made by investigators from Canada, England, Mexico, and the United States. Levine opened the conference with a survey of the significance of the Bh factor, bringing out the history and development of the subject, and discussing the genetics of the Rh, HI He has fully considered the practical aspects system, as well as the present terminologies. and the specific therapy of the affected infant. In discussing a public health program, Levine recommends a comprehensive program of Rh testing, and suggests that this procedure eventu, ally be included as a state compulsory premarital or prenatal test, since the morbid effects in. cidental to isoimmunization are observed more frequently than those resulting from syphilis. Race, of London, discusses the Rh genotypes and Fisher’s theory. He considers that the antigenie allelomorphisms revealed by Fisher are fundamental to an understanding of the Rh blood groups, and that Fisher’s ideas have brought order and simpIieity to a confused mass of apparently arbitrary facts about Rh antigens and antibodies. The text continues with the study of hemolytic mechanism by Dameshek, and the nucleolar content by Guzman, of Mexico City. Witebsky discusses the relationships between the Rh system and the A Ii system, citing two illustrative cases, referring to the iso-antibodies, anti-A and anti-B, Thcb possibility of a third order of antibodies, hemolytic Rh immune globulins, is described by Hill and his associates. The
lower nephron nephroses are discussed by Muirhead of acute renal insufficiency.
fusions, subject
‘The
causes, particularly incompatible There is an excellent paper Hospital series, factors other
blood transon the general than hemolysis
and Reproductive Physiology. By J. M. Rohson. M.D., D.Sc. Pharmacology, Guy’s Hospital Medical School, University of by Professor F. A. E. Crew, M.D.. D.&z, F.R. S. Third Edition, The Blakiston Company, Philad&,hia-Toronto. 1947. Rh Fsctor in the OUnieaad the Labrbow#oty, B h Jlwh M. Hill, M.D., and William M.D., 190 pages, GREne & Stratton, New Yor ,
6R%Cent
Advanres
in
(Leeds), F.R.S.E., Reader London. With Introduction 336 pages, 65 illustrations. Dameshek,
from various and others. In the Baylor
Sex
in