Reviews of Books

1367 checked during filling and the chloride concentration1 is checked after filling. Preheated dialysate is delivered to the

dialyser with a roller pump and negative pressure is provided by a venturi attached direct to the cold-water supply. No heating, mixing, or de-aeration is needed, and there is no monitoring of dialysate other than blood-leak detection. The cost of the tank, pump, and venturi is approximately

Reviews of Books Hydrocephalus

and the

THOMAS HERRICK

Cerebrospinal Fluid M.D., chief of neurosurgery,

MILHORAT,

Children’s Hospital National Medical Center, and associate

professor of neurosurgery, George Washington University, Washington, D.C. Baltimore: Williams & Wilkins. Edinburgh : Churchill Livingstone. 1972. Pp. 237.$18.50; E8.50.

Insulated

dialysis tank. the internal finish, all seams on paid ridge-free and a recessed outlet minimised

Special attention the inner surface were pooling of residual fluid when was

to

not

in

use.

A$800 (E444). Blood-pressure, blood-leak, and fistula monitoring and a blood pump are additional costs and are provided as modular units. The tank is rinsed after use and left dry. Each week, 5 litres of 2% formalin is left in the tank for 24-48 hours. This is emptied and the tank is well rinsed before re-use and tested to ensure that all the formalin has been removed.2 Bacterial growth has been negligible with this simple cleaning routine. Comment This simple fluid-supply system has been used exclusively with one square metre flat-plate dialysers. Dialysers with reduced surface area 3 or hollow-fibre units do not provide adequate dialysis with low dialysis flow-rates (200 ml. per

minute). Although simplified tank systems have been advocated before,the unique feature of the present unit is its excellent insulation which eliminates any need for heating or deaeration. The combination of a dextrose-free dialysate, a seam-free internal finish, and a free-draining recessed outlet greatly reduces the opportunity for bacterial growth. Preparation and cleaning has proved quicker than for automated systems. We have found the complexity of automated fluidsupply systems an obstacle to training in many older, more anxious, or less capable patients. This equipment is less demanding, and our experience so far suggests it will reduce training-time, increase the proportion of patients capable of home dialysis, and reduce the frequency of mechanical failure and the cost of maintenance.

Requests

for

reprints

should be addressed

to

J. K. D.

REFERENCES

1. 2.

Scribner, B. H. Proc. Staff Meet. Mayo Clin. 1950, 25, 209. Pollard, T. C., Barnett, B. M. S., Eschbach, J. W., Scribner, B. H. Trans. Am. Soc. artif. intern. Organs, 1960, 6, 114. 3. Ginn, H. E., Bugel, H. J., James, I., Hopkins, P. Proc. clin. Dialysis Transplant. Forum, 1971, 1, 53. 4. Esmond, W. G., Strauch, M., Zapata, A., Hernandex, F., Cox, E., Lewitinn, A., Moore, S. Bull. Sch. Med. Univ. Md, 1967, 52, 3.

IF anyone understands the circulation of cerebrospinal fluid it ought to be Dr Milhorat. He modestly disclaims this honour and acknowledges frankly the paradoxes which beset the generally accepted facts about the subject. When he has finished with his account of the physiology, pathology, pathogenesis, pathophysiology, and diagnosis and has given his opinion regarding the more controversial aspects of his subject, even the paradoxes look less formidable than they were. Despite lengthy lists of references at the end of each chapter the text is rational and coherent. If anyone were to come to this subject for the first time and wanted a thoroughly comprehensive logical account of the present position as it affects physiologists, pathologists, paediatricians, and neurosurgeons, here it is. If Dr Milhorat does more than justice to normal-pressure hydrocephalus and perhaps less than justice to the intricacies and difficulties of the aetiology of communicating hydrocephalus in infants, at least he has one penetrating remark on these very subjects-namely, that arrested hydrocephalus and normal-pressure hydrocephalus are probably one and the same thing. This must give considerable cause for thought to those who have to deal with either condition; for the treatment of the one (which is sometimes to do nothing) and the diagnosis of the other (which is sometimes a thing of exquisite obscurity) are both clarified by this probably accurate point of view. It is interesting that Dr Milhorat does a ventriculoperitoneal shunt as the initial operation for hydrocephalus in most infants-a practice which has much to commend it. As a neurosurgeon, he is sound on the less common causes of hydrocephalus which demand a general neurosurgical approach, and his volume can be commended without reservation for general education or for higher examinations in medical, surgical, pasdiatric, neurosurgical, and neuroradiological subjects. It even has relevance to psychiatrists who have to deal with dementia due to normal-pressure hydrocephalus. People who reckon to know about hydrocephalus may well find their fondest notions exploded by It should probably not some hard facts recounted here. be read by students, or they may get into the dangerous position of knowing more than their examiners.

Herpes Simplex Encephalitis L. S. ILLIS, M.D., B.sc., M.R.C.P., consultant neurologist, Wessex Neurological Centre, Southampton; and J. V. T. GOSTLING, M.A., M.B., F.R.C.PATH., consultant virologist, Public Health Laboratory, Portsmouth. Bristol: Scientechnica. 1972. Pp. 117. S4.75.

VIRAL inflammation of the

relatively unexplored subject,

nervous

system is still

a

and there have been few

attempts to review any of its specific forms. This book, which is meant mainly for clinicians, is a generally successful compilation of the authors’ experience of 20 cases and of about 170 reports from the literature. It includes accounts of the clinical features in adults and children, details of the associated and sometimes diagnostically valuable electroencephalographic findings, of changes in the cerebrospinal fluid, and of diagnostic virological methods and their relative value. There is an account, too, of pathology and patho-

1368

genesis, and, as Dr McNair Scott had pointed out in the foreword, the authors are fashionably confused about the value of treatment with steroids, although firm proponents of idoxuridine. The strong points of the book are its emphasis on clinical features and differential diagnosis, as well as its frank evaluation of the problem of obtaining virological proof of the diagnosis. Its weaknesses are the frequent lack of critical analysis of published data, much of which can at best be regarded as naive; and the number of questions raised but neither answered nor even fully exposed (e.g., what is the role of herpes simplex in causing subacute encephalitis and psychiatric disorders, are immunological factors responsible for the Arthus-like nature of the necrotising vascular lesions in the brain, and why should the limbic system be affected so severely ?). This book should be regarded, perhaps, as a useful source of information and a good read, but it is an expensive and far from definitive account of a grave disease.

operation would be performed in hospitals only for medical reasons " may be thought dated; and they may feel that it is not for them to instruct the patient seeking artificial insemination by donor as to how the baby should be registered. Doctors in psychiatric practice may be pleased to see that Dr Speller firmly supports the view that practi" tioners other than consultants may be responsible medical omcers within the meaning of the Act. Regarding the section on ownership of medical records, a definition of " public records " would perhaps have added clarity for the medical reader. Those who advise doctors will of course always buy a Speller ". They too will not agree with everything they read-but then they would neither wish nor expect to. Consent forms are dealt with at length, but has the time not come to cease theorising and to look at the result of a single multipurpose form ? This book, despite several printing errors, deserves a wider medical readership than it may obtain. "

"

Management

Soap Photodermatitis PETER Centre

Halogenated Salicylanilides. Photosensitivity HERMAN, professor dermatology, Hospitalier Universitaire, University Sherbrooke, Quebec; to

SIMON

assistant

of of

and W. MITCHELL SAMS, JR., department of dermatology, Mayo Clinic, Rochester, Minnesota. Springfield, Illinois: Charles C. Thomas. 1972. Pp. 181.$14.75.

THE finding in 1961 that tetrachlorosalicylanilide, a bacteriostatic used in soap, was a potent photosensitiser, caused as much surprise to dermatologists as to the manufacturers. It raised a number of fundamental questions of photobiology and immunology and stimulated a lot of experimental work and clinical investigation. Since this has been done in many different disciplines, it is perhaps not surprising that the resulting literature has sometimes been confusing and even contradictory. Had this book done no more than review and discuss the published work, the extent of which is indicated by the 365 references given, it would have been a valuable contribution in its own right. But it also includes a body of original work, carried out by Dr Herman for his M.D. thesis, on the binding properties of salicylanilides and on several aspects of the induction and detection of their immunological effects. The text is admirably short and concise, and the format is of a high standard. The authors have raised as many questions as they solved, and their experimental results will doubtless provide and stimulate further work. Photobiologists and immunologists may differ in their interpretation of this work, but the clarity of presentation (and the illustrations) will command respect. This book will be widely read and constantly referred to by all those faced with the problem of photosensitisation.

Law of Doctor and Patient S. R. SPELLER, LL.B., PH.D., lately secretary and director of education, Institute of Health Service Administrators. London: H. K. Lewis. 1973. Pp. 202. f.5.

THIS book, the author tells us, is addressed to those who advise doctors, to doctors themselves, to dentists, and to lawyers. Its value to lawyers is not easy to judgethough they will know that Bravery v. Bravery was not of 1945 vintage. There is little for dentists, and their confidence can perhaps not escape being shaken when they read of the " Dentists Act 1927 ". Doctors may not yet be prepared to pay E5for a book of 200 pages, and this is unfortunate, for this book is medical law, not legal medicine, and the other man’s point of view is always instructive. Doctors may not agree with everything they read. Referring to sterilisation, the view that " such an

of

Emergencies

in Thoracic

Surgery

2nd ed. JOHN BORRIE, CH.M., F.R.C.S., F.R.A.C.S., surgeon-incharge, Southern Regional Thoracic Surgical Unit, Dunedin and Wakari Hospitals, Dunedin, New Zealand. New York:

Appleton-Century-Crofts.

1972.

Pp. 478.$17.

THE second edition of Mr Borrie’s book maintains the high standard of the first. It is a very readable book illuminated by flashes of humour. It covers thoracic emergencies thoroughly and represents the now very considerable personal experience of its author. The text is well illustrated with X-rays. The first five chapters, on general procedures in thoracic surgery and chest-wall emergencies, are invaluable to anybody working in a hospital, and the descriptions of diagnostic procedures and treatment are easy to read and understand. The section on low tracheostomy on p. 53 describes the incision from the cricoid cartilage to the infrasternal notch (clearly a misprint for suprasternal). The author recommends a vertical incision in a tracheostomy (except in pretty girls), but a transverse incision is very often equally satisfactory if not better. The rest of the book is split into chapters on the management of pleural and pulmonary emergencies which are extremely detailed, especially that on inhaled foreign bodies. In the section on oesophageal emergencies the author once again deals with almost every conceivable trouble. He follows this with a section on cardiac emergencies, including the treatment of cardiac arrest, accompanied by a very useful list of how a cardiac-arrest trolley should be arranged and the cechnique of carrying out the various procedures. He might, perhaps, have added a section on the management of complete heart-block and the treatment of pacemaker failures. The final chapter is on respiratory distress in the newborn. This book can confidently be recommended to all grades of surgical staff. The author is to be congratulated on producing this extremely useful volume.

The Scientific Basis of Medicine: Annual Reviews 1973 (London: Athlone Press. 1973. Pp. 241. £ 4).Most of these reviews are based on scripts prepared for television programmes on postgraduate medical education, and the collection is edited by Ian Gilliland and Margaret Peden. With only thirteen lectures this time, it is arguable that too many of them are linked together-e.g., E. W. Horton and J. M. Beazley write on prostaglandins, Lynne Reid covers the bronchial epithelium in one talk and mucus in another, and there are contributions on articular cartilage, total hip replacement, and skeletal scintigraphy. But if coverage seems narrower than in some earlier years the quality is as high as ever. The series is a gem-studded bridge between medical science and practice.