806

antibiotic therapy were due to cross-infection by insensitiveorganisms, such as staphylococci, and to moniliasis of thelungs or intestines. If there was fibrosis and loculation, asin pericarditis, empyema, or brain abscess, a theoreticallyeffective antibiotic may not penetrate to the infecting organ-isms. It may be difficult to prove that a pyrexia duringprolonged penicillin or streptomycin therapy was entirelydue to the antibiotic, and it required a very fine clinical

judgment to stop treatment. Allergic manifestations to

penicillin and streptomycin were relatively common-

cutaneous hypersensitivity in those who handled the drugsconstantly, local irritation at the site of inoculation, and(relatively rarely) anaphylactoid reactions to penicillin.Dr. Rogers described 4 cases of anuria which were probablydue to penicillin. The anuria lasted from 4 to 8 days and thepatients involved were children between the ages of 8 monthsand 5 years. All recovered after treatment with Bull’s regime,although 1 had a permanent disability after a further com-plication of monilial cystitis. Uncontrolled prophylacticumbrella therapy has produced staphylococci resistant to awide range of antibiotics and these have caused serious

complications in surgical units such as chest centres.Blood-acetoacetate Levels after Operation

Dr. L. NAFTALTN said that other workers had shown thatin the first postoperative days endogenous fat was burnedat the rate of about 2250 cals. per day-i.e., many times therate observed in semi-starvation. On the assumption thatincreased acetoacetate is formed only when 2C fragmentsare being produced in excess of immediate tissue needs,serial examinations were made of blood-acetoacetate 1 inthe hope of timing the switch-over to fat utilisation. Inevaluating the results, starvation ketosis and certain othervariables had to be considered ; nevertheless, a sharp risein blood-acetoacetate level appeared regularly soon after

operative trauma, and sometimes after intravenous thio-

pentone only. The immediate rise was probably an adrenalineeffect : the first high peak at 4-5 hours postoperativelymight also be due to adrenaline, since corticotrophin andcortisone had been shown to depress blood-acetoacetatelevels.2 The curve of blood-acetoacetate against time mightthereafter show a dip before rising to a further peak in excess,sometimes far in excess, of the level produced by simplestarvation at comparable time. The effect of postoperativeinfusion of blood or glucose at or immediately after operationwas also studied : the results suggested that after theimmediate calorie value of the material infused had beenmade use of, the postoperative pattern of high blood-aceto-acetate returned; In 3 well-defined cases of postoperativeileus no rise in blood-acetoacetate was found. Temporary ionpoisoning of the acet6-,CoA-inase enzyme system mightbe responsible.

Pathology of Fatal Aircraft AccidentsWing-Commander J. K. MASON pointed out that until

recent years the limitations on air-frame and engine structurehad confined the human factors in aviation to the sphere ofthe physiologists. But the jet engine had so increased thehazards of flight that aviation pathology had emerged as asubject distinct from aviation physiology and general trau-matic pathology. The recently formed Royal Air Forcesection of aviation pathology regarded its main objectivesas : (a) the correlation of post-mortem findings with engineer-ing and other evidence in fatal accidents, thus helping toelucidate obscure causes of accidents ; (b) the discovery ofany recurring injuries which may suggest faults in aircraftdesign ; (c) the assessment of new and experimental typesof safety equipment in the light of previous post-mortemfindings ; (d) the search for pre-existing disease in aircrewswhich might be missed on ordinary methods of medicalexamination and yet might have a bearing on aircraftaccidents ; (e) the attempt to clarify some of the confusionwhich surrounded traumatic pathology in general and aviationpathology in particular, and which is mainly due, it wasbelieved, to the fact that no single team of observers had hadan opportunity to make a large number of necropsies onpersons killed in aircraft accidents. Such uncertain aspectsof aviation pathology included anoxia, injuries induced bypure accelerative and decelerative forces, the aetiology andprognosis of fat embolism, and, most important, explosivedecompression. The section was anxious to secure the coopera-tion of coroners and coroners’ pathologists.1. Walker, P. G. Biochem. J. 1954, 58, 699.2. Kinsell, L. W., Margen, S., Michaels, G. D., McCallie, D. P.

J. clin. Invest. 1951, 30, 1486.

Reviews of Books

The House Physician’s HandbookC. ALLAN BiRcH, F.R.C.P., physician, Chase Farm Hospital,Enfield. Edinburgh : E. & S. Livingstone. 1955.Pp. 160. 10s. 6d.

Tms little book contains much information andpractical advice that will be useful to the young resident.Though the chapter on clinical pathology covers groundwhich is also covered in many larger works, the sectionon general duties and information has a wide range ofhelpful hints and advice which are not so easily found.In places perhaps rather more detail would be welcomee.g., on the subject of filling in the cause of death on adeath certificate. Again in the chapters on clinicalprocedures those two problems of the house-physician-hysteria and malingering-might have been more fullydescribed. Of the newer drugs cortisone is not men-tioned, and the account of antibiotics gives little indicationof the respective action of the different preparations ortheir drawbacks. But in a book of this size someomissions are inevitable. Dr. Birch has compressed aremarkable amount into his 160 pages.

Radio-diagnostic des occlusions intestinales aiguesCLAUDE OLIVIER, agrege de la Faculte de Medecine deParis. Paris : Masson. 1955. Pp. 258. Fr. 3300

Tms excellent review is based on extensive experience.The early chapters deal with technique and indications for

radiography ; the relation of the radiographic appearances tothe pathological cause are well described and clearly illus-trated. Succeeding chapters deal in detail with the varioustypes of intestinal obstruction and with other conditions, suchas renal colic and acute pancreatitis, which give rise to changesin the radiographic picture. The final chapter, on intestinalobstruction in the newborn, might with advantage beelaborated.

This book will be of value to those interested in thesubject-clinicians and radiologists alike.

Neuro-vascular Hila of Limb MusclesJAMES COUPER BRASH, M.C., M.D., D.SC., F.R.C.S.E.,

professor emeritus of anatomy, University of Edinburgh.Edinburgh : E. & S. Livingstone. 1955. Pp. 100. 30s.

THE work embodied in this small atlas was started in1941 at the suggestion of Sir James Learmonth, whoforesaw its potential value not only to the vascular

surgeon but also to those working in the peripheral-nerveinjuries centres set up during the war. Professor Brash’saim was to determine the extent to which the principalblood-supply of the muscles is associated with thenerves-i.e., the constancy or otherwise of a definite" neuro-vascular hilum." To achieve this, observationsalready recorded on the points and mode of entry of thenerves of supply had to be checked and extended.

In this long and exacting task the departments ofanatomy at Aberdeen, Leeds, and Glasgow collaboratedwith him. The data for the upper limb were circulatedto the peripheral-nerve injuries centres and others in1945, but it is only now that it has been possible to collateand analyse the complete data for the lower limb also.This atlas is the result. In brilliantly clear diagrams,drawn exactly to a defined scale, it shows the nerveand vascular supply of all the principal muscles of thelimbs with appropriate notes on the variations found byProfessor Brash and earlier investigators. It is of coursea highly specialised work but will prove invaluable toall surgeons interested in peripheral-nerve injuries or

ischaemia of muscles-quite apart from its merit as acontribution to pure anatomy.

The Physiological Basis of Medical Practice (6th ed.London : Bailliere, Tindall, & Cox.- 1955. Pp. 1355. 91s. 6d.).- proof. C. H. Best, F.R.S., and Prof. N. B. Taylor have sub-jected their notable work to " the most extensive revisionsince it was first published," so that hardly a page of it hasescaped emendation, deletion, or addition. A good book keptwell up to date can defy the ageing process which afflicts therest of us. " Best and Taylor " has this secret of perpetualyouth.