Gynecology

Gynecology

Department CONDUCTED of Book Reviews BY ROBERT Review T. FRANK, of New M.D., NEW YORK Books Gynecology The ninth edition of the now classic t...

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Department CONDUCTED

of Book Reviews

BY ROBERT

Review

T. FRANK,

of New

M.D.,

NEW YORK

Books

Gynecology The ninth edition of the now classic textbook of Diseases of Women1 by H. S. Crossen and R. J. Crossen has appeared. This edition continues to show improvement throughout in its presentation of the fundamentals of gynecology. All in all it is one of the most informative treatises for the practitioner, as well as for the specialist, because of it.s accuracy, the cfareful arrangement, and the concentrated presentation of facts. In spite of its being kept fully up-to-date, the increase in number of illustrations by sixty-nine, and the addition of a bibliography of twenty-three pages, the volume is fifty-one pages shorter than the previous edition. This difficult task has been accomplished by meticulous sifting am1 condensation. In this edition, special emphasis has lIeen placed on the physiologic aspects of diseases. Ii. T. FRXSK. Novak’s Gynecology and Female Endocrinology~ is designed primarily for the general practitioner and medical student. It covers both of these fields in a fairly exhaustive fashion, conforming in most ways to the usual standard textbooks. While diagnosis and treatment have been featured, all operative (letails have been purposely and wisely omitted. The text is concise aud clear. The endocrine mechanism of menstruation and pregnancy is very well presented. The discussion of physiologic tumors of the ovary likewise deserves commendation for its clear-cut exposition. A main feature is played by the abundant and exceptionally good illustrations. For gross illustrations, many are borrowed from classical sources, with due credit to the source ; the microscopic illustrations are mainly from the collection of the author and are numerous, well chosen and most beautifully executed. In addition there are a number of handsome colored plates. Each chapter is concluded with a short, well-selected, useful bibliography, Of the more than GO0 pages, 145 are devoted to gynecology, the remainder to endocrinology. The present trend to overemphasize organotherapy, rather than endocrine diagnosis, is unconsciously evidenced by the fact that the chapters on endocrinology begin with ‘ ( General Principles of Gynecological Organotherapy. ’ ’ The author shows a more marked trend toward conservative therapy in endocrinology than he has heretofore. He overemphasizes, in my opinion, the applicability and value of suction biopsy as may be seen from the following: Under the heading of “Occasional Therapeutic Value,” he states that “ As with ordinary curettage, functional bleeding may be cured by suction curettage.” Nor can we agree with the statement that “It is probable that certain endometria are refractory to the growth ‘Diseases of Women. By Harry Sturgeon Crosaen, Professor Emeritus of Clinical Gynecology, Washington University School of Medicine, etc., and Robert James Crossen. Assistant Professor of Clinical Gynecology and Obstetrics, Washington University School of Medicine, etc. Ninth edition, entirely revised and reset. 948 pages with 1127 engravings, including 45 in color. The C. V. Mosby Company, St. Louis, 1941. *C+yneoology and Female Endocrinology. By Emil Novak, Associate in Gynecology, the Johns Hopkins Medical School, etc. I395 Pages with 425 illustrations, many in color. Little, Brown and Company, Boston. 1941.

900

BOOR

901

REVIEWS

The multiple subdivision of causes of both menorrhagia effects of estrogen. . . .‘I and amenorrhea appear hardly warranted in the present state of our knowledge. The chapter on sterility, which includes both the male and female, is excellent. It might have been wise to emphasize even more strongly that lipiodol hysterosalpingography must be limited to patients whose tubes have already been proved nonpatent by means of the insutllation test. The volume is concluded by a chapter on pregnancy conditions in gynecologic practice. R. T. FRANK.

Obstetrics A new monograph, Preeclamptic and Eclamptic Toxemia of Pregnancy,s by Lewis Dexter and Soma Weiss, analyzes this problem by a physiologic approach. The recent untimely death of Dr. Weiss is greatly lamented in the loss to American medicine of his brilliant mind. Among the various clinical and pathologic phases investigated were edema, changes in arterial pressure and other factors of hemodynamics, and function of the kidneys. In discussing the findings of these investigations, the authors have sought to interpret recent literature in the light of their own results. By exclusion, a primary humoral etiology of generalized edema in pregnancy is suspected. No significant relationship between posterior pituitary and hypertension of late pregnarmy could be adduced, nor could the toxic reactions of this pituitary be regarded as similar to. toxemia of pregnancy. The authors were unable to determine the presence of a pressor substance (renin) in the placentas of hypertensive pregnant patients. A circulating pressor substance, if present in the mother, apparently does not cross the placenta to affect the infant similarly. Hormones were not found to produce a syndrome comparable to human toxemia in experimental animals, and pregnancy in animals evidently does not ac,centuate hypertension induced by renal ischemia. In discussing the clinical and pathologic features of pre-eclampsia and eclampsia the authors have exhaustively studied 80 such cases with special reference to hypertension antedating pregnancy. The results of these clinical and laboratory studies again have been compared with a large group of similar studies in recent literature. The pathology of renal changes in eclampsia and infections and the degenerative lesions are well illustrated. There is an excellent section on cortical necrosis and another on vascular collapse in eclampsia. The various theories of etiology are careThe classification of the toxemias of pregnancy offered by the Amerifully analyzed. can Committee on Maternal Welfare is regarded as mildly unsatisfactory, at least, on grouping. The immediate renal lesion of eclampsia is regarded as a glomerulonephrosis. The authors feel that while no specific “toxin” has been found responsible the placenta must be regarded as the L ‘intrauterine factor” responsible, although the pathogenesis is due to multiple rather than to single operative factors. They offer a diagrammatic representation of their conception of the factors involved. There is a significant suggestion that the relationship of isoimmunization and isoagglutinins has not been sufficiently studied. The various methods of treatment are dissected, many are discarded, some are recommended. Aside from prenatal care and practice of preventive measures, reduction or prevention of edema, and of sodium retention in the tissues is regarded as the most important single principle involved. This monograph vvill greatly interest not only the clinical obstetrician but as well the internist and the physiologist, one from the medical, the other from the research aspects presented. PHILIP 3PrereJnmptic

and

Eclamntic

Toxemia

of

Preznancy.

F. \vILLIABIS.

Bv Lewis Dexter. M.D. Research Fellow in Medicine, Harvard Medical School, and Soma Weiss, M.D., Jersey Professor of the Theory and Practice of Physic, Harvard University, etc. ~a collaboration with Florence W. Haynes, Herbert S. Sise, and James V. Warren. 415 pages with 44 illustrations. Little, Brown and Co., Boston. 1941.