Recent Psycho-Analysis

The author describes methods of ensuring-as far as it is possible-that adequate air replacement may be brought about in all the important channels traversed by the cerebrospinal fluid. Excellent radiographs with explanatory diagrams illustrate the text, and he interprets the pictures well. The theories that he propounds to account for the physical processes occurring in these investigations are interesting though unconvincing-as are the ingenious experiments that are supposed to confirm them. He records some noteworthy data, hitherto disregarded, among the observations on cerebrospinalfluid pressures. Perhaps it will not be considered out of place here to warn the prospective encephalographist that the manometric pressure in the lumbar theca does not always correspond with the intracranial pressure. The author might have mentioned this, as well as the fact that in some cases even absence of papilloedema does not prove that the intracranial pressure is not raised. On p. 49 is the comment: "It is reasonable to assume that the maintenance of a constant pressure will diminish the risk of investigation when a tumour is present." How justifiable the performance of encephalography may be in a case of suspected tumour is a matter for serious consideration. But the statement on p. 48 that, "when a patient is confused or drowsy and a cerebral tumour is suspected, the employment of an initial sedative is contraindicated," is not applicable, for few, if any, neurosurgeons would sanction this procedure in any patient in such a clinically deteriorated state. The author's work in encephalography is well known, and the present monograph reveals the high standard characteristic of it. The book should be studied by all who intend to employ this method of visualizing changes within the brain and in the associated cerebrospinal-fluid pathways. HARVEY JACKSON.