Epidemiology and Control of Epidemic Syphilis

The Atlas of Exfoliative Cytology is a valuable distillate of the vast experience of the master cytologist, Dr. George N. Papanicolaou. The doubtless heavy subsidy from the Commonwealth Fund has been well employed. The book has been prepared in all modesty in loose-leaf form "to keep abreast of new advances," and an appeal is made for new material. As befits an atlas, the illustrations are many and the text is brief but informative. Following a historical introduction, and a useful section on methods, there are general chapters devoted to each of the large subjects of the atlas-female genital system, urinary and male genital systems, respiratory tract, digestive system, exudates, and breast. One bit of philosophy might perhaps have been discussed: that the initial study of the smears should be without knowledge of any aspect of the clinical history. How else can one avoid seeing with the eye of faith? How else can the contribution of the cytological method be evaluated quantitatively? The author seems to differ from this point of view and tends rather to stress the sources of error, for example, previous instrumentation or radiation and the need of a knowledge of these things in arriving at a final conclusion. In the body of the volume each of the magnificent plates is accompanied not only by a caption for every illustration but also by a discussion. There is some repetition in these discussions of material presented in the general chapters, but the proximity to the figures perhaps makes this desirable. Sometimes the discussion adds nothing to the caption. Occasionally, the caption leaves the reader somewhat in doubt as to the true nature of the cells illustrated, as for example that which accompanies Figure 10 on Plate E II. It would be desirable, also, to know just what is meant by "early" carcinoma. One cannot quarrel with the author's statement that the drawings cannot be compared with photographs. The latter are magnificent, there being some loss of verisimilitude only because the background has been removed. The warrant for use of the drawings is stated to be the difficulty of showing all levels of a multistratified cell mass. Yet most of the drawings show single cells or groups of isolated cells. The criticism is not of the artist, who has done superlatively well with a very difficult subject, but rather that the photographs have a closer resemblance to the actual material. An atlas such as this is not intended as a "key" in the taxonomic sense. But it is a thing of beauty and wisdom valuable in extending the knowledge of those with less experience than its author; and who has more?