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It is an interesting fact that the citric acid content in blood has apparently increased in patients with advanced alveolar atrophy.1 Insofar as this hypercitricemia appears to be associated with some types of periodontal disease, it was thought to be of interest to investigate the effect of the many factors that influence the citric acid.Numerous workers have studied the effect of fluoroacetate2, 3 vitamin D,4 5 and parathyroid hormone6 on the citric acid and enzyme systems that may be concerned in the formation or destruction of citric acid. Recently, Banerjee, Biswas, and Singh7 have found that the citric acid content in the tissues has significantly increased in scurvy and that treatment with insulin in such cases has brought the level of citric acid to normal. Agrell, Lindell, and Westling8 have found that adrenalectomy has been followed by a significant increase in the citric acid content of blood serum in guinea pigs and that this increase could have been prevented by cortisone or desoxycorticosterone.However, few workers have studied in detail the effect of adrenal cortical hormone on citric acid and have observed simultaneously the periodontal tissues. This paper deals with the influence of adrenocorticotropic hormone (ACTH), cortisone, and desoxycorticosterone (DOC) on the blood citric acid content in normal and scorbutic animals. It also demonstrates the histologic changes in the periodontal tissues which acompany the changes in blood citric acid. MATERIALS AND METHODSFemale guinea pigs weighing 320-70 gm. were initially fed on a vitamin C-deficient diet, made adequate by the addition of fresh vegetables. This diet plus water was continued ad libitum for 10 days. Then they were divided into 8 groups, 4 groups continuing with the adequate diet and 4 groups restricted to the vitamin C-deficient diet. Animals in 3 groups with adequate nutrition and 3 groups on the scorbutic diet were given intraperitoneal injections of hormones each day for 17 days. The other 2 groups were continued on the respective diets only. The groups and the hormones injected were as follows-Division A = normal adequate diet: 1 no injections, 2 ACTH 5 units daily, 3 = cortisone 5 mg. daily, 4 DOC 5 mg. daily; Division B vitamin C-deficient diet: 5 = no injections, 6 ACTH 5 units daily, 7 cortisone 5 mg. daily, 8 = DOC 5 mg. daily.On the seventeenth day, the animals were allowed water but no food for 15-18 hours. Then blood was collected by heart puncture. Blood citric acid was determined

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pituitary antidiuretic hormone, renal hlemodynamic factors, and the secretion of adrenocortical salt-retaining hormones. Of these, the first and the third are, the author believes, by far the most important and what happens to salt and water balance during the postoperative period is, in his view, largely determined by the relationship between these two. He suggests that if the release of the antidiuretic hormone is only short-lived and that of the salt-retaining corticoids delayed in onset, the salt which is retained on the day of operation will on the day after operation be excreted, with diuresis, while salt and water retention will occur during the day after that. The pattern will therefore be one of separated retention. If, on the other hand, the secretion of antidiuretic hormone lasts until the day after operation and there is an overlap with the secretion of salt-retaining corticoids, then on the day after operation a pronounced diuresis will not occur, and the pattern of sodium retention will be distinct or coalescent. Unfortunately at present no direct evidence is adduced for this interesting hypothesis, which does, however, provide a ready explanation of much of what is seen in practice.With the use of intravenous replacement has come the need to study the maintenance of the patient over long periods of time by means of intravenous ailments. Full consideration of these aspects lies beyond the scope of the volume under review but they are lightly touched upon, and the big problem of the negative nitrogen balance in patients maintained on intravenous electrolyte solutions and 5 % glucose, is briefly discussed.The book is well illustrated with clear diagrams, into the construction of which much thought has clearly gone. The writing is on the whole satisfactory, though occasionally the construction of the sentences makes the readingXa little hesitant. The index is satisfactory and the production is good.In the words of Thomas Gale (1586) "The restoring of that which is lost, is properly the office of nature, as to engender flesh, blood, and such lyke partes as are to be engendered. Notwithstanding the chirurgion herein is nature's minister." To the surgical ministers of nature Mr. Le Quesne's book is to be recommended, and particularly to those whose knowledge of modern ideas and practice with respect to fluid balance needs adding to or bringing up to date. Dental and Oral X-ray Diagnosis.