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7. Nestel, P. J., Caroll, K. F., Havenstein, N. Metabolism, 1970, 19, 1.8. MacDonald, I. Am. J. clin. Nutr. 1965, 16, 458.9. Lees, R. S. Clin. Res. 1965, 13, 549.

10. Porte, D., Jr. Bierman, E. L., Bagdade, J. D. Proc. Soc. exp. Biol.Med. 1966, 123, 815.

11. Antonis, A., Iles, C., Pilkington, T. R. E. Proc. Nutr. Soc. 1968,27, 2A.

12. Dunnigan, M. G., Fyfe, T., McKiddie, M. T., Crosbie, S. M. Clin.Sci. 1970, 38, 1.

13. Glueck, C. J., Levy, R. I., Fredrickson, D. S. Diabetes, 1969, 18, 739.14. McGandy, R. B., Hegsted, D. M., Stare, F. J. New Engl. J. Med.

1967, 277, 186, 242.15. Hardinge, M. G., Swarner, J. B., Crooks, H. J. Am. dietet. Ass.

1965, 46, 197.16. Abell, L. L., Levy, B. B., Brodie, B. B., Kendal, F. E. J. biol. Chem.

1952, 195, 357.17. van Handel E., Zilversmit, D. B. J. Lab. clin. Med. 1957, 40, 471.18. Lees, R. S., Hatch, F. T. ibid. 1963, 61, 518.19. Kaufmann, N. A., Poznanski, R., Blondheim, S. H., Stein, Y.

Israel J. med. Sci. 1966, 2, 715.20. Carlson, L. A., Lindstedt, S. Acta med. scand. 1968, suppl. 493.

Reviews of Books

Aphasiology and Other Aspects of LanguageMACDONALD CRITCHLEY, C.B.E., M.D., F.R.C.P. London:Edward Arnold. 1970. Pp. 405. E9.

Dr. Macdonald Critchley’s interest in speech disordersis well-known, and few, if any, neurologists write better.As he confesses in his preface, this book is not a text-book on aphasia, and many purists or mechanists mayfind it incomplete. It is largely a collection of Dr. Critchley’spapers and lectures, published or delivered mostly withinthe past 10 years. Inevitably, there is some repetition andduplication, but this is never tedious and usually serves toamplify points of importance in the text. Appreciating theobvious gaps in restricting himself to previously publishedwork, Critchley has written a series of additional chapterswhich give the book balance and depth. Its pages aboundin the felicitous phrases, flashes of humour, quotations,and literary allusions which characterise so much of hiswriting. Not every neurologist or research-worker interestedin aphasia will agree with everything he says; some will beirritated and a few even enraged. But those who read thisbook will delight in the author’s wide-ranging knowledgeand interests and in his mastery of language, in the widestsense; they will also be instructed and edified as Dr.

Critchley’s theses about the nature of language and speechand their disorders become increasingly clear. While somewill consider this to be a highly personal account, it is so

absorbing and logical, despite occasional flights of whimsy,as to represent an outstanding literary and (dare one sayit ?) scientific achievement. It is a somewhat costly pearl,but certainly one to possess.

Fundamentals of Clinical EndocrinologyREGINALD HALL, M.D., B.SC., M.R.C.P., senior lecturer in

medicine, JOHN ANDERSON, M.B., M.R.C.P., senior lecturer inmedicine, and GEORGE A. SMART, M.D., B.sc., F.R.c.P., pro-fessor of medicine, University of Newcastle upon Tyne.London: Pitman Medical. 1969. Pp. 418. 8Qs.

THIS book aims to present the fundamentals of endocrino-

logy for clinicians, and it succeeds. The text bears the stampof its authors’ wide clinical experience of modern endocrino-logy, and they wisely concentrate on the diagnosis of earlyendocrine disease before permanent and crippling changeshave developed. The arrangement is mainly conventional,with sections on the anterior and posterior pituitary and thethyroid, but a number of chapters are included dealing withtopics of special importance such as pregnancy, disorders ofgrowth, and hormonal syndromes associated with neo-

plasms. Tests of endocrine function are especially welldescribed, and useful appendices give all necessary practicaldetails. The book is up-to-date, and accurate apart froma few errors. For example, 1 g. vitamin D is said to equal40,000 i.u., and in another place vitamin D is referred to as ahormone. Many will take exception to the statements thatthe optimal vitamin-D intake is as high as 1800 i.u. daily,and not all agree that the long-acting thyroid stimulator isdetectable in a high proportion of patients with Graves’disease. However, this is clearly the best book of its sizeon clinical endocrinology.

The BreastDAVID M. WITTEN, M.D., M.S., consultant, section of roent-genology, Mayo Clinic, and assistant professor of radiology,Mayo Graduate School of Medicine, University of Minne-sota, Rochester, Minnesota. Chicago: Year Book MedicalPublishers. Chichester, Sussex: John Wiley & Sons. 1970.

Pp. 330.$20; 9 7s.THIS is the second atlas of tumour radiology sponsored

by the American College of Radiology. The object is to

provide, as far as possible, a uniform type of atlas formatthroughout the series with the minimum of text and asmuch space as possible devoted to high-quality illustrationswith helpful descriptive captions. Any references includedin the text are intended as supplementary reading, andexhaustive reference coverage is deliberately avoided. Thepresent volume deals with the basic concepts and tech-

nique of breast radiography, the appearances of the normalmammogram at varying ages, the appearances of benigndisease of the breast, and malignant tumours of the breast(which, rightly, occupies much more than half the book).Dr. Witten has certainly met the requirements of his remitin devoting about ten times as much space to illustrationsand their captions as he does to text. The illustrations areall excellent and the captions are clear, detailed, and

pertinent. The text is well arranged and is designed tolead the reader to the appropriate illustrations. The authorand publishers are to be congratulated upon the presenta-tion and upon the superb material set out in an authoritativework of great value to radiologists and surgeons.

The Reticulo-Endothelial SystemA. E. STUART, reader in pathology, University of Edinburgh.Edinburgh: E. & S. Livingstone, Toronto: Macmillan Co. ofCanada. 1970. Pp. 255. E6;$19.25.

THIS book is beautifully written, excellently produced,and magnificently illustrated; its publication has been

heavily subsidised by the Carnegie Trust. It tells the storyof the reticuloendothelial system from the early days of theclassical anatomists and pathologists. There is an extensivebibliography, and a number of historical references areincluded so that the reader can follow the trend of research" and incidentally learn that not all that is recent is new ".The great virtue of this book is its clarity. Since phagocyticcells were first identified by means of vital staining, theidentification and classification of these widely disseminatedcells has been a student’s nightmare. All is made plain,however, as Dr. Stuart deals with the reticulum cells whichform the pulp cords or cortical nodules of spleen and otherlymphatic organs, the phagocytic endothelial cells oflymphatic tissue, liver, or bone-marrow, and the migratingmacrophages of histiocytes of the blood and tissues. Thefunction of macrophages in handling antigens, their inter-action with antibody-forming cells, and their ability to trans-fer cellular immunity have all been intensively studiedlately. For some time the lymphocytes seemed dull andinert in comparison, so that A. R. Rich saw them as " phleg-matic spectators watching the turbulent activity of thephagocytes ". This view is at last giving way to some

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credible alternatives, and, in summarising the present posi-tion, this book is of considerable interest to the immuno-logist. The reactions provoked by bacteria and viruses,cancer, and homografts are also discussed and are of interestto pathologist and clinician. The reticuloendothelial systemdoes not fit into any one discipline. The author’s object hasbeen to provide a basic text for anybody who is interested inthe subject, whatever his parent discipline might be. In thishe has succeeded completely.

Cell FusionHENRY HARRIS, fellow of Lincoln College and professor ofpathology in the University of Oxford. London: Oxford

University Press. 1970. Pp. 108. 40s. (boards); 20s.

(paperback).IN the five years since Professor Harris and his colleague,

J. F. Watkins, produced the first viable interspecific hybridcells by attacking human (HeLa) and mouse (Ehrlichascites) cells in culture with inactivated Sendai virus, cellfusion has developed into an elegant technique for studyingnucleocytoplasmic relations in the expression of geneticinformation. In this book, based on the Dunham lecturesgiven at Harvard University last year, Harris reviews thepublished work on hybrid cells, much of which has beendone in his own department at Oxford. (In a year or two,he suggests, proliferation of experimental work using thetechnique will make selection and organisation for sucha review almost impossible.) His early observations onnuclear reactivation in end-cells (e.g., hen erythrocytesand rabbit macrophages) which had lost the power to

synthesise R.N.A. and D.N.A. led him to reject Jacob andMonod’s hypothesis of operator genes and diffusion of

information-carrying R.N.A. from nucleus and cytoplasm;and inevitably, in this book, he returns to this old hobby-horse and to his own explanation of genetic control,which places the nucleolus in a central role. A brief

description of recent work on dominance relationships inmalignancy introduces a sober note which indicates thatthe scope of cell fusion is far from exhausted.

Liver DiseaseA. PATON, M.D., F.R.c.r., physician, Dudley Road Hospital,Birmingham. London: William Heinemann Medical Books.1970. Pp. 185. 30s.

THIS book grew out of a series of lectures given to variousdoctors, not necessarily those specialising in medicine. Itcontains excellent accounts of the management of obstruc-tive jaundice and of the relationship between chronicalcoholism and liver damage. The sections on portalhypertension, ascites, and hepatic coma are also sound.There are, however, some inconsistencies—for instance,in discussing the frequency of severe jaundice in metastatichepatic disease and its relation to enlarged glands in theporta hepatis. Adequate details of treatment regimens arenot always given. The use of antifibrinolytic agents and ofheparin in the treatment of increased fibrinolysis and intra-vascular coagulation in cirrhosis is considered in a fewsentences with no mention of the care needed in their use.There are also some errors (including one in the firstsentence of the book where the liver is said to be one-fifthof the body-weight). Some of the views expressed indifferent sections are not widely accepted-e.g., thatnarcotics such as opium and marihuana may cause cirrhosis,that there may be at least three distinct viruses in infectioushepatitis, and that renal failure is no commoner in patientsoperated on for obstructive jaundice than in those under-going other types of major surgery. There may indeed bea gap between the sections on liver disease in under-graduate textbooks and the larger monographs on liverdisease, but it would seem a pity to separate liver diseasefrom gastroenterology early in postgraduate training.

U.C.H. Notes on PsychiatryEdited by R. F. TREDGOLD and H. H. WOLFF, departmentof psychological medicine, University College Hospital.London: Gerald Duckworth. 1970. Pp. 293. 50s.

THIS is not intended as an integrated, coherent, andhomogeneous textbook. Prepared for medical students toaugment psychiatric teaching, it is a collection of

" broad-sheets " written over numerous years by many colleagues.The approach is useful in that sections can be replaced byupdated information. The sections on certain of the

psychosomatic disorders, such as ulcerative colitis, anorexianervosa, and asthma, are especially successful. The troublewith multiauthor notes is that the editors are faced withcontributions of discrepant orientation and intention. Adivisive quality is hard to avoid, especially in the frag-mentation of "

psychodynamic " from more clinicallybased areas. For example, sleep and dreaming is discussedin terms of symbolisation on p. 18, and in terms of levels ofunconsciousness and the reticular hypothalamic system onp. 37: one reads that " the unconscious or ’ latent’ dreamcontent is modified or disguised by the so-called censorwhich converts it into the actual or ’ manifest’ dream ",and elsewhere that " Dreams have been associated withbursts of alpha activity ". The student may well needclarification whether synthesis can or need be attemptedbetween the two levels of discourse. The book advocatesa sceptical approach to the nosology of psychiatric dis-orders but agrees that some classification must be putforward. In the framework for diagnosis " in terms ofpersonality reacting to stress " the student clinician is notcalled upon to name the disorder from which the patient isconsidered to be suffering. The section on hysteria com-ments on the somatic conversion reactions, but does notdiscuss the dissociative hysterical psychoneurotic dis-orders. That amnesia can be hysterical, which.casualtyofficers will need to know, figures neither under" amnesia " nor under " memory ". In the chapter onPsychopathic Personality or Pathological Personality,schizoid personality is referred to only briefly; and theterm is not in the index. Nor are hysterical or obsessionalpersonality disorders, and neither gets much attention inthe text. "

Psychotherapy directed at releasing aggressionhas had some success in reducing hypertension ", and thereader is referred to a paper published 18 years ago. He

may well expect that a promising treatment approach to adisease as serious as hypertension would have had furthertrial. But his confidence in this role for psychotherapy willnot be enhanced by the remark:

"

Malignant hypertensionhas been improved by leucotomy, presumably because itenabled the patient to benefit from psychotherapy ..."One hopes no student will be left with the impression thatrecourse to the former is a necessary therapeutic prelude tobenefit from the latter.

Aids to Postgraduate MedicineJ. L. BURTON, M.B., B.SC., M.R.C.P., senior registrar, univer-sity department of dermatology, Newcastle upon Tyne.Edinburgh: E. & S. Livingstone. 1970. Pp. 136. 20s.

THIS book consists of lists for revision for examinationsand is specifically intended for candidates for the M.R.C.P. ;it applies to both parts I and 11 (i.e., the written, clinical, andoral examinations). There is a most valuable four-pageintroduction giving hints on the clinical examination, withuseful suggestions for presenting the findings. This part is

very sensible and has obvious application beyond theM.R.C.P. and other examinations. Another useful section isthe bibliography at the end, for those unsure of what to read.It could be more selective, but most candidates would, inany case, prepare along the lines he suggests. Dr. Burton

gives no advice about journals; his impressions might havebeen interesting to editors and examiners, as well as candi

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dates. The bulk of the book, however, is a different matter.There are long and usually accurate lists of causes, symp-toms, signs, and results-really the sort of material forrevision that candidates should themselves prepare as theyacquire their knowledge. If this book helps them with theirown lists, it will have achieved a worthwhile purpose, butone fears that many will try to memorise Dr. Burton’sefforts and fail to achieve his aim of encouraging " anorderly and rational approach to the subject."

Hearing and Noise in IndustryW. BURNS, c.B.E., M.B., D.sc., professor of physiology in theUniversity of London at Charing Cross Hospital MedicalSchool; and D. W. ROBINSON, B.SC., D.SC., M.LE.E., head ofthe acoustics section, National Physical Laboratory. London:H.M. Stationery Office. 1970. Pp. 241. 35s.

43 PAGES of text and 198 pages of appendices constitutethis research report of a large-scale survey started in 1962by the Medical Research Council and the National PhysicalLaboratory. Their terms of reference were to do fieldstudies to evolve quantitative relations between noise

exposure and deterioration of hearing. A new concept, thatof " noise immission level", is advanced; this consists of ameasure of noise exposure as a function of noise intensityand time. Hearing loss was found to be proportional to thisnoise-immission level. This allows a system for predictionof the hearing deteriorations to be expected from specifiedexposures within a wide range of occupational noises, withor without use of ear protection. In turn, the necessarymaterial for a formal code of practice for the preservation ofhearing in industry is provided. For anyone working inresearch or extensively in the more practical aspects ofhearing conservation, this book is of very great interest andvalue. If, as seems likely, the material in this book is

adopted by the Government for purposes of legislationunder the Industrial Injuries Act and also under theFactories Act, then the book will become a vital item in thelibrary of industrial medical officers or hygienists concernedwith implementation of these Acts. Whatever the applica-tions of the book may be, the authors and the team ofsupporting workers are to be congratulated on a very care-ful piece of research and on their efforts to prepare thereport in such detail.

Surgeons in the FieldJOHN LAFFIN. London: J. M. Dent. 1970. Pp. 306. 50s.

THERE are some unaccountable gaps in medical literature.One need which persists is for a comprehensive history ofmilitary surgery; but this book goes a long way towards fill-ing the gap. Perhaps previous authors who aspired to pro-viding such a work have been deterred by the thought thatit would be subject to criticism from at least three sides-from soldiers, doctors, and historians. Mr. Laffin provesthat he has little to fear from any of these, and his medicallyqualified readers will admire his accuracy. (How manydoctors would get the name of the St. John AmbulanceAssociation correct ?) The evolution of the ambulance is setout very concisely, and with some unusual illustrations.

Originally the word " never meant anything but a field hos-pital attached to an army "; only in Britain was it applied toa conveyance. But a book is not to be praised only becauseit contains, amongst a profusion of dates, technical infor-mation, and statistics, no obtrusive errors. The principalmerit of this one is the skill with which its author has dealtwith a theme which, though very exciting, could have beenvery tedious. In the event, it is a book which can be readat several different levels-by the layman, as easily as

a good detective novel, and by the historian. Nor shouldthe serving medical officer overlook it. He will find thatthe smallest details of the way in which he still examines arecruit were very well described over one hundred and

thirty years ago: and will be reminded that his predecessorsnot only examined recruits, but also paved the way to ourunderstanding of yellow-fever and ophthalmia, Malta

fever, guineaworm infestation, beriberi, and many otherconditions.

Problems and Progress in Medical CareEssays on Current Research: Fourth Series. Edited byGORDON McLACHLAN. London: Oxford University Press.1970. Pp. 204. 35s.

THIS book contains essays about planning and practice inthe National Health Service in relation to beds in a region,prescriptive screening of schoolchildren, the organisation ofsupporting services in a large region, the operational syntaxof medical records, the Glasgow linkage system of child-health records, and an experiment in management educationfor senior nurses. These problems are among those chosenby the Nuffield Provincial Hospitals Trust as worthy ofsupport and investigation.. There is a very excellent articleby Knox and Dale, on syntax of medical records, dealingwith the different approaches to analysing computerisedrecords. They challenge the lighthearted way most peopleview records, and their analysis raises issues in relation tothe control of errors in medicine, the concept of usage ofmedical terms, and the relationship between data processingand the process of inference. This book discusses somevital problems in the N.H.S.: it can be recommended to allthose who are looking for solutions.

Diseases of the Colon and Anorectum (2nd ed.

Philadelphia and London: W. B. Saunders. 1969. Pp. 1375.Two vols. E27 12s. 6d.).-Dr. Robert Turell (Albert EinsteinCollege of Medicine) has gathered together a team of well-recognised authorities on colonic disorders. The subject isdealt with comprehensively, and this book will cater for awide variety of interests—paediatrician, geriatrician, psychia-trist, and gynaecologist are among the specialists who willfind here much valuable information presented in a clearand concise style. The chapters on anaesthesia, incisions inthe abdominal wall, and intestinal transplantation are alittle superfluous; but the chapters on medicolegal problemsof colonic practice and the patient’s view of a colostomy fitin admirably. The section on anatomy is clear and concise,and physiology is dealt with both separately and throughoutthe text. Pathology is well covered, and the illustrations aregood. The medical aspects of the subject are, on the whole,dealt with in a more compact and efficient manner than the

surgical conditions. Sigmoid myotomy for the treatment ofdiverticulitis and electrical stimulation of the anal sphincterin the management of incontinence are surprising omissions.The section on outpatient procedures for minor anorectalconditions is most useful. The multiauthor approach leadsto unevenness and some repetition.

The Vocabulary of Science (London: WilliamHeinemann. 1970. Pp. 184. 42s.).-Today even a

rudimentary classical education is denied those specialisingearly in science, and students of all ages are going to find itincreasingly difficult to work out the meanings of wordswith Latin or Greek roots; and research-workers establish-

ing their own little niches will find it hard to devise newterms. But, just as elegant English is possible with a

vocabulary of well under a thousand words, a workingcompendium of scientific terms has been constructed from asmall group of classical roots. In this witty crash courseDr. Lancelot Hogben, F.R.S., shows us how, and providesthe rules, lists of Latin and Greek root words, and manyexamples.

Galen on Sense Perception. This book, reviewed in TheLancet on March 7, is published by S. Karger AG (Basle andNew York) and distributed in the U.K. by the Academic Press.