775 DISCUSSION
hypothesis implies that impairment of hepatic synthesis renders the organism susceptible to stresses which would normally have little effect. This vulnerability has been extensively noted and is expressed in the concept of "increased cerebral sensitivity" of Schenker.28 Infection or injury may stimulate glucagon release which then becomes greatly amplified by persistent hyperammonsemia. Ingested protein may contribute to hyperaminoacidaemia and hyperammonaemia both primarily, when it is metabolised, and also secondarily, when aminoacids and ammonia produced by its breakdown stimulate glucagon secretion. Low levels of
Reviews of Books
This
urea
branched-chain aminoacids in the blood enhance the uptake by brain of phenylalanine, tyrosine, and tryptophan, while a high rate of glutamine synthesis in brain promotes the exchange of brain glutamine for the neutral aminoacids in blood. Our hypothesis also implies that therapeutic benefit may be obtained from a variety of methods and agents which either reduce intestinal absorption of ammonia and aminoacids (by cathartics or oral antibiotics), lower blood ammonia, or reduce brain ammonia uptake and hence brain glutamine synthesis or increase competition with aromatic aminoacids at the blood-brain barrier (infusion of branched-chain aminoacids). Other lines of treatment may also be useful-for example, the success of levodopa in restoring consciousness in encephalopathic patients suggests that it is possible to intervene at the level of neurotransmitter metabolism itself. Further progress in this area requires finding some common basis for integrating the diversity of observations, theories, and treatments. This hypothesis is directed toward that
goal. of
Requests for reprints should be addressed to J. E. F., Department Surgery, University of Cincinnati Medical Center, 231 Bethesda
Avenue, Cincinnati, Ohio 45267, U.S.A. REFERENCES
Human Growth Vol. III, Neurobiology and Nutrition. Edited by FRANK FALKNER,Wright State University of Medicine, Yellow Springs, Ohio,
NER,Wright State University of Medicine, YellowHealth, Springs, Ohio, U.S.A., TANNER, J. and M. Institute of Child London: Bailliere Tindall. 1979. Pp. 606. /;24.75.
London.
THIS volume completes the trilogy on human growth which will doubtless reign supreme for many years as the outstanding work in its field. Neurobiology and Nutrition has 26 contributors, and it concludes with a history of growth studies by Professor Tanner. The master plan for the organisation of the neurobiology section (9 chapters) is not very clear. Subjects range from the embryology of perceptual development to neonatal behaviour, with brain organisation and sexual differentiation (for which there seems to be no evidence in primates), critical periods of growth, patterns of early neurological development, and other matters being touched upon on the way. Some of the material is only remotely connected with growth-for example, that in the chapters on the development of sleep organisation (by C. Dreyfus-Brisac) and on the neuronal control of breathing (by F. J. Schulte). There is more cohesion in the nutrition section, which covers nutrition-
growth relationships, protein-energy malnutrition, obesity, malnutrition and mental development, and sociological and epidemiological aspects of nutrition and growth. The only other general deficiencies of the book are the heterogeneity of style (for example, the difference between the stimulating review of brain plasticity and the dull personal research data on the evolution of 11 regions of the brain) and the inconsistency of chapter structure in which some chapters include excellent summaries and others none. Particularly good chapters in the neurobiology section include the useful review of neonatal neurology (I. Brandt) and the well-written article
Oldendorf WH. Transport of metabolic substrates through J Neurochem 1977; 28: 5-12. 14. Hjelle JT, Baird-Lambert J, Cardinale G, Spector S, Undenfriend S. Isolated micro-vessels: the blood-brain barrier in vitro. Proc Natl Acad Sci USA 13.
Pardridge WM,
the blood-brain barrier.
1978, 75: 4544-48. 1. Baldessarini RJ, Fischer JE. Serotonin metabolism in rat brain after surgical diversion of the portal venous circulation. Nature New Biol 1973; 245:
25-28.
2. Cummings MG, Soeters PB, James JH, Keane JM, Fischer JE. Regional brain indoleamine metabolism following chronic portocaval anastomosis in the rat. J Neurochem 1976; 27: 501-09. 3. Curzon G, Kantameneni D, Fernando JC, Woods MS, Cavanagh JB. Effects of chronic portocaval anastomosis on brain tryptophan, tyrosine and 5-hydroxytryptamine. J Neurochem 1975; 24: 1065-70. 4. Smith A, Rossi-Fanelli F, Ziparo V, James JH, Perelle B, Fischer JE. Alterations in plasma and CSF amino acids, amines, and metabolites in hepatic coma. Ann Surg 1978; 187: 343-50. 5. Young SN, Lal S, Sourkes F, Feldmuller F, Aronoff A, Martin JB. Relationships between tryptophan in serum and CSF, and 5-hydroxyindoleacetic acid in CSF of man: effect of cirrhosis of liver and probenecid administration. J Neurol Neurosurg Psychiat 1975; 38: 322-30. 6. Fischer JE, Funovics JM, Aguirre A, et al. The role of plasma amino acids in hepatic encephalopathy. Surgery 1975; 78: 276-88. 7 James JH, Hodgman JM, Funovics JM, Fischer JE. Alterations in brain octopamine and brain tyrosine following portocaval anastomosis in rats. J Neurochem 1976; 27: 223-27. 8
Fischer JE, Rosen HM, Ebeid AM, James JH, Keane JM, Soeters PB. The effect of normalization of plasma amino acids on hepatic encephalopathy
Surgery 1976; 80: 77-91. HN, Fernstrom JD, Wurtman RJ. Insulin, plasma amino acid imbalance, and hepatic coma. Lancet 1975; i, 722-24. 10. James JH, Escourrou J, Fischer JE. Blood-brain neutral amino acid transport activity is increased after portocaval anastomosis. Science 1978; 200: in man.
9. Munro
1395-97.
11. James JH, Hodgman JM,
Funovics JM, Yoshimura N, Fischer JE. Brain tryptophan, plasma free tryptophan and distribution of plasma neutral
amino acids. Metabolism 1976; 25: 471-76. 12. Sherwin R, Yoshi P, Hendler R, Felig P, Conn HO. Hyperglucagonemia in Laennec’s cirrhosis: the role of portal-systemic shunting. N Engl J Med
1974; 290: 239-42.
15. Fernstrom JD, Faller DJ. Neutral amino acids in brain: changes in response to food ingestion. J Neurochem 1978; 30: 1531-38. 16. Oldendorf WH, Szabo J. Amino acid assignment to one of three blood-brain barrier ammo acid carriers. Am J Physiol 1976; 230: 94-98. 17. Soeters PB, Weir G, Ebeid AM, Fischer JE. Insulin, glucagon, portal-systemic shunting and hepatic failure in the dog. J Surg Res 1977; 23: 183-88. 18. Nance FN, Batson RC, Kline DG. Ammonia production in germ-free Eck fistula dogs. Surgery 1971; 70: 169-74. 19. Rudman D, Galambos JT, Smith RB III, Salam AA, Warren WD. Comparison of the effect of various amino acids upon the blood ammonia concentration of patients with liver disease. Am J Clin Nutr 1973; 26: 916-25. 20. Strombeck DR, Rogers Q, Stern JS. The effects of intravenous ammonia infusion on plasma levels of amino acids, glucagon and insulin in dogs. Gastroenterology 1978: 74: 1165 (abstr). 21. Fernstrom JD, Wurtman RJ. Elevation of plasma tryptophan by insulin in the rat. Metabolism 1972; 21: 337-43. 22. Williams AH, Kyu MH, Fenton JCB, Cavanagh JB. The glutamate and glutamine content of rat brain after portocaval anastomosis. J Neurochem
1972; 19: 1073-77. Gjedde A, Lockwood AH, Duffy TE, Plum F. Cerebral blood flow and metabolism in chronically hyperammonemic rat: effect of an acute ammonia challenge. Ann Neurol 1978; 3: 325-30. 24. Hawkins RA, Miller AL, Nielsen RC, Veech RL. The acute action of ammonia on rat brain metabolism in vivo. Biochem J 1973; 134:
23.
1001-08. 25. Hourani BT, Hamlin EM, Reynolds TB. Cerebrospinal fluid glutamine as a measure of hepatic encephalopathy. Arch Intern Med 1971; 127: 1033-36. 26. Toth J, Lajtha A. Rates of exchange of free amino acids between plasma and brain in mice. Neurochem Res 1977; 2: 149-60. 27. Jaikin A, Agrest A. Cerebrospinal fluid glutamine concentrations in patients with chronic hypercapnia. Clin Sci 1969; 36: 11-14. 28. Schenker S. Hepatic coma: current concepts of pathogenesis. Viewpoints Dig Dis 1970; 2: 1-4. 29. Pardridge WM, Oldendorf WH. Kinetic analysis of blood-brain barrier transport of amino acids. Biochim Biophys Acta 1975; 401: 128-36.
776
Scott), although it concenneurological development and does not Dobbing. In the nutrition section R. L. and K. E. Bergmann give plenty of useful data in their piece on nutrition and growth, but there is too heavy a reliance on S. Fomon’s work. Joaquin Gavioto contributes a characteristically readable and stimulating survey of many years of work on nutrition and mental development. The only disappointing chapter is that on obesity (G. F. Cahill and Aldo Rossini) which is too brief to be of much use and contains no discussion on the role of energy expenditure in obesity. This book is as attractive to the eye as its two companions (see Ldncet, June 2, p. 1169). Reference lists are up to date.
on
critical
periods
in
growth (J.
P.
behavioural than on refer to work by John
trates more on
believes -indeed takes it for granted-that coronary heartdisease is caused to a major and decisive degree by nutritional factors. But unlike many others with similar views, he is prepared to identify and discuss the weak links in the chain of evidence. The recent decline in coronary heart-disease mortality in some countries is, unfortunately, not dealt with in much detail. This decline is perhaps the most intriguing epidemiological development for many years. There is little doubt the decline is real, but its causes have not yet been identified with certainty; unravelling them will have major implications for prevention. Other chapters discuss the interrelation between risk factors, lysosomes, and vascular disease, and the molecular properties and clinical relevance of lipoprotein lipase. Each is reasonably intelligible to the non-expert, who will be able to see their clinical relevance.
The Natural History of Mind
Exploration. GORDON RATTRAY TAYLOR, London: Secker Warburg. 1979. Pp. 370. 6.95
An
,
&
IN The Natural History of Mind Gordon Rattray Taylor shows us once more that he is a stylish, knowledgeable, and reflective writer. Here he explores the brain and the mind by reviewing mainly modern research; however, he does cover a large territory, which includes some ancient work. The earlier chapters describe the brain and some of the theories about its function. Some advances in the more physical of the brain sciences are described in the later chapters; but it is largely the phenomena of conscious experience and the dependence or not upon the brain which preoccupy the author-hallucinations, depersonalisation, multiple personality, dreaming, subliminal perception, and other such related phenomena. Reading this easily assimilated survey is like going on a voyage of exploration of this vast and complicated area. A good feature of the book is the wide range of the illustrative material in the text which is the result of ten years of preparation-the author does not hesitate to draw on material from philosophy, literature and the arts and there is much philosophical discourse on controversial matters. The book will please both students of the subject and the general reader.
Atherosclerosis Reviews. Vol V. Edited by RoDOLFO PAOLETTI, University of Milan, Italy, and ANTONIO M. GOTTO, JR. Baylor College of Medicine, Houston, Texas. New York: Raven Press. 1979. Pp. 264.$31.20.
THIS series has already dealt with many topics since the first volume appeared in 1976. Advances in the field of atherosclerosis are not so rapid that contributions appearing at this rate can all cover new ground, and a good deal of this book is a repetition of what has appeared in earlier volumes. However, the book can be recommended for selective reading. Joan Slack deals comprehensively with clinical, genetic, and biochemical aspects of familial hypercholesterolaemia, a topic which has been inadequately discussed over the years-the disorder is of considerable interest, not only in its own right, but also because it may in some respects be a valuable model for atheroma and coronary heart-disease as a whole. G. R. Thompson’s chapter on the management of familial hypercholesterolaemia and new approaches to the treatment of atherosclerosis will be useful to clinicians who need authoritative, up-to-date guidance on the value of dietary modification, drugs, or surgery. He also describes the techniques and early results of plasma exchange, a safe procedure which can be done on an outpatient basis. There is no doubt about its dramatic short-term effect on the plasma cholesterol level, which may be more than halved in both homozygotes and heterozygotes. Patients with angina appear to improve, but more experience is needed before beneficial clinical effects for this condition can be claimed with any confidence. Epidemiologists will probably find F. H. Epstein’s contribution more stimulating than most run-of-the-mill accounts of nutrition and atherosclerosis. He
Boswell’s Clap and Other Essays Medical
Analyses of Literary Men’s Afflictions. WILLIAM B. OBER, Hackensack Hospital, New Jersey. Carbordale and Edwardsville: Southern Illinois University Press. London and Amsterdam: Feffer & Simons. 1979. Pp. 290.$17.50.
DESPITE an arresting title, the first of these ten essays on the maladies of famous writers sits a little uneasily amongst the rest. It is by no means certain that all Boswell’s surviving papers have yet been discovered, for half a dozen separate collections have come to light even in the past fifty years: but his promiscuity is established and his twenty distinct attacks of gonorrhoea are well documented. Before attributing this unenviable record, as Dr Ober does, to childhood repressions and excessive parental piety, one must set it against that of some of his contemporaries (and, let it be admitted, against that of some present-day patients). There is no doubt, however, that his indulgences hastened his death, from renal failure consequent upon chronic urinary obstruction. The author’s erudition does emerge brilliantly when he turns his attention to Swinburne, and postulates that a difficult birth, and probable cerebral anoxia, may well have determined the physical and mental peculiarities of the poet’s life. His hyperkinesia and unusual physiognomy have been adequately attested already: masochistic practices and dipsomania are now convincingly presented as features of a single syndrome. A brief review cannot convey an adequate impression of Dr Ober’s literary skill, or of the depth to which he has researched all his subjects, particularly Cowper (obsessed by visions of bleeding, and of flagellation) and John Wilmot, second earl of Rochester (haunted by a compulsive sexuality, but frustrated by ambivalence and impotence). No other book by any histopathologist is likely to be as widely read, and admired, by exponents of a very different discipline, as this.
New Editions in General Medicine.-2nd ed. Edited by Thomas B. Arthur Z. Eisen, Klaus Wolff, Irwin M. Freedberg & K. Frank Austen. Maidenhead, Berks: McGraw-Hill. 1979. Pp. 1884.
Dermatology
Fitzpatrick,
47.60. Immunopathology of
the Skin.-2nd ed. By Ernst H. Beutner, Tadeusz P. Chorzelski, and Samuel F. Bean. Chichester, Sussex: Wiley. 1979. Pp. 496.[23.80. Care of the Trauma Patient.-2nd ed. By G. Tom Shires. Maidenhead, Berks: McGraw-Hill. Pp. 642. 1979. 22.15. Understanding ECG’s in Infants and Children.-2nd ed. By L. C. Harris and Ellen Feinstein. Boston: Little Brown, London: Quest. 1979. Pp. 109.8.40,$12.50. ICHPPC-2 (International Classification of Health Problems in Prr mary Care).-2nd ed. Prepared by WONCA. 1979. Pp. 146. £8.50
(boards); £3.95 (papercover). Better Patient Care Through Nursing Research.-2nd ed. B" Faye G. Abdellah & Eugene Levine. West Drayton, Middx: Colher Macmillan. 1979. Pp. 753. 12.75.
hypothesis implies that impairment of hepatic synthesis renders the organism susceptible to stresses which would normally have little effect. This vulnerability has been extensively noted and is expressed in the concept of "increased cerebral sensitivity" of Schenker.28 Infection or injury may stimulate glucagon release which then becomes greatly amplified by persistent hyperammonsemia. Ingested protein may contribute to hyperaminoacidaemia and hyperammonaemia both primarily, when it is metabolised, and also secondarily, when aminoacids and ammonia produced by its breakdown stimulate glucagon secretion. Low levels of
Reviews of Books
This
urea
branched-chain aminoacids in the blood enhance the uptake by brain of phenylalanine, tyrosine, and tryptophan, while a high rate of glutamine synthesis in brain promotes the exchange of brain glutamine for the neutral aminoacids in blood. Our hypothesis also implies that therapeutic benefit may be obtained from a variety of methods and agents which either reduce intestinal absorption of ammonia and aminoacids (by cathartics or oral antibiotics), lower blood ammonia, or reduce brain ammonia uptake and hence brain glutamine synthesis or increase competition with aromatic aminoacids at the blood-brain barrier (infusion of branched-chain aminoacids). Other lines of treatment may also be useful-for example, the success of levodopa in restoring consciousness in encephalopathic patients suggests that it is possible to intervene at the level of neurotransmitter metabolism itself. Further progress in this area requires finding some common basis for integrating the diversity of observations, theories, and treatments. This hypothesis is directed toward that
goal. of
Requests for reprints should be addressed to J. E. F., Department Surgery, University of Cincinnati Medical Center, 231 Bethesda
Avenue, Cincinnati, Ohio 45267, U.S.A. REFERENCES
Human Growth Vol. III, Neurobiology and Nutrition. Edited by FRANK FALKNER,Wright State University of Medicine, Yellow Springs, Ohio,
NER,Wright State University of Medicine, YellowHealth, Springs, Ohio, U.S.A., TANNER, J. and M. Institute of Child London: Bailliere Tindall. 1979. Pp. 606. /;24.75.
London.
THIS volume completes the trilogy on human growth which will doubtless reign supreme for many years as the outstanding work in its field. Neurobiology and Nutrition has 26 contributors, and it concludes with a history of growth studies by Professor Tanner. The master plan for the organisation of the neurobiology section (9 chapters) is not very clear. Subjects range from the embryology of perceptual development to neonatal behaviour, with brain organisation and sexual differentiation (for which there seems to be no evidence in primates), critical periods of growth, patterns of early neurological development, and other matters being touched upon on the way. Some of the material is only remotely connected with growth-for example, that in the chapters on the development of sleep organisation (by C. Dreyfus-Brisac) and on the neuronal control of breathing (by F. J. Schulte). There is more cohesion in the nutrition section, which covers nutrition-
growth relationships, protein-energy malnutrition, obesity, malnutrition and mental development, and sociological and epidemiological aspects of nutrition and growth. The only other general deficiencies of the book are the heterogeneity of style (for example, the difference between the stimulating review of brain plasticity and the dull personal research data on the evolution of 11 regions of the brain) and the inconsistency of chapter structure in which some chapters include excellent summaries and others none. Particularly good chapters in the neurobiology section include the useful review of neonatal neurology (I. Brandt) and the well-written article
Oldendorf WH. Transport of metabolic substrates through J Neurochem 1977; 28: 5-12. 14. Hjelle JT, Baird-Lambert J, Cardinale G, Spector S, Undenfriend S. Isolated micro-vessels: the blood-brain barrier in vitro. Proc Natl Acad Sci USA 13.
Pardridge WM,
the blood-brain barrier.
1978, 75: 4544-48. 1. Baldessarini RJ, Fischer JE. Serotonin metabolism in rat brain after surgical diversion of the portal venous circulation. Nature New Biol 1973; 245:
25-28.
2. Cummings MG, Soeters PB, James JH, Keane JM, Fischer JE. Regional brain indoleamine metabolism following chronic portocaval anastomosis in the rat. J Neurochem 1976; 27: 501-09. 3. Curzon G, Kantameneni D, Fernando JC, Woods MS, Cavanagh JB. Effects of chronic portocaval anastomosis on brain tryptophan, tyrosine and 5-hydroxytryptamine. J Neurochem 1975; 24: 1065-70. 4. Smith A, Rossi-Fanelli F, Ziparo V, James JH, Perelle B, Fischer JE. Alterations in plasma and CSF amino acids, amines, and metabolites in hepatic coma. Ann Surg 1978; 187: 343-50. 5. Young SN, Lal S, Sourkes F, Feldmuller F, Aronoff A, Martin JB. Relationships between tryptophan in serum and CSF, and 5-hydroxyindoleacetic acid in CSF of man: effect of cirrhosis of liver and probenecid administration. J Neurol Neurosurg Psychiat 1975; 38: 322-30. 6. Fischer JE, Funovics JM, Aguirre A, et al. The role of plasma amino acids in hepatic encephalopathy. Surgery 1975; 78: 276-88. 7 James JH, Hodgman JM, Funovics JM, Fischer JE. Alterations in brain octopamine and brain tyrosine following portocaval anastomosis in rats. J Neurochem 1976; 27: 223-27. 8
Fischer JE, Rosen HM, Ebeid AM, James JH, Keane JM, Soeters PB. The effect of normalization of plasma amino acids on hepatic encephalopathy
Surgery 1976; 80: 77-91. HN, Fernstrom JD, Wurtman RJ. Insulin, plasma amino acid imbalance, and hepatic coma. Lancet 1975; i, 722-24. 10. James JH, Escourrou J, Fischer JE. Blood-brain neutral amino acid transport activity is increased after portocaval anastomosis. Science 1978; 200: in man.
9. Munro
1395-97.
11. James JH, Hodgman JM,
Funovics JM, Yoshimura N, Fischer JE. Brain tryptophan, plasma free tryptophan and distribution of plasma neutral
amino acids. Metabolism 1976; 25: 471-76. 12. Sherwin R, Yoshi P, Hendler R, Felig P, Conn HO. Hyperglucagonemia in Laennec’s cirrhosis: the role of portal-systemic shunting. N Engl J Med
1974; 290: 239-42.
15. Fernstrom JD, Faller DJ. Neutral amino acids in brain: changes in response to food ingestion. J Neurochem 1978; 30: 1531-38. 16. Oldendorf WH, Szabo J. Amino acid assignment to one of three blood-brain barrier ammo acid carriers. Am J Physiol 1976; 230: 94-98. 17. Soeters PB, Weir G, Ebeid AM, Fischer JE. Insulin, glucagon, portal-systemic shunting and hepatic failure in the dog. J Surg Res 1977; 23: 183-88. 18. Nance FN, Batson RC, Kline DG. Ammonia production in germ-free Eck fistula dogs. Surgery 1971; 70: 169-74. 19. Rudman D, Galambos JT, Smith RB III, Salam AA, Warren WD. Comparison of the effect of various amino acids upon the blood ammonia concentration of patients with liver disease. Am J Clin Nutr 1973; 26: 916-25. 20. Strombeck DR, Rogers Q, Stern JS. The effects of intravenous ammonia infusion on plasma levels of amino acids, glucagon and insulin in dogs. Gastroenterology 1978: 74: 1165 (abstr). 21. Fernstrom JD, Wurtman RJ. Elevation of plasma tryptophan by insulin in the rat. Metabolism 1972; 21: 337-43. 22. Williams AH, Kyu MH, Fenton JCB, Cavanagh JB. The glutamate and glutamine content of rat brain after portocaval anastomosis. J Neurochem
1972; 19: 1073-77. Gjedde A, Lockwood AH, Duffy TE, Plum F. Cerebral blood flow and metabolism in chronically hyperammonemic rat: effect of an acute ammonia challenge. Ann Neurol 1978; 3: 325-30. 24. Hawkins RA, Miller AL, Nielsen RC, Veech RL. The acute action of ammonia on rat brain metabolism in vivo. Biochem J 1973; 134:
23.
1001-08. 25. Hourani BT, Hamlin EM, Reynolds TB. Cerebrospinal fluid glutamine as a measure of hepatic encephalopathy. Arch Intern Med 1971; 127: 1033-36. 26. Toth J, Lajtha A. Rates of exchange of free amino acids between plasma and brain in mice. Neurochem Res 1977; 2: 149-60. 27. Jaikin A, Agrest A. Cerebrospinal fluid glutamine concentrations in patients with chronic hypercapnia. Clin Sci 1969; 36: 11-14. 28. Schenker S. Hepatic coma: current concepts of pathogenesis. Viewpoints Dig Dis 1970; 2: 1-4. 29. Pardridge WM, Oldendorf WH. Kinetic analysis of blood-brain barrier transport of amino acids. Biochim Biophys Acta 1975; 401: 128-36.
776
Scott), although it concenneurological development and does not Dobbing. In the nutrition section R. L. and K. E. Bergmann give plenty of useful data in their piece on nutrition and growth, but there is too heavy a reliance on S. Fomon’s work. Joaquin Gavioto contributes a characteristically readable and stimulating survey of many years of work on nutrition and mental development. The only disappointing chapter is that on obesity (G. F. Cahill and Aldo Rossini) which is too brief to be of much use and contains no discussion on the role of energy expenditure in obesity. This book is as attractive to the eye as its two companions (see Ldncet, June 2, p. 1169). Reference lists are up to date.
on
critical
periods
in
growth (J.
P.
behavioural than on refer to work by John
trates more on
believes -indeed takes it for granted-that coronary heartdisease is caused to a major and decisive degree by nutritional factors. But unlike many others with similar views, he is prepared to identify and discuss the weak links in the chain of evidence. The recent decline in coronary heart-disease mortality in some countries is, unfortunately, not dealt with in much detail. This decline is perhaps the most intriguing epidemiological development for many years. There is little doubt the decline is real, but its causes have not yet been identified with certainty; unravelling them will have major implications for prevention. Other chapters discuss the interrelation between risk factors, lysosomes, and vascular disease, and the molecular properties and clinical relevance of lipoprotein lipase. Each is reasonably intelligible to the non-expert, who will be able to see their clinical relevance.
The Natural History of Mind
Exploration. GORDON RATTRAY TAYLOR, London: Secker Warburg. 1979. Pp. 370. 6.95
An
,
&
IN The Natural History of Mind Gordon Rattray Taylor shows us once more that he is a stylish, knowledgeable, and reflective writer. Here he explores the brain and the mind by reviewing mainly modern research; however, he does cover a large territory, which includes some ancient work. The earlier chapters describe the brain and some of the theories about its function. Some advances in the more physical of the brain sciences are described in the later chapters; but it is largely the phenomena of conscious experience and the dependence or not upon the brain which preoccupy the author-hallucinations, depersonalisation, multiple personality, dreaming, subliminal perception, and other such related phenomena. Reading this easily assimilated survey is like going on a voyage of exploration of this vast and complicated area. A good feature of the book is the wide range of the illustrative material in the text which is the result of ten years of preparation-the author does not hesitate to draw on material from philosophy, literature and the arts and there is much philosophical discourse on controversial matters. The book will please both students of the subject and the general reader.
Atherosclerosis Reviews. Vol V. Edited by RoDOLFO PAOLETTI, University of Milan, Italy, and ANTONIO M. GOTTO, JR. Baylor College of Medicine, Houston, Texas. New York: Raven Press. 1979. Pp. 264.$31.20.
THIS series has already dealt with many topics since the first volume appeared in 1976. Advances in the field of atherosclerosis are not so rapid that contributions appearing at this rate can all cover new ground, and a good deal of this book is a repetition of what has appeared in earlier volumes. However, the book can be recommended for selective reading. Joan Slack deals comprehensively with clinical, genetic, and biochemical aspects of familial hypercholesterolaemia, a topic which has been inadequately discussed over the years-the disorder is of considerable interest, not only in its own right, but also because it may in some respects be a valuable model for atheroma and coronary heart-disease as a whole. G. R. Thompson’s chapter on the management of familial hypercholesterolaemia and new approaches to the treatment of atherosclerosis will be useful to clinicians who need authoritative, up-to-date guidance on the value of dietary modification, drugs, or surgery. He also describes the techniques and early results of plasma exchange, a safe procedure which can be done on an outpatient basis. There is no doubt about its dramatic short-term effect on the plasma cholesterol level, which may be more than halved in both homozygotes and heterozygotes. Patients with angina appear to improve, but more experience is needed before beneficial clinical effects for this condition can be claimed with any confidence. Epidemiologists will probably find F. H. Epstein’s contribution more stimulating than most run-of-the-mill accounts of nutrition and atherosclerosis. He
Boswell’s Clap and Other Essays Medical
Analyses of Literary Men’s Afflictions. WILLIAM B. OBER, Hackensack Hospital, New Jersey. Carbordale and Edwardsville: Southern Illinois University Press. London and Amsterdam: Feffer & Simons. 1979. Pp. 290.$17.50.
DESPITE an arresting title, the first of these ten essays on the maladies of famous writers sits a little uneasily amongst the rest. It is by no means certain that all Boswell’s surviving papers have yet been discovered, for half a dozen separate collections have come to light even in the past fifty years: but his promiscuity is established and his twenty distinct attacks of gonorrhoea are well documented. Before attributing this unenviable record, as Dr Ober does, to childhood repressions and excessive parental piety, one must set it against that of some of his contemporaries (and, let it be admitted, against that of some present-day patients). There is no doubt, however, that his indulgences hastened his death, from renal failure consequent upon chronic urinary obstruction. The author’s erudition does emerge brilliantly when he turns his attention to Swinburne, and postulates that a difficult birth, and probable cerebral anoxia, may well have determined the physical and mental peculiarities of the poet’s life. His hyperkinesia and unusual physiognomy have been adequately attested already: masochistic practices and dipsomania are now convincingly presented as features of a single syndrome. A brief review cannot convey an adequate impression of Dr Ober’s literary skill, or of the depth to which he has researched all his subjects, particularly Cowper (obsessed by visions of bleeding, and of flagellation) and John Wilmot, second earl of Rochester (haunted by a compulsive sexuality, but frustrated by ambivalence and impotence). No other book by any histopathologist is likely to be as widely read, and admired, by exponents of a very different discipline, as this.
New Editions in General Medicine.-2nd ed. Edited by Thomas B. Arthur Z. Eisen, Klaus Wolff, Irwin M. Freedberg & K. Frank Austen. Maidenhead, Berks: McGraw-Hill. 1979. Pp. 1884.
Dermatology
Fitzpatrick,
47.60. Immunopathology of
the Skin.-2nd ed. By Ernst H. Beutner, Tadeusz P. Chorzelski, and Samuel F. Bean. Chichester, Sussex: Wiley. 1979. Pp. 496.[23.80. Care of the Trauma Patient.-2nd ed. By G. Tom Shires. Maidenhead, Berks: McGraw-Hill. Pp. 642. 1979. 22.15. Understanding ECG’s in Infants and Children.-2nd ed. By L. C. Harris and Ellen Feinstein. Boston: Little Brown, London: Quest. 1979. Pp. 109.8.40,$12.50. ICHPPC-2 (International Classification of Health Problems in Prr mary Care).-2nd ed. Prepared by WONCA. 1979. Pp. 146. £8.50
(boards); £3.95 (papercover). Better Patient Care Through Nursing Research.-2nd ed. B" Faye G. Abdellah & Eugene Levine. West Drayton, Middx: Colher Macmillan. 1979. Pp. 753. 12.75.
