111
considered significant. Electronmicroscopic examinanot reveal surface antigen or the cytoproliferation commonly associated with core antigen of hepatitis-B virus can fre-
tion, too, did
plasmic
microscopic of the
core
and immunohistochemical demonstration antigen would help to clarify this issue.
S.E.R.
it.9,12 The
be demonstrated in the liver-cell nucleus in carriers and in patients suffering from various forms of hepatitis associated with infection by this virus, particularly the chronic forms.9,10 This is true not only for adult patients but also for infants born to mothers who contract hepatitis during pregnancy or early post-partum period." Absence of the core component in our material would thus indicate that infection by this virus is highly unlikely in I.c.c. We did not observe core antigen either by electronmicroscopy or by immunostaining with human sera known to contain antibodies against this antigen.I8 Diseases related to infection with hepatitis-B virus are
quently
generally associated with presence of antigen or antibody in the serum at some stage or other. Reports on antigenæmia in patients with I.C.C. have a very wide variation, and indeed in several studies the positivityrate has been extremely low or even zero.’-6 None of the sera from 20 patients tested in the present study were positive for HBgAg. The results of the present study support our belief that infection with hepatitis-B virus does not play a significant role in the xtiology of I.C.C.1,2,15 Studies using purified anti-core antibody for immunoelectron-
Reviews of Books Common Neuroses in General Practice A Behavioural Approach. J. C. M. WILKINSON, M.R.C.PSYCH., and K. LATIF, D.P.M. Bristol: Wright. 1974. Pp. 153. E2.95.
GENERAL practitioners face a flood of overtly and covertly emotionally disturbed patients. Drugs are often ineffective and many general practitioners feel unable to use psychotherapy, because they do not feel sufficiently experienced or, perhaps, because their own emotional problems prevent them from discussing similar problems with their patients. Behaviour therapy seems an easier way out. It is used in many psychiatric hospitals, and its success-rate seems quite good, if by success is meant the removal of the symptom. Some of its more spectacular efforts (e.g., trying to cure people of smoking, gambling, or homosexuality) have been less successful. Dr Wilkinson and Dr Latif promise to describe simple procedures that may be carried out in general practice. The aim is laudable. They discuss the principles of behaviour therapy and its history, and describe a typical hospital behaviour-therapy unit and the neuroses that they feel will be susceptible to behaviour therapy (anxiety, phobias, sexual dysfunctions and deviations, eating disorders, and obsessional compulsive behaviours). They describe minutely the manifestations and differential diagnoses of these conditions and append a number of interesting case-reports. Unfortunately, the type of patient that appears in hospital for behaviour therapy is either very rare in general practice or presents in a different manner. How many general practitioners have patients like 11-month-old Albert with a phobia for white furry objects, or Peter, who had a fear of white rabbits ? In describing the role of the general practitioner the authors seem to assume that doctors are generally able to solve their patients’ problems for them: wise counselling, " they say, guides [the patient] towards more constructive modes of behaviour " and some patients may only
REFERENCES 1.
Nayak, N. C., Ramalingaswami, V. in The Liver: Normal and Abnormal Functions (edited by E. F. Becker); ch. 25. New York,
2.
Nayak, N. C., Ramalingaswami, V. in Clinics in Gastroenterology: Cirrhosis (edited by H. Popper); vol. iv, ch. 7. London, 1975. Achar, S. T., Raju, V. B., Sriramachari, S.J. Pediat. 1960, 57, 744. Chandra, R. K., Chawla, V., Verma, I. C., Ghai, O. P., Malik, G. R. Am. J. Dis. Child. 1972, 123, 408. Kelkar, S. S., Ingle, V. N., Toshniwal, M. R. Indian J. Pediat. 1973, 40, 220. Dhatt, P. S., Singh, H., Gupta, H. L., Lal, M. M. Indian Pediat. 1973, 10, 7. Huang, S., Groh, V. Lab. Invest. 1973, 29, 743. Nowoslawski, A., Krawczynski, K., Brzosko, W. J., Madalinski, K. Am. J. Path. 1972, 68, 31 Gudat, F., Bianchi, L., Sonnabend, W., Thiel, G., Aenishaenslin, W. Stalder, G. A. Lab. Invest. 1975, 32, 1. Gerber, M. A., Hadzyiyannis, S., Vissoulis, C., Schaffner, F., Paronetto, F., Popper, H. Am. J. Path. 1974, 75, 489. Shikata, T., Uzawa, T., Yoshiwara, N., Akatsuka, T., Yamazaki, S. Japan. J. exp. Med. 1974, 44, 25. Sun, S. C., Anderson, K. E., Shu, C. P., Kau, S. L. Archs Path. 1974, 97, 373. Nayak, N. C., Sachdeva, R. Am. J. Path. (in the press). Seth, H. N., Nayak, N. C., Venkataraman, S. J. appl. Med. 1974, 1, 385. Nayak, N. C., Visalakshi, S., Singh, M., Chawla, V., Chandra, R. K., Ramalingaswami, V. Indian J. med. Res. 1972, 60, 246. Roy, S., Ramalingaswami, V., Nayak, N. C. Gut, 1971, 12, 693. Schweitzer, I. L., Dunn, A. E. G., Peters, R. L., Spears, R. L. Am. J. Med. 1973, 55, 762. Hoofnagle, J. H., Gerety, R. J., Louisa, Y. N., Lewellys, F. B. New Engl. J. Med. 1974, 290, 1336.
1974.
3. 4. 5. 6.
7. 8.
9. 10. 11. 12.
13. 14.
15. 16. 17.
18.
need wise advice from their family doctor and their problems fade away ". In their descriptions of behaviour therapeutic techniques the authors include deep muscular relaxation,
augmented respiratory relief, covert positive reinforcement, carbon-dioxide inhalation, bio-feedback, assertive training, and desensitisation, which require the filling of questionaries and sessions, ranging from six to twenty in number, each lasting 20 minutes. All the treatments take much time than is available for the treatment of individual in general practice and require a technical competence that cannot be learned from books. The worst of the book is that no effort is to made treat the aspect his but that manner or in a semiautomatic patient problems, relief of symptoms is aimed at, irrespective of how the patient is able to function in the various areas of his life. The.book is a useful brief review of techniques of behaviour therapy, but it seems inappropriate to the treatment of emotionally disturbed people in general practice by general more
patients
practitioners. The Biology and Clinical Management of Bladder Cancer Edited by E. H. Coorstt, F.R.C.P., University of Leeds, and R. E. WILLIAMS, F.R.C.S.E., General Infirmary, Leeds. Oxford: Blackwell. 1975. Pp. 293. E9.75.
AFTER an international meeting on bladder cancer held Leeds in 1971, the editors of this book decided that the time was opportune to review the present state of knowledge of this disease and to point the way in which progress could be made. They have collected an international panel. The result is a readable, comprehensivereview of bladder cancer covering experimental studies, biology, epidemiology, pathology, cytology, and immunology, as well as the surgical and radiotherapeutic treatment. In the discussion on the epidemiology of bladder cancer, D. B. Clayson, while stressing the many difficulties, rightly concludes that " many cases of bladder cancer are no act of God but a disease which stems from the environment ". E. K. Mostofi has written an excellent chapter on the at
112
pathology of the disease, and points out the difficulty that pathologists still have in assessing malignancy in fragments that do not include any of the muscularis. Maybe the adoption of urinary enzyme studies used by the Leeds workers will help those in routine practice to distinguish invasive from non-invasive tumours. L. G. Koss has contributed an excellent chapter on the use of cytology in management. However, while stating that cells in urine disintegrate rather rapidly, he recommends the collection of an earlymorning specimen. In Britain a complete mid-morning sample would be preferred, as recommended by D. M. Wallace in the chapter on total urethral neoplasia. Mention might also have been made of the use of the cytocentrifuge, which is of great value in the examination of specimens of low cellularity. The chapters on treatment are firstrate and make it clear that up to now the management of bladder cancer is just as confused as that of carcinoma of the breast. The illustrations are of a high standard, and there is an extensive and up-to-date bibliography. This is a valuable book and is recommended to surgeons, patho-
logists, radiotherapists,
and
The Health of Staff in
J. A. LUNN,
Hospitals
M.F.C.M.,
London: Heinemann.
experimentalists.
George’s Hospital, London. Pp. 104. El.50. largely from his considerable St. 1975.
Dr Lunn, drawing experience in running an occupational-health department for hospital staff, suggests the following requirements for a district general hospital: a full-time nurse (Salmon grade 7 or 8B, a basic-grade ward sister will not do), a doctor giving 3-5 sessions a week, a secretary, 1000 sq. ft., and equipment of the highest standard. He emphasises the aspects that distinguish such a service from occupationalhealth work in, say, industry. These features include care for residential staff (mainly nurses), the special two-way problem of infection, and radiological and laboratory hazards. The role of the team in investigating accidents and sickness absences is well illustrated, but not so clear-cut is the likely work-load for immunisations and medical examinations. Dr Lunn paints a rosy picture, but those who want to improve on hospitals’ often lackadaisical arrangements will do well to turn to this paperback for a glimpse of the ideal. Health
at
Work
WARD GARDNER and PETER TAYLOR. London: Associated Business Programmes. 1975. Pp. 170. E5.95.
MANY doctors show little interest in occupational health, many of their patients spend much of their time at work. The influence of work on health and health on work are underinvestigated problems. Management in industry is even less well informed, and this is in part due to a paucity of readable texts on the subject. Dr Gardner and Dr Taylor have now produced a short book which goes a long way towards filling this need. Both authors are experienced occupational physicians, and their accounts of the organisation of health services at work, the value of screening tests, sickness absence, disability, shift work, and mental health are masterly. The managerthey define this as anyone from the chairman to supervisor - can acquire a balanced modern view on these subjects and should thereby be able to understand many of the problems facing industrial physicians. Gardner and Taylor rightly emphasise the preventive rather than curative bias of occupational medicine, but fail to enlighten the reader on the rather complex and delicate relationships the doctor in industry faces in his dealings with family doctors, hospitals, management, and the worker himself. They attempt a brief analysis of occupational hazards, and, although this has to be short in a book of this size, it is
despite the fact that
rather oddly classified. Using one of the more conventional classifications might have been less confusing to the lay reader. Trifling errors-such as the incorrect dating of the first edition of Ramazzini’s de morbis Artificium-are excusable in a first edition. This book has few competitors, and all doctors concerned with health at work should ensure that their managements are conversant with its contents. This could well mean that the doctor’s role in industry is better understood and as a result the service he gives is im-
proved. The
Esophagus
W. SPENCER PAYNE, M.D., Mayo Medical School, and ARTHUR M. OLSEN, M.D., Mayo Graduate School of Medicine, Rochester, Minnesota. ’Philadelphia : Lea & Febiger. London :Kimpton. 1974. Pp. 339.$16; S7.60.
ŒSOPHAGEAL. surgery has come to lie in the no-man’s land between otolaryngology, cardiothoracic surgery, and general surgery. It frequently forms a small part of a practice of a clinician whose primary interests may lie elsewhere. It is therefore refreshing to read a book by experts with a special interest in the subject and with experience of benefit to all. Throughout the comprehensive text the physiology, anatomy, and pathology are presented in a detailed and easily understood fashion. The section on oesophageal manometry is superb, though to describe this technique as an essential tool in the management of the average patient with oesophageal disease may be overstating the case. The section on management represents the considered judgment from the long experience of the Mayo Clinic team and provides valuable yardsticks for the occasional oesophageal surgeon. Some may consider the authors’ approach too parochial in that alternative treatments are less comprehensively described than their own. However, Dr Payne and Dr Olsen make no apology for this, for they were concerned to prevent a succinct book from becoming an unwieldy tome. It is not intended as a reference work, but for those who value a review of expert practice in this specialty, this book can be recommended. Each chapter provides key references for those who wish to pursue the subject more fully.
Engineering in Medicine B. McA. SAYERS and S. A. V. SwANSON, Imperial College, and B. W. WATSON, St. Bartholomew’s Hospital Medical College, London. London: Oxford University Press. 1975. Pp. 103. C3.25.
THIS interesting book, by two engineers and a physicist, reviews the medical applications of electronic and mechanical engineering and speculates on future possibilities. Physiological measurement, ultrasonics, computing, controlsystem analysis, and the design of limb prostheses are briefly and skilfully surveyed in a style that will be appreciated by clinicians as well as by engineers. Attacking " the unimaginative pragmatism of many consulting physicians, more particularly so when they have teaching responsibilities ", the authors advocate a massive effort by engineers and physiologists, supported by computers, to learn more about the body’s complex control systems and so to devise better methods for diagnosis, treatment, and prevention. In this part of the book, the approach is academic rather than practical. The authors say that funds should be provided to support bioengineers in universities, industry, and hospitals, so that they may accumulate knowledge of physiological mechanisms, construct data banks of signs and symptoms, and instruct clinicians in the use of the new methods. Engineering, the authors admit, has made little
medicine. Perhaps it never will. Small come from the concentration of clinical and scientific resources on limited problems. Whether the all-out attack proposed in this book would be more fruitful is a provoking question.
impact
on
successes
have
considered significant. Electronmicroscopic examinanot reveal surface antigen or the cytoproliferation commonly associated with core antigen of hepatitis-B virus can fre-
tion, too, did
plasmic
microscopic of the
core
and immunohistochemical demonstration antigen would help to clarify this issue.
S.E.R.
it.9,12 The
be demonstrated in the liver-cell nucleus in carriers and in patients suffering from various forms of hepatitis associated with infection by this virus, particularly the chronic forms.9,10 This is true not only for adult patients but also for infants born to mothers who contract hepatitis during pregnancy or early post-partum period." Absence of the core component in our material would thus indicate that infection by this virus is highly unlikely in I.c.c. We did not observe core antigen either by electronmicroscopy or by immunostaining with human sera known to contain antibodies against this antigen.I8 Diseases related to infection with hepatitis-B virus are
quently
generally associated with presence of antigen or antibody in the serum at some stage or other. Reports on antigenæmia in patients with I.C.C. have a very wide variation, and indeed in several studies the positivityrate has been extremely low or even zero.’-6 None of the sera from 20 patients tested in the present study were positive for HBgAg. The results of the present study support our belief that infection with hepatitis-B virus does not play a significant role in the xtiology of I.C.C.1,2,15 Studies using purified anti-core antibody for immunoelectron-
Reviews of Books Common Neuroses in General Practice A Behavioural Approach. J. C. M. WILKINSON, M.R.C.PSYCH., and K. LATIF, D.P.M. Bristol: Wright. 1974. Pp. 153. E2.95.
GENERAL practitioners face a flood of overtly and covertly emotionally disturbed patients. Drugs are often ineffective and many general practitioners feel unable to use psychotherapy, because they do not feel sufficiently experienced or, perhaps, because their own emotional problems prevent them from discussing similar problems with their patients. Behaviour therapy seems an easier way out. It is used in many psychiatric hospitals, and its success-rate seems quite good, if by success is meant the removal of the symptom. Some of its more spectacular efforts (e.g., trying to cure people of smoking, gambling, or homosexuality) have been less successful. Dr Wilkinson and Dr Latif promise to describe simple procedures that may be carried out in general practice. The aim is laudable. They discuss the principles of behaviour therapy and its history, and describe a typical hospital behaviour-therapy unit and the neuroses that they feel will be susceptible to behaviour therapy (anxiety, phobias, sexual dysfunctions and deviations, eating disorders, and obsessional compulsive behaviours). They describe minutely the manifestations and differential diagnoses of these conditions and append a number of interesting case-reports. Unfortunately, the type of patient that appears in hospital for behaviour therapy is either very rare in general practice or presents in a different manner. How many general practitioners have patients like 11-month-old Albert with a phobia for white furry objects, or Peter, who had a fear of white rabbits ? In describing the role of the general practitioner the authors seem to assume that doctors are generally able to solve their patients’ problems for them: wise counselling, " they say, guides [the patient] towards more constructive modes of behaviour " and some patients may only
REFERENCES 1.
Nayak, N. C., Ramalingaswami, V. in The Liver: Normal and Abnormal Functions (edited by E. F. Becker); ch. 25. New York,
2.
Nayak, N. C., Ramalingaswami, V. in Clinics in Gastroenterology: Cirrhosis (edited by H. Popper); vol. iv, ch. 7. London, 1975. Achar, S. T., Raju, V. B., Sriramachari, S.J. Pediat. 1960, 57, 744. Chandra, R. K., Chawla, V., Verma, I. C., Ghai, O. P., Malik, G. R. Am. J. Dis. Child. 1972, 123, 408. Kelkar, S. S., Ingle, V. N., Toshniwal, M. R. Indian J. Pediat. 1973, 40, 220. Dhatt, P. S., Singh, H., Gupta, H. L., Lal, M. M. Indian Pediat. 1973, 10, 7. Huang, S., Groh, V. Lab. Invest. 1973, 29, 743. Nowoslawski, A., Krawczynski, K., Brzosko, W. J., Madalinski, K. Am. J. Path. 1972, 68, 31 Gudat, F., Bianchi, L., Sonnabend, W., Thiel, G., Aenishaenslin, W. Stalder, G. A. Lab. Invest. 1975, 32, 1. Gerber, M. A., Hadzyiyannis, S., Vissoulis, C., Schaffner, F., Paronetto, F., Popper, H. Am. J. Path. 1974, 75, 489. Shikata, T., Uzawa, T., Yoshiwara, N., Akatsuka, T., Yamazaki, S. Japan. J. exp. Med. 1974, 44, 25. Sun, S. C., Anderson, K. E., Shu, C. P., Kau, S. L. Archs Path. 1974, 97, 373. Nayak, N. C., Sachdeva, R. Am. J. Path. (in the press). Seth, H. N., Nayak, N. C., Venkataraman, S. J. appl. Med. 1974, 1, 385. Nayak, N. C., Visalakshi, S., Singh, M., Chawla, V., Chandra, R. K., Ramalingaswami, V. Indian J. med. Res. 1972, 60, 246. Roy, S., Ramalingaswami, V., Nayak, N. C. Gut, 1971, 12, 693. Schweitzer, I. L., Dunn, A. E. G., Peters, R. L., Spears, R. L. Am. J. Med. 1973, 55, 762. Hoofnagle, J. H., Gerety, R. J., Louisa, Y. N., Lewellys, F. B. New Engl. J. Med. 1974, 290, 1336.
1974.
3. 4. 5. 6.
7. 8.
9. 10. 11. 12.
13. 14.
15. 16. 17.
18.
need wise advice from their family doctor and their problems fade away ". In their descriptions of behaviour therapeutic techniques the authors include deep muscular relaxation,
augmented respiratory relief, covert positive reinforcement, carbon-dioxide inhalation, bio-feedback, assertive training, and desensitisation, which require the filling of questionaries and sessions, ranging from six to twenty in number, each lasting 20 minutes. All the treatments take much time than is available for the treatment of individual in general practice and require a technical competence that cannot be learned from books. The worst of the book is that no effort is to made treat the aspect his but that manner or in a semiautomatic patient problems, relief of symptoms is aimed at, irrespective of how the patient is able to function in the various areas of his life. The.book is a useful brief review of techniques of behaviour therapy, but it seems inappropriate to the treatment of emotionally disturbed people in general practice by general more
patients
practitioners. The Biology and Clinical Management of Bladder Cancer Edited by E. H. Coorstt, F.R.C.P., University of Leeds, and R. E. WILLIAMS, F.R.C.S.E., General Infirmary, Leeds. Oxford: Blackwell. 1975. Pp. 293. E9.75.
AFTER an international meeting on bladder cancer held Leeds in 1971, the editors of this book decided that the time was opportune to review the present state of knowledge of this disease and to point the way in which progress could be made. They have collected an international panel. The result is a readable, comprehensivereview of bladder cancer covering experimental studies, biology, epidemiology, pathology, cytology, and immunology, as well as the surgical and radiotherapeutic treatment. In the discussion on the epidemiology of bladder cancer, D. B. Clayson, while stressing the many difficulties, rightly concludes that " many cases of bladder cancer are no act of God but a disease which stems from the environment ". E. K. Mostofi has written an excellent chapter on the at
112
pathology of the disease, and points out the difficulty that pathologists still have in assessing malignancy in fragments that do not include any of the muscularis. Maybe the adoption of urinary enzyme studies used by the Leeds workers will help those in routine practice to distinguish invasive from non-invasive tumours. L. G. Koss has contributed an excellent chapter on the use of cytology in management. However, while stating that cells in urine disintegrate rather rapidly, he recommends the collection of an earlymorning specimen. In Britain a complete mid-morning sample would be preferred, as recommended by D. M. Wallace in the chapter on total urethral neoplasia. Mention might also have been made of the use of the cytocentrifuge, which is of great value in the examination of specimens of low cellularity. The chapters on treatment are firstrate and make it clear that up to now the management of bladder cancer is just as confused as that of carcinoma of the breast. The illustrations are of a high standard, and there is an extensive and up-to-date bibliography. This is a valuable book and is recommended to surgeons, patho-
logists, radiotherapists,
and
The Health of Staff in
J. A. LUNN,
Hospitals
M.F.C.M.,
London: Heinemann.
experimentalists.
George’s Hospital, London. Pp. 104. El.50. largely from his considerable St. 1975.
Dr Lunn, drawing experience in running an occupational-health department for hospital staff, suggests the following requirements for a district general hospital: a full-time nurse (Salmon grade 7 or 8B, a basic-grade ward sister will not do), a doctor giving 3-5 sessions a week, a secretary, 1000 sq. ft., and equipment of the highest standard. He emphasises the aspects that distinguish such a service from occupationalhealth work in, say, industry. These features include care for residential staff (mainly nurses), the special two-way problem of infection, and radiological and laboratory hazards. The role of the team in investigating accidents and sickness absences is well illustrated, but not so clear-cut is the likely work-load for immunisations and medical examinations. Dr Lunn paints a rosy picture, but those who want to improve on hospitals’ often lackadaisical arrangements will do well to turn to this paperback for a glimpse of the ideal. Health
at
Work
WARD GARDNER and PETER TAYLOR. London: Associated Business Programmes. 1975. Pp. 170. E5.95.
MANY doctors show little interest in occupational health, many of their patients spend much of their time at work. The influence of work on health and health on work are underinvestigated problems. Management in industry is even less well informed, and this is in part due to a paucity of readable texts on the subject. Dr Gardner and Dr Taylor have now produced a short book which goes a long way towards filling this need. Both authors are experienced occupational physicians, and their accounts of the organisation of health services at work, the value of screening tests, sickness absence, disability, shift work, and mental health are masterly. The managerthey define this as anyone from the chairman to supervisor - can acquire a balanced modern view on these subjects and should thereby be able to understand many of the problems facing industrial physicians. Gardner and Taylor rightly emphasise the preventive rather than curative bias of occupational medicine, but fail to enlighten the reader on the rather complex and delicate relationships the doctor in industry faces in his dealings with family doctors, hospitals, management, and the worker himself. They attempt a brief analysis of occupational hazards, and, although this has to be short in a book of this size, it is
despite the fact that
rather oddly classified. Using one of the more conventional classifications might have been less confusing to the lay reader. Trifling errors-such as the incorrect dating of the first edition of Ramazzini’s de morbis Artificium-are excusable in a first edition. This book has few competitors, and all doctors concerned with health at work should ensure that their managements are conversant with its contents. This could well mean that the doctor’s role in industry is better understood and as a result the service he gives is im-
proved. The
Esophagus
W. SPENCER PAYNE, M.D., Mayo Medical School, and ARTHUR M. OLSEN, M.D., Mayo Graduate School of Medicine, Rochester, Minnesota. ’Philadelphia : Lea & Febiger. London :Kimpton. 1974. Pp. 339.$16; S7.60.
ŒSOPHAGEAL. surgery has come to lie in the no-man’s land between otolaryngology, cardiothoracic surgery, and general surgery. It frequently forms a small part of a practice of a clinician whose primary interests may lie elsewhere. It is therefore refreshing to read a book by experts with a special interest in the subject and with experience of benefit to all. Throughout the comprehensive text the physiology, anatomy, and pathology are presented in a detailed and easily understood fashion. The section on oesophageal manometry is superb, though to describe this technique as an essential tool in the management of the average patient with oesophageal disease may be overstating the case. The section on management represents the considered judgment from the long experience of the Mayo Clinic team and provides valuable yardsticks for the occasional oesophageal surgeon. Some may consider the authors’ approach too parochial in that alternative treatments are less comprehensively described than their own. However, Dr Payne and Dr Olsen make no apology for this, for they were concerned to prevent a succinct book from becoming an unwieldy tome. It is not intended as a reference work, but for those who value a review of expert practice in this specialty, this book can be recommended. Each chapter provides key references for those who wish to pursue the subject more fully.
Engineering in Medicine B. McA. SAYERS and S. A. V. SwANSON, Imperial College, and B. W. WATSON, St. Bartholomew’s Hospital Medical College, London. London: Oxford University Press. 1975. Pp. 103. C3.25.
THIS interesting book, by two engineers and a physicist, reviews the medical applications of electronic and mechanical engineering and speculates on future possibilities. Physiological measurement, ultrasonics, computing, controlsystem analysis, and the design of limb prostheses are briefly and skilfully surveyed in a style that will be appreciated by clinicians as well as by engineers. Attacking " the unimaginative pragmatism of many consulting physicians, more particularly so when they have teaching responsibilities ", the authors advocate a massive effort by engineers and physiologists, supported by computers, to learn more about the body’s complex control systems and so to devise better methods for diagnosis, treatment, and prevention. In this part of the book, the approach is academic rather than practical. The authors say that funds should be provided to support bioengineers in universities, industry, and hospitals, so that they may accumulate knowledge of physiological mechanisms, construct data banks of signs and symptoms, and instruct clinicians in the use of the new methods. Engineering, the authors admit, has made little
medicine. Perhaps it never will. Small come from the concentration of clinical and scientific resources on limited problems. Whether the all-out attack proposed in this book would be more fruitful is a provoking question.
impact
on
successes
have
