Reviews of Books The Genetics of the Jews A. E. MOURANT, ADA C. KOPEC, and KAZIMIERA DOMANIEWSKASOBCZAK, formerly of the M.R.C. Serological Population Genetics Laboratory. Oxford: Clarendon Press. 1978. Pp. 122.

/;12.50. ARCHAEOLOGISTS tell us that the original Jewish occupation of Palestine took place between 1300 and 1200 B.C. when they conquered the Canaanite peoples who lived there. The first dispersion occurred in 586 B.C. when Nebuchadnezzar deported much of the population to Babylon, and many remained there after 538 B.C. when Cyrus the Persian allowed them to return. The main dispersion took place after the Romans sacked Jerusalem in 70 A.D. Today, apart from the small Samaritan sect, there are no Jews in Palestine whose forbears have lived continuously in the country since biblical times. But there are present in contemporary Israel people from almost every country in which Jewish populations eventually settled. By studying them and some in other places Dr Mourant and his colleagues hoped to get evidence whether, despite intermarriage and accession of converts, the Jews are still a distinguishable population, and to obtain some scientific information to bear on the vexed question of the origin of the large group of Ashkenazy Jews from Poland and Lithuania. They have studied the distribution of blood-groups, mainly the ABO and Rh systems together with smaller numbers of other systems. They also checked some biochemical markers such as phenylthiocarbamide tasting. In addition they discuss the incidence of hereditary diseases, like Tay-Sachs disease, known to be specially important among Jewish people. The two main groups of Jews are known as the Sephardim and the Ashkenazim. There are definite historical links between the Sephardim and the original Jews of Palestine since they migrated via Egypt and North Africa to Spain when that country was Arab-ruled. In 1492

from Spain together with the Arabs; most North Africa and Turkish eastern Europe, but some went to the Netherlands, France, and Britain, and the older Jewish families in these countries are of Sephardic origin; they spoke a Spanish dialect. The Ashkenazim speak Yiddish, a mixture of German, Slavonic, and Hebrew; most authorities think that the large population of these Jews in Poland and Lithuania already there in mediaeval times migrated from west Germany because of persecution. But an alternative theory, recently supported by Arthur Koestler, is that they represent a Turkish population, the Khazars, who originally lived between the Black Sea and the Caspian who adopted Judaism as the state religion in the 8th century A.D. Poland was partitioned at the end of the 18th century; in the Russian sector, which included Warsaw, persecution of the Jews was rife. There was then a new migration of the Ashkenazim mainly to Germany, and later to the U.S.A.; smaller numbers went to other western European countries including Britain. From their studies Mourant and his co-workers conclude that "the Ashkenazim are essentially a single population largely, if not mainly of Palestinian Jewish descent". Between the two Jewish groups there are some differences in the distribution of each main blood-group system, "but the difference for any one system is not very great. That is what one would expect for two populations of common origin but separated for not more than a thousand years." The authors also record similar studies of small Jewish groups in various parts of the world, prefacing each chapter with a short historical account. This book is an interesting and impressive application of the methods used by Mourant and colleagues in their study of the world distribution of blood-groups. Their data are presented in the manner of their previous publications and the book will be of particular interest to geneticists and anthropologists.






Medical Students, Medical Schools and Society During Five Eras Factors Affecting the Career Choices of Physicians 1958-1976. DANIEL H. FUNKENSTEIN. Ballinger Publishing Co., Cambridge, Massachusetts. Chichester: Wiley. 1978. Pp. 225. 10.40.

Dr Funkenstein, who was consultant on admissions to the dean of the Faculty of Medicine at the Harvard Medical School, has written an interesting book, essentially about the career choices of undergraduates and graduates, and the factors that influence their choice. The first fact to emerge is that teachers and their attitudes have almost no effect. This should not occasion surprise to members of the medical faculty, who should know their place by now, but it is of interest to them to know the other operating factors. They can all be guessed at, but the merit of this book is that it is able to document them over the period 1958 to 1976. In some senses the study was prospective in the collection of data. All students for admission undergo extensive tests, which are given in full in appendices, and then there are the Medical College Admissions Test (M.C.A.T.) and the Strong Vocational Interest Blank. At certain times the author was able to include students from several different medical schools in his data. Students can on admission be broadly divided into bioscientific and biosocial types, these last being more person-oriented in their attitudes than the science type. The bioscientific students will tend to head for work in basic sciences or academic subspecialties, while the biosocial will go towards primary care (here including general medicine, general paediatrics, and family medicine) and psychological medicine, if they are able to follow their essential natures. Not all can do that, and the main extrinsic checks are those of society’s attitudes to medicine and what at the time society seems to want. Dr Funkenstein identifies six of these, though his concern is with the last five. The General Practice Era (1910-1939) explains itself. The Specialty Era (1940-1958) saw the relative decline of general practice and the rapid rise of specialties, often with the practitioner still maintaining a base in general medicine. The scientific Era of 1959-1968 directed students towards academic departments. It coincided with the space-race and the launching of satellites and massive government funding of science. The Student Activism Era (1969-1970) was evidence of the reaction against science, and the beginnings of interest once more in the delivery of health-care, especially of primary care. The faculty, mainly appointed in the Scientific Era, were at odds with students and society, and in some cases still are. The Doldrums Era (1971-1974) followed, during which time students and faculty doodled and tried to adjust to each other. They, and society, have now settled on the Primary-Care and IncreasingGovernment-Control Era (1975 to the present). The parallels with Britain are evidently strong. Students are quickly sensitive to these changes in societal attitudes. During the relatively stable eras the various admissions tests will quite reliably predict career choices, but in the unstable periods, where attitudes are changing fast, biosocial students may feel constrained to switch to scientific careers; and at other times, particularly now, bioscientific students may be forced into the biosocial ones. The adjustments may be made with very little difficulty, but some doctors may be uncomfortable or even embittered. This brief review does not do justice to the book’s sidelights on women, on attracting doctors to inner city or rural areas, and on helping minority groups, social and ethnic, into medicine. The more simply-inclined contributors to the recent series in The Lancet "If I were Dean ..." might find they would have to change their basic assumptions on reading this book. There are always assumptions about what society needs from medicine ; students are consciously or unconsciously selected to meet them, and by the time they are ready to make a contribution, the apparent needs have changed again. Who will confidently predict society’s beliefs ten years from now?


Cholera, Fever, and English Medicine 1825-1865 MARGARET PELLING. Oxford: Oxford


Atlas of Neonatal Histopathology

Press 1978.


352. [,7 .50. MAJOR discoveries, such

as those of Pasteur and Koch, simwell as increase understanding; thus, in studying fevers, the medical student of 1890 (after the advent of bacteriology) had an easier time than his counterpart in 1850, who faced conflicting theories of great complexity. Although it is often believed that the first half of the 19th century, in contrast to the second, was mostly devoid of scientific developments of any consequence, the period 1825-1865 was one of intense speculation on the nature of fevers, and of cholera in particular after the first epidemic of 1832. The reader of this scholarly and fascinating book cannot fail to be impressed by the thoroughness with which the evidence was collected and examined and the intellectual quality of the theoretical discussions. The early days of the science of epidemiology were impressive. The major controversy, of course, was between the miasmatic and "contagium vivum" theories. With hindsight, as the author points out, "there has grown a conviction of the superiority of contagium vivum theories of any description and of the inferior claims of what is set up as their opposite, the miasmatic theory". The intriguing way the story is told makes one ask "What would I have believed, given the evidence available at the time?" Some of the most persuasive arguments were those which proved, in the end, to be on the wrong track; being right in the long run is not just a matter of ability-it is partly luck. That is a salutary thought because, allowing for the dangers of analogy, it is at least possible that the stage of our understanding of malignant disease today is similar to that of the understanding of fevers 120 years ago. Margaret Pelling is assistant to the director of the Wellcome Unit for the History of Medicine in the University of Oxford. She has compressed an enormous amount of research into this book which will be a standard reference on cholera and fevers in the time of the English cholera epidemics. It is strongly recommended to everyone interested in the history of scientific controversy in medicine.



Autism A

Reappraisal of Concepts

and Treatment. Edited



RUTTER, University of London, and ERIC SCHOPLER, University of North Carolina at Chapel Hill. New York and London: Plenum. Pp. 540.$29.40.

BIOLOGISTS often wryly jest that each naturalist comes to resemble the species with which he is preoccupied. The same phenomenon is evident in this, the latest of so many volumes on the early infantile autism of Kanner. "An obsessive insistence on the maintenance of sameness" is said to be the hallmark of autistic children; this characteristic also applies to most

of those who write about them. In the book there


MORAGAS, A. BALLABNIGA, and M. T. VIDAL. London: Saunders. 1977. Pp. 238. /;43.75

Philadelphia and

THIS atlas for the general pathologist illustrates histological appearances, but no gross findings, of necropsy material from 370 cases selected from three departments of pathology in Barcelona. Four colour pictures on each right-hand page are accompanied by panels of text on the left which give a brief history of the case up to the time of death and details of investigations. The features shown in the picture are then described before the other necropsy findings and clinico-pathological correlations are referred to. The photographs are well reproduced and the text, translated from Spanish, reads easily. However, the book does not show the pathologist how to recognise and interpret histological appearances in neonatal pathology. To this end each picture needs to illustrate one selected feature in such a way that its distinguishing characteristics can be clearly seen. In addition, interpretation of the findings requires supposed clinical correlates and theories of pathogenesis to be supported by evidence and statistics. The selection of material is confined to the first thirty days of life and is very uneven. Dogmatic statements are unsupported by references. Too much space is given to results of investigation to the exclusion of relevant information. In short, although a few sections are very valuable this atlas contains too few useful illustrations and comments to justify its expense.

Renaissance of Interstitial Brachytherapy Frontiers



Series. Vol.Fo/. 77. XII.

Therapy Editedby J.ofM. VAETH,Basle: S.Karger.Oncology 1978.Pp. 180.$59.

MEGA VOLTAGE therapy, with its better depth dose and skin sparing, greatly simplifies the treatment of many malignant lesions and enables a uniform dose to be given over the volume to be treated without too much danger to staff. As a result the well established implant techniques, by which it was difficult to obtain uniform irradiation and to measure the dose given,

fell into disuse. However, in recent years there have been new developments, new radioactive materials, afterloading techniques, accumulated knowledge of the biological effects of radiation, and computers which have not only facilitated the calculation of doses but have made possible calculations which were impossible in the heyday of brachytherapy. A re-look at interstitial techniques was taken at the 12th Annual San Francisco Cancer Symposium held in March 1977, the proceedings of which are reported in this volume. The preliminary chapters deal with the application of the new developments and are followed by accounts of clinical experience of their applications at various sites of the body which will form a useful baseline for further studies.

are a

few fresh voices. Richer contributes an ethological study and a stimulating novel theory. Others, notably Rodnight, Delong, and Coleman, report on neurophysiological and biochemical investigations. An important study on autistic twins from the Maudsley Hospital shows suggestively higher concordances for monozygotic twins but laterality is not reported. Boklege’s important new study of schizophrenic twin data, bringing in the crucial variable of handedness, showed that concordance for right handedness increased concordance for schizophrenia to 92%. The processes involved in lateralisation of social and language functions are emerging as central to the schizophrenic syndromes of later onset. Their exploration in infantile autism is now mandatory. The social, psychological, linguistic, educational, therapeutic, and pharmacological chapters largely repeat their authors’ well entrenched views. This work will be useful to those who were not invited to the congress in 1976 on which it is based. Serious workers in this field will learn little that is new and should be warned that "an obsessive insistence on the maintenance of sameness" is catching.

Minski’s Handbook of Psychiatry.-7th ed. By Robert G. Priest and Gerald Woolfson. London: Heinemann. 1978. Pp. 200. 3.95. Interpretation of Diagnostic Tests.-3rd ed. By Jacques Wallach. Boston: Little, Brown. London: Quest. 1978. Pp. 639. /;6.50;$9.95. Education physical Growth.-2nd ed. By J. M. Tanner. London: Hodder & Stoughton. 1978. Pp. 144. k2.45. Fluids electrolytes with Clinical Applications.-2nd ed. By Joyce LeFever Kee. London: Wiley. 1978. Pp. 608. /;6.50. Drug Treatment in Psychiatry.-2nd ed. By Trevor Silverstone & Paul Turner. London: Routledge & Kegan Paul. 1978. Pp. 268. 6.50

(cloth ed.); 3.75 (paperback). Cardiology.-3rd ed. By D. G. Julian. London: Bailliere Tindall. 1978. Pp. 347./;4.25. The Biochemical Basis of Ncuropharmacology.-3rd ed. By Jack R. Cooper, Floyd E. Bloom, and Robert H. Roth. Oxford: Oxford University Press. 1978. I’p. 327. /;3.95. Increased Intracranial Pressure in Children.-2nd ed. By William E. Bell and William F. McCormick. London & Philadelphia: Saunders. 1978. Pp. 485. 21.00.

Primary biliary cirrhosis and coeliac disease.

713 Reviews of Books The Genetics of the Jews A. E. MOURANT, ADA C. KOPEC, and KAZIMIERA DOMANIEWSKASOBCZAK, formerly of the M.R.C. Serological Popul...
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