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Ten patients with familial Mediterranean fever (FMF) and histologically confirmed amyloidosis received cadaver kidney transplants for treatment of terminal renal disease. Colchicine, 1 mg daily, was included in the routine postoperative regimen from 1974 for amyloidotic patients. Graft and patient survival were compared with ten nonamyloidotic recipients of renal grafts matched for age, sex, type of allograft, and HLA compatibility. In the FMF group, five of ten grafts have survived from 20 to 64 months; in the control group, six of ten. While only recipients with functioning grafts survived in the FMF group, patient survival in the control group is eight of ten after one year. In all five FMF survivors, graft function is satisfactory, proteinuria is absent, and blood creatinine levels are normal. Amyloid involvement of an allograft was documented 16 months after transplantation in the only patient whose maintenance colchicine dosage had been reduced to 0.5 mg daily.(Arch Intern Med 139:1135-1138, 1979)

We analyzed the clinical and laboratory findings of 19 patients with tuberculous meningitis seen between 1966 and 1974 at the Henry Ford Hospital. Eighteen patients were adults at the time of diagnosis. In eight patients, the history suggested that the infection with the tubercle bacillus had occurred in the remote past. Cerebrospinal fluid analysis was often typical for tuberculous meningitis; stains for Mycobacterium tuberculosis were usually negative. Of 16 patients who were treated, five died and five suffered permanent neurological sequelae. The addition of rifampin to isoniazid therapy did not improve either survival or permanent sequelae. We were not able to analyze the effect of steroids on the disease.(Arch Intern Med 137:1518-1521, 1977)

An acquaintance, an ancient gentleman who was an intimate of Theodore Roosevelt, told me that just inside his house in Oyster Bay, T.R. had a prominent sign which read: "If you are not an American what the hell are you doing here?" People usually laughed dutifully when they read the sign—they love to shine in the reflected image of the great and neargreat, the famous and infamous. The price of this reflection is often sycophancy. Thus, apparently, no one made an adverse comment until one day a guest asked T.R. what he meant —did he mean American by birth or by ideals, and if so to which ideals was T.R. referring? T.R. took offense: "If you don't know you are not an American so get the hell out of here."I was reminded of that ludicrous incident shortly after beginning this book, City on a Hill. While it discusses the

MULTIPLE.ULTIPLE peripheral gangrene as used here refers to the rapid and practically simultaneous development of necrosis of the distal portions of two or more widely separated external appendages. At times this rare event can be a difficult diagnostic problem. The purpose of this communication is to present an unusual case of multiple peripheral gangrene and to enumerate the disorders associated with such a complication. REPORT OF A CASE A 38-year-old Negro woman was admitted to the Ben Taub General Hospital on Jan 4, 1964, and died on January 30. She was first seen seven months before her admission, after receiving a beating about the head and neck. Her blood pressure then was 130/90 mm Hg. Neurological examination, urinalysis, and roentgenograms of her chest and skull revealed no abnormalities.About two weeks later, she experienced the abrupt onset of severe, intermittent pain in the epigastrium and lower anterior portion of her

NIACIN THERAPY IN PSYCHIATRY. By A. Hoffer, PhD, MD. Price, $6.75. Pp XVI and 161, with no illustrations. Charles C Thomas, Publisher, 301-327 E Lawrence Ave, Springfield, Ill, 1962. RECENT ADVANCES IN BIOLOGICAL PSYCHIATRY, Vol 4. Edited by Joseph Wortis, MD. Price, $13.50. Pp 385, with no illustrations. Plenum Press, 227 W 17th St, New York, 1962. RECENT ADVANCES IN BIOLOGICAL PSYCHIATRY, Vol 5. Edited by Joseph Wortis, MD. Price, $13.50. Pp 380, with no illustrations. Plenum Press, 227 W 17th St, New York, 1963.Before the time of Pinel, Psychiatry was a hose-keeping job—or more correctly a punitive job not unlike that of running a penal institution. Thereafter it became a housekeeping job—more correctly a custodial one with better rapport with patients. With Freud it became a sacerdotal job—frequently one surrounded with the mysticisms of the various so-called dynamically oriented schools.Schools of thought are usually based upon plausible

Suicide is a dirty word in our civilization. So was syphilis—and was allowed to do its dirty work by suppression of its cognizance.I shall quote only one statistic: 18,000 suicides are reported a year in the United States. This figure will be clothed in glaring significance by comparing it to two facts: (1) the 35,000 deaths a year through motorcar accidents—while there is an outcry against traffic deaths, there is a suppression of information on death by suicide; and (2) our society considers suicide a disgrace, and therefore if a death can be ascribed to other causes, it is usually not reported as suicide.For example, newspaper accounts often report the death of a prominent person through accidental ingestion of an overdose of sleeping pills. The fact is that that is rather improbable: assuming that an individual has forgotten that he took a dose of a hypnotic only ten

THE CONDITION first recorded by Werlhof1 and now known as "idiopathic," "essential," or "primary" thrombocytopenic purpura is usually described as a disease of unknown causation characterized by such hemorrhagic manifestations as purpura, bleeding from the mucous membranes, thrombocytopenia, a prolonged bleeding time, and failure of the clot to retract, in the absence of an underlying disease known to lead to thrombocytopenia.In the many reviews published during the last 15 years the diagnostic features mentioned above have always been emphasized, together with the often dramatic results following splenectomy.2 On the other hand, the natural course of the disease has been discussed in relatively few publications,3 in spite of the fact that the tendency to remissions and relapses is well recognized. Although chronic mild hemorrhagic symptoms are mentioned, one usually gains the impression that while one attack of thrombocytopenic purpura leaves the patient subject to further attacks the

THE IMPORTANCE of antibiotics in medicine is reflected in the tremendous number of scientific papers published on the subject and the many new antibiotics described since penicillin became available. The clinically useful antibiotics at present are derived from the metabolic products of molds or filamentous fungi, from bacteria, and from the Actinomycetes.1 The search for new antimicrobial agents has encompassed a wide variety of sources,2 including human red blood cells, algae, toadstools, hops, the banana, the sweet potato, and even the onion, cabbage, turnip and horse-radish. Clinical studies on such new compounds as viomycin, fumagillin, picromycin,3 and rhodomycin4 are in progress. The many rapid developments in this field periodically require evaluation and review. The purpose of this paper is to survey briefly the current status of antibiotics in the treatment of gastrointestinal diseases. PENICILLIN Penicillin5 is derived from the mold Pénicillium notatimi. The accepted preparation for clinical use is crystalline

Bile acid synthesis in the liver is controlled by a negative feedback mechanism: hepatic bile acid synthesis varies inversely with the hepatic bile acid flux. Two regulatory enzymes appear to be involved in this process, cholesterol 7α-hydroxylase and hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase. It seems likely that the activity of these enzymes varies in response to changes in the magnitude, circulation rate, and composition of the bile acid pool.

In contradistinction to typhoid, the present day knowledge of paratyphoid infections of man is as yet incomplete, although important advances in this field have been made during the last few years. The identification of the various members of the Salmonella group presents difficulties far greater than those encountered in the recognition of the typhoid bacillus. The genus Salmonella is comprised of many different species and types. As a matter of fact, more than one hundred species have been described in the past as pathogens for human beings or animals or both. Special diagnostic antiserums are required to establish species or type identity. To add to the difficulty, the members of the Salmonella group are responsible for a variety of clinical syndromes. The diseases may be classified conveniently into three large groups: (1) paratyphoid, (2) gastroenteritis and (3) pyogenic infections. To the latter group belong such syndromes as septicemia, peritonitis, osteomyelitis,

No wonder Koestler's thesis in this book is that man acts out of his schizophysiology! Man can discern acts that are illogical, inconsistent, or bizarre—but his history tells the story of his illogical, inconsistent acts, and bizarre behavior. For example, if a prisoner under sentence of death attempts to kill himself the day before execution and almost succeeds, prison authorities will give him the best medical care available and postpone the execution until he has recovered so he can be hung in good health.Man professes love as a virtue and claims adherence to a deity as mentor and giver of all love. Nonetheless, man has been known to persecute, torture, and kill others who worship a variant of the same deity or who worship different deities, all in the name of the deity of love (the Albigensians, Huguenots, Jews, and other "heretics" can attest to that).Man seeks justice

FEW AUTOPSY examinations have been made on patients with polyostotic fibrous dysplasia. The present report is concerned with an individual (Fig 1) with extensive skeletal involvement with this disorder, who had a small area of cutaneous pigmentation and who, during the course of 18 years of observation, developed and was treated for thyrotoxicosis. The patient had generously willed his body to Baylor University College of Medicine and at his death, from extensive cardiopulmonary disease, autopsy was performed and the entire skeleton was reconstructed (Fig 2-4). This skeleton is now in the Anatomy Museum of that institution and is believed to be the only one in this country. The only other known skeleton of an individual with this disorder is (or was) in Berlin.1 REPORT OF A CASE D. C. was first seen in the emergency room of the Jefferson Davis Hospital in 1947 at age 37 because of pain

It has been clearly demonstrated in numerous clinical and anatomical studies that arteriosclerosis and its complications are commoner in patients with diabetes mellitus than in nondiabetic patients.* In the autopsy series at Washington University, diabetes mellitus is three times as common among men with acute myocardial infarction as among men in the general autopsy population. The corresponding ratio for women in this series is 4:1.7Thus, the close association between diabetes mellitus and acute myocardial infarction is well known. However, inadequate information is available regarding the clinical and anatomical features of diabetics with acute myocardial infarction as compared with the corresponding characteristics of nondiabetics with acute myocardial infarction. The purpose of this report is to present the clinical and anatomical features in 94 diabetics who died with acute myocardial infarction compared with those in 406 nondiabetics who died with acute myocardial infarction. MATERIAL AND METHODS During the period 1910-1954,

Recreation, Leisure and Politics. By Arnold W. Green. Price, $5.95. Pp 193. McGraw-Hill Publishing Co., 330 W 42nd St, New York, NY 10036, 1964.Michael Harrington's The Other America appeared in 1962 as a reaction to Galbraith's The Affluent Society. Harrington gave facts and figures on poverty in present day, midcentury American, ie, in the country at large. Harrington's objective apparently was not to disprove what Galbraith said but to point out that Galbraith omitted areas so huge that his description of society was a distortion— a picture of a highly select small sample— better classified as a group than a society.The Affluent Society can be said to be a view with a magnifying glass of a rich portion of the tapestry that is America. The first book under review, Caudill's Night Comes to the Cumberlands, has similarly been held to be a view with a magnifying glass over

It is well known that biologically oriented psychiatric investigators believe aberrant emotional or mental states to be disturbances of the biological or biochemical homeostasis. Many write as if the structural formulae for various emotions are not far off. On the other hand, psychologically, dynamically, or analytically oriented investigators view and interpret these aberrant states almost wholly from a psychologic viewpoint.Then comes a new battle cry—interdisciplinary investigation. When one enters into the shadowland between two disciplines to bridge them, one may be assailed by both disciplines. One complaint may be that when a book has 2,000 bibliographic references to both disciplines it is less than critical in its inclusiveness, but if it carries few references bearing more heavily on one side it is often considered to be discriminatory. If a book gives an account of the state of a discipline it is said to be merely a reportorial account.

If biography is the history of an individual, history is the biography of nations or other groups. History (or biography) is a story of conflict or concord—usually both. The individuals concerned wrestle with other individuals-either with their contemporaries or their predecessors. They may also wrestle with that specter of their predecessors called tradition, and here the battle may be waged within the minds of men.But both history and biography, potentially fertile subjects, can become preoccupied by tedious overconcern with dates or emasculated by the mere cataloging of events—processes which debilitate the intrinsic richness of the subject.What makes a good history or biography? Surely a set of anecdotes does not fill the bill, although such an account would make good fiction. In our opinion history or biography should be considered to be a study of the past with a view towards illuminating the present. Above all, it should be

Diseases of Medical Progress is a book with multiple functions. First, it can serve as a guide to contraindications to the use of a drug or cautions to be observed when prescribing a given drug. For example, the relatively safe drug, griseofulvin (Fulvicin, Grifulvin) may hardly be the drug of choice in a fungal infection if the patient is suspected of having systemic lupus erythematosus, because griseofulvin has been suspected of precipitating it.Second, it can serve as a guide in toxicology. Third, it can be of diagnostic help in clearing up the occurrence of an unrelated condition in a patient, by pointing to a side effect of a drug administered for a different purpose. For example, one can be at a loss to explain sudden and appreciable hair loss in a patient who may be euthyroid, has no topical lesions, or has not been exposed to radiation. But due

To praise this book would be gilding the lily. To outline what it contains would be almost superfluous as it is well known to be a most comprehensive pharmacology text, embellished by many peripheral yet important facets which lend it comprehensiveness. To state how it presents its material and for what particular purpose it is most suitable would perhaps be more germane.Before Goodman and Gilman's first edition appeared, Sollmann's Manual of Pharmacology was the pharmacologist's pharmacology text. It gave details on a variety of effects some of which were of recondite properties of drugs then used. The appearance of Goodman and Gilman's text put the strong emphasis of pharmacology upon therapy and how the pharmacological effect of drugs can be utilized in therapy or is limited in therapeutic use.In the process, many of the older drugs were justifiably dropped. For example, there is no trace in Goodman and

The final paragraph of the 20-page chapter "A Brief Review" (and it is, by-and-large, a good review) reads: "We feel that detailed first-hand accounts of experiences as they occurred (typescripts of tape recordings) by subjects, screened for stability, in sensorilly controlled environments, will help to resolve the question of whether the hallucinogenic experience should be an available adjunct to life." That statement leaves one rather puzzled: if such an account can resolve or help resolve a question as fundamental as the one posed, I would consider this one of the longest inductive leaps. After the obeisance given to the signals such as control, placebo, and other magic words, can one so readily accept the account of three students each of whom (save one) received psilocybin, LSD, as well as Sernyl at separate times?Another statement in the introduction leaves me equally nonplused, namely that only one student requested a drug

The first English edition (1922) of this classic work had a salubrious side effect: it stimulated the study of Latin on the part of the then young men—and others—who sought to indulge their prurience with las- civious accounts. The literature on plain, dripping sex was then, more or less, sparse or nonexistent. There were the classics of course, including Rabelais' books, the novels of Defoe (Roxana, etc.), Steckel, and the Old Testament. There were the scholarly books, anthropological in note, but nothing which bluntly and plainly spoke of sex, its orgies, details of aberrant sexual encounters and of sexual perversions. The Psychopathia Sexualis of von Krafft-Ebing gave these in straight detail, but the most picturesque or exciting accounts were in frustrating Latin. Many pored over von Krafft-Ebing in the search for the salacious which was often blocked by Latin. But whatever the aim in reading von Krafft-Ebing, the reader was

Phantastica—Narcotic and Stimulating Drugs, Their Use and Abuse. By Louis Lewin, MD. Price, 30 s. Pp 335, with no illustrations. Routledge & Kegan Paul, Ltd., 68-74 Carter Lane, London E.C.4, England, 1964.It seems that from earliest times man as well as angels has sought to surpass himself. Man's attempt has been by drugs or selfinduced transcendence. The angel of the first hierarchy, of the first order of that hierarchy, who attempted to transcend himself was named Lucifer. It was Tertullian, I believe, who referred to Lucifer as the wisest of all angels. Origen, a father and founder of the Greek Orthodox Church, says that Lucifer, in attempting to surpass his intelligence and his grasp by vowing, "I will be like unto the Most High," fell with a profound fall for his apostasy. And long after, in the 14th century, Duns Scotus was the protagonist of the opinion that Lucifer—by

I undertake the review of this book with trepidation. This is not said in awe or in mock humility, but in the honest belief that a review cannot encompass the book. Any space for review is oppressively small, words that one can use are too obtuse, and gains from a book such as this are too many to be adequately condensed. Nor is this feeling due to Koestler's erudition, immense as it is. Erudition, used alike by savants and pedants, is of little consequence unless put to constructive ends. I believe it was Morris R. Cohen, the philosopher and logician, who expressed that thought pithily in another connection: "Facts are meaningless except as parts of a system."This is a book about the creative quality in man. It is a submission and particularly an evaluation of facts and observations, and above all, a speculation as to how these are involved

He has a need to do it is frequently offered as a full and pat explanation for a particular action or trait of an individual which, of course, explains nothing. It is perhaps so much easier to use cliches and strike a posture of dubious profundity instead of thinking it through or using the healing phrase, "I don't know." It is like explaining the act of a murderer with "he had a need to do it." Similarly the phrase acting out is also used as an explanation for a trait, an activity or a self-defeating act or similar self-sabotage, or even for diseases such as alcoholism. In these the patient is said to be acting out his hostilities or maladjustments or to be making a social protest to express his contempt for his society or his world, or to be making a good attempt to destroy himself with alcohol. Though

Recent Advances in Biological Psychiatry. Vol 7. Edited by Joseph Wortis, MD. Price, $13.50. Pp 297. Plenum Press, 227 W 17 St, New York, NY 10011, 1965.There is no doubt that exogenous agents affect the psyche and behavioral states. Obvious examples would be tranquilizers, antidepressants, or psychodelic agents. There is no doubt of the reverse—that an accentuation of emotions gives evidence of physical manifestations, as rage, for example, increasing the level of epinephrine. In other words, while chemical and electrical stimuli produce changes in the nervous system the opposite can also occur as well. By the latter example I am referring to emotions causing an output or elaboration of a substance normally present in the body. By extrapolation this may be tantamount to emotions producing molecular changes, and evidence may be forthcoming that pervading states, such as boredom, may create somatic changes. There is a third condition in which

A Pharmacological Approach to the Brain From Its Inner and Outer Surface. W. Feldberg, MD, FRS. Price, $4.50. Pp 128, with no illustrations. The Williams & Wilkins Co., 428 E Preston St, Baltimore 21202, 1963.The symptoms of a disease do not often change. But the significance of a symptom may change. This is particularly striking in the psychiatric areas. For example, not too many years ago, an individual who insisted that "people have a machine and are taking down what I say" was clearly thought to be paranoid. And the "people who were doing this to me" were hidden in the most unlikely places, such as air-conditioning outlets, hotair registers, electric outlets, etc. What doubt was there that individuals making such claims were psychotic? Today, however, one cannot be so certain: while listeners may not be hiding in electric outlets, microphone and recording equipment may be hidden in the

The phrase, flash of genius, has become a commonplace one and also has taken on a parochial connotation. Tn the first case it is used with little discrimination. In the second case, since the use of the phrase in a court decision arising from litigation of a patent, it has taken on a particular technical meaning as a test of inventiveness in patents.What does a genius do? We, a materialistically oriented culture, say he invents. And in this sense the invention is, or has to do, with things. This is no criticism if we are speaking of things. But our preoccupation with things overrides the most fertile attribute of genius, the creation of concepts, new ideas, new models of thought—different ways of looking at the old.It is quite widely held that the chance happening—the lucky break—is hardly accidental. Tt is rather the culmination of activities and thoughts which

From time to time, Dr. Di Cyan and I have discussed and debated the objectives and weaknesses of some of our ideas in the essay which follows. We hope that our caveat will stimulate the reader to cast his speculations into the general area which we discuss. We urge readers to refresh themselves by reading two earlier essays by William B. Bean: "Some Musing on Reviewing Medical Books" (Arch Intern Med97:497, 1956) and "A Critique of Criticism in Medicine and the Biological Sciences in 1958" Perspect Biol Med 1:224, 1958). D.B.S.Few dispute the fact that the intellect needs its special food in order to thrive. Among varieties of pabulum, books offer a choice form. They feed the informational reservoir from which spring informed fools as well as knowledgeable men. Books offer many other diversions or goodies, of course; many of us find that, through books, we prefer to communicate with dead

"Side Effects of Drugs. Ed 4. By L. Meyler, MD. Price, $7.50. Pp 356, with no illustrations. Excerpta Medical Foundation, 2 E 103 St, New York, NY 10029, 1963.Annual Review of Pharmacology: Vol 4, 1964. W. C. Cutting, Editor, R. H. Dreisbach and H. W. Elliot, Associate Editors. Price, $8.50. Pp 453, with no illustrations. Annual Reviews Inc., 231 Grant Ave, Palo Alto, Calif 94306, 1964.When the history of our times is written we may be known as the era of poisons and placebos. Virtually all drugs have side-effects and therefore have varying degrees of toxicity. Inactive drugs are placebos—and they too have side effects of their very own. Thus we are enveloped in an era of pharmacological anxiety, which, it must be said, is justifiable in some measure. But it is extraordinary that the list of drugs considered ineffective is growing, and at the same time the

TO THE EDITOR.— The report of Murray et al in the Archieves (136:480-483, 1976) contains implications that if applied clinically might prove to be dangerous. The patient, who had Staphylococcus aureus endocarditis, continued with a low-grade fever up to 38.8 C during the first two weeks while being treated with methicillin sodium alone. He also had peripheral emboli with hematuria, left upper quadrant (abdominal?) pain, and an abnormal spleen scan. The emboli were probably the cause of the fever. Emboli can occur even after the institution of adequate antibiotic treatment for endocarditis.1 The authors failed to show that the initial regimen of methicillin was failing to achieve a bacteriologic remission. There is no data to support the contentions that rapid sterilization of vegetations prevents "further vital tissue destruction" or changes the fever. Defervescence should not be ascribed to the increased dosage of methicillin or to intermittent injections of gentamicin

A patient with Legionnaires' disease had extensive pulmonary cavitation, a finding not previously described. We review the radiological and pertinent clinical observations.(Arch Intern Med 139:485-486, 1979)

One of the questions to be answered for virtually every book is the nature of the reader for whom it would be best suited. Another question is whether an additional book might be necessary or desirable to supplement the scope of the book in question—as a sort of textual magnifying glass. A general caution is appropriate here: an incomplete account may at times be as hazardous as a false account-the omission of relevant material in an incomplete account has the same effect as an account which by its silence can be misleading. This caution is intended as a general note in this age of the quick-and-easy summaries.While Cutting's Handbook of Pharmacology is not and cannot be even relatively comprehensive, it signals the important properties of a substance by its excellent organization. The usual pattern by which drugs or groups of drugs (as ganglionic blocking agents for example) are described

That modern biochemistry is of fundamental importance in medical practice is well enough known. In fact, modern biochemistry is the system or language in terms of which most biological events are more informatively expressed. For example, a comprehensive understanding of modern pharmacology encompasses biochemical events: on what substrate a drug acts; why is it assumed or presently known to act that way; what inhibits, accentuates, or otherwise modifies its action, and so on and so forth. Most bio-chemical happenings are subject to a feedback system, whereby the product of interaction itself modifies the subsequent reaction of the substances which built it. These are simple enough and easily understandable phenomena. And they hold the key to an appreciation about what goes on in the body.While this book refers to biochemical functions in the mammal generally, it makes specific reference to human biochemistry. As such, it has a clinical or

The first use of a substance frequently fixes, for a time, its purpose, dose, or method of use. That was the case with papaverine, used for decades in about 30-mg doses—too small to be effective. The situation was similar with nicotinic acid.Though used by Spies in the late 1930's to reverse the mental changes in pellagra, the image of nicotonic acid became substantially that of a vitamin—given in doses of 10-15 mg a day—to prevent deficiency symptoms. It was also administered in daily doses of 25-50 mg, occasionally in 100 mg doses per day. The mental stereotype of milligram doses of that order of magnitude became fixed. Perhaps this accounted for the resistance to the use of nicotinic acid in depressing blood cholesterol levels, as described by Altschul and Hoffer in 1955. They used doses of 3 gm a day—at times up to 10 gm(!) per day. Others had

During the Middle Ages, executions of criminals were occasions for feasts and public display. Originally intended as deterrents to heresy or other crimes, these public functions became reasons for jubilation on the part of the populace—with each participant rejoicing when the condemned man was broken at the wheel or drawn and quartered or otherwise tortured. The onlookers may have secretly transferred their own sins upon the executed and in so doing purged their own consciences of their wrongdoings which had not been detected. Men of the Middle Ages prided themselves on their morality—but thus were most amoral and un-Christian in their relationships with their fellow men.But the Middle Ages ended. The community became increasingly concerned with its sick and its poor and with those who suffered as a result of wars or natural disasters. The rise of civilization coincides with the systematic organization of means taken by the community

The value of a book is a shifting quality, as a number of dimensions are involved in the cumulative judgment thrust upon it. One dimension is time: say, a given Practice of Physick may have justifiably held a pre-eminent place in the 18th Century, for what it taught was then held to be truth. Another dimension is place: the superb Perspectives in Malnutrition (Joseph Gillman and Theodore Gillman, 1951) for example, has preeminent utility in Africa, for the nutritional problems and anomalies so marvelously described therein were tested in the African milieu; they apply more specifically to nutritional problems in Africa (though for the United States the book has a heuristic value).But at all times, the third dimension is the reader. No book is good per se unless the nature of interest and the level of the reader for whom it is good, are mentioned. (Parenthetically, the converse is

There will come a time when our present assessment of drugs will have lost some of its smugness, and the teaching of pharmacology will be altered to encompass a newer concept. That concept has to do with the fact that a genetic anlage, or diathesis, modifies the action of drugs. This is the field of pharmacogenetics—the term is new—the phenomenon is old.Yet, pharmacogenetics will not solve all or even most problems connected with drugs. In fact, it rather recognizes the existence of problems in the aberrant reaction to drugs. Its main thesis is that conditions genetically determined can modify the classical or well-known action of drugs, altering their metabolic conversion, degradation, or rate of excretion, thus influencing the effect and the the toxicity of such drugs in genetically susceptible individuals. This is far beyond the simple concept of allergy.Certain inborn conditions are known to make individuals more resistant

At times there is catapulted into our midst a man or an event we wish to, or feel compelled to, explore. Thudichum is such a man. His Treatise on the Chemical Constitution of the Brain is such an event. The book was originally published in England in 1884, and this is a facsimile thereof.At times the opportunity is given to us to gain prescience through looking at the past, by reading an 80-year-old book. Projecting ourselves into the past when the book was written, we can look ahead into the future from there—the outcome of which we know very well, because we live in that future into which we look. It is a sort of game of forecasting, and it allows us to test—after a fashion—our perception and our judgment, for we know what has happened. And it allows us, too, to make an excellent judgment of the man

The small monograph reports on the author's experience with 1,100 cases where diagnostic x-ray studies were made prior to laparoscopy. With the author's increasing experience in this diagnostic procedure he was able to come up with accurate diagnoses in the majority cases.The method proved useful in conditions of the diaphragm, the abdominal wall, the liver, spleen, gall bladder, pancreas, and the female pelvic organs. Complications and risks of the procedure, although mostly minor, should be well recognized and the diagnostic gain weighed against the involved risk.The booklet is recommended for physicians doing laparoscopy and those radiologists who will have opportunity to work with the laparoscopist.

Encyclopedias, in general, have common traits—which can be both virtues and drawbacks. For example, they usually have hundreds of specialist-contributors who often write as if they are speaking to other specialists of the same stripe. A good editor reduces such presentation to common parlance. Since encyclopedias have status, readers tend to consult them on subjects about which they know little, and they often consider the monographs to be the last word on the subject. As a matter of fact, while the contributions themselves are usually factually valid, they must, perforce, be oversimplified. One reason is the heterogenous audience; another is the brevity of a presentation. If the reader views the material in a monograph as a representative cut of a picture rather than a peak, the information he will derive will be skewed. An unfamiliar reader may consider a subject to be unimportant because a given encyclopedia may dispose of

In an area which carries large zones of ignorance, it may be well to talk around a topic. While that may serve a purpose of the speaker or writer's convenience, there may be a more constructive purpose: that of opening up heuristic speculations; they often lead to findings.In some ways the above may be said of this book. Also, as the book is concerned with the physical aspects of anomalies which manifest themselves in the mental sphere, perhaps it should not be expected to be holistically oriented, ie, also concerned with behavioral or cultural aspects which are believed by some to be causal and others to be associated with disturbances of mental function. The title clearly expresses the physical or biochemical aspect or bias. In fact, as stated in the preface to the book, the aim of research in mental health is to recognize inborn cellular errors of metabolism

At the outset, the authors point out that most scientific studies on the metabolism of alcohol are made wih alcohol itself. But in real life by real people, they continue, alcohol is not ingested as such, but in the form of whiskey, wine, beer, and other available forms. Therefore, they reason, there can be no one-to-one correspondence of effect between alcohol and its beverages—though that can be disputed. However, the setting in which alcoholic drinks are consumed differs from the laboratory ingestion of diluted alcohol, and its influence may thus be modified. Other aspects which will influence the effect of alcohol are total dose; rate at which it is consumed, converted, and excreted; plus collateral factors such as food intake. But while we do not, as far as I am aware, have a critical study of the comparative effect of alcoholic beverages (as against alcohol) there is an immense amount

One of the reasons the world moves is that individuals arise from time to time who provide impetus to significant events. "Good" leaders—like good guys—can push it to constructive ends. "Bad" leaders—like bad guys—can push the events in the world of perdition. And at times good leaders through stupidity have been known to push the world toward hell, and bad leaders through cupidity have unintentionally given it a push upward. Perhaps the history of events is parallel to the history of their leaders. These events may occur at various levels or stages.We must not construe the term "leader" in a literal sense. The same "impetus giver" principle can apply to the classroom where the student-leader soon emerges, to the dogpack, to the societal complex of caged rats, to the political leader, to the therapist and his group. It may occur in any societal setting, even at a dinner party,

The aim of the book is to counter the prejudice existing against several types of sexual deviates and deviations. While it inveighs against one brand, it substitutes its own brand of prejudice. Its thesis is an examination of the nature, basis, and reasons for societal disapproval or condemnation of sexual deviations such as sodomy, sexual sadism, exhibitionism, necrophilia, anilinction, voyeurism—all erotic minorities. The author holds that homosexuals have their own organized groups and publications, but that the other erotic practitioners have no champions. And he sets forth to champion them in this tendentious little book.It is true that we have sanctions against homosexuals which are reminiscent of the Middle Ages. In fact, in North Carolina the law with respect to one deviation, sodomy, is based on the English law of 1533, which prescribes death. North Carolina has "modernized" the punishment to a jail sentence not exceeding 60 years! Other

Everyone knows the meaning of the term research but it has a different meaning to different people. To some it is to explore in unknown areas to see what happens—basic research. Others hope to confirm or to refute a particular notion. Often, merely a matter of refinement of techniques is called research wherein the researcher aims to push a decimal point another place or two to the left. Nonetheless, all agree that, at best, research uses the faculty of creativeness which is necessary in order to define or to discover.It is desirable, I believe, to restate certain truisms which are involved in research. For example, the scientific method is taken as a vade mecum and we speak of it as if it were a talisman showing the right road. But this is not necessarily so. There are many philosophies of science. We speak of logic as if it were

Many events take place in disease, which are ostensibly removed from the site of symptom or complaint. For example, in myocardial infarction, there is a change in the level of serum enzymes, which rises or drops during the course of the episode. Or, in shock there is an electrolyte disturbance, which is in a sense the ecological aspect of the condition. These changes in levels are often so predictable that they may be used as a point in diagnosis, or in prognosis to assess the course of a disease, its repair or exacerbation.It is only about 15 years since the determination of serum enzymes has been used regularly in diagnosis and only about 10 years since fractionation into isoenzymes refined their diagnostic use.Enzymes are ubiquitous in tissues—including bone—and their determination represents a particularly useful procedure in diagnosis and prognosis. Since their predominance often differs from organ to

Annual Review of Pharmacology, vol 9. Edited by Henry W. Elliott, MD; Windsor C. Cutting, MD; and Robert H. Dreisbach, MD. Price, $8.50. Pp 591. Annual Reviews, Inc., 4139 El Camino Way, Palo Alto, Calif 94306, 1969.These two books are subject to common review since such volumes usually point to trends, both retrospectively and prospectively. And it should be borne in mind that comparisons, while valid, are not necessarily parallel. One reason is that Annual Review of Pharmacology is published yearly, while the previous edition of Recent Advances in Pharmacology was published six years ago.The subjects chosen for such review volumes often coincide with the current interest in a drug, a therapy, or a mechanism. Yet timeliness may not be a virtue as nothing can be so obsolete as an item that may have been the current rage at the time it was written. For that reason, new

Alcoholism is a serious disease. In many respects, overindulgence in alcohol is more serious than self-administered overdosage of, say, adrenal corticosteroids. In the latter case, overuse destroys the user, but in the case of alcohol it destroys those around him as well. Over indulgence in alcohol is a euphemism—alcohol poisoning is more descriptive.Before one considers alcoholism one must first consider alcohol, because in all probability it has the broadest ramifications of any drug. For example, one aspect is political. The huge excise taxes collected by the government are a consideration of profound influence should a question of control come up—assuming that control is desired. Another ramification is societal—alcohol is a sort of "pot" or marijuana of which society heartily approves. This virtually encourages alcoholism. It is only when the alcoholic is on the skids—for drunken driving, arrests, loss of job, or splintering of the immediate family—that society invokes its

Drug Interactions—Clinical Significance of Drug—Drug Interactions and Drug Effects on Clinical Laboratory Results. By Philip D Hansten, Pharm D. Price, $9.50. Pp 437. Lea & Febiger, Washington Sq, Philadelphia 19106, 1971.The phenomenon of the interaction of drugs taken with therapeutic intent is far from new. Only the importance of drug interaction upon the human organism is new. One of the reasons why drug interaction has not been accorded the importance it deserves is that methods of assessing it have not been developed; another, that untoward or bizarre effects may not have been thought of as due to the interaction of drugs. A motto, such as drug interaction, is needed to stimulate people to consider it as a possible explanation of unexpected happenings or to sharpen observation on unaccustomed effects certain drugs may have. An added impetus was given to this subject by the study of side effects of drugs.