Reviews of Books
2
441 Reviews of Books Clinical Tests of Thyroid Function JOHN A. THOMSON F.R.C.P.G., university department of medicine, Royal Infirmary, Glasgow. London: Crosby Lockwood Staples. 1974. Pp. 108. S4.50. THERE have been many technical advances lately in tests of thyroid function, and the clinician can now confirm or refute clinical diagnoses or suspicions relatively simply and with little disturbance to the patient. However, the variety of tests is great and often confusing to the non-expert. There is therefore a need for a simple and informative book to explain and interpret the available investigative procedures, and this is the intention of Dr Thomson’s book. It begins with an explanation of the physiological background, and then deals with well-established routine tests, then more recently established ones, special indica- tions for special tests, and finally some case examples. The book is well presented, but many may feel that there is a lack of balance, with insufficient attention paid to recent but now generally available procedures and too much space devoted to tests that are somewhat old-fashioned. It does seem surprising to take some 10 pages to discuss radioactive-iodine uptake tests, now regarded by many as rarely necessary owing to their intrinsic inefficiency. They occupy a lot of technician-time, yet have relatively poor sensitivity and require administration of radioactive isotope to the patient. This contrasts with the short sections on the protein-bound-iodine, thyroxine, and resin-uptake tests, which clearly constitute the basic thyroid-function tests in almost all centres. In-vivo isotopic tests have been replaced by in-vitro tests for initial investigation, and, even when there is then no clear answer, further in-vitro tests, are now usually employed rather than isotopic tracer studies. The exception is the use of thyroid- scanning techniques, and this is well covered in this book. Few would agree that direct measurement of thyroid- binding-globulin levels by electrophoresis, basal metabolic rate, or tyrosine-tolerance tests should be in a section on routine thyroid-function tests, but some might question the suggestion that thyroid-stimulating-hormone assays with thyrotrophin-releasing-hormone tests or serum-triiodo- thyronine measurement deserve only scant mention. These essential assays are rapidly replacing thyroid suppression and T.s.H.-stimulation tests, to the great benefit of the patient and clinician, since diagnostic accuracy is increased and time and inconvenience reduced. The supraregional assay service is making available T.S.H. assays for all. De- spite the emphasis on older tests this book provides a rich source of easily digested and important information for the clinician managing patients with thyroid diseases. Hypertension Manual Edited by JOHN H. LARAGH, M.D., Columbia-Presbyterian Medical Center, New York. New York: Yorke Medical Books. 1974. Pp. 934.$37. THIS book is based on two series of articles which appeared under the editorship of Dr Laragh in the American Journal of Medicine in 1972 and 1973. The lavish presenta- tion in a single volume unfortunately does not conceal the distinctly hybrid nature of the work. 14 of the 37 papers are by Laragh and his associates, the remainder by various authorities throughout the world. Despite a good deal of interesting material, the book lacks unity of style, form, and purpose. The awkward attempts at grouping the articles into sections (Mechanisms, Methods, Management, &c.) have not improved the underlying imbalance. For example, a chapter on renin-assay methodology appears in the section on Clinical and Epidemiological Characteristics rather than, as might seem more suitable, under Methods. The title is also misleading. A volume of 934 pages cannot be regarded as a handy compendium; nor is this a straight- forward guide to the investigation and management of hypertension. There is little or no attempt to indicate to the uninitiated reader which procedures have been well- documented and validated and which remain controversial. The views of Laragh and his school are in several respects idiosyncratic and contentious-for instance, on the possible role of renin in the causation of heart-attacks and strokes; on the use of urinary sodium-excretion rate to assess the state of sodium balance; and on renin suppression in the treatment of hypertension-yet the reader is, in this book, given only the barest hints of controversy. There are other instances of material likely to beguile the general reader. Laragh’s group suggests here a possible method of estimat- ing renin secretion simply from peripheral venous and renal venous plasma-renin activity estimations, without the need for measurements of either renal blood-flow or plasma- renin-substrate levels. Although this hypothesis seems to lean heavily on studies performed in animals in other labora- tories using different techniques, the authors are not deterred from printing tables of renin-secretion rates consisting predominantly of arbitrarily chosen numbers. Laragh’s ideas are of such interest that it seems unfortunate he has chosen not to develop them in a briefer, more pointed, monograph. As he remarks in the preface, many of the methods used in his laboratory are amongst the best cur- rently available. He would lose nothing by recognising that a number of his views are also at present amongst the most disputed. The Pathology of the Heart E. G. J. OLSEN, M.D., National Heart Hospital, London. Stuttgart: Georg Thieme. New York: International Medical Book Corporation. 1974. Pp. 224. DM79;$22.50. NOT all books based on teaching sessions come off, but Dr Olsen seems to have effected the translation smoothly and successfully. He aims at a point between the specialist cardiac-pathology text and the chapters on the heart which can be found in texts on general pathology. The high- quality photographs are generous in both number and size. The sequence of chapters takes the reader from the normal heart via acquired conditions and congenital anomalies to end with a couple of pages on cardiac transplantation. References later than 1970 seem thin on the ground. The author’s personal experience shines through these pages, so it is surprising to find no mention of modern methods of biopsy. The student, at whom Dr Olsen also sets his sights, is told to look elsewhere for the atheroma story, and he may find this frustrating. But this is not really an under- graduate text, nor is it one for the specialist pathologist; it is the surgeon, physician, and radiologist who will value it most. Environmental Medicine Edited by G. MELVYN HowE, PH.D., and JOHN A. LORAINE, F.R.C.P.E. London: William Heinemann Medical Books. 1974. Pp. 271. E6. DOCTORS tend to be fatalistic about aetiology just as they tend to be optimistic about therapy: terms such as " idiopathic " and " essential " are as acceptable as they are meaningless. This view is hard to reconcile with the epidemiological fact that all diseases have highly irregular geographical distributions. For every condition which in Britain is common, there is generally somewhere in the world a place where it is rare. Genetic variation is not the main explanation, for migrants from low-risk to high-risk regions tend to acquire the susceptibilities of their new
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441
Reviews of Books
Clinical Tests of Thyroid Function
JOHN A. THOMSON F.R.C.P.G., university department of
medicine, Royal Infirmary, Glasgow. London: CrosbyLockwood Staples. 1974. Pp. 108. S4.50.
THERE have been many technical advances lately in testsof thyroid function, and the clinician can now confirm orrefute clinical diagnoses or suspicions relatively simply andwith little disturbance to the patient. However, the varietyof tests is great and often confusing to the non-expert.There is therefore a need for a simple and informativebook to explain and interpret the available investigativeprocedures, and this is the intention of Dr Thomson’sbook. It begins with an explanation of the physiologicalbackground, and then deals with well-established routinetests, then more recently established ones, special indica-tions for special tests, and finally some case examples.The book is well presented, but many may feel that there isa lack of balance, with insufficient attention paid to recentbut now generally available procedures and too muchspace devoted to tests that are somewhat old-fashioned.It does seem surprising to take some 10 pages to discussradioactive-iodine uptake tests, now regarded by many asrarely necessary owing to their intrinsic inefficiency. Theyoccupy a lot of technician-time, yet have relatively poorsensitivity and require administration of radioactive
isotope to the patient. This contrasts with the shortsections on the protein-bound-iodine, thyroxine, and
resin-uptake tests, which clearly constitute the basic
thyroid-function tests in almost all centres. In-vivo
isotopic tests have been replaced by in-vitro tests for initialinvestigation, and, even when there is then no clear answer,further in-vitro tests, are now usually employed rather thanisotopic tracer studies. The exception is the use of thyroid-scanning techniques, and this is well covered in this book.Few would agree that direct measurement of thyroid-binding-globulin levels by electrophoresis, basal metabolicrate, or tyrosine-tolerance tests should be in a section onroutine thyroid-function tests, but some might question thesuggestion that thyroid-stimulating-hormone assays with
thyrotrophin-releasing-hormone tests or serum-triiodo-thyronine measurement deserve only scant mention. Theseessential assays are rapidly replacing thyroid suppressionand T.s.H.-stimulation tests, to the great benefit of thepatient and clinician, since diagnostic accuracy is increasedand time and inconvenience reduced. The supraregionalassay service is making available T.S.H. assays for all. De-
spite the emphasis on older tests this book provides a richsource of easily digested and important information for theclinician managing patients with thyroid diseases.
Hypertension ManualEdited by JOHN H. LARAGH, M.D., Columbia-PresbyterianMedical Center, New York. New York: Yorke MedicalBooks. 1974. Pp. 934.$37.
THIS book is based on two series of articles whichappeared under the editorship of Dr Laragh in the AmericanJournal of Medicine in 1972 and 1973. The lavish presenta-tion in a single volume unfortunately does not conceal thedistinctly hybrid nature of the work. 14 of the 37 papersare by Laragh and his associates, the remainder by variousauthorities throughout the world. Despite a good deal ofinteresting material, the book lacks unity of style, form,and purpose. The awkward attempts at grouping thearticles into sections (Mechanisms, Methods, Management,&c.) have not improved the underlying imbalance. For
example, a chapter on renin-assay methodology appears in
the section on Clinical and Epidemiological Characteristicsrather than, as might seem more suitable, under Methods.The title is also misleading. A volume of 934 pages cannotbe regarded as a handy compendium; nor is this a straight-forward guide to the investigation and management ofhypertension. There is little or no attempt to indicate tothe uninitiated reader which procedures have been well-documented and validated and which remain controversial.The views of Laragh and his school are in several respectsidiosyncratic and contentious-for instance, on the possiblerole of renin in the causation of heart-attacks and strokes;on the use of urinary sodium-excretion rate to assess thestate of sodium balance; and on renin suppression in thetreatment of hypertension-yet the reader is, in this book,given only the barest hints of controversy. There are otherinstances of material likely to beguile the general reader.Laragh’s group suggests here a possible method of estimat-ing renin secretion simply from peripheral venous and renalvenous plasma-renin activity estimations, without the needfor measurements of either renal blood-flow or plasma-renin-substrate levels. Although this hypothesis seems tolean heavily on studies performed in animals in other labora-tories using different techniques, the authors are not
deterred from printing tables of renin-secretion rates
consisting predominantly of arbitrarily chosen numbers.Laragh’s ideas are of such interest that it seems unfortunatehe has chosen not to develop them in a briefer, more pointed,monograph. As he remarks in the preface, many of themethods used in his laboratory are amongst the best cur-rently available. He would lose nothing by recognisingthat a number of his views are also at present amongstthe most disputed.
The Pathology of the HeartE. G. J. OLSEN, M.D., National Heart Hospital, London.Stuttgart: Georg Thieme. New York: InternationalMedical Book Corporation. 1974. Pp. 224. DM79;$22.50.
NOT all books based on teaching sessions come off, butDr Olsen seems to have effected the translation smoothlyand successfully. He aims at a point between the specialistcardiac-pathology text and the chapters on the heart whichcan be found in texts on general pathology. The high-quality photographs are generous in both number and size.The sequence of chapters takes the reader from the normalheart via acquired conditions and congenital anomalies toend with a couple of pages on cardiac transplantation.References later than 1970 seem thin on the ground. Theauthor’s personal experience shines through these pages, soit is surprising to find no mention of modern methods ofbiopsy. The student, at whom Dr Olsen also sets his
sights, is told to look elsewhere for the atheroma story, andhe may find this frustrating. But this is not really an under-graduate text, nor is it one for the specialist pathologist; itis the surgeon, physician, and radiologist who will valueit most.
Environmental Medicine
Edited by G. MELVYN HowE, PH.D., and JOHN A. LORAINE,F.R.C.P.E. London: William Heinemann Medical Books.1974. Pp. 271. E6.
DOCTORS tend to be fatalistic about aetiology just as theytend to be optimistic about therapy: terms such as" idiopathic " and " essential " are as acceptable as theyare meaningless. This view is hard to reconcile with theepidemiological fact that all diseases have highly irregulargeographical distributions. For every condition which inBritain is common, there is generally somewhere in theworld a place where it is rare. Genetic variation is not themain explanation, for migrants from low-risk to high-riskregions tend to acquire the susceptibilities of their new
442
hosts. It seems that most diseases have some roots in theenvironment and way of life. Our environment, and theways in which we are exposed to it, are changing fast, andhence it is not surprising that the incidence-rates of mostdiseases are changing. Unfortunately the happy byproductsof environmental improvement (control of major epidemicdiseases, for example) are now diminishing, but the futureis wide open for the adverse health effects of environ-mental deterioration. Affluence and industrialisation areresponsible for at least some of today’s major diseases; thecauses of most are still unknown, and so is the true import-ance to health of environmental pollution and modemlife-styles. This book is therefore timely. It represents aneffort by environmental scientists and doctors to becomemutually informed of one another’s problems. Theoriginal plan was to set out systematically the scientificbasis of environmental medicine. In the event this task
proved too large, and what emerges is a series of selectedpapers by some leading authorities. Some relate to environ-mental problems (e.g., radiation, water supply, pesticideand other chemical pollution, meteorology) and others
present the environmental background to medical problems(e.g., infectious disease, drug dependence, heart-disease).Inevitably there is overlap, and the approaches and stylesare uneven. Some authors provide excellent accounts oftheir subjects for non-specialist readers; others are moreconcerned to summarise their own work, complete withirrelevant technical data. Bibliographies are short, but onlysome give balanced guides to further reading; most
annoyingly, some evade the order on brevity by citingauthors with no guide to where their papers may be found.Some editorial whip-cracking would have produced a
better book. The book undoubtedly succeeds in its mainpurpose. The reader, doctor or lay, cannot fail to becomeaware of the importance of the subject: health is pro-foundly influenced by environment. The book providessome informative and interesting reading for anyoneconcerned with these wider issues of medicine-but theywill not want to read it from cover to cover.
Microbiology of Human Skin
Major Problems in Dermatology: vol. II. W. C. NOBLE,M.R.C.PATH., Institute of Dermatology, London, andDOROTHY A. SOMMERVILLE, PH.D., department of bacterio-logy, University of Glasgow. London: Saunders. 1974.
Pp. 341. E7.
THE microbial flora (and fauna) of the skin are of obviousimportance in medicine on account of their role in infection.The medical problems include sepsis of surgical andtraumatic wounds due to bacteria from the patient’s ownskin, the transfer of infective organisms from the skin ofone person to susceptible tissues of another, and infectionsof the skin. The range is wide, and has become widerwith the increased importance of " opportunist " organisms,which may include many normal skin bacteria which are
non-pathogenic for healthy persons and tissues. Theskin flora is of great interest also to the biologist as aselected population of microorganisms which flourishunder peculiar conditions that are inhospitable to mostmicrobial species. Among the biological interests are
some unsolved problems. Why, for example, should astrictly anaerobic organism, Corynebacterium acnes, beable to flourish on the exposed skin of the forehead ?Why do men disperse more staphylococci than women ?And why do some persons, but not others, harbour
Staphylococcus aureus in their noses ? This book gives anauthoritative and up-to-date account of the subject. In asection on the skin as a habitat, the authors review the roleof physical and nutrient factors. The concept, " bothuseful and confusing ", of transient and resident bacteria
is discussed, and there is a detailed consideration of thepresence and pathogenic role of Corynebacteria, Micro-coccacew, streptococci, gram-negative bacilli, fungi,viruses, mycoplasmas, and animal parasites. In a chapteron the microbiology of non-infective conditions theauthors describe the variety of microorganisms whichhave been isolated from the lesions of psoriasis, eczema,rosacea, napkin rash, ulcers, and bums. In their view theterm " infective " eczema is probably a misnomer; thoughpathogenic organisms can be found in the lesions, treatmentmust be directed against the skin lesions rather than theorganisms. Burns present a different picture; though theyare non-infective in origin, infection, as the authors pointout, is an important potential cause of death in patientswith severe burns, and its prevention and treatment are ofthe greatest importance. There are chapters on the roleof host factors, including race, age, sex, diabetes, preg-nancy, chronic infections, and malnutrition, on the incidenceand pathogenic role of skin microbes, and there is one onexternal agents, including antiseptics, steroids, and environ-mental conditions, including temperature, humidity, andclothing. Numerous tables and figures illustrate and
complement the text, and there are extensive lists ofreferences for each chapter. The book, written by twomicrobiologists with clinical interests, will be of the
greatest value not only to dermatologists but to all studentsof infection and its control.
Evaluation of Radiation Emergencies and AccidentsSelected Criteria and Data. EDWARD J. VALLARIO, U.S.Atomic Energy Commission. London: H.M. StationeryOffice. New York: Unipub. Vienna: I.A.E.A. 1974.
Pp. 136. E2.70,$6; Sch. 122.
THIS useful handbook, no. 152 in the Technical ReportsSeries of the International Atomic Energy Agency, hasbeen given the wrong title. It deals solely with the calcula-tion of radiation doses and radioactive body burdens
following release of massive radioactivity such as mighthappen after a failure at an atomic power station. Thereis no clinical material or discussion whatever. Those whowant this sort of book will find here many useful formula:and reference tables. Perhaps the title should have read" Data for health physics assessment following release ofradioactivity ", the volume does not evaluate other sorts ofradiation emergencies or accidents.
New Editions
Metabolic and Endocrine Physiology. 3rd ed. By J. Tepperman.Chicago: Year Book. London: Lloyd-Luke. 1974. Pp. 246.E6.75 (paperback E4.95).
Year Book of Urology 1973. Edited by J. T. Grayhack.Chicago: Year Book. London: Lloyd-Luke. 1974. Pp. 381.E8.25.
Year Book of Anesthesia 1973. Edited by J. E. Eckenhoff.Chicago: Year Book. London: Lloyd-Luke. 1974. Pp. 392.S7.75.Advances in Surgery; vol. VII. Edited by James D. Hardy
and R. M. Zollinger. Chicago: Year Book. London: Lloyd-Luke. 1974. Pp. 277. Ell.75.
Advances in Internal Medicine, vol. XIX. Edited by G. H.Stollerman. Chicago: Year Book. London: Lloyd-Luke.1974. Pp. 472. E12.75.Advances in Pediatrics, vol. XX. Edited by I. Schulman.
Chicago: Year Book. London: Lloyd-Luke. 1974. Pp. 374.S10.25.Advances in Nephrology, vol. III. Edited by J. Hamburger
and others. Chicago: Year Book. London: Lloyd-Luke. 19*4.S14.30.Year Book of Psychiatry and Applied Mental Health 1974.
Edited by F. J. Braceland and others. Chicago: Year Book.London: Lloyd-Luke. 1974. Pp. 432. E10.75.
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