Rose makes a most valuable clinical point, well known to students of bone ... expanded by the many points of interest along theway. The book is presented by its ...
one of the most lucid and accurate descriptions available. Since the various osteoporoses have different radiologic appearances, Siegelman well illustrates three of the most important types: that of immobilization, that produced by excess glucocorticoids (with its pathognomonic eburnation of the vertebral endplates), and that of osteogenesis imperfecta. While the most common postmenopausal type is not illustrated, it is clearly described. Rose makes a most valuable clinical point, well known to students of bone diseases, but poorly popularized and essential for evaluation of therapy. He points out that in adults loss of bone is irreversible. Thus, it is toQ much to expect to see restoration of bone substance, even by the most sensitive techniques. Since bone restoration is not accomplished by any formi of treatment, methods for demonstrating that a proposed treatment can stop bone loss are an important part of any discussion of osteoporosis. Neither the Meemas nor Cameron have'a chapter on their elegant, objective methods of measuring bone density, though Erik Meema participated in discussion.
The Cameron techniquie is described by Davis et al., from the University of Chicago, who review their published evidence that estrogens retard bone loss after the menopause. Bauer's review of the epidemiology of fractures, previously published elsewhere, also emphasizes the sex-linked nature of bone fragility, as evidenced by the increased incidence of fractures in postmenopausal Swedish women. Ethnic susceptibility is also described. Several authors comment on the relative lack of osteoporosis in Negro populations. Makin et al. confirm the more frequent occurrence of hip fractures in women over the age of 50 and show that in Israel this excess is limited to women of European or American origin, while the Afro-Asian group shows no significant increase. Unfortunately, the chapter on the role of fluorides was not included in the final publication. It would be of interest in view of suggestions that induced fluorosis may be effective in treating some types of osteoporosis. The discussion, however, emphasizes the seriousness of endemic fluorosis, the fact that the bone is abnormally brittle, that neurologic complications are frequent, and that a fall on a rigid spine of breakable bone can be fatal in a person with endemic fluiorosis. It is of interest that the proponents of calcium therapy have changed the rationale of this investigational treatment from deposition of calcium in bone to inhibition of bone resorption, possibly by stimulation of endogenous calcitonin. Looking at James Arnold's beautiful vertebral preparations in this volume, it is obvious that osteoporosis is characterized by a dearth of bone tissue to be calcified. The concept of calcium deposition has long been untenable since, as Ernest Schwartz points out, it is not accompanied by phosphate retention. It is apparent from this volume that each expert rides his own' hobby, that osteoporosis' is a heterogeneous group of conditions, and that no single treatment for these various conditions can be expected to provide a panacea. It is also clear that several currently investigational therapies can be expected to carry their own toxicity. The clinician will have to decide in each case whether the hazard is worth the possible benefit. The volume has been beautifully printed on glossy paper with excellent reproduction of x-ray films and charts. As the editor points out, it is not intended as a textbook. The clinician will find the well-written chapters by Urist et al., by Siegelman, by Davis et al., and by Rose, well worth reading. GILBERT S. GORDAN, M.D,, PH.D. 86
FEBRUARY 1971 *
14 * 2
GENERAL PATHOLOGY-Fourth Edition-Edited by Lord Florey, Provost of The Queen's College, University of Oxford, W. B. Saunders Company, West Washington Square, Philadelphia, Pa. (19105), 1970. 1259 pages, with 575 illustrations on 484 figures, 7 color plates, $24.00.
This book, as in earlier editions, has a distinctive character through its focus upon the interpretation and understanding of tissue changes in disease. With this approach to "General Pathology" it has no sections on diseases of organs, and relatively few specific diseases are segregated, although atherosclerosis and tuberculosis have special chapters. Tumors and viral diseases are considered as groups of related conditions. This type of presentation is not encyclopedic, but, together with the readable style, it provides interesting reading, and reference to a specific subject brings the reader in touch with a variety of well-presented related material. Using the book is like making a trip. The primary purpose is expanded by the many points of interest along the way. The book is presented by its 2Q co-authors as a memorial to Lord Florey who died as it was nearing completion. This edition retains the form of its predecessors but has been rewritten in some sections. Two chapters have been eliminated and one on "Pathological Consequences of ChromQsomal Abnormalities" has been added. With these successful moves toward updating the book, it is unfortunate that the ambiguous term, hyaline degeneration, has been perpetuated. This includes such umrelated processes as aging Qf scars, deposits of resorbed protein in renal tubular cells and changes associated with injury to liver cells. The subject of the book is general pathology in the broadest sense. The volume should be of value to anyone who has a fundamental interest in disease. ALVIN J. COX, M.D. SURGERY-Principles and Practice-Fourth Edition-Jonathan E. Rhoads, M.D., D.Sc. (Med.), Joh'n Rhea Barton, Professor of Surgery, School of 'Medicine, University of Pennsylvania, Philadelphia; J. Garrott Allen, M.D., Professor' of Surgery, Stanford University Medical School; Attending Surgeon, Stanford University Medical Center, Stanford; Ienry N. Harkins, M.D., Ph.D., Late Professor of Surgery, University'of Washington School of Medicine, Seattle; and Carl A. Moyer, M.D., Formerly Bixby Professor of Surgery, Washington University School of Medicine, St. Louis. J. B. Lippincott Company, East Washington Square, Philadelphia, Pa. (19105), 1970. 1864 pages, 758 illustrations, $24.00.
With publication of the fourth edition, Surgery-
Pritnciples and Practice becomes even more firmly established as one of the basic surgical texts for the student and House Officer. The fourth edition is also the end of a cycle in which each one of the four original editors
has now had the opportunity to leave his particular mark as the senior editor. The excellent chapters on Nutrition, Parenteral Alimentation and Fluid, and Electrolyte Balance reflect the ongoing interest and continuing contributions of this edition's senior editor, Dr. Rhoads. There are several factors distinguishing this edition from its predecess.ors: A notable loss is the History of Surgery chapter, parts of which have been incorporated uwnder the individual sub-topics which make up the book's chapters. Although the surge for new knowledge and new areas of surgical application has blunted the interest in surgical tradition and history, it seems that this is the place where the student should be oriented to the continuity of surgical experience and the evolution of surgical techniques and research. New disciplines, as reflected in the new chapter Tissue and Organ Transplantation, do not arrive de novo but are inexorably linked with each step that went before it. Introducing the student to the history and methodology of surgical innovation is still study of the History of Surgery.
Another new chapter, The Molecular Attack on, Cancer is a valuable addition to this new volume as an introduction to the subject. It would seem that this chapter could be expanded, particularly to reflect the waning interest in cancer chemotherapy and the exciting new developments in tumor immunology. The chapter on Military Surgery has been expanided to include the experience of the Vietnam War and is augmiented by photographs and descriptions of newer concepts in resuscitation, evacuation and early care of the traumatized patient. The final chapter on Mathematical Analysis of Surgical Data should provide the student with some basic tools for assessing the significance and experimental discipline of many of the concepts he will be reading when he moves beyond the textbook stage. The original design of the book, to provide a uniform zipproach yet reflect the basic thinking of the foremost surgical teachers in different areas, has been well preserved. HERBERT I. MACHLRDER, M.D. MEDICINE AND STAMPS-Edited by R. A. Kyle, M.D., and M. A. Shampo, Ph.D. Published by the American Medical Association, 535 North Dearborn Street, Chicago (60610), 1970. 216 pages, $1.00.
"Medicine and Stamnps," edited by R. A. Kyle, M.D. and M. A. Shampo, M.D., published bv the A.M.A. in 1970 records on 206 pages in alphabetical order the biographies of 160 different physicians and scientists. This work is printed on glossy paper and is of excellent legibility. With very few exceptions a full page has been allocated to each item. Next to the title a stamp, portraying the specific physician, is shown in black and white and enlarged as prescribed bv law. Scott Catalogue numbers, cosuntry and year of issuie, and identification of the particular author appear at the end of each biography. Between pages 110 and 111 there is a double page of special glossy paper, like the very attractive book jacket, entitled: "Representative Stamips Honoring Medical Pathfinders and Illustrious Practitioners." Vhile the stamps shown on the double page are considerably reduced in size, those on the jacket are even more enlarged than those embellishing the biographies. The stamps on the jacket and on the double page are shown pretty close to their original colors. Besides an informiative forewvord and the Table of Contents (7 pages )-listed alphalbeticallv by the co(untries that issuied the stamiips shoNvn-tlhere also is an index of seven pages. Here the variouis personalities are listed uinder leadings indicatinig their special field(s) of activity-a very uisefil addition. As to the biographies, thev are miiostly of a basic (Iquality, especially so if compared with those in the well known ATA IIlandbook No. 39 "Medical History in Philately" by Dr. C. Newerla, a highly esteemied memiiber of the American Topical Association (ATA )-Medical Suibjects Unit and considered an aisthority in this field, and in "Doctors Philatelic" by Oscar Gottfried, also a greatly respected, scholarlv memiiber of the ATA Medical Suibjects Unit. 1-his soft-cover book, containing 283 biographies, each witlh a portrait stamnp, and also a very usefuil bibliography, has fouir suppleml-ents, bringing the whole collection lip to October 1966. (Incidentally, no snore suipplements can be expected because-most regretfumlly-the author had to discontinuie them for reasons of ill-health). It would have been an appreciable imiprovemient of the book's value, had such a cut-off date been added. But even if July 1961, as mentioned in the Foreword, would have to be considered as a limit, it wousld seem that many
imnlportalnt personatlities lhave been osiitted within the
scope of the presentation. For this exclusion various reasons could fairly be stated but as none has been specified the reviewer is unable to express an opinion in that regard.
R. L. BALLIN THE NEW SOCIAL DRUG-Cultural, Medical, and Legal Perspectives on Marijuana-Edited by David E. Smith, M.D., Medical Director, Haight-Ashbury Medical Clinic; Consultant on Drug Abuse, San Francisco General Hospital; Assistant Clinical Professor of Toxicology, University of California, San Francisco Medical Center. Prentice-Hall, Inc.. Englewood Cliffs, New Jersey (07632), 1970. 186 pages, $5.95.
This is a collection of eleven articles addressed to presenting informed material abouit marijucana. One is ani original article, one is reprinted froml Science, one is reprinted from the Joutrntal of Health and Social Behavior and eight are reprinted fromii the Journal of Psychle(lelic (drugs, edited by the editor of this volumie. In general, all the articles are well written and constittute major and substantive contribuitions. The gathering of these together uinder one cover is an obviouis attempt to promote one point of view as intimated by both the title and the Introdiiction. This is the soft-sell for use wvhereas in the past ther-e has been a hard sell for abstinence. In this reviewer's opinion neither point of view is appropriate for reasoned scientific presentation or for responsible poptilar reporting. The assumiiption is that now that our society has finally found the pharmacological cookie jar-as presstures of stuper-indtistrialization mouint-ouir tie to reality and subsequent defense will be our hand in the jar. Eachi vill work out his own Social Drtug and the case presented in this voltume is that marijssana should not be exeluded as an option. The editor and author nmay protest "misinterpretation," but the choice of title and content of the Introduiction leave no doubt as to the point of view. The rexviewer recommends the book for the valtue of the individual articles and for the convenience that they are boiind
together. KE-ITiI F. KILLANI, PH.).
MORE THAN SKIN DEEP-Thomas H. Sternberg, M.D., Protessor and Chairman, Division of Dermatology, School ofMedicine, University of California, Los Angeles. Doubleday & Company, Inc., 277 Park Avenue, New York, N.Y. (10017), 197(0. 330 pages, $7.95.
According to the auithor this book was written to satisfy the vast reservoir of interest and concern abouit one's skin among those mlillions of people who never find occasion to visit a dermatologist. It is an attempt to explain in laymnan's terms the signs and wonders of the human skin. It is concerned with beauty and the appearance of the skin as well as its medical aspects and the aging process. It also is iieant to teach its readers the skin changes which indicate the need to see a physician. In the foreword there is a discussion of the anatomiiy and physiology of the skin. It details some of the physical and chemical agents and microorganisms to which one's skin is constantly exposed and mention is made of the skin's miiany and varied attributes which allow man to adjuist to his environment. Part One of the book is titled "A Deermliatologist Talks Abouit Beauty." This occupies 138 pages and ineludes chapters on general skin care, cosmetics, nails, hair, pigmentation, aging skin, reactions to medications and body odor. Past Two is 68 pages long and is entitled: "A Dermiatologist Talks About a Program of Skin Health Throuighout Life." Chapters are devoted to pregnancy and the skin, CALIFORNIA MEDICINE The Western Journal of Medicine
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