Edwin R. Bickerstaff

AETIOLOGY OF ACUTE HEMIPLEGIA IN CHILDHOOD.

The evolution of gastric atrophy to latent pernicious anaemia has been described by Wood et al. (1960), but it is not known whether gastric atrophy invariably progresses to this stage. The transformation of latent into clinical pernicious anaemia is believed to depend on the individuals body stores of vitamin B and on external precipitating factors, such as infection. The fact that achlorhydria was so often found in those of our patients whose absorption of vitamin B 12 was normal suggests that the patients with latent pernicious anaemia may have had a pre-existing simple atrophic gastritis.

Relapses and remissions in brain stem tumours.

Three cases of brain stem astrocytoma and one of a para-stem vascular tumour are described, each showing a history of relapses and remissions. The diagnoses were confirmed by necropsy, and it is suggested that the relapsing course may have been due to oedema and necrosis in both the tumour and the surrounding brain tissue. Features indicating repeated recurrence of a lesion at the same site in the brain stem justify full neuroradiological investigation before a diagnosis such as multiple sclerosis can be accepted.

Explaining the Brain

This is a comprehensive text whose authors are respectively a pathologist, a surgeon, and a radiologist, all practising in Edinburgh. The numerous contributors mostly also come from Scotland, and one must praise the Scottish school of medicine for yet another fine tome on pathology. The outstanding feature of this book is the close collaboration between the disciplines of pathology, surgery, and radiology so that the clinical features of the diseased patient are closely correlated with the x-ray appearances of the condition and its morbid anatomy. The opening chapters concern such general topics as wound healing, cancer, injury and burns, haemostasis, thromboembolic disease, and tissue transplantation, all of which are covered adequately, if perhaps a little erratically. But the bulk of the book is regional special pathology of a very high order of excellence, in which few omissions can be cited. All the organs of the body, including the skin and subcutaneous tissue, the breast, and the female genital tract, are covered, and there is a fine section on the central nervous system, but the authors have wisely omitted the special sense organs. The book is copiously illustrated; the radiographs are uniformly excellent, and so are many of the pictures of gross specimens, but some of the photomicrographs are of poor quality. It is a large book, and its considerable weight seems to have outdistanced the outer hard binding; my copy at least showed a partial drift of the main contents from the covers. This is probably the finest textbook on surgical pathology by British authors at present on the market, and it can be recommended most heartily, as the authors intended, to surgeons. Pathologists will gain less from it because of the brief histological descriptions and the variable quality of the photomicrographs, but they may nevertheless find it useful in their routine work. It will help radiologists to gain greater insight into the diseases they so often meet in front of the x-ray screen. The considerable price of the book is not unreasonable. M S ISRAEL

More on Epilepsy

This book is eminently factual. Its editor and fourteen contributors are well qualified to write about their subjects from direct experience. Epidemiological and public health aspects of drug dependence are prominent, and the story of the spread of drug abuse, in this country and in the United States of America, is well documented. As social history the account is an intriguing and compelling one, which invites comparisons with the histories of epidemics of infectious microbial disease in the last century. The comparison, however, applies to the period before bacteriological discoveries gave understanding and control in infectious disease, and comparably fundamental discovery is required in studies of drug dependence. Legislative reactions to alcoholism and to the growth of drug dependence are well described. Control of drugs in the United Kingdom, and implementation of current legislation both in the U.K. and U.S.A. are recounted by Home Office, Department of Health, and Health Service workers. These relatively formal matters now have much scientific involvement. One after-care unit in New York State can be expected to require chromatographic analysis of urine specimens at each of several visits by the 10,000-strong case-load. In addition, methadone-maintenance treatment of opiate addiction is evaluated, and the attempted use of other therapeutic agents in place of methadone is described. The status of alcoholism as a disease, the reality and role of a withdrawal syndrome in its maintenance, and the possibility of alcoholics returning to relatively normal social drinking are appraised by Griffith Edwards. Others contribute histories of voluntary and religious organizations in the treatment of alcoholism and drug addiction. The book ends with an account of the development and action of drugs of dependence. It is well produced and has a good subject index.

Puzzle of Migraine

In 1950 the late Professor Payling Wright published An Introduction to Pathology, a scholarly account of the principles of general pathology. In 1958 he and Professor Symmers embarked on this major work on systemic or regional pathology. They persuaded 26 colleagues to contribute chapters on subjects in which they were expert and wrote some themselves. It is sad that Payling Wright did not live to finish his work, though it will remain a tribute to his scholarship. This is a major work comparable with Andersons American text and is the only work of its kind by purely British authors. It was perhaps inevitable that with the first edition of so large a work, with multiple authorship and with Payling Wrights premature death, the period of gestation should have been prolonged, and this meant that the work is less up to date than it might have been. Nevertheless, it is a fine work; the 28 authors write with the authority of experience and write well. The illustrations are numerous, well chosen, and supplemented by legends that. are more than usually explanatory. The editing has been well done, because errors and misprints are singularly few. Although this is a book for the advanced reader, the approach has been kept simple and in most cases the normal structure and function are briefly reviewed first. This has made it easy to read and understand, and even beginners will find the text completely comprehensible. For the advanced reader tX* facts and their interpretation are fairly prsented, and the references (at the bottom of the page) are available for further study and have been well chosen. It would be invidious to mention particular chapters, though naturally some appeal more than others. I am convinced that this is a first-class work that will become the standard British work for the established pathologist and for those studying for higher qualifications, and, one hopes, for the more inquiring undergraduates. There are a few sins of omission, all of recent work, but these will be righted in the future editions that will most surely be demanded. It is a pity that this admirable book is so expensive, but, in fairness, it is very well produced.