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Reviews of Books

Measurement of Subjective ResponsesQuantitative Effect of Drugs. HENRY K. BEECHER, M.D., HenryIsaiah Dorr professor of research in anaesthesia, HarvardUniversity. London and New York: Oxford University Press.1960. Pp. 494. 102s.

THE main problems of therapy are to relieve, and if possibleabolish, pain and to ease anxiety; and there are age-old remediesfor these conditions and brand-new ones hot from the chemist’sbench. The difficulty is to find the agents which work bestand have the fewest disabling and harmful side-effects. Thisis not easy since we have little knowledge of the physiologicalbasis of anxiety, though we all think we mean the same thingwhen we use the word. Again, we cannot describe pain norcompare one person’s pain with that of another. A goodcontrolled experiment demands the use of dummy drugs, andthis raises a question of ethics. Should sufferers be givenplacebos ? Dr. Beecher points to the interesting fact that theworse a patient feels the more probable is it that a placebowill help him, which seems to show that pain and anxietyrender patients more suggestible. Placebos may even induceundesirable side-effects. As far as relief of pain is concernedit is possible that few drugs relieve the pain itself, but manylessen the reaction to pain; and it is the reaction which is dis-tressing, as the response of people who have undergone frontalleucotomy or lobotomy illustrates. Pain, like all perceptions, isnot pure, but contaminated by the reaction component, and itis this rather than the pain per se which differs so muchfrom person to person, or in the same person in differentconditions.

This last point raises the question of the usefulness ofexperimental as against clinical assays of pain-relieving drugs.In experimental conditions the human subject suffers littleanxiety; he knows that the trauma is transitory and un-important. He is, therefore, a bad experimental animal. Onthe other hand, the use of animals yields results which areclinically useful since to the animal the experimental threat isas great as any other and holds the same elements of anxiety.Thus, the animal and the sick man hold remarkably similarviews on the efficacy of certain drugs. These are some of thefacts discussed by Dr. Beecher. He has planned a number ofways in which errors of assay can be avoided and imponderablesmeasured to some extent. He deals with pain- and anxiety-relieving substances, and a number of others affecting nausea,pruritus, cough, euphoria, sedation, and so on. He makes theinteresting statement that many cough-suppressing drugs donot really reduce the frequency of cough but do reduce thepatient’s awareness of it. Clearly this is an important andinteresting book, well worth study, especially since the methodsadvocated can be used for measurement of reactions, quiteapart from the effect of drugs on the causes of the reactions.

The Neurological Examination of the InfantANDRE-THOMAS, YVES CHESNI, S. SAINT-ANNE DARGASSIES.Editors: R. C. MAC KEITH, P. E. POLANI, E. CLAYTON-JONES.London: National Spastics Society. 1960. Pp. 50. 5s.

THIS concise, informative, and well-produced guide to theneurological examination of the infant is published as a hard-cover supplement to the Cerebral Palsy Bulletin. Pxdiatriciansand others will be grateful for the information in this handybut durable volume because it is not readily accessible else-where although essential for the acquirement of the importantskills required.The first part, which deals with the neurological examina-

tion of the newborn, is based on a regional scheme whichenables the examination to be carried out in a methodical

well-organised way. This is described with great clarity bothin words and in diagrams. The second part is concerned with theexamination of older infants and has perforce to consider theevolution of each function separately. This makes it less

helpful as a technical handbook, and in spite of the inherentdangers it might have been useful to include a chronological

table synthesising the approximate neurological responsesexpected at appropriate months during the first year of life.

Medical Physiology and BiochemistryHowell’s Textbook of Physiology. 18th ed. Editors: THEODORE C.

RUCH, PH.D., professor and executive officer, department ofphysiology and biophysics, University of Washington School ofMedicine; the late JOHN F. FULTON, M.D., Sterling professorof the history of medicine, Yale University School of Medicine.Philadelphia and London: W. B. Saunders. 1960. Pp. 1232.112s.

THIS is an excellent edition of an old textbook, under a newname and with an additional editor. The title attempts tosummarise the aims of the book-namely, to give an account ofphysiology which is firmly based on the fundamental sciences,and to show how it relates to clinical problems of a somatic,nervous, or psychiatric kind. The editors have had admirablehelp from an array of workers each of whom is well known inhis own territory. The writing is clear and the informationaccurate. Discussion of the clinical applications has beenwoven successfully into the general text and not placedseparately as though clinical and scientific physiology werethings apart. Many chapters have been entirely rewrittenand the others drastically revised. Purely biochemical matterhas been omitted. At the beginning of each chapter there is auseful summary of its contents, and at the end of each a numberof references is given. This edition is a great improvement onits immediate predecessors in that the index is full andinformative so that the book can be used without difficulty.

Publishers face enormous difficulties in keeping down theprice of a new book, particularly one which must have manyclear figures, and few of those for whom this book is written-medical students-will feel able to buy it. We may have toreturn to the days when books were so costly that they werechained, and lecturers revert to their original task of reading tothose who sit under them.

The Urological Aspects of Bilharziasis in RhodesiaR. M. HONEY, M.B., F.R.C.S., consultant urologist, SalisburyHospitals Group, Rhodesia; M. GELFAND, C.B.E., M.D., F.R.C.P.,consultant physician, European and African Hospitals, Salisbury,Rhodesia. Edinburgh: E. & S. Livingstone. 1960. Pp. 71.7s. 6d.

FROM a study of 300 European and 100 African cases, theauthors of this valuable book define a number of importantdifferences from the more widely known Egyptian form of thedisease and draw attention to its varied manifestations in whiteand coloured races. The disease is so endemic among Africansthat the early symptoms are often disregarded and advice issought only in the later stages. On the other hand, the age-incidence among Europeans at the time of diagnosis is consider-ably lower. This difference may in part account for the factthat no cases of carcinoma in association with bilharziasis wereencountered among Europeans although in Africans they werenot uncommon. Neither race, however, seems particularlyprone to secondary urinary calculi. The cystoscopic appear-ances and radiological findings in various phases of the diseaseare discussed in detail and amplified by a number of well-chosen illustrations.

In the matter of treatment the authors emphasise the value ofpyelography in conjunction with instrumental examination indistinguishing between the effects of ureteric obstruction andreflux and in determining the appropriate management ofcomplications in the upper urinary tract.

Stress and Psychiatric Disorder (Oxford: BlackwellScientific Publications. 1960. Pp. 151. 21s.).-The twelvepapers read and discussed at the second Oxford conference ofthe Mental Health Research Fund provide a varied and

stimulating survey of modern research into the effects of stresson men and animals. The papers on the effects of trainingunder stress in children (E. J. Anthony), experimental neurosesin animals (Howard S. Liddell), and prevention and treatmentof psychiatric reactions to stress by psychosocial means (J. D.

: Sutherland) deserve special mention. The editor is Dr. J. M.Tanner, secretary of the research committee of the Fund.