457

DR SCHWARZ: REFERENCES

1. Schwarz, K., Milne, D. B. Nature, 1972, 239, 333.2. Carlisle, E. M. Science, 1972, 178, 619.3. Schwarz, K. Fedn Proc. 1974, 33, 1748.4. Carlisle, E. M. ibid. p. 1758.5. Schwarz, K. Proc. natn. Acad. Sci U.S.A. 1973, 70, 1608.6. Schwarz, K., Chen, S. C. Fedn Proc. 1974, 33, 704.7. Schwarz, K. Unpublished.8. Loeper, J., Polet, Cl. C.r. Séanc. Soc. Biol. 1957, 151, 263.9. Loeper, J., Loeper, J., Lemaire, A. Presse med. 1966, 74, 865.

10. Mars, G., Nebbia,M. L., Nebuloni, G., Necchi Della Silva, A. G. Geront.1970, 18, 646.

11. De Franciscis, P., Oliviero, G., Greco, A. M. Boll. Soc. ital. Biol. sper. 1974,50, 577.

12. De Franciscis, P., Oliviero, G., Greco, A. M., Maranelli, C., De Maria, E.,Monti, G. Clinica term. 1974, 27, 61.

13. Burkitt, D. P., Walker, A. R. P., Painter, N. S. J. Am. med. Ass. 1974, 229,1068.

14 Trowell, H. Am. J. clin. Nutr. 1972, 25, 926.15. Walker, A. R. P., Arvidsson, U. B. J. clin. Invest. 1954, 33, 1358.16. Higginson, J., Pepler, W. J. ibid. p. 1366.17. Bersohn, I., Walker, A. R. P., Higginson, J. S. Afr. med. J. 1956, 30, 411.18. Hardinge, M. G., Stare, F. J. Am. J. clin. Nutr. 1954, 2, 83.19 Hardmge, M. G., Chambers, A. C., Crooks, H., Stare, F. J. ibid. 1958, 6,

523.20. Keys, A., Grande, F., Anderson, J. T. Proc. Soc. exp. Biol. Med. 1961, 106,

555.21. Werch, S. C., Ivy, A. C. Am. J. dig. Dis. 1941, 8, 101.22 Lin, T. M., Kim, K. S., Karvinen, E., Ivy, A. C. Am. J. Physiol. 1957, 18,

66.23 Wells, A. F., Ershoff, B. H. J. Nutr. 1961, 74, 87.

24. Cummings, J. H. Gut, 1973, 14, 69.25. Dairy Council Digest, 1974, 45, 31.26. Burkitt, D. P., Trowell, H. C. (editors) Refined carbohydrate Foods and Dis-

ease. New York, 1975.27. Story, J. A., Kntchrevsky, D. in Fiber in Human Diseases (edited by D.

Stiller and R. Amen). New York (in the press).28. Sundaravalli, O. E., Shurpalekar, K. S., Narayana, R. M. J. agric. Fd Chem.

1971, 19, 116.29. Fischer, H., Griminger, P. Proc. Soc. exp. Biol. Med. 1967, 126, 108.30. Palmer, G. H., Dixon, D. G. Am. J. clin. Nutr. 1966, 18, 437.31. Trowell, H. ibid. 1972, 25, 464.32. Baumann, H. Hoppe-Seyler’s Z. physiol. Chem. 1960, 319, 38.33. Underwood, E. J. Trace Elements in Human and Animal Nutrition. New

York, 1962.34. Kritchevsky, D., Story, J. A. J. Nutr. 1974, 104, 458.35. Story, J. A., Kritchevsky, D. Nutr. Rep. int. 1975, 11, 161.36. Fischer, H., Griminger, P. Proc. Soc. exp. Biol. Med. 1966, 122, 551.37. Morrison, K., Endnck, N. L. Angiology, 1973, 24, 269.38. Howard, A. N., Gresham, G. A., Jones, D., Jennings, I. W. J. Atheroscler.

Res. 1965, 5, 330.39. Huth K., Fettel, M. Lancet, 1975, ii, 456.40. Bremner, W. F., Brooks, P. M., Third, J. L. H. C., Lawrie, T. D. V. Br.

med. J. 1975, iii, 574.41. Iler, R. Colloid Chemistry of Silica and Silicates; p. 286. New York, 1955.42. Engel, W.Planta, 1953, 41, 358.43. Sauer, F., Laughland, D. H., Davidson, W. M. Can. J. Biochem. Physiol.

1959, 37, 183.44. Lancet, 1969, i, 1012.45. WHO Chronicle, 1972, 26, 51.46. Schwarz, K., Ricci, B. A., Punsar, S., Karvonen, M. J. Unpublished.

Reviews of Books

Influenza

The Viruses and the Disease. Sir CHARLES H. STUART-HARRIS,F.R.C.P., University of Sheffield, and G. C. SCHILD, PH.D.,National Institute for Biological Standards and Control, London.London: Arnold. 1976. Pp. 242. 02.

THE influenza virus is the most intensively studied of all theviruses that afflict mammals. It has provoked a large and stillincreasing flood of literature. And yet the disease reigns trium-phant, and epidemics come and go in pigs, horses, birds, and,especiallY1 in man, with little hindrance from general preven-tive measures and from specific vaccines. In general, the rea-sons for this are poorly understood by doctors. They have avague idea that influenza vaccines are not much good, andthat the capacity of the virus for change has defeated the viro-logists and epidemiologists. This relatively short book could domuch to correct many misapprehensions, by enabling practis-ing physicians to approach the protection of their patientsfrom a position of knowledge. Influenza vaccines do functionefficiently against homologous viruses, although for only arelatively short period. If they and the epidemic viruses aresuitably matched and if they are available in the right quantityat the right time, they can do as much for the population asmost other virus vaccines. The advantage of this book is thatit represents a fusion of applied and academic thought. Scien-tists and physicians have tended to work on this subject in sec-lusion, with the hope, as with parallel lines, of an ultimate ren-dezvous at infinity. But much of the basic knowledge availableon the viruses can already be applied to the prevention of thedisease or to an understanding of its mechanisms, althougheffort and study are required to achieve this. The book de-scribes authoritatively the complex properties of the influenzaviruses, what is known about their antigenic make-up, andwhy vaccines have often been judged ineffective. The naturalhistory and epidemiology of the disease are interestingly de-scribed, and sections have been added on disease processes, im-mune mechanisms, chemotherapeutic measures, and labora-tory techniques. That one is left with the feeling that so muchmore remains to be discovered is in itself a tribute, and thebook can be warmly recommended as basic reading for allthose concerned in the prevention, treatment, and control ofinfluenza, and for those who are anxious to make vaccineswork.

Recent Advances in Clinical Virology I

Edited by A. P. WATERSON, F.R.C.PATH., Royal PostgraduateMedical School, University of London. Edinburgh: Churchill

Livingstone. 1977. Pp. 200. /;9.7S.

IN virology today there are two main factions—one con-cerned primarily with investigation of viral virulence and dis-ease spread, the other devoted to the study of viral substruc-ture properties, ecology being of. less import. The formergroup, sometimes believing themselves overshadowed, nowtend to identify their interests as clinical, though on occasionthis may sound more euphonic than precise. To their supporthas come the first of this new series on advancesin clinical vir-

ology. Edited by Professor Waterson, which should providesome guarantee of merit, the volume contains twelve reviewson current topics relating to infectivity. These are of varyingrelevance to the practice of clinical virology, but importantenough to justify selection. The contents range over problemsof vaccination, the encephalopathies, and some individual ill-nesses. The chapters on vaccines are concerned with cytomega-lovirus and measles, rubella, and rabies viruses. The encepha-lopathies take in subacute sclerosing panencephalitis (S.S.P.E.),Creutzfeldt-Jakob disease, scrapie, and the progressive multi-focal leucoencephalopathy associated with the still enigmaticgroup of papovaviruses. There are also chapters on herpes en-cephalitis, Lassa fever, viral gastroenteritis, and Coxsackievirus infection of the heart. Every chapter is the work of anexpert. From relative brevity on Lassa fever to lengthy cover-age on S.S.P.E. they reflect the degree of complexity of the dif-ferent topics. They also provide numerous references. Whereelectron micrographs are included reproduction is fairly good,though there is some loss of fine detail. Despite editorial wordson the benefit of interchange between human and veterinaryvirology the book is predominantly medical in outlook. Thecomparative virology of gastroenteritis is but a shadow on thescene and the impression is that scrapie is there for its simi-larity to Creutzfeldt-Jakob disease as much as in its own right.Such things do not necessarily detract from the merits of thebook, but if there is to be intermingling with the veterinaryprofession there must be a more equable distribution of topicsin future volumes. Caution in giving rabies vaccine intrader-mally may be needed, and there is no mention of Marburg dis-ease, but these are quibbles. This book can be recommendedas a worthwhile introduction to a new series.

458

Metabolism and the Response to InjuryEdited by A. W. WILKINSON and Sir DAVID CUTHBERTSON. 1977.Pp. 350. London: Pitman. [10.

THIS is a fitting tribute to Sir David Cuthbertson for hisfundamental and continuing researches into the metaboliceffects of injury. It was he who discovered the basic informa-tion about increased oxygen consumption and nitrogen excre-tion in the early thirties, and it is hard to believe that he is 76,still active after nearly 50 years of productive work. His open-ing paper on Surgical Metabolism: Historical and Evolution-ary is a masterpiece, and the other 24 papers are of a high qua-lity by leading workers in Britain and elsewhere. The contentsare not organised as a textbook but virtually the whole subjectis covered. There are excellent reviews of particular aspects,and information not previously published and new ideas oncontroversial and difficult topics are included. The coverageranges from a variety of experimental and theoretical aspectsof changes in energy metabolism during the "ebb" and "flow"phases after injury (terms introduced by Sir David) to the rolesof the central nervous system and hormones (with specialreference to catecholamines and the hypothalamus), thesources and effects of increased metabolism, the importance ofgluconeogenesis and fat catabolism in respect of protein break-down, practical considerations of nutrition by the intravenousand other routes, and the reduction of excess catabolism bytherapeutic glucose-insulin administration and a warm-air en-vironment. This volume is a fine record of past and presentachievements with pointers to the future and is recommendedto the many who are or should be interested in scientific

aspects of surgery, trauma, and bums, or are involved in anyway with metabolic investigation.

Patient Care Guidelines for Family Nurse PractitionersAXALLER J. HOOLE, M.D., ROBERT A. GREENBERG, M.D., C.GLENN PICKARD, JR, M.D. Boston: Little, Brown. London: Quest,1976. Pp. 339.$7.95; {, 5. 75.

THIS is a multiauthor manual emanating from the enterpris-ing University of North Carolina at Chapel Hill. It is brokendown into sections dealing with each organ system and coversthe diagnosis and management of conditions commonly pre-senting in general practice in the United States. It is clearly in-tended for quick reference by busy nurse practitioners, and thetext is set out as formal headings with very brief lecture notes.In this it succeeds admirably though often resorting to a medi-cal shorthand that only a very highly trained nurse could un-derstand. The North American flavour of the diagnostic en-vironment comes over strongly (e.g., the differential diagnosisof measles is Rocky Mountain spotted fever). The widespreaduse of nurse-practitioners is some way off in Britain, which willlimit the market. As an exercise in precis work, however, it hasmuch to commend it. Nurse practitioners are charged to usethe book as "standing orders", implying that they can beaudited according to how completely they adhere to these in-structions. Dr Hoole and his colleagues did experiment with adecision-tree format but, wisely, abandoned it because of theobserved idiosyncrasies in the way each clinician approachesproblems. All those working within the five-minute time con-straint of British general practice realise that whereas decision-trees work well for the rapid sorting of acute infectious dis-orders they are virtually useless for managing complex socialand psychological situations. Indeed it is the psychologicalaspect of medicine that is almost totally absent from themanual. There is a short section on anxiety, but no mentionof depression. Perhaps these common psychiatric problems areconsidered to be beyond the conipetence or remit of nurse prac-titioners--or is it that the philosophical bent of the authors istowards efficient medical technology rather than the more in-tellectually and spiritually challenging task of family doctor-ing ?

iAbdominal Ultrasound

_

HANS HENRIK HOLM, M.D., URGEN KviST KRISTENSEN, M.D.,STEN NØRBY RASMUSSEN, M.D., JAN FOG PEDERSEN, M.D., andSØREN HANCKE, M.D., Gentofte/Herlev Hospital, University ofCopenhagen. Copenhagen: Munksgaard. 1976. Pp. 134. D. kr.200.

THIS work is the product of the experience of more than15 000 abdominal examinations performed at the Gentofte

Hospital, Copenhagen, since 1965. Most of the scans wereobtained with conventional storage technique, but A mode andgray-scale (and multi-element transducer) scans are included.A short history of the development of diagnostic ultrasound isfollowed by the basic physics and general principles involvedin scanning of the abdomen. Chapter 4 is an atlas of normalsectional abdominal anatomy with B mode scans for compari-son, providing an excellent method for anatomical orientationvital for the interpretation of ultrasound scans. The remainderof the book is devoted to studies of pathology of all the abdomi-nal and pelvic viscera, ending in a description of the techniquefor ultrasonically guided percutaneous puncture for aspirationor biopsy of cysts, abscesses, and tumours. The final chaptersdeal with measurement of organ volume and with errors andpitfalls to which even the most experienced are exposed. Theauthors’ claim that "the book is intended for everyone inter-ested in ultrasonic scanning of the abdomen" is certainly justi-fied, for there is sufficient material in it to satisfy both thebeginner and the experienced operator. The format is good,and the reproductions, drawings, and sketches so well pre-sented that it is probably the most important book yet to

emerge on abdominal ultrasound.

Handbook of Critical Care

Edited by JAMES L. BERK, M.D., JAMES E. SAMPLINER, M.D.,SHELDON ARTZ, M.D., and BARRY B. S. VINCOUR. Boston: Little,Brown. London: Quest. 1976. Pp. 574.$12.50; z8.50.

THE editors deserve praise for the way that they have man-aged to gather an impressive list of authors and produce abook containing their wealth of experience and skill. Theresult is very readable, and it manages to bridge the gapbetween the physiology of the very ill and the management ofsuch patients in the intensive-care unit. Recent advances in in-tensive care are well described and this book will no doubt findits way into many intensive-care units where it will be of prac-tical value to both medical and nursing staff.

The Movement of the Heart and Blood

WILLIAM HARVEY. Translated by GwENETH WHITTERIDGE,D.PHIL., Hon.F.R.c.P: Oxford: Blackwell. 1976. Pp. 204. !9.75(paperback 4.75).

THE quatercentenary of Harvey’s birth in 1978 makes atranslation of De motu cordis timely, but it is hardly a newidea. Three others have been there before, but Dr Whitteridge,a considerable authority on Harvey, makes no apologies. Theanonymous translation of 1653 is, -she says, too archaic;Thomas Willis’s of 1847 is too pompous; and K. J. Franklin(1957) was too free. Physiological anachronism is certainlyavoided in this latest version; the English is not the tongue ofCharles I’s England, nor is is set in the verbose style of alearned country doctor of Victoria’s reign. But the generalreader who is neither a Harveian scholar nor a Latin one willask two different questions-is Harvey’s meaning clear and isthe translation easy to read? The answer to the first is simple- yes abundantly-but there are times when a little tighten-ing up, falling well short of paraphrase, would have helped.especially where Harvey is repetitive or tautologous ("Ichanced once to see and have at hand..."). The 50-pageintroduction is excellent.