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Reviews of Books

The Background of TherapeuticsJ. HAROLD BURN, M.n., professor of pharmacology,University of Oxford. London : Oxford .UniversityPress. 1948. Pp. 367. 22s. 6d.

Professor Burn describes this book as a series ofchapters written for those engaged in teaching clinicalmedicine, but in fact it is a remarkably interesting workwhich should by no means be restricted to teachers.Clinical medicine today, he thinks, greatly needs youngpeople trained for at least two, and preferably for five,years in the laboratory, and one of his aims in writingis to encourage the research mind. In explaining howdrugs act and what they may scientifically be expectedto achieve, he will earn the gratitude of clinicians, whofind it harder and harder to keep pace with the advancesin therapeutics-even though more and more dangersresult from the inexpert handling of drugs. The 18

chapters all show the same critical, lucid, and forciblestyle. Such subjects as the use of BAL and its mode ofaction demand a fair knowledge of pharmacology andphysiology, but other chapters such as those on obesity,on iron and calcium, and on statistics, are instructiveeven to the inexperienced reader. Few recent books willgive so much pleasure to the thinking doctor.

The Metabolic Brain Diseases and Their Treatment

By G. TAYLEUR STOCKINGS, M.B., D.P.M., late deputymedical superintendent, City Mental Hospital, Birm-

ingham. London: Bailliere. 1947. Pp. 262. 16s.

To explain the psychoses, or at least to present the- sceptic with a rational basis for the treatment in voguetoday, Dr. Stockings attempts to bring together someaspects of what is known of the function of the brain.Though the attempt is a brave one, it is also, at ourpresent stage of knowledge of the biochemistry of brain,exceedingly rash. Ignoring the whole field of neuro-pathology, he calls all those behaviour disorders whichsome think have a physical basis, but which somethink entirely due to environmental factors, metabolicencephalopathies. He then divides this hypotheticaldisorder of brain chemistry into Dysglycic Encephalo-pathies (Dysglycia) which includes the field of schizo-phrenia and most of its variants, and DysoxicEncephalopathy (Dysoxia) which includes the affectivedisorders. From this he takes knowledge by the fore-lock and replaces convulsive therapy by anoxic therapy.

. It is true that the physiological work of Quastel,Gellhorn, and Himrich has added to our understandingof the more simple and overt processes in brain chemistry.It is also true that the therapeutic’stabs in the dark usedin modern psychiatry have a physical basis and may besuccessful in achieving their object. But the argumentsadvanced here seem to have little scientific justification.Many feel that the psychoses and neuroses will be shownto have specific causes or contributory causes based ondiscrete chemical or physical disorders in brain function.Most realise that the life situation must modify theeffects of these disorders, and some hold the environ-mental patterns of the patient’s life to be all-important.Dr. Stockings has cloaked our ignorance in a mantle oftortuous argument.

Telepathy and Medical PsychologyJAN EHRENWALD, M.D. London : Allen & Unwin.1947. Pp. 212. 12s. 6d.

Prof. J. B. Rhine used large statistics to show thatextrasensory perception occurs ; Dr. Ehrenwald, at theother extreme, relies on clinical experience and singleincidents for factual support as he speculates about thenature of telepathy and its bearing on normal personalityas well as paranoid schizophrenia. His argument istemperately developed, but radical. Accepting tele-pathy as sufficiently proved, he questions whether aparanoid delusion expresses the patient’s telepathicawareness of repressed desires on the part of the supposedenemies. He concludes that it is so, and that in schizo-phrenia heightened perceptiveness of what goes on inthe mind of other people is a consequence of the morbidprocess at work ; normality requires that, except atrare moments of fatigue or emotional upheaval, we

shall have no conscious " heteropsychic " knowledgeof others’ minds. Dr. Ehrenwald expounds a " scattertheory " to account for the approximate and inexactnature of telepathic cognition; he examines thecharacteristics of mediums and other persons giftedin this direction, and discusses telepathy in dreams.He puts forward an original conception of personalityas the outcome of a struggle to exclude extrasensoryalong with other repressed material from consciousness,in order to preserve the unitv and coherence of the self.The main theme of the work is cogent : if we accept

the evidence of Rhine, Soal, Carrington, Tyrrell, andothers about extrasensory’ perception, we must desist’from blandly assuming that patients who pretend totelepathic powers are necessarily deluded ; furthermore,if we accept their claims in any instance, we shall haveto revise the psycho-analytic explanation of suchparanoid symptoms. Dr. Ehrenwald’s clinical examples,however, are illustrative rather than convincing; hemakes too little allowance for that heightened perceptive-ness, more familiar than the one he postulates, whichcan read much from an unguarded look, a gesture, anda tone of voice ; and he is surely expressing a fallacywhen he says, in his concluding chapter, that the gapbetween physical (i.e., physiological) and psycho-logical -happenings is essentially of the same nature asthat between " heteropsychic " awareness and the under-lying physical phenomena (of which we have not evenan inkling).The thoughtful final chapter of Dr. Ehrenwald’s

interesting work contains a warning that telepathy" cn only be reconciled with our familiar world picture

at the price of throwing some of our cherished conceptsof a strictly individual cerebral localisation of mentalprocesses, and perhaps of causality within the field ofpsychology in general, overboard."Slit Lamp Microscopy of the Living Eye

(2nd ed.) ALFRED VOGT, professor of ophthalmology,University of Zurich. Zurich : Schweizer Druck- und

Verlagshaus. London : H. K. Lewis. Vol. III. Pp. 1058.£ 16 1Os.’ ‘

.

, Alfred Vogt died in 1943, shortly after he had completedthe revision of his classical work in three volumes on theslit-lamp microscopy of the living eye. Begun in 1919,the work covers a period of over 20 years of his life.and it was just before this period that Gullstrand’sinvention of the slit-lamp had made possible the minuteexamination of the conjunctiva, cornea, anterior chamber,iris, lens, and vitreous in the living state. The first twovolumes contained the technique of slit-lamp micro-scopy and the atlas of microscopic findings in the corneaand lens. The present ’volume is the third, and theonly one to be translated into English. This, the secondedition, contains Vogt’s microscopic work on the iris,vitreous humour, and conjunctiva.Towards the latter part of his life he became especially

interested in the manifestations of heredity in ophthalmo-logy, particularly as displayed in twins. The latterpart of the volume is given up to this subject, part of it-an appendix on the twin pathology of senile cataract-being designed to be read in conjunction- with volume n.Nearly a thousand paintings are reproduced, each witha full case-history attached ; tumours of the iris anddiabetic changes in the anterior part of the eye are

beautifully illustrated. Many of the observations wereoriginal when first described and carry Vogt’s name. Healso became interested in tuberculosis of the iris, on whicha chapter is included. The work will stand as a monu-ment to his acute powers of observation, and the fineartistry which set them down on paper so accurately.

Midwifery (8th ed. London : E. Arnold. 1948. Pp. 560.20s.).-" Ten Teachers " is a well-tried textbook whichperforms the phoenix rite every few years with notablesuccess. It is edited, and partly written, as usual by Mr.Clifford White, assisted by Mr. Frank Cook and Mr. WilliamGilliatt, and it carries the contributions of seven other

distinguished teachers. The book is an example of genuineteam-work, for the writers have advised one another on thevarious sections, and galley proofs have been freely amendedat a series of meetings attended by all of them. The bookthus represents the best agreed practice in London.