PSYCHOSOMATICS

ganization were attained to facilitate rapid learning,the retention of memories of a single experience, theabstraction from these of common features, andfinally, integration with symbolic patterns.

At the conclusion, he states that men have morethan the physiologieal functions of mammals: "Andwe have also an understanding and inquiring mind,an insatiable curiosity, a noble ambition, a qUickenedsympathy, a tender affection, a social conscience, andaltruistie aspirations."

In reading this book, one becomes wiser, and moreconcerned about both the immediate and the ultimatedestiny of man. He tells us ahout our hiologie heri­tage and makes us feel proud. His ennohled view ofman leaves no room for pettiness. One feels that itmay be pOSSible not to be afraid, and instead tolive with the requisite dignity and respect whiehhumanity needs if it is to survive.

The book is full. One is thankful that it wasnot re-edited or "brought up to date." In the shortintroduction to this reprint, Dr. Paul Roofe says, "Pro­fessor Heriek's basic aim in life was to understandmore concerning the natural history of the humanspirit." This book is living testimony to that aim.

JOHN J. SCHWAU, M.D.

SIGNS AND SYMPTOMS. APPLIED PATHOLOGICPHYSIOLOGY AND CLINICAL INTERPRETA­TION. Edited by C. M. MacBryde, M.D. FourthEdition, 971 pages. Philadelphia: J. B. Lippiru:ott,1964.

This fourth edition of a well-recognized text ondiagnosis is dedieated to the acquisition of insight bythe physician. In each chapter, a major sign orsymptom is thoroughly analyzed and dissected, withmajor emphasis placed on the interrelationships ofmultiple factors.

The 35 chapters are contributed by 31 contributors;yet each is not an unrelated monograph. The editorhas succeeded in providing an interdisciplinary cover­age of each problem, wherever possible.

In the very first chapter emphasis is placed on thepatient-doctor relationship in all of its ramifications,which should be valuable to all readers of PSYCHOSO­MATICS. Other chapters stress recent progress ingenetics, the functions of DNA and R!'\A. Humoralfactors resulting from neurol'lal excitation are discussedin several chapters. Neurohormonal transmittingagents and the knowledge acquired through recentadvances in psychopharmacology are also emphasized.

A most interesting chapter on "Abdominal Pain" isprovided by Stewart \Volf in that a greater consid­eration of psychogenic factors was anticipated thanprovided. However, in the chapter on "Anorexia,Nausea and Vomiting," contributed by Drs. John L.Horner and Stewart \VoU, a more thorough ~urvey isprovided. Here, emotional and psychie re:\(:tions tolife situations art' noted to often cauS(' these symp­toms; yet chemieal and vascular variations and im­pulses transmitted to thl' midhrain from the visceraand other organs are also discussed in ddail. It isevident that this approach is truly a comprehensiv('one in which psyche and soma art' both considered.

184

The chapter on "Nervousness and Fatigue" byEdwin F. Gildea is also rewarding. The pathologicphysiology and psychopathology of these conditionsare considered, as well as the differential diagnosis ofmental disorders. The diencephalon, its ramifications,and the role of the newer drugs in neurohumoraltransmission are thoroughly discussed. It is interestingto note that the author includes in this chapter asurvey of various endocrine and other somatie prob­lems whieh can produce fatigue and nervousness.

A chapter on obesity is contributed by Doctor Mac­Bryde. Here, too, metabolic factors are intertwinedwith hypothalamic, heredity and psychological con­siderations to providl' a most comprehensive coverageof a truly interdisciplinary problem.

These few examples can hardly do justiee to theencyclopedie coverage provided by this unusual text.It is recommended to all physicians; those with apartieular interest in psychophysiologic correlationswill be delighted by a most comprehensive coverage.

\V.D.

MARRIAGE COUNSELING IN MEDICAL PRAC­TICE. By Ethel M. Nash, Lucie Jessner and D.Wilfred Abse. 359 pages. Chapel Hill: Universityof North Carolina, 1964. $9.00,This is a practieal book for the general physician,

A "siek" marriage is often responsible for a longand complex series of reactions and interactions, witha wide range of social and psychosomatic effects onthe married couple, their children, and others.

:\Iany physicians have largely ignored the medicalimplications of marital conflict; the authors maintainthat this "psychologieal blind spot" is the result ofdeficiencies in medieal training. The main part ofthe book is for those physicians who recognize thata large proportion of their patients are suffering, di­rectly or indirectly, from such conflict, and wish tolearn how to help them. The last section describesthe marriage counseling programs now offered inthree different medical schools.

Case matl'rial is presented, with criteria for decid­ing whether the partners should be seen together orseparately, for a brief time or for what is called "longterm," in one case as many as 75 time.,. Beforeundertaking counseling it is recommended that thephysician arrange for supervision hy an expert in thefield, He should be prepared for initial resistance andfor psychological defensiveness manifested as symp­toms or complaints. These may bl' expected gradual­ly to give way to the frel' ventilation of conflict mater­ial. Because of the unrealistc image of the physicianas an omnipotent parent, the patient may demand thathe be told what is wrong and how to change it. Ifthe physician yields to the tl'mptation to offer solu­tions, improvement is not likely to occur. In anycase, patterns which began early and have continuedfor several years are difficult to modify. In manyinstances if a spouse can gain a "feel" for the part­ner's point of view this may be the most to be ex­pected; however, such a "feeling" for the partneroften leads to a shift toward marital adjustment.

Sexual symptoms as presenting complaints require

Volume VI