PSYCHOSOMATICS

PHARMACOGENETICS: HEREDITY AND THERESPONSE TO DRUGS. By Werner Kalow, M.D.231 pages, 69 figures, photo oDset printing. Phila­delphia-London: W. B. Saunders Co., 1962. Pricenot given.

Many obscure findings have led to the develop­ment of a formidable literature on the differencesin drug response with variations in genetic composi­tion of the responding organism. These findings havebeen compiled and interrelated in a most interestingfashion in this work. The topics covered include gen­etic factors of drug resistance in micro-organisms,in tissue cultures, and in insects. Variations in phar­macological effects with heredity in laboratory ani­mals and in man are discussed in detail.

Particular attention is paid to alterations of drugresponse in man which occur in genetic disturbancesand as a result of racial differences. Since the ulti­mate effect of most drugs is to alter enzyme func­tion, the science of pharmacogenetics is capable ofproviding information both of clinical usefulness andof basic physiologic and pathophysiologic importance.Doctor Kalow is to be commended for his excellentsurvey of the field and for his intensive and lucidapproach.

The book is recommended for all those interestedin basic mechanisms of drug action and in pharma­cologic studies.

JOHN H. NODINE, M.D.

ADVANCES IN PSYCHOSOMATIC MEDICINE.Edited by Arthur Jones and Hellmuth Freyburger.334 pages. New York: Robert Brunner, 1961.$8.50.This book is the result of the Fourth European

Conference on Psychosomatic Research, held in 1959in Hamburg. It is a comprehensive report of cur­rent European theories, research and techniques.

Divided into four parts, and a total of 46 chap­ters, it covers methods, principles of research, theconcept of constitution, the problem of "trainingfor psychosomatic medicine," and assorted problems(model psychoses with LSD-25, hypertrichosis,asthmatic wheezing, colitis, myxedema, psychiatricaspects of coronary disease, et cetera).

An interesting chapter on psychopharmacology iswritten by M. PHanz of Giessen. The correlationswith the ascending reticular system, which is the"link between organic sensations and consciousness"are discussed. The effects of drugs are describedas due to purely somatic factors, such as the dose,the route of administration, the rate of absorptionand the condition of the vegetative nervous system.In addition, the personality of the patient, his inter­pretation of the drug effect, and the socio-psycholog­ical setting in which the drug is given, are allimportant.

Mitscherlich of Hamburg points up the most im­portant fact that the frame of reference of thepsychoanalyst is quite different from that of thegeneral physician (but fails to point out that thismakes for differences in management).

S. Barton Hall of Liverpool notes that thereis a healthy trend for psychiatry to move in thegeneral direction of medicine, returning to a holisticconcept.

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H. Hoff and E. Ringel of Vienna revive Adleriantheory and point up the value of the concept of"organ inferiority" in psychosomatic medicine, whereevery human being has his Achilles heel.

A most valuable chapter is contributed by M.Balint of London. The author predicts that "psycho­somatic medicine will sooner or later establish itselfas a special branch of our profession"; he thenambivalently concludes that someday it will "becalled simply medicine." He makes a most worth­while plea for "equal rights for physical and psycho­logical diagnostic examination." His description ofthe training of G.P.s in the Tavistock Clinic shouldbe mandatory reading for every doctor interested inpost-graduate psychiatric education. Balint is proudthat none of the trainees were "lost to psychiatryor psychoanalysis," but remained in their ownpractices.

The book is indeed comprehensive. Since it rep­resents the viewpoints of so many whose trainingand orientation differ quite markedly, it is difficultto reach any conclusions as to the status of Psycho­somatic Medicine in Europe. This should come as nosurprise, since the same problems exist in the West.

W.O.

THE EPIC OF MEDCINE. Edited by Felix Marti­I1Jtiliez, M.D., New York: Clarkson N. Potter, 1962.

The Epic of Medicine is an unusual history ofmedicine, in which its progress is closely interwovenwith the history of mankind and civilization. Its useof graphic colored illustrations produces a vivid anddynamic portrayal of the many landmarks.

The beginnings of medicine are traced to theShaman who used exorcism, made prophecies, andcombined the functions of the physician with that ofthe magician. The ancient code of Hammurabi, withits established fee schedules for physicians (as wellas penalties if the treatment failed) is examined.

Early Greece is seen to have had two basic medi­cal philosophies: (1) The Aesculapian cult, with itsmagic and religious roots and (2 ) the School ofCos, based on rational thought. Hippocrates, thehead of this latter school, was the first to treatpatients rather than diseases.

In Roman medicine, Asclepiades (who was orig­inally from Greece), is noted to be the first phy­sician to calm the insane with gentleness. Galen'sconcepts are seen to be anatomic, but his thinkingincluded teleologic elements which eventually ledto a decline in experimental interests after theChurch gained power. The rise of humanism is thenconsidered with Vesalius, Paracelsus, Juan LuisVives, Johann Weyer and others as the forerunners.

The story then continues, highlighted by the con­tributions of Harvey, Sydenham, Boerhaave, Pinel,Lavoisier, Virchow, Claude Bernard, Kraepelin, Char­cot and Freud.

Dr. Marti-Ibanez is to be congratulated for thisdynamic presentation of the history of medicine.The illustrations, when coupled with the vividnessof his writing, makes the reading of this book amost pleasurable experience.

W.O.

Volume IV