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Reviews of Books

Fringe MedicineBRIAN INGLIS. London : Faber & Faber. 1964. Pp. 288. 30s.

FRINGE medicine means the " unorthodox " systems of

healing, such as herbalism, homoeopathy, osteopathy, chiro-practice, naturopathy, Christian Science, spiritual healing,radiesthesia, and acupuncture. Their origins, tenets, and

present status in society are the main subjects of Brian Inglis’sthorough and provocative book. As a prelude to his survey,however, Inglis examines "

current medical orthodoxy ",because he believes that the existence, and certainly theclaimed resurgence, of the unorthodox must spring from theshortcomings of the orthodox. Indeed, so strongly does heurge its inadequacies and indiscretions that he plainly has astrong personal distaste for the medical establishment (readersof Queen will have no doubt of this) : he assumes the role ofprosecuting counsel rather than of impartial judge.

Inglis indicts orthodox medicine on three counts. Firstly, heseriously questions one of its basic creeds-allopathy, the useof drugs in pharmacological doses to counteract disease. His

opposition derives from his belief (shared, he says, by manybranches of fringe medicine) in the vis medicatrix naturoe-the body’s recuperative power or

" life force ". In his view the aimof rational treatment should be to stimulate this healing power,whereas allopathy ignores or impairs it. To support this

contention, he first returns to the days when ill patients whorecovered after allopathic treatment did so in spite of its

purges, emetics, clysters, and bleedings. Then he reminds usof the several recent drugs and therapeutic regimens hailedwith enthusiasm only to be ushered out with embarrassment.And he does not spare medicine the supreme reproach ofthalidomide. Secondly, he accuses orthodoxy of neglect of themind-body relationship, alleging inadequacy of undergraduatepsychiatric training and consequent ineptitude of the pro-fession at large (not excluding the psychiatrists) in their

dealings with the neuroses and psychosomatic disorders.

Finally, he takes the medical establishment to task for its

intransigent attitude to new ideas and concepts, particularlyfrom outside its closed shop.Some of the rods with which Inglis beats the doctors are of

their own making. Thus, his evidence for prodigal anduncritical prescribing has largely been drawn from medicaljournals. And his views on the place of psychiatry in thecurriculum are shared by many doctors.Yet doctors are not always so forgetful of the relation between

psyche and soma as Inglis maintains; nor are psychiatristsalways as poorly trained and helpless as he implies. Hisaccusation that the profession has been too rigid and reactionaryin its approach to new ideas has often been true; but his ownevidence could be used to show that in recent times medicinehas accepted innovations too readily and uncritically.In his examination of orthodox medicine, Inglis argues as a

Jekyll, in a conventional, logical way; and we quarrel only withsome of his interpretations of objective evidence rather thanwith the evidence itself. His views are comprehensible, if notalways acceptable. But when he turns to fringe medicine hebecomes a Hyde, discarding the reasoning that is the basis ofrational judgment. He substitutes a " willing suspension ofdisbelief ".

It is probably fair to say that Inglis regards most illness asthe result of changes in the life force, changes which can bedetected and corrected by any of several methods of healing.And he does not exclude suggestion as playing an importantpart in therapy. Not surprisingly, the effective application ofthese techniques tends to be more a congenital than an acquiredskill, so that their practitioners are more likely to be born thanmade. The innate extra sense with which they are endowedmay make any formal training unnecessary. Indeed, such atraining-especially if it is orthodox-may actually impairthe natural healing process. A knowledge of pathology, forinstance, can be a positive hindrance, according to one chiro-

practor, because " if we could estimate the destruction withinthe patient’s body we would immediately doubt the power ofthe healing forces resident in the cell to overcome the ravagesof disease. Whereas in truth there was no limit to what the

healing forces could do if given the chance."But not all healing systems take this view of vocational

training, and two already approve a curriculum which includeseither a full orthodox training (homoeopathy) or what closelyapproximates to it (some schools of osteopathy). Indeed,perhaps the most interesting aspect of this subject is the

tendency for some unorthodox systems to grow closer to

orthodox medicine as they grow older-a trend which Inglisdeplores.The techniques of these systems of treatment cannot always

be satisfactorily demonstrated to sceptics, whose presencemay interfere with results. If there is no evidence which would

satisfy a panel of scientists, the fault, as Inglis sees it, lies withscience and not with fringe medicine. And if unorthodox

practitioners try to impart to their method a bogus " scientificgloss", this is evidence of their craving to justify their work;for Inglis holds that those who become fringe practitionersordinarily do so because they are convinced-even possessed-by their beliefs, rather than because the job offers rewardingfinancial and social prospects.

Inglis concludes that the sheer weight of " anecdotalevidence obliges us to accept the existence of

" certain forcesand manifestations ". We agree that there is much to be

explained; and we do not join those who condemn simplybecause there is no orthodox explanation. Yet Inglis and thosewhose work he expounds should not ignore the fact that anexamination of their claims by

" orthodox " scientific inquiryis the best way of ridding their critics of the suspicion thatmuch of fringe medicine is compounded of misconception,superstition, distortion, self-deception, and plain hocus pocus.

Biochemical Lesions and Lethal SynthesisSir RUDOLPH PETERS, M.c., M.D., F.R.S., emeritus professor ofbiochemistry, University of Oxford. Oxford: Pergamon Press.1963. Pp. 321. 70s.

IT took a long time for pathologists to show more than inci-dental interest in the biochemical changes that underlie themorphological changes they observe. Books such as Cameron’sNew Pathways in Chemical Pathology and Dawkins and Rees’A Biochemical Approach to Pathology show the direction inwhich current experimental pathology is moving. In recent

years there has also been a great deal of fundamental work onchemical changes in virus-infected tissues, in tumours, and inother pathological conditions. The biochemistry of disease isnow an enormous area of investigation in its own right.

Sir Rudolph Peters is the leading pioneer in this field. Takingparticular conditions and analysing them with the thoroughnessof the professional biochemist, he revealed the underlyingchemical disturbances, thereby contributing to both pathologyand biochemistry. Well-known examples of his work includethe demonstration of lowered co-carboxylase activity in thia-mine deficiency, the inhibition of sulphydryl enzymes byarsenical substances and its reversal by B.A.L., early work onpoisoning by mustard gas and other alkylating agents, andanalysis of the mechanism of poisoning by fluoracetate. Histerms " biochemical lesion " and " lethal synthesis " have

passed into the general vocabulary of science. The developmentof knowledge about these and other problems is discussed inan agreeable and leisurely manner in the essays in this book.In his choice of subjects and the way in which he directedresearch into them, Peters showed great insight, and this comesout again in the reprinted lectures which form the second partof the book. The Harben Lectures of 1929 have nearly ascontemporary a ring as the Linacre Lecture of 1962; a clearand deep vision of basic scientific problems rarely becomesdated, as rereading Darwin or Clerk Maxwell will show.These lectures will instruct as well as entertain. Too much

of the biochemical work undertaken by experimental path-ologists is rather superficial. Peters’ work shows not only thesort of problems that can be tackled but also how the work

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should be conducted. In this field, as in any other, there is noexcuse for any but the highest standards.The high price suggests that the publishing costs and profits

are to be recovered from sales to libraries; certainly the bookis outside the range of all but a few private pockets.Indications and Techniques in Arterial Surgery

Editor: PETER MARTIN, V.R.D., M.CHIR., F.R.C.S., F.R.C.S.E.,

surgeon to Hammersmith and Chelmsford Hospitals. Edinburgh:E. & S. Livingstone. 1963. Pp. 112. 30s.

IN the past decade or so vast improvements have been madein peripheral vascular surgery. Clinical and experimentalresearch in many countries has established reliable methodsof correcting or ameliorating many lesions which were con-sidered irreversible. The scope has extended so much thata working knowledge of present-day techniques must be partof the armamentarium of every general surgeon; often it willbe needed in an emergency if valuable time and even livesare to be saved. This book is intended as a practical guide forthose without special experience in vascular surgery andshould make a valuable addition to every surgeon’s bookshelf.The editor has chosen five contributors who, with himself,

describe the methods which have proved most effective intheir hands. They have avoided any attempt to review all

techniques, and by concentrating on well-tried methods haveproduced an admirable do-it-yourself handbook for the non-specialist. Pathology and the clinical aspects are discussedonly when they influence or indicate treatment, and theauthors have confined themsevles to the more common

peripheral vascular lesions. There are chapters on peripheralischaemia and peripheral artery grafts, the treatment ofocclusion and stenosis of all the major vessels amenable toreconstructive surgery, and aneurysms and peripheral arterialembolism. The style is remarkably uniform; superfluousmatter which might have confused the descriptions has beenruthlessly excised, but special attention is given to the smalldetails in technique which are of such value to the surgeontackling an operation for the first time. The many clear linedrawings are original and give the reader a quick grasp of theessential steps. The discussions on indications show thewisdom of great experience, and even the specialist in

peripheral vascular surgery will find the book well worth hisattention.

Some Aspects of Medical GeographyL. DUDLEY STAMP, C.B.E., D.SC., D.LITT., LL.D., professoremeritus of social geography, University of London. London:Oxford University Press. 1964. Pp. 103. 21s.

THIS book contains the text of the Heath Clark lectureswhich Professor Stamp gave in 1962. Among other things hediscusses the influence of climate on disease and health andindicates a number of phenomena imperfectly understood, orat least insufficiently appreciated and acted upon. For example,irrigation, which may bring fertility and food to an arid

region, may also endanger life, for water can carry disease, andunless there is liaison between the irrigation engineer and thehealth officer, schistosomiasis or malaria may destroy the verypeople irrigation is designed to help. Investigations in Indialeave no doubt that the new irrigation canals have helped tospread malaria-a warning not yet fully learnt elsewhere.

Again, controlled temperature, humidity, and air-flow has. been introduced into offices, hotels, factories, and many homes

in North America, Continental Europe, and more recently inBritain, yet the long-term effect of air-conditioning on healthhas yet to be ascertained. Patients with rheumatism and

people with old scars are influenced by weather, sometimes,indeed, in advance of a falling barometer. Professor Stampsuggests that atmospheric ionisation, qualitative and quanti-tative, may provide a scientific explanation of this and alsoaccount for the fact that in Iceland arthritic attacks are associ-ated with the aurora borealis. So far little is known of thestate of ionisation under air-conditioning and whether thereis any harmful increase of positive ions. Again, no intelligentfruit farmer would consider establishing an orchard withoutexpert advice, not only on soil and rainfall, but also on such

matters as the flow of cold air. Yet in siting the new town ofKinlochleven climatic conditions were ignored. In midwinterthe town receives no sunlight and is completely envelopedby mountain and hill shadows.The main theme running through the book, however, is a

plea for the map as a tool of medical research. A map showingthe distribution, say, of mortality or morbidity from a diseaseis a factual document which explains nothing but which posesa number of questions. The striking anomalies of distri-butional pattern will invite the investigator who fails to estab-lish a correlation with known or suspected factors to look forhitherto unsuspected causes. Professor Stamp believes thatgeographical analysis may make a real contribution to know-ledge, for maps will suggest correlations and causes, permithypotheses to be followed up (and, if need be, discarded),rather than provide ready-made answers. Statistics of mor-

bidity, as distinct from mortality, are hard to come by (savefor notifiable infectious diseases) and most of the informationis in the files and case-books of general practitioners. Hewishes some of these would put their findings on a map,for he thinks the results might be surprising. Perhaps the

College of General Practitioners might take up the challenge.Fundamentals of Blood Coagulation in Clinical Medicine

CECIL HOUGIE, M.D., associate professor in pathology, Universityof Washington, Seattle. New York and London: McGraw-Hill.1963. Pp. 303. 92s.

THIS book is intended for " the medical student, generalpractitioner, internist, surgeon and clinical pathologist "-notfor the specialist or research-worker in ha:matology. It sets

out to present the facts of blood coagulation that are relevantin diagnosis and treatment of coagulation disorders. The partson diagnosis are very well done, but the sections on treatmentare less satisfactory. The first two chapters are a generalintroduction and an account of present ideas on coagulationand the tests used for assessing clotting function. Thesechapters are excellent and up to date; they give particularlyclear accounts of the difference between extrinsic and intrinsic

thromboplastin formation; the various tests of clotting functionare ably described and illustrated by apt diagrams.But the chapters on the treatment of haemophilia and

similar conditions are out of date: there is no reference tothe detailed papers on the clinical findings in haemophiliathat have been published from Oxford and Manchesterin the past few years. Haemophilia patients in Seattle

are, it seems, still subjected to the via dolorosa of not

more than two dental extractions at a time, a practice longabandoned in Oxford and Manchester; there is no referencelater than 1957 to dental management. The same disparityappears in the discussion of platelet function and disorders;there is a clear account of present ideas, such as the role of" platelet factor 3 ", but the treatment recommended for

thrombocytopenic purpura is outmoded. The chapter onanticoagulant therapy with coumarin and indanedione drugsis sensible and practical.

Dr. Hougie prefers the one-stage prothrombin-time test forcontrol and favours direct reporting of prothrombin-timesrather than " indices " or percentages : he sees no practical ortheoretical advantages in Owren’s thrombotest technique. Hebelieves that anticoagulant treatment should be used for venousthrombosis in the legs and for myocardial infarction up tothree years after the original incident.Those for whom this book is intended will benefit from

all but the sections on treatment. The appendix on

recommended technical methods is well worth the attentionof even specialist haematologists, attention to detail is properlyemphasised as essential if reproducible results are to beobtained.

The Normal Child (3rd ed. London: J. & A. Churchill.1964. Pp. 331. 40s.).-Over half of Prof. R. S. Illingworth’sbook has been rewritten; and the drawings illustrating thevarious stages of development have been replaced by photo-graphs. For concise description and sound advice, we againcommend this book.