BRITISH MEDICAL JOURNAL 28 FEBRUARY 1976
straightforward and most impressive account.
The operation was strangely successful, and
yet it looks as though it really was cancer:
she had first noticed it in 1804, with an
exacerbation in 1806, and Dr Dubois thought
it was too far advanced for operation.
For the rest, there is plenty of interest about
people, and important people at that, including
an interesting visit to David's studio, but
most of it is for specialists rather than the
general reader.
CHARLES NEWMAN
Diabetes: Its Physiological and
Biochemical Basis
Ed J Vallance-Owen. (Pp 208; £8 50.)
Medical and Technical Publishing. 1975.
This book consists of six chapters on different
aspects of the biochemistry of diabetes. The
subject is vast, perhaps because so much is
known but so little understood. We are still
arguing about whether diabetes is due to a lack
of insulin or a resistance to its action-a rather
fundamental doubt, you might suppose, to
persist 50 years after Banting and Best.
This book does not pretend to be compre-
hensive-much of the endocrinology of
diabetes is omitted-but there are some excel-
lent reviews of its physiology. The first chapter
on proinsulin and insulin biosynthesis is by
Donald Steiner and Arthur Rubenstein,
whose contribution to this subject has been
outstanding. And it shows in their chapter,
which is masterly. Ashcroft and Randle
write of insulin release, and they too are clear
and learned. To the non-biochemist the subject
is complicated and becoming more so, and
Professor Randle has for long been a helpful
guide through its intricacies, only occasionally
getting too far ahead of his flock. Keith
Buchanan reviews the gastrointestinal tract and
diabetes, a subject of rapidly enlarging interest
to which he too has made important contribu-
tions. Felig, of Yale, on the complex subject
of the liver in relation to carbohydrate
metabolism, is almost as fluent in print as he
is in speech. Stout, Bierman, and Brunzell
discuss atherosclerosis and lipid disorders, a
difficult and controversial subject. The last
chapter is rather different. It is by the editor,
Professor Vallance-Owen, of Belfast, and in
it he restates the individual views on the
cause of diabetes which he has advocated with
tenacity over the last 15 years.
The authors-six American, five British,
and one Indian-have provided a stimulating
and helpful review of the present state of
knowledge of many complicated and puzzling
aspects of the aetiology of diabetes.
D A PYKE
The Internal Auditory Meatus:
Anatomy, Pathology and Surgery
M Portmann, J M Sterkers, R Characon,
and C H Chouard (Pp 312; £15 50.) Churchill
Livingstone. 1975.
Few otologists are as well qualified as Michel
Portmann to write on this specialised topic,
and a book devoted to it is long overdue.
Although this is a team effort, Michel Port-
mann is a world authority in the field of
otology, and this book is yet another addition
to the numerous publications to his credit.
It was first published in French in 1973.
Churchill Livingstone are to be congratulated
on producing this beautiful English edition
for wider circulation, and Anthony Richards-
a practising British otologist-for a lucid
translation. This volume fills a gap and I am
sure will be popular.
The text is divided into four sections. The
first covers the basic anatomy, measurements,
and variations in the temporal bone. The
chapter on blood supply to the internal
auditory meatus is full of detailed variations
and references. The section on symptoma-
tology and investigations gives a brief but
adequate description of audiological and
vestibular tests. The chapter on radiological
assessment describes fully the methods and
techniques employed in diagnosing early
lesions in the internal auditory canal. A final
summary of the methods of investigation in
tabulated form is excellent.
Most readers of this book are unlikely to
practise this type of surgery. However,
there is a full account of different approaches
to the meatus, their complications and
management. Excellent line drawings, radio-
graphs, and superb photographs-reproduced
from yet another Portmann publication
Chirurgie ORL et Cervica-faciale, by Portmann
and Guerrier-make the text clear and easy
to follow. Finally, the book includes clinical
histories of some cases and an exhaustive bib-
liography.
If criticism must be made, it is sad that the
price is so high. However, the book is a most
useful contribution to the field of neuro-
otology and is very warmly recommended.
N SHAH
Uganda Atlas of Disease Distribution
S A Hall and B W Langlands. (Pp 165;
$12-00.) East African Publishing House. 1975.
First published in 1968, this book has been
reprinted unaltered. This is a poignant
commentary on the great value of some 40
authoritative articles on the prevalence of
diseases in Uganda and on the dispersal of
most of the contributors. The cover photo-
graph warmed my heart, for it portrayed
kwashiorkor and marasmus, a subject which
has attracted many research workers to
Uganda. Half of the book is occupied with
infective disease, beautifully illustrated by
maps and concise statements by many experts.
The prevalence of infective disease differs
enormously from one area of the country to
another; so do climate and the insect vectors:
this is the environment in action.
Cancer research is outstanding in Uganda.
The results pose an enormous problem. Up to
the age of 45 years total cancer rates in Uganda
are similar to those of the United States Blacks
and Whites and those of Norway. However,
the varieties differ. In Uganda Burkitt's
lymphoma is common in children and skin
cancer is commoner at all ages. It has been
clearly established that after the age of 45
the rising cancer gradient in Uganda is not
maintained at the level that is characteristic
of many Western countries. Cancer of the
gastrointestinal tract, especially that of the
large bowel, and also cancer of the breast are
less common in Uganda. This can be explained
only in terms of environmental factors which
remain unidentified.
I suggest that at the end of this provocative
531
study there should be one more map, a blank
map of Uganda, depicting the "almost absent
diseases", for these are some of the commonest
disorders of the Western world, and their
aetiology is largely unexplained. This report
tells us that ischaemic heart disease is "almost
unknown," multiple sclerosis "has never
been recorded" in Africans there but occurs
in Europeans and Indians; ulcerative colitis
is "extremely rare"; and there is " less than
one case of thyrotoxicosis per year at the
university teaching hospital" in Uganda.
There was also "less spina bifida and anen-
cephaly in a large survey in the maternity
department" at the same hospital. The list
continues-pulmonary embolism, varicose
veins, deep vein thrombosis, even haemor-
rhoids. This well documented book offers
no suggestion of what environmental factors
protect the inhabitants of Uganda, but not
Britain, from these diseases. There is no
information on the diet ofthe adults of Uganda.
It is almost entirely unprocessed plant foods,
rich in fibre.
HUGH TROWELL
Refined Carbohydrate Foods and
Disease
Ed D P Burkitt and H C Trowell (Pp 356;
£7 80.) Academic Press. 1975.
In this book the authors provide extensive
evidence for their views on the epidemiology
of the so-called Western diseases. These
include appendicitis, diverticular disease of
the colon, other diseases of the large intestine,
ischaemic heart disease, diabetes, and diseases
associated with constipation and straining at
stool. The incidence of all these diseases,
the authors believe, is related to a reduction
in the consumption of dietary fibre resulting
from modern methods of refining foods.
Dietary fibre includes celluloses, hemi-
celluloses, and lignin, and it is true to say that
until recently such substances have been
largely neglected in nutrition and food science.
Early chapters are concerned with problems
that arise when relating disease to environment
in a search for causative factors. Next described
are the changes that have taken place in the
milling of cereals and in the refining of sugar
resulting in a drastic reduction in fibre.
Gastrointestinal transit times together with
stool weights and consistency are considered
in relation to fibre content of the diet.
In succeeding chapters the authors contrast
the prevalence of the diseases of the large
intestine, of varicose veins and haemor-
rhoids, of gallstones, ischaemic heart disease,
obesity, diabetes, and other diseases in
Western and developing countries. They show
that the incidence of these diseases in countries
where cereals are refined is much greater than
in those where whole grain is still consumed.
The book may be criticised for providing
relatively imprecise information, but the
authors take care to point out that such
information can be of epidemiological value
and that much of the evidence set out in the
book may be considered in that category.
It is well documented and contains many
references to other publications in related
fields. The book should be read by general
practitioners and all concerned with aiding
public health by dietary means who are
anxious to learn more about the authors'
hypotheses.
IVAN M SHARMAN