BRITISH MEDICAL JOURNAL 28 FEBRUARY 1976 531

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