Clinical aspects of immunology, 4th edn (2 vols)

Clinical aspects of immunology, 4th edn (2 vols)

312 of an epidemic? Which viruses should be included in the vaccine? How best to deliver the vaccine to the population at greatest risk? Arthur Silver...

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312 of an epidemic? Which viruses should be included in the vaccine? How best to deliver the vaccine to the population at greatest risk? Arthur Silverstein is well equipped for this effort. An accomplished immunologist, he was fortunate to observe these events from the privileged vantage point of a visiting staff m e m b e r on Senator Edward M. Kennedy's Senate Health Subcommittee. As a consequence, he is uniquely qualified to weave together the political and scientific issues into this cogent narrative. The book is arranged chronologically with background chapters included at appropriate points. One of these chapters is an excellent historic and scientific review of influenza. This organization is logical in that it helps the reader understand how different events interacted to affect the political and scientific outcome of the vaccination program. Even without the NIIP, the year was an exceptional one in the history of public health and infectious diseases. Certainly, the identification of the A / N e w Jersey/8/76 of swine flue virus in February 1976, was the most important event, but other things happened. The year began with a serious influenza epidemic due to the A/Victoria/75 virus. Some of these events were directly related to the vaccination program, but others were coincidence. For example, the severe outbreak of Legionnaire's disease a m o n g m e m b e r s of the American Legion in Pennsylvaffia was crucial to the outcome of the NIIP, yet Legionnaire's disease and influenza turned out to be separate entities. The vaccination program was launched by President Gerald R. Ford on 24 March I976, and he called ' . . . for the production of sufficient vaccine to inoculate every man, woman and child in the United States.' This vast enterprise in public health dwarfed all previous attempts to control influenza through vaccination. One of the important features ot" the NIIP experience was the fact that a public health program of this scale brought into focus many important questions about public health programs. The issue of liability insurance threatened the program from the beginning, and Arthur Silverstein carefully describes the considerations and events which produced a temporary resolution of this issue. The problem of liability and compensation for injury remains, and it is certain that the experience during the N I I P will affect the resolution of

trnmunology Today, vol. 3, No. l l, 1982 these problems. The arguments tot stockpiling vaccine as opposed to vaccinating the population in anticipation of the influenza epidemic were also important concerns. Silverstein articulately describes the notorious unpredictability of influenza and the relative ease with which it spreads, and how these factors affected the decision to vaccinate rather than to stockpile. The strength of this book is the excellent description of the interactions of the imperfect science of influenza and the political currents in 1976. Silverstein proves to be a superb analyst and reporter. In summary,

this is an excellent book. The issues, events and outcome of an important and unique public health event are carefully presented and reviewed. Students and observers of the public health scene will find this book particularly useful and fascinating. Reference 1 Beveridge, W. I. B. (1977) Influenza: the Last Great Plague, Heinemann .IOtIN R. I.A MONTAGNE

J. R. LaMontagne is Influenza Program O[ficer, Microbiology and Infectious Diseases Program, National Institute qf Allergy and Infectious Diseases, Bethesda M D 20205, U.S.A.

Essential reading for clinicians Clinical Aspects of

Immunology, 4th edn

(2 v o l s ) edited by P. ]. Lachmann and D. If. Peter.~, Blackwell Scient~c Publications, 1982. £90 (xvi + /O04 pages) I S B N O (532 00702 8 Most of the previous edition of this classic treatise on clinical aspects of immunology, first presented by P. G. H. Gell and R. R. A. Coombs in 1962, was written in 1973 and 1974 and the speed of progress in basic and clinical immunology since then fully justifies a fourth edition. The shifts in emphasis given to various areas of immunology in its 64 chapters and the largely new cast of authors (of the previous 85 only 20 reappear) make this to a large extent an entirely new book. The new editors have chosen not so much to revise the previous edition but to complement it with new topics and the addition of new chapters, such as those dev6ted to the assessment of immune complexes, rosette-forming reactions, the preparation and use of monoclonal antibodies, amyloid diseases, and various aspects of allergy and inflammatory mediators. For that reason, and probably also to keep the size down, some of the 'classical' content of almost every textbook of clinical immunology has been dropped - e.g. the description of basic methods such as precipitation and agglutination that have changed little in two or three decades, the description and evaluation of skin tests, the immunological aspects of blood transfusions and of forensic medicine, as well as the extensive description of some diseases with an immunological pathogenesis.

Compensating for these losses are some excellent new chapters which are certain to become standard references, such as the overview on complement by P. Lachmann and D. K. Peters and the C-reactive protein system by M. B. Pepys. The chapter by T. Platts-Mills on immediate-type allergy is also very informative, even if the author gives particular emphasis to some of his own preoccupations (personal bias is after all more enjoyable to read than a neutral, bland statement elaborated by some W H O committee). Some chapters on technique, such as those on monoclonal antibodies and rosette-forming reactions, are very helpful but do the current and prospective uses of rosette tests in clinical immunology really justify the 54 pages devoted to it? Other examples of relative imbalance can be found but it must be remembered that in putting together a textbook with so many authors the editors had an almost inhuman task. Some chapters are rather less informative than their predecessors in former editions, e.g. those on HLA typing and allergic drug reactions. Here again one must sympathize, since it is little nowadays that scientifically active editors can do to improve a basically flawed manuscript. When building such a textbook, some weak contributions have to be accepted to avoid production delays. One could criticize some overlaps and undue repetition, such as the duplication of a table on T-cell subsets in different chapters and the presence elsewhere in the book of much of the information given in the chapter on interpretation

Immunology Today, vol. 3, No. 1/, L982 of tests of immune functions. However, la critique est facile mais l'art est difficile... The book's construction differs somewhat fi'om that of the two other most complete textbooks of clinical immunology, Immunological Diseases edited by M. Samter and Clinical Immunology edited by C. W. Parker. It has eleven sections: physiological systems of the allergic response, induction of the allergic response, advances in immunological technology, immunological intervention,

313 allergic mechanisms of tissue damage, organ-based immunology, connective tissue disease, tumour immunology, transplantation, immunology of infection and miscellaneous. As the impact of immunology on all aspects of medicine and biology increases, can any well-balanced, upto-date, complete and stimulating textbook of clinical immunology still be produced by anyone? Lachmann and Peters have chosen to build on an already well-established foundation. Their book is a must tot any clinical

immunologist and clinician dealing with immunological diseases. Those who have the third edition of the treatise will continue to find it useful in several ways. Probably only the possession of two or three of the major textbooks in clinical immunology does the field full justice and secures an adequate nucleus of references. A L A I N L. D E W E C K

Alain L. de Week is in the Institute for Clinical Immunology, University of Bern, Swi&erland.

Texts for basic and advanced teaching The Cellular Basis of the Immune Response by Edward S. Golub, Sinauer Associates, Inc., 1987. $14.50 (xii + 330pages) I S B N 0 87893 272 7 Golub's text, which now appears in a second edition, occupies a special niche among introductory textbooks on immunology. It is not in fact a textbook at all in the usual sense. It makes no attempt to cover the whole of the subject, or even the whole of cellular immunology. There is little here on the distribution of cells within tissues or on immune physiology; immunity in the gut, for example, is hardly touched on. O d d m e n t s of clinical immunology enter from time to time, but there is no systematic treatment of effector mechanisms in the immune system. And, at the other end, the molecular biology of antibodies receives fairly perfunctory treatment: no E-M pictures, no WuKabat plot, no s-Ig. What it does olter is an exceptionally clear, profound, and idiosyncratic view of one particular kind of cellular immunology. Cellular immunology, as seen through Golub's eyes, is essentially

coextensive with the subject as it has appeared in the pages of the J . Exp. Med. over the decade. It concerns the activities, phenotypes, and descent of T cells, B cells and accessory cells. The subject is handled in a logical way, but with a historical bias. What we are offered is a guided tour of the hundred or so best experiments on T and B cells. The guidance is very well thought out, and it is a joy to find that Golub lets us know quite frankly who and what he personally thinks matters. There are clear and helpful illustrations, references, and a useful glossary and index. A treatment of this sort has strengths and weaknesses. The strongest point is the vividness with which it conveys the way things have developed. This is a volume which one can read cover-to-cover with continuous excitement. On the other hand, by omitting consideration of disease resistance and of immune deficiencies, one misses the arenas in which all these lovely theories are actually tested. But the main weakness is the obsolescence effect. This is a risk in any fast-moving subject, but it applies with special force to the

particular area chosen here. gurnet has complained about the circularity and repetitiveness of this area, but I think that one can be misled by the amount of huffing and puffing. In fact decisive steps forward are taken from time to time, and when this occurs, an amazing amount of earlier work can more or less be forgotten. This has just happened with the 'unification of function' (Klein's term) in the MttC, and is just happening to the molecular biology of the T cell receptor. When that does happen, so much of the old story can be forgotten. Golub would answer that it is only by closely observing a paradigm being broken that the student can learn what science is really like. That is certainly true for the very bright, but do most of us have the time? So I shall recommend the book warmly to my students, but I shall tell them what they won't find in it. And 1 shall reserve for myself the pleasure of telling them where this particular text has got it wrong. N. A, M r I ' C I l I S O N

N. A. Milchison z.~ head of the 7)~mour Immunology Unit at University College, London.