History of British Hospitals

Symposia of experts have become a method of communication of advancing ideas appropriate to this epoch. Sometimes they are incomplete and fragmentary in composition, but both these volumes are models of thoroughness with well-prepared chapters, good bibliographies, interspersion of relevant expert criticism, and useful indices. The Chicago volume concentrates on the plaque itself. Among the many new and revised ideas the reviewer was struck by the important lipid-accumulating role of smooth muscle cells in the intima. The source of lipid may be the blood-stream, but it can be synthesized -and metabolized locally (B6ttcher). Hass presents evidence that experimentally induced hypercholesterolaemia forms an atheromatous plaque more easily when intimal injury has led to local mesenchymal reparative proliferation. Dr. Mustard emphasizes the importance of haemodynamic eddy effects in the deposition of platelets at areas in the blood-vessels which, in models, closely mimics the selective sites of atheroma. The role of haemorrhage within the plaque and embolization of plaque debris are also discussed. This book should be on all medical school library shelves. The Cambridge report devotes a substantial part of its space to the surrounding borderland of the problem. Gillman opens the volume with a broad comparative functional biological review of human and animal arteries under a variety of physiological conditions. The chemistry and metabolism of the vessel wall and the part played by lipids (Adams) and mucopolysaccharides (Muir) are fully discussed as well as the function of mast cells (Parish) and modem ideas on connective-tissue formation. A large section is devoted to clotting (Koller), thrombus formation (Poole), the place of anticoagulants (Walker), and fibrinolytic agents (Douglas). The last hundred pages are devoted to the pathology of human vascular disease, comparative studies on animals, together with experimental observations on the effects of diet and hypertension. The session was concluded by discourses on the problems of clinical and therapeutic studies (Shillingford, Fleming). Even though some of the lines of approach may lead into blind alleys, our understanding of this complex maze will undergo gradual improvement. Nobody can study these reports without being wiser as a result. This very great concentration of research effort can only be regarded as appropriate to the importance and magnitude of the problem.