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Medicine and Books

As research continues to dissect out the various arms of our immunological defence system it becomes more and more complex rather than simpler. It is therefore hardly surprising that the practising physician may find it difficult to keep up with discoveries in immunology and how these may apply to general and special clinical interests. At one time immunological aspects of disease could be adequately studied from large textbooks and specialist journals, but now the large number of publications in this subject make it a demanding task. Thus specialist publications now appear that deliberately focus on the immunological aspects of individual systems, organs, and tissues, such as Immunology of the Lung and Upper Respiratory Tract. The 19 chapters broadly cover structure and function of the normal upper and lower respiratory tract; inflammatory effector cells; the individual immune responses to infection by viruses, bacteria, and parasites; and clinically orientated sections on hypersensitivity pneumonitis and immunodeficiency and systemic lung diseases. The blend of anatomical, pathological, and clinical components should give the reader an up to date and comprehensive view of the role of immunology in diseases of the respiratory tract. In the exceptionally well written opening chapter the details of the gross and microscopical structure of the respiratory tract are supported by some elegant electron microscope photographs. There is a much needed review of immune functions of the human nasal mucosa and tonsils, which will be of use to ear, nose, and throat specialists. One recent major advance in clinical immunology is in understanding how mobile inflammatory cells such as neutrophils and eosinophils interface with other components of the immune system. A general consideration ofhow phagocytic cells initiate and prolong inflammatory responses provides a useful summary of a complex topic. In allergic diseases of both the nose and lower respiratory tract the eosinophil is a prominent cell, and the review of the functions of this leucocyte should be well received. Bronchoalveolar lavage is a relatively non-invasive way of obtaining cells from the human respiratory tract, which provides an interesting approach for investigating bronchial and alveolar disease in man. The confusing published work on this subject is brought together in one chapter, though only with time will a clearer picture emerge of the contribution that this technique makes to our understanding of disease in the lung. Half way through the book the emphasis changes towards the more clinical aspects of immune responses. No book on the immunology of the respiratory tract would be complete without a section on immunodeficiency, but the chapter on this is short and lacks new information. The role of inflammatory mediators and their pharmacological control are of paramount importance in understanding allergic reactions of the respiratory tract, and the concise review of this brings together some of the complex biochemistry and pharmacology of chemical mediators and their potential role as effector mechanisms of inflammation. Recent developments in the understanding of hypersensitivity pneumonitis presented in the penultimate chapter provides refreshing new data on the pathogenesis of this group of diseases. The last chapter on systemic lung diseases ends on a strongly clinical note, drawing attention to the relative lack of knowledge of how the immune mechanisms of the lung continue to challenge our understanding of pulmonary diseases. The book is beautifully produced with clear photographs and diagrams. All the chapters are well referenced and have useful reviews and critical papers related to the individual topics. It is not primarily directed to the generalist, but anyone who wants a better understanding of immunological reactions in respiratory disease could hardly do better than read it. S T HOLGATE