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If you have had this kind of experience, I suspect you will recall it when reading Autoimmune Reactions. There are undoubted highs, starting with the concise review by Rose of the mechanisms underlying autoimmune disease, and continuing with well-written, stimulating, thorough reviews by Groeggel on kidney damage and autoimmune disease, Marion on DNA as an immunogen, and Ajjan and Weetman on autoimmune thyroid disease, among others. However, what jars the reader in this book is its random approach to the subject. We pass from insights into mechanisms of autoimmune disease to autoimmunity and B-cell tumors, autoimmune thyroid disease, and Sjogren's syndrome, and by way of a remarkably short chapter on autoimmunity in central hypertension, pass back to antigen presentation in autoimmunity, take in a little T-cell immunology in rheumatoid arthritis, come round to aspects of B-cell abnormalities and then to kidney damage in autoimmune disease, then take a quick hike back to autoimmunity in paraneoplastic syndromes, and finally arrive at a single chapter on one therapeutic approach. Along the way we encounter two excellent but substantially overlapping chapters on cellular penetration by DNA antibodies and an oddly configured chapter on alcohol, anesthetics, and analgesics in autoimmune reactivity. Reading this book is in almost equal measures both pleasurable and chaotic, leaving the distinct feeling that a more logical approach, cutting out the overlap and expanding the coverage of therapy (not least because we stand on the threshold of a revolution in the therapy of autoimmune diseases), would have produced a much better final product. Better editing might have helped to reconcile the divergent views expressed by Rose, Pritsch, and Dighiero as to whether Ehrlich's ideas in the early part of this century supported the concept of autoimmunity.
However, I did enjoy some of the historical vignettes included by various authors, such as the discovery of Bence Jones protein in 1845 by the eponymous Henry Bence Jones, physician at St. George's Hospital, London. Having been sent a urine sample by the astute William MacIntire, physician at the Metropolitan Convalescent Institution (late of the parish of London), Bence Jones confirmed MacIntire's original observations of a urinary protein that precipitated with heating at 40 to 60°C, disappeared with boiling, and reappeared with cooling. He then went on to analyze it in detail and later described it in his Gulstonian Lectures on chemical pathology, delivered to the Royal College of Physicians. However, neither he nor MacIntire linked this protein to multiple myeloma (or mollities ossium, as it was then called).
David A. Isenberg, M.D.
University College London
London W1P
9PG, United Kingdom
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