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244pp Price £14.99 ISBN 1-84358-137-X
London: Metro Publishing .
Professor Feldman describes how our understanding of the mechanism of action of curare has developed, from the early demonstrations by Squire Waterton and Benjamin Brodie that it kills by poisoning the muscles of respiration, leading on to the work of Bernard who showed that it poisoned the motor but not the sensory nerves, and of his pupil Vulpian who concluded that its site of action was at the muscle end-plate. The reader is led through the elegant work of Loewi and Dale, who used curare to prove that acetylcholine came from the nerves and was not a product of muscular activity, to the theory of competitive inhibition (and the limits and deficiencies of that theory) and on into the era of molecular biology with studies on single acetylcholine receptors. The author can be forgiven for devoting a disproportionate amount of space to his own research but it is less easy to condone the over-enthusiasm for his subject which leads him to claim that it was the knowledge derived from the study of neuromuscular blockade which has brought about the development of drugs for asthma, hypertension, depression, mania, Parkinson's disease and many other illnesses—though he does eventually concede, on the final page of the book, that 'it would be foolish to pretend that these discoveries would not have been made had curare not been available'.
It is easy for us to forget that our predecessors had to learn how to use these drugs safely, and there is an interesting account of the introduction of curare into clinical practice, from the earliest employment of crude extracts in the nineteenth century to the use of purified preparations in the 1940s and of other neuromuscular blockers in subsequent decades.
However, the reader is required to extract these facts from a morass of incidental information. The ten-page Introduction which explains how the contents of our cells are derived from primordial seawater would, in abbreviated form, be relevant to the discussion on chemical transmission which comes five chapters later, but here it is bereft of all context; and, while we do indeed need to know something of the academic milieu in which Claude Bernard worked if we are to appreciate the significance of his studies of curare, Feldman does not achieve this aim in the nine pages which he devotes to the subject.
The absence of an index is always an irritation but an even greater annoyance is caused by Feldman's decision to dispense with an orthodox system of referencing in favour of a lengthy list of citations which are not linked to statements in the text, so that the reader cannot readily pursue some of the issues which are raised. Moreover, the relevance of many of the citations is not readily apparent, and readers will have difficulty pursuing those from scientific journals because page numbers are never given and even the volume number is sometimes omitted. If Feldman had submitted himself to the discipline of constructing a proper list of references he might have avoided several errors, which include statements that the Poor Law Reform Act was enacted in 1828 (it was 1834) and that Lister introduced antisepsis in 1845 (it was 1867); and, if he had checked the existing references more carefully, then the name of the author of a paper on Spencer Wells might have been given correctly (Shepherd not Shepard), as might the year of publication (1970 not 1907). How can an author who is presumably meticulous when writing papers in his professional discipline (in this case, clinical science) think it acceptable to be any less diligent when he moves into another (history of medicine)? It may well be that the facts and opinions which relate to the author's area of specialist interest are all correctly stated but, inevitably, the reader is left wondering.