Book reviews
Pathology of soft tissue tumors
Steven I. Hajdu, Philadelphia, 1979, Lea &
Febiger. 599 pages with illustrations. $65.00.
This book is organized into nine chapters and
three appendices. The first chapter is a history and
classification of soft tissue tumors; the next eight
deal respectively with fibrous tissue, tenosynovial
tissue, adipose tissue, muscle, vessels, peripheral
nerves, extraskeletal bone tumor, and miscellane-
ous tumors.
Each chapter is introduced by a historical sec-
tion which considers terminology, morphology,
physiology, and chemistry. This is followed by a
discussion of the tumors which is lavishly illus-
trated. Each chapter also includes charts and dia-
grams which represent incidence, recurrences,
location, age, distribution, and survival. An ex-
tensive bibliography is at the end of each section.
The appendices of the book represent a unique
feature. The first is entitled "Recent Trends in
Treatment of Soft Tissue Sarcomas" and is writ-
ten by M. Shiu, G. Magill, and S. Hopfan of the
Memorial Sloan-Kettering Cancer Center. These
authors, in five pages, discuss the treatment mo-
dalities varying from excision, amputation, and
node dissection to chemotherapy.
The second appendix, entitled "Differential
Diagnosis of Soft Tissue Tumors," contains
charts which give age incidence, sex incidence,
size, and site. The author has also made charts of
the histologic morphology, special stains, and
electron microscopic features as well as metastatic
sites.
The third appendix is a self-assessment quiz
consisting of 150 questions.
The text is well written and, for the most part,
well illustrated. Some of the illustrations are un-
necessarily large, but they demonstrate what the
author intended. The use of electron microscopic
photographs is not excessive. One aspect I would
consider inappropriate is Appendix 3. This' appar-
ently represents an appeal to the current interest
in, and abuse of, testing technics. Most examina-
tions are tests of that which one has committed to
memory. The test-taking student has developed to
the point where he can memorize great masses of
material and then cleanse his mind completely
after a test so that it may be filled with other
"facts. " Of greater importance is whether the stu-
dent knows where to acquire the needed informa-
tion.
This book does perform as the author intended
in his preface. It is a compilation of many aspects
of soft tissue tumors which will be very useful to
pathologists and less so to the oncologists and sur-
geons because of the emphasis on morphology.
Bernard F. Fetter, M.D.
Durham, NC
The invisible alcoholic: Women and alcoholic
abuse in America
Marian Sandmaier, New York, 1980, McGraw-
Hill Book Co. 298 pages. $12.95.
The female fix: Women and legal drug
addiction
Muriel Nellis, Boston, 1980, Houghton Mifflin
Co. 228 pages. $8.95.
Social causes of illness
Richard Totman, New York, 1979, Pantheon
Books, Inc. 263 pages. $10.00.
Holistic medicine has been much in the news
lately, attaining a popularity which seems entirely
undeserved. Most reviewers who have a moderate
knowledge of science and philosophy find holism
to be shallow, intellectually, but the general public
does not agree. Marian Sandmaier's The Invisible
Alcoholic: Women and Alcoholic Abuse in Amer-
ica, Muriel Nellis's The Female Fix: Women and
Legal Drug Addiction, and Richard Totman's So-
cial Causes of Illness are three popular and well-
advertised books. What the hell is holism, you
ask. Holism is a semireligious faith in mentalism
(opposed to materialism), intuition (opposed to
scientific analysis), and in a mystical unity of all
the universe. The faith owes primary allegiance to
Hegelian idealism, a European philosophy which
flourished briefly and was rejected a century ago.
Holism is favored by many recent college grad-
uates, mostly students of the new idealist doctrines
in the social studies, especially psychology. Some
105

106 Book reviews
of these students, who were holistically critical of
established medicine, have found jobs in jour-
nalism. Holistic true believers tend to be utopian,
faddish, reformist, and metaphoric, reminding one
of 1960·style hippies. Most physicians are prag-
matic, realistic, conservative, and literal, rather
like midwestern parents. Conflict is inevitable.
Within the medical community, the holistic
viewpoint (sometimes is printed (w)holistic to
emphasize the unity concept) is expressed by some
members of the family practice movement, but
traditionally this philosophy has belonged to a
segment within psychiatry. In a sense, family
practice has developed in close philosophic asso-
ciation with modern psychiatry. The specialties of
both family practice and psychiatry are well
financed by state and federal governments, and, as
expected, many members work inside government
and many more are active in state and national
politics. A second reason for the strong political
emphasis in holistic medicine is that a principal
thesis of the faith claims that mental forces cause
almost all diseases. Most holistic physicians say,
"The mind really does control the body" and
would claim the power of the mind is "unlimited"
in some sense. More importantly, these disease-
causing mental forces do not originate within the
individual, but are induced in these unfortunate
patients by ugly social forces beyond their control,
such as evil leadership, injurious customs, and es-
pecially by injustices. Exploitation, harassment,
oppression, hatred, poverty, racism, sexism,
greed, malfeasance, and other social ills are the
real causes of disease, and, therefore, the cure of
most diseases is by means of a thoroughgoing re-
form of society. Preventive medicine, by this
holistic view, becomes indistinguishable from re-
form politics.
For instance, according to Marian Sandmaier
Journal of the
American Academy of
Dermatology
and Muriel Nellis, women may abuse alcohol and
other drugs because social and cultural injustices
to women cause unbearable tensions. Physicians
and industrialists are the villains because they pre-
scribe and manufacture these drugs, instead of
offering proper (holistic) therapy. Two solutions
are obvious: banish social injustice to women and
remove greedy industrialists and physicians from
power. Totman's Social Causes of Illness, al-
though more moderate and well argued, extends
much of the holistic argument to apply to infec-
tious diseases, cancer, degenerative conditions,
and immunologic disorders. Totman is critical of
traditional medicine but favors a combination of
traditional and (in his terms) "alternative" meth-
ods of medical care.
Philosophically or logically, or even on the
commonsense level, radical holism does not hold
up to examination. The views are peculiar and
imprecise, and tragic failures may follow when
mentalistic medicine is practiced by the faithful
laity. Much of holistic medicine is arbitrary or
emotional. Key arguments often decline into a
sloppy mysticism. However, the appeal of medi-
cal mysticism to the troubled heart in these
frightening times is impressive, and the wise phy-
sician may wish to anticipate his patients who are
buying and reading books like these three.
Readers wanting to know more about holism
and (w)holistic medicine might be interested in
Nicholas Davis's editorial (South Med J 72:
1357-1358, 1979) and in several other books, such
as Michael L. Johnson's Holistic Technology,
Lillian Grant's The Holistic Revolution, D. C.
Phillips' Holistic Thought in Social Science, and
Norman Cousin's Anatomy of an Illness.
Philip C. Anderson, M.D.
Columbia, MO