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discusses all aspects of pathology of the lung except tuberculosis. This $30.00 book comprises 850 pages with over 1,800 references. book is reasonably welt-written and moderately up-to-date. The coverage amments on Book by H. Spencer: Pathology of the Lung. New, York, Macmillan compery, - 1962: f~.. ~Nri4A otA 'y ~ ~'l.'.. '1 tr•.. . . . . . . . . . . { a~[4'~~~~~.~. or ttie mglish is somewbat better than that of the'American literature. .~ to "this country" apply to England and not to the United States. I believe .r ~ w ~fY~~' ~' ~',r L'f } +y Y: ~' .'i/ .5.~ r' r ~'- t,._ _ In reading the book, it is important to remember that the frequent references .. ., .,:a,~._2~,:.• . ~ - `' _ - , .. _. , ' _. * .. .... .. - , . F - - ~ . ~ -. "~t ~._ ' .. .. _ the book might make an interesting background reference on diseases of the ltuzg in general, although relatively small parts of it are directly con- cerned with smoking. I am inclosing advertising data submitted with the .book which lists the table of contents. The index lists three primary . items under smoking, namely the effects on bronchial epithelitun, carcinoma of the lung and chronic bronchitis, and two under tobacco, namely arsenic The chapter on carcinoma of the lung extends from pages 612 to 679. The general problem of the statistics relative to increase of carcinoma of the lung is discussed. Difference, in incidence in various countries is discussed on pages 614-615 as well as factors pertaining to urban and in lung cancer is not stressed by Spencer. poorest social classes. The role of smoking as a possible etiologic factor On page 615 Spencer states, "These (etiologic factors) are now known to include occupational factors, general environmental causes and personal habits such as smoking. To these might be added an hereditary factor-,

-for which, however, there is no proof in man, althovgh it is,oY proved importance in certain mouse pulmonary tumours, as was shown y (1936 ):" It should be noted that the pulmnnar tinnors in mice are not ..;comparabl.e to hwmn epidermoid carcinoma. Under occupational causes are discussed the Schneeberg and Joachimstal miner's lung, arsenic, nickel, metallic-iron and iron ox3.d.es, chromates, asbestos, gas-workers, and etiologic factors discussed include atmospheric pollution, smoking, f~.~,i.:. Fo other industries associated with a high incidence of lung cancer. F~ r e . . .. ~-K7 _ .. .... . . hereditary factors and chronic inflaunnation. Under smoking, four points of evidence in addition to the statistical evidence are mentioned and ='discussed on pages 621-622. I must say that the significance and " nence of point (c), The increased incidence of other diseases associated Y;~E - with smoking in patients with lung cancer," do not impress me. The short- comings of the work of Roffo and Blacklock, reported on page 622, have been previously discussed. ing an "expert witness" in that they might not have as readil,y available The discussion of hereditary and racial factors on pages 622-623 is of some interest. Some quotes out of context might be useful in exaadn- _. _. . . . . ., .. apparent significance of isolated sentences. Some of the quotations, for as cited in the book on pages 622-623 statements which detract from the ..- . . . ~ . . : , . ; y being approximately 1:3:4."; "Rakawer (195T) recently reviewed the eRa.mple, are: "In the U.S.A., the incidence of lung cancer in the Indian, Negro and white populations shows considerable variation, the proportion figures for lung cancer in Israel, and has shown that the incidence was much lower among Asiatic and African born Jews than among those born in Europe, and this despite the fact that the Jewish people have reme,ined INCIASt?RE No. 3, page 2 ...,;_ M MWIlerr- P "P. F. W or 'ei PKW

,7--- P Q ...~ ~. ~+ C3 .. . .~ . . .. .. . . . - . . ' ' ~ ' . . ' ~ . .. . . r . ~ . ._ ~ ~ .. .. . ~ .. ...1 ;~. ;.. ~ .;;.. ,. . .,r: ~ ..,> .. .. . ~ .. .." t-'~..`~ ~ . ~.., .. .. , ~._. , ~.~, . ~ ~_. . . ; ~~,~..~. racially pure throughout the centuries."; "Buechley et al. {1957) showed _. , ~.~. , ... . . • , ,. . ,. _ . . r; that there was a twofold excess of lung cancer in Mexican women born in Mexico • but resident in California, over a similar group of Spanish-surname Bronchial metaplasia and the effects of smoking on the large bronchi women born in California. This was attributed to the different environment 'under which the former group of women had been reared."•.It may be noted in ... .._ ,._. _ . . .-:,~ . l t . A ,... .; this connection that he does not quote the work of Dean referring to ~~R • • ~. `~r . ~. .. . ~ .. . ~~ . , _ . . - F~'differences in lung cancer incidence in residents of South Africa and I .e: . .- . -. ..... . -. . _, ~, i. - - ':,~ , . .~.. ~ n _ ~- ~ • - c~.x , f' ' 'i'•.`, > t., , s_ .. .:. , - . . ~ .. . _ .. - ... ., ~. believe of Australia, depending on whether they had been life-time resi- r:~" dents of those countries or had spent mary prior years in England. are discussed on pages 626-629. -0n page 630, reference is made to multiple lung cancers in the case of asbestosis reported by NordmEUn1 (1938). I believe that other examples of multiple lung cancer, such as from the Schneeberg miners can be found. On the other hand, I do not know of any reports dealing with multiple cancers reported from smoking; Auerbach does, of course, report multiple carcinoma in situ and precancerous lesions. Data is given on page 631 stating that most carcinomas of the lung r R .,, ~- ~~ Y~ -•-. arise in the central areas. I believe that this probably agrees with most of the statistics in literature and is contrary to the work E. V. Ermolayeva and I. L.•Tager, cs of lung cancer development based on a retrospective analysis of repeated roentgenologic prophylactic ezamination," sumnarized in the attachment to the Current Digest, Vol. VII, No. 9, September 1962, page 5. CA shoara a slight preponderance of growths in the right lung ( Ihiguidy 1927; : The reference on page 630, "Most large series of lung cancers haire

Siabons 1937; Mason, 19I+9; Bryson and Spencer, 1951), and ...: . : . .. . . T .. . . ~ . . . . . . Z.. ;`:`great ntanber of growths have started in the upper °, the right upper lobe." -It is of interest and which has been made that if cigarette smoking causes lung cancer, one ... ~ : .. . . .. shou.ld not expect any preponderance of t 5;4~'..'t ~ . ~• . , ~ ~ ' lobe of the lung. + On pages 645-651 there is a discussion of.lung scar cancer. It is r' y- ; F, a t ns ~,n a . • . . : ,• . • , _. , • , ::n _r'_ :i~ '~ ~•~' ` ~-¢;'• F ?.'t~ -.rr~.ira ~t•u~ny "~ `;~.r~ ... . , + ; ~.. r ~ . . . , . • ~ . ~ .,.. . .. ..,. . . . _ t= • + aud of the adenocarcinoms in the periphery of the lung grow in istated that the majority of the one-third of the squampus-celled carci- relation to areas of scarring. One might attempt to meke some.point of .. . . . . •. 4•. 1 t this since the work of Orr and Warburg suggested that scarring and anoxia .:;.. - .. . were factors in the production of cancer. It is mW opinion, however, that most expert pathologists in this country would feel that the scarring -~` observed in the lungs reported here is not of primary etiologic importance, but rather represents either an area of scarring in which,tumpr ha secondarily become entrapped or an area of scarring which arose secondary to the tumor or intercurrent pneumonia. In Chapter 4, "Acute Bronchitis and Bronchiolitis, Chronic Bronchitis and Bronchiolitis," pa•ges 62-96, there , . - , :.. .. ,• ~.. . . is relatively little mention of any role of smoking. .On page 72 Spencer :•.,t~ evidence is difficult to obtain, Palmer (1954) and Oswald and Medvei (1955) factor in causing chronic bronchitis although accurate statistical `states "The habit of snxokin.g has been repeatedly blamed as an important both concluded from independent investigations that there was a very . significant correlation between the two. "So far no satisfactory reason has been offered to explain the 3-1/2 CA , 0 times greater frequency of the disease in males, though the greater habit UQ

of smoking in the latter sex and more intimate contact with industrial 3,Y .._. . . ' . -_ . .. . . .... . . " . . - ".. .. -. . '`sources of atmospheric pollution may be in part responsible." .,It should : ._ . . _ . . be remembered that chronic bronchitis is a much more conmonly diagnosed condition in IIigland than, in the thlited States. _ ... ...y,., ~..: ' . ~ ..,. : ~ ' ' . , . ~ : .~ :. . : .. ~. . - .,.. ,. . -. .~ ' : ~~. . .. -. ,~..:;, '.. . :; , _ . _.. .~ ' • ..4 ,', t ~ ~lt.i$QF In the discussion on emphSrsema beginning on page 40$, I Was unable . . _:, , .... . . . . although it has been mentioned as one of the diseases in which smoking pre siunably plays an important part. to find on casua.I perusal any reference to smoking as a signj.ficant factor . . ~. , I think you might find this book to be a reasonably useful source .for general reading and reference, although I would not regard it as a work of very extreme importance. If you want to borrow my copy of this .- : ...--. „.. _ - . book to look it over, you are welcome to do so, or I think that if I were to photocopy for you pages 612-633 this would provide you withsome of the more important material. Attachments: Mamai i lan advertising data

i~-i5•5.Y7'.i.^ . _ , encer's PATHOLOGY OF THE LUNG "S p What do you do_when you come up against a pulmonary case ;:. f.~ d F t ) that is really perplexing? . ,... . _ - .. .. .. ."S.... ... .~ 1 .. . . . ,. .. « .. . ... .. .-.. ;f ..c . .. .. ,., You may not have time to consult another specialist or to pore through .your research files. And, until now, there has never been a single source you could turn to for sound advice. But.. has now solved the problem: In one new volume, you'll find all the medical facts you need to 'know about the whole area of lung pathology '(excluding pulmonary tuberculosis) 9E # ~E # -1E , t s. ,' z _ ' s # jE lE # jE This new book is so thorough that it will become a constant work refer- ence for you -- whether you are a pathologist, a surgeon, a diagnostician, or a clinician. ~ , . ., . I have enclosed a circular which lists the exhaustive contents of the lymphomas, and even includes fungal and parasitic diseases. are described for you. It extends from chronic bronchitis to malignant book. See for yourself the wide variety of pathologic lung conditions that And for these 20 different categories of lung disease, Dr. Spencer organisms ... predisposing causes ... experimental pathology...pathological evi- gives you the etiology...prognosis...treatment...age of occurrence...causative dence in man~...complications. And if you are doing research or want further readings, you'll welcome the 1,800 references selected from standard and recent literature. Added to this comprehensive text are 543 clearly defined illustrations conveniently reproduced--right on the page where the disease phenomena are of disease manifestations. Angiograms, x-rays, slides, gross sections are being discussed. You'll probably find yourself comparing your own x-ray and lab findings. h,n3y4; N CD H. Spencer, M.D., Ph.D., F.R.C.S., is unusually well qualified to under- take the enormous task of bringing together and condensing the vast amount Q.f ~, .•,- . . . ~

literature on lung pathology. He is Reader in Morbid Anatomy & Histology in r 7.... ~ "The time is surely ripe for a sound and comprehensive ,statement of what is now known. Doctor Spencer has supplied this'need admirably, and with afine sense of l',history. `'Only a'rare concurrence of meticulous scholar- ship and discernment could have enabled the condensation of so much informa.ti=into so little space. This work will long be of interest and value to all students of disease." ~;, ~. ~, ~- _. ... s..... ;; Hospita,l, London. the University of London) and' Honorary Consultant Pathologist to St. Thomas's Dr. Averill A. Liebow of Yale University had this to say in praise of the book: I have arranged for you to examine and~use this new volume for 30 days without charge or obligation to buy. Justsend us your instructions on the enclosed order card, and the book will be in your office for you to consult on some of your own lung cases. ... ._ ,,. ,. :... . .,_If, after using PATHOLOGY OF THR LUNG for.a month, you decide it doesn't have the kind of information you-require, 3ust'ship the book back to us. Otherwise, we will bill you for $30. (Or you~ma'y elect to have us bill you for 3 monthly payment's of $10 each.) __. .._ . .. , Please\send for your examinati'on copy today, while theorder form is handy. There's a postage-free envelope enclosed for your convenience. Cordia111y, John Meredith MACMILLAN Distinguished Medical Books • 60 Fifth Avenue, New York 11