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Monoclonal and polyclonal hypergammaglobulinemia
636
Book Reviews
and experimentally. It has also provided a better insight into problems of immunopathology. Chapter 6 gives a critical appraisal of research in these areas. Chapter 7 continues the analysis of antibodies, but it is limited to antibodies in sera of allergic individuals. It considers the biological, chemical and physicochemical properties of reagins and of blocking antibodies, and it discusses the possible relationship of agglutinins to reagins and blocking antibody. The subject of allergy and hypersensitivity reactions is continued in Chapter 8 but from the point of view of pharmacological agents that mediate the symptoms of allergy initiated by antigen-antibody reactions. The last three chapters are devoted to problems in immunobiology, an area of rapid development and great importance in clinical medicine. The chapter on the thymus reviews the biology of the thymus, its relationship to circulating lymphocytes, its probable immunological functions as they relate to antibody formation, tolerance and autoimmunity. Several autoimmune diseases associated with thymus abnormality are discussed from a clinical and experimental point of view, noting the possible relationship between autoimmune diseases and malignancy. The chapter on transplantation and immunosuppression deals with questions of mechanisms, the role of cells and humoral antibody in mediating graft rejection and the mode of action of immunosuppressive agents so vital to the success of organ transplantation. Perhaps more important for successful organ transplantation is the careful matching of donor and recipient in terms of histocompatibility antigens present in leucocytes. The subject of leucocyte antigens is expertly treated in the final chapter and includes the therapeutic use of white cells and platelets in transfusion. Although the 11 essays of this volume can be grouped into four general categories, each is a self-contained unit and may be read independently of the others without regard to order. Together they provide the reader with a reliable index to the important developments in immunology. This volume is recommended to all having a serious interest in immunology, student as well as professional investigator. OTTO J. PLESCIA
Monoclonal and polyclonal hypergammaglobulinemia-by Jan G6sta Waldenstr6m. Vanderbilt University Press, Nashville, Tenn., 1968. 222 pp. illustrated. Professor Waldenstr6m took the opportunity presented by a series of lectures at Vanderbilt University in 1965, to develop a general x:eview of the pathologic physiology of diseases which affect the gamma globulin (immunoglobulin) system. This is not a clinical monograph in which the manifestations of disease are catalogued and the courses of therapy evaluated. Rather, this is a highly personal and, in part, anectodal account of experience by an astute and original
Book Reviews
637
clinical investigator. The author's interests in this broad area of pathology and his experience over the past 30 yr or more includes a skillful correlation of laboratory evidence and clinical observation in a far ranging effort to elaborate the nature and mechanisms of disease. The disorders include multiple myeloma and macroglobulinemia, plus a considerable discussion of the cryoglobulins, cold agglutinins, benign essential monoclonal hypergammaglobulinemia, lupus erythematosis, and other autoimmune diseases, rheumatoid arthritis, sarcoidosis, purpura hyperglobulinemia, and antibodies as circulating anticoagulants. The author's views are documented by his own experiences as well as by analysis of relevant literature including some experimental studies in animals. The chapter on the immunogiobulin molecules serves as a general introduction to the gamma globulin family, although some of the details have been superseded by recent contributions to the structural and genetic understanding of this system. The clinical and pathologic physiology portions of the book, however, are not out-dated by passage of time. The personal flavor of the book makes for interesting reading. The general themes are the nature of pathologic processes leading to significant immunoglobulin changes, and the role specific immunoglobulins may play in producing pathology-i.e, cryoglobulins, anticoagulants, etc.--is examined. The significance of 'nonspecific specificity in serology', i.e. biologic false positive tests for syphilis, rheumatoid factors, etc., is also explored. In particular, the discrete immunoglobulin (M-component) increases occasionally seen in older persons without disease, as well as in patients with non-plasmacytic neoplastic disease, are reviewed. Particular attention is given to the possible relations of these findings to pre-malignant or sub-malignant lymphoid or plasma cell disease. Immunocytochemical techniques, such as immunofluorescent cytology or biosynthetic studies can help to answer these questions. The author, however, does note many areas in which knowledge is not explicit, and he distinguishes between a postulate and demonstrable fact. The illustrative material is largely clinical or clinically related. In many graphs, significant laboratory and clinical findings in individual patients closely followed for long periods are lucidly presented. Some of the graphs exploring possible disease interrelationships are c o m p l e x - but these are complex areas. The author has chosen to emphasize the limits of knowledge. He moves from fact or clinical problem to hypothesis. In many cases he stops short of suggesting experimental approaches to solutions of the problem-clearly wanting to inspire a recognition of opportunities to acquire new knowledge and leaving the details to individual initiative. Professor Waldenstr6m clearly indicates his belief, and supporting evidence, that myeloma proteins are antib o d i e s - a view recently and enthusiastically confirmed in a number of laboratories. It is likely that his views in other areas of this book will also be substantiated by future work. JOHN L. FAHEY
Book Reviews
and experimentally. It has also provided a better insight into problems of immunopathology. Chapter 6 gives a critical appraisal of research in these areas. Chapter 7 continues the analysis of antibodies, but it is limited to antibodies in sera of allergic individuals. It considers the biological, chemical and physicochemical properties of reagins and of blocking antibodies, and it discusses the possible relationship of agglutinins to reagins and blocking antibody. The subject of allergy and hypersensitivity reactions is continued in Chapter 8 but from the point of view of pharmacological agents that mediate the symptoms of allergy initiated by antigen-antibody reactions. The last three chapters are devoted to problems in immunobiology, an area of rapid development and great importance in clinical medicine. The chapter on the thymus reviews the biology of the thymus, its relationship to circulating lymphocytes, its probable immunological functions as they relate to antibody formation, tolerance and autoimmunity. Several autoimmune diseases associated with thymus abnormality are discussed from a clinical and experimental point of view, noting the possible relationship between autoimmune diseases and malignancy. The chapter on transplantation and immunosuppression deals with questions of mechanisms, the role of cells and humoral antibody in mediating graft rejection and the mode of action of immunosuppressive agents so vital to the success of organ transplantation. Perhaps more important for successful organ transplantation is the careful matching of donor and recipient in terms of histocompatibility antigens present in leucocytes. The subject of leucocyte antigens is expertly treated in the final chapter and includes the therapeutic use of white cells and platelets in transfusion. Although the 11 essays of this volume can be grouped into four general categories, each is a self-contained unit and may be read independently of the others without regard to order. Together they provide the reader with a reliable index to the important developments in immunology. This volume is recommended to all having a serious interest in immunology, student as well as professional investigator. OTTO J. PLESCIA
Monoclonal and polyclonal hypergammaglobulinemia-by Jan G6sta Waldenstr6m. Vanderbilt University Press, Nashville, Tenn., 1968. 222 pp. illustrated. Professor Waldenstr6m took the opportunity presented by a series of lectures at Vanderbilt University in 1965, to develop a general x:eview of the pathologic physiology of diseases which affect the gamma globulin (immunoglobulin) system. This is not a clinical monograph in which the manifestations of disease are catalogued and the courses of therapy evaluated. Rather, this is a highly personal and, in part, anectodal account of experience by an astute and original
Book Reviews
637
clinical investigator. The author's interests in this broad area of pathology and his experience over the past 30 yr or more includes a skillful correlation of laboratory evidence and clinical observation in a far ranging effort to elaborate the nature and mechanisms of disease. The disorders include multiple myeloma and macroglobulinemia, plus a considerable discussion of the cryoglobulins, cold agglutinins, benign essential monoclonal hypergammaglobulinemia, lupus erythematosis, and other autoimmune diseases, rheumatoid arthritis, sarcoidosis, purpura hyperglobulinemia, and antibodies as circulating anticoagulants. The author's views are documented by his own experiences as well as by analysis of relevant literature including some experimental studies in animals. The chapter on the immunogiobulin molecules serves as a general introduction to the gamma globulin family, although some of the details have been superseded by recent contributions to the structural and genetic understanding of this system. The clinical and pathologic physiology portions of the book, however, are not out-dated by passage of time. The personal flavor of the book makes for interesting reading. The general themes are the nature of pathologic processes leading to significant immunoglobulin changes, and the role specific immunoglobulins may play in producing pathology-i.e, cryoglobulins, anticoagulants, etc.--is examined. The significance of 'nonspecific specificity in serology', i.e. biologic false positive tests for syphilis, rheumatoid factors, etc., is also explored. In particular, the discrete immunoglobulin (M-component) increases occasionally seen in older persons without disease, as well as in patients with non-plasmacytic neoplastic disease, are reviewed. Particular attention is given to the possible relations of these findings to pre-malignant or sub-malignant lymphoid or plasma cell disease. Immunocytochemical techniques, such as immunofluorescent cytology or biosynthetic studies can help to answer these questions. The author, however, does note many areas in which knowledge is not explicit, and he distinguishes between a postulate and demonstrable fact. The illustrative material is largely clinical or clinically related. In many graphs, significant laboratory and clinical findings in individual patients closely followed for long periods are lucidly presented. Some of the graphs exploring possible disease interrelationships are c o m p l e x - but these are complex areas. The author has chosen to emphasize the limits of knowledge. He moves from fact or clinical problem to hypothesis. In many cases he stops short of suggesting experimental approaches to solutions of the problem-clearly wanting to inspire a recognition of opportunities to acquire new knowledge and leaving the details to individual initiative. Professor Waldenstr6m clearly indicates his belief, and supporting evidence, that myeloma proteins are antib o d i e s - a view recently and enthusiastically confirmed in a number of laboratories. It is likely that his views in other areas of this book will also be substantiated by future work. JOHN L. FAHEY