Claude Bernard and the Internal Environment (review)

political road that the nursing care institutions and movement began shortly after World War II. There are a number of issues which Cohen raises in which I am in total agreement. Many physicians do not use adequate doses of narcotic analgesics, spend enough time in explanation of options, or help patients and families deal with their separation anxieties, sadness, or grief. But rather than encourage or otherwise help promote the installation of such models in the medical community , Cohen would set about to establish an adversary establishment that sets itself up as uniquely suited to deal with dying patients. Unfortunately, his book mostly reads like a political pamphlet rather than a useful guide to a prescription for terminal care and is, I suspect, a personal expression of one man's concerns about death. Donald L. Sweet Department ofMedicine University ofChicago Claude Bernard and the Internal Environment. Edited by Eugene Debs Robin. New York: Marcel Dekker, Inc., 1979. Pp. 299 + xvi. $40.00. It is proper to honor one of the great men of medicine on the one-hundredth anniversary of his death. This little volume is the record of a Memorial Symposium for Claude Bernard, one of the fathers of physiology and experimental medicine. Organized by Eugene Debs Robin, professor of medicine at Stanford University, the proceedings began on February 10, 1978, at Stanford with brief, graceful addresses by President Richard A. Lyman and the French ambassador, Francois de Laboulaye. The list of distinguished participants included four American winners of the Nobel Prize: Andre Cournand, Arthur Romberg, Joshua Lederberg, and Jonas SaIk. The theme of the symposium—the internal environment, which Bernard called the milieu intérieur—led to a bit of harmless wordplay. Thus, there is a chapter entitled "Claude Bernard and His Historical Milieu," another, "The Life and Scientific Milieu of Claude Bernard," and yet another, "Claude Bernard as Dramatist and His Cultural Milieu." Robin helps us out by identifying Bernard's ultimate concept of the milieu intérieur as the "circulating organic liquid which surrounds and bathes the tissue elements, etc." It was his belief that "the stability of this milieu intérieur is the primary condition for freedom and independence of existence." The study and understanding of the mechanisms that operate to maintain the constancy of the internal environment is now the domain of regulatory biology and a central concern of medicine. The majority of the scientific presentations deal with contemporary aspects of such regulatory systems as acid-base balance, osmoregulation, respiratory controls, and glucoregulation. Other papers are related to topics that Bernard actually studied in laboratory: gluconeogenesis, piqûre, the action of curare, and the measured difference of temperature of blood in the right and left ventricles. The tone of the essays is a 334 Book Reviews pleasant blend of science and history and admiration. The ambience should be congenial to regular readers ?? Perspectives in Biohgy and Medicine. There are three chapters of general discussion which one suspects are only small samples of what actually occurred in the course of the meeting. Nevertheless they add delightful footnotes to the formal statements. Three lithographs by Honore Daumier suggest that in some ways medicine in Bernard's France was not much different from medicine today. Finally, and happily, the editor has included 14 examples of doodlings by Claude Bernard that are preserved in the archives of the College de France. Their message is clear: in spite of his dedication to science he was really a rather simple person—just like you or me—unable to resist the challenge of a blank sheet of paper. George V. Le Roy 1 71 North Rutledge Street Pentwater, Michigan 49449 ERRATA In "A 'Pure' Chemist's Downward Path: Chapter 3—'Retirement' " by Michael Heidelberger (Summer 1981), page 619, quotation, read Charmian for Charimon. On page 631, line 41, read K81for Kl3. In "It Has Been Said," by John H. Whitlock (Summer 1981), line 9, read it is not necessaryfor it is necessary. Perspectives in Biology and Medicine, 25, 2 ¦ Winter 1982 335 ...