The family doctor, his life and history

and science fulfil similar functions". As he says, "The human brain needs to have a representation of the world that is unified and coherent." In his discussion of evolution Jacob is an out-and-out Darwinian, but gives a good analysis of the problems raised by molecular biology. He contrasts the selectionist Darwinian model with the instructionist theories of creationists. As an immunologist, he is rightly convinced of the ubiquity of selection among natural phenomena. He refers to the possibility that learning in the brain depends on selection, but he has not caught up with the evidence that some of us have provided about this. He makes an interesting comparison between the muscle Tabulae of Vesalius, revealing the layers of the body, and molecular anatomy showing a hierarchy of structure. He is not afraid to expose the weakness of his subject, for instance the "only logic that biologists really master is one-dimensional. As soon as a second dimension is added, not to mention a third one, biologists are no longer at ease". For this reason, they do not like to abandon their current type of analysis to study developmental problems. If he has a weakness it is in the understanding of "lower animals". Fishes, for instance, are not so dependent on "innate releasing mechanisms" as he suggests. In his final section on 'Time and the invention of the future', Jacob has many wise things to say about such subjects as senescence, intelligence testing, and cultural development in general. He considers that "mind is a product of brain organisation in the same way that life is a product of molecular organisation", but is not afraid to admit that "Any history of the brain and of the mind remains, therefore, merely a story, a scenario". This is evidently not a very profound philosophical position, but it shows the humble wisdom that is typical of the book. The changes that have occurred in general practice since the National Health Service was introduced have been far greater than in any comparable period in the past. Yet, to anyone unfamiliar with primary care, it may seem surprising that the Ministry of Health (and its successor, the Department of Health and Social Security) has played little part in the initiation of these changes. This is not necessarily a condemnation of the Ministry: indeed, in part it is an inevitable consequence of the independent-contractor status of the general medical …