British Journal of Anaesthesia 90 (6): 813±16 (2003)
Book Reviews Oxford Textbook of Medicine, 4th Edn. D. A. Warrell, T. M. Cox, J. D. Firth and E. J. Benz Jr (editors). Published by Oxford University Press, Oxford. Pp. 4150; indexed; illustrated. Price £275.00. ISBN 0-1926-2922-0.
Ó The Board of Management and Trustees of the British Journal of Anaesthesia 2003
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on June 4, 2015
The fourth edition of this famous tome is again in three volumes. One stands in awe as one surveys it. It is truly a great work, and the effort that must go into producing this book is inestimable. It is now 20 yr since it was ®rst published. The original editor, David Weatherall, has passed on the burden not only to David Warrell (Oxford) who helped edit the earlier edition, but also two physicians from Cambridge (Cox and Firth). For the ®rst time, the book also has an American editor, Edward J. Benz JrÐa fashionable trend, rightly used in an attempt to increase international sales. The books have more modern covers than the original classic Oxford blue, and the text, although still of a small font, now has purple headings and ®gure colouring in contrast to the green hues of the third edition. (Oxford University Press has always had a conventional approach to publishing.) The book is full of clear diagrams (many of which are completely new), and, as always, wonderful photographs of medical conditions such as schistosomiasis, and even of poisonous plants (Digitalis purpurea and Atropa belladonna are here). I recall my undergraduate medical education. Then, these photographs would have entranced me, but I realize that most of these conditions I am unlikely to see in a clinical lifetime. What use does this book have for a practising anaesthetist today? I have regularly used every edition of this book. David Weatherall was Professor of Haematology in Liverpool before he went to Oxford. My teacher, John Utting, often noted that he was the best product of this medical school since Cyril Clarke, also FRS. Thus, this text was our main line medical reference from its ®rst issue. It has always been easy to search, once one got use to the indexing system, which refers to the volume and page but not the chapter. All the rare diseases that may challenge an anaesthetist are here; I have not been able to ®nd one that is not mentioned, from Pompe's disease (glycogen storage), to Joubert syndrome (cerebellar malformation), and Ladd's operation (for small intestinal malrotation in infancy). Every condition your patient may have preoperatively is surely mentioned in this book. There is no doubt that you will ®nd it, whether your patient has a rare endocrine disorder of the pancreas or porphyria. This is, I think, the main use for this text in anaesthetic practice. The standard approach used in these volumes may not be attractive to anaesthetists, for the ®rst volume of the book has long sections on infectious, including tropical, diseases, as in previous editions. Substantial contributions on typhus, leprosy and envenoming are of little interest to the majority of us. But this approach is understandable; it makes the book truly international. What is a little surprising, in such a conventional text, is the introduction at the beginning of Volume 1, in addition to the small chapters entitled `On being a patient', and `Science in medicine', of such trendy subjects as Evidence-based medicine, and Complementary and alternative medicine. Giving such importance to these topics, ahead of the `Molecular mechanisms of disease' and `Immunological mechanisms', seems less than scienti®c. Environmental factors, Clinical pharmacology, and Nutrition end Volume 1, before Volume 2 starts a systematic approach to disease states. A huge, international list of famous names such as R. Peto (Large-scale randomized evidence), Hampton (Chest pain), and Herxheimer (Principles of clinical pharmacology) contribute to
the innumerable short sections in all these volumes, including 10 contributors to critical care medicine (Section 16). Many of these sections have been substantially reorganized since the third edition, with a host of new authors. There are contributions from the President of the Royal College of Physicians of London on systemic sclerosis, Imrie on pancreatitis, and de Swiet on thromboembolism and chest diseases in pregnancy. An anaesthetist may not be attracted to such a book for its information about intensive therapy, but it does provide a good background to this subspecialty for a trainee in general medicine (or surgery). In contrast, the section on reference intervals for biochemical data (number 32) is useful for all medical practitioners. It covers hormones, paediatric reference intervals, trace elements, and drug levels. Conversion factors (SI to conventional) are given when appropriate. The approach to practical procedures (33.10, p. 1496), which is provided at the end of Volume 3 under `Emergency medicine', would probably be of limited use to the anaesthetist too. But it is interesting that the laryngeal mask airway is now mentioned in this famous medical text, alongside tracheal intubation and noninvasive positive pressure ventilation. Other medical emergencies, such as anaphylaxis (Chapter 16.4), are mentioned on more than one occasion in the text. The sense of desperation experienced when this life-threatening condition explodes before one's eyes is probably best allayed by the section on its management under emergency medicine (33.1.12, p. 1444). Indeed, the section on Emergency medicine (Volume 3, Section 33) at the end of the book takes a change of approach. No longer do we have dry text, but lists, charts and diagrams systematically guide us through the management of a number of acute conditions from diabetic ketoacidosis and sickle cell crisis to heat stroke. It is pleasing that one of the four authors of this section is a director of an intensive care unit; he may make the text more appealing to anaesthetists. The section on poisoning by drugs and chemicals in Volume 1 (Section 8.1) is also very useful for every emergency clinician. How many of us know how to treat aluminium poisoning, or that from carbon tetrachloride and lavatory sanitizers? The instructions are laid out in alphabetical order of the poison, for ease of access. It is a little surprising that there are such long sections on protozoa, tapeworms and ¯ukes, yet `Geratology' only merits 20 pages, when most medical beds in the UK are ®lled with such patients. If I was a geriatrician I would be disappointed, especially as sports and exercise medicine, and adolescent medicine have received such exposure, and even oral contraceptives, HRT, and diseases of high altitude get their own section. If, despite all the technological advances of our age, you still appreciate books, then this text cannot fail to give you pleasure. From the colour plates in the centre to the index at the end of each volume, the book is inspiring to use. There are so few typographical errors, that one is tempted to search for them. It would be churlish to do so (although I did ®nd a few!). Every anaesthetic department throughout the world should have a copy of this book. There is no better medical reference text in the UK. The only problem will be securing itÐalthough it does not have wheels, it will disappear as if it did. J. M. Hunter Liverpool, UK