BOOK REVIEWS

Pocket Atlas of Human Anatomy: Based on the International Nomenclature H Feneis and W Dauber Thieme, Stuttgart & New York
£19.00, ISBN 0865779287

This volume is clearly a real pleasure to handle and to use. The illustrations principally consist of simple line drawings enhanced by minimal shading and stipple to give the effect of depth. The book is divided into well-defined sections. These cover all of the regions of the body that the physician or medical student could wish to refer to. The present edition is the revised English translation of the 8th German edition published in 1998. It is more of an encyclopaedia than a dictionary, as it contains an authoritative repository of diagrams complemented by a dictionary of anatomical terminology based on the “Nomina Anatomica”. The authors state that they considered, then rejected, the use of colour, as they believed that the present drawings more than adequately captured the essential elements of the structures they wished to portray. One can only be sympathetic with this view, but wonder how many further editions will be published before colour makes its insidious way into these drawings.

Who would benefit most from this book? While most doctors might reasonably be expected to be aware of most of the terms used, it is quite another matter to expect individuals to have instantaneous recall, thus, the need for an aide memoire. Difficulties will inevitably arise for those students who were taught principles, but whose factual knowledge of anatomy, in particular, is little more than fragmentary. This is certainly a problem amongst those who have been exposed to the minimalist approach to the biomedical sciences. While this may be fine in theory, it is difficult to see how they will cope as doctors when they will need to make a detailed diagnosis and communicate this to their colleagues.

In any book review, the reviewer has to find a few points to criticise otherwise the reader begins to suspect that he is in some way in league with the author(s). In the present case, this is particularly difficult, as this volume has already been through so many editions that it is difficult to believe that others have not already drawn attention to any obvious errors or deficiencies. If it was justified to include a diagram of the “milk line”, why have the authors chosen to omit diagrams of the more useful dermatome patterns that display the cutaneous distribution of the segmental spinal nerves as well as being invaluable for neurological diagnosis? Few students will notice the absence of eponyms on these pages. This is only likely to be appreciated by the older generation of English-speaking anatomists and clinicians, as their usage provided a little colour and no doubt confusion to an otherwise rather bland subject. Equally, few English speakers will be familiar with the Latinised version of the “Nomina”, and would be advised, to avoid unnecessary confusion, to stick to the anglicised version indicated in the text. While no effort has been spared to prepare a comprehensive index, the impression is gained that no attempt has been made to update the bibliography. Having noted these minor deficiencies, the reviewer would be happy to recommend this invaluable pocket-sized Atlas of Human Anatomy to students and clinicians alike.

M.H. Kaufman, University of Edinburgh

Controversies in Total Knee Replacement Edited by RS Laskin Oxford University Press, Oxford
£75.00, ISBN 0192630725

More than a quarter of a century ago, orthopaedic surgeons in the UK and Europe started to treat osteoarthritis of the knee using metal on metal hinge prostheses. Since then, things have evolved enormously, and total knee replacement, using metal and polythene (with or without cement) has become a most successful orthopaedic operation. Although a total knee replacement is well established and cost effective, controversies in this field abound.

Dr Richard S Laskin, Professor of Clinical Orthopaedic Surgery at Weill Medical College, Cornell University and attending orthopaedic surgeon at the Hospital Special Surgery, New York, has been the Chairman of the annual Total Knee Course held in New York. The course has now reached its 12th year, and this book is the brilliant product. The book has retained the original form of the course. Two of the 15 chapters, start with the statement to which divergent opinions are offered. Once the arguments have been made, the chairman asks probing questions of the presenters. The topics covered are wide-ranging. They range from the use of prosthetic wedges to correcting bone effects, whether the posterior cruciate ligament should be salvaged, the need to resurface the patella, the economic complications of total knee replacement, to the outcome measurements in total knee replacement.

There is little doubt that, as the vast majority of the speakers are from North America, the book is aimed mostly at that market. Nevertheless, European, Australian and British Surgeons are represented, and, at times, breathe an air of dissent to the North American mainland wisdom. I found the question and answer sections to be the most enjoyable part of the book.

Dr Laskin is a real ‘stirrer’ when it comes to identifying areas that need clarification. This book is not for beginners. The reader needs to be well acquainted with the topics, and have more than a working knowledge about some of the technicalities of the procedures. The question and answer sections make it a valuable tool for candidates embarking on board exams. It is likely that some of the question that Dr Laskin was asking may well be part of the written papers or of the viva. There are several spelling mistakes that could have been corrected to make the presentation even better. Given the finality of this book and the inevitable time lag between the Annual Total Knee Course and the publication of the text, I think it would be unlikely that another edition would appear before some 3-5 years. As it is a distillation of the present controversial knowledge of this topic, I look forward to the next one. Finally, I was pleased to see that of three of the surgeons that made the greatest impression on Dr Laskin’s (orthopaedic) career, two were British; Graham Apley and John Inssall.

N. Maffulli, Professor of Orthopaedic Surgery, North Staffordshire Hospital, Stoke-on-Trent

Q Base Surgery: 1 MCQs for the MRCS JSA Green and SA Wajed GMM, London 2001
£22.50, ISBN 1900151375

This book is one of the many publications now available with samples of and the answers to multiple choice questions. The questions are based on the most traditional format of a stem and five branches each of which must be answered as either true or false. The preface outlines the principles of multiple choice questions and gives advice on a candidates approach to clearly understand the question before answering.

The questions are generally of a satisfactory standard but there are many examples that highlight the difficulty in setting this format of examination. There are also a number of questions which there is some ambiguity relating to the correct response and those that are involved in setting and validating multiple choice questions know only too well how difficult this can be. There are a few questions where all the answers are given as false. Whilst not cast in stone, it is generally accepted that this situation should not occur.

There are a number of inaccuracies in this book, e.g. in exam 3, question 40; two of the branches are identical. The answer to exam 4, question 27 makes no sense. Most worrying, however, are a few examples where the answers are simply incorrect. Questions 36 in exam 2 is a particular example. The question relates to Crohn’s disease and it is suggested that toxic megacolon does not occur as a complication. While it is true to say that it is more commonly seen in ulcerative colitis, it most certainly can occur in Crohn’s disease. In the same question it is suggested that transmural inflammation and giant cells are not seen in Crohn’s disease which is patently untrue. In question 19 in the same paper, it is suggested that Crohn’s disease does not predispose to malignant transformation. This is again totally incorrect and misleading, as it is a risk factor for tumours of both small and large bowel.

The questions do relate well to the syllabus set by the UK Surgical Colleges and the CD-ROM is a very helpful addition and easy to use. I think this is a good text for candidates preparing for the MRCS examination, provided that further editing deals with some of the inaccuracies mentioned.

W.S. Hendry, Stirling Royal Infirmary

Oxford Textbook of Surgery Volume 2, 2nd edition Edited by PJ Morris and WC Wood Oxford University Press, Oxford 2000
£295.00, ISBN 0192628844

There will be a widespread welcome for this second edition of the successful Oxford Textbook of Surgery, some 6 years after the first edition. Ron Malt has been replaced on his retirement as American co-editor by William C Wood, resulting in slightly less emphasis on the Massachusetts General Hospital in the list of contributors. The authors of the second edition have clearly been recruited widely and chosen for their international standing, expertise and ability to communicate.

The book has a most attractive format and full colour is often used even more extensively than in the first edition. The layout is very easy on the eye, and the quality of the operative drawings, operative photographs and reproduction of radiological images is uniformly high. As before, chapters are supported by key references, each accompanied by a useful precis. The editors are clearly committed to an evidence-based approach and have exhorted their contributors to make sure that the contributions were as up to date as possible. Some production delay is inevitable with such an extensive work, but the hard work of the writing team is reflected in the fact that articles published as recently as 1999 are used in the reference lists.

The book still aims to cover surgery in its totality, and provide the experienced surgeon with something more useful than a basic textbook. Satisfying the needs of both specialist and general surgeons is an almost impossible achievement but the book comes laudably close. I do not doubt that both experienced surgeons and their trainees will find it accessible, authoritative and above all, readable. The second edition runs to three volumes and my brief was to review the middle volume. This begins with coverage of the lymphatic system (arterial and venous disease comes at the end of the first volume), going on to cover the endocrine system and breast disease, the digestive system, hernia, gynaecology and obstetrics, skin, urology and cardiac surgery. I suspect that the most general surgeons will not read the 280 pages of cardiac surgery, although they may well refer occasionally to the gynaecology and urology. Coverage of digestive disease (my own area of surgical interest) is uniformly excellent and the opportunity has been taken to incorporate advances in the minimally invasive surgery. I understand that the first volume now gives much greater coverage to injury, shock and surgical nutrition, areas that were covered extensively in the first edition.

For my money, this is the modern benchmark surgical textbook. It is beautifully produced, well written and well edited, and as up to date as ventures of this scale can be. Trainees and established surgeons alike will wish to have ready and repeated access to it. While I have no doubt that most will wish to buy it, they may think long and hard about whether all three volumes will be of equal use. Many general surgeons may agonise about buying the third volume with its emphasis on neurosurgery, orthopaedics, head and neck surgery in developing countries. My advice to them would be to bite the bullet, pay £350 and purchase the entire set. To do anything less would be to deprive oneself of ready access to key areas of the generality of surgery. Peter Morris and William Wood are to be congratulated on bringing this second edition to such excellent fruition.

Sir David Carter, University of Edinburgh

Extended matching questions for the MRCS S Auplish and MK Hossain-Ibrahim GMM, London
£22.50, ISBN 1841100625

This book is aimed at candidates who plan to sit the MRCSEng examination as it seeks to fill a gap by covering the new format of extended matching questions (EMQs). From the Preface it seems clear that the authors wish to exploit this gap commercially by publishing examples of questions with comments on the answers. By their own admission they have used questions “that our peers and we could remember from recent examinations” but qualify the statement by adding “with subtle changes”. There is, therefore, at least plagiarism and at worst possible infringement of copyright as I see no acknowledgement for permission to use questions from the Royal College of Surgeons of England (RCSEng). Despite this, the publishers assert the author’s own legal rights for copyright protection!

For those unfamiliar with EMQs the book is a useful introduction, the comments after each set of answers mostly helpful and well argued. Some of the questions would have benefitted from closer scrutiny and modification before publication. For example, in a question with the theme of postoperative nerve palsies, six options were given with three clinical scenarios (one of which merely stated an operation with no clinical problem described). There was only one operation not around the neck and only one nerve which extended below the diaphragm. These two had to match, as they did. Of ten options listed for abdominal masses the choice could only be limited to only two of them for one of the scenarios described.

In other questions there were missed opportunities to produce extra matches which would have tested a candidates’ application of knowledge. The two matches from the seven options of postoperative pyrexia would have been correctly answered by any competent clinical medical student. Others could easily have been written as also with the theme of Diagnosis in the Primary Survey where again only two possible matches were asked from seven options.

Any question in which there is uncertainty or debate about the answer has NO place in a multiple choice paper or EMQ. The discussion after the question on carcinoma of the prostate did state that the treatment of this disease is “very controversial”. I would contend that all four of the selected matches were wrong, but concede that one of them was possible but very debatable. This question is misleading, should never have appeared and should be excluded from any future edition of the book.

In many ways, the most helpful aspect of this book was the discussion of the selected matching answers. The majority were clear with no ambiguity. I was, however, confused by the discussion on an abdominal incision for right hemicolectomy. The answer selected neither fitted the clinical scenario nor the rationale for choosing it. In contrast of the ten options for the diagnosis of a leg ulcer, the three were well chosen, an excellent discriminatory question.

The candidate with no experience of EMQs will gain a very practical introduction to this form of examination, but I would not rate the quality control of these questions very highly as the answers were too easy in too many instances. I assume that those who set the EMQs at the RCSEng will recognise which of their bank of questions have been plagiarised and respond appropriately.

M.F. Smith, Stirling Royal Infirmary

Synopsis of Systemic Pathology for Surgeons R Spence, J Sloan and G McCluggage Arnold, London
£29.99, ISBN 0 340 76378 7

This compact book is ambitious in its aims. Categorised according to organ it provides a brief but remarkably comprehensive coverage from normal structure through specific categories or disease. Presented as bullet points, the coverage is inevitably curtailed compared with a full textual exposition but the format does allow for a very comprehensive factual coverage if not a full discursive approach. One slight reservation might be the inevitable inability to encompass all the exceptions to the rule but these are allowed for in the form of “occasionally”, “rarely”. The important feature is the concentration on the general rules of pathological processes and disease classification as encountered by surgeons in day-to-day practice and in their digestion of pathology reports. In most organ systems, the TNM staging system is provided, diagrams are included, e.g. the descent of the thyroid and consequent abnormalities found at different levels. Challenging the book in a wide range of organ systems and disease, I was impressed by its accuracy.

The MRCSEd examination concentrates on systemic pathology and this book would provide and excellent companion to examination preparation as well as a most useful revision text. It should be used not only prior to the examination, but also during working practice when a scanning of the appropriate section can refresh the memory of whatever disease process is encountered. General mechanisms are not excluded, this considering complications of other forms of immuno-compromise and the chapter on organ transplantation gives a brief reminder of mechanisms and a classification of various types of rejection plus their differential diagnosis.

I strongly recommend this textbook for usage as a revision manual and a companion during working practice.

K. McLaren, University of Edinburgh

Taxation Aspects for Medical Doctors - A Friendly Guide M Bashir Khatri PKA Books Ltd, Leicester
£14.49, ISBN 0 9534516 1 5

This is an excellent little booklet aimed at both hospital doctors and general medical practitioners. It covers all grades of doctors as well as current salaries, although clearly this will need to be revised with the recent changes in salaries. It covers all aspects of taxation with copious examples of how tax is calculated. It gives very helpful advice on tax returns and what is allowable by way of expenses and how to approach the Inland Revenue. Armed with this book, one could undoubtedly complete one’s self-assessment taxation form without undue difficulty. This book can, therefore, be recommended to those who wish to complete their own self-assessment forms.

“Taxation Aspects for Medical Doctors - A Friendly Guide” is available to Fellows of the College for the special price of £11.25 including p&p from:
PKA Books Ltd 33 Seagrave Drive Oadby Leicetser LE2 5GJ

A.B. McGregor, RCSEd

The History of the Royal College of Physicians and Surgeons of Glasgow: Physicians and Surgeons in Glasgow, 1599-1858 Johanna Geyer-Kordesch, Fiona Macdonald Hambledon Press, London
£30, ISBN 1852851864

The History of the Royal College of Physicians and Surgeons of Glasgow: The Shaping of the Medical Profession, 1858-1999 Andrew Hull, Johanna Geyer-Kordesch Hambledon Press, London
£30, ISBN 1852851872

The histories of Royal Colleges and other similar institutions can easily fall into one of two categories. The first is the “golf club” type - easy to read, full of anecdotes, superficial and of little interest to anyone but present and recent office-holders. Alternatively, there is the deeply historical monograph -replete with footnotes, turgidly accurate and most likely unread except by its authors, the occasional historian and the odd hapless reviewer. These two volumes, however, fall into neither category: they are an admirable and interesting account not just of a college but of the development of medicine in the west of Scotland, the interplay of a university and a medical corporation and the role of powerful and farsighted men.

Written by three authors, the two books present a fascinating history of medicine in the west of Scotland from 1599 to the present day. The first volume describes the Faculty of Physicians and Surgeons of Glasgow from its founding to the middle of the 19th century, and traces its development alongside the growth of the city of Glasgow from a small burgh with an ancient cathedral and university to a handsome city. Like other Colleges, faculties and corporations of the time, the Faculty began by regulating successfully the training, registration and practice of medicine, partly to raise standards and protect the public, and partly to protect doctors from competition. Training by the apprenticeship system was abandoned in favour of lectures undertaken by university professors. An excellent library and specimen teaching collections were assembled. The Faculty prospered and shared in the Scottish Enlightenment of the 18th and early 19th century. Together the Faculty and the University encouraged the importing what was useful from abroad and made those at home innovative. Two systems of medical education developed side by side: the University’s and that of the Faculty’s consortium of extra-mural schools. By 1830 Glasgow had become a good place to study medicine.

The second, slimmer, volume deals with the period after the 1858 Medical Act to the present day. The Medical Act changed dramatically the way in which medical education and practice were organised. The Faculty lost its role of granting first registrable qualifications and was soon at odds with other Royal Colleges and indeed the University. How and why these battles were fought, and how the Royal College (it became Royal in 1909 and a College in 1962) developed its successful role as an examining and teaching body in post-graduate medicine, are charted in comprehensive detail. In the late 19th and the first half of the 20th centuries the University expanded its role in medical education and its double qualification became more popular. The new academic medicine was brought to Glasgow by a series of key full-time appointments to clinical chairs in the major Glasgow teaching hospitals. The Goodenough Report of 1944, which advised the centring of hospital organisation and of medical education around the local university, and the introduction of the National Health Service seemed to spell the end of the Faculty’s influence in Glasgow’s, and indeed Scottish, medicine. The University of Glasgow had complete control of under-graduate medical education and command of the funds from the University Grants Commission for the taught elements of post-graduate education.

Tragedy for the Faculty was averted by two factors. First, Sir Hector Hetherington, the Principal and Vice-Chancellor of the University at the time, realised that the medical school needed local, high-quality post-graduate training to supply staff to the hospitals. Since the University would too occupied with under-graduate education in the post-NHS period, a separate but closely integrated body was needed to organise post-graduate matters. Secondly, many of the key players in the University had at the same time strong Faculty affiliations. One of these was Charles Illingworth who argued that the destinies of the Faculty and the University should be linked. There then developed a strong troika of the University, the Faculty and the Regional (later Health) Board that produced one of the most formidable and effective post-graduate medical bodies in the United Kingdom. The Faculty became the intellectual centre for post-graduate provision.

The Faculty was now reoriented and revived. There was a dramatic upturn in its fortunes, and the College, as it now was, became one among equals in collegiate matters in the United Kingdom.

These two volumes represent a fascinating read for those interested not only in the history of a prestigious and ancient Royal College but also in the parallel growth in influence of two separate institutions committed to medical education in one city. Similar tensions between medical schools and Royal Colleges were seen in London but, in Glasgow, their resolution had been earlier and the outcome more successful.

Sir Robert Shields, Liverpool

AO Principles of Fracture Management. Thomas P Ruedi and William M Murphy Thieme, Stuttgart
$369.00, ISBN 3131174412

This book is the logical successor to the “AO Manual” and the AO Comprehensive Classification of long bones. It is extremely impressive and sets new standards for presentation and graphics. The editing has been superb. There is remarkable consistency throughout the book despite the relatively large number of authors. The book is supplied with two CD-ROMs so that readers have a traditional or electronic option! If the latter is chosen there are a number of useful video clips to illustrate particular points.

The text is divided into six main sections dealing with the AO philosophy and its basis, decision making and planning, reduction and fixation techniques, specific fractures, general topics such as open fractures, soft tissue management, children’s fractures and antibiotic prophylaxis and complications. There is also an extensive and useful glossary.

As one would expect from the AO Group the approach is didactic with the mechanical aspects of fracture treatment and operative techniques being particularly well covered. All of the AO implants are discussed except, curiously, the calcaneal plate which this surgeon has found to be extremely useful.

The operative approaches are particularly well covered and the graphics used to illustrate the different approaches are in a different league from all other texts. They are the first illustrations that I have seen that actually look similar to an operative field. Surgical anatomy is beautifully illustrated and surgeons-in-training will find the sections dealing with pitfalls and complications to be particularly useful.

It is always unfair to criticise a book for not dealing with subjects that it did not set out to discuss. However, there is very little discussion of the literature and a strong implication that all the techniques described in the book have no peers! At best, non-AO techniques receive scant attention and a number, such as non-bridging external fixation of the wrist, are not mentioned at all. I suspect that the next edition might remedy this!

It is important to remember that this is not a definitive guide to the management of fractures. It is an excellent guide to the AO philosophy, equipment and techniques and the book does not claim to be anything more than this. It will be of immense value to surgeons and, particularly, to surgeons-in-training who will find the didactic approach useful. However, I suspect that experienced surgeons will use the book, in conjunction with other reference books which contain more discussion and argument.

C. Court-Brown, University of Edinburgh