75
death.3 13 With this mechanism cells die in interphase without attempting mitosis. There is evidence to suggest it is applicable to the thyroid, at least at high doses,3 16 and that with some cell types it has a linear dose-effect
relationship." The distinction between early and late hypothyroidism is based on differences in the magnitudes of the rates of incidence when referred to the original radiated population, and the fact that one is strongly dose dependent, while the other is not. There is also evidence to suggest that the two mechanisms may be uncoupled and that one is susceptible to influences to which the other is not. This means that each mechanism may give rise to differing proportions of the overall incidence, in different groups of patients, or with varied modes of treatand Einhorn found patients younger ment--e.g., than ’50 years had a larger early incidence than those over 50. Yet in both groups the pattern of late incidence was identical. 12 Smith et al. found that patients given very small doses had a low early incidence, and practically no late incidence, suggesting that a threshold may apply to the late rate. However, it is difficult to interpret many of these results, as sometimes combined forms of therapy have been used, and as mentioned already, small contributions from autoimmune factors and the natural history of the diseases may also be significant.3 14 15 Nevertheless they support the view that early and late incidence may not be intimately linked. It is possible that viewing the onset of hypothyroidism as a two-step process, as suggested above, may lead to novel approaches to reducing it. It is also evident that the entire hypothyroidism-vs.-time curve is necessary when evaluating the effectiveness of a new treatment. Presenting bulked figures for the incidence at a particular time may hide clinically significant variations, that could give insight into the mechanisms involved. Similar considerations may apply to hypothyroidism consequent
Beling
on
surgical treatment of thyrotoxicosis. 2 18
We are grateful to J. K. Taaffe for his support, and to Mrs M. Taaffe, Mr J. Robinson and Mrs E. Flanagan for their assistance in preparing the manuscript. Support was received from the Medical Research Council, the National Science Council of Ireland, and the Commission for the European Community. Requests for reprints should be addressed to J.F.M., Department of Physics, College of Technology, Kevin Street, Dublin 8, Eire. REFERENCES 1. Greig, W. R. Curr. med. Res. Opinion, 1973, 1, 331. 2. Becker, D. V., McConahey, W. M., Dobyns, B. M., Tomkins, E., Sheline, G. E., Workman, J. B. in Further Advances in Thyroid Research (edited by K. Fellinger and R. Hofer); p. 603. Vienna, 1971. 3. Malone, J. F. Curr. Top. Rad. Res. 1975, 10, 263. 4. Dunn, J. T., Chapman, E. M. New Engl. J. Med. 1964, 271, 1037. 5. Smith, R. N., Munro, D. S., Wilson, G. M. in Further Advances in Thyroid Research (edited by K. Fellinger and R. Hofer); p. 611. Vienna, 1971. 6. Bremner, W. F., McDougall, I. R., Greig, W. R. Lancet, 1973, ii, 281. 7. Glennon, J. A., Gordon, E. S., Sawin, C. T. Ann. intern. Med. 1972, 76, 721. 8. Buchannan, W. W., Kuntras, D. A., Crooks, J., Harden, M. B. Br. J. Radiol. 1965, 38, 536. 9. Malone, J. F., Cullen, M. J. ibid. 1975, 48, 762. 10. Werner, S. C. in The Thyroid (edited by S. C. Werner and S. H. Ingbar);
p. 697. 1971. 11. Greig, W. R. J. clin. Endocr. 1965, 25, 1411. 12. Beling, U., Einhorn, J. Acta Radiol. Ther. Phys. Biol. 1961, 56, 275. 13. Doniach, I. in Thyroid Neoplasia (edited by S. Young and D. R. Inman, p. 259, 265. New York, 1968. 14. Wood, L. C., Peterson, M., Ingbar, S. H. 48th Meeting of the American Thyroid Association, 1972. 15. Gordin, A., Wagner, G., Hernberg, C. A. Acta. med. scand. 1973, 194, 335. 16. Maloof, F., Dobyns, B. M., Vickery, A. L. Endocrinolology, 1952, 50, 612. 17 Okada, S. in Radiation Biochemistry, vol. 1. p. 247, 260. New York, 1970. 18. Green, M., Wilson, G. M. Br. med. J. 1964, i, 1005.
Reviews of Books Psychiatry in Dissent Controversial Issues in Thought and Practice. ANTHONY CLARE. London: Tavistock. 1976. Pp. 438. £7.50 (paperback £4).
Pascal might well have written to his publishers: "I’m sorry I haven’t had time to write a short book". Dr Clare first hurried into ken when he vociferously forced the Royal College of Psychiatrists to heed the needs of his less fortunate (i.e., not at the Maudsley) contemporaries. Now, in this quite long book he holds hard to that purpose; he presents an informed exposition of the wide-ranging arguments that go on concerning a number of chosen psychiatric issues. The young Maudsley registrar gets this as part of his birthright but those in training in the shires will enjoy and benefit. Concepts and models of mental illness, psychiatric diagnosis, the nature of and the aetiologies of the schizophrenias, controversial treatments (electrical, surgical, and compulsory detention) are all dealt with roundly and soundly. Chapter by chapter his conclusions parade establishment viewpoints. Perfectly proper. Little dissent. The young Turk is become a Pasha. Dr Clare draws his bow firm and true. This is an easy book to read because it is well written. It is not aimed at the laity but at psychiatrists in training anywhere where educated discussion is scant. It is informed with apt quotations and abundantly referenced. Professor Shepherd in his foreword writes: "It is indisputable that while the gap between established knowledge and much psychiatric theory and practice remains uncomfortably wide, there has been an understandable but nonetheless mistaken tendency on the part of some psychiatrists to traffic in uncertain assumptions, unfounded speculations, and unproven hypothesis, which in some quarters have invested their role with the mystique of a priest or shaman equipped with the qualifications of an emotional engineer." Dr Clare’s prose style is more spare, and the careful reader of this book will find his thinking finely sharpened so that he may avoid such trafficking. He will also find one or two dubious statements: "Approximately one in every ten alcoholics in active treatment (do Clare’s italics] kills himself’. Can that be substantiated? Surely not. And there are too many rhetorical questions, perhaps a relic of Dr Clare’s debating days. The thoughtful reader will also find that he has been shown how to pick his way intelligently through controversies and for that high peak of education he will stand in Dr Clare’s debt. This book should be in the library of the Royal College of Psychiatrists and places concerned with the training of careful and thoughtful
psychiatrists. Drug Effects
on
Monographs
the Fetus
on
Drugs: vol. II. H. TUCHMANN-DUPLH ssis, Labora-
d’Embryolgie, Faculté de Medicine de Paris. Acton, Mass.: Publishing Sciences Group. Sydney: Adis Press. 1975. Pp. 267.
toire
$15. WHILE the incidence of malformations continues at a rate of 27 per 1000 live births there is an obvious need to explore all avenues that may lead to prevention. The control of birth defects can be attempted by two practical means-either recognition and abortion of the malformed embryo or identification and modification or removal of teratogenic agents. This monograph, somewhat misleading in title, describes those factors, pharmacological and otherwise, that may have dysmorphogenic effects on the embryo and fetus. There is a brief and lucid account of prenatal physiology, embryonic nutrition, and the principal mechanisms of teratogenic action. These sections are concise, interesting, and easy to follow. Simple diagrams contribute to the clarity of the text and provide a sound basis for the discussion of known and suspected teratogens which follows. Most of the agents suspected of dysmorphogenic
76 action have been indicted
on
the results of
experiments
in
laboratory animals. The author has sprinkled his annotated catalogue of potential teratogenic agents with horrific photographs of embryopathy in rats, mice, and rabbits. Nevertheless, obvious effort is made to extrapolate, to the everyday world of clinical medicine, the significance of these animal studies. Each section, whether it relates to drugs, vaccines, metabolic disorders, or radiation damage, includes advice on the likely risk to the human fetus of the suspected teratogens described. It is at this point that time has overtaken the text. The author, faced with difficult decisions, has decided that diazepam and warfarin are unlikely to be teratogenic in man. More recent reports suggest the contrary view, and there seems to be a strong association between cleft lip and cleft palate and maternal diazepam ingestion. There is also a characteristic warfarin embryopathy which includes stippled epiphyses and saddle nose. The author, a noted experimentalist, also queries the reports of alcohol-induced fetal defects because they have not been confirmed in laboratory rodents. Those who have observed the syndrome of growth retardation, microcephaly, and mental deficiency in the offspring of alcoholic mothers would doubt the validity of the animal evidence described and find confirmation in the experiments of S. Sandor whose work has been overlooked in this text. Despite these deficiencies (significant enough when one realises how few human teratogens have actually been identified) this monograph will be of interest and assistance to all concerned with improving the quality of human neonates. There is a useful bibliography at the end of each chapter, and the volume will justify its position in libraries catering for practitioners with an interest in developmental pathology.
Children’s
Orthopaedics
Practical Problems. N. J. BLOCKEY, M.CH.ORTH., don : Butterworths. 1976. Pp. 141. £4.50.
F.R.C.S.
Lon-
a selection of essays written in dogmatic style based personal experience. The message on each subject is clear and precise and provides a guideline for the postgraduate student of orthopaedics who wishes to practise these methods. There is a long essay on osteomyelitis and another on congenital dislocation of the hip, whilst the rest of the book is made up of shorter essays-and sometimes a single paragraph on a particular condition. This is in no way intended to be a comprehensive textbook of orthopaedic conditions. The extensive chapter on C.D.H. is a painstaking study of many of the individual problems of this complex condition. Mr Blockey has
Wilms’ Tumor Edited by CARL POCHEDLY, M.D., Nassau County Medical Centre, East Meadow, N.Y., and DENIS MILLER, M.D., New York Hospital, Cornell Medical Center. New York and London: ’iley. 1976.
Pp. 239. $22.75; £12.30. THE fact that a book has been written on Wilms’ tumour-a rare malignant tumour of childhood-is an indication of the interest in the progress which has been achieved in the management of this disease. It is now the yardstick by which paediatric oncologists judge advances in the treatment of other forms of malignancy in childhood. This multiauthor text deals in separate chapters with the historical background to today’s approach to therapy, the clinical manifestations of the tumour (with special reference to the associated congenital abnormalities), and the rare occurrences of increased output of renin. Excessive erythropoietin activity and abnormal mucopolysaccharide excretion are also discussed. Diagnostic work-up, radiographic findings, surgical management, radiation therapy, and chemotherapy are all dealt with in detail and there is clear information for those who only deal with occasional cases. Bilateral tumours are dealt with separately. There are also chapters on immunological studies and genetic and teratogenic aspects of the tumour. There is a very interesting chapter on nephroblastomas in animals and in-vitro studies on human nephroblastoma lines. The management of the controversial congenital Wilms’ tumour is well discussed and emphasises the difficulties in this group. Estimation of prognosis is dealt with in the final chapter, and this, along with the chapter on histopathology, indicates that by careful and detailed investigation and analysis it is now possible accurately to assess prognosis and hence to tailor therapy for the individual child with this tumour. The whole book forms an excellent, easily read text which should be a useful source of reference for all clinicians and research-workers interested in the treatment of Wilms’ tumour.
THIS is
on
evolved a system of management based on dissatisfaction with other methods and he is at times outspoken in his criticism of these. Some readers will in turn criticise manipulative reduction and the prolonged period in plaster which he advocates. However, his results testify to the method, and many would be happy to emulate them. This particular section is stimulating in its analysis of specific problems: all will agree that the growth of the acetabular roof remains unpredictable. The other main chapter on osteomyelitis, is very detailed and expresses Mr Blockey’s well-known conservative attitude in the acute disease. He makes a very careful appraisal of the antibiotics of choice. Surgery is initially withheld until there is clinical evidence of an abscess. The difficulty of accurate localisation of the lesion, which is at present a valid objection to early surgery, may be overcome in the future by bone scanning techniques. Other types of the disease are found under separate headings, including osteomyelitis in infancy, subacute osteomyelitis, chronic osteomyelitis, and Brodie’s abscess. The section on management of bone infections will be particularly useful to surgeons in developing countries. Most of the rest of this book is under such chapter headings as minor problems, lesions to be left alone, and lesions where timing of treatment is important. Mr Blockey again imposes his own ideas; nevertheless, much valuable information is stored here that is often lacking in more comprehensive textbooks.
Drug Treatment of Mental Disorders LANCE L. SIMPSON, Columbia University College of Physicians & Surgeons. New York. New York: Raven Press. 1976. Pp. 323.
$13.50. Raven Press has published several first-rate books on psychiatric subjects. This volume- maintains the high standard-indeed it would have to in order to justify publication in an area where there are many competitors. It succeeds because of its
thoroughly professional approach-few other texts sistently comprehensive, authoritative, and
are as con-
up to date. Dr
the preface that only those drugs that are "used often and with notable therapeutic success" are described, and throughout the book only clinically relevant material is emphasised. A distinguished array of twenty-four contributors cover all the main drug treatments for the functional psychoses and neuroses. There are also valuable chapters on these drugs in paediatrics and geriatrics, and on the important subjects of unwanted effects and drug interactions. The pharmacological basis of drug action and the rationale for their use in psychiatry is presented economically and well, and the tendency in some psychopharmacological textbooks to discourse at length over minor structure-activity relationships is avoided. The reader sometimes feels disoriented by the absence of a unifying theme and the occasional seeming contradiction of one author by another, but in general the text is coherent and well edited. The book can be recommended to all those who prescribe psychotropic drugs and wish to know more about them than the information provided by standard psychiatric textbooks and by the pharmaceutical manufacturers. It is not, and does not pretend to be, a book for the specialist psychopharmacologist, but it is ideal for the clinician. It deserves a wide readership but such is the pace of development in psychopharmacology that it will need revision in a year’s time if it is not to become dated.
Simpson explains in
death.3 13 With this mechanism cells die in interphase without attempting mitosis. There is evidence to suggest it is applicable to the thyroid, at least at high doses,3 16 and that with some cell types it has a linear dose-effect
relationship." The distinction between early and late hypothyroidism is based on differences in the magnitudes of the rates of incidence when referred to the original radiated population, and the fact that one is strongly dose dependent, while the other is not. There is also evidence to suggest that the two mechanisms may be uncoupled and that one is susceptible to influences to which the other is not. This means that each mechanism may give rise to differing proportions of the overall incidence, in different groups of patients, or with varied modes of treatand Einhorn found patients younger ment--e.g., than ’50 years had a larger early incidence than those over 50. Yet in both groups the pattern of late incidence was identical. 12 Smith et al. found that patients given very small doses had a low early incidence, and practically no late incidence, suggesting that a threshold may apply to the late rate. However, it is difficult to interpret many of these results, as sometimes combined forms of therapy have been used, and as mentioned already, small contributions from autoimmune factors and the natural history of the diseases may also be significant.3 14 15 Nevertheless they support the view that early and late incidence may not be intimately linked. It is possible that viewing the onset of hypothyroidism as a two-step process, as suggested above, may lead to novel approaches to reducing it. It is also evident that the entire hypothyroidism-vs.-time curve is necessary when evaluating the effectiveness of a new treatment. Presenting bulked figures for the incidence at a particular time may hide clinically significant variations, that could give insight into the mechanisms involved. Similar considerations may apply to hypothyroidism consequent
Beling
on
surgical treatment of thyrotoxicosis. 2 18
We are grateful to J. K. Taaffe for his support, and to Mrs M. Taaffe, Mr J. Robinson and Mrs E. Flanagan for their assistance in preparing the manuscript. Support was received from the Medical Research Council, the National Science Council of Ireland, and the Commission for the European Community. Requests for reprints should be addressed to J.F.M., Department of Physics, College of Technology, Kevin Street, Dublin 8, Eire. REFERENCES 1. Greig, W. R. Curr. med. Res. Opinion, 1973, 1, 331. 2. Becker, D. V., McConahey, W. M., Dobyns, B. M., Tomkins, E., Sheline, G. E., Workman, J. B. in Further Advances in Thyroid Research (edited by K. Fellinger and R. Hofer); p. 603. Vienna, 1971. 3. Malone, J. F. Curr. Top. Rad. Res. 1975, 10, 263. 4. Dunn, J. T., Chapman, E. M. New Engl. J. Med. 1964, 271, 1037. 5. Smith, R. N., Munro, D. S., Wilson, G. M. in Further Advances in Thyroid Research (edited by K. Fellinger and R. Hofer); p. 611. Vienna, 1971. 6. Bremner, W. F., McDougall, I. R., Greig, W. R. Lancet, 1973, ii, 281. 7. Glennon, J. A., Gordon, E. S., Sawin, C. T. Ann. intern. Med. 1972, 76, 721. 8. Buchannan, W. W., Kuntras, D. A., Crooks, J., Harden, M. B. Br. J. Radiol. 1965, 38, 536. 9. Malone, J. F., Cullen, M. J. ibid. 1975, 48, 762. 10. Werner, S. C. in The Thyroid (edited by S. C. Werner and S. H. Ingbar);
p. 697. 1971. 11. Greig, W. R. J. clin. Endocr. 1965, 25, 1411. 12. Beling, U., Einhorn, J. Acta Radiol. Ther. Phys. Biol. 1961, 56, 275. 13. Doniach, I. in Thyroid Neoplasia (edited by S. Young and D. R. Inman, p. 259, 265. New York, 1968. 14. Wood, L. C., Peterson, M., Ingbar, S. H. 48th Meeting of the American Thyroid Association, 1972. 15. Gordin, A., Wagner, G., Hernberg, C. A. Acta. med. scand. 1973, 194, 335. 16. Maloof, F., Dobyns, B. M., Vickery, A. L. Endocrinolology, 1952, 50, 612. 17 Okada, S. in Radiation Biochemistry, vol. 1. p. 247, 260. New York, 1970. 18. Green, M., Wilson, G. M. Br. med. J. 1964, i, 1005.
Reviews of Books Psychiatry in Dissent Controversial Issues in Thought and Practice. ANTHONY CLARE. London: Tavistock. 1976. Pp. 438. £7.50 (paperback £4).
Pascal might well have written to his publishers: "I’m sorry I haven’t had time to write a short book". Dr Clare first hurried into ken when he vociferously forced the Royal College of Psychiatrists to heed the needs of his less fortunate (i.e., not at the Maudsley) contemporaries. Now, in this quite long book he holds hard to that purpose; he presents an informed exposition of the wide-ranging arguments that go on concerning a number of chosen psychiatric issues. The young Maudsley registrar gets this as part of his birthright but those in training in the shires will enjoy and benefit. Concepts and models of mental illness, psychiatric diagnosis, the nature of and the aetiologies of the schizophrenias, controversial treatments (electrical, surgical, and compulsory detention) are all dealt with roundly and soundly. Chapter by chapter his conclusions parade establishment viewpoints. Perfectly proper. Little dissent. The young Turk is become a Pasha. Dr Clare draws his bow firm and true. This is an easy book to read because it is well written. It is not aimed at the laity but at psychiatrists in training anywhere where educated discussion is scant. It is informed with apt quotations and abundantly referenced. Professor Shepherd in his foreword writes: "It is indisputable that while the gap between established knowledge and much psychiatric theory and practice remains uncomfortably wide, there has been an understandable but nonetheless mistaken tendency on the part of some psychiatrists to traffic in uncertain assumptions, unfounded speculations, and unproven hypothesis, which in some quarters have invested their role with the mystique of a priest or shaman equipped with the qualifications of an emotional engineer." Dr Clare’s prose style is more spare, and the careful reader of this book will find his thinking finely sharpened so that he may avoid such trafficking. He will also find one or two dubious statements: "Approximately one in every ten alcoholics in active treatment (do Clare’s italics] kills himself’. Can that be substantiated? Surely not. And there are too many rhetorical questions, perhaps a relic of Dr Clare’s debating days. The thoughtful reader will also find that he has been shown how to pick his way intelligently through controversies and for that high peak of education he will stand in Dr Clare’s debt. This book should be in the library of the Royal College of Psychiatrists and places concerned with the training of careful and thoughtful
psychiatrists. Drug Effects
on
Monographs
the Fetus
on
Drugs: vol. II. H. TUCHMANN-DUPLH ssis, Labora-
d’Embryolgie, Faculté de Medicine de Paris. Acton, Mass.: Publishing Sciences Group. Sydney: Adis Press. 1975. Pp. 267.
toire
$15. WHILE the incidence of malformations continues at a rate of 27 per 1000 live births there is an obvious need to explore all avenues that may lead to prevention. The control of birth defects can be attempted by two practical means-either recognition and abortion of the malformed embryo or identification and modification or removal of teratogenic agents. This monograph, somewhat misleading in title, describes those factors, pharmacological and otherwise, that may have dysmorphogenic effects on the embryo and fetus. There is a brief and lucid account of prenatal physiology, embryonic nutrition, and the principal mechanisms of teratogenic action. These sections are concise, interesting, and easy to follow. Simple diagrams contribute to the clarity of the text and provide a sound basis for the discussion of known and suspected teratogens which follows. Most of the agents suspected of dysmorphogenic
76 action have been indicted
on
the results of
experiments
in
laboratory animals. The author has sprinkled his annotated catalogue of potential teratogenic agents with horrific photographs of embryopathy in rats, mice, and rabbits. Nevertheless, obvious effort is made to extrapolate, to the everyday world of clinical medicine, the significance of these animal studies. Each section, whether it relates to drugs, vaccines, metabolic disorders, or radiation damage, includes advice on the likely risk to the human fetus of the suspected teratogens described. It is at this point that time has overtaken the text. The author, faced with difficult decisions, has decided that diazepam and warfarin are unlikely to be teratogenic in man. More recent reports suggest the contrary view, and there seems to be a strong association between cleft lip and cleft palate and maternal diazepam ingestion. There is also a characteristic warfarin embryopathy which includes stippled epiphyses and saddle nose. The author, a noted experimentalist, also queries the reports of alcohol-induced fetal defects because they have not been confirmed in laboratory rodents. Those who have observed the syndrome of growth retardation, microcephaly, and mental deficiency in the offspring of alcoholic mothers would doubt the validity of the animal evidence described and find confirmation in the experiments of S. Sandor whose work has been overlooked in this text. Despite these deficiencies (significant enough when one realises how few human teratogens have actually been identified) this monograph will be of interest and assistance to all concerned with improving the quality of human neonates. There is a useful bibliography at the end of each chapter, and the volume will justify its position in libraries catering for practitioners with an interest in developmental pathology.
Children’s
Orthopaedics
Practical Problems. N. J. BLOCKEY, M.CH.ORTH., don : Butterworths. 1976. Pp. 141. £4.50.
F.R.C.S.
Lon-
a selection of essays written in dogmatic style based personal experience. The message on each subject is clear and precise and provides a guideline for the postgraduate student of orthopaedics who wishes to practise these methods. There is a long essay on osteomyelitis and another on congenital dislocation of the hip, whilst the rest of the book is made up of shorter essays-and sometimes a single paragraph on a particular condition. This is in no way intended to be a comprehensive textbook of orthopaedic conditions. The extensive chapter on C.D.H. is a painstaking study of many of the individual problems of this complex condition. Mr Blockey has
Wilms’ Tumor Edited by CARL POCHEDLY, M.D., Nassau County Medical Centre, East Meadow, N.Y., and DENIS MILLER, M.D., New York Hospital, Cornell Medical Center. New York and London: ’iley. 1976.
Pp. 239. $22.75; £12.30. THE fact that a book has been written on Wilms’ tumour-a rare malignant tumour of childhood-is an indication of the interest in the progress which has been achieved in the management of this disease. It is now the yardstick by which paediatric oncologists judge advances in the treatment of other forms of malignancy in childhood. This multiauthor text deals in separate chapters with the historical background to today’s approach to therapy, the clinical manifestations of the tumour (with special reference to the associated congenital abnormalities), and the rare occurrences of increased output of renin. Excessive erythropoietin activity and abnormal mucopolysaccharide excretion are also discussed. Diagnostic work-up, radiographic findings, surgical management, radiation therapy, and chemotherapy are all dealt with in detail and there is clear information for those who only deal with occasional cases. Bilateral tumours are dealt with separately. There are also chapters on immunological studies and genetic and teratogenic aspects of the tumour. There is a very interesting chapter on nephroblastomas in animals and in-vitro studies on human nephroblastoma lines. The management of the controversial congenital Wilms’ tumour is well discussed and emphasises the difficulties in this group. Estimation of prognosis is dealt with in the final chapter, and this, along with the chapter on histopathology, indicates that by careful and detailed investigation and analysis it is now possible accurately to assess prognosis and hence to tailor therapy for the individual child with this tumour. The whole book forms an excellent, easily read text which should be a useful source of reference for all clinicians and research-workers interested in the treatment of Wilms’ tumour.
THIS is
on
evolved a system of management based on dissatisfaction with other methods and he is at times outspoken in his criticism of these. Some readers will in turn criticise manipulative reduction and the prolonged period in plaster which he advocates. However, his results testify to the method, and many would be happy to emulate them. This particular section is stimulating in its analysis of specific problems: all will agree that the growth of the acetabular roof remains unpredictable. The other main chapter on osteomyelitis, is very detailed and expresses Mr Blockey’s well-known conservative attitude in the acute disease. He makes a very careful appraisal of the antibiotics of choice. Surgery is initially withheld until there is clinical evidence of an abscess. The difficulty of accurate localisation of the lesion, which is at present a valid objection to early surgery, may be overcome in the future by bone scanning techniques. Other types of the disease are found under separate headings, including osteomyelitis in infancy, subacute osteomyelitis, chronic osteomyelitis, and Brodie’s abscess. The section on management of bone infections will be particularly useful to surgeons in developing countries. Most of the rest of this book is under such chapter headings as minor problems, lesions to be left alone, and lesions where timing of treatment is important. Mr Blockey again imposes his own ideas; nevertheless, much valuable information is stored here that is often lacking in more comprehensive textbooks.
Drug Treatment of Mental Disorders LANCE L. SIMPSON, Columbia University College of Physicians & Surgeons. New York. New York: Raven Press. 1976. Pp. 323.
$13.50. Raven Press has published several first-rate books on psychiatric subjects. This volume- maintains the high standard-indeed it would have to in order to justify publication in an area where there are many competitors. It succeeds because of its
thoroughly professional approach-few other texts sistently comprehensive, authoritative, and
are as con-
up to date. Dr
the preface that only those drugs that are "used often and with notable therapeutic success" are described, and throughout the book only clinically relevant material is emphasised. A distinguished array of twenty-four contributors cover all the main drug treatments for the functional psychoses and neuroses. There are also valuable chapters on these drugs in paediatrics and geriatrics, and on the important subjects of unwanted effects and drug interactions. The pharmacological basis of drug action and the rationale for their use in psychiatry is presented economically and well, and the tendency in some psychopharmacological textbooks to discourse at length over minor structure-activity relationships is avoided. The reader sometimes feels disoriented by the absence of a unifying theme and the occasional seeming contradiction of one author by another, but in general the text is coherent and well edited. The book can be recommended to all those who prescribe psychotropic drugs and wish to know more about them than the information provided by standard psychiatric textbooks and by the pharmaceutical manufacturers. It is not, and does not pretend to be, a book for the specialist psychopharmacologist, but it is ideal for the clinician. It deserves a wide readership but such is the pace of development in psychopharmacology that it will need revision in a year’s time if it is not to become dated.
Simpson explains in
