Emergency Department Organisation and Management

800

Reviews of Books

Neoplastic Development 2

LESLIE FOULDS. London and New York: Academic Press. 1975.Pp. 729. £16.80, $43.50.

Dr Foulds, over the years he was involved in cancerresearch, developed a way of thinking about neoplastic condi­tions which, in the later years of his life, he committed topaper. Whereas the first of his two volumes dealt with muchof the theoretical background, the second one attempts toencompass what Foulds refers to as the stark reality of malig­nancy. The central theme of both volumes is that neoplasticdevelopment should be thought of as a continuous process ofwhich the end product is presented to the clinician. The pro­cess can be divided into phases A, B, and C which Fouldsexemplifies fully from studies of laboratory and domestic ani­mals and of human pathology. Each major chapter of thesecond volume deals with neoplasia in a different organ systemand tells what is known and thought about the disease in ques­tion. Paucity of information is underlined, and where an inter­pretation raises doubts in Foulds' mind he says so clearly. Bothbooks are highly stimulating. They are written in a readableform with numerous wry and lively asides, and the intellectualapproach to cancer research is leavened with enormous experi­ence and knowledge. It says much for Foulds' art that, despitethe ubiquitous exemplification of the facets of his centralhypothesis, one can disagree with it and yet read the bookswith pleasure. They should provide a source of enlightenmentfor cancer research-workers for years to come.

Emergency Department Organisation and Management

Edited by A. L. JENKINS, M.D., SI Mary's Memorial Hospital,Knoxville, Tennessee. St Louis: Mosby. London: Kimpton. 1975.Pp. 257. $14.50; £7.25.

THIS book has been produced by the American College ofEmergency Physicians with the aim of improving the emer­l ency medical services of the U.S.A. It assumes a recognitionof the emergency physician as a specialist. Although a lot ofit is of interest only in the U.S.A., many chapters will be readwith interest by all doctors in Britain and elsewhere and es­pecially by consultants in accident-and-emergency work and byyoung doctors who may consider a career in this specialty. Thedemand for emergency medicine has greatly increased in mostWestern countries. The authors take the view that all patientspresenting should be accepted, though in Britain it is moreusual to try and define emergencies and to decline to treatthose cases which do not fall within this definition. Thechapters on planning and equipment are useful as a basis forconsideration in other countries. There are chapters on staff­ing, which suggest the need for four doctors for every 30 000patients seen and make the case for training nurses speciallyfor accident-and-emergency work. There is some discussion onthe teaching of undergraduates and on the early introductionof the student to the emergency department. Much space isgiven to the training of the specialist, and a complete residencytraining programme is outlined. Examples are given of medi­cal-records sheets; and the new post of nurse scribe is men­tioned. The chapter on disaster planning is similar to Britishideas, but the chapter on ambulance design and personneltraining des~rves consideration. The administrative problems,such as finding a bed for the emergency admission, seem muchthe same on the two sides of the Atlantic, as are the solutions.The contributions on legal and financial problems are not rele­vant outside the U.S.A., nor is much of the material in theappendices, on contracts, bylaws, and regulations. All in all,this is a useful book which could be read by any doctor whois interested in the working of the accident and emergencydepartment.

THE LANCET, OCTOBER 25, 1975

The Pathology of the Heart

Edited by ARtELA POMERANCE, M.R.C.PATH., Northwick Park Hos­pital, Harrow, and MICHAEL J. DAVtES, M.R.C.PATH., Universitvof London. Oxford: Blackwell. 1975. Pp. 622. £22.50. .

THIS book is predominantly the work of the two editorsthough seven contributors are responsible for five of thechapters and make other contributions. It is aimed at the path­ologist and those studying for higher examinations, but manyothers will find the book valuable. A concise description of nor­mal anatomy is followed by chapters on degenerative changes,atherosclerosis, coronary-artery disease, cor pulmonale, cardio­myopathies, and rheumatic heart-disease and bv severalchapters on cardiac pathology in relation to other conditionssuch as connective-tissue diseases, cardiac surgery, andtumours. The text reads well; the illustrations are well pre­sented, clear, and contribute considerably to the value of thebook; and the references are extensive in each chapter and areup to date, several papers in 1975 being cited. Some areas areespecially well covered, and the chapters on the conductionsystem and the cardiomyopathies are very good. However, CDn­genital heart-disease is treated sparingly, being allotted thes~me apace as that allocated to the pathology of the conduc­non system: aortic atresia and cor triatriatum are not men­tioned and the standard of illustrations is lower than else­where. This suggests some lack of balance in the materialcovered. The editors succeed in their aim of providing a valu­able reference work for pathologists, but their book is suffi­ciently clinically oriented for cardiologists to find it a valuableaddition to their library.

Obesity

Its Pathogenesis and Management. Edited bv TREVORSILVERSTONE, F.R.C.PSYCH. Lancaster: Medical and TechnicalPublishing. 1975. Pp. 240. £8.50.

THIS book covers recent developments in non-endocrineobesity. Potentially, it has a wide appeal and, to be successful,should be so written that each chapter can be understood bythose whose primary interest may lie elsewhere. This is largelyachieved, apart from some of the otherwise excellent chapteron adipose-tissue metabolism and most of the strangely unpa­latable one on experimental psychology. The section devoted topathogenesis also includes a succinct description of the regula­tion of body-weight and an attempt at a global epidemiologicalreview: this highlights the magnitude of the problem but alsoreveals the dangers of trying to draw conclusions without anyuniformity on the definition and measurement of obesity. Thesection on management is concise and well written: the chapteron the behavioural approach is outstanding, but those on die­tary and drug therapy might have emphasised presentignorance. Bypass surgery is abruptly dismissed, which seemsstrange in a book aimed at emphasising "those topics in whichthe most significant and practical advances are currently beingmade". This deficiency should be made good when this erudite,liberally referenced, and generally readable book enters itssecond edition.

New Editions

Red Cell Metabolism. 2nd ed. By Ernest Beutler. New York andLondon: Grone & Stratton. 1975. Pp. 160. $14.75; £7.25.

Atlas d'anatomie du corps humain. 54th ed. By Ferenc Kiss andJanos Szentagothai. Paris: Masson. 1975. Vol. I, pp. 313; vol. It, pp.225; vol. III, pp. 308. Each vol. F68.

Abdominal Operations. 6th ed. By Rodney Maingot. New York andLondon: Prentice Hall. 1975. Vol. r, pp. 1194; vol. II, pp. 1046. $85;£46.75 the set.

Bailey and Love's Short Practice of Surgery. 16th ed. Edited by A.J. Harding Rains and H. David Ritchie. London: Lewis 1975. Pp.1308. £10.