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Book Reviews
Anaesthesia Science. N. R. Webster and H. F. Galley
(editors). Published by Blackwell Publishing/BMJ Books,
London, UK. Pp. 466; indexed; illustrated. Price £69.50.
ISBN 9780-7279-1773-7.
Anaesthesia Science is a new book that aims to cover in
detail areas of science related to the practice of
Anaesthesia, Critical Care and Pain Management. The
editors state, in their Preface, that they wish to comp-
lement rather than replace more comprehensive texts, and
concentrate on areas covered less well elsewhere. It is
aimed at trainee anaesthetists preparing for their pro-
fessional examinations. The 30 chapters have been written
by 46 authors, mostly European, the vast majority of
whom are well-known experts in their respective field.
The book contains 466 pages and is very well produced
in a medium sized hardback edition, which is more than
pocket-sized but small enough to be used in the theatre or
clinic environment. It is comprehensively referenced and
the text clearly set out, with good use of tables, line dia-
grams, and clinical images where appropriate. It is to the
editors’ credit that the chapters generally conform to a
lucid style, and most provide a historical perspective to the
subject matter, which is both interesting and informative.
Most chapters are referenced through the text with a range
of 20–180 current references, though a small minority
refer simply to ‘further reading’.
The reasons for failure in professional examinations
often reflect poor knowledge of the fundamental principles
of basic physiology, pharmacology, and statistics. The
outside cover states that Anaesthesia Science is based on
the syllabus for the primary FRCA examination and,
although it does not profess to be comprehensive, the
mixture of topics included is slightly eclectic. The book is
broadly divided into Pharmacology, Physiology, and
Measurement, but these are rather artificial distinctions.
For example, there is a very good chapter on heart failure,
which is mostly concerned with advances in pharmaco-
logical and other management, but is included under
‘Physiology’, whereas the chapter on cardiovascular
assessment contains mostly physiology, but is listed under
‘Measurement’. There is more emphasis on certain topics
at the expense of others. Specific, brief chapters on ana-
phylaxis and antibiotics are included, but no mention of
renal or haematological pathophysiology, topics that are
changing rapidly and often cause confusion among trai-
nees. However, the first two sections of the book are
largely very good, and the chapter on pharmacogenomics
is the best resume of this topic I have read. Conversely,
the ‘Measurement’ section was a little thin, with a fairly
basic chapter on assessment of respiratory function; chap-
ters on nanotechnology and study design seemed incongru-
ous within the whole book, but there was an excellent
chapter on magnetic resonance imaging.
So should you buy it? It really depends on what you are
looking for. Anaesthesia Science would not replace
Scientific Foundations, were it still in print, yet is much
more than a collection of vignettes, is very well produced,
and reasonably priced. In many respects, this book will
enable practitioners to fill gaps in their knowledge and fill
a gap in the market. Therefore, it should achieve its stated
aims. As the editors recognize, examination candidates
will still need to read both more specialized and also more
inclusive texts. However, I suspect that examiners will
also find it useful, because it provides up-to-date details in
several selected areas and so potential candidates may
follow suit.
J. P. Thompson
Leicester, UK
E-mail: jt23@le.ac.uk
doi:10.1093/bja/aem107
Oxford Handbook of Clinical Medicine, 7th Edn.
M. Longmore, I. Wilkinson, T. Turmezei and
C. K. Cheung (editors). Published by Oxford University
Press, Oxford, UK. Pp. 840; indexed; illustrated. Price
£22.95. ISBN 0-19-856837-1.
The Oxford Handbook of Clinical Medicine enters its
seventh edition, 21 yr after the first edition entered junior
doctors’ white-coat pockets. In itself, such ongoing
demand is an indication of this book’s appeal. The Oxford
Handbook series was originally ground-breaking in its
format; bullet-points, a matter-of-fact approach married
with a white-coat-pocket size, and splash-proof covers
made them a big hit. Their compact dimensions belied
their detailed contents. Many readers will be familiar with
the enormous amount crammed into the current Oxford
Handbook of Anaesthesia. The Oxford Handbook of
Clinical Medicine does not disappoint in this regard—its
840 pages of tightly spaced text waste no words on flowery
prose or descriptive style, and information is delivered in a
direct and unambiguous style, with minimal preamble.
Photographs, radiographs, and line illustrations are used
generously, and this edition is the first to use colour
#The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
British Journal of Anaesthesia,98 (6): 849–51 (2007)
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photographs and illustrations. Images are used to illustrate
important points where necessary, and occasionally to
provide clinical examples. While radiographs or clinical
photographs may measure only 1 – 2 cm in width, they are
remarkably clear and comprehensible. A small selection of
radiographs is presented in larger format in an appendix
towards the end of the book.
The text is split intelligently into digestible chunks that
are headed clearly and follow in logical progression.
Knowledge is presented very much in the style of a guide-
book, with advice being offered didactically and with
minimal discussion of the alternatives. Clearly, this has
strong and weak points; for examination preparation, the
reader may be insufficiently informed of the broader per-
spective around a clinical problem, but for practical, ward-
based medicine, the reader will be efficiently prepared.
The range and depth of content are breath-taking. The
book begins, as it has in previous editions, with a generic
and philosophical section regarding the role of the doctor,
communication skills, diagnostics, and empathy. Clinical
skills follow and, system by system, a large variety of
signs and symptoms are described. This rather general, but
interesting, section occupies around 80 pages. The largest
section of the book follows: ‘internal’ medicine,
comprising cardiovascular, chest, gastroenterology, renal,
haematology, infectious diseases, neurology, oncology,
palliative care, and rheumatology. This section occupies
almost 500 pages and is impressively detailed. The next
section, which occupies around 190 pages, covers surgery,
epidemiology, clinical chemistry, eponymous syndromes,
and radiology. This seventh edition is the first to contain a
radiology section. This new section is well written, and is
comprehensive enough to inform doctors requesting radio-
logical investigations. The next 30-page section contains
reference intervals and descriptions of a number of ward-
based, physician-orientated practical procedures. These
will not be very useful to most surgeons or anaesthetists,
but will be greatly appreciated by junior medical trainees.
Finally, the book finishes with a nicely written and well-
illustrated section on medical emergencies. These are
indexed for rapid availability on the inside front cover of
the book. Many of these emergencies have pertinence for
anaesthetists (e.g. status epilepticus, dysrhythmias, pul-
monary oedema, and acute asthma), and most will be of
use in intensive care.
The style of the book is generally pleasing and invites
occasional browsing. As a pocket book, it would certainly
be very useful to medical trainees, and its direct, clear,
and didactic style suits this purpose well. I doubt its use-
fulness as a revision text because of its lack of discursive-
ness, but I am sure that this was not the authors’ aim. The
text is well proofed, on the whole, although the occasional
error has made it into print (e.g. ‘loosing weight’).
With a modest price, this compact book seems to me a
sensible investment for many trainees and consultants in
anaesthesia. Our occasional brush with other medical
specialties and our tendency to be first at the scene may
well make this book a life-saver. For trainees in intensive
care, this book will also be useful and worth carrying to
work daily. On the whole, I congratulate the authors and
the publishers on improving a book that already holds a
prominent place in British medical practice, and commend
it to all medical practitioners.
J. G. Hardman
Nottingham, UK
E-mail: J.Hardman@nottingham.ac.uk
doi:10.1093/bja/aem108
Anaesthesia and the Practice of Medicine: Historical
Perspectives. M. K. Sykes and and J. P. Bunker (editors).
Published by The Royal Society of Medicine Press Ltd,
London, UK. Pp. 303; Price £15.95. ISBN 978-1-85315-
674-8.
This concise book of 23 chapters tells the story of
advances in anaesthetic knowledge and practice over 150
years since its demonstration in the Ether Dome in
Massachusetts in 1846. It is the story of the development
of anaesthesia as a speciality in its own right. The book
also shows how these developments in anaesthesia have
allowed advances to be made in other specialities such
as cardiac surgery, intensive care, resuscitation, the treat-
ment of chronic pain, and the provision of pain relief in
obstetrics.
Of the 23 chapters, 15 are written by M. K. Sykes, for-
merly Professor of Anaesthesia at Hammersmith and
Oxford, and 8 are by J. P. Bunker, formerly Chair of
Anaesthesia at Stanford and Visiting Professor at Harvard.
The book is written from their European and American
perspectives. They took 6 years to write this book, which
is based on their professional experience and on their
extensive research. They have similar styles of writing
and, as in any good book with a tale to tell, one chapter
leads easily on to another. The breadth and depth of this
book are impressive, and you can read it cover to cover.
Four of the chapters (curare, the Copenhagen polio epi-
demic, anaesthesia for cardiac surgery, and halothane
hepatitis) are especially interesting.
The book demonstrates that ideas can be born before
their time. Humphry Davy had described the narcotic
effects of nitrous oxide in 1799, but it was another 47 yr
until Morton demonstrated surgical anaesthesia with ether.
However, although anaesthesia now permitted patients to
undergo surgery painlessly, further developments in major
surgery had to wait until Lister demonstrated how to
prevent sepsis, in 1867.
In cardiac surgery, Souttar had performed a mitral
valvotomy in 1925, in a patient who survived, and in
Book Reviews
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