A manual of dermatology for developing countries (2nd edition)

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TDR continues to make significant contributions to diseasecontrol.’ The bulk of the report (73 pages) is aimed at the ‘big six’ TDR infections. The accounts are all reliablv and concisely written and serve as valuable up-dates in-these specific areas. All are, furthermore, accompaniedby useful lists of well chosen referencesto recent work on these diseases. The malaria section summarizes the present state of affairs regarding artemisinin, mefloquine, halofantrine and the primaquine analogue WR238605; but the major topic is research into a possible vaccine. Ivermectin continues to undergo clinical trial in onchocerciasis and lymphatic filariasis; for the latter diseaseit has been combined with diethylcarbamazine. In leprosy, ofloxacin, clarithromycin, and minocycline come to the fore. All of these sections contain a summary table: ‘Research highlights 1991-92 and next steps’: A separate chapter tackles ‘Integrated chemotherapy for African tryuanosomiasis.Chaaasdiseaseand Leishmaniasis’. ‘ An overview of ‘fhe TDR strategiesfor basic research, product development, and applied researchin the field is provided by Tore Godal in the introduction to the report, which is rounded off by broader contributions: ‘Biological Control of Vectors’, ‘Social and Economic Research’, ResearchCapability Strengthening’, ‘Product Development Unit’! and lastly, but very importantly, ‘Management and Finance’. Although, therefore, essentially a progress report of work currently being carried out by TDR, this well produced, paper-backed volume really is worthy of perusal by anyone with an interest in those diseasesconsidered to deserve special study by the WHO; but, of course, so many of the health problems associatedwith the tropics fail to lit under this tidy umbrella! G. C. Cook Hospital for Tropical Diseases 4 St Pancras Way London, NW1 OPE, UK The Epidemiology of Cardiovascular Diseases in the Ethnic Groups of Singapore. K. Hughes. Tokyo:

Southeast Asian Medical Information Centre, 1993. x+21 lpp. Price not stated. ISBN 4-930783-66-6. The comparison of diseaseand risk factor frequency in societies which differ in their environmental setting and their ethnic origin has long been the mainstay of epidemiology, and has helped considerably in uncovering the aetiology of disease.When peoplesof different ethnic origin live together in the same macro-environment, those in search of causality come into their own. Singapore is a model for such situations and Kenneth Hughes has taken full advantage of the setting and the skills associated with a renowned Department of Community, Occupational and Family Medicine in the National University of Singapore. This island-state has a population of some 2.5 million ueonle. comoosed of Chinese 177%). Malays (15%), Indians(6%), and others (2%). Cardiovas: cular diseaseaccounts for about one-third of all deaths, as in many developed societies, and Kenneth Hughes set out to examine the nrevalence of risk factors for ischaemic heart diseasein a cross-sectional survey of some 2000 men and women in 1982-1985, against the backaround of the 1980-1984 mortalitv data for cardiovascular diseases.This book, successfully submitted for a DM (Oxon) degree, describes the trends and pattern of cardiovascular diseasein the various ethnic groups in Singapore, and the methods used in the survey. The data are well .set out, the Tables and Figures are clear, and the text is straiahtforward. The book is not intended to be comprehen&e and its main value lies in the detailed description of the risk factors in the different ethnic groups. Mortality from ischaemic heart diseasein the Indian men and women in Singapore is much higher than in England and Wales or the USA. Mortality from stroke is

highest in the Malays, followed by the Indians, and then the Chinese; all of these have rates higher than those in Japan, England and Wales or the USA. A similar pattern is observed for hypertensive disease.Although cardiovascular mortality has declined in Singapore in recent years, rates are still high compared with other developed countries. This is presumed to be due to the high levels of blood cholesterol and cigarette smoking. The high rate of ischaemic heart diseasein the Indian population, a phenomenon seen in other parts of the world to which people from the Indian sub-continent have migrated, appears to be associatedwith a disproportionate prevalence of diabetes mellitus and abnormal glucose tolerance. The Indians also have lower concentrations of HDL-cholesterol than do Chinese and Malays, and this does not appear to be accounted for by cigarette smoking. The Malay population has the highest mean systolic blood pressure and the highest rates for hypertensive disease. Physical activity appearsto differ little between the various ethnic groups and body massindex differs only in women, with more obese subjects among the Malays and Indians. There are no data on heart rate or respiratory function and there is no information on haematological indices such as haematocrit, viscosity, white cell count or coagulation factors. There are also no data on salt intake in relation to blood pressure. This small book will be of particular interest to those concerned with the increased risk of ischaemic heart diseasein Indian communities living abroad and to those planning further work in the Singapore setting. A. G. Shaper Royal Free Hospital London, UK A Manual

of Dermatology

for Developing

Countries

(2nd edition). 0. Canizares. New York: Oxford University Press, 1993. 370~~. Price &50. ISBN O-19-262293-5. Major advanceshave occurred in the field of dermatology since the first edition of this book was written. Therefore, this secondedition is very welcome. The introductory chapter discusses the fundamentals of structure and functions of the skin as well as those of diagnosis and therapeutics. In the second chapter the author gives a brief but very useful account of epidemiological and ecological factors that play a role in the distribution and prevalence of skin disease in the tropics. The importance of climatic and environmental conditions is highlighted. The bulk of the text provides details, in 16 chapters, of a wide spectrum of infectious diseasesand endemic disorders. Conventional areas such as eczema and skin tumours are also taken into account, not forgetting skin manifestations of systemic, nutritional and tropical diseases.Towards the end of the book a chapter of miscellaneous disorders also gives a brief description of some of the rarer dermatosesand light-induced eruptions. The last 2 chapters are devoted to sexually transmitted diseases,as would be expected. Those who care for the skin in developing countries also take care of the dermatological manifestations of venereal diseases. The last chapter contains updated information on human immunodeficiency virus (HIV-l) infection (AIDS). It maintains the generally high standard and consistency present throughout. The book concludes with 2 appendices, of which Appendix 1 is particularly useful in presenting a practical formulary. The author’s wide experience of the limitations and difficulties in availability of therapeutic means in developing countries enabled him to provide a simple, effective and affordable preparations guide. Appendix 2 provides a comprehensive topographical diagnosis with emphasis on skin disease localization in the tropics. These remarks are very helpful, as with infectious diseases a wider differential diagnosis needs to be considered.

367 Most chapters are well illustrated with good quality black-and-white photographs and maps or body diagrams referring to disease distribution. Key summary statements located in the margins make the book a pleasure to read. In addition, a good number of colour plates of typical clinical caseshave greatly enhanced its practical value. The book is well presented in a hardback bound volume. The author is to be congratulated on his aim to produce a book with emnhasis on clinical diagnosis intended primarily for physicians, medical students and health workers in developing countries where there is no access to sophisticated laboratories or other diagnostic procedures. The aim is readily achieved with a clear, concise, and well-structured text. There is also a comprehensive and accurate index. The book is not designed to cover the subject exhaustively, but it provides the necessaryinformation for its intended readership. Physicians in temperate climates will also be very pleased with this new edition as, more often, they are dealing with exotic dermatosesas a result of ever increasing international travel and immigration. There are a few spelling mistakes which could perhaps have been eliminated by more ruthless editing. However, it is undoubtedly good value for money. W. S. Robles Department ofMedical Mycology StJohn’s Institute of Dermatology St Thomas’s Hospital Lambeth Palace Road London, SE1 7EH, UK The Epidemiology of Malaria and Filariasis in the Ok Tedi region of Papua New Guinea, 2nd printing (with

minor corrections). G. J. T. Schuurkamp. Tabubil, Papua New Guinea: Ok Tedi Mining Limited, 1993. xivS341pp. Price not stated [see below]. ISBN 99809997-o-s. This superbly produced and illustrated text represents the published version (surely one of the most sumptuous ever produced) of the author’s PhD thesis in Community Health which was accepted by the University of Papua New Guinea (PNG) in 1993). The author’s primary sources of inspiration were: P. C. C. Garnham’s Malaria Parasites and Other Haemosporidia (1966) and W. Peters’s Chemotherapy and Drug Resistance in Malaria (1970); other mentors were G. Nurse, University of PNG, and I’. Spicer, Chief Medical Officer of Ok Tedi Mining Ltd-the major sponsor for the work here described. The Ok Tedi Mining project was launched in 1981in the remote northern-most corner of the Western Province (situated on the Irian Jaya border) of PNG, an area hyperendemic for both Plasmodium falciparum infection and lymphatic filariasis. Within 3 years of the introduction of control strategies the overall ‘malaria parasitaemia’ rate had been reduced from 70% to
cant reduction in microlilaraemia and splenomegaly was demonstrated. The author concludes that the Ok Tedi project has established that classical malaria control measures remain effective in PNG-provided they are properly implemented and adequately supervised. The book consists of 12 chapters and a 17-pagebibliography. Following an historical introduction, there are chapters on epidemiology, field and laboratory techniques, ‘passive case detection’ and village-based surveys; the next 2 are devoted to 4-aminoquinoline resistance in P. falciparum and P. vivax, respectively. Lymphatic filariasis (Wuchereria bancrofti) dominates chapter 8, and the concluding chapter (which summarizes the specific health programmes initiated in the Ok Tedi area)is preceded by others on an immunological (serological) study of the local population and protective genetic factors, and a literature review and discussion. The reader is thus presented with a wealth of data collected in this limited, and relatively little known, area of PNG. As a monograph the book is exemplary, the standard of presentation, including Tables and photographs, being exceedingly high. Ok Tedi Mining Ltd is offering complimentary copies to Fellows of the Royal Society of Tropical Medicine and Hygiene, together with researchers, universities! and libraries; the book is available free (by first classairmail in the Australasian region, and seamail to all other international destinations). What an incredible offer! [Requests should be addressedto Ok Tedi Public Health, Ok Tedi Mining Ltd, P.O. Box 1, Tabubil, Western Province, Papua New Guinea. The book will be airmailed to destinations outside Australia on payment of US $30 by International Bank Draft to Ok Tedi Public Health.] G. C. Cook Hospital for Tropical Diseases London, UK Studies on the Natural History of Yellow fever in Trinidad. E. S. Tikasingh (editor). Trinidad: Caribbean Epidemiology Centre (CAREC), 1991. xii+170 pp. Price

US$12. ISBN 976-8001-91-7. This book contains 21 papers on a range of aspectsof yellow fever in Trinidad. The location of the Caribbean Epidemiology Centre (CAREC) in Trinidad has been an important factor contributing to long-term studies of the disease.Historically, yellow fever in Trinidad goes back a long way. The first suspectedoutbreak there took place in 1739. Thereafter, outbreaks were a regular feature. The late Wilbur Downs briefly reviews the history of yellow fever in Trinidad and draws attention to the comments of Charles Kingsley associating monkey mortality and yellow fever outbreaks. He also comments on Balfour’s paper of 1914 which raised the possibility that monkeys might constitute a natural reservoir for the causative organism of yellow fever. The 3 major sections in the book deal with the outbreaks of yellow fever occurring between 1978 and 1980, the period 1980-1988, between the epidemiciepizootic years, and the 1988-1989 epizootic. In the first outbreak documented in the book there were 18 human cases.The diagnosis of the infection in humans, red howler monkeys and Haemagogus mosquitoes is discussed. The major contributions relate to studies in Haemagogus mosquitoes and red howler monkeys. In the second epizootic, disease was confined to the monkeys with no human case occurring. Details of vaccination programmesand the control of urban vectors are presented. In the years between these outbreaks there was fairly intensive activity trying to identify the yellow fever virus in mosquito populations and undertaking surveillance of the red howler monkeys. No evidence of the virus was found in either animal group. During the second episode of infection described. diseasewas confined to the monkeys.