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A clinical and pathological atlas: the records of a surgeon in St Vincent, The West Indies
609
relatively high concentrations in the necrotic skin lesions for over 29 d after the bite. This discovery adds support to the current practice, with L. reclusa bites in the United States of America, of excising necrotic tissue as early as possible (FARDON et al., 1967). This work was supported by a grant from the EEC. References
Berger,R. 8, hGlhkan,L. E. & Conway,F. (1973). An in vitro test for Loxosceles reclusa snider bites. Toxicon. 11. 465-470. Fardon, D. W., Wingo, C. W., Robinson, D. W. & Master, F. W. (1967). The treatment of the brown spider bite. Plastic Reconstructive Surgery, 40, 482-488. Fink, J. H., Campbell, B. J. & Barrett, J. T. (1974). Serodiagnostic test for Loxosceles reclusa bites. Clinical Toxicology, 7, 375-382. Ho, M., Warrell, M. J., Warrell, D. A,., Bidwell, D. & Voller, A. (1986). A critical reappraisal of the use of
1 BookReview
1
A Clinical and Pathological Atlas: the Records of a Surgeon in St Vincent, The West In-dies. A. Cecil
Cyrus. St Vincent, W.I.: A. Cecil Cyrus, 1989 xvii+263 pp. Price: &85, US$ 150. ISBN 976801245-5.
For 25 years from 1963, Dr Cyrus worked as an isolated surgeon in St Vincent, West Indies (population 110 000). This personally-produced colour atlas of nearly 1000 pictures, beautifully printed and laid out, is the record of his work. The pictures are clinical photographs, intra-operative views, radiographs, photographs of grosspathological specimens, and a few histopathological photomicrographs. Few do not clearly make their point. The accompanying text is terse, interlarded by introductory paragraphs to the sections which are laid out broadly according to disease:congenital, trauma, infections, tumours, the abdomen, and miscellaneous. The emphasis is not on ‘tropical diseases’as taught in developed countries., but on trauma and the effects on standard, global diseasesof late presentation and poverty. Simple medical means are the norm-strong rum instead of methylated spirits; rainwater instead of distilled; spinal and ketamine anaesthesia (which can be managed single-handed) instead of inhalation general anaesthesia.The hardiness of the people of St Vincent, their tolerance of anaemia, hypertension and diabetes, and their healing capacity come over well. Appropriate operations feature strongly (‘gastrectomy would be a minitragedy in a people-accustomed to enjoying one big meal a dav’); and Dr Cvrus makes some nice slv digs at the n&use of sophisticated medical facilities in other countries, compared with the rewards of simple but meticulous clinical observation.
enzyme-linked immunosorbent assays in the study of snake bite. Toxicon, 24, 211-221. Lucas, S. (1988). Spiders in Brazil. Toxicon, 26, 759-772. Rees. R. S. & King. L. E. (1985). Theranv for brown recluse spider bites is dependent’on venom persistence. Clinical Research, 33, 302. Theakston, R. D. G., Lloyd-Jones, M. J. & Reid, H. A. (1977). Micro-ELISA for detecting and assaying snake venom antibody. Lancer, ii, 639-641. Vest, D. K. (1988). Emergent patterns in the occurrence and severity of probable hobo spider (Tegenuria agrestis) envenomation in humans. 9th World Congress on Animal, Plant and Microbial Toxins. Intentotional Sociew of Toxin&y, Stillwater, Oklahoma, 31 July5 August 1988. Abstracts, p. 31. White, J.,, Hirst, D. & Hender, E. (1989). 36 cases of bites by spiders, mcluding the white-tailed spider, Lampona cylindrata. Medical Journal of Australia, 150, 401-403.
Received 14 March 1990; accepted for publication 28 March 1990
Trauma is particularly well treated in the atlas: tendons severedby kingfish, human bites, kids falling from mango trees (in fright at being caught), nerve injuries from banana cutlass, extraordinary stab wounds, burns, and child abuse are all here. All the common tumours and their management problems are illustrated, and Dr Cyrus is not left behind in prevention either: 59% of skin squamous carcinomas in St Vincent arise from chronic ‘tropical ulcer’, so he regularly excisesand grafts ulcers, and seesa decrease in the incidence of carcinomas. The infection sectionsinclude osteomyelitis, orthopaedic aspects of tuberculosis, yaws, syphilis, lymphogranuloma venereum, amoebic colitis, intestinal obstruction and perforation by ascarids, and the ever-present bacterial abscesses.Fortunately, St Vincent doesnot suffer from the curse of schistosomiasis. Medicine in the tropics (not to be confused with ‘tropical medicine’) sometimesseemsto be a victim of polarized philosophies. On the one hand are the ‘low-tech’ public health and preventive strategies (standard vaccination, drains, education and breast milk). On the other are the molecular biologists who seek to interpret diseasethrough the T cell and wish to twist its arm. What is often stranded in the middle is classical, ‘medium-tech’ medicine and surgery, where careful observation, simple operations, knowledge of the local environment, and respectfor human wishes and dignity prevail. No sophisticated medical advice will eliminate most of the congenital defects, fractures, spear wounds! benign and malignant tumours, hernias, obstetric problems and the conseauencesof unquenchable, universal human silliness th& surgeons in-the tropics face daily. Three cheers for Dr Cvrus for illustratina ‘medium-tech’ medicine in the tropics for those -who have not had the opportunity
to witness
it first
hand.
S. B. Lucas
relatively high concentrations in the necrotic skin lesions for over 29 d after the bite. This discovery adds support to the current practice, with L. reclusa bites in the United States of America, of excising necrotic tissue as early as possible (FARDON et al., 1967). This work was supported by a grant from the EEC. References
Berger,R. 8, hGlhkan,L. E. & Conway,F. (1973). An in vitro test for Loxosceles reclusa snider bites. Toxicon. 11. 465-470. Fardon, D. W., Wingo, C. W., Robinson, D. W. & Master, F. W. (1967). The treatment of the brown spider bite. Plastic Reconstructive Surgery, 40, 482-488. Fink, J. H., Campbell, B. J. & Barrett, J. T. (1974). Serodiagnostic test for Loxosceles reclusa bites. Clinical Toxicology, 7, 375-382. Ho, M., Warrell, M. J., Warrell, D. A,., Bidwell, D. & Voller, A. (1986). A critical reappraisal of the use of
1 BookReview
1
A Clinical and Pathological Atlas: the Records of a Surgeon in St Vincent, The West In-dies. A. Cecil
Cyrus. St Vincent, W.I.: A. Cecil Cyrus, 1989 xvii+263 pp. Price: &85, US$ 150. ISBN 976801245-5.
For 25 years from 1963, Dr Cyrus worked as an isolated surgeon in St Vincent, West Indies (population 110 000). This personally-produced colour atlas of nearly 1000 pictures, beautifully printed and laid out, is the record of his work. The pictures are clinical photographs, intra-operative views, radiographs, photographs of grosspathological specimens, and a few histopathological photomicrographs. Few do not clearly make their point. The accompanying text is terse, interlarded by introductory paragraphs to the sections which are laid out broadly according to disease:congenital, trauma, infections, tumours, the abdomen, and miscellaneous. The emphasis is not on ‘tropical diseases’as taught in developed countries., but on trauma and the effects on standard, global diseasesof late presentation and poverty. Simple medical means are the norm-strong rum instead of methylated spirits; rainwater instead of distilled; spinal and ketamine anaesthesia (which can be managed single-handed) instead of inhalation general anaesthesia.The hardiness of the people of St Vincent, their tolerance of anaemia, hypertension and diabetes, and their healing capacity come over well. Appropriate operations feature strongly (‘gastrectomy would be a minitragedy in a people-accustomed to enjoying one big meal a dav’); and Dr Cvrus makes some nice slv digs at the n&use of sophisticated medical facilities in other countries, compared with the rewards of simple but meticulous clinical observation.
enzyme-linked immunosorbent assays in the study of snake bite. Toxicon, 24, 211-221. Lucas, S. (1988). Spiders in Brazil. Toxicon, 26, 759-772. Rees. R. S. & King. L. E. (1985). Theranv for brown recluse spider bites is dependent’on venom persistence. Clinical Research, 33, 302. Theakston, R. D. G., Lloyd-Jones, M. J. & Reid, H. A. (1977). Micro-ELISA for detecting and assaying snake venom antibody. Lancer, ii, 639-641. Vest, D. K. (1988). Emergent patterns in the occurrence and severity of probable hobo spider (Tegenuria agrestis) envenomation in humans. 9th World Congress on Animal, Plant and Microbial Toxins. Intentotional Sociew of Toxin&y, Stillwater, Oklahoma, 31 July5 August 1988. Abstracts, p. 31. White, J.,, Hirst, D. & Hender, E. (1989). 36 cases of bites by spiders, mcluding the white-tailed spider, Lampona cylindrata. Medical Journal of Australia, 150, 401-403.
Received 14 March 1990; accepted for publication 28 March 1990
Trauma is particularly well treated in the atlas: tendons severedby kingfish, human bites, kids falling from mango trees (in fright at being caught), nerve injuries from banana cutlass, extraordinary stab wounds, burns, and child abuse are all here. All the common tumours and their management problems are illustrated, and Dr Cyrus is not left behind in prevention either: 59% of skin squamous carcinomas in St Vincent arise from chronic ‘tropical ulcer’, so he regularly excisesand grafts ulcers, and seesa decrease in the incidence of carcinomas. The infection sectionsinclude osteomyelitis, orthopaedic aspects of tuberculosis, yaws, syphilis, lymphogranuloma venereum, amoebic colitis, intestinal obstruction and perforation by ascarids, and the ever-present bacterial abscesses.Fortunately, St Vincent doesnot suffer from the curse of schistosomiasis. Medicine in the tropics (not to be confused with ‘tropical medicine’) sometimesseemsto be a victim of polarized philosophies. On the one hand are the ‘low-tech’ public health and preventive strategies (standard vaccination, drains, education and breast milk). On the other are the molecular biologists who seek to interpret diseasethrough the T cell and wish to twist its arm. What is often stranded in the middle is classical, ‘medium-tech’ medicine and surgery, where careful observation, simple operations, knowledge of the local environment, and respectfor human wishes and dignity prevail. No sophisticated medical advice will eliminate most of the congenital defects, fractures, spear wounds! benign and malignant tumours, hernias, obstetric problems and the conseauencesof unquenchable, universal human silliness th& surgeons in-the tropics face daily. Three cheers for Dr Cvrus for illustratina ‘medium-tech’ medicine in the tropics for those -who have not had the opportunity
to witness
it first
hand.
S. B. Lucas