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Brain Function and Metabolic Disorders: Neurological Effects of Changes in Hydrogen Ion Concentration. By Wyke Barry. Published by Butterworth & Co. (Publishers) Ltd., London. Pp. 242. Price 50s.
BRITISH JOURNAL OF ANAESTHESIA
392
be required to spend a period working whole-time in the Department of Anaesthesia, while those who complete house appointments outside Nigeria should do so on their return. In the United States of America surgical residents spend one month in anaesthesia, but here twice as long would be more realistic. No one would pretend to train an anaesthetist in a few weeks, but with a carefully thought-out programme, basic principles can be taught, and important techniques mastered. It would certainly be better than the present system which solves the problem by ignoring it. This, of course, is only part of a wider problem. There is a need for a new specialty, which might be termed "outpost medicine", to consist basically of surgery and medicine, but including essential elements of anaesthetics, pathology, radiology, public health, etc., and also equipment maintenance. Whether any government can be persuaded to accept as specialists persons who have undergone such training, and to pay them accordingly, remains to be seen. AILEEN K.
ADAMS
Lagos* *Dr. Adams has now returned to Cambridge.
BOOK REVIEWS Drugs, Medicines and Man. By Harold Burn, M.D., F.R.S. (2nd edition, 1963). Published by Unwin University Books, London. Pp. 236; 10 figs. Price ISs. This book, which we reviewed encouragingly last year, has already gone into a second edition, this time as a paperback, 7.5. cheaper than previously. It is unchanged, save for a short chapter on The Thalidomide Disaster, and we welcome it a second time with this addition, which may go some way to rehabilitate doctors in the public esteem after that catastrophe. Professor Burn writes: ". . . there was no negligence. No previously discovered drug had been observed to produce such an effect, and no one had even suspected that a drug would produce such an effect, especially a drug of so simple a structure as thalidomide." Once again, we stress that this book, although purporting to be addressed to the layman, can be read with benefit, amusement and interest by all doctors, to whom we sincerely recommend it. We must, however, point out with regret that the imperfections against which we previously adverted are still upon its head. Thus, in the Index, which is quite inadequate, "Oliver Wendell Holmes" is still to be found under the O's (!), and in Chapter 10 the date of the isolation of morphine by Sertiirner is still given as "1803". So good a book deserved better treatment, and so sound
an author should be more careful of his reputation. After all, this book is going to be read, as it certainly ought to be, by many, all of whom will be intelligent and who have a right to be treated as such. M. H. Armstrong Davison Brain Function and Metabolic Disorders: Neurological Effects of Changes in Hydrogen Ion Concentration. By Barry Wyke. Published by Butterworth & Co. (Publishers) Ltd., London. Pp. 242. Price 50*. This book was originally intended to be a chapter in a larger work and is therefore in effect a review of the literature on this subject. As a bibliography and work of reference to those interested in the subject it will be invaluable. The author does attempt to review the literature critically but it must be said that, perhaps inevitably, he shows signs of commitment which might by some be regarded as detracting from the value for the interested reader. Too often the many references to his own work are to articles which are as yet unpublished. The reader is therefore unable to assess their merit. The book is pleasantly produced and represents, if the number of works to which reference is made is an indication of the time spent in reading and collecting them, many years of study by the author. T. Cecil Gray
Printed in Great Britain by John Sherratt & Son, Park Road, Aitrincham
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on June 5, 2015
inapplicable techniques. He must use the apparatus available in each hospital, and advise on the necessary minimal additions to this, as expense is a major consideration. The specialist would thus be able to give individual tuition to a few doctors at a time, and, particularly in mission hospitals where staff changes are relatively infrequent, I am convinced that the benefits would justify the effort involved. So far firms have been very willing to sell new equipment, but have made available no maintenance service whatsoever. Consequently many machines are lying idle which could fairly easily be made usable. I recently brought back into use three such machines, by minor adjustments. An instrument technician, therefore, would be a valuable person to accompany the anaesthetist on his travels. The long-term solution must be different. In countries as underdoctored as this, anaesthesia is low in order of preference. Dr. Farman rightly deprecates that British medical schools are neglecting undergraduate teaching in the specialty. Professor Shirley Fleming has no intention of allowing that to happen here, lest the scanty supply of candidates should cease altogether. But, in addition, postgraduates must be trained. All house officers in teaching hospitals should
392
be required to spend a period working whole-time in the Department of Anaesthesia, while those who complete house appointments outside Nigeria should do so on their return. In the United States of America surgical residents spend one month in anaesthesia, but here twice as long would be more realistic. No one would pretend to train an anaesthetist in a few weeks, but with a carefully thought-out programme, basic principles can be taught, and important techniques mastered. It would certainly be better than the present system which solves the problem by ignoring it. This, of course, is only part of a wider problem. There is a need for a new specialty, which might be termed "outpost medicine", to consist basically of surgery and medicine, but including essential elements of anaesthetics, pathology, radiology, public health, etc., and also equipment maintenance. Whether any government can be persuaded to accept as specialists persons who have undergone such training, and to pay them accordingly, remains to be seen. AILEEN K.
ADAMS
Lagos* *Dr. Adams has now returned to Cambridge.
BOOK REVIEWS Drugs, Medicines and Man. By Harold Burn, M.D., F.R.S. (2nd edition, 1963). Published by Unwin University Books, London. Pp. 236; 10 figs. Price ISs. This book, which we reviewed encouragingly last year, has already gone into a second edition, this time as a paperback, 7.5. cheaper than previously. It is unchanged, save for a short chapter on The Thalidomide Disaster, and we welcome it a second time with this addition, which may go some way to rehabilitate doctors in the public esteem after that catastrophe. Professor Burn writes: ". . . there was no negligence. No previously discovered drug had been observed to produce such an effect, and no one had even suspected that a drug would produce such an effect, especially a drug of so simple a structure as thalidomide." Once again, we stress that this book, although purporting to be addressed to the layman, can be read with benefit, amusement and interest by all doctors, to whom we sincerely recommend it. We must, however, point out with regret that the imperfections against which we previously adverted are still upon its head. Thus, in the Index, which is quite inadequate, "Oliver Wendell Holmes" is still to be found under the O's (!), and in Chapter 10 the date of the isolation of morphine by Sertiirner is still given as "1803". So good a book deserved better treatment, and so sound
an author should be more careful of his reputation. After all, this book is going to be read, as it certainly ought to be, by many, all of whom will be intelligent and who have a right to be treated as such. M. H. Armstrong Davison Brain Function and Metabolic Disorders: Neurological Effects of Changes in Hydrogen Ion Concentration. By Barry Wyke. Published by Butterworth & Co. (Publishers) Ltd., London. Pp. 242. Price 50*. This book was originally intended to be a chapter in a larger work and is therefore in effect a review of the literature on this subject. As a bibliography and work of reference to those interested in the subject it will be invaluable. The author does attempt to review the literature critically but it must be said that, perhaps inevitably, he shows signs of commitment which might by some be regarded as detracting from the value for the interested reader. Too often the many references to his own work are to articles which are as yet unpublished. The reader is therefore unable to assess their merit. The book is pleasantly produced and represents, if the number of works to which reference is made is an indication of the time spent in reading and collecting them, many years of study by the author. T. Cecil Gray
Printed in Great Britain by John Sherratt & Son, Park Road, Aitrincham
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on June 5, 2015
inapplicable techniques. He must use the apparatus available in each hospital, and advise on the necessary minimal additions to this, as expense is a major consideration. The specialist would thus be able to give individual tuition to a few doctors at a time, and, particularly in mission hospitals where staff changes are relatively infrequent, I am convinced that the benefits would justify the effort involved. So far firms have been very willing to sell new equipment, but have made available no maintenance service whatsoever. Consequently many machines are lying idle which could fairly easily be made usable. I recently brought back into use three such machines, by minor adjustments. An instrument technician, therefore, would be a valuable person to accompany the anaesthetist on his travels. The long-term solution must be different. In countries as underdoctored as this, anaesthesia is low in order of preference. Dr. Farman rightly deprecates that British medical schools are neglecting undergraduate teaching in the specialty. Professor Shirley Fleming has no intention of allowing that to happen here, lest the scanty supply of candidates should cease altogether. But, in addition, postgraduates must be trained. All house officers in teaching hospitals should