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Dictionary of medical ethics
BOOK REVIEWS
Handbook of Percutaneous Central Catheterisation. By Michael Rosen, Ian Latto
219 Venous
and W. Shang Ng. First Edition. Pp. ix+ 134 with 172 illustrations. (Philadelphia, London, Toronto: W. B. Saunders Company, 198 1). Price E6.95. The technique of percutaneous central venous catheterisation is widely practised but often in circumstances which preclude detailed instruction of trainees in the finer points of the technique used. The trainee is left to cull what information he can on the anatomy and practical details of techniques from widely different sources. This book serves a useful purpose in bringing together in one volume most of the available techniques with a full discussion of their relative merits and disadvantages and those of the types of cannulae currently available. The insertion of Swan-Ganz flotation catheters is also discussed. The first three chapters of the book are concerned with the choice of vein and general aspects of techniques including the prevention of complications. The chapter on equipment is particularly useful to the beginner and is well illustrated with very clear line drawings. The chapter on practical technique contains some X-ray photographs which illustrate the correct and incorrect positioning of catheters although it is unfortunate that the one showing a’ Swan-Ganz catheter is cluttered by a number of ECG leads. There follow chapters on each of the major routes for central venous cannulation: arm, subclavian, internal jugular, external jugular and femoral veins. These chapters describe in detail the various approaches adopted by different workers and contain all the information one requires before, preferably with supervision, embarking on the practical procedures. The anatomy of and approaches to the various veins are described and well illustrated with line drawings and, where appropriate, photographs and the chapters include tables which summarise the success rates and associated with the various techniques complications described. These tables are backed up by an extensive, although not exhaustive, list of references. If one is forced to criticise a generally excellent book it is on minor points such as the lack of emphasis on the dangers of producing a pneumothorax if cannulation of jugular and subclavian veins is attempted during positive pressure respiration unless the patient is disconnected from the ventilator during the actual passage of the needle; or on the point that holding the catheter hub below the level of the right atrium will only be effective in preventing air embolism if the catheter is full of liquid. Some diagrams would have been useful to illustrate the skin tunnelling techniques for removing the skin puncture from the point of entry to the vein. This is a well produced and excellently illustrated book which deserves a place on the shelves of any library that serves those whose lot it is to care for the critically ill. It is to be strongly recommended to those whose operating theatres or intensive care units are lucky enough to have a case of “emergency” reference books because its format makes it invaluable as a quick reference source. Equally it will repay more leisurely study particularly by the novice to whom it presents a well balanced introduction to the art of central venous catheterisation. D. J. DYE
Dictionary of Medical Ethics. Edited by A. S. Duncan, G. R. Dunstan and R. B. Welbourn. Second Edition. Pp. xxxi+459. (London: Darton Longman and Todd, 1981). Price i12.50. The title of this book is somewhat misleading and this may possibly explain why the first edition, published in 1977. was not more widely known. It is more a compendium than a dictionary in the true sense of the word. The need for this kind of source book is obvious now that the attitudes of modern society are changing fast and many individuals and pressure groups are challenging the ethical and moral foundations of medical practice. The three editors are distinguished in different fields: A. S. Duncan, Emeritus Professor of Medical Education in the University of Edinburgh was formerly a Professor in Obstetrics and Gynaecology: G. R. Dunstan is Professor of Moral and Social Theology at Kings College, London and R. B. Welboum is Professor of Surgery at the Royal Postgraduate Medical School in London. They are supported by 148 well chosen contributors who have helped them provide brief authoritative statements on a whole range of subjects which have moral or ethical implications. These include such topics as for example abortion, animal experiments, attempted genetic euthanasia, suicide, engineering, eugenics, contraception, determination of death, confidentiality, spina psychiatry, misuse of, human bifida, psycho-surgery, experiments and even cosmetic surgery to name but a few. Each entry presents the scientific basis of the matter under discussion, lists the relevant background information and discusses the ethical issues dispassionately. Each contribution is the work of a named expert who is well qualified to deal with the particular item under discussion. Like all good books of reference it is a source book that will stimulate every research worker to read more widely and critically. It is also a book to dip into during moments of leisure, to have with you at your bedside or take on a journey. For those of us who may find ourselves involved in the medical equivalent of “Any Questions” this background information will help us to justify our answers with a great deal more conftdence and authority. The volume also includes in full all the International Declarations of the World Medical Association, the Nuremburg Code and the Hippocratic Oath, information that is not readily available in any other text. ‘Ibis is a book which deserves a very wide readership and I, for one, am very grateful indeed to the publishers for sending us this little masterpiece to review. MICHAEL N. TEMPEST Handbook of Total Parenteral Nutrition. By John
P. Grant. Pp. 197 with 64 illusrtations. (Philadelphia and London: W. B. Saunders Company, 1980). Price ~10.00. Dr Grant justifies his book by saying “There was an apparent need for a reference source which presented a workable ‘cook-book’ approach to parenterai nutrition as well as a review of pertinent past and ongoing research material to answer specific questions and to guide further investigation for the nutritional enthusiast”. This exceedingly long sentence, devoid of punctuation may leave the reader feeling rather breathless. Fortunately, it is not typical of the rest of the book. In fact the text is easy to follow and generally free from the verbosity that is sometimes mistaken for “style” in scientific writing. The text is easy to
Handbook of Percutaneous Central Catheterisation. By Michael Rosen, Ian Latto
219 Venous
and W. Shang Ng. First Edition. Pp. ix+ 134 with 172 illustrations. (Philadelphia, London, Toronto: W. B. Saunders Company, 198 1). Price E6.95. The technique of percutaneous central venous catheterisation is widely practised but often in circumstances which preclude detailed instruction of trainees in the finer points of the technique used. The trainee is left to cull what information he can on the anatomy and practical details of techniques from widely different sources. This book serves a useful purpose in bringing together in one volume most of the available techniques with a full discussion of their relative merits and disadvantages and those of the types of cannulae currently available. The insertion of Swan-Ganz flotation catheters is also discussed. The first three chapters of the book are concerned with the choice of vein and general aspects of techniques including the prevention of complications. The chapter on equipment is particularly useful to the beginner and is well illustrated with very clear line drawings. The chapter on practical technique contains some X-ray photographs which illustrate the correct and incorrect positioning of catheters although it is unfortunate that the one showing a’ Swan-Ganz catheter is cluttered by a number of ECG leads. There follow chapters on each of the major routes for central venous cannulation: arm, subclavian, internal jugular, external jugular and femoral veins. These chapters describe in detail the various approaches adopted by different workers and contain all the information one requires before, preferably with supervision, embarking on the practical procedures. The anatomy of and approaches to the various veins are described and well illustrated with line drawings and, where appropriate, photographs and the chapters include tables which summarise the success rates and associated with the various techniques complications described. These tables are backed up by an extensive, although not exhaustive, list of references. If one is forced to criticise a generally excellent book it is on minor points such as the lack of emphasis on the dangers of producing a pneumothorax if cannulation of jugular and subclavian veins is attempted during positive pressure respiration unless the patient is disconnected from the ventilator during the actual passage of the needle; or on the point that holding the catheter hub below the level of the right atrium will only be effective in preventing air embolism if the catheter is full of liquid. Some diagrams would have been useful to illustrate the skin tunnelling techniques for removing the skin puncture from the point of entry to the vein. This is a well produced and excellently illustrated book which deserves a place on the shelves of any library that serves those whose lot it is to care for the critically ill. It is to be strongly recommended to those whose operating theatres or intensive care units are lucky enough to have a case of “emergency” reference books because its format makes it invaluable as a quick reference source. Equally it will repay more leisurely study particularly by the novice to whom it presents a well balanced introduction to the art of central venous catheterisation. D. J. DYE
Dictionary of Medical Ethics. Edited by A. S. Duncan, G. R. Dunstan and R. B. Welbourn. Second Edition. Pp. xxxi+459. (London: Darton Longman and Todd, 1981). Price i12.50. The title of this book is somewhat misleading and this may possibly explain why the first edition, published in 1977. was not more widely known. It is more a compendium than a dictionary in the true sense of the word. The need for this kind of source book is obvious now that the attitudes of modern society are changing fast and many individuals and pressure groups are challenging the ethical and moral foundations of medical practice. The three editors are distinguished in different fields: A. S. Duncan, Emeritus Professor of Medical Education in the University of Edinburgh was formerly a Professor in Obstetrics and Gynaecology: G. R. Dunstan is Professor of Moral and Social Theology at Kings College, London and R. B. Welboum is Professor of Surgery at the Royal Postgraduate Medical School in London. They are supported by 148 well chosen contributors who have helped them provide brief authoritative statements on a whole range of subjects which have moral or ethical implications. These include such topics as for example abortion, animal experiments, attempted genetic euthanasia, suicide, engineering, eugenics, contraception, determination of death, confidentiality, spina psychiatry, misuse of, human bifida, psycho-surgery, experiments and even cosmetic surgery to name but a few. Each entry presents the scientific basis of the matter under discussion, lists the relevant background information and discusses the ethical issues dispassionately. Each contribution is the work of a named expert who is well qualified to deal with the particular item under discussion. Like all good books of reference it is a source book that will stimulate every research worker to read more widely and critically. It is also a book to dip into during moments of leisure, to have with you at your bedside or take on a journey. For those of us who may find ourselves involved in the medical equivalent of “Any Questions” this background information will help us to justify our answers with a great deal more conftdence and authority. The volume also includes in full all the International Declarations of the World Medical Association, the Nuremburg Code and the Hippocratic Oath, information that is not readily available in any other text. ‘Ibis is a book which deserves a very wide readership and I, for one, am very grateful indeed to the publishers for sending us this little masterpiece to review. MICHAEL N. TEMPEST Handbook of Total Parenteral Nutrition. By John
P. Grant. Pp. 197 with 64 illusrtations. (Philadelphia and London: W. B. Saunders Company, 1980). Price ~10.00. Dr Grant justifies his book by saying “There was an apparent need for a reference source which presented a workable ‘cook-book’ approach to parenterai nutrition as well as a review of pertinent past and ongoing research material to answer specific questions and to guide further investigation for the nutritional enthusiast”. This exceedingly long sentence, devoid of punctuation may leave the reader feeling rather breathless. Fortunately, it is not typical of the rest of the book. In fact the text is easy to follow and generally free from the verbosity that is sometimes mistaken for “style” in scientific writing. The text is easy to