Hoffmann's double frame external anchorage

Book Reviews to be compared with ‘Recent Advances’ because chapters such as those dealing with water electrolytes, or the management of shock, contain nothing new to those who undertake the care of severely injured persons. The chapter on the so-called shock lung is admirably frank about our ignorance of this condition and it also deals sensibly and clearly with what can usefully be done to manage it. While this book will appeal in some parts to readers seeking a general picture of current practice, and in others to those wanting a summary of recent advances, it offers little to those who may turn to it for a comprehensive and balanced treatment of the many conditions that are part of so-called trauma: fractures and minor injuries are not dealt with at all. The book has far too many spelling mistakes for one from the house of Thomas, who must regret as much as any of their readers the noticeably lower than usual standard of paper; this has reduced the value of some of the reproductions of X-ray appearances, and two illustrations are upside down. Even for today the book is rather expensive, and the reader who refers to it in a library is less likely to be disappointed than he who buys it himself. P. S. LONDON Drug Resistance in Antimicrobial Therapy. By E. J. L. L~WBURY, MA, DM, FRCPath, MRCP, Bacteriologist MRC Industrial Injuries and Burns Unit, Birmingham and G. A. J. AYCLIFFE,MD, MRCPath. Scientific Staff, MRC, Consultant Bacteriologist, Hospital Infection Research Laboratory, Birmingham. 9) x 6& in. Pp. 216. 1974. Springfield, Illinois, C. C. Thomas. The science of microbiology, like that of immunology, has developed so rapidly over the past decade that we have grown accustomed to find that our ‘ general ’ medical journals are almost unreadable and that even the correspondence cohunns are packed with highly technical ‘ letters to the editor’ which are virtually articles in their own right. But the importance of all this literary and scientific effort falls into perspective when one reads this volume which is a model of clarity and common sense, as one would expect from the pens of the two authors who are both distinguished bacteriologists in the Hospital Infection Research Laboratory in Birmingham. They described clearly the ways in which drug resistance can develop and be transmitted. They explain the difficulties of measuring drug resistance in v&o and correlating the laboratory findings with the clinical response to antimicrobial therapy. They also demonstrate the very serious dangers of the injudicious choice and use of the various compounds that are now available to the clinician. The emergence of resistant bacterial infection and its effective control by antimicrobial therapy depend on a proper understanding of four factors: the drug, the pathogen, the host and the environment. In this context the environment is the hospital and, as we are

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all painfully aware, much illness, mostly mild but occasionally fatal, is due to infection by bacteria acquired in hospital. We must therefore not only plan our new hospitals well but define as a matter of urgency the rational indications for combined chemotherapy, the restriction or rotation of certain antibiotics and the place of prophylactic chemotherapy. Excellent recommendations for such an antibiotic policy are given in the last chapter. Unless this kind of action is taken, the patient’s only hope of survival may be to follow the advice of a distinguished Professor of Medicine who used to warn his students ’ I always say that you have to be fighting fit to go into a Teaching Hospital ‘. Unfortunately, some bacteria must have taken note of this exhortation, for resistant strains no longer confine their attention to the so-called ’ centres of excellence ‘. M. N. TEMPEST

Hoffmann’s Double Frame External Anchorage. By DR HENRY CONNES, Chief Resident, Montpellier Hospital. 8&x6 in. Pp. 120 with 67 illustrations. 1973. Paris, Gead. FF 90. Dr Connes has written a comprehensive monograph on the use of external fixateurs, as practised at Montpellier University in Professor Vidal’s department. An extremely stable, double-frame Hoffmann apparatus is used, and great ingenuity is demonstrated in its application at various sites. The author demonstrates the versatility of the apparatus which allows reduction of the fracture, compression, simple maintenance of the reduction, or distraction. Its great stability allows early mobilization of joints or early ambulation. The convenience of bone grafting, skin grafts and a variety of wound treatments in the presence of the external stabilizers is stressed. The author recommends that these external fixateurs are most suited for severe destructive open fractures of the leg, particularly when external fixateurs are the only means available for limb stabilization and salvage. This indication is in keeping with the experience of many other authors. This type of stabilization is also well suited for the treatment of infected non-union. For arthrodesis of joints the knee is ideally suited to this type of compression arthrodesis which is more stable and provides better compression than the Charnley apparatus. Its use is also advocated for the shoulder and in certain cases of open dislocation and open articular fractures. The reduction of pelvic symphysial diastasis can also be achieved, but the method seems unnecessarily complex. Cross-leg skin flaps can be efficiently immobilized with greater comfort to the patient and easier access to the flap than using plaster-of-Paris methods. An excellent, comprehensive bibliography is appended. Unfortunately the author is not well served by the translation, which frequently taxes the reader’s ingenuity. Nevertheless, the English reader will be rewarded for his persistence. N. D. REIS