Oxford handbook of tropical medicine

TRANSACTIONS

OF THE ROYAL

SOCIETY

OF TROPICAL

MEDICINE

/ Lymphatic Filariasis. Tropical Medicine: Science and Practice, volume 1. T. B. Nutman (editor). London: Imperial College Press, 2000. viii+283pp. Price E16.00/ US$24. ISBN l-89094-059-5 This multi-authored compilation covers all aspects of lymphatic filariasis from the history of its discovery, to its biology, clinical manifestations, diagnosis, treatment, immunology, epidemiology and cor&ol. This book is the first in a series entitled Tronical Medicine. Science and Practice published by Imperial College Press. This series seems to plug a gap in the literature on tropical diseases which is mostly provided in a conventional textbook format where only minimal information on each disease is provided. Alternatives are considerably more expensive where the latest research is reviewed. The historical perspective on lymphatic tilariasis made interesting reading, peppered with quotes from eminent early workers on filariasis. The chapter entitled ‘Lymphatic-dwelling filariae’ gives a comprehensive review on the life-cycle, anatomy, and physiology, moving into some coverage of molecular development. I felt that with the advent of molecular techniques and the analysis of genomes, the tantalizing amount provided by this author could have been expanded somewhat, perhaps into its own chapter. The following chapter describes the population dynamics and epidemiology of the parasite and convinced me of the value of mathematical modelling in prioritizing research questions and methods of control. There are 2 chapters covering immunological aspects of the disease. One, entitled ‘Resistance to infection’, discusses the evidence for acquired resistance in human populations-this proved to be quite small due to the difficult nature of observational studies. The other chapter later in the book describes current controversies and covers the interesting questions currently challenging filarial immunologists. This chapter perhaps poses more questions than it answers, giving me many ideas to pursue. Chapters on the clinical manifestations and treatment give detailed descriptions of the disease and the appropriate surgical, nursing and chemotherapeutic regimens for each particular symptom. Diagnosis and control are extremely well covered in separate chapters. Finally the ongoing debate as to whether worms or bacterial infection cause the nathologv in tilariasis is discussed. It seems that at varidus poin& in history it has been thought that ‘infestation with Filaria bancrofti, perse produces no symptoms; all the pathological manifestations associated with filariasis are due to secondary infection by pyogenic organisms’ (as quoted by the British filariasis commission in 1924). Although many details of the pathogenesis in lymphatic filariasis are not understood, after reading this chapter it seems clear that both worms and microorganisms can be involved. My only minor criticism of the book, which perhaps would only be noticed by a reviewer reading the book in one sitting, was that there was some repetition between chapters. At El 6 this book is, in my opinion, a bargain and is an essential nurchase for all workers on lilariasis. It will also be of interest to all individuals working in the field of tropical diseases, or teachers of parasitology. I will certainly be purchasing future volumes in the series, quoted at present to include amoebiasis and schistosomiasis. I feel sure there will be many more titles.

J. E. Bradley Department of Biological Sciences University of Salford Salford MS 4wT, UK

AND HYGIENE

(2000) 94,350

Herbs, Health, Healers: Africa as Ethnopharmacological Treasury. P. A. G. M. De Smet. Berg en Dal: Afrika Museum, 1999. 180~~. Price not known. ISBN 90-71611-09-4. A treasury is what this book is. The author, a distinguished ethnopharmacologist, has dedicated it to the indigenous peoples of sub-Saharan Africa for their pharmacological and artistic creativity. The book contains a unique photographic record of medical instruments, practices, practitioners and conditions that convey the breadth of the African indigenous response to disease. Organized into 4 broad sections, it addresses images of illness; traditional healers and their skills; intoxicants and poisons; and an ethnopharmacological perspective on the contemporary relevance and potential of herbal medicines and the need to conserve medicinal plants. In an introductory volume of this scope, covering the disease burden of a continent across time, ethnicity, geography and climate, the author is clearly faced with a choice between breadth and depth. Breadth is the correct choice that has been made, with the text serving as a useful overview of the concepts and practices of African traditional medicine. The spiritual beliefs underlying theories of disease and of treatment in African traditional medicine are highlighted. The author delineates a range of other indigenous health practitioners including traditional midwives, herbalists, surgeons, orthopaedic practitioners and diagnosticians as well as the more widely known spiritual healers. De Smet discusses contemporary trends towards cooperation between modern and traditional health systems and records the willingness of traditional African health practitioners to share their own experience and to learn about Western medical concepts. This is particularly important in Africa today, where partnerships in managing the twin epidemics of AIDS and malaria may be the only way that effective healthcare coverage can be achieved. In Uganda, for instance, where there is only one doctor for every 20 000 people, there is one traditional health practitioner per 200-400 people. Clearly, partnerships not only make good public health sense but, based on the pharmacological insights that De Smet provides, may also yield important preventative and treatment modalities. One surprising inconsistency is that, while dedicating the book to ‘indigenous peoples’, the author refers to members of African ethnic groups throughout as ‘natives’-a colonial vestige not warranted in a work otherwise characterized by scholarship and sensibility. The uniqueness and strength of this book lie in the power of its visual images. Rare historic photographs, privileged insights into ritual practice, and sculptural images of disease, delivery and diagnosis make it a rich introduction to African health traditions for both the general and the medical reader. Gerard

Bodeker

Green College University of Oxford Oxford OX2 6HG, UK

Oxford Handbook of Tropical Medicine. M. Eddleston & S. Pier%. Oxford: Oxford Universitv Press, 1999. xx+646pp. Price E19.95. ISBN O-19-262772-4.. Many will be familiar with the popular Oxford Handbook series ofpocket-sized, plastic-covered books. These distinctive volumes occupy junior doctors’ and medical students’ pockets throughout Europe and North America, providing key information in the ward and emergency room. This excellent addition to the series aims to be similarly useful in hospitals and clinics in less-

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BOOK REVIEWS

developed countries, where most of the world’s sick are to be found. A pocket book that contains clinical information for use throughout the developing world is clearly an ambitious task. Inevitably, the outcome is a compromise but one that is likelv to be useful in practice. It draws together a variety of guidelines and information princinallv from the WHO and UNICEF but also the CDC. me World Bank and the Wellcome Trust. These reports; resources and algorithms, often so difficult to access where they are most needed, are printed together for the first time. They are blended with general notes about ‘tropical’ diseases and by almost as much general medicine. The latter sections are similar to selected pages from the Oxford Handbook of Clinical Medicine but have been somewhat adapted for the tropical setting. Much of this general medical information will be of limited use outside of teaching hospitals, and future editions may usefully focus more closely on the challenges of clinical diagnosis and improvised medical care where laboratory support and available medicines are limited. For example, those who have to recognize and manage ketoacidosis in a rural hospital will be little helped by the list of diagnostic features that do not mention dehydration and by the recommendation that K+ should be measured hourly. Empirical guidelines for the bedside diagnosis and care of this and other conditions, however imperfect, would be valuable to many who have to guess blood test results and blindly administer fluids and drugs. The balance of the book’s portability versus comprehensiveness seems reasonable in most respects, with pages on appendicitis and subdural haematomas but little other surgery and obstetrics limited to medical complications. Except for making malaria films, those looking for advice on laboratory procedures are referred to other sources. However, the inclusion of a formulary for WHO essential drugs would have been space well used and this omission could usefully be corrected in the next edition. References to the growing list of Internet sites useful for tropical medicine and parasitology diagnosis should also be added as web access alreadyreaches manv clinics that still lack libraries and laboratories. The 3 pages of gray pictures of malaria parasites will help little in their identification-colour printing would surely have justified the additional cost for this challenging subject and perhaps for the notes on rashes, too. This is not designed to be a text-book of tropical medicine and infectious diseases for use in the UK, where medical students and physicians may be better served by Lecture Notes on Tropical Medicine by Dion Bell, or the excellent pocket-sized Infectious Diseases Manual by David Wilks et al. However, it is a well-written and longoverdue resource for use in the tropics. I shall certainly be taking a copy with me for future work abroad and would strongly recommend this well-written book to others working in poorer countries. Carlton

to cover too much ground, and in some places is inaccurate and misleading. The first 45 pages are intended as a molecular biology primer, covering DNA and RNA structure, and introducing the reader to techniques such as polymerase chain reaction (PCR), DNA sequencing, recombinant DNA technology and vaccine development. The descriptions are in places unnecessarily complicated for the stated target audience, who do not need to understand the chemical structure of DNA, just how it replicates and what it does. Why include the Maxam-Gilbert chemical cleavage method for DNA sequencing, when it is hardly ever used? The explanations could have been assisted by better diagrams-on the whole these are difficult to follow. The remaining 140 pages deal with parasitic, bacterial and viral infections, and neoplastic and hereditary disorders, relevant to tropical medicine. In order to cover such a broad range of topics, each organism or disease receives around 6 pages of coverage, organized into sections on the clinical picture, pathology and immunology, diagnosis (including molecular techniques if available), and vaccine development. Here, the problems of one author trying to cover everything become very apparent. There are too many factual mistakes, for example a trypanosome life-cycle stage called a prometacyclic is discussed (some strange hybrid of two lifecycle stages, the procyclic and metacyclic), the malaria parasite species Plasmodium vivax is referred to throughout as a &, the descriptions of the ‘dipstick’ test for I? fulciparum seem to suggest that the test is for detection of early gametocytes, rather than the asexual blood stages associated with pathology. It is perhaps unfair to expect one person to be expert in so many fields (the author’s speciality is leprosy), but nevertheless such basic mistakes detract significantly from the quality of the product. Another unfortunate feature of the book is the enormous number of typographical and grammatical errors: on average 5 per page. These can lead to amusement, e.g., ‘gametocytes [of malaria parasites] move to the insect’s midget .’ [should be midgut], but they can also be very confusing, e.g., ‘through the action of RT [reverse transcriptase] the DNA [should be RNA] strand is converted into cDNA’. This is certainly not a book that I would recommend to students or those wishing to ‘brush up’ on their molecular biology, as it is factually incorrect and poorly edited. It is admirable that a single author has attempted such a wide-ranging book, and there is definitely a need for a simple text covering molecular biology relevant to tropical medicine. Unfortunately, in my opinion this book does not meet that need. Lisa C. Ranford-Cartwright Division of Infection and Immunity Institute of Biomedical and Life Sciences University of Glasgow Glasgow G12 8Q(2 UK

Evans

Hospital for Tropical Diseases Mortimer Market, Capper Street London WClE 6A U, UK

Tropical Molecular Medicine. M. G. Deo, New Delhi: Oxford University Press, 1999. xv + 192 pp. Price E17.50. ISBN o-19-564630-4. The objective of this book is to acquaint graduate medical students, physicians and basic biologists working in tropical medicine with recent advances in molecular medicine. The work is extremely wide ranging, covering not only tropical infectious diseases, but also cancer and hereditary disorders. There is obviously a great need for a basic, reasonably priced text covering this ground. Unfortunately this book suffers from attempting

Microbiology in Clinical Practice (3rd edition). D. C. Shanson. Oxford: Butterworth-Heinemann, 1999. xix+5OOpp. Price E29.99. ISBN o-7506-31 10-4. This established textbook has been revised, and those entering the infection specialities at a junior level should greet the appearance of the third edition with enthusiasm. The first edition of the book, published in 1982, was original, in that it was one of the first books primarily written for students and junior doctors to translate the core knowledge of laboratory microbiology to the bedside. This reflected the increasingly clinical nature of the practice of specialists in medical microbiology in the UK. The original layout has been retained in the new edition, although, like most textbooks, it seems to have grown considerably with each revision. The first section is devoted to essential background