- Email: [email protected]
Principles of medicine in Africa (2nd edition)
684
NUTRITION
AND
HEALTH
IN
FIRST
Watkinson, M., Lloyd-Evans, N. & Watkinson, A. M. (1980).The useof oral glucoseelectrolytepreparedwith untreated well water in acute non-specificchildhood diarrhoea.Transactions of the Royal Sociefyof Tropical
YEAR
OF
LIFE
ON
PACIFIC
ATOLL
World Health Organization(1972). The Health Aspects of Food andNu?Sm. (2nd edit.). RegionalOfficeJor.the E7e;n Pa&c of the World Health Organization,
Medicine and Hygiene, 74, 657-662.
Woodruff, A. W., Adamson, E. A., Asma El Suni, Maughan, T. S., Kaku, M. & Bundm, N. (1983). Infants in Juba,SouthernSudan:The first six monthsof life. Lancer, ii, 262-264.
Accepted for publication 29th October, 1984.
Book Review
ofMedicine in Africa (2nd edition). E. H. 0. Parry (Editor). Oxford: Oxford University Press, 1984; xii + 1119 pp., illus. ISBN: 0 19 261337 5. Price &45. This large textbook of medicine in an African environment is intended to provide students and practising doctors with basic information and an opportunity to “read a little more deeply and with adequate reference to original articles.” The editor has brought together 44 contributors-predominantly from Nigeria, Ghana, Ethiopia, Uganda, Kenya and Tanzania but also with contributions from Zimbabwe, Cameroon, Gambia and Sudan. There are a few chapters from British and Canadian workers with African experience. This is an extremely attractively produced book with references, diagrams and tables placed alongside the text wherever possible to make their origin obvious. The first few chapters (103 pages) make an important introduction to environmental aspects of health in the developing countries. Climatic effects, in particular heat and fluid loss, and the balancebetween the host, the invader and the climate are all briefly but clearly described. A good demographic chapter brings the movement of people to attention and also the movement of disease,as well as focussing attention on the critical role of customs, habits and beliefs. Food, agriculture and nutrition are covered in a useful section which could perhaps have given more spaceto the problems of famine relief, but there is good coverage of malnutrition and other nutritional problems. The role of animals in disease forms another chapter and snakes,not unreasonably, feature large in this section. I have discussed this opening set of chapters in some detail as it gives an indication of the nature of this textbook. It is attempting to present medicine in Africa from the inside, so that those who read it do not have to adapt what they are reading to that environment, as they have to do with texts written by expatriates and largely for expatriates. This is an ‘inside’ book, and that feeling is evident in every chapter and in every page of every chapter. Clearly, there is a large amount of material, particularly physiological, which will be found in non-African textbooks, but here it is integrated into the clinical fabric of the African scene. The next 6 chapters (325 pages) constitute a very well desiened book on infection in the African environm&t. Immunity, transmission, clinical features and treatment are covered in readable, clear essays followed by 72 short sections on specific problems, ranging from leprosy and tuberculosis, through sexually transmitted diseasesto viral, protozoal and hehninthic problems. Psychiatry and neurology (33 and 43 pages)are briefly but adequately covered and it is in chapters like these that the real undergraduate purpose of the book are achieved. The neurology chapter and that on fluid balance (21 pages) Principles
are good examples of the emphasis on physiology and the mechanismsof diseasewhich permeatesthe book. Most of the rest of the book (10 chapters) is devoted to organ systems, including the skin, rheumatology and endocrine/metabolic disorders. The chapter on the kidney is surprisingly brief (7 pages) given the importance of renal disorders in Africa but the other chapters are fuller and more satisfactory for undergraduate students. There are additional chapters on cancer and the pregnant patient and an excellent 50-page section on emergencies (shock, cardiovascular emergencies, acute respiratory distress, nervous system emergencies, metabolic derangements, blood transfusion). The chapter on essential laboratory requirements lists methods to be discarded and recommends alternatives! but many of these may be readily available in teaching and large district hospitals but not elsewhere. I have enjoyed reviewing this book but it would be a most unusual contribution that did not attract some criticism. The system of referencesis attractive but a more orthodox one would have saved some 300 pages and considerably reduced the cost of the book. The references are mainly up to 1980, with only a few extending to 1983. This may not matter a great deal to most undergraduates but to practising doctors and those concerned to explore specific problems in depth, this is a major disadvantage. In the main, this book achieves what it has set out to do, by providing a general medical textbook for undergraduates and doctors which is completely part of the African environment. It reads well, is clearly presented and has an excellent index. For any doctor from the developed countries going to work in Africa, this book provides a more intelligent and balanced view as well as a more practical vade-mecum, than most classical textbooks of tropical medicine. But is there really a place for monumental books of this kind within the present African scene? The editor is aware that “The goal of Health for All 2000” will be very hard to reach in Africa; it will certainly not be reached if those who deliver health care lack the necessary resources and books.” One thing seemscertain and that is that no medical student or practising doctor in Africa is going to be able to buy this book for personal use, and very few African libraries can afford to buy a copy. The English Language Book Society may eventually provide a means whereby this book can become more readily available, and even then it will not be a cheap book. Unless some means can be found to make books of this high quality and appropriatenessreadily available to those who read it, the considerable effort and dedication involved will have been wasted. In his new capacity as Director of the Wellcome Tropical Institute, Eldryd Parry will have an opportunity to find ways in which ‘distance learning’ in medicine in the tropics and tropical medicine can be put into practice. A. G. SHAPER
NUTRITION
AND
HEALTH
IN
FIRST
Watkinson, M., Lloyd-Evans, N. & Watkinson, A. M. (1980).The useof oral glucoseelectrolytepreparedwith untreated well water in acute non-specificchildhood diarrhoea.Transactions of the Royal Sociefyof Tropical
YEAR
OF
LIFE
ON
PACIFIC
ATOLL
World Health Organization(1972). The Health Aspects of Food andNu?Sm. (2nd edit.). RegionalOfficeJor.the E7e;n Pa&c of the World Health Organization,
Medicine and Hygiene, 74, 657-662.
Woodruff, A. W., Adamson, E. A., Asma El Suni, Maughan, T. S., Kaku, M. & Bundm, N. (1983). Infants in Juba,SouthernSudan:The first six monthsof life. Lancer, ii, 262-264.
Accepted for publication 29th October, 1984.
Book Review
ofMedicine in Africa (2nd edition). E. H. 0. Parry (Editor). Oxford: Oxford University Press, 1984; xii + 1119 pp., illus. ISBN: 0 19 261337 5. Price &45. This large textbook of medicine in an African environment is intended to provide students and practising doctors with basic information and an opportunity to “read a little more deeply and with adequate reference to original articles.” The editor has brought together 44 contributors-predominantly from Nigeria, Ghana, Ethiopia, Uganda, Kenya and Tanzania but also with contributions from Zimbabwe, Cameroon, Gambia and Sudan. There are a few chapters from British and Canadian workers with African experience. This is an extremely attractively produced book with references, diagrams and tables placed alongside the text wherever possible to make their origin obvious. The first few chapters (103 pages) make an important introduction to environmental aspects of health in the developing countries. Climatic effects, in particular heat and fluid loss, and the balancebetween the host, the invader and the climate are all briefly but clearly described. A good demographic chapter brings the movement of people to attention and also the movement of disease,as well as focussing attention on the critical role of customs, habits and beliefs. Food, agriculture and nutrition are covered in a useful section which could perhaps have given more spaceto the problems of famine relief, but there is good coverage of malnutrition and other nutritional problems. The role of animals in disease forms another chapter and snakes,not unreasonably, feature large in this section. I have discussed this opening set of chapters in some detail as it gives an indication of the nature of this textbook. It is attempting to present medicine in Africa from the inside, so that those who read it do not have to adapt what they are reading to that environment, as they have to do with texts written by expatriates and largely for expatriates. This is an ‘inside’ book, and that feeling is evident in every chapter and in every page of every chapter. Clearly, there is a large amount of material, particularly physiological, which will be found in non-African textbooks, but here it is integrated into the clinical fabric of the African scene. The next 6 chapters (325 pages) constitute a very well desiened book on infection in the African environm&t. Immunity, transmission, clinical features and treatment are covered in readable, clear essays followed by 72 short sections on specific problems, ranging from leprosy and tuberculosis, through sexually transmitted diseasesto viral, protozoal and hehninthic problems. Psychiatry and neurology (33 and 43 pages)are briefly but adequately covered and it is in chapters like these that the real undergraduate purpose of the book are achieved. The neurology chapter and that on fluid balance (21 pages) Principles
are good examples of the emphasis on physiology and the mechanismsof diseasewhich permeatesthe book. Most of the rest of the book (10 chapters) is devoted to organ systems, including the skin, rheumatology and endocrine/metabolic disorders. The chapter on the kidney is surprisingly brief (7 pages) given the importance of renal disorders in Africa but the other chapters are fuller and more satisfactory for undergraduate students. There are additional chapters on cancer and the pregnant patient and an excellent 50-page section on emergencies (shock, cardiovascular emergencies, acute respiratory distress, nervous system emergencies, metabolic derangements, blood transfusion). The chapter on essential laboratory requirements lists methods to be discarded and recommends alternatives! but many of these may be readily available in teaching and large district hospitals but not elsewhere. I have enjoyed reviewing this book but it would be a most unusual contribution that did not attract some criticism. The system of referencesis attractive but a more orthodox one would have saved some 300 pages and considerably reduced the cost of the book. The references are mainly up to 1980, with only a few extending to 1983. This may not matter a great deal to most undergraduates but to practising doctors and those concerned to explore specific problems in depth, this is a major disadvantage. In the main, this book achieves what it has set out to do, by providing a general medical textbook for undergraduates and doctors which is completely part of the African environment. It reads well, is clearly presented and has an excellent index. For any doctor from the developed countries going to work in Africa, this book provides a more intelligent and balanced view as well as a more practical vade-mecum, than most classical textbooks of tropical medicine. But is there really a place for monumental books of this kind within the present African scene? The editor is aware that “The goal of Health for All 2000” will be very hard to reach in Africa; it will certainly not be reached if those who deliver health care lack the necessary resources and books.” One thing seemscertain and that is that no medical student or practising doctor in Africa is going to be able to buy this book for personal use, and very few African libraries can afford to buy a copy. The English Language Book Society may eventually provide a means whereby this book can become more readily available, and even then it will not be a cheap book. Unless some means can be found to make books of this high quality and appropriatenessreadily available to those who read it, the considerable effort and dedication involved will have been wasted. In his new capacity as Director of the Wellcome Tropical Institute, Eldryd Parry will have an opportunity to find ways in which ‘distance learning’ in medicine in the tropics and tropical medicine can be put into practice. A. G. SHAPER