- Email: [email protected]
The granulomatous disorders
230
[Chapter 31’. Then comes Makerere, where the concentration of attention is on 1923, a year which marked the genesis of the training of medical assistants (Chapter 4). ‘Makerere’s medical students [in the 1930s and 1940s unlike the first East Africans to practise modern medicine] often came from privileged strata within colonial society’; in this chapter, especially, the author (who is not medically qualified) seems to have minimal understanding of what clinical medicine is all about. ‘The pursuit of nrofessional status’, ‘The transfer of power’- (events i-mmediately before and after Ugandan independence in 1962) and ‘ . . . doctors and a disintegrating state [i.e. Uganda]’ (especially that of the Amin years) are the headings given to Chapters 5-7, respectively. One of Iliffe’s underlying arguments is that ‘professionalism’ (which was closely associated with decolonization) has been misunderstood in East Africa (and other colonial territories); the ‘three branches of the modem medical profession Fe tells his readership are] medical administrators, hospital doctors, and private practitioners’-presumably in that order! To me, it seems ridiculous to purposely ignore the major contributions made by countless British doctors to under- and post-graduate medical education in Africa. Perhaps the author should have sought the opinion(s) of expatriates who had firsthand knowledge in, for example, the days of Makerere’s zenith in the 196Os, rather than rely entirely on (largely oral) evidence from African doctors. Without the British doctors, medical education and its ultimate products (many of whom are named in this book) could not have achieved the level of excellence in medicine and surgery that it has today and could not possibly have ‘got off the ground’, unless vast numbers of East African students had been sent to ‘westernized’ countries-in which case the orientation of their training would have been completely inappropriate. In summary, this is a lopsided (largely anti-colonial) version of a crucially important episode of medical history in Uganda (and to a lesser extent Kenya and Tanzania); it will (in my opinion) be of limited use to future (unbiased) historians who will require an overall picture of the development of medical education in East Africa. G. C. Cook The Wellcome Institute for the Histo y of Medicine 183 Euston Road London NW1 2BE, UK An Illustrated History of Malaria. C. M. Poser & G. W. Bruvn. New York and London: Parthenon Publishing Group, 1999. xv + 165~~. Price ~45.OOAXS75.00. ISBN l-85070-068-0. There is nothing more fascinating in the entire history of medicine than the story of the unravelling of the cause and management (including the bitter controversies involved) of Plasmodium spp. infection. The authors of this beautifully illustrated text (both neurologists [and therefore familiar with cerebral malaria] from Boston, USA, and Leiden, The Netherlands, respectively) have drawn from numerous sources to bring together 7 1 pages (most involving physicians/investigators or title pages of seminal works) of black-and-white illustrations (and 1 coloured plate; repeated in black and white) covering all aspects of the history of malariology. The text is divided into 7 sections: ‘Introduction ‘, ‘General history.. ‘, ‘ From swamp fever to the malarial parasite’, ‘The transmission of malaria’, treatment, prevention, and impact. ‘In many ways [say the authors in the preface], the history of malaria reflects the evolution of science and medicine over the centuries, from myth and superstition to a sound scientific basis.’ ‘The study of the history of malaria [they conclude] demonstrates the close involvement of many disciplines in the solution of a problem: botanists, pharmacists, and pharmacologists [the various treatments prior to quinine make fascinating
BOOK REVIEWS
reading]; geographers and explorers; epidemiologists and sanitarians; entomologists and veterinarians; historians, social scientists, and philosophers, as well as physicians and pathologists.’ It is exactly this multidisciplinary approach which made the formal discipline ‘tropical medicine’ so successful in its heyday! Being neurologists, the authors have attributed several clinical entities (including multiple sclerosis) to infection with this protozoan parasite; such hypotheses ignore much epidemiological evidence, and in my opinion would have been better left unsaid. There is excellent coverage of (what is probably) malaria in the ancient world and in pre-Columbian America, but the substantial literature on ‘ague’ and intermittent fevers in Britain-from the time of Thomas Sydenham (1624489), when ‘the bark’ was certainly available-is largely ignored in the early chapters. Most of the major dramatis personae in the exciting saga are portrayed, in the majority of cases both visually and biographically. There is a lo-page bibliography, 3 pages of names (with dates when known) of prominent individuals, and an index occupying 61 pages. Unfortunately, in my review copy 32 pages (i.e., pp. 49-80 inclusive) are, owing to a production error, duplicated. Despite that, the book is to be highly recommended to all historians ofmedicine, and anyone with an interest in one of the world’s most important and lethal diseases. G. C. Cook The Wellcome Institute for the Histo y of Medicine 183 Euston Road London NW1 2BE, UK The Granulomatous Disorders. D. G. James & A. Zumla (editors). Cambridge: Cambridge University Press: 1999. xii + 616~~. Price E130.00 (US8240.00). ISBN O-521-59221-6. To produce a multi-author book about diseases of different aetiologies on the basis of a common tissue response is an interesting challenge. I am not convinced, however, that this approach has been entirely successful. Although this new work contains some truly excellent contributions, the pathological thread that links the chapters follows a somewhat tortuous course which, on occasions, becomes lost amongst the large amount of clinical and pathological information. This is inevitable given the striking differences in the level of current understanding of the mechanisms of granuloma formation in different disease states. The first chapter describes the immunological events that occur during the formation of granulomas, and is followed by a classification of the granulomatous disorders and the definition of ‘a granuloma’. In many ways these latter topics should have been in the first chapter as they focus the reader’s attention on the central theme. The subsequent sections deal with a variety of different subjects from the imaging of granulomas, their electron microscopy to their microbiology, and are followed by reviews of diseases where granulomas occur, a list that ranges from infections to cancers. There are sections on granulomas in different locations such as the skin, eye and gastrointestinal tract. There is also a chapter on unexplained granulomas which addresses a difficult issue in pathology, the interpretation of granulomas in biopsy or tissue material when there is no identifiable cause or explanation. Some of the other authors have had considerable difficultv in keeping to the central theme. The pathology and evolution dfgranulomas is not well understood and it is difficult to nrovide exnlanations which fit in with the theme of the book. * The work is well produced and illustrated with specific pages of colour illustrations. A minor irritation is the large number of spelling mistakes in some chapters. Overall this book provides an interesting read and there are many good chapters that come close to justifying a book dedicated to an inflammatory response: the chapter
231
BOOK REVIEWS
on berylliosis is a good example. The section on leprosy carefully links the immunological events with both clinical and pathological features. However, at other times one wonders whether many of the authors might have preferred to have written their sections without the granulomatous theme. It will be interesting to see whether this can be addressed in a future edition. R. J. Hay Guy’s, King’s and St Thomas’ School of Medicine St John’s Institute of Dermatology Block 7, Basement St Thomas’ Hospital Lambeth Palace Road London SE1 7EH, UK Protozoa1 Diseases. H. M. Gilles (editor). London, etc.: Arnold, 1999. x + 707~~. Price E145.00. ISBN O340-74090-6. This is a large book-over 700 almost-A4-sized pages, 19 chapters, 52 contributors (some ofwhom are credited with their degrees, and some not). The diseases/parasites covered include malaria, babesiosis, trypanosomiases (African, American and Typanosoma rangeh), leishmaniases, toxoplasmosis, amoebiasis, Dientamoeba, giardiasis (the author uses the specific name Giardia intestinalis for the human form, instead of the arguably more correct G. duodenalis), balantidiasis, cryptosporidiosis, Pneumocystis (‘the weight of evidence now points to a fungal classification’), sarcosporidiosis, microsporidiosis, isosporiasis, Chilomastix (half a page: ‘no evidence’ of pathogenicity), the nasty free-living amoebae [my classification], and trichomoniasis. The largest section (nearly one-third of the book) is, not surprisingly, devoted to malaria. The trypanosomiases come second (164 pages) and the leishmaniases third (116 pages). The major sections start with interesting short histories. Descriptions of the organisms, their life-cycle, clinical manifestations, diagnosis, pathogenesis and pathology, epidemiology, treatment and prevention then usually follow, with some variations between chapters. There is a good index, covering nearly 20 pages (maybe about 4000 entries). The coverage is generally fairly detailed and comprehensive, and reasonably up to date. Numerous references are listed at the end of each chapter (although there are not many later than the mid-1990s: the leishmaniasis chapter is an exception; the editor writes, in the Preface, that the ‘book has had an unusually long gestation period’, which probably accounts for this). On the whole, the book is adequately illustrated (mainly with blackand-white photographs, including light -and electron microarauhs). What a nitv. though, that the nublishers did no: indulge in colour for Yap coy Fong’s drawings of the 4 ‘human’ species of Plasmodium, which occupy 4 whole pages. However, 4 chapters have no illustration at all. This may not be very serious with Dientamoeba, Zsospora and Chilomastix, but a chapter on amoebiasis with no picture of any kind seems rather bizarre. Even Leishmania is not granted a recognizable micrograph or drawing of the organism itself. Another omission which I personally regretted was the absence of any reference to the pioneering work of W. M. Hutchison on the transmission and coccidian nature of Toxoplasma. However, these are small points. Overall, this is a book-a good book-for clinicians in particular, and also for parasitologists who, like myself, need a ready source of reference on the clinical and pathological aspects of their favourite protists. It would not, however, be adequate on its own for use in diagnostic laboratories. John Baker clo The Royal Society of Tropical Medicine and Hygiene Manson House 26 Portland Place London WIN 4EY, UK
District Laboratory Practice in Tropical Countries. Part 1. Monica Cheesbroueh. Doddinsrton. Cambridgeshire: Tropical Health T&hnology, l?998: viii + 456~~. Price ElO.90 (surface post) or A19.00 (airmail). ISBN 9507434-4-5 [Also available from Cambridge University Press (E35.00; ISBN 0-521-6654771.1
This soft-backed book replaces the earlier Medical Laboratory Manual for Tropical Countries, which I have always considered an excellent book, and it was with interest that I received a copy ofthis new book to review. I have not been disappointed. Like its predecessor this book provides a large amount of up-to-date information, with colour plates, all aimed at those with the task of organizing and managing laboratory services and training staff in a developing country. The first 4 chapters, which take up a little under half the book, deal with the organization and staffing of a laboratory, quality management, health and safety, and the equipping of a laboratory. This section is very comprehensive and includes selection of tests, financial control, training and education, decontamination and discard methods, emergency first aid, methods for the preparation and standardization of reagents and the choice and use of equipment, amongst many other areas. It is well illustrated with black-and-white line drawings, and the use of clear Tables, Figures and charts makes even complex subjects such as predictive values of tests and the preparation of Standard Operating Procedures easy to follow. The last 2 chapters in this manual are large and are divided between parasitology and clinical chemistry. The parasitology chapter covers the classification, distribution and identification of all the major human parasites from different sites in the body. It has excellent colour plates within the text, an improvement over the old Manual, as well as black-and-white photographs and line drawings. As a diagnostic parasitologist I could find little to fault and feel that the methods and information given are the best available and most applicable to district practice. The clinical chemistry chapter is equally comprehensive and clearly set out with excellent summary charts for each of the tests covered. These include those for whole blood, serum and plasma, urine, faeces and cerebrospinal fluid. Different methods are given for these tests including manual techniques, kit tests, reagent strip tests and direct read out analysers, allowing readers to choose those appropriate to their own needs and resources. As previously, there are also excellent appendices giving useful information on reagent recipes, addresses and facts and figures such as chemical formulae and relative atomic masses. I cannot recommend this book highly enough. It is an excellent publication and everyone working in a tropical laboratory should have a copy. It also makes an excellent choice for all students who require a low-cost text book of medical parasitology or clinical chemistry and I certainly would recommend it to all those following a career in tropical medicine. I look forward to the publication of Part 2. J. E. Williams Deparnnent of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine Keppel Street London WClE 7HT, UK Sight and Life Manual on Vitamin A Deficiency Disorders (VADD). D. S. McLaren & M. Frigg. Basel: Task Force Sight and Life, 1997. xii+l38pp. Price not known. ISBN 3-906412-00-8. This invaluable 138-page manual on vitamin A deticiencv disorders (VADD) has been comniled bv 2 internationally recognized’authorities in the field. The achievements and respective backgrounds of Dr McLa-
[Chapter 31’. Then comes Makerere, where the concentration of attention is on 1923, a year which marked the genesis of the training of medical assistants (Chapter 4). ‘Makerere’s medical students [in the 1930s and 1940s unlike the first East Africans to practise modern medicine] often came from privileged strata within colonial society’; in this chapter, especially, the author (who is not medically qualified) seems to have minimal understanding of what clinical medicine is all about. ‘The pursuit of nrofessional status’, ‘The transfer of power’- (events i-mmediately before and after Ugandan independence in 1962) and ‘ . . . doctors and a disintegrating state [i.e. Uganda]’ (especially that of the Amin years) are the headings given to Chapters 5-7, respectively. One of Iliffe’s underlying arguments is that ‘professionalism’ (which was closely associated with decolonization) has been misunderstood in East Africa (and other colonial territories); the ‘three branches of the modem medical profession Fe tells his readership are] medical administrators, hospital doctors, and private practitioners’-presumably in that order! To me, it seems ridiculous to purposely ignore the major contributions made by countless British doctors to under- and post-graduate medical education in Africa. Perhaps the author should have sought the opinion(s) of expatriates who had firsthand knowledge in, for example, the days of Makerere’s zenith in the 196Os, rather than rely entirely on (largely oral) evidence from African doctors. Without the British doctors, medical education and its ultimate products (many of whom are named in this book) could not have achieved the level of excellence in medicine and surgery that it has today and could not possibly have ‘got off the ground’, unless vast numbers of East African students had been sent to ‘westernized’ countries-in which case the orientation of their training would have been completely inappropriate. In summary, this is a lopsided (largely anti-colonial) version of a crucially important episode of medical history in Uganda (and to a lesser extent Kenya and Tanzania); it will (in my opinion) be of limited use to future (unbiased) historians who will require an overall picture of the development of medical education in East Africa. G. C. Cook The Wellcome Institute for the Histo y of Medicine 183 Euston Road London NW1 2BE, UK An Illustrated History of Malaria. C. M. Poser & G. W. Bruvn. New York and London: Parthenon Publishing Group, 1999. xv + 165~~. Price ~45.OOAXS75.00. ISBN l-85070-068-0. There is nothing more fascinating in the entire history of medicine than the story of the unravelling of the cause and management (including the bitter controversies involved) of Plasmodium spp. infection. The authors of this beautifully illustrated text (both neurologists [and therefore familiar with cerebral malaria] from Boston, USA, and Leiden, The Netherlands, respectively) have drawn from numerous sources to bring together 7 1 pages (most involving physicians/investigators or title pages of seminal works) of black-and-white illustrations (and 1 coloured plate; repeated in black and white) covering all aspects of the history of malariology. The text is divided into 7 sections: ‘Introduction ‘, ‘General history.. ‘, ‘ From swamp fever to the malarial parasite’, ‘The transmission of malaria’, treatment, prevention, and impact. ‘In many ways [say the authors in the preface], the history of malaria reflects the evolution of science and medicine over the centuries, from myth and superstition to a sound scientific basis.’ ‘The study of the history of malaria [they conclude] demonstrates the close involvement of many disciplines in the solution of a problem: botanists, pharmacists, and pharmacologists [the various treatments prior to quinine make fascinating
BOOK REVIEWS
reading]; geographers and explorers; epidemiologists and sanitarians; entomologists and veterinarians; historians, social scientists, and philosophers, as well as physicians and pathologists.’ It is exactly this multidisciplinary approach which made the formal discipline ‘tropical medicine’ so successful in its heyday! Being neurologists, the authors have attributed several clinical entities (including multiple sclerosis) to infection with this protozoan parasite; such hypotheses ignore much epidemiological evidence, and in my opinion would have been better left unsaid. There is excellent coverage of (what is probably) malaria in the ancient world and in pre-Columbian America, but the substantial literature on ‘ague’ and intermittent fevers in Britain-from the time of Thomas Sydenham (1624489), when ‘the bark’ was certainly available-is largely ignored in the early chapters. Most of the major dramatis personae in the exciting saga are portrayed, in the majority of cases both visually and biographically. There is a lo-page bibliography, 3 pages of names (with dates when known) of prominent individuals, and an index occupying 61 pages. Unfortunately, in my review copy 32 pages (i.e., pp. 49-80 inclusive) are, owing to a production error, duplicated. Despite that, the book is to be highly recommended to all historians ofmedicine, and anyone with an interest in one of the world’s most important and lethal diseases. G. C. Cook The Wellcome Institute for the Histo y of Medicine 183 Euston Road London NW1 2BE, UK The Granulomatous Disorders. D. G. James & A. Zumla (editors). Cambridge: Cambridge University Press: 1999. xii + 616~~. Price E130.00 (US8240.00). ISBN O-521-59221-6. To produce a multi-author book about diseases of different aetiologies on the basis of a common tissue response is an interesting challenge. I am not convinced, however, that this approach has been entirely successful. Although this new work contains some truly excellent contributions, the pathological thread that links the chapters follows a somewhat tortuous course which, on occasions, becomes lost amongst the large amount of clinical and pathological information. This is inevitable given the striking differences in the level of current understanding of the mechanisms of granuloma formation in different disease states. The first chapter describes the immunological events that occur during the formation of granulomas, and is followed by a classification of the granulomatous disorders and the definition of ‘a granuloma’. In many ways these latter topics should have been in the first chapter as they focus the reader’s attention on the central theme. The subsequent sections deal with a variety of different subjects from the imaging of granulomas, their electron microscopy to their microbiology, and are followed by reviews of diseases where granulomas occur, a list that ranges from infections to cancers. There are sections on granulomas in different locations such as the skin, eye and gastrointestinal tract. There is also a chapter on unexplained granulomas which addresses a difficult issue in pathology, the interpretation of granulomas in biopsy or tissue material when there is no identifiable cause or explanation. Some of the other authors have had considerable difficultv in keeping to the central theme. The pathology and evolution dfgranulomas is not well understood and it is difficult to nrovide exnlanations which fit in with the theme of the book. * The work is well produced and illustrated with specific pages of colour illustrations. A minor irritation is the large number of spelling mistakes in some chapters. Overall this book provides an interesting read and there are many good chapters that come close to justifying a book dedicated to an inflammatory response: the chapter
231
BOOK REVIEWS
on berylliosis is a good example. The section on leprosy carefully links the immunological events with both clinical and pathological features. However, at other times one wonders whether many of the authors might have preferred to have written their sections without the granulomatous theme. It will be interesting to see whether this can be addressed in a future edition. R. J. Hay Guy’s, King’s and St Thomas’ School of Medicine St John’s Institute of Dermatology Block 7, Basement St Thomas’ Hospital Lambeth Palace Road London SE1 7EH, UK Protozoa1 Diseases. H. M. Gilles (editor). London, etc.: Arnold, 1999. x + 707~~. Price E145.00. ISBN O340-74090-6. This is a large book-over 700 almost-A4-sized pages, 19 chapters, 52 contributors (some ofwhom are credited with their degrees, and some not). The diseases/parasites covered include malaria, babesiosis, trypanosomiases (African, American and Typanosoma rangeh), leishmaniases, toxoplasmosis, amoebiasis, Dientamoeba, giardiasis (the author uses the specific name Giardia intestinalis for the human form, instead of the arguably more correct G. duodenalis), balantidiasis, cryptosporidiosis, Pneumocystis (‘the weight of evidence now points to a fungal classification’), sarcosporidiosis, microsporidiosis, isosporiasis, Chilomastix (half a page: ‘no evidence’ of pathogenicity), the nasty free-living amoebae [my classification], and trichomoniasis. The largest section (nearly one-third of the book) is, not surprisingly, devoted to malaria. The trypanosomiases come second (164 pages) and the leishmaniases third (116 pages). The major sections start with interesting short histories. Descriptions of the organisms, their life-cycle, clinical manifestations, diagnosis, pathogenesis and pathology, epidemiology, treatment and prevention then usually follow, with some variations between chapters. There is a good index, covering nearly 20 pages (maybe about 4000 entries). The coverage is generally fairly detailed and comprehensive, and reasonably up to date. Numerous references are listed at the end of each chapter (although there are not many later than the mid-1990s: the leishmaniasis chapter is an exception; the editor writes, in the Preface, that the ‘book has had an unusually long gestation period’, which probably accounts for this). On the whole, the book is adequately illustrated (mainly with blackand-white photographs, including light -and electron microarauhs). What a nitv. though, that the nublishers did no: indulge in colour for Yap coy Fong’s drawings of the 4 ‘human’ species of Plasmodium, which occupy 4 whole pages. However, 4 chapters have no illustration at all. This may not be very serious with Dientamoeba, Zsospora and Chilomastix, but a chapter on amoebiasis with no picture of any kind seems rather bizarre. Even Leishmania is not granted a recognizable micrograph or drawing of the organism itself. Another omission which I personally regretted was the absence of any reference to the pioneering work of W. M. Hutchison on the transmission and coccidian nature of Toxoplasma. However, these are small points. Overall, this is a book-a good book-for clinicians in particular, and also for parasitologists who, like myself, need a ready source of reference on the clinical and pathological aspects of their favourite protists. It would not, however, be adequate on its own for use in diagnostic laboratories. John Baker clo The Royal Society of Tropical Medicine and Hygiene Manson House 26 Portland Place London WIN 4EY, UK
District Laboratory Practice in Tropical Countries. Part 1. Monica Cheesbroueh. Doddinsrton. Cambridgeshire: Tropical Health T&hnology, l?998: viii + 456~~. Price ElO.90 (surface post) or A19.00 (airmail). ISBN 9507434-4-5 [Also available from Cambridge University Press (E35.00; ISBN 0-521-6654771.1
This soft-backed book replaces the earlier Medical Laboratory Manual for Tropical Countries, which I have always considered an excellent book, and it was with interest that I received a copy ofthis new book to review. I have not been disappointed. Like its predecessor this book provides a large amount of up-to-date information, with colour plates, all aimed at those with the task of organizing and managing laboratory services and training staff in a developing country. The first 4 chapters, which take up a little under half the book, deal with the organization and staffing of a laboratory, quality management, health and safety, and the equipping of a laboratory. This section is very comprehensive and includes selection of tests, financial control, training and education, decontamination and discard methods, emergency first aid, methods for the preparation and standardization of reagents and the choice and use of equipment, amongst many other areas. It is well illustrated with black-and-white line drawings, and the use of clear Tables, Figures and charts makes even complex subjects such as predictive values of tests and the preparation of Standard Operating Procedures easy to follow. The last 2 chapters in this manual are large and are divided between parasitology and clinical chemistry. The parasitology chapter covers the classification, distribution and identification of all the major human parasites from different sites in the body. It has excellent colour plates within the text, an improvement over the old Manual, as well as black-and-white photographs and line drawings. As a diagnostic parasitologist I could find little to fault and feel that the methods and information given are the best available and most applicable to district practice. The clinical chemistry chapter is equally comprehensive and clearly set out with excellent summary charts for each of the tests covered. These include those for whole blood, serum and plasma, urine, faeces and cerebrospinal fluid. Different methods are given for these tests including manual techniques, kit tests, reagent strip tests and direct read out analysers, allowing readers to choose those appropriate to their own needs and resources. As previously, there are also excellent appendices giving useful information on reagent recipes, addresses and facts and figures such as chemical formulae and relative atomic masses. I cannot recommend this book highly enough. It is an excellent publication and everyone working in a tropical laboratory should have a copy. It also makes an excellent choice for all students who require a low-cost text book of medical parasitology or clinical chemistry and I certainly would recommend it to all those following a career in tropical medicine. I look forward to the publication of Part 2. J. E. Williams Deparnnent of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine Keppel Street London WClE 7HT, UK Sight and Life Manual on Vitamin A Deficiency Disorders (VADD). D. S. McLaren & M. Frigg. Basel: Task Force Sight and Life, 1997. xii+l38pp. Price not known. ISBN 3-906412-00-8. This invaluable 138-page manual on vitamin A deticiencv disorders (VADD) has been comniled bv 2 internationally recognized’authorities in the field. The achievements and respective backgrounds of Dr McLa-