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Estonia, Latvia, and Lithuania, which are clamouring forindependence. Historically, these countries had a briefindependence from 1918 to 1940 after centuries of occu-pation by Germany, Poland, Sweden, or Russia. There isalso communal unrest in the predominantly Muslim regionsof Soviet Central Asia. Again, what can we in the West doto help President Gorbachev, whose survival is our besthope for peace in Europe?

MEDICALLY,THEREIS not much news. The slanging matchbetween the British Medical Association and Ministers ofHealth continues, with the patients as 'pigs in the middle'.A child has died from liver failure, although a liver was

Book Reviews

THE NATIONALMEDICALJOURNALOF INDIA VOL.2, NO.5

available for transplantation, because there was no suitablebed in Addenbrooke's Hospital in Cambridge. And sixdoctors were offered a balloon trip over Bath by a pharma-ceutical firm as part of a promotion for a new anti-histaminedrug for hay-fever. Five doctors accepted, and onerefused. Later the company said that the balloon trip hadbeen organized as a 'clinical meeting' to discuss the drug'squalities.? August is indeed the silly season.

REFERENCES1 Quote Unquote. The Independent, 26 August 1989.2 Erlichman J. The Guardian, 21 August 1989. '

JOHNBLACK

Child Health and Disease: A short textbook of clinicalpaediatrics. Bijon Kumar Chakraborty. New CentralBook Agency, Calcutta, 1986. 201pp, Rs 45.

I quote from the book's blurb: 'This clinically-orientedtextbook of paediatrics is a sincere and humble attempt toassist the students, both in the under-graduate and post-graduate levels, more so the over busy general practitionersand the para-medical staff .... This is no doubt a pioneeringattempt to dish out [sic] a textbook on clinical paediatricsboth by an author and a publisher from the eastern region.'Whereas such an attempt may be praiseworthy the end-product leaves much to be desired.

The space given to consideration of various systemicdisorders is not proportionate to their importance.Respiratory disorders are covered in 5 pages and those ofthe kidney and nervous system in 8 pages each. Liver dis-eases get 31 pages and haematology 27. Some importantconditions such as upper respiratory tract and urinarytract infections are not even mentioned. Two pages areunnecessarily given to smallpox vaccination and the samenumber to the much more important problem of bronchialasthma (under the title 'Wheezy child').

A peculiarity of this book is its reproduction of fulllength previously published journal articles in the chapterson liver diseases and haematology. The conclusions ofthese papers could have been summarized. and acknow-ledged at appropriate places in the text.

The postgraduate student will find little of use in thisbook, since other standard texts are available. The under-graduate student cannot use this book as a basic textbecause it does not discuss many important topics.

A large number of controversial statements have been

made, e.g. 'One should be worried more due to nomeconium passed after 24 hours instead of no urine'(p. 121); while performing peritoneal dialysis 'at everyfifth cycle, the abdomen is allowed to drain dry' (p. 103);'nephrotic syndrome is defined with the characteristicfeatures of massive proteinuria (5 g in 24 hours)' (p. 99).

There are a large number of black and white and elevencolour illustrations, most of poor quality and of littleimportance. Grammatical and spelling mistakes abound.This book will require major and extensive revision if it isto achieve its stated purpose. In its present form, I find itdifficult to recommend, despite its very low price.

R. N. SRIVASTAVA

Antibiotics.in the Tropics: Antibacterial therapy withlimited resources. S. Enenkel, W. Stille. Springer-Verlag,Berlin, 1988. 328pp, DM 98.

Infections are among the leading causes of morbidity andmortality in India, and they are often preventable by correctantibiotic therapy. To select the most appropriate com-pound, one must not only consider its spectrum of activityand the sensitivity of the organisms but also other factorssuch as cost and local availability. There is therefore aneed forclinicians to periodically update their knowledgeregarding antibiotic usage, particularly in areas of limitedresources.

In this book the authors have achieved their stated goalof endeavouring to narrow the gap between the 'haves'

BOOK REVIEWS

and the 'have nots'. They show that physicians in poorcountries can match the therapeutic results of those in thewestern world. The authors have managed to simplifychoices by listing a dozen commonly used compoundswhich make it possible to treat almost all bacterial infec-tions in a cost-effective manner.

The format and contents of the book are appropriate.There are chapters on both cure and prophylaxis withdetailed descriptions of antibiotic use for the ambulatoryand emergency care physician who works in rural clinicsand district hospitals. Modern concepts underlying thetherapy of infectious diseases have been incorporatedwherever necessary. The main weakness of the book liesin the paucity of data, which leaves it inadequate as asingle text on the management of infectious diseases. Italso does not sufficiently emphasize simple diagnosticprocedures like the Gram stain which remains the mostcost-effective first step for initiating antibacterial therapy.

This book will be useful to primary care physicians,medical students and residents. It will not fulfil therequirements of tertiary care practice where nosocomiallytransmitted infections are common and multiple drugresistant organisms occur when the patient is oftenimmunocompromized. In these situations more compli-cated considerations in antibiotic therapy are required.

The book is well organized and balanced in itsapproach, emphasizing also the treatment of fungal,parasitic and viral illnesses that we commonly encounterin practice. There is little emphasis on side effects anddrug interaction.

This book is comprehensive and noteworthy for itsaccurate, up-to-date useful information. The referencesare recent and the discussions appropriate. It has a pleasingappearance but, rather sadly, lacks figures and illustrations.

DILIP MATHAI

Congenital Diaphragmatic Hernia. Edited by P. Puri.S. Karger, Basel, 1989. 161pp, Rs 1280.

During the last two decades, congenital diaphragmatichernia (CDH) has attracted the attention of neonatologistsand anaesthesiologists because of the poor outcome ofbabies presenting with respiratory distress within the firsteight hours of life. Although interest in this subject isamply reflected in journals, a book was required tosummarize the present research. Such a book has nowbeen published with P. Puri as its editor.

This volume has 13 chapters contributed by 23 authorswho are all experts. The main strength of the book lies inits chapters on the development of the lung and ventilatorymanagement and blood gas changes in diaphragmatichernia. But, the chapter on management of CDH innewborns should have discussed operations more com-prehensively, especially the repair of large defects.Similarly, whether to place chest drainage tubes or not

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should have received detailed attention. In the chapter onprenatal diagnosis of diaphragmatic hernia the authorshave clearly outlined how to diagnose diaphragmatic herniabefore birth but they have not discussed whether prenataldiagnosis helps improve survival. The cost effectivenessof expensive, high technology gadgets such as highfrequency ventilation and extracorporeal membraneoxygenation needs to be examined closely.

The chapter on eventration of the diaphragm is wellwritten and brings together facts regarding itspathophysiology. There is a growing consensus that atten-tion should be paid to preoperative management and theauthor believes that surgery should be deferred until thepreoperative management is complete.

This book will be valuable to all those involved in thecare of children with diaphragmatic hernia. The book iseasy to read with a clear typeface and well-presentedphotographs. However, it is surprising that a publishinghouse of Karger's repute has overlooked spelling mistakesin the last chapter. For Indians the price is exorbitant.This 161-page book costs Rs 1280!

D. K. MITRA

Lecture Notes on Anatomy. D. B. Moffat. Indian Edition:Oxford University Press, New Delhi, 1989. 418pp, Rs 95.

The preface of this book states that 'this is not a textbookof anatomy and does not make any claim to completeness'.What it does claim, however, is to 'offer explanations ofthose parts of human anatomy which students most oftenfind difficult'. Unfortunately, the text consists mainly of atraditional factual account of various structures; thedescriptions are brief, often to the point of being sketchy.Here and there it does provide some interesting clarifica-tions and explanations, but these are lost in vast amountsof routine descriptions. Even some of the explanations,although traditional, are no longer acceptable: Forexample, Fig. 1.14 which describes the rotation of thelimbs during development; and Fig. 2.4(b) which explainswhy a carrying angle is present.

The general appearance of the book is reasonablyattractive. However, the typeface is rather small for abook of this kind. Most of the diagrams are well drawn,and their labelling clear, but some (for example those ofbones) are crudely shaded. The reproduction of Fig. 1.15is poor. The offsetting of the contents page also leavesmuch to be desired.

It is true that publishing costs are escalating sharply. _Even so for an edition that has obviously been reprintedfrom a pre-existing copy, and one that is only in black andwhite, the price is somewhat on the high side.

While teachers of Anatomy might find some points ofinterest, I doubt whether undergraduates-for whom ithas been primarily written-will find it of much value.

INDERBIR SINGH