Reviews and notices of books

lnstructional Course Lectures. Volume XXIV, 1975 I n this excellent handbook we have the distillation of the The Americaii Acadeniy of Orthopaedic Surgeons. 280 x 2/5 mnr. experience of at least 20 experts in the field. The available data PD. 328. with 669 illiistrations. 1976. London: Kimaton. f14. have been collected, catalysed and leavened into a firmly THIS book lives up to its preface in that it presents a wide- ranging and seemingly random selection of topics. The content, however, is extremely interesting and many of the ‘lectures’ are but poorly covered in standard textbooks.

Because of the immense detail in some quite narrow fields, it is difficult to criticize individual chapters. Some, such as the chapters on stroke patients, cover a wide if rather, neglected topic, while others, such as the chapter on peroneal spastic flatfoot, cover a much narrower field in some detail.

The book makes excellent reading for all grades of ortho- paedic surgeons. For the juniors, all the chapters have a great deal to offer, while for more senior surgeons who may have well-formed ideas of their own on some of the topics, there is the opportunity to contrast their own views with others, as well as to learn a considerable amount about more general and perhaps less popular subjects to which they may not have given adequate attention in the past.

This book is an essential for the library in any institution where orthopaedics is taught at postgraduate level. It probably will not be bought by individual students as the cost and rather specialized topics make it something of a luxury item.

DAVID F. PATON

Atlas of Surgical Operations Robert M . Zollinger and Robert M . Zollinger j u n . Fourth edifion. 355 x 260 mm. Pp. 932, with 184 illusrmfions. 1975. London: BailliPre Tindall. f 2 7 . THE fourth edition of this well-known work returns to a single volume which contains most of the two volumes of the third edition suitably amended and brought up to date. The book is written primarily for the young American general surgeon doing his residency programme. It therefore contains details of most of the commonly performed abdominal surgical pro- cedures, but very few of even the most common specialized operations. Urology is omitted, so that operations such as nephrectoniy and prostatectoniy, which are commonly performed by general surgeons here, are not mentioned. Neurosurgery is excluded, and even emergency post-traumatic craniotomy is not mentioned. Thoracotomy is described but no intrathoracic operations are given. On the other hand, there is a large section o n gynaecological procedures.

The general layout of the book is excellent. There is a short description of each operation and its indications on the left hand page and excellent drawings of the various steps of the operation on the right hand page.

The book will be of use to surgical trainees, and of some limited value to the established surgeon who is called upon to do an operation which he performs only rarely. The work is essentially a reference book and at f27 it is unlikely that it will be bought by many individual surgeons. However, it should be in the possession of every surgical library.

A. R . HIRT

Control of Hospital Infection. A Practical Handbook Edited E. J . L. Lowbirry, G . A . J . Ayliffe, A. M . Geddes and J . D . Williams. 225 x 155 mm. Pp. 306 t x i . 1975. London: Chapman & Hall. f8 .50. AT last, a complete and reliable guide to the control of hospital infection. The emphasis is on practical control, and this is where many earlier publications have fallen short. Like reluctant virgins confronted with naked truths these shyly theorize, approach the problem tangentially and finally baulk at a firm choice of action, but the history of control of cross- infection reads like a detective story and its micro-criminals are never caught without resolute and positive action. An apt quote from that ace of detectives, the incomparable Sherlock Holmes, explains the nature of the dilemma: ‘It is a capital mistake to theorize before one has data.’ Perhaps this is why Control of Hospital Infection by Lowbury et al. succeeds where others have faltered, and consequently why it should be required reading in every hospital claiming, or clamouring for, a control of infection programme.

realistic and practical recipe-for control by four principals, each of whom has justifiably earned international renown for his research on vital aspects of the subject. The value of their particular contribution lies less in any academic approach than in their immense practical experience. It is this that they draw upon to formulate effective and thoroughly up-to-date control, casting aside old rituals, correcting techniques and systematiz- ing administration so as to provide hospital authorities every- where with a complete set of workable solutions to problems that will continue to plague them. Readers will note in par- ticular the expert classification of isolation for patients and the clearly defined unequivocal directions set against individual diseases. Perhaps the most striking aspect of this publication is that despite the multifarious complexities of the problems dealt with, it defies serious sustained criticism. The acid test of the value of this type of handbook usually lies in a close examination of the information and directives put forward under specialized headings such as sterilization, disinfection and cleaning. It is here in particular that the informed critic will find his arrows and darts flightless and his knives with no edge. ‘Best treatments’ are clearly outlined along with suitable alternatives, not only for day-to-day requirements such as care of the operator’s hands, but also for such complexities as the disinfection of ventilators and dialysis machinery. All aspects of asepsis and hygiene are covered, whether in the operating theatre or in the hospital laundry. There is the customary statement on the importance of domestic staff to control of hospital infection, but in this instance it is properly emphasized by a clear definition of their duties and responsibilities. This is supplemented with the provision of specific directives to domestic superintendents on how best to organize and supervise this most indispensable of contributions to any control of infection programme-good housekeeping.

If a note of criticism is justified it must relate to the chapter on the use of antibiotics and chemotherapeutic agents. This is the only part of the book which might be said to be restricted to the prescribing doctor. Therefore from the viewpoint of other readers it is unnecessarily long and, particularly in relation to sensitivity tables, irrelevant. As an aid to therapeutic practice it will not compete with the more complete manuals dealing solely with this subject and for which there is no substitute for the doctor seeking skill in antibiotic usage.

The authors promise a revision of this neat handbook. When the time comes to implement this promise it is to be hoped that such revision will not produce a bulky expansion, for the real value of this publication lies in its concise readability for all grades of hospital staff.

H. G . SMYLIE

Procedures in Vascular Surgery Chilton Crane and Richard Warren. Second edition. 2 8 0 ~ 215 mm. Pp. 206. Illustrated. 1976. Boston: Little Brown. No price given. DURING the fifteen years since the first edition of this descrip- tive atlas appeared the speciality of vascular surgery has established itself as one of the busiest and least esoteric parts of the practice of large general hospitals everywhere. The great advances of the 1960 era are mostly accepted and common- place, and have been put into their true perspective in the practice of the seventies. Crane and Warren maintain the fine tradition of critical excellence for which the surgical depart- ments of the Harvard school have been famous since Cushing and before. With a true sense of the immediate, and like a great general away from the military academy, the text plunges almost at once into the crucial maneuvre of the arrest and control of a leaking abdominal aneurysm, in fine clear prose that makes the occasion come to life. The rest of the text is set in this strong key. Principles are laid down that establish a sure foundation for good practice and a fertile field for the many developments that the second edition of this book both includes and promises for the future. The diagrams are clear and really helpful. There are no references, and none is needed.

H. H. G. EASTCOTT

838