Book reviews

There is a History in all Mens Lives C . Illingworth. 145 x 210 mm. Pp. 125. Illustrated. Distributed by Tenovus-Scotland, Glasgow (a charitable trust for medical research in Scotland), 1988. W.OO.

Between the decades from the 1940s to the 1960s a remarkable phenomenon affected academic surgery in Scotland which has had repercussions to this day throughout Great Britain and many countries overseas and can be likened to the impact of Halsted on North American surgery. It had its origins in three men, all with comparatively modest backgrounds and all of them combatant participants in World War I. The three were James Learmonth of Gatehouse of Fleet, William Wilson of Edinburgh and Charles Illingworth of Halifax in Yorkshire. To the best of my knowledge they were between them responsible for producing 21 professors from their junior staff and indirectly responsible for creating many more in the next generation. Of the three, Sir Charles was by a short head the most prolific, creating what became widely and usually affectionately known as the ‘Glasgow Mafia’. This group have gone on to add great lustre to British surgery and many of them are mentioned in the pages of this short but appealing biography.

By his own admission, Sir Charles was not a high flyer at what he regards as an undistinguished school-Heath Grammar at Halifax. He left that institution during the first years of the War and eventually became a pilot in the Royal Flying Corps, being shot down behind enemy lines in the closing months of the War. After his return he went: almost by accident, t o Edinburgh University where he served some of the giants of the day, Wade and Wilkie in particular. From there he progressed to the Regius Chair of Surgery in Glasgow where by his zeal, industry and ability he created what became one of, if not the, most influential departments in the country. Here in this little book is a delightful account of the years of struggle and success; it is full of deft and felicitous phrases which show that Sir Charles has lost none of the sharpness of mind which those of my generation recall so well. For this reviewer, who pursued the same path from the same school (which I held in higher regard than Sir Charles) to the same university- though not thereafter to the heights achieved by the author- there is pleasant nostalgia in his description of both Yorkshire and Edinburgh life, and the author’s clarity of recall shames my own fuzzy memories. For a larger audience, the personal descriptions and vignettes, both from Edinburgh and Glasgow, will have an importance for future historians and make enjoyable reading, as does the author’s personal description of his heart operation.

This book is an account-albeit highly selective-of a surgically and personally outstanding life. It is a pleasure to acknowledge his continued health and vigour. His colleagues in the enterprise of academic surgery in Scotland will, from beyond the grave, salute him, though I would have welcomed a little recognition from him that he was part-perhaps the most important part-of a wider historical event.

H. A. F. Dudley

Proj’essor of Surgery S t . Mary’s Hospital Medical School London W 2 I N Y U K

Modern Surgery in Africa D. Pantanowit-. 170 x 242mm. Pp. 372. Illustrated. 1988. Wynberg Sandton: Southern Book Publishers. 75 SA Rands.

On the outskirts of the rich white city of Johannesburg is a black township called Soweto. Two million people live, love and fight there. It is a dormitory town to supply black workers for the homes, the shops, the mills and the mines of its parent city. Immediately outside the perimeter fence of Soweto is its one and only hospital. a phenomenon called Baragwanath. It was taken over from the British by the South African government in 1948 and now contains 2780 beds-the largest hospital in the southern hemisphere. It accepts patients not only from Soweto, but also from many of South Africa’s neighbouring black countries.

Baragwanath is the largest of the five teaching hospitals of the medical faculty of the University of the Witwatersrand (which, like most South African universities, has a policy of no racial discrimination-a policy that brings it into connict with the government from time to time). Serving the 500 or so surgical beds are 50 white and 23 black doctors. Half of the students are black, as are nearly all the nurses. About 45 000

surgical patients attend as outpatients every year, and 15000 are admitted. The precise number is not known, owing to a remarkable deficiency in what is otherwise a technologically advanced hospital: there is no systematic audit of any kind. A few surgical units have introduced personal computers, but for the most part the storage and retrieval of data about patients is purely manual.

This is the background from which a splendid book has been produced. It is called a textbook but it is far more than that. Written by 47 surgeons and skilfully edited by Desmond Pantanowitz, the book is beautifully illustrated by line drawings and photographs, and the references are comprehensive, many being as up to date as 1987. There are four sections, these being trauma, vascular, general and miscellaneous.

We tend t o think of AIDS as the scourge of Africa, but there is no mention of it in Baragwanath, and it seems to be much less important than trauma. ‘Approximately 10000 people die on our roads each year, and about 30000 lose their lives from assault’. The chapters on trauma are fascinating and, like the rest of the book, authoritative. Nowhere, however, can I find any reference to the rehabilitation of patients who have recovered, nor to the management of the disabled, nor indeed t o long-term follow-up after admission for trauma or operations.

There are useful accounts of diseases that are rare in western countries. These include not only idiopathic neurotrophic feet, Takayasu’s arteritis, carotid body tumours and plunging ranulas, but also the extraordinary range of diseases caused by the ministrations of the traditional healers-for instance, battery acid enemas. The chapters on appendicitis, ulcerative colitis and Crohn’s disease are thoughtful and reveal our ignorance of the reasons for their rarity at Baragwanath compared with ‘white’ countries. Throughout the book there are also clear instructions on the management of diseases that are common all over the world.

This is an eminently practical book, well presented and interesting. It will remain on my shelves and I will often consult it.

A. V. Pollock

Consultant Surgeon Scarborough U K

Acute pancreatitis G . Glazer. 180 x 238 mm. Pp. 440. Illustrated. 1988. London: Bailliere Tindall. €35.00.

This is an excellent overview on the state of the art concerning acute pancreatitis. The editors have won an impressive panel of experts including anatomists, pathologists, radiologists, internists and surgeons from the UK, the USA and one from Germany to report on all aspects of the disease, both experimental and clinical.

The book begins with a well-balanced analysis of the contentious issues in acute pancreatitis. Each of these controversies is then discussed in 16 well-illustrated and eminently readable articles. Each one begins with an illuminating historical introduction, thus putting the subject into perspective, and concludes with a complete and up-to-date list of references.

There are contributions on the anatomy of the pancreas (with all the numerous vascular and ductal variations), on the aetiology and pathology of pancreatitis as well as experimental models of the disease.

Three articles concern themselves with diagnostic assessment and prognostication. The value of CT studies with contrast application is well documented here by convincing illustrations.

The final five chapters deal with treatment and here all the evidence is in favour of early non-operative management. Surgical intervention is reserved for the diagnosis of unclear cases (a rare event nowadays) and the management of complications, including protracted and recurrent pancreatitis.

I would strongly recommend that anyone concerned with acute pancreatitis in the experimental laboratory. in the intensive care unit and in the operating theatre should buy this book.

M. Trede The Chairman Department of Surgery Mannheim F RG

Br. J. Surg., Vol. 75. No. 11, November 1988 1151