Oxford Handbook of Tropical Medicine.

Oxford Handbook of Tropical Medicine 

Michael Eddleston and Stephen Pierini. Oxford University Press, New York, 672 pages.

In judging a new textbook, one is initially influenced by the authors' reputation and qualifications. The authors of this Oxford Handbook, Michael Eddleston and Stephen Pierini, are listed on the front cover, but their names do not appear again. In the introduction, these mystery authors tell us that the Oxford Handbook of Tropical Medicine was written to answer a need for a soft-cover, pocket-sized (18 x 10 x 2.5 em), inexpensive, lightweight (300 grams) handbook of clinical medicine in the tropics for "junior doctors" who work in the developing world, where few laboratory tests are available and technical and human resources may be lacking. This book was written in collaboration with World Health Organization (WHO) staff, as evidenced in the acknowledgments, in which no fewer than 22 WHO consultants appear, as well as the foreword by David Heymann, Executive Director, Communicable Diseases, WHO.

So what's in this handbook, and how is it organized? The first 16 pages make up the introduction, which briefly covers such topics as WHO's Essential Drugs Programme, outbreak investigations, universal and isolation precautions, and integrated management of childhood diseases. The next section (160 pages) covers five major infectious disease areas (malaria, HIV and sexually transmitted diseases, tuberculosis, diarrheal diseases, and acute respiratory infections). Except for the section on fevers and systemic signs, the rest of the book is systems based, coveting most internal medicine topics, including cardiology, chest medicine, renal diseases, gastroemerology, neurology, dermatology, endocrinology, hematology, nutrition, injuries and poisoning, and immunization. Each section spas 30-50 pages of very small print, for which those of us over 40 will need the assistance of a magnifying glass.

Before we tell you what we thought of the book, let us point out two refreshing features. The authors ask that readers provide comments and criticisms for improving future editions. (This is a clue as to the identity of the authors.) The second is the authors' expectation that readers would and should adapt the book for local conditions. To this end, they have included blank pages throughout the book for the reader to add and modify treatments and diagnostic tests as necessary.

This book focuses on diseases, both infectious and non-infectious that are seen in tropical developing countries and on therapies that are available there.

You will not find imipenem, moxifloxacin, insulin pumps, or even culture and sensitivity data. Drugs recommended may not always be ideal, but they are likely to be available locally. Another major feature of the infectious disease section is the liberal use of excellent WHO algorithms, which are particularly useful for the inexperienced physician.

Disease descriptions are concisely written and organized with a section on etiology/life cycle, clinical features, diagnosis, management, and control. Most diseases are summarized in one page or less, except for major diseases such as malaria, tuberculosis, and HIV. A good part of the book is problem-based, by symptoms, and this is by far its major strength. This problem-oriented approach is ideal for the rural developing world, where "medicine by intuition" is often practiced, and clinical skills, knowledge, and judgment are all that may be available for disease management.

The major infectious disease sections and the one on nutrition are excellent. The systems sections are very good but somewhat lacking in perspective. Differential diagnoses are always listed, but the inexperienced physician may have some difficulty sorting out the top five conditions to be considered. Clearly, these vary in different parts of the world (hence the blank pages), but there are common problems everywhere that tend to head most lists. We particularly loved the section on how to do a burr hole, complete with diagrams (a worthwhile technique to practice on your teenage children).

We were a bit disappointed that Bacille Calmette-Guerin vaccine was covered in only seven lines, that bed nets were not mentioned for malaria control, that typhoid was not included in the differential diagnosis of lymphocytosis or prolonged fever, that short-course therapy was not recommended for typhoid fever, and that tinidazole or single-dose metronidazole were not suggested for invasive amebiasis. In addition, the book is somewhat inconsistent about which diagnostic tests are recommended: on the one hand, bacterial cultures are almost never available in rural areas of the tropics, but little emphasis is given to presumptive treatment. On the other hand, in the nephrology section, the authors surprisingly recommend an autoantibody screen and complements, urine pH, and calcium levels.

Enough of nitpicking. The bottom line? This is an excellent first edition of a handbook of tropical and internal medicine for the rural practitioner. It is a comprehensive, concise, well written, and (for the most part) practical handbook that provides a wealth of information on diagnosis, treatment, and decision making. We recommend it highly for medical students, residents, and even infectious and tropical disease consultants planning to work in the tropics or to care for patients from the tropics.

Given their level of training, the authors have done a remarkable job. We have decided, on the basis of the following clues, that the authors of this handbook are probably medical residents, or "registrars" in the British system. First, the book is dedicated to their parents rather than their spouses, so they are probably young and unmarried. They acknowledge their "long-suffering mentors, David Warrell and David Theakston," who send "fresh-faced medical students out to remote comers of the world ..." This book was almost certainly written by "kids," recent medical students who had an international health experience during training. In this world of academic medicine, it is a shame that credibility is accorded only those who have more initials after their names than in their names. We should judge an excellent book such as this one by its contents and not by the prestige of its authors. As Butch Cassidy said to the Sundance Kid, "Who are those guys?" In this case, it doesn't matter.

Rani Beharry(*) and Jay S. Keystone([dagger])

(*) Royal College of Surgeons in Ireland, Dublin, Ireland; and ([dagger]) University of Toronto, Toronto, Canada