BMJ

Keeping Abreast Of The GutRecent Advances In Gastroenterology by Ian D. BouchierReview by: J. R. BennettThe British Medical Journal, Vol. 281, No. 6238 (Aug. 16, 1980), p. 506Published by: BMJStable URL: http://www.jstor.org/stable/25440993 .

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506 BRITISH MEDICAL JOURNAL 16 AUGUST 1980

repeat what is readily available in innumerable texts on the

same subject with the apparent justification of explaining the

events in atopic dermatitis. The reader who ploughs through the prolonged litany of immunological assays in children with

this disorder emerges with no idea of whether the authors intone

this as a duty or because they really believe that some of these

factors contribute to the pathogenesis of eczema. There is a

curious chapter entitled the "molecular property of allergens," in which the author omits any diagrams, despite the fact that

the book is largely designed for clinical readers. This and the

remaining chapters are either repetitive or too truncated to

serve as a comprehensive guide. Thus an extraordinary omission

in the chapter on drug sensitivity is the absence of any reference

to acetylator status in drug-induced systemic lupus erythema tosus?this is most important for defining the nature of drug

hypersensitivity. In all anthologies one has also to look for evidence of careful

orchestration by the series editors. In this respect this volume is

good in that the chapters are properly balanced and there is

little needless repetition of the same material by different

contributors. Even so, in a subject that is only just emerging from folklore to exact science it is important that the terminology

employed is properly defined and used with reasonable uni

formity. I was irritated, therefore, to find that the introductory

paragraph in the chapter on the "molecular properties of

allergens" used terminology that is logical but none the less at

variance with that employed in most other chapters in this book

?and, indeed, in other immunological textbooks. On balance,

however, it is rare to find a multiauthored book in which half

the chapters are not only excellently written but also surprisingly fresh and original. This volume shows that even in this crowded

specialty carefully chosen authors and topics may still produce a

worthwhile book.

A M Denman

Keeping abreast of the gut

Recent Advances in Gastroenterology. No 4. Ed Ian D Bouchier.

(Pp 347; ?16.) Churchill Livingstone. 1980.

The term "recent advances" is part of our vocabulary now, but

is often used sardonically to imply that many of the advances

are to be measured in paper and ink rather than in any real

contribution to patients' welfare. One journal even carries a

series of articles on "recent retreats" as a salutary antidote.

Nevertheless, as research, theoretical and applied, gallops

ahead, books are required which will act as bench-marks for

those whose bearings are temporarily lost, as reference sources

for students setting out in pursuit of knowledge, and as sum

maries of the present position in certain subjects. Nowhere is

this more necessary than in the boom area of gastroenterology? a specialty in which development and research are so rapid that

it threatens to undergo fission, the different segments and off

shoots of the gut each having its own specialists.

Particular gifts are required to present in 20 or 30 pages a

balanced analysis of important developments in a small segment

of a clinical specialty that will be readable and coherent as well

as up to date and comprehensively referenced. Professor

Bouchier clearly has an eye for contributors with such abilities,

for a careful reading of this volume shows that he picked no

duds. The editing has not been so severe that an individual

author's characteristics have been obliterated, but the presenta

tion is pleasantly uniform in style. The topics chosen for this 1980 volume show the main

aspects of gastroenterologists' endeavour in the preceding

decade. There is no chapter on the small bowel, which reflects

the slowing down in research after the great advances of the

'60s in understanding the digestive and absorptive function.

Coeliac disease does not even appear in the index. Indeed, less

than half the book is devoted to the alimentary canal, equal

Space being given to the liver and pancreas, the balance taken

up with a detailed review of the rapidly changing subject of

endoscopy (Paul Salmon) and the burgeoning specialty of

paediatric gastroenterology (Alex Mo wat and John Harries).

Every chapter is clearly written, but John Cumming's account of the colon comes ?out best for readability with its

touches of gentle humour. Each author has covered his topic

well; I found only one surprising omission?the absence from

the liver chapter of any discussion of endoscopie sclerosis of

oesophageal varices. The plentiful references are almost all

from the last five years. Robert Allan and W T Cooke limited

theirs to 197 in their comprehensive survey of inflammatory bowel disease "because of the exigences of space," though

J H Baron, M J S Langman, and C Wastell were less inhibited and ran up a score of 400 in covering stomach and duodenum

from physiological, epidemiological, and therapeutic stand

points. To be so up to date the book must have been produced

quickly, but Professor Bouchier's practical editorship has let

through only a few slips of spelling and typesetting. I recom

mend this volume to all who hope to keep abreast of the rapid and important developments in gastroenterology.

J R Bennett

Valuable for students

Companion to Clinical Medicine in the Tropics. A Adetuyibi.

(Pp 339; ?20 hardback, ?9-95 paperback.) Macmillan. 1980.

One of the problems facing an undergraduate medical student is

how to get a sense of perspective, an appreciation of the relative

importance of different diseases. In our medical schools students

still complain, often legitimately, that we concentrate too

much on rarities and too little on the common, less dramatic

disorders that they are likely to encounter in practice. In a

tropical region the problem is compounded by the lack of

emphasis given in most textbooks to the types of disease

prevalent in the community. As Professor Akinkugbe says in

his foreword, students often know more about frostbite or

multiple sclerosis (rare in Africa) than the major killers of

tropical countries?typhoid, tuberculosis, and tetanus. This is

one sound justification for Professor Adetuyibi's book. Another

is the shortage of clinical teachers and of beds for teaching

purposes in his own clinical school at Ibadan, and he has

chosen the written word rather than the extended use of

devices such as audiovisual aids. Throughout his book he

concentrates on practice rather than concepts, on the practical

steps of diagnosis and management of disease in a tropical

setting. As part of this approach he cites case histories in every

chapter; this might make up for a deficiency in clinical

experience and simultaneously encourage a problem-based

approach. This format succeeds, I believe, although there is a

tendency to repetition, and most sections would have been

improved by a little more basic information. If a student is to be

encouraged to think, to go on learning after qualification, and be

able to adapt to changing concepts, understanding of disease

processes is needed and this usually depends on a sound

grasp of physiology and biochemistry as well as pathology. It

should not be difficult to expand each section in this way

without destroying the overall format.

Professor Adetuyibi seems to have written the whole book

himself. This remarkable achievement shows a profound

knowledge across a broad range of subjects. Understandably, some chapters are better than others, and in those that I felt

competent to judge I found too many errors and some perpetua

tion of outmoded forms of diagnosis and treatment. To take a

few examples : practolol is recommended in various parts of the

book despite its withdrawal in the United Kingdom on grounds of safety ; provocation of hypertension as a test for phaeochromo

cytoma should surely have been abandoned; some of the

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