Diseases of the Alimentary Tract

(Pp. xiii + 411; figs. 60. 60s.) London: William Heinemann Medical Books, 1963. THE appearance of this book is an important event. There has not been for many years a standard British textbook of gastroenterology, and recent attempts to supply one have not been so successful as one could have wished. The authoritative and massive three-volume work of Bockus is the stand-by of every gastroenterologist; but is not for the student, and perhaps not routine reading even for the M.D. candidate. There is little doubt that, for want of a convenient manual, the teaching and understandiing of alimentary diseases has not reached the standard attained in, for instance, cardiology, or neurology. Deficiency is most marked in the knowledge of the natural history of the alimentary diseases, and in treatment; so that the upper abdomen is the centre of more irrationality and obscurantism than any other system or organ. The book in your reviewer's opinion remedies the lack of a suitable textbook. It is a highly intelligent and discerning survey of gastroenterology in 1963. A satisfactory account of the clinical syndromes is given. The chapter on malabsorption is particularly good. Treatment is discussed realistically and in practical detail and these sections are truly helpful. Surgery is given its due place. The usefulness and limitations of special investigations are described and details of methods given in an appendix. The radiographs and diagrams are very good. The index is good. The print is agreeable. Gastroenterologists will be pleased that so much worthless digestive and abdominal folklore is openly condemned. What may most impress a reader unfamiliar with the new gastroenterology is the integration of medicine, surgery, radiology, clinical pathology and biochemistry in a majestic and beautiful discipline. The book is worthy of the subject. Per contra it is a pity that gastric and duodenal ulcer are considered together under the heading of peptic ulcer. Where these subjects are not separated, the reader has to read analytically if he is not to be confused. It is a pity, too, that in the just revolt against the uselessly restrictive diets of the past, the author should seem to abandon the formal prescription of food. There is only a single diet programme in the book-the gluten-free. The gastroenterologist's concern with food is mainly with obtaining optimum nutrition and with using maximum food to neutralise gastric acid, not with penitential or propitiatory deprivations. Precise advice about food need not imply restriction. General directions will not avail with most hospital patients-especially when the "lady next door" is only too ready to step into the place of the physician and the dietitian. Typhoid fever is not described, nor are worm infestations, though cholera rightly is. Five hundred milligrams of mepacrine t.i.d. for five days, for giardiasis, seems a very large dose for a child, but it may be that the doses of mepacrine hitherto used have been too small. Certainly in the case of a therapeutic test of a diagnosis, it is essential that the dose should be adequate and perhaps current dosage of mepacrine in giardiasis should be reviewed. J. s. L.