PROBLEMS OF VISION IN FLIGHT

Clinical Toxicology: The Clinical Diagnosis anid TreatuneilI of Poisoning. By S. Locket, M.B., B.S., M.R.C.P. With special sections by W. S. M. Grieve, M.Sc., Ph.D., F.R.I.C., and S. G. Harrison, B.Sc. (Pp. 772+xii; illustrated. £5 5s.) London: Henry Kimpton. 1957. Most works on toxicology are written by experts in forensic medicine, pathologists, biochemists, or public-health officers who have little personal experience of treating cases of poisoning, or by pharmacologists whose experience is confined to animals and not to patients. This book is different in that it is written by a physician actively engaged in the practice of clinical toxicology and who admits patients suffering from poisoning to his acute general medical wards so that they are treated basically on the same lines and by the same sort of methods as are employed in standard medical practice, which is all to the good. Most of us should know more about poisoning than we do; for example, it has been estimated that in many countries the number of adult males requiring treatment for alcoholism vastly exceeds those in need of treatment for tuberculosis, yet in most medical schools a great deal of formal instruction is given on the latter condition and very little about the former. In England and Wales alone in 1953 there were 2,888 suicidal and 932 accidental deaths from poisoning, and probably at least 2% of all medical admissions to hospital are due to this cause. This book, which contains much useful information, is therefore to be welcomed, but unfortunately it is written in somewhat careless Englishsometimes in a florid, complicated style, and at others relapsing into a series of notes in the imperative tense. The subjects considered range over a wide field, and include industrial chemicals, agents used in warfare, venoms, poisonous plants, and therapeutic substances. Every necessary step in treatment is enumerated. The author states that the fear which most practitioners have of treating a case of poisoning is unjustified, since the therapeutic principles are simple. It must be confessed, however, that the directions which fol!ow for the management of a large number of emergencies are hardly calculated to allay the ordinary practitioner's misgivings, since the therapeutic agents advised are so seldom to hand, and he may well quail at the thought of continuing artificial respiration in a case of carbon monoxide poisoning till the patient recovers or is indubitably dead " because of the presence of rigor mortis." The text contains two sections written by experts on the identification of common toxic substances (arsenic and carbon monoxide are not included) and of poisonous plants. The work is handsomely produced with good illustrations and is well documented, but in the numerous references throughout the text the authors' names are printed in capitals, which serves no particularly useful purpose and gives the pages an unsightly appearance. D. M. DUNLOP.