Dictionary of Medical Ethics

Dictionary of Medical Ethics

310 Respiratory Failure. By M. K. Sykes, M. W. McNicol and E. J. M. Campbell. Published (1976) by Blackwell Scientific Publications, London. Pp. 461; ...

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310 Respiratory Failure. By M. K. Sykes, M. W. McNicol and E. J. M. Campbell. Published (1976) by Blackwell Scientific Publications, London. Pp. 461; illustrated; indexed. Price £11.50. Since the first edition of this book was published in 1969 there have been considerable changes in the treatment of respiratory failure. Experiences in intensive therapy units, improved laboratory services and the development of better monitoring equipment have increased understanding of the mechanisms causing respiratory failure and of the effects of treatment. The authors say in their preface that these advances have encouraged them to change the rather pragmatic style of the first edition to a more scientific approach. In so doing they have produced a lucid, authoritative and valuable addition to the literature. It must always be a considerable temptation, when writing texts of this nature, to extend the subject matter outside the remit of the title, usually to the confusion of the reader. This temptation the authors have avoided admirably. This is not a textbook of respiratory physiology, respiratory medicine or intensive care. It does, however, embrace all the aspects of these disciplines relevant to the cause, diagnosis and treatment of respiratory failure. The book falls into three sections. The first outlines the basic relevant physiology of the normal state and of respiratory failure. The second section deals in general terms with the principles of treatment and ranges from the clearance of secretions and oxygen therapy to the management of artificial ventilation. The third part of the book deals in more detail with the treatment of specific conditions and covers comprehensively the wide variety of states that can give rise to respiratory failure. There is a useful appendix dealing mainly with the derivation of respiratory equations. The book is copiously illustrated with easily understood line diagrams and graphs. A sad aspect of contemporary medicine that this book demonstrates is the present controversy on units of measurement. Throughout the book each equation is stated twice, in S.I. and in "old" units. This clumsy device is forced at present upon all authors of books such as this which will command worldwide sale. This book is a compendium of useful information, presented ia a logical, easily assimilated and easily retrieved form. The expert and the tyro will each derive much from it. The guidelines that it offers in the management of respiratory failure should lead to improved treatment of this common condition. C. M. Conway Dictionary of Medical Ethics. Edited by A. S. Duncan, G. R. Dunstan and R. B. Welbourn. Published (1977, paperback) by Darton, Longman and Todd Ltd, London. Pp. 336, Price £4.90. Do not be put off by the title of this book. It is not a dictionary in the ordinary sense of the word but a miniature encyclopaedia—a comprehensive collection of brief essays arranged alphabetically on every subject with even the remotest relevance to "medical ethics". The list of contributors—over 100 of them—reads like an abbreviated "Who's Who" in medical ethics. They are drawn from every stratum of intellectual activity; Medicine, Law, Theology, Business and many others are represented. Two anaesthetists are on the list also. Naturally, each author has a

BRITISH JOURNAL OF ANAESTHESIA personal view of the inevitably difficult moral and ethical problems involved in the subject he writes about. However, almost without exception, a fair and balanced view is presented for which not only the authors but also the Editors must be praised. The range of subjects is very wide. Thus, while such topics as the Rights of the Unborn Child, Confidentiality and Animal Experiments might have been expected, Transcendental Meditation, the Right to Strike and the Pharmaceutical Industry come as welcome and interesting surprises. Indeed, the searcher will find much, much, more. He will find, for example, brief but informative accounts of the attitude of the major world religions to the medical ethical problems of today, the Helsinki Declaration and a good deal about the E.E.C. Each entry is followed by a few references so that the subject can be followed up. The only notable omission is "Anaesthesia", and this is both surprising and disappointing. The ethical and moral position of one who deprives another of all sensation and consciousness, and who then holds their life in his hands, deserves some discussion. The position of the anaesthetist vis-a-vis his patient is unique. Although the surgical procedure is the therapeutic objective, it is sometimes forgotten that the anaesthetist is the guardian, both physical and moral, of the patient, and that he is the self-accepted instrument which permits injury and assault, however desirable that may be considered to be. The next edition will surely remedy such an obvious oversight. There can be no doubt that this book is outstanding and should be a personal possession of every doctor. How nice, and indeed how appropriate, it would be if every doctor was presented with one on qualifying. Not only can this book be consulted as a reliable authority, but it will provide endless hours of enjoyment and information, as straight bedside reading. William W. Mushin Applied Cardiovascular Physiology, 2nd edn. By G. R. Kelman. Published by Butterworths. Pp. 321; illustrated; indexed. Price £12.50. On the whole this book makes a favourable impression. For the most part it is well written, although most readers will pause over a sentence such as the following: "It is a well known physical principle that such periodic waveforms may be regarded as the sum of a constant term plus a series of sine waves (harmonics) of frequencies which are integral multiples of the frequency of the parent waveform (the fundamental frequency)." The accompanying diagram is equally unhelpful and it is surprising that an author who spells out in simple terms the anatomy and physiology of the autonomic system ignores the difficulty that many readers have with physics and mathematics. The provision of a few appendices does not solve this problem and, although the chapter on physical principles is well presented, the author has assumed a depth of knowledge in his readers that most examiners would refute. The chapters on the heart, on the peripheral circulation and its control, and on the regulation of cardiac output are good and deserve detailed study. Perhaps not surprisingly, the author is weakest when he deals with the effects of anaesthesia on the heart and it is unfortunate, to say the least, that he has chosen to disregard the pioneering contribution of Michael Johnstone to the study of cardiac arrhythmia during anaesthesia. Moreover, to assert that