BOOK REVIEWS - Europe PMC

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Sep 28, 1974 - Foundation of Thanatology. It consists of edited versions of papers given by multi- disciplinary investigators and practitioners at a convention ...
BRITISH MEDICAL JOURNAL

28 SEPTEMBER 1974

813

BOOK REVIEWS The Difficulties of Dying disciplinary investigators and practitioners at a convention which covered most aspects of drug usage in terminal illness and bereavement. There are too many contributions to allow individual comment, but this is as well because the book makes its impact as a whole rather than in parts. One lesson of special importance is that treatment, of whatever kind, should be individual to the patient. Each patient has his own life situation, his own Dersonality, and his own pain. Adequate management often makes it possible for a patient to do more than just stay alive. The section on drugs contains a sincere account of the use of hallucinogenic drugs in depressed, anxious, and isolated dying patients. Statistically acceptable benefit did result and the consumption of narcotic drugs was reduced. The initial horror that I felt at the idea of the sensorium being distorted in this way rapidly disappeared when I reflected on the distortion that pain and fear bring, along with the changes brought about by the "acceptable drugs" whose use we do not question. There is clearly much research to be done in this area, and the present climate of clinical practice in Britain

makes it unlikely that much will be done here. The contribution on bereavement is particularly useful. Time and time again the point is made that normal grief is not a disease and that sedatives and tranquillizers do not help the working out of the situation. However, depression does occur, and can be treated effectively. Failure to do so is no more or less a failing than the excessive use of drugs in those who do not need them. The concluding section, on research, soberly sets out the problems to be solved, and the need for supervision of ethical standards. Inevitably there is a good deal of repetition, and many of the papers are no more than vague humanitarian statements. For myself, I dislike the term "thanatology;" it separates the care of the dying from the remainder of medicine and encourages the feeling that the subject is taboo. It is a subject in which all doctors should specialize, and this book can be recommended to any member of any health profession who wishes to re-examine his attitudes. Unlike so many books about drugs this one deals with the context for their proper use.

Textbook of Environmental Physiology. 2nd species to special environments. The edn. G. Edgar Folk, jun. Ph.D. (Pp. 465; kangaroo rat can concentrate salt to 7 % double the salt concentration of sea water £830.) Henry Kimpton. 1974. -and urea to 23% (2 2% and 60o respectively for man). It could, presumaibly, survive Current interest in the environment has on sea water, though it never sees the sea. made appropriate the publication of a second Camels can tolerate over 27% loss of body edition of this book. Though intended pri- weight during dehydration, 12-14% loss marily for science graduates who have being the limit for other species. They have studied mammalian physiology, it has a much a mechanism for excreting urea into the wider appeal, since it deals with topics such rumen and recycling the nitrogen rather than as biological rhythms, high pressure in air excreting it. The bottle-nose whale can and water, hibernation, ape-men, the earth's breath-hold for 120 minutes and dive to resources, and atmospheric pollution, as well 3.000 feet (914 m), where it is subject to a as adaptation to cold, heat, and altitude. pressure of 100 atmospheres. Seals can An intriguing feature for the medical breath-hold for 15-40 minutes, and have a reader will be the adaptation of various mechanism whereby blood flow can be

virtually cut off from active muscles during diving and confined to the central nervous system. The book can be criticized for an inadequate treatment of the subject of solar radiation and its effect on the thermal environment. It is not widely realized that the energy flux per square metre of horizontal surface in conditions of strong sunlight may reach values over one horse power, and that, even in heavy overcast, the incoming shortwave radiation is one fifth of the clear sky value. Too little attention has been paid to this important aspect of the thermal environment by environmental physiologists and architects alike.

Psychopharmacological Agents for the Terminally Ill and Bereaved. Ed. Ivan K. Goldberg, Sidney Malitz, and Austin K. Kutscher. (Pp. 339; £6 50.) American University Publishers. 1974.

Every practising doctor is faced at some time with the problems of the dying patient and the difficulties of the bereaved relatives. Most of us, providing we are humanitarian and able to learn from our experiences, ultimately function reasonably well in this situation. However, some dying patients are rejected by attendants and family, some have to endure greater mental and physical suffering than is necessary, and many bereaved people do not get effective help when they need it. Modern undergraduate curricula recognize these shortcomings and the importance of the problem, and because it is hard to give clinical instruction in the care of the dying and the bereaved every new text on the subject must be welcomed, if only as a substitute. This book is edited by faculty menmbers of Columbia University associated with the Foundation of Thanatology. It consists of edited versions of papers given by multi-

R. A. WOOD

Adaptation

L. G. C. PUGH

Background to Health Though this is well recognized in occupational health practice, the paramount importance of these factors has only gradually come to be aippreciated in other branches of the practice of medicine. Also, at this time, There can be no doubt that social and when the over a century old concept of environmental factors play a major role in public health is passing into history and the causation of most disease conditions. being replaced by the wider ranging

Environmental Medicine. Ed. G. Melvyn Howe, Ph.D., and John A. Loraine, F.R.C.P.E. (Pp. 271; £6-50.). Heinemann. 1974.

discipline of community medicine, it is significant that this new book describing recent advances in environrmental medicine should be published. It is a salutary reminder to the innovators of the valuable contribution environmental studies will continue to make to the health of the public. The environment is under oonstant inter-