The Vesico-vaginal Fistula

TREATMENT OF COMMON ACUTE POISONING. By Henry Matthew and A. A. H. Lawson. (Pp. vii+ 151. 16s). Edinburgh and London: E. & S. Livingstone, 1967. THIS concise well indexed book should be in the hands of all casualty officers. It is written by two general physicians who have had extensive experience of the treatment of acute poisoning at the Poisoning Treatment Centre at the Edinburgh Royal Infirmary. It gives clear if dogmatic instructions of what is needed in crises where often a life is at stake. There is a proper concern about the importance of prompt management of respiratory depression of shock and of the measures which should be taken to prevent further absorption of poisons. Many doctors still labour under the illusion that for each poison there is a specific antidote but in practice this is true in less than 2 per cent of poisoning episodes. The authors give a useful table which shows when forced diuresis or other methods of encouraging the elimination of poisons is useful and when it is not: the therapy is not without its dangers. If there is any criticism of the book it is that it omits to state that it is becoming increasingly common in our over medicated community for patients to take a number of different drugs at once when they attempt suicide. There is a brief but interesting account of the size of the problem acute poisoning accounts for up to 10 per cent of all medical admissions to some hospitals, a useful comment on the great reductions in mortality achieved by the successive introduction of the methods which now constitute the Scandinavian regime, and a helpful chapter on the psychiatric treatment of patients in whom so often attempted suicide is an anguished plea for help to a tortured mind. O.L.W.