Handbook of Treatment of Acute Poisoning

D. Adams, M.D. (Pp. x + 270; figs. 47. 32s. 6d.) Edinburgh and London: E. & S. Livingstone, 1958. IT has only been in comparatively recent years that the position of muscular dystrophy as a clinical entity has been seriously challenged by the discovery that a somewhat similar clinical picture may be seen in polymyositis, dermatomyositis, and scleroderma. The authors, who have based their monograph on a comprehensive review of the literature (some twelve pages of references are given) and upon a series of forty cases of their own, note that before the year 1948 in no instance was a pathological diagnosis of polymyositis made in a patient without clinical evidence of skin involvement. Classification presents a difficulty for a syndrome in which muscular wasting and weakness -may be uppermost in one case, skin changes prominent in another, and in a third both features and more pronounced evidence of collagen disease seen. They propose that these cases should be grouped under four headings: 1, Polymyositis, sub-acute and chronic, occurring in childhood, early or late adult-life (in this group the disease is confined to muscles); 2, polymyositis with associated collagen disease or dermatomyositis, in which skin changes are minimal; 3, severe collagen disease with only light muscular weakness; 4, polymyositis in association with malignant disease, e.g., primary bronchial carcinoma. In six of their cases pseudohypertrophy of muscles was present. In distinguishing polymyositis from muscular dystrophy they emphasise the clinical frequency of dysphagia and involvement of the neck muscles in the former condition. The book is well illustrated with colour photographs of skin lesions and the pathological section is very fully dealt with by Dr. Raymond Adams. There are chapters on investigation by laboratory and electromyographic procedures and a short chapter on treatment. Evidence, however, that successful results follow cortisone or A.C.T.H. treatment is not very convincing, but the inclusion of full clinical details of the forty cases in the appendix is a valuable point, and the book serves a useful purpose in reviewing the present state of knowledge in relation to these diseases. R. S. A.