Book Review

Oxford Textbook of Pathology

N Engl J Med 1993; 328:1503May 20, 1993

Article

Oxford Textbook of Pathology
Edited by James O. McGee, Peter G. Isaacson, and Nicholas A. Wright. 2344 pp. in three volumes, illustrated. New York, Oxford University Press, 1992. $295. ISBN: 0-19-261976-4

My first perusal of this three-volume textbook, which was compiled by a team of some 150 British pathologists and strengthened by a few continental and transatlantic colleagues, ended on a positive note. I was impressed with the visual quality of this beautifully produced book printed on heavy paper and illustrated with numerous color photographs and sketches. Soon I began noticing discomforting details, however; these finally overwhelmed me and led me to conclude that I cannot recommend the book. Simply, I do not know to whom to recommend it: it is too bulky for medical students (and too expensive!) and too sketchy and rough-hewn for residents or practicing pathologists. My criticism can be summarized as follows.

The book is extremely uneven in approach, style, and depth of topics covered. By virtue of the sheer breadth of the contents, this may be expected, but mediocre and weak chapters are too many to be ignored.

The editors have not assigned the topics specifically, or have simply not purged the redundancies that result in considerable repetition and overlap between one chapter and another. This is particularly bothersome when the authors of two chapters that present closely related data arrive at divergent conclusions.

These volumes present many new concepts and techniques, which is laudable. However, many of these novelties are described in such laconic terms that a reader who does not have the proper technical background might not understand the message without referring to additional textbooks for help.

There are too many statements that differ with contemporary interpretations of modern pathology. Regrettably, most of these controversial assertions cannot be confirmed since they are not supported by references. The upshot is that the reader begins doubting the authority of the contributors, a death knell for any purportedly authoritative textbook. For example, is it possible that 15 to 30 percent of all persons with chronic alcoholism will have liver cancer, as stated in the text? Furthermore, is there evidence that alcohol acts as a tumor promoter? I was perplexed, confused, and often incredulous, to say the least, about this and many similar assertions.

In many respects the book is not up to date. For example, recent advances in cystic fibrosis research are better described in a standard American textbook of pathology published in 1989 (R.S. Cotran, S.L. Robbins, and V. Kumar. Robbins' Pathologic Basis of Disease. 4th ed. Philadelphia: W.B. Saunders) than in this work. In some chapters references are listed as documentation of the authors' claims, and in others as suggestions for further reading. These references are often poorly chosen and outdated. For example, the chapter on renal transplantation has three references -- one from 1972 and two from 1977.

The index is 103 pages long. Is this really necessary? I am sure that there must be a better way of helping readers. Editing might be a good place to start. “Riedel's struma” is misspelled in the index (“Reidel”), it is misspelled when first mentioned in the text, and is spelled correctly in another chapter.

Generally, I liked the multicolored sketches. However, when I tried to use them to teach medical students, some sketches proved too complex and others too simplistic. For example, I found the multicolored diagram of wound healing more difficult to decipher than an old-fashioned black-and-white drawing. The colors for various cells were computer-chosen, and the color code was not explained in the text; one could only guess whether all these differently encoded cells have a distinct role in wound healing or whether the colors were chosen for artistic purposes only.

To quote a famous proprietor in Casablanca, my criticism may not “amount to a hill of beans.” But if this book is to survive as time goes by, it will need a major overhaul in subsequent editions. I enjoyed its metaphors, such as the comparison of apoptosis to “renegade members of holy orders.” I found it amusing that Wallis Warfield Simpson is quoted in the chapter on nutrition: “No woman can be too rich or too thin.” However, I believe that most pathologists would prefer a matter-of-fact approach and authoritative data supported by current references and presented in comprehensive, well-edited, no-nonsense expository prose.

Ivan Damjanov, M.D.
Jefferson Medical College, Philadelphia, PA 19107