Book Review

Manson's Tropical Diseases

N Engl J Med 1996; 334:1482-1483May 30, 1996

Article

Manson's Tropical Diseases
20th edition. Edited by G.C. Cook. 1779 pp. Philadelphia, W.B. Saunders, 1996. $115. ISBN: 0-7020-1764-7

In 1898, Dr. Patrick Manson wrote that “A manual on the diseases of warm climates, of handy size, and yet giving adequate information, has long been a want; for the exigencies of travel and tropical life are, as a rule, incompatible with big volumes.” The 20th edition of Manson's Tropical Diseases is a far cry from a “handy” monograph and, at 1779 pages, may result in overweight-baggage charges for those traveling to the tropics. Yet this edition represents an ambitious and radical overhaul of a well-respected British textbook.

The practice and study of clinical tropical medicine have regained importance in the industrialized world. In response to a study by the Institute of Medicine that documented the declining ability of the U.S. medical establishment to address emerging pathogens and tropical diseases, the American Society of Tropical Medicine and Hygiene developed an initiative to promote diploma courses and an examination in clinical tropical medicine in the United States. The examination will be offered for the first time in November 1996.

This 20th edition of Manson's Tropical Diseases, many of whose contributors are seasoned practitioners in the tropics, is an important resource. As with any large work, it has both weaknesses and strengths.

The book begins with a section on symptoms and signs in tropical medicine (consisting predominantly of tables), followed by an excellent section on system-specific diseases in the tropics. A section on related specialties (pediatrics, surgery, and obstetrics as practiced in the tropics) has been added. There is an eclectic section on environmental and genetic disorders (with travel medicine curiously included), which is followed by chapters discussing specific diseases. The last 200 pages include appendixes on immunologic aspects of tropical diseases, parasitic protozoa, acarology (the study of ticks and mites), entomology, and laboratory diagnosis and radiology in the tropics.

Because of the way in which the book is organized and the large number of contributors, there are bound to be repetitious and uneven passages. Certain chapters are geared toward practice in a setting of limited resources, whereas others review state-of-the-art medicine. For example, the treatment of gonorrhea in the tropics is discussed in the chapter on sexually transmitted diseases, with a lucid explanation of plasmid and chromosomally mediated resistance to penicillin, yet in the chapter on obstetrics and gynecology in the tropics, ampicillin is discussed as a primary therapeutic option for gonorrhea. Ampicillin may be the only option if resources are limited, but such issues should be put into better perspective in the book. The chapter on malaria, by N.J. White, uses both approaches superbly by describing case histories as well as the newest developments in the understanding of cytoadherence, vascular endothelial ligands, and immunologic processes in malaria.

Certain chapters are not on the cutting edge. The chapters on viral hemorrhagic fevers tend to be superficial and do not include, for example, information on practical doses of ribavirin for the treatment of Lassa fever or a discussion of new human pathogens in the arenavirus family. To state that “whether Helicobacter pylori is an epiphenomenon associated with peptic ulceration or plays a role in ulceration is not yet determined” may not be quite state of the art for a textbook on infectious diseases. Perhaps future editions can better correlate the prevalence of specific tropical diseases with geography. And the absence of chapters on public health and primary care organization in the tropics is clearly an oversight for a textbook in tropical medicine.

Nevertheless, this new edition of Manson's Tropical Diseases is a formidable and invaluable addition to the literature available for students of tropical diseases. Professor Cook has done an admirable job with his ambitious revision of a book available for almost a century. His revision provides a solid foundation for future editions and is clearly worth the extra baggage charge.

Michèle Barry, M.D.
Yale University School of Medicine, New Haven, CT 06504