Book Review

Diagnosis in Color: Physical signs in general medicine

N Engl J Med 1997; 336:1110-1111April 10, 1997

Article

Diagnosis in Color: Physical signs in general medicine
Second edition. By Michael Zatouroff. 439 pp., illustrated. St. Louis, Mosby, 1996. $65. ISBN: 0-7234-2326-1

This book is a collection of images, mainly color photographs but also x-ray films, magnetic resonance images, computed tomographic scans, biopsy slides, and even photographs of urine and stool samples. The book is divided into sections covering parts of the body as they might be encountered in meeting and examining a patient (i.e., the head, the hand, the neck, the chest, the abdomen, the leg, the foot, and the skin). The text that accompanies each image is succinct, informative, stimulating, and at times even entertaining. In the preface, the author explains his goal in combining images and text as follows:

Photographs of physical signs may sometimes be dull and repetitive. Problem pictures are more fun. Thus, where possible, the caption begins with the clinical context in which to frame your thoughts, then describes the picture in order to heighten your interest, draws attention to the detail and gives the highlighted diagnosis. Where appropriate, the causes, differential diagnoses and additional points to look for are mentioned.

Accompanying each image are one or two key references, often to the original description of the syndrome, sign, or disease. The intriguing image on the cover, of a young woman with eyes of two different colors, is image 237 in the book. The text suggests a differential diagnosis and lists some facts that would favor or eliminate one diagnosis or another but leaves the final conclusion to the reader.

The quality of the photographs is generally high. However, they were taken by many contributors, presumably under different conditions. This may explain why images 195 and 196, showing ptosis in myasthenia gravis, might have been used to illustrate jaundice. The presentation of more than one image to illustrate the range of normal findings as well as the varied appearance of disease is very useful, as is the illustration of occupationally and culturally related changes in the skin.

This book has something to offer clinicians at any level of experience and can be usefully shared with medical students, house officers, physicians, and nurses in a busy practice.

Julius Kritzman, M.D.
New England Medical Center Hospital, Boston, MA 02111