Book Review

Textbook of Travel Medicine and Health

N Engl J Med 1997; 337:1702-1703December 4, 1997

Article

Textbook of Travel Medicine and Health
Edited by Herbert L. DuPont and Robert Steffen. 370 pp., with CD-ROM. Hamilton, Ont., B.C. Decker, 1997. (Distributed by Blackwell Science, Cambridge, Mass.) $125. ISBN: 1-55009-037-2

Tens of millions of trips are taken by travelers from developed to developing countries annually, for pleasure, business, education, and religious reasons and to visit family. Responding to the demand for travelers' health services, clinics to provide immunizations, preventive medical advice, and diagnosis and treatment of exotic diseases have proliferated.

A modern textbook to guide that work is needed. This book was developed, as the editors state, “to provide a single source of information for physicians and paramedical personnel interested in the medical problems of travelers.” It achieves this goal remarkably well because of its organization and its expert authors. Most chapters have at least two authors, usually from different continents, giving the book a truly international flavor.

Some chapters are excellent, such as Peter H. Hackett's “Medical Problems of High Altitude.” “Parasitic Tropical Infections,” by Mary Elizabeth Wilson and Thomas Löscher, is concise and practical. “Economic Evaluation in Travel Medicine,” by Philippe Beutels et al., analyzes the economic costs and benefits of measures such as specific immunizations. Jay S. Keystone and Daniel Reid remind us how difficult it is to get patients to follow advice in “Compliance with Travel Health Recommendations.” Chapters on unique problems of very-short-term travel; expatriates; expedition participants; traveling with children; pregnancy, nursing, contraception, and travel; and the aged, infirm, or handicapped traveler also excel.

The book has some faults. Repetitive information on obtaining a history and the delivery of pretravel health services is given in three chapters. The section “Travel and Travel Clinics in Asia” is limited to China, Hong Kong, and Singapore. The section “Physiology and Decompression: Diving-Related Health Problems” is too abbreviated. Chapter 11, “ `Hot and Cold!' Medical Risks of Environmental Extremes,” does not discuss clothing. The chapter on wilderness clothing by A.L. Dickensen in Wilderness Medicine, edited by P.S. Auerbach (3rd ed. St. Louis: Mosby, 1995) covers that topic competently and should have been referenced.

Discrepancies between chapters need resolution. We are advised to boil water for five to seven minutes to make it potable on page 50 and just bring it to a boil on page 90. Fatal cardiac arrhythmias associated with halofantrine are not mentioned in the chapter “Treatment of Malaria,” but they are mentioned in that on emergency self-treatment of malaria.

The rarity of transmission of malaria above 2000 m should have been discussed under the epidemiology of the disease. The purpose of chapter 8, “Developing Regions,” is obscure, and its content could have been integrated elsewhere. The section on motion sickness is excessively historical and anecdotal and deals inadequately with prevention and treatment. Chapter 20, “Psychiatric Illness and Stress,” contains cryptic statements about complications of the use of monoamine oxidase inhibitors and lithium treatment that are neither substantive nor referenced. The problem of culture shock is covered superficially; a useful reference would have been The Art of Crossing Cultures by C. Storti (Yarmouth, Me.: Intercultural Press, 1989).

Two chapters contain potentially dangerous misinformation. Recommending tourniquets, ice, and incision for poisonous-snake bites is, at best, controversial and may increase morbidity and mortality. Postexposure rabies vaccination should be given intramuscularly, not intradermally, to patients who have been immunized before exposure, according to Public Health Service guidelines.

Imaginatively, the book predicts future trends in travel medicine. Unfortunately, the effect of environmental changes on future tourism and geographic medicine is neglected. Global warming could change the distribution of vectors of tropical diseases and cause coastal flooding and massive migrations. Loss of biodiversity will decrease the attractiveness of certain areas for tourism; countries that conserve their natural resources will become more desirable destinations.

The specialized medical organizations that promote continuing education and research in travel, tropical, and wilderness medicine are not mentioned. The American Society of Tropical Medicine and Hygiene offers an examination for certification in clinical tropical medicine and travelers' health. That development should have been discussed in the chapter on travel medicine and travel clinics in the United States and Canada, and its implications for the future of the specialty should have been discussed in chapter 34 (“Travel Medicine 2007”).

Despite these shortcomings, this book organizes and presents a unique and broad range of information very well. It will be a valuable asset for anyone interested in the medical problems of travelers. I recommend it highly.

Leonard C. Marcus, V.M.D., M.D.
Travelers' Health and Immunization Services, Newton, MA 02165