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Hunter's diseases of occupations, 9th edition.
  1. R L MAYNARD

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    Hunter's diseases of occupations, 9th edition. Edited by: P Baxter, P H Adams, T-C Aw, et al. (Pp 1001; £155.00). 1999. London: Arnold. ISBN 0340677503 (HB).

    “Hunter” has been an institution in the field of occupational medicine since it was first published in 1955. The first six editions were written by Hunter alone and came to reflect the thinking experience and views of this most unusual and distinguished physician. These early editions provided an extraordinary and perhaps eccentric blend of medicine, history, science, and social comment. Hunter's death led to the book being taken over by an editorial team and to chapters being commissioned from recognised experts. The current edition has contributions from more than 60 authors. The book has, therefore, changed and the current edition cannot be considered to be an updating of the “Hunter editions”: on the contrary it is a new book.

    The editors have divided the book into 11 sections and 44 chapters. Sections dealing with chemical, physical, and microbiological agents are complemented by sections dealing with occupational disorders of organ systems including the lung and the skin. Cancer, mental disorders, reproductive disorders, and effects of occupational exposures to chemicals on the liver, kidney, and haemopoietic system are also discussed. Such an arrangement might have led to repetition but this is remarkably rare. An introductory section dealing with topics including how to take an occupational history, compensation, and medicolegal matters is provided.

    The first impression one receives on examining sections of this book is of its readability. The temptation to “turn the page” is unusually strong and I found myself reading late into the night as one excellent chapter followed another. The editing is first class and I failed to detect any errors. I examined a series of chapters in detail. Peter Baxter's chapter on gases is long (56 pages) but remarkably easy to read and interesting. It is much more than simply a catalogue of gases and their effects. Sound advice is provided on patterns of exposure, the dangers posed by major accidental releases of gases and by fires. The author's interest in natural disasters is well shown by the interesting account of carbon dioxide poisoning following the Lake Nyos disaster which killed more than 1700 people. The author's note on the 1832 report of the “Valley of Death” is in the great Hunter tradition! Gases that pose problems at both an occupational and environmental level are considered and thus one can look up common air pollutants—such as ozone and nitrogen dioxide—and find useful advice on the likely effects on health of ambient concentrations. Gibson's chapter on flying is equally absorbing and informative. The physical aspects of high altitude are dealt with clearly as are the problems of acceleration. Spatial disorientation and illusions (not encouraging phenomena for would be fast jet pilots!) are explained as are the fitness requirements for flying. I looked for a note on the raised concentrations of ozone found in passenger aircraft and failed to find it: perhaps this could be added in the next edition.

    A chapter that stands out as a triumph is that by Venitt on “Biological mechanisms and biomarkers in occupational cancer”. If you don't read anything else in this book, read this. The explanation of complex issues including oncogenes, p53, free radicals, and hotspots, is unusually lucid and the illustrations, reproduced in the colour section, are a joy. I learnt more about cancer from this chapter than I would have thought possible.

    This edition of Hunter stands midway between the shorter handbooks of occupational medicine and the large reference works—such as “Rom” (Environmental and occupational medicine, 3rd edition, 1999). As such it seems an almost ideal book for somebody taking up the specialty of occupational medicine to read for both pleasure and instruction. Candidates for the Faculty examinations should certainly read it.

    Is there any “Hunter” left? Yes, the style is unmistakably there. If this is doubted, see Chapter 39 on the clinical aspects of occupational cancer. A deliberate attempt to include some of the history and social comment from the earlier editions is made by Carter in the appendix. This could hardly fail to be interesting and is very well presented. In conclusion then, an excellent book and an important contribution to the literature of occupational medicine. I recommend it strongly. Anything missing? Well, I looked for the picture of the molten metal spattered spectacles that provided such an awful warning in the earlier editions and could not find it. Odd—as our editor has the very spectacles in her keeping!

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