Atlas of occupational health and disease

This book caused me to question the assertion that a picture is worth a thousand words. The use of illustrations in Agricola’s De Re Metallica, carefully annotated and described as they were, would undoubtedly have aided comprehension of his descriptions of preventive measures in an era when such concepts had become unfamiliar, and all well trained occupational physicians should know of the influence on Parliament of the illustrations in the report of the Children’s Employment Commission in 1842. We were all introduced to reading via picture books, and well chosen illustrations still enhance the value of many texts. Only relatively recently however has the concept of “atlases” of illness and disease become popular, led by those specialties where pictorial illustration is essential, pathology (including haematology) and dermatology. Presumably the financial success of such works and the superficial appeal of the product have led publishers to expand the concept into areas where illustration is less useful, and I await an atlas of psychotherapy (maybe there is one).

Occupational medicine is a field in which illustration should be useful. Why did I find this book unsatisfactory? After all, we teach the importance of visiting a workplace to see for ourselves what people do, a fundamental aspect of our practice, and we take our cameras with us to record what we see so that we can teach others. But when we do this, we describe the dynamic of work captured in that instant snapshot at some length. Two problems are noted by the authors in their introduction—the difficulty of finding sufficient suitable pictures and the apparent need to confine their text to 150 words per picture. Thus many of the illustrations are barely or inadequately described and some of them are of little more interest than holiday snaps—photographs of a mountain, a parrot, a florist, or a bronzed lifeguard, for example. The ones of workplaces often only serve as a loose connection to text about a disease that might occur in such a place rather than what the picture actually shows. And occasionally the caption is wrong—for example, a radiograph of a hydropneumothorax and mesothelioma is described as a pleural effusion.

Of course, there are some very good and interesting pictures of the sort of things you would expect—skin diseases, blood films and some radiographs, some workplaces. and one thing I had not seen before, argyrosis of the eyes. But who would find this book good value at £55? I don’t honestly know.