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B O O K R E V I E W

Gastrodntestinal X-Ray Diagnosis. A Descriptive Atlas. By D. H. CUIV~vIACK. Pp. 344, with 1000 illustrations. Edinburgh: E. & S. Livingstone Ltd., 1969. Price £8.10s.0d.

The most important factor in attaining skill in gastro-intes- tinal radiological diagnosis is personal experience. The best substitute is to learn from the personal experience of experts. Study of Dr. Cummack's atlas shows that the author has /tad a tremendous personal experience of his subject and, moreover, has clearly profited from it.

An author is able to illustrate a far greater range of appearances of a given lesion in an atlas than is possible in a text-book. One thousand illustrations are included and all are carefully annotated. Most of the illustrations are excel- lent, but some could be enlarged or accompanied by line drawings, e.g. one has difficulty in seeing the lesions in Figs. 418 and 707, Valuable information is provided on practically every gastro-intestinal lesion. It was interesting to see sonic conditions illustrated that elude diagnosis despite extensive investigations.

Besides the illustrations, methods of diagnosis and radio- graphic appearances are described in the text. Hardly a word is wasted, so the reader is warned that this atlas must be studied in detail and not merely skimmed. I learnt a lot from reading this work and I have no hesitation in recommending it to all colleagues, whatever their form of gastro-intestinal

practice. A few criticisms arise that in no way detract from the general merit of the volume.

Some radiologists would not agree with the assertion that Micropaque is the most satisfactory medium for examining the small intestine (many prefer Raybar). The term 'meniscus sign' is used in the sense described in most text-books. However, this is not the sign originally described by Carman and it loses much of its value when used merely to define the translucent zone around the margin of an ulcer.

The author describes his techniques for the benefit of more junior colleagues. Few radiologists personally insert the barium enema catheter in every, or even, in any patient. I would warn junior colleagues to be wary of the statement that 'it is never necessary to waste time in an attempt to make a precise diagnosis during fluoroscopy'. This rather hinges on the meanings of 'wasting time' and 'precise'. The author shows by his illustrations how gifted a fluoroscopist he is. Demonstration of some of the lesions, notably some gastric ulcers, borders on the miraculous. One feels that if many of such lesions had not been suspected during fluoroscopy, then the appropriate radiographs would not have been obtained.

The atlas should prove to be very popular and it is a credit to the author and to gastro-intestinal radiology. At £8.10s.0d. the book is good value. It is recommended for personal purchase and for all departmental and larger medi- cal libraries.

PHILIP JACOBS