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Management of Poisoning - A Handbook for Health Care Workers, by J. Henry & H. Wiseman
World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland, Publication Date 1997, 315 pages, ISBN 92-4-154481-3, NLM Classification: QV 600: Price: Sw. fr. 71.40 (in developing countries)
I read this book for the first time several years ago while working in another institute, and was immediately impressed. Though the book is meant primarily for health workers such as community health workers who have little or no medical training, I still learnt a great deal about poisoning that I had not been aware of earlier. This compact book is packed with a lot of practically useful information that can be utilized by a wide spectrum of medical and paramedical personnel dealing with cases of poisoning.
The International Programme on Chemical Safety (IPCS), which is a cooperative venture of the World Health Organization (WHO), the International Labour Organization (ILO), and the United Nations Environment Programme (UNEP), convened a group of experts in February 1987, to address the problem of poisoning in areas where access to health care facilities was difficult. As a direct outcome of this initiative, a draft text on the fundamental aspects of treatment of poisoning was prepared by Dr.J.A. Henry and Ms. H.M. Wiseman, which in fact forms the basis for this book. The draft was scrutinized, modified, and approved by several other experts, as well as reviewed in an IPCS Workshop in Senegal, in 1995. The United Kingdom Department of Health, through its financial support to the IPCS, provided the resources for the drafting of the text.
The main aims of this handbook are twofold: to provide people who are far removed from medical help (especially rural folk), with information on what should be done when someone is poisoned, and to suggest preventive measures with reference to poisoning. In fact, the handbook is meant to be used as a practical reference book in the prevention of, and emergency management of poisoning. It is mainly targeted at community health workers and first-aiders with very basic training in diagnostic procedures and clinical medicine. However, almost every section has additional information of specific interest to doctors, especially those who are working in rural health stations.
The book is divided into two parts. The first part deals with general information on poisons and poisoning, with chapters on various modes of poisoning, common poisons encountered in most parts of the world, diagnosis of poisoning (especially acute poisoning), first aid measures, and preventive aspects. Descriptions relating to all these are couched in simple and lucid language, without using technical terms that may be incomprehensible to non-medical personnel, and are well supported by excellent illustrations.
The second part of the book deals with specific poisons with emphasis on those toxic substances that are commonly encountered (in a rural scenario) in most parts of the world. There is extensive discussion on pesticides, which is entirely justified, since they account for a vast majority of poisoning cases. It is quite fitting that aluminium phosphide leads the list, since in India at least, this pesticide is now the commonest culprit in accidental and suicidal cases. There are also detailed descriptions of the toxicity of household chemicals and common pharmaceutical agents such as antipyretics, antihistamines, sedatives, tranquillizers, and antibiotics. The last section deals with plant and animal toxins, which are ubiquitous in tropical countries such as India. Apart from toxic plants and snakes, even mushrooms, spiders, and venomous fish find mention.
The presentation is unique with every chapter beginning with a set of objectives and ending with suggestions on follow-up. The entire emphasis is on practical measures, and theoretical discussions are kept at a minimum, which is in keeping with the target readership. However, the text is interspersed throughout with additional information of interest to doctors. The get-up is impeccable which is the hallmark of all WHO publications, and the size is convenient for easy handling.
While recommending the book very highly, this reviewer has a few suggestions to offer as improvement for the next edition (which incidentally is a little overdue!): addition of information on some basic analytical tests that can be performed as bedside diagnostic aids, a little more information on chronic toxicity in the case of poisons known to cause chronic poisoning more commonly than acute manifestations, and provision of translated versions in areas where English is not spoken widely.
Dr. Pillay is one of the foremost exponents of toxicology in the Asian continent. He has authored two books on toxicology, besides a Comprehensive textbook on Forensic Medicine. His books on toxicology include the bestseller "Pocketbook of Pesticide Poisoning for physicians". He is currently the Chief of Poison Control Centre, at the Department of Forensic Medicine & Toxicology, Amrita Institute of Medical Sciences, Cochin - 682 026. He is the Chief Reviewer of Best Toxicology Books. His Phone number is 0484 - 339080
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