Technical Books on Forensic Science and Forensic Medicine: Anil Aggrawal's Internet Journal of Forensic Medicine, Vol.3, No. 1, January - June 2002
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Anil Aggrawal's Internet Journal of Forensic Medicine and Toxicology

Volume 3, Number 1, January - June 2002

Book Reviews: Technical Books Section

(Page 13)

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TOXICOLOGY IN A NUTSHELL



 Dreisbach's Handbook of Poisoning: Prevention, Diagnosis and Treatment, 13thEdition, by Bev-Lorraine True and Robert H. Dreisbach.  Softcover, 4.5" x 6.5".
CRC Press-Parthenon Publishers, The Parthenon Publishing Group, 23-25 Blades Court, Deodar Road, London SW15 2NU, UK. Publication Date 11/29/2001. viii + 696 pages, ISBN 1-85070-038-9 (alk. paper). Price $49.95

Dreisbach's Handbook of Poisoning: Prevention, Diagnosis and Treatment
Click cover to buy from Amazon

In an overburdened toxicology ward, the first aim of the physician is to administer the right treatment at the right time. An amazing variety of cases come to these toxicology wards, out-patient departments and poison centers. Many of them are cases of common poisoning, such as poisoning with household poisons, agricultural poisons, lab chemicals etc. But sometimes, a physician may be faced with a rare type of poisoning, say, with beryllium, or, say, aconite. What does he do then? Does he go back to his room, consult some heavy tomes on toxicology, come back to the out-patient department and administer treatment. Or does he fish out some simple, handy book from his drawer, look for the vital points and start straightaway? Undoubtedly most would like to go for the latter option.
"Dreisbach" through the ages

 Dreisbach has been with us for almost half a century now. The first edition came out in 1955. It was published by Lange Medical Publications, Los Altos, California, and quickly became a classic. The information given was correct, accurate, concise and practical. Treatment was explained in no-nonsense manner, in straightforward steps.

Handbook of Poisoning: Diagnosis and Treatment, second edition
Second Edition of "Dreisbach" (1959), published by Lange Medical Publications

When I was studying for my undergraduate toxicology examinations (way back in 1975), I relied on Dreisbach heavily. During the time I was specializing in Forensic Medicine and Toxicology (from All India Institute of Medical Sciences, New Delhi, from 1979 till 1982), again Dreisbach had been my constant companion. New Editions of this book used to come quite frequently - every two years in the beginning, the freqency decreasing to once every five years in latter years. For the last few years, I had not seen a new edition of Dreisbach, and I was quite anxious as to what had become of this book.

Handbook of Poisoning: Diagnosis and Treatment, third edition
Third Edition of "Dreisbach" (1961)

Then one fine day, this book arrived at the journal office for review. A brand new edition - the 13th - was there at last! It had been published by another publishing house - The Parthenon Publishing Group of the CRC Press - the Group which is now known for its erudite publications on Forensic Medicine and Toxicology. I thumbed through the pages anxiously, noting for changes. And I did find many. For instance, sections on diagnosis and treatment had been revised and updated to reflect the latest procedures in emergency rooms and poison centers. Sections on management of poisoning had been simplified for easier use in emergencies, and new sections had been added in the medicinal chapters to include the enormous expansion of drugs since the last edition. I feel the book in its new avatar has a lot more to offer to its fans.

The book under review provides material for just such cases. The first edition of this book - now a classic - was published way back in 1955, when its author Robert H. Dreisbach was a Professor of pharmacology at the Stanford University School of Medicine, Stanford, California. At that time, it was simply called Handbook of Poisoning: Diagnosis and Treatment. The epithet Dreisbach was not there. The latest edition has this epithet added to it; the book had already become known as Dreisbach anyway. There is yet another change in the current edition; the word "prevention" has been added to the title. There is more stress on prevention of poisonings in the current edition.

In Association with Amazon.com

The book was written by Dreisbach alone for first eleven editions. For the twelfth, we saw Dr. William O. Robertson, Medical Director of the Washington Poison Center as the co-author. And for the current edition, there is a yet another co-author, Bev-Lorraine True of the Washington Poison Center, Seattle.

Since I was thoroughly acquainted with the book already, my main idea was to look for changes. And I did find many. For instance, sections on diagnosis and treatment have been revised and updated to reflect the latest procedures in emergency rooms and poison centers. Sections on management of poisoning have been simplified for easier use in emergencies. New sections have been added in the medicinal chapters to include the enormous expansion of drugs since the last edition. Another new thing that I noticed was that in the References section, there were completely new references. Most of the references were from the last five years, many from 1999 or even 2000. This shows the authors have done their homework well, and have cared to incorporate the latest changes. Keeping in tune with the latest, the book provides not only the latest references, but important websites as references too. For instance on page 37, you read about the website about poison information centers (http://www.aapcc.org); on page 401 you learn about a number of websites which offer help to physicians in providing information about the management of drug addicts. Some websites mentioned here are (i) http://www.jcaho.org/standard/pm.html (JCAHO Standards) (ii) http://www.ampainsoc.org (American Pain Society) (iii) http://www.painfoundation.org (American Pain Foundation) and (iv)http://www.guideline.gov (National Guideline clearinghouse). We see similar websites as references scattered throughout the book.
Dreisbach's Handbook of Poisoning: Prevention, Diagnosis and Treatment
"...sections on diagnosis and treatment have been revised and updated to reflect the latest procedures in emergency rooms and poison centers..."

Classifying poisons has always been a problem for toxicology writers. One main reason for this of course has been that everything under the sun can act as a poison. It all depends on the dose, to use an over worn cliché from Paracelsus. Many authors - among them the great Indian J.P. Modi - preferred to classify poisons into five classes according to their modes of action. These were corrosives, irritants, neurotics, poisons acting on the heart and poisons acting on the lungs. Dreisbach, however, from the very beginning, has classified his poisons according to where you would find your poisons, rather than how they act on your body. In a way, this is a more practical approach. If an anxious mother tells you, her child has ingested something in the house, you immediately start concentrating on household poisons, narrowing down your search considerably among the all-too-confusing maze of poisons. Dreisbach classifies his poisons as (i)Agricultural poisons (ii)Industrial poisons (iii) Household poisons (iv)Medicinal poisons and (v)Natural poisons (which includes various animal and plant poisons).

There are six sections in the book. The first chapter deals with general considerations such as prevention of poisoning, emergency management of poisoning, diagnosis and evaluation of poisoning, management of poisoning and legal and medical responsibilities of the doctors in poisoning cases. After that we see one section devoted to each of the above five classes of poisons. The biggest section is Section V (on medicinal poisons), which spans about 220 pages, followed by section III (on Industrial poisons), which spans about 180 pages. The smallest section is section IV (on household poisons), which spans just 25 pages.
NEW FEATURES AT A GLANCE

Some New Features of Dreisbach's Handbook of Poisoning at a glance:

  • The book is now about 20% larger
  • Substantially revised diagnosis and treatment sections reflect the latest procedures in use in emergency rooms and poison centers
  • Reorganized sections on agricultural poisons expanded to include many new compounds
  • Toxic effects and side-effects of drugs used in medical practice thoroughly discussed
  • Sections on water and electrolyte balance and acidosis simplified for easier use in emergencies
  • Toxic agents in brand-named products listed in index
  • Latest references, many of them from the years 1999 and 2000.

A number of informative tables liven up the entire text. These little tables provide a lot of information at a glance. Sample some of these; on page 26 you find a table giving a summary of emergency management of poisoning, on page 27 you find a table giving a big list of drugs useful in the treatment of poisoning (to be sure, this table runs from page 26 till 29) and on page 588, you find a table giving venoms of important poisonous snakes. This table (on snake venoms) gives not only the LD50 in mg/kg of these venoms, but also the average length of each adult snake and also the approximate yield of dry venom in one bite. Tables of a similar nature are found throughout the book. These tables are the 'soul' of this book. One can open this book at any page, and the chances are he would be greeted by one such table. One can spend hours looking and gleaning information from these tables.
Dreisbach's Handbook of Poisoning: Prevention, Diagnosis and Treatment
"...the book should be useful to medical and toxicology students both at the undergraduate and postgraduate levels, the young doctor, forensic practitioners, clinicians, internists and nurses. Even seasoned toxicologists could turn to this book to refresh memory..."

Each poison is discussed under several headings. Headings which are seen in most cases are formula, general information, clinical findings (of both acute and chronic poisoning), laboratory findings, prevention, treatment, prognosis and references. Treatment is given in a point-by-point form, rather than in an essay, making it easy for the overburdened toxicologist to fish out information relevant to him very quickly.

All kinds of poisons you can think of appear in this book. There are organophosphates, organochlorines, plant and animal poisons, metallic poisons, corrosives, pesticides, nitrogen compounds, halogenated hydrocarbons, alcohols, Esters, aldehydes and ketones, cyanides, metallic particulates, cosmetics - even food poisoning. And in addition to these overdoses of almost all kinds of medicines are dealt with. As mentioned earlier, this section covers a major chunk of this book.

Who would benefit from the book most? I would imagine that the book should be most useful to medical and toxicology students both at the undergraduate and postgraduate levels, and the young doctor. Besides these, the book should also be useful to seasoned toxicologists as a useful tool to refresh their memories. Other professionals who can use this book to advantage are forensic practitioners, clinicians, internists and nurses. Fully recommended to all of them.

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-Anil Aggrawal





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