Hunter's Diseases of Occupations, 8th Edition

Edited by PAB Raffle, PH Adams, PJ Baxter and WR Lee
London: Edward Arnold, 1994; 804 pp;
ISBN 0-340-55173-9; $265.00 (CAN)

With the release of its eighth edition, Hunter's Diseases of Occupations can rightly lay claim to the longest tradition of any of the standard texts in occupational medicine. This most recent version marks a distinct departure from previous editions, having been rewritten almost completely. The stated aim of the editors is to provide a reference restricted to the clinical aspects of occupational medicine and intended for specialists in the field. To this end, new sections dealing with stress and substance abuse in the workplace have been added.

However, the revisions seem to have been carried only halfway. An entire chapter is retained on byssinosis, an uncommon condition in today's working environment,while no mention whatsoever is made of occupational trauma and scarcely two chapters deal with all musculoskeletal problems.

To accommodate the new material, the chapter on the history of occupational medicine, authored by Donald Hunter himself and a highlight of previous editions, has regrettably been removed. Nevertheless, much historical background on specific occupational hazards permeates the text. This, combined with fluid writing, makes the book generally quite readable.

The opening section, "General considerations," contains a rather eclectic chapter on occupational history that fails to provide the reader with a systematic approach to clinical assessment. The remaining chapters in this section are of interest because they outline the British experience of compensation, medicolegal and administrative concerns. A useful survey comparing compensation systems in various countries is included.

With respect to chemical and physical hazards, the text is fairly strong. The treatment of the toxicology of metals is superb, containing much useful information not to be found in other texts. However, by applying almost exclusively a hazard-based (as opposed to systems, occupational or disease-based) approach, many topics are neglected or disjointed. For example, there is very little coverage of the general mechanisms of toxic organ injury, and the important clinical entity, metal fume fever, is variously covered in five different parts of the book. (One of these entries, "Inhalational polymer and metal fume fever," fails to include zinc oxide as a cause of this condition.) Such a layout leads to redundancy and is awkward for the practising clinician.

Of the remaining sections, the chapter on occupational skin diseases stands out. This topic is thoroughly covered and numerous high-quality colour illustrations are provided.

With a publisher's price of $265, this is one of the more expensive texts in occupational medicine, costing approximately $40 more than the standard American work by Zenz. In view of the book's deficiencies, this may not be money well spent.

Overall rating:

Good

Strengths:

Covers chemical hazards and occupational dermatology well. Gives British and European perspectives.

Weaknesses:

Very little coverage of occupational trauma and musculoskeletal problems.

Audience:

Physicians specializing in occupational medicine.