• Volume 57 , Number 1
  • Page: 121–6

Book Reviews

Enna, Carl D. Peripheral Denervation of the Hand. New York: Alan R. Liss, Inc., 1988, 200 pp., hardbound, index, black and white illustrations, US$55.00 (ISBN 0-8542-4252-6).

As stated in the author's Preface, "A single volume on the peripheral denervation of the hand, its consequences and management, has not been available until now. This book remedies the situation by consolidating all accessible current information.

"By observation and study, the perspective on the problems of insensitivity and paralysis of the hand can be changed from one of dehabilitation to rehabilitation. This review demonstrates that the complications of denervation are not the direct result of the hand's insensitivity but, rather, are due to the harmful effects of activity or inactivity. These problems may be prevented by correcting the primary paralytic deformities and by avoiding trauma and infection.

"Complications of activity are similar in both the innervated and denervated hand. However, differences do exist as a result of the greater intensity, frequency, and rapidity of the forces applied to the denervated fingers and hand through lack of sensory feedback." The author, a general surgeon, draws on approximately 25 years' experience in managing denervated extremities.

The book begins with a carefully illustrated chapter dealing with functional anatomy of the hand. Such knowledge is essential in choosing the appropriate management for the denervated hand. The next chapter deals with secondary deformities of the insensitive hand. Patterns of deformities and peripheral paralyses are then explained. The book ends with chapters on rehabilitation and the complications and sequelae of neuropathy.

Although intended for more general audiences, the author illustrates many of his points with cases drawn from his long experience with leprosy. The book should therefore be of considerable value to those caring for leprosy patients with denervated extremities.-RCH

Enna, Carl D. Peripheral Denervation of the Foot. New York: Alan R. Liss, Inc., 1988, 196 pp., hardbound, index, black and white illustrations, US$55.00 (ISBN 0-8451-4253-4).

As stated by the author in the Preface to the book, "Peripheral Denervation of the Foot is a companion volume to Peripheral Denervation of the Hand. The information is derived from the experience of managing denervated extremities for approximately 25 years. It includes significant observations about the mediative and causative factors; the degree and extent of involvement; the pathomechanics of deformities secondary to insensitivity and paralysis; and, most interesting, the occurrence of similar changes encountered in the innervated extremity. The latter, of course, occur less rapidly and with lesser severity because there is feedback of pain experienced through normal sensory pathways.

"I have compiled my observations and experience, along with those of authorities on the subject, and have presented them in a single volume. The value of these observations lies in the continuing portrayal of clinical pathology, allowed by denervation to proceed to its ultimate predicament."

The book begins with a chapter on the anatomy and function of the foot. This chapter includes ulcerations of the lower extremities and bone changes secondary to denervation of the foot. Paralytic deformities of the foot are discussed together with management techniques. The consequences of insensitivity are discussed together with patterns of destruction of the foot, ulcerations of the lower extremity, contractures, and the orthotic care of the denervatcd foot. Complications commonly encountered in the denervatcd extremity of long standing are discussed. The book concludes with a chapter on the consequences of the neuropathic foot.

As in the companion book, the book is intended for more general audiences but is illustrated with cases from the author's extensive experience in leprosy. It should be of considerable interest to those called upon to care for leprosy patients with neuropathy involving the foot.- RCH

Jagadisan,T. B. Fulfillment Through Leprosy. Pondichcrry: Kasturba Kushta Nivaran Nilayam, 1988, 436 pp., hardbound with index, US$20.00.

"Jagadisan took his Honors Degree in English Language and Literature in 1930 and taught English for 11 years, winning the love of his students, the esteem of his colleagues and a reputation for himself as a scholar and writer. It was in Annamalai University that he came under the influence of the Right Honorable V. S. Srinivasa Sastri, the great statesman and orator. Leprosy attacked Jagadisan and might have triumphed over him. But his indomitable will and faith triumphed over it. At the age of 32, he left teaching and saw his role in a wider perspective, that of liberating those afflicted with leprosy from 'man's inhumanity to man.'

"What he had personally undergone helped him to realize to the full the physical and mental anguish of others suffering from the same affliction. There is nothing which he has not done to minimize this affliction not only for his countrymen in India, but through his eloquence and example for leprosy patients throughout the world. This book tells of his close association in leprosy work with Mahatma Gandhi and the galvanizing force which that association became.

"It will be the barest truth to say that he has become an international figure, invited to important seminars and conferences on leprosy in various parts of the world. What he says or writes on the subject is listened to and read with the utmost attention and respect.

"Jagadisan has been lucky in his contacts-not only those who have worked in leprosy like Wade, Muir, Cochrane, Dharmendra, Donald Miller, Paul Brand, Perry Burgess, Follereau, Tubby Clayton, Cheshire and Sue Ryder, but also some of the finest spirits of our time-Srinivasa Sastri, Thakkar Bapa, Vinoba Bhave, Jawaharlal Nehru and Indira Gandhi.

"His autobiography is a record of the history of leprosy-from ostracism to care, from care to cure, from cure to rehabilitation. He has been a witness to the various phases of treating the disease, from chaulmoogra oil to dapsone and multidrugs, always insisting on avoiding euphoria, and the supreme necessity of supporting treatment with education and the raising of standards of living.

"This fascinating story of his life told by himself with utter candor and humility is a very human document, portraying in some detail its lights and shadows, the close-knit bonds with his wife and children, the sympathy which having been must ever be, the faith that looks through death. It is an autobiography where the cause is more than the man, but the man is seen as not less than the cause."- (From the book jacket)

Jopling, Willian H. and McDougall, A. Colin. Handbook of Leprosy. 4th ed. Oxford: Heinemann Medical Books, 1988, 180 pp., hardbound, index, illustrated, £25.00.

First published in 1971, this well-established and popular handbook, now with dual authorship, has once again been revised to take into account increasing knowledge and experience of all aspects of this important and challenging worldwide disease. The authors have succeeded in giving a concise, authoritative, yet down-to-earth description of the disease and its management, and have expanded the sections on antileprosy drugs, multidrug therapy, and differential diagnosis. There is a timely new chapter on leprosy control and field work describing the methodology and problems of combating the disease in endemic regions. Thus the book will remain invaluable to leprosy field workers, medical students, and to the medical profession itself, including dermatologists and neurologists; in fact, to all those involved in the study and treatment of the disease in various parts of the world-(From the book jacket)

Multidrug Therapy for Leprosy: An End in Sight. How Five Countries, India, Ethiopia, Malawi, Venezuela, Brazil, are Using Drugs of Today to Make Leprosy a Disease of Yesterday. Geneva: World Health Organization, 1988, 32pp. softbound, many color illustrations.

"Leprosy is more than a disease. The physical deformities for which it is notorious cause more than physical suffering and affect more than the diseased individual. Whole families and even communities live under the social, psychological pall cast by leprosy-related stigma. A country living under this pall pays a price in lost self-esteem, in lost social, cultural and economic productivity, in lost hope for the future. These costs are incalculable and are in no way reflected in numbers of cases. They do explain, though, why countries afflicted with far more pressing health problems are prepared to go to great lengths to bring leprosy under control. They also explain why the international community has been so willing to help these countries in their leprosy control efforts.

"First recommended by WHO in 1981, multidrug therapy (MDT) has introduced a new dimension to leprosy control. Experience of its use over the past 7 years in over two million patients has shown it to be highly effective and applicable in a wide variety of geographic, socioeconomic and public health circumstances. This new disease control technology is here to stay. It is likely to remain for long the most important component of leprosy control strategy.

"For the first time, thanks to MDT, leprosy can be seen not as a historical fatality but as a problem with a solution. There are probably still about eight to 10 million leprosy patients, however, who are not benefiting from this solution. The purpose of this brochure is to explain what MDT is, what it can do for leprosy control, and why every effort should be made to extend its benefits to all communities with leprosy.'"- (From the Preface by S. K. Noordeen)

Péan, Claude. La Maladie de Hansen en Haiti. Outrcmont, Quebec, Canada: Les Éditions des Partenaires, 1988, 48 pp., spiral bound, illustrations in color.

"La lutte contre la lèpre ou maladie de Hansen en Haïti a pris son essor grâce à l'initiative de pionniers comme le Dr Gérard Boyer et le Père Jean-Marie Ollivier, o.m.i. Depuis 1983, l'Institut Cardinal Léger contre le lèpre, autrefois connu sous le nom de l'Institut Fame Pereo pour les lépreux, supporte activement un programme de dépistage, de traitement et de réhabilitation des patients atteints par la maladie.

Un programme d'éradication de la lèpre est une entreprise vaste qui nécessite un effort concerté de tous. La population doit être l'actrice principale d'une telle action. C'est donc un appel à cette mobilisation qui est souhaité.

L'étude du Dr Claude Péan, responsable du laboratoire de l'Institut Cardinal Léger contre le lèpre (Famé Perco) de Port-au-Prince et médecin consultant à l'Hôpital Cardinal Léger de Siguenau se veut un document facile d'accès pour tous les agents de santé, tant en milieu rural qu'urbain. C'est un instrument de travail que toute personne du monde médical et tout agent de santé communautaire devra connaître et consul ter au besoin pour être agent actif de cette campagne d'éradication de la lèpre en Haïti.

En reconnaissant la compétence remar quable et le dévouement du Dr Péan, l'In stitut Cardinal Léger contre la lèpre, une société filiale de la Fondation Jules et Paul- Emile Léger, s'est fait un devoir de financer la publication de son ouvrage intitulé <<La maladie de Hansen en Haïti>>. C'est doncen souhaitant qu'on donne à ce document la diffusion et l'utilisation la plus large possible que notre lutte commune se poursuivra."-René Lacoste, Directeur du Service des Projets, Institut Cardinal Léger Contre la Lèpre

Pfaltzgraff, Roy E. How to Diagnose and Classify Leprosy; a Study Guide. Elmwood Park, New Jersey: American Leprosy Missions, 1988, 32 pp., softbound, illustrated in color and black and white.

This 32-page booklet is designed to enable a physician to make a diagnosis of leprosy with a high level of accuracy in both the diagnosis and the classification of the disease as to type. The booklet is designed to be used with a video tape and includes a pre- and post-test of the material being presented. The booklet is lavishly illustrated with excellent clinical photographs as well as simple but clear illustrations in the form of line drawings, graphs, etc. The booklet is masterfully written and should be of considerable value in teaching the diagnosis and classification of the disease.- RCH

Proceedings of the Joint Meeting of Indian and Chemotherapy of Leprosy (TIIELLP) Scientists on Multidrug Therapy in Leprosy, March 14-15, 1988. Karigiri: Schicffelin Leprosy Research & Training Centre, n.d., 140 pp., softbound.

"1988 has been a watershed in the history of Karigiri. The Institution hosted the Joint Meeting of Indian and THELEP Scientists on 14 and 15 March 1988. This was followed by the THELEP Steering Committee Meeting from 16 to 19 March 1988.

"For delegates as well as organizations attending such important scientific meetings, the most arduous task is perhaps to bring home and to implement the many ideas and recommendations introduced and shared at the meeting by a galaxy of experts from different fields. It is therefore imperative that the important deliberations and papers of the conference be compiled, not only for implementation and usage but also to serve as a permanent record for posterity.

"It gives me great pleasure to present to you the Proceedings of the Joint Meeting of Indian and THELEP Scientists. I hope it will receive the attention of all concerned in the field of leprosy so that we can make further inroads against this doughty enemy M. leprae."-(From the Foreword by Dr. Melville Christian who passed away 12 June 1988)

Ryan, Terence J. and McDougall, A. Colin, eds. Essays on Leprosy by Oxford Medical Students. Headington, U.K.: Department of Dermatology, The Slade Hospital (for the St. Francis Leprosy Guild), 1988, 186 pp., softbound, £10.00 (includes packing and postage). [May be ordered from Dr.T. J. Ryan, Dept. of Dermatology, The Slade Hospital, Headington, Oxford OX3 7JH, England.]

"One of the rewards of being associated with leprosy research in Oxford, including the better strategies for control programs, has been the interest of successive generations of students in the Oxford Medical School. Several have chosen the subject for dissertations in their Final Honors School or for participation in competitions, such as LEPRA's Annual Essay Prize or the Renwick Vickers Prize for Dermatology. Often such essays have been rich sources of information and ideas as well as usefully comprehensive reviews. For that reason, we have selected some recent essays for publication in association with the Conference of'Dermatology in the developing World' sponsored by the International Society of Dermatology and the International Society of Dermatopathology, September 1988, to be held in Oxford. We are grateful to the students themselves, to the journals which have already published a selection of their essays, and to the St. Francis Leprosy Guild and Squibb-ConvaTec for their support."- (From the Preface by Ryan and McDougall)

Thangaraj, R. H. and Yawalkar, S. J. Leprosy for Medical Practitioners and Paramedical Workers. 3rd rev. cd. Basic: CIBA-GEIGY Limited, 1988, 108 pp., softbound, in color.

This authoritative monograph, first published in 1986, has again been revised and brought out as a third edition. Besides several minor updatings, a new chapter on eye involvement in leprosy has been included in this edition. This is a practical booklet intended for medical practitioners, medical students, and paramedical workers. As in previous editions, the booklet is extensively illustrated with superb examples of the manifestations of the disease, including its differential diagnosis. The authors are again to be congratulated, together with CIBA-CEIGY Limited, in having produced an extremely attractive as well as useful guide to leprosy for nonspecialists.-RCH

World Health Organization. A Guide to Leprosy Control. 2nd cd. Geneva: World Health Organization, 121 pp. softbound, (English available, French and Spanish in preparation), US$18.40 (ISBN 92-4- 154223-3).

"This book is the second edition of a guide covering virtually every technical and managerial consideration involved in the planning and operation of a leprosy control program. The book has been thoroughly revised in an effort to help managers and field workers meet the new challenges resulting from the use of multidrug therapy. Guidelines and advice, whether concerning the perfomance of a technical operation or the overall objectives of control, take their authority from the proven capacity of multidrug therapy to prevent or cure drug resistance in all patients.

"Information is presented in 13 chapters. To encourage comprehension of principles as well as procedures, readers are first introduced to the global leprosy situation, including its historical evolution, the natural history of the disease and its epidemiological features, and the main reasons why a control strategy based on dapsone monotherapy is no longer recommended. The book then shows how the practical demands of multidrug therapy are reflected in revised procedures for case-finding and screening, diagnosis and classification, treatment, and patient care. Details range from a list of standard criteria and standardized methods of clinical examination, through an explanation of mistakes affecting the results of smear examinations, to precise guidelines for the selection of multidrug regimens that are therapeutically effective, operationally feasible for field use, and socially acceptable. These chapters are followed by a thorough examination of the reorganization of services and operational strategics necessitated by the introduction of multidrug therapy. Each component activity, from casefinding to the transport and storage of drugs, is discussed in terms of related tasks, required knowledge and skills, supplies and equipment, and the need for logistic and community support.

"Other chapters discuss the types of health education needed to produce a reasoned attitude toward leprosy, outline training objectives for different levels of health workers, and consider the special features of urban leprosy control. The book concludes with chapters on social aspects and rehabilitation, program evaluation through the use of epidemiological and operational indicators, and guidelines for planning, formulating, and monitoring a control program. Further practical information is presented in a series of nine annexes, featuring examples, tests, checklists, and specimen forms and cards that can faciliate the operation of a successful control program.

"Whether concerning the types of shoes suitable for leprosy patients or the differences between reversal reactions and relapse, the book will serve as a guide to every clinical consideration, technical operation, or managerial procedure needed to extend the benefits of multidrug therapy to the world's estimated 10-12 million leprosy patients."-WHO New Book Announcement

WHO Expert Committee on Leprosy. Sixth Report. WHO Technical Report Scries 768. Geneva: World Health Organization, 1988, 52 pp., softbound, US$6.40 (ISBN 92-4-120768-X).

"Reviews worldwide developments in leprosy research and control that have occurred over the past ten years. Emphasis is placed on knowledge relevant to the success of control operations, particularly in view of the alarming increase of primary and secondary resistance to dapsone.

The report opens with a brief discussion of the global significance of leprosy as a public health problem, followed by a summary of epidemiological features important to control. Clinical issues are addressed in the third section, which proposes changes in case definitions and classifications necessitated by the use of multidrug therapy, discusses ways to improve the collection and processing of skin smears, and outlines protocols for the management of drug reactions. The neglected problem of quiet nerve paralysis is also considered. Other sections interpret the practical significance of advances in basic biology and immunology, high lighting prospects for the development of an antileprosy vaccine. Of particular practical value is a state-of-the-art review of leprosy chemotherapy, incorporating what has been learned following the widespread introduction of standard regimens for multdrug therapy. Readers are given guidance on the problems of drug resistance and microbial persistence, the use of standard reatment regimens, and the recommended duration and frequency of post-treatment surveillance. In view of the prediction that the number of persons needing care because of disabilities will gradually outnumber those receiving antimicrobial treatment, the report also includes advice on the prevention and management of disabilities, the grading of disabilities to facilitate data colection, and strategies for patient rehabilitation. The concluding sections review the components of leprosy control in light of current knowledge and identify priorities for further research in a number of different fields.

"Apart from its value as a state-of-the-art report on the leprosy situation, the book also serves as a practical alert to a range of operational problems, whether concerning the collection and interpretation of data or the administration of new drugs, that can influence the success of leprosy control.

"Main headings include: global leprosy situation; epidemiology; clinical aspects of leprosy related to control; Mycobacterium leprae; immunology of leprosy; chemotherapy of leprosy; disabilities, rehabilitation and social problems in leprosy; leprosy control; research needs; conclusions and recommendations."-WHO New Book Announcement

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