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Primer of Medicine

This is an expanded edition of Dr Pappworth's original book, a superb account of bedside diagnosis by clinical examination. Of particular value are the chapters dealing with the chest, heart, abdomen and nervous system, the kernel of the book. There are undoubtedly errors, such as the statement that bacterial endocarditis is nearly always associated with polymorph leucocytosis. In parts also the book is outdated, as when retrograde pyelography is advocated for the diagnosis polycystic disease in the presence of renal failure, and ultrasound is not mentioned. These problems mainly arise where the author departs from his central theme, the elicitation and interpretation of physical signs. Candidates for MRCP part II, who will form the main readership, should have no difficulty in separating what is valuable from what is doubtful. This edition has been enlarged in three ways. Extra clinical material, generally quite good, has been added. Secondly, there are many clinical photographs. It was a happy thought to save costs by reproducing them in black and white and to increase interest by printing the captions upside down on the same page. The selection of photographs is generally good, although seven pages on myxoedema seem excessive. Thirdly, an irritating feature of this edition is the extra space devoted to the author's personal and polemical views on subjects ranging from the correct length of a ward round to the diagnosis of brain death. These are not relevant to the real purpose of the book. Despite this I believe all MRCP candidates and more senior doctors who have not read an earlier edition would greatly benefit from reading the appropriate sections.