64
eluding chapter on testing and risk assessment.
The illustrations and tables provided are sufficient
to adequately complement the text for beginning
students. The glossary remains a very useful ex-
planatory tool, and the index gets one to the right
location promptly. In contrast to the relatively
large, expensive or specialized texts that have pro-
liferated, this brief introductory publication pro-
vides a practical yet credible tome for use in the
many introductory courses about toxicology now
springing up. Introduction to Toxicology remains
an excellent source of toxicologic principles and
chemical hazard for the general public and for
non-toxicologists who have sufficient interest in
this growing discipline to read a brief well-written
and scientifically-sound text.
Frederick W. Oehme
Comparative Toxicology Laboratories,
Kansas State University,
Manhattan, KS 66506-5606, USA.
PII: SO378-4274(96)03650-8
Casarett and Doull’s Toxicology: The Basic Science
of Poisons, Fifth Edition. Edited by Curtis D.
Klaassen. McGraw Hill, Health Professions Divi-
sion, 1221 Avenue of the Americas, New York,
NY 10020-1095, 1996, 1111 pp., $69.00.
It was a privilege to review the fifth edition of
this classic reference source as it marks its 20th an-
niversary, representing new material, and material
updated to the rapidly changing field of toxi-
cology. The volume’s stated purpose remained un-
changed, to serve adjunct to or as a source for
graduate toxicology courses. It is approximately
30% larger than its previous edition. This book
contains at least three new chapters, ‘Mechanisms
of toxicity’, ‘Toxicokinetics’, ‘Toxic responses of
the endocrine system’ and an Appendix: ‘Recom-
mended limits of exposure to chemicals’. These
chapters have three new authors. In addition,
some of the chapters carrying the same title have
Book reviews
new authors, an additional 30+ authors. Both of
these changes represent the large scale changes
happening in the field of toxicology during this
decade and indicate that this reference classic is
moving with our rapidly growing field. The book
is divided into several different main sections,
General principles, Disposition, Non-organ-
directed toxicity, Target organ toxicity, Toxic
agents, Environmental toxicology, and Applica-
tions of toxicology. Of these sections, Disposition
and Non-organ-directed toxicity represent exten-
sions of what had formerly been introductory ma-
terial, growing each edition. All chapters reviewed
were of high quality, defining the current research
structure in their respective subfields. Chapters
were marked by the expected increase in emphasis
on molecular aspects of toxicology. In addition,
those in the target organ toxicity section also
distinguished by an integrating approach, em-
phasizing the connections between anatomy,
physiology, molecular biology, pathology and
medicine of the various classes of toxins and of
specific toxins. Of the chapters reviewed, perhaps
most memorable were those relating to toxic
responses of the respiratory and cardiovascular
systems. Both had new authors, and an approach
very closely aligned with recent classic reference
texts in these subjects. They contained new,
fascinating information relating to specific impor-
tant mechanisms in these two systems. The corre-
lation of anatomic, pathologic, molecular
biological, and interpretative mechanistic informa-
tion was enlightening. These two chapters clearly
fulfill the objective stated in the foreword to each
edition, to serve as reference for postgraduate
courses in toxicology. Both chapters do well as
reference for new areas of inquiry for toxicologists
working in these two systems, structuring the
knowledge of these complex fields. This reviewer
was particularly pleased with the efforts of the
authors to make this mass of different facts
understandable and cohesive, so that beginning
post-graduate toxicology students could learn in
this exciting atmosphere. These two chapters,
reviewed in perhaps more detail than several of the
others, merely illustrate the superb quality and
remarkable uniformity of this volume. The chapter
 Book reviews
on poisonous plants included some interesting sys-
temic groupings and new information along the
lines of those in target. organ toxicity. It was an ex-
cellent reference for plants, but organized in such
a way that beginnisg toxicology students could
learn more about this, system. Mechanisms of tox-
icity describes the: wealth of information
originating in the last decade, specifically detailing
different detoxications, and the result of failure of
detoxication, its effects on cells, signal transduc-
tion, dysregulation and dysrepair and car-
cinogenesis are dealt with in detail. Toxicokinetics
extends work in pre:vious editions to the newly
developed models, taking into account anatomy,
physiology, thermodynamics, transport, perfusion
limitation, diffusion limitation, and specialized
compartments such aa lung, liver and blood. Both
chapters represent fascinating new information
relevant to the practi’ce of toxicology today for the
beginning graduate student, for post-graduate
courses, and for each new area initiated for prac-
ticing toxicologists. In addition, reviewing
chapters provides a consistent perspective for tox-
icologists heavily into their respective research
areas. This classic volume carries my highest
recommendation.
John A. Pickreil
Comparative Toxicology Laboratories,
Kansas State University,
Manhattan, KS 66506-5606, USA
PII SO378-4274(96)03651-X
Clinical Reasoning in the Health Professions.
Edited by J. Higgs and M. Jones. Butterworth-
Heinemann, 225 Willdwood Avenue, Unit B, PO
Box 4500, Wobum, MA 01801-2041, 1995, 347
pp., $65.00.
What an appropriate title to coincide with the
increasing interest and concern about the learning
of clinical methodology and decision-making and
the increasing controversy about problem-based
(case presentation) instruction in the medical
professions! With the 37 authors coming from
North America, Australia, England and The
65
Netherlands, the global scope of input provides
refreshing and yet cohesive views on how health
professionals reason effectively, make sound and
defensible clinical decisions, and learn through ex-
perience to progressively develop their knowledge
base for continuing as effective practitioners. The
book covers all the health professions by pro-
viding contributions in five different sections:
Clinical reasoning; Clinical reasoning in the health
professions; Dimensions of teaching clinical rea-
soning; Approaches to teaching clinical reasoning;
and Directions for the future. The first section
deals with what clinical reasoning is and how it
develops. The following section provides an over-
view of methods of investigating clinical reasoning
and then examines reasoning used in the practice
of medicine, nursing, physiotherapy and occupa-
tional therapy. The disciplines discussed approach
clinical reasoning in unique but also related ways,
illustrating the common core features of such rea-
soning. The third section focuses on teaching clini-
cal reasoning in the various health sciences,
addressing the multi-disciplinary concerns and the
resulting broad dimensions of clinical instruction.
Designing curricula, the role of biomedical knowl-
edge, various knowledge bases in health sciences,
the importance of categorization in clinical reason-
ing, educational technology, and assessing clinical
reasoning behaviors are exciting fodder for clinical
instructors. The large fourth section is from
educators who have already constructed and im-
plemented learning programs for students
developing clinical reasoning skills and are pro-
gram and/or discipline specific in their experience-
sharing. These chapters demonstrate that learning
through experience, searching for personal mean-
ing, the importance of learner responsibility and
empowerment, internal motivation, and self-
reward through inquiry are adult learning con-
cepts vital to the successful teaching of clinical rea-
soning. The final section and chapter draws
attention to the future of practicing, teaching and
studying clinical reasoning. It asks us to build
upon our current ideas, interpretations and
strategies to explore and successfully implement
this fundamental element of clinical practice. This
publication is a ‘must read’ for all clinical instruc-