Alex S. Tulsky

Women Under the Knife: A Gynecologist's Report on Hazardous Medicine

There would be nothing easier than writing a review longer than this little tome. It is addressed to the public by a mature obstetrician-gynecologist and emphasizes to its readers the need to stop, look, and listen before any procedure, diagnostic or therapeutic, is recommended to them. The review could be longer because it would properly embrace medical, sociological, cultural, economic, and medicolegal changes impinging on our profession, as well as our specialty, with an enormity that boggles the imagination. The thrust of the book is that, although a small group of doctors are culpable (and the author emphasizes that throughout), motivated by venality, incompetence, or both, far too many obstetrical and gynecological tests and procedures are unnecessary, potentially dangerous, or both. Drawing on specific increases from a long academic and nonacademic career, he cites cases with unhappily complex, even tragic, denouements following hastily planned or inappropriate surgery. He specifically emphasizes

Medical Counseling Before Pregnancy

I think it only fair to say that the arrival of this book on the scene of medical bibliogenesis represents a true integration of our specialty with those that have always impinged on it, and one that is long overdue. I cannot recall the last time I enjoyed reading a book as much as Medical Counseling Before Pregnancy . Let me tell you why. We live in a sophisticated age—an electronic age, if you will—of video and audiocommunication with our senses under constant assault. I think that future historians will contrast the technological changes in dissemination of information wrought in the last half century alone with pre-20th century times much as today we contrast Gutenbergs revolutionary printing press with the lonely monk laboring in a monastery to create an illuminated manuscript for the privileged few. It is a given that todays woman (and her mate) is not only educated and educable,

Signs and Symptoms in Gynecology

Signs and Symptoms in Disorders of Pregnancy, edited by Edward H. Bishop and Robert C. Cefalo, 188 pp, with illus,

The Clinical Professor

29.50, Philadelphia, JB Lippincott Co, 1983. It always pleases me to see a well-organized, reasonably evenly written book, especially when it is multiauthored. Signs and Symptoms in Gynecology is such a book, basically because the coeditors established a format each contributor was asked to follow, so that the style is consistent. The contents are essentially a differential diagnosis of conditions that directly or indirectly impinge on our specialty. In each instance, the condition is preceded by a basic physiological or pathophysiological explanation to facilitate its understanding and management. The diagrams and illustrations are clear, but, as is my bias, I am unhappy with the black-and-white illustrations in the chapter on lesions of the vulva, vagina, and perineum, although I recognize the added cost of publication when color photographs are used.

Intrauterine Devices and Their Complications

To the Editor.— I am compelled to respond to the COMMENTARY (1982; 248:2851) regarding the clinical professor. This unnamed veteran hero (heroine?) of the clinical faculty has recited a history of disadvantages perceived in the unsalaried (voluntary) staff of several medical schools, with recommendations for some kind of correction. Well, I, too, am a clinical professor of some years and am not only comfortable but happy with this rank and its attendant responsibilities. I am grateful to the COMMENTARY because it rekindled in me those basic feelings that prompted me to seek such rank originally. It happens that I love to teach; I have always loved to teach, whether it be on a graduate or undergraduate level. The classroom, the operating room, and the ward all give me an opportunity to foist myself on young (sometimes not so young) and innocent (sometimes not so innocent) aspirants to our profession and

Practical Obstetrics and Gynecology: Manual of Selected Procedures and Treatments

In the late 1930s there was a brief flurry of activity around the use of the intrauterine device (IUD) as a contraceptive agent following Otas work with it in Japan. I recall my colleagues and I, among others, laboriously fashioning such a device of silkworm gut and stainless steel wire (two of the various materials suggested). We were soon disenchanted, however, because of the many major and minor complications that ensued, and which, even in that much less litigious era, gave us pause to reflect and then desist. After a hiatus of 20 years, renewed interest, expedited by improved inert plastic materials with metal and hormone additives, has led to a resurgence in the development and use of the IUD as a contraceptive. When it is estimated that in the United States alone some 3 to 4 million women use IUDs, along with 12 to 15 million women worldwide, it

Perimenopausal and Geriatric Gynecology

When I was a youth in medical school we used abbreviated booklets in various courses called compendiums. This volume is such a booklet, updated of course, in obstetrics and gynecology. It is in a loose-leaf format with glossy paper and, as the authors indicate, is geared to the house staff level. They refer to it as a manual that they evidently intend to flesh out, but their primary selection has been rather odd. It consists basically of complications of pregnancy, labor, and delivery, a gratuitous chapter on obstetrical regional anesthesia, a few chapters on uterine and ovarian carcinoma, management of postmenopausal bleeding, and a finale on evaluation of female infertility, which includes organization of a fertility clinic. If the book addresses itself to the house staff, it would appear to me that chapters on proper conduct of normal pregnancy, labor, and delivery are equally important as their aberration. They have