Goldf rank 's Tox ico log ic E m e r g e n c i e s , ed 3 LR Goldfrank, NE Flomenbaum, NA Lewin, et al (eds) 1985, Appleton-Century-Crofts, 929 pages, $85

Evolution is an interesting and complex process. In organ- isms it often takes at least several generations, and may stretch over many millenia. Yet sitting before me is evi- dence of a true evolutionary process. The evidence is in the form of the three editions of Goldfrank, et al's Toxicologic Emergencies. Published first in 1978 as A Handbook of Problem Solving, it was primarily a casebook in toxicology. While it was well done and interesting reading, it was defi- cient in both breadth and depth - - running a scant 179 pages. The second, more substantial, ed i t ion emerged in 1982. This text, while still written in the case study style, was divided into general sections that included the most common toxicologic topics. A self-assessment section was added as well as an index consistent with the book's new utility for reference use.

The third edition has demonstrated the final stage of a book's development. The introductory sessions have been enlarged substantially to include not only general manage- ment, but also the chapters "The Toxicologic Laboratory" and "Toxicologic Radiology." Two entire sections, "The Ap- plication of the Organ-System Approach to Clinical Tox- icology" and "Epidemiologic, Research, Preventative and Psychology Perspectives," have been added. Part icularly useful is a succinct chapter on the role of the poison control center, which should be read by all emergency physicians.

Another, possibly unique, chapter is "Toxicology in Preg- nancy."

At the same time, the essence of the book, its well-writ- ten discussions of specific drugs and drug classes, prefaced by cases for discussion, has been maintained and expanded. These chapters begin with a discussion of the most impor- tan t pr inciples and broad differential diagnoses, pro- gressively narrowing the scope until the specific toxic is d i sce rned . I m p o r t a n t p r i nc ip l e s are h i g h l i g h t e d by clinically-oriented questions in bold-face type. While all of the chapters are well written, those covering psychoactive drugs and drugs of abuse are particularly Well done.

But the measure of a reference text in toxicology can be tested only on the battlefield that is the emergency depart- ment. A brief test in this arena demonstrated that although the index can still be improved upon, information could be retrieved quickly and easily for use in treating patients. (We did find that, for some reason, the toxicology of thyroid medication was omitted).

The evolution is complete. Toxicologic Emergencies has progressed from a nice introductory reader in toxicology to its present form - - a standard by which other textbooks and reference texts in emergency toxicology must be compared. Add it to your library. (Royalties go to the Bellevue Hospital Poison Control Center - - our hats off to the editors.)

Kenneth V Iserson, MD, FACEP Section of Emergency Medicine University of Arizona Health Sciences Center Tucson

16:2 Feb ruary 1987 Annals of Emergency Medicine 242/149