rics. Dunnihoo states that the main
Dunnlhoo
disadvantage is the time it takes the
phystcian to train the patient There is
no apparent recognition that the pa-
tient cculd easily bereferred to a clin-
ical psychologist, psychiatrirt, or a
nurse-midwife trained in hypnosis.
There are also several question-
able sta$ments in Dunnihoo’s chap-
tar on human sexuality. For example,
in a section on pubertal sexual
chanw he states. “Prior to puberty,
there- is little sexual at&ion b;-
twen the two sexes.” This ignor.x
male-female sex play that is very
common long before puberty. Dun-
nihw then states, “Initially seduction
develops as the Rrst stag-?. of sexual
acttvitu.” He asseristhat seduction is
foU&ed by sexual excitement, sex-
ual involvement that includes heavy
petting and coitus, and then the indi-
vidual’s interpretation of the sexual
encounter. Dunnihoo doesn’t ex-
plain exactly what he means by
“seduction,” and it is difficult to
imagine how “seduction” in any
sense could be considered the first
stage of sexual activity in puberty. At
the other end of the continuum,
Dunnihoo paints a rather dkmal pic-
ture of sex after 60.
In this chapter on human sexuality,
he also makes the statement that
“Couples who are having sexual
problems are really having trouble
with the rest of their relationship, and
the sexual aspects merely retkct the
greater problem.” Although it is true
that interpersonal problems can lead
to sexual dtfftcultiesin a rektionshb.
Dunnihw’s statemem ignores tii
large number of cases where the
cause of the sexual dysfunction is ei-
ther physiologic or is due to prior
events (eg, childhood bauma, sexual
attitudes and beliefs, previous sexual
interactions) outside the cunent rela-
tionship.
Although most of !he questionable
statements in thk book are in the sec.
tions dealins with ~sycl~olosical is-
sues, there a& a few Inother &as as
well. For example, Dunnihoo sug-
geststhat breast exams by the physi-
cian should be performed every
three years tehveen the ages of 20
and 40. This may not be often
enough. especially in patients who
have risk factors for breast cancer or
those who do not do breast self-
examinations. The chapter on phys-
ical examination includes a diagram
of positions of the “tams, but the text
does not explain how one deter-
mines the podtton by bimanual ex-
amination. A section on puerpzral
mastitis does not say whether breast-
feeding should be discontinued.
Dunnihw seemsvery negative about
exercbe in pregnancy and lii a large
number of ~~srnctb~sthat would
seem to be hard for the patient to
understand or follow. Finally, the au-
thor’s discussionof the treatment of
pyelonephdtis appears conbadictoy,
vague, and confusing. First, he notes
that there c M simple, reliable tach-
nique for differentiating eysti6.sfrom
waloneph~tis. He then obsewesthat
&h a histinclion is of little impor-
tance in management anyway be-
cause the same organisms suscepii-
ble to the zame aniibtotics are seen in
either case. His next sentence. how-
ever, appzars to sugg+?st that the dii-
tinction is important because he
notes that an upper urinay ixxt in-
fection requires a longer cnume of
therapy and/or an amincqlycoside
antibiotic. But, a few sentences later
be st&es that acute pyelonephritis is
usually treated with tntravenous
ampici&n. Dunnihoo does not men-
tion that maw strains of Eschtichh
co/i are nmu~resistant to ampictltin.
and he never really makes il spsdfic
recommendatic.~ for heatmart
.:Jthough this review has focused
mainly on the book’s weaknesses,
this text provides a go& oven&w of
obstetrics and gynec&gy. As noted
earlier, full chap& are dewed to
imp&imt topics that many texts in
obstetdcs and gynecology mention
only briefly, if at all These include
paa-tice &~gement_ wound heal-
ing, death and dying. ganeUcs,sexual
assault, statistics,and psychosomatic
obstetdrs and gynecol~. Aftbough
a majority of the confusing, errone-
ous, or misleading statements deal
with psychological issues.
is to be commended for recogntztng
the importance of ~holcgiczl fac-
ion in obstetricsand gynecology. It is
honed that these sections can be
strengthened in future editions of this
book. Tbis wuld be a seed. basic
text for studentsin medici&, n&sing,
or midwifery. as well as for nurse-
midwives and residents in family
PW.CSC~ ~r obstetdcs and gyecool-
WJ.
Pediatric Telephone Medicine:
Principles, Triage and Advice. By
Jeffrey L. Brown. Philadelphia: J. B.
Lippincott. 1989. 237 pages.
w.50, softcover.
Revfewad by: Sue G. Bayer, RN. MN,
Cwrdinator of Undemraduate Ma-
ternal-Child Nursing, Irtiiversity of U-
ltnois at Chiw, College of Nursing,
Chicago, l!linois.
This very practical manual would be
useful in any pediatric ambulatmy
setting. Although the author includes
in:xnation aimed at the physician or
nurse-practitioner relating to tele-
phone communications with parents.
thtt book is primarily written for use
by “offke employees who may have
to c&e immediate adviee to &tents
until a practitioner can be reached”
(p. vii). Thus, the format and Ian-
guage used avoid technical termind-
09~. Even the tiral bimiillq and in-
d& make the book conv&ient to
use.
The book is divide” into chapters
on common symptoms, emergencies
and bauma, minor infections, infez-
t&us diseaws, and infant and child
care. Each chapter is fuiher orgy-
ntzed to help the office staff person-
usually a receptionist who might also
be a medical assistant-answer
phone inquiries quickly and appm-
ptiately. The chapter on common
symptoms, for example, includes
screening questions (to elicit mean-
ingful assessmentdata) and cdteda 3
determine If the child should be seen
immediately or in the near htture.
There is also a treebent and discus-
sion section that gives more in-depth
information on the symptom. The
discussion section is good back-
ground infornwion but would re-
quire readiny prior to using the book
for actual telephone triage. The au-
thor cautions the practitioner to re-
vieur the book to be sure recomn~en-
dations are consistentwith hisiher ac-
hml practice.
Indeed, some areas seem ruperf-
ciai an&or minimally covered. As a
former office nurse in a busy pediit-
dc practice and presently the mother
of three young children, this reviewer
found the areas on traume to be
rather minimal and the infant and
child care section sparse. The other
chapters are more complete. Al-
though nurse-midwives will find the
infornmtion on handling telephone
calls helpful, the renminder of the
book does not contain sufficient in-
depth information to be useful as a
pediatric reference. However, for the
author’s intended audience, this
would be a very helpful reference.
Gunecolow: A Cli+a: Atlas. BY
J.-L. H. E& and M. J. Heineman.
St. Louis: Mosbv. 1990. 176 pwes.
$39.00, hardcover.
-
Reviewed byz Ronald K. McGraw,
PI,“, co, Resident in Obstehics and
Gynecology, BI-County Community
Hospital, Warren, Michigan.
According to the preface, this book is
intended for medical students, gyne-
co!ogy v&dents. and “all those inter-
ested in a visual presentation of gy-
naecological problems.” It was de-
signed to be a “trait d’union between
the knowledge gained in the pre-
clinical period and that gained at the
bedside.” Both aluthors are obstetri-
clans and gynecologists in the Neth-
erlands.
The material is organized into nine
chapiers according to chronologi~el
age rather than by specific organ or
disorder. The opening chapter de-
scribesthe anatomy of the female re-
productive system. This is followed
by a chapter on gametogenesis. fer-
tilization. preembryonic develop-
ment. and implantation. Chapter
three covers normal and abnornal
development of the female reproduc-
tive system. Next is a chapter on pa-
thology of early pregnancy, which in-
cludes threatened. inevitable. and
missed abortions; ectopic pregnan-
cies; habitual abortion; and hydatid-
ifonn mole. The next five chapters
cover various aspects of gynecology
relevant to specific ages: childhood,
adolescence. the reproductive pe-
riod, the climacteric, and old age.
There is a list of recommended fur-
ther readings but there are no refer-
ences gwen in the text i&elf. The
stated reason seems a curious non-
sequitur: “Textbooks and medical
]oumals are available in every hospi-
tal. Therefore, no attempt has bee”
made to include specificreferencesin
the text.”
The text contains both black-and.
white and color drawinss of histo-
logic slides, gross anatomy speci-
mens. and patients. Examples of a
few x-rays, hysterosalpinyograms.
and pelvic ultrasounds are also in-
cluded. Topics are generally intro-
duced by a short description of a pa-
tient the authors actually examined
and treated.
This atlas suffers from three major
weaknesses:the textual material, the
ilkxtrai,o”s. and the editing. There is
more space here devoted to text then
one might expect to find in a” atlas.
However. n 15doubtiui whether the
text would meet either the needs of a
student OT a resident. Procedures,
tans, and pathology are “or ex-
“lained in enoush basic detail for the
student or in enough sophisticated
detail for the resident. This is most
striking in the captions accompany-
ing diagrams of histologic slides. Ex-
amples of these vague captions are:
“A histological preparation from en-
domehiu;showi”g characteristicsof
hvoernlasia”: “Cvtological findings
c&&tent with &r&oma of the
cervix”; and “Histological picture of
the gonads. They have the appear-
ance of testicular t&sue.” Another
caption reeds, “Histological appeer-
ante of a complete abort+m with ve-
sicular degeneration of the ~i”i.
There is no trophobtic prcaifera-
tion but vascular structures are
present in the tilli.” However, nei-
ther the vascular stnl*“?s nor the
tilli are pointed out for the reader.
This reviewer believes that SOme
things in medicine are best illustrated
by a drawing whereas other things
are best shown by a photograph.
This atlas sufferssk#ftca”tiy because
no photographs are employed ex-
cept for the few ultresoxd exam-
ples. Furthermore. there are vada-
tions in both diseeeezend in normal-
ity, not only in gynecology but in
other areas of medicine as well.
Thus, a” atlas such es thii can be
most valuable if several examples of
a disease process or of variations in
normal anatomy are shown. This
book, for the most part. limits itself to
one diagram of a parttcular disorder
or disease.
Last, the editing leaves much to be
desired. Certain topics only margin-
ally related to gynecology are @en
space whereas other more common
or relevant topics are essentially ig-
nored. For example, methods of con-
vaception are not covered at all. Ex-
cept for a single diagram of a lapa-
roscopy, gynecologic surgeries are
not described or illustrated. The tech-
nique of the Pap smear is not de-
xribed except for the Qetement that
a wet cotton web should be used
This is probably not how most Pap
smears are collected in this counby
today. Techniques for obtaining cul-
tures, wet mounts, or biopsies or of
performing a colpoxopy are also not
illustxated or described. There is a
section on the gynecol~c exatina-
tie” of cnildre” but not one on the
-ination of the adult.
Althouoh there is a chapter on
early pre&ncy, there is nothing on
late pregnancy. Only hue pages are
devoted to infections of the vulva
and vagina. Syphilis, ADS, “lollus-
cum contagiosum. gia”x!oma in@
nale, chaxmid, lymphogranufoma
venereum, and group B streptococ-

downa, of Nurse-Midwtfery . Vol. 36. No. 5. September/October1991 317