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472 BOOKSHELF Aesthetic Facial Surgery Peter McKinney, Bruce L. Cunningham. Edinburgh: Churchill Livingstone. 1992. Pp 368. 88. ISBN 0-443087032. Aesthetic surgery is better respected by patients than by doctors. Other surgeons frequently look with disdain at their colleagues who specialise in this branch of medicine. However, all members of the health-care team would benefit from reading passages from Aesthetic Facial Surgery by McKinney and Cunningham. The busiest clinician would contemplate the subject with awe if he or she gave a minute or two to reading only the preface. One reason that aesthetic surgery has not found its rightful place in medicine is that many of its practitioners have embraced the hyperbole and attempted to sell their procedures like pedlars on a busy street corner. Many texts on aesthetic surgery are illustrated by glossy portraits of the author’s best retouched photographic results. This approach serves to reinforce the already tawdry opinion of most observers about the field. The authors of this text have assiduously avoided the temptation to publish only perfect results. The photography is realistic and emphasises the "usualness" of the average result. Although everyone recognises the artistic input necessary to obtain the best outcome from aesthetic surgical procedures, many onlookers probably believe that the science of aesthetic surgery is an oxymoron. However, the psychological make-up of these patients and the minute details of anatomy of which the surgeon must be aware comprise an independent body of scientific knowledge. The chapters devoted to science are as carefully presented as those on more artistic aspects. The honest surgeon accepts that not every operation is a complete success. Only when all of the possible outcomes are described in a text is it worth the sale price or the time involved in reading. This text is worth both the price and the time. I believe that everyone who studies McKinney and Cunningham’s book will come away feeling enriched, with a greater appreciation for and understanding of the specialty of aesthetic surgery. Division of Plastic Surgery, University of Texas Medical Branch at Galveston, Galveston, Texas 77550, USA MARTIN C. ROBSON Malignant Mesothelioma Edited by Douglas W. Henderson, Keith B. Shilkin, Suzanne Le P. Langlois, and Darrel Whitaker. New York: Hemisphere. 1992. Pp 412. /;71/$99.50. ISBN 0-891169776. Outside Australia few have ever heard of Wittenoom, a small isolated town about 1100 km north of Perth. Asbestos mining started there in 1937. In 1943, the mine was extended, a rail link was built to Port Sampson, and Wittenoom developed as a "one company town". Inefficiency, ineptitude, and rejection of well-established medical knowledge about the then known hazards of asbestos led to appalling working and living conditions. The whole town became covered with asbestos dust and the tailings from the mine were used in school playgrounds, house yards, and public venues. During the next 23 years, until the mine was closed in 1966, 7000 people worked or lived at Wittenoom. Few stayed long, but by 1986,356 had asbestosis, 141 carcinoma of the lung, and 94 malignant mesothelioma. By 2020, there will be another 600 people who will have manifested malignant mesothelioma and a further 180 will get carcinoma of the lung. Wittenoom is the worst industrial disaster in the history of Australia. Pathologists, chest physicians, and occupational health officers will welcome the detailed reviews on the epidemiology, pathology, and the diagnostic and radiological difficulties posed by this disease. Lawyers and philosophers will benefit from reading the discussion about the medicolegal issues relating to mesothelioma, and about the moral responsibilities of employers and governments. When I read this book the years rolled back for me. W. T. E. McCaughey, then a young pathologist in Belfast, reviewed the histology of 15 cases of mesothelioma in 1958 and confirmed that this lesion was indeed a tumour. In 1959, I learned that Chris Wagner in South Africa suspected that mesotheliomas were related to previous exposure to asbestos dust. Peter Elmes and I asked McCaughey to look again at his sections; in 12 of his 15 specimens he found asbestos bodies, and in 4 of these he was able to obtain a clear history of exposure to asbestos in the Belfast shipyards. Elmes and I, with no encouragement from the management, went aboard an old aircraft carrier that was being refitted for the Indian navy. Deep in the hold, we peered through the bluish grey dust at unmasked laggers and craftsmen who later ate their sandwiches off the dusty work surfaces. Then we did something only possible in a city like Belfast, where families occupy the same house for successive generations. We identified 42 patients who had died of malignant mesothelioma and selected as controls patients of the same sex and age, but with other diseases, whose names were closest to those of the propositi. Two of our social workers, Mrs Simpson and Mrs Dudgeon, who did not know which of the 84 patients had had mesothelioma, then visited the patients’ homes and obtained information about the type of work the patients had done. We found that 32 of 42 patients with mesothelioma had a known history of exposure to asbestos. Only 9 of the 42 controls had such a history. We published these data in 1965; they were a helpful confirmation of Wagner’s suspicion. What we did not publish was a finding that surprised us. We found that most of the laggers and insulating workers knew that their life expectancy was limited. It was quite usual for them to make informal arrangements so that their widows would be looked after and comforted by colleagues after they had gone. The Australian authors of this book make no comments about the perceptions that the public and the media have about asbestos. People have forgotten that asbestos compounds were once the most effective insulating and fire-resistant materials available. Although those who mine or process asbestos are at considerable hazard, asbestos compounds have saved innumerable lives. Most fears that the public have about asbestos are exaggerated. Several years ago I watched with interest a university spend an inordinate amount of money stripping out asbestos sandwich boarding that was of no hazard to anyone-until the contractors created dust by their stripping.
