JGG Ledingham was a famously affable man, the very epitome of the Oxford academic clinician with a legendarily unruffled bedside manner and razor-sharp intellect. He was awarded a personal Chair in Medicine in 1989 and such was his sangfroid, I only ever witnessed the legendary JLed composure crack slightly on two occasions.
After a bizarre clerical error had led to my appointment as one of his last cadre of house officers, I approached him to provide a reference for an ENT SHO job in Southmead Hospital. He regarded me with a quizzical air and apologised that he was accustomed to writing recommendations for professorial appointments in the great tertiary centres, but after some encouragement on my behalf, agreed to give it a go anyway. On my subsequent successful appointment, he sent me a beautifully hand-written letter of fulsome congratulations at my well-deserved elevation which I kept for many years, so effusive was its tone. It is only now after all these years that I ask myself is there a possibility he was not being completely sincere?
Anyway, the reason I’m dredging all this up was that the good professor spent huge amounts of his time painstakingly editing the Oxford Textbook of Medicine – a vast three-volume behemoth of erudition. He once claimed to have read all of the references to every single chapter of this prodigious work, which was clearly a great labour of love. However, the second time I encountered a hint of exasperation in his demeanour came when he had optimistically agreed to proofread the entire first edition of the Oxford Textbook of Pathology. He had slogged several hundred pages into the first volume and I obtained the distinct impression that his overwhelming enthusiasm for academic pathology was somewhat on the wane.
Thus it was, dear reader, that when I was approached to provide a review of the Oxford Textbook of Otolaryngology, my first question involved the pagination.
“About 720,” came the reply.
There was a long pause…
“But there are lots of pictures.”
Thus it was that a sizeable package plopped into my vestibule a few days thereafter. To paraphrase the late Duke of Gloucester, it is indeed another damn’d thick square book, but is a surprisingly easy read. Only an idiot would attempt to take it on from start to finish like a Jackie Collins, rather than dip in and out as intended, so of course I poured myself a large whisky and soda, opened at the foreword (by Dame Professor Valerie Lund DSO and Bar of this parish) and got stuck in.
This stupendous work represents the latest addition to the Oxford Textbooks in Surgery series, which has already produced six volumes devoted to (somewhat inferior) surgical subspecialities aiming to provide a comprehensive resource for the busy clinician. According to OUP, they aim to provide careful integration of basic science and the best of clinical practice, with an international focus and exhaustive coverage. It is certainly a fine-looking beast despite the unnecessarily hideous redesign of the publisher’s logo, fitting comfortably into my shoulder-bag next to laptop, festive bake and Daily Mail. Thus, it occupies a place in the market between the Oxford Handbook of ENT – designed to fit into the non-existent white coat pocket a la ‘Cheese and Onion’ – and the shelf-busting old-school Scott-Brown. The latter once left me with a sunburnt face after an ill-judged attempt to photocopy the entire six-volume edition during a night shift in High Wycombe. This procedure severely tested my boredom threshold (as sadly did the entire Audiology volume) and was my final foray into wholesale copyright fraud, entailing an emergency visit to Ryman’s for two toner cartridges and several reams of paper. Were I to attempt a repeat today, I would inevitably need an emergency visit to the surgical appliance stores to adjust my faithful truss, such is the scale of the 2008 edition.
Anyway, there is certainly a gap in the market for a single-volume textbook of ENT which covers all a consultant with general exposure to ‘undifferentiated’ patients may require. Whatever that means. Our speciality is famously diverse, seeing allcomers from cradle to grave over a broad range of complex anatomy and pathologies, and although the text is clearly aimed at the trainee facing the Intercollegiate Exam, it is also highly relevant for the subspecialist covering the breadth of the speciality on-call or in the clinic room.
In our paperless digital utopia, it would appear that the role of the modern textbook should be to provide a digest of current best practice – the fundamental unarguable bedrock of the speciality learnt over decades of hard clinical experience and scientific progress – but also to allude to the shifting sands at the extremes of our knowledge. Perhaps we forget that our journals and conferences inhabit this zone of curiosity and controversy, and a disproportionate amount of our CPD is spent arguing over fascinating but perhaps fringe issues. Six weeks of poring over this text has proven to my jaded self a refreshing tonic, revisiting the fundamental principles of our work whilst not skirting controversies; most authors include a section on the most pressing contemporary areas of dispute.
Unlike Caesar’s Gaul, the book is divided into four parts, addressing conditions of the ear, nose, thoat and children respectively, each with an introductory chapter on clinical assessment and relevant investigations. The rest of the chapters in each section address common clinical presentations and their differential diagnoses, with a few chapters reserved for particularly important or interesting conditions. Illustrations are profuse and of excellent quality, with diagrams (Peter Rea’s summary of vestibular medicine on page 47 is a particular favourite), photos (the head and neck reconstruction and sinus surgery chapters being particularly lavish) and schematic illustrations. The text is succinct and clarity is valued over jargon – the entirety of maxillofacial surgery appears to be adequately summarised in three illustrated pages.
There is undoubtedly an Anglophile bias, although no fewer than 17 contributors hail from North America, and 14 from Europe, with significant Antipodean input. Any sense of parochialism is however rarely in evidence, other than in the opening chapters of ‘foreplay’ regarding good medical practice and rights of the patient, where readers may encounter the delights of GIRFT, duty of candour, IMCAs and revalidation. I personally found these introductory forays were some of the most engaging and thought-provoking, but I fear our global colleagues may gaze on with bewilderment at the current peccadilloes of UK practice.
My only other slight issue is the shadow of Covid, which looms large over many (but not all) chapters. When a textbook is compiled during unprecedented times, we should perhaps expect a significant impact on content and, in retrospect, it is easy to write off the period as an aberration and dismiss lessons learnt. As you read this, we may possibly find ourselves immersed in yet another wave and you may find me in a mask and apron frantically scouring Home Bargains for hand gel. I hope not.
In all this is an indispensable work for the ENT clinician, whether senescent consultant or vestal trainee, covering in a single authoritative volume a synopsis of our specialist body of knowledge in clear pithy prose. In the time it took to transfer a paediatric airway disaster from Slough to Headington, I was able to idly leaf through the relevant chapter and sink a double espresso. There is a whole chapter on a pragmatic approach to post-nasal drip, vestibular migraine finally earns prominence equal to Ménière’s, and the chapter on CRS oh-so-gently hints at the clinical difficulties of endotyping. I learnt about the wonders of the Bonfils retromolar intubation scope, first bite syndrome and a Bayesian approach to neck lumps.
If there are better ways to spend £190 in this world, I remain ignorant of them. Buy it, read it, mark it and inwardly digest it. You will not regret it and, in the process, may find yourself a better doctor, ENT surgeon and human being.
