BOOK OF THE DAY:The Deadly Dinner Party By Jonathan A Edlow MD Yale University Press 242pp. $27.50

DR EDLOW is a distinguished emergency room physician in Boston and is an associate professor of medicine at Harvard Medical School.

In this book he presents 15 medical conundrums, where initial diagnosis was far from certain and many of which required exhaustive tests and expert opinions. He goes to great lengths to make these highly complex cases intelligible to the general reader and indeed to professional colleagues. He describes the case histories of patients and the background to their initially baffling illnesses.

His presentations show that not all illnesses can be readily diagnosed and that the fashion for planning discharges on the day of admission is not compatible with best medical practice. Time and patience are of the essence in investigation of unusual clinical presentations.

Essentially the book is about differential diagnosis, where all possible conditions are considered and appropriate tests conducted. Enlisting of relevant expertise in time is stressed, some other doctor may have encountered a condition like this, or the medical literature may point in the right direction. It’s all about perseverance. Time is not always on the physician’s side and the sense of urgency of diagnosis is evident.

The chosen case histories would make you wonder if any human activity is risk free. The answer is probably no. Those folk who place reliance on folk medicines, dietary supplements and additional vitamins might read this book with interest. They might find it scary and realise you have to be careful about what you take and consider the possibility of unpleasant side effects.

Sometimes there is little the consumer can do. An illustrative case shows how a dairy inadvertently added toxic doses of vitamin D to fortify their milk. Dr Edlow explains the background to the addition of such additives; in this case the fight against rickets. The role of the American Food and Drugs Administration in this and similar cases was crucial.

The book provides further examples of the importance of food safety, something we often take for granted. Even doctors fall into this trap as illustrated in another episode concerning inadequately prepared fish at a lunch party of doctors in a hotel; all who partook of the fish became acutely ill.

A further fishy tale tells of six amateur fishermen who caught 28 Yellowfin Tuna in one outing. The boat lacked proper refrigeration and one pious fisherman donated a portion of his catch to a local convent. The good Sisters shared their bounty with another convent. The good deed poisoned two convents, although nobody died.

The case in the overly hot honeymoon chapter is more a medical story. I am not sure it fits well here, as it really concerns a condition that is not uncommon. While the patient was on her honeymoon it was noted that while she was intolerant of the heat, she could swim in ice cold water. It is a case with an Irish background, one of Graves disease, named after the Irish physician Robert Graves, or Hyperthyroidism, and is a classic case study of a patient with the condition. It illustrates the point that even relatively common conditions can pose diagnostic problems.

Medicine is not a conveyer belt. Dr Edlow shows us that time, effort and skill are as necessary now as in the earliest days.

Maurice Neligan is a retired cardiac surgeon and was director of the National Cardiac Surgical Unit. His weekly column, Heart Beat, appears in Healthplus today.