Who has the gall to try to review critically a 10-kg, three-volume textbook with 4000+ pages? If you are eager to know, look quickly below.

With these dimensions, is this book a dinosaur that has survived out of historical times? Or is it simply a leviathan, a creature clearly living but so huge that it necessarily lags behind smaller and more nimble sources of information? The editors knew that these questions would be likely to come up. In their preface, they refer to such "jaundiced" views of the first two editions but tell us quickly that these views did not keep them from producing a new edition, that they are "unrepentant."

If one disregards the question of the day-to-day utility of such huge textbooks, one can unreservedly admire the Oxford Textbook as a great monument of modern medicine. It is both a practical book for today and a panorama of those aspects of basic science that almost certainly will be relevant to clinical medicine for a long time to come. It advises the clinician on how to proceed, often in specific detail. But it also sets out a clear picture of the scientific concepts that lie behind today's practice. It looks out at the whole world of disease and avoids the parochialism of some North American texts of its kind. Indeed, one can hardly imagine some chapters surfacing in an American textbook. An excellent example is the chapter called "The Diseases of Gods: Some Newer Threats to Health," by MH King and CM Elliott, which takes a clear headed and almost despairing look at the ills of mankind that are well beyond the touch of medicine: overconsumption of goods in the industrialized nations, the imiseration of much of the rest of the world, the collapse of community, the "temptations of technological immortality." Most of the authors are British, but the editors have also brought in authors from the European Commonwealth countries and a few other regions in which physicians probably have greater expertise in particular problems than do physicians in the United Kingdom. References have been carefully chosen; most direct one to additional, more detailed, synoptic sources, usually review articles and other books.

A textbook of these dimensions is a good candidate for a CD-ROM format, through which one can move quickly to those parts of text that are relevant to specific questions. Indeed, Oxford has promised that a CD-ROM version will be published in the summer of 1996. But physicians who see little advantage in turning on a computer beyond using it to find a book on the shelf can be assured that this text has been so thoughtfully and carefully indexed that it can be used about as efficiently as its size permits. Each volume contains the entire index, and the type conventions of boldface, plain face, and italics indicate, respectively, main discussions, minor points, and tables.

One could probably practice exemplary medicine with this text and Grateful Med as one's sole resources; this text would serve as a great foundation of concepts and practice not likely to change rapidly, and Grateful Med would provide access to recent changes in therapeutics. The value of the CD-ROM version will probably hinge on whether the product is revised and issued often enough to keep up with the evidence for changes in therapy from new clinical trials and new meta-analyses drawing on the data in those trials.