My first reaction as I began reading this book is that the subject does not match the expectation I had formed from the title. I expected Chemical Exposures to cover examples of classical and newly discovered chemical toxicities from environmental, industrial, and other settings over the full range of concentrations. The subtitle, Low Levels and High Stakes, does indicate that the focus is on the lower limits of sensitivity. In fact, this book focuses on a relatively narrow, controversial area of so-called "chemical sensitivity" or "multiple chemical sensitivity" (MCS). I don't emphasize this point to be critical of the book, because the authors take a rational, scientific approach to this important subject; but I do want to alert potential readers to the fact that a more narrow subject is covered than they might assume from the title.

Unlike many second editions, this book is not a rewrite of information in the earlier edition but rather focuses on MCS literature published since 1991. It is presented in four parts: Part I is Defining Chemical Sensitivity; Part II is Mechanisms, Diagnosis and Treatment; Part III is Responding to the Problem; and Part IV is Update since the First Edition.

In Part I, Ashford and Miller define and describe MCS and related terms and concepts. Their definition of the condition is based on a process of environmental testing of patients, first, by removal of the suspected offending agent, and second, after an appropriate period of time, by rechallenge. A number of occupational and environmental scenarios are described that have been associated with MCS, and a listing of offending substances is provided. Part II presents several possible physiologic or psychogenic mechanisms for the development of MCS. There are also discussions of methods for diagnosis and treatment of MCS and the controversies surrounding the condition between allergists and clinical ecologists. Ashford and Miller provide a description in Part III of how MCS is viewed by society, governmental agencies, and the law. They describe their concerns and offer recommendations on directions for research, the health care system, and governmental policy. Part IV provides a review of research and other developments on MCS since the first edition was published in 1991. This is the most comprehensive part of the book, with a section on changes in governmental policies and actions relative to MCS and a summary of recent research findings. This includes discussion of some "hot" topics such as the reported increases in chemical sensitivity in veterans of the Gulf War and in women with silicone breast implants.

There are also informative appendices on Health Effects Associated with Chemicals or Foods, Laboratory Diagnostic Tests Used in MCS Studies, and an Environmental Exposure and Sensitivity Inventory. An extensive bibliography is provided with references through 1996.

This is a valuable book for anyone who has an ongoing interest in MCS or for those new to the field who would like to be brought up to date on the subject. The authors have done a good job providing a comprehensive overview of both research and societal issues and the health-related controversy associated with low-level chemical exposure.