BOOK REVIEWS

The Hyperactive Child with Minimal Brain Dysfunction. J. Gordon Millichap. 1975. London. Chicago : Year Book Medical Publishers. Lloyd Luke. s

This book, written by a paediatric neurologist, is an attempt to introduce some order and definition into a very vague field. States of minimal brain dysfunction no doubt exist but their delineation has always been difficult. Having read the book, however, and despite the considerable help provided by it, it must be said that this reviewer still feels that the diag- nosis of MBD remains a difficult one.

The book is organised on a question and answer basis. It is intended to be read by paediatricians, general practitioners, students, teachers, parents and informed laymen and is necessarily somewhat didactic, although the author is at pains to point out the uncer- tainties which exist as to the aetiology, diagnosis and management of the syndrome. As might be expected it will not be of equal value to the different categories of readers for whom it is meant. Much space, for instance, is devoted to e!ementary accounts of such subjects as mental retardation, cerebral palsy, epilepsy and the clinical examination of the nervous system. These will be of interest to students and parents but not of much assistance to paediatricians. In the section on diagnostic evaluation, however, there is an informative account of the EEG changes which may be met with. Also included is a useful survey of methods of neuropsychological testing and of examination of the special senses.

Although the early chapters may not be of great benefit to paediatricians the later sec- tions on treatment and management will be hetpful to them and to all those who have to deal with the very difficult problems so often presented by these children. The author obviously writes from wide experience and provides clear and definite advice as to what can and should be done. There is a helpful review of the wide variety of methods of treat- ment which have been suggested. These have included a large number of drugs, systems of behaviour modification, special educational methods and even special diets. It is pointed out that proof of the efficacy of many of these measures is lacking. It will be of interest to paediatricians that this comment is applied to lhe patterning theory first put forward by Doman and Delcato. The author considers that singly or in combination, behaviour modi- fication by a system of reward and punishment, the use of stimulant drugs such as methyl- phenidate and the provision of special educational facilit ies will benefit many of these children. He points out, however, that the prognosis shares in the general uncertainty which surrounds the syndrome but that the hyperactivity and behaviour disorders may be expec- ted to improve with age.

The book concludes with a number of case histories. These illustrate some of the difficulties in diagnosis. Two of the five children described, for example, came from un- stable homes, thus making it hard to decide how far emotional disturbance may have been the prime cause of the children's abnormal behaviour.

This short book is well and clearly written. All doctors and some laymen who are con- cerned with the care of difficult children will benefit from reading it.

RICHARD BARRY.

Modern Medicine. A textbook for students, practitioners and examiners by members of the teaching staff of the University of Bristol School of Medicine. Edited by Alan E, Read, D. W. Barritt, R. Langton Hewer. 1975. Pitman Medical Publishing Co. Ltd. Cased edition s + VAT. Paperback edition s + VAT.

"This textbook is intended for students, practitioners and examiners" - -an intriguing and challenging pot-pourri of medical personnel. That its layout and approach is original there can be little doubt. That some will approve enthusiastically and others protest violently, there can also be little doubt and obviously therefore it must present the reviewer wilh a dilemma. It is the product of the combined efforts of the Bristol University Medical School under the leadership of Professor Alan Read and throughout the book's mercifully modest compass of 542 pages there is ample evidence of this unifying influence and purpose. Each section is introduced by a short, clearly written exposition of relevant basic pathophysiology all of remarkably similar style and depth and the virtue of simplicity is given high priority. In the accounts of individual diseases there is no attempt at descriptive writing, symptoms and signs being presented in the form of brief l ists--a practice which if making for visual

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BOOK REVIEWS 315

clarity is certainly expensive in the consumption of page space--a fact which again empha- sises the essential brevity of the book in terms of reading. Perhaps wisely, therapy is presented in the form of "basic treatment" wherein essential principles are outlined rather than detailed therapeutic procedures. This seeming short dismissal of treatment is how- ever more than compensated for by excellent sections wherein the "diff icult" subjects such as water and electrolyte problems, clinical immunology and the principles of antimicrobial therapy are presented with the kind of realstic relevance to the daily practice of modern medicine so often lacking in similar accounts by others.

The text is illustrated generously but economical ly by simple black and white drawings and tables, which in the great majority of instances seem to achieve their common objects of clarification and visual aid to communication, though a minority would appear to be naive and unhelpful. Opinion on this aspect of the book will vary with individual tastes in the exercise of learning and one is convinced that it will be considered critically in the composition of future editions.

Perhaps one of the outstanding qualities of the book is the manner in which the authors have achieved a sensitive perspective in the presentation of the true essentials of relatively common conditions by avoiding the temptation to produce a mini-encyclopaedia of disease. The reader will find that what is important is presented with clarity and precision. If, occas- ionally, generous coverage is given to some entities rarely encountered in practice, it is because they are necessary to the understanding of such major advances in modern medi- cine as those achieved by geneticists and biochemists in the exciting areas of inherited and molecular disease and this is work which must eventually play a profoundly important part in future disease prevention. Here also in a more general way the authors recognise the paramount importance of epidemiological and ecological surveys in obtaining informa- tion vital to the development of preventive medicine.

One has endeavoured to convey that "Modern Medicine" is an interesting, original and in some ways exciting arrival on the crowded scene of medical literature. It definitely war- rants admission to all libraries, giving it a fair chance to win a place in the competit ive market of medical textbooks. Your reviewer would favour its use by senior students and interested junior hospital doctors with membership in view. The cost of the paperback edition at s plus VAT is perhaps a little high for this type of publication. It will not, one suspects, survive too long the wear and tear imposed by frequent and enthusiastic handling. The authors and publishers would be well advised to get together on this problem otherwise, while this fine exercise of team work by the staff of the Bristol School of Medicine should find an honoured place in most libraries, it is unlikely to become a favoured com- panion of the individual "student, practit ioner or examiner".

W. F. O'DWYER.

Diverticular Disease: Clinics in Gastroenterology. Vol. 4, No. 1. Edited by A. Smith. 1975. London. W. B. Saunders. s (s for 3).

Diverticular disease is truly a disease of this century and in particular of the industrial- ised West. In this issue of Clinics in Gastroenterology a panel of experts, almost all British, summarise current thoughts on its aetiology and management. Painter and Burkitt review the historical background emphasising that the disorder was still not even mentioned in text books of surgery in 1920. They develop the now familiar theory of dietary fibre de- ficiency as the major aetiological factor in the development of diverticular disease. This theory, though attractive and popular, is still circumstantial and final proof is awaited. Surgical management is adequately covered and there is a good ,chapter on sigmoid myotomy by Reilly and Smith. Medical management is summarised by Eastwood with clarity and a laudibly critical approach.

This is a useful review volume for the gastroenterologist. It ;suffers perhaps from a reluctance by the editor to trim some of the contributions. This has led to much repetition but it does emphasis.e the lack of consensus on many aspects of m~nagement of diverticular disease. Confusion also arises from the attempt by many of the contributors to cover similar facets of surgical management mostly based on personal experience. The importance of angiography in diagnosis of bleeding is only mentioned in passing and deserved fuller coverage. Bleeding from right sided diverticular disease is not given any prominence. It is hoped that 10-15 g. cereal bran plus appropriate fruit ingested daily may reduce the incid- ence of this disease in the coming decades.

M. J. WHELTON.

316 IRISH JOURNAL OF MEDICAL SCIENCE

Anatomic Guide for the ElectromyographerlThe Limbs by E. F. Delagi, A. Perotto, J. lazzetti and D. Morrison. 1975. Springfield, Illinois. Charles C. Thomas. Price $6.50.

This book illustrates in black and white the anatomy of muscles which might require to be needled by an electromyographer. The text records the origin and insertion of each muscle, supplies a recommended site and depth of needling and gives the test manoeuvre for the muscle. Finally, pitfalls if the needle is incorrectly sited are mentioned.

Anatomical variations such as absence of muscles and variations in innervation are not referred to. There are no references. The illustrations are all in surface anatomy style and compare unfavourably with touched up photographs.

This is a book of handy size and easily referred to but the electromyographer who has retained his Gray's Anatomy with its two dimensional colour illustrations will have no need of it. Also, from Gray he will get a clearer idea of what his needle is going near or through to get to its target.

EDWARD A. MARTIN.

A Colom Atlas of General Surgical Diagnosis. William F. Walker. 1976. London. Wolfe Medi- cal Publications.

This atlas contains 750 seven colour illustrations of high quality used for a review course in Final Medical year at Dundee University. The author states that these are used as a "hat peg" on which to base discussion on aetiology, pathology, diagnosis and treat- ment. Comparison with Hamilton Bailey's "Physical Signs" is inevitable. For reasons of size and the use of colour the illustrations in this Atlas are, for the most part, superior. The text, unlike the lecture course for which the illustrations are used, is brief and consists in the main of a three-line description of the condition. Unlike the lengthy, and some feel it too lengthy, account of methods of physical diagnosis in "Physical Signs". Somewhere between these two books must lie a via media.

Two examples of anthrax are shown and contain a word of warning to the increasing band of amateur gardeners in that each developed as a result of exposure to bone-meal. The pigmented naevus shown is almost certainly intradermal which is the least dangerous and it is about time that the more accurate term epidermoid cyst should be used for seb- aceous cysts in surgical textbooks. One would also wish that cleft lip should be used instead of hare-lip. A ganglion would be better illustrated by a lesion of the wrist or foot than one on the dorsum of a finger as shown here. The illustration of venous ulceration provides a good opportunity not availed of, to differentiate between primary varicosities and the post phlebitic limb.

The gastro-intestinal tract is well covered by means of operative photographs, radio- graphs and pathological specimens. The surface marking of the femoral pulse is not the mid point of the inguinal ligament but the mid inguinal point which is just medial to this, Buerger's disease (or syndrome !) would be better illustrated by active disease in a foot lhan by burnt out disease in a hand.

In summary, this is a very readable and informative book for student and postgraduate which leaves me with a feeling of what might have been with more expansion of its text.

MICHAEL P. BRADY.

Harriet Lane Handbook by D. L. Headings, 7th edition. 1975. London. Lloyd Luke. s

This is the most useful paediatric vademecum available. Designed to meet the needs of paediatric house-officers it should be kept to hand for easy reference in every paediatric ward and every hospital admission unit. It is also suitably small to fit in the bag of a practitioner who has many children in his practice.

Normal values are covered fully, including blood, ECG and biochemical data. There are tables of normal heights and weights, admittedly derived from American studies, and in addition tables for skull circumference, blood pressure and other variables. Normal mile- stones of development are given in sufficient detail to enable the doctor to reach a prelimin- ary conclusion about the LQ. of children of all ages up to five years. Fluid therapy guide lines and drug dosages are included, together with an analysis of commonly used infant feeds. The only deficiency encountered was in this section as the infant feeds most com- monly used in these islands it would be worth including these in future editions, as this book is likely to continue to be widely used.

O. C. WARD.

BOOK REVIEWS 317

Year Book of Ear Nose and Throat 1975 by M. Panarella and M. S. Strong. London. Lloyd Luke. s

The first Year Book, published in 1900, was the Year Book of Nose, Throat and Ear, edited by Gustavius P. Head, an eminent laryngologist from Chicago. Seventy-five years later the Year Book of Ear, Nose and Throat still flourishes, thus showing in no uncertain manner the popularity of this type of publication.

As in 1974, the Ear Section has been edited by Michael M. Paparella, co-editor of a recent four volume publication on diseases of the ear, nose and throat, and the nose and throat section by M. Stuart Strong, an outstanding graduate of Trinity College, Dublin, and recent recipient of the Wilde Medal. Both editors are to be congratulated on their continued efforts in reading, selecting, and condensing some 260 articles into some 360 pages. Again, their personal comments on several articles give added interest to the publication.

The majority of the articles are taken from English language publications, and as one would expect, the majority come from American sources. However in reality, the choice of both journal and author is quite internat ional-- f rom Canada to Vienna, and from Scandinavia to Australia. Again the articles have been chosen from a wide spectrum of specialist jour- nals relating to every branch of medicine and surgery, and the reviewer considers this wide choice adds to the attractiveness of this volume.

It would be invidious to mention specific articles with particular appeal to the reviewer. Suffice it to say that there is something to interest every oto-laryngologist in this volume, and it can be recommended as a valuable addition to any library, personal or reference, but because of its nature should be mar.ked "For Immediate Attention".

A. J. 13LAYNEY.

White Cells in Inflammation by C. Gordon van Arman. 1975. Springfield, U.S.A. Charles C. Thomas. $14.50.

This book is the product of a meeting held in Philadelphia in 1972 under the joint auspices of the Inflammation Research Association and the Philadelphia Physiological Society. It deals with some of the phenomena of inflammation in seven short chapters. The subjects covered range from platelets and permeabil i ty factors to the formation of pedal edema in normal and granulocytopenic rats. There are several interesting chapters on the macrophage, and white blood cells and crystal-induced inflammation, and a review of the role of serum complement in neu/rophil mediated inflammation. There is an attempt to present the information in as palatable a form as possible and while this is achieved to a certain extent through the use of electron micrographs and schematic representations of the inflammatory process, the reader is left with an uneasy feeling of neither having read a satisfactory review of any of the subjects covered nor a truly hard presentation of data. The chapter on complement is no more than a poor overview in contrast to that written by Speirs and Speirs which deals with quantitative aspects of inflammation and provides much in the way of experimental design and detailed results. It is difficult to see why the results of a scientific meeting should be presented in such markedly contrasting ways. The volume is likely to be of most use to experimental pharmacologists and pathologists.

JOHN F. GREALLY.

Smoking and its Effects on Health. Report of a WHO Expert Committee. Technical Report Series 568. Geneva, 1975. 100 pp. S.F. 9.

This monograph contains a collection of recent WHO reports on the health effects and control of smoking. It is of value to those who are concerned with the public health aspects of the smoking habit.

There is a summary of additional evidence on the deleterious effects of cigarette smok- ing which has accumulated since the 1970 report of the Director General of WHO. This is fol lowed by sections on smoking trends in various countries, smoking control measures which have been tried and recommendations to national governments and health agencies about smoking control. Further research needs are also defined.

There is much of interest in this monograph, particularly in those sections dealing with control of smoking. However, in the reviewer's opinion much of what is stated here and elsewhere about control is mere waffling if one ignores the responsibil ity of our govern- ments.

318 IRISH JOURNAL OF MEDICAL SCIENCE

The community's attitudes to cigarette smoking witl continue to be ambivalent and young people will continue to be unfairly pressurised to smoke cigarettes as long as our govern- ments allow advertising of cigarettes in any form or in any medium. Nobody should be prevented from smoking cigarettes in this liberal world of ours but government, in exercising its paternalistic function, should ensure that all forms of advertising, including the sponsor- ship of sporting events by cigarette companies, should be prohibited. How can our govern- ment claim to be concerned about the health and morals of the younger generation when it allows major sporting events in our country to be the means whereby the high incidence of coronary heart disease, stroke, lung cancer and chronic lung disease are sustained for future generations ?

Our public representatives should disapprove and be seen to disapprove, of the callous efforts of the cigarette trade to increase profits at the cost of widespread ill-health and unhappiness.

R. MULCAHY.

Handbook of Endocrine Tests in Adults and Children by Robert N. Alsever and Ronald W. Gotlin. 1975. London. Lloyd-Luke. s

The provision of an up-to-date compendium of the various endocrine function tests available is the purpose of this book. Although a paper-back of 280 pages, it is not as long as it seems, since the print is type-script with wide margins (about six words per line). It is largely limited to endocrine tests which involve "biochemical analyses--but not com- pletely. For example, radiological investigations are discussed in relation to pituitary, but none in relation to adrenal or parathyroid disorder.

It is reasonably up-to-date--to about early 1974, and provides data on many interesting tests, in particular of pituitary function in relation to releasing factors and prolactin kinetics --g iv ing the method of performing the test and the response in normals.

Most useful biochemical tests are mentioned, and many others in addition which are of research interest or are obsolete. This is because "we must be knowledgeable concerning these tests since they continue to appear in the literature or in patients' previous records". However, for the non-endocrinologist, there is little critical analysis of the relative practical information to be gained from the multiple tests quoted.

The majority of useful tests discussed will, of course be contained in a large up-to-date standard text of endocrinology. However, this book might be a useful ready reference in a clinical biochemistry department where, a clinical decision to perform the test having been taken elsewhere, the pathologist must try to provide a useful interpretation of the results compared to normals.

DAVID POWELL.

Understanding Your New Life With Dialysis by E. T. Oberley and T. D. Oberley, 1975. Spring- field, Illinois. C. C. Thomas. $12.50 Cloth. $7.95 Paper.

This is an easily read and understood introduction to the new life for the patient with chronic renal failure. There is, throughout, a cheerful and optimistic note which is en- hanced by the author's own obvious success and the many case histories of people from all walks of life who have mastered the techniques and resumed a full and active life.

The writers do not presume any prior knowledge. The reader is offered a concise ex- planation of the symptoms and pathological processes in renal failure. There is then an excellent explanation, with simple diagrams of the working of the machine accompanied by explanations of the terminology used in units by patients and staff.

The importance of dietary regimes and supplementary medications is stressed by em- phasising the benefit to the patient. This is supplemented by an exhaustive set of tables giving contents of salts and protein in a wide range of foods.

There is no attempt to gloss over problems, indeed everything from prognosis to pro- creation is discussed. It does not strike an optimistic note about the present state of trans- plantation which might be unpopular in centres pursuing an active programme.

The presentation is "expensive" for a book which should be cheaply available to patients and attendants.

KEVI N MOORE.