E Graham Davies, David A C Elliman,. C Anthony Hart ... -DAVID ISAACS, head, department of immunology ... Secondly, in 1908 James Kerr,the school medical ...
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Manual of Childhood Infections E Graham Davies, David A C Elliman, C Anthony Hart, Angus Nicoll, Peter T Rudd Saunders, £17.95, pp 393 ISBN 0 7020 1832 5
ccR _he only book written by a committee that is beyond criticism is the King James Version of the Bible." Thus Stan Plotkin in his introduction to the red book. The red book is for many of us the Bible of paediatric infectious diseases, produced as a Report of the Committee on Infectious Diseases for the American Academy of Pediatrics, and revised every two to three years. We may not agree with all the recommendations, but the scientific basis behind them is likely to be sound, given the intense consultation that precedes each edition of the red book. Now we have the blue book, as it may yet come to be called, produced for the British Paediatric Association by five principal authors (three paediatricians, a microbiologist, and an epidemiologist) and 18 additional contributors, with acknowledgments to many others who contributed. The Manual of Childhood Infections has a strong emphasis on public health, but does not neglect diagnostic dilemmas for primary care doctors seeing children with infections. The first part of the book offers a symptom based approach: the child with diarrhoea and vomiting, the child with a rash, the child with suspected immunodeficiency,
etc. It is arguable whether this approach is not more appropriate to a textbook of paediatric infectious diseases-written descriptions of rashes without photos are of limited value. Nevertheless, there is much to be admired in the attempt, and sections such as those on preparation for overseas travel, the management of refugees, and internationally adopted children are valuable resources. The second part, as in the red book, deals with a large number of specific infections from amoebiasis to yersiniosis, not forgetting meningococcus and infestations. Many of these sections are too brief to be useful, and will need to be reconsidered in future editions. Others offer more definitive advice on the public health implications of different problems. The appendix includes tables with antibiotic doses for neonates and older children, exclusion periods from school, and a small section on specialised aspects of immunisation. Do we need an altemative to the red book? Unequivocally yes. The red book is written for North America, and medicolegal considerations sometimes outweigh com-
tion of the blue book every two to three years. The British Paediatric Association should canvass opinions from its members and from other health care professionals in general practice and public health, as well as "experts," before each edition. It will be a major undertaking, but the rewards of a definitive manual of paediatric infections with a British emphasis will be enormous. -DAVID ISAACS, head, department of immunology and infectious diseases, Royal Alexandra Hospital for Children, Sydney, Australia
The Health of the Schoolchild: A History of the School Medical Service in England and Wales Bemard Harris Open University Press, £16.99, pp 260 ISBN 0 335 09994 7
passion. Is the blue book the alternative we have been seeking? Not quite, but getting close, in my opinion. Common conditions and common problem situations need to be emphasised and definitive practical advice given. Different situations arising with chickenpox is a good example. Neither the red nor the blue book provide references for the rationale for recommendations, and I think the advice would carry more weight if its scientific basis was thus spelled out. Where now? I would like to see a new edi-
he Health of the Schoolchild provides
a
detailed history of the school medical services. It also provokes a very strong feeling of deja' vu because it shows how current arguments about the value of selective or universal medical examinations, or the accuracy of collected statistics, have been rehearsed many times before. It also gives a powerful description of the "mission" of the service, and the sometimes competing views of politicians, educationists, and health professionals, especially where responsibility for funding is discussed. A few examples, in chronological order, taken from the book will illustrate these points. Firstly, the Physical Deterioration Report of 1904 found that there was "very abundant evidence of physical defects traceable to neglect, poverty and ignorance" and that "there is every reason to anticipate rapid amelioration of physique as soon as improvement occurs in external conditions." Secondly, in 1908 James Kerr, the school medical officer for London, put forward the view that it was unnecessary to subject every child to a medical examination, and that there was little point in examining children for whom there was no prospect of proper medical treatment.
To order books reviewed here contact the BMJ7 Bookshop, PO Box 295, London WC1H 9JR. Tel 0171 383 6244. Fax 0171 383 6662. You can pay Human leucocyte antsgens (HI-A) as part of tme structure ot the major nhstocompatsiility complex. From hne Lye: B1asm by cheque in sterling drawn on a UK bank or credSciences in 1Practce by John V Forrester, Andrew D Dick, Paul McMenamin, and William R Lee (Saunders, ISBN it card (Mastercard, Visa, or American Express) 0 7020 1790 6), which, as the title suggests, embraces all the disciplines that contribute to understanding of eye disease. stating number, expiry date, and full name.
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By 1910 the battle was already being fought between those who felt that the medical inspection of each child should not occupy more than a few minutes and others whose opinion was that "the statistics will be unreliable, many defects will be overlooked, and the Medical Officer will have no time to think of what he is doing." In 1913, the BMA recommended that the minimum starting salary for a full time school medical inspector should be £500 a I year, but a junior officer could be appointed for as little as £250 a year. In the end "assistants" were appointed for £30-50 a year. Many of us will feel great empathy with Dr John Underwood, who in 1930 complained that for three years the local education authority had failed to implement any of his recommendations; however, I could hardly see any contemporary critic writing as follows: "the School Medical Officer is partly to blame for his inability or unwillingness to influence a difficult and reactionary Committee." The Health of the Schookhild puts a serious face on this often ill understood service in the context of the social conditions and the important historical events of the 20th century. It describes its roles in overseeing health, health promotion, and treatment as well as controversies over "medical inspection." I occasionally got lost in the detail, but this book would make excellent compulsory reading for our current politicians and planners as well as for practitioners.-LEON POLNAY, reader in child health, University of Nottingham
Psychosocial Disturbances in Young People: Challenges for Prevention Ed Michael Rutter Cambridge University Press, £30, pp 403 ISBN 0 521 46187 1 Psychosocial Disturbances in Young People presents strong evidence that criminal activity, suicidal behaviour, substance abuse, depression, and eating disorders have all increased in frequency since the second world war. All the more surprising as this coincides with a steady improvement in physical health and better living conditions.
has a very strong tendency to continue from childhood to adolescence and approximately half of all children aged 8-10 who show antisocial behaviour will continue to have this problem at 14. Similarly, troublesomeness at 8-10 years strongly predicts truancy, bullying, and aggression at 12-14. Longitudinal studies have confirmned that the likelihood of conduct disorder in young children continuing into adolescence is much greater if the conduct disorder is associated with hyperactivity. The second part of the book focuses on prevention, concentrating on three strategies: adolescent coping mechanisms; school intervention programmes; and youth organisations. The chapter on school function is of particular interest since recent research confirms that school influences can make all the difference between success and failure for individual pupils. Schools where teachers take a clear lead and have high expectations of pupils tend to have more successful outcomes and there is a strong tendency for low achievers to cluster in failing schools. This process could well be exaggerated by the current system in Britain of schools opting out. Throughout the book the influences of individual factors, family factors, and social and cultural factors are highlighted. The interaction between these multiple influences is complex and potentially confusing. Family dysfunction is repeatedly identified as one of the most important risk factors for problem behaviours in adolescence, and poor parental supervision has been shown to be the best predictor of both violent and property crimes committed by boys. One of the most interesting chapters is on puberty and the various reactions to pubertal changes. Apparently the average age of onset of puberty has decreased by at least two years over the past century. This may have some important implications because early onset of puberty has been found to be associated with early experience of sexual intercourse, drug abuse, and delinquency in girls. The large amount of research on the effects of puberty on girls contrasts with an amazing lack of research on male puberty. It has been assumed that, in contrast to girls, boys generally benefit from early onset of puberty, but the most recent research evidence suggests that this may not be so. Psychosocial Disturbances in Young People brings together a comprehensive range of research to shed light on what disturbs the young people of today who will become the parents of tomorrow. Some preventive approaches for dealing with this increasing disturbance are outlined, but the conclusion is that there remain worrying gaps in our knowledge. Anyone who is concerned with young people and the future of our society should read this excellent book. -JOHN PEARCE, professor of child and adoles-
The book focuses first on understanding adolescence and its associated problem behaviours. There are numerous interesting research findings. For example, delinquency is the only problem behaviour that peaks in adolescence and then declines-affecting 60% of 15 year olds and then declining to 400/o of 20 year olds. Antisocial behaviour cent psychiatry, Nottingham University
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