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Manual of tropical pediatrics.
  1. PAUL EUNSON, Consultant Paediatric Neurologist
  1. Royal Hospital for Sick Children, Edinburgh

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    Manual of tropical pediatrics. Edited by Seear, MD. (Pp 480, hardback, £50.00) UK: Cambridge University Press, 2000. ISBN 0 521 65835 7

    This is a handsome book, with hard, thick covers, quality printing, and superb illustrations. It will look just grand on a bookshelf, but how often will it come down from that bookshelf? This manual is a comprehensive textbook of child health. In 480 pages, it covers general paediatrics, as well as infective and nutritional disorders confined to developing countries. The quality of the illustrations is superb, and relative to the text. Thex rays in particular enhance the teaching message. However, the microbiology illustrations seem designed to relieve the tedium of grey text, rather than adding useful information. The chapter on rashes would benefit from more illustrations but perhaps the cost implications were too high.

    The chapter on paediatric emergencies is informative but not easy to access and the readability of the text would be improved by more tables and diagrams. There is not a specific chapter on practical procedures, such as insertion of chest drains, abdominal paracentesis, or subdural taps, yet there is a chapter on laboratory procedures.

    The book lacks references. Are these are not considered necessary now that we all have access to electronic journals? Try getting on to Medline from Chad. If this is to be a comprehensive textbook, the reader needs need guidance on where to go next. I would want to know whether surgery has anything to add to the treatment of spinal tuberculosis; what are the reasons for using lorazepam rather than diazepam in the management of status epilepticus; and what advice would you give to a girl with rheumatic mitral valve disease who is about to get married?

    Health workers in tropical countries are dividing into two groups: those who are practising in city hospitals with improving facilities, delivering services to a slowly growing affluent population, who are demanding neonatal intensive care, renal dialysis, etc, and the remainder who still deal with poor populations, poor medical resources, coping with recyclable diseases, such as gastroenteritis, malaria, malnutrition, and HIV.

    The majority of children in developing countries are treated by health workers who do not have medical degrees. To them, the physiology in this book is largely irrelevant. Most would make diagnoses based on recognition of clinical patterns, as exemplified in the Integrated Management of Childhood Illnesses. They require a portable, cheap book with advice on practical procedures, drug doses, and management of acute conditions. Many will combine curative medicine with primary health. They will see many children with chronic intractable disease, where the disease impinges upon the whole family, such as cerebral palsy, malnutrition, and AIDS. These problems require a whole chapter to themselves, and will vary depending on cultural practices in individual societies. This is not easy to cover in a textbook written for the whole tropics.

    I appear to have said little that is positive about this manual, which is written for two audiences with disparate needs. It is neither the authoritative textbook of child health with a tropical flavour, nor the pragmatic, functional pocket book. I suspect it will continue to look handsome sitting on the bookshelf. At £50, much cheaper than some alternatives, it deserves better.

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