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Nelson. Textbook of Pediatrics.
  1. ROBERT A F BELL, Consultant paediatrician

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    Nelson. Textbook of Pediatrics. 15th Ed. Edited by Waldo E Nelson (senior editor) and Richard E Behrman, Robert M Kliegman, and Ann M Marvin (editors). (Pp 2200; £70 hardback.) W B Saunders, 1996. ISBN 0-7216-5578-5 .

    Hardly anyone encounters a new edition of ‘Nelson’ with an innocent mind: it has simply been the standard paediatric text for the English speaking world for too long. True, ‘Forfar and Arneil’ is a UK production with many virtues, but it hasn’t been around for so long, it costs more—even in Britain—and it isn’t updated quite so frequently. In any case, as anyone who has spent much time in the witness box of an English court knows, it is Nelson that our own lawyers consider to be the ‘Bible’ on paediatric matters.

    To have reached a 15th edition is an achievement in itself, having taken 63 years in the process. As this writer knows too well, the passage of the years tends to bring obesity, and textbooks, too, tend to get fatter and heavier. While this edition contains 12% more pages than the previous one, it weighs 3% less, their thickness is within a millimetre of each other. The structure is much the same as previous editions, although there has been a very thorough revision of the contents. It is strikingly up-to-date: the editors have achieved marvels in gathering their material from contributors who know how to keep to a deadline.

    When I spent a summer as an extern at an American hospital 30 years ago, I was struck by the fact that American students used larger textbooks than most of my Edinburgh classmates, indeed there seemed to be very few short American texts on anything medical. The text they used for paediatrics was Nelson, and this new edition still has a section introducing the newcomer to the special problems of child health and development. There is a short chapter on the evaluation of medical literature, which, I suspect is too elementary for those who need to critically assess data, and incomprehensible to those who know little of statistical theory. There is also a chapter on medical ethics.

    I cannot help feeling that Nelson is far too big to be a student text, other than for reference: there is simply too much information to give perspective to a student. What Nelson does best is to give, in a single (just) manageable volume, an overview of the state of the art of paediatrics for the practising paediatrician, and that it does supremely well.

    Its contributors are almost all from North America with just single ‘strays’ from France and Israel, but its all-American provenance does not, as far as I can judge, limit its usefulness to the paediatrician in the UK: I have kept close to this volume over the last seven months, consulting it over almost every difficult case, and reading closely through several sections, and day by day, I have become ever more impressed by its authority and practical value. No individual can be qualified to judge all the sections of such a large book, but when I read those chapters on conditions with which I have more than a nodding acquaintance, I found its combination of accuracy and conciseness striking. Furthermore each part of the book is prefaced by an elegant overview of the topic: these will be missed if the book is used purely for reference. It would be inconceivable that such an enormous text would be entirely free of inconsistencies, but I did not find any major ones, while endomysial antibodies are emphasised as valuable in the diagnosis of gluten enteropathy, they are not mentioned in the section on screening for malabsorption. A reader in the UK may be surprised that gabapentin is mentioned in the treatment of epilepsy, but lamotrigine or vigabatrin are not. I was disappointed that there was no mention of streptococcal proctitis, a cause of much misery in young children.

    The excellent chapter on respiratory diseases is marred by poor quality of reproduction of x rays: on page 1202 there is anx ray picture purporting to show the ‘Steeple’ sign: it defeated my attempts to decipher it, but I suspect that making such pictures clearer would have required thicker, heavier paper, and pushed up the book’s price considerably.

    For years we British have sneered at the turgid prose of some American and European texts, yet I defy anyone to find a better written textbook of paediatrics in English than this new edition of Nelson. That it costs only £70 is wonderful, and in this secular age when daily Bible reading is no longer universally de rigeur, a paediatrician of any age or seniority could do worse than opening this book at a new part each day and reading it for five minutes: Nelson continues to deserve the title of Bible of Paediatrics. Congratulations to all concerned in its production.