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Cerebral palsy, principles and management
  1. M Wheater

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    Edited by Christos Panteliadis, Hans-Michael Strassburg. Stuttgart: Thieme, 2004, €69.95, pp 270. ISBN 3131400218

    We devote time and energy, disproportionate to their numbers but not to their need, to these children. Diagnosis is often difficult, may be delayed, and the physical and psychological problems, intractable. There is an enormous and fast growing literature to help us, had we time to access it. A well organised, clear and concise introduction to the conditions which fall under the heading of cerebral palsy, and an update on management of the difficulties which come with it, would be welcome.

    Unfortunately, Cerebral palsy, principles and management, does not fill the bill. As I read, I felt like a diver, struggling deeper into a hostile environment, hoping to surface with some pearls, but aware that there would be few, if any, to take home, and increasingly frightened of drowning.

    The most striking obstacle is the language. A substantial proportion of the book reads as if mechanically translated by a computer unfamiliar with conventional English medical phrases. So there are such novelties as EPH-gestosis, superior and inferior kinetic neurones, asphyctic insults, athetosic cerebral palsy, and stimulation buttons on the tooth vestibule or the palate plates. I liked the idea of suspicious newborns, but was less happy to read about non-functional children. And when it came to the “batrachoidal state of the trunk”, I began to wonder if I had carelessly strayed into a botany or zoology text. So there are some problems with reading and writing. The arithmetic is not too hot either—I was surprised to be told that “there have been more than 200 years since the first description of cerebral palsy made by Little in 1843”. How time flies!

    Twenty four authors contributed. The editorial hand has been light, and there is considerable repetition of information between, and sometimes even within, chapters. Misprints abound. Some illustrations are of poor definition, duplicated, or reversed, and their relevance is not always obvious. Legends are not always accurate. One of the tables is in three languages. Of the 131 references in the bibliography to the first chapter, only 104 are referred to in the text. Conversely, 10 references in the text have no corresponding entry in the bibliography. Feeling despondent, I checked the 12 references to published papers by Little—all were inaccurate and one paper (admittedly the best known) appeared twice.

    No doubt form is less important than substance. But it was not just the distractions of form that made it impossible in all but a very few chapters to shell out a pearl. I was unable to decipher the meaning of considerable portions of the book. There is undesirable grit as well—controversial advice regarding anticonvulsants, annual pertussis immunisation, and treatment of undescended testicles by hormone injection in preference to orchidopexy, to take three random examples. And any candidate for MRCPCH who holds a baby upside down by one leg to test the Collis II reaction as depicted in the chapter on therapeutic concepts, is likely to fail. Another child on the same page appears to be being smothered beneath an ample bosom.

    I cannot recommend this book.

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