IJOURNAL OF THE ROYAL SOCIETY OF MEDICINE Volume 90 May 1 997 Harrison states that he hopes the text will go (some way to demystifying the whole subject'. The book is aimed at the clinical medical student and is split into three sections dealing with history and examina- tion, common problems and investigations. The section on history and examination is concise and well structured. It was pleasing to see the inclusion of colour plates illustrating normal and abnormal fundi since diagrams rarely give an accurate impression of what will be seen when confronting a patient with an ophthalmoscope. The photo- graphs and illustrations of the motor and sensory examination and typical patterns of loss are excellent in their clarity. The 'common problems' section attempts to break down the subject in terms of symptoms. This is adequately dealt with considering that only 48 pages are devoted to it. However, neurological disorders are often complex, with many symptoms. Although it deals specifically with the neurological examination, many students will reach for this book when faced with a neurological case. To get information on a common neurological disorder such as Parkinson's disease one would need to refer to six different sections. Perhaps a small section could have specifically dealt with the commoner neurological disorders so that the typical features of these conditions could be easily accessed by the reader. In the 'investigations' the standard investigative techniques used in neurology are reviewed. The discussion of electromyo- graphy, nerve conduction studies, evoked potentials, electroencephalography and elec- tronystagmography can provide only a brief overview of these subjects but the informa- tion contained would certainly be adequate for any medical student. Indeed, many a physician doing a ward round would be horrified to be questioned by a student about the significance of the 'M' response and 'F' waves of the patient lying before them. The section on neuroimaging is well illustrated although a few of the plates are rather small and of relatively poor resolution, particularly the computerized tomography images. The acid test was to circulate the book amongst the medical students attached to our department. Approval was unanimous. A few felt that, although this book is dedicated to clinical skills, an indication of the prevalence and incidence of the neurological disorders would have been useful. Perhaps most significant of all is that the book disappeared with two student firms,re emerging only after the end of clinical exams. Other student oriented books on the clinical examination may discuss the exam- ination technique in more detail. However, Professor Harrison's book wins in its clarity of text and quality of diagrams and photographs. I recommend it as a general introduction to the clinical neurological skills required in medicine. It is cheap enough for most students to afford. Mark Silva Royal Free Hospital, London NW3 20G, England Feeding the Disabled Child Eds Peter B Sullivan, Lewis Rosenbloom 160pp Price £37.50 $64.95 ISBN 1 898683 08 5 London: Mac Keith Press, 1996 I am sure this book will be welcomed by a large number of professionals caring for disabled children. The list of contributors displays a range of disciplines and experience from both sides of the Atlantic and the contents page offers a feast of theoretical and practical topics arranged in a clear and logical sequence. In his foreword Professor Bosma summarizes, with obvious understanding, the issues that present difficulties and introduces some of the topics to be covered. So, even before reaching chapter one, I felt that the book had been carefully conceived and targeted to be a useful reference for clinical practitioners The thirteen chapters cover many aspects of cause and effect of neurological and physical difficulties encountered by disabled children with regard to eating-such as the processes of acquiring, handling, chewing and swallowing food. Gastro-oesophageal reflux, drooling and constipation are all extensively covered, and a chapter deals with associated respiratory problems, such as aspiration. Specific nutritional needs of disabled children are discussed, particularly how and why these differ from those of healthy children. Therapeutic approaches are divided into three chapters-assessment, management and treatment, and enteral nutrition-and finally there is a chapter discussing ethical issues. Malnutrition and neurodevelopmental disorders have direct effects on one another and this is well addressed in the chapter on nutrition, co-authored by the two editors. Disabled children are often unable to feed themselves and difficult for carers to feed (well described in the first chapter). Subsequent poor intake of calories, protein and essential fatty acids may then cause adverse effects on growth and muscle power, immune function, circulation and IQ. Deficiency of micronutrients such as vitamins and iron is common but frequently un- diagnosed. Treatment of such deficiencies can greatly improve overall function. The chapter on nutritional assessment contains a useful table of clinical signs of specific nutrient deficiency as well as centile charts of anthropometric measurements that will be helpful for assessment of the non- ambulatory child. This chapter also highlights the difficulties of nutritional assessment in disabled children and acknowledges the current lack of specific recommendations. The first chapter dealing with therapeutic aspects focuses on assessment of feeding difficulty and is written by two occupational therapists. They emphasize the importance of direct observation and identify six areas to be addressed behaviour, tactile responses, general motoric control, oral-motor con- trol, swallowing, and coordination of oral activity with swallowing and breathing. Each area is discussed in detail, with description of common clinical problems, and there is a summary of tools and scales with which objective assessment can be made. The second therapeutic chapter is written by speech and language therapists and deals with aspects of communication and oral-motor and oral-sensory dysfunction. Again it has many practical suggestions, including details of various feeding utensils that may be beneficial. In the third therapeutic chapter, written by two paediatric surgeons, non-oral methods of food delivery, such as nasogastric feeding, gastrostomy and jejunostomy are discussed with their advantages, disadvan- tages and indications. Methods are described in some detail with line illustrations. Medical and surgical management of gastro-oesopha- geal reflux is also addressed in detail. Overall, this book conveys a strong sense of personal experience as well as being extensively referenced. It will be of great value to all those involved in management of the disabled child, both as a source of rapid advice and as a resource for in-depth learning. Alison A Leaf Southmead Hospital, Bristol BS1O 5NB, England 296