Book Reviews

The Avitaminoses: The Chemical, Clinical and Pathological Aspects of the Vi tamin Deficiency Diseases. B r ~VALTER H. EDDY, PH.D., AND GILBERT DALL- DORF, 1Vi.D., WITH FOREWORD BY JA~[ES EWING. 338 pages, 24 plates. Baltimore, 1937, Williams and Wilkins Company, price $4.50.

The authors have prepared an orderly account of the problems, evidence and conclusions respecting the effects of vi tamin deprivation. Following a br ief introduc- tion, each of the well-recognized vitamins, A , the B complex, C, D, and E, is con- sidered from the s tandpoint of i ts chemical nature and properties, its functions, the clinical and anatomic manifestat ions of its deficiency and the significance of sub- clinical and border l ine conditions tha t may be associated with i ts shortage. In this connection, especially, the directions in which future experimental and clinical in- formation should be sought are pointed out. Separate chapters are devoted to the rSle of v i t amins in resistance to infection, in blood regeneration and in multiple or complicated effects including dental caries.

A short bibliography of the impor tant references doses each chapter. The morbid anatomy is well i l lustrated b y excellent plates, mostly photomicro-

graphs of the pathologic tissue changes observable in the deficiency diseases. Pa r t I I (29 pages) contains the s tandard methods for vi tamin bioassays and the

clinical tests for vitamins A and C, together with tables of reported vitamin values of common foods.

Several of the structural chemical formulas conta in errors and the index of authors is incomplete, bu t these minor faul ts do not detract f rom the value of the book, which is wri t ten in narrat ive style. The emphasis is usually well placed, and the authors have presented an immense amount of factual material and reliable con- clusions in condensed and accessible form for the convenient use of physicians, pathologists, and students of nutrit ion.

It . A. 1VL

Children Handicapped by Cerebral Palsy . Psychological Factors in Management. El izabe th Evans Lord, Ph.D., New York, 1937, The Commonwealth Fund. Price, $1.25.

A psychologist writes this book, which is a study of the child handicapped by a defect of the brain. The author stresses throughout tha t an understanding of this type of child from the psychologic point of view is of the greatest importance in helping him develop into a well=adjusted individual in spite of his physical handi- cap. I n an introductory chapter by Bronson Crothers, the medical aspect of cerebral palsy is described as a ~ ~ disturbance of motor function due to damage to the bra in before, during, or shortly a f te r delivery of the i n f a n t . " The amount of damage to the brain varies from so small a lesion that only mild motor disabilities result to s o great a destruction of the brain tha t the child never reaches much beyond the intellectual level of idiocy.

I n cerebral palsy in children there are certain characteristics which i t is well to keep in mind: first, the responsible cause has done its job and is no longer op- era t ing; second, the lesion is likely to be diffuse ra ther than localized; third, the

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damage has been inflicted on a growing organism. This last is most important~ for the '~influence of the lesion on the growth of the bra in and upon the dr i f t ing pat- terns of behavior in the developing child explain many of the difficulties which dis- tu rb those who take charge and manage these chi ldren ."

The evaluation of the inental status of these children is the chief concern of the psychologist, and in Chapter 3 the author discusses the mental test ing program. In eases of cerebral palsy there is often disagreement between the parents ~ conceptions of the mental capacity of the child and that of the teacher. This is usually due to the fai lure to recognize specific disabilities. 3. Stanford-Binet test may be suitable to estimate the intelligence of a mildly affected child who is able to talk, but a child who is shown to have a very high intelligence quotient may have a specific disability which totally prevents progress in one or more school subjects. The author then advises tests for specific abili ty and discusses methods by which these may be ac- complished.

I n helping the handicapped child to develop into a well-adjusted adult, the teacher plays an important part, and in Chapter 5 the teacher 's problem is discussed. Suc- cessful education leads to the adjustment of the child to his handicap and his obtain- ing sat isfaction in occupations within his ability. This means tha t the child has not suffered from a sense of inadequacy, but has recognized his capacity in relation to others so tha t he will not be disappointed when he finishes school and goes into the outside world.

Another chapter, " T h e Emotional 1)reblems of the Child and Parent , '~ deals with the emotional instabil i ty of many of these children. A large percentage of handicapped children belong to this group showing marked emotional disability, and the general impression is tha t this is directly due t o damaged brain. The author had found that many children of average or more than average intelligence are quite well controlled emotionally. Since in these children the motor disabili ty is slight, physical independence may account to a certain extent for this stability, but this can account for only a small proportion. The severely handicapped children are passive i f physically comfortable. Children mentally normal, or nearly so, present the greatest problem in adjustment. I f these children are severely handicapped, the conflict between themselves and their parents is great ly emphasized. This at t i tude can be corrected, and the child helped to lead a happy life by the early establish- merit of routine. The child whose defect is relatively slight is likely to suffer from self-consciousness and a feeling of inadequacy brought about by unsuccessful com- petition.

These brief notations serve to indicate the breadth of view of the writer of this book. In this brief treatise of about I00 pages the author succeeds in placing be- fore the reader the most important problems which the child~ the parent, the teacher, the psychologist~ and the physician face. In a s traightforward, simple fashion Lord gives the reader an idea of the complexity of the problems which cMldren handicapped by cerebral palsy present. As a result of the study of 300 children over a con- siderable length of time, the author is convinced of the great importance of re- peated psychologic tests of the specific abilities of these children in order to assist the doctor~ the teacher~ and the parent. The aim is so to guide these children that they may use their abilities to the utmost~ and at the same time recognize their handi- cap and obtain satisfaction in occupations within their ability. In this way the child is not pushed beyond his capacity~ and much emotional disturbance is avoided.

S. I. S. ~ . L.