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The last two thirds of the book are devoted to a discussion of the execution and problems of clinical trials. Here Dr. Silverman deals with assignments to treatment groups, the use of placebos, problems of precision and accuracy in measurement, and the criteria that should be applied in the choice of outcomes.

Throughout, Dr. Silverman is concerned to point out what the difficulties in undertaking a clinical trial might be. To this end, one chapter is entitled “Avoiding Entrapment.” The difficult problems of stopping rules, and matters of inference (more particularly the use of significance tests and confidence limits) are given some attention. Dr. Silverman considers the ways in which trial results lead to decisions in the field, and briefly adverts to the formal approaches to such questions in decision analysis. The last chapter is devoted to the ethics of human experimentation.

Dr. Silverman avoids an excess of technical detail. His chief concern is to guide the clinician to a way of thinking about the evaluation of clinical procedures in general. In doing so, he purveys wisdom with force and almost always clarity. Murky patches exist but are few.

Any clinician and any medical student who does not have a thorough grounding in epidemiology will both enjoy and benefit from this book. Those who do have a grounding in epidemiology will be more familiar with the material, but should enjoy reading it equally well.

M. SUSSER

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Premature Babies: A different beginning by William A.H. Sammons and Jennifer M. Lewis C.V. Mosby Co., St. Louis-Toronto-Princeton, 1985 419 pages, E13.50

This book by two American-style paediatricians comes from across the Atlantic with a laudatory foreword by Berry Brazelton, who points out quite correctly that it displays a sensitive insight into the dilemma faced by parents trying to adjust to the birth of a vulnerable premature infant. It comprises some twenty seven chapters which, with the forward, a glossary, an appendix and the index add up to some 417 pages. The book is divided into sections each including a number of short chapters; the first dealing with the history of premature infant care, the second with pregnancy and labour, the third with the problems of parents, the fourth with the organisation of intensive care units, the fifth with development, the sixth with going home, the seventh with common issues for families, and the eighth with medical problems and procedures.

It is written in quite good American English, easily comprehensible if occasion- ally irritating, and the authors are to be congratulated on covering their ground in such a way that a critical reviewer would find it difficult to identify any mis-state- merits, imbalance or important omissions. It does, however, leave him with two important questions unanswered: the first, whether the book is intended for parents or paediatricians or both: the second, whether it is meant to be read through or used

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as a kind of encyclopaedia. With regard to the first question, British paediatricians might find it a bit irksome to read through synopses of what is known about the biology and psychology of the premature infant set out at a level to suit the intelligent, inquisitive and demanding American middle-class parent (and for this purpose rather well done); on the other hand parents might find the examination and explanation of their anxieties and preoccupations somewhat voyeuristic though these sections could be read with great profit by paediatricians engaged in intensive and special care and perhaps by their nursing colleagues.

The best way to put this book to useful work might be to leave it around the special care unit for parents or staff to dip into, or even to read through when the occasion offers, in the expectation that in the light of what it says they will find more common ground than comes naturally and so be able to work together more effectively for the good of the baby. It certainly adds a dimension missing from “Attachment in premature infants”, the British equivalent edited by the reviewer. It would also be profitable reading for general practitioners and clinical medical officers concerned with the after care of premature babies, and perhaps also to health visitors.

J.A. DAVIS

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Continuity of Neural Functions from Prenatal to Postnatal Life Ed. H.F.R. Prechtl Blackwell Scientific Publications, Oxford, SIMP, 1984 255 pages, E16.00

Twenty years ago Clinics in Developmental Medicine published Heinz Prechtl’s “Neurological Examination of the Newborn Infant” which had a profound impact on paediatric neurology by increasing doctors’ interest in, and diagnostic com- petence for, the nervous system of very young infants. The last volume recently edited by Prechtl for the same series will certainly have an equally strong effect taking child neurology further back into the prenatal period.

For legal and organizational, but partly also for conceptual reasons the fetus and the newborn are, to a certain extent, still regarded as different beings. Birth is thought to mark the transition, the “onset of life”, and transfers medical responsibil- ity from the obstetrician to the paediatrician. There have been, to be sure, diligent medical observers during the last hundred years who, after an occasional glimpse at a fetus, suggested that in certain ways it already behaved like a real baby (see some interesting references in the book). For an even longer time many mothers were for sound emotional reasons convinced that their fetus was in fact already a real baby. But it was only the recent advent of real time ultrasound that made systematic studies of fetal behaviour and reactivity possible which, besides adding a new personal dimension to the relationship between the fetus and his doctor, lead to a