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media to protect viruses from inactivation. This paperindicates, however, that human and cow’s milk may, ifincorporated into the culture medium, inhibit the

growth of a wide range of viruses. In many of the com-binations tested, (e.g., v.s.v. and human milk, or in-fluenza B and cow’s milk) antibodies are very unlikelyto be present. Lactoferrin and lysozyme do not haveantiviral activity when tested in this way. We, therefore,think that the effect is likely to be due to an unknownsubstance or substances but much further work is

required to characterise this. The characteristics of thetest suggest that milk alters reversibly the properties ofthe cell surface, interfering possibly with virus entry.The most important outstanding question to us is

whether this antiviral effect can protect infants againstinfection with viruses such as those of gastroenteritis.4If so it will then have to be decided how important thisis in comparison with other ingredients of milk such assecretory antibody. We wonder, however, whether it

may not be significant that milk formulæ and boiledcow’s milk have little of this antiviral activity.We thank Dr S. E. Reed for supplying test viruses, Dr H. B. Valman

for assistance in obtaining breast-milk samples, and Dr J. Dolby forsupplying lysozyme and lactoferrin.

Requests for reprints should be addressed to T.H.J.M.

REFERENCES

1. Zisman, B. R., Merigan, T. C. Proc. Soc. exp. Biol. Med. 1973, 142, 11742. Fieldsteel, A. H. Cancer Res. 1974, 34, 712.3. Falker, W. A., Diwan, A. R., Halstead, S. B. Archs Virol. 1975, 47, 3.4. Flewett, T. H. Proc. R. Soc. Med. 1976, 69, 693.

Methods and Devices

ROCKING-HORSE PÆDIATRICWEIGHING-MACHINE

H. B. VALMAN B. M. WRIGHT

J. DE COURTIN

Northwick Park Hospital and Clinical Research Centre,Watford Road, Harrow, Middlesex HA1 3UJ

WEIGHING is probably the single most important measure-ment made on children in the 1-3 year age-group in a pzdia-tric outpatient clinic, but it is also often the one by which theyare most frightened. If a child struggles it may be impossible

to weigh him and it is also a traumatic experience for the childand his parent and upsetting to any other children present. Wehave therefore fitted a wooden horse of beguiling appearance,designed and made in the occupational therapy workshop, toa beam weighing-machine, as shown in the accompanyingfigure. The horse is positioned so that, with its rider, its centreof gravity is near the Centre of the platform. The platformoscillates slightly on its knife edges, so the child can rock thehorse, but this does not seriously interfere with weighing on abeam machine. The device has been in use for 18 months andhas completely eliminated trouble with weighing, the onlyremaining difficulty being to persuade the child to get off thehorse at the end of the weighing. The weighing-machine usedwas a Marsden 721, which is much cheaper than a conven-tional pædiatric machine. A suitable rocking-horse is availablecommercially.We thank the Department of Medical Illustration for the photo-

graph.

Reviews of Books

The Clumsy Child

A Study of Developmental Apraxia and Agnosic Ataxia. SASSONS. GUBBAY, F.R.A.C.P., Princess Margaret Hospital for Childrenand Perth Medical Centre. Philadelphia and London: Saunders.1976. Pp. 194.$12.50; £6.50.

THE subtitle is a better guide to the contents of this bookthan is the main title. Two studies are reported. The first is aninvestigation of 21 clumsy children. The case summaries areinteresting, instructive reading and illustrate the variety of dis-orders encountered under the global term of clumsiness. Thesecond report concerns a survey of clumsiness in school-children. The tests devised for the survey and the results ofboth the pilot study and the total study are described. Thisreport and all the associated tables need to be examined care-fully by all who are concerned with clumsy children. Dr Gub-bay’s careful work and extensive practical experience justifyserious attention to his findings and recommendations. As aresult of these two studies the author is able to provide twouseful, practical chapters on the assessment and managementof the clumsy child. The whole subject of clumsiness is ana-lysed and critically discussed in the two introductory chapters.There is a strong neurological bias and frequent resort to

Greek terminology which does not always produce enlighten-ment. Despite the wealth of information it contains this bookdoes not provide the clear logical guides to an understandingof the problems of clumsy children which clinicians might seekand which teachers require if they are to provide constructivehelp. This failure should not deter would-be readers: manymay well find what they want to know about clumsy childrenfrom its information-packed pages.

Crisis Intervention

Studies in Community Care. J. K. W. MORRICE, F.R.C.PSYCH., RossClinic, Aberdeen. Oxford: Pergamon. 1976. Pp. 119. £4.50,$9(paperback ,(;2.25,$4.50).

THE aim of this concise book, written by a psychiatrist whohas had extensive clinical experience, is to demonstrate how

many people in the throes of a social or emotional crisis canbe successfully managed without formal psychiatric interven-tion. Dr Morrice points out that the social worker, school-teacher, vicar, family doctor, and policeman are handling thevast majority of the emotionally disturbed, although how wellor badly it is difficult to tell. In arguing for a more effectivemarshalling of the available resources, Dr Morrice adds hisvoice to those who deplore the separation of the general medi-cal and social services. However, as with so many blueprintsfor multidisciplinary teamwork, this one is based on a theory,

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in this case the theory of crisis intervention associated with thename of Gerald Caplan. A crisis is defined as a transitional orturning point, an opportunity for achieving greater mastery, achallenge to customary habits, an opportunity for growth ordecay. Such a definition is so all-embracing as to includealmost every acute stressful moment which the average man

experiences, and its limitations are sorely exposed when DrMorrice provides practical examples of the sorts of crises whichprofessional workers encounter. In almost every case-and hisexamples of child abuse, marital strife, adolescent disturbance,and the plight of the elderly are noteworthy in this respect-the crises in fact do not approximate to Caplan’s crisis theoryin that they are not, and never were, acute turning points butrather are continuing, grumbling, slowly evolving states. Inpractice, we know very little about the truly short-lived, socialand emotional disturbances which appear to fit the crisis inter-vention and treatment theories enunciated in this book. Suchconsiderations limit the implications for prevention which thisbook enthusiastically endorses. Dr Morrice readily acknow-ledges the nugatory nature of the advances made in the under-standing of such problems as marital breakdown, alcohol

abuse, delinquency, and violence but he refuses to be pessimis-tic or down-hearted and insists that a helping hand, even ifrelatively unskilled, applied in a timely and understanding waymay prevent serious mental or social deterioration. His enthu-siasm is reflected in the text which is energetically written, andeven those who may demur here and there from some of themore questionable assumptions are sure of a lively read.

Hepatocellular Carcinoma

Wiley Series on Diseases of the Liver. Edited by KUNIO OKUDA,M.D., Chiba University School of Medicine, Japan; and ROBERTL. PETERS, M.D., University of California School of Medicine.New York and London: Wiley. 1976. Pp. 499.$49, /;27.

THIS beautifully produced book covers the pathogenesis,aetiology, pathology, pathophysiology, and clinical picture ofhepatocellular carcinoma. There are also sections on otherforms of liver cancer and on benign lesions, so that the scopeof the book is wider than its title suggests. The authors are

mainly from Japan and the U.S.A., with a smaller numberfrom Britain, Canada, and Taiwan. Some have written generalreviews of particular aspects of liver cancer, while others pres-ent data from personal series. The largest sections are those bythe editors on clinical and pathological aspects of hepatocellu-lar carcinoma, and a chapter on mesenchymal liver tumoursby Dr Kamal Ishak. Other topics include genetic aspects ofliver cancer, its relation to viral hepatitis and to cirrhosis,ot-fetoprotein, diagnostic techniques, and surgical treatment.Together, the contributions form a comprehensive and up-to-date survey. There are abundant references, but with someduplication between chapters. The illustrations, particularlythe black and white photomicrographs, are lavish and of highquality. The book has faults and is not uniform in quality:nomenclature of tumours, for example, differs confusinglyfrom chapter to chapter, and there is surprisingly little infor-mation on the electron microscopy of liver tumours. Suchproblems will not prevent the book from becoming a majorsource of reference on liver cancer for the next few years.

Recent Trends in Medical Education

Edited by ELIZABETH F. PURCELL. New York: Josiah Macy, Jr.Foundation. 1976. Pp. 279.$7.50.

THIS book is based on a conference, but the origins are welldisguised: the contributions (chapters) are substantial offeringsand the ensuing discussions are reduced to editorial sum-maries. Readers outside the United States will be especially in-terested in the radical experiments: at one extreme Dr RobertD. Sparks describes the compressed three-year curriculum atthe University of Nebraska while at the other Dr John Stewardand Dr Clayton Rich assess the flexible elective curriculum at

Stanford. Three-year curricula (tried during the 1939-45 war)may be going too far and there is a tendency to revert to lesstaxing learning-rates; the Stanford students opt for curricularpackages that closely resemble conventional courses whilesome can get an M.D. without clinical experience in psychiatryor emergency medicine. Like many European countries, Ameri-can medical schools are flooded with applications, and deanswill be interested in the administrative procedures for copingwith these. Statistics on the social and cerebral characteristicsof students are covered by Dr Joseph Ceithaml and Dr DavisG. Johnson. The willingness to experiment in U.S. medicaleducation emerges clearly in these pages. Less happy is the in-volvement of the courts in admissions procedures: the years1971-74 saw 19 actual and 63 threatened lawsuits allegingthat medical schools were biased.

Cleft Craft

I: the Unilateral Deformity. D. RALPH MILLARD, JR, M.D. Bos-ton : Little, Brown. London: Quest. 1976. Pp. 810.$85; J51.

THIS is an incredible extravaganza. In 1957, Dr Millardwith the late Sir Harold Gillies wrote The Principles and Artof Plastic Surgery, a book which broke with textbook tradi-tions in being partly anecdotal and in having pages in whichvery wide margins carried most of the unnumbered, uncap-tioned illustrations. Here Dr Millard is even more anecdotal,and the similar wide margins are used not only for photo-graphs and drawings but also for artist’s sketches of plasticsurgeons and for comments on the neighbouring text in theauthor’s handwriting. There are 810 pages and thousands ofillustrations, all of very high quality and some in colour. In1957 Dr Millard also published his rotation advancement tech-nique for closing a hare lip. More than half of this book isdevoted to a blow-by-blow account of his battle to have histechnique recognised not just as a good technique but as byfar the best technique. Much of this part of the book is veryboring; even to those who know the personalities involved, thelong-dead arguments are of little interest, and some of Dr Mil-lard’s remarks might well cause resentment. But there are

many good things too. The sections on history, anatomy, andphysiology and general factors are concise and well written,and the final section on secondary repairs will be of value toevery plastic surgeon who handles these difficult problems. The37 pages of references must be the fullest list ever assembledon the unilateral cleft lip. This huge volume covers single lipclefts only; vol. n, on double clefts, is in the press, and therewill be a third volume, on cleft palates. Many will jib at theprice but if the biggest work on single cleft lips is wanted, thisis it.

Biographical Memoirs of Fellows of the Royal Society:vol. XXII (London: Royal Society. 1976. Pp. 653.

£19.75)—The latest volume in this authoritative and

thoroughly excellent series from the Royal Society will be disap-pointing to those whose interest in science is medically parti-san, but the broader minded will get nothing but pleasure fromthe detailed memoirs of three giants, one each from physics,biology, and chemistry. These are James Chadwick, Sir JulianHuxley, and Sir Robert Robinson (whose output of over 700publications is reflected in a 115-page contribution from LordTodd and J. W. Cornforth).

New Editions

Gradwohl’s Legal Medicine.-3rd ed. Edited by the late Francis E.Camps; completed by Ann E. Robinson and Bernard G. B. Lucas.Bristol: Wright. 1976. Pp. 717. £52.

Physics Applied to Ancesthesia.-3rd ed. By D. W. Hill. London:Butterworth. 1976. Pp. 411. £12.

Health Services in Norway.-4th ed. By Karl Evang. Oslo:

Universitetsforlaget. London: Global Book Resources. 1976. Pp. 233.£ 6.60.