J. Roswell Gallagher, Felix P. Heald, and Dale C. Garell, editors MEDICAL CARE OFTHE ADOLESCENT New York: Appteton-Century-Crofts, 1976, 774 pp., $36.50.
In his preface, Dr. Gallagher states the objectives and purpose he had in compiling this book: he wanted it to be "of value to all who are concerned with the maintenance or improvement of the health of adolescents and with the prevention and treatment of their illnesses." He has achieved his goal.
He has chosen well in selecting his coeditore, Drs. Felix P. Heald and Dale C. Garell, and some 50 contributors. This book is a "must" for the library of every pediatrician or family practitioner, and I am sure it will also be of great value to those allied professionals who deal with adolescents - secondary- and upper-grade school nurses and teachers, social workers, and psychologists and psychiatrists.
No book can deal with adolescents without providing a great deal of psychiatric input. Each chapter in this book has a complete bibliography, which will be of great help to those interested in any one facet of the subject for further study.
The great span in what can be considered "normal" behavior in the adolescent reminded me of the remark of a college professor who pointed out to us that "there are more differences within a race than between races." The differences in adolescents who are within the normal acceptable range is so great that no classic description can fit all. The text constantly emphasizes this and also notes that the generation gap is not so great as the public is often led to believe. More often, the "generation gap" is a misunderstanding on the part of older persons of the fluctuations and the range of reactions and emotions with which most adolescents are blessed.
In one chapter, Dr. Joseph L. Rauh makes some very timely observations on the maturation age and its clinical application. He points out that as schools and society move more and more into the direction of having girls and boys equal in such things as physical and sports activities, we are going to have to change our evaluation of what constitutes fitness; it will have to be based on developmental age rather than on the adolescents' chronologic age.
Dr. Reginald S. Lourie, in a chapter on the psychology of adolescents, provides an excellent, succinct commentary on the differences between the aggressive adolescent and the passive adolescent. These are descriptive terms, of course. Finding the answer that will provide the way to help the adolescent with undesirable traits change them to desirable traits is something I have yet to accomplish.
Dr. Gallagher's discussion on the care of the adolescent is stimulating. His method of classifying maturity of pubertal and adolescent boys and girls is not new, but the article does provide an excellent review and will be helpful to many of us in general practice.
Disorders of bone and muscle are discussed by Dr. Arthur W. Trott. This is an excellent brief review that will be particularly helpful for school nurses and social workers who may need help in understanding a problem that has not been emphasized in their training. Another chapter that should come into use many times as the pediatrician attempts to explain to adolescents and parents what we know about the condition is Dr. Willard DaIrymple's brief summary of infectious mononucleosis.
Dr. Allan J. Ryan's chapter on prevention and management of sports injuries provides an excellent review of sprains and softtissue injuries. The physician who becomes concerned with school sports will appreciate the opportunity to go over this chapter before the season begins.
Psychologic and psychiatric problems are discussed by Dr. Herbert 1. Harris, sufficiently in depth for this to be a useful quick review for the pediatrician. In the past few years, for example, there has been a great deal of publicity about homosexuality, and we are now seeing more of it in our junior-high- and high-school students. Many of us need help in understanding and dealing with this problem. The only subject that Dr. Harris failed to touch upon is jealousy, a problem I find very common among adolescents.
Anorexia nervosa is the subject of a chapter by Dr. Hilde Bruch. She goes into more detail than the average practitioner is probably interested in - although undoubtedly not enough to satisfy the psychologist or psychiatrist. Anorexia nervosa is certainly a condition that we all see, and Dr. Bruch's chapter is well put and easy to read.
Dr. Gallagher has provided a second chapter, on fatigue and fitness. Here he brings out the importance of the evaluation of motor skills, agility, coordination, and strength. These are factors that will receive much more emphasis in the future than they have in the past, and as physicians we will be expected to know how to measure these perimeters in evaluating the fitness and potential of our sports-minded adolescents.
Leukemia and malignant tumors are reviewed by Dr. Prisdlla Ann Gilman. Her review is excellent, but I must point out that some of her tables are 10 years old. Perhaps this is the latest information that is available, but so many strides have been made in this area in the past few years that the data really should be brought up to date.
It is a temptation to make favorable comments on every author. There is something for the pediatrician to learn in each chapter. I shall certainly see that this book goes into the library in the two schools of which I am medical adviser, and I hope there will be enough general distribution to make the book available to all professionals who deal with the adolescent.