H. Homewood Nixon SURGICAL CONDITIONS IN PAEDIATRICS Woburn, Mass.: Butterworths U.S.A., 1978, 448 pp., $55.95.
In this era of multiauthored megatextbooks, what a delight it is to encounter Surgical Conditions in Paediatrics, the distillation of one man's lifetime of practice, teaching, and research in pediatric surgery. The man is H. Homewood Nixon, Consultant Paediatric Surgeon at London's reknowned Hospital for Sick Children on Great Ormond Street. I had the privilege of making ward rounds with "Nickie" Nixon last year while visiting Great Britain and found him to be a warm and compassionate surgeon of enormous versatility. This readable book gives full expression to those qualities, providing the reader with the essence of an enormous and varied experience, as edifying and enjoyable as rounds with Nixon himself. AU the reader misses is the excellent tea brewed by the ward sister when rounds have ended.
Nixon disavows the encyclopedic approach in his preface. What he provides, in lucid, conversational prose, is a very personal guide to the diagnosis and management of a wide spectrum of childhood surgical disease with just enough technical detail to keep pediatricians informed and interested but not overwhelmed.
The book is strongest in those areas in which the author's experience and interest is greatest. Thus, sections on neonatal intestinal obstruction, Hirschsprung's disease, anorectal malformations, appendicitis, spina bifida, and disorders of the urinary tract are particularly good. Nixon was a pioneer in the development of anorectal manometry as a clinical tool, and his book is enriched in many areas by his application of lessons he learned in the research laboratory to the diagnosis and treatment of diseases of children. The book is full of practical pointers in physical diagnosis for the practicing pediatrician, as reflected, for example, by sensitive descriptions of how to examine a painful abdomen, how to reduce an incarcerated hernia, how to palpate a tiny rectum, and how to relax a retractile testis. Some subjects that are in large part nonsurgical are extremely well done - the chapter on constipation, for example.
American pediatric surgeons will note that some of the author's preferences in operative technique differ from their own, reflecting, in some cases, an international difference (e.g. Nixon uses the Mitchell-Bank's approach to inguinal hernia), and in others, a personal difference (Nixon likes a decompressing colostomy at the time of pull-through for Hirschsprung's disease). Although their preferences may differ in some cases, Nixon's American colleagues will find his explanations for his choice of surgical techniques reasonable and sound. His practice, in the British tradition, covers a wider range of surgical disease than that of most American pediatric surgeons, in that it includes an extensive neurosurgical, plastic surgical, and urologie experience; and these areas are authoritatively covered in his book.
The book's limitations, as its strengths, are those imposed by its personal nature. Since this is a personal, one-man effort, there are bound to be gaps representing areas outside Nixon's range of interest and expertise. Thus, there are no sections on cardiovascular disease, orthopedics, or trauma (except for a few comments on birth injuries). The references are selective rather than comprehensive. The photographs and drawings are excellent, but one would like more of them. The pharmaceuticals bear British names, many unfamiliar to American readers.
On balance, this is a highly readable and informative book that will not tell pediatricians more about pediatric surgery than they want to know.