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394 Book reviews found much of the present knowledge on of their authors to reorientate their International Co-ordination of Drug Trials. the topics covered, including in certain presentations, add other chapters, and Rheumatological Research and the Fight cases the conflicting views. produce the prototype textbook of child- against Rheumatic Disease in Switzerland. Without exception the authors have hood arthritis. Until that time this book Edited by K. Fehr, E. C. Huskisson, and kept to the point and wasted words are should be freely available in every hospital E. Wilhemi. (Pp. 290; illustrated + tables. few. Some of the clinical descriptions are dealing with these diseases. The price is SFr. 32.00, paperback.) Monograph Series, rather formal and stereotyped and the highly competitive by today's standards. No. 1. EULAR Bulletin: Basel. 1977. clinical picture of the disease does not P. J. L. HOLT The 30th Anniversary of the European come across well. Perhaps this is due to League against Rheumatism was cele- the papers being delivered to a peer brated by a meeting in Zurich in April audience rather than for wider con- 1977. The papers and discussion are pub- sumption, the presenters forgetting that lished in the first of a monograph series by the diseases they describe may be un- Peripheral Manipulation. 2nd edition. By EULAR Bulletin through the generosity of familiar to some members of this wider G. D. Maitland. (Pp. 363; illustrated + Merck, Sharp, and Dohme, Zurich. audience. tables. £13.50.) Butterworth: Sevenoaks. Almost two thirds of the monograph is In addition to discussion of the principle 1977. taken up by the first part of the meeting diseases, unusual diseases and presenta- This book, written by a manipulative entitled 'The International Co-ordination tions are detailed and there is discussion physiotherapist, pairs with one by the ofDrugTrials', a subject ofgreat interest to of the attempts to define disease sub- same author on vertebral manipulation. the pharmaceutical industry and to many groups. The discussion following each I was able to review the latter favourably clinicians. Thirty-eight papers, almost ex- section, although readable, would prob- because experience had taught me that clusively from centres in Europe, were pre- ably have been enhanced if a rapporteur the common spinal mechanical syndromes sented in 4 sessions grouped under the system had been used. can be easily recognised and do some- headings 'Methodology', Drug safety and The clinical aspects have been enhanced times respond dramatically to empirical effectiveness', 'What the health authorities by the inclusion of chapters on back- manipulative treatment, without needing require from clinical trials', and 'Design of ground subjects, of which one might pick to determine exactly the nature of the protocols and other practical problems'. out those by Omenn on genetics and lesion. Similar lesions undoubtedly occur The papers vary in quality, length, and histocompatibility genes, Phillips on in peripheral joints as a late result of clarityand, like manyother conference pro- pathogenic mechanisms of infectious trauma, inflammation, or degenerative ceedings, they fall short of the standard of agents, and amyloidosis by Schnitzer and change, but I cannot accept the im- formal papers for rheumatology journals; Ansell. plication that passive manual procedures they can only hint at the valuable exchange Interesting chapters deal with specific are the main key to treatment. of ideas that probably took place. Despite problems such as growth retardation and In the introduction Mr Maitland states some editing there is repetition, particu- eye and cardiac involvement. that 'diagnosis will not be discussed as larly in measurement and trial design. There are faults. It is often not clear this is the province of the medical With international co-ordination it is when authors are extrapolating from practitioner'. However, a large proportion hoped that reduplication of trials will be results found in adults and when they of doctors referring patients for treatment avoided but, on the other hand, clinicians base statements solely on childhood cases. are not skilled in orthopaedic or rheuma- have faith in the results when they know There are surprising omissions such as tological diagnosis and physiotherapists the centre where the trial was performed. scant reference to tenosynovitis and the must be constantly attuned to locomotor Seldom is reference made to the research- enthesopathy of ankylosing spondylitis, diagnosis. It cannot be sufficient to assess ing experience or working conditions of both of great practical importance in only pain and stiffness in the joint and the person carrying out a clinical trial. diagnosis and management of these cases. set out to correct these by mobilising Standardisation of trials has hazards as The psychological aspects of childhood without constantly questioning the under- well as advantages. There are thoughtful rheumatic diseases and their management lying cause. For example, pain and contributions at the beginning from Dr are not discussed, nor are the dental stiffness could arise in a hip with un- M. F. Grayson and at the end from complications. Haemophilia, the heredit- remarkable x-rays from osteomyelitis, Dr A. St. J. Dixon. Dr Graysoh points ary disorders of connective tissue and soft rheumatoid, osteoarthrosis, aseptic ne- out that although studies must be con- tissue disorders, and the many postural crosis, or slipped epiphysis. ducted in many places by many in- and orthopaedic problems are not dealt The author is guiding his less experi- vestigators in a wide variety of con- with. enced colleagues up a very narrow ditions the 'large and hectic multicentre It is because of the emphasis on pathway. Although he is undoubtedly studies now so popular in drug evaluation quantitative facts over a limited range of aware of the value ofancillary treatment- must be seen to be the juggling act and the spectrum of disorders seen in a such as muscle re-education, heat, ice, and conjuring tricks that they are'. Dr Dixon children's arthritis clinic and the lack of friction-these are not mentioned. The explains the positive ethic in attempts to practical advice that this book cannot tenor of the book is such that it will tend improve methods of treatment and in replace a textbook (nor was it meant to). to produce a cultist manipulative physic- studying a new drug efficiently, but As complementary to such a textbook it therapist who could devote too much time advises that, when considering a trial, the would be excellent. Unfortunately there is to the elaborate mobilising procedures researcher should decide whether the no textbook covering childhood arthritis without utilising other important tech- company is interested in his opinion or at present. Perhaps the organising com- niques. whether he is taking part in a promotional mittee might think of inviting some D. A. H. YATES exercise disguised as research..

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