current knowledge about hyperlipidemia.

The final index of the success of the book will be whether the community-based physician finds the book's general information worth the price.
Simon W. Rabkin, MD, FRCPC Department of Medicine University of British Columbia Vancouver, BC

Differential diagnosis in children

Pediatric Diagnosis: Interpretation of Symptoms and Signs in Infants, Children, and Adolescents. 5th ed. Morris Green. 530 pp. Illust. W.B. Saunders Company/Harcourt Brace Jovanovich, Inc., Philadelphia; HBJ-Holt-Saunders Distribution Services, Toronto. 1992. Price not stated. ISBN 0-72163469-9 T n his is the latest revision of Green and Richmond's Pediatric Diagnosis; the fourth edition was published in 1986. Providing a problem-oriented approach to pediatric symptoms and signs this book is an excellent companion text to any of the standard systems-oriented pediatric textbooks, such as the Nelson Textbook of Pediatrics, 14th edition (Saunders, Philadelphia, 1992), edited by R.E. Behrman, R.M. Kliegman, W.E. Nelson and V.C. Vaughan. It will be valuable to medical students, family practi-

chapter on rectal bleeding, which lists 28 causes and how to diagnose them; there are five journal references, including two very recent review articles. It is beyond the author's chosen mandate to deal with treatment issues. The reader learns how to suspect bacterial meningitis and how to identify other causes of meningismus but is not informed about pertinent cerebrospinal fluid findings or the antimicrobial therapy for various types of meningitis. It is interesting that each of the six chapters added to this fifth edition is far more related to psychosocial pediatrics than to organic disease. These chapters are about obsessive-compulsive symptoms, substance abuse, sexual abuse, self-injurious behaviour, fire setting and the pediatric psychosocial diagnostic interview. The book is further proof that the pediatrics of the 1 990s is probably based much more in the community than in the hospital.
John P. Anderson, MD, FRCPC Director Child Protection Team Izaak Walton Killam Hospital for Children Halifax, NS

exercise that, although supposedly prepared for, results in mass bedlam, frustration and the avowed intention of all involved to retire from medical practice before they ever go through that again. Add to this the accreditation requirement that a hospital's plan must be tested at regular intervals and you have the potential for even more disenchantment. No wonder the whole point of disaster preparedness - to be ready for the real thing - is frequently forgotten. In this book James A. Hanna has made a laudable effort to demystify disaster planning. Although obviously not an all-inclusive book it does give the reader a reasonably extensive view of disaster planning and preparedness, with one eye firmly focused on the 1991 standards of the Canadian Council on Health Facilities Accreditation. Building on his first edition Hanna has added chapters on earthquake preparedness, radiation accidents, pharmacy and food service continuity, power outages, uniform disaster codes, external air exclusion and multihospital emergency operations
centres. In writing the book Hanna uses a "soup-to-nuts" approach, including items such as the layout of a typical field hospital, a map of Canada showing the seismic hazard zones and a suggested list of contents for a hospital disaster

Preparing for the worst

Disaster Planning for Health Care Facilities. Revised edition. James A. Hanna. 273 pp. Illust. Canadian Hospital Association Press, Ottawa. 1991. $49.95. ISBN 0tioners, pediatricians, pediatric 919100-69-4 and family medicine residents, Preparing for the worst is and pediatric nurses. often the thing we do worst. I have always found this to be The mere mention of the excellent reference text that an provides a rapid, up-to-date dif- words "disaster exercise" rarely ferential diagnosis for an infre- evokes an enthusiastic response of quently encountered symptom or "Let's do it!" Rather, thoughts of sign (e.g., vertigo) in a child. The planning for disaster and impletext is liberally sprinkled with re- menting the plan tend to conjure cent pertinent journal references. up visions of endless and nonproA good example is the three-page ductive meetings followed by an
SEPTEMBER 15,1992

kit.
In some areas the book falls short of the mark. For example, in his chapter on the hospital's role in community disaster Hanna implies that a hospital can "preselect" the number of casualties above which the disaster plan would be activated. Experience dictates that such a move is fraught with hazards. Indeed, it is most often the injury severity and type, combined with the number of victims, that determine a facility's ability to cope. Also, when discussing hospital reception of casualties he ignores the possible
CAN MED ASSOC J 1992; 147 (6)

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