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Book reviews

Pete Moore. Pregnancy: A Testing Time. Lion, 1997, 160pp, £7.99. ISBN: 0 7459 3819 1. Reviewed by Louise Jackson.

A concise and clear description of the tests available to mothers during pregnancy in order to assess the health of the developing baby and the issues surrounding decision-making for parents before and after the tests.

Topics such as the status of the developing baby; the tests available to monitor both mother and baby during pregnancy; information on specific diseases and disorders; and decision-making before and after tests are covered in the eight chapters in the book. Several case studies are also included which focus on real-life accounts of antenatal testing, the subsequent results and their consequences. A glossary of terms and an index serve to provide a quick reference point.

Each antenatal test is described in detail: how and when the test is carried out, its purpose, risk and possible interpretations and limitations of the results. More complex issues such as statistics and genetics are described simply, meaningfully and without jargon. There is a wealth of information to address the moral and ethical considerations and arguments surrounding testing.

The author makes no attempt to bias the reader in favour of or against testing, or gives guidance as to what choices should be made.

As a recent mother and hopefully future expectant mother I found this book interesting and thought provoking. It provided information which I would have valued during my first pregnancy, although it also brought home some facts which at the time might have made me more anxious. Some of the case studies were very emotive and stressed the importance of decision-making associated with antenatal testing.

Not every expectant mother or father will want to be read this book. There are many families who would benefit from reading it, and I would hope that this text could be offered to prospective parents by their antenatal clinic or doctor's surgery early in pregnancy.

Big fleas and all that

William H McNeill. Plagues and Peoples. Basil Blackwell, Oxford, 1977. ISBN 0-631-17880-5.

In about 542 in the reign of Justinian there occurred perhaps the first outbreak of bubonic plague in Europe. In Constantinople people were dying at a rate of about 10,000 a day - at its peak it was 16,000 in one day. Overall the mortality was about 40%, killing some 300,000 people in the city. The effects throughout the rest of the Byzantine empire were similar, and it spread through the former (Western) parts of the Roman empire with similar results. There has even been a suggestion that the collapse of post-Roman Britain had more to do with the visitation of the Justinian plague than the arrival of the Saxons.

Whenever a new disease has visited a human population in modern (the last 2000 years) times, the effects have been devastating. Mortality rates of 30-50% are often quoted for the immediate visitation. But a feature of plagues (and not just bubonic plague) has been their re-occurrence at intervals, and a collapse of population and economies. Estimates for the 14th century plague in England include a fall in population of 85% in the ensuing century.

Devastation occurred for the Roman and Chinese empires in the third and fourth centuries, both from a population peak of about 50 million. American indians and Pacific islanders have been ravaged in more recent times.

What William McNeil, a celebrated Chicago historian, did in his book 'Plagues and Peoples', written nearly a quarter of century ago, was to examine the effects of disease on history. The language may be slightly florid for modern tastes, and the microbiology and genetics hardly cutting edge today, but for anyone who is interested in history, and also in disease, this opens a window previously barred.

It is the detail that is so interesting: the presence of Roman traders in Pondicherry at the end of the Republic (and not long later visiting China by travelling up the Irawaddy, though that's from Encyclopaedia Britannica). There's also the tale about the outbreak of bubonic plague in China in 1911, brought about by incomers catching and skinning infected marmots which the nomad tribespeople left well alone because of ritual taboo. If any marmot colony showed signs of sickness, custom required the human community to move away to avoid bad luck.

You are unlikely to get this book in the local bookshop, but a reference library may find it for you. If you are lucky enough to find a copy, try reading it first, and then delve into John Julius Norwich's Byzantium trilogy to compare and contrast how these two historians treat the impact of disease on history.

Out of mind, out of sight

Mount Misery by Samuel Shem. Black Swan £7.99 ISBN 0-552-99813-3

Samuel Shem wrote House of God (ISBN 0-552-99122-8). This 1978 book followed interns through their year in Beth Israel Boston. Shem told it like it is, and these threads were then picked up in St Elsewhere's and Cardiac Arrest. House of God is one of the best medical novels of the century, and when Shem spoke to a medical student audience in Oxford three weeks ago it was amazing how many of the students had read the book. Shem did for medicine what Upton Sinclair's 'The Jungle' did for the meat trade in Chicago early in the century.

Mount Misery follows Dr Basch through his psychiatric residency at Misery in Boston. He rotates through alcohol and drug recovery, through psycho-pharmacology, borderlines and the analytic unit. Yes it is American. Basch is told that the first question in the psychiatric interview is 'What is your insurance coverage?'. But this book is deeper than the House of God. The one on one doctor patient encounters are relevant to all of us doing talk therapy, and are done with insight above the humour. The nightmares and the satisfactions of psychiatry are laid out for you. As in the House of God Shem gives us laws, and the thirteen laws of Mount Misery are:-

  1. There are no laws in psychiatry.
  2. Psychiatrists specialise in their own defects.
  3. At a psychiatric emergency, the first procedure is to check your own mental status.
  4. The patient is not the only one with the disease, or without it.
  5. In psychiatry, first comes treatment, then comes diagnosis.
  6. The worst psychiatrists charge the most, and world experts are the worst.
  7. Medical school is a liability in becoming a psycho therapist.
  8. Your colleagues will hurt you more than your patients.
  9. You can learn everything about a person by the way he or she plays a sport.
  10. Medical patients don't take their medication fifty percent of the time, and psychiatric patients don't take their medication much at all.
  11. Therapy is part of life, and vice versa.
  12. Healing in psychotherapy has nothing to do with psychology; connection, not self, heals.
  13. The delivery of psychiatric care is to know as little as possible, and to understand as much as possible, about living through sorrows with others.

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