BOOK REVIEWS 383

HUMAN MALFORMATIONS. British Medical Bulletin, Volume 32, No. I. Pp. 94. Published by the Medical Department, The British Council, 65 Davies Street, London WIY 2AA. Price UK E3.00, other countries E3*50.

This issue of the British Medical Bulletin contains 15 invited papers by acknowledged authorities on various aspects of the problems associated with human malformations. As Professor T. McKeown of the Department of Social Medicine in Birmingham University points out in the introduction: in spite of decades of research and many conferences, symposia and seminars, the problem of human malformation is essentially unchanged. Thalidomide, a terarogenic drug, has been identified, and a teratogenic infection, rubella, is so well known for its harmful effects that if it occurs during pregnancy, it is accepted as grounds for abortion; but the number of infant deaths from malformations remains about the same. There are, however, some encouraging signs of improvement.

Malformations may result from one of three causes: genetic anomalies in one or both parents, chromo- somal aberrations following fertilisation of the ovum, and environmental factors during gestation.

C. 0. Carter writes about the genetics of common single malformations. Of these the best documented are clefts of the lip and palate since most sufferers survive into adulthood and are readily recalled by their descendents. But like all other single malformations, genetically determined clefts make up a very small proportion of the total incidence. The risk too of one affected parent producing an affected child is also small and many take it rather than remain childless.

Chromosomal aberrations following conception are common but the great majority are aborted. Two which may survive are Down’s syndrome and central nervous system malformations and both may be diagnosed in utero, the former by culturing a small portion of the amnion and finding the abnormal chromosomes, the latter by the presence of a-fetoprotein, a constituent of cerebrospinal fluid, in the amni- otic fluid. The indications for and the ethics of amniocentesis are well discussed by K. M. Laurence and P. Gregory.

The environmental chemical teratogens are described by R. W. Smithells. In addition to thalidomide, alcohol, anticonvulsants, sex hormones, warfarin and folate antagonists have been inculpated. To any surgeon or member of theatre staff, the most disturbing factor is “operating-room environment”. Women working in operating theatres have a higher incidence of abortions and congenital deformities than controls and this apparently applies to the unexposed wives of exposed males. It is widely believed but still un- proved that anaesthetic gases are to blame.

The infective agents other than rubella which may cause congenital defects are described by J. A. Dudgeon and the mechanism of action of the various teratogens by D. E. Poswillo.

The controversy whether certain limb deformities are due to primary errors in morphogenesis or to intrauterine posture and pressure seems to be resolved. I’. M. Dunn details the evidence which shows that they are often associated with such factors as primigravidity, maternal hypertension, oligohydramnios and breech presentation.

This issue is an excellent reference source for anyone interested in human malformations. T. GIBSON

DEVELOPMENTS IN DISASTER MANAGEMENT. Edited by J. HOWARD, Superintendent of Police. Pp. 95 with 21 illustrations. Privately printed. Price &3-50.

This is the proceedings of a conference held in Glasgow in April 1976. It was organised by Action for Disaster, a charitable organisation which was set up a few years ago following three major disasters in the Glasgow area. All the services who are involved in disasters, police, fire and rescue, communications and medicine, were represented and the conference was truly international with papers from Switzerland, West Germany and France. Of particular interest, although horrifying, are 3 papers on the Moorgate crash on the London Underground in which 41 died and many were injured. This disaster presented the rescuers with problems which were virtually unique and from which much has been learned.

This publication, which is of great interest to all who might become involved in a disaster, may be purchased from The Secretary, Action for Disaster, 3 Queen Margaret Road, Glasgow G20 6DP.

T. GIBSON