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33. Clutter WE, Bier DM, Shah SD, Cryer PE. Epinephrine plasma metabolic clearancerates and physiologic thresholds for metabolic and haemodynamic actions in man. JClin Invest 1980; 66: 94-101.

34. Fitzgerald GA, Barnes PJ, Hamilton CA, Dollery CT. Circulating adrenaline andblood pressure: the metabolic effects of infused adrenaline in man. Eur J Clin Invest1980; 10: 401-06.

35. Editorial. Why does blood-pressure rise with age? Lancet 1981; ii: 289-90.36. Pohorecky LA, Wurtman RJ. Adrenocortical control of epinephrine synthesis.

Pharmacol Rev 1971; 23: 1-35.37. Folkow B. The haemodynamic consequences of adaptative changes of the resistance

vessels in hypertension. Clin Sci 1971; 41: 1-12.38. Philipp T, Distler A, Cordes U. Sympathetic nervous system and blood pressure

control in essential hypertension. Lancet 1978; ii: 959-63.39. Bean BL, Brown JJ, Casals-Stenzel J, et al. The relation of arterial pressure and plasma

angiotensin II concentration. A change produced by prolonged infusion of

angiotensin II in the conscious dog. Circ Res 1979; 44: 452-58.40. Langer SZ. Presynaptic receptors and their role in the regulation of transmitter release.

Br J Pharmacol 1977, 60: 481-97.41. Majewski H, Tung L-H, Rand MJ. Adrenaline-induced hypertension in rats. J

Cardiovasc Pharmacol 1981; 3: 179-85.42. Ostman-Smith I. Cardiac sympathetic nerves as the final common pathway in the

induction of adaptive cardiac hypertrophy. Clin Sci 1981; 61: 265-72.

43. Laks MM, Morady F, Swan HJC. Myocardial hypertrophy produced by chronicinfusion of subhypertensive doses of norepinephrine in the dog. Chest 1973; 64:75-78.

44. Caldarera CM, Giorgi PP, Casti A. The effect of noradrenaline on polyamine andRNA synthesis in the chick embryo. J Endocrinol 1970; 46: 115-16.

45. Guyton AC, Coleman TG, Cowley AW, Manning RD, Norman RA. Arterial pressureregulation: Overriding dominance of the kidneys in long-term regulation and inhypertension. Am J Med 1972; 52: 584-94.

46. Poston L, Sewell RB, Wilkinson SP, et al. Evidence for a circulating sodium transportinhibitor in essential hypertension. Br Med J 1981; i: 847-49.

47. Cannessa M, Adragna N, Solomon HS, Connolly TIM, Tosteson DE. Increasedsodium-lithium countertransport in red cells of patients with essential hypertension.N Engl J Med 1979; 302: 772-76.

48. Rand MJ, Law M, Story DF, McCulloch MW. Effect of beta-adrenoceptor blockingdrugs on adrenergic transmission. Drugs 1976; 11 (Suppl. 1,): 134-43.

49. Pendleton RG, McCafferty JP, Roesler JM. The effects of PNMT inhibitors uponcardiovascular changes induced by hemorrhage in the rat. Eur J Pharmacol 1980;66:1-10.

50. Saavedra JM, Axelrod J. Adrenaline forming enzyme in brain stem: elevation ingenetic and experimental hypertension. Science 1975; 191: 483-84.

51. Engelman K. The adrenal medulla and sympathetic nervous system. In: Beeson P,McDermott W, eds. Textbook of Medicine. Philadelphia: WB Saunders & Co,1975.

Reviews of Books

Nuclear Magnetic Resonance Imaging in Medicine

Edited by Leon Kaufman, Lawrence E. Crooks, and Alexander R.Margulis, University of California, San Francisco. New York and Tokyo:Igaku Shoin. 1981. Pp. 242.$29.50

IMAGES of lemons, wrists, chests, and now brains can all beproduced by a plethora of new imaging techniques which areclamouring for our attention. The newest technique, which uses themagnetic properties of water (and called regrettably "zeugmato-graphy" by a man with great vision but less Greek), probablydeserves a closer look by the medical investigator and by clinicianswell beyond the usual interested parties, the radiologists. This isbecause, in principle and now in practice too, the technique ofobserving the radio signals emitted by certain atoms within apowerful magnetic field allows body chemistry to be studied in anon-invasive manner.

Zeugmatography, or NMR imaging, creates familiar anatomicalphotographs by the recording of the relative distribution of the mostabundant atom, hydrogen in water. If that was all, NMR might be aminor branch of CT scanning or ultrasonography. However, thedifferences between magnetic properties of the water in tumours,abscesses, kidney cortex versus medulla, and many other tissues arelarge enough to be easily measured. The full significance of thesedifferences is not clear. The most -exciting by far-their possibleusefulness in the diagnosis of cancer, as promoted originally by theAmerican prophet, R. Damadian-is one of the topics dealt with inthis book.

Although physicists can refine and perfect the NMR method,clinicians and medical investigators of all walks are required toestablish its place in medicine. To do so requires a brushing up onquantum mechanics, molecular theory, physics,- electronics, andbiochemistry. It is to the credit of the predominantly physicistcontributors and to the editors of this book that difficult conceptsare simplified, and the whole volume could be read at a sitting. Thebook deals succinctly with the principles of nuclear magneticresonance in one of the best accounts for the non-physicist that Ihave read, and it gives an account of the esoteric methods required toproduce a spatial image and record T 1. Excellent photographs whetthe appetite for what this technique can tell of human physiologyand pathology; there follows a diversion into an area in which NMRis less likely to displace existing methods, the measurement of bloodflow. Perhaps the most exciting section deals somewhat

speculatively with elements other than hydrogen-notablyphosphorus, which already makes non-invasive investigation ofbody chemistry by NMR a clinical reality, and carbon, for whichinjection of an isotope (13C) will be needed and clinical use is thatmuch more remote.

This book is the first of its kind. It is written in somewhattechnocratic English, but is well worth a place on the bedside table.Inevitably, it is out of date; the subject is galloping on, but not as fastas did roentgenography, on which 1044 publications appearedduring its first year. Which reminds me, since it will soon be oneveryone’s lips, could not the term zeugmatography be betteredbefore it is too late?

Nuffield Department of Medicine,University of Oxford B. D. Ross

Management of Anaerobic Infections: Prevention andTreatment

Antimicrobial Chemotherapy Research Studies Series. A. T. Willis, P. H.Jones, and S. Reilly, Luton and Dunstable Hospital. Chichester: ResearchStudies Press (Wiley). 1981. Pp. 97. :&9.50.

THIS very concise and comprehensive account of the preventionand management of anaerobic infections is the first of a new seriesand, as might be expected from the reputation of the authors, thetext is authoritative and fully referenced and sets a high standard forthe remainder of the series.In the first chapter, which briefly describes the various infections

caused by anaerobic bacteria, the only surprising feature is the

inclusion, without any explanation, of enteritis due to

Campylobacter coli and Campylobacter jejuni. A clue to why thesemicroaerophilic bacteria have been included is perhaps provided bythe later discussion of their susceptibility to metronidazole.However, it is unlikely that many microbiologists will be convincedby this reasoning, since the MICs for these organisms are

higher than those for anaerobes, some strains are resistant, and theirinhibition by metronidazole differs from that of oxygen-tolerantanaerobes in that it occurs in the presence of air. In the second

chapter in which the anti-anaerobe activity of all the majorantibiotics is discussed, the many references given will be extremelyuseful to the microbiologist with an interest in bacterial

susceptibility to antibiotics. The clinician will find his needs fullyprovided for by metronidazole, with occasional recourse to

chloramphenicol, clindamycin, penicillin, and vancomycin. Theauthors have found the currently available cephalosporins (orcephamycins) disappointing and do not recommend them. The restof the book covers the prevention and management of tetanus, gasgangrene, and gastrointestinal diseases, and the treatment of andprevention of non-clostridial anaerobic infections. It is of the lastchapter that criticism must be made. The authors rightly emphasise theimportance of anaerobic bacteria in sepsis occurring after colonicsurgery but dismiss aerobic infection as unimportant, a view whichmany surgeons would challenge. They also dismiss short-termprophylaxis without any discussion of the experimental data on whichit is based or of the results of several successful clinical trials of

single-dose prophylaxis. They also regard the argument that longcourses of antibiotics may increase the prevalence of resistant

1083

organisms as invalid, a viewpoint which can only be sustained if onebelieves that aerobes are of no significance and is sure that resistanceto metronidazole will never develop.Although I disagreed with the authors on a few points, I enjoyed

this well-written book, and am sure that many readers will find ituseful, both as a means of bringing themselves up-to-date and as asource of references for further study.

Department of Microbiology,General Hospital, Birmingham D. W. BURDON

Clinical Pediatric DermatologyA Textbook of Skin Disorders ofChildhoodandAdolescence. SIdney Hurwitz,Yale University School of Medicine. Eastbourne and Philadelphia:W. B. Saunders. 1981. Pp. 479. 49.75.

Do not be fooled by the title-American paediatricians deal withpatients up to the age of eighteen (and above); the geriatrists dealwith the rest. Written by an experienced paediatrician turneddermatologist this book is up to date and comprehensive-evenencyclopaedic. Practically all of the 500 clinical photographs are incolour (some a little dark though) and pertinent to the text. Theindex is thorough and the chapter references include one-sentencesummaries of the papers cited-a feature which will appeal to thosetoo busy or too idle to go to the sources.The whole work is evidence of wide clinical experience and

diligent reading, and an impressive example of what a single authorcan accomplish even today. It would be mean-spirited to carp atsuch a herculean effort, and the following points are made simplyfor the author’s consideration when preparing the next edition.There are a few misprints and misspellings-for example, Walter B.Shelley spells his name thus consistently (and would do so especiallyon the same page); and pear-sized papules (p. 228) are presumably ofthe same class as giant dwarfs.These days clotrimazole is not advocated with much enthusiasm

for systemic use, not even by the manufacturers, in view of itstoxicity. Dermatologists who cannot demonstrate the

pathognomonic burrow in more than 7-13% adult cases of scabies(p. 303) are either not really trying or recklessly overdiagnosing thisdisease. There seems to be a similar difficulty in recognisingCandida organism in direct microscopy of skin scrapings (p. 28)-adifficulty easily and profitably overcome by practice and patience.The role of argininosuccinic acid in monilethrix (p. 372) can nolonger be maintained, hence the phrase "this association requiresconfirmation" requires rewriting. Lyell’s original work in toxicepidermal necrolysis ("TEN syndrome") goes virtuallyunacknowledged, though on this side of the water the condition isoften called Lyell’s syndrome. Perhaps if it had been named theLYELL syndrome (scaLded skin sYndrome somEtimes but notaLways due to staphyLococci), the term might have stuck.

I know of no good evidence that seborrhoeic dermatitis is "relatedto a dysfunction of the sebaceous gland" (p. 12), but this myth is stillalive and well-and perhaps living in Yale? Dhobi’s itch, when Ilived in the tropics, was grotty groins from fungus infection, not dyedermatitis from the dhobi’s laundry mark (p. 61). The treatment ofpolymorphic light eruption by /3-carotene (p. 72) is by no meansfully accepted as having any effect whatsoever in this complaint.The value of topical idoxuridine in both herpes simplex and herpeszoster is established by perfectly adequate trials, most convincinglywhen the agent is incorporated in dimethylsulphoxide.Many European dermatologists are becoming less and less

enchanted with topical corticosteroids as "the mainstay of topicaltherapy in psoriasis" (p. 87). Tissue addiction, patient addiction,and ultimately doctor addiction all occur, and the only realbeneficiaries are the drug companies.Despite these few, though not always trivial, blemishes,

paediatricians or dermatologists and their libraries must have thisbook, even at 49.75. Like Rook, Wilkinson, and Ebling in generaldermatology, Hurwitz has set a standard for the years to come.General practitioners too should clamber off their wallets to buy thebook.

University Department of Dermatology,Royal Victoria Infirmary,Newcastle upon Tyne J. S. COMAISH

Lung Function for the Clinician

D. T. D. Hughes, London Hospital, and D. W. Empey, London ChestHospital. London: Academic Press. New York: Grune and Stratton. 1981.Pp. 122.6.80;$16.50.

THIS book is intended as an "overview" of respiratory physiologyand is aimed primarily at clinicians. Many doctors find lung-function tests confusing, and a book of this size and level is

undoubtedly valuable in giving a simple account of the mostimportant aspects of respiratory physiology from the clinical

viewpoint.The chapters have been arranged so that theory is interspersed

with very practical descriptions of lung function tests, equipment,and calculations. Chapters dealing with the more sophisticatedtechniques such as plethysmography are followed by chapters ondiseases causing restrictive and obstructive defects; the examples oftypical patterns of results make it easier for the reader to learn howto interpret findings. The basic advice on choice of equipment for asimple hospital laboratory is useful, and appendices of conversionfactors and predicted normal values are given.This book will be helpful to clinicians who are unfamiliar with

lung function testing and with the considerable advances that havebeen made in this specialty in recent years. I hope that it will also beread by those clinicians who are not yet convinced of the clinicalvalue of these techniques. This useful introduction to the subjectshould facilitate the use of more detailed reference books, whichtend to daunt the beginner with equations on every page. It shouldalso prove helpful to junior technicians taking up respiratoryphysiology for a career, by relating the techniques to a simpleunderstanding of the diseases which they are used to study. Itcontains about the right amount of detail for candidates for theM.R.C.P. examination, not only for answering questions directlyrelated to pulmonary physiology, but also for the improvedunderstanding of many clinical problems (for example, acute

asthma attacks) which can only be achieved with a sound knowledgeof the physiological principles involved. In this respect, the bookdeals very clearly with areas such as ventilation-perfusion imbalancewhich often seem to confuse undergraduate and postgraduate alike.I would have liked, however, to have seen more attention paid to theinterpretation of the gas transfer test for carbon monoxide indifferent diseases, which many doctors find difficult to understand,because of a failure to appreciate the relative effects of the separatecomponents of the test-i.e., diffusing capacity and pulmonarycapillary blood volume. The book gives an analogy with the LondonUnderground, but this does not quite succeed in making theprinciples of the test clear.My only other criticism of this excellent book is its price, which

will deter medical students from reading it, although there is muchin it for them.

Department of Medicine,Whittington Hospital, London M. R. HETZEL

Spinal Degenerative DiseaseR. S. Maurice-Williams, Royal Free Hospital, London. Bristol:

John Wright. 1981. Pp. 341. 16.

THE title of this excellent book is misleading in that it gives theimpression of being about osteoarthritis, whereas it is a

comprehensive text on the spine. The bibliography is excellent andvery up to date. The book is presumably aimed at the registrar inneurosurgery or orthopaedics, but I am sure physicians interested inthe spine would find it instructive.

Parts of the book, especially in the section on spinal fusion, gaveme the feeling that they were based entirely on published work andnot written from personal experience. However, the author doescome down against spinal fusion in discogenic back pain, and onthat I would agree.The diagnosis and management of spinal disorders is so

controversial that inevitably there will be points on which readersdisagree with authors. I do not agree that in 10% of cases disc

prolapse occurs at two levels, or that spinal stenosis is common,even in the elderly. Verbiest, who first described the condition in

1084

1949, had by 1980 operated on only 140 patients whom he felt hadtrue spinal stenosis, but the North American literature is full ofenormous series of "spinal stenosis".

I would have liked more on certain investigations such as epiduralvenography, which many surgeons feel is quicker, safer, and moreaccurate than intrathecal contrast in showing disc lesions of thelumbar spine. Similarly, there is a place for discography, but not asan acceptance test for localisation of lesions in the lumbar spine.This book needs to be read with care, or a great many gems could

be missed-for example, how bleeding from extradural veins cancause an extremely simple first-time operation for disc excision tobe abandoned and make it necessary for a difficult second operationto be performed. ,

I can thoroughly recommend this book to all those interested inthe spine, whether physicians or surgeons, but especially to traineeswho will be operating on the spine. Also, anyone contemplatingwriting a paper on the spine would be well advised to refer to theexcellent bibliography.

Royal National Orthopaedic Hospital,London MICHAEL F. SULLIVAN

Casualty RadiologyA Practical Guide for Radzological Diagnosis. Paul Grech, NorthernGeneral Hospital, Sheffield. London: Chapman and Hall. 1981. Pp. 242..615.

YouNG doctors often find it difficult to interpret X-rays of boneand joint injuries. Since each new batch of casualty officers ortrainee radiologists seems to have the same difficulty, it would

appear that the radiology of trauma does not receive the attentionwhich it merits in undergraduate teaching-or in postgraduateeducation either. Junior staff are often left to interpret casualtyradiographs with little or no supervision, because of the generalbelief that most radiographs are easy to read, and that skeletalradiographs are the easiest of all.Having drawn our attention to this serious deficiency in the

medical curriculum, Dr Grech has attempted to provide a solutionby offering a treatise on the use of radiology in the early and accuratediagnosis of those skeletal injuries which are apt to cause confusion,on injuries which are easily overlooked, and on the pitfalls whichawait the inexperienced or unwary practitioner. Besides providingground rules for the plain X-ray investigation of injuries, he givesattention to the applications of tomography, arteriography, CTscanning, radioisotope scanning, and ultrasound in the

investigation of traumatic injuries. There is also a chapter on theradiology of foreign bodies, a constant problem in all casualtydepartments.Although the principal theme is trauma sustained at home, the

book also discusses the more serious and multiple injuries resultingfrom traffic and industrial accidents. Much emphasis is placed uponthe principles underlying the constructive use of radio diagnosis incasualty departments, a feature which forms one of the mostvaluable aspects of this work. Fundamentals such as how to look,where to look, the importance of soft tissues, and the caveat of nevertaking anything for granted bear upon all aspects of radiology anddeserve constant repetition. The need for good communicationbetween casualty and radiology departments is clearly stated, andhow joint contribution of the two disciplines leads to a high standardof patient care is made clear. The salutary examples from previouscourt cases, together with references to the literature on trauma, areof particular relevance in demonstrating the potential of radiologyin the management of injured patients.Although some of the texrwould benefit from pruning in order to

drive home points more clearly, in any future edition the first

objective should be to improve and increase the number ofillustrations. Whereas many of the radiographs are useful for

teaching and study, a considerable number do not survive thehazards of reproduction to a standard adequate for this purpose (inaddition, fig. 7.22 is labelled incorrectly, with duplication of thelegend for fig. 7.23). There is no satisfactory alternative to thecumbersome process of collecting films for teaching within a

department, but this book has much to offer junior casualty officersand trainee radiologists.

Department of Radiology,Wharfedale General Hospital,Otley, West Yorkshire KENNETH SWINBURNE

Harvey and the Oxford PhysiologistsA Study of Saentific Ideas, Robert G. Frank, Jr. Berkeley, California, andLondon: University of California Press. 1981. Pp. 368.$34.45; L16.50.

STARTING with Harvey’s discovery of the circulation of the blood,this book traces the various problems which this discovery raisedduring the remainder of the seventeenth century. Its virtue is that itmakes one realise how long it took for the implications of thediscovery, now so obvious, to be realised. Harvey was, of course,aware of the difference in colour between arterial and venous blood,but since he was passionately concerned that the identity of venousand arterial blood should be accepted, he said nothing about thedifferences between them. Richard Lower realised that the changein colour was due to air in the lungs, that shed venous blood in abowl became red on top and that exposure of the lower part of theclot resulted in it too becoming red. He even correctly pointed outthe obvious corollary that arterial blood must lose its "air" again asit goes on to become venous blood, but he then missed the point andspoke of the air being given up to the viscera and the pores of theskin. Don Mayow, however, had moments of crystal clarity. The oldproblem of the fetus in its membranes alive but not breathing, aproblem which balled Harvey, he solved by saying that thefunction of the uterine arteries is to pick up "nitro-aereal spirit"from the maternal circulation, and that one should think of theplacenta as a uterine lung rather than as a uterine liver. In his earlierwork he was quite clear that the major site of "combustion" is in themuscles and that the arterial blood carries nitro-aereal spirit to themuscles and is essential to their activity. In his later work, however,he continued to maintain that combustive material reached themuscles from the arterial blood but unhappily decided that thenitro-aereal spirit passed through the arterial blood to the brainwhere it becomes "animal spirit" which then flows in the usual waydown the nerves to the muscles and initiates contraction. This flightof fancy, which may have helped to decrease Mayow’s standing inthe post-Lavoisier period, is passed over by Robert Frank in acharacteristically involved comment that here Mayow was

concerned only with the metabolic aspects of contraction.Frank, however, makes it clear that Mayow’s major contribution

was the suggestion that nitro-aereal spirit is carried by the arterialblood and given up to the tissues when it is required for combustion.This is in itself a considerable achievement, and by its side some ofthe shortcomings of this book-its suggestions of "old-school-tie"links between Westminster scholars in the seventeenth century andthat worthy Oxford figures concerned with theology, money-making medical practice, and even law should be regarded as a"research school" of "physiologists" though silly-are of no greatimportance. The author is vastly learned and the work would beimproved by judicious pruning to prevent the reader from

succumbing to feelings of deja-vu. On the whole, however, theimportant points do for the most part succeed in shining throughthe learning.Winterslow,Boars Hill, Oxford GWENETH WHITTERIDGE

New Editions

Year Book of Plastic and Reconstructive Surgery.-Edited by Raymond 0.Brauer, B. W. Haynes, Jr. Robert J. Hoehn, Stephen H. Miller, Linton A.Whitaker. Chicago and London: Year Book Med. Pub. 1981. Pp. 359. 32.75.

Year Book of Nuclear Medicine. -Editor Paul Hoffer. Chicago and LondonYear Book Med. Pub. 1981. Pp. 404..E32.25.

Nephrology Reviews.-Vol 2. Edited by Louis H. Diamond and James E.Balow. New York and Chichester: John Wiley. 1981. Pp. 306. 27.20.Ackerman’s Surgical Pathology.-Vols 1 and 2. 6th ed. Juan Rosal. London.

Year Book Med. Pub. St. Louis: C. V. Mosby. 1981. Pp. 1086..E85.00.Dorland’s Illustrated Medical Dictionary.-26th ed. Philadelphia and

Eastbourne: W. B. Saunders. 1981. Pp. 1468. 20.

1085

THE LANCET

After the Trial at Leicester

THE trial and acquittal of a paediatrician, DrLeonard Arthur, charged with the murder (in mid-trialthe charge was reduced to the attempted murder) of anewborn infant with Down syndrome (see p. 1101), hasleft much uncertainty and some apprehension amongthe public and the medical profession. The simplest,though not necessarily the right, course for doctorsfaced with a decision on the treatment of a baby withDown syndrome might be to set in train all possiblemeasures for the preservation of life, even though theparents’ initial reaction to the tragedy and to

experienced advice about the prospects for the child’sdevelopment and upbringing has been a mood ofrejection. Preservation at all costs is the one way tosatisfy those who believe that the acquittal has openedthe path to the widespread acceptance of euthanasia asan estimable feature of modern society. For those whocondemn euthanasia or non-treatment, the issue is

simple: no doctor must ever do less than his utmost topreserve life. Anyone suspected of breaking this

implied principle, however humane the motives, stoodand still stands in danger of subjection to legal processesinitiated by organisations and persons opposed to non-treatment of seriously defective newborn infants andby those who supply them with information. Theverdict in the Arthur trial has not abated that threat,though the Director of Public Prosecutions is unlikelyto undertake a second prosecution unless he has a verymuch stronger case in law than he turned out to have inthe prosecution of Dr Arthur.The situation as it stands after the trial is far from

satisfactory. It could be improved if the AttorneyGeneral chose to pursue the suggestion’ of a referral tothe Court of Appeal on the general principle of whatmedical action or inaction is defensible in suchcircumstances. The Court might then be able to give ajudgment that would prove legally and medicallyvaluable in the future and, moreover, provideclarification for the many citizens who remain

disquieted. By proceeding on a charge of murder withmedical evidence which collapsed under scrutiny bythe defence, the Director of Public Prosecutions

1 Leader. Case for a post-mortem. Observer, Nov. 8, p. 12.

forsook the opportunity to secure a judgment declaringa general principle. It hardly needs saying, however,that a whole court of Solomons would be taxed to framesuch a judgment in terms that would not immediatelyrekindle the arguments that have been raging this pastweek. Short of revision by statute, such a process seemsthe only course likely to clarify the law. A barristerwriting in our medicolegal column this week believesthat, if the position at common law is to be brought intoharmony with widely accepted medical practice, thenreform by statute is essential.There are, nevertheless, grounds for some

satisfaction about the verdict. A paediatrician of

conspicuous integrity is not suffering the penalty ofthe law for murder or attempted murder. Paedia-tricians still have some freedom of manoeuvre, wherethey might have been drastically restricted. Those, forexample, who apply prescribed criteria for theassessment of degree of disability in spina bifida needno longer be glancing too anxiously over theirshoulders. In addition, the verdict may deter thosemedical technologists who believe that if a thing can bedone it must be done.

If doctors deny that life must be preserved at any cost,to child, parents, or society, then society and itslawmakers must decide what sort of intervention is

justified and what is not. At the Leicester trial therewere paediatricians who declared that it might bepermissible to withhold treatment from a baby withDown syndrome who was otherwise normal. An

anonymous article in The Lancet2 two years agoexpressed the view that a newborn baby did not qualifyas a real person, only as a potential person. Thisargument, of course, is a slippery slope which mightend in the despatch of babies with red hair, or girls. Amore generally acceptable view would be that care maybe withheld if there is some additional defect whichthreatens life—though the courts may disagree, and sotoo would those cardiac units which devote much oftheir energy to operating on cardiovascular defectsassociated with Down syndrome.The Leicester verdict was Not Guilty, so we have no

means of knowing what the opinions of the jury—representing society—were on this matter. Respectedphysicians declared at the trial that "nursing care only"is within the spectrum of acceptable management for-Down syndrome without additional handicap. Such acourse can lead to slow and distressful death, but it isnevertheless pursued because a rapidly lethal"treatment" is believed to be unethical as well as

illegal. Of course, there must be full consultation withthe parents (though, as our legal correspondent pointsout on p. 1101, their preferences can have no weight inlaw over the child’s right to life). But do the advocatesof "nursing care only" advise parents on the quality ofdeath? Another doubt arises. Can proper decisions bemade in the space of a day or two after birth; can a

2. Anonymous. Non-treatment of defective newborn babies Lancet 1979; ii: 1123-24.