Wreath on the Crown

White has been considerably augmented by several editions of their works. The catalogue also lists over two dozen copies of the works of Franqois Mauriceau in several languages, and other additions to the writings of French and German authors. The library is now well provided with books of the seventeenth and eighteenth centuries, covering the formative years of modem obstetric practice. More recent books listed include Walter Channing's A Treatise on Etherization in Childbirth and Charles Clay's account of his pioneer ovariotomies, both published in 1848. This catalogue is well produced, and includes five blank pages at the end for notes, and the attractiveness of the booklet is enhanced by the addition of sixteen well-chosen plates, which include a little-known wood-cut of 1516 portraying a Caesarean operation, apparently just performed by the midwife. This is the case presentation of a little Welsh girl who was wrecked on the rocks of puberty, exhibiting, in the process, the characteristic clinical picture of anorexia nervosa. The author has unfolded the case history and described the family interrelationship accurately-the proud, headstrong stupid father, the snivelling mother, and even the grey negativity of the brothers and sisters is typical. Aided and abetted by these complex inter-personal patterns, Sarah Jacob achieved her desire for ex-hibitionism and, as a result of the present account, immortality as well, for she died one hundred years ago in a remote part of the Welsh countryside. The Victorian era and the hidebound setting helped to kill her prematurely by encompassing an otherwise satisfying form of exhibitionism by an overstrict set of rules and a trap to catch her out. The author provides a vivid portrayal of this unedifying business, for which many culprits were to blame but for which only the father and mother received prison sentences for manslaughter of their child. The necropsy report describes the telltale chocolate brown liver of chronic starvation; this hue because of the wear and tear pigment, lipofuschin. The author ends his epilogue with a provocative series of questions for which every reader of the case history will have his own set of answers, particularly so if he has had the responsibility of the management of patients, and the parents of patients, with anorexia nervosa. There is no need to assume that a mysterious bottle of fluid was hidden in her armpit when she was openly receiving hot or warm water bottles. Doctors who stumbled …