`Merciful release': the history of the British euthanasia movement

transplantation, so interdependent in clinical practice. It is an exciting story. As medical students in the 1950s, we were told by Professor Max Rosenheim, who later played a substantial role in examining cross infection in dialysis units, about the transplantation ofa kidney between two identical twins. We were warned that to fail to ask the potentially life-saving question about the existence of such a twin would lead to failure in finals. Within a single generation of doctors, the diagnosis of acute or chronic kidney failure has changed from a death sentence into a requirement for careful but optimistic life planning. Cameron lays out the many steps and blind alleys in the development of this new technology, where advances could occur in one of many countries, and communication between workers in the same field was not always good. The interplay of personalities and the varying approaches worldwide make fascinating reading, as do the insights into problems from the patients' perspective. Advance was dependent on new materials often developed for quite different reasons, such as those used for membranes and shunts. Improved methods of analysis such as flame photometry and better understanding of physiological issues such as electrolyte balance were essential in clinical care. Today dialysis appears so routine that we may forget that clinical problems and uncertainties still exist. This book provides a salutary reminder that dialysis itself created clinical conundrums not apparent until those with renal failure lived longer. Emotional problems mattered, for many would come to wish to end their dialysis. Patients were at high risk of suicide, heart attack and blindness. There were syndromes previously unknown such as toxicity from aluminium in the water used for dialysis, and bone and joint pain from amyloid as microglobulins were removed inadequately by dialysis. Then there was the problem of anaemia, largely solved by erythropoietin, and the susceptibility of staff and patients to hepatitis. Cameron discusses how the financial structure within which health services operate influences the clinical nature of the care patients receive. Some systems such as the NHS, partly for economic reasons, have placed great emphasis on ending the need for dialysis by transplantation, freeing resources for other patients. Others have been content to expand dialysis services seemingly without limit, driven by commercial imperatives. None have been able to avoid the problem of explicit or implicit rationing. As well as clinicians, other medical historians-such as myself-will find this book a treasure trove in both its contents and the way in which the curtain is drawn back on the complexity of clinical advances. Few are made by an isolated genius. Too seldom do clinical disciplines have a well-recorded history and Cameron's book could serve as a pattern for others. Indeed, this book goes beyond history and could help those concerned with policy development and clinical practice.