- Email: [email protected]
Landmines past, present, and future
THE LANCET
There was no pathognomonic finding that identified these patients, which underscores the need for a complete evaluation. The book provides a comprehensive review of the evaluation and treatment of male infertility and will serve as a useful reference and guide book for practising physicians. Grace Centola and Kenneth A Ginsburg have assembled a group of leading authorities in the field, who have written reviews cov-
ering all aspects of evaluation and treatment. The chapter on endocrine assessment is especially noteworthy for its clear explanations of the neuroendrocine control of male reproduction and how disruptions in this system can affect male fertility. Although treatment options are limited, several protocols are presented. Detailed chapters are also included on the urological evaluation, semen analysis, sperm function testing, as well as the newer assays for evaluating sperm function. A chapter on intrauterine insemination for male factor infertility provides a complete summary of the published success rates with this technique, and provides useful treatment guidelines. The chapter on therapeutic donor insemination presents an excellent review of the ethical and legal views towards donor insemination in several countries and summarises success rates and the factors that affect them. Infertility is a very personal and emo-
tionally sensitive issue for many patients. Treating infertile patients requires a great deal of empathy, compassion, and willingness to provide emotional support along the way. The male partner’s emotional needs may be less apparent, and therefore not addressed during this process. In Evaluation and Treatment of the Infertile Male, the chapter on the psychological aspects of male infertility deals directly with these issues and provides very useful suggestions on how to help men deal with their infertility. There is a definite need for a reemphasis of the evaluation of the male partner in couples seeking infertility investigation. This text can serve as a useful guide for gynaecologists, reproductive endocrinologists, and other health-care practitioners who help couples with this frustrating and sometimes elusive medical problem.
Guy E Ringler Department of Obstetrics and Gynecology, UCLA School of Medicine, 1245 16th Street, Santa Monica, California 90404, USA
Landmines past, present, and future Aftermath: the remnants of war Donavan Webster. New York: Partheon. 1996. Pp 279. $23.00. ISBN 0-679-43195-0.
resident Clinton should read this book, at least the chapters on landmines in Europe and Kuwait, which are the most compelling of the six stories that journalist Donovan Webster tells about the deep, oozing scars that wars have left on the earth and on the lives of survivors. While Afghanistan, Angola, Bosnia, Cambodia, and Kuwait might be the countries that come to mind in today’s discussion of landmines. Donovan’s chilling account of France’s 50-yearold problem is a haunting reminder of just how difficult it is to rid the soil of these remnants of war. About 16 million acres of land in France is still offlimits because of the 12 million unexploded World War I artillery shells and mines near Verdun. Several million more World War II devices are embedded in the beaches of Normandy and Brittany. More than 630 demineurs from France’s Department du Deminage have died since they began the clean-up 50 years ago. Thirty-six farmers were killed in 1991 alone when their ploughs
P
216
and tractors hit the explosives below the earth’s surface. Aftermath: the remnants of war, takes the reader on Donovan’s reporting trips. For instance, one day Donovan is walking with a demining team in the dense forest near Verdun, site of some of the fiercest battles of World War I, when he finds an unexploded artillery shell as big as a beer keg. The team debates whether to blow it up there or to free it from the tree roots and haul it away. They cannot tell from the exposed foot-long section whether the shell contains explosives or toxic gas. “Working with a shovel, demineur Christian Cleret begins to spade . . . slowly, gingerly . . . around the tree’s roots . . . in a few more seconds, Cleret drops the shovel and, slipping on his rubber gloves, begins to ease the shell from the home it has had since the age of horse-drawn carriages. He’s lifting the shell now, straining, breathing heavily. Another demineur comes to help and together they lift and steady the shell, which weighs about a hundred pounds. Finally, the shell is free of
the roots, and the two demineurs slowly lower its base to the ground.” They see that it is a German Minenwerfer carrying 90 pounds of high explosives. “The shell’s flaking, corroded skin meets sunlight for the first time since 1918 and the air fills with its scent . . . Cleret rests for a moment, then . . . on the count of three . . . he and the other demineur hoist the shell and slowly, being sure not to stumble, begin walking towards the trucks.” One down, 12 million to go. The international effort to ban landmines is at a crucial point right now. In May, after months of internal debate within his administration, President Clinton endorsed the Pentagon-led status quo on landmines, which was to ban older model “dumb” mines, except near the demilitarised zone between North and South Korea. Although an immediate ban on all antipersonnel mines was endorsed by 15 retired generals, including General H Norman Schwarzkopf, commander of US troops during the Gulf War, Clinton buckled to Pentagon concerns, in part because it was election session. The top US warfighting commanders, which dominate the Pentagon’s thinking on this issue, want a worldwide ban on the newer, self-destructing “smart” mines before they agree to give
Vol 349 • January 18, 1997
THE LANCET
them up. They argue that mines are crucial in channelling enemy troops and are an irreplaceable early warning against enemy approaches. There are an estimated 110 million landmines in the ground in 64 countries. The Clinton administration will soon decide whether to join a bold new Canadianled initiative to ban antipersonnel landmines, or to back a second track through the Conference on Disarmament (CD), a famously slow international body that will probably take years to reach even the narrowest of agreements. The Clinton administration is split on the subject. Some members of the diplomatic corps in the State Department favour lending US prestige to the Canadian effort, known as the Ottawa Conference. It is likely that the conference, which intends to have a legallybinding international treaty as early as December, 1997, will not be signed by China and Russia. But it is likely, too, that they will win support from the states mentioned above that have the biggest, immediate problems. Supporters of the Ottawa Conference hope to establish a moral standard that other non-signing countries might feel compelled to meet also. A first working session is set for February in Vienna. If Washington bows out the pressure will be off other ditherers— such as the UK and France—to participate. If it were to join, then all other
naysayers might feel compelled to do the same. The National Security Council and the Pentagon are said to favour the CD, in part because the group works on a consensus, which means the United States would not have to commit to anything unless members China and Russia went along too. That kind of titfor-tat thinking has defined US arms control and military strategy for decades. For example, both Iraq and the allied coalition forces that defeated Saddam Hussein helped to turn a large swathe of Kuwait into a bed of exploding nails during the Gulf war. Donovan’s anxiety-provoking account of how one US firm is clearing them is evidence that landmines are not a cheap weapon. It will cost Kuwait $1 billion just to sanitise the sand. In his book Donovan also visits the bone fields of Stalingrad (now Volgograd) where the defeated Germans left thousands of dead or dying soldiers; the Nevada Test Site where atomic weapons were detonated, Vietnam (an unfocused chapter except when he visits recent victims of landmines); Kuwait, and the US Army’s chemical weapons incinerator in Tooele County, Utah. The chapters on Europe and Russia read as a look into the future, to places where the wars have not yet been fought and the earth has not yet been littered with the mines
and the bones of combatants. “Look hard, and tell me: What do you see?” Russian guide Valery Shtrykov asks Donovan as he escorts him onto the Stalingrad battlefields. “I squint into the untracked snow, and slowly . . . as my eyes grow accustomed to the glare . . . the blanket I once thought was perfectly flat assumes subtle relief. Sticking from the snow in any direction are bones. Between the furrows, femurs jut into the air, ribs and hips and ulnas and shoulder blades poke from the snow, too. As we begin into it, crusted snow again crunching, beneath our boots, thick thigh bones and narrow clavicles are everywhere . . ..” These are farmers’ fields now. “ ‘How do they plow this?’ I ask Shtrykov. ‘It’s not too bad plowing here’, he says. ‘The farmer’s plowshares break up the bones. Still, in this field and some of the others around here, there are times when a farmer comes to a place where the skeletons are simply too numerous.’ Shtrykov shrugs. ‘When the bodies clog his plow,’ he says, ‘the farmer will usually get down off his tractor and pile the bones at a corner of the field. I will show you such a pile’.”
Dana Priest The Washington Post , 1150 15th St, NW, Washington, DC 20071, USA
No thank you She didn’t feel so cold when she was plump and old men used to pinch her cheek; workmen always whistled at her, and everyone said how happy she must be having such eyes, hair, thighs, breasts… . No-one loves her still. But at least they look the other way now her teeth are too big, and her blue skin a corset over cheekbones. She doesn’t love her either: so stuffed full, gorged on self she wants to spit her out; always—that sick taste of self.
Afternoon Darren Harris
Gillie Bolton Northern General Hospital, Sheffield, UK
Vol 349 • January 18, 1997
217
There was no pathognomonic finding that identified these patients, which underscores the need for a complete evaluation. The book provides a comprehensive review of the evaluation and treatment of male infertility and will serve as a useful reference and guide book for practising physicians. Grace Centola and Kenneth A Ginsburg have assembled a group of leading authorities in the field, who have written reviews cov-
ering all aspects of evaluation and treatment. The chapter on endocrine assessment is especially noteworthy for its clear explanations of the neuroendrocine control of male reproduction and how disruptions in this system can affect male fertility. Although treatment options are limited, several protocols are presented. Detailed chapters are also included on the urological evaluation, semen analysis, sperm function testing, as well as the newer assays for evaluating sperm function. A chapter on intrauterine insemination for male factor infertility provides a complete summary of the published success rates with this technique, and provides useful treatment guidelines. The chapter on therapeutic donor insemination presents an excellent review of the ethical and legal views towards donor insemination in several countries and summarises success rates and the factors that affect them. Infertility is a very personal and emo-
tionally sensitive issue for many patients. Treating infertile patients requires a great deal of empathy, compassion, and willingness to provide emotional support along the way. The male partner’s emotional needs may be less apparent, and therefore not addressed during this process. In Evaluation and Treatment of the Infertile Male, the chapter on the psychological aspects of male infertility deals directly with these issues and provides very useful suggestions on how to help men deal with their infertility. There is a definite need for a reemphasis of the evaluation of the male partner in couples seeking infertility investigation. This text can serve as a useful guide for gynaecologists, reproductive endocrinologists, and other health-care practitioners who help couples with this frustrating and sometimes elusive medical problem.
Guy E Ringler Department of Obstetrics and Gynecology, UCLA School of Medicine, 1245 16th Street, Santa Monica, California 90404, USA
Landmines past, present, and future Aftermath: the remnants of war Donavan Webster. New York: Partheon. 1996. Pp 279. $23.00. ISBN 0-679-43195-0.
resident Clinton should read this book, at least the chapters on landmines in Europe and Kuwait, which are the most compelling of the six stories that journalist Donovan Webster tells about the deep, oozing scars that wars have left on the earth and on the lives of survivors. While Afghanistan, Angola, Bosnia, Cambodia, and Kuwait might be the countries that come to mind in today’s discussion of landmines. Donovan’s chilling account of France’s 50-yearold problem is a haunting reminder of just how difficult it is to rid the soil of these remnants of war. About 16 million acres of land in France is still offlimits because of the 12 million unexploded World War I artillery shells and mines near Verdun. Several million more World War II devices are embedded in the beaches of Normandy and Brittany. More than 630 demineurs from France’s Department du Deminage have died since they began the clean-up 50 years ago. Thirty-six farmers were killed in 1991 alone when their ploughs
P
216
and tractors hit the explosives below the earth’s surface. Aftermath: the remnants of war, takes the reader on Donovan’s reporting trips. For instance, one day Donovan is walking with a demining team in the dense forest near Verdun, site of some of the fiercest battles of World War I, when he finds an unexploded artillery shell as big as a beer keg. The team debates whether to blow it up there or to free it from the tree roots and haul it away. They cannot tell from the exposed foot-long section whether the shell contains explosives or toxic gas. “Working with a shovel, demineur Christian Cleret begins to spade . . . slowly, gingerly . . . around the tree’s roots . . . in a few more seconds, Cleret drops the shovel and, slipping on his rubber gloves, begins to ease the shell from the home it has had since the age of horse-drawn carriages. He’s lifting the shell now, straining, breathing heavily. Another demineur comes to help and together they lift and steady the shell, which weighs about a hundred pounds. Finally, the shell is free of
the roots, and the two demineurs slowly lower its base to the ground.” They see that it is a German Minenwerfer carrying 90 pounds of high explosives. “The shell’s flaking, corroded skin meets sunlight for the first time since 1918 and the air fills with its scent . . . Cleret rests for a moment, then . . . on the count of three . . . he and the other demineur hoist the shell and slowly, being sure not to stumble, begin walking towards the trucks.” One down, 12 million to go. The international effort to ban landmines is at a crucial point right now. In May, after months of internal debate within his administration, President Clinton endorsed the Pentagon-led status quo on landmines, which was to ban older model “dumb” mines, except near the demilitarised zone between North and South Korea. Although an immediate ban on all antipersonnel mines was endorsed by 15 retired generals, including General H Norman Schwarzkopf, commander of US troops during the Gulf War, Clinton buckled to Pentagon concerns, in part because it was election session. The top US warfighting commanders, which dominate the Pentagon’s thinking on this issue, want a worldwide ban on the newer, self-destructing “smart” mines before they agree to give
Vol 349 • January 18, 1997
THE LANCET
them up. They argue that mines are crucial in channelling enemy troops and are an irreplaceable early warning against enemy approaches. There are an estimated 110 million landmines in the ground in 64 countries. The Clinton administration will soon decide whether to join a bold new Canadianled initiative to ban antipersonnel landmines, or to back a second track through the Conference on Disarmament (CD), a famously slow international body that will probably take years to reach even the narrowest of agreements. The Clinton administration is split on the subject. Some members of the diplomatic corps in the State Department favour lending US prestige to the Canadian effort, known as the Ottawa Conference. It is likely that the conference, which intends to have a legallybinding international treaty as early as December, 1997, will not be signed by China and Russia. But it is likely, too, that they will win support from the states mentioned above that have the biggest, immediate problems. Supporters of the Ottawa Conference hope to establish a moral standard that other non-signing countries might feel compelled to meet also. A first working session is set for February in Vienna. If Washington bows out the pressure will be off other ditherers— such as the UK and France—to participate. If it were to join, then all other
naysayers might feel compelled to do the same. The National Security Council and the Pentagon are said to favour the CD, in part because the group works on a consensus, which means the United States would not have to commit to anything unless members China and Russia went along too. That kind of titfor-tat thinking has defined US arms control and military strategy for decades. For example, both Iraq and the allied coalition forces that defeated Saddam Hussein helped to turn a large swathe of Kuwait into a bed of exploding nails during the Gulf war. Donovan’s anxiety-provoking account of how one US firm is clearing them is evidence that landmines are not a cheap weapon. It will cost Kuwait $1 billion just to sanitise the sand. In his book Donovan also visits the bone fields of Stalingrad (now Volgograd) where the defeated Germans left thousands of dead or dying soldiers; the Nevada Test Site where atomic weapons were detonated, Vietnam (an unfocused chapter except when he visits recent victims of landmines); Kuwait, and the US Army’s chemical weapons incinerator in Tooele County, Utah. The chapters on Europe and Russia read as a look into the future, to places where the wars have not yet been fought and the earth has not yet been littered with the mines
and the bones of combatants. “Look hard, and tell me: What do you see?” Russian guide Valery Shtrykov asks Donovan as he escorts him onto the Stalingrad battlefields. “I squint into the untracked snow, and slowly . . . as my eyes grow accustomed to the glare . . . the blanket I once thought was perfectly flat assumes subtle relief. Sticking from the snow in any direction are bones. Between the furrows, femurs jut into the air, ribs and hips and ulnas and shoulder blades poke from the snow, too. As we begin into it, crusted snow again crunching, beneath our boots, thick thigh bones and narrow clavicles are everywhere . . ..” These are farmers’ fields now. “ ‘How do they plow this?’ I ask Shtrykov. ‘It’s not too bad plowing here’, he says. ‘The farmer’s plowshares break up the bones. Still, in this field and some of the others around here, there are times when a farmer comes to a place where the skeletons are simply too numerous.’ Shtrykov shrugs. ‘When the bodies clog his plow,’ he says, ‘the farmer will usually get down off his tractor and pile the bones at a corner of the field. I will show you such a pile’.”
Dana Priest The Washington Post , 1150 15th St, NW, Washington, DC 20071, USA
No thank you She didn’t feel so cold when she was plump and old men used to pinch her cheek; workmen always whistled at her, and everyone said how happy she must be having such eyes, hair, thighs, breasts… . No-one loves her still. But at least they look the other way now her teeth are too big, and her blue skin a corset over cheekbones. She doesn’t love her either: so stuffed full, gorged on self she wants to spit her out; always—that sick taste of self.
Afternoon Darren Harris
Gillie Bolton Northern General Hospital, Sheffield, UK
Vol 349 • January 18, 1997
217