The third edition


I've just finished rewriting my two chapters for a well-known postgraduate textbook. The first edition was published in 2004 and the second in 2010, and now, apparently, it's time for a third. I thought that after only 4 years I might get away with a little tweaking here and there, but how wrong I was. My chapters are on maternal and perinatal mortality, and both subjects have changed, if not beyond recognition, then certainly enough to need radical revision and a new cartridge for my printer. (Why do typing errors show up only on paper and never on the screen?)

The changes are all for the better. Global maternal mortality is falling, although I can't help wondering how reliable those improved estimates are. Still, it felt good to be able to revise the numbers downwards. Here in Britain the sudden death of our Confidential Enquiries in 2011 has been followed by the birth of MBRRACE-UK, which is easy to find on Google once you realise that it doesn't begin with an ‘E’. It has reinstated the maternal death enquiry and – even better for us textbook-writers – introduced a new way of classifying perinatal deaths. Out go the old systems that took up a whole column in my chapter and unhelpfully categorised most stillbirths as ‘unexplained’.

Heroes of the past

The modern textbook is a team effort and I'm just one of the 66 foot-soldiers in this literary task force. How different it seems from the days when I was an MRCOG candidate and our books were written by omniscient single authors. But yet again my memory is playing me false. At the back of high shelves in my study are my old textbooks, and a quick check (standing on a swivel chair – always a challenge) shows that even those god-like authorities had a little help from their friends. I see that in Edinburgh's professorial textbook of the 1960s the chapter on X-rays in pregnancy was written by a radiologist, and going even further back, the legendary Victor Bonney had a co-author for his ground-breaking textbook on gynaecological surgery, first published in 1911.

I'm glad I kept those old books, if only for their prefaces. A favourite with us trainees was Practical Obstetric Problems, written by Ian Donald, the pioneer of ultrasound. It was full of his entertaining opinions but he too needed support from co-authors, as he acknowledged in the first edition in 1954: “My views upon the misuse of antibiotics are so strong that I thought it a good plan to seek the help of one whose views are even stronger…”. That first preface began: “The art of teaching is the art of sharing enthusiasm” (a motto that should be on every professor's desk) but as edition followed edition the strain began to tell. In 1969 the opening line of his fourth preface was, “A millstone round the neck can carry its wearer into deep waters”. Then as now, a new edition was needed every 4–5 years, though I suspect that real medical progress was faster in those days.

The future is paper

A few years ago we were all wondering if books could survive the on-line revolution, but they seem to be doing OK. The journal that I edit receives papers from many countries, and their lists of references often feature the standard American textbook Williams Obstetrics, now in its 24th edition. When the book first appeared in 1903, its author, the impressively moustachioed John Whitridge Williams, was chief of obstetrics at the Johns Hopkins Hospital in Baltimore, Maryland. Today the entire 23rd edition can be downloaded for free (or so they say) from various pirate websites. That's immortality for you, Dr Williams.

So what's the attraction? Well, we all need something solid to hang on to, and a heavy book has an air of authority that a smartphone lacks. What's more, a book is finite, with a beginning and an end. It makes MRCOG candidates feel that all they need to do is read it and everything will be fine. The problem, I seem to remember, is staying awake.

That was the deadline that was

Now that my chapters are in, I'm anxiously awaiting the editors' verdict. Theirs will be the only feedback I get. None of the 66 authors will hear from the people who actually read the book. It's our own fault, as we strive for faceless uniformity. If there's a fourth edition, maybe I should follow Donald's example and leaven my death-filled chapters with a few jokes.