Teratology in the 20th Century. Environmental Causes of Congenital Malformations in Humans and How They Were Established, by Harold Kalter.

In 2003, the journal titled Neurotoxicology and Teratology published an article by Kalter summarizing the history of teratology in the 20th century. Now that article is available as a hardback text. At approximately 150 pages, the book is small, but replete with a combination of historical anecdotes, a compilation of serendipitous findings, and a summary of the current state of the art.

Early in the book, there is a discussion of definitions and the limitations of common terms. For many years there has been a common connotation that the term "teratology" was derived from a Greek root and meant the "study of monsters." Kalter provides a clearer derivation from Latin, suggesting that in the superstitions-ridden Dark Ages, the combination of teras and monere implied forebodings of unnatural events, but not monsters. This example is but one of the preciseness evidenced in Kalter's work.

Kalter also addresses the major issues that have plagued the study of congenital anomalies. These issues include identification, establishing frequency, genetic predispositions, and multifactorial factors.

Kalter's language always remains professional; however, it often is also entertaining. His ability to verbally paint a picture of Fred Hale feeding a vitamin A-deficient diet to his "favored subjects," that is, swine, so as to study mammalian teratology makes the reader almost feel the heat of the Texas sun. Yet never do his descriptions overwhelm the science or the importance of various studies in the overall evolution of the discipline. The text is well referenced.

Specific teratogens such as rubella, radiation, mercury, and thalidomide are addressed in detail. Nonteratogens such as Bendectin are also discussed. Folic acid studies are summarized, and environmental agents such as pesticides are included, at least to the extent known.

This book is not written for the casual reader. The depth on history, trends, and current science makes it an excellent niche publication. It is ideal for the reader who wants to understand the field of teratology better, or for the nurse who wants more details on specific research, such as the studies that potentially linked hot tubs (hyperthermia) to congenital anomalies. Although small, this text contains a wealth of information on the subject of teratology. Kalter sets the stage for the 21st century where it can be argued that teratology will benefit from advances in genetics so that many of the multifactorial or host susceptibility issues will be answered, allowing teratogenic agents themselves to be understood more clearly.

Mary C. Brucker, CNM, DNSc, FACNM

Director, Women's Health Program, Parkland School of Nurse-Midwifery at the University of Texas