Volume 4 is a transcription of the vital records of the towns of Bristol, 1785-1854; Brookfield, 1788-1852; Brooklyn, 1786-1850; and Burlington, 1806-1852.

The Bible Crosswords is an excellent pasttime. It will further your knowledge of the scriptures. It is also a great tool for sunday school as well as other christian gatherings. I recommend it highly.

This book is just the right size to tuck into the pocket of my bible cover and take along to church, meetings, etc. and take notes. Each page has a heading you can fill out regarding who the teacher/speaker is, where you heard them, the date, the title or subject of the talk, and what chapters & verses were covered. Then the balance of the front & back of that page is lined for your notes, with a small section at the end for noting how you might like to apply what you've learned. I love it! I get so much more out of sermons when I focus on taking notes, and then each notebook also serves as a record book of things I've heard. I've sometimes referred back to my notes when thinking through a particular topic. Very useful.

"Caring For Patients," by Allen Barbour, MD
A Book Review
By Vincent J. Felitti, MD

"Caring For Patients" by Stanford physician Allen Barbour is an important medical book which addresses issues critical to routine
medical practice. An uncommon treatise like this could shape the future of one's medical practice as well as the economics of
medical care.

Barbour points out that experienced physicians have been trained to diagnose and treat organic disease although most patients seen in any
given medical practice have illness caused by personal distress; many patients who come for help are not well accommodated by the
biomedical system of diagnosis and treatment. Many diagnoses are deferred indefinitely, and evaluations are commonly extended and
futile. A major component of the soaring costs of modern medical care, "high-tech" diagnostic procedures are often ordered when
seeking a disease-based explanation for what are really unrecognized functional disorders. In the organ-based specialties, physicians rule
out conditions instead of ruling them in, leading to both dilution of responsibility and collusive physician anonymity. The author recalls
Eugene Stead's famous comment: "What this patient needs is a Doctor."

Barbour considers several common functional disorders worth listing because they are frequently misrecognized and misrepresented:
anxiety, depression, fatigue, weakness, obesity, anorexia, impotence or anhedonia, disturbed sleep, headache, backache, constipation,
diarrhea, indigestion, bloating, abdominal pain, musculoskeletal chest pain, and chronic pelvic pain. Although 87% of all emotionally
based illnesses manifest as "medical" symptoms, functional symptoms are evaluated for organic disease as though the opposite were true.

Emotional expressions are inherently physical: they have evolved to unify mind and body in a common purpose, and great overlap can be
seen between functional and organic expression. In organic disease, biologic determinants predominate; however, long-term psychosocial
aspects of human life are the factors which actually determine morbidity and mortality. Indeed, much disease results from attempts to
control the forces which initially led to illness. Thus, for example, endocarditis may result from intravenously administered drugs used to
feel better by someone who feels profoundly bad. That is the core problem. Barbour quotes Stead's comment: "If one doesn't know what
is actually going on, then one doesn't really know how to handle it."

Commonly, each possible organic disease is ruled out before the physician considers functional disorder as the diagnosis. This practice is
improper and destructive: both varieties of diagnosis should be considered from the outset. Psychosomatic disorders can be detected only
as a result of positive diagnosis and not by default. Personal situations which correlate with increased morbidity and mortality from
physical disease include degree of parental deprivation, quality of childhood experience, and quality of social support. The author
references a 7000 person study in which middle-aged men with the fewest interpersonal connections had three times the mortality rate of
a matching group with the most interpersonal connections.

Feelings are either expressed or suppressed; they cannot be obliterated through containment. If suppressed, they emerge either as
physical symptoms or as unfocused emotional expression such as anxiety, depression, or other psychiatric syndromes. Because most
emotionally distressed persons are only dimly aware of the source of their distress or are overwhelmed by it, their tension mounts until
physical symptoms result or until anxiety or depression increase to a level triggering a psychiatric diagnosis. Indeed, unconscious
suppression of emotions and failure to understand their link to symptoms is the rule in medicine: by focusing on symptoms instead of
their underlying personal problems, people define themselves as sick and thus seek relief from doctors. Complaints about symptoms
trigger the medical model.

In general, pain is usually and incorrectly thought to be primarily caused by organic disease. Barbour studied 400 consecutive Stanford
University Medical Center outpatients and found that in 174 of them, pain was the dominant symptom. However, when these 174
patients were thoroughly evaluated, the pain was found to be due to psychophysiologic reaction in 28%, somatoform disorder in 39%, or
organic disease in 33%.

As an example of the diverse origin of pain, the three most common causes of recurrent anterior chest pain are cardiac, esophageal, and
psychogenic. Unfortunately, exclusion of a cardiac cause typically discourages further diagnostic or therapeutic steps from being taken.
This practice is unsatisfactory from the patient's viewpoint because lack of diagnosis equates with lack of knowledge: if the doctor
doesn't know what is going on (i.e., doesn't confidently apply a diagnostic term), why should the patient trust the doctor's opinion of
what is not going on? This failure to resolve the problem is expensive, partly because it virtually assures future visits to find an answer.
In a large study of patients in a headache clinic, for example, the dominant concern for 77% was explanation of their illness, not pain
relief. Barbour elsewhere describes chronic backache as "an illness in search of a disease." In this regard, Barbour points out that CAT
scans showed herniated nucleus pulposus in 10% of asymptomatic volunteers aged <40 years; 27% of asymptomatic volunteers aged 40
years, had a herniation. Chapter 13 includes interesting, scholarly, well-referenced discussions of fibromyalgia, chronic fatigue syndrome,
pelvic pain, irritable bowel syndrome, chronic abdominal pain, and various types of headache.

Because the biologic focus is currently so strong, depression has come to be viewed as a disease instead of a response to problems of the
human condition. According to Barbour, the biology of depression is the resultnot the causeof feeling depressed. Genetic factors in major
depression act not by initiating, but by accentuating intensity of the depressive response. Tricyclic antidepressants are not particularly
specific: their effects occur at both ends of the anxiety-depression spectrum. Of little use in mild depression, they are often effective for
reversing the biologic dysfunction of more advanced depression. In situations where antidepressants are not effective or are refused,
physicians must contribute more time, energy, and personal commitment than most are willing to give. Sufficient time does exist, given
the large amounts of time typically ultimately spent prescribing for symptoms one at a time instead of exploring central issues. (This
phenomenon is easily observed from patient records.)

Barbour points out that in personal illness, outcome is determined by the physician's concept of care, i.e., whether care is limited to
"ruling out" a particular condition or whether it expresses a more general concern for clinical judgment, helping, and healing.
Unfortunately, efforts to understand the patient as a person are most often relegated to psychiatry, a field which itself seems to have
abdicated that goal. This problem is compounded by patients who do not consider personal growth to be their responsibility.

Ultimately, how illness is explained to a patient is a pivotal issue determining subsequent events. In psychosomatic illness, it is always
helpful to explain that the illness is a common response to distress and that the illness fortunately does not result from disease. Naming
the illness is critical; an illness without a named diagnosis will not attract an adequate response from the patient. A useful explanation that
the severity of stress-induced illness is often greater in irritable bowel syndrome than in cancer, that the pain of fibromyalgia typically is
worse than in rheumatoid arthritis. Saying only that "nothing was found so it must be stress-related" is the mark of the therapeutically
destitute and is doomed to failure because it fails to fully acknowledge that something is wrong. The crowning achievement for any
clinician is to make the correct diagnosis and, with the patient, to reach an understanding of the underlying problem.

In selecting and abstracting some of Allen Barbour's words and ideas, I hope that I have done justice to "Caring For Patients." The
entire book is highly readable, eruditely written, and meticulously referenced. This uncommon triad of qualities, combined with the
author's extensive clinical experience, creates a work of great merit such as comes along once in a decade or longer. Although Dr.
Barbour died just before its publication, his book carries the contemporary banner for ideas developed by George Engel, Richard
Magraw, Michael Balint, and Walter Alvarez in their important, earlier books about

This is a beautiful gift book, with truly lovely photographs and layout. However, it is much more than the usual snippets and quotes I find in most gift books like this. The author, Ellyn Sanna (who also wrote my favorite book about being a mother), has included a true feast of original ideas. This is a deeply spiritual meditation on the meaning of hospitality, as well as a delightful package that includes a wonderful CD of classical music. I have bought a bunch for gifts--but I'll keep one to reread again and again.

This lively book of recipes & remembrances of Italian holidays thoughout the year reminded me of my Sicilian grandmother's traditions.

Well-written, informative, & fun! I enjoyed reading it & actually use it from time to time.

It's funny to see the subject given for this book as Flight-Fiction because that is so incidental to what this beautiful book is about. When I saw this book I knew I had to get a copy for my daughter and I would love to buy one for every young girl and newborn baby girl I know. That may sound sexist, but the reason I love this book so much is that it's message is of liberation, imagination, endless possibilities and beauty in the everyday. The pictures are stunning, the language and style is music (watch for the pause icons as well as the punctuation - it reads much better if you count a beat whenever the little symbol appears.) In a world of Barbies and Sailor Moons, this book offers a much more compelling image of what a young girl can aspire to -- anything. Oh, one other thing - this is the only kid's book I know that uses words I didn't know and named animals and plants I had never heard of. Something I look for in a book - that it holds my attention and teaches me something as well. Also one of the few children's books that I read to my wife when we are alone.

I wish the picture accompanying the synopsis of this guide book were clearer. The strong geometrics in the photo on the cover give one a strong flavor of what to expect in this picturesque country. Get this book and read it thoroughly and you'll suprise yourself with a strong desire to visit south Africa.

The Newfoundlanders in this book show the intelligence, determination, and resourcefulness of these island people. Once you start this book you can't put it down. All those that love the sea will enjoy this book. The North Atlantic can be very unfriendly and you really get to see it first hand here. It is hard to believe that people can over come such hardships and battle 'mother nature,' but step by step we see it here. Great reading.

I think Ellyn Sanna (the author of this book) must have the same friends I do. She shared so much of her heart, that this book goes way beyond the usual gift book collection of other people's quotes. The CD is beautiful too, and the book truly expresses the real spiritual value of friendship. Ms. Sanna is not your ordinary gift book compiler, for all of her books are unusually deep and beautifully worded. She not only expresses her own heart, but manages to speak for us all as well.