Reviews of Books

468

Trends in EpidemiologyApplication to Health Service Research and Training.Edited by GORDON T. STEWART, M.D., Henry Mechanprofessor of public health, University of Glasgow. Spring-field, Illinois: Charles C. Thomas. 1972. Pp. 603.$29.75.

THE objective of this massive book is to present examplesof the current interest of epidemiology in new problemstogether with reviews of its traditional exploration of olderissues. The presentation of such material to a wideaudience is an interesting concept-but how well is thisimportant objective met ? The factor which unites all

epidemiologists is the study of groups and defined popula-tions, and in two of the examples of recent advances inthis book-studies of addiction and medical-care needs-this basic epidemiological criterion is neglected. The

chapter on the involvement of medical students in theassessment of social and health needs highlights thisdeficiency. The students do not seem to have been madeaware of the problems of population selection, bias inanswers, and so on, and have become more concerned withsocial action. There should, of course, be plenty of roomfor such involvement in medicine, but a textbook on

epidemiology should be more concerned with advances ina subject or in its methodology than with advocacy. Anotherdefect of the book is its language. The quality and con-sistency of writing in different parts of the book are veryuneven-this is almost inevitable in a work with fourteen

chapters and twenty-three authors. At the very beginningcomes the statement that the traditional engagement ofepidemiology has been with infectious disease. This isinaccurate historically (Hippocrates on lead poisoning andPotts on scrotal cancer in chimney sweeps), and non-infectious disease has been a major concern of epi-demiologists for at least 20 years. In some of the investiga-tions, the basic words of epidemiology are not being usedadequately. Peter Peacock is considered to have done a

prevalence study of stroke when in fact he has done aprevalence and incidence study. And it is disturbing toread that the epidemiology of arthritis, accidents, andmental and pulmonary disease has made no great progresswhen some substantial advances have been made in theseconditions-e.g., comparative studies of arthritis in Icelandand Germany and the interesting work on Yersinia arthritis.The first chapter by P. E. Sartwell, on trends in epi-demiology, is the best in the book. It sets the scene anddiscusses the problems better than any succeeding chapter.A long chapter by M. Susser on procedures forestablishing causal association repeats what Sartwell hasalready said. E. A. Murphy’s contribution on the

application of genetics is excellent, but the language isobscure. The chapter on psychology in epidemiology byC. N. Jenkins is repetitive: if it had been related to theprevious chapter, many of the historical factors could havebeen left out. The chapters on coronary heart-disease

epidemiology, the Framingham study, and the multifactorpreventive trials in heart-disease are good but do not breakmuch new ground. It seems a pity to devote so muchspace to coronary heart-disease, where recent advances havebeen comparatively few, and so little to psychiatry, wherethere have been some recent significant contributions toknowledge. The chapter on stroke and rehabilitation is

very interesting. But is it appropriate to have the onlycomplete description of one study (by Peacock’s group) ina review volume ? The chapter on infectious disease makesvery little mention of infectious-disease epidemiology indeveloping countries or the eradication of malaria or small-

pox. The chapter on priorities in community health isan erudite, philosophical discussion but does not help inevaluating what ought to be done. The verdict on thisbook must be that, while some of the chapters are good, itis, in general, disappointing.

Psychological Medicine for StudentsJOHN POLLITT, M.D., F.R.C.P., F.R.C.PSYCH., physician-in-charge, department of psychological medicine, St Thomas’Hospital, London. Edinburgh: Churchill Livingstone.1973. Pp. 294. E1.50.

THERE are many good things in this book: the type-faceis pleasing and there is a reasonable index. This is a bookfor students, and it is didactic in form and shows a propermedical bias. The first three chapters (introduction,personality development, and psychological defences andmechanisms) are good; Dr Pollitt’s concept of a dichotomisedmemory store in which memories of rewarded and un-rewarded behaviour are separately stored has a satisfactorysimplicity. Similarly, the chapters on personality, case-taking, affective disorders, and neurosis are clear andreadable. There is a clear and concise account of obsessionalneurosis and its treatment. However, there are some

passages to which experienced psychiatrists may take

exception. On p. 38 it is implied that there is a significantcorrelation between body build and type of psychologicaldisturbance; one would have thought that this view isnow at least questionable. On p. 31 it is stated that a highproportion of men with XYY syndrome show criminal

tendencies, but this is not really justified on the basis ofpresent evidence. In chapter 14 (schizophrenia) the

emphasis on intragroup classification (? out of date)contrasts with the failure to emphasise the importance of agraduated rehabilitation programme and the long-termuse of depot phenothiazines. The value of token-economyprogrammes is not mentioned. Chapter 20 makes, as onewould expect in a book from St. Thomas’, much playwith monoamine-oxidase inhibitors and M.A.o.r./tricycliccombinations but gives limited reference to the use oflithium salts. Chapter 18 (subnormality) is perhaps asinadequate as one has come to expect in publicationsemanating from teaching hospitals.

Textbook of Dermatology (2nd ed. Oxford: BlackwellScientific Publications. 1972. Pp. 2204. £32.50).-Sinceits publication in 1968 " Rook " has established itself asthe standard major textbook of dermatology in the English-speaking world. It is in constant use, and second-handcopies are hard to come by. The new edition, under thedirection of A. Rook, D. S. Wilkinson, and F. J. G. Ebling,is a little longer although slimmer than the original, but itis £11.50 dearer. An index for both volumes is providedin each, but it is inaccurate. Additions are obviously moreconspicuous than deletions, but the opportunity has notbeen taken to shed some of the unnecessary material whichcontributes to the size and high cost of this invaluablebook. It is regrettable that its price must place it beyondthe reach of many who need it most.

World Directory of Schools of Public Health 1971(Geneva: World Health Organisation. London: H.M.Stationery Office. 1972. Pp. 280. Sw. fr. 40; E4; S10).-The second edition of this reference work contains informa-tion on 121 public-health schools in forty-four countries,and summarises curricula, conditions of entry, and examina-tions. Italy, where a public-health diploma is only preferredin candidates for public-health posts, has 21 schools and800 students. Countries differ widely in course lengthsand content.