214 Book Bevie~lw

THE REGIONALIZATION OF PERSONAL HEALTH SERVICES. Edited by Ernest W. Saward, M.D. Pp. 305. New York, Neale Walson, for the Milbank Memorial Fund. 1976. 56.95 paperback, $15.00 hardback.

There are at prcsenl some 250.(10I ~ ~I~:~C,I'S, 7000 hospitals and 200 major medical centres in the Ihlitcd S~atc.~. I)c~pi~z i]t~c 5hk.td. Medicaid, Kaiser-Permanente and other forms of funding health-care, wide dispz~rific:~ slili cxist there. Again, although the concept of so-called'"socialized medicine" as practised here is anathema to many Americans and certainly to the American medical profession, it is being increasingly realized that some form o f state intervention will be necessary to iron out the evident deficiencies in the current system and to help bear the burden o f escalating costs in care and technology.

This paperback is based on discussions which took place in the University o f Rochester in February 1975 under the auspices o f the Milbank Merooriat Fund. The debate was stimulated by a resurgence of interest in the concept o f regionatization as first enunciated in the 1922 Dawson Report which is reprinted in full at the end of the book!

The comments on the National Health Service will be of great interest as well as the opinion expressed by Gordon MacLachlan on page 133 that the present position here is that there is a desire for politicians to give authori ty to the recently constituted areas who will operate directly f rom the D.H.S .S . - -and to get rid o f the Regions!

Despite the American tendency to repetitious verbosity, this is an interesting booklet which gives insight into how Americans are trying to cope with the present system of health care and their attempts to change it.

IML

A QUESTION OF QUALITY. Edited by Gordon MacLachlan. Pp. 297. London, Oxford University Press, for Nuffield Provincial Hospitals Trust. 1976. £9.00.

The Oxford dictionary defines the word "qual i ty" as "degree of excellence". The hallmark o f a profession is its willingness to strive for excellence on the one hand, whilst, on the other, to en- courage voluntary self-criticism in pursuance of this ideal. Despite this, no word nowadays pro- vokes a greater emotive response from the medical profession. Perhaps this is a natural reaction to increasing State dominance in a once so-called free profession.

Be that as it may, the Nuffield Provincial Hospitals Trust has long been concerned with improving medical care at all levels. This hardback o f 297 pages is published under their auspices and analyses Variot.~s approaches in the assessment o f such care. It is greatly influenced by the Rock Carling Monograph o f 1971 by A. L. Cochrane on "Effectiveness and Efficiency."

Of the thirteen chapters, the first six comment on clinical matters such as surgical care, quality in general practice and in pathological laboratories. The later ones deal with administrative ques- tions. The twelfth chapter is specially concerned with quali ty assessment in the U.S.A. and is written by two members o f the RAND Corporation. The work ends with some interesting and amusing reflections by Professor Cochrane. Gordon MacLachlan, the Editor , then given an overall summing up.

As with most similar publications it is like the curate's egg--good in parts. I liked the contri- butions on surgical care and on regional medical problems.

The production and printing are o f the highest qual i ty--which is only to be expected in a small book costing £9.00. It should be o f especial value to community physicians to whom it can be unreservedly recommended.

I~4L

ESSAYS AND NOTES ON THE HISTORY OF MEDICINE. Edited by Saul Jarcho. Pp. 446. New York, Neale Watson (Science History Publications). 1976. 815.00.

This book is a selection o f papers published in The Bulletin o f the New York Academy o f Medicine. Because o f this, the 34 papers vz.ry enormously in their style and presentation. The papers have

Book Re~4ews 215

been written by doctors, professional historians and scholars in many disciplines and reflect the professional interest of each author. This leads to an unevenness in both style and presentation as individual authors stress different aspects. In addition to the usual topics in medical history, ancillary subjects such as paleopathotogy, medical numismatics and medical geography are covered. Indeed, the choice of subject matter reflects a very broad interpretation of the "history of medicine". The majority of the papers are in approximate chronological order from antiquity to modern times and follow present day research and writing about the social aspects in the development of the subject. This means that the book deals with some of the more esoteric aspects such as "The Medieval Crossbow as a Surgical Instrument", "'Migraine in Astronomers and Natural Philoso- phers", "'The Sears Roebuck Catalogue of 1897" and the "Doctors" Riot in New York City on April 13th-15th, i788". This is a book to be savoured over a long period by anyone with more than a passing interest in medical history, who will find it fascinating. The general reader is warned that its erudition might be rather disconcerting.

Ja/I D

A MATYER OF LIFE OR DEATH. By P. N. Paterson-Brown. Pp. 16. Printed by Buccleuch Printers Ltd., Hawick, Scotland. 1977. 25p.

This is the second edition of an excellent handbook, produced by a practising family doctor in a rural area, It is designed to enable anyone of any age to deal competently with the common First Aid emergencies. Unlike almost all other books on First Aid, it does not attempt to be compre- hensive. It deals simply and adequately with those vital points which save life in an emergency. No school, factory or office should be without a copy and in this reviewer's opinion, it is the best available on the market as regards conciseness, ease of reference, accuracy and vaJue for money. Indeed, funds should be made available to ensure that every school-child is given a copy, together with an appropriate set of lectures, as part of the normal health education programme in the school curriculum.

J M D

HIGHER EDUCATION FOR PUBLIC HEALTH. Mitlbank Memorial Fund Commission. New York, Prodist for Millbank Memorial Fund. 1977. Paperback, $7.95, hardback $12.00.

TIlE LAW AND THE PUBLIC'S HEALTH. By Kenneth R. Wing. Pp. 167. St Louis, The C. V. Mosby Company (Distributed in Great Britain by Henry Kimpton Ltd). 1976. £5.50.

These two books from the U.S.A. illustrate the considerable changes that are taking place in American health services. The purpose of the Report from the Millbank Commission was to produce for the U.S.A. the equivalent of a "'Hunter Report". "Public health" in America covers the same territory that in Britain we call "community medicine". During the MacCarthy era the advocates of social medicine in the States found themselves under attack; the American Medical Association was also less than sympathetic. The term "social medicine" disappeared to be replaced by "human ecology", "community medicine" and "public health". The oldest of these terms has been retained by the Millbank Commission. Were it not for our curious British habit of demoting the worthy and the good, it would be seen as the best o f many terms invented for the work o f community physicians.

The education o f the American "physician health officer" ("a general practitioner in health" !) would be based on the broad subject areas: epidemiology, statistics, social policy, history and philosophy of public health, and management and organization studies in public health.

Related to these they see studies of "clinical, biomedical, environmental, and social sciences, the applied techniques of management and administration, the law, and ethics". While not diminishing the emphasis on epidemiology and the related sciences, our American colleagues take more seriously than us the "medical humanities". This is to be welcomed in a specialty like our own where the