- Email: [email protected]
Espace et santé: Géographie médicale du midi de la France
780
Book reviews
fully understand the process of persuasion has, in the past, been due to the failure to recognim that beliefs, attitudes, intentions, and behaviours are four very different components with systematic relations among them (p. 103). He explains that the four components cannot be collapsed under one generic term “attitude” because recent research has indicated that attitudes, intents, and behaviours actually rest on beliefs and are usually a function of them (p. 111). He also emphasizes that the content of a message must be understood in light of a speaker’s beliefs, attitudes, intents, and behaviors, and that a communicator is successful only if he succeeds in bringing about a change in the hearer with respect to these four components. Fiihbein’s approach is most useful for an understanding of how communication and persuasion work, and as a methodological tool for the study of conversational data in medicine. If we want to improve communication between physicians and patients and if we believe that language is a pervasive component of medical practice, we must teach medical students to change their own beliefs about language use in medicine. This training should enable medical students to acquire effective listener and speaker skills previously gained only through years of experience. Department of Public Health Cornell University Medical College New York, N.Y., U.S.A.
bJcD?.NNB SKOPEK
ToBeanInvaBd:TheIBoaaaofCharleaDarwIn,byRALPtr COLP, JR. University of Chicago, Ill., 1977. 285 pp. 317.50 For nearly a century the life of Charles Darwin has fascinated the biographer and the scientist, while his ideas have excited controversy among all who have encountered them. At this point it would be difficult to 6nd anyone who has not. Hence another study of Darwin’s life can be potentially exciting as well aa significant when it can integrate the historical data with recent developments in medicine and the social sciences. Unfortunately Ralph Colp’s To Be an Invalid provides limited satisfaction. Prior to his journey on the Beagle from 1831 to 1836, Darwin was known to have had vague ailments which did not prevent him from undertaking the risky journey. He had an “upset stomach” that lasted “for a good many breakfasts”, hands that “were not well”, and “eruptions about the mouth” which he treated with arsenic. However, for two years after his return to England he enjoyed a respite from his illness and worked on his evolutionary notebooks. In the Transmutation Notebooks he commented that he “feared great evil from vast opposition” upon the publication of his work. He also developed cardiovascular, gastrointestinal, neurological and psychological symptoms which worsened in his later life. At one time or another Darwin had chest pain, weakness, joint pain, nausea vomiting and pamsthesias. Darwin tried many of the treatments in vogue during his lifetime, like hydrotherapy, and died from a cardiac arrest in 1882. Dr. Colp reviews Darwin’s life-long treatment plans and summarizes the numerous theories about causes and reasons. It has been hypothesized that he suiTered from toxic reactions from tropical pathogens, such as Chagas’ disease; from heavy metals, including arsenic, which he took to cure himself. These points have been rebutted by observations that he took arsenic before the trip and the symptoms reappeared years after his return. A contemporary physician described the illness as “various irregular manifestations of a gouty constitution, such as eczema vasomotor nerve storms, vertigo, and other disorders of sensation”. Reading To Be an Invalid is like reviewing an extensive medical record from which an evaluation should be made.
What is missing is what makes Darwin’s ailments so interesting. Colp fails to correlate the appearance of the symptoms with the appearance of Darwin’s revolutionary work and the scandalous reception it received. If one were to incorporate a theory of psychological stress as a prime factor in the reappearance of Darwin’s symptoms, it would be. important not only to describe carefully the stressful events, but also to be aware of Darwin’s response to them. This correlation is implicit throughout the text. Darwin himself was aware of the psychological factors associated with his physical symptoms. Instead of arriving at a synthesis, there is a list of symptoms and cures recommended by the leading specialists, dates when such and such a work was published and theories of Darwin, his doctors and biographers. Dr. Colp believes that a battery of laboratory tests are necessary to rule out any physical illness and acknowledges the difficult question of why one particular symptom should appear at one time and another later on. A second question which he hesitates to answer is “why in June 1858, when Darwin suddenly had to confront many stresses -rivalry with Wallace and the publication of his theory of natural selection, and family death and illness, and the possibility of more death and illness-why at this time, did Darwin only become terribly anxious and not suffer upsets of hrs stomach, heart or skin?” His alternative is to postpone a reply until “more is learned about mindbody interaction”. One could learn about this interaction by elaborating the points at which psychological and physical symptoms come together. For example perhaps the external stresses served as a distraction for Darwin from his preoccupation with his own symptoms and so he was only anxious in 1858. To Be an Invalid chronicles the facts of Darwin’s life and neatly summarizes and rebuts past theories. However, it would have been more beneficial if Dr. Colp had correlated psychological and physical symptoms, and elaborated Darwin’s insights and the relevance of a “gouty constitution and other symptoms” in the context of Darwin’s public life. Department of Psychiatry Harvard Medical School Boston, Mass., U.S.A.
ANASTASIAKUCI-LWKI
Eqmce et Santk Gkegraphie Me&ale do Midi de la Fnmee, by HENRI PVZHERAL.Montpellier, Imprimerie du “Paysan du Mid?‘, 1976. Maximilien Sorre’s Fondements hiologiques de la giographie humaine shows how medical geography owes more to France than English readers and writers often recognise. One striking example, of course, is Dr. Jacques May, whose middle years gave us, the American Geographical Society, via methodological and atlas work, later his world nutritional geography. Since these studies, a kind of generation gap in good work, with notable exceptions, ensued. One such exception is Jacqueline Beauieu-Gamier’s conceptual thinking in her work in population geography. Now another is this nublished thesis bv Henri Picheral. It establishes a new ‘level in French contributions to the field of geography and further tills the gap. While the work concerns the Midi from Roussillon to Provence and Corsica, by no means is it narrowly conceived. Most of distribution patterns studied are related to France as a whole, and some by map analysis to a broader canvas of Mediterranean geography. The scope and methods are fresh and stimulating, the French elegant, the traditional usage with an occasional modernism to challenge the reader. The detailed regional discussion make the reviewer wish for a closer knowledge of the Midi, but many omissions can
Book reviews be filled with the aid of the final folded map of cantons and by reference to a good atlas. After two interesting prefaces and an introduction, including some of the philosophical side of the author’s methodology, comes Book I, “A Sick Region’? This consists of a short chapter showing the broad spatial patterns of demands and costs of medical services. Picheral establishes a key approach in the work by graphing and mapping relationships, for instance, consumption of medical services by age and urbanization. The Midi is an area of high service use, but not uniform. For example, agricultural workers have underconsumption while small towns tend to be somewhat underprovided. Chapters follow on mortality, excessive in some areas, especjally soon after the Second World War with its admittedlv excentional conditions, and specifically on the locally heavy burden of infant mortality. The use of maps at several periods since. the war brings out the steady retreat of under-development in isolated and backward areas. The book also points out the continued poor life expectancy among indigent immigrant communities in the bidonuilles on the periphery of Marseilles; and leads to an interim conclusion on the social pathology of high infant mortality areas. The figures introduce one of the author’s main themes, that there is a socio-pathogenic complex, complementary to the pathogenic complex concept of Maximilien Sorre some 30 years before. Book II is on bastions and shelters of infectious diseases more important to&y in the under-developed than in the developed countries. This chapter noted the retreat of what I have called post-war under-development; and also indicates how the position of Mediterranean Europe is transitional between temperate Europe, and sub-tropical and tropical Middle East and Africa. The following chapters interestingly depict the varying climatic and vegetation factors (Sorre’s pathogenic complexes) which underly a whole series of diseases that are not necessarily very heavy public health burdens, but of interest: in Corsica is malaria, needing continued vigilance after the control campaigns; next the arboviruses. linked by bird migrations with the Nile delta; then visceral and dermal leishmaniasis and the two vector species of sandfly (Phlebotomus); the rickettsias (Rick&ha conori, Marseilles fever) with a reservoir of infection in dogs, rabbits, and rodents; and finally Coxiella hwneti (Q fever) mainly from ovine and bovine stock. Picheral distinguishes among the anthropozoonoses (animal diseases affecting man) the orthozoonoses like Q fever into which man accidentally, or through his occupation, acquires the infection directly from the animal or its excreta, etc., from the phorozoonoses (borne zoonoses) which involve a vector like Marseilles fever, which is tickor flea-borne. Picheral goes on to further connections, of leptospirosis and ricefields: of brucellosis, from Brucella rnelitensis associated with sheep and goat rearing, especially in areas of archaic, unhygienic stock-farming that is linked in a fascinating analysis of transhumance or drove roads, of typhoid and paratyphoid, the foci of which are linked with residual areas of poor water supply, and with a high consumption of shellfish not as a luxury food but as a protein source for poorer populations. Finally, the admittedly selective infection, poliomyelitis is discussed as a disease retreating under the assault of preventive campaigns, but with residual victims among families of manual workers and especially in the bidonuilles and other poor urban areas. Book III is entitled “The Rise of the Degenerative Diseases”, and similar techniques show that the Midi, while less affected than the industrial northeast of France. shares the rise of degenerative diseases. The first detailed example is, surprisingly perhaps. again an infectious disease, namely tuberculosis. The general retreat of the disease from the grim post-war picture is graphically presented, the Midi sharing this improvement though with some residual foci
781
in urban and industrial areas on the mainland and in some rural communities in Corsica. The differing life expectance of different social groups are both tabulated and mapped. The chapter on alcoholism is particularly important in itself and in relation to a later d&usaion of liver cirrhosis. While the neode of the Midi are characteristicallv auite abstemiou; l&al areas of alcoholism, in some rural areas of viticulture, including parts of I/anguedoc, Vaucluse and the Alpes Maritimes do exist; so does a different alcoholism. leading to cirrhosis, in some poor areas of industrial cities. The latter is associated with much indiscriminate drinking. The costs and the social selectiivities (largely of wage earners) are analysed There are three examples in the chapter on the increase in maladies &sure (systems failure), Diabetes, rising in France as a whole, differs within the general trend of higher percentage in the Midi. High areas within the Midi seem to be linked to the consumption of sugar, fats (as margarine and vegetable oil rather than butter1 and not least, of alcohol (linking the areas of rural alcoholism mentioned above) In circulatory disorders, the Midi shares the national rise and while less affected than parts of central and eastern France, has high areas within the region. They include mining and industrial. rather than service towns and cities, but also important rural areas where agricultural labour is particularly at risk. The third case is a 4Opage discussion of cancer. Cancers are initially discussed in relation to France and to urbanization but rather frustratingly since the data justify a much more pointed discussion of particular sites of cancer. The author proceeds to this latter analysis, making temperate use of statistical devices, like correlation and assessment of significance, standardization oT data for the age and sex composition of the population. Picheral has a good eye for mapping two-variable relationships rather than just single ones. For instance, he g s into depth on cancer of the esophagus (long correlate.% with alcohol in France) and cirrhosis of the liver, or themcartographic differentiation of rural and urban incidenc& of cancers of the lung, of the stomach and of the esophagus (and many disease distributions). The last two cited show some relationship with alcoholism and with the vulnerable rural groups while lung cancer is related to manufa&tring and mining towns (without of course denying the well established relationship with smoking). After reviewing hereditary factors, difficult to tie in conclusively, Picheral concludes that the cancers, affected by place of residence, age, occupation, life-style, diet and addictions like smokin and alcohol, can well be treated seriously as a social di f ase. He concludes book III with a development of his concept of sociopathological complexes. This includes a large ‘two-variable map of the Midi in which age is plotted against low or excess mortality from tuberculosis, alcoho sm, cirrhosis, diabetes, tumors and circulatory disease. #hr‘s leads to a discussion and mapping of the demographic and sociopathogenic determinants which the reviewer found very stimulating. Book IV is on patients and doctors, medicine and health. Picheral starts with a discussion of the difficult concept of health, which Jacques May, regarded as undefinable in any scientific way but faute de Meux goes on to develop a composite index of lack of health from 60 aspects of mortality, from the general and infant rates to those for cancer of the esophagus. This is mapped broadly for France, for three age groups, and for males and females. The Midi and sub-regions within it are further analysed by graphs and by some quite sensitive mapping. A generally favorable but locally unfavorable health picture is complemented by a very full provision of medical services. and this is mapped in some detail, though not in terms of catchment areas. Inequalities in provision appear, and this theme is given its own chapter, with Corsica as one detailed example, showing the greater importance of infectious diseases in poor and backwitrd areas contrasted with
782
Book reviews
Marseilles Rural depopulation combined with the attractions of towns and the inevitable monopoly of specialized services in the cities are increasing the problem in relatively isolated areas. A short but stimulating conclusion puts the whole study into some perspective in relation to medical sociology and to trends in geography, including the gap in French medical geography referred to earlier. The apparent cause, fear of (physical) determinism may be removed by modifying
Sorre’s “pathogenic complex” to Picheral’s “sociopathogenie complex”. Two final perspectives are in relation to Mediterranean geography and to fresh health legislation in France in the year 1970. Faculty of Social Sciences The Open University Milton Keynes, England
A. T. A. LEARMONTH
Book reviews
fully understand the process of persuasion has, in the past, been due to the failure to recognim that beliefs, attitudes, intentions, and behaviours are four very different components with systematic relations among them (p. 103). He explains that the four components cannot be collapsed under one generic term “attitude” because recent research has indicated that attitudes, intents, and behaviours actually rest on beliefs and are usually a function of them (p. 111). He also emphasizes that the content of a message must be understood in light of a speaker’s beliefs, attitudes, intents, and behaviors, and that a communicator is successful only if he succeeds in bringing about a change in the hearer with respect to these four components. Fiihbein’s approach is most useful for an understanding of how communication and persuasion work, and as a methodological tool for the study of conversational data in medicine. If we want to improve communication between physicians and patients and if we believe that language is a pervasive component of medical practice, we must teach medical students to change their own beliefs about language use in medicine. This training should enable medical students to acquire effective listener and speaker skills previously gained only through years of experience. Department of Public Health Cornell University Medical College New York, N.Y., U.S.A.
bJcD?.NNB SKOPEK
ToBeanInvaBd:TheIBoaaaofCharleaDarwIn,byRALPtr COLP, JR. University of Chicago, Ill., 1977. 285 pp. 317.50 For nearly a century the life of Charles Darwin has fascinated the biographer and the scientist, while his ideas have excited controversy among all who have encountered them. At this point it would be difficult to 6nd anyone who has not. Hence another study of Darwin’s life can be potentially exciting as well aa significant when it can integrate the historical data with recent developments in medicine and the social sciences. Unfortunately Ralph Colp’s To Be an Invalid provides limited satisfaction. Prior to his journey on the Beagle from 1831 to 1836, Darwin was known to have had vague ailments which did not prevent him from undertaking the risky journey. He had an “upset stomach” that lasted “for a good many breakfasts”, hands that “were not well”, and “eruptions about the mouth” which he treated with arsenic. However, for two years after his return to England he enjoyed a respite from his illness and worked on his evolutionary notebooks. In the Transmutation Notebooks he commented that he “feared great evil from vast opposition” upon the publication of his work. He also developed cardiovascular, gastrointestinal, neurological and psychological symptoms which worsened in his later life. At one time or another Darwin had chest pain, weakness, joint pain, nausea vomiting and pamsthesias. Darwin tried many of the treatments in vogue during his lifetime, like hydrotherapy, and died from a cardiac arrest in 1882. Dr. Colp reviews Darwin’s life-long treatment plans and summarizes the numerous theories about causes and reasons. It has been hypothesized that he suiTered from toxic reactions from tropical pathogens, such as Chagas’ disease; from heavy metals, including arsenic, which he took to cure himself. These points have been rebutted by observations that he took arsenic before the trip and the symptoms reappeared years after his return. A contemporary physician described the illness as “various irregular manifestations of a gouty constitution, such as eczema vasomotor nerve storms, vertigo, and other disorders of sensation”. Reading To Be an Invalid is like reviewing an extensive medical record from which an evaluation should be made.
What is missing is what makes Darwin’s ailments so interesting. Colp fails to correlate the appearance of the symptoms with the appearance of Darwin’s revolutionary work and the scandalous reception it received. If one were to incorporate a theory of psychological stress as a prime factor in the reappearance of Darwin’s symptoms, it would be. important not only to describe carefully the stressful events, but also to be aware of Darwin’s response to them. This correlation is implicit throughout the text. Darwin himself was aware of the psychological factors associated with his physical symptoms. Instead of arriving at a synthesis, there is a list of symptoms and cures recommended by the leading specialists, dates when such and such a work was published and theories of Darwin, his doctors and biographers. Dr. Colp believes that a battery of laboratory tests are necessary to rule out any physical illness and acknowledges the difficult question of why one particular symptom should appear at one time and another later on. A second question which he hesitates to answer is “why in June 1858, when Darwin suddenly had to confront many stresses -rivalry with Wallace and the publication of his theory of natural selection, and family death and illness, and the possibility of more death and illness-why at this time, did Darwin only become terribly anxious and not suffer upsets of hrs stomach, heart or skin?” His alternative is to postpone a reply until “more is learned about mindbody interaction”. One could learn about this interaction by elaborating the points at which psychological and physical symptoms come together. For example perhaps the external stresses served as a distraction for Darwin from his preoccupation with his own symptoms and so he was only anxious in 1858. To Be an Invalid chronicles the facts of Darwin’s life and neatly summarizes and rebuts past theories. However, it would have been more beneficial if Dr. Colp had correlated psychological and physical symptoms, and elaborated Darwin’s insights and the relevance of a “gouty constitution and other symptoms” in the context of Darwin’s public life. Department of Psychiatry Harvard Medical School Boston, Mass., U.S.A.
ANASTASIAKUCI-LWKI
Eqmce et Santk Gkegraphie Me&ale do Midi de la Fnmee, by HENRI PVZHERAL.Montpellier, Imprimerie du “Paysan du Mid?‘, 1976. Maximilien Sorre’s Fondements hiologiques de la giographie humaine shows how medical geography owes more to France than English readers and writers often recognise. One striking example, of course, is Dr. Jacques May, whose middle years gave us, the American Geographical Society, via methodological and atlas work, later his world nutritional geography. Since these studies, a kind of generation gap in good work, with notable exceptions, ensued. One such exception is Jacqueline Beauieu-Gamier’s conceptual thinking in her work in population geography. Now another is this nublished thesis bv Henri Picheral. It establishes a new ‘level in French contributions to the field of geography and further tills the gap. While the work concerns the Midi from Roussillon to Provence and Corsica, by no means is it narrowly conceived. Most of distribution patterns studied are related to France as a whole, and some by map analysis to a broader canvas of Mediterranean geography. The scope and methods are fresh and stimulating, the French elegant, the traditional usage with an occasional modernism to challenge the reader. The detailed regional discussion make the reviewer wish for a closer knowledge of the Midi, but many omissions can
Book reviews be filled with the aid of the final folded map of cantons and by reference to a good atlas. After two interesting prefaces and an introduction, including some of the philosophical side of the author’s methodology, comes Book I, “A Sick Region’? This consists of a short chapter showing the broad spatial patterns of demands and costs of medical services. Picheral establishes a key approach in the work by graphing and mapping relationships, for instance, consumption of medical services by age and urbanization. The Midi is an area of high service use, but not uniform. For example, agricultural workers have underconsumption while small towns tend to be somewhat underprovided. Chapters follow on mortality, excessive in some areas, especjally soon after the Second World War with its admittedlv excentional conditions, and specifically on the locally heavy burden of infant mortality. The use of maps at several periods since. the war brings out the steady retreat of under-development in isolated and backward areas. The book also points out the continued poor life expectancy among indigent immigrant communities in the bidonuilles on the periphery of Marseilles; and leads to an interim conclusion on the social pathology of high infant mortality areas. The figures introduce one of the author’s main themes, that there is a socio-pathogenic complex, complementary to the pathogenic complex concept of Maximilien Sorre some 30 years before. Book II is on bastions and shelters of infectious diseases more important to&y in the under-developed than in the developed countries. This chapter noted the retreat of what I have called post-war under-development; and also indicates how the position of Mediterranean Europe is transitional between temperate Europe, and sub-tropical and tropical Middle East and Africa. The following chapters interestingly depict the varying climatic and vegetation factors (Sorre’s pathogenic complexes) which underly a whole series of diseases that are not necessarily very heavy public health burdens, but of interest: in Corsica is malaria, needing continued vigilance after the control campaigns; next the arboviruses. linked by bird migrations with the Nile delta; then visceral and dermal leishmaniasis and the two vector species of sandfly (Phlebotomus); the rickettsias (Rick&ha conori, Marseilles fever) with a reservoir of infection in dogs, rabbits, and rodents; and finally Coxiella hwneti (Q fever) mainly from ovine and bovine stock. Picheral distinguishes among the anthropozoonoses (animal diseases affecting man) the orthozoonoses like Q fever into which man accidentally, or through his occupation, acquires the infection directly from the animal or its excreta, etc., from the phorozoonoses (borne zoonoses) which involve a vector like Marseilles fever, which is tickor flea-borne. Picheral goes on to further connections, of leptospirosis and ricefields: of brucellosis, from Brucella rnelitensis associated with sheep and goat rearing, especially in areas of archaic, unhygienic stock-farming that is linked in a fascinating analysis of transhumance or drove roads, of typhoid and paratyphoid, the foci of which are linked with residual areas of poor water supply, and with a high consumption of shellfish not as a luxury food but as a protein source for poorer populations. Finally, the admittedly selective infection, poliomyelitis is discussed as a disease retreating under the assault of preventive campaigns, but with residual victims among families of manual workers and especially in the bidonuilles and other poor urban areas. Book III is entitled “The Rise of the Degenerative Diseases”, and similar techniques show that the Midi, while less affected than the industrial northeast of France. shares the rise of degenerative diseases. The first detailed example is, surprisingly perhaps. again an infectious disease, namely tuberculosis. The general retreat of the disease from the grim post-war picture is graphically presented, the Midi sharing this improvement though with some residual foci
781
in urban and industrial areas on the mainland and in some rural communities in Corsica. The differing life expectance of different social groups are both tabulated and mapped. The chapter on alcoholism is particularly important in itself and in relation to a later d&usaion of liver cirrhosis. While the neode of the Midi are characteristicallv auite abstemiou; l&al areas of alcoholism, in some rural areas of viticulture, including parts of I/anguedoc, Vaucluse and the Alpes Maritimes do exist; so does a different alcoholism. leading to cirrhosis, in some poor areas of industrial cities. The latter is associated with much indiscriminate drinking. The costs and the social selectiivities (largely of wage earners) are analysed There are three examples in the chapter on the increase in maladies &sure (systems failure), Diabetes, rising in France as a whole, differs within the general trend of higher percentage in the Midi. High areas within the Midi seem to be linked to the consumption of sugar, fats (as margarine and vegetable oil rather than butter1 and not least, of alcohol (linking the areas of rural alcoholism mentioned above) In circulatory disorders, the Midi shares the national rise and while less affected than parts of central and eastern France, has high areas within the region. They include mining and industrial. rather than service towns and cities, but also important rural areas where agricultural labour is particularly at risk. The third case is a 4Opage discussion of cancer. Cancers are initially discussed in relation to France and to urbanization but rather frustratingly since the data justify a much more pointed discussion of particular sites of cancer. The author proceeds to this latter analysis, making temperate use of statistical devices, like correlation and assessment of significance, standardization oT data for the age and sex composition of the population. Picheral has a good eye for mapping two-variable relationships rather than just single ones. For instance, he g s into depth on cancer of the esophagus (long correlate.% with alcohol in France) and cirrhosis of the liver, or themcartographic differentiation of rural and urban incidenc& of cancers of the lung, of the stomach and of the esophagus (and many disease distributions). The last two cited show some relationship with alcoholism and with the vulnerable rural groups while lung cancer is related to manufa&tring and mining towns (without of course denying the well established relationship with smoking). After reviewing hereditary factors, difficult to tie in conclusively, Picheral concludes that the cancers, affected by place of residence, age, occupation, life-style, diet and addictions like smokin and alcohol, can well be treated seriously as a social di f ase. He concludes book III with a development of his concept of sociopathological complexes. This includes a large ‘two-variable map of the Midi in which age is plotted against low or excess mortality from tuberculosis, alcoho sm, cirrhosis, diabetes, tumors and circulatory disease. #hr‘s leads to a discussion and mapping of the demographic and sociopathogenic determinants which the reviewer found very stimulating. Book IV is on patients and doctors, medicine and health. Picheral starts with a discussion of the difficult concept of health, which Jacques May, regarded as undefinable in any scientific way but faute de Meux goes on to develop a composite index of lack of health from 60 aspects of mortality, from the general and infant rates to those for cancer of the esophagus. This is mapped broadly for France, for three age groups, and for males and females. The Midi and sub-regions within it are further analysed by graphs and by some quite sensitive mapping. A generally favorable but locally unfavorable health picture is complemented by a very full provision of medical services. and this is mapped in some detail, though not in terms of catchment areas. Inequalities in provision appear, and this theme is given its own chapter, with Corsica as one detailed example, showing the greater importance of infectious diseases in poor and backwitrd areas contrasted with
782
Book reviews
Marseilles Rural depopulation combined with the attractions of towns and the inevitable monopoly of specialized services in the cities are increasing the problem in relatively isolated areas. A short but stimulating conclusion puts the whole study into some perspective in relation to medical sociology and to trends in geography, including the gap in French medical geography referred to earlier. The apparent cause, fear of (physical) determinism may be removed by modifying
Sorre’s “pathogenic complex” to Picheral’s “sociopathogenie complex”. Two final perspectives are in relation to Mediterranean geography and to fresh health legislation in France in the year 1970. Faculty of Social Sciences The Open University Milton Keynes, England
A. T. A. LEARMONTH