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From the central departments
PUBLIC
BOOK REVIEWS
HEALTH
general ideas are illustrated by case studies o f enterprises u n d e r t a k e n in m a n y parts o f the w o r l d - - i n c l u d i n g the h i s t o r y o f a cholera epidemic in C h i n a , a n d o f a n a t t e m p t to secure the boiling of c o n t a m i n a t e d w a t e r in Peru. T h e studies are classified u n d e r s u c h h e a d i n g s as " R e - e d u c a t i n g t h e C o m m u n i t y , " " R e a c t i o n to C r i s e s " a n d " V e h i c l e s o f H e a l t h A d m i n i s t r a t i o n . " T h e b o o k s h o u l d be invaluable for t h o s e w h o belong to, or i n t e n d to join, t h e Oversea Medical Service ; b u t it is n o t w i t h o u t lessons for those w h o are engaged in public h e a l t h w o r k in this country.
Health, Culture and Community. E d i t e d by BENJAMIN D. PALTL. (Pp. viii + 493. Price 37s. 6d.). N e w Y o r k : T h e Russell Sage F o u n d a t i o n . 1955. This is a b o o k w h i c h gives case studies o f public reactions t o h e a l t h p r o g r a m m e s . Its e d i t o r is a Lecturer o n Social A n t h r o p o l o g y at t h e H a r v a r d School o f Public Health. T h e score o f c o n t r i b u t o r s to it h a v e all b a d t r a i n i n g a n d practical experience in t h e social sciences ; b u t only a few have, in addition, medical qualifications. It c a n therefore fairly b e said that, in so far as purely medical m a t t e r s are dealt with, they are seen f r o m the outside. T h e p o i n t o f view is t h a t of t h e social w o r k e r r a t h e r t h a n of t h e clinician. Such questions are p o s e d as " H o w does a h u m a n c o m m u n i t y see a n d solve its p r o b l e m s ? . . . . H o w does it perceive a n d receive efforts f r o m t h e outside or the inside to i m p r o v e its h e a l t h ? " T h e c o m m u n i t y is recognised as a p o w e r structure ; a n d any n e w v e n t u r e in the h e a l t h field will s t a n d o r fall partly o n its merits a n d partly o n its implications for s t r e n g t h e n i n g o r w e a k e n i n g t h e prevailing p a t t e r n of power. V a s t stores of i n f o r m a t i o n n o w exist a b o u t h e a l t h p r o b l e m s a n d h o w to solve t h e m , b u t successful a p p l i c a t i o n m u s t in m a n y cases d e p e n d o n t h e use o f c o n c e p t s a n d techniques w h i c h are social r a t h e r t h a n medical in nature. T h e s e
District Nursing. By E. J. MERRY, S.R.N., S.C.M., M.C.S.P., Q.N., H.V. CERT., a n d I. D. IRVEN, S.R.N., S.C.M., Q.N., f l y . CERT. (Pp. 262. Price 18s.). L o n d o n : Balliere, Tindall a n d Cox. 1955. W r i t t e n b y two very experienced nurses, this will u n d o u b t e d l y be f o u n d a useful guide to t h o s e w h o have t o take u p district n u r s i n g as a career. T h e o p e n i n g c h a p t e r s give a s h o r t history of district n u r s i n g d u r i n g r e c e n t years, a n d also include a s u m m a r i s e d a c c o u n t o f the present set-up u n d e r t h e N a t i o n a l H e a l t h Service A c t a n d o t h e r p u b l i c health legislation. T h e r e is a great deal o f useful i n f o r m a t i o n c o n t a i n e d in the v o l u m e w h i c h deals with detailed n u r s i n g techniques, t o g e t h e r with the place of h e a l t h e d u c a t i o n a n d t h e preventive o u t l o o k b y t h o s e nurses a t t a c h e d t o p u b l i c h e a l t h d e p a r t m e n t s .
From the Central Departments The Registrar General's Statistical Review of England and Wales for 1952. Text Volume (H.M.S.O., price 8s. net). The volume,
startling number of deaths caused or accelerated by London " s m o g " in December which drew public attention to the health hazards of atmospheric polution. Infant Mortality.--Although a smaller proportion of babies died under one year of age during 1952 than in any previous year, the rates for s!illbirths and for deaths under one week showed only slight improvement. The losses by stillbirth and in the first week after birth together represented three-quarters of the total loss under one year and it is evident that continued progress in reducing losses of life by stillbirth and infant death must become increasingly dependent on what can be achieved before the first week of life and on success in combating respiratory infections during the rest of the first year.
which falls into two main parts, contains the official commentary on the civil and medical statistics for 1952 which have already been published in Parts I and II of the Review for that year. Population.--Final figures derived from the 1951 Census (as distinct from the preliminary figures and those deduced from the one per cent. sample) have made it possible to complete a final revision of the population estimates for England and Wales. The total population at tnid-1952 is estimated to have been 44,166,000 : this figure.includes members of H.M; Forces belonging to England and Wales and serving overseas but excludes foreign and Commonwealth Forces temporarily stationed in this country. Births.--The evidence suggests that by 1952 the volume of births had settled down to a comparatively stable level after the post-war fluctuations, and the long decline experienced before the early thirties had not been resumed, though the high marriage rates of the post-war years were still exercising some, but a diminishing, inflationary effect upon the number of births. The trend of fertility in the next few years will be very important in determining population replacement ; the evidence upon which to found a reasonably reliable judgment has not yet sufficiently accumulated. Married couples still tended to concentrate their family building into the earlier years of their marriage.
Accidental Deaths Increase Causes of Death at Different Ages.--The figures show that more than one-fifth of all deaths of those aged 1 to 24 were caused by accidents ; cancer was responsible for more than one-fifth of the deaths at ages 25 to 44 and for nearly a quarter at ages 45 to 64 ; heart disease accounted for more than a quarter of the deaths at ages 45 to 74. There was a serious increase in the number of deaths of young men aged 15 to 34 caused by accidents or other violence ; since 1948 deaths from these causes increased by 12% though the total number of deaths of young men from all causes decreased by 27 %. The death rates for men aged 15 to 24 from accidents and other violence were the highest recorded since the end of the war. The figures given in a table showing the seasonal variation of deaths from certain causes by age reflect a lower resistance to injury among older people in the winter months, when the number of deaths of persons aged 45 and over from motor vehicle accidents and accidental falls was greater than during the summer months. Tuberculosis.--There were 10,585 deaths from tuberculosis in 1952 compared with 23,076 in 1947, but notifications declined only slightly, probably reflecting a combination of improved treatment, more intensive search for cases and reduced incidence. (Since 1952, mortality has continued to decline--7,897 deaths in 1954-and notifications show more definite signs of following snit). The importance of local variations in tuberculosis is emphasised by discussion of differences between administrative counties and county boroughs.
Marriage and Divorce Marriages.~Generally, the high marriage rates of the post-war years have tended to persist and, as a result of the depletion of the unmarried population, there has been a relative increase in the number of very young couples, the average age of both spinster brides and bachelor bridegrooms having fallen, though not as yet to the low level of the war years. Divorces.---Though the number of divorces effected in 1952 was higher by virtue of a sharp rise in petitions following the Legal Aid and Advice Act of 1949, there is no sign that without this stimulus there would have been any significant recession from the higher level established after the immediate post-war peak had passed. Deaths.--The low death rate for 1952, the lowest since 1948, was no doubt due to the absence of any influenza epidemic and to the freedom from prolonged cold weather. Nevertheless, it was the 136
BOOK REVIEWS
HEALTH
general ideas are illustrated by case studies o f enterprises u n d e r t a k e n in m a n y parts o f the w o r l d - - i n c l u d i n g the h i s t o r y o f a cholera epidemic in C h i n a , a n d o f a n a t t e m p t to secure the boiling of c o n t a m i n a t e d w a t e r in Peru. T h e studies are classified u n d e r s u c h h e a d i n g s as " R e - e d u c a t i n g t h e C o m m u n i t y , " " R e a c t i o n to C r i s e s " a n d " V e h i c l e s o f H e a l t h A d m i n i s t r a t i o n . " T h e b o o k s h o u l d be invaluable for t h o s e w h o belong to, or i n t e n d to join, t h e Oversea Medical Service ; b u t it is n o t w i t h o u t lessons for those w h o are engaged in public h e a l t h w o r k in this country.
Health, Culture and Community. E d i t e d by BENJAMIN D. PALTL. (Pp. viii + 493. Price 37s. 6d.). N e w Y o r k : T h e Russell Sage F o u n d a t i o n . 1955. This is a b o o k w h i c h gives case studies o f public reactions t o h e a l t h p r o g r a m m e s . Its e d i t o r is a Lecturer o n Social A n t h r o p o l o g y at t h e H a r v a r d School o f Public Health. T h e score o f c o n t r i b u t o r s to it h a v e all b a d t r a i n i n g a n d practical experience in t h e social sciences ; b u t only a few have, in addition, medical qualifications. It c a n therefore fairly b e said that, in so far as purely medical m a t t e r s are dealt with, they are seen f r o m the outside. T h e p o i n t o f view is t h a t of t h e social w o r k e r r a t h e r t h a n of t h e clinician. Such questions are p o s e d as " H o w does a h u m a n c o m m u n i t y see a n d solve its p r o b l e m s ? . . . . H o w does it perceive a n d receive efforts f r o m t h e outside or the inside to i m p r o v e its h e a l t h ? " T h e c o m m u n i t y is recognised as a p o w e r structure ; a n d any n e w v e n t u r e in the h e a l t h field will s t a n d o r fall partly o n its merits a n d partly o n its implications for s t r e n g t h e n i n g o r w e a k e n i n g t h e prevailing p a t t e r n of power. V a s t stores of i n f o r m a t i o n n o w exist a b o u t h e a l t h p r o b l e m s a n d h o w to solve t h e m , b u t successful a p p l i c a t i o n m u s t in m a n y cases d e p e n d o n t h e use o f c o n c e p t s a n d techniques w h i c h are social r a t h e r t h a n medical in nature. T h e s e
District Nursing. By E. J. MERRY, S.R.N., S.C.M., M.C.S.P., Q.N., H.V. CERT., a n d I. D. IRVEN, S.R.N., S.C.M., Q.N., f l y . CERT. (Pp. 262. Price 18s.). L o n d o n : Balliere, Tindall a n d Cox. 1955. W r i t t e n b y two very experienced nurses, this will u n d o u b t e d l y be f o u n d a useful guide to t h o s e w h o have t o take u p district n u r s i n g as a career. T h e o p e n i n g c h a p t e r s give a s h o r t history of district n u r s i n g d u r i n g r e c e n t years, a n d also include a s u m m a r i s e d a c c o u n t o f the present set-up u n d e r t h e N a t i o n a l H e a l t h Service A c t a n d o t h e r p u b l i c health legislation. T h e r e is a great deal o f useful i n f o r m a t i o n c o n t a i n e d in the v o l u m e w h i c h deals with detailed n u r s i n g techniques, t o g e t h e r with the place of h e a l t h e d u c a t i o n a n d t h e preventive o u t l o o k b y t h o s e nurses a t t a c h e d t o p u b l i c h e a l t h d e p a r t m e n t s .
From the Central Departments The Registrar General's Statistical Review of England and Wales for 1952. Text Volume (H.M.S.O., price 8s. net). The volume,
startling number of deaths caused or accelerated by London " s m o g " in December which drew public attention to the health hazards of atmospheric polution. Infant Mortality.--Although a smaller proportion of babies died under one year of age during 1952 than in any previous year, the rates for s!illbirths and for deaths under one week showed only slight improvement. The losses by stillbirth and in the first week after birth together represented three-quarters of the total loss under one year and it is evident that continued progress in reducing losses of life by stillbirth and infant death must become increasingly dependent on what can be achieved before the first week of life and on success in combating respiratory infections during the rest of the first year.
which falls into two main parts, contains the official commentary on the civil and medical statistics for 1952 which have already been published in Parts I and II of the Review for that year. Population.--Final figures derived from the 1951 Census (as distinct from the preliminary figures and those deduced from the one per cent. sample) have made it possible to complete a final revision of the population estimates for England and Wales. The total population at tnid-1952 is estimated to have been 44,166,000 : this figure.includes members of H.M; Forces belonging to England and Wales and serving overseas but excludes foreign and Commonwealth Forces temporarily stationed in this country. Births.--The evidence suggests that by 1952 the volume of births had settled down to a comparatively stable level after the post-war fluctuations, and the long decline experienced before the early thirties had not been resumed, though the high marriage rates of the post-war years were still exercising some, but a diminishing, inflationary effect upon the number of births. The trend of fertility in the next few years will be very important in determining population replacement ; the evidence upon which to found a reasonably reliable judgment has not yet sufficiently accumulated. Married couples still tended to concentrate their family building into the earlier years of their marriage.
Accidental Deaths Increase Causes of Death at Different Ages.--The figures show that more than one-fifth of all deaths of those aged 1 to 24 were caused by accidents ; cancer was responsible for more than one-fifth of the deaths at ages 25 to 44 and for nearly a quarter at ages 45 to 64 ; heart disease accounted for more than a quarter of the deaths at ages 45 to 74. There was a serious increase in the number of deaths of young men aged 15 to 34 caused by accidents or other violence ; since 1948 deaths from these causes increased by 12% though the total number of deaths of young men from all causes decreased by 27 %. The death rates for men aged 15 to 24 from accidents and other violence were the highest recorded since the end of the war. The figures given in a table showing the seasonal variation of deaths from certain causes by age reflect a lower resistance to injury among older people in the winter months, when the number of deaths of persons aged 45 and over from motor vehicle accidents and accidental falls was greater than during the summer months. Tuberculosis.--There were 10,585 deaths from tuberculosis in 1952 compared with 23,076 in 1947, but notifications declined only slightly, probably reflecting a combination of improved treatment, more intensive search for cases and reduced incidence. (Since 1952, mortality has continued to decline--7,897 deaths in 1954-and notifications show more definite signs of following snit). The importance of local variations in tuberculosis is emphasised by discussion of differences between administrative counties and county boroughs.
Marriage and Divorce Marriages.~Generally, the high marriage rates of the post-war years have tended to persist and, as a result of the depletion of the unmarried population, there has been a relative increase in the number of very young couples, the average age of both spinster brides and bachelor bridegrooms having fallen, though not as yet to the low level of the war years. Divorces.---Though the number of divorces effected in 1952 was higher by virtue of a sharp rise in petitions following the Legal Aid and Advice Act of 1949, there is no sign that without this stimulus there would have been any significant recession from the higher level established after the immediate post-war peak had passed. Deaths.--The low death rate for 1952, the lowest since 1948, was no doubt due to the absence of any influenza epidemic and to the freedom from prolonged cold weather. Nevertheless, it was the 136