book is divided into five parts: Per- spectives, Teaching and ... patient and family care. This book is very ... group practice mode of dental care delivery. Although ...
BOOK -~~~~~~~~ Rehabilitation Nursing, Perspectives and Applications. Victor A. Christopherson, Pearl Parvin Coulter, and Mary Opal Wolanin. McGraw-Hill Book Company, New York. 586 pp, paperback. 1974. $7.95. Rehabilitation Nursing, Perspectives and Applications is a collection of articles, most of which have been published within the last 10 years. The book is divided into five parts: Perspectives, Teaching and Prevention, Rehabilitation Nursing Care in NonLife-Threatening Conditions, Rehabilitation Nursing Care in Life-Threatening Conditions, and Alcoholism and Drug Abuse. As with any such compilation of readings, some articles are more helpful than others. Although there are few illustrations, those articles including them (examples: Stump Hygiene, Tips on Using Crutches, Canes and Walkers, and Exercises for Bedfast Patients) help to reinforce principles. As the authors indicate, much of the content would be useful for any member of the patient care team, but it is perhaps most helpful for nurses engaged in assessing and planning patient and family care. This book is very inclusive of a wide variety of rehabilitation topics and since there is voluminous material available in this area, it is helpful to have a book which provides a compact representation on the subject of reha-
bilitation.
Mary Ann Lough, RN, MS School of Nursing and Allied Health Professions St. Louis University St. Louis, MO Group Practice and the Future of Dental Care. Charles R. Jerge, William E. Marshall, Max H. Schoen, and Jay W. Friedman. Lea & Febiger, Philadelphia. 420 pp. 1974. The authors in 420 pages have presented a logical argument for the group practice mode of dental care delivery. Although there are 11 different contributors to the book, each chapter flows easily into the next, indicating a thorough editorial hand. The first section of the book deals with the current social arrangement of health care delivery, providing the reader with the significant concepts in the development of dentistry as a 650
AJPH JUNE, 1975, Vol. 65, No. 6
segment of comprehensive health care. Included are some traditional data on the dental care needs of the country and the availability of services as well as some interesting views of the dental health care system from the point of view of the consumer as well as the provider. The second section, less generalized in nature, specifies group practice as a significant organizational scheme for the effective and efficient delivery of dental care. It provides up-to-date information regarding legislation which affects dental care as well as the necessary economic models for evaluating group practice. The third section is a "how-todo-it" description of the important steps in planning, establishing, and evaluating dental group practice. Adequate detail is provided for the reader who wishes to use the book as a manual for establishing his or her own group practice yet the section is organized in such a way as to permit the more general reader to skim the material for an overview of the essentials of group practice management. The book serves as an excellent text for a dentist interested in establishing a group practice yet has a much more universal appeal in those sections which deal with concepts which affect the entire structure of the dental care delivery system. Anthony Jong, DDS, MPH
From Medical Police to Social Medicine: Essays on the History of Health Care. George Rosen. Science History Publications, New York. 327 pp. 1974. The opening salvo in this scholarly collection aims not only at the question, hardly controversial, of why medical history should be taught but at the much more difficult issue of how to infiltrate historical perspective into the general course of learning. The precept of Osler and others, that the historical approach is pertinent in each phase of the process of learning, poses a stiff challenge both to instructor and student. The segregation of historical studies, in contrast, may lead to sterile pursuit of data divorced from context. For those who study health services in the context of political philosophy, economic institutions, and technological change, these essays are a rich resource. As Rosen notes, few
have stated the importance of historical studies better than F. W. Maitland: "Today, we study the day before yesterday, in order that yesterday may not paralyse today, and today may not paralyse tomorrow." Or, in the words of another philosopher, "Those who will not learn from history are doomed to repeat it." Marcus Rosenblum, FAPHA Maternal and Child Health Practices: Problems, Resources and Methods of Delivery. Edited by Helen M. Wallace, Edwin M. Gold, and Edward F. Lis. Charles C Thomas, Springfield, IL. 1364 pp., 49 il., 170 tables. 1973. $37.50. Maternal and Child Health Practice is a book without a focus. It isn't clear why it lacks focus-whether it is the failure to define adequately the goals as a text and to achieve them, or whether it is a failure to decide in advance the target population and to marshal contributors in a common objective, or whether it is the profound inequality in strengths and weaknesses of individual chapters, or a combination of these failures. The preface lists seven areas of expanded MCH effort, but does not organize the text around them. Instead, the book is divided into six sections, the first an "introduction" and the last, a brief overview of MCH programs outside the U.S. The interior sections constitute (1) a chronology from pregnancy and birth to adolescence and (2) a look at children with special problems. What is to be imparted by these sections is unclear; perhaps they are merely to be a sharing of recent experiences, but that purpose is scarcely one of a text. A textbook needs a specific audience for instruction. Certainly no one class either in medical school or in a school of public health would be interested simultaneously in a copious description of how to perform fetal monitoring and a cursory overview of air and water pollution programs. It is not the topics per se, but rather their treatment and textual goals, which are so uneven. At least two themes are repeated in numerous chapters: (1) poverty is the greatest maternal and child health probllem in the U.S. today (for example, chapters 4, 6, 12, 14, 15, 21, 24, 37); and (2) comprehensive care is
the desirable and inevitable organization of services in the future (such as chapters 1, 2, 3, 7, 27, 44). Portions of other chapters are also devoted to one or the other of these themes. The authors of a given chapter seem to be unaware of the contributions of the other authors, and present the same statistics to reach the same conclusions. Both themes are important to students of maternal and child health, not to mention to other health fields, and a real teaching aid could have been provided were the various contributions combined and given focus. At times the book is not easy to read because of typographical errors and poor sentence structure. More troubling are the occasional errors in interpretation of data, such as the statement that in the Minnesota Children and Youth Project "there has been a 50 percent decrease in the number of children needing hospitalization" (p. 60) when, in fact, the number of children hospitalized slightly increased. The proportion of patients in the program who are hospitalized patients has, indeed, decreased by 50 per cent, but this is apparently due to an increase in the proportion of well-child visits, not because of a decline in the number of hospital admissions. Another example: "Genetic counseling has a portion of its methods in the mathematical expression of biological mistakes. Thus, obstetric antecedents to perinatal mortality and morbidity include subsequent pregnancies in a mother of one child with spina bifida, the risk of recurrence being twelve times the norm.... However,... one may reproduce successfully... eleven times...: the risk is relatively great and increases with subsequent pregnancies" (pp. 268-269). This ignorance of probabilistic relationships could carry over to benighted genetic counseling with sad results. Maternal and Child Health Practice could be a worthy crusade, but it is lost in too many missions, choosing to fight a number of skirmishes against a number of different foes rather than to concentrate its energies toward a specific objective in a manner expected of a treatise of this scope and dimension (65 authors and 50 chapters). But if it cannot be dealt with as a text, then it must be approached as a treasure trove, for indeed there are riches to be discovered here. The most effective chapters are those which focus on the "selected facts . .. which have ready application to practice in the areas of health promotion, early case finding, management and rehabilitation.. ." (p. 586). To name only three of the outstanding individual
essays-the late Alan Guttmacher's "Family Planning," Helen Wallace's "Comprehensive Care of Children," and Kenneth Rogers' "The School Health Problem." "Family Planning" offers no new information on the history of birth control or the indications for appropriate use of the modern methods of contraception. What it does, however, is to present these facts in a concise and entertaining. The result is an introduction to birth control for physicians and nonmedical health personnel alike who are laypersons in the population specialty. "Comprehensive Care of Children" is a compendium of the concept of comprehensive care which could well serve as a guideline for programmatic development. Although professional evaluators are not included in the list of personnel needed for a comprehensive service, the idea of evaluation is implicit. Of course, if comprehensive care is to be implemented on a large scale, its effect on health of mothers and children must be documented. "The School Health Problem" raises the issue that while social and emotional needs are the greatest health problems of school age children, those needs are not being met by traditional school health programs. Unless programs change, they will die a natural death for want of evolution. Rogers suggests methods to revive the existing structure so that current problems can be treated. The section on handicapped children, for which Lis took major responsibility and to which Wallace contributed, does not suffer as much from lack of direction and coordination. The first three chapters serve as an overview, the middle contributions as specific examples of programs, and the last chapter as a summary of evaluation procedures for services offered. These chapters and other fine contributions would justify acquisition of the book for reference and consultation, but those seeking a text in maternal and child health may want to take a closer look. Carol J. Hogue, PhD, MPH Assistant Professor of Biostatistics University of North Carolina Patient Power. Philip Margolis. Charles C Thomas, Springfield, Ill. 1973. $8.95. Dr. Margolis presents us with a brief, interesting, and thoroughly readable description of the development of a therapeutic milieu over the years of his administration of the psychiatric
unit of a university general hospital. The book is rich with quotations and clinical illustrations. It traces the slow, often painful stages in the evolution of a traditionally organized psychiatric inpatient service toward a therapeutic democracy. The straightforwardness of this book is a strength and a limitation. The author fails to take up thb complications introduced on the unit by the strong development of transference to the "democratic" unit leader. He does not seriously consider his inpatient unit as a contributing member of a team of health and mental health services. He has provided us with a clear, warm, and engaging view of his ward becoming a therapeutic family. Staff at any level of a psychiatric inpatient service will find this account familiar and refreshing. Administrators and those concerned with health and mental health care delivery will find it informative and helpful. C. Martel Bryant, MD Mount Zion Hospital and Medical Center San Francisco, CA The Poisons Around Us. Toxic Metals in Food, Air, and Water. Henry A. Schroeder. Indiana University Press, Bloomington. 144 pp. 1974. $6.95.
Dr. Schroeder brings to this short but wide-ranging book his vast experience as director of the Trace Element Laboratory at Dartmouth Medical College. The author places the toxic metals in their proper perspective by including chapters on man's evolution from the mineral-laden oceans, comparison of his biochemical composition with the natural environment from which he arose, and comparison of the relative contributions of nature and present-day industry to his environmental contamination. In addition to discussions of the direct toxic effects of such metals as lead, mercury, cadmium, beryllium, and antimony (which the author suggests are involved in "at least half the deaths in the U.S."), one chapter deals with the public health impact of deficiencies of essential elements in the American diet. The book is written in nontechnical language and should be of interest to the concerned layman as well as to a whole host of environmentally interested administrators and scientists, particularly toxicologists. Dr. Robert J. Rubin Professor of Environmental Medicine Johns Hopkins School of Hygiene and Public Health
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