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- I meric uii .I Irlhropologisl

[6S, 19631

I)rt\veen natural iind supernatural causation are creatures of the rcal worlcl rather than categories of our own culture. Throughout the section on primitive medicine, the implication is that it is all false, truth being found only in scientific medicine. One of the explicit aims of the book is to convince medical students that social factors are important in the etiology and the treatment of disease. I n the practice of his primitive medicine the shaman often diagnoses illness in a framework that includes the assumption that disturbed social relationships can make people sick. And the anthropological literature affords abundant documentation for the contention that the primitive medicine man can often make patients well by repairing these disturbed social relationships. The idea that breach of taboo may cause disease is presented as an interesting idea that has been outmoded by scientific medicine, and yet the work of Srole and his colleagues in the Midtown study has demonstrated that alienation from the basic values of ones culture increases the risk of developing mental illness in contemporary Manhattan. It is certainly true that primitive medicine has much to learn from scientific medicine, but it may also be true that many primitive medical systems have long recognized the importance of the very psychic, social, and cultural factors that this book tries to teach to modern medical students. The last two parts of the book deal with the social and cultural setting within which disease is diagnosed and treated in the modern Western world. The roles of physician, nurse, medical social worker, and patient are subjected to searching analysis. The modern hospital is viewed from the standpoint of social structure and from that of specialized subculture. Here the author has done a valuable job of synthesizing a vast and scattered literature. It is an important contribution to knowledge of a segment of our own culture, and it will undoubtedly be very useful in broadening the perspective of the health professional who will practice in this setting.

Life ia the W a r d . ROSELAUB COSER.East Lansing, Michigan: Michigan State University Press, 1962. xxxi, 182 pp., appendices, bibliography, 6 charts, indices, 23 tables. $7.50. Keviewed by STEWART E. PISRRY, Hurvard Ulziversity
Rose Laub Coser has brought a swift and discerning insight to her functional analysis of the life of patients and staff on the wards of a teaching and community hospital. This is a short book, modestly and clearly written, that will engross readers from Chapter I on. The author has a t least touched upon all the major features of the hospital ward as a social system-as it greets the eye of an attentive, intelligent observer. The book presents persuasively the social interlocking of patient, nurse, and doctor on their good and bad behavior in the context of the ward organization. The author fits her observations together with a deft sureness that is functional analysis a t a high level indeed. Illustrations, aptly selected from free observation on medical and surgical wards, are combined with analyses of coded interview responses, simple quantitative materials well presented. The study avoids that fault of so many analyses of interview materials today, that sense of data and categories manufactured, serried, and boxed for easy thoughtless consumption. Instead her constructions are few, basic, simple, and solid. They clearly evolve from the nature of the ward and its members in their social roles, illuminated by qualitative observations. I was especially interested in hospital-oriented patients vs. outside-oriented patients-an immediately persuasive grouping that arose from the answers given to such simple questions as What is your idea of a good doctor; a good patient; a good nurse? The classification takes on further meaning as we see that the hospital-

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oriented patient, while perhaps out-going and active on the ward, passively accepts and enjoys what the hospital offers, deriving primary gratification from his stay. He contrasts strongly with the other group of patients-who tend to be younger, who see the hospital in instrumental terms and want to get out quickly, who are apt to be surgical rather than medical patients, and who are much more productive of answers to a question, How do you think the ward could be improved? The relationships of members of these two groups to nurses and doctors can be seen in the context of the problems in thc interrelations of student doctors and harried nurses-a matter that the author deals with in detail. The study materials are organized in a naturalistic manner from the vantage point of the patient, who is of course the node of hospital activity. Thus there are, for example, chapters on admission, on the contradictions in the doctors role for the patients (Father and Student), on the role of the nurse (Mother or Career Girl), on fellow patients (Brothers and Strangers), and on problems of discharge. I n short, this book gives a swift once-over of ward life. That is not to say that it is superficial. I n fact, it will be suggestive and stimulating for those who are quite experienced in studying medical settings. Cosers book will be especially attractive as a competent introduction to the world of the hospital for those students who contemplate entering the growing field of social science in medical settings. However, there is one problem with the report that can make it almost misleading to the inexperienced student. That is, one does not gather how the author herself must have responded to the research scene. There is a curious sense of impersonal distance from it all. It is almost as if the whole, loaded experience of being an observer of the drama and anxiety of hospital life has been decanted out. The student ought to be warned that there is a severe culture shock for the observer in such settings just as much as for the observer of the exotic outside his own society. Moreover, an adequate evaluation of any observational study requires some assessment in depth of the way in which the observer has managed to live in the observational setting. When one has not insulated ones self by a wall of tests and questionnaires, one uses other means of defense but perhaps one is also more aware of why defenses are needed. Reporting these modes of adjustment is a responsibility that insightful observers like Coser should not avoid. Among other reasons, it can lead to a better understanding and a strengthening of the scientific essence of naturalistic investigative techniques in the face of increasing use of the easier, standardized research techniques like the questionnaire. There are other very minor limitations to this book: The Introduction makes the perhaps necessary obeisance to the literature, but it does not promise the high standard that the later chapters achieve. Also, a bit too much stress is put on percentage differences in some of the tables, considering the small Ns involved. But all such criticism aside, Cosers book will be esteeemed by students and experienced workers alike for its sure reportorial and analytical skill.

A Practice of Social Medicine: A South African Teams Experiences in Different African Communities. SIDNEY L. KARK and GUYW. STEUART (eds.) Edinburgh and London: E. & S. Livingstone Ltd., 1962. xii, 372 pp., figures, index, 20 plates, tables. 40s. Reviewed by ROBERT F. GRAY,Tulane University
The 24 chapters of this book, written by 16 different authors, deal with various aspects of a research-action program carried out by the Institute of Family and Community Health in seven communities of Natal. The project began over 20 years ago