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- I meric uii .I Irlhropologisl
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 one’s 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-
who are apt to be surgical rather than medical patients. chapters on admission. But all such criticism aside. loaded experience of being an observer of the drama and anxiety of hospital life has been decanted out. STEUART (eds. & S. Moreover.) Edinburgh and London: E. Among other reasons. 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. one does not gather how the author herself must have responded to the research scene. SIDNEY L. That is not to say that it is superficial. Reviewed by ROBERT F. and on problems of discharge. deal with various aspects of a research-action program carried out by the Institute of Family and Community Health in seven communities of Natal. “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. while perhaps out-going and active on the ward. However. 1962. Thus there are. Livingstone Ltd. 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. I n short. KARK and GUYW. 372 pp. deriving primary gratification from his stay. who see the hospital in instrumental terms and want to get out quickly. index. Coser’s 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. one uses other means of defense but perhaps one is also more aware of why defenses are needed. 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. on the role of the nurse (“Mother or Career Girl”). There is a curious sense of impersonal distance from it all. I n fact. considering the small N’s involved. That is. passively accepts and enjoys what the hospital offers. a bit too much stress is put on percentage differences in some of the tables. on fellow patients (“Brothers and Strangers”). 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. Reporting these modes of adjustment is a responsibility that insightful observers like Coser should not avoid. Also. He contrasts strongly with the other group of patients-who tend to be younger.. The project began over 20 years ago . but it does not promise the high standard that the later chapters achieve. 20 plates. and who are much more productive of answers to a question. A Practice of Social Medicine: A South African Team’s Experiences in Different African Communities. It is almost as if the whole. 40s.Tulane University The 24 chapters of this book. tables. written by 16 different authors.Rook Reviews 1207 oriented patient. The study materials are organized in a naturalistic manner from the vantage point of the patient. this book gives a swift once-over of ward life. on the contradictions in the doctor’s role for the patients (“Father and Student”). it will be suggestive and stimulating for those who are quite experienced in studying medical settings. xii. there is one problem with the report that can make it almost misleading to the inexperienced student.. When one has not insulated one’s self by a wall of tests and questionnaires. for example. GRAY. figures. who is of course the node of hospital activity. Coser’s book will be esteeemed by students and experienced workers alike for its sure reportorial and analytical skill.
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