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12 6 I meric u I Irlhropologisl [6S 963I)rt\veen natural i ind supernatural causation are creatures of the rcal worlclrather than categories of our own culture. Throughout the section on primitivemedicine, the implication is tha t it is all false, truth being found only in scien-tific medicine. One of the explicit aims of the book is to convince medical studentsth at social factors are important in the etiology and the treatment of disease. In thepractice of his primitive medicine the shaman often diagnoses illness in a frameworkthat includes the assumption tha t disturbed social relationships can make people sick.And the anthropological literature affords abundant documentation for the contentionthat the primitive medicine man can often make patients well by repairing thesedisturbed social relationships. The idea tha t breach of taboo may cause disease is pre-sented as an interesting idea that has been outmoded by scientific medicine, and yetthe work of Srole and his colleagues in the Midtown study has demonstrated thatalienation from the basic values of ones culture increases the risk of developing mentalillness in contemporary Manhattan. It is certainly true that primitive medicine hasmuch to learn from scientific medicine, bu t it may also be true tha t many primitivemedical systems have long recognized the importance of the very psychic, social, andcultural 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 whichdisease is diagnosed and treated in the modern Western world. The roles of physician,nurse, medical social worker, and patient are subjected to searching analysis. Themodern hospital is viewed from the standpoint of social structure and from that ofspecialized subculture. Here the author has done a valuable job of synthesizing a vastand scattered literature. It is an important contribution to knowledge of a segment ofour own culture, and it will undoubtedly be very useful in broadening the perspectiveof the health professional who will practice in this setting.L i f e i the W a r d ROSELAUB COSER.East Lansing, Michigan: Michigan State Uni-versity Press, 1962. xxxi, 82 pp., appendices, bibliography, 6 charts, indices, 23tables. 7.50.

Keviewed by STEWART. PISRRYurvard UlziversityRose Laub Coser has brought a swift and discerning insight to her functional anal-ysis 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 thehospital ward as a social system-as it greets the eye of an attentive, intelligent ob-server. The book presents persuasively the social interlocking of patient, nurse, anddoctor 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 functionalanalysis at a high level indeed. Illustrations, aptly selected from free observation onmedical and surgical wards, are combined with analyses of coded interview responses,simple quantitative materials well presented. The study avoids that fault of so manyanalyses of interview materials today, that sense of data and categories manufactured,serried, and boxed for easy thoughtless consumption. Instead her constructions arefew, basic, simple, and solid. They clearly evolve from the nature of the ward and itsmembers in their social roles, illuminated by qualitative observations.I was especially interested in hospital-oriented patients vs. outside-orientedpatients-an immediately persuasive grouping that arose from the answers given tosuch simple questions as What is your idea of a good doctor; a good patient; a goodnurse? The classification takes on further meaning as we see that the hospital-

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Rook Reviews 1207oriented patient, while perhaps out-going and active on the ward, passively acceptsand enjoys what the hospital offers, deriving primary gratification from his stay. Hecontrasts strongly with the other group of patients-who tend to be younger, who seethe hospital in instrumental terms and want to get out quickly, who are apt to besurgical rather than medical patients, and who are much more productive of answersto a question, How do you think the ward could be improved? The relationships ofmembers of these two groups to nurses and doctors can be seen in the context of theproblems in thc interrelations of student doctors and harried nurses-a mat ter tha tthe author deals with in detail.The study materials are organized in a naturalistic manner from the vantage pointof the patient, who is of course the node of hospital activity. Thus there are, for ex-ample, chapters on admission, on the contradictions in the doctors role for the patientsFather and Student), on the role of the nurse Mother or Career Girl), on fellowpatients Brothers and Strangers), and on problems of discharge. In short, this bookgives a swift once-over of ward life. That is not to say t ha t i t is superficial. In fact, itwill be suggestive and stimulating for those who are quite experienced in studying med-ical settings.Cosers book will be especially att ractive as a competent introduction to the worldof the hospital for those students who contemplate entering the growing field of socialscience in medical settings. However, there is one problem with the report that canmake it almost misleading to the inexperienced student. That is, one does not gatherhow the author herself must have responded to the research scene. There is a curioussense of impersonal distance from i t all. It is almost as if the whole, loaded experienceof 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 observerin 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 assessmentin depth of the way in which the observer has managed to live in the observationalsetting. When one has not insulated ones self by a wall of tests and questionnaires, oneuses other means of defense but perhaps one is also more aware of why defenses areneeded. Reporting these modes of adjustment is a responsibility that insightful ob-servers like Coser should not avoid. Among other reasons, it can lead to a betterunderstanding and a strengthening of the scientific essence of naturalistic investigativetechniques in the face of increasing use of the easier, standardized research techniqueslike the questionnaire.There are other very minor limitations to this book: The Introduction makes theperhaps necessary obeisance to the literature, but i t does no t promise the high standardthat the later chapters achieve. Also, a bit too much stress is put on percentage differ-ences in some of the tables, considering the small Ns involved. But all such criticismaside, Cosers book will be esteeemed by students and experienced workers alike for itssure reportorial and analytical skill.A Practice of Social Medicine: A South Afric an Tea ms Experiences i n Different African

Communities SIDNEY . KARK nd GUYW. STEUARTeds.) Edinburgh and London:E. S Livingstone Ltd., 1962. xii, 372 pp., figures, index, 20 plates, tables. 40s.Reviewed by ROBERTF. GRAY,Tulane University

The 24 chapters of this book, written by 16 different authors, deal with variousaspects of a research-action program carried out by the Institu te of Family and Com-munity Health in seven communities of Natal. The project began over 20 years ago