The Spiral After-Effect

fhis little book by two London paediatricians paints a picture of the state of dhild health in Britain to-day which is probably as accurate a representation as is possible from one viewpoint. Inevitably it has a London bias and some of the ills of paediatrics described are peculiar to the meitropolis, being avoided by better management in the great regional centres. Nevertheless, most of the authors' credo will be acceptable as their own to paedi'aLricians throughout the country. In looking to the future, the sights are set high-perhaps unrealistically high-4but they give the thoughtful paediatrician a glimpse of a paediatric Utopia to aim at. In the opening chapters, the nature and problems of child health are described, and if the claims made for paediatrics and paediatricians are at times inflated, they are exaggerated for the sake of emphasis. In comparing paediatric attitudes with those of general medicine, however, the authors do less than justice to the development of social medicine. They seem to forget that, whereas the academic Department of Child Health comprises both hospital and social paediatrics, these two aspects of medicine are represented in most medical schools by two separate Departments-Medicine and Social Medicine. While the former may be preoccupied with hospital medicine, the latter shares with Child Health a broad interest in community and preventive medicine. The authors go on to describe the work of the general practitioner in paediatrics, of the hospitalbased paediatrician, and of the preventive services for children. Current thought about theories and practice of child care in hospital receives detailed consideration and a short survey is made of paediatric research in progress and needed. A chiapter on administration deals concisely wiith the organization of health services for children in England. The chapter on education is perhaps least satisfactory, but it could hardly be expected that teachers in a London hospital could adequately present the ferment of new ideas and the variety of experiments in undergraduate teaching centres in other parts of the country. Many of the innovations suggested are standard practice elsewihere and it is doubtful if it is true of many medical schools outside London that "most students first hear about percentiles and standard deviations during their paediatric appointment". Nevertheless, it must not be forgotten that half the undergraduate medical schools in the country are in the south-east and that none has a dhair of Child Health, so that there is justification for emphasizing the lowest prevailing standards, at the risk of giving a misleading impression of Britisth paediatrics as a whole. This is not to say that all is well elsewhere far from it. As Joseph and Mac Keith point out, what paediatrics is and does-let alone what it could do-are unknown to many, even in the medical profession. There is too little collaboration and co-operation between the many services concerned with children, and too little understanding of the needs of children by the boards and committees which decide policy and make plans. Many exjcellent recommendations are made by the authors, but it is to be feared that too few will be implemented, at least in the forseeable future. If every administrative officer and board chairman would "read, learn and inwardly digest" this book, the children of to-morrow might be better served than they are to-day, or indeed are likely to be as things are developing in some areas. Perhaps the least encouraging aspect of the future of Child Health in this country is the dearth of young paediatricians with a thorough grounding and real interest in the aims and outlooks of social and preventive paediatrics. Too many of ithose in training are intent on being hospital doctors for children and it is doubtful whether, if given more time to acquire wider understanding of child life as recommended by Joseph and Mac Keith, they would use it in this way. The suggested recruitment of senlior medical registrars to paediatrics may help to make up the deficit in numbers but will not improve the qual,ity. Perhaps if all students, undergraduate and postgraduate, could be persuaded to read this book, they might succumb to the fascination of the study of Child Health, and learn that it is a university discipline of wide social and academ,ic significance as well as a life's work of absorb'ing interest.