1398

Books

Mental Health and the Environment

Edited by Hugh L. Freeman, University of Manchester. Edinburgh:Churchill Livingstone. 1984. Pp 490. £40.

Dr Freeman, a leading figure in the field of social psychiatry (andalso Editor of the British Journal of Psychiatry) has edited a volumewhich is important, impressive, and heavy. It is not just anothercontribution to the current debate about community care vs hospitalcare for the mentally ill, and it is not the psychiatrist pontificatingfrom the blinkered safety of the consulting room about the evils ofsociety. It is a collection of essays, research reports, and overviewsby seventeen authors drawn from general practice, clinical andepidemiological psychiatry, criminology, sociology, geography,biology, and architecture and thereby providing a more varied menuthan usual.This book is mainly about the inner city. The pathogenic effects

of tower blocks-overcrowding; noise; loss of the neighbourhoodfamily; featureless architecture, commuter anomie; and otherfeatures of the modern megalopolis-are presented forcibly andwith the appropriate research references. The effect is powerful anddepressing; the conclusion-that large cities are uncivilised andmentally unhealthy places to live-seems inescapable. When welearn that in industrialised countries more than 70% of the

population are urban dwellers, and that developing countries arerapidly heading in the same direction, we are confronted by issueswhich we cannot ignore, either as clinicians or citizens. As with allmulti-author anthologies, there are variations in tone and depth aswe switch between the high-power microscope and the wide-anglecamera, but Freeman’s own introductory and linking chaptersprovide some continuity. Is mental illness actually more prevalentin cities? S. D. Webb’s chapter reviews the evidence thoroughly,and his verdict (surprisingly) is: not proven. The chapters by J. A.Giggs, K. Dean and H. James, D. R. Hannay, and others confirmthat there are certainly differences between different parts of cities,correlated with social and demographic factors. But illness statisticsare only one indicator of social disintegration: criminality is

another, and in that area the findings, well-presented by K.Wedmore and Freeman, are incontrovertible.There are some surprising omissions. The book may have been a

long time in preparation but even so one would have expected somereferences to Brixton or Toxteth; the impact of highunemployment; and the increasing dimension of race and racism.Migration, and the multicultural communities it produces, receivemuch less attention than they deserve. It must also be said that thebook is long on diagnosis but short on treatment. The Inner CityConsultations set up by the Archbishop of Canterbury are

published under the title The Fertile City (British Council ofChurches), and a touch of that optimism would have been welcomehere.Few people will wish to read this book from cover to cover, but as a

source book it is wide-ranging and authoritative, and shouldcertainly be in the libraries of medical schools and postgraduatetraining centres for both psychiatry and general practice.Lynfield Mount Hospital,Bradford PHILIP H. RACK

Surgical Approaches to Cutaneous MelanomaPrgnrent Cell Senes, vol 7. Edited by C. M Balch, MD Anderson Hospitaland Tumor Institute, Houston, Texas Basle: Karger. 1985. Pp 212. Swfr170; DM204;$72.50; ;C53.20.

MALIGNANT melanoma of the skin is increasing in incidence inthe UK as in many other countries. The appearance of this

comprehensive surgical text edited and contributed to byacknowledged experts is therefore timely. A review of the

management of melanoma-in-situ and biopsy techniques opens thebook; this is followed by sections on melanomas at differentanatomical sites and finally by chapters on special surgicaltechniques-isolated perfusion, surgical treatment of distant

metastases, and plastic and reconstructive aspects.

Separate descriptions with reference to the different anatomicalareas lead inevitably to some reduplication, since the same generalprinciples apply. The trend towards less wide excisionis a commontheme, for example. The question of elective lymph node dissectionremains unresolved, although Dr Balch’s own retrospective studiesin particular have defined subsets of patients for whom this seems toconfer benefit. Analysis of large retrospective series has certainlyprovided data which help the surgeon tailor treatment according tothe biological behaviour of the tumour as predicted by pathologicalstage.The major lymphadenectomies-groin, axilla, and neck-are

covered by three different authors and a fourth contributes a chapteron the complications of each. This is also reduplicative but

instructively so, since C. P. Karakousis, who discusses compli-cations, uses somewhat different technical approaches fromthe others. This gives the reader room for choice and reminds us thatdogma is dangerous.The techniques of isolated perfusion are fully described, although

the Groningen group again seem somewhat dogmatic in theirrecommendation of patients for these procedures. In defining theplace of surgery for distant metastases, Balch reminds us that reliefof symptoms is often achieved and occasionally unexpectedly longsurvival may follow in selected cases. S. Ariyan’s closing chapter onplastic and reconstructive surgery outlines useful procedures forflap-cover at various sites, but is it really necessary to describe indetail the technique ofsplit skin grafting to those surgeons likely tomake use of this volume?This book has the great merits of clarity and compactness. In spite

of its slimness, its authoritative content and ample bibliographymake it a valuable work of reference.

Department of Surgery,Royal Marsden Hospital,I,ondcn G. WESTBLRl’

Pediatric EndocrinologyA Clmrcal Gitide. Clinical Pediatrics, vol 3. Edited by F. Lifshitz, CornellUniversity Aledical College, New York. New York: Marcel Dekker, 1985.Pp 668.$95 (USA and Canada).$114 (all other countries)

THIS is the most recent volume in an American series designed tobring practising paediatricians up to date (the first two volumes areon Common Pediatric Disorders and Congenital Metabolic Diseases).The editor has assembled a team of distinguished Americanclinicians who contribute a series of review chapters on most aspectsof paediatric endocrinology. The first section covers growth, withcontributions on growth disorders, growth hormone therapy, thesomatomedins, psychosocial short stature, intrauterine growthretardation, and the fetal alcohol syndrome. The second sectionreviews disorders of puberty, gynaecomastia, adrenal disorders, andintersex states. The thyroid is the subject of the third section, withchapters on hypothyroidism, goitre, thyroid nodules, and thyroidcarcinoma in childhood and adolescence. The fourth and fifthsections discuss calcium disorders, diabetes, and hypoglycaemia,and the final chapters cover autoimmune endocrinopathies, guthormones, diabetes insipidus, and low-renin hypertension.

Pediatric Endocrinology is very readable. Most of the chapters areclearly written and give scholarly and reasonably up-to-date reviewsof a range of endocrine disorders of childhood and adolescence. I

specially enjoyed the accounts of somatomedins by Louis

Underwood, congenital adrenal hyperplasia by Maria New, anddiabetes by Alan Drash. Each chapter ends with a useful list ofreferences, but inevitably the most rapidly advancing fields receivelittle mention—eg, it looks as if the volume went to press before theavalanche of papers on the clinical effects of growth hormonereleasing hormone started.This is not a book to turn to for a quick answer on a clinical

problem-most of the chapters need to be read in entirety to be offull value. While it will be of interest to adult and paediatricendocrinologists, its main appeal will be to clinicians who wish torefresh their knowledge of endocrine disease in childhood.

Hospoal for Stck Chtldl tIl,Great Ormond Street,London D. B. GRANT