Endangered lives. Public health in Victorian Britain

somewhat tempted to put in a word for the swine. Of course, William Pickles's classic on Epidemiology in country practice is readily available in medical libraries; but I suspect that Lord Moynihan's Truants is not, and Ruth Holland's collection of Richard Asher's writings is certainly not thus available. I hope that after a decent interval, A sense of Asher will be reprinted, possibly even as a paperback, for it is both excellent in itself, and an admirable complement to Richard Asher talking sense, the selection made by Sir Francis Avery Jones. The three first volumes were reviewed at some length in the British Medical Journal of 3 December 1983; and the contents of each of them are there clearly delineated. Perhaps I can depart still further from formality, and simply give my own personal reaction to each of them. The copies of Pickles's book which I have come across previously have tended to be rather well-worn; and it was an added pleasure to have it in one's hands in superb mint condition. And re-reading it, I was again aware of the quality of the man who more than anyone else brought a new dimension into family practice, by exploiting the advantages of his long spell in the same practice for making real advances in epidemiology. These are not advantages to be found in the practices of inner cities; yet over the years there have been many rural doctors, but few with the vision and pertinacity of William Pickles, let alone the faithful recording of his observations made by his wife and daughter. There is more than a hint in Michael Harmer's introduction to the book by Moynihan that this is not what a tutor would call "his best work"; and this Linacre Lecture of his is indeed compared unfavourably, and in so many words, with his Romanes Lecture. The construction of his list of truants is as random as the Madamina aria in Don Giovanni but lacks Mozart's music. There are, of course, good things in it, and his account of the rather pointless discussions whether medicine is a science or an art brings forth a sentence which could not be bettered: "The quarrel whether medicine is science or art has not yet quite subsided, nor will it be silenced until men recognize that medicine has contact with both: with science in its enquiries, with art in its practice". But to deal with over eighty "truants" in sixty-seven pages implies a certain superficiality; and his paragraph on Conan Doyle does not mention Sherlock Holmes, which must set something of a record in omission. I don't think it is only my physician's bias which makes me give the preference to the Richard Asher collection. There is an admirable preface, and the richness of the store is shown by the excellence of this collection of gleanings, after the classics on the dangers of going to bed, Munchausen's syndrome, and straight and crooked thinking in medicine have been pre-empted. Richard Asher took great pains with his writing; and then went on to take the additional trouble which is needed to conceal the previous labour. And how much the reader benefits. It would not be fair, though more than tempting, to quote from the book reviews or the "Asherisms"; but what about the onomatopoeia in this description of a somewhat untranquil maternity block "In its capacious and hygienic spaces each sound echoes and re-echoes so that the cacophany of crockery blends with the banging of doors, and the mewling and puking of the babies is drowned by the jangle of wrangling bedpans." This last phrase does not make much sense, untess "wrangling" is a transferred epithet to the utensils from those who handle them. In another context, the whole passage might be thought excessive but in its own context, a chapter on noise, I think it succeeds. Sir Douglas Black Wellcome Institute