The geography of famine

present and traces, somewhat tediously at times, the struggle of the medical profession in Victoria to control the supply of doctors, divisions within its ranks and competition from without the alternative practitioner (chemists, homoeopaths and opticians), Friendly Societies, and various attempts by the government to establish a national health scheme. Instrumental in the favourable outcome of this struggle was the rise of a strong medical trade union and the effective application and control of developments in medical science and technology. The resultant solidarity and authority of the profession is not only reflected in its enhanced socio-legal status and consequent economic and political power, but has so increased the distance between the practitioner and the public, and the doctors' control of the medical market, that today "what is in the best interests of the consumer is frequently determined by a profession which sees the public's welfare as synonymous with its own." (p. 179). Current reaction to this situation both within the profession (the Doctors' Reform Society) and without (recent legislation favouring chiropractors) suggests that the medical practitioner will need to continue the struggle to maintain his present position. Although these processes are common to the professionalization of European, freeenterprise medicine, there are certain Australian features which, while hinted at, bear further examination. One is the gradual dominance of the native-born and -trained doctor, aggressive in his growing independence of British, colonial medicine and in the adaptation of medical science to Australian conditions. Mr. Pensabene could have demonstrated more effectively that the present status of the medical practitioner has been achieved largely by capitalizing on a traditionally conservative profession functioning in a relatively isolated, materially prosperous but politically immature environment. Nevertheless, this timely monograph provides the data and arguments for some fruitful developments in both Australian and comparative medical history. Helen Woolcock Wellcome Institute