BMJ (Clinical Research Edition)
Pp. 302+xxi. 25s.) London: Oxford University Press. 1958. Although the risks of some of the major epidemic diseases were shared by all classes of society, it has always been fairly evident that people who were sick were frequently poor. It has not always been recognized that a considerable proportion of them were sick because they were poor. Until the nineteenth century it was possible to believe that those who were sick and poor were in some way intrinsically inferior, and that an improvement
... n their income would have little effect on their health, and perhaps only a temporary effect on their poverty. In preferring £5 which he would be happy to spend to £50 which he would be unhappy to save, Mr. Doolittle in Shaw's Pygmalion would have been regarded by some people as typical of a class for which little could be done in respect of health or wealth by public action. To-day no thoughtful person questions that social conditions have an immense influence on health. To a considerable extent this change in viewpoint is attributable to the careful reporting of observers from Mead to Rowntree, and in title and content A Survey of Social Conditions in England and Wales deserves to be regarded as the latest contribution to a distinguished series. The task of describing the social scene is, however, very different now from what it was in the eighteenth and nineteenth centuries. At that time so little was known that almost any carefully documented statement was bound to be of interest. To-day there are few facets of social life which are not either reflected in national statistics or described by some crass observer, and to be of value a new book must either give more information than is available elsewhere to the research worker or develop a theme which will catch the attention of the general reader. This one does neither of these things. It attempts what the authors describe modestly as " the pedestrian task " of presenting "a coherent picture of some of the more important aspects of social life in England and Wales so far as they can be illustrated by statistics." The result is that the statistics are too few for the one purpose and too many for the other. The point may be illustrated by the treatment of the sex ratio. The data are inadequate for the research worker, who would have to consult other sources; yet the discussion of this fascinating subject is not one which would hold the attention of the general reader not already interested in it. Moreover, the statement that "the excess of males over females must be greater at conception than at birth" ignores the fact that until there is more information about the sex of early abortions the ratio at conception must remain an open question. In relation to the broad theme of the book the treatment of the sex ratio is perhaps a small matter, but it illustrates the difficulties presented by a statistical approach to so large a subject. It should be said, however, that within the framework of its own intentions the book succeeds admirably. It is the intentions about which one is doubtful.