A Mono- graph from the Department of Com- munity Medicine, St. Thomas's Hos- ... Holland describes the effects of chang- ing patterns of ageing, morbidity and.
BOOK REVIEWS
Health Services Planning. A Monograph from the Department of Community Medicine, St. Thomas's Hospital, London, England. Edited by Karen Dunnell. 55 pp. King Edward's Hospital Fund for London; Pitman Medical Publishing Co. Ltd., New York, 1976. $6.24, paperbound This book is a model of brevity. It defines planning parameters and identifies issues but does not tell the expectant planner "how to". This seeming shortcoming is, in reality, the book's major strength. The initial chapter by Dunnell and Holland describes the effects of changing patterns of ageing, morbidity and universal insurance on the need, demand and use of health care services. However, the ways in which resources are deployed to meet these needs and demands have become political decisions under universal insurance. Florey and Weddell describe the epidemiologist's contribution to planning by showing how the epidemiologic method has been used to deal with health care and chronic illness problems in recent years in the same way in which it dealt with infectious diseases earlier. They cite the recent study that, using a randomized clinical trial, revealed the failure of multiphasic screening to reduce mortality in two general practices in London, England - although it did sharply increase utilization. Creese examines the spectrum of economic thought that has been applied to health care: a pure marketplace approach, limited government intervention to correct problems the market cannot solve (medicare for those 65 and older in the United States) and complete removal from the marketplace with government control. The pure government model characterizes the English and Canadian national health systems. Creese also describes the use of cost-effectiveness studies to compare costs and outcomes of different ways of using resources and the use of cost: benefit studies to make choices between programs or population groups under conditions of scar-
city. However, he makes it clear that "the economist cannot make the decisions nor eliminate the element of judgement from planning decisions. He can only widen the planner's information base, to take some account of the value-for-money implications of decislons Owen and Holland identify the uneasy relationship between research and administration. Administrators, like clinicians, they state, must realize that a new service or program does not guarantee better results. Despite its importance, health services research and program evaluation account for only 0.4% of the total National Health Services budget. Obviously in England, as in Canada, the operating costs are so great that only a few pounds or dollars remain after the service bills are paid. Although this is a thin book, there is much meat on its spare frame. It can be recommended as an excellent introduction to health planning concepts, issues and the people involved. EUGENE VAYDA, MD Professor and chairman Department of health administration Faculty of medicine University of Toronto Toronto, Ont.
Lacrimal Disorders: Diagnosis and Treatment. Edited by Everett R. Viers. 179 pp. IlIust. The C.V. Mosby Company, St. Louis, 1976. $25.75 Viers, a leading authority on diseases of the nasolacrimal system, has compiled a successful book reviewing the common disorders of the system, and offering practical methods for their diagnosis and treatment. Its brevity is both an advantage and a shortcoming. The book could be easily read in an evening or two, and presents to the reader the methods of management that the author has found successful over many years of practice. Alternative methods of management, however, are described briefly, or simply mentioned in passing. The chapters on the anatomy and physiology of the lacrimal system are
succinct and well illustrated, stressing the relationship of various important structures to surgical anatomy. There is an excellent chapter on congenital abnormalities of the nasolacrimal system in children; advice is given on the management of these children and possible complications are discussed. No mention is made, however, of the nasolacrimal intubation technique using polyethylene tubing as recommended by Quickert. An entire chapter is devoted to dacryocystography, including its indications and possible place in the diagnosis of nasolacrimal disease; it includes a description of the newer technetium99m lacrimal scan. The indications for and possible pitfalls of external dacryocystorhinostomy are well covered, special emphasis being given to a thorough knowledge of the surgical anatomy as a prime method of avoiding complications. Traumatic and reconstructive surgery of the canaliculi and sac are discussed at some length, the author describing his success in this respect over the years. The book would be beyond the scope of the average family practitioner, but it would be of much interest to residents and practitioners in the field of ophthalmology. I recommend its inclusion in the library of ophthalmologists interested in the primary care of the nasolacrimal system. WILLIAM N. CLARKE, MD, FRcs[c] 267 O'Connor St. Ottawa, Ont.
Nuclear Medicine and Ultrasound. (A Seminars in Nuclear Medicine Reprint, October 1975.) Edited by Leonard M. Freeman and M. Donald Blaufox. 169 pp. lIlust. Grune & Stratton, Inc., New York; Longman Canada Limited, Don Mills, 1976. $15.50 This inexpensive monograph is of value in helping one keep a sense of perspective as to how the branches of radiologic science - disciplines such as nuclear medicine and ultrasono-
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