1586 Book Reviews

Still, this is a most important movement and advance in health care. I challenge Dr Dubois and other authors not only to sing the well-deserved praises which he tunes in this book, but to offer to the hospice movement his critical perception and voice. Only such candid and honest evalu- ation can assist the hospice movement to reach real, achiev- able, mature goals in the coming years of upheaval within the American health care system.

Temple University School of Medicine

Philadelphia. PA, U.S.A. Formerly St Christopher’s Hospice London, England

JOHN E. FRYER

Running Hot: Structure and Stress in Ambulance Work, by DONALD L. METZ. ABT Books, Cambridge, MA, 1981. 237 pp. 316.95

Don Metz is a participant observer. and Running Hot is a report and analysis of his extensive (seven years) research on emergency ambulance work, two years of which he w’orked as an ambulance attendant. Participant observation is not the dominant mode of social science research these days. Observational research requires long hours away from comfortable university settings and social skills to interact with a wide range of individuals. The goal of this style of research is for the observer to get close to the phenomena of research interest, to develop personal ties involving trust with those in the setting, and from this to formulate research analysis which remains true to the observational facts and the perspectives of the participants. The pay-off for this kind of research is usually high in terms of insight and rich detail. The costs involvequestions raised about the represen- tativeness of the findings. The famous University of Chicago sociologist Robert Park thought all budding scientists should spend some time in the field to “get the seat of their pants dirty”. But most prefer the relative comfort and quiescence of the university setting.

Don Metz got the seat of his pants dirty. He studied urban private ambulance companies, although most of his own experience is with one company. The research examined the occupational subculture of the emergency ambulance technicians (EMT), their backgrounds, perspectives, ex- pectations, and feelings about their work. These “blue collar professionals” are dedicated, but marginal to the related medical professions. The stressful nature of their work, combined with low inter-occupational mobility, leads to the well-known high turnover rates among ambulance company employees. This of course reduces the quality of the medical care provided by EMTs. It is the singular achievement of the research done by Don Metz that he is able to articulate the complex relations between occupa- tional structure, intraoccupational relationships, personal expectations, daily stress and the ultimate impact of all these on the quality of medical care provided by emergency ambulance services. His conclusion is straight- forward: EMT work can be done well only when supported by all other parts of the system, and at the moment this is rarely found. Metz calls for a re-evaluation of emergency medical care.

Running Hot is an exceptionally well done piece of ethnographic research, and gives the reader a deep sense of EMT work and its daily stresses. The book addresses policy and ethical questions relating to emergency ambulance service. In a reflective and provocative conclusion, Metz raises the possibility that our provision of emergency ambulance services unwittingly creates the need for more of them, in that the availability of emergency medical care may lead some individuals to increase their risk-taking behavior.

While much of the Metz research is exploratory in an

empirical sense, his observations and reflections on policy and ethical questions are very advanced. This book is must reading for ail those interested in the complexities of emergency medical care.

Center for the Study Sj’Justice JOHN M. JOHNSON Ari-ona State Universitv Teipe. AZ, U.S.A. .

Alcohol and the Family, edited by JIM ORFORD and JUDITH HARWIN. St Martin’s Press. New York. 1982.295 pp. $29.95

As a contribution to understanding alcohol problems in the real world this book is very welcome. Presumably the disease concept of alcoholism was a necessary step towards the more comprehensive and functional understanding of alcohol problems, which is now emerging. The textbook preoccupation with the classical symptoms of chronic alco- holism and pictures of grotesque livers had little relevance to actually dealing with this very large scale and serious socio-medical problem. For the last decade there has been an increasing tide of contributions showing that excessive drinking cannot be understood, or effectively counteracted. in biochemical disease terms; that the scope has to be widened to include at least biochemistry, individual be- haviour, the domestic social situation and the socio- economic and legal context. This book deals with the person and the family, in social context. It is not a textbook telling us just how to go back to our clinics to deal with whole families of alcoholics. It makes clear that we do not yet have proven methods which can be so advocated. This book explores the boundaries of its particular field, fmding them to be alarmingly wide and it summarizes much of what we know within it. which is considerable.

There are twelve chapters, covering family interactions with alcohol in terms of history, literature, social influences, genetic and social transmission, sex roles, spouses, family systems, children, family law, services for families, treatment approaches and prevention. There is a closing overview chapter by the editors. The chapters are all well researched, clearly and concisely written. The authors of chapters are American and British. Where an author is covering an area involving factors pecuiiar to one country, e.g. the law. the chapter refers specifically to one country only, although the principles of the argument are universally relevant.

The opening chapters on alcohol and the family in history and in literature are particularly illuminating. _Unfortu- nately; the insight they show is not always maintained in some subsequent chapters. Thus the variability in what a “family” consists of, in different contemporary cultures, is scarcely explored. The economic aspect is also rather neglected. The pressures of poverty or affluence surely interact with different family structures and with varying cultural drinking practices, to give rise to the diverse sorts of drinking problems that we observe.

Taken as a whole this is an excellent book. Its pages are well packed with sound information and careful argument. It leads us towards an adequently sophisticated under- standing of alcohol problems in Western society and I thoroughly recommend it.

Department of Psychology University of Birmingham England

HUGH NORRIS

Health Care in East Africa: Illness Behaviour of the Eastern Oromo in Hararghe (Ethiopia), by W. F. L. BUSCHKENS and L. J. SLIKKERVEER. Van Gorcum, Assen, The Nether- lands. 1982. 142 pp. Dfl24.50

One third of Ethiopia’s 34 million people are Oromo (also known as the Galla), living mainly in the southern and