BOOK REVIEWS

to lack the means to permit this, the following options shouldbe considered:1. Upgrade the status of our major teaching institutions tothose of institutes of national importance and enhance thesalaries and perquisites of the staff members so that theyare at par with those at the All India Institute of MedicalSciences in New Delhi and the Postgraduate Institute ofMedical Education and Research in Chandigarh. Fundsfor this could be obtained from the University GrantsCommission and other sources.

2. These institutions should be granted a semi-autonomousstatus under the Municipal Corporation and the stategovernment respectively and be permitted to raise fundsfor their own needs to meet the demands of enhancedsalaries and purchase of equipment. The Deans should begranted full freedom to decide how funds are raised andspent.

Book Reviews

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3. All full-time staff members should be granted leave forone year after Jive years of service, during which theyshould be permitted to work abroad to make money. Thisis the practice at the All India Institute of Medical Sciences,New Delhi; the Postgraduate Institute of Medical Educa-tion and Research, Chandigarh; and the Christian MedicalCollege and Hospital, Vellore.

4. Immediate stop-gap arrangements to fill vacant postsshould be made by nation-wide advertisements.

5. Appoint retired teachers on contract. The feasibilityof this system has been shown by the Department ofAnatomy at the Seth G.S. Medical College, Bombaywhich gives contractual appointments to retiredteachers only when full-timers are not available.'

The present situation calls for urgent action.

S. K. PANDYA

Yamaraja's Brother. M. K. Mani. Bharatiya Vidya Bhavan,Bombay, 1989. 27~pp; Rs 85.

This book begins with a description of the learned antecedentsof the author who is a pioneer of Indian nephrology and theaccounts of his interactions with many notable personalitiesin south and north India are historically interesting. He facedmany difficulties during his early career in India whereas hisstay in Sydney, Australia provided him opportunities togreatly increase his knowledge and experience. There hecame into contact with persons who had greater academicresilience and were more cooperative than his colleagues inIndia. In spite of being asked to stay in Australia, he chose tocome back and introduce nephrology, a new specialty, intohis own country.On his return he again faced discouragement but eventually

succeeded in making a name for himself while working in thelaslok Hospital in Bombay. There he did not face the samedaily red-tapism that impeded his progress in state-runinstitutions.His well-known association with the late layaprakash

Narayan has been interestingly presented and will be usefulin filling gaps in the biographies of that great politician andhumanist.It is charming of the author to have recognized that Rama,

his charming and erudite wife was his intellectual superior.In our male-dominated society this is a rare gesture.This book will interest Dr Mani's friends and colleagues,

his former patients, as well as aspiring nephrologists andmedical historians.

ASOKE K. BAGCHIBidhandan

CalcuttaWest Bengal

Child Mental Health in India. Savita Malhotra, Anil Malhotraand Vijoy K. Varma (eds). Macmillan India Limited,New Delhi, 1992. 232pp, Rs 275.

This ambitious and interesting book attempts to survey theentire scene of children's mental health in India today.Further, it offers recommendations for improving the sorrystate of affairs for India's children; recommendations whichare sensitive to Indian cultural values, but are also foundedon current world psychiatric knowledge.As noted by one of the contributors, child mental health

service development in India has not kept pace with otherdevelopments in general health and education.This book arose from a national workshop on 'Child

Mental Health: Needs and Priorities', held in November1988, organized by the Department of Psychiatry, Post-graduate Institute of Medical Education and Research,Chandigarh. The participants were experts from all aspectsof child mental health in India and 19 of them contributedchapters to this report. Because of the delay in publishing,nearly all the presentations have had to be revised in orderto make this book more up-to-date.Given the fact that 40 per cent of India's population con-

sists of children, one need hardly make an argument forconsidering them, if the future of the country is of concern.Nevertheless, malnutrition is high, literacy low, and govern-ment spending on education and social programmes forchildren's development has been decreasing in recent years.Evidence is gathered to support the contention that withoutthe facilitating effects of adequate child mental health,attention to children's health, educational and social needswill not be well utilized.In addition to the chapters on child psychiatry training and

practice, there are chapters on policies that affect children;

244

on research; on treatment; on high-risk children; on schoolmental health. There are interesting chapters on tempera-mental differences in children by Savita Malhotra and onchild development from an Indian perspective by DwarkaPershad and Adarsh Kohli.The book concludes with 18straightforward recommenda-

tions. These not only stress the need to support training inchild psychiatry, but also the development of trainingcentres, support of interdisciplinary work and, ultimately,the development of a professional body to support this work. .The recommendations go further; they also urge integrationof child psychiatry with the general health and educationalservices. They posit the importance of mental health profes-sionals educating parents about their children and how theydevelop, noting that better child rearing practices couldimprove developmental and even nutritional outcomes,without great investment of financial resources.The book is well written, carefully edited and printed in a

clear, easy-to-read format. Anyone interested in children inIndia, working in education, health or social services woulddo well to become familiar with this book. It will serve as auseful resource as well as a guide book for the integration ofall support systems and services to children and theirfamilies.

BERT PEPPERThe Information Exchange Inc.

New City, New YorkUSA

Social Stress and Mental Health: A Social-Psychiatric FieldStudy of Calcutta. Ajita Chakraborty. Sage Publications,New Delhi, 1990.200pp, Rs 195.

This book is based on the findings of a large mental healthsurvey conducted in Calcutta in the late 1970s. A stratifiedrandom sample of 13235 individuals, taken from the totalpopulation of the Calcutta Metropolitan District was studiedwith the help of structured questionnaires to detect thepresence of psychiatric symptoms and abnormal behaviourpatterns. The positive symptoms elicited were groupedtogether to generate 'potential diagnoses'. These were corre-lated with social and demographic variables. The findings ofthe survey included a relatively high rate of neuroses and alow rate of psychoses. The author has attempted to correlatethese findings with the high level of social stress prevailingin present-day Bengal.There are six chapters arranged in the pattern of an

original research monograph. They include an introduction,the methodology and results of the field survey, a discussionon the mental health of families and special groups and endswith conclusions. The appendices provide the structuredinterviewschedulesused inthe studyand data on their validity.A list of about 150references and a combined author-subjectindex are also given. An addendum describes another originalstudy in the same general area conducted in Calcutta, by adifferent author.The book claims to correlate social stress consequent

to industrialization and urbanization with mental healthproblems. It even goes to the extent of joining the debate onthe desirability or otherwise of technological development in

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 6, NO.5, 1993

the Third World. However, the results are confined topsychiatric symptoms in a community and cannot directlylead to such inferences. No independent measure of theextent and nature of social stress and mental health havingbeen studied, the relationship between stress and mentalhealth remains, at best, speculative. Even the basic resultsof the survey are open to criticism in view of a number ofmethodological limitations, especially while convertingsymptoms into 'potential diagnoses'. The differences inprevalence rates of these between the Bengali and non-Bengali subjects may perhaps have been partly due tolanguage artefacts.This book exemplifies the problems of publishing theresults of original scientific research without it undergoingthe process of peer review. This interesting study should havebeen assessed critically by psychiatrists, psychologists andpublic health personnel before publication. My opinion,for what it is worth, is that the results do not provide anyscientific evidence relating social stress to mental health.The general appearance of this hard cover book is satisfac-

tory and there are very few printing errors ..But the priceseems inordinately high for such a slimvolume.

SHEKHAR SAXENADepartment of Psychiatry

All India Institute of Medical SciencesNew Delhi

Aging and Heart Care. H. S. Wasir (ed). Vikas PublishingHouse, New Delhi, 1993.436pp; Rs 450.

Since the Vedic Indians yearned to live for a hundred years'sound in body and mind' , growing old with grace has been ahuman obsession. The successful prevention and treatmentof illnesses that caused many deaths in the past have nowraised the percentage of India's senior citizens over the ageof 60 years to 6.5 which, in absolute numbers, accounted for45 million people in the 1980s.As the ageing process affectsthe cardiovascular system which is no less susceptible todisease than others, Professor Wasir's latest book is oftopical interest.In the 26 chapters of this book, expert contributors have

dealt with a varietyof subjects.Part I openswithan overviewofthe problems of heart care for the elderly by Padmavati andstraightaway plunges into the mechanisms of ageing todistinguish age-related decrements in cardiovascular functionfrom cardiovascular diseases of the elderly which constitutePart II of the book. Quoting the classicwork of Hayflick onthe limited in vitro life of human diploid cells, Bijlani andPuri have discussed the physiology of ageing in a succinctaccount of the current theories and the age-relatedphysiological changes in the cardiovascular system. Thistheme continues in the chapters on the biochemical andmolecular correlates of ageing which may, however, be ofgreater interest to specialists in gerontology. The effect offree radicals.on ageing is discussed in a chapter by Kothariand Wasir, indicating the growing popularity of this theorywhich postulates that ageing is a consequence of the damageto macromolecules and the peroxidation of membrane lipidsby the action of free radicals. The. morphological andbiomechanical changes in the myocardium, aorta, valves,conduction system and arteries which are variations of the

BOOK REVIEWS

general theme of degeneration are graphically describedby Wasir and Sanghvi who also draw attention to the haemo-dynamic phenomena of ageing such as declining strokevolume and rate, drop in cardiac flow velocities and progres-sive reduction in plasma renin. activity. Even though theclaim that 'the aged are the nation's precious asset' is arguable,Vinod Kumar's paper on the health problems of the elderlyis remarkable for its many references to Indian literature andthe breadth of its coverage.Part II deals with cardiovascular problems and their

management in the elderly. Following a review of theepidemiology and magnitude of ischaemic heart disease,hypertension, car.diomyopathies, valvular heart disease,arrhythmias and cor pulmonale, Chaudhury and Wahi haveoffered sound suggestions on the delivery of comprehensivehealth care to the elderly by its integration with primaryhealth care in the community. Manolio and Yusuf completethe epidemiological story by supplying detailed informationon the status of coronary artery disease in the elderly inthe USA and emphasizing its essential similarity with thedisease in the younger age groups. Seth has inserted a noteof caution on the use of drug treatment because of the alteredpharmacokinetics in old age. A chapter discussing mitral andaortic valvular disease clearly shows that valve replacementcan be carried out with an acceptable mortality and thatballoon valvoplasty has a role in selected patients. In themanagement of ischaemic heart disease, Bhatia favours theuse of thrombolytic therapy for acute myocardial infarctionand reports good results with coronary angioplasty in a smallseries of 34 patients above 65 years which corresponds to theexperience at the All India Institute of Medical Sciences(AIIMS) where short-term results of percutaneous trans-luminal angioplasty (PTCA) in the elderly were no differentfrom those in younger patients. Of the results. of coronaryartery· bypass surgery reported from the AIIMS and theEscorts Heart Institute, the Escorts data contain more detailsand confirm that the surgical procedure can be carried outwith an operative mortality as low as 5.6% and a betterquality of life after the procedure.The question whether the age-related rise of blood pressure

in adults is a physiological process or whether it is apathophysiological phenomenon is examined by Reddy et al.in an erudite paper which gives reasons to hope that age-related hypertension is fully preventible or at least in part. Ina 'complementary chapter on isolated systolic hypertension,Celis et al. refer to a clinical trial in the USA which provedthat significant reductions in stroke, non-fatal myocardialinfarction and left ventricular failure could be achieved withdrug treatment which did not however reduce the incidenceof fatal stroke or total cardiovascular mortality. Whilethe approach of Talwar and Wasir to the management ofarrhythmias has practical merit, one is less confident of thevalidity of the observations of Jain and Wasir On hyper-cholesterolaemia in the elderly because the data they haverelied upon relate entirely to western populations. Themanagement of congestive heart failure and peripheralarterial disease which are common clinical syndromes in theelderly are competently discussed by other authors. In thepenultimate chapter Kothari and Wasir deal at length withthe risk factors and preventive measures In ischaemic heart

245

disease and Wasir concludes with a philosophical essay,brightened by quotations from Charaka.A drawback of multi-author presentations is the many

repetitions and this is true in this book especially in thechapters on epidemiological and clinical aspects includingmanagement. Similarly the quality of the papers varies froma 6-page, crisp account of arrhythmias to a 34-page discourseon atrial fibrillation with 133 references, many of which haveonly a partial relevance to ageing. These defects do not how-ever detract from the interest of this highly informative andreadable publication on a subject of growing importance.

M. s. VALlATHANSree Chitra Tirunal Institute of Medical Sciences

and TechnologyThiruvananthapuram

Kerala

Modern Concepts in Surgery. S. K. Srivastava (ed). TataMcGraw-Hill Publishing Company Limited, New Delhi,1992. 485pp; Rs 360.

As a young surgeon the Editor of this book was disillusionedthat most textbooks on surgery originated from westerncountries. He has, therefore, tried to present material whichis relevant and up-to-date in a precise and practical mannerto help young surgeons who work with limited resources.There are 21 Indian and 26 foreign contributors, each one ofwhom is a master of his chosen field. This is reflected in thequality of the book as well as the clarity and accuracy of thetext. There are important introductory chapters on ImagingTechniques, Endoscopy and Total Parenteral Nutrition. Thechapters on Trauma, Male Infertility, Breast, Oncology,Surgery in Infancy and Childhood, Plastic and Reconstruc-tive Surgery, and Gynaecology for Surgeons are of practicalvalue and commendable quality.However, there are times when the aims of the Editor

seem to have gone a little askew. It was disheartening tonote that while open cholecystectomy, percutaneouscholecystostomy, dissolution therapy, percutaneouscholecystostomy with contact dissolution and cholecystec-tomy with the use of hydro-lithotripsy and laser fragmentationare discussed in fair detail, the terms laparoscopic chole-cystectomy or mini-laparotomy cholecystectomy are noteven mentioned. Unfortunately, one seldom comes acrossmatter which is of specific relevance to surgeons in develop-ing countries. An awareness of what is being performed andwhat can actually be performed in this country might helpyoung surgeons make rational decisions on appropriatemanagement.Printed and illustrated excellently, the book makes easy

and inforniative reading and by and large will serve as ahelpful, concise companion to the young surgeon and topostgraduate students.

T. E. UDWADlACook's Building

D. Naoroji RoadBombay

Maharashtra