Review

Too few hands on today’s pumps

The Epidemiological Imagination
Edited by John Ashton
Open University Press, 1994, £12.99

Eleven eminent epidemiologists have each selected a favourite paper from the scientific literature of the past fifty or so years, together with a paper of their own, to form each chapter of this book, and the whole thing is rounded off by an introduction from John Ashton, together with his choice of papers.

The bulk of the text consists of the 24 selected papers themselves, reproduced in as close to their original form as possible. Some of the papers are well known and widely cited and others are widely cited but hardly ever read. Any public health specialist has heard the story of John Snow, who is said to have curtailed an epidemic of Cholera in London simply by removing the handle of the Broad Street pump. But who has read a historical account of the events which followed this dramatic public health intervention? The extract in this book reveals that, in reality, it took another ten years of persistent pressure on the authorities for the pump — an acknowledged danger to the public health — to be permanently closed. Somehow this makes the story even more relevant to our times.

There are other fascinating papers in this collection which remind us both how epidemiology has served to chart a territory which we now take for granted — such as the idea of the ‘iceberg of morbidity’ — and how often epidemiology alone has been unable to catalyse the social change which its practitioners have urged.

Papers on ‘Food, health and income’ (published in 1936) and the ‘Social aetiology of stillbirths and infant deaths’ (published in 1946) emphasise how we are still failing to act effectively on knowledge from half a century ago.

Yet despite this the book remains, in the best epidemiological tradition, worthy but dull. For the student of epidemiology, it is not enough simply to serve up ‘the classics’ with little explanation of the methods used and alternative possible approaches. For those coming to the subject from the outside — and the title invites interest from health service managers, health promotion specialists and others — epidemiology will appear, as always, technically impenetrable and far too distant from real life.