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author's thesis is that suicide results from a consciousrational choice, and that the act is the last of a chain ofevents which follow a recognisable sequence. The suicideatternpter has long-term personal problems which havelately escalated, and formerly successful adaptive techniqueshave ceased to be effective, His residual resources collapseand social isolation becomes absolute. Before the act ofsuicide, he goes through a process which defines deathas the only and necessary solution, the problems he facesbeing not of his making, nor capable of solution, and onlyto be resolved by his death. The book makes an interestingcontribution to the understanding of suicide, but is marredby arrogance; the author sees his theoretical position asproviding the (not an) approach, and alternatives aredismissed. The limitations of the study arc not adequatelyconsidered; it cannot be assumed that controls drawn froma single school can be considered as matched with admissionsto a county general hospital, even if certain indices betweenthe two samples show good agreement. The emphasisupon the need to understand the suicidal net in the suicidalperson's own terms is admirable, but to suppose thatknowledge of public life events or the reading of suicidenotes alone can always lead to such an understanding isnaive, though a necessary consequence of the nuthor'sposing "conscious rational" and "unconscious irra­tiona 1" explanations as mutually exclusive rather than ascomplementary. To understand how an individual choosessuicide 01' any other course of action, one must sec how heperceives and construes the reality of his world and ofhimself. The interpretation of data requires knowledge ofthe individual's culture and personal history and personalsymbolism-e-i.e., it requires the application of sociologicaland psychological understanding. Despite these criti­cisms, the findings deserve the attention of doctors.The book should appeal to doctors working in schools anduniversities, for they have an opportunity to witness, define,and ultimately modify the social processes which precedesuicide, which, as the author notes, frequently overlapwith those which precede dropping-out of education.

Plastic Surgery in Infancy and ChildhoodEdited by JOHN CLARKE MUSTARDll, M.B., a.sc., F.R.C.S.,F.R.C.S.G., D.O.M.S., consultant plastic surgeon to the West ofScotland Plastic Surgery Unit, Canniesburn Hospital,Glasgow. Edinburgh: E. & S. Livingstone. Baltimore:Williams & Wilkins. 1971.Pp. 581. £7; $22.50.

THIS book's editor, describing the kind of book he isplanning, writes that it "must ruthlessly eschew anytendency to become merely another textbook on plasticsurgery with a bias towards the treatment of children ".In the event he has achieved a not-very-well-balancedtextbook of plastic surgery with a bias towards the treat­ment of children. It depends On how one defines a child,but girls with breasts large enough to require a reductionmammaplasty or old enough to have a skin-grafted vaginaconstructed are no longer children. One of the bestchapters in the book is that on Deformities of the Jaws,by H. L. Obwegeser, but most of his illustrations arc ofadults and much of the surgery described is as applicableto adulthood as to the last year or so of childhood. And in afigure illustrating the correction of prominent ears, thepatient is a balding, middle-aged man. The fault is hardlythe editor's, except in so far as he has made a completelyartificial division of plastic surgery into prediatric and adult.General plastic surgery has always included the care ofchildren with certain congenital deformities, children withburns and scalds, and children with soft-tissue injuries andfractures of their facial bones. The basic techniques ofskin replacement and skin manipulation are equally

THE UNCllT, SHl''l'HMDHR 11, 1971

applicable to children and adults; the correctlon ofprominent ears is exactly the Same whether the patient isa preschool-age child 01' a middle-aged man. Most of the27 contributors arc intemntionally known plastic surgeons;the result is an excellent series of articles which varyenormously in content and style. There nrc gaps whichthe editor has tried to plug with" addenda" to several ofthe chapters; although this ensures that the editor's ownviews arc known, most of the articles represent largely theviews of their authors, who vary considerably in the degreeof impartiality with which they write about their topic.There arc other chnptcrs, such us that on hydrocephalusin children, which have only a very tenuous connectionwith plastic surgery, and there arc some more suited to ajournal than a textbook (e.g., the treatment of facial hemi­atrophy in children by silicone injection). There b muchthat is first class in this compllution, und one hopes that itwill be widely read. The general peedlutrlc surgeon maybe put off, since a basic knowledge of I'luHtic RUI'f\Cl'Y isassumed, and most of the cases dcecribcd nrc those which herefers to his plastic surgical C(IJ1cUgllCS. Plastic surgcon«should ignore the title and buy the book; there is muchthat is well worth reading. Illcvitllbly much hns UIHO heel!published before, and the render of plastlc surgll:lll litera­turc will see some fumilhll' faces, but: the main value ofsuch books is as a distillate of the individual uutbors'writings in an easily retrievable form.

The Analyals of Mortality and Other ActuarIalStatfntlcs

n. 13IlNIAMIN, I'II.n., I'.I.A., lind the lnte H. W. HAYCOCKS.London: Cambridge University I'ress. 19'10. 1'p. 392.£3; $9.50.

TIllS book was commissioned by the Institute ofActuaries and the Faculty of Actuaries in Scotland as atextbook for actuarial students. The authors hope that"non-actuarial readers may be given some insight intowhat may hitherto have been regarded as the mystique ofactuarial methods of investigation of mortality and otherrates". How far are these hopes likely to be fulfilled forthe medical reader? The first chapter discusses theproblems of deriving measures of mortality from vitalstatistics. Chapter 8 deals similarly with marriage andfertility rates, and chapter 9 discusses the estimation oftrends in rates and demographic forecasting. These chap­ters are wide-ranging and for the most part elementary,but in places the discussion is complex, Medical readersapproaching the topic for the first time would he betteradvised to read Benjamin's Health and Vital Statistics(1968). Chapters 2-5 and 7 deal in detail with the calcu­lation of death-rates and rates of sickness from the dataaccumulating in a life office or pension fund. The methodsavailable arc clearly explained and simple examples arcgiven. These chapters will be very useful to those handlingthe precisely analogous data collected in prospectiveepidemiological studies and follow-up analyses. Also ofinterest to epidemiologists would be chapter 10 on selec­tion, and the part of chapter 17 which deals with themortality of impaired lives. Chapters 11-16 will be oflittle interest to medical readers. Chapter 18 discussesthe social and economic factors affecting mortality and isof general medical interest. The section on the interpre­tation of the Registrar General's occupational mortalitytables is especially good. Other parts of the chapter arevague and sometimes inaccurate (e.g., rickets is attributedto lack of calcium). The book would have benefited froma glossary of actuarial terms, and we should pity the pooractuary who must wade through four pages of errata toget his formulre right.