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of Handicapped Persons, and the Minister notes encour-agingly that the services which scheme-making localauthorities will bind themselves to provide are not costlyand yet will make a great difference to the handicapped.As might be expected, many of them are social measuresdesigned to give these handicapped people a larger sharein the life of the community, to help them to overcomethe effects of their disabilities and get all necessarytreatment for them, and to advise them on personalproblems. Working with the voluntary bodies, theauthorities will encourage the handicapped to join socialcentres, clubs, and other institutions for social inter-course, and will arrange as far as possible that they shallbe visited by voluntary workers who will comfort,encourage, and help them in their domestic difficulties.In addition the authorities may, if they wish, providepractical help to the handicapped in their homes, helpthem to get wireless, books, or other means of recreation,make it possible for them to attend lectures or games atsocial centres, provide outings for them, arrange forthem to attend special religious services, help them overtravelling difficulties, and arrange for them to take

holidays when necessary, perhaps in holiday homes-either their own or those of voluntary bodies. Welfareofficers will be appointed to help in carrying out this work.Handicapped people who wish to be trained under theEducation Act or the Disabled Persons (Employment)Act, 1944, will be encouraged and given practical help,and those wishing to start work will be assisted as far aspossible to find jobs. The authority will also help crippledpeople to find home employment at a reasonable rate.The adoption of such schemes will benefit a large num-

ber of handicapped people : there are 25,000 people inEngland and Wales who were either born deaf or deafenedat an early age ; in addition there are some 250,000 sohard of hearing that they need to use a hearing-aid ;and people registered under the Disabled Persons

(Employment) Act number 900,000. It is good to knowthat they can now count on getting the sort of helpwhich-to the profit of the community and to their ownprofit-the blind have received for thirty years.

CHLOROFORM—THE LATEST WORD

FOR nearly fifty years chloroform has been viewed withthe gravest suspicion by anaesthetists, who have hadtheir opinion continually reinforced and sustained bypapers based on laboratory work giving clear evidenceof the toxicity of this substance. The feeling is widespreadthat to use chloroform when any other method is availableborders on negligence. This clinical view has beensupported by frequent statements both from the post-mortem. room and-more publicly-in the coroner’scourt. In spite of all this, many general practitioners findin chloroform sufficient good to make it their standby.They will obtain some, but not much, encouragementin a new book 1 written by a team at Madison under thegeneral guidance of Dr. Ralph Waters. The pharmacologyand anaesthetic properties of chloroform have been

investigated afresh under modern conditions and withmodern methods of study. The effect of chloroform oneach of the main body systems-the liver, the kidneys,the cardiovascular system, and the respiratory system-are reviewed, and the authors discuss the place ofchloroform in anaesthesia, using statistics gathered in theanaesthetic department at Madison. Their conclusionsare not on the whole startling : they call attention tothe great potency of chloroform, to the difficulty of

controlling the vapour strength accurately with the

apparatus available, and the unreliability of physicalsigns in estimating depth of anaesthesia clinically whenthese are checked against blood-levels of chloroform.The action of chloroform in depressing respiration,1. Chloroform. A Study after 100 Years. Editor Ralph M. Waters,

M.D., emeritus professor of anesthesiology, University ofWisconsin. Madison : University of Wisconsin Press. 1951.Pp. 138. $2.75.

lowering blood-pressure, and causing cardiac arrest areconfirmed. In suggesting that the hypotensive effectof chloroform be used deliberately to control bleeding,Waters and his colleagues seem unaware that in thiscountry it has been used for that purpose for years inoperations like mastectomy. But they make it perfectlyclear that chloroform can only be administered safely whenthe administrator is " keenly aware of what he is doing."The book contributes much to the scientific under-

standing of chloroform anaesthesia, and must be readby everyone interested in this ; but it does not alter thefact that chloroform is a highly potent agent, full oftroubles and dangers for the unwary. Until there areaccurate means of controlling the vapour strength, it willcarry inherent hazards, even in the hands of a skilledanaesthetist.

ACTIVITIES FOR THE MENTALLY SICKPATIENTS in mental hospitals usually respond to the

chance of joining in social activities ; and it has now beengenerally recognised that they enjoy and profit byeducational chances as well. In 1948, the mental-

hospitals committee of the London County Council, afterdiscussion with the British Institute of Adult Education,decided to extend the range of interests for patients inall their mental hospitals. Miss Anne Coghill, who wasappointed in April of that year to arrange a diversionaland educational programme at Claybury Hospital, hasnow reported her experience of the first two years of thescheme. The aims were to help convalescent patients torecover their former interests, and to discover theirlatent talents and so add to their inner resources, and to

encourage self-confidence at work and in social relation-ships. For the chronic patient new interests, it was

thought, would at all events enrich what is often a barrenand tedious life. The occupational-therapy departmentof any mental hospital naturally shares these aims ;but it works within fixed time-limits. Miss Coghill’s taskwas to help patients to fill their leisure time pleasantly,profitably, and to the benefit of their health.At one time Claybury Hospital, at Woodford Bridge,

Essex, served the East End of London; but in theNational Health Service it serves only its own area. Asa result, the more recent patients are on the whole bettereducated than the older long-term patients. There areabout 1000 men and 1300 women in residence, andmost of them are elderly patients who have been inhospital for many years ; but about 60% of them areable to do some work. Only 100 of the patients arepsychoneurotics ; and these, with a proportion of acutepsychotic patients, form a recoverable or short-term

group, housed in the convalescent villas. During thesummer most of these patients were allowed out onparole after tea ; and since occupational therapy or

other work engaged the mornings, most of the newactivities had to be planned for the afternoon. Theyincluded dressmaking classes (which were very popular)for the women, shorthand typing taught by a memberof the hospital clerical staff, film shows, and—at the

special request of the patients-ballroom dancing undera qualified instructor. Lectures on such things as localgovernment, travel, astronomy, and economic problemsfell rather flat ; only music was a popular subject, andthe lecture series was therefore replaced by a course onmusic appreciation. This went well so long as the

patients were allowed to listen to the music instead oflearning about it ; and probably composers would agreethat they had the right idea. A discussion group inwhich the patients discussed such topics as difficultchildren, and " Is honesty the best policy ?

"

provedvery successful, the patients attending it without per-suasion. Drama too was popular, as it always is ; for

acting gives gifted amateurs an outlet, helps shy peopleto gain self-confidence, and provides entertainment for

1. Mental Health, 1951, 10, 96.

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everybody. A social club, run by the patients themselves,was a great success, and arranged all its own socialoccasions including whist-drives, parties, quizzes, recordrecitals, community singing, and quiet evenings. Thesewere specially welcome in the winter, when patientscould not get out on parole ; but the constantly changingmembership made it difficult to establish a tradition.Long-term patients were found to enjoy, and benefit

from, most of the same activities as those on the roadto recovery. Before 1948 they had been used to a weeklymixed social, and a film show, with variety concerts oncea month during the winter. The women in an acute wardtook kindly to ballroom dancing, and nearly all the

patients enjoyed a fortnightly community singsong,conducted by a charge nurse. A group of about 12 haveattended regularly at a more serious singing class, andhave formed a choir which has sung at patients’ concerts,and gives carols at Christmas. More non-parole patientswould have attended choir-practice if nursing staffcould have been spared to bring them to the classes.Concerts run by the patients were enthusiasticallysupported ; they produced three in the two years underreview. More serious music is provided by the Councilfor Music in Hospitals ; but as only a limited numberenjoy it, small concert recitals are held instead of largeorchestral concerts. Many patients enjoy painting, andprofit by learning to interpret their work with the aidof a psychotherapist. Puppetry was tried, but provedtoo complicated for all but a few. Elementary book-keeping, taught by a charge nurse, was attractive topatients of a mathematical turn, and was attended byrecovering as well as chronic patients.

’Miss Coghill notes that the shorthand-typing class, inparticular, seemed to benefit patients of several differentkinds-perhaps because it has a definite and practicalrelation to real life. Diversional activities, such as singingand acting, seem to work by distracting the patient’sattention from himself and bringing him into touch, withother people. The social club gave a sense of interestand responsibility, and many capable men and womenregained their confidence through taking office on thecommittee. Painting allowed the patient to relieve hisinner tensions, and helped his doctor to follow his

progress. Miss Coghill makes the sensible suggestion thatorganisers of such schemes would be at better advantagewith the staff, as well as with the patients, if before

starting work they had attended a short course on themain causes of mental disorders, and their treatment.

AN EXPERIMENT WITH TIME

ON another page Miss Smith and Dr. Parkes describethe extension of their experiments on the low-temperaturepreservation of red blood-cells and spermatozoa to

ovarian rat tissue. The survival of the tissue was testedby its ability to form a functional graft in the oophorec-tomised donor ; and there is no doubt that the bestresults were obtained with ovarian tissue frozen to the

temperature of liquid oxygen (-196°C) in media con-

taining 15% glycerol. In his address to the physiologyand agriculture sections of the British Association in

Edinburgh last month, Dr. Parkes drew attention to theimportance of the experiments with spermatozoa tobreeders of pedigree farm animals, and a great exten-sion of the technique of artificial insemination seems

likely. The consequences of the preservation of the

sperm of - a valuable bull or boar could be great, andthe economic value of particular animals could extendover many years. The possible applications of oophorec-tomy to animal breeding are of considerable interest,though the operational procedures needed to ensureproper grafting will doubtless restrict any large-scaleapplication.

’

One of the valuable possibilities hinted at by Parkesand Smith is the extension of their inquiry to endocrinetherapeutics, and work in this important field is-to be-

welcomed. Knowledge as to how a particular endocrinesystem works follows, rather than precedes, the certaintyof its functional mechanism. The grafting of preservedtissue may ’therefore turn out to be of great medicalimportance.

It is possible to welcome the agricultural and thera-peutic consequences of these experiments and neverthe-less to view with consternation their possible applicationto the human species. To read of such things in Wells orHuxley is one thing ; to add to our present complexitiesin this manner raises grave doubts as to whether man iswholly competent to project, into an uncertain future,the giants of his past. It is good to remind ourselves thatwhat may be right for Rattus may well be wrong for Hom6,sapiens.

PLASMA-CHOLESTEROL AND THE THYROID

IT has long been known that plasma-cholesteroltends to be inversely related to the state of thyroidfunction. Patients with myxoedema usually, though notalways, have plasma-cholesterols above the normal

range ; patients with thyrotoxicosis usually have plasma-cholesterols in the region of the lower limit of normal.This estimation is decidedly useful in the diagnosis ofmyxoedema, but less so in that of thyrotoxicosis. But inboth diseases successful treatment is associated witha sharp change in plasma-cholesterol in the directionof the mean normal value. Thus the test has its greatestuse as an objective index of the patient’s response tospecific therapy.

Peters and Man 1 have lately made an extensive

comparison of plasma-cholesterol and plasma-protein-bound iodine levels in thyrotoxic, myxoedematous, andeuthyroid subjects. They were able to show that therewas an inverse relation between these two estimations ;but the correlation was far from exact and could not beused for prediction. This is not surprising, for thoughplasma-cholesterol is related in some way to thyroidfunction it is also influenced by several other factors. Both clinical and experimental work has demonstratedthe influence of diet and the effect of biliary obstruction.Keys et a1.2 have shown that in normal subjects plasma-cholesterol rises slightly but significantly with age.Its relation to arteriosclerosis is still a matter of disputebut it can certainly be elevated in diabetes and inxanthomatosis.The fact that so many influences are at work may mean

that the relation between thyroid function and plasma-cholesterol is really much more precise than appearsin present data. If so, we have at present no clue towhy this should be. It is difficult to make even an

intelligent guess at the nature of the mechanism whichenables the thyroid to control cholesterol levels in theblood. But Rosenman, Friedman, and Byers 3 have nowpublished some observations which at least provide ahint for further work. They find that hyperthyroidisminduced in the rat by feeding thyroid extract is associatedwith an increase in the biliary excretion of cholesterol.Conversely, hypothyroidism is associated with decreasedbiliary excretion of cholesterol. These observations

suggest that the high plasma-cholesterol in hypo-thyroidism is due not to increased production but todecreased excretion. Leblond 4 has shown that a largeproportion of injected thyroxine (labelled with radio-active iodine) is excreted in the bile. It seems thereforethat when the blood-thyroxine level is high the liverexcretes increased quantities of both thyroxine andcholesterol. It is tempting to suppose that these twoprocesses are connected in some way, but there is not

yet any experimental evidence that this is so.

1. Peters, J. P., Man, E. B. J. clin. Invest. 1950, 29, 1.2. Keys, A., Mickelsen, O., Miller, E. v.O., Hayes, E. R., Todd, R. L.

Ibid, p. 1347.3. Rosenman, R. H., Friedman, M., Byers, S. O. Science, 1951,

114, 210.4. Leblond, C. P. Ann. New York Acad. Sci. 1949, 50, 444.