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SURVEY OF PUBLIC OPINION

IT took the last war to make the Department ofScientific and Industrial Research and the MedicalResearch Council integral parts of the state, but since1918 these two bodies have increasingly been recognisedas such. Now in 1940 we see in the daily press thebirth-pangs of another scientific effort which if allowedto fructify may be equally important. In the breathingspace since 1918 social science has gone forward apace.Methods have been developed for testing public opinionon many subjects and for studying at first hand theconditions cf life of the people. This work has proceededon two separate lines. First there have been the effortsof market-research organisations designed to test theeffects of advertising. Most large advertising agencieshave field-work sections which explore public reactionsto wide-scale advertising campaigns and estimate theefficiency of the various advertising media. Thesemarket-research organisations employ door-to-door ques-tioners. who interview a random sample of the population.Secondly, the departments of sociology of the Britishuniversities have employed similar methods to studythe ways of life of the poorer sections of the community.One of the best of these studies is described in HerbertTout’s " The Standard of Living in Bristol " (Arrow-smith, 1938, Is.), a comprehensive survey of the economiclife of the poorer classes in one of our most prosperouscities. It is not surprising therefore that a Governmentcalled on to fight an adversary who uses every facet ofscience should have decided that these new methods ofstudying the population would be helpful not only inplanning legislation but also in watching the effects oftotalitarian war on the communitv as a whole. It is theduty of the Ministry of Information not only to dissemi-nate but also to collect facts, so it fell to its lot to organisea public-opinion testing machine for the Government.This machine is called the War-time Social Survey. Itworks under the auspices of the National Institute ofEconomic and Social Research, the acting director ofwhich is Mr. Geoffrey Crowther, and is thus connectedwith but separate from the Ministry. The survey workson a random-sample basis. Its supervisors are trainedeconomists, and many of its investigators are trainedsocial workers. It does not use postal questionnaires,for they are often fallacious. In its interviews withsomething like 10,000 people so far less than one in ahundred have refused to answer the questions, and thegreat majority have welcomed the opportunity of tellingthe Government exactly what they think of them.Naturally in assessing answers to the questionnairesmany difficulties arise. No-one knows better than doctorsthat the manner of an answer may be more importantthan its matter. The trained social worker is howeveroften able to add such an assessment to the bald answers.The investigators’ bias has to be calculated and neutral-ised, and the sampling has to be done most carefully.An insight into the type of work the survey performs

can be obtained from the following typical questions.1. Have you read a copy of this leaflet ? (The interviewer

holding in his hand the invasion leaflet.)2. What have you done with your copy of it ?3. Are you feeling the tea-rationing ?4. Have you yourself had any difficulty in finding a way

to do your bit ?5. Have the shops got the things you want apart from

food ?6. If not, what do you find it hard to get ?7. Do you think we are getting too much or too little news ?

Statistically representative answers to these questionswill be of great value to the Government in planningfuture legislation and publicity. If, for example, only60 % of the public have read the invasion leaflet somethingmust be done about it. If certain sections of the com-munity are for justifiable reasons finding the tea-rationing an undue burden, this again is capable ofcorrection. Similarly public nausea attributed to fre-quent radio news bulletins can, if discovered, easily beput right. The greatest care is taken to make sure thatthe names of the persons interviewed, and even theinterview sheets, never reach the Ministry of Information.

The results are analysed at the National Institute andonly these results are available for the Government’s use.The value of a Government social-research organisation

has rapidly been appreciated by several departments,and already it has cooperated with the Ministry of Food,the Ministry of Health and the Board of Trade. Itsstudies have ranged from brown and white bread to milkprices. In the past the Government has relied for itsestimation of public opinion on Parliament and thepress. These two must continue as the great safeguardsof our liberty, but a direct access to the raw material ofgovernment, the people themselves, may be an eye-opener to the Civil Service.

In England NowA Running Commentary by Peripatetic CorrespondentsHERE is a new collecting game for doctors. It’s called

" harbingers " and this is its origin. During a round ina private mental hospital the knowledgeable matron said," I’m afraid Mrs. S. is going off again-she had a thirdcup of tea this morning." From long experience she knewthis to be the first sign that this charming, cultured,dresden-china lady would in a few days or even hoursbe a tireless, raging maniac. I asked the matron tomake me out a list of similar heralding signs in otherpatients and I have it still. " Miss H. puts on a blackdress and asks for two hot-water bottles. The usuallyreserved Mr. M. comes up and asks for a cigarette," andso on. At another mental hospital a number of patientswere on parole and went out every afternoon. Whenthe door was unlocked they had to cross a courtyard toget to the road. This courtyard had a grass centre with apath round it, and the doctor’s office window opened onto it. One afternoon the doctor stood at his window,idly watching the patients as they started out on theirwalk. Suddenly he turned round and rang for the headattendant : " Go and fetch Mr. So-and-So," naming apatient with recurrent mania who had been rigidly self-controlled and well for some years.

" He’s gone downthe road, he’s not well." The doctor had noticed thatMr. So-and-So had cut across the grass-the first signthat the dam was breaking.But it isn’t only mental disease that has these har-

bingers. A friend of mine with a chronic tuberculouslung tells me that when he is going to have any activityhe always gets an increased appreciation of colour andtries to write poetry.

" I almost think in rhyme ormetre." Another good one I got from the wife of a manwho had a regular bi-yearly attack of lumbago, probablya gouty variant. " He always cuts the hedge and rollsthe lawn, then he comes in all wet, and sits up at thattable and counts his stamp collection, and tots up hisStock Exchange account. Then he wonders why hegets lumbago." I have some other quaint mentalharbingers of the common cold and malaria, but prob-ably most people will prefer to make their own collection.After all there is nothing surprising in our sensitive top-sails getting the first puff of an approaching squall.

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It is strange that, despite its importance both for thoseprimarily concerned and now for every inhabitant of thisisland, there has been no intensive psychological study ofthe normal, as distinct from the definitely pathological,military mind. I commend such an investigation to ourpsychologists, many of whom must at the present timehave ample material on which to work. Everyone willagree that in many admirable qualities the military issuperior to the civilian mind, but in one respect it seemsto have been inferior, and this defect has had an im-portant bearing on the outcome of past campaigns. The

military mind at all times and in all lands has expe-rienced the greatest difficulty in envisaging any progressin the science and art of war, despite the obvious andrapid progress in sciences ancillary to war. The psycho-logical reasons for this condition are probably com-plex. It should, however, be possible to find out whetherthose who adopt the army as a career in peace-time havehad essentially conservative minds to begin with, orwhether the army training itself has engendered thischaracteristic. Curiously enough navies and (though

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here my experience is more limited) air forces appear tohave suffered far less from this resistance to new ideas,although in our navy at any rate both officers and menare recruited at a younger and more impressionable agethan they are in the army. The difference in the

receptivity to new ideas of navy and army is wellillustrated in the history of the Russo-Japanese war. TheJapanese army refused to entertain the idea that a diet ofpolished rice had any connexion with the genesis ofberiberi ; the navy was prepared to experiment. As aresult the army suffered heavily from beriberi, the navydid not.As Freud and his school have shown in their psycho-

analytic studies, much important information on theworkings of the military mind may be obtained from astudy of history. Again and again one cannot help beingastonished at the capacity of the military mind for beingtaken by surprise by some change in tactics. The militaryforces of the Egyptian middle empire, for instance, werecompletely surprised and as completely overwhelmedby the horse-drawn chariots of the Semitic Hyksos,although the Egyptians had for many centuries been inclose contact with Asia and Asiatics and must certainlyhave heard of the existence of the horse. In April, 1915,I happened to be working in a casualty clearing stationto which were sent the victims of the first German gasattack. No warning of such an attack had been givento the French territorial regiment involved or to themedical authorities, though it appears that some timepreviously our intelligence had reported fully on thepreparations made by the Germans to use gas. Theconservatism of the military mind extends equally to bothsmall and great things. In 1914 many of the Belgianregiments went into action in uniforms, which, if theywere not actually those worn by their ancestors atNVaterloo, were at least excellent imitations-plum-coloured breeches with bottle-green tunics and silverbuttons. The Belgians had had no wars to speak ofsince those of Napoleonic times, so why should the uni-forms which had been up to date in 1815 be changed ?The French, too, as they stormed the great dune atNieuport in 1915, were still clad in the bright red trousersand blue coats which had been so much admire d by themilitary experts of 1870.

It was the distinguished military author of " The GreenCurve " who insisted on the close similaritv betweenburglars and generals. Both are limited to a singletechnique. If it is known how a particular burglar or aparticular general has carried out one job of work all iswell, for he can be relied on to repeat the same techniqueagain and again. This tendency has repeatedly led todisaster in the face of some change in the methods of theenemy. The Assyrian, whose militarism was responsiblefor " the burden of Nineveh," owed his invincibilitymerely to the fact that he provided his mounted archerswith heavy armour, while the discovery of the phalanxby the Spartans was one of the main factors in theirvictory in the Peloponnesian war. The Spartan phalanx,however, collapsed a hundred years later before theAthenian light armed troops, while these in their turnwere crushed by the Macedonian phalanx in which theindividual phalangite was provided with a somewhatlonger spear than the Spartan had used. The techniqueof the Macedonian phalanx remained static for more thana hundred years with the inevitable result, as Polybiuspoints out, that the phalanx proved quite inadequate tostand up to the mobile Roman legionary who was welladapted for every situation and emergency. In moremodern times it was the introduction of the long bowthat enabled the English archers at Crecy and Agincourtto mow down the flower of French chivalry, which, likethe Bourbon dynasty years later, forgot nothing andlearnt nothing. Examples from our own age of the samefailure to foresee changes in technique will occur to all.Conservatism has thus been a characteristic of the mili-tary mind certainly for hundreds, perhaps for thousandsof years. Essential conservatism, in fact, may well havebeen the reason why the fierce Homo nearaderthalensiswas exterminated by the new-fangled flint technique ofmodern man. The psychologist who attempts to studythe workings of the present-day military mind will have toinvestigate, in the words of one of my old teachers,

" a

nest of problems " ; he will be lucky if, in the course ofhis investigations, he does not stir up a nest of hornets.

The information that the long expected convoy wouldconsist chiefly of French soldiers was received with mixedfeelings, but the initial shock soon passed. We foundthat an unexpectedly large proportion of the staff spokeFrench. Two fluent linguists amongst our studentswere immediately detailed as interpreters and we weredelighted to find that many of the nursing staff possessedall the necessary qualifications to get the languagesituation under control. Our confidence was justifiedand at no time were we obliged to call in outside inter-preters. The hour came when " nos blessés " arrived-tired, unshaven, but brown with the sun and for the mostpart cheerful and very glad that their long and tryingjourney was at last ended. Within an hour of theirarrival they were washed or bathed, had had a good teaand were in bed. Most of them were quickly asleepuntil our surgical staff with their satellites began to rollup their sleeves. Our emergency theatre was soon goingstrong, the X-ray staff worked like trojans and forthirty-six hours or so a hectic time was had by all. Someof us whose experience went back a quarter of a centuryhad visions of another convoy, of Flanders mud, tetanusand gas gangrene, but thanks to modern methods-andperhaps no mud-these grim memories were not to berevived this time. The " shake-down " took verv littletime and with their native gallantry and cheerful chatterour patients quickly made themselves at home. Thevis medicatrix naturae helped by the untiring effortsof les medecins and les nourrisses rapidly restored theirgood spirits.

Then, of course, came the flood of would-be visitors.Every one in the town who had spent a day on a cross-channel steamer proclaimed him or herself a fluent Frenchlinguist and wanted to come along to interpret or chat.A little tactful barrier building was necessary before wecould keep the flood within bounds. We were short ofwireless sets-the want was supplied-and many com-forts for the troops were quickly at our disposal includinga plentiful supply of vin rouge and beer in wood ; ourpatients didn’t keep either waiting very long. Therewere days when their spirits flagged, for the news fromFrance was bad and getting worse. We did our bestto keep them smiling, but the worst part was the absenceof family news, though some men managed to gel somethrough before the final word of the armistice came.Meanwhile health was being restored and wounds werehealing. Parties were arranged and enjoyed and thetown’s hospitality was gratefully accepted. Booksarrived, including many petits dictionnaires and old schoolbooks, and series of informal language lessons were givenand received. The " Ici Londres " broadcasts provided awelcome substitute for the French news and soon therewere earnest discussions among the men as to their futuredestiny. Many have now lett us to join the Legion-bon chance to them. Others will go home, but whereverthey may be, we hope that they will look back with acertain amount of pleasure to their stay at cet hopital debons souvenirs.

* * *

That hope springs eternal was brought home to meforcibly when I was besought for help by three dis-traught-looking women weighed down by babies, string-bags, attache cases and other appurtenances. They hadleft Rochester, they said, at 7.30 that morning to visit asoldier son " somewhere in Bucks." Their informationas to his whereabouts was a little more precise than that,but at 4 o’clock in the afternoon they were still withoutany real knowledge of the location of the object of somuch devotion. I bundled babies, bags and all into mycar and set about the task with the feeling that we shouldall end up in a madhouse or a police-station. Certainlyno-one was more surprised than I when half an hour latersuccess crowned our efforts. I ran some risk of beingembraced and left hurriedly, shuddering to think of theirreturn journey from an erstwhile rural mansion 2 milesfrom a station to the urban amenities of Kent. On aninadequate allowance of petrol I felt I had done my gooddeed for the day.

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In the discussion as to where the G.P. comes in inA.R.P. there is a point that might well be noted. Achild of my acquaintance, living in a relatively saferural area, is, on the sounding of the siren, awoken byher fearful aunt and made to dress, descend to the

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kitchen and lie under the table. The particular virtue ofthe kitchen table is not specified, but one night she spentthree hours there. The G.P. knows as little as the rest ofus of the real risks of aerial bombardment but he mightbe able to inculcate some sense of proportion in the popu-lation he serves. Personally I prefer the other extreme,an example of which is worth quoting. A young officerwho spent a day on the beach at Dunkirk was asked whatit was like. "

Rotten," he replied, " it rained all day."

* * *

Let me commend a side-step into an art gallery if youwant to get away from thoughts of war. In the NationalGallery we can busy ourselves in British painting sinceW’histler, and we will come away without any shame atthis result of fifty years work, though opinions differ asto what will last. Already we can see how quickly timehas put down the mighty from their seats and also howit brings up the less known of a former day. WalterGreaves is chief among these latter-at times a slavishfollower of Whistler, the more he is seen the better onerealises his real independence. Mark Fisher is anotherwho improves with every year. Here also we can seehow many-sided was John Sargent or be amazed at thegenius of Augustus John and at the weird contrast inStanley Spencer, who can vie with Albrecht Diirer inpainting vegetation and make the English landscapestand out behind it in all its loveliness, and yet, when hepaints the human form, seems to be at the stage of theEastern-Islander outside the British Museum. Fromthis exhibition we may feel what a pity it was thatConder’s life was short ; and how right the conservativemind at times may be to refuse to take new art into itssurvey, how wrong at others. It is youth that judgessuch things, not age. It is youth that is interested in thisexhibition. Except for an R.E. major and his wife I wasthe only grown-up in the place ; the rest were youths,boys and girls at the turn of the teens, with none of thedilettante nonchalance so often noticeable at exhibitions,but all working intently with pencils and catalogues.

IRISH LABOUR FACING HEALTH PROBLEMS

THE Irish Trade Union Congress in session last weekat Limerick found time to give attention to public health.The national executive was instructed to take all possiblesteps to secure : (a) extension of benefits from theNational Health Insurance Society ; (b) investigation bythe Medical Research Council of the incidence and causesof diseases associated with industries and agriculturaloccupations ; (c) the scheduling of all diseases consequentupon a worker’s occupation, so that the victim mightsecure the benefits of the Workmen’s CompensationAct ; (d) government action without delay on theschemes recommended by the Hospitals Commission.The N.H.I. scheme in Ireland, from its inception nearlythirty years ago, has been almost exclusively concernedin providing sick benefits and what little concern it hadwith treatment was soon abolished. Systems of treat-ment for insured members have been worked out but sofar-partly from the inertia of health administration inIreland and partly from fear of expense-no step forwardhas been taken. Little can be effected by grafting a fewadditional benefits on the existing scheme, but even thatlittle is worth doing. The N.H.I. Society, since the unifi-cation of approved societies in 1936, has not ceased topress on the Government the need for a completelyremodelled system, based on a study of schemes es-

tablished in other countries. Unfortunately, in thepresent state of Europe, such a study is impracticableand any changes that can be made at present are notlikely to be more than patching of an outworn garment.The next point raised by the trade-union council is onethat should not brook delay. Many new industries haverecently been established in Ireland, entailing manu-facturing processes hitherto little known in the country.Some of these processes are dust-producing and thereforelikely to produce disorders of the respiratory tract unlesssuitable protective measures are adopted. Others—e.g.,in the manufacture of sugar-are irritating to the skin.No investigation has yet been made of the incidence ofsuch diseases, despite its importance from the social aswell as the scientific point of view. Until such a surveyhas been made no protective measures can be devised.

Letters to the Editor

PLASTER

I wonder it Mr. J.oston has not missed the pointof your leader. It does not call for the displacement ofsurgeons or nurses orthopsedically trained from theirproper functions, but it does offer a suggestion wherebythe very obvious

" bottleneck " that appears in all unitsdealing at high pressure with large batches of woundedmay be by-passed.Under conditions that have occurred in some sectors,

and that may occur again all over the country, all theorthopaedic teams available could not cope with one-tenth of the work that has to be done. As many woundsas possible must be cleaned, drained and plastered withina few hours. The opportunity is one that, for thatbatch of casualties, will never come again and everyavailable person must be roped in to ensure that it isused to the full. At such times, if the output of savedlives can be doubled by a division of labour, the youngorthopaedic surgeon is far better employed in the theatreoperating on limb wounds than outside it applyingplaster. Also, at such times, it is not a matter of guard-ing the ranks of a union from dilution with unskilledlabour, but of saving lives.

Mr. Poston’s qualifications to speak on orthopaedicsubjects are undoubted, but plaster work is not as

difficult as he suggests, nor are dental surgeons as stupidas he seems to imply. They would lead emergencyplaster teams well and would be only too glad, when therush was over, to return to their own work and leave theorthopaedic surgeons to theirs.

Harley Street, W.1. W. H. OGILVIE.

SiR,-Professor Pannett asks for simple instructionsfor applying a plaster spica of the thigh. It shouldextend from the nipples to the toes, and is applied inthree sections. The first section extends from the middleof the patella to the nipple line, the second from knee toankle, and the third takes in the foot. The casing maybe applied directly to the skin, or over a single or doublelayer of closely fitting stockingette. To protect thesacrum, spinous processes and iliac crests, pads of i-inchsticky white felt are usually recommended. My prefer-ence is for gamgee, because felt, especially the greyvariety, may contain tetanus spores. I have met with afatality from tetanus infection arising from a pad ofgrey felt lying near a dressing beneath a plaster casing.Blood soaked into the felt, and it was proved that thepad and the roll from which it was cut contained tetanusspores. If felt is used it should be sterilised, and so forthat matter should the stockingette if there is a wound.The trunk and leg portions of the stockingette are

retained smoothly in position by a few stitches round theperineum and groin. With the non-padded casing it isnot necessary to pad the head of the fibula or back of theheel, but it is best to do so when using stockingette.Before drawing on the stockingette, a dusting powder,equal parts of talc and French chalk, is sprinkled on theskin.

Before beginning to apply a plaster, have all thebandages ready and a sufficient number of buckets oftepid water, so that there is no waiting to get freshsupplies. Stand the bandages on their ends in the water,and lift them out with one hand at each end, expressingthe excess of water towards the centre. Unwind thefirst two inches. The bandage is now ready for use andwill not unwind in a spiral.The patient is lifted on to the special table. If this is not

available he is laid with his shoulders resting on a padded boxabout 8 in. high, the sacrum is supported on a small paddedupturned bowl or can of sufficient height, and the legs are heldby assistants in the desired position. A sacral rest is usuallyprocurable, and is used in preference to the bowl. A thinwoollen bandage, 6 in. broad, is passed round the trunk at thenipple level and serves to retain in position the strip of gamgeeor felt, also 6 in. broad, which has been laid along the sacrumand spinous processes.The first section of the casing is now applied from the middle

of the patella to the nipple level, ascending and descendingspica turns being used at the hip. About fifteen to twentyplaster bandages, 6 or 8 in. broad and 5 or 6 yards long, are

W. H. OGILVIE.