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examination of the uterine contents, and an excellent Idescription is given of the technique. Dr. Holland isnot convinced that auto-infection plays any part in theseverer forms, but he assigns a definite place to latentgonococcal infection. The portion of the book dealingwith Csesarean section includes a short description ofthe two lower-segment operations which, the authorclaims, are especially suitable for cases in whichinfection has occurred or is suspected. There is lessrisk of adhesion, and so far no case has been reportedof rupture of a scar in the lower uterine segment;whereas in a collective follow-up investigation into1000 cases or more carried out by Dr. Holland in 1920,it was found that rupture of the scar occurred in4 per cent. of cases after the classical operation.

This edition of the manual bids fair to maintain itsposition as one of the best students’ text-books ofobstetrics.

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MEDICAL ELECTRICITY FOR NURSES.

By HAROLD WIGG, Radiographer, Royal Bucking-hamshire Hospital. London: The ScientificPress, Ltd. 1925. Pp. 196. 6s.

THIS little book has been written to assist the nursein an electrical department to acquire a workingknowledge of the uses of electricity for medicalpurposes. In less than 200 pages the author dealswith physical principles, the sources of currentelectricity, the effects of electricity on the body,faradic, galvanic and sinusoidal apparatus, the methodsof applying these currents, medical and surgicalionisation, muscle and nerve testing, radiant heatand light, X rays, static electricity and high-frequency,diathermy, and the electrical circuits in certainsurgical instruments such as the cystoscope. Anindex of electrical treatment concludes the book.We fear that in attempting to convey to the averagenurse an intelligible exposition of all branches ofmedical electricity and of the relevant parts ofchemistry and physics in so small a book the authorhas undertaken an almost impossible task. He haswritten clearly, and in a manner well suited for theworker with some preliminary knowledge of science.For the nurse a more colloquial description and thefrequent use of analogy would have been helpful.

LATIN ON THE DIRECT METHOD.

By W. H. D. RousE, M.A., Headmaster of thePerse School; and R. B. APPLETON, M.A., ChiefClassical Master at the Perse School. London :University of London Press, Ltd. 1925. Pp. 226.7s. 6d.

IF the teaching of languages, alive or dead, on theprinciples so lucidly expounded in this book were tobecome universal, we should hear less about timewasted on the study of the classics, and have gone farto roll away a national reproach. The results actually Iobtained by the direct method in the Perse school,as here exemplified, are astonishing, and the bookdeserves to be read by all concerned in education. Itis plain that for the fortunate boys in that school thelearning of Latin is not attended by terrors, but is fullof lively interest.

JOURNALS.

JOURNAL OF PATHOLOGY AND BACTERIOLOGY.Vol. XXVIII., No. 3. Pp. 397-539.-The Action ofSensitised Antigen in the Production of Specific andIsophile Haemolytic Immune Body, by T. lijimaTokyo). There has been a good deal of difference ofexperience as to whether antigens saturated withspecific immune body act as efficient stimulants forantibody production, whether in other words theantigen-immune-body combination will dissociatein vivo like a neutral toxin-antitoxin mixture. Theauthor’s experiments with hasmolysins show that fullysaturated red corpuscles have a very small antigeniceffect.-The Nature of the Acquired Resistance toBacteriophage Action, by F. M. Burnet (Melbourne).

If a large bacterial population is acted on by a bacterio-phage a small number of individuals escape the lyticaction and give rise to similarly resistant descendants.d’HérelJe interpreted this as an acquisition of

immunity to a parasite. The author shows that thisis unlikely and explains the phenomenon in terms ofthe bacteriophage being a catalyst for the normalautolytic ferments which are concerned in fission,showing that the acquisition of resistance is accom-panied by the production of long undivided bacillaryforms. In a second paper the idea is developed thatthe differences between different bacteriophages aredue to the readiness with which they are adsorbed on tothe bacillary enzymes.-Experimental PneumococcalInfections of the Lung, by J. F. Gaskell (Cambridge).-The Thyroid in Experimental Tuberculosis, byS. R. Gloyne (London). The thyroid in man issurprisingly immune to tuberculosis ; the same istrue of the guinea-pig, less so in the rabbit. Thyroidpreparations have no ill-effect on tubercle bacilliin vitro nor any curative action on infected animals,nor is the natural resistance of the white rat influencedby thyroid medication. The immunity of the gland ispossibly due to some anatomical cause.-Attempts toTransmit Epidemic Encephalitis to Rabbits, byJ. H. Dible (Manchester). Failed in ten cases. Afresh pitfall of abnormal appearances in the brains ofnormal animals is described.—Immunological Notes,by A. T. Glenny, C. G. Pope, H. Waddington, andU. Wallace (Beckenham). The ratio between thein vivo and the in vitro antitoxin values is not constantas Ramon claims. In making Ramon tests care mustbe taken not to be misled by a non-specific flocculationwhich may occur at a point in the titrations farremoved from the true value. The relative strengthof two batches of antitoxin may vary according to thetoxin used for titration. Many diphtheria toxin-antitoxin mixtures can be greatly diluted withoutmuch loss of antigenic efficiency ; beyond a certainpoint there is no advantage in increasing the dose.Strong diphtheria toxin cannot always be relied uponto keep ; dilutions made up ready for the Schick testare very easily destroyed by shaking with air ; half-full bottles cannot be transported safely even a shortdistance. Phenol of about 5 per cent. strengthdestroys relatively more antitoxin than toxin in amixture which may be thus converted from a neutralto a toxic preparation ; apart from this toxin-antitoxinmixtures are stable enough. High-grade tetanusantitoxin is best produced by giving horses a fewpreliminary doses of toxin and then resting them forat least a month, after which they rapidly respond tofurther doses.-The Excretion of Water Urea andChlorides in Experimental Oxalate Nephritis, by’

‘

J. S. Dunn and N. A. Jones (Manchester). In thetubular nephrosis produced in rabbits by oxalatepoisoning urea retention may be relieved by thecopious administration of water and the kidney has nodi-fficulty in excreting extra salt at the same time. Itis suggested that the urea retention is due to thedamaged tubules being unable to prevent the indis-criminate reabsorption of the glomerular filtrate andall its constituents.-The Relief of ExperimentalArterial Anoxemia by Compressed Air, by C. F.Nelson and P. Woodard. Anoxaemia produced byunilateral pneumothorax or the intratracheal injectionof gum solution can be largely removed by compressedair at about 21 lb. pressure.-The Preparation ofCertain Substituted Ureas and their Use in theTreatment of Trypanosomiasis, by T. H. Fairbrother,F. A. Mason, W. H. Perkin, and A. Renshaw(Manchester). A preparation made according toFourneau’s formula for Bayer 205 had markedtrypanocidal properties on T. equiperdum in mice.-An Improved Method of Mounting PathologicalSpecimens in Flat Celluloid Cases, by C. M. Acland(Cardiff).—The Temperature of White and Black andWhite Rats, by C. Price-Jones (London). Usefuldata for 200 normal animals ; the range is from 97°to 103°.-Sarcoma of the Ampulla of Vater withoutJaundice Leading to Acute Pancreatitis, by H. H.Moll (Leeds).

231

THE LANCET.

LONDON: SATURDAY, AUGUST 1, 1925.

HOSPITAL ADMINISTRATION IN ITSBROADER OUTLOOK.

IT is 50 years since the Public Health Act of 1875,the charter of English preventive medicine, was

placed on the Statute Book. A long struggle hadled up to its enactment and the way for its passagehad been paved by the work of pioneers who were notalways popular. The efforts of Lord SHAFTESBURY,the factory legislation of the forties, the writings ofCHARLES KINGSLEY, under the name of Parson Lot,and the steady education of public opinion by a hostof other writers and speakers culminated in a newoutlook. Finally, at the end of this period the dis-coveries of PASTEUR and LisTER revolutionised ourviews on infective disease. To read through theclauses of the 1875 Act and the statutes, such as theRivers Pollution Prevention Act, which followedimmediately after, is to get a historical view of theeffort which was made by the sociologists of the

day to attain to a healthy standard of living. Withthe passing of the Public Health Act there came toan end the age-long practice of laissez fairc, whichheld that a man might do what he liked with hisown, and that his doings, even if inimical to health,were no concern of his neighbours and least of allof the State. Throughout this initial period of reformwe may trace three main lines of progress: (1) theattempt to make our expanding industrial systemsafe and healthy for the workers ; (2) the endeavourto improve the sanitation of rapidly growing town-ships with their tenement dwellings-the word slumis a product of this period-which the new industrieswere calling into existence ; and (3) the task of apply-ing the new standards of cleanliness, sterilisation,disinfection, and isolation, which the work of PASTEURand LISTER had introduced into infective andepidemic disease. Alongside these reforms therehad been slowly growing up a public conscience onthe question of poverty and destitution, and it isthe modern reflection of this feeling which findsexpression in the Social Service Department of thehospital.No country in the world has witnessed such efforts

as are made in our islands to relieve sickness andpoverty by voluntary means, but much of this effortcan only be described as indiscriminate charity;and it was inevitable that there should follow in thewake of the sanitary reforms, marking the closingyears of what ARNOLD TOYNBEE termed the industrialrevolution, an attempt to understand and relievethe causes and results of poverty. About the timeof the passing of the Public Health Act the develop-ment of the University Social Settlements under theinfluence of the late Canon SAMUEL BARNETT andTOYNBEE, and the foundation of charity organisationsocieties, began to emphasise the importance ofunderstanding these questions. To use the words ofCanon BARNETT, it was necessary that " citizensshould learn to understand the lives of each other,"and so, gradually, the State came to realise, throughthe pressure of hard facts, that the care of its less

fortunate citizens could not be left to indiscriminatecharity. The legislation of this century, therefore, hasseen a great increase in all measures for sociologicalamelioration. The care of the blind, the deaf, theepileptic, the feeble-minded, and the insane was

an essential first step in the work in which our examplehas been followed by other nations, but we have nowgone much further and have recognised that the schoolchild, the child of pre-school age, and the expectantmother must also be the concern of the State if a

healthy standard of living is to be maintained. Itwould be difficult to assess in actual figures the valueof the great voluntary hospitals of this country inthis movement, but in medical education, in research,in the high standard of clinical practice which theyhave maintained, the hospitals have made no smallcontribution. Great as these contributions havebeen there remains much yet to be done. Clinical

practice and surgical treatment have been raisedto a high level, but there is still a vast work in frontof us in correlating the sociological causes of disease.In this matter the hospitals may have been slow toact, but their hands have always been over-full. It

may perhaps be considered that this particular phaseof a vast set of problems lies outside the scope of thehospitals’ work, but at every stage in the progressof medical research, especially in clinical research,it becomes clear that the patient’s habits and mannerof life, his environment, his work, and his opportunitiesfor a healthy life are intimately relevant to histreatment.A reference to the reports of hospital almoners

-those most important officers of the Social ServiceDepartment of the institution-makes this clear,especially in special departments where a preliminarysorting of cases has already taken place. Themore carefully cases are followed up by home visita-tion and inquiry, the more it is realised that thefinancial side of the work forms only a small part ofthe Social Service Department of a hospital. It istrue that the prevention of abuse soon became oneof the essential needs and cardinal rules of the earlydays of hospital administration, but a great dealhas happened during the last quarter of a century,especially as a result of the war, to alter the pointof view of financial inquiry. Indeed, to a certainextent, it can be said inquiry into hospital abusemay obscure real sociological issues. The work ofthe Social Service Department, if it is to be inter-preted rightly, is an essential part of clinical research,and from the point of view of medical educationthe sociological background must have a bearingon all teaching, whether clinical or preventive.General practice to-day is becoming more and morepreventive and educational in its outlook,. and theyoungest student sees the narrow limits of the

palliative measures with which a past generation hadto be content. Thus the outlook is steadily changing.In the past too much stress has been laid on rulesand regulations, especially negatives-the things whichpatients must not do. Nowadays, stress is beingmore and more laid on the positive educational sideof hygiene. The modern patient has had an oppor-tunity of acquiring a knowledge of elementaryhygiene and physiology in school and in the popularscience press, and he is keen to know the reasonsfor things and able to appreciate their importanceand significance. The period under review has seenthe introduction of many new words in sociologicalliterature ; preventive medicine is by no means

the happiest of these. We need a term which is widein its embrace of all the problems and is educationaland constructive in its outlook.