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624 whether folinic, rather than folic, acid is the important factor in the treatment of these diseases, and whether folic acid really acts only when converted to folinic acid. It should not be hard to get the facts, but we hope that a sufficiency of reliable clinical tests will be assembled before any new theories about the ætiology of megaloblastic ansemias are proposed. Annotations SYMPTOMS OF PUBERTY " JuvENiLE delinquency is what the law says it is " ; and the law draws the line in different places in different countries. Dr. Lucien Bovet, who quotes this saying in a new W.H.O. monograph.! notes that in many European countries a minor is a delinquent only if his behaviour is an offence to the whole population, whereas in parts of the United States he may be brought into court for a number of other things, including truancy from school, consistent disobedience to parents, con- sumption of alcohol, and smoking in public. In England a boy is legally incapable of sexual intercourse before the age of 14 ; and though he may have raped another child and caused her death, if he is less than 14 he must be declared " not guilty." A country with an efficient police force has a higher delinquency-rate than a country where the police are slack ; and in any country the social position and influence of the parents may decide whether a child is charged or not. Even the severity with which an offence is punished varies from one magistrate or judge to another. Indeed, our response to the whole idea of juvenile delinquency is illogical. We can never outgrow, it seems, our astonishment that those so young should be so bad ; yet statistics make it quite clear that the peak age for crime is in the teens and early twenties. In other words, if criminal behaviour is ever to be expected, it is to be expected then, along with neurotic or schizoid episodes, erotic fantasies, physical ebullience, a taste for brilliant garments, and all the other signs of adolescent instability and stress. Moral indignation is no more relevant to the aberrant conduct of the adolescent than it would be to the depres- sion, hot flushes, and giddiness of the menopausal woman : both are expressions of hormonal disequili- brium of which the subject is only obscurely conscious. The social difficulty is that in the adolescent such expres- sion may range from giggling inconsequence to seemingly wanton destructiveness or brutal outrage. What decides the form it takes ? That is for research to discover, as Dr. Bovet insists. Mr. Joyce Carey, in Charley is my Darling. gives an intuitive answer as far as destructiveness goes. The need to boast, the need to make the boast good, the need to get excited and break things, are not forces the boy can reason about ; they befall him, and so do the consequences. Probably no living adult has made the curious and difficult adjustment perfectly at every step ; who, then, is qualified to advise the growing child ? Dr. Bovet’s monograph is studded with reports of our ignorance, but he outlines the growing body of knowledge and opinion and directs attention to whatever is sure. Treatment may vary-and indeed it should vary, if it is to be adapted to the needs of individual children -but the aim of even the most diverse methods is the same : to help the child to build up safe and stable relationships with the people round him, and to achieve that inner security on which are founded his own moral independence and that consideration for others which lies behind good social behaviour. In time we shall know better how to do this difficult thing. 1. Psychiatric Aspects of Juvenile Delinquence. World Health Organisation, Palais des Nations, Geneva, 1951. Pp. 90. 5s. SWEDISH HOSPITALS SWEDEN, with its lakes and forests, clean air, and bracing climate, is a fine place for hospitals ; and indeed it has some of the most up-to-date hospitals in the world. Nevertheless, the members of the International Hospital Federation 1 who made a study tour of Swedish hospitals last September were more taken with the older, smaller, more homely, hospitals than with the great Sodersjukhus at Stockholm,2 with its 9 floors, 40 wards, 50 lifts, and vast central kitchen, perched at the top of the main block and connected to its 11 branch kitchens by a 400 ft. corridor, along which the staff dash to and fro on scooters. Scooters, indeed, are a good idea, and might well be introduced into some of our own long hutted hospitals (Stoke Mandeville, for instance). But the mere notion of anything so large as the Sodersjukhus shocks our new British thrift, concerned as never before with the cost of upkeep. The expense of maintaining the great place is, in fact, already beginning to weigh heavily on the authorities of this hospital. We have plenty to learn, however, from other aspects of the Swedish hospitals. They seem to pay more attention to the comfort of the patient and his relatives than is usual here. These hospitals are quieter than ours, for instance : walls and ceilings are made of sound- absorbing material, and lift-doors of wood with no clanging inner gates ; trolleys are often electric and are all well made and easy to move ; doors are fitted with door-checks, and many of them are designed to push open so that noisy handles are unnecessary. Relatives are received in a large and pleasant entrance hall which usually contains a florist’s shop, a tobacco and news- paper stall, a cafeteria, and sometimes a post-office, and a hairdressing salon for the use of ambulant patients. There is nearly always an information bureau as well, and a large model of the hospital on which a visitor can learn his way about. The beds, it is true, were thought to fall short of British models. They measure 2 ft. 6 in. across, and have their bottom legs set back some way from the foot, which gives them rather a makeshift look. Actually they are rather ingenious, for they are fitted with a wheeling device, and when the foot is lifted they can be pushed easily about like a wheelbarrow. Screens are not used in the wards, since treatments, dressings, and blanket-baths are given in a separate annexe and patients are usually wheeled to the water-closet either in their beds or in a lavatory chair. This must reduce greatly the traffic in bedpans, though these are of course provided. The pans are all made of stainless steel, and are well maintained, though the cleaning equipment is not of that latest type which cleans and sterilises. They are washed in a deep metal sink, usually in cold water, sometimes under pres- sure; but they are only sterilised in maternity and gynaecological wards. The pans are numbered, however, and each patient retains his own throughout his stay in hospital. The medical equipment is of a very high standard indeed, and extremely lavish and well cared for. Theatres in the newer hospitals are spacious and well planned, and many operations are done by daylight-another advantage of clean bright air. In the wards lights are conveniently placed over the beds, and are -often fitted with a revolving shutter which allows the patient to adjust the amount of light given out. The night light is never overhead, but usually placed in a recess in the wall, near the door, about a foot from the floor. In one hospital the night light was sunk flush in the centre of the floor of the ward, which must give a specially restful effect. 1. Report of Study Tour of Hospitals in Sweden. International Hospital Federation, at King Edward’s Hospital Fund for London, 10, Old Jewry, London, E.C.2. 1951. Pp. 60. 7s. 6d. 2. See Lancet, 1945, ii, 571.
