357

The definition of an initial illness and an active phaseare important advances and confirmation of these findingsin other areas is clearly needed. The epidemiological cluesmust be followed up. The curious tribal distribution ofthe disease noted in Uganda 14 needs explanation. But ifa seasonal febrile illness is the start of endomyocardialfibrosis in other areas, then it seems we must seek thecause in an infection or toxin rather than in some nutri-tional insult.l5 Parry and Abrahams may thus have givenus the key.

GROUPS

THE analysis 16 of small groups by Miss MargaretPhillips is an unusual social document which cocks a mild18th-century snook at the sophisticated discipline of 20th-.century research techniques. She wanted to discover

something about the formation and development of smallgroups-of any collection of people, that is, who feltthemselves to be a group and who were not too many toknow each other at least by sight. Studies in the UnitedStates had been made on group models under laboratoryconditions, but the results seemed hardly relevant to

spontaneous groups in their natural environments, andwere of little help to those struggling with group manage-ment in " real life." A group, Miss Phillips felt, was aproduct of its setting and must be studied as such. Shetherefore asked her friends to report on any groups ofwhich they were themselves members. In their replies shesought common factors and recurrent patterns, and heranalysis gives an entertaining series of vignettes of life inthis country and the germs of one or two testable hypo-theses.The stories were collected between 1940 and 1960.

Many were wartime groups-interned aliens, evacuees, anENSA team, infantry in training. Some had sprung upspontaneously for a specific purpose-for example, pro-fessional men who wished to draw up a statement of

political policy. Others were dependent on a larger, con-taining institution and had been assembled arbitrarily byits authority. These included room-mates in a teachers’

training college, teachers on a school staff, and nurses inhospital. Whatever the nature of the group, however, thereporter’s account showed how unity flourished where theenvironment was friendly, where there were common aimsand ideals, and where common effort met with some suc-cess. In the fire-fighting team, for example, there was fric-tion between regular and auxiliary members until theteam proved itself during the London blitz, and earnedpublic acclamation. Once the emergency was over,

bickering reappeared. The internees’ camp committeelost cohesion and support in the face of persistent failureto induce the authorities to improve camp conditions. Agroup of young people pursuing common intellectualinterests was virtually destroyed by one egocentric anduncooperative member and by the pairing-off of itsmembers. The religious groups studied (Roman Catholicnuns, a Protestant community, and a Friends’ meeting)seemed to have the most effective methods of controllingdisruptive members and influences. Among the nuns, forinstance, personal friendships were discouraged, and nunswere moved from house to house to counter the growth of14. Shaper, A. G., Coles, R. M. ibid. 1965, 27, 121.15. McKinney, B., Crawford, M. A. Lancet, 1965, ii, 880.16. Small Social Groups in England. By MARGARET PHILLIPS. London:

Methuen. 1965. Pp. 318. 15s.

natural affection. All three groups made use of silence asan aid to harmony.

Every group, Miss Phillips confirmed, had a "

workingtogether " (or instrumental), and a " living together "(or expressive) phase. In the latter its integrity was mostvulnerable. Leadership had to provide coordination andorganisation in the first phase and a little " mothering " ofmembers in the second. These two sides to the leader’srole were not necessarily found in the same person. In

general the larger the containing organisation the less

satisfactory the expressive side of group life. In theArmed Forces, for instance, harmony and satisfactionwere found only where work was absorbing and to theliking of those detailed to do it. Reports from the nursingprofession rivalled those from the Forces in unhappiness,with complaints of isolation and the cold and uncaringattitude of authority. Nursing, Miss Phillips contends, isstill suffering from the relics of conventual and militarydiscipline imposed by Florence Nightingale. The 1960

reports were happier by far than those of 1940, but stillprovided evidence of a rigid hierarchy, the anxiety thispossibly encourages among superiors, and the consequentharshness visited upon juniors. Miss Phillips suggeststhat nurses should work throughout their training insmall compact groups, that social intercourse should be

encouraged regardless of rank and seniority, and that ahome sister should be at hand as confidante and " mother".

Many of the reports from teachers showed signs of poorleadership. They told of staff-rooms unused, teachersarriving at or leaving the school without hail or farewell,and conflicting aims and intentions. Lack of cohesion wasespecially evident in State secondary schools. The stafftended to have widely differing trainings and back-

grounds ; and they were subject to many outside pres-sures-the Ministry of Education, the public, parents,and the Press. Outside influence was also obvious inaccounts of Women’s Institute meetings. Middle-class

members, for instance, sat in the front, labourers’ wivesat the back.

Miss Phillips advises administrators, when examiningan unsatisfactory group, to consider not only its make-upbut also its social setting. And she insists that the design ofbuildings should take account of the group’s expressive aswell as its instrumental side. She might have added thatlooking at things as they are is still a good way ofdiscovering how they work.

TETRACYCLINES AND

THE LIVER IN PREGNANCY

IN the 1950s, when the tetracyclines were introducedto clinical medicine, they were recognised to be generalinhibitors of cell metabolism, and this effect was particu-larly apparent in the liver. More specifically, tetracyclinesapparently interfere with the incorporation of glutamateinto protein, inhibit acetate metabolism, and impairoxidative phosphorylation. This depression of cellanabolism is so clearcut that tetracyclines were even usedin cancer chemotherapy. Bateman and co-workers 1 gave1-2 g. of oxyterracycline daily by the arterial route to 23patients with cancer; but, in several patients, jaundiceand renal damage developed and this treatment of malig-nant disease was abandoned. When the tetracyclineswere introduced for the chemotherapy of infections, liver1. Bateman, J. C., Barberio, J. R., Grice, P., Klopp, C. T., Pierpoint, H.

Archs intern. Med. 1952, 90, 763.