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NOTES, COMMENTS, AND ABSTRACTS

A SURVEY OF HOUSING PROBLEMS

MOST of us have heard of the Karl Marx Hof,and some perhaps have glimpsed from their aeroplanethe curious towers of Drancy, but few have anintimate knowledge of European working-class hous-ing. The outcome of expert study is now to hand.After several years as secretary to a public utilityhousing society in London Miss Denby has recentlyspent a year on the Continent as Leverhulmeresearch fellow, investigating low-rented housingestates, and her survey is thus entitled, as LordHorder points out in his foreword, to close attention.She classifies the countries under review by their statusafter the war ; and from the study of two winners,two losers, and two neutrals concludes that there isno necessary connexion between national wealth andsuccess in building houses for families with lowincomes. Vienna, despite her poverty, produced ascheme which, taken as a whole, Miss Denby thinksranks higher than any other, while it is the mainthesis of the book that England, spending far moreper dwelling, has got less value for her money thanany other country. Vienna, for example, had beenable by 1931 to build 111 nursery schools containing9600 children ; in London in 1938 there are 26, with1162 children. The Viennese achievement was made

possible by the elimination of profiteering in buildingmaterials and by the collapse of land values whichenabled the municipality to buy land cheaply. In

England it is on building materials and expensivecompensation that the bulk of our money has gone.France also has had to spend heavily on compensation,with the result that she is behind-hand with slumclearance ; against this must however be set the

imaginative new garden cities round Paris, whichare in the front rank of modern housing work. FromFrance also comes the most up-to-date method ofrefuse disposal, the Garchy system. In Italy andGermany it is interesting to note the effect of politicson housing. Social centres are not provided in thenew schemes, and in Germany the Nazi emphasis onthe family is apparently discouraging nursery schools.London might well envy Rome her plenary powersto clear slums and preserve beautiful buildingsregardless of vested interests. We should expect tolearn most from Holland and Sweden as they arenearest to us in climate and political structure, butthe Dutch suffer from such shortage of space as tomake their problem peculiar. We share Miss Denby’sdislike of the Dutch system of segregation of undesir-ables ; the estates-are quite attractive, but people notunnaturally prefer " a good address." Sweden isheld up as the model we could most easily imitate.Private enterprise is given scope, but central planningand control prevent our own often chaotic results.In comparing British estates unfavourably with con-tinental ones Miss Denby does not give sufficientcredit to the new British interiors. It is after all

something to have a bathroom to each family andan outside window to a w.c. She is also on uncertainground when she stigmatises as lazy the policy ofbuilding satellite towns. It is true that our slums aremore horizontal than vertical, and that replanningat the centre should therefore be easier for us thanfor continental towns which were intensively developedin tenement blocks before the war ; true also thatwe could with advantage economise on road space,

1 Europe Rehoused. By Elizabeth Denby. London:George Allen and Unwin. Pp. 284. 14s.

and that our spreading development will look foolishin fifty years’ time if the predicted decline in popula-tion takes place. But attractive as the scheme of

cottages at 30 to the acre in the centre of the townmay be, it cannot be carried out under the presentsystem of private ownership of expensive urban land.It is to be hoped, however, that the builders of thesatellite towns will take to heart the most necessarywarning against repeating the dreary effect of our

past " zoning snobberies," and will follow the exampleof Chatenay Malabry in providing dwellings for a

wide range of income levels in one scheme. It is a

pity that Russia was not included in the survey, andit would have been interesting to hear more of ruralhousing.

PHYSICIAN AND APOTHECARY

IN ancient times the fellowship of London physicianssupervised the sale of drugs by apothecaries. Had its

regime survived, there might have been the less

anxiety to-day over the unrestricted retailing ofsecret remedies: Those old days are recalled bycertain proposed amendments to the Food and DrugsBill. The Bill had already scheduled for repealmany existing laws which it is about to supersedeand replace. Opportunity is evidently being takento clear away also some early enactments which,though obsolete, are at present unrepealed. Thus itis proposed to get rid of part of an Act of Henry VIII(32 Henry VIII, Cap. 40, Section 2) whereby four ofthe best learned, wisest, and most discreet physicianswere to be chosen annually for the inspection of

apothecaries’ premises, with authority to burn or

otherwise destroy any wares found to be defective,corrupt, or not meet to be ministered in medicine forthe health of men’s bodies. Any apothecary whoobstructed the search would forfeit E5 ; if the

appointed four neglected their duty, they would befined 40s. Thirteen years later came another enact-ment which the amended Bill now seeks also to

repeal. Section 3 of an Act of Mary " touchingthincorporations of the Phisitions in London " addedthat, for the better execution of the search, thewardens of the Grocers’ Company should accompanythe four inspecting physicians. In the same scheduleof proposed repeals it is intended also to insertSections 3 and 4 of the Apothecaries Act, 1815.These provisions authorised the Society of LondonApothecaries to enter the shops of persons using theart or mystery of an apothecary in England or Walesand to search, survey, prove, and determine if themedicines, wares, and drugs therein were wholesome,meet, and fit for the health, ease, and cure of HisMajesty’s subjects. The society was to destroy anydrugs found, in the pleonastic phraseology of the

period " false, unlawful, deceitful, stale, unwhole-some, corrupt, pernicious or hurtful." No one wasto take part in this search in London or within a30-mile radius unless he was a member of the societyof ten years’ standing, nor elsewhere in England andWales unless he had ten years of actual practice asan apothecary. The Food and Drugs Bill, in itslaudable effort to tidy up the law, has discoveredthese dead enactments and now takes the oppor-tunity to give them formal burial.

It must be many generations since the censors ofthe Royal College of Physicians inspected apothecaries’shops-presumably not since the year 1858, at anyrate. The Grocers’ Company, it is believed, has notexercised its right of search under the Act of Mary

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since the year of the fire of London, though its charterof 1689 seems to concede or confirm the privilege ofsupervising and correcting druggists. The Societyof Apothecaries has not been required to inspect anddestroy defective medicines since the modern law offood and drugs has made it an offence to sell waresnot of the nature and substance demanded by thepurchaser. No vested interests, therefore, will sufferif these vestigial survivals disappear, though thenational spirit of conservatism may regret the formalremoval of any relic of times when life was simplerif more carefully supervised.

LIBRARIES FOR HOSPITALS

THE second conference of the International Guildof Hospital Librarians was held in Berne fromJune 7th to llth. Delegates came from Belgium,Finland, France, Germany, Great Britain, Norway,and Switzerland. Three reports were presented bythe British section of the Guild. Mrs. M. E. Roberts(hon. secretary) spoke on methods of establishinghospital libraries, and papers were sent by Mrs.Raymond on methods of collecting books and byMrs. Beddington on the hospital librarian, herrecruitment and status. Dr. Wyrsch also spoke onbooks and reading for mental patients. Dr. ReneSand, the president of the Guild, at the end of hisreport announced that an invitation had beenreceived to hold the next conference in London in1940, and the delegates unanimously agreed to this.On June 16th at Portsmouth, at the annual

conference of the Library Association, the provisionof libraries for patients through the county libraryauthority was considered. Miss A. S. Cooke, thecounty librarian of Kent, spoke of the difficulties.In Surrey, for example, there are 86 hospitals, somefor general cases, some for infectious cases, and somefor mental cases. Again some are voluntary hos-pitals, some are under the Surrey county council,some under the London County Council, some underCroydon county borough, and so on. The supplyand transport of books can usually be arranged, butin scattered country places the provision of adequatesupervision is more difficult. Voluntary helpers canreceive some training under professional direction ata central library, which can also supply the cataloguecards, but the visits of a county librarian or a memberof the staff can only be occasional. Miss Gerard, theborough librarian of Worthing, described the arrange-ments made in a small hospital. Worthing Hospitalis believed to be the first voluntary hospital to havea service organised by the public library. Thirty tofifty books are sent from the library to the hospitaland exchanged month by month. A proportion ofthe new cheap editions, replacements, and reboundbooks which are passing into the library are reservedfirst for the hospital service. For several years insuccession the association have devoted a session tothis subject and the increasing interest shown isevidence that hospital authorities can rely upon thesympathetic interest and assistance of the libraryauthorities in providing a book service for patients.

A POPULAR EXPOSITION OF MEDICAL

PROGRESS

Mr. Paul De Kruif has already shown himself tobe a master of the art of popular exposition ; hehas been a laboratory worker himself and unlikemany popular medical writers he always gets theright end of the scientific stick. If his emotions areebullient and his personal interpretations over-

dramatic, his facts are generally sound and it isquite clear that his books aim at being somethingmore than merely amusing. They are, in fact,in their way powerful propaganda in the cause ofmedical research and the advance of public health.In his new book 1 Mr. De Kruif dramatises some of

1 The Fight for Life. By Paul De Kruif. London : JonathanCape. 1938. Pp. 320. 12s. 6d.

the incidents of present-day medical research andhealth work, and, incidentally, drags persons into themelodramatic limelight who would probably muchprefer to remain in decent scientific obscurity. Unlikethe " Microbe Hunters " the book does not confineitself to the big original advances of medical science ;it rather describes the type of infantry attack whichis daily going on against disease in all parts of theworld in laboratories and health offices. Among thesubjects are the fight against child-bed death, againstpellagra, streptococcal disease, syphilis, and tuber-culosis. The chapter on Detroit against tuberculosisis only a piece of local, one might almost sayparochial, history brought into the open, but itgives a graphic picture of that odd mixture of efficiencyand ballyhoo that makes up a typical Americanpublic health campaign. Sticklers for pure andundefiled English and those who are over-sensitiveabout the dignity of the medical profession had bestgive Mr. De Kruif a miss ; but the reading public asa whole, both lay and medical, will find plenty toamuse and not a little to instruct them and willagree that his flamboyant faults are more thanredeemed by some very solid qualities.

THE BERNHARD BARON LABORATORIES

FORMIDABLE difficulties were encountered in con-structing the new research laboratories of the RoyalCollege of Surgeons at the top of the old building inLincoln’s Inn-fields, and Messrs. Lanchester andLodge, the architects responsible for the work, havenow prepared an attractively illustrated pamphletshowing how they were overcome. The alterationsincluded the addition of another story to the centralblock and the erection of a three-story tower at eachend of it, and the support of these towers introducedsome intricate structural problems. To bear theirweight the main walls and foundations had to beexamined and strengthened where necessary andreinforced concrete joists had to be provided todistribute the load over as many points as possible.It is to the architects’ credit that they were able tomake such drastic changes without detracting fromthe appearance of George Dauce’s original portico.Their account of the new laboratories opened lastDecember should be of value not only to otherarchitects but to all concerned with the planning ofresearch laboratories.

FILM-STRIPS

THE film-strip, which has been introduced as asubstitute for lantern slides for showing still pictures,consists of a length of safety cinema film on which isprinted a series of individual pictures. These canbe shown either by an ordinary lantern with a specialadapter or by a simple projector working from themain or from a battery, and can be used in con-junction with a gramophone to give necessary sound-effects or dialogue. Film-strips are lighter and lessliable to breakage than lantern slides, and a typicalstrip containing 18 pictures will go safely by postin a small container for 1d. Short strips can bebought with descriptive notes for 3s. or can be hiredthrough dealers. New strips are being publishedevery week on a variety of subjects of which a listcan be obtained from the agents, Messrs. RonaldSmall and Partners, Ltd., of Bush House, London,W.C.2. They should be of considerable use tolecturers and for demonstrations generally.

AN ATHLETE ON TRAINING

MOST great athletes feel the urge to communicatetheir personal experience but not all are able to do so.Moreover, the desire to emphasise his conceptionof the mechanics and physiology of violent exercisesometimes leads an amateur in these matters intowaters beyond his depth. Mr. Guy Butler 1 has aimedat telling the young man who wants to get fit and to

1 Athletics and Training. By Guy Butler. LondonA. and C. Black. 1938. Pp. 247. 5s.

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win races how to train and how to run as fast aspossible. He has said nothing about oxygen-debt orof mysterious foodstuffs which can impart speed orstaying power ; in fact diet is only mentioned in halfa dozen lines respecting the lunch to be recommendedon the day of athletic competition, with the specialindications for sugar. Mr. Butler makes only onescientific excursion which is open to criticism ; wedoubt whether his advice to indulge in considerableexercise immediately before a race is altogether wise.The principle that an engine works best when it iswarm is sound enough, but in securing the optimumefficiency in this way it would not be easy to avoidan accumulation of lactic acid which only time candisperse. The book as a whole is a sound guide tothe principles of preparation and of technique incompetitive sport. It is of interest to learn that atthe Marathon race the taking of drugs if discoveredmeans disqualification and that the official medicalofficer is empowered to compel anyone to retire fromthe race. It is a pity that some names are misspelt-notably Kolehmainen and Cunningham, and a

celebrated German starter has become anglicised toMiller.

DOMICILIARY MEDICAL SERVICES INNEWCASTLE-UPON-TYNE

Dr. J. A. Charles has presented a careful statisticalanalysis 1 of the working of the system of domiciliarymedical attendance under the poor-law in Newcastle-upon-Tyne. The system has undergone modificationsince its introduction in November, 1933. Originallyapplied to 6 of the 10 medical relief districts of thecity it now applies to 8, and it is estimated that theaverage number of persons in receipt of relief inthese districts during the period under review was15,095 ; these presumably might be regarded as

potential patients.Original medical remuneration was from a pool

of £1200; in March, 1935, there was introduced thecapitation system of payment of 5s. per quarter perpatient treated with a payment of :61 for a " chronic "case-i.e., one requiring treatment for more thantwo consecutive quarters ; since January, 1938, anincrease of 25 per cent. in the scale of fees has beengranted. There are extra fees for certificates,confinements, and emergency medicines. Drugs aresupplied from two dispensaries. Expenditure on

medical services was : remuneration of practitioners£3950 15s., fees for certificates £326 16s., fees forconfinements £33, emergency medicines £ 8 13s. 10d.—total £4319 4s. 10d. The number of persons treatedwas 10,707, the average cost per patient in medicalremuneration 7s. 4.5d., the average number of unitservices per patient 8-4, and the average remunera-tion per unit service 10’6d., which may be comparedwith the figure of 5-656d. under the original poolsystem. The cost of the dispensing services was£1637, or 3s. 0’7d. per patient treated, and of clericalservices, &c., £362, or 8’ld. per patient treated. Thefinal average total cost per patient treated was11s. 9-6d. The number of participating practitionerswas 56, or 55 per cent. of the National HealthInsurance panel.

Medical records are kept and the somewhat non-committal statement is made that they " are keptwith a degree of accuracy and completeness notinferior to the standard of record keeping under theNational Health Insurance Scheme." Much usefulinformation has been abstracted from these records.It may be noted that children under 15 years of ageconstituted 43-5 per cent. of persons treated. Atable compares the incidence of groups of diseaseswith those recorded for insured persons. There areunexpected differences considering the large pro-portion of children-for example the figure fororganic heart disease is 55-9 per 1000 as compared

1 Report of the Medical Officer of Health of the City andCounty of Newcastle-upon-Tyne on the Working of theDomiciliary Medical Services in the Joint Medical Relief Districtduring the period March 1st, 1936, to Feb. 28th, 1937.

with 12-6 among insured persons, and the correspond-ing figure for malignant disease is 3,9 as comparedwith 1-8. Another table shows the age-distributionof various forms of rheumatism. Such medicalrecords, if accurately kept, should assist in throwinglight on the incidence and distribution of sickness.A fear expressed on the introduction of this method

of medical attendance was of the possible increasein the prescription of medical extras. It is shownthat in Newcastle there has been an increase perpatient treated from Is. 4.4d, under the previoussystem to 2s. 0-ld’. Dr. Charles adduces variousreasons for this increase. A further anticipationwas as regards possible discordant relations betweenrelieving officers and a much larger number of practi-tioners, and it is satisfactory to learn that suchrelations have been excellent.

This is a useful report. It is clear that the costof the service has increased and is increasing, andunfortunately the demands on the domiciliarymedical service are especially heavy in districts whosefinancial resources are otherwise severely strained.The important consideration is whether there hasbeen improvement in the standard of medical servicecommensurate with the increased cost, and thiscannot be gauged by any statistical analysis. Onthe question of cost Dr. Charles says : " In viewof the inadequate remuneration paid to the medicalofficers under the old arrangement, any comparisonof the cost of the two systems is also quite fallacious."

THE NEW PATHOLOGY BUILDING ATGUY’S HOSPITAL

THE new building opened at Guy’s Hospital by theEarl of Athlone on June 23rd will bring into a self-contained unit the formerly scattered laboratories ofpathology, clinical chemistry, and bacteriology andwill provide these departments with much-neededaccommodation for teaching and research. It willalso house the new clinical research unit. Thebuilding stands behind the present anatomy andphysiology departments on the site of Spur Inn-yard.It has cost about £85,000, half of which has beenpaid by London University and half by the medicalschool from accumulated surpluses.The lower ground-floor contains a large lecture

theatre and a smaller theatre for practical demon-strations, both of which can be rapidly darkened byelectrically operated blinds, and a well-equippedworkshop for instrument-making and repairs. Theupper ground-floor is occupied by the physiologyclass-room and research room and the physics depart-ment, and the two floors above this will contain thedepartment of bacteriology. The clinical chemistrylaboratories and research rooms for the pharmaco-logist are on the third floor, and above these is thepathology department, with a comfortable and well-lighted library.The fifth floor contains a room for kymographic

work, a sterile operating-room and preparation room,laboratories for research in experimental pathologyand for the clinical research fellow, and four roomsfor the clinical research unit. The top floor willhouse the experimental animals. Three rooms,complete with steam sterilising equipment, will be usedfor inoculated animals. and entirely apart from thesethere are two large and six small rooms, all openingout of a central glass-covered area, in which thestock animals will be kept. In this way it will bepossible to segregate completely animals in quarantineand infected animals.

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Mr. HANS ROWAN-HAMILTON writes (from9, Thurloe-square, London, S.W.7.) : In preparing agenealogical history of my family, the Hamiltonsof Killyleagh, Co. Down, I find that there was in usein 1649 a drug called Histernum Crapulum whichwas used for " fleabittings " I should be gratefulif any of your readers would tell me the nature of thisdrug.