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Causes and Prevention of Tuberculosis
151
PUBIAC I I E A L T t I , June, 1952
BOOK
REVIEWS
The Edueability of Cerebral Palsied Children.
By M. I.
DUNSDON. (Pp. 163. Price 21s.) London : Newnes E d u c a t i o n a l P u b l i s h i n g Co., Ltd. 1952. T h i s is a book w h i c h s h o u l d be read by all w h o are c o n c e r n e d with cerebral palsied children. It will be particularly valuable to school medical officers w h o have to decide what c a n be done about their education. W e h a v e b e e n u r g e d recently to do m o r e for their c h i l d r e n a n d m a y h a v e b e e n led to take a s o m e w h a t optimistic view of their possibilities. S o m e of t h o s e w h o m we have w r i t t e n off as hopelessly ineducable m a y seem to be crying out to u s to review their cases in t h e light of m o d e r n knowledge so that we m a y give t h e m a n o t h e r chance, a n d as we e x a m i n e a n d r e - e x a m i n e t h e less severe cases we m a y w o n d e r w h e t h e r we are doing all that is possible to help t h e m to " free t h e m s e l v e s f r o m the shackles of their h a n d i c a p . " (Earl Carlson.) 111 a foreword, M r . T o m l i n s o n , M i n i s t e r of E d u c a t i o n in the late G o v e r n m e n t , explains t h a t in 1945 t h e A d v i s o r y C o m m i t t e e on H a n d i c a p p e d C h i l d r e n advised his predecessor to go into this question, a n d as a result t h e National F o u n d a t i o n for Educational R e s e a r c h in E n g l a n d a n d W a l e s e n t r u s t e d M i s s D u n s d o n with the task. S h e d r e w u p o n i n f o r m a t i o n supplied b y t h e British Council for t h e W e l f a r e of Spastics, b y t h e M i n i s t r y of Education, by certain L . E . A . s a n d b y special schools for cerebral palsy cases. T h e total n u m b e r of c h i l d r e n included in t h e research was j u s t over 3,700, of w h o m 916 were individually .assessed b y M i s s D u n s d o n , special attention b e i n g g i v e n to 468 w h o were candidates for a special school a n d to 38 or so w h o were actually in a t t e n d a n c e at s u c h a school. A f t e r describing t h e m a i n types of cerebral palsy a n d their incidence, t h e book goes on to deal w i t h intellectual d e v e l o p m e n t of t h e children, a n d t h e n w i t h verbal ability a n d s p e e c h developm e n t , sensory defects, emotional stability a n d so forth, factors w h i c h d e t e r m i n e t h e educability. T h e c h a p t e r on appreciation of spatial concepts is particularly interesting. Chapters on scholastic a t t a i n m e n t s in relation to disability a n d educational progress are followed by t h e selection of children for special schools a n d t h e book concludes with p l a n n i n g educational care. A n a p p e n d i x deals with t h e aetiology of the condition. M i s s D u n s d o n ' s findings wilt be m o r e c o m f o r t i n g to t h e school medical officer w h o m a y h a v e b e e n pessimistic a b o u t his o w n efforts o n behalf of spastics t h a n to t h e p a r e n t w h o feels optimistic about h e r palsied child. It s e e m s t h a t t h e a s c e r t a i n m e n t of cerebral palsy cases in this c o u n t r y is s a t i s f a c t o r y - - " v e r y few cerebral palsied children of school age are u n k n o w n to L . E . A . s . " Bearing in m i n d t h e recent s u g g e s t i o n that we m i g h t look to A m e r i c a to i m p r o v e o u r school health service, t h e school medical officer will be gratified to read that " m a n y h a n d i c a p p e d children m a y exist there " (in m a n y A m e r i c a n states) " u n k n o w n , u n d i a g n o s e d a n d w i t h o u t a n y facilities for t r e a t m e n t or special school e d u c a t i o n . " M i s s D u n s d o n claims t h a t t h e o r d i n a r y tests of intelligence, s u c h as t h e T e r m a n Merrill, are applicable to these cases, a l t h o u g h of course a g o o d deal of special c o n s i d e r a t i o n has to be given in applying t h e m . S h e does n o t say w h e t h e r s h e agreed with the I.Q.s s u p p l i e d b y S . M . O . s , n o r w h e t h e r there was a n y i m p r o v e m e n t in t h e I . Q . s of individual c h i l d r e n after t h e y h a d b e e n for a period in special schools, p o i n t s o n w h i c h m a n y w o u l d have liked f u r t h e r information. S h e refutes t h e s u g g e s t i o n t h a t a n o r m a l scatter of intelligence is to be f o u n d a m o n g t h e athetoids, a l t h o u g h s h e acknowledges that t h e negligible n u m b e r with superior potential capacity are to b e f o u n d a m o n g this group. O n t h e w h o l e t h e greater t h e physical h a n d i c a p t h e greater will be t h e intellectual b a c k w a r d n e s s . T h e n u m b e r of c h i l d r e n capable of benefiting f r o m education in special cerebral palsy schools is limited. C h i l d r e n w i t h I.Q.s below 85 m a k e little p r o g r e s s a n d s h o u l d n o t be s e n t to t h e m . it is r e m a r k e d t h a t only 17.7% of candidates for s u c h schools were above this level. M i s s D u n s d o n s u g g e s t s that d u r i n g early school life t h e social a n d physical aspects of t r a i n i n g s h o u l d receive m o s t attention. T h o s e c h i l d r e n w h o by 9 or 10 years of age h a v e m a d e sufficiently good progress could t h e n be t r a n s ferred to t h e special schools for cerebral palsy cases. F o r others, m u c h formal e d u c a t i o n is largely a waste of time, a n d s h o u l d be replaced by a s c h e m e of " education for living." N o d o u b t m a n y of M i s s D u n s d o n ' s c o n t e n t i o n s w i l l be eriticised, b u t s h e p r e s e n t s h e r facts fairly ( a l t h o u g h n o t always clearly) a n d s h e a r g u e s h e r case well. T h e book is free f r o m psychological j a r g o n , b u t it is n o t easy reading. S o m e of t h e medical facets n e e d polishing. A g u i n e a s e e m s a h i g h price to pay for so small a book, b u t it is well w o r t h it, for it p r e s e n t s aspects of t h e p r o b l e m of t h e cerebral child w h i c h have n o t b e e n accessible to u s before, and it offers s u g g e s t i o n s for dealing with t h e cases w h i c h are not
impossible. M i s s D u n s d o n , with h e r experience in child guidance work a n d with spastics, is particularly well fitted to deal with the subject a n d has done so m o s t ably.
Causes and Prevention of Tuberculosis. By BR~c~" R. CLARKE, M.D. (Pp. 296. Price 32s. 6d.) E d i n b u r g h : E. & S. Livingstone, L t d . 1952. I n no o t h e r disease have t h e events of t h e last 10 years caused so great a c h a n g e in outlook as in the field of tuberculosis. A t t e n t i o n h a s b e e n mainly given to the a d v a n c e s in t r e a t m e n t , for t h e s e h a v e b e e n spectacular a n d m a y yet be even m o r e so. C h e m o t h e r a p y a n d s u r g e r y have b r o u g h t w i t h i n t h e scope of successful t r e a t m e n t m a n y t u b e r c u l o u s conditions w h o s e p r o g n o s i s was considered n o t so long ago to be hopeless. B u t these m e a s u r e s c a n only be of u s e to t h o s e w h o s e disease is discovered at a stage w h e n t h e y c a n be applied, a n d these are still the m i n o r i t y . If t h e eradication of tuberculosis is to be accomplished, m o r e e m p h a s i s m u s t be laid on t h e epidemiological a n d preventive aspects. D r . Clarke's book excellently p r e s e n t s w h a t is involved. T h e e x t e n t of t u b e r c u l o u s infection a n d f r a n k tuberculosis in t h e c o m m u n i t y is considered in t h e light of t u b e r c u l i n surveys, m a s s r a d i o g r a p h y a n d other case-finding m e a s u r e s . P r i m a r y infection a n d its i m m e d i a t e effects are clearly described, together with m e a s u r e s to p r e v e n t or m i n i m i s e t h e risk o f infection, w i t h o u t w h i c h disease c a n n o t develop. U n t i l s u c h t i m e as t h e infection rate is very m u c h lower t h a n at present, t h o s e conditions of living w h i c h m a y influence infection will c o n t i n u e to be of great importance. D r . Clarke deals a d e q u a t e l y with s u c h t h i n g s as overcrowding, m a l n u t r i t i o n , habits of work, leisure, social c u s t o m s a n d other relevant m a t t e r s . T h e c h a p t e r on infections by t h e bovine t y p e of bacillus is an excellent r e m i n d e r of t h e u n n e c e s s a r y m o r t a l i t y a n d suffering f r o m this cause. A l t h o u g h statistically small in c o m p a r i s o n with infection b y t h e h u m a n strain, t h e presence of e v e n this n u m b e r of cases m i g h t cause d o u b t of t h e w h o l e - h e a r t e d n e s s of o u r a t t e m p t s to s t a m p o u t t h e disease. H e discusses in detail t h e preventive m e a s u r e s applicable to t h o s e w h o have n o t y e t h a d their p r i m a r y infection a n d those w h o s e infection h a s been a c c o m p l i s h e d w i t h o u t m i s h a p . I n t h e m a n a g e m e n t of t h e clinically ill t h e places of h o m e a n d hospital t r e a t m e n t , education a n d segregation are considered. T h e r a p e u t i c s are m e n t i o n e d only as a c o n t r i b u t i o n to p r e v e n t i n g t h e spread of infection in t h e p o p u l a tion. A critical appreciation a n d favourable o p i n i o n of B . C . G . vaccination f o r m a n o t h e r u s e f u l chapter. A f t e r consideration of all t h e facts a cautiously optimistic view of t h e f u t u r e of tuberculosis control is taken. We quote from page 156 : " Provision of a n a d e q u a t e food s u p p l y is far t h e m o s t i m p o r t a n t of living conditions in relation to tuberculosis, because t h e a l m o s t universal latent infection will m a n i f e s t itself as disease in p r o p o r t i o n to t h e severity of m a l n u t r i t i o n . " " O t h e r living conditions are i m p o r t a n t either as c o n t r i b u t o r y causes of m a l n u t r i t i o n or as factors w h i c h p r e d i s p o s e to infection. I m p r o v e m e n t in living conditions will aid t h e eradication of tuberculosis only in so far as s u c h i m p r o v e m e n t c o n d u c e s to the control of infection. T h e scientific control o f infection, s u p p o r t e d b y i n f o r m e d public opinion, is t h e special e n v i r o n m e n t a l c o n d i t i o n w h i c h alone p r o m i s e s t h e eradication of t h e disease f r o m t h e c o m m u n i t y . T h e raising of t h e level of resistance b y non-specific m e a s u r e s or b y vaccination will be m o s t effective in societies w h i c h strive to reduce o p p o r t u n i t i e s of infection to a m i n i m u m , for n o k n o w n m e a n s of raising resistance p r o m i s e s c o m p l e t e protection."
The Rhesus Danger.
Its Medical, M o r a l a n d Legal Aspects. By R. N. C. McCuRDY, M.m, CH.B., D.P.H. (Pp. 138. Price 5s. net.) L o n d o n : H e i n e m a r m M e d i c a l Books, L t d . 1951. T h i s is a c o m p r e h e n s i v e review of t h e subject, for doctor a n d l a y m a n , w r i t t e n clearly a n d simply. T h e significance of R h e s u s incompatibility a n d t h e p r o b l e m s arising f r o m it are s h o w n in t h e introduction. A review of the medical b a c k g r o u n d follows, starting w i t h a description of M e n d e l i a n inheritance, blood g r o u p s, t r a n s f u s i o n s a n d a n t i g e n - - a n t i b o d y reactions. T h e r e is t h e n an a c c o u n t of t h e discovery of R h e s u s factors a n d a s u r v e y of all that is n o w k n o w n a b o u t t h e m , i n c l u d i n g t h e diagnosis and m e t h o d s of t r e a t m e n t of t h e affected baby. T h e second part of t h e book gives t h e details of all the possible ways of dealing with t h e p r o b l e m for a h u s b a n d a n d wife w h o are faced with t h e tragic situation of R h e s u s incompatibility. D r . M c C u r d y takes a wide view of the R h e s u s factor a n d disc u s s e s it in c o n n e c t i o n with s u c h controversial facets as abortion, artificial i n s e m i n a t i o n , R h e s u s incompatibility as a g r o u n d for divorce a n d p o p u l a t i o n problems. T h e interest of the book is increased by the historical a p p r o a c h to each subject a n d t h e excellent a c c o u n t of t h e relevant legislation. N u m e r i c a l evidence f r o m various sources, s u c h as t h e RegistrarG e n e r a l ' s R e t u r n s a n d the publications of P E P , is freely used.
PUBIAC I I E A L T t I , June, 1952
BOOK
REVIEWS
The Edueability of Cerebral Palsied Children.
By M. I.
DUNSDON. (Pp. 163. Price 21s.) London : Newnes E d u c a t i o n a l P u b l i s h i n g Co., Ltd. 1952. T h i s is a book w h i c h s h o u l d be read by all w h o are c o n c e r n e d with cerebral palsied children. It will be particularly valuable to school medical officers w h o have to decide what c a n be done about their education. W e h a v e b e e n u r g e d recently to do m o r e for their c h i l d r e n a n d m a y h a v e b e e n led to take a s o m e w h a t optimistic view of their possibilities. S o m e of t h o s e w h o m we have w r i t t e n off as hopelessly ineducable m a y seem to be crying out to u s to review their cases in t h e light of m o d e r n knowledge so that we m a y give t h e m a n o t h e r chance, a n d as we e x a m i n e a n d r e - e x a m i n e t h e less severe cases we m a y w o n d e r w h e t h e r we are doing all that is possible to help t h e m to " free t h e m s e l v e s f r o m the shackles of their h a n d i c a p . " (Earl Carlson.) 111 a foreword, M r . T o m l i n s o n , M i n i s t e r of E d u c a t i o n in the late G o v e r n m e n t , explains t h a t in 1945 t h e A d v i s o r y C o m m i t t e e on H a n d i c a p p e d C h i l d r e n advised his predecessor to go into this question, a n d as a result t h e National F o u n d a t i o n for Educational R e s e a r c h in E n g l a n d a n d W a l e s e n t r u s t e d M i s s D u n s d o n with the task. S h e d r e w u p o n i n f o r m a t i o n supplied b y t h e British Council for t h e W e l f a r e of Spastics, b y t h e M i n i s t r y of Education, by certain L . E . A . s a n d b y special schools for cerebral palsy cases. T h e total n u m b e r of c h i l d r e n included in t h e research was j u s t over 3,700, of w h o m 916 were individually .assessed b y M i s s D u n s d o n , special attention b e i n g g i v e n to 468 w h o were candidates for a special school a n d to 38 or so w h o were actually in a t t e n d a n c e at s u c h a school. A f t e r describing t h e m a i n types of cerebral palsy a n d their incidence, t h e book goes on to deal w i t h intellectual d e v e l o p m e n t of t h e children, a n d t h e n w i t h verbal ability a n d s p e e c h developm e n t , sensory defects, emotional stability a n d so forth, factors w h i c h d e t e r m i n e t h e educability. T h e c h a p t e r on appreciation of spatial concepts is particularly interesting. Chapters on scholastic a t t a i n m e n t s in relation to disability a n d educational progress are followed by t h e selection of children for special schools a n d t h e book concludes with p l a n n i n g educational care. A n a p p e n d i x deals with t h e aetiology of the condition. M i s s D u n s d o n ' s findings wilt be m o r e c o m f o r t i n g to t h e school medical officer w h o m a y h a v e b e e n pessimistic a b o u t his o w n efforts o n behalf of spastics t h a n to t h e p a r e n t w h o feels optimistic about h e r palsied child. It s e e m s t h a t t h e a s c e r t a i n m e n t of cerebral palsy cases in this c o u n t r y is s a t i s f a c t o r y - - " v e r y few cerebral palsied children of school age are u n k n o w n to L . E . A . s . " Bearing in m i n d t h e recent s u g g e s t i o n that we m i g h t look to A m e r i c a to i m p r o v e o u r school health service, t h e school medical officer will be gratified to read that " m a n y h a n d i c a p p e d children m a y exist there " (in m a n y A m e r i c a n states) " u n k n o w n , u n d i a g n o s e d a n d w i t h o u t a n y facilities for t r e a t m e n t or special school e d u c a t i o n . " M i s s D u n s d o n claims t h a t t h e o r d i n a r y tests of intelligence, s u c h as t h e T e r m a n Merrill, are applicable to these cases, a l t h o u g h of course a g o o d deal of special c o n s i d e r a t i o n has to be given in applying t h e m . S h e does n o t say w h e t h e r s h e agreed with the I.Q.s s u p p l i e d b y S . M . O . s , n o r w h e t h e r there was a n y i m p r o v e m e n t in t h e I . Q . s of individual c h i l d r e n after t h e y h a d b e e n for a period in special schools, p o i n t s o n w h i c h m a n y w o u l d have liked f u r t h e r information. S h e refutes t h e s u g g e s t i o n t h a t a n o r m a l scatter of intelligence is to be f o u n d a m o n g t h e athetoids, a l t h o u g h s h e acknowledges that t h e negligible n u m b e r with superior potential capacity are to b e f o u n d a m o n g this group. O n t h e w h o l e t h e greater t h e physical h a n d i c a p t h e greater will be t h e intellectual b a c k w a r d n e s s . T h e n u m b e r of c h i l d r e n capable of benefiting f r o m education in special cerebral palsy schools is limited. C h i l d r e n w i t h I.Q.s below 85 m a k e little p r o g r e s s a n d s h o u l d n o t be s e n t to t h e m . it is r e m a r k e d t h a t only 17.7% of candidates for s u c h schools were above this level. M i s s D u n s d o n s u g g e s t s that d u r i n g early school life t h e social a n d physical aspects of t r a i n i n g s h o u l d receive m o s t attention. T h o s e c h i l d r e n w h o by 9 or 10 years of age h a v e m a d e sufficiently good progress could t h e n be t r a n s ferred to t h e special schools for cerebral palsy cases. F o r others, m u c h formal e d u c a t i o n is largely a waste of time, a n d s h o u l d be replaced by a s c h e m e of " education for living." N o d o u b t m a n y of M i s s D u n s d o n ' s c o n t e n t i o n s w i l l be eriticised, b u t s h e p r e s e n t s h e r facts fairly ( a l t h o u g h n o t always clearly) a n d s h e a r g u e s h e r case well. T h e book is free f r o m psychological j a r g o n , b u t it is n o t easy reading. S o m e of t h e medical facets n e e d polishing. A g u i n e a s e e m s a h i g h price to pay for so small a book, b u t it is well w o r t h it, for it p r e s e n t s aspects of t h e p r o b l e m of t h e cerebral child w h i c h have n o t b e e n accessible to u s before, and it offers s u g g e s t i o n s for dealing with t h e cases w h i c h are not
impossible. M i s s D u n s d o n , with h e r experience in child guidance work a n d with spastics, is particularly well fitted to deal with the subject a n d has done so m o s t ably.
Causes and Prevention of Tuberculosis. By BR~c~" R. CLARKE, M.D. (Pp. 296. Price 32s. 6d.) E d i n b u r g h : E. & S. Livingstone, L t d . 1952. I n no o t h e r disease have t h e events of t h e last 10 years caused so great a c h a n g e in outlook as in the field of tuberculosis. A t t e n t i o n h a s b e e n mainly given to the a d v a n c e s in t r e a t m e n t , for t h e s e h a v e b e e n spectacular a n d m a y yet be even m o r e so. C h e m o t h e r a p y a n d s u r g e r y have b r o u g h t w i t h i n t h e scope of successful t r e a t m e n t m a n y t u b e r c u l o u s conditions w h o s e p r o g n o s i s was considered n o t so long ago to be hopeless. B u t these m e a s u r e s c a n only be of u s e to t h o s e w h o s e disease is discovered at a stage w h e n t h e y c a n be applied, a n d these are still the m i n o r i t y . If t h e eradication of tuberculosis is to be accomplished, m o r e e m p h a s i s m u s t be laid on t h e epidemiological a n d preventive aspects. D r . Clarke's book excellently p r e s e n t s w h a t is involved. T h e e x t e n t of t u b e r c u l o u s infection a n d f r a n k tuberculosis in t h e c o m m u n i t y is considered in t h e light of t u b e r c u l i n surveys, m a s s r a d i o g r a p h y a n d other case-finding m e a s u r e s . P r i m a r y infection a n d its i m m e d i a t e effects are clearly described, together with m e a s u r e s to p r e v e n t or m i n i m i s e t h e risk o f infection, w i t h o u t w h i c h disease c a n n o t develop. U n t i l s u c h t i m e as t h e infection rate is very m u c h lower t h a n at present, t h o s e conditions of living w h i c h m a y influence infection will c o n t i n u e to be of great importance. D r . Clarke deals a d e q u a t e l y with s u c h t h i n g s as overcrowding, m a l n u t r i t i o n , habits of work, leisure, social c u s t o m s a n d other relevant m a t t e r s . T h e c h a p t e r on infections by t h e bovine t y p e of bacillus is an excellent r e m i n d e r of t h e u n n e c e s s a r y m o r t a l i t y a n d suffering f r o m this cause. A l t h o u g h statistically small in c o m p a r i s o n with infection b y t h e h u m a n strain, t h e presence of e v e n this n u m b e r of cases m i g h t cause d o u b t of t h e w h o l e - h e a r t e d n e s s of o u r a t t e m p t s to s t a m p o u t t h e disease. H e discusses in detail t h e preventive m e a s u r e s applicable to t h o s e w h o have n o t y e t h a d their p r i m a r y infection a n d those w h o s e infection h a s been a c c o m p l i s h e d w i t h o u t m i s h a p . I n t h e m a n a g e m e n t of t h e clinically ill t h e places of h o m e a n d hospital t r e a t m e n t , education a n d segregation are considered. T h e r a p e u t i c s are m e n t i o n e d only as a c o n t r i b u t i o n to p r e v e n t i n g t h e spread of infection in t h e p o p u l a tion. A critical appreciation a n d favourable o p i n i o n of B . C . G . vaccination f o r m a n o t h e r u s e f u l chapter. A f t e r consideration of all t h e facts a cautiously optimistic view of t h e f u t u r e of tuberculosis control is taken. We quote from page 156 : " Provision of a n a d e q u a t e food s u p p l y is far t h e m o s t i m p o r t a n t of living conditions in relation to tuberculosis, because t h e a l m o s t universal latent infection will m a n i f e s t itself as disease in p r o p o r t i o n to t h e severity of m a l n u t r i t i o n . " " O t h e r living conditions are i m p o r t a n t either as c o n t r i b u t o r y causes of m a l n u t r i t i o n or as factors w h i c h p r e d i s p o s e to infection. I m p r o v e m e n t in living conditions will aid t h e eradication of tuberculosis only in so far as s u c h i m p r o v e m e n t c o n d u c e s to the control of infection. T h e scientific control o f infection, s u p p o r t e d b y i n f o r m e d public opinion, is t h e special e n v i r o n m e n t a l c o n d i t i o n w h i c h alone p r o m i s e s t h e eradication of t h e disease f r o m t h e c o m m u n i t y . T h e raising of t h e level of resistance b y non-specific m e a s u r e s or b y vaccination will be m o s t effective in societies w h i c h strive to reduce o p p o r t u n i t i e s of infection to a m i n i m u m , for n o k n o w n m e a n s of raising resistance p r o m i s e s c o m p l e t e protection."
The Rhesus Danger.
Its Medical, M o r a l a n d Legal Aspects. By R. N. C. McCuRDY, M.m, CH.B., D.P.H. (Pp. 138. Price 5s. net.) L o n d o n : H e i n e m a r m M e d i c a l Books, L t d . 1951. T h i s is a c o m p r e h e n s i v e review of t h e subject, for doctor a n d l a y m a n , w r i t t e n clearly a n d simply. T h e significance of R h e s u s incompatibility a n d t h e p r o b l e m s arising f r o m it are s h o w n in t h e introduction. A review of the medical b a c k g r o u n d follows, starting w i t h a description of M e n d e l i a n inheritance, blood g r o u p s, t r a n s f u s i o n s a n d a n t i g e n - - a n t i b o d y reactions. T h e r e is t h e n an a c c o u n t of t h e discovery of R h e s u s factors a n d a s u r v e y of all that is n o w k n o w n a b o u t t h e m , i n c l u d i n g t h e diagnosis and m e t h o d s of t r e a t m e n t of t h e affected baby. T h e second part of t h e book gives t h e details of all the possible ways of dealing with t h e p r o b l e m for a h u s b a n d a n d wife w h o are faced with t h e tragic situation of R h e s u s incompatibility. D r . M c C u r d y takes a wide view of the R h e s u s factor a n d disc u s s e s it in c o n n e c t i o n with s u c h controversial facets as abortion, artificial i n s e m i n a t i o n , R h e s u s incompatibility as a g r o u n d for divorce a n d p o p u l a t i o n problems. T h e interest of the book is increased by the historical a p p r o a c h to each subject a n d t h e excellent a c c o u n t of t h e relevant legislation. N u m e r i c a l evidence f r o m various sources, s u c h as t h e RegistrarG e n e r a l ' s R e t u r n s a n d the publications of P E P , is freely used.