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Flour “Improvers”
PUBLIC HEALTH, March, 1950 Lack of Information from Hospitals I n o t e d w i t h i n t e r e s t i n t h e r e c o m m e n d a t i o n s of t h e L e e d s conference of O c t o b e r 21st, 1948,* w i t h w h i c h we are all familiar, t h a t R e c o m m e n d a t i o n 1 (b), r e f e r r i n g to this d r e a d f u l word " s o c i o - m e d i c a l , " s t a t e d t h a t c o - o p e r a t i o n in some areas between t h e h o s p i t a l a u t h o r i t i e s a n d e d u c a t i o n a u t h o r i t i e s for the e x c h a n g e of i n f o r m a t i o n , b o t h o n a d m i s s i o n a n d on discharge, was satisfactory. I s h o u l d b e m u c h i n t e r e s t e d to k n o w where these h a p p y areas are s i t u a t e d ! I doubt that this experience is o t h e r t h a n exceptional. I n m y o w n area, in spite of having, as a r e s u l t of p a r a g r a p h 11 of C i r c u l a r 179, a n d i n accordance w i t h t h e r e c o m m e n d a t i o n s o f t h e c o r r e s p o n d i n g circular b y regional h o s p i t a l b o a r d s to hospital m a n a g e m e n t committees, h a d p r i n t e d a s i m p l e r e c o r d card, t h e practical result h a s b e e n a blank. W e h a v e two h o s p i t a l m a n a g e m e n t c o m m i t t e e s c o n c e r n e d w i t h g e n e r a l hospitals. F r o m o n e o f these n o t a single c a r d has b e e n r e t u r n e d . F r o m t h e o t h e r m a n y cards have b e e n r e t u r n e d carefully filled in, e x c e p t for the o n l y p a r t w h i c h really m a t t e r s , n a m e l y , " F u r t h e r t r e a t m e n t r e q u i r e d . " I t has, too, b e e n a p p a r e n t t h a t o n l y c e r t a i n d e p a r t m e n t s of t h e h o s p i t a l services w e r e r e t u r n i n g these cards at all, even in a partially c o m p l e t e d form. I t is p e r h a p s w o r t h m e n t i o n i n g t h a t these cards were in r e g u l a r use u p to July 5th, 1948, w h e n , of course, t h e y h a d a financial value, being in t h e n a t u r e of v o u c h e r s u p o n w h i c h t h e claims of hospitals for t h e t r e a t m e n t of school c h i l d r e n were based. O f t h e value of this i n f o r m a t i o n , especially in a r u r a l c o u n t y w h e r e distances b e t w e e n t h e h o m e o f t h e school child a n d the hospital rule o u t effective after-care a n d control b y t h e hospital, t h e r e can b e n o d o u b t at all ; equally, i n m a n y cases the i n f o r m a t i o n w o u l d b e of t h e u t m o s t v a l u e to the school medical officer in a n y a r e a - - u r b a n or rural. F o r example, in a r e c e n t case, i n w h i c h a child was f o u n d to b e a bleeder, the i n f o r m a t i o n was t r a n s m i t t e d to m e directly b y t h e specialist, a n d as a result t h e c h i l d ' s n a m e was placed o n o u r d a n g e r list in c o n n e c t i o n w i t h s u c h m a t t e r s as f u t u r e t o n s i l l e c t o m y a n d dental extractions. Nevertheless, I was a s t o n i s h e d at a r e c e n t m e e t i n g of m e d i c a l officers in a n o t h e r p a r t of t h e c o d n t r y to l e a r n t h a t a certain p r o p o r t i o n do n o t desire to receive this i n f o r m a t i o n f r o m t h e hospitals. I f t h a t is a generally a c c e p t e d policy it m e a n s quite clearly t h a t t h e school m e d i c a l officer c a n n o t m a i n t a i n an effective grip o n t h e t r e a t m e n t side of t h e service, a n d t h a t assistant school m e d i c a l officers, at f u t u r e medical i n s p e c tions, will m e e t t e a c h e r s a n d p a r e n t s minus essential i n f o r m a t i o n w h i c h t h e y h a v e h i t h e r t o possessed, e n a b l i n g t h e m to give useful advice. T h e r e s u l t is b o u n d to b e t h a t school m e d i c a l officers of all g r a d e s will " lose face." Before J u l y 5th, 1948, w h e n cases of infantile paralysis were discovered or s u s p e c t e d in m y c o u n t y I a r r a n g e d for t h e i r admission to a selected isolation hospital w h e r e iron l u n g s were available, a n d w h i c h c o u l d c o n v e n i e n t l y b e visited by o r t h o p a e d i c specialists. N o case was a d m i t t e d w i t h o u t m y knowledge. Since July, 1948, I find t h a t cases h a v e b e e n a d m i t t e d of w h i c h I have k n o w n n o t h i n g , n o r do I k n o w w h o is s u p e r v i s i n g t h e o r t h o p a e d i c care of these cases.
The Ophthalmie Serviee I f a n o t h e r p r o o f were n e e d e d t h a t we h a v e lost o u r grip on t h e School H e a l t h Service, it can b e f o u n d in t h e o p h t h a l m i c services. I find, o n l o o k i n g at t h e figures s u b m i t t e d to t h e M i n i s t r y o f E d u c a t i o n for 1948 for this e d u c a t i o n authority, that of t h e c h i l d r e n for w h o m glasses were p r e s c r i b e d , i n n e a r l y t w o - t h i r d s of t h e cases I have n o i n f o r m a t i o n as to w h e t h e r glasses h a v e or h a v e n o t b e e n provided. I t h i n k m o s t o f us appreciate t h a t in all t h e aerobatics w h i c h a c c o m p a n i e d t h e initiation of t h e o p h t h a l m i c services, w i t h t h e m u l t i p l i c i t y of forms a n d i n s t r u c t i o n s involved, o n e o f t h e m o s t r e m a r k a b l e features has b e e n t h a t o n t h e key f o r m - - O . S . C . 2 - - t h e space made available for t h e e y e specialist's r e m a r k s a m o u n t s to exactly 3 i n . × ½ in. I do n o t k n o w w h a t h a p p e n e d i n other areas, b u t in this area t h e eye specialists h a v e b e e n accustomed over t h e years to write extensive i n s t r u c t i o n s , e.g., in h i g h myopes, as to limitations of school w o r k - - n o fine * Quoted in the memorandum on Almoners under the National Health Service on page 112 of this issue.
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s e w i n g , n o music, advice as to t h e position in t h e class-room w h i c h t h e c h i l d s h o u l d occupy, as to special desks, as to advisability to avoid eye s t r a i n in p r e p a r a t i o n for examinations, as to t h e choice of a career, as to t h e dates of f u t u r e ree x a m i n a t i o n s , a n d so on, a n d t h e s e remarks, to w h i c h we h a b i t u a l l y a t t a c h e d t h e greatest i m p o r t a n c e , could, b y n o s t r e t c h of imagination, h a v e b e e n i n c l u d e d in a space of 3 in. × ½ in. I n a d d i t i o n to this, t h e fantastic situation arose, a n d still exists, t h a t t h e eye specialist m a k e s t h e s e r e c o m m e n d a tions to t h e O p h t h a l m i c C o m m i t t e e of t h e Executive C o u n c i l , a n d n o t to t h e school m e d i c a l officer, so t h a t t h e o n l y c h a n n e l t h r o u g h w h i c h a p p r o p r i a t e action can b e t a k e n in s u c h cases as h i g h m y o p e s in c o n t r o l l i n g t h e work of the child at school is deliberately b y p a s s e d . O n e n e e d n o t s p e n d a n y m o r e t i m e in e l a b o r a t i n g t h e t h e m e t h a t t h e i m p a c t of t h e N a t i o n a l H e a l t h Service o n t h e School H e a l t h Service has n o t in all respects b e e n beneficial. T h e s e t h i n g s m a y sort t h e m s e l v e s o u t in time, b u t I a m quite clear t h a t I will c o n t i n u e to utilise t h e services of specialists at t h e expense of t h e local e d u c a t i o n a u t h o r i t y in all cases w h e r e this seems to b e indicated, a n d in w h i c h it seems particularly i m p o r t a n t t h a t o n e s h o u l d b e in possession of the specialist's opinion. T h a t this m a y m e a n some additional cost to t h e a u t h o r i t y seems to m e to m a t t e r n o t at all. T h e i m p o r t a n t t h i n g is t h a t it retains t h e grip of t h e school m e d i c a l officer o n t h e i m p o r t a n t case, a n d also m a i n t a i n s his direct contact w i t h t h e specialists i n his area, w h i c h is also, a l t h o u g h secondary, a m a t t e r of i m p o r t a n c e .
CORRESPONDENCE
D.P.H. (LONDON), 1929--39 To the Editor of PUBLIC HEALTH SIR,--We are most anxious to get into touch with all old students of the London School of Hygiene and Tropical Medicine who attended the D.P.H. classes between 1929 and 1939. We have already sent a letter to those whose addresses we could find, but there are many that we have been unable to trace. W e should be most grateful if all old students, whether they are at home or abroad, who took the D.P.H. courses between 1929 and 1939 and who have not yet received our letter, would write to Dr. Windle Taylor, 51, Woodside Avenue, London, N.10, giving their addresses. Yours faithfully, A. H. GALE, G. E. GODBER. E. PEREIRA, T. STANDRING, E. WINDLE TAYLOR, ANN ~¢IOWER WHITE, and S. L. WRIGHT. February 3rd, 1950. PUBLIC HEALTH HISTORY TO the Editor of PImLIC HEALTH SIR,--Your annotation 6n Dr. H..C. Mattrice Williams' splendid account of the early public health history of Southampton did well to emphasise that such surveys have " a more than local interest." They are, in fact, the key to much general history of public health in this country that has still to be written. For example, until more material from local sources has been brought to light a great part of the early history of our own profession will remain a dosed book and our ideas about the growth of local sanitary administration prior to 1875 will continue to be hazy. These observations are based on experience of research in this field that has been going on for some time at the London School of Hygiene and Tropical Medicine. In connection with this work we would be grateful for a copy of past or future reports or papers by medical officers of health that contain references to the early history of their departments. Yours faithfully, IAN E. McCRACKEN. London School of Hygiene and Tropical Medicine, London, W.C.I. February 13th, 1950. FLOUR ¢' IMPROVERS" To the Editor of PUBLIC HEALTH SIR,--The decision of the authorities to discontinue the use of nitrogen trichloride (agene) in flour, after the Medical Research Council had recognised its serious and often fatal effects on animals, is to be welcomed.
i l0
It is difficult to understand, however, why it should have been necessary to replace this " improver " by another chlorine compound ---chlorine dioxide--which, in my opinion, is not only unnecessary but, furthermore, will cost vital dollars, as it will have to be obtained from the United States. " Improvers " are not necessary to safeguard baking qualities. They are merely artificial means to speed up the natural maturing of flour, at the same time bleaching it and giving a whiter looking loaf. It is regrettable that in the popular belief whiteness in bread should be synonymous with purity. In fact, the very opposite is the case. To my mind, bread should contain nothing but pure unadulterated wheat flour. In the case of other foodstuffs, such as milk and butter, the addition of chemicals is already forbidden by law. Why not in the case of the " Staff of Life " - - b r e a d ? Yours faithfully, C. P. ALLINSON. The Mill House, Streetly End, West Wickham, Cambs. February 9th, 1950.
BOOK REVIEWS Epidemlology in 0ountry Practice. By W. N. PICKLES, M.I). (LOND.). (Pp. 120. Illustrated. Price 10s. 6d. net.) Bristol: John Wright & Sons, Ltd. London: Simpkin Marshall, Ltd. 1949. This is a very welcome reissue, unaltered from its first appearance in 1939, of Dr. Pickles' classic description of what an acutely observant G.P.-M.O.H. can learn of the spread of infection in a scattered but relatively closed community, like that of his " parish " --Aysgarth rural district in Wensleydate, Yorkshire. The younger members of the public health service who did not have the opportunity of reading this book on its first appearance should not miss the chance of getting it now. As Prof. Robert Cruickshank has pointed out in his survey of 50 years' advance in prevention and control of infection (British Medical ffournal January 7th, 1950, 1, 25), it was Dr. Pickles' epidemiological nous which revealed catarrhal jaundice as a droplet infection. The late Prof. Major Greenwood, in his preface to this book, wrote: " I firmly believe that, just as tropical epidemiology received its greatest stimulus from Manson ' the doctor,' so will the epidemiology of our own country receive a fresh impulse from discoveries made, not by experts but by medical practitioners working patiently on the lines of Dr. Pickles." This, we would add, applies to medical officers of health as well as those in general practice and should be an encouragement to those also who believe that field work still presents the greatest of opportunities. Brompton Hospital Reports. Vol. XVII. 1948. (Pp. 183. Obtainable from the Secretary, Hospital for Consumption, Brompton, London, S.W.3. Price 10s.). In a dissertation on " The Pneumonias Associated with Epidemic Respiratory Infections," J. G. Seadding discusses the possible place of virus infections in this connection, but concludes that the evidence is equivocal. " Some Atypical Primary Tuberculous Lesions," by Margaret Macpherson, is an interesting account of five cases followed for ten or more years. In " Medical Contraindications to Flying," by Kenneth Robson, there is much sound advice for both lay and medical readers, but w e t h i n k that he over-stresses the anxiety and fatigue of ordinary flying on ordinary people. " Cerebral Metastasis in Association with Intrathoracic Disease," by Maurice Davidson, reminds us of this most unpleasant complication of pulmonary and pleural sepsis by an account of three cases, and discusses possible routes of travel whereby bacterial and neoplastic elements can become lodged in the brain. A report of " Three Cases of Pulmonary Valvulotomy for the Relief of Congenital Pulmonary Stenosis," by R. C. Brock, is a noteworthy contribution to the growing literature on cardiac surgery. The conception of this operation, its execution, and its results are clearly described. Apart from its surgical aspect, this paper is of special interest and importance to cardiologists and paediatricians. In a paper on " Recurrent and Chronic Spontaneous Pneumothorax," the same author gives a very complete account of these clinical conditions. A critical survey of the existing literature, combined with a study of 71 personal cases, make most interesting reading. These two papers not only confirm by their subject matter the high reputation which Mr. Brock has gained as a master of his art, but are also written in a most attractive style. W. P. Cleland contributes two papers, one an account of a fatal case of cavernous haemangioma of the lung, the other a description of a lateral branch of the internal mammary artery which is found sufficiently frequently to make it a possible cause of haemorrhage after extra-pleural pneumonolysis
PUBLIC HEALTH, March, 1950 A. T. M. Roberts reviews a follow-up of 128 cases of extra-pleural pneumothorax performed at the Brompton Hospital from 1937 to 1942, and discusses reasons for success and failure in this operation. "Advances in Thoracic Surgery," by N. R. Barrett, surveys the progress made in this speciality since 1943. One has only to read this article to realise what vast strides have been made in a short space of time. The value of the text of the papers is much enhanced by the high standard of the x-ray reproductions and other illustrations. By HARLEY"WILLIAMS,M.D., D.P.H. (Pp. 408. Price 15s. net.) London : Jonathan Cape. 1949. Dr. Harley Williams has with this book completed a trilogy of biographical portraits. T h e first dealt with five doctors from John Elliotson to Robert W. Philip, and the second with Woodrow Wilson, Andrew Carnegie and Lord Leverhulme. T h e present volume covers three royal physicians, Sir William Knighton, Sir James Clark and Sir William J e n n e r ; two prophets, Chadwick and Southwood Smith ; Brown-S6guard, one of the founders of experimental medicine and discoverers of endocrinology; the Mayo brothers, Welch, Halstead and Harvey Cushing. These studies are as fascinating for the other characters they introduce as for the protagonists. Thus Knighton is seen mainly in contrast to his master, King George IV, whom he served finally as factotum and closest adviser rather than as physician; and Clark and Jenner involve many intimate sidelights of Queen Victoria in the earlier and later periods of her reign and a moving description of the Prince Consort's fatal illness; Brown-S6guard's story brings glimpses of Claude Bernard and of Dr. Thomas Addison (of " Addison's disease " ) ; Florence Nightingale is linked with two other great Victorian women, Elizabeth Fry and Octavia Hill. In his portrayal of two great pioneers of public health, Dr. Williams describes Chadwick's early association with Jeremy Bentham, and shows how the secretary of the General Board of Health's method was moulded by his master's utilitarian philosophy. Chadwick was by training a barrister and, says the author, " public medicine was an illegitimate offspring of the law." Southwood Smith was a much more attractive figure and he is here most sympathetically portrayed. Dr. Harley Williams has a most gifted pen, and this is a thoroughly readable book, full of human interest, while it recalls some of the milestones which have marked the road to modern medicirte.
The Healing Touch.
Guifle~to Diagnosis of Occupational Diseases.
By the staffs of the Industrial Health Division, Department of National Health and Welfare, and the Division of Industrial Hygiene, Department of Health for Ontario. Ottawa : Edmond Cloutier. 1949. The aim of the authors is to provide a ready reference manual on the diagnosis of occupational diseases, for the use of Canadian medical officers, to whom it is sold at the low price of one dollar. The authors have succeeded in producing a book, fiaost of which is of great value to industrial medical officers even outside the Dominion of Canada. Chapter II, which gives a list of occupations and their potential hazards, is particularly useful, and by means of it a practitioner is able to see at a glance what diseases may be caused by a particular process. Chapter III concerns "Harrnful Conditions and Substances," and is divided into sections of varied utility. Abnormalities of temperature and humidity are tackled in too sketchy a manner, as is the section on Infections. Perhaps the best section is on " Harmful Chemicals," which are described under the following headings: Properties, Uses and Occurrence, Mode of Entry into the Body, Physiological Action and Toxicity, Signs and Symptoms. Unfortunately, both preventive and curative treatments are omitted. Should there be future editions of this publication, it is to be hoped that this important omission will be rectified. The chapter on the legal aspects is suitable for use in Canada only. Not only will the student or newcomer to the industrial medical service find this book useful, but to the average industrial medical officer it will serve as a most helpful publication of reference.
The Work 0t the Sanitary Engineer (A. J. MARTIN). Rewritten and enlarged by L. B. ESCRITT, A.M.I.C.r~., M.I.S.E., M.R. (SAN.) L, and S. F. RICH, LL.B. (Pp. 669. Price 42s. net.) L o n d o n : Macdonald & Evans. 1949. A textbook on water supply, sewerage and sanitation of buildings, this book, based on the original work by the late Arthur J. Martin, is addressed to civil engineers, sanitary engineers, architects, surveyors, sanitary and building inspectors, and students of sanitary science. It has been rewritten and enlarged by Mr. L. B. Escritt, chartered civil engineer, and Mr. S. F. Rich, LL.B., and the result is a wellwritten, comprehensive manual covering the whole field of sanitary engineering.
The Ophthalmie Serviee I f a n o t h e r p r o o f were n e e d e d t h a t we h a v e lost o u r grip on t h e School H e a l t h Service, it can b e f o u n d in t h e o p h t h a l m i c services. I find, o n l o o k i n g at t h e figures s u b m i t t e d to t h e M i n i s t r y o f E d u c a t i o n for 1948 for this e d u c a t i o n authority, that of t h e c h i l d r e n for w h o m glasses were p r e s c r i b e d , i n n e a r l y t w o - t h i r d s of t h e cases I have n o i n f o r m a t i o n as to w h e t h e r glasses h a v e or h a v e n o t b e e n provided. I t h i n k m o s t o f us appreciate t h a t in all t h e aerobatics w h i c h a c c o m p a n i e d t h e initiation of t h e o p h t h a l m i c services, w i t h t h e m u l t i p l i c i t y of forms a n d i n s t r u c t i o n s involved, o n e o f t h e m o s t r e m a r k a b l e features has b e e n t h a t o n t h e key f o r m - - O . S . C . 2 - - t h e space made available for t h e e y e specialist's r e m a r k s a m o u n t s to exactly 3 i n . × ½ in. I do n o t k n o w w h a t h a p p e n e d i n other areas, b u t in this area t h e eye specialists h a v e b e e n accustomed over t h e years to write extensive i n s t r u c t i o n s , e.g., in h i g h myopes, as to limitations of school w o r k - - n o fine * Quoted in the memorandum on Almoners under the National Health Service on page 112 of this issue.
109
s e w i n g , n o music, advice as to t h e position in t h e class-room w h i c h t h e c h i l d s h o u l d occupy, as to special desks, as to advisability to avoid eye s t r a i n in p r e p a r a t i o n for examinations, as to t h e choice of a career, as to t h e dates of f u t u r e ree x a m i n a t i o n s , a n d so on, a n d t h e s e remarks, to w h i c h we h a b i t u a l l y a t t a c h e d t h e greatest i m p o r t a n c e , could, b y n o s t r e t c h of imagination, h a v e b e e n i n c l u d e d in a space of 3 in. × ½ in. I n a d d i t i o n to this, t h e fantastic situation arose, a n d still exists, t h a t t h e eye specialist m a k e s t h e s e r e c o m m e n d a tions to t h e O p h t h a l m i c C o m m i t t e e of t h e Executive C o u n c i l , a n d n o t to t h e school m e d i c a l officer, so t h a t t h e o n l y c h a n n e l t h r o u g h w h i c h a p p r o p r i a t e action can b e t a k e n in s u c h cases as h i g h m y o p e s in c o n t r o l l i n g t h e work of the child at school is deliberately b y p a s s e d . O n e n e e d n o t s p e n d a n y m o r e t i m e in e l a b o r a t i n g t h e t h e m e t h a t t h e i m p a c t of t h e N a t i o n a l H e a l t h Service o n t h e School H e a l t h Service has n o t in all respects b e e n beneficial. T h e s e t h i n g s m a y sort t h e m s e l v e s o u t in time, b u t I a m quite clear t h a t I will c o n t i n u e to utilise t h e services of specialists at t h e expense of t h e local e d u c a t i o n a u t h o r i t y in all cases w h e r e this seems to b e indicated, a n d in w h i c h it seems particularly i m p o r t a n t t h a t o n e s h o u l d b e in possession of the specialist's opinion. T h a t this m a y m e a n some additional cost to t h e a u t h o r i t y seems to m e to m a t t e r n o t at all. T h e i m p o r t a n t t h i n g is t h a t it retains t h e grip of t h e school m e d i c a l officer o n t h e i m p o r t a n t case, a n d also m a i n t a i n s his direct contact w i t h t h e specialists i n his area, w h i c h is also, a l t h o u g h secondary, a m a t t e r of i m p o r t a n c e .
CORRESPONDENCE
D.P.H. (LONDON), 1929--39 To the Editor of PUBLIC HEALTH SIR,--We are most anxious to get into touch with all old students of the London School of Hygiene and Tropical Medicine who attended the D.P.H. classes between 1929 and 1939. We have already sent a letter to those whose addresses we could find, but there are many that we have been unable to trace. W e should be most grateful if all old students, whether they are at home or abroad, who took the D.P.H. courses between 1929 and 1939 and who have not yet received our letter, would write to Dr. Windle Taylor, 51, Woodside Avenue, London, N.10, giving their addresses. Yours faithfully, A. H. GALE, G. E. GODBER. E. PEREIRA, T. STANDRING, E. WINDLE TAYLOR, ANN ~¢IOWER WHITE, and S. L. WRIGHT. February 3rd, 1950. PUBLIC HEALTH HISTORY TO the Editor of PImLIC HEALTH SIR,--Your annotation 6n Dr. H..C. Mattrice Williams' splendid account of the early public health history of Southampton did well to emphasise that such surveys have " a more than local interest." They are, in fact, the key to much general history of public health in this country that has still to be written. For example, until more material from local sources has been brought to light a great part of the early history of our own profession will remain a dosed book and our ideas about the growth of local sanitary administration prior to 1875 will continue to be hazy. These observations are based on experience of research in this field that has been going on for some time at the London School of Hygiene and Tropical Medicine. In connection with this work we would be grateful for a copy of past or future reports or papers by medical officers of health that contain references to the early history of their departments. Yours faithfully, IAN E. McCRACKEN. London School of Hygiene and Tropical Medicine, London, W.C.I. February 13th, 1950. FLOUR ¢' IMPROVERS" To the Editor of PUBLIC HEALTH SIR,--The decision of the authorities to discontinue the use of nitrogen trichloride (agene) in flour, after the Medical Research Council had recognised its serious and often fatal effects on animals, is to be welcomed.
i l0
It is difficult to understand, however, why it should have been necessary to replace this " improver " by another chlorine compound ---chlorine dioxide--which, in my opinion, is not only unnecessary but, furthermore, will cost vital dollars, as it will have to be obtained from the United States. " Improvers " are not necessary to safeguard baking qualities. They are merely artificial means to speed up the natural maturing of flour, at the same time bleaching it and giving a whiter looking loaf. It is regrettable that in the popular belief whiteness in bread should be synonymous with purity. In fact, the very opposite is the case. To my mind, bread should contain nothing but pure unadulterated wheat flour. In the case of other foodstuffs, such as milk and butter, the addition of chemicals is already forbidden by law. Why not in the case of the " Staff of Life " - - b r e a d ? Yours faithfully, C. P. ALLINSON. The Mill House, Streetly End, West Wickham, Cambs. February 9th, 1950.
BOOK REVIEWS Epidemlology in 0ountry Practice. By W. N. PICKLES, M.I). (LOND.). (Pp. 120. Illustrated. Price 10s. 6d. net.) Bristol: John Wright & Sons, Ltd. London: Simpkin Marshall, Ltd. 1949. This is a very welcome reissue, unaltered from its first appearance in 1939, of Dr. Pickles' classic description of what an acutely observant G.P.-M.O.H. can learn of the spread of infection in a scattered but relatively closed community, like that of his " parish " --Aysgarth rural district in Wensleydate, Yorkshire. The younger members of the public health service who did not have the opportunity of reading this book on its first appearance should not miss the chance of getting it now. As Prof. Robert Cruickshank has pointed out in his survey of 50 years' advance in prevention and control of infection (British Medical ffournal January 7th, 1950, 1, 25), it was Dr. Pickles' epidemiological nous which revealed catarrhal jaundice as a droplet infection. The late Prof. Major Greenwood, in his preface to this book, wrote: " I firmly believe that, just as tropical epidemiology received its greatest stimulus from Manson ' the doctor,' so will the epidemiology of our own country receive a fresh impulse from discoveries made, not by experts but by medical practitioners working patiently on the lines of Dr. Pickles." This, we would add, applies to medical officers of health as well as those in general practice and should be an encouragement to those also who believe that field work still presents the greatest of opportunities. Brompton Hospital Reports. Vol. XVII. 1948. (Pp. 183. Obtainable from the Secretary, Hospital for Consumption, Brompton, London, S.W.3. Price 10s.). In a dissertation on " The Pneumonias Associated with Epidemic Respiratory Infections," J. G. Seadding discusses the possible place of virus infections in this connection, but concludes that the evidence is equivocal. " Some Atypical Primary Tuberculous Lesions," by Margaret Macpherson, is an interesting account of five cases followed for ten or more years. In " Medical Contraindications to Flying," by Kenneth Robson, there is much sound advice for both lay and medical readers, but w e t h i n k that he over-stresses the anxiety and fatigue of ordinary flying on ordinary people. " Cerebral Metastasis in Association with Intrathoracic Disease," by Maurice Davidson, reminds us of this most unpleasant complication of pulmonary and pleural sepsis by an account of three cases, and discusses possible routes of travel whereby bacterial and neoplastic elements can become lodged in the brain. A report of " Three Cases of Pulmonary Valvulotomy for the Relief of Congenital Pulmonary Stenosis," by R. C. Brock, is a noteworthy contribution to the growing literature on cardiac surgery. The conception of this operation, its execution, and its results are clearly described. Apart from its surgical aspect, this paper is of special interest and importance to cardiologists and paediatricians. In a paper on " Recurrent and Chronic Spontaneous Pneumothorax," the same author gives a very complete account of these clinical conditions. A critical survey of the existing literature, combined with a study of 71 personal cases, make most interesting reading. These two papers not only confirm by their subject matter the high reputation which Mr. Brock has gained as a master of his art, but are also written in a most attractive style. W. P. Cleland contributes two papers, one an account of a fatal case of cavernous haemangioma of the lung, the other a description of a lateral branch of the internal mammary artery which is found sufficiently frequently to make it a possible cause of haemorrhage after extra-pleural pneumonolysis
PUBLIC HEALTH, March, 1950 A. T. M. Roberts reviews a follow-up of 128 cases of extra-pleural pneumothorax performed at the Brompton Hospital from 1937 to 1942, and discusses reasons for success and failure in this operation. "Advances in Thoracic Surgery," by N. R. Barrett, surveys the progress made in this speciality since 1943. One has only to read this article to realise what vast strides have been made in a short space of time. The value of the text of the papers is much enhanced by the high standard of the x-ray reproductions and other illustrations. By HARLEY"WILLIAMS,M.D., D.P.H. (Pp. 408. Price 15s. net.) London : Jonathan Cape. 1949. Dr. Harley Williams has with this book completed a trilogy of biographical portraits. T h e first dealt with five doctors from John Elliotson to Robert W. Philip, and the second with Woodrow Wilson, Andrew Carnegie and Lord Leverhulme. T h e present volume covers three royal physicians, Sir William Knighton, Sir James Clark and Sir William J e n n e r ; two prophets, Chadwick and Southwood Smith ; Brown-S6guard, one of the founders of experimental medicine and discoverers of endocrinology; the Mayo brothers, Welch, Halstead and Harvey Cushing. These studies are as fascinating for the other characters they introduce as for the protagonists. Thus Knighton is seen mainly in contrast to his master, King George IV, whom he served finally as factotum and closest adviser rather than as physician; and Clark and Jenner involve many intimate sidelights of Queen Victoria in the earlier and later periods of her reign and a moving description of the Prince Consort's fatal illness; Brown-S6guard's story brings glimpses of Claude Bernard and of Dr. Thomas Addison (of " Addison's disease " ) ; Florence Nightingale is linked with two other great Victorian women, Elizabeth Fry and Octavia Hill. In his portrayal of two great pioneers of public health, Dr. Williams describes Chadwick's early association with Jeremy Bentham, and shows how the secretary of the General Board of Health's method was moulded by his master's utilitarian philosophy. Chadwick was by training a barrister and, says the author, " public medicine was an illegitimate offspring of the law." Southwood Smith was a much more attractive figure and he is here most sympathetically portrayed. Dr. Harley Williams has a most gifted pen, and this is a thoroughly readable book, full of human interest, while it recalls some of the milestones which have marked the road to modern medicirte.
The Healing Touch.
Guifle~to Diagnosis of Occupational Diseases.
By the staffs of the Industrial Health Division, Department of National Health and Welfare, and the Division of Industrial Hygiene, Department of Health for Ontario. Ottawa : Edmond Cloutier. 1949. The aim of the authors is to provide a ready reference manual on the diagnosis of occupational diseases, for the use of Canadian medical officers, to whom it is sold at the low price of one dollar. The authors have succeeded in producing a book, fiaost of which is of great value to industrial medical officers even outside the Dominion of Canada. Chapter II, which gives a list of occupations and their potential hazards, is particularly useful, and by means of it a practitioner is able to see at a glance what diseases may be caused by a particular process. Chapter III concerns "Harrnful Conditions and Substances," and is divided into sections of varied utility. Abnormalities of temperature and humidity are tackled in too sketchy a manner, as is the section on Infections. Perhaps the best section is on " Harmful Chemicals," which are described under the following headings: Properties, Uses and Occurrence, Mode of Entry into the Body, Physiological Action and Toxicity, Signs and Symptoms. Unfortunately, both preventive and curative treatments are omitted. Should there be future editions of this publication, it is to be hoped that this important omission will be rectified. The chapter on the legal aspects is suitable for use in Canada only. Not only will the student or newcomer to the industrial medical service find this book useful, but to the average industrial medical officer it will serve as a most helpful publication of reference.
The Work 0t the Sanitary Engineer (A. J. MARTIN). Rewritten and enlarged by L. B. ESCRITT, A.M.I.C.r~., M.I.S.E., M.R. (SAN.) L, and S. F. RICH, LL.B. (Pp. 669. Price 42s. net.) L o n d o n : Macdonald & Evans. 1949. A textbook on water supply, sewerage and sanitation of buildings, this book, based on the original work by the late Arthur J. Martin, is addressed to civil engineers, sanitary engineers, architects, surveyors, sanitary and building inspectors, and students of sanitary science. It has been rewritten and enlarged by Mr. L. B. Escritt, chartered civil engineer, and Mr. S. F. Rich, LL.B., and the result is a wellwritten, comprehensive manual covering the whole field of sanitary engineering.