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if inflamed ; (3) that a circulating carcinogen may becomconcentrated in an inflamed tissue ; (4) that when appliesdirectly to an inflamed surface a carcinogen may bretained there ; and (5) that the appearance of a tumouin an already predisposed tissue may be accelerated b,inflammation of that tissue. Pullinger 4 has recentlydescribed some experiments in which she combined smalexcisions of skin with applications of 0-05% benzpyren4to the same areas on the mouse’s back, and her result!support the conclusion of other workers using othe:methods that repeated inflammation encourages th<

development of epithelioma in skin which has beer

subjected to a carcinogen. She found that a singlEexcision combined with applications of benzpyrentincreased the tumour-incidence by less than 1 %, whereasmultiple excisions in otherwise similar conditions causeda twofold or threefold increase in the incidence oftumours.To the references which PuIlinger has appended to

her useful papers might be added Burrows’s summary ofinformation on the localisation of substances from theblood-stream by inflamed tissues and Brunelli’s paperson the concentration of intravenously given cestrone-itself a carcinogen-in the inflamed subcutaneous tissuesof the rabbit.6

AN ARCHITECT’S VIEW OF A HEALTH SERVICE

WE are beginning to realise that pooled experiencederived from many minds can often turn out a betterjob than the limited experience of one mind, or even ofone trade or profession : Mulberry and Pluto showed asmuch. Nowadays housewives are being asked their

opinion about the convenient placing of household

equipment, teachers offer their views on classroom

design, and’doctors -often describe their ideal healthcentres. Mr. Hjalmar Cederstrom, chief architect of.the Southern Hospital, Stockholm, whose article on

planning a hospital service appeared in our columns lastyear,7 has lately published in a Swedish journal 8 hisviews on the part this great hospital may hope to playin the health service of his country, not only as a centreof social welfare but also as a model for other regionsand perhaps for other countries. The Southern Hospital-the Sodersjukhus-is designed to be comprehensive,offering preventive and welfare advice, treatment for bothacute and chronic cases, and aftercare. This presentsspecial problems for the architect, who must have inmind both administrative convenience in designing hisblocks and also the dangers of infection which arisewhen large numbers of people are gathered together inbuildings. Cederstrom thinks there should be two mainblocks, one for examination and treatment, and one forbed-patients. The outpatient department should bein the treatment block, outpatients needing specialinvestigations travelling vertically to the various depart-ments by lifts or stairways. The bed-patients visit thesame departments, but travel there horizontally alongcorridors from the bed block, and the paths of the twogroups of patients never cross. In the same way, the wardsin the bed block belonging to the ear, nose, and throatdepartment are connected by a separate corridor withthe operating-theatre in the treatment block. As he

points out, these special plans for limiting the risk ofinfection as far as possible are bound to raise buildingcosts ; but he thinks them a good investment. Heconsiders that once the diagnosis has been made, andtreatment established, inpatients should be transferredto aftercare blocks in the hospital grounds where treat-ment can be continued ;- and such blocks, he says, can

4. Pullinger, B. D. J. Path. Bact. 1945, 57, 467, 477.5. Burrows, H. Some Factors in the Localisation of Disease,

London, 1932.6. Brunelli, B. Arch. int. Pharmacodyn. 1935, 49, 214, 243, 262, 295.7. Lancet, 1945, ii, 571.8. Svenska L&auml;kartidningen. Nov. 30, 1945, p. 3005.

Le be inexpensively run. The suggestion is tempting,d especially where the hospital stands in open airy country,Ie as the Sodersjukhus does ; but it would be difficult toLr apply in our crowded metropolitan hospitals where spacey is at a premium and it is hard to find enough room eveny for acute cases.11 Cederstrom goes on to suggest that an experiment ine social security should be tried in a social investigations district-what he calls a " social city "-where peopler should be distributed according to their occupationse and social diseases-textile workers with tuberculosisn being grouped together, for example. He seems toe advocate that village communities, like Papworth,e should be formed in different parts of the city, but hes does not develop this interesting proposal at all fully.1 On the face of it, the experiment could only succeed iff tried in an unnaturally docile and cooperative society.

DAMAGES FOR SHOCK[ SINCE the Medico-Legal Society last considered the question of judicial damages and compensation for’

nervous shock, the courts have several times had it

brought to their notice.In the discussion held by the society on Jan. 24 the

present position was reviewed. Judge W. G. Earengey,K.c., recalled that the foundation of all damages is thatif one person in breach of his duty to another causesdamage to the other, he is liable to pay compensation.The cause of action relied on is nearly always negligence-the breach of a duty to take care. The test of culp-ability is whether an ordinary reasonable person wouldhave foreseen that the act or default might probablycause damage. The earlier attitude of the law wasthat it could not value mental pain or anxiety andwould only award damages for a material injury. Thedecisions.of the last generation, culminating in the Houseof Lords case Hay v. Young (1943) A.c.92, have mademental or nervous injury as good a ground for a claimas physical injury. In both classes of injury super-sensitivity only comes into account in so far as the courtmust be satisfied that an ordinary average person wouldhave suffered some damage ; if he would, then com-pensation is based on what the supersensitive personactually suffered and not what an ordinary person wouldhave suffered. The present position, as stated byJudge Earengey, seems to be that a wrongdoer shouldforesee the risk of shock to a person within the area ofpotential danger caused by reasonable fear of danger ofinjury to that person or to his close relations. Therecent Australian Act establishing nervous shock as acause of action lays down a long list of relatives, fearfor whose safety may be the cause of actionable shock-a list roughly corresponding to the degrees of affinitywithin which marriage is prohibited.

Mr. Zachary Cope, dealing with the medical aspect,emphasised the misfortune by which the word " shock,"which has become familiar as meaning a condition oflowered vitality resulting from the application of harmfulstimuli to the body, has been attached by lawyers to theentirely different condition which he regards as practicallyidentical with anxiety neurosis. Mental shock, he -said,is rare in persons who have suffered severe physicalinjury, common in those who have suffered none. Itis increased and prolonged out of all proportion by thesuspense associated with litigation, and seldom developsafter accidents in which no question of compensationarises, or in persons who are completely responsible forthe mishap. The average person does not, Mr. Copebelieves, develop mental shock merely from seeing orhearing something terrible on one occasion. Thosewho framed the Emergency Legislation had wiseadvisers, he thought, when they decreed that the Stateshould not compensate for war injuries which were notphysical. He sees need, in the assessment of damages