933

for many years. Difficulties reached their climaxthrough a marriage in which, unconscious calling to

unconscious, hysterical symptoms on the one side werewelcomed on the other as maintaining an emotionalbond that otherwise would have snapped. Such a

false adjustment could not satisfy emotional needs,and each of the pair, even whilst declaring the ever-lasting strength of the bond, formed another attach-ment that inevitably brought bickering and mutualhurt. Behind these experiences we can imagine a

sense of frustration, unformulated by himself, thatsustained Havelock Ellis in a task the unconsciousgoal of which was his own salvation, rationalised tohimself and the world as a desire to save others fromthe difficulties in himself which he dimly perceivedand never defined. With this aim he set out to collectin minutest detail the material he later published.The curiosity so thoroughly repressed in his youth hadnow come into its own, but the knowledge thus gainedfailed to guide him to sexual maturity, for it couldnot influence his unconscious difficulties. Nevertheless,he reached salvation of a kind, in so far as he madepeace with himself and was able finally to attain aphilosophy of life that fitted his own needs and limita-tions. In his external aim he has also come near toindirect achievement, for he has furnished knowledgethat can serve us in the understanding of humandifficulties which, without the influence of his work,would still be ignored or counted as wanton perversity.

CONTRASTS IN MORTALITY BETWEEN ENGLAND

AND THE UNITED STATES

A SEASONAL swing’ in the incidence of mortalityhas long been a feature of the Registrar-General’sreturns. The maximum invariably falls in the first

quarter of the year, the minimum in the third quarter,and with the virtual disappearance of summer

diarrhoea, as a major cause of infant mortality thedifference between crest and trough has increasedconsiderably. For instance, in 1851-55 the death-ratein the March quarter was 25.3 per 1000 living and inthe September quarter 21.0; the maximum is 20 percent. greater than the minimum. In 1931-35 the

corresponding figures were 15-4 and 9.6, and themaximum is 60 per cent. greater than the minimum.Is there any way, it might be asked, of reducing thislarge difference, or is the winter excess due to causesof death-e.g., influenza-over which we at presenthave little control? An indication that its level mayinclude components amenable to preventive medicineis shown when the seasonal swing in England andWales is compared with that revealed by the mortalityfigures of the United States. Such a comparisonshows that the winter peak is higher in this countryalthough in the summer we fall to a lower point thanthe U.S.A. It looks as if the English excess at theformer time and the American excess at the lattermay both include causes of death due to remediableconditions, and that, in fact, is the conclusion reachedby Mr. E. Lewis-Faning, Ph.D., in a detailed statisticalstudy of the problem.l Mortality in Germany is alsoincluded in his picture but owing to lack of sufficientlydetailed information he is unable to make much useof it. In this country and the United States, however,many causes of death are tabulated 1w month ofoccurrence, and Lewis-Failing has found it possibleto calculate average daily death-rates (standardised)in each month of the year for each country, and alsofor the New England states separately. From the1. A comparative study of the seasonal incidence of mortality

in England and Wales and in the United States of America.By E. Lewis-Faning. Spec. Rep. Ser. med. Res. Coun.,Lond. No. 239. H.M. Stationery Office. 1940. Pp. 69. 1s.

numerous comparisons made it appears that the maincontributors to the unfavourable winter balance inthis country are influenza, respiratory tuberculosis,bronchitis and pneumonia. To its advantage in thesummer the two most important factors are diseasesof the heart and deaths from violence, the formershowing a large decline in the summer in bothcountries but more strikingly in England and Wales,and the latter revealing no great seasonal variationin this country but a large summer rise in the U.S.A.Diarrhoea and enteritis also show a considerablygreater upward swing in the summer months in theU.S.A. as a whole but in the New England states suchmortality is uniformly below that in England andWales. Lewis-Faning’s conclusion, therefore, is thatthe winter disadvantage and the summer advantageof our country are both dependent, at least in part,on factors of mortality preventable in some degree.The relatively high rate of mortality from violence inthe U.S.A. is clearly open to attack, and it would beinteresting as a first step to examine its components.On the other hand, influenza in the pandemic of1918 fell, the Registrar-General concluded, equally onthe sanitarily just and unjust, and in recent yearsmortality attributed to it has, unlike that of otherinfectious diseases, tended to be higher in the ruralthan in the urban districts of this country. If wemust perhaps exclude it from the field of preventivemedicine at present the same does not apply to

mortality from pneumonia and bronchitis. Dr.Stevenson long ago stressed his belief that the formerwas.a preventable disease and that judging from localvariations some parts of England and Wales had agood deal to learn in regard to prevention. Thatconclusion still holds, while the importance of environ-mental and nutritional factors in respiratory tuber-culosis is today a commonplace. It seems thereforethat there is certainly some scope for reduction in ourwinter death-rate. It is the only figure to fluctuatematerially from year to year; in the decennium 1927-36the death-rate in the last three quarters of the yearvaried only between 10.7 and 11-4 per 1000 while inthe first quarter it ranged from 13.2 to 20-9. Lewis-Faning’s report is a valuable contribution to the studyof such seasonal variations and their underlying causes.

RESULTS OF RADIUM THERAPY

NEARLY all of the reports published by national andinternational commissions responsible for the collec-tion of radium statistics and by individual radiumcentres give the results from year to year, and includethe cases recently treated. It is therefore a welcomechange to find the Holt Radium Institute producing areport which deals only with survival-rates fiveyears after treatment. This centre is fortunate inserving a large population which provided in the twoyears under review, 1932 and 1933, enough cases togive significant figures for analysis of results in thecommon cancers accessible to radium treatment. Thereare two sections, written from different points of view.The first gives complete tables for all cases arrangedso that they are easily understood by the layman;the second gives a detailed analysis of the methods oftreatment and their results. The number of cases

treated was 1918 out of a total of 2531 examined;294 were considered too advanced for treatment, andthe rest were submitted to surgery or were found notto have cancer. Of those treated only 2 per cent. havenot been traced. The net survival-rate for all casestreated in 1932 is 38 per cent.; for those treated in

1. Christie Hospital and Holt Radium Institute, Manchester.Statistical Report on the Results of Radium Therapy in theTreatment of Malignant Disease.