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scientists wishing to keep abreast of advances madein this field." Perhaps this may disappoint the generalreader, who may well feel that all the articles in his newencyclopaedia should be intelligible to him ; and indeedthe whole tradition of encyclopaedias is with him inthis. But the medical practitioner at least has no causefor complaint, for the present aspects of all branches ofmedicine are shown plainly and in considerable detail.Even for doctors, however, the plan has drawbacks :

the expert briefed to address a medical audience is soapt to forget his mother tongue. Most of the articlesare clear enough, but in some of them deep is evidentlycalling unto deep-a kind of intercourse better reservedfor the scientific journals. Two quotations will show thedifferent approaches. Dr. H. L. Marriott begins an

article : ’

" Blood transfusion is the introduction into the circulationof a human being or an animal of blood from other humanbeings or animals."

He goes on to describe the history of transfusion, theprocess of clotting, storage of blood, plasma and serum,uses of transfusion, the meaning of anaemia, technique,and the future of the method-six columns of informa-tion readily grasped at a first reading and yielding muchdetail on closer study. In contrast, an article on blood-groups starts as follows :

" The fundamental work of Landsteiner (1901) showed thathuman red blood cells are divisible into four main groupscalled 0, A, B and AB according to their content of two

agglutinable substances A and B which react with comple-mentary agglutinins (a or &bgr;) in the serum of persons wholack A or B."

This precise, if portmanteau, sentence will probablyconvey little, at first reading, to even a doctor who is notconstantly thinking in such terms ; and, though the sensewill be clear enough after a moment’s thought, he willhave to wrestle much longer over other passages in thearticle. The intelligent layman, who may very wellwish to learn something about blood-groups, will be

brought to a stand at the outset. Of course the difficultyof presenting technical material varies with the subject :thus in writing on radiotherapy for cancer Prof. J. S.Mitchell is driven to use technical terms. But he comes

upon them cautiously, first naming the agents used, andsetting out the aims of treatment and the results in generalterms-subjects in which his readers may be expected tohave an immediate, even a personal, interest. Andwhen he has to describe the biological action of the rayshe gives cross-references to articles which may throwfurther light on his technicalities.

Experts are notoriously headstrong about their copy,often defending every word as a dog defends a bone.The team of distinguished advisory editors, and Mrs.Law, the managing editor, are to be congratulated thatin so few of the 240-odd medical articles has the authorbeen allowed to bury his meaning.The accounts of diseases, or groups of diseases, are

almost uniformly well done. Prof. L. J. Witts con-

tributes a long clear article on the blood diseases, fullof information and beautifully written for its purpose.Dr. George Graham discusses diabetes well ; and diph-theria and diphtheria immunisation are clearly explainedby Dr. Thomas Anderson. Common disorders likebronchitis (Dr. J. G. Scadding), migraine (Dr. MacdonaldCritchley), and rheumatism (Dr. W. S. C. Copeman)are given their proper due. The account of skin dis-eases (Dr. J. T. Ingram) suffers, as this subject alwaysmust, from a lack of illustrations ; and it is even divorcedby many pages from the diagram of the skin (whichappears in the article on sensation, and is in any caserather vague and dim). The article on deafness (Mr.R. Scott Stevenson) is also poorly served by its diagram.The digestive system is handsomely covered in some

twenty columns by several different authors, and thesection on digestive diseases by Dr. R. Bodley Scott is short,clear, and easy for any reader to follow. It illustratesanother difficulty, however, for Dr. Scott, writing fordoctors, says of the oesophagus, truly enough,

" cancer is

common." But the layman will read this not as

" œsophageal cancer is a common cause of dysphagia,"but as " cancer of the oesophagus is a common disease"

"

-perhaps to his alarm. The difficulty of writing fortwo kinds of audience at once is certainly great, and it isnot surprising that it has not always been overcorne.’The distribution of space among the various subjects

throws an interesting light on modern trends in medicine.Mental disorders, seldom accorded much notice in thepast, receive twelve columns from the capable pen ofProf. Aubrey Lewis, while psychology gets even moregenerous treatment, for Mr. 0. L. Zangwill contributesnearly eighty columns on the general and experimentalaspects of the subject, and Dr. Ernest Jones anothertwelve on psycho-analysis ; while there are supple-mentary articles on psychological testing, psychologicalstatistics, and social psychology. In the article on

crime, Sir William Norwood East gives the modernview on this troubling aspect of social life, fair-mindedlybut without sentimentality ; but the article on juveniledelinquency and that on the borstals are disappointinglybrief and superficial. Chemotherapy appears to havebeen rather shabbily treated in a bare column; until itbecomes clear that the sulphonamides, penicillin, andstreptomycin are discussed in separate articles. Morerecent remedies, including Aureomycin,’ chloram-

phenicol, ’ Cortisone,’ and adrenocorticotropic hormonehave unfortunately missed this edition, probably becausethey fall so early in the alphabet. Social medicine iswell up to date with articles on absenteeism, handicappedpersons, old age, and reablement ; and bacteriology isparticularly well covered by Dr. A. A. Miles, whoseaccount of advances in this rapidly developing field willgive back to many a general practitioner the confidencehe had before the old familiar organisms developed apassion for aliases. Deficiency diseases, once a leadingsubject, are treated only shortly. Anatomy’ is nicelydone in the space allotted to it, but physiology is toovast to compass in seven columns.Taken as a whole, the medical contributions to the

new enclyclopaedia have been very well and carefullydone, and will serve the doctor as the editors haveintended that they should ; that is, if he is not beguiledinto reading the fascinating articles on other topics whichwait like sirens to divert him from the reference he is

seeking.

COÖRDINATION IN THE N.H.S.THE need for arrangements in each area to secure

closer consultation between the general-practitioner ser-vice, the hospital authority, and the local health authorityon questions of mutual interest in the National HealthService is emphasised in a circular just issued by theDepartment of Health for Scotland. This circularfollows a conference on the subject held in Edinburghin January.lNo attempt is being made to lay down any uniform

pattern for the local machinery : where this does notalready exist, it should be set up locally in the way bestsuited to the needs of the particular area.

" At the executive level coordination is mainly a matter offrequent and friendly contacts.... No formal machinery isneeded for thispurpose or indeed can contribute much to itsachievement ; that is dependent on the cultivation of theright outlook among those concerned, namely that all divisionsof the service are engaged in a common task and no doubtsor differences about respective jurisdiction should be allowedto prejudice patients or public."

1. Lancet, Jan. 20, 1951, p. 179.

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Examples are given of circumstances in which consul-tation is valuable :

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.

On the executive level there is the case of a patient inhospital who need not on purely medical grounds remain asan inpatient. If the hospital can look to the medical officerof health for an assessment of home conditions by healthvisitors, and for the provision in suitable cases of domiciliarynursing and domestic help, the patient’s discharge can thenbe arranged with his own doctor with a minimum of delayand risk."

" On the planning level a project by hospital authority toestablish a special unit for tuberculous patients who can, aftera short stay there, be adequately looked after at home, willnot function as intended if the family doctors do not under-stand what is expected of them or the local health authoritydo not arrange any necessary reinforcement of the healthvisitor service."

The circular makes it plain that the question of whichbody should take the initiative in establishing coördin-

ating machinery is not considered important. But inorder to get developments under way in areas wherenothing has yet been done it suggests that the executivecouncil should take the lead in convening a meeting withthe local health authorities and regional hospital boards.Among other advantages this procedure has the meritthat the general-practitioner members of an executivecouncil "

are in a particularly good position to say inwhat respects their patients are experiencing defects ordeficiencies that might be attributable wholly or partlyto lack of coordination."

Parliament

A Healthy Shrinkage ?ON Feb. 22 Mr. WALTER ELLIOT moved a prayer

against the order transferring some of the functions ofthe Minister of Health to the Minister of Local Govern-ment and Planning. It sounded reasonable, Mr. Elliotadmitted, to say " Let health be health. What has itto do with local government or housing ? " But imme-diately the tuberculosis service rose everywhere andsaid : " Housing and tuberculosis are so closely connectedthat- a positive sputum is almost the only passport torapid re-housing." The curative services were closelylinked with the preventive service and should remain so.From the time of the Chadwick report which led to thesetting up of the first Board of Health in 1848 a divisionof powers had never proved successful. When theInsurance Act was passed in 1911 Morant opposed thecreation of a special ad-hoc body for health work onthe grounds that it would lay too much stress on treat-ment to the neglect of preventive medicine. Mr. Elliotthought we were now moving along that dangerousroad. For the first time for many years, Mr. Elliotpointed out, health was out of the Cabinet. Yet eventhe Haldane Committee, when it suggested 10 maindivisions of government, named health as one of them.With the passing of this order we must face that healthbecame a Ministry of the second rank.Mr. F. MBSSEB agreed that the expansion of the

health services had thrown an immense amount ofwork on the Ministry. But though there might be acase for a- division of functions, the division as outlinedin this order required some explanation. We couldnot, he held, have ah efficient health service unless itwas a united service. Yet under this order the sanitaryservices were to go to the new Minister of Local Govern-ment and Planning. Formerly the local authoritieshad been responsible for the preventive services, forcurative and remedial services, and for aftercare andrehabilitation. The National Health Service Act hadtaken- away their positive health services and now therewas a division. Experience had unfortunately shownthat the ’gap was detrimental to the interests of thepeople. He did not want to see the gap get any wider.He feared that the new Minister of Health might placean overdue emphasis on the curative and remedialservices, for there was always a danger of -thinking thatwhat was sensational must be of the greatest importance.

Mr. J. E. MACCOLL agreed that in the past the Ministryof Health had had too much to do. Now he feared itmight have too little and be tempted to interfere undulywith the delegation of administration to the regionalhospital boards and the executive councils. Had theGovernment, he asked, considered combining with theNational Health Service the functions of the Ministry ofNational Insurance ?

A WHOLE-TIME JOB .

Dr. CHARLES HILL thought that relief for the Ministryof Health was overdue. He believed that the NationalHealth Service was something which would tax theresources of a Ministry and Minister. Many of thefunctions to be removed from the Ministry of Healthwere, he thought, thinly related to health. In housing,for instance, it was the standards of design rather thanthe production of houses which was primarily a healthproblem. The pressure of its local-government activitieshad for many years tended to divert the attention ofthe Ministry of Health from its primary health functions.Of the other functions, it was destined to lose sewetage,building and sanitary by-laws, water-supplies, wash-houses, canal boats, tents, and the sanitary problems ofhop-pickers; all had, he suggested, largely becomeengineering problems. But there were a few functionsabout which there seemed to be reasonable doubt, forinstance, nuisance discovery. To carry out a duty ofthis kind the new Ministry would need a medical staff,which he hoped would not be provided, for there wastoo much dispersal of medical staff in the public servicesalready. The care of verminous persons, and the supervisionof sanitary conveniences in shops and offices, were otherresponsibilities he was uneasy to see pass to a newMinistry " unspoiled by medical staff and untroubledby medical advice." He regretted the opportunity hadbeen missed to bring under the Ministry of Health theindustrial health service and the health education workof the Ministry of Food.

Mr. HERBERT MORRISON began his reply by wishingthe new Minister of Health good luck in administeringa great and complicated service. He agreed with Dr. Hillthat the Minister would, not for the time, at any rate,be unemployed. The N.H.S. was a vast new serviceand there was a lot of organising work to be done.The first reason for the changes made, Mr. Morrison said,was that the Ministry of Health had become overlarge,and it was not easy for one Minister to keep his fingerson the administrative organ. The first principle theyhad applied in making the changes was that the Ministryof Health should really become the Ministry of Health.He did not deny that there was a relationship betweentuberculosis and housing, but there was also a relationshipbetween tuberculosis and other things, such as excursiontrains to the seaside to keep people’s lungs full of freshair. But that would not be a reason to merge healthand transport.The arguments about prevention and cure were, he

agreed, useful up to a point. But the question was :how do we tie things up so that they work in the mostpractical way ? On the whole he thought the divisionof duties between the two Ministries was pretty reason-able. If a matter was really a health matter it wentto the Ministry of Health, but regulatory and adminis-trative functions went to the Ministry of Local Govern-ment and Planning.

Evacuation and reception were not mentioned in theorder. Mr. Morrison understood, however, that theywould both come under the Ministry of Local Governmentand Planning, but that rest-centres for bombed peoplewould be the responsibility of the Ministry of Health.

QUESTION TIMEBenefits for Tuberculous Nurses

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In answer to a question Dr. EDITH SuMMERSKILL, Ministerof National Insurance, stated that from March 1, 1951,nurses and certain others whose occupation brings them intoclose contact with tuberculous infection will be entitled tobenefit under the Industrial Injuries Act if they contracttuberculosis as a result of their employment.l All forms ofthe disease, not only of the lungs, are covered.

1. See Lancet, 1950, ii, 752.