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become the property of the State, but the intentionis that the regional boards and the teaching hospitals’committees shall have the legal liability for the welfareof the patients and not the Minister. Can he therefore beexpected to answer questions in the House about them ?This is not an academic question, for the way in whichit is answered is crucial in the constitutional control ofpublic-service corporations. In a letter to the Timesof Dec. 10, Mr. 1. J. Pitman, M.P., asked : " Is it notclear that, so long as the nation through Parliamentowns the property and even more particularly so longas the Minister has powers to direct,’ the force ofParliamentary and of public opinion will insist thateven the question of a dirty brass button shall be not toosmall for Parliamentary attention if it can become theoccasion of injustice or of other high principle " OnDec. 11 Mr. Bevan assured Colonel Stoddart-Scott thatthe Minister of Health will in fact be answerable for thenew health services and for their administration bylocal or regional bodies,! adding, however, that he hopedthat the proper responsibilities of these bodies wouldnot be diminished by too many inquiries on detailedday-to-day matters unless some point of general impor-tance was involved. As Mr. Pitman pointed out," questioning of the affairs of the Post Office is notrestricted yet is not apparently abused," and this appearsto be a proper precedent.

OBSTETRIC SHOCK

THE idea of " shock " seems to have come into itsown again in Professor Sheehan’s description in thisissue of the pre-mortem signs and immediate post-mortem findings in obstetrical fatalities. In at leasthalf the cases haemorrhage can be ruled out, but in agreat many of them the uterus was unable to rid itselfof its contents, either baby or placenta. Afferent stimulifrom the uterus may therefore have helped to precipitatethe circulatory collapse which followed, and Sheehanpoints out that, though there was no visible blood-loss,many of the signs of shock are consistent with the auto-nomic reaction to haemorrhage having taken place.The blood, however, does not seem to be there, andaccording to Sheehan it is neither circulating nor visiblypooled anywhere. Where is it ’? He does not exclude

general pooling, but this can only mean capillary dilata-tion, and this seems conspicuously absent from so many.parts of the body that one would expect it to be detect-able in the others. Hsematocrit figures are not given,so one cannot judge of the possibility of a good deal offluid being lost by transudation into the tissues-a

possibility of more than usual importance in this type ofshock. Albers 2 claims that the high venous pressurewhich is maintained during the latter part of the secondstage of labour is normally responsible for driving aconsiderable amount of fluid out of the capillaries.Brown and her colleagues 3 in San Francisco, who areinterested in the reasons for heart-failure after delivery,have confirmed that over a litre of plasma may dis-

appear from the blood during a normal labour. Iflabour were unduly prolonged the circulation mightbecome actually depleted in this way, though one wouldexpect the venous pressure to fall with exhaustion andthe colloid osmotic pressure of the plasma to oppose theloss of fluid as the blood became concentrated. Sheehanfound no gross oedema. Nevertheless, the possibilitywould be worth investigating, particularly in view of thefact noted by Brown et al. that their patients whoreceived ergot had an unusually high venous pressurefor the first 24 hours after delivery ; presumably the same1. Lancet, 1947, ii. 929.2. Albers, H. Normale und pathologische Physiologie im

Wasserhaushalt der Schwangeren. Zwanglose Abhandlungenauf dem Gebiete der Frauenheilkunde, vol. I, Leipzig, 1939.

3. Brown, E., Sampson, J. J., Wheeler, E. O., Gundelfinger, E. F.,Giansiracusa, J. E. Amer. Heart J. 1947, 34, 311.

effect might be seen during a long labour if patientswere receiving oxytocic agents and it would augmentthe already high venous pressure. The capacity of thecirculatory system relative to the volume of bloodseems to be crucial ; if the subendocardial lesion describedby Sheehan had determined any kind of heart-failureone would have expected venous congestion. A primarypressor reaction of the autonomic is equally improbable,since this would lead to a high arterial blood-pressure.’Pressor phenomena together with circulatory failure are,on the other hand, easily reconcilable with fluid loss.Unusual difficulties encountered by Brown et al. insecuring reliable blood-volume measurements duringlabour appeared to be due to the existence somewhereof " poclets " of blood partially excluded from thecirculation.Brown and her colleagues came to no definite con-

clusion regarding the peculiar nature of the strain onthe heart during labour, but the tendency of susceptiblepatients to heart-failure even after cesarean section ismysterious. They are inclined to attribute it in partto the sudden loading of the circulation consequent onclosure of the arteriovenous shunt supposedly repre-sented by the placenta. They point out that whereasduring natural labour the circulation may becomeconditioned to this loading by repeated contraction of theuterus, it may not. do so in caesarean section. It is

interesting that attention should be drawn at the sametime to two types of postpartum circulatory collapse,neither satisfactorily explained, one apparently due toshortage of intravascular fluid and the other to toomuch. <

THE MASTER HAND

Professor Blau’s monograph on lateral dominance 1

has.a destructive freshness, stimulating to the readerwho has previously taken it for granted that left-handedness is an inherited "constitutional" attribute,that it is manifest from early infancy, that we are doingharm if we try to induce a left-handed child to preferthe use of his right hand, and that stuttering and specificreading disability may be consequences of such retrainingor of incomplete dominance. Blau polishes off thesenotions with detailed argument and blunt denial. Thus :

" The alleged dangers of retraining are non-existent.This misconception is due to not understanding theemotional background of sinistrality or the psychologicaland organic physiology and pathology of the brain."

This plain speaking, however, follows an impressive arrayof observations, and is accompanied by a positive theory,implied in the foregoing passage where it refers to " theemotional background of sinistrality." Blau is convincedthat people who would ordinarily become right-handedin the normal way may be deflected into left-handednessby some deficiency (such as a physical defect in the rightarm), or faulty education, or-most important of all-emotional contrariness. In a situation that causes

conflict, the child is driven to express hostility andresentment by

"

negativism," which may take the formof left-handedness and kindred anomalies. Consequently’he may show in later life, along with his persistentsinistrality, neurotic symptoms left over from these

early struggles, or he may have a rebellious, rigid,self-willed, obsessional personality. Stuttering, when itoccurs in left-handed people, is another sign of theirearly neurosis, rather than itself a consequence of theirsinistrality. Dr. Blau would make his case for theseviews much stronger if he gave more information aboutthe number of left-handed people he had himself studied,and the biographical or direct observations which had1. The Master Hand: a Study of the Origin and Meaning of Right-

and Left-sidedness and its Relation to Personality andLanguage. By ABRAM BLAU, M.D., assistant clinical professorof psychiatry, New York University College of Medicine. NewYork: American Orthopsychiatric Association. 1946. Pp. 206.

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confirmed his opinion. But as it stands, his treatise isan interesting contribution to this theme, more scholarlythan Orton’s and more provocative than Selzmer’s, andimportant to the child-psychiatrist and educationalpsychologist because of its practical suggestions for the

education of children who prefer to use their left hands.

ALCOHOLICS ANONYMOUS IN LONDON

WE have previously described the work of " Alcoholics

Anonymous," 1 the American voluntary association inwhich those who have been heavy drinkers help others toovercome their addiction. A branch has now been formedin London, and meetings are held weekly in restaurants,or at the homes of one or other of the nine members.The only aim is to help the alcoholic who asks for help ;there are no dues to pay, and what few expenses ariseare met by voluntary contributions. Growth will dependon attracting those who need this particular type of

friendly assistance : no formal plan for promoting thescheme is being adopted, and organisation is being keptas simple as possible. Alcoholics Anonymous wish towork in close cooperation with doctors. Their methodis simple, but has proved effective : members are ableto gain the confidence of the alcoholic because their ownhistories prove that they understand his difficulties, andbecause they offer him companionship. A corre-

spondent defines the movement as " a free associationof men and women who have learned how to obtain andmaintain sobriety and development of personality, andwho spend much time sharing their experience withothers." The hon. secretary receives inquiries addressedsimply BM/AAL, W.C.I.

COST OF THE NEW ZEALAND HEALTH SERVICE

THE report for 1946-47 of the director-general ofhealth for New Zealand provides a detailed statementof the health budget for the year which enables us toreview early conceptions and predictions about thecourse of the New Zealand health service.The total cost of the service continues to rise and has

now reached the considerable sum of i3 12s. 6d. per headof population. One of the more rapidly increasingitems of expenditure continues to be the pharmaceuticalbenefit, which now absorbs a sum of nearly &pound; li/2 millionper annum. This means an expenditure on drugs of16s. 11<. per year for every man, woman, and child inNew Zealand. The report points out that part of thisincreased spending is due to the rising costs of drugs,and to the fact that " many expensive new drugs havebeen introduced during recent years and that, in theabsence of health benefits legislation, the majority ofthem would not have been available to most patientson account of their cost." This is, however, not the wholestory, for the actual number of prescriptions each yearhas increased steadily and is now nearly .5,900,000-a million more than in 1945 and nearly 2,400,000 morethan in 1943. The actual cost of the pharmaceuticalservice is 21/2 times what it was in 1943.The statistics for the services given by general

practitioners provide a clearer picture than has some-times emerged from reports sent from New Zealand orfrom the tales of returned travellers. New Zealand’spresent population is 1,705,550. During the year underreview claims were made on the social security fund by1121 general practitioners. On the assumption thatthis was the total of general practitioners in the Dominioneach one was responsible, on average, for 1521 patients.Probably, however, each has slightly less than thisnumber, since some doctors in scattered areas and in thepredominately Maori communities are paid by salary ;but their number is unlikely to account for an error ofmore than 2-3% in the calculation. The money paidout on the claims of these 1121 doctors was 1,600,601,

1. Lancet, 1947, i, 681.

providing an average income of E1428 per doctor. It

represented an annual payment per patient of 18s. 9d.-a sum which (when we consider that the New Zealandpound is worth less than the pound sterling) would notbe regarded as a very generous per-capita payment inthis country. If we can assume that these claims wereall charged to the State at the rate of 7s. 6d. per item ofservice, this would represent 21/2 items of service perpatient per year-only half the figure of 5, often quotedin this country as the average number of items of servicegiven to each _panel patient. This seems to contradictthe oft-told stories of over-visiting by the doctor or offrivolous calls by the patient in New Zealand. Besidesthese payments for general medical services the medicalpractitioners share E232,088 paid for maternity work and95,114 paid for mileage. The addition of these twosums brings the practitioner’s average income from Statesources up to the total of E1720. There is, however,no way of estimating the extent to which the practitionermay augment this income by private practice or by part-time consultant work in hospitals or clinics. A consider-able amount of this work falls to the lot of the generalpractitioner in New Zealand.

AMPHIBIOUS VISION

-Francis Galton used to amuse himself, more thaneighty years ago, by trying to obtain distinct vision underwater when diving. In his own words 1 :

" The convex eyeball stamps a concave lens in the water,whose effect has to be neutralised by a convex lens. Thishas to be very ’ strong,’ because the refractive power of alens is greatly diminished by immersion in water. Myfirst experiment was in a bath, using the two objectives ofmy opera-glass in combination, and with some success.I then had spectacles made for me, which I described at theBritish Association in 1865. With these I could read the

print of a newspaper perfectly under water, when it washeld at the exact distance of clear vision, but the range ofclear vision was small." .

The importance of equal vision in air and in water forwhales is obvious, and such vision is made possible tothem by peculiar modifications described by Mann.2To counteract underwater pressure at great depths, theeye is small,,exposing a minimal surface, the sclera is

extraordinarily thick, the cornea is flattened and has athick edge, the corneo-scleral junction is bevelled, and theeyeballs are immovable. The eye is further divided intoan upper part with a long axis for vision in water, and alower part with a short axis for vision in air. Owingto the scanty illumination of objects under water, variousingenious adaptations, including a perilenticular space,a spherical crystalline, a very forward position of thelens, and a remarkably retractile iris, make use of all theavailable light. Undulations in the retina enable manymore receptors to occupy a small area, so that the move-ments of objects under water can be better seen. Mannhas discovered retinal cones in the cachalot (Physetermacrocephalus) and the finback (Balce7aoptera physalus),which fact suggests that whales, contrary to acceptedopinion, can see colours.

RELEASE OF DOCTORS FROM SERVICES

THE Central Medical War Committee has been notifiedof the following arrangements for the release in class Aof medical officers during the first quarter of the year :

Royal Navy.-January, group 66 ; February. groups67 and 68 ; March, groups 69, 70, 71, 72, and 73.

Army.-General-dicty officers : January, group 64February, group 65 ; March, group 66. Physicians,slwgeons, and gyrzcecologists : January, group 59February, group 60 ; March. group 61. Other specialists :January, group 57 ; February, group 58 ; March,group 59.

Royal Air Force.-January, groups 65, 66, and 67February, no release; March, group 68.

1. Galton, F. Memories of My Life. London, 1908, p. 186.2. Mann, G. Biologica, Santiago, 1946, p. 23.