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Group 3.-This comprises a number of diseases whichshow that nurses and students are infected outsidetheir place of work; such infections include mumps,.acute hepatitis, measles, and others-all diseases veryrarely treated in our hospital. The incidence of mumpsseems to accord fairly well with epidemic variations,the proportion attacked being about the same in thehospital nursing staff as in the population in general(see figure). Similar comparisons, with the same results,have been made for acute hepatitis and measles. Wereit not for immunisation, diphtheria would probablycause a great deal of sickness in the hospital staff, sinceall diphtheria cases in Drammen, as well as many fromthe adjacent districts, are treated in the hospital. No
attempt has been made to distinguish diphtheria-immunised people from the non-immunised, or from thosewho have acquired immunity. The incidence amongtrained and student nurses roughly corresponds with theincidence in the population in general (see figure). Studiesof dysentery and typhoid fever indicate the same sortof thing, but the number attacked in the hospital staff
Incidence of mumps and diphtheria in Drammenhospital female staff, compared with experiencein whole county and in trained and student nurses.
Actual numbers of cases in Drammen. AdjustedIncidence for the whole county of Buskerud for com-***"**
(in which Drammen is situated). parisonIncidence among trained and untrained
incidence among trained and untrained Drammen..... nursing staff. figures.is too small for exact comparison. The possibility ofinfection must necessarily be present in - a hospital,but when it does not result in a relatively high per-centage of absences, the credit must be given to goodprophylactic measures.
Group 4.-Three-quarters of the injuries were sustainedoutside working hours (except for burns among thekitchen staff). Occupational myalgia, the incidence ofwhich in many other Norwegian occupations -increasedduring the war, is insignificant as a cause of absence inthe Drammen Hospital.Group 5.-This is a miscellaneous group, but contains
no diseases representing any special problem as causesof absence from work, or of special interest for comparisonwith other occupations.
The percentage of absence through illness amongtrained nurses and students at the Drammen Hospitalis lower than in other Norwegian occupations wherewomen are employed.
There are no special diseases, or groups of diseases,causing a higher percentage of absence among the hos-pital staff than among women in other occupations.
With the exception of tuberculosis, infectious diseasesseem to show the same incidence in the nursing staff asin the population in general.
Court, D. (1949) Lancet, ii, 874.Hauge, M. F. (1949) Nord. hyg. Tidskr. 30, 207.Heimbeck, J. (1936) Tubercle, 18, 97.- (1948) Tidsskr. norske Lœgeforen. 68 463.
Malmros, H., Hedvall, E. (1939) Nord. Med. 1, 643.Scheel. O. (1924) Tidsskr. norske Lœgeforen. 44, 709.Strem, A. (1949) Sosialt Arbeid, 23, 1.
THE NEW CHAMBERS’S ENCYCLOPÆDIAFOR the better part of a century, the preface to the
fine new edition tells us, Chambers’s Encyclopœdia hasbeen a household name. A name, as it happens, almostuniversally mispronounced as
" Chamber’s " ; and in
any case misleading, for the just title should surely be" Chamberses’s," after the two Scottish brothers whofirst compiled it. William and Robert had a smallbookshop in Leith Walk, Edinburgh, where they printedhandbills, and also-in the ten years from 1859to 1868-published the first edition of their encyclo-paedia, in 150 parts at 1d. each. There were a hundredcontributors, under the editorship of Andrew Findlater,a distinguished schoolmaster and doctor of theology.The first edition deserved to be successful and was ;and Dr. Findlater and his successors, David Patrick andWilliam Geddie, had among their contributors FlorenceNightingale, Oliver Wendell Holmes, Andrew Lang,George Saintsbury, G. K. Chesterton, Gilbert Murray,Sir Oliver Lodge, Lord Haldane, Sir Edmund Gosse,and Bernard Shaw. Up to 1935 there had been foureditions in all, and one revised re-issue, all of one pattern, in10 volumes with very large numbers of entries and no index.At the end of the war, however, Messrs. George Newnes,
acting by arrangement with Messrs. W. & R. Chambers,decided the time had come to publish an entirely newwork, and entrusted the managing editorship to Mrs.M. D. Law. She has attracted a team of eminent
advisory editors ; and her method has been, she says,to entrust each main section to one of these authorities,and leave him to plan the articles, allot space, and choosehis own contributors. Moreover, instead of largenumbers of short entries there are in each subject a setof main articles, a large number of shorter articles
describing in greater detail the principal points in themain articles, and an even larger number of brief descrip-tive entries. Certainly in the medical articles -this
system is fully justified by the results.The historical and contemporary scene is surveyed
without bias towards political or other beliefs ; but, sincecontributors are individual and human, the aim withcontroversial topics has been to present every pointof view. This is in the national tradition and makes for
good reading. As Mrs. Law says :" Chambers’s Encyclopœdia, though it numbers among its
contributors scores of scholars from nearly every country inthe world, is primarily a British production and thereforeno doubt reflects to some extent the intellectual atmosphereof postwar Britain. This implies belief in internationalcooperation rather than nationalistic isolationism, and infreedom of speech and worship, information and associationrather than in any totalitarian conception. If these basicideas should anywhere be regarded as prejudices, the.editorand contributors will cheerfully put up with this criticism.This belief in freedom of thought and speech finds practicalexpression in the pages of the Encyclopaedia. And if
occasionally a bee be heard to buzz in an academic bonnet,the work is all the livelier on that account."
The medical contributors, while agreeing harmoniouslyon matters of fact, show their individualism in the
variety of their attack. Their articles, strangely enough,are for the most part aimed not at the layman seekingenlightenment but at " the general practitioner lackingthe facilities of a good reference library, and at other
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
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.