354 



NATUR'E 



[May 19, 192 1 



The war is doubtless responsible for this in part ; 

 the divided responsibility of poor law, public 

 health, and insurance authorities has seriously 

 contributed to the same result ; and until poor- 

 law hospitals become available generally for non- 

 paui>er advanced and acute consumptives there 

 will still persist on a large scale failure to utilise 

 to the utmost already existing arrangements for 

 the hospitalisation of those consumptives whose 

 continued residence in small dwellings, where good 

 nursing and good hygiene alike are impracticable, 

 is a chief reason why our national death-rate from 

 tuberculosis is not declining so rapidly as it can 

 be made to do. 



It is unfortunate that in the campaign for the 

 better housing which is so badly required no 

 importance has been attached — apparently from 

 lack of penetration or knowledge — to the fact that, 

 so far as the problem of tuberculosis is concerned, 

 a great, and the most urgent, contribution to the 

 housing problem consists in securing attractive 

 hospital beds for those advanced and acute cases 

 of tuberculosis which are now treated at home 

 under unsatisfactory conditions. 



Health and Work. 



The Health of the Industrial Worker. By Prof. 

 E. L. Collis and Dr. Major Greenwood. Con- 

 taining a chapter on Reclamation oiF the Dis- 

 abled, by Dr. A. J. Collis. With an Intro- 

 duction by Sir George Newman. Pp. xix-f 

 450. (London: J. and A. Churchill, 192 1.) 

 305. net. 



MANY books have been written on the 

 diseases of occupations, but this is the 

 first adequate modern treatise upon the hygiene 

 of industry in general. A more ideal combina- 

 tion of authors for the purpose it would be diffi- 

 cult to find. Prof. Collis, professor of preventive 

 medicine in the Welsh National School of Medi- 

 cine, was formerly one of H.M. Inspectors of 

 Factories ; during the war he served as Director 

 of Welfare and Health in the Ministry of Muni- 

 tions and was an active member of the Health of 

 Munition Workers Committee.* Dr. Greenwood, 

 who is reader in medical statistics in the Uni- 

 versity of London, vi^as in charge of the Medical 

 Research Branch of the Ministry of Munitions 

 during the war. By his refinements and judi- 

 cious application of statistical methods he has 

 done more than anyone else in this country to dis- 

 courage the issue of statistically worthless medi- 

 cal and physiological data. Both authors are 

 members of the Industrial Fatigue Research 

 NO. 2690, VOL. 107] 



Board, and they have made full use in their book 

 of the valuable reports published by the Board. 



As they point out, the keynote of the nineteenth; 

 century was the discovery of the industrial value 

 of the inanimate machine ; while the keynote of 

 the twentieth century will prove to be the dis- 

 covery of the industrial value of the living, intelli- 

 gent worker. They indicate the relation of the- 

 early epidemics of plague and typhus to want and' 

 overcrowding, and the effects of the now 

 restricted employment of children in improving 

 physique and reducing birth-rate. They describe 

 the medieval measures in this country to prevent: 

 the worker from changing his trade and from 

 leavinir his district ; they show the far greater 

 protection now afforded by the law to women 

 than to men workers ; and they point out the 

 opposition which each legislative advance has had 

 to meet before it was finally countenanced. 



The very thoughtful chapter on the utilisa- 

 tion of statistical methods in industrial preventive 

 medicine deals with the fallacies of comparing 

 average ages at death, the methods of standard- 

 isation, and proportionate mortality in vitaF 

 statistics. A well-founded plea is advanced for 

 the instruction of medical students in the elements- 

 of statistics. 



Chap. vi. contains a fascinating epidemiologi- 

 cal inquiry into phthisis, especially valuable for 

 its keenly critical and temperate character. The- 

 greater decline of phthisis among women than, 

 among men in the past fifty years is attributed! 

 to the more potent influence of factory conditions, 

 on the latter, so that they react more readily 

 than the women to the home influences of over- 

 crowding and of poor {? vitamin-poor) diet- 

 Stress is laid on the importance of viewing indus- 

 trial phthisis from the industrial aspect, sanator- 

 ium treatment being useless unless combined with- 

 suitable and remunerative occupation for the- 

 skilled convalescent craftsman and with organised' 

 methods to nurse the patient back to his proper 

 industrial sphere. 



The next chapter discusses the increasing 

 death-rate from cancer. The authors regard the 

 remarkable increase between 1900 and 1913 as. 

 being too great to be attributable to improved 

 methods of diagnosis. Evidence is adduced that 

 the prevalence of cancer is connected with indus- 

 trial conditions, and that, ceteris paribus, its fre- 

 quency is greater in cities and among males. 



The striking statistical regularity of accidents 

 is demonstrated in chap, viii., comparable to that 

 of the frequency curves of disease. The maxi- 

 mal reduction in accident-rate, obtainable by 

 the better safeguarding of machinery, is estimated! 



