82 



NATURE 



[October 4, 19 17 



justify it. The claims of industry, narrowly 

 viewed, must g-ive way to the supreme claim that 

 every child born to the nation is entitled to the 

 fullest opportunities of development of which his 

 natural powers are capable. There will be a strong 

 opposition in certain industrial areas to these 

 measures, but it is to be hoped that Mr. Fisher 

 will receive the fullest possible support from 

 all who seek the lasting- well-being of the 

 nation. 



Among other proposals in the Bill is one provid- 

 ing for the establishment of provincial associations 

 under the direct initiative and control of the Board 

 of Education. Whilst it is very desirable that 

 such associations should be formed, having regard 

 to the common interests of areas larger in extent 

 than those of individual education authorities, 

 it should surely be regarded as more consonant 

 with the free spirit of English institutions to have 

 encouragfed the voluntary alliance of neighbouring 

 authorities rather than the erection of a bureau- 

 cratic organisation centred in the Board of Educa- 

 tion in London. It is to be hoped that before pro- 

 ceeding to a second reading this and other sections 

 of the Bill which tend to strengthen the central 

 body at the expense of the local authorities will 

 receive serious consideration. Mr. Fisher has 

 shown commendable enterprise and wisdom in his 

 provincial campaign. He has come face to face 

 with various interests; he has been well received 

 and has created a favourable impression, whilst 

 there has been no lack of determined and well- 

 informed criticism of some im.portant sections of 

 his measure. Doubtless he will have profited much 

 by his intimate contact with men and women of all 

 ranks of life, educational and industrial, and the 

 cause of education will have unquestionably gained 

 much thereby. 



HEALTH AND THE STATE. 

 Health and the State. By Dr. W. A. Brend. Pp. 



xi + 354. (London: Constable and Co., Ltd., 



1917.) Price los. 6d. net. 



'T'^HE main object of this book is to establish 

 -L the case for putting- our public health 

 affairs in the hands of those who have real know- 

 ledge of the subject," and "to demonstrate the 

 need for complete re-organisation of the public 

 health services." It is not necessary to read the 

 whole of the eleven chapters which compose the 

 volume to be fairly convinced that some re-organ- 

 isation is indeed needed. Perhaps the chapter 

 entitled "The Complexity of Public Health Ad- 

 ministration " is sufficient by itself to achieve the 

 author's aim. 



Dr. Brend maintains tha*^ while there exists a 

 very large mass of scientific knowledge at our 

 NO. 2^01, VOL. IO0I 



disposal, the channels by which it reaches those 

 who might be expected to benefit thereby are im- 

 perfect and obstructed. No fewer than eleven 

 Government offices, five central authorities, and 

 six local authorities are concerned to a greater or 

 less extent in public health administration. 

 Knowledge that has run the gauntlet of the 

 Government offices and then weathered the storm 

 of vested interests in the country at large is 

 finally turned into law by a House in which it 

 receives little or no expert scientific criticism. 

 The seventh chapter — more than one-fifth of the 

 book — is devoted to the Insurance Act, and is a 

 remarkable exposition of the discrepancy that 

 exists between knowledge a-nd its application. 

 The proposals and promises of 191 1 are com- 

 pared with the working of the "Act to-day ; the 

 waste of opportunity for collecting- valuable in- 

 formation, and the failure of the Act to apply the 

 best medical treatment to the sick poor who are 

 in need of it, are discussed at length. 



Yet withal, the general impression left by the 

 book is that though it is a careful study of pre- 

 sent administration and a vigorous piece of 

 destructive criticism, nevertheless the reconstruc- 

 tive proposals outlined are by no means neces- 

 sarily sound. The author frequently postulates 

 that environment lies at the root of nearly all the 

 ills that flesh is heir to. He maintains that the 

 number of unfit in a State depends more upon 

 environment than upon any other factor, and that 

 the main cause of the continuance of tuberculosis 

 is a bad environment. "Defectiveness in school 

 children, as most diseases elsewhere, is mainly 

 a matter of environment." "Take a patch of, 

 say, fifty acres from the most crowded and worst 

 built district ... set it down precisely as it is 

 among the pines of Surrey ... the probability is 

 that the improvement in the health of the in- 

 habitants would be enormous. There are, in fact,, 

 patches of bad housing in many country towns 

 and villages presenting- the worst features of 

 I slums, whose inhabitants, nevertheless, exhibit a 

 high degree of healthiness." 



The chief factor at work in bad environment 

 {i.e. overcrowding of cities) is, in Dr. Brend 's 

 view, an atmosphere polluted by dust and smoke. 

 That polluted air may be harmful, as is polluted 

 water, is not questioned, but the argument con- 

 tained in the passage cited, that bad housing and 

 slum conditions are in themselves comparatively 

 unimportant, does not appear valid. It is a 

 matter of experience that so long as communities 

 are small and scattered human beings can live 

 under the most primitive conditions without suf- 

 fering unduly, but even picked individuals when 

 aggregated in larg-e numbers suffer heavily from 

 preventable disease unless the most strict pre- 

 cautions are taken. It is not recorded that the 

 armies of the Napoleonic wars were particulnrly 

 subjected to dusty, smoke-polluted atmosphere, 

 yet their sickness rate was terribly hisfh. We 

 question whether the fifty crowded acres in Surrey 

 would necessarily prove to be particuhrlv 

 healthy, although, of course, it is not proposed 



