1250

an action on the pituitary similar to the action of

large doses of cestrone. He found that subcutaneousimplantation of the synthetic crystals in rats regularlyinterfered with growth and sometimes stopped it

altogether. Another constant result was atrophy ofthe reproductive organs, both of male and female,and assay of the pituitary glands of animals thustreated showed that they were lacking in the gonado-tropic hormones which maintain sexual function. Itwill be observed that these effects of large doses ofoestrogenic substances on the gonads resemble in someways the changes following hypophysectomy. Afterlarge doses of diethy Istilbaestrol in oil, however,Noble 7 has found that the ovaries of rats will still

respond, by an increase in weight, to pregnancy-urine extracts. As hypophysectomised animals donot give this response, the effects of cestrogen treat-ment must be qualitatively or quantitatively differentfrom those of hypophysectomy. Studies of the fluidbalance of treated rats indicated that the secretionof the diuretic principle of the anterior pituitary wasunaffected, and the clinical use of oestrogenic sub-stances to suppress anterior-lobe function in diabetes

insipidus receives no support from these experiments.Indeed, in view of the other effects produced experi-mentally, including enlargement of the pituitary,such therapy must be viewed with concern.At present the multiple changes brought about

by cestrogens in animals appear very complex. Their

power to inhibit growth and gonadotropic function,however, may yet prove applicable in therapeutics,and their effect on early pregnancy, 8 to which wehave already referred, is likely to show itself extremelyimportant.

LONDON’S MUNICIPAL HOSPITALS

THE scale of the work under the control of the

hospitals and medical services committee of theL.C.C. defies any attempt at a comprehensive survey.Or that is what one would say if in less than 60 pagesSir Frederick Menzies had not supplied an accountof its development during 1937 that cannot fail toabsorb attention, whether read as a continuous story,without reference to the tables which make up thebulk of this section 9 of the annual report of theCouncil, or as an illuminating commentary on them.The 44 general hospitals and institutions and the31 special ones between them have over 35,000 beds.The general hospitals admitted nearly 190,000patients in 1937, 8000 more than in 1936, and thespecial hospitals some 47,000. The elasticity and

interchangeability of the accommodation in differentgroups of hospitals under one authority was welldemonstrated in the early part of 1937, when a suddeninfluenza epidemic occurred at a time when theincidence of other infectious diseases was low. Itwas possible to admit over 4700 cases, mostly mild,as in-patients, using empty beds at infectious diseaseshospitals to supplement those available in generalones. The relief that the removal of these patientsmust have brought to homes where they could nothave been adequately cared for can hardly be over-estimated ; a quarter of them developed complica-tions and 490 died. We have already announced thepro-posed erection of a new general hospital on the site ofSt. Benedict’s Hospital at Tooting and of a mentalobservation block of 76 beds at St. Pancras-being thefirst psychiatric unit planned for its special purpose.

7 Noble, R. L., J. Physiol. 1938, 94, 177.8 Parkes, A. S., Dodds, E. C., and Noble, R. L., Brit. med. J.

Sept. 10th, 1938, p. 557.9 Annual Report of the London County Council, 1937.

Vol. 4 (Part I) : Public Health—General and Special Hospitals.London : P. S. King and Son. Pp. 146. 2s. 6d.

Three hospitals were appropriated-tbat is, removedfrom the scope of the poor-law-during the yearunder review. At St. Francis’ Hospital (formerlythe Constance-road Institution) wards previouslyoccupied by healthy inmates have been adapted for124 sick patients. Imposing lists of major andminor works at various centres include new accom-modation for nurses in four hospitals and improvedamenities in others. Existing buildings have beenreconditioned and adapted to new purposes; radio-

logical, pathological, and dental departments havebeen extended ; and heating systems and hot waterservices have been modernised. Remodelling of

sanitary annexes has included the provision of extralavatory accommodation not only for patients andstaff but in some hospitals for visitors. As to staff,innovations during 1937 included the experimentalappointment of full-time dental surgeons and of part.time obstetricians and gynaecologists at some general.hospitals ; the Council also reviewed and extendedthe arrangements for the employment of other part-time consultants and specialists. The work of thepathological laboratory service has continued to

expand. The pathologists at the central histologicallaboratory attend all post-mortem examinations ofpatients who have died under an anaesthetic, or whosedeaths could be connected with maternity, and thenumber of requests received from coroners for post-mortem examinations by pathologists from this

laboratory is increasing. The account and diagramsof the isolation accommodation now provided forinfectious diseases-notably at the reconstructedNorth-Eastern Hospital-are worth careful study.Other sections in the report of particular interestare those on the district medical service and on thealterations contemplated at special hospitals. The

expansion of the maternity work in the Council’shospitals has meant a serious strain on accommoda-tion and personnel, which it is hoped the

inauguration of a domiciliary midwifery service willrelieve. Not only students of medicine but studentsof pharmacy and of dietetics have access to certainof the Council’s hospitals. We shall have occasion toconsider other aspects of this remarkable record ofthe progress of London’s municipal hospitals.

AT a council meeting of the Board of MedicalAuxiliaries held last week it was decided to admitto the Board’s national register members of theIncorporated Society of Chiropodists and the BritishAssociation of Chiropodists. Some 1200 practitionersof chiropody, it is stated, are eligible for registration.ON Jan. 1st Cadbury Brothers Ltd. will begin to

pay children’s allowances to their regular employees.Five shillings will be added weekly for each childafter the second, payment to continue during whole-time education at school or college. It is emphasisedthat the payment will be distinct from ordinary wagesand parents will be required to sign a form applyingfor the allowance.

Miss ARABELLA KENEALY, who died in London on.Nov. 18th, was the daughter of a well-known counsel.After studying at the London School of Medicinefor Women she took a Dublin qualification in 1883and practised for some years in London and Watford.An attack of diphtheria left her with impaired healthand she turned to writing stories beginning with"Dr. Janet of Harley Street." Little touches in herwork reveal the some-time physician and in a war-time book in 1915 she narrated with insight t1e

rivalries of doctor and lawyer.