system. Circulation-times have often been too glibly interpreted in the past. Prinzmetal’s new methods
will enable us to make better use of such measurements, since it is bound to lead to a better understanding of what is going on. All circulation-time techniques are somewhat comparable to pouring a lot of dye or other visible indicator into the tributary of a river ; on reaching the main stream the dye is at once diluted by the conference of other large tributaries. The stream then broadens into a (pulmonary) lake of variable dimensions, and we usually note the circulation-time by subjective recognition of the indicator at some arbitrary point following exit from the lake. Prinzmetal’s method narrows down the problem to concentration of the indicator substance and speed of passage in the main stream at the points of entry and exit from the lake. The reduction of the variables is an immense advantage, and when the new method is combined with other methods of observing the pulmonary circulation it should yield a rich harvest of new data for the better understanding of various forms of circulatory failure. TAKING US ALL ROUND IMPRESSED by the danger that in a scientific age we shall learn to look at things rather than people, Dr. Iago Galdston1 pleads for " comprehensive medicine." The term has other meanings than the one he chooses for it, and he did, at first, consider calling his concept " eubiotic " " medicine. " But," he says sadly, very few took to the term, and more seemed to prefer comprehensive medicine." This type of medicine, he suggests, is not content to cure disease, but postulates that a man may be cured of his disease and remain in bad health. It rejects as barbaric the notion of specific aetiology, recognising that many factors operate to produce pathological processes. " The more advanced students in comprehensive medicine employ with extreme caution and only for convenience the term and concept of causation." They find no clear line between sickness and health, but see these as degrees of functional efficiency. Nor do they grant the existence of specific therapies, though they recognise that various therapeutic agents have direct or indirect effects. They are " immune to the unfortunate dichotomy ofbody and mind,’ and also to its only slightly less unfortunate substitutepsychosomatic medicine’. " They see living as a sustained adventure, and comprehensive medicine as an ancillary to that adventure-" dynamic, progressive and anticipatory." This all sounds agreeable enough, if not particularly Any patient fond of a chat would welcome a doctor in his comprehensive mood ; but those feeling really ill would perhaps be inclined to ask, Yes, but where does it get me" And here Dr. Galdston has something practical to suggest. The uppermost concern of comprehensive medicine, he says, is What can best be done with what we have" And " what we have " includes social services, reablement, re-education, convalescent care-and no doubt (though he does not say so) curative agencies. But besides using all these (which are, after all, the common tools of the ordinary less-than-comprehensive doctor) the comprehensive physician will look beyond his patient’s current ills to his adventure, and prepare him to meet it. He will recognise that few young people are prepared for adult life, few married people for parenthood, and few of any kind for growing old. The physician can help to fit him, by instruction, to face these hazards. Modern science, Dr. Galdston suggests, has in a large measure exchanged mortality for morbidity ; and modern medicine falls short of its goal, which should be " the promotion of robust and enthusiastic living, physically, emotionally, socially and in other ways too." His lecture is a warning against the other kind of comprehensive medicine-the social kind,
Annals, Dist. Columbia, 1949, 18, 59.
which we are trying. " The basic and essential problem," he says, " is notwho pays ’ but what kind of medical service will be rendered. If it be in the order of curative medicine, it is hopeless and can only lead to economic and professional bankruptcy." Without pausing to argue this out, we may just note that, unless sick people have the chance of being treated, comprehensive medi. cine becomes incomprehensible ; and that comprehensive medicine in our sense can-and should-comprehend Dr. Galdston’s kind. HEALTH CONGRESS AT BRIGHTON OVER 1800 delegates attended the Royal Sanitary Institute’s health congress held at Brighton from May 23 to 27, and 28 overseas countries were represented. The subjects discussed included the development of the medical services under the new Act; the care of children under the Children Act, 1948, and in nurseries; the training of health visitors ; housing ; hygiene in industry ; the care and preservation of fish as food; and public-health research. Their wide scope illustrated the wide range of community services which are involved in maintaining the health of modern society. This congress brings together not only doctor and layman but also the members of a variety of other professions whose work has a bearing on health. Some of the advantages which might accrue are unfortunately lost by-the overlapping of meetings, and this is a strong argument for holding sessions in the afternoons as well as in the mornings in future. In his presidential address to the preventive medicine section Prof. Andrew Topping criticised the National Health Service for having its emphasis on curative medicine, with prevention " very much the poor hangeron " ; the Minister, in his view, should show his appreciation of the value of preventive services by making the financial rewards comparable with those of the curative branches. Sir Allen Daley said the new machine had begun to work with much less friction than many expected, largely because of the abundant good will displayed by all concerned. It must be remembered, though, that the three pillars of the service are all parts of the same structure-for example, a new housing estate affects the number of hospital beds needed in the locality-and there must be free trade in information at the earliest stages of any new project. CONVALESCENT HOMES AND THE KING’S FUND " CONvALESCENT homes offer one of the clearest opportunities for voluntary service still remaining." In his preface to the new issue of the King Edward’s Hospital Fund Directory of Convalescent Homes 1 Sir Henry Tidy explains how the visits made by the Fund’s representatives to collect data for the directory revealed a widespread lack of funds, aggravated by a tendency to isolationism. He has already detailed 2 the help which the Fund has provided towards remedying this state of£ affairs. Many of the homes outside the National Health Service now receive grants from the Fund, but even more has been the encouragement given them to important " look upon themselves with a critical eye, and to plan active steps which will make good any defects that this scrutiny may reveal." .
MEDICAL RESEARCH COUNCIL THE Medical Research Council have appointed Prof. Harold Percival Himsworth to be their secretary from Oct. 1, on the retirement of Sir Edward Mellanby, F.R.S. Dr. Himsworth is at present professor of medicine in the University of London and director of the medical unit at University College Hospital : he has been a member of the council since February, 1948. directory, obtainable from King Edward’s Hospital Fund for London, 10, Old Jewry, London, E.C.2, price 5s., covers homes receiving patients from the four metropolitan regions. 2. Tidy, H. Lancet, April 2, p. 577. 1. The