A History of the Acute Abdomen

to be devoted to an outline of sources and methods, but this long explanatory section is most welcome, as it makes an interesting and informative narrative. Mr. Pinker covers the types of hospital service available-the voluntary, the poor law and the local authority. He has a section on the number of patients, the average size of hospitals, bed provision, bed occupancy and the average length of patients' stay, concluding with a chapter on the complex subject of voluntary hospital finance. Sometimes London and provincial provisions are compared. Besides supplying us with knowledge, this study gives us a few interestingly startling jolts. Two factors emerge very clearly. First, that although the voluntary hospitals have always received the honour and glory because of their historic significance and their contribution to medical knowledge and progress, the mass of the sick received institutional care, custodial or curative, in poor law hospitals, well into the twentieth century. In 1861 80% of hospital beds were in workhouse sick wards or infirmaries, and in 1938, 20% were still under the destitution authorities. In the latter year, 29% ofall beds in poor law and local authority general hospitals lacked X-ray and operating facilities. (The number of nineteenth-century sick cared for by the poor law authorities were much greater than Mr. Pinker states, as he has included only those workhouse hospitals where there were training schools for nurses). The second factor which is so striking is the very recent nature of the provision for the many special categories of sick. While we groan and complain about our present inadequate health services, we are here made to realize how much has been done so very recently. We must be thankful to be ill today rather than even twenty years ago. The dissemination of accurate information, particularly of statistics expedites reform. A continuation of Brian Abel-Smith's and Robert Pinker's volumes a few generations hence should not have to include the many stones of frustration and delay due to ignorance. RUTH G. HODGKINSON