Yellow Jack and the worm: British naval administration in the West Indies, 1739–1748

surgery, or with those who might become great men, would be of interest only within the profession, but the surgical details are condescendingly described in lay terms. Gullet and digestive juices figure prominently. The historians of the NHS can learn something from this account of the enthusiasm which pervaded the early years but less from the chapters devoted to the present discontents. McKeown's views on the managerial revolution are predictable, although not for that reason misconceived; his comments on the current situation lack freshness for the good reason that his opinions are those of the great majority of his contemporaries. There are here many truthful reflections upon the nature of health care but they are essentially retrospective. New thinking cannot ignore these truths but they do not constitute a blue print for future construction.