WISE ANDREW BOORDE
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1531 theatres, rather than a mere addition to the number of beds. A further large sum has also been allocated to the 56 convalescent homes which take London patients without being attached to any particular hospital; these homes contain some 3500 beds and sheltered last year nearly 31,000 convalescents. Over and above these benefactions the Fund has during the year provided 2000 for district nursing, and a special gift of :E10,000 to the radium fund will enable important additions to be made to the hospital radium service. The Fund keeps up interest in current matters of hospital policy. In his message the King expressed pleasure at its success in inducing hospitals to combine their several flag days, and at the continued thought being given to out-patient waiting. A committee of the Fund is now consider- ing with the hospitals the quickest way of doing efficiently all the things that have to be done after patients arrive at hospital and before they see the doctor. The visitors who keep the Fund informed of what goes on from day to day in the hospitals have reported that there are still thirteen hospitals which wake their patients before 6 o’clock in the morning. It is true that the proportion of patients thus disturbed is only 9 per cent. of the total hospital population in London, but it must still stand for a large amount of distress and discomfort. It is unfortunately not quite certain that the same grant can be given this time next year ; the hon. treasurer of the Fund had to report that the estimated income for next year was down by about 20,000, the decrease being due almost entirely to a shortage in legacies. There is yet a little time before the end of the year and although no one wants hospital well-wishers to pass away at Christmas-time, yet if they must it may be hoped that they will be both rich and generous. All the cheques for this year’s grants were posted on Friday, Dec. 18th. DOMESTIC HEATING BY GAS ONE of the greatest labour-saving devices in the modern home is the fire which makes no dirt, and which can be put on and off at will, by pressing a switch or turning a tap. It is inevitable that gas and electric fires, starting as substitutes for the coal fire, should develop along independent lines and give rise to new problems. At the request of the governor of the Gas Light and Coke Company, the Royal College of Physicians of London appointed a committee to examine domestic heating by gas from the point of view of health and comfort, with particular reference to " the construction of rooms without flues or air bricks." The report of this committee has just been published and makes interesting reading. It begins by stating the optimal conditions for comfort -namely, that loss of heat by the body should proceed at a certain rate, and by radiation, convection, and evaporation in certain proportions. This leads to a general survey of the ventilation and heating requirements of rooms, and the relative merit, in different circumstances, of fires which throw out a lot of radiant heat and those which merely heat the air by convection. The plan of the report is then to say that, under average conditions of ventila- tion, the flueless room requires so many cubic feet of gas per hour to heat it, and to discuss the possible harmful effects of burning such a quantity of gas. 1 Domestic Heating by Gas considered from the point of view of Health and Comfort. Report of an Advisory Com- mittee of the Royal College of Physicians of London. London : Harrison and Sons, Ltd. 1936. Pp. 31. Price 1s. (The members of the committee were Prof. W. W. Jameson, M.D., Sir Joseph Barcroft, F.R.S., Sir Arthur Hall, M.D., Dr. G. P. Crowden, and Dr. Reginald Hilton.) An astonishing difficulty is recorded, which, though it did not prevent the carrying out of this plan by the committee, introduces an element of surmise into their findings : "... the committee is of opinion that the degree of air change which takes place in rooms under ordinary conditions of occupation has never been adequately investigated." ... There is " no general agreement as to what constitutes sufficient ventilation in a room unprovided with a flue, and dependent entirely on the opening of windows and doors...." The bulk of the report consists of a survey of the effects of a gas fire, using 1 cubic foot of gas per hour per 100 cubic feet of room space, in a flueless room where the air is changed not less than once per hour. In such a room, the heating would be adequate, and the ventilation, though probably just sufficient, rather on the low side. It is thought, however, that a less degree of ventilation than this would be unlikely, even in a flueless room, so that from the point of view of products of combustion, worse conditions would not be encountered. Tables are given showing the maximum gas rates permissible in a room of standard size with reference to the ventilation-rate, and the effect of the sulphur content of the gas upon these maxima. Provided that the given rates of combustion are not exceeded, and they are adequate for heating purposes, no danger is to be anticipated from fumes. The committee dispels a few popular illusions about carbon dioxide, and devotes a good deal of space to carbon monoxide. Other products of combustion are considered, but those first likely to rise above the threshold of comfort or safety are the oxides of sulphur. Fortunately, these are smelt long before they become toxic, so that they are in every way a desirable criterion for the maximum permissible rate of gas usage. It is less fortunate that the percentage of sulphur in gas varies with the process of manufacture. The report itself should be consulted for reservations, often important, but in general it may be said that the heating of even flueless rooms by gas is compatible with comfort and health. In view, however, of the lack of knowledge about the ventilation of such rooms, the committee strongly deprecates their construction, and advises the provision of at least an air brick. It is useful to have this independent verdict on a matter of everyday importance. WISE ANDREW BOORDE ANDREW BooRDE was born in Sussex in the last years of the fifteenth century and lived till the middle of the sixteenth. His two small books are among the earliest written in English on medicine after the Renaissance, and are especially of interest because they represent the revolt from mere authority and the rise of a spirit of inquiry and recourse to actual observation, which were to come to fruition in the later years of the century. The Garswood Press, whose first publication 1 this is, and its editor, have chosen from the two books those passages which may " best reveal the author, the usages of his age and more particularly the organisation of a Tudor house hold." The original volumes were published, probably in 1542, for in that year Boorde dedicated the Dyetary to the Duke of Norfolk ; and there were later editions in 1562 and 1576, long after Boorde’s death which took place probably in 1549. They have been reprinted in the nineteenth century by the Early 1The Wisdom of Andrew Boorde. Edited by H. M. Poole. Illustrated by A. E. Christopherson. Leicester : Garswood Press. 1936. Pp. 63. 7s. 6d.
Transcript of WISE ANDREW BOORDE
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theatres, rather than a mere addition to the numberof beds. A further large sum has also been allocatedto the 56 convalescent homes which take London
patients without being attached to any particularhospital; these homes contain some 3500 beds andsheltered last year nearly 31,000 convalescents.Over and above these benefactions the Fund has
during the year provided 2000 for district nursing,and a special gift of :E10,000 to the radium fund willenable important additions to be made to the hospitalradium service. The Fund keeps up interest in currentmatters of hospital policy. In his message the
King expressed pleasure at its success in inducinghospitals to combine their several flag days, andat the continued thought being given to out-patientwaiting. A committee of the Fund is now consider-
ing with the hospitals the quickest way of doingefficiently all the things that have to be done afterpatients arrive at hospital and before they see thedoctor. The visitors who keep the Fund informedof what goes on from day to day in the hospitalshave reported that there are still thirteen hospitalswhich wake their patients before 6 o’clock in the
morning. It is true that the proportion of patientsthus disturbed is only 9 per cent. of the total hospitalpopulation in London, but it must still stand for a
large amount of distress and discomfort. It is
unfortunately not quite certain that the same grantcan be given this time next year ; the hon. treasurerof the Fund had to report that the estimated incomefor next year was down by about 20,000, the decreasebeing due almost entirely to a shortage in legacies.There is yet a little time before the end of the yearand although no one wants hospital well-wishers topass away at Christmas-time, yet if they must it maybe hoped that they will be both rich and generous.All the cheques for this year’s grants were posted onFriday, Dec. 18th.
DOMESTIC HEATING BY GAS
ONE of the greatest labour-saving devices in themodern home is the fire which makes no dirt, andwhich can be put on and off at will, by pressing aswitch or turning a tap. It is inevitable that gas andelectric fires, starting as substitutes for the coal fire,should develop along independent lines and giverise to new problems. At the request of the governorof the Gas Light and Coke Company, the RoyalCollege of Physicians of London appointed a
committee to examine domestic heating by gas fromthe point of view of health and comfort, with particularreference to " the construction of rooms withoutflues or air bricks." The report of this committee hasjust been published and makes interesting reading.It begins by stating the optimal conditions for comfort-namely, that loss of heat by the body shouldproceed at a certain rate, and by radiation, convection,and evaporation in certain proportions. This leadsto a general survey of the ventilation and heatingrequirements of rooms, and the relative merit, indifferent circumstances, of fires which throw out alot of radiant heat and those which merely heatthe air by convection. The plan of the report isthen to say that, under average conditions of ventila-tion, the flueless room requires so many cubic feetof gas per hour to heat it, and to discuss the possibleharmful effects of burning such a quantity of gas.
1 Domestic Heating by Gas considered from the point ofview of Health and Comfort. Report of an Advisory Com-mittee of the Royal College of Physicians of London. London :Harrison and Sons, Ltd. 1936. Pp. 31. Price 1s. (Themembers of the committee were Prof. W. W. Jameson, M.D.,Sir Joseph Barcroft, F.R.S., Sir Arthur Hall, M.D., Dr. G. P.Crowden, and Dr. Reginald Hilton.)
An astonishing difficulty is recorded, which, thoughit did not prevent the carrying out of this plan by thecommittee, introduces an element of surmise intotheir findings : "... the committee is of opinionthat the degree of air change which takes place inrooms under ordinary conditions of occupationhas never been adequately investigated." ... Thereis " no general agreement as to what constitutessufficient ventilation in a room unprovided witha flue, and dependent entirely on the opening ofwindows and doors...."The bulk of the report consists of a survey of the
effects of a gas fire, using 1 cubic foot of gas perhour per 100 cubic feet of room space, in a fluelessroom where the air is changed not less than once
per hour. In such a room, the heating would beadequate, and the ventilation, though probablyjust sufficient, rather on the low side. It is thought,however, that a less degree of ventilation than thiswould be unlikely, even in a flueless room, so thatfrom the point of view of products of combustion,worse conditions would not be encountered. Tables are
given showing the maximum gas rates permissiblein a room of standard size with reference to theventilation-rate, and the effect of the sulphur contentof the gas upon these maxima. Provided that the
given rates of combustion are not exceeded, and theyare adequate for heating purposes, no danger is to beanticipated from fumes. The committee dispelsa few popular illusions about carbon dioxide, anddevotes a good deal of space to carbon monoxide.Other products of combustion are considered, butthose first likely to rise above the threshold of comfortor safety are the oxides of sulphur. Fortunately,these are smelt long before they become toxic, sothat they are in every way a desirable criterion forthe maximum permissible rate of gas usage. It isless fortunate that the percentage of sulphur in gasvaries with the process of manufacture. The reportitself should be consulted for reservations, often
important, but in general it may be said that the
heating of even flueless rooms by gas is compatiblewith comfort and health. In view, however, of thelack of knowledge about the ventilation of such rooms,the committee strongly deprecates their construction,and advises the provision of at least an air brick. Itis useful to have this independent verdict on a matterof everyday importance.
WISE ANDREW BOORDE
ANDREW BooRDE was born in Sussex in the lastyears of the fifteenth century and lived till the middleof the sixteenth. His two small books are amongthe earliest written in English on medicine after theRenaissance, and are especially of interest because
they represent the revolt from mere authority andthe rise of a spirit of inquiry and recourse to actualobservation, which were to come to fruition in thelater years of the century. The Garswood Press,whose first publication 1 this is, and its editor, havechosen from the two books those passages which may" best reveal the author, the usages of his age andmore particularly the organisation of a Tudor household." The original volumes were published, probablyin 1542, for in that year Boorde dedicated the Dyetaryto the Duke of Norfolk ; and there were later editionsin 1562 and 1576, long after Boorde’s death whichtook place probably in 1549. They have been
reprinted in the nineteenth century by the Early
1The Wisdom of Andrew Boorde. Edited by H. M. Poole.Illustrated by A. E. Christopherson. Leicester : Garswood Press.1936. Pp. 63. 7s. 6d.
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English Text Society, principally for their philo-logical interest.
Boorde’s age was the period of the travelling scholar,and a considerable portion of his life was passed inforeign travel. He had been brought up as a
Carthusian monk, but when he was nearing histhirtieth year he obtained a dispensation from hismonastic vows, and set out to see the world. Thisfirst journey occupied about two years, at the endof which he returned to England and practised theart of medicine, having many notable patients, amongthem the great Duke of Norfolk, by whose favourhe was introduced to the Court, but was not
apparently among the King’s physicians. He washowever restless, and, fired by a zeal to " se and toknow the trewth of many thynges " and to " havea trewe cognyscyon of the practis of Physicke,"he visited all the best known universities and schools" within the precinct of Chrystendome " in a secondtour of Europe. In 1534 he was back in London, andwas shortly afterwards employed by Thomas Cromwellto visit the principal Courts of Europe and reporton political matters. After this journey he visitedScotland, still in communication with Cromwell.Then came the dissolution of the monasteries andBoorde departed from England on a journey whichtook him to France, Germany, Italy, Rhodes, andthence to Joppa and Jerusalem ; he returned byNaples and Rome and then passed the Alps to settlefor a considerable period in Montpellier, wherehe appears to have written his two books. On hisreturn to England he is said to have settled inWinchester, and for an alleged offence against moralswas in prison. In the Fleet prison he made hiswill in 1549 and died almost immediately afterwardsin his sixtieth year.He was certainly a learned man and a good scholar,
and at that time scholarship and learning entitleda man to style himself a physician, for medicine wasalmost entirely the outcome of a study of Galen’swritings. However, in Montpellier and elsewhere,men were beginning to break away from mere
authority and Boorde was not in the least, so far aswe can judge, prepared to accept things on hearsay ;he wished " to se and to know the trewth of manythynges." And so, though he quotes authorityoften, he is quite ready to contradict it with the factswhich he has himself observed, and his remarks ondiet, the rules for retaining health, and the effects ofclimate are full of good sense derived from his ownexperience. His English style, as exhibited in theseexcerpts, is always lucid, and occasionally achieveselegance and terseness. Half a century later thatmonarch among essayists scarcely bettered Boorde’sdirections for building a house. It is almost thetongue of the great Lord Chancellor: " For thecommodious building of a place doth not only satisfythe mind of the inhabitor, but also it doth comfortand rejoiceth a man’s heart to see it, specially thepulcruse prospect. For my conceit is such, that Ihad rather not to build a mansion or a house, thanto build one without a good prospect in it, to it, andfrom it."
This charming brochure is something of a curiosity.In the first place it is not a complete edition of thetext of Andrew Boorde’s Brevyary of Health, nor ofhis Dyetary of Health, but contains one excerptfrom the Brevyary and a score or more from theDyetary. It is to a certain extent modernised,especially in the spelling, in which Andrew, like mostof his contemporaries, was content to write down theform which for the moment appealed to his eye ;and it is published in a limited edition of five hundred
copies. It is obviously not intended for scholars ;it is difficult to believe that it will appeal to the general,or even to the medical, public ; so that it must besupposed that it is addressed to his fellow virtuososby a virtuoso. At any rate its format, its illustra-tions, its type, its essays on mediaeval medicine andthe school of Montpellier are all delightful.
POISONS DISPENSED BY PRACTITIONERS
WE would remind practitioners who supply medi-cines to their patients that on Friday next theyshould be careful to comply with the requirementsof the rules in regard to the labelling of poisonswhich then come into force. It will be necessary fora dispensing practitioner, when supplying poison asa medicine, to take steps to ensure that the con-
tainer is distinctly labelled with his name and address.In the case of an embrocation, liniment, lotion,liquid antiseptic, or other liquid medicine for externalapplication the container must be labelled with thename of the article (e.g., "The Lotion") and thewords " For external use only." It is also incumbenton the dispensing practitioner, when he supplies his,
patient with any substance in the First Schedule,to enter in a book which he regularly uses for thatpurpose the following particulars : (a) the date onwhich he supplied the medicine; (b) the ingredientsof the medicine supplied ; and (c) the name of thepatient. No such entry is required, however, whenthe medicine is prescribed on an insurance form oron one issued by the local authority’s health service.Nor is a practitioner required to keep a record of a,
medicine administered by him personally to a patient.or left with the patient when attending him.
DIAGNOSTIC VALUE OF HORMONE ASSAYS INPREGNANCY
THE excretion of gonadotropic substances in theurine, recognised by a qualitative test on mice, is thebasis of the Aschheim-Zondek reaction for detectionof early pregnancy. Quantitative tests have indicatedthe approximate course of their excretion duringpregnancy, and some attention has been given to thedifferences between individual cases. In our presentissue Dr. Browne and Dr. Venning describe how theyhave followed in detail the variation in urinarygonadotropic substances throughout pregnancy infive cases. This laborious work has led to several
important conclusions. In the first place, these casesdid not follow the generally accepted normal curveof amounts excreted at different stages of pregnancy.Further the results demonstrate, in confirmation ofHeim, the great individual variations that mayoccur, and suggest that big variations are highlysignificant of the state of the pregnancy.
It may be argued that, however laborious the work,an investigation of this kind must be extended tovery many more cases before generally valid con-
clusions can be drawn. But this extension mustdepend on advances in technique ; for the stage isnot yet reached at which cases examined in differentlaboratories can be directly compared and the data.accumulated to form the basis of adequate generalisa-tions. Several methods of extraction of the gonado-tropic fraction from urine are known, but there isno general agreement about the best. The means of
assay are in a still greater state of confusion : withdifferent methods, different stocks of animals, andwithout any common standard of comparison, resultsfrom different laboratories are only broadly com-parable. Two workers might agree that gonadotropicmaterial reaches a maximum concentration at a.
