526 THE CANADIAN MEDICAL AssocIATION JOURNAL
[Nov.1939~~~~~
dealt with. No detailed account is given of electro-
surgery but it is dealt with under general headings.
Ultra-violet radiation is dealt with in detail under
three headings, Sunlight, Carbon Are Light, and
Mercury Arc Light. This subject is very well dealt
with, in particular the dangers associated with ultra:
violet radiation.
The last two chapters are devoted to lists of dis-
eased conditions and their treatment by various
physiotherapeutic measures. This cannot be considered
altogether satisfactory as no mention is made of
massage, corrective exercises or hydrotherapy, all of
which could be used in some of the conditions
mentioned.
The Immortal Tooth. E. Smason. 271 pp. $2.75.
Macmillan, Toronto, 1939.
"The Immortal Tooth", an easily readable trea-
tise, concerns itself with the part played by the tooth
of man throughout the centuries.
It is the first book of its kind written for public
consumption in explanation of the multiple and varied
mythological, religious, criminal and superstitious ac-
counts in which the tooth has been a nucleus. The
reader, be he patient or dentist, is carried along in
an inereasingly interesting manner from the evolution
of the tooth to curious and interesting facts concern-
ing it.
Truly, a book of dental and public interest, en-
lightening in its presentation and appealing in its
humour.
Problems of Ageing. Edited by E. V. Cowdry. 758
pp., illust. $10.00. Williams & Wilkins, Balti-
more, 1939.
The phenomenon of ageing, relatively unimportant
to youth, takes on an increasing interest as one ap-
proaches that final stage of life. Is there a definite
life-span which is incapable of prolongation? The
question cannot be positively answered. The expecta-
tion of life has been greatly increased in recent years,
but this is far from saying that the span of life has
been extended. Statistically, there is little evidence
to support a contention that the span of life has been
increased. For all practical purposes 100 years is the
maximum limit and it would appear to have always
been so. Experimentally, however, there are some in-
dications that by artificial means the life-span of
'
animals can be prolonged, and, if this is so, one can
hope for a similar prolongation of man's life-span.
This book represents the first serious attempt to
assemble present day knowledge of the phenomenon
of ageing. It is not the work of a single hand, but
the result of the collaboration of a large number of
men, each an authority in his own field. The various
chapters deal with the ageing process in the different
systems of the body, and a summary and an extensive
bibliography is attached to each.
Although the large number of references quoted
might indicate a considerable body of knowledge on
the subject, it is probably true to say that compara-
tively little thought has been given to the problem of
ageing. The basic question. "Why do we grow oldt"
still remains unanswered. Why animals should have
a life-span at all, and why, in the case of man, this
should be set at about 100 years, while other animals
reach their dotage in 3 or 5 years, is an enigma. The
answer is complicated bv the difficulty of distinguish-
ing between disease and physiological senescence. We
have not yet established standards of normality at
various ages for the different organs, nor are we in a
position to detect early signs of disease. The question
as to whether arteriosclerosis is a physiological or
pathological process, for example, cannot be answered
dogmatically, yet this obviously has an important
bearing on the problem of whether certain organs are
diseased or merely old.
1939
The book is a well done, timely piece of work.
The calibre of the writers, the extensive bibliographies,
and the comprehensive index make it an invaluable
book of reference.
Health Insurance with Medical Care: The British
Empire. D. W. Orr and J. W. Orr. 271 pp. $2.50.
Macmillan, Toronto, 1938.
It is probably not due to any fortuitous circumstance
that Dr. and Mrs. Orr published their survey of health
insurance in Great Britain at this particular time. The
medical economic waters on the North American Con-
tinent are being stirred as they have never been stirred
before, and this book by a young American physician
and his wife, who is a trained social worker, presents a
viewpoint refreshingly different from those commonly
expressed by their compatriots. The Orrs studied
National Health Insurance and approved of what they
saw. The few adverse criticisms which they record are
matters of detail rather than principle, and represent
inadequacies in the service which have been pointed out
on many occasions by official pronouncements of the
British Medical Association.
The interviews which form the basis of this book
represent the opinions of insured workers and their un-
insured dependents, panel physicians and medical officials,
social workers and public health authorities, nurses and
sehool medical officers, insurance committee clerks and
trades union secretaries, members of Parliament and
officials of the Ministry of Health,-in fact every section
of the population seems to be represented. The comment
is reiterated again and again,-" The plan of National
Health Insurance is a good one, as far as it goes, but it
should and will be extended ". The authors dispose
rather lightly of two important criticisms of the opera-
tion of the British scheme of health insurance, namely,
that many insurance practitioners have degenerated into
mere issuers of certificates, and that overprescribing of
medicines constitutes a serious threat to the stability of
the whole structure.
One very commendable feature of this book is the
manner in which National Health Insurance is related to
other sources of medical aid. The trans-Atlantic ob-
server is materially assisted in orientating himself among
the various agencies by the brief but adequate descrip-
tions of the Public Assistance Medical Service, the
School Medical Service, the Public Health Services with
their various clinics, the District Nursing Services, the
Voluntary Hospitals, the Public Authority Hospitals,
the various medical missions and charity dispensaries,
and the thriving plan of voluntary health insurance, the
Public Medical Service.
One would have been interested to have read a more
detailed analysis of the economics of the National Health
Insurance; a discussion of the adequacy or otherwise of
the capitation fee, comparing the remuneration of the
physician with that of doctors engaged in contract prac-
tice on this side of the water; some reference to the
administrative cost of the plan, both in its purely medi-
cal aspects and in relation to the operation of the
Approved Societies; a word on the relationship between
the cost of drugs and the amount allotted for medical
services; these and other important points await the
appraisal of an observer who approaches National Health
Insurance with the viewpoint of an administrator.
The final chapter is entitled, "Some Implications
for America". This summary, while not unbiased, is
worthy of the attention of doctors who live in that por-
tion of America which lies north of the 49th parallel of
latitude, as well as of those to whom it is primarily
addressed.
The Foreword is written by David Lloyd George,
th3 man who for better or for worse placed upon the
Statute Book the Act which brought into being National
Health Insurance in Great Britain. He says of the
volume under discussion,- "I commend it warmly to the
attention of the public, both in Britain and in America",
and this reviewer can do no less.