677

the authors deprecate routine paralysis of the

diaphragm on the affected side. As might be

expected, complications were relatively few amongpatients who had lost their fever and toxemia

during a preliminary period of sanatorium treat-ment. Those with a large amount of sputum,and in particular those showing a fluid level in a

cavity, were especially prone to post-operativepulmonary complications. Full use is being madeat Passy of the exceptional facilities for the clinicalstudy of tuberculosis, and further bulletins will beawaited with interest.

REBUILDING PROGRAMME

THOUGH local conditions provide the text for theargument in a stimulating study of the housingquestion in Manchester Sir Ernest Simon is better quali-fied than most people to write on housing problemsin general, and much of what he says deserves awider application. Beginning with a glance at theterrible story of laissez-faire in the housing of thelower paid workers, he and his collaborator set outthe achievements of the city council in reconditioning,in building new houses, and in town-planning. Oneof the most important parts of the book is the section,to which Lady Simon contributes, on Wythenshawe,the first complete garden city planned as a satelliteby a local authority. All the difficulties, parlia-mentary as well as local, which have delayed thedevelopment of Wythenshawe are described in detailand quite impartially. The conclusion stands outthat a big local authority is very well placed tofoster the garden city movement, because it can

supply both cheap capital for development andhouses in large numbers to make the capital remunera-tive. The absence of these two factors has donemuch to retard the successful growth of Welwynand Letchworth. It is perhaps going rather far tosay that the garden city movement can only succeedif it is sponsored by our great cities, but it is highlyprobable in view of the success of the Wythenshaweexperiment that this is the line which garden citydevelopment will generally follow. The story of

Wythenshawe illustrates two conditions which arevital to success in an enterprise of this kind : (1) themother city must own the land, and (2) it mustalso be the local authority for the satellite. Tostate these two conditions is to indicate some ofthe difficulties to be overcome, but it is to be hopedthat even now many progressive local authoritiesare laying plans to follow the example of Manchester.

In discussing the future Simon and Inman empha-sise the need for a long range plan, and give reasonsfor the view that factors of population, transport,and trade are likely to be more stable and thereforemore amenable to plan during the coming than duringthe past 100 years. The relative merits and costsof cottages and flats are compared, the former beingfavoured. In conclusion, a time plan is suggested,stretching over a century, of which 50 years are

allotted to the building of 20,000 additional housesand to the replacement of the whole of the existingslums in Manchester, and 50 years thereafter to therebuilding of the business centre. The cost of thefirst 50 years’ programme, including a second satellitegarden city, is estimated at 50,000,000, apart fromGovernment subsidies, and in this connexion it is

noteworthy that during the fourteen years, ending1934, the expenditure of the housing department

1 The Rebuilding of Manchester. By Sir E. D. Simon, M.A.,chairman of the Manchester Housing Committee, 1912-23, andJ. Inman, B.A. London: Longmans Green and Co., Ltd. 1935.Pp. 173. 5s.

has been on an average :E1,000,000 a year, preciselythe figure estimated for the future.The problems of replanning a built-up area are

different from and more complex than those of creatinga new garden city on an agricultural site. Herealso if the slums are to be rebuilt the city councilmust do it. An incidental result will be the transferto the municipality of the freehold of most of itsarea. It is significant of the change of public opinionon housing that these far-reaching proposals shouldbe made.

TREATMENT OF SYPHILIS DURING PREGNANCY

CONGENITAL syphilis may be an irreparabletragedy for the victim, and the fact that syphilisin the new-born living child is readily amenableto early treatment is no excuse for allowing womento go through a full-term pregnancy after several

miscarriages, only to be faced ultimately with a

florid syphilitic offspring. In an admirable survey of2150 pregnancies in coloured women whose Wasser-mann reaction was positive, carried out over a periodof 17 years, J. R. McCord,l of Atlanta, Georgia,shows that timely treatment of the mother assures

her of a syphilis-free baby in 95 per cent. of cases.What he rightly calls " disastrous pregnancies " can infact be reduced from 49-4 per cent. in the untreatedto 5-4 per cent. in the treated by insistence on aroutine Wassermann reaction early in pregnancy,followed by a combined arsenical and mercurialcourse. Dr. McCord bases his treatment entirelyon the prevention of disease in the baby. "Wemake no effort," he says, " to cure the disease in themother." But while those in this country who havehad similar opportunities will agree with him thatit is desirable for pregnant women to have a

Wassermann reaction done at least once duringpregnancy, preferably early enough to ensure sixmonths’ treatment before the birth of the child,they will not agree with McCord’s principle that

antepartum therapy should be based only on theprevention of the disease in the child, not on itseradication in the mother. His criterion of sufficienttreatment designed to this end is 10 injections ormore once a week of 0-45 gramme N.A.B. combinedwith a heavy metal (mercury or bismuth), andhe recommends the continuance of the treatment

irrespective of its effects on the mother’s Wassermannreaction. There is in fact little danger in submittingpregnant women to rigorous antisyphilitic treatmentextending over more than twice the period sug-gested. By this means it would be possible almostto guarantee the birth of a healthy child as faras freedom from syphilis is concerned, and the motherwould herself be receiving curative rather than

merely palliative treatment.1 Jour. Amer. Med. Assoc., 1935, cv., 89.

AN ANGLO-SCANDINAVIAN PILGRIMAGE.-The VikingSociety, of which Mr. A. Rugg-Gunn, F.R.C.S., ispresident for the third successive year, is organisinga celebration at Shaftesbury on Oct. 5th in honourof the ninth centenary of Canute the Great. Themeeting will be attended by several Scandinavian ambas-sadors or their representatives, and, it is expected, bythe Earl of Shaftesbury, Lord Lieutenant of Dorset.The programme includes an Anglo-Scandinavian religiousservice in the Abbey ruins, a reception by the Mayor,luncheon, lecture, ramble around the historic city, and tea.The inclusive cost of the pilgrimage is one guinea perhead, and any medical man or woman is welcome to joinit. Application for tickets should be made to Mr. A. W.Johnston, 30, Goblin’s Green, Welwyn Garden City.