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If the Federation’s own " Advice to Healers " and its

president’s " Guide to Spirit Healing " can be relied on,

the " healers " in the wards will not be concerned withthe spirit or spiritual health of any patient to whom theyminister, but with the application of

" healing power " ofwhich they believe themselves to be repositories or

vehicles. This power, though unidentified, is apparentlyphysical and can " travel through blankets with ease ";it is transmitted by touch and is credited with remarkabletherapeutic effects. " In the case of a growth situated inthe bowels, it has repeatedly been found that, after spirithealing has been invoked, there is a most unusual heavyrectal discharge, of such a character that it cannot bemistaken for an ordinary motion. Whenever this hasoccurred, an immediate betterment has followed, evenwith patients whom the doctors have only given a fewdays to live. The obvious inference is that by someunknown means the healing guides have been able todissociate the growth and expel it from the body."

" Spiritual " or " spirit " healing-the phrases are usedas if equivalent-seems to have close affinities with

spiritualism. " No healer should ever go under trancecontrol when attending a patient in hospital " but, clearly,might expect to do so in

" his place of healing "-presum-ably a private treatment room where " the healer is theresponsible person ". The president of the Federation,Mr. Harry Edwards, writes:

"

Although the author hasmany times received information (of a highly evidentialcharacter) to establish that both Pasteur and Lister areclosely associated with this healing work, he never

appeals to them as spirit guides for any particular healing,but opens himself to be used freely by any healing guide."There seems also to be a looser association with manipula-tive therapy. " The healer should not undertake manipula-tions by himself. The medical staffs will resent this andthey may be justified in thinking the healer is doing harmunless they know what is taking place." Much of the"Advice to Healers" inculcates restraint, tact, and

conciliatory behaviour in the wards-excellent things inthemselves but given a rather different complexion whenpreceded by the words " In these early days we shall needto proceed carefully...."

The whole situation is, to put it mildly, very curious.The Federation is unquestionably a body of personspractising a therapy of their own, not recognised inorthodox medicine. They are not medical ancillaries norare they spiritual advisers or ministers of religion; theChurches’ Council of Healing does not recognise them;yet they are to be admitted to the wards of hospitals toadminister " healing power " through manual contact topatients for whose care and treatment the medical staff isresponsible. It is true that they are to receive permissionand are advised not to make approaches to patients atlarge. " If other patients ask for healing, the normalpermission must first be obtained." But they will seem tothese " other patients " to have the sanction of the hos-pital for what they do, although it can hardly be supposedthat their ministrations will have been prescribed or

directed by the medical staff.

The unanimous advice of the Regional Hospitals’Consultants and Specialists Association that members ofthe Federation should have no special privileges, and thatmanagement committees who have already given theirpermission should reconsider their decision, seems in thecircumstances remarkably restrained.

ABDOMINAL DECOMPRESSION IN LABOUR

A PROMISING method for reducing the pain and dura-tion of the first stage of labour by abdominal decom-pression was described last year by Heyns.l Severalobstetric units in this country have been developingapparatus to test this technique; but clear conclusions havebeen delayed by practical difficulties involved in bringingabout the required drop in pressure inside the plastic suitenclosing the abdomen. The choice of a suitable sourceof suction and the exact design and supply of suits areimportant factors in the success of the method and com-fort of the patient. All leaks of air into the suit must be

prevented, and this leads to excessive sweating and dis-comfort from pressure of the suit on the legs. These andother technical difficulties have evidently been largelyovercome by Dr. Scott and Mr. Loudon, whose reportappears on p. 1181 of this issue. These workers have intro-duced ingenious modifications : their successful design ofa light, discardable, polyethylene suit which allows thelegs to remain free, and costs only 2s. to replace, is

especially notable.Their results, though not yet advanced enough for

detailed analysis, have been most favourable. The relieffrom pain is convincingly indicated by the reluctance oftheir patients to have the suit removed for pelvic examina-tion-wliich, fortunately, is not often necessary. The

frequent finding of full dilatation of the cervix within threehours of the time at which distress from contractions first

began must surely be unusual in primigravidx, and

supports the suggestion by Scott and Loudon thatabdominal decompression profoundly alters uterineaction. Internal tocography during decompressionshowed uterine contractions of normal duration. Further

investigation along these lines may throw valuable lighton the nature of pain in labour in relation to changes inintra-amniotic pressure. It is perhaps slightly alarming toread that " the conventional fcetal stethoscope can beused ... the whole procedure being completed in a fewminutes". It would be unfortunate if inconvenience in

listening to the foetal heart sounds reduced too much thefrequency of auscultation. The technique may take aspecially important place in the management of laboursin which the fcetus is at greater than normal risk, whenrepeated observations of the foetal heart sounds are

essential. In such cases a continuous monitoring devicewhich could be used without interrupting the decom-pression would be invaluable.

Certainly this paper will stimulate renewed interestin abdominal decompression in the management oflabour, and we hope that clear evidence will shortlybe forthcoming concerning its effect on the pain andduration of the first stage.

A HOPEFUL PACKAGE

RECURRENT disputes about pay between the professionand the Government have for years clouded the atmos-phere of the National Health Service and diminished theenthusiasm and efficiency of those who work in it. Inproposing new arrangements for keeping medical anddental remuneration under review, the Royal Commissionhoped to avert these damaging conflicts and to securesome assurance for doctors and dentists that " theirstandards of living will not be depressed by arbitraryGovernment action". The Government’s prompt1. Heyns, O. S. Med. Proc. S. Afr. 1959, 5, 121; J. Obstet. Gynœc. Brit.

Emp. 1959, 66, 220. See Lancet, 1959, ii, 91.

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acceptance of the Commission’s report, and the outcomeof last week’s special representative meeting of the BritishMedical Association, have raised further hopes that a

period of tranquillity is at last beginning, that this Govern-ment and its successors will do more than their fore-runners to win the confidence of the profession, and thatthe lingering rancour and the dissatisfaction, which nearlybrought the B.M.A. to the point of advising doctors towithdraw from the service, will now abate.

The Minister of Health told Parliament on April 11 Ithat the Government was " prepared to accept theCommission’s recommendations as a whole as they standprovided that the doctors and dentists respectively fortheir part are ready to accept them on the same basis ".Though many people had doubts about just what wasmeant by

" as a whole ", and the description " a package

deal was sometimes given a disparaging ring, thecouncil of the B.M.A., the Conference of Local MedicalCommittees, which also met last week, and the JointConsultants Committee were all three in favour of

accepting the Minister’s offer and his invitation to beginwithout delay detailed discussions by means of Jointworking parties. Nevertheless the agenda for the repre-sentative meeting of the B.M.A. was full of misgivings-chiefly about the Commission’s proposals for a reviewbody to advise the Prime Minister on the remuneration ofdoctors and dentists and about the suggested differentialpayments for general practitioners. Would the professionhave " access " or " direct access " to the review body ?Why should doctors have to use the Government as a sort ofpost-office through which to communicate with the reviewbody? Was not a merit-award system wholly unsuitablefor general practice ? When it came to the vote, however,there were very few who felt strongly enough on thesequestions to turn away the Government’s offer: for, as thechairman of the council of the B.M.A., Dr. SolomonWand, declared, any firm amendment of the council’srecommendations would nullify the Government’s offer.

So, though the meeting was long, its outcome wasseldom in doubt: the Government’s offer was accepted;working parties will be in action soon on the RoyalCommission’s proposals; and there can be no regretsabout loss of excitement if the future is, in Dr. Wand’swords,

" a little less exciting but more dignified and more

rewarding ".

SEX RATIO OF STILLBIRTHS

STATISTICS of stillbirths are among the less spectacularof the data supplied by the Registrar-General. In Englandand Wales the stillbirth-rate declined only slowly, and,in contrast with mortalities in infancy and childhood,it still stands at more than half the figure for 1928.1Causes of stillbirth are not registered in England andWales, but are usefully analysed in the annual reports ofthe Registrar-General for Scotland. These reports have

supplied data of real biological value with respect toanencephalus and have helped to establish the existenceof social-class correlations, geographical variations,seasonal cycles, and long-term secular changes in the rate.2Difficulties over the reliability of diagnosis of other statedcauses of stillbirth and the relative smallness of theScottish figures have hindered further exploitation of thedata, and most studies based on official statistics have been

1. Morris, J. N., Heady, J. A. Lancet, 1955, i, 342.2. Edwards, J. H. Brit. J. prev. soc. Med. 1958, 12, 115.

concerned with stillbirths as a whole. They includestudies of variation according to social class, maternal ageand parity,l 3-5 and, recently, sex ratio. 6

Allan observed that the sex ratio (M/F) of stillbirths inEngland and Wales was virtually static from 1938 to 1951at about 1-17, after which it decreased progressively to1-08 in 1957: in fact the absolute female stillbirth-rate

rose, while the male stillbirth-rate remained almostconstant. The sex ratio of Scottish stillbirths also fellbetween 1938 and 1957, but in a more complex mannerwhich did not correspond with the pattern for Englandand Wales. Neither in Scotland, nor in Denmark, nor inthe Netherlands was there a rise in the absolute rate forfemales comparable with that observed in England andWales. Allan also shows that the recent English rise infemale stillbirths was accompanied by a rise in maledeaths in the age-period between 30 minutes and 24 hoursafter birth.

The overall pattern is a challenge to anyone who likesto seek biological explanations, and for the time being thepicture is perplexing rather than illuminating. We needto know more of the possible parts played by secularchanges in the incidence of anencephalus with its 1:3

M/F ratio, of possible effects of changes in birth-weightand prematurity-rates on the sex ratios of stillbirth andearly death, and of the effects of changing incidences,survival-rates, and ages at death in other malformationsand diseases (such as hyaline-membrane disease) withasymmetrical sex ratios. We join with Allan in regrettingthat official figures for England and Wales, because theydo not include the causes of stillbirth, cannot help in thissearch.

CONGENITAL CYSTIC LUNGS

CONGENITAL cystic disease of the lungs, first describedin the 17th century,7 is still confused with acquired cystsof granulomatous origin. 8 Oswald and Parkinson 9

showed, in a series of 16 cases, that cystic disease of thelungs could arise in various pathological conditions, butthey were unable to exclude a developmental origin inonly 2. Moffat 10 has now studied 9 cases, all in patientsunder 18 months of age, and claims that minor degreesare probably often unrecognised. He shows that threedifferent types of congenital abnormalities may give riseto a

" honeycomb " lung and that two of the types maybe found together: in each of the types, the malformationmay be either extensive, involving both lungs or individuallobes, or confined to a small part of one lobe. The first

type involved the air-passages at different levels: in 2cases large cysts involved almost a whole lobe withsmaller loculi round the periphery; in 2 cases cystsinvolved terminal air-passages in which the actual levelcould not be clearly defined; while in another 2 thelesions were intermediate and focal, consisting of a fewsmall cysts lined by ciliated columnar epithelium andconnected with larger and smaller air passages. In thecases with involvement of the terminal air passages,pyogenic inflammation was present, leaving some of thecysts lined with granulation tissue. In the second typethe cystic dilatation involved the lymphatics; and

3. Heady, J. A., Daly, C., Morris, J. N. Lancet, 1955, i, 395.4. Daly, C., Heady, J. A., Morris, J. N. ibid. p. 445.5. Heady, J. A., Stevens, C. F., Daly, C., Morris, J. N. ibid. p. 499.6. Allan, T. M. Brit. J. prev. soc. Med. 1960, 14, 35.7. Koontz, A. R. Bull. Johns Hopk. Hosp., 1925, 37, 340.8. Cunningham, G. J., Parkinson, T. Thorax, 1950, 5, 43.9. Oswald, N., Parkinson, T. Quart J. Med. 1949, 18, 1.

10. Moffat, A. D. J. Path. Bact. 1960, 79, 34.