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of their staff, as projected, would include, not onlydirect participation in certain lines of chemo-

therapeutic research, but the planning and coördina-tion of the work in this field supported from theCouncil’s fund in chemical and medical laboratorieselsewhere. This institute will, we understand,probably form one wing of the building of theNational Institute for Medical Research when thisis rebuilt in the near future at Mill Hill. In addi-tion, support will be given as hitherto, but on alarger scale, to chemical and biological work inchemotherapy in laboratories all over the country.Here is a scheme which offers promise of greatachievement. Biologist and chemist will be

working together in one building, able to discusstogether their day-to-day problems and to acquirean insight into their common problem which hasbeen almost impossible in the past. The schemewill, of course, have to face difficulties. It will not,for instance, be easy to find adequately trainedbiologists and chemists for the new centre. Weare confident, however, that difficulties will beovercome, and that an important new chapter inBritish medical research has been opened.

SOCIAL REHABILITATION OF PROSTITUTESTHE rehabilitation of prostitutes has been a

subject of heated debate for many centuries.The methods adopted to this end have variedfrom the orders given by the court of governorsof St. Thomas’s Hospital in 1599-that the

patients should be beaten after discharge to

discourage them from sinning again and " thatby the terror thereof others may be admonishedfrom falling to the like vice " —to the occupa-tional training given during treatment in the

prophylactoria of the U.S.S.R., where efforts aremade to place patients in suitable posts after

recovery. Free treatment for venereal diseases isnow organised by the State in most countries, butthe so-called social services-follow-up, financial

help during treatment, moral guidance, andvocational training-are still lacking in many ofthem. The League of Nations therefore issued aworld-wide questionnaire on the subject in 1935,and the answers have now been summarised.2Twenty-two of the forty-eight countries repliedthat there were no social services available for

prostitutes. In most of the others attention, it issaid, is paid more to their medical than to theirsocial or moral rehabilitation, and in some attemptsto promote the latter have been given up as

useless. Even in the United States there is " littleor no direct effort to improve the patients’ moralsor to provide vocational training." In Russiathe Commissar in Public Health works on the

assumption that " in a worker’s state there is noplace for prostitutes." The government thereforesets itself the task of suppressing prostitution andhas taken up rehabilitation as a means to thatend. There is no attempt to reform prostitutesunless they have venereal disease ; they are then1 Parsons, F. G., History of St. Thomas’s Hospital, Vol. I,

p. 240, London, 1932.2 Social Sources of Venereal Disease. League of Nations

Publications. London: Allen and Unwin. 1938. Pp. 66. 1s. 3d.

treated in prophylactoria, first to cure them

secondly to educate them to work, and thirdlyto enable them to earn their living afterwards.The length of treatment is eighteen months onthe average ; a shorter period has been founduseless. It is claimed that the system has beena success. Of 3800 women treated in Moscow,56 per cent. found employment afterwards, and90 per cent. of those who found employmentremained in their jobs. The Russian experiment,of course, has a limited application outside theU.S.S.R. because the practice of prostitution inRussia does not produce material gain-luxuriousrooms, clothing, or food-and there is no difficultyin finding employment for women after completingtreatment. Estonia tried to follow the exampleof Russia, but the experiment proved a failure.In France there is a special division of the

"service social a l’hôpital" which deals withrehabilitation. It has been established now for

twenty years and is State-aided. Its function isto overcome the moral, social, and economicobstacles that retard or prevent the prostitutefrom resuming her place as a useful member ofsociety. The social assistants are generally trainednurses who have taken up social work as a specialbranch, and do not therefore correspond with thealmoner as understood in this country. Ouralmoner service was primarily started to preventhospitals from being exploited; and follow-up,care of patients after discharge, and philanthropicwork were added to this function later. TheFrench system was started primarily for the

patients, and has nothing to do with hospitalfinance. The duties of the social assistants areto instruct the patient in the nature of her illness,ensure regular and continuous treatment, tracethe source of infection and any infected contacts,and to give help and advice.

In England social service for the rehabilitationof prostitutes has been in existence for over 150years, though apparently those conducting the

League of Nations inquiry are unaware of thisfact. It was started in London by the Rev.THOMAS SCOTT, the commentator, when he foundedthe rescue home attached to the London LockHospital in 1787. ScoTT was chaplain to the

hospital, and he found it was impossible to doanything for the moral benefit of the patientsunless he could provide them with shelter, food,and clothing for a considerable period after theywere fit for discharge from hospital. The rescuehome was therefore started alongside the hospital,and suitable patients were transferred there as

soon as they had reached a non-contagious stage.They were taught dress-making, laundry work, anddomestic duties. When cured they were foundsuitable posts, supplied with an outfit, and given abonus for each year they remained in the postfound for them. That is probably still the best

system if it is carried out with wisdom andhumanity, but it is obviously very expensive.Accordingly the London County Council, whenthey took over the poor-law infirmaries in 1930,tried the " hostel " system ; there are seven ofthese hostels in London. In them women are

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given free or cheap board and lodgings, and carryout their treatment at the hospitals to which thehostels are attached. Not many adult prostitutesfind their way into them. A certain number of

young women who have just lapsed into prosti-tution are admitted ; but the greater number arewage-earners who for the time being are unable toearn their living. By taking them in hand, lookingafter their creature comforts, and giving them theshelter of a home temporarily such women. areoften saved from prostitution. One advantage ofthe system is that girls are not cut off from theoutside world, as they would be in a home, and sohave not to be reacclimatised to the world again.The disadvantages are that a hostel is not a suitableplace for women in the acute stages of venerealdisease, for pregnant women, or for girls on proba-tion. These require institutional treatment. InFrance this is given in hospital until patients are fitfor ambulatory treatment; but in England the LockHospital authorities have found from long experi-ence that such women do best if kept until cured.The London County Council have now followed thisexample, in spite of the extra cost entailed, becausethey too have found that women who are willingto remain as in-patients in the wards will not comeback regularly for treatment once they have left.

It may thus be seen that most European countriesare taking this problem in hand, and handling itafter some method adaptable to each country’snational character. The results of these experi-ments in social reclamation, if judged from thepercentage of genuine rehabilitation, are dis-

appointing. But if one thinks rather of theindividual women that have been rescued from

misery, and saved from spreading disease, it seemswell worth while to persevere and extend thiswork in spite of many disheartening failures.

THE THERAPEUTIC POSSIBILITIES OFHEPARIN

THE anticoagulant substance known as heparinwas discovered accidentally in 1916 by JAYMcLEAN while he was working in W. H. Howell’slaboratory ; it was subsequently investigated byHowELL and HoL (1918) but it is only withinthe last ten years that interest in the practicalexploitation of its properties has been revived.This revival is due in part to C. H. BEST and hisassociates in Toronto and in part to a group ofworkers in Stockholm. Until quite recentlypreparations of heparin have not been pure enoughto allow of its introduction into the body, thoughheematologists have found it a serviceable anti-

coagulant for drawn blood. The work of CHARLESand ScoTT (1933) and of E. JORPES (1935) hasnow, however, made the substance available in aform that can be introduced into the blood intra-venously without the production of untoward

symptoms. Studies of the chemistry of heparinhave led JosrES to believe it to be a mucotin

polysulphuric ester 1; and with others he has

1 Jorpes, E., Uppsala LäkFören. Förh. 1937, 43, 83.2

— Holmgren, H., and Wilander, O., Z. mikr.-anat.Forsch. 1937, 42, 242.

put forward reasons for suggesting that it is

produced by the tissue mast cells throughout thebody and that it may normally have the functionof a physiological anticoagulant. The possiblescope of heparin in medicine has been extendedby this work and its developments. WILANDER 3

has shown that heparinised samples of venous

blood may be used for routine haematologicalexaminations as well as for measuring the sedi-mentation-rate and also for determinations of

blood-sugar, calcium, uric acid, non-proteinnitrogen, and phosphatase. This discovery shouldreduce considerably the trauma which the haplesspatient now suffers at the hands of clinical patho-logists. Heparin has also been tried as an intra-vital anticoagulant for blood transfusion and inthe treatment, prophylactic or therapeutic, ofintravascular thrombosis. We published last yeara review by HEDENIUS of 150 transfusions forwhich the blood donor had been " heparinised,"no other anticoagulant being applied. Althoughno ill effects were observed this method seems tohave no advantage over the simpler technique ofadding sodium citrate to the shed blood and is ofinterest rather as a tour de force than as a usefuladdition to the armamentarium of a transfusionservice.

The hope that heparin in suitable dosage mayact as a prophylactic against post-operative throm-bosis has some experimental justification. BESTand his colleagues have shown that in hepariniseddogs thrombotic occlusion of traumatised veinsdoes not take place and, more recently, that insuch animals blood may be

" shunted " through aglass tube without the formation of white thrombiwhich occurs in such experiments in the normalanimal.4 4 The success and safety of these experi-ments has led them to administer intravenous

heparin to patients following operation 5 ; 1000units of heparin (10 mg. of the purified substance)are added to each 100 ml. of saline solution andthe fluid given by the intravenous drip method atsuch a rate as will keep the coagulation time atthree times its normal value. It is stated that" the injection is continued for varying periodsup to fourteen days after the operation." Already222 cases have received this treatment but no

analysis of the results is yet available. CRAFOORD(1937) has recorded a small series of cases whichshowed that the injection was without danger andwas not productive of a haemorrhagic tendency.It is impossible to draw any conclusions, as MURRAYand BEST are careful to point out, until figures fora much larger series have been published. Since,however, deaths from pulmonary embolism afteroperation occur only about once in every thousandcases the therapeutic endeavour is bound to seemdisproportionate to the results and only if almostcomplete success is attainable would post-operativeinjection of heparin be likely to become a routinepractice. Of more practical importance, for the

3 Wilander, O., Acta med. scand. 1938, 94, 258.4 Best, C. H., Dowan, C., and Maclean, D. L., J. Physiol.

1938, 92, 20.5 Murray, D. W. G., and Best, C. H., J. Amer. med. Ass.

1938, 110, 118.