- Email: [email protected]
EUGENICS SOCIETY
1022 treatment was with the galvano-cautery point; in this way sometimes polypi which had been the reason for the discharge had been brought away. Mr. DOUGLAS GUTHRIE (Edinburgh) said that in the Army suppurative otitis media had been and remained one of the commonest causes of rejection of recruits and of invaliding. He saw every recruit in Scotland, and he did not hesitate to reject any candidate who suffered from chronic suppurative otitis, even though by the time he was seen the ear might be dry. It was also the custom to pension
who were actually serving, unless they were It was of no use to near the time of retirement. perform radical mastoid operations in the Army, because the operation did not render men fit. It was not uncommon to see intracranial complications following acute otitis media in the acute stage, but he had seen these only once in a chronic case. Conservative treatment having been decided upon in a given case, he insisted that this must be thorough; it should not be left to the mother or a nurse to carry out, the otologist must himself do it. He had himself recently taken up the ionisation treatment with success, but it needed great care and attention to detail. Mr. L. GRAHAM BROWN agreed that in most cases the simple Schwartze operation sufficed, though for long-continued suppuration he had been doing transmastoid attico-tympanotomy, which was first suggested by Charles Heath 30 years ago and was modified by several otologists later. He had found this operation very satisfactory. Mr. JAMES ADAM (Glasgow) expressed his general agreement with Dr. Ritchie Rodger’s views. For many years he had been carrying out occlusion of the Eustachian tube in the radical operation. Mr. W. S. THACKER-NEvILLE (Harrogate) considered that the wide dissemination of Dr. Ritchie Rodger’s paper in the profession would be of real benefit. Cases of chronic otorrhoea would get far better treatment in otologists’ consulting-rooms than in crude clinics. Dr. SOPHIA JEVONS said that to reduce the incidence and complications it was necessary to come out into the open and explain the possibilities of cure. From close observation she entertained much admiration for Dr. Friel’s work with ionisation. off
men
Dr. RITCHIE RODGER, in reply, said he had tried ionisation, but did not secure such good results as did Dr. Friel; he adhered to the old-fashioned treatment which he detailed in his paper.
It
was
very
important to get the ear clean before putting in the wall of protective antiseptic powder; this should be left in the ear until it began to break down of itself. If the suppuration had extended into the antrum no conservative treatment was likely to succeed. He did not think the chronicity of these cases depended on secondary organisms, but on the site which the suppuration had reached. Mastoid tenderness in the early stage-i.e., before rupture-did not mean there was necessarily infection of the mastoid process. EUGENICS SOCIETY AT a meeting of this society held on May 3rd, Dr. AUBREY LEWIS read a paper on the Inheritance of Mental Disorders He said that as the result of the very active inquiry into the subject during the last two decades, there is now a definite, though far from complete, body of knowledge about the inheritance of mental dis-
order. There had been much sifting of the evidence and examination of the methods employed. The difficulties were partly psychiatric and partly biological. The psychiatric problem depended mainly on the provisional nature of the current groupings, which might not have biological validity. Hysteria and schizophrenia were examples of this difficulty : if one contrasted them with some of the neurological disorders, the difference was striking. The uncertain relation of types of personality, not necessarily abnormal, to pronounced mental disorder also The biological resulted in much controversy. of methods,. concerned the choice chiefly problem especially statistical methods, and the question of constitution, blastophthoria, and multiple gene determination. Most of the more strictly genetic troubles in this field had arisen from inadequate use of the available methods and data. Important obstacles to research had been the relatively long life of the human subjects investigated and the inaccessibility of their families to full investigation. For example, in involutional melancholia one could draw no conclusions about the patients’ children until they had reached their fifth or sixth decade of life, and the patients’ parents were usually dead by the time he or she was seen. A single investigator was hampered by this circumstance and by the inadequacy of diagnoses made by others many years before. In spite of the difficulties enumerated, much useful information had been collected. Investigations in a rural area where the population remains settled through several generations were of special value. Definite knowledge had been obtained on the inheritance of rare-conditions such as Huntington’s chorea and myoclonus epilepsy, and the affective psychoses had been found, especially in their characteristically endogenous forms, to show In schizophrenia the forms a high transmissibility. in which physical or psychic trauma had been a prominent causative factor showed less striking hereditary relationships than the far more numerous group, commonly known as dementia prsecox. In
paranoid
states,
paranoia,
psychopathic forms,
cerebral arterio-sclerosis, the relations were complicated. It was usually possible in any individual case to predict the probable risks for the offspring if sufficient information was available about the family history on both sides. Investigations were at present being conducted at the Maudsley Hospital into special and general problems in the inheritance of mental disorder. These referred to the special inheritance of obsessional states, of schizophrenia in children, of involutional melancholia in men, and the psychoneuroses asso-ciated with compensation claims and prolonged unemployment. More general studies were beingmade of mental disorders in twins, in the children of parents who had both been insane, and in the general population. Special methods were needed for each of these studies. The cooperation of one or more specially trained psychiatric social workers was essential. The assessment of the frequency of mental disorder and abnormal types of personality in the average population was of great importance for genetic prognosis. Mendelian relations could not always be determined satisfactorily for mental disorders, but empirical studies had yielded valuable information on the frequency of a given mental’ disorder in the different relatives of a patient with the disorder. It was necessary to ascertain whether the frequency discovered was any greater than that which would be found if one started with unselected members of the average population.-
‘
1023 For the
study now being carried on, patients in the surgical ward of a general hospital had been the starting point ; data were thus obtained for the average population of a given district of London. Individual genetic prognosis was the chief concern of the doctor ; he was often asked by patients or by the children of patients whether they should marry and have children. The question of marriage was not, but procreation was, essentially a matter of genetic concern. It was, as a rule, unwise for a tainted person to marry one in whose family a similar morbid taint was present, if the couple proposed to have children.
The
particular
risks could
never
merely by making a diagnosis and applying rule ; careful inquiry into the family history simple
be settled a
of both husband and wife’ was essential. Where this was possible, it was seldom difficult to reach a conclusion. In many cases the psychiatrist would refrain from giving advice, but would merely state the probabilities and relevant facts and leave the decision to the people concerned. Positive qualities of personality and intellectual or other endowment must be taken into consideration as well as the negative qualities of mental disorder. This was
also an important consideration in schemes of national improvement by the elimination of mental disorder. It could not be said that the knowledge at present available would be sufficient, if applied in the widest possible way, to eradicate mental disorder. It
whether in any case so drastic a would be advisable, since many valuable qualities might also be eliminated. Until further knowledge of the inheritance of normal personality and special endowment was available, as well as of the inheritance of mental disorder, schemes of this kind were premature. One would hope for the maximum provision for the giving and implementing of eugenic advice to individuals. But carriers, not themselves manifesting the disorder, could not at present be recognised with certainty, and measures to eliminate mental disorder must therefore fail to achieve more than a small or moderate diminution in the total incidence. Both for individual and national well-being, the collection of further knowledge by painstaking and critical genetic research was desirable. It was necessary to compile accurate records and to train competent and enthusiastic workers for research of this kind. was
questionable
measure
REVIEWS AND NOTICES OF BOOKS Great Men of Science By PHILIPP LENARD, Nobel Laureate. Translated by STAFFORD HATFIELD. With preface by Prof. E. N. DA C. ANDRADE. London : G. Bell and Sons, Ltd.
1933.
Tms is
a
Pp. 389. history of
12s. 6d.
scientific progress described
through the medium of a series of biographical portraits whose subjects range in date from Pythagoras and Archimedes to Clerk Maxwell, Crookes, and Heinrich Hertz, under the last of whom the author himself worked. Sixty-five men are selected to illustrate a great story of continuity in discovery, and the composition of the list is somewhat surprising until the principles upon which it has been made are grasped ; for while the list must appear brief, seeing that the progress of over 2000 years is being considered, it none the less includes names that will be familiar to few who are not working in the world of physics. Both the omissions and additions are mainly accounted for by the fact that Prof. Lenard does not take art or philosophy into accountregarding medicine, it would seem, as a blend of these-but finds room for the biographies of special workers in physics whose contributions to knowledge have been of fundamental importance. The list of such men he finds to be brief, and he finds also, in some pessimistic reflections, that additions to it are needed at the present day. For a man to find a place in Prof. Lenard’s list it is not sufficient for that which he has begotten to be new, it has also to be supplemental to previous knowledge at the time or to be found later, in light of further experiences, confirming such knowledge and assisting in its further potentialities. Discoverers of such new things are the founders of our present progress in knowledge and technical power. For example, in astronomy we have the separate contributions, set out with their general message, of
and of the difference between the really new things and the development of the old things which do not add to fundamental wisdom. The group may be started with Faraday, that prince of original investigators, though he was Humphry Davy’s pupil, and is continued by Wilhelm Weber, Julius Meyer, Joule, and Helmholtz. Their work, though separate, was interdependent ; reaching backwards it is founded on the labour of Laplace, Ampere, Ohm, and Gauss, while reaching forwards it makes contact, intimate or otherwise, with the discoveries of Helmholtz, Kelvin, Clerk Maxwell, and Hertz. How each of these relied upon the results obtained by the others, and how their joint efforts brought about units of standardisation on which the world relies in the most important fields of development, make the material of a fascinating section of the book ; continuity could not have been more aptly exemplified. Similar sequences, as they appear in the book, could have been brought forward to show how associated researches along widely differing lines give results which perpetually reinforce and interdigitate with researches in other spheres of investigation. To the readers of this book the veritable leaders of scientific thought and action will appear as members of one
great family. Inherited Abnormalities of the Skin and its
Appendages By E. A. COCKAYNE, M.D., F.R.C.P., Physician
,
,
Copernicus, Tycho Brahe, Kepler, Galileo, Huygens, Newton, who enabled man to see the visible world as one great unity. In electricity we are far less familiar with the roles of the protagonists, and here the sequence of biographies forms an even clearer picture of the interdependence of knowledge and
to the Middlesex Hospital for Sick
London.
Hospital,
and to
Out-patients,
Children, Great Ormond-street,
Oxford Medical Publications.
Humphrey 1933, Pp.
Milford, 394.
Oxford
London:s University Press.
32s.
book, as Dr. Cockayne says in his preface, is attempt to deal with the genetics of the defects which cause some change in the skin, teeth, hair, or nails. It is an analysis from the genetic point of view of all the hitherto recognised congenital-developTnis
an
mental abnormalities and " diseases " in any way the skin and its appendages. The task set himself by the author must have involved an immense amount of labour spread over years, and
affecting
who were actually serving, unless they were It was of no use to near the time of retirement. perform radical mastoid operations in the Army, because the operation did not render men fit. It was not uncommon to see intracranial complications following acute otitis media in the acute stage, but he had seen these only once in a chronic case. Conservative treatment having been decided upon in a given case, he insisted that this must be thorough; it should not be left to the mother or a nurse to carry out, the otologist must himself do it. He had himself recently taken up the ionisation treatment with success, but it needed great care and attention to detail. Mr. L. GRAHAM BROWN agreed that in most cases the simple Schwartze operation sufficed, though for long-continued suppuration he had been doing transmastoid attico-tympanotomy, which was first suggested by Charles Heath 30 years ago and was modified by several otologists later. He had found this operation very satisfactory. Mr. JAMES ADAM (Glasgow) expressed his general agreement with Dr. Ritchie Rodger’s views. For many years he had been carrying out occlusion of the Eustachian tube in the radical operation. Mr. W. S. THACKER-NEvILLE (Harrogate) considered that the wide dissemination of Dr. Ritchie Rodger’s paper in the profession would be of real benefit. Cases of chronic otorrhoea would get far better treatment in otologists’ consulting-rooms than in crude clinics. Dr. SOPHIA JEVONS said that to reduce the incidence and complications it was necessary to come out into the open and explain the possibilities of cure. From close observation she entertained much admiration for Dr. Friel’s work with ionisation. off
men
Dr. RITCHIE RODGER, in reply, said he had tried ionisation, but did not secure such good results as did Dr. Friel; he adhered to the old-fashioned treatment which he detailed in his paper.
It
was
very
important to get the ear clean before putting in the wall of protective antiseptic powder; this should be left in the ear until it began to break down of itself. If the suppuration had extended into the antrum no conservative treatment was likely to succeed. He did not think the chronicity of these cases depended on secondary organisms, but on the site which the suppuration had reached. Mastoid tenderness in the early stage-i.e., before rupture-did not mean there was necessarily infection of the mastoid process. EUGENICS SOCIETY AT a meeting of this society held on May 3rd, Dr. AUBREY LEWIS read a paper on the Inheritance of Mental Disorders He said that as the result of the very active inquiry into the subject during the last two decades, there is now a definite, though far from complete, body of knowledge about the inheritance of mental dis-
order. There had been much sifting of the evidence and examination of the methods employed. The difficulties were partly psychiatric and partly biological. The psychiatric problem depended mainly on the provisional nature of the current groupings, which might not have biological validity. Hysteria and schizophrenia were examples of this difficulty : if one contrasted them with some of the neurological disorders, the difference was striking. The uncertain relation of types of personality, not necessarily abnormal, to pronounced mental disorder also The biological resulted in much controversy. of methods,. concerned the choice chiefly problem especially statistical methods, and the question of constitution, blastophthoria, and multiple gene determination. Most of the more strictly genetic troubles in this field had arisen from inadequate use of the available methods and data. Important obstacles to research had been the relatively long life of the human subjects investigated and the inaccessibility of their families to full investigation. For example, in involutional melancholia one could draw no conclusions about the patients’ children until they had reached their fifth or sixth decade of life, and the patients’ parents were usually dead by the time he or she was seen. A single investigator was hampered by this circumstance and by the inadequacy of diagnoses made by others many years before. In spite of the difficulties enumerated, much useful information had been collected. Investigations in a rural area where the population remains settled through several generations were of special value. Definite knowledge had been obtained on the inheritance of rare-conditions such as Huntington’s chorea and myoclonus epilepsy, and the affective psychoses had been found, especially in their characteristically endogenous forms, to show In schizophrenia the forms a high transmissibility. in which physical or psychic trauma had been a prominent causative factor showed less striking hereditary relationships than the far more numerous group, commonly known as dementia prsecox. In
paranoid
states,
paranoia,
psychopathic forms,
cerebral arterio-sclerosis, the relations were complicated. It was usually possible in any individual case to predict the probable risks for the offspring if sufficient information was available about the family history on both sides. Investigations were at present being conducted at the Maudsley Hospital into special and general problems in the inheritance of mental disorder. These referred to the special inheritance of obsessional states, of schizophrenia in children, of involutional melancholia in men, and the psychoneuroses asso-ciated with compensation claims and prolonged unemployment. More general studies were beingmade of mental disorders in twins, in the children of parents who had both been insane, and in the general population. Special methods were needed for each of these studies. The cooperation of one or more specially trained psychiatric social workers was essential. The assessment of the frequency of mental disorder and abnormal types of personality in the average population was of great importance for genetic prognosis. Mendelian relations could not always be determined satisfactorily for mental disorders, but empirical studies had yielded valuable information on the frequency of a given mental’ disorder in the different relatives of a patient with the disorder. It was necessary to ascertain whether the frequency discovered was any greater than that which would be found if one started with unselected members of the average population.-
‘
1023 For the
study now being carried on, patients in the surgical ward of a general hospital had been the starting point ; data were thus obtained for the average population of a given district of London. Individual genetic prognosis was the chief concern of the doctor ; he was often asked by patients or by the children of patients whether they should marry and have children. The question of marriage was not, but procreation was, essentially a matter of genetic concern. It was, as a rule, unwise for a tainted person to marry one in whose family a similar morbid taint was present, if the couple proposed to have children.
The
particular
risks could
never
merely by making a diagnosis and applying rule ; careful inquiry into the family history simple
be settled a
of both husband and wife’ was essential. Where this was possible, it was seldom difficult to reach a conclusion. In many cases the psychiatrist would refrain from giving advice, but would merely state the probabilities and relevant facts and leave the decision to the people concerned. Positive qualities of personality and intellectual or other endowment must be taken into consideration as well as the negative qualities of mental disorder. This was
also an important consideration in schemes of national improvement by the elimination of mental disorder. It could not be said that the knowledge at present available would be sufficient, if applied in the widest possible way, to eradicate mental disorder. It
whether in any case so drastic a would be advisable, since many valuable qualities might also be eliminated. Until further knowledge of the inheritance of normal personality and special endowment was available, as well as of the inheritance of mental disorder, schemes of this kind were premature. One would hope for the maximum provision for the giving and implementing of eugenic advice to individuals. But carriers, not themselves manifesting the disorder, could not at present be recognised with certainty, and measures to eliminate mental disorder must therefore fail to achieve more than a small or moderate diminution in the total incidence. Both for individual and national well-being, the collection of further knowledge by painstaking and critical genetic research was desirable. It was necessary to compile accurate records and to train competent and enthusiastic workers for research of this kind. was
questionable
measure
REVIEWS AND NOTICES OF BOOKS Great Men of Science By PHILIPP LENARD, Nobel Laureate. Translated by STAFFORD HATFIELD. With preface by Prof. E. N. DA C. ANDRADE. London : G. Bell and Sons, Ltd.
1933.
Tms is
a
Pp. 389. history of
12s. 6d.
scientific progress described
through the medium of a series of biographical portraits whose subjects range in date from Pythagoras and Archimedes to Clerk Maxwell, Crookes, and Heinrich Hertz, under the last of whom the author himself worked. Sixty-five men are selected to illustrate a great story of continuity in discovery, and the composition of the list is somewhat surprising until the principles upon which it has been made are grasped ; for while the list must appear brief, seeing that the progress of over 2000 years is being considered, it none the less includes names that will be familiar to few who are not working in the world of physics. Both the omissions and additions are mainly accounted for by the fact that Prof. Lenard does not take art or philosophy into accountregarding medicine, it would seem, as a blend of these-but finds room for the biographies of special workers in physics whose contributions to knowledge have been of fundamental importance. The list of such men he finds to be brief, and he finds also, in some pessimistic reflections, that additions to it are needed at the present day. For a man to find a place in Prof. Lenard’s list it is not sufficient for that which he has begotten to be new, it has also to be supplemental to previous knowledge at the time or to be found later, in light of further experiences, confirming such knowledge and assisting in its further potentialities. Discoverers of such new things are the founders of our present progress in knowledge and technical power. For example, in astronomy we have the separate contributions, set out with their general message, of
and of the difference between the really new things and the development of the old things which do not add to fundamental wisdom. The group may be started with Faraday, that prince of original investigators, though he was Humphry Davy’s pupil, and is continued by Wilhelm Weber, Julius Meyer, Joule, and Helmholtz. Their work, though separate, was interdependent ; reaching backwards it is founded on the labour of Laplace, Ampere, Ohm, and Gauss, while reaching forwards it makes contact, intimate or otherwise, with the discoveries of Helmholtz, Kelvin, Clerk Maxwell, and Hertz. How each of these relied upon the results obtained by the others, and how their joint efforts brought about units of standardisation on which the world relies in the most important fields of development, make the material of a fascinating section of the book ; continuity could not have been more aptly exemplified. Similar sequences, as they appear in the book, could have been brought forward to show how associated researches along widely differing lines give results which perpetually reinforce and interdigitate with researches in other spheres of investigation. To the readers of this book the veritable leaders of scientific thought and action will appear as members of one
great family. Inherited Abnormalities of the Skin and its
Appendages By E. A. COCKAYNE, M.D., F.R.C.P., Physician
,
,
Copernicus, Tycho Brahe, Kepler, Galileo, Huygens, Newton, who enabled man to see the visible world as one great unity. In electricity we are far less familiar with the roles of the protagonists, and here the sequence of biographies forms an even clearer picture of the interdependence of knowledge and
to the Middlesex Hospital for Sick
London.
Hospital,
and to
Out-patients,
Children, Great Ormond-street,
Oxford Medical Publications.
Humphrey 1933, Pp.
Milford, 394.
Oxford
London:s University Press.
32s.
book, as Dr. Cockayne says in his preface, is attempt to deal with the genetics of the defects which cause some change in the skin, teeth, hair, or nails. It is an analysis from the genetic point of view of all the hitherto recognised congenital-developTnis
an
mental abnormalities and " diseases " in any way the skin and its appendages. The task set himself by the author must have involved an immense amount of labour spread over years, and
affecting