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HYDATID DISEASE IN WALES
88 REHABILITATION OF THE TUBERCULOUS Sm,-Dr. McDougall in his letter (Lancet, June 26) stresses an important difference in Papworth and Preston Hall policies-namely, permanent and temporary residence. I would like to call attention to an aspect not in his letter, and that is the patient’s point of mentioned view. I have had the opportunity of discussing the matter fully, with a number of patients from both settlements, and am satisfied that the Papworth policy gives the patient a feeling of future security lacking in the Preston Hall policy. The policy of keeping arrested patients in Papworth Village Settlement has certainly not led to stagnation. After five years in a village settlement, the opportunity of subsequently earning one’s living does not always exist. What percentage of ex-patients do actually earn their own living ? Dr. McDougall mentions assessing the patient as distinct from the disease, but omits an even more important factor, assessing the patient’s reactions to conditions. The virtue of village settlements is that the working and the living conditions are suitable, whereas we know that this does not apply outside the settlement, and therefore a lesion remaining arrested in a settlement does not necessarily remain so after discharge. I do know that a number of these ex-patients live with their families under unsuitable conditions, and that a number, sooner or later, have to be admitted to sanatoria, or to tuberculosis wards in county hospitals. It would seem that permanent social security for a limited number is preferable to temporary security for a larger number. Dr. McDougall concludes : "Except by the expensive process of building more and more houses, no new cases can be taken into the village settlement so long as places are being occupied by groups of men for whom there are no longer any solid medical grounds for continued residI do not understand the meanence in the settlement." ing of "solid " medical grounds, but it appears obvious that it is largely finance which dictates the policy of discharging patients ; the policy is not one of choice. If tuberculous patients have to be discharged after three to five years in a settlement, it is essential that they should be supplied with satisfactory home conditions and placed in suitable industries with an adequate income. Unfortunately in every branch of tuberculosis work, policy is controlled by financial considerations, and this control is much increased by the present system of watertight financial liability of various different authorities, which does more than anything else to prevent eradication of the disease. Tuberculosis is a disease of national importance ; surely the time has come for it to be dealt with on a national basis. H. J. ROBINSON. MR. HUXLEY’S
EYES
SIR,-I have read with great interest the letter from Mr. Affleck Greeves in your issue of June 5. In it he says that my hypothesis of Mr. Huxley’s eye defect will not bear scrutiny. Unfortunately he does not give his grounds for this statement, but instead he goes on to describe an hypothesis of his own. When I was working at the details of my hypothesis I took care to make it fit in with the various phases of Mr. Huxley’s illness. I was therefore surprised to find that Mr. Greeves had not done the same thing. For example he says : " pari passu with the resolution of the uveitis these deposits are absorbed or, less commonly, are replaced by newly organised fibrous tissue. No corneal deposits would therefore have been present, &c." On the contrary, Mr. Huxley states (preface, p. 7) that the opacities of his cornea had remained unchanged for upwards of 25 years. It is clear that Mr. Greeves’s hypothesis does not fit Mr. Huxley’s description at all, nor does it explain the hyperopia and astigmatism from which Mr. Huxley suffered. Lastly Mr. Greeves asks whether the rapid improvement of Mr. Huxley’s vision (when he had adopted Dr. Bates’s methods) may’not have been of a functional nature. In my opinion the reply to this " question must be, Certainly not entirely functional." " Mr. reason is that Huxley clearly states, And the My for the worse eye, which opacity has cleared sufficiently for years could do no more than distinguish light from darkness, to recognise the ten foot line on the chart at This clearly is not entirely a functional one foot"
I feel therefore that it is Mr. Greeves’s theory that will not bear scrutiny, for in many important respects it does not fit in with Mr. Huxley’s account. There is one point in my article (May 22) which I didn’t make as clear as I would like. I stated that in my opinion Mr. Huxley’s cure was- not due to Dr. Bates’s methods but to the vigorous eye movements which form a part of some of the exercises. Some of your readers may think that in making such a statement I am splitting hairs. So may I point out that many of Dr. Bates’s exercises do not involve eye movements at all-for example, passive relaxation (p. 36), palming (p. 37), imagining black (p. 37), blinking (p. 41), breathing (p. 43) and central fixation (p. 55). I find it hard to believe that exercises like these did Mr. Huxley’s opacities any good. The ones which seem the most likely to have done good are those where rapid eyeball rotations were performed. But better ones than those of Dr. Bates could, in my opinion, readily be devised.
change.
Cambridge.
HAMILTON
HYDATID DISEASE
HARTRIDGE.
IN WALES
SiR,-As one who has performed many autopsies in Wales, especially in its northern counties, I can confirm
the findings of Surgeon Lieut.-Comdr. Wolfe (Lancet, June 26, p. 795). One of my brain cyst series had been regarded in life as a cerebral tumour, while three others had been thought to be epilepsy. A gamekeeper who had had " trouble with his liver " for twelve years was found to have multiple hepatic and three intrathoracic cysts. It is perhaps unusual to be infected by a fox : one of my cases, a cripple who was never in contact with dogs and whose hobby was skinning foxes for people who wanted the skins for showcases and the like, seems to have been infected in this way. Practitioners in Wales should keep the possibility of hydatid cysts in mind, and when in doubt make early use of intradermal, complement-fixation, and differential leucocyte tests and counts.
ARWYN ROBERTS.
Runwell Hospital, Essex.
LIBRARIES AND LEARNED
SIR,—Alter this war,
even more
PERIODICALS
than after the former
war, learned and scientific libraries will be faced with the problem of attempting to fill gaps in their sets of periodicals caused not only by the inability to obtain journals from enemy and enemy-occupied countries during the war-period, but also by losses at sea and by destruction in air-raids over this country. As stocks in European countries may also have been destroyed in air-raids, there is likely to be a shortage in many cases, and in order to prevent an unseemly scramble on the part of individual libraries to get volumes of which there may be an insufficient number of copies to go round, it is highly desirable that a representative and impartial body should decide on a national scale to which libraries the available copies should be allotted. This allocation should form part of a much larger scheme whereby the present holdings of learned periodicals in all important libraries in the country would be surveyed and the needs of research in the various centres of learning assessed, due regard being had to existing ‘
subject specialisations in various institutions. Interchanges of stock could then be arranged so as to ensure the presence of complete sets ofimportant publications in the libraries where they are most needed and the elimination-of many incomplete sets where they are little used. This may entail on the part of some libraries the sacrificing of treasured possessions, but it would ’be greatly to the benefit of research workers as a whole. The obvious body to undertake responsibility for this work is the Library Association, which by its royal charter is entrusted, among other tasks, with promoting the better administration of libraries and encouraging bibliographical study and research. In practice it will probably be found most economical for the actual work
to be done at the National Central Library, where the machinery for this kind of undertaking already exists and would only need expanding. Funds for the purpose would no doubt be forthcoming. At least two such schemes in limited fields of knowledge-those of German studies and of medicinewere already being prepared before the war. The former,
EYES
SIR,-I have read with great interest the letter from Mr. Affleck Greeves in your issue of June 5. In it he says that my hypothesis of Mr. Huxley’s eye defect will not bear scrutiny. Unfortunately he does not give his grounds for this statement, but instead he goes on to describe an hypothesis of his own. When I was working at the details of my hypothesis I took care to make it fit in with the various phases of Mr. Huxley’s illness. I was therefore surprised to find that Mr. Greeves had not done the same thing. For example he says : " pari passu with the resolution of the uveitis these deposits are absorbed or, less commonly, are replaced by newly organised fibrous tissue. No corneal deposits would therefore have been present, &c." On the contrary, Mr. Huxley states (preface, p. 7) that the opacities of his cornea had remained unchanged for upwards of 25 years. It is clear that Mr. Greeves’s hypothesis does not fit Mr. Huxley’s description at all, nor does it explain the hyperopia and astigmatism from which Mr. Huxley suffered. Lastly Mr. Greeves asks whether the rapid improvement of Mr. Huxley’s vision (when he had adopted Dr. Bates’s methods) may’not have been of a functional nature. In my opinion the reply to this " question must be, Certainly not entirely functional." " Mr. reason is that Huxley clearly states, And the My for the worse eye, which opacity has cleared sufficiently for years could do no more than distinguish light from darkness, to recognise the ten foot line on the chart at This clearly is not entirely a functional one foot"
I feel therefore that it is Mr. Greeves’s theory that will not bear scrutiny, for in many important respects it does not fit in with Mr. Huxley’s account. There is one point in my article (May 22) which I didn’t make as clear as I would like. I stated that in my opinion Mr. Huxley’s cure was- not due to Dr. Bates’s methods but to the vigorous eye movements which form a part of some of the exercises. Some of your readers may think that in making such a statement I am splitting hairs. So may I point out that many of Dr. Bates’s exercises do not involve eye movements at all-for example, passive relaxation (p. 36), palming (p. 37), imagining black (p. 37), blinking (p. 41), breathing (p. 43) and central fixation (p. 55). I find it hard to believe that exercises like these did Mr. Huxley’s opacities any good. The ones which seem the most likely to have done good are those where rapid eyeball rotations were performed. But better ones than those of Dr. Bates could, in my opinion, readily be devised.
change.
Cambridge.
HAMILTON
HYDATID DISEASE
HARTRIDGE.
IN WALES
SiR,-As one who has performed many autopsies in Wales, especially in its northern counties, I can confirm
the findings of Surgeon Lieut.-Comdr. Wolfe (Lancet, June 26, p. 795). One of my brain cyst series had been regarded in life as a cerebral tumour, while three others had been thought to be epilepsy. A gamekeeper who had had " trouble with his liver " for twelve years was found to have multiple hepatic and three intrathoracic cysts. It is perhaps unusual to be infected by a fox : one of my cases, a cripple who was never in contact with dogs and whose hobby was skinning foxes for people who wanted the skins for showcases and the like, seems to have been infected in this way. Practitioners in Wales should keep the possibility of hydatid cysts in mind, and when in doubt make early use of intradermal, complement-fixation, and differential leucocyte tests and counts.
ARWYN ROBERTS.
Runwell Hospital, Essex.
LIBRARIES AND LEARNED
SIR,—Alter this war,
even more
PERIODICALS
than after the former
war, learned and scientific libraries will be faced with the problem of attempting to fill gaps in their sets of periodicals caused not only by the inability to obtain journals from enemy and enemy-occupied countries during the war-period, but also by losses at sea and by destruction in air-raids over this country. As stocks in European countries may also have been destroyed in air-raids, there is likely to be a shortage in many cases, and in order to prevent an unseemly scramble on the part of individual libraries to get volumes of which there may be an insufficient number of copies to go round, it is highly desirable that a representative and impartial body should decide on a national scale to which libraries the available copies should be allotted. This allocation should form part of a much larger scheme whereby the present holdings of learned periodicals in all important libraries in the country would be surveyed and the needs of research in the various centres of learning assessed, due regard being had to existing ‘
subject specialisations in various institutions. Interchanges of stock could then be arranged so as to ensure the presence of complete sets ofimportant publications in the libraries where they are most needed and the elimination-of many incomplete sets where they are little used. This may entail on the part of some libraries the sacrificing of treasured possessions, but it would ’be greatly to the benefit of research workers as a whole. The obvious body to undertake responsibility for this work is the Library Association, which by its royal charter is entrusted, among other tasks, with promoting the better administration of libraries and encouraging bibliographical study and research. In practice it will probably be found most economical for the actual work
to be done at the National Central Library, where the machinery for this kind of undertaking already exists and would only need expanding. Funds for the purpose would no doubt be forthcoming. At least two such schemes in limited fields of knowledge-those of German studies and of medicinewere already being prepared before the war. The former,