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CHRISTMAS AND THE RMBF
429
Letters
to
the Editor
AND THE RMBF my custom each autumn, through your columns, to invite my medical colleagues to take their part in the Christmas Gifts fund of the Royal Medical Benevolent Fund. This scheme, so generously supported by many, has become very remarkable ; not only has it been the means of bringing to many old and lonely people a gift of friendship and sympathetic understanding at Christmas time, but it has also given many of your readers an insight into the great work which the Royal Medical Benevolent Fund is doing daily in helping medical brethren, or the widows and children of deceased medical practitioners, who are in financial difficulties. We look upon the Christmas gift of 22 to each beneficiary’ as something " extra," but I must emphasise ’that the regular allowances have to be paid throughout the year. New annual subscribers are very urgently needed for our general funds, and surely it is for the present generation of practitioners to take up their share in a work which is a common professional inheritance and tradition. It is not difficult to realise what happiness and comfort
CHRISTMAS
,
SiR,—It is
Christmas gift of 22 brings to an old doctor, an aged widow or daughter living alone, possibly suffering from illness or infirmity. We’ourselves know the difficulties and discomforts of our own lives caused by the present war. May I appeal, Sir, very earnestly on behalf of those who have suffered so uch more than ourselves ? I venture to make this letter a twofold appeal: (a) to all regular subscribers, - to send their " extra " for the Christmas Gifts fund ; (b) to all others, to show their practical sympathy by becoming subscribers to our general funds. I do not ask for large contributions. Christmas gifts donations should be marked " Christ-mas Gifts," and all cheques made payable to the hon. treasurer, Royal Medical Benevolent Fund,’ 1, Balliol House, Manor Fields, London, S.W.15. THOS. BARLOW, a
President.
TUBERCULOSIS
NURSING
SIR,—Dr. Houghton’s letter in your issue of Sept. 4 was opportune. As things stand a’nurse in training at a
general hospital
has little
of learning how its incurable stage, and effort to find and treat making yet patients before they reach such a stages When she goes to a sanatorium as a nurse (or, if less fortunate, as a patient) she is astonished to find how much there is to learn in the management of thoracoplasty, artificial pneumothorax, Monaldi drainage, postural drainage, &c., as well as in the routine of ordinary sanatorium treatment. The position is entirely different from what it was 20 or even 10 years ago, and to meet these altered conditions the nurse needs a special training which cannot be acquired in a three-months visit to sanatorium or tuberculosis ward. If the segregation of fever cases and mental cases has created a need for state registration of those who specialise in their nursing, it is even more necessary for those who nurse tuber’culosis, which still ranks high among fatal diseases. Dr. Ellman’s arguments support rather than detract from the value of a register for improving the standard of tuberculosis nursing and the education of the nurse. Dr. Houghton’s last paragraph reveals a serious defect in the existing system which should not be ignored for an utopian ideal. WM. C. FOWLER. Wokingham, Berks. to
opportunity
nurse tuberculosis in any but a supreme we are
NEUROSIS AND INTELLIGENCE
SIR,—Dr. Eysenck’s article of Sept. 18 raises a point that is usually overlooked in such investigations and one which might help him to reconcile the difference between his results and those of Hollingworth and others.
Some15 years ago, under the influence of J. S. Bolton’s thesis (Brain in Health and Disease, London, 1914) that
the chronic and recurrent insanities were evidence either of subevolution of the cerebrum on the one hand (the " amentias ") or of dissolution on the other (the " dementias "), I did intelligence tests on a large number of certifies patients of various types in the mental hospital.
I was looking for psychological verification of this thesis and in view of Hollingworth’s findings in psychoneurotics expected to have a fairly easy task. To my surprise the results were so erratic and irregular that I did not think them worth publishing. In the course of the investigation I realised one source of this irregularity. In order to obtain some standard of comparison,I did the same tests (Binet, picture completion, Burt’s reasoning test, Porteus) on an unselected sample of the nurses and attendants at the same hospital whom I took to be a comparable social and intellectual group. With these I found that the scores were very greatly influenced by age, being comparably much lower with the older persons. This effect was so great that it quite swamped the variation I was looking for. (Some of the results
quite startling-for instance, one charge attendant, just over forty with many years good service, age of less than 9 by Burt’s reasoning test and barely 10 on the Binet scale.) The possible reasons for this great reduction of performance with advancing age are many (the naive trusting outlook of children in these tests as contrasted with the varying attitude of adults unused to such "inquisitions " is one that shows up clearly), but whatever they are the effect must be allowed for in any investigation on adults. It could be avoided by studying the problem in children,
were a married man of had a mental
where moreover the tests are more relevant. There must be plenty of material today in the numerous childguidance clinics. Perhaps there one might get corroboration of my general impression, shared by most child psychiatrists, that true neurosis has little to do with intellectual level.
HARRY
Leeds.
EDELSTON.
SCIENTIFIC FREEDOM IN GOVERNMENT
SERVICE
SIR,—Sir Edward Mellanby is not alone in thinking that the dominant factor in deciding health legislation has often a political rather than a scientific basis. and that the great delay which often occurs before the results of scientific progress are adopted is sometimes due to administrative inertia or to lack of political or social interest.! The Civil Service has many excellent qualities, but it would be an exaggeration to say that it is. by tradition or organisation receptive to science or enthusiastic in the application of scientific teaching. Administrative reaction is influenced to a considerable extent by political expediency. Politics has been defined as " the art of the practicable," which means that expediency is bound to be the governing consideration and that wisdomCommay have to take second place to prudence. promise and science are unhappy bedfellows ; and the administrator can always find many good reasons for doing nothing. The guiding principle is that nothing must be done or said or written that is likely to embarrass a Minister and, since any form of progress is likely tocause a certain amount of upheaval, science is apt to be regarded with suspicion. There are stringent Treasury regulations affecting the freedom of speech of civil servants and their liberty to publish without prior authority. A doctor working in the Civil Service is, in fact, effectively gagged he can say or write only what has official approval. There is an administrative tendency, not confined to any particular Ministry, to regard the scientist as one whose job it is to provide his political chief with -titbits with which to garnish a speech on the Estimates. There may be good reasons for all this-it may even be an inescapable feature of democratic governmentand presumably a doctor who- becomes a Civil Servant does so with due recognition of what he is surrendering in return for his established position ; but it is scarcely surprising that many have found themselves bewildered and shaken in an environment far removed from that of science, one in which a frank statement of ignorance on a specific point is often regarded as something little removed from official sin. It is difficult for a doctor in the service not to become isolated from his. professional work and, consequently, a diminishing asset to the state. It is not easy to preserve a scientific outlook in such a to find that the setting, and it must be
demoralising
1. Recent Advances in Medical Science, London, 1939.
Letters
to
the Editor
AND THE RMBF my custom each autumn, through your columns, to invite my medical colleagues to take their part in the Christmas Gifts fund of the Royal Medical Benevolent Fund. This scheme, so generously supported by many, has become very remarkable ; not only has it been the means of bringing to many old and lonely people a gift of friendship and sympathetic understanding at Christmas time, but it has also given many of your readers an insight into the great work which the Royal Medical Benevolent Fund is doing daily in helping medical brethren, or the widows and children of deceased medical practitioners, who are in financial difficulties. We look upon the Christmas gift of 22 to each beneficiary’ as something " extra," but I must emphasise ’that the regular allowances have to be paid throughout the year. New annual subscribers are very urgently needed for our general funds, and surely it is for the present generation of practitioners to take up their share in a work which is a common professional inheritance and tradition. It is not difficult to realise what happiness and comfort
CHRISTMAS
,
SiR,—It is
Christmas gift of 22 brings to an old doctor, an aged widow or daughter living alone, possibly suffering from illness or infirmity. We’ourselves know the difficulties and discomforts of our own lives caused by the present war. May I appeal, Sir, very earnestly on behalf of those who have suffered so uch more than ourselves ? I venture to make this letter a twofold appeal: (a) to all regular subscribers, - to send their " extra " for the Christmas Gifts fund ; (b) to all others, to show their practical sympathy by becoming subscribers to our general funds. I do not ask for large contributions. Christmas gifts donations should be marked " Christ-mas Gifts," and all cheques made payable to the hon. treasurer, Royal Medical Benevolent Fund,’ 1, Balliol House, Manor Fields, London, S.W.15. THOS. BARLOW, a
President.
TUBERCULOSIS
NURSING
SIR,—Dr. Houghton’s letter in your issue of Sept. 4 was opportune. As things stand a’nurse in training at a
general hospital
has little
of learning how its incurable stage, and effort to find and treat making yet patients before they reach such a stages When she goes to a sanatorium as a nurse (or, if less fortunate, as a patient) she is astonished to find how much there is to learn in the management of thoracoplasty, artificial pneumothorax, Monaldi drainage, postural drainage, &c., as well as in the routine of ordinary sanatorium treatment. The position is entirely different from what it was 20 or even 10 years ago, and to meet these altered conditions the nurse needs a special training which cannot be acquired in a three-months visit to sanatorium or tuberculosis ward. If the segregation of fever cases and mental cases has created a need for state registration of those who specialise in their nursing, it is even more necessary for those who nurse tuber’culosis, which still ranks high among fatal diseases. Dr. Ellman’s arguments support rather than detract from the value of a register for improving the standard of tuberculosis nursing and the education of the nurse. Dr. Houghton’s last paragraph reveals a serious defect in the existing system which should not be ignored for an utopian ideal. WM. C. FOWLER. Wokingham, Berks. to
opportunity
nurse tuberculosis in any but a supreme we are
NEUROSIS AND INTELLIGENCE
SIR,—Dr. Eysenck’s article of Sept. 18 raises a point that is usually overlooked in such investigations and one which might help him to reconcile the difference between his results and those of Hollingworth and others.
Some15 years ago, under the influence of J. S. Bolton’s thesis (Brain in Health and Disease, London, 1914) that
the chronic and recurrent insanities were evidence either of subevolution of the cerebrum on the one hand (the " amentias ") or of dissolution on the other (the " dementias "), I did intelligence tests on a large number of certifies patients of various types in the mental hospital.
I was looking for psychological verification of this thesis and in view of Hollingworth’s findings in psychoneurotics expected to have a fairly easy task. To my surprise the results were so erratic and irregular that I did not think them worth publishing. In the course of the investigation I realised one source of this irregularity. In order to obtain some standard of comparison,I did the same tests (Binet, picture completion, Burt’s reasoning test, Porteus) on an unselected sample of the nurses and attendants at the same hospital whom I took to be a comparable social and intellectual group. With these I found that the scores were very greatly influenced by age, being comparably much lower with the older persons. This effect was so great that it quite swamped the variation I was looking for. (Some of the results
quite startling-for instance, one charge attendant, just over forty with many years good service, age of less than 9 by Burt’s reasoning test and barely 10 on the Binet scale.) The possible reasons for this great reduction of performance with advancing age are many (the naive trusting outlook of children in these tests as contrasted with the varying attitude of adults unused to such "inquisitions " is one that shows up clearly), but whatever they are the effect must be allowed for in any investigation on adults. It could be avoided by studying the problem in children,
were a married man of had a mental
where moreover the tests are more relevant. There must be plenty of material today in the numerous childguidance clinics. Perhaps there one might get corroboration of my general impression, shared by most child psychiatrists, that true neurosis has little to do with intellectual level.
HARRY
Leeds.
EDELSTON.
SCIENTIFIC FREEDOM IN GOVERNMENT
SERVICE
SIR,—Sir Edward Mellanby is not alone in thinking that the dominant factor in deciding health legislation has often a political rather than a scientific basis. and that the great delay which often occurs before the results of scientific progress are adopted is sometimes due to administrative inertia or to lack of political or social interest.! The Civil Service has many excellent qualities, but it would be an exaggeration to say that it is. by tradition or organisation receptive to science or enthusiastic in the application of scientific teaching. Administrative reaction is influenced to a considerable extent by political expediency. Politics has been defined as " the art of the practicable," which means that expediency is bound to be the governing consideration and that wisdomCommay have to take second place to prudence. promise and science are unhappy bedfellows ; and the administrator can always find many good reasons for doing nothing. The guiding principle is that nothing must be done or said or written that is likely to embarrass a Minister and, since any form of progress is likely tocause a certain amount of upheaval, science is apt to be regarded with suspicion. There are stringent Treasury regulations affecting the freedom of speech of civil servants and their liberty to publish without prior authority. A doctor working in the Civil Service is, in fact, effectively gagged he can say or write only what has official approval. There is an administrative tendency, not confined to any particular Ministry, to regard the scientist as one whose job it is to provide his political chief with -titbits with which to garnish a speech on the Estimates. There may be good reasons for all this-it may even be an inescapable feature of democratic governmentand presumably a doctor who- becomes a Civil Servant does so with due recognition of what he is surrendering in return for his established position ; but it is scarcely surprising that many have found themselves bewildered and shaken in an environment far removed from that of science, one in which a frank statement of ignorance on a specific point is often regarded as something little removed from official sin. It is difficult for a doctor in the service not to become isolated from his. professional work and, consequently, a diminishing asset to the state. It is not easy to preserve a scientific outlook in such a to find that the setting, and it must be
demoralising
1. Recent Advances in Medical Science, London, 1939.