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FACING DISABILITY
572 associates have shown in studies of tar warts that a, visible wart is the product of many factors besides tar which lead to emergence of the tumour. In the case of mammary tumours of virus origin FOULDS11 has drawn attention to a sequence that sometimes precedes some of these progressively growing carcinomas. - There is scope here for more skill in detecting milk factor or a variant of it by means of the benign or the early microscopic lesions which are also associated with it. Moreover, those concerned with the genesis of other forms of mammary cancer cannot afford to ignore the possibility of chance infection by the milk factor.
Annotations FACING DISABILITY
SiNCE many people who are physically normal make poor hand of adjusting themselves to life, it is not remarkable that those with a physical handicap, whether present at birth or acquired later, should find the process of maturing even more difficult. The child born crippled, or crippled in his early years, is much at the mercy of his parents : if they are people of judgment and discretion he will not only be given security but also be helped towards independence ; and though taught early to recognise and accept his limitations, he will be encouraged to adventure to the utmost of his scope. Not all parents are wise, however. The preparatory commission of the World Federation for Mental Health, in a paper on this subject, submitted to the Fourth International Congress on Mental Health,12 note that many of the attitudes of those crippled from childhood reflect the values that their society places on deformity, and which their parents have transmitted to them. Those who acquire their handicap later, when their personality structure is complete, respond as they would to any other frustration, a
or abuse ; but their attitude, too, is coloured the towards deformity which they acquired by feelings in childhood. The crippled child may accept the idea that he is different from others passively and almost complacently, valuing the secondary gain of devoted parental attention above his independence ; or he may resent the pity or impatience of others towards him, and show his hostility in rages and refusals. Again he may deny the effect of his disability to himself, and attribute his failures to the malice of other people. These attitudes have their counterpart in those of adults who are disabled. Thus a person who prefers to be dependent may make overwhelming demands to be cared for, and thus find his handicap a useful tool. Those oppressed by a chronic sense of guilt may feel that their disabilities are a punishment for sin ; and this makes some feel even guiltier, and others relieved at getting their deserts. Yet the job of the disabled is to learn to fit in : as the The handicapped are part of the commission put it, social group and have to live, work, and play as do
trauma,
"
other
people."
Whether children can learn to do this best in the company of other handicapped children, or whether it is better to segregate them in special schools, is not yet clear. Probably the first method will suitsome, and the second others. Certainly some feel that segregation intensities their sense of being " different," while others only lose their feelings of inferiority among Both typesof care children with similar handicaps. should he available, and transfer of children from one to the other, according to their needs, should be made easy. Vocational guidance for those reaching earning age 11. Foulds, L. Brit. J. Cancer, 1949, 3, 345. 12. Arch. industr. Hyg. 1952, 5, 389.
should be based on the principles followed when such guidance is given to normal young people : the interests and capacity of’the disabled person and his readiness to work at a realistic programme of training must be the deciding factors-not his physical deficiencies. The commission also note the importance of educating the public to treat the handicapped as equals, not as special members of society. Camps and other entertainments reserved for cripples, though kindly meant, do not prepare them for being members of the crowd when they grow up. In fact disabled children would be far more likely to mature into emotionally normal people if society directed the same effort (and far less money towards integrating them as it does towards segregating them. Doubtless society would benefit too, and not only financially. After all we should be able to take the handicapped in our stride, since if we live long enough we are likely to join them. Moreover it is fooli.li to add to their reasons for maladjustment, since maladjusted people are a drain on the spirits of others. Mental health, however, begins not in the schoolroom but the cradle ; and the commission glance in passing at the need to educate parents " in controlling their own emotional reactions to their disabled children so as not to traumatise them further." This considerable field of education is tackled realistically in a little book by Millicent V. Kennedy and H. C. D. Somerset.13 Written wisely, in straightforward English, with many illustrative anecdotes, it should set parents faced with this responsibility thinking on the right lines-not only about the disabled child but about his siblings, who may be suffering from unintentional neglect. The handicapped child must be just one of the family, not the centre of it. As these authors point out, a crippled child suffers as much from idleness as any other child. When he comes out of hospital the parents should discuss with the doctor and the hospital teacher how he can be taught; and when the best arrangements possible have been made for his education these should, if possible, not be interrupted. NEW ATROPINE SUBSTITUTE
DESPITE much investigation, we are still uncertain of the extent to which nervous impulses via the vagus nerve account for - peptic ulceration, by promoting Experimental gastric motility and acid secretion. evidence may well be dangerously misleading ; for, in the words of one gastric surgeon, " not all of our patients behave exactly like dogs." ’It is,nevertheless clear from studies on man that the " inter-digestive secretion tends. to be higher in duodenal ulcer patients than in normals and that this inter-digestive secretion is largely nervous in origin." 14 So, while we may not fully agree with Connell 15 that the final method of treatment "must await development of a clinically applicable antisecretagogue," we should not ignore the possibilities of the anticholinergic drugs. The belladonna alkaloids have been widely used in is that treatment, with good effect.16 The with hyperacidity and hypersecretion large doses have to be given ; and then side-effects—visual disturbance. dryness of the mouth, tachycardia, dysuria, and 80 on —may be troublesome. Many synthetic anticholinergic drugs have been developedl? with the object of these reactions and obtaiuing " a cholinergic blocking agent with specificity for site of action."18 ...
difficulty
reducm.:
13. Bringing Up Educational
Crippled Children. New Zealand Council for Research, in association with New Zealand Crippled Children Society. London : Oxford University Press, 1952. Pp. 94. 6s. 14. Jones, F. A. Modern Trends in Gastro-Enterology. London. 1952 ; p. 383. 15. Connell, F. G. Amer. J. Surg. 1945, 68, 388. 16. Anderson. W. F. Lancet, Aug. 9, 1952, p. 255. 17. See leading article, Ibid, Sept. 6. 1952. p. 472. 18. Krantz, J. C. jun., Carr, C. J. The Pharmacological Principles of Medical Practice. London, 1951 ; p. 736.
Annotations FACING DISABILITY
SiNCE many people who are physically normal make poor hand of adjusting themselves to life, it is not remarkable that those with a physical handicap, whether present at birth or acquired later, should find the process of maturing even more difficult. The child born crippled, or crippled in his early years, is much at the mercy of his parents : if they are people of judgment and discretion he will not only be given security but also be helped towards independence ; and though taught early to recognise and accept his limitations, he will be encouraged to adventure to the utmost of his scope. Not all parents are wise, however. The preparatory commission of the World Federation for Mental Health, in a paper on this subject, submitted to the Fourth International Congress on Mental Health,12 note that many of the attitudes of those crippled from childhood reflect the values that their society places on deformity, and which their parents have transmitted to them. Those who acquire their handicap later, when their personality structure is complete, respond as they would to any other frustration, a
or abuse ; but their attitude, too, is coloured the towards deformity which they acquired by feelings in childhood. The crippled child may accept the idea that he is different from others passively and almost complacently, valuing the secondary gain of devoted parental attention above his independence ; or he may resent the pity or impatience of others towards him, and show his hostility in rages and refusals. Again he may deny the effect of his disability to himself, and attribute his failures to the malice of other people. These attitudes have their counterpart in those of adults who are disabled. Thus a person who prefers to be dependent may make overwhelming demands to be cared for, and thus find his handicap a useful tool. Those oppressed by a chronic sense of guilt may feel that their disabilities are a punishment for sin ; and this makes some feel even guiltier, and others relieved at getting their deserts. Yet the job of the disabled is to learn to fit in : as the The handicapped are part of the commission put it, social group and have to live, work, and play as do
trauma,
"
other
people."
Whether children can learn to do this best in the company of other handicapped children, or whether it is better to segregate them in special schools, is not yet clear. Probably the first method will suitsome, and the second others. Certainly some feel that segregation intensities their sense of being " different," while others only lose their feelings of inferiority among Both typesof care children with similar handicaps. should he available, and transfer of children from one to the other, according to their needs, should be made easy. Vocational guidance for those reaching earning age 11. Foulds, L. Brit. J. Cancer, 1949, 3, 345. 12. Arch. industr. Hyg. 1952, 5, 389.
should be based on the principles followed when such guidance is given to normal young people : the interests and capacity of’the disabled person and his readiness to work at a realistic programme of training must be the deciding factors-not his physical deficiencies. The commission also note the importance of educating the public to treat the handicapped as equals, not as special members of society. Camps and other entertainments reserved for cripples, though kindly meant, do not prepare them for being members of the crowd when they grow up. In fact disabled children would be far more likely to mature into emotionally normal people if society directed the same effort (and far less money towards integrating them as it does towards segregating them. Doubtless society would benefit too, and not only financially. After all we should be able to take the handicapped in our stride, since if we live long enough we are likely to join them. Moreover it is fooli.li to add to their reasons for maladjustment, since maladjusted people are a drain on the spirits of others. Mental health, however, begins not in the schoolroom but the cradle ; and the commission glance in passing at the need to educate parents " in controlling their own emotional reactions to their disabled children so as not to traumatise them further." This considerable field of education is tackled realistically in a little book by Millicent V. Kennedy and H. C. D. Somerset.13 Written wisely, in straightforward English, with many illustrative anecdotes, it should set parents faced with this responsibility thinking on the right lines-not only about the disabled child but about his siblings, who may be suffering from unintentional neglect. The handicapped child must be just one of the family, not the centre of it. As these authors point out, a crippled child suffers as much from idleness as any other child. When he comes out of hospital the parents should discuss with the doctor and the hospital teacher how he can be taught; and when the best arrangements possible have been made for his education these should, if possible, not be interrupted. NEW ATROPINE SUBSTITUTE
DESPITE much investigation, we are still uncertain of the extent to which nervous impulses via the vagus nerve account for - peptic ulceration, by promoting Experimental gastric motility and acid secretion. evidence may well be dangerously misleading ; for, in the words of one gastric surgeon, " not all of our patients behave exactly like dogs." ’It is,nevertheless clear from studies on man that the " inter-digestive secretion tends. to be higher in duodenal ulcer patients than in normals and that this inter-digestive secretion is largely nervous in origin." 14 So, while we may not fully agree with Connell 15 that the final method of treatment "must await development of a clinically applicable antisecretagogue," we should not ignore the possibilities of the anticholinergic drugs. The belladonna alkaloids have been widely used in is that treatment, with good effect.16 The with hyperacidity and hypersecretion large doses have to be given ; and then side-effects—visual disturbance. dryness of the mouth, tachycardia, dysuria, and 80 on —may be troublesome. Many synthetic anticholinergic drugs have been developedl? with the object of these reactions and obtaiuing " a cholinergic blocking agent with specificity for site of action."18 ...
difficulty
reducm.:
13. Bringing Up Educational
Crippled Children. New Zealand Council for Research, in association with New Zealand Crippled Children Society. London : Oxford University Press, 1952. Pp. 94. 6s. 14. Jones, F. A. Modern Trends in Gastro-Enterology. London. 1952 ; p. 383. 15. Connell, F. G. Amer. J. Surg. 1945, 68, 388. 16. Anderson. W. F. Lancet, Aug. 9, 1952, p. 255. 17. See leading article, Ibid, Sept. 6. 1952. p. 472. 18. Krantz, J. C. jun., Carr, C. J. The Pharmacological Principles of Medical Practice. London, 1951 ; p. 736.