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KNEE INJURIES IN SOLDIERS
802
-
"
patients to get
back to
so, the natural
thing is to hand out a certificate that patient to keep quiet and. be free from
those of other forms of nursing work and those of other professions. Only full acceptance of these ideals will will permit the bring to the profession the intelligent, educable woman the worries and strain of work. It is not up to the so badly needed. But who is to undertake the non-nursing duties ? doctor to put himself in an employer’s place, nor even A new type of skilled worker is required. to consider whether, owing to the exceptional circumUnder the auspices of the Ministry of Labour a new stances, his patient might not make a special effort to National Auxiliary’Service for Hospitals (NASH) could carry on. He does "hot feel that he ought to debate be created. This would supply trained hospital orderlies, Now let me see, there’s a war on. the matter and say, male and female, many of whom could be recruited Some people might not have come to me about this matter, but would have gone on working until they felt direct from similar service in the Forces. Others-both Service and civilian-whb are willing but have no worse." Hence men and women who are not quite fit can take advantage of the usual good nature of medical experience will need short courses of practical training. For this purpose the Ministry of Labour could requisition men who regard it as theii duty to make their patients the various training centres which already exist under better as soon as possible. It is the easiest thing in the world to get a certificate the " training for all " scheme. In hospital the trained of unfitness from the average practitioner, so long as orderly will need good working conditions. Hours of one actually has something wrong. This certificate duty, remuneration, duties to be performed, holidays, has only to be sent to an employer, and neither he nor and so on would be settled by negotiation with the the national service officer can do anything about it. trade-union that would no doubt be formed. The To the doctor it is a small matter that a man or woman work should be pensionable, and—a matter of no little with an indisposition takes a few days off in order to importance-a smart uniform should be supplied. This much, at least, can be embarked upon without get better. It may be much more important, however, to the employee’s firm, where the absence may cause a delay. Until the heavy burden which lies upon nursing services today is, relieved, nurses can have little time hold-up. ; ,...., . t spea most respecttuiiy to a learnea, pmiantnropic, or indeed strength to discuss matters relating to future and self-sacrificing profession when I suggest that the policy. J. EYRE. elderly members who are mostly left to look after the KNEE INJURIES IN SOLDIERS civilian population should harden their hearts and put SiR,—Major Wilkinson and Captain Burt in their the brake on so generous an issue of certificates for interesting paper of June 2 draw attention to the unsatisworkers who seek - them. I know that, in ordinary times, these certificates are justified. But. these are factory results of knee-joint injuries in the present war. not ordinary times. These are days when patriots This disquieting fact has also been recorded by others. work at their machines and benches until thev can do so May I stress the point, with which the authors would no doubt- concur, that the poor results seen under war no longer. There are many genuine cases who secure certificates ; but, on the other hand, there are more conditions should not be regarded as characteristic of normal times. We should avoid unjustifiable pessimism’ than a few who shirk their legitimate duties by waving about the treatment of knee-joint injuries, if only in the medical man’s slip of paper in the faces of the fairness to those who havelaboured to improve it. authorities and their firms. History is repeating itself, for during the,1914-18 war When I was in a great aircraft engineering factory I precisely the same phenomena wereapparent. May I saw machines left saw the two types around m.e. not an explanation be found in two principal causes ? vacant periodically by employees who managed always 1. Inadequate treatment of the early stages of many to get certificates from doctors of whose leniency they boasted. I watched others working while under doctors’ injuries of the knee-joint before patients reach the convalesorders, taking vitamins and thelike to keep them going. cent depots and orthopcedie centres.-There is still insufficient appreciation in many quarters of the great importIt is unfortunate that the former type can so often make ance of preventing wasting of the quadriceps and other a doctor into an active ally. In their hearts, the muscles, and particularly of the vastus internus. slackers have4no real gratitude for the goodness of their doctors. And workers who keep on keeping on are Major Wilkinson and Captain Burt point out that many of the cases that arrived at the convalescent depot showed roused to suspicion, quite unjustly, of the medical profession when they see their unworthy colleagues able to (a) inability to brace back the knee, (b) localised areas of produce medical certificates practically whenever they periarticular tenderness, (c) effusion, and (d) joint inlike. stability. I have, times without number, observed (f<), D. A. SCOTT. (c) and (d) in cases where the quadriceps has become London, NW6. weak and wasted owing to inadequacy of early treatment. SHORTAGE OF NURSES With regard to (b), the areas of persistent tenderness,m often be prevented by appropriate physical treatin columns may your S1R.-The correspondence concerning ment in the early stages. A stitch in time saves nine.! the training of nurses reflects the urgency of the situation. I am unable to speak with recent experience of the While thousands of patients are withheld from treatment EMS hospitals, but at the 1000-bed EMS hospital where for lack of nursing care, no positive steps are evident to I worked for a few months in 1940 the department of attract into this work suitable personnel now leaving the Forces. The matter must receive attention quickly physiotherapy was a little larger than an average bathroom, and there was a mere handful bf physiotherapists or the opportunity will be lost for ever. shortage of nurses, if it truly exists, is doubled by the who were unable to cope with the large number of fact that nurses today spend nearly half their working cases of injuries to joints, including many knee-joint day in extraneous duties. End this, and not only will injuries. Such cases often had tp be placed upon a available nursing-power immediatelv be increased but waiting-list ! Eventually a good many of these patients found their way to orthopaedic centres and convalescent set out to donurses will be free to do the work to nurse. The emancipation of nursing-power from its depots, where adequate treatment was presumablyavaildomestic shackles will be the first step towards true able ; but the damage had been done and the syndrome’ to which Major Wilkinson and Captain Burt refer had professional status. As a teacher of nurses, I applaud the scheme put already often been established. In the subsequent years some of these grave deficiencies, but perhaps not all, have forward by Miss Carter and Miss Pearce for the new training of professional nurses (Lancet, June 9. p. 737). doubtless been rectified. 2. The second cause is mainly psychological. Men in Its essentially practical character should re-embody in the nursing spirit that kindly, gentle, and capable the’ Services have done a magnificent job in this war, This plan comes back in a way no but the great majority long to return to their civil person we want. other has done to fundamental issues. The pre-hospital occupations and to their families from whom they hav et course of simple scientific and technical subjects, followed often been separated for long periods. Heaven forbid by two years’ hospital training and practice of basic the implication that these splendid fellows do not try to nursing procedures is sound reasoning. This is the second get well, but these factors sometimes create a subconscious psychological atmosphere which is inimical to step towards true status. The third step is recognition of the trained bedside complete recovery. Genuine malingering I believe to be nurse’s right to salary and conditions comparable with much less common than is sometimes supposed. "
complete health.
.
.
they
That
being
803
,
.
.
The results of removal of a semilunar cartilage in Service patients illustrate this point, for they are almost grotesquely at variance with those seen under normal peace-time conditions. Major Wilkinson and Captain Burt rightly emphasise this, and also the excellent results of removal of a semilunar cartilage in professional footballers. I may perhaps be permitted to mention that the player described by them who played in a practice game four weeks, and in the 1st division team six weeks, after operation was one of my operation cases. Such results are by no means exceptional, and to the best of my knowledge and belief no professional footballer in my personal series operated upon for an uncomplicated lesion of a semilunar cartilage has had to cease playing owing to persistent unsoundness of the knee. But the results in other followers of strenuous athletic pursuits and occupations are, as is well known (or was before the present wave of pessimism), equally gratifying. As an example of another strenuous occupation, that of the merchant seaman may be cited. With the kindness and cooperation of my colleagues at the Seamen’s Hospital, Greenwich, and other hospitals, it fell to my lot some years ago to remove the semilunar cartilage in a large number of seamen. A careful follow-up showed that an extremely high percentage were completely cured. Now follows a point which seems to me of great significance and importance. At about the same time, in my capacity as surgical specialist and visiting surgeon to a Ministry of Pensions hospital, I operated upon a large pensioners suffering from semiluna-cartilage number .of injuries, and in a similar follow-up found that the answers to the questionnaire, often checked by re-examination, were in many cases quite unreliable and valueless for statistical purposes. I came to this conclusion with reluctance, but no useful purpose is served considerable in concealing the facts. It is noteworthy that the professional footballer loves football, just as the merchant seaman usually enters the merchant service because he loves the sea. In both groups, an important factor is present which is often lacking in the Service patient-viz., a strong urge to resume their previous avocations at the earliest possible moment. In the case of the professional footballer, an additional and important cause of his early recovery is, as a rule, the excellent condition of his thigh muscles before operation, which renders unnecessary a long period of subsequent re-education.
London,
Wl.
A. G. TIMBRELL FISHER.
BLOOD IN THE EYE SiB,—In your annotation of March 24 (p. 349) you draw timely attention to the caution which should be exercised in the treatment of hyphaema, and you point out that atropine may not only increase the tension of the eye but also diminish the surface area of the iris which is available for absorption. There is also a third reason why atropine is dangerous in recent partial hyphaema. By dilating the pupil it is liable to reopen iris blood-vessels and cause further haemorrhage. Three cases have been noted in this theatre of war in which a small hyphaema, which would probably have disappeared in 48 hours, was converted into a total hyphaema after atropine had been used. In total hyphsema it is unlikely that atropine will be absorbed. The correct treatment for a recent severe hyphaema per se is to tie up both eyes and not to use drops which disturb the shape of the pupil in the early stages. B. W. RYCROFT, CMF. Adviser in Ophthalmology, AFHQ.
TUBERCULOSIS
SiR,—The letter to the Times from Lord Horder and Drs. Conybeare, Hope Gosse and Geoffrey Marshall, which you quote in your leading article of June 2, contains serious criticisms of the tuberculosis service which should not be accepted without further proof. It is the fashion nowadays for physicians not connected with tuberculosis schemes to talk about " backauthorities." The accusation may be justifiable ward in a small number of cases, but on the whole the service provided by local authorities for the treatment of tuberculosis compares very favourably . with that provided by voluntary organisations and institutions.
At present, as you, Sir, suggest, there are numerous difficulties with regard to nursing and domestic staff. There is also a serious shortage of experienced medical. personnel. This shortage would be aggravated by the establishment of a Ministry of Pensions or War Office institution for the treatment of pulmonary tuberculosis, and it is by no means certain that the service provided would be better than, or even as good as, that provided by the local authorities. A. P. FORD. Welwyn, Herts. " NAVAL DEMOBILISATION.—Will " Accidie please send his name and address (not for publication). Also if possible the text of the announcement to which he refers.
us
Obituary BISHOP HARMAN MANC., F R C S AFTER a long illness, Mr. Bishop Harman died on .June 13 at his home at Crockham Hill in Kent. He was a man of exceptional attainments who did much for ophthalmology and also gave his time and talents to the profession through the British Medical Association. His interest in his own specialty and in the good of the public found joint expression in his work to create the National Eye Service. A direct representative of the profession on the General Medical Council from 1929 until a few weeks ago, he showed himself logical and clear-sighted ; and in all relations of life he was respected as upright and unselfish. Son of W. J. Harman of Highgate, he was-born in 1869 and educated at the City of London School and St. John’s College, Cambridge, where he was a foundation scholar. He took a first in both parts of the natural sciences tripos and qualified from the Middlesex Hospital in 1898, taking his FRCS in the same year. From 1897 he was lecturer in anatomy at two Cambridge colleges, and after service as a civil surgeon in the South African war, when he wrote a thesis on veldt sore, he became university demonstrator and examiner in anatomy. At this time he was writing not only on such subjects as the outflow of visceral efferent, nerves in man, but also on the comparative anatomy of the oculomotor apparatus, and his thoughts increasingly turned to ophthalmology, both academic and practical. In 1901 he was elected ophthalmic surgeon at the Belgrave Hospital for Children and 1909 he joined the staff of the West London Hospital where he became vice-dean and, later, dean of the postgraduate college. He wrote much on ophthalmic subjects and to younger members of the profession he was known as editor for a time of Aidsto Ophthalmology. Meanwhile, in 1902, he had been appointed oculist to the London County Council blind schools, and had thus set his hand to a great task. "Bishop Harman’s chief contribution to ophthalmology," writes J. H. P., " is his pioneer work in the investigation of the, vision of school-children, and in the prevention or amelioration of their visual defects. In conjunction with the late Dr. James Kerr, and largely inspired by his early efforts in the same field, he examined thousands of children’s eyes in the LCC schools, and organised the routine examination with his conspicuous administrative skill. He was responsible for the segregation and special training of partially sighted children in schools which he rather unfortunately called ‘ myope ’ schools. He naturallv became very interested in the treatment of squints, and designed an instrument for the measurement of binocular defects which has been almost universally adopted. The treatment of visual defects under the National Insurance Act was largely organised, and carried through with considerable success, by his enthusiasm." The profession owes much to Harman’s efforts to educate people in the necessity for a medical eye exa.mination. A. C. recalls that " in the late twenties, when the Government was being urged to put the sight-testing opticians on’a special register and thus recognise them as a separate profession it was alleged, and with truth, that large sections of the public could not afford an examination by an ophthalmic specialist but were coii-ipelled to go either to a hospital or to a sight-testing optician. Harman was the founder and the active NATHANIEL .
M B
CAMB,
.
LLD
-
"
patients to get
back to
so, the natural
thing is to hand out a certificate that patient to keep quiet and. be free from
those of other forms of nursing work and those of other professions. Only full acceptance of these ideals will will permit the bring to the profession the intelligent, educable woman the worries and strain of work. It is not up to the so badly needed. But who is to undertake the non-nursing duties ? doctor to put himself in an employer’s place, nor even A new type of skilled worker is required. to consider whether, owing to the exceptional circumUnder the auspices of the Ministry of Labour a new stances, his patient might not make a special effort to National Auxiliary’Service for Hospitals (NASH) could carry on. He does "hot feel that he ought to debate be created. This would supply trained hospital orderlies, Now let me see, there’s a war on. the matter and say, male and female, many of whom could be recruited Some people might not have come to me about this matter, but would have gone on working until they felt direct from similar service in the Forces. Others-both Service and civilian-whb are willing but have no worse." Hence men and women who are not quite fit can take advantage of the usual good nature of medical experience will need short courses of practical training. For this purpose the Ministry of Labour could requisition men who regard it as theii duty to make their patients the various training centres which already exist under better as soon as possible. It is the easiest thing in the world to get a certificate the " training for all " scheme. In hospital the trained of unfitness from the average practitioner, so long as orderly will need good working conditions. Hours of one actually has something wrong. This certificate duty, remuneration, duties to be performed, holidays, has only to be sent to an employer, and neither he nor and so on would be settled by negotiation with the the national service officer can do anything about it. trade-union that would no doubt be formed. The To the doctor it is a small matter that a man or woman work should be pensionable, and—a matter of no little with an indisposition takes a few days off in order to importance-a smart uniform should be supplied. This much, at least, can be embarked upon without get better. It may be much more important, however, to the employee’s firm, where the absence may cause a delay. Until the heavy burden which lies upon nursing services today is, relieved, nurses can have little time hold-up. ; ,...., . t spea most respecttuiiy to a learnea, pmiantnropic, or indeed strength to discuss matters relating to future and self-sacrificing profession when I suggest that the policy. J. EYRE. elderly members who are mostly left to look after the KNEE INJURIES IN SOLDIERS civilian population should harden their hearts and put SiR,—Major Wilkinson and Captain Burt in their the brake on so generous an issue of certificates for interesting paper of June 2 draw attention to the unsatisworkers who seek - them. I know that, in ordinary times, these certificates are justified. But. these are factory results of knee-joint injuries in the present war. not ordinary times. These are days when patriots This disquieting fact has also been recorded by others. work at their machines and benches until thev can do so May I stress the point, with which the authors would no doubt- concur, that the poor results seen under war no longer. There are many genuine cases who secure certificates ; but, on the other hand, there are more conditions should not be regarded as characteristic of normal times. We should avoid unjustifiable pessimism’ than a few who shirk their legitimate duties by waving about the treatment of knee-joint injuries, if only in the medical man’s slip of paper in the faces of the fairness to those who havelaboured to improve it. authorities and their firms. History is repeating itself, for during the,1914-18 war When I was in a great aircraft engineering factory I precisely the same phenomena wereapparent. May I saw machines left saw the two types around m.e. not an explanation be found in two principal causes ? vacant periodically by employees who managed always 1. Inadequate treatment of the early stages of many to get certificates from doctors of whose leniency they boasted. I watched others working while under doctors’ injuries of the knee-joint before patients reach the convalesorders, taking vitamins and thelike to keep them going. cent depots and orthopcedie centres.-There is still insufficient appreciation in many quarters of the great importIt is unfortunate that the former type can so often make ance of preventing wasting of the quadriceps and other a doctor into an active ally. In their hearts, the muscles, and particularly of the vastus internus. slackers have4no real gratitude for the goodness of their doctors. And workers who keep on keeping on are Major Wilkinson and Captain Burt point out that many of the cases that arrived at the convalescent depot showed roused to suspicion, quite unjustly, of the medical profession when they see their unworthy colleagues able to (a) inability to brace back the knee, (b) localised areas of produce medical certificates practically whenever they periarticular tenderness, (c) effusion, and (d) joint inlike. stability. I have, times without number, observed (f<), D. A. SCOTT. (c) and (d) in cases where the quadriceps has become London, NW6. weak and wasted owing to inadequacy of early treatment. SHORTAGE OF NURSES With regard to (b), the areas of persistent tenderness,m often be prevented by appropriate physical treatin columns may your S1R.-The correspondence concerning ment in the early stages. A stitch in time saves nine.! the training of nurses reflects the urgency of the situation. I am unable to speak with recent experience of the While thousands of patients are withheld from treatment EMS hospitals, but at the 1000-bed EMS hospital where for lack of nursing care, no positive steps are evident to I worked for a few months in 1940 the department of attract into this work suitable personnel now leaving the Forces. The matter must receive attention quickly physiotherapy was a little larger than an average bathroom, and there was a mere handful bf physiotherapists or the opportunity will be lost for ever. shortage of nurses, if it truly exists, is doubled by the who were unable to cope with the large number of fact that nurses today spend nearly half their working cases of injuries to joints, including many knee-joint day in extraneous duties. End this, and not only will injuries. Such cases often had tp be placed upon a available nursing-power immediatelv be increased but waiting-list ! Eventually a good many of these patients found their way to orthopaedic centres and convalescent set out to donurses will be free to do the work to nurse. The emancipation of nursing-power from its depots, where adequate treatment was presumablyavaildomestic shackles will be the first step towards true able ; but the damage had been done and the syndrome’ to which Major Wilkinson and Captain Burt refer had professional status. As a teacher of nurses, I applaud the scheme put already often been established. In the subsequent years some of these grave deficiencies, but perhaps not all, have forward by Miss Carter and Miss Pearce for the new training of professional nurses (Lancet, June 9. p. 737). doubtless been rectified. 2. The second cause is mainly psychological. Men in Its essentially practical character should re-embody in the nursing spirit that kindly, gentle, and capable the’ Services have done a magnificent job in this war, This plan comes back in a way no but the great majority long to return to their civil person we want. other has done to fundamental issues. The pre-hospital occupations and to their families from whom they hav et course of simple scientific and technical subjects, followed often been separated for long periods. Heaven forbid by two years’ hospital training and practice of basic the implication that these splendid fellows do not try to nursing procedures is sound reasoning. This is the second get well, but these factors sometimes create a subconscious psychological atmosphere which is inimical to step towards true status. The third step is recognition of the trained bedside complete recovery. Genuine malingering I believe to be nurse’s right to salary and conditions comparable with much less common than is sometimes supposed. "
complete health.
.
.
they
That
being
803
,
.
.
The results of removal of a semilunar cartilage in Service patients illustrate this point, for they are almost grotesquely at variance with those seen under normal peace-time conditions. Major Wilkinson and Captain Burt rightly emphasise this, and also the excellent results of removal of a semilunar cartilage in professional footballers. I may perhaps be permitted to mention that the player described by them who played in a practice game four weeks, and in the 1st division team six weeks, after operation was one of my operation cases. Such results are by no means exceptional, and to the best of my knowledge and belief no professional footballer in my personal series operated upon for an uncomplicated lesion of a semilunar cartilage has had to cease playing owing to persistent unsoundness of the knee. But the results in other followers of strenuous athletic pursuits and occupations are, as is well known (or was before the present wave of pessimism), equally gratifying. As an example of another strenuous occupation, that of the merchant seaman may be cited. With the kindness and cooperation of my colleagues at the Seamen’s Hospital, Greenwich, and other hospitals, it fell to my lot some years ago to remove the semilunar cartilage in a large number of seamen. A careful follow-up showed that an extremely high percentage were completely cured. Now follows a point which seems to me of great significance and importance. At about the same time, in my capacity as surgical specialist and visiting surgeon to a Ministry of Pensions hospital, I operated upon a large pensioners suffering from semiluna-cartilage number .of injuries, and in a similar follow-up found that the answers to the questionnaire, often checked by re-examination, were in many cases quite unreliable and valueless for statistical purposes. I came to this conclusion with reluctance, but no useful purpose is served considerable in concealing the facts. It is noteworthy that the professional footballer loves football, just as the merchant seaman usually enters the merchant service because he loves the sea. In both groups, an important factor is present which is often lacking in the Service patient-viz., a strong urge to resume their previous avocations at the earliest possible moment. In the case of the professional footballer, an additional and important cause of his early recovery is, as a rule, the excellent condition of his thigh muscles before operation, which renders unnecessary a long period of subsequent re-education.
London,
Wl.
A. G. TIMBRELL FISHER.
BLOOD IN THE EYE SiB,—In your annotation of March 24 (p. 349) you draw timely attention to the caution which should be exercised in the treatment of hyphaema, and you point out that atropine may not only increase the tension of the eye but also diminish the surface area of the iris which is available for absorption. There is also a third reason why atropine is dangerous in recent partial hyphaema. By dilating the pupil it is liable to reopen iris blood-vessels and cause further haemorrhage. Three cases have been noted in this theatre of war in which a small hyphaema, which would probably have disappeared in 48 hours, was converted into a total hyphaema after atropine had been used. In total hyphsema it is unlikely that atropine will be absorbed. The correct treatment for a recent severe hyphaema per se is to tie up both eyes and not to use drops which disturb the shape of the pupil in the early stages. B. W. RYCROFT, CMF. Adviser in Ophthalmology, AFHQ.
TUBERCULOSIS
SiR,—The letter to the Times from Lord Horder and Drs. Conybeare, Hope Gosse and Geoffrey Marshall, which you quote in your leading article of June 2, contains serious criticisms of the tuberculosis service which should not be accepted without further proof. It is the fashion nowadays for physicians not connected with tuberculosis schemes to talk about " backauthorities." The accusation may be justifiable ward in a small number of cases, but on the whole the service provided by local authorities for the treatment of tuberculosis compares very favourably . with that provided by voluntary organisations and institutions.
At present, as you, Sir, suggest, there are numerous difficulties with regard to nursing and domestic staff. There is also a serious shortage of experienced medical. personnel. This shortage would be aggravated by the establishment of a Ministry of Pensions or War Office institution for the treatment of pulmonary tuberculosis, and it is by no means certain that the service provided would be better than, or even as good as, that provided by the local authorities. A. P. FORD. Welwyn, Herts. " NAVAL DEMOBILISATION.—Will " Accidie please send his name and address (not for publication). Also if possible the text of the announcement to which he refers.
us
Obituary BISHOP HARMAN MANC., F R C S AFTER a long illness, Mr. Bishop Harman died on .June 13 at his home at Crockham Hill in Kent. He was a man of exceptional attainments who did much for ophthalmology and also gave his time and talents to the profession through the British Medical Association. His interest in his own specialty and in the good of the public found joint expression in his work to create the National Eye Service. A direct representative of the profession on the General Medical Council from 1929 until a few weeks ago, he showed himself logical and clear-sighted ; and in all relations of life he was respected as upright and unselfish. Son of W. J. Harman of Highgate, he was-born in 1869 and educated at the City of London School and St. John’s College, Cambridge, where he was a foundation scholar. He took a first in both parts of the natural sciences tripos and qualified from the Middlesex Hospital in 1898, taking his FRCS in the same year. From 1897 he was lecturer in anatomy at two Cambridge colleges, and after service as a civil surgeon in the South African war, when he wrote a thesis on veldt sore, he became university demonstrator and examiner in anatomy. At this time he was writing not only on such subjects as the outflow of visceral efferent, nerves in man, but also on the comparative anatomy of the oculomotor apparatus, and his thoughts increasingly turned to ophthalmology, both academic and practical. In 1901 he was elected ophthalmic surgeon at the Belgrave Hospital for Children and 1909 he joined the staff of the West London Hospital where he became vice-dean and, later, dean of the postgraduate college. He wrote much on ophthalmic subjects and to younger members of the profession he was known as editor for a time of Aidsto Ophthalmology. Meanwhile, in 1902, he had been appointed oculist to the London County Council blind schools, and had thus set his hand to a great task. "Bishop Harman’s chief contribution to ophthalmology," writes J. H. P., " is his pioneer work in the investigation of the, vision of school-children, and in the prevention or amelioration of their visual defects. In conjunction with the late Dr. James Kerr, and largely inspired by his early efforts in the same field, he examined thousands of children’s eyes in the LCC schools, and organised the routine examination with his conspicuous administrative skill. He was responsible for the segregation and special training of partially sighted children in schools which he rather unfortunately called ‘ myope ’ schools. He naturallv became very interested in the treatment of squints, and designed an instrument for the measurement of binocular defects which has been almost universally adopted. The treatment of visual defects under the National Insurance Act was largely organised, and carried through with considerable success, by his enthusiasm." The profession owes much to Harman’s efforts to educate people in the necessity for a medical eye exa.mination. A. C. recalls that " in the late twenties, when the Government was being urged to put the sight-testing opticians on’a special register and thus recognise them as a separate profession it was alleged, and with truth, that large sections of the public could not afford an examination by an ophthalmic specialist but were coii-ipelled to go either to a hospital or to a sight-testing optician. Harman was the founder and the active NATHANIEL .
M B
CAMB,
.
LLD