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MAGISTRATES IN THE NEW JUVENILE COURTS
1048
Having freely exposed the joint, he found that its capsule was detached from the whole of the lower half of the circumference of the glenoid cavity. The periosteum had been displaced with the capsule, being detached from the anterior surface of the neck of the scapula. Not only was the articular cartilage of the glenoid cavity missing, but its bony margins were also worn down. The discovery of this condition suggested a bone graft which, inserted into the periosteal pocket formed by the chronic state of dislocation, would, by forming a new bony margin to the glenoid cavity, deepen it and thus facilitate
the retention of the head of the humerus within it. Should the periosteal pocket not have been created by previous dislocations, it can be artificially made at the time of the operation by the detachment of periosteum from the anterior surface of the neck of the scapula. The bone graft is taken from the crest of the ilium. The operation is followed by an immobilisation of the arm in a scarf for a fortnight, at the end of which the patient is allowed up. After three weeks he makes movements of his arm in various directions only in so far as they cause no pain and encounter no obstruction. Six weeks after the operation he can usually raise his arm to the level of his shoulder, and put his hand on his forehead, nape of his neck, and back. At this stage he begins energetic, systematic exercises, which three months after the operation restore him to a complete capacity for work, even hard work. In the two cases in which the operation did not completely restore full working capacity it was partially vitiated by a local infection in the one case, in association with an attack of influenza, and by a fracture of the glenoid cavity with displacement of the bony fragment in the other. OLD MICROSCOPES
Mr. R. A. Clay, D.Sc., and Mr. T. H. Court have compiled from original instruments and documents a History of the Microscope 1 up to the introduction of the achromatic lens. To the busy worker with the microscope, concerned more with the practical application of its disclosures, a volume such as this might not have an immediate appeal. The fact too that it deals with an early period, before the evolution of the achromatic microscope on which present-day work entirely depends, might still further tend to reduce his interest. And yet many who have even the slightest acquaintance with the mechanics and optics of the microscope can hardly fail to find here much that is fascinating even apart from its historic value. The writers are acknowledged authorities on the history of what is still the most important optical instrument. They have compiled with meticulous care and with great accuracy an account of such early microscopes, whether in this or in other countries, as may be necessary to unfold the story of its early evolutionary period. The information so gathered together is based upon examination of the instruments themselves ; most of the examples described are to be found in the Science Museum at South Kensington or in the collection of the Royal Microscopical Society now being exhibited at B.M.A. House. Among living collectors Mr. Court holds a foremost place. Not only has he devoted many years to the gathering together of historical optical instruments and documents relating thereto, but he acquired many of the gems in the unrivalled collection of the late Sir Frank Crisp when its disposal at auction took place in 1925. Many points in early design and construction are suggestive of present-day practice, 1 London : Charles Griffin and Co., Ltd. 30s.
illustrations.
Pp. 266.
With 164
and the story may be commended to all who desire to know what is worth learning of a period when mechanical improvements were rapid but optical developments were awaiting disclosure of still
unsuspected physical principles. Craftmanship was at a high level, particularly in this country which had
such masters as Chippendale, and the influence of skilled workmanship is seen in the body-tubes of some of the microscopes described and even in the The book is fully cases which contained them. illustrated from photographs. MAGISTRATES IN THE NEW JUVENILE COURTS ONE of the provisions of the new Children and Young Persons Act is to set up juvenile courts under the care of justices chosen by panels of the bench of each area. These tribunals will have a delicate task, and the problems they will have to solve were the main subject of discussion at the conference of the Magistrates’ Association held in London last week. As Lord Feversham pointed out, juvenile crime is likely to increase for a number of years with the increase in the number of children leaving school. The causes are numerous : unemployment is perhaps the chief, but another, as Mrs. C. D. Rackham suggested, is the fact that large numbers of boys and girls go straight into unregulated employment at 14, and are not eligible for national
health or unemployment insurance benefits until two years later. Even if they pass into the factory or the shop the legislation that protects them is inadequate and out of date ; it allows them to work for 60 and 72 hours a week respectively, with no medical attention. She considers that the overwork, strain, and lack of leisure and interest to which many young persons are subjected are a fruitful source of crime. The magistrates of the juvenile court, if they are to do their work properly, must be familiar with these and other predisposing causes of adolescent wrong-doing. At the same time when one reads1 that in Manchester, for example, there will be 46 magistrates on the panel and that each of them will only do three days’ duty a week for three weeks in the year, it is hard to see how they are going to acquire much skill through actual practice. Recognising the importance of the new opportunity, the Magistrates’ Association invited Dr. R. D. Gillespie and Dr. Helen Boyle to address them. Dr. Gillespie explained the scope and aims of the scientific method, and Dr. Helen Boyle pointed out the defect of the new Act in not sufficiently providing for psychological examination of the delinquent. Only five lines of the Home Office circular,2 she said, dealt with medical examination, and she appealed to the magistrate, as the captain of the ship, to use the psychiatrist as his navigator in the rock-strewn seas. The subsequent discussion was illuminating as showing the views which magistrates of practical experience and conscientious sympathy with the medical side have formed. Mrs. P. E. Cusden, of Reading, pleaded for more use of the temporary provisions of the Mental Treatment Act, and a member of the Worthing bench spoke highly of the value of the local out-patient clinic for mental disease. Mr. Claud Mullins asked the psychiatrists to assure him that he could obtain effective treatment for any offender whom he considered to need it. The psychiatrists, he said, confined themselves almost entirely to diagnosis and were silent about treatment and results. In the two years he has been on the bench he has found his instincts entirely opposed to imprisoning 1 Manchester Guardian, Oct. 28th, p. 13. 2 See THE LANCET, Sept. 23rd, p. 711.
1049 certain types of sexual offenders, such as exhibitionists .and homosexuals, but having no sure prospect of
them away to get cured he has been forced to continue to sentence them to prison. Dr. Gillespie, in reply, said that treatment was long and costly,
,sending
and was hindered chiefly by economic considerations. The Institute of Medical Psychology, he explained, had 1 paid whole-time officer and 11I voluntary assistants who could spare only a part of their time. RADIUM AT THE CENTRES
THE report of the Medical Research Council on medical uses of radium, summarising the work of the research centres in 1932,1 shows, in spite of the .scarcity of money, substantial advances in many fields. The centres are sending in less information
.concerning new developments in radiotherapeutic technique, for much of the ground has been sufficiently On the other hand, statistical information has gained in value, as it now covers a large enough number of years to allow conclusions to be drawn with some certainty. More experimental work in radiology is being done than has ever been undertaken before. There have been several additions to the research centres, and the allocation of radium to the council by the Radium Commission has given a great stimulus to general research into the action of radium - on normal and malignant tissues. As larger quantities of radium become available for application externally, the tolerance of the skin becomes more .and more important, for this factor limits the dose which may be given by any one port of entry. The report mentions several papers which seem to show that skin tolerance does not entirely depend on the time over which a dose is fractioned but also varies with the region of the body which it covers and with its own blood-supply. The new observations may, suggests the report, be very significant if they tend to cast doubt on the reliability as a unit of the skin ,erythema dose. For instance, observations in the Manchester Royal Infirmary and Holt Radium Institute seem to indicate that the skin of the scalp is about 50 per cent. more tolerant than the skin of other regions, these being grouped as if they all reacted in the same degree. Dr. J. C. Mottram has shown, in a communication to the Council, that regions with a depleted blood-supply react less than normal areas and that the skin of the face is more sensitive than that of the neck. If the skin is in any way a typical organ of the body, suggests the report, similar differences may be discovered in other organs and tissues, and the reaction to irradiation of a patient suffering from malignant disease may be proved to be not simply a question of the direct action upon the tumour but also of the general physiological response of the individual. These developments bear out the recent work of Dr. B. D. Pullinger on the indirect action of radium in affecting the blood-supply to a malignant growth. The advantage of spreading the dose over a long period is being more and more recognised by radiologists, and the Radium Institute, which has just issued its annual report for 1932, has recently brought all its radium apparatus under review. Many of the tubes and applicators of high content have been dismantled and smaller units have been constructed. The flat applicators now fall into two groups : "full strength " containing 5 mg. and " half strength" containing 2.5 mg. of radium element per square centimetre. They are all square or rectangular, these
.covered.
1 Special Report Series No. 186. 1933. Pp. 36. 1s.
Office.
London: H.M. Stationery
shapes being more convenient for the treatment of certain surface lesions. Applicators of higher content The can be made up out of the smaller units. Institute has modified its technique for treatment of carcinoma of the cervix, and is well satisfied with the results which have so far been obtained. Intrauterine and vaginal applications are still combined and the former have not been changed, but by increasing the secondary screening of the vaginal applicators from 1 mm. to 5 mm. it has been found possible to increase the dose without infringing the limits of tissue tolerance. Vulcanite or bakelite is now used instead of para rubber ; the applicators are spheroidal or cylindrical with rounded ends, so that the pressure on the vaginal walls is more even. This arrangement will probably obviate the severe immediate reaction and delayed radium necrosis which used to occur in some cases where there was not sufficient room in the fornices for the lead tubes which were then inserted. The secondary screening was of rubber, but undue pressure from the ends was doubtless a predisposing cause. The activity of the applicators has been increased from 10 mg. of radium to 15 millicuries of radon ; the primary screening is 1-5 mm. of platinum as before. The applicators are inserted under a general anaesthetic and left in position for 48 hours ; another 48 hours later a vaginal application is made with the patient in the knee-chest position under the influence of scopolamine and omnopon. A week after the first combined application another is given. The total dose is 2880 mg. hrs. in the uterus and the equivalent of 5500 to 7300 mg. hrs. in the vagina, depending on whether three or four capsules are used. The old dosage in the vagina was 5040 mg. hrs. The new dosage has not caused local damage or any abnormal irritation of the rectum. The radon is to be replaced by radium as soon as more radium is available. The results of the new technique will be awaited with interest. Although the development of technique has tended to slacken, there is still, it seems, room for ingenuity in rectal carcinoma. Although for many years growths in this site have been looked upon as hopeless or radio-resistant, some have responded well, and the Council sees indications that, with greater experience and better understanding of the dosage, treatment is becoming more effective. Its tables show 2 cases out of 8 surviving from 1926, 5 out of 31 surviving from 1928, and 4 out of 37 surviving from 1929. On the other hand, the five- and four-year survival figures from the Institute are negligible. The results from different clinics vary considerably, the best being from St. Bartholomew’s, and this variation suggests that close study would produce interesting and helpful data. ULTRAFILTRATION IN BACTERIOLOGY FILTRATION has long been an integral part of bacteriological technique. Its uses-the separation of bacteria from their toxins, the sterilisation of fluids, and the separation of filtrable viruses from the ordinary bacteria-are well known. But the ordinary bacterial filters, even at their best, are unsatisfactory for some of these purposes. Especially is this so in the filtration and separation of filtrable viruses, where loss by adsorption and the inability to produce a closely graded series of efficient filters of varying porosity, has set a limit to their usefulness. This has led to the adaptation of collodion filters to bacteriological research-the so-called technique of ultrafiltration-and their use is extolled in a paper by R. Le Guyon.I He illustrates the value of ultra1 Ann. de l’Inst.
Pasteur, 1933, li., 377.
Having freely exposed the joint, he found that its capsule was detached from the whole of the lower half of the circumference of the glenoid cavity. The periosteum had been displaced with the capsule, being detached from the anterior surface of the neck of the scapula. Not only was the articular cartilage of the glenoid cavity missing, but its bony margins were also worn down. The discovery of this condition suggested a bone graft which, inserted into the periosteal pocket formed by the chronic state of dislocation, would, by forming a new bony margin to the glenoid cavity, deepen it and thus facilitate
the retention of the head of the humerus within it. Should the periosteal pocket not have been created by previous dislocations, it can be artificially made at the time of the operation by the detachment of periosteum from the anterior surface of the neck of the scapula. The bone graft is taken from the crest of the ilium. The operation is followed by an immobilisation of the arm in a scarf for a fortnight, at the end of which the patient is allowed up. After three weeks he makes movements of his arm in various directions only in so far as they cause no pain and encounter no obstruction. Six weeks after the operation he can usually raise his arm to the level of his shoulder, and put his hand on his forehead, nape of his neck, and back. At this stage he begins energetic, systematic exercises, which three months after the operation restore him to a complete capacity for work, even hard work. In the two cases in which the operation did not completely restore full working capacity it was partially vitiated by a local infection in the one case, in association with an attack of influenza, and by a fracture of the glenoid cavity with displacement of the bony fragment in the other. OLD MICROSCOPES
Mr. R. A. Clay, D.Sc., and Mr. T. H. Court have compiled from original instruments and documents a History of the Microscope 1 up to the introduction of the achromatic lens. To the busy worker with the microscope, concerned more with the practical application of its disclosures, a volume such as this might not have an immediate appeal. The fact too that it deals with an early period, before the evolution of the achromatic microscope on which present-day work entirely depends, might still further tend to reduce his interest. And yet many who have even the slightest acquaintance with the mechanics and optics of the microscope can hardly fail to find here much that is fascinating even apart from its historic value. The writers are acknowledged authorities on the history of what is still the most important optical instrument. They have compiled with meticulous care and with great accuracy an account of such early microscopes, whether in this or in other countries, as may be necessary to unfold the story of its early evolutionary period. The information so gathered together is based upon examination of the instruments themselves ; most of the examples described are to be found in the Science Museum at South Kensington or in the collection of the Royal Microscopical Society now being exhibited at B.M.A. House. Among living collectors Mr. Court holds a foremost place. Not only has he devoted many years to the gathering together of historical optical instruments and documents relating thereto, but he acquired many of the gems in the unrivalled collection of the late Sir Frank Crisp when its disposal at auction took place in 1925. Many points in early design and construction are suggestive of present-day practice, 1 London : Charles Griffin and Co., Ltd. 30s.
illustrations.
Pp. 266.
With 164
and the story may be commended to all who desire to know what is worth learning of a period when mechanical improvements were rapid but optical developments were awaiting disclosure of still
unsuspected physical principles. Craftmanship was at a high level, particularly in this country which had
such masters as Chippendale, and the influence of skilled workmanship is seen in the body-tubes of some of the microscopes described and even in the The book is fully cases which contained them. illustrated from photographs. MAGISTRATES IN THE NEW JUVENILE COURTS ONE of the provisions of the new Children and Young Persons Act is to set up juvenile courts under the care of justices chosen by panels of the bench of each area. These tribunals will have a delicate task, and the problems they will have to solve were the main subject of discussion at the conference of the Magistrates’ Association held in London last week. As Lord Feversham pointed out, juvenile crime is likely to increase for a number of years with the increase in the number of children leaving school. The causes are numerous : unemployment is perhaps the chief, but another, as Mrs. C. D. Rackham suggested, is the fact that large numbers of boys and girls go straight into unregulated employment at 14, and are not eligible for national
health or unemployment insurance benefits until two years later. Even if they pass into the factory or the shop the legislation that protects them is inadequate and out of date ; it allows them to work for 60 and 72 hours a week respectively, with no medical attention. She considers that the overwork, strain, and lack of leisure and interest to which many young persons are subjected are a fruitful source of crime. The magistrates of the juvenile court, if they are to do their work properly, must be familiar with these and other predisposing causes of adolescent wrong-doing. At the same time when one reads1 that in Manchester, for example, there will be 46 magistrates on the panel and that each of them will only do three days’ duty a week for three weeks in the year, it is hard to see how they are going to acquire much skill through actual practice. Recognising the importance of the new opportunity, the Magistrates’ Association invited Dr. R. D. Gillespie and Dr. Helen Boyle to address them. Dr. Gillespie explained the scope and aims of the scientific method, and Dr. Helen Boyle pointed out the defect of the new Act in not sufficiently providing for psychological examination of the delinquent. Only five lines of the Home Office circular,2 she said, dealt with medical examination, and she appealed to the magistrate, as the captain of the ship, to use the psychiatrist as his navigator in the rock-strewn seas. The subsequent discussion was illuminating as showing the views which magistrates of practical experience and conscientious sympathy with the medical side have formed. Mrs. P. E. Cusden, of Reading, pleaded for more use of the temporary provisions of the Mental Treatment Act, and a member of the Worthing bench spoke highly of the value of the local out-patient clinic for mental disease. Mr. Claud Mullins asked the psychiatrists to assure him that he could obtain effective treatment for any offender whom he considered to need it. The psychiatrists, he said, confined themselves almost entirely to diagnosis and were silent about treatment and results. In the two years he has been on the bench he has found his instincts entirely opposed to imprisoning 1 Manchester Guardian, Oct. 28th, p. 13. 2 See THE LANCET, Sept. 23rd, p. 711.
1049 certain types of sexual offenders, such as exhibitionists .and homosexuals, but having no sure prospect of
them away to get cured he has been forced to continue to sentence them to prison. Dr. Gillespie, in reply, said that treatment was long and costly,
,sending
and was hindered chiefly by economic considerations. The Institute of Medical Psychology, he explained, had 1 paid whole-time officer and 11I voluntary assistants who could spare only a part of their time. RADIUM AT THE CENTRES
THE report of the Medical Research Council on medical uses of radium, summarising the work of the research centres in 1932,1 shows, in spite of the .scarcity of money, substantial advances in many fields. The centres are sending in less information
.concerning new developments in radiotherapeutic technique, for much of the ground has been sufficiently On the other hand, statistical information has gained in value, as it now covers a large enough number of years to allow conclusions to be drawn with some certainty. More experimental work in radiology is being done than has ever been undertaken before. There have been several additions to the research centres, and the allocation of radium to the council by the Radium Commission has given a great stimulus to general research into the action of radium - on normal and malignant tissues. As larger quantities of radium become available for application externally, the tolerance of the skin becomes more .and more important, for this factor limits the dose which may be given by any one port of entry. The report mentions several papers which seem to show that skin tolerance does not entirely depend on the time over which a dose is fractioned but also varies with the region of the body which it covers and with its own blood-supply. The new observations may, suggests the report, be very significant if they tend to cast doubt on the reliability as a unit of the skin ,erythema dose. For instance, observations in the Manchester Royal Infirmary and Holt Radium Institute seem to indicate that the skin of the scalp is about 50 per cent. more tolerant than the skin of other regions, these being grouped as if they all reacted in the same degree. Dr. J. C. Mottram has shown, in a communication to the Council, that regions with a depleted blood-supply react less than normal areas and that the skin of the face is more sensitive than that of the neck. If the skin is in any way a typical organ of the body, suggests the report, similar differences may be discovered in other organs and tissues, and the reaction to irradiation of a patient suffering from malignant disease may be proved to be not simply a question of the direct action upon the tumour but also of the general physiological response of the individual. These developments bear out the recent work of Dr. B. D. Pullinger on the indirect action of radium in affecting the blood-supply to a malignant growth. The advantage of spreading the dose over a long period is being more and more recognised by radiologists, and the Radium Institute, which has just issued its annual report for 1932, has recently brought all its radium apparatus under review. Many of the tubes and applicators of high content have been dismantled and smaller units have been constructed. The flat applicators now fall into two groups : "full strength " containing 5 mg. and " half strength" containing 2.5 mg. of radium element per square centimetre. They are all square or rectangular, these
.covered.
1 Special Report Series No. 186. 1933. Pp. 36. 1s.
Office.
London: H.M. Stationery
shapes being more convenient for the treatment of certain surface lesions. Applicators of higher content The can be made up out of the smaller units. Institute has modified its technique for treatment of carcinoma of the cervix, and is well satisfied with the results which have so far been obtained. Intrauterine and vaginal applications are still combined and the former have not been changed, but by increasing the secondary screening of the vaginal applicators from 1 mm. to 5 mm. it has been found possible to increase the dose without infringing the limits of tissue tolerance. Vulcanite or bakelite is now used instead of para rubber ; the applicators are spheroidal or cylindrical with rounded ends, so that the pressure on the vaginal walls is more even. This arrangement will probably obviate the severe immediate reaction and delayed radium necrosis which used to occur in some cases where there was not sufficient room in the fornices for the lead tubes which were then inserted. The secondary screening was of rubber, but undue pressure from the ends was doubtless a predisposing cause. The activity of the applicators has been increased from 10 mg. of radium to 15 millicuries of radon ; the primary screening is 1-5 mm. of platinum as before. The applicators are inserted under a general anaesthetic and left in position for 48 hours ; another 48 hours later a vaginal application is made with the patient in the knee-chest position under the influence of scopolamine and omnopon. A week after the first combined application another is given. The total dose is 2880 mg. hrs. in the uterus and the equivalent of 5500 to 7300 mg. hrs. in the vagina, depending on whether three or four capsules are used. The old dosage in the vagina was 5040 mg. hrs. The new dosage has not caused local damage or any abnormal irritation of the rectum. The radon is to be replaced by radium as soon as more radium is available. The results of the new technique will be awaited with interest. Although the development of technique has tended to slacken, there is still, it seems, room for ingenuity in rectal carcinoma. Although for many years growths in this site have been looked upon as hopeless or radio-resistant, some have responded well, and the Council sees indications that, with greater experience and better understanding of the dosage, treatment is becoming more effective. Its tables show 2 cases out of 8 surviving from 1926, 5 out of 31 surviving from 1928, and 4 out of 37 surviving from 1929. On the other hand, the five- and four-year survival figures from the Institute are negligible. The results from different clinics vary considerably, the best being from St. Bartholomew’s, and this variation suggests that close study would produce interesting and helpful data. ULTRAFILTRATION IN BACTERIOLOGY FILTRATION has long been an integral part of bacteriological technique. Its uses-the separation of bacteria from their toxins, the sterilisation of fluids, and the separation of filtrable viruses from the ordinary bacteria-are well known. But the ordinary bacterial filters, even at their best, are unsatisfactory for some of these purposes. Especially is this so in the filtration and separation of filtrable viruses, where loss by adsorption and the inability to produce a closely graded series of efficient filters of varying porosity, has set a limit to their usefulness. This has led to the adaptation of collodion filters to bacteriological research-the so-called technique of ultrafiltration-and their use is extolled in a paper by R. Le Guyon.I He illustrates the value of ultra1 Ann. de l’Inst.
Pasteur, 1933, li., 377.