"THE SOCIAL PROBLEM GROUP"

33

ANNOTATIONS HONOURS THE list of honours issued on Jan. 1st contains but a small number of medical men, and is mainly composed, according to what is becoming a regular plan, of those who obtain recognition or advancement in the various Services, militant and civil. Medicine, however, welcomes a new peer, and Sir Thomas Horder will be acclaimed by his fellow-practitioners as a worthy recipient of the high honour. Alike as a great clinical physician, and as a vigorous and acute worker in fields of wide social interest, Sir Thomas has the personality needed for effective membership of the Upper House, and the well-merited distinction will surely receive further justification. Four members of the medical profession receive knighthoods, among them being Major-General Dick Megaw, the Director-General, I.M.S., and Dr. F. J. Willans, surgeon apothecary to H.M. Household at Sandringham. Dr. Charlotte Purnell, who is created O.B.E., is the devoted medical missionary, who has worked for 20 years in Palestine, and is now in charge of the Mission Station in Amman. We note with pleasure the knighthood awarded to Prof. F. T. G. Hobday, the Principal of the Royal Veterinary College, in the interests of which he has worked long and untiringly ; and many will appreciate, as we do, how well deserved was the same honour by Principal R. S. Rait, Vice-Chancellor of Glasgow University. Our readers will also approve highly of the bestowal of ’ the C.B.E. on Mrs. Alice Baker, a founder of the ’, Medical Research Institute, Melbourne ; Mr. Reginald Blunt, for half a century associated with the Cheyne Hospital for Children ; Mr. Peter Evans, an energetic worker in the cause of the blind ; and Prof. F. H. A. Marshall, director of the Institute of Animal Nutrition at Cambridge and an authority on sexual physiology. A detailed list of recipients is published on another page, to all of whom we otier congratulations on the public acknowledgment of their merits. THE

NEW YEAR

RECTAL OR VAGINAL EXAMINATION IN LABOUR THE examination of patients by the rectum during labour was recommended by Reis and Kronig in 1893, in the hope that the avoidance of vaginal examination might diminish the incidence of puerperal sepsis. The method has been widely used but has not met with general approval, and it is doubtful whether it has any advantage other than saving the trouble of washing the hands. H. W. Mayes has analysedthe results of rectal and vaginal examinations in 3884 cases at the Methodist Episcopal Hospital in Brooklyn. He found that the morbidityrate among those patients who were examined per vaginam was about 1 per cent. higher than the morbidity-rate of those who were examined only per rectum. In 1947 cases examined by the rectum alone the morbidity-rate was 5-08 per cent. Rectal examination therefore does not abolish the danger of puerperal infection, and the higher rate following vaginal examination is accounted for by the fact that the parturient woman was examined by this route in all cases of difficult or prolonged labour. Of several objections to the routine adoption of rectal examination the most important is its inaccuracy. Dr. Mayes states that a 10 per cent. error is generally admitted for those with experience, and he suggests that the prevailing high stillbirth-rate may be due 1 Surg., Gyn., and Obst., December, 1932, p. 771.

in

part

to the fact that abnormal conditions

are

not

in time by rectal examination. The student in fact finds it hard enough to make a diagnosis by vaginal examination and would, one fears, learn nothing if he were to examine his quota of 20 cases by the rectum instead. Before a man is sure of his rectal findings, Dr. Mayes remarks, he must follow at least 100 patients through labour. It should also be borne in mind that the posterior vaginal wall which is forced into the cervix during rectal examination cannot be considered much more sterile than the examiner’s finger. Moreover, the rectal mucous membrane may be injured and pathogenic organisms escape into the tissues of the recto-vaginal septum. When the finger is withdrawn the perineum is left contaminated. The question is bound up with that of vaginal antisepsis which is

recognised

yet settled. In this country bacteriologists tell that it is impossible to sterilise the vaginal wall, and most obstetricians think that the introduction of antiseptics into the vagina gives no better results than the customary swabbing of the vulva. Dr. Mayes advises the injection of mercurochrome, and thinks that by its means it is possible to sterilise the vagina. To one holding this view vaginal examination becomes a safe procedure, and he therefore recommends the abandonment of rectal examination during labour. not us

"THE SOCIAL PROBLEM GROUP" AT the conference of the Central Association for Mental Welfare held last month in London, Mr. E. J. Lidbetter read a paper upon the Value of Family Histories in the Study of the Inheritance of Mental Defect. For the last 25 years he has been conducting an inquiry into the relation between heredity and social inadequacy in an East London area, his procedure having been to prepare elaborate family pedigrees of persons admitted into the poor-law institution of that area. This investigation has now attained comprehensive proportions, and he was able to show the meeting a few of his charted pedigrees. The following are among the chief conclusions reached : that a conspicuously large, number of mentally defective children are born in families containing a record of certifiable insanity ; that the families studied have a much larger fertility-rate and, as a result of the improvement of their conditions in recent years, a larger survival-rate than any other social element in the community; and that the principle of assortative mating clearly holds in the families he has studied. This last observation Mr. Lidbetter regards as eugenically encouraging. His evidence suggests that families containing defective, "sub-cultural," and mentally backward persons which, in aggregate, have been referred to by the Wood Committee as comprising the social problem group, are closely intermingled and overlap ; Mid that they preserve their characteristics from generation to generation, and probably do not often, by intermarriage, vitiate good stocks or derive survival strength from out-breeding with such stocks. Mr. Lidbetter’s inquiries, conducted over a long period of years in a restricted urban area, confirm the findings of the much more comprehensive though less intensive survey conducted by Dr. E. O. Lewis These findings and described in the Wood report. raise biological problems of the first importance. To what extent are the various manifestations of

LONDON’S

34

UNIVERSITY CENTRE

social inadequacy evinced by the social problem group the product, on the one hand, of inborn and hereditary factors, or on the other, of such extrinsic influences as are constituted by the insanitary environment of a slum district, the bad family tradition, and subversive parental example which too often exist among themThe remedies adopted by social reformers will clearly depend on the answer to this question. In concluding his address, Mr. Lidbetter stressed the need of a comprehensive and impartial investigation, carried out under proper authority and by competent persons, and planned so as to supplement such local investigations as those now being carried out by Mr. Caradog Jones, of the department of social science at Liverpool University, and the Eugenics Society. The latter has devised a questionnaire which has the object of reversing the procedure followed by Dr. Lewis. The latter, starting from a specific investigation into mental defectiveness, was led to recognise the importance of a social problem group, largely composed of subnormal though not certifiably defective persons, who are the main procreators of mental defectiveness. The inquiry of the Eugenics Society, starting from a special manifestation of social inadequacy-in this case the continuous receipt of poor-law relief for two years or longerseeks to ascertain whether the incidence of mental defectives in such families is higher than the average familial incidence obtaining in the community at large. It will be difficult to imagine an investigation of greater social importance than that proposed by Mr. Lidbetter. If the conception of a "social problem group" is justified, and if it has the characteristics which have been described, it is clearly a matter of national urgency that the fertility of its constituent members be limited by any reasonable methods that do not involve compulsion or injustice. In view of the high fertility-rate which all observers have noted as characterising the group, it would appear that if measures designed with this end are not soon adopted, seeds may be sown which, several generations hence,will germinate with disastrous social consequences.

found after 24 or 48 hours. The precise details of the necrosis varied a good deal in different cases ; the damage was sometimes central, while in others it had no particular lobular distribution ; extensive fatty change might be present or absent; and in one animal considerable portal thrombosis was found. The destruction was in some instances enough to cause death ; a pregnant cat had five half-minute " fits," and was killed moribund 18 hours later. Other abdominal organs were not affected, though small hsemorrhages were sometimes found in the lungs and brain. Dr. Theobald draws the obvious conclusion that it is of the greatest importance to prevent the onset or limit the number of eclamptic convulsions. are

LONDON’S UNIVERSITY CENTRE

ON Dec. 29th the first excavations were made on the site of the new University of London buildings to the north of the British Museum. The history of this great project has already been outlined in our columnsand we printed more recently2 a reproduc. tion of one aspect of Mr. Charles Holden’s model. large holes have now been cut at points which mark the

I Four

corners

of the

proposed Senate

House and administ r a ti v e block. The object of this survey is to discover the character of the subI, soil ; the southern part of the site will be THE LIVER IN ECLAMPSIA excavated at once, and the formal laying of the DEGENERATION of liver cells is present in all or foundation-stone is planned for the early summer. nearly all fatal cases of eclampsia, though only about The new centre will cover 10! acres and be half of them show the nbrino-haemorrhagic necroses bounded, roughly, by Russell-square and Montaguewhich are characteristic of the disease in the sense street on the east, Malet-street on the west, Byngthat they are never seen in its absence. But how the place on the north, and the British Museum on liver changes are produced has never been satisfac- the south; its main part includes what was The main group of buildings torily determined, despite a great deal of investigation, Torrington-square. mostly along biochemical lines. Dr. G. W. Theobald,l is to occupy the centre, and open spaces roughly working at University College, now produces an equal to those which at present exist are to be left attractively simple mechanical explanation. He along the east and west frontages. The arrangement thinks that the lesions are due to increased intra- will greatly reduce traffic noise and vibration and abdominal pressure-i.e., that they are the result allow generous parking accommodation for cars rather than the cause of the convulsions. He supports near each department. The Woburn-square frontage his thesis with some striking experiments on dogs and will be occupied by a private garden with a covered cats. The animal has its belly tightened up somewhat walk. As Mr. Holden points out, this type of plan by the injection of about a litre of bland liquid into offers great possibilities for a composition of the masses the peritoneal cavity. Binders are then placed round into one great whole which will be impressive even while the abdomen and drawn tight, by which manoeuvre still incomplete. The group will be dominated by the intra-abdominal pressure is raised to 80-100 em. a tower, and the whole centre will be so placed as to of salt solution. Maintained for two minutes, this appear with quiet insistence from each of the main constitutes an imitation "fit." By this means, arteries in the neighbourhood-Tottenham Courtsevere and extensive necrosis of liver is produced in road, Gower-street, Malet-street, and Southamptonnearly all animals, and as the liver is sensitive to row. The composition of the buildings will be seen changes in its blood-supply and autolyses quickly, to its best advantage from Russell-square. Mr. quite obvious alterations, naked eye and microscopical, Holden’s object has been to express the plan naturally ____

1 Jour. Path. and Bact., 1932, xxxv., 843.

1 THE LANCET, 1931, i., 1303.

2 Ibid., 1932, ii., 32.