- Email: [email protected]
SENDING CHILDREN OVERSEAS
84 National Institute of Health, Washington, D.C.. and he agreed that " the process is not inconsistent with tulareemic foci in the second month of a non-fatal illness." Some months later Dr. Kuno Burgi of Switzerland wrote to me to say that histological changes similar to those we described were to be found in the livers of animals soon after infection with fluke (Fasc’iola hepatica) and that he believed that was the true explanation of our cases. I am convinced that Dr. Burgi was right and that our cases had nothing to do with tularaemia. Since that time I have collected evidence that fluke infection of men is not nearly so rare in this country as is generally believed. A. P. THOMSON. THOMSOX. Edgbaston, Birmingham. CRIMINOLOGY APPLIED TO TOTAL WAR
SIR,-The other day I listened to the story of an unfortunate refugee colleague who had been maltreated for several months in Nazi concentration camps before he came to this country. His narrative was not less moving because it was a repetition of all these revolting bestialities one has so often heard and read of before ; but for the one difference that it gave some glimpses into psychology of Hitler’s hangmen. Some of it should be known here before they are to descend on us as parachutists or other shock troops. I was interested to learn how Nazi organisation has succeeded in finding the right type of persons for tormenting defenceless Jews. From the experiences of this Austrian doctor the jailers were undoubtedly criminals taken out of prisons, and correcting houses, convicts who were promised alleviation of their long sentences if they wreaked their brutality on their victims. There is little doubt that similarly special personality types have been chosen for forming the famous Nazi shock troops and who by threat, extortion and reckless brutalitv have to overcome the resistance and morale of the civilian population, as they did so successfully in Norway. Holland, Belgium and France. One has to remember that there is no private life under Nazi rule and that the mental make-up of every man is just as well known and in -the files of the party machine as his lists of convictions and his propensities. Thus it is relatively easy to collect groups of ruthless psychopaths, cold-blooded blackguards and murderers, and givethem suitable tasks like deception by disguise, house-breaking, cutting communications, brutalising women and children, and all the cunning ruses applied in front and behind the They have been carefully trained fighting army proper. for this kind of .. modern warfare " but-what is more important-thev have been taken from the dregs of the people and nobody cares what happens to them, least of all their Nazi despots. This is, of course, only one of many examples of psychology and criminology applied to total war by our enemies for their selection of man power." It seems worth knowing in order to deal with this part of invasion in the appropriate manner. PSYCHIATRIST. "
DETECTION OF TUBERCULOSIS IN RECRUITS SIR,-The recommendations of the Horder Committee, outlined in your issue of July 6 (p. 28), support the value of mass radiological examinations in the detection of pulmonary tuberculosis in recruits. Of the available methods for such examinations-full-size radiograms, the use of sensitised paper instead of X-ray film, fluoroscopy and miniature screen photography-the last, a recent technical development, is known to be a rapid, reliable and an economic proposition. Unfortunately the committee have found that it is not, for various reasons, practical at the present time. I have for some time been interested in a case-finding programme in the industrial community, the aims and purposes of which have been specially directed towards the finding of significant pulmonary lesions in a large group of presumably healthy individuals. In such mass surveys refined diagnostic procedure may not be initially required and the two principal methods have been (a) tuberculin testing and (b) mass X-rayexamination of the chest. The latter has been found to be the best known single means of detecting such lesions. Failing miniature screen photography, I have found that fluoroscopy is the most economic and practicable method for mass examinations. Any doubtful macroscopic
can be readily detected and if necessary photographed, and the financial saving in films is considerable. In an investigation of 3229 X-ray screen examinations, compared with an equal number of films taken for purposes of control, the interpretation in 94% of cases has coincided exactly with the interpretation of the film. While, therefore, the fluoroscopic method is not foolproof it can, in the hands of an experienced observer, be a practical substitute for X-ray miniature screen photography until such time as the necessary apparatus is generally available. As emphasised by Ordway and
lesion
Fellows of the
Metropolitan
Life
Insurance
Co.
of
America, routine fluoroscopy is accurate, inexpensive, minimal lung lesions and is an efficient selector of cases for rontgenography. Finally may I suggest that in suspected cases of pulmonary tuberculosis medical boards might with advantage make full use of Trudeau’s five diagnostic criteria : (1) Tubercle bacilli in the sputum on more than one examination; (2) Persistent rales at one apex; (3) Radiological evidence of infiltration of the lung parenchyma ; (4) History of frank haemoptysis of more than 1 drachm ; (5) History of pleurisy with effusion. At least two of these should be present before the diagnosis of pulmonary tuberculosis is justifiable with the exception of (1), which, in peace-time at any rate, is alone pathognomonic. In war-time, however, experience has shown that malingerers may manage to secure tuberculous sputum and try to pass it as their own; hence the presence of two criteria should be demanded. PHILIP ELLMAN. ELLMAX. Wimpole Street, W.I.
expeditious, selects
SENDING CHILDREN OVERSEAS
SIR,-The general advantages of evacuating schoolchildren to the Dominions need no further stressing, but I would draw attention to one which especially concerns those of us in the Public Health Service, namely the removal of such children from households where there is open tuberculous infection. I have found at my dispensaries that a large proportion of parents had yet to make a decision about evacuation, and tuberculosis officers with their dispensary organisation could play a prominent part in persuading parents in such households to take advantage of the scheme. This could be accomplished not only by personal contact but also by circularising homes where children were exposed to infection. In addition, medical superintendents of sanatoria could take steps to point out the benefits of the plan to patients in their care, whilst the family practitioner might assist undecided parents in those households having no contact with the tuberculosis service. A time like the present, when the risk of infection is increased by close congregation in air-raid shelters and by a lowered resistance due to general strain, calls for an energetic appreciation of the possibilities of the scheme in reducing the incidence of tuberculous infection in our young population. A. CAPES. Mount Sanatorium, Bishopstoke, Hants.
PLENTY of books
are
available
on
the diet of the soli-
tary child, but group feeding of a number of small children presents special problems, and these are confidently tackled by Margery Abrahams, dietitian to St. Bartholomew’s Hospital, in her pamphlet, 11 Nursery School Diet" (London : Nursery School Association, pp. 40, 6d.). In its second edition she has brought the text up to date, and talks sensibly about her subject, giving the composition of essential foods, menus for nursery schools and recipes showing quantities for groups of children. A few of her statements are unquantitative ; for example, writing of inorganic salts and vitamins, she says : " Some of these dissolve into the water in which they are cooked, and therefore vegetable water used as a stock for soup and stew gravy in which vegetables have been cooked have a special value " ; and again, brown bread, for instance, should be used as well as white because of the larger amount of calcium, iron and phosphorus it contains..." Statements of this kind give an exaggerated idea of the quantities involved and But these are minor blemishes may mislead the layman. in an otherwise excellent and welcome pamphlet. "
"
SIR,-The other day I listened to the story of an unfortunate refugee colleague who had been maltreated for several months in Nazi concentration camps before he came to this country. His narrative was not less moving because it was a repetition of all these revolting bestialities one has so often heard and read of before ; but for the one difference that it gave some glimpses into psychology of Hitler’s hangmen. Some of it should be known here before they are to descend on us as parachutists or other shock troops. I was interested to learn how Nazi organisation has succeeded in finding the right type of persons for tormenting defenceless Jews. From the experiences of this Austrian doctor the jailers were undoubtedly criminals taken out of prisons, and correcting houses, convicts who were promised alleviation of their long sentences if they wreaked their brutality on their victims. There is little doubt that similarly special personality types have been chosen for forming the famous Nazi shock troops and who by threat, extortion and reckless brutalitv have to overcome the resistance and morale of the civilian population, as they did so successfully in Norway. Holland, Belgium and France. One has to remember that there is no private life under Nazi rule and that the mental make-up of every man is just as well known and in -the files of the party machine as his lists of convictions and his propensities. Thus it is relatively easy to collect groups of ruthless psychopaths, cold-blooded blackguards and murderers, and givethem suitable tasks like deception by disguise, house-breaking, cutting communications, brutalising women and children, and all the cunning ruses applied in front and behind the They have been carefully trained fighting army proper. for this kind of .. modern warfare " but-what is more important-thev have been taken from the dregs of the people and nobody cares what happens to them, least of all their Nazi despots. This is, of course, only one of many examples of psychology and criminology applied to total war by our enemies for their selection of man power." It seems worth knowing in order to deal with this part of invasion in the appropriate manner. PSYCHIATRIST. "
DETECTION OF TUBERCULOSIS IN RECRUITS SIR,-The recommendations of the Horder Committee, outlined in your issue of July 6 (p. 28), support the value of mass radiological examinations in the detection of pulmonary tuberculosis in recruits. Of the available methods for such examinations-full-size radiograms, the use of sensitised paper instead of X-ray film, fluoroscopy and miniature screen photography-the last, a recent technical development, is known to be a rapid, reliable and an economic proposition. Unfortunately the committee have found that it is not, for various reasons, practical at the present time. I have for some time been interested in a case-finding programme in the industrial community, the aims and purposes of which have been specially directed towards the finding of significant pulmonary lesions in a large group of presumably healthy individuals. In such mass surveys refined diagnostic procedure may not be initially required and the two principal methods have been (a) tuberculin testing and (b) mass X-rayexamination of the chest. The latter has been found to be the best known single means of detecting such lesions. Failing miniature screen photography, I have found that fluoroscopy is the most economic and practicable method for mass examinations. Any doubtful macroscopic
can be readily detected and if necessary photographed, and the financial saving in films is considerable. In an investigation of 3229 X-ray screen examinations, compared with an equal number of films taken for purposes of control, the interpretation in 94% of cases has coincided exactly with the interpretation of the film. While, therefore, the fluoroscopic method is not foolproof it can, in the hands of an experienced observer, be a practical substitute for X-ray miniature screen photography until such time as the necessary apparatus is generally available. As emphasised by Ordway and
lesion
Fellows of the
Metropolitan
Life
Insurance
Co.
of
America, routine fluoroscopy is accurate, inexpensive, minimal lung lesions and is an efficient selector of cases for rontgenography. Finally may I suggest that in suspected cases of pulmonary tuberculosis medical boards might with advantage make full use of Trudeau’s five diagnostic criteria : (1) Tubercle bacilli in the sputum on more than one examination; (2) Persistent rales at one apex; (3) Radiological evidence of infiltration of the lung parenchyma ; (4) History of frank haemoptysis of more than 1 drachm ; (5) History of pleurisy with effusion. At least two of these should be present before the diagnosis of pulmonary tuberculosis is justifiable with the exception of (1), which, in peace-time at any rate, is alone pathognomonic. In war-time, however, experience has shown that malingerers may manage to secure tuberculous sputum and try to pass it as their own; hence the presence of two criteria should be demanded. PHILIP ELLMAN. ELLMAX. Wimpole Street, W.I.
expeditious, selects
SENDING CHILDREN OVERSEAS
SIR,-The general advantages of evacuating schoolchildren to the Dominions need no further stressing, but I would draw attention to one which especially concerns those of us in the Public Health Service, namely the removal of such children from households where there is open tuberculous infection. I have found at my dispensaries that a large proportion of parents had yet to make a decision about evacuation, and tuberculosis officers with their dispensary organisation could play a prominent part in persuading parents in such households to take advantage of the scheme. This could be accomplished not only by personal contact but also by circularising homes where children were exposed to infection. In addition, medical superintendents of sanatoria could take steps to point out the benefits of the plan to patients in their care, whilst the family practitioner might assist undecided parents in those households having no contact with the tuberculosis service. A time like the present, when the risk of infection is increased by close congregation in air-raid shelters and by a lowered resistance due to general strain, calls for an energetic appreciation of the possibilities of the scheme in reducing the incidence of tuberculous infection in our young population. A. CAPES. Mount Sanatorium, Bishopstoke, Hants.
PLENTY of books
are
available
on
the diet of the soli-
tary child, but group feeding of a number of small children presents special problems, and these are confidently tackled by Margery Abrahams, dietitian to St. Bartholomew’s Hospital, in her pamphlet, 11 Nursery School Diet" (London : Nursery School Association, pp. 40, 6d.). In its second edition she has brought the text up to date, and talks sensibly about her subject, giving the composition of essential foods, menus for nursery schools and recipes showing quantities for groups of children. A few of her statements are unquantitative ; for example, writing of inorganic salts and vitamins, she says : " Some of these dissolve into the water in which they are cooked, and therefore vegetable water used as a stock for soup and stew gravy in which vegetables have been cooked have a special value " ; and again, brown bread, for instance, should be used as well as white because of the larger amount of calcium, iron and phosphorus it contains..." Statements of this kind give an exaggerated idea of the quantities involved and But these are minor blemishes may mislead the layman. in an otherwise excellent and welcome pamphlet. "
"