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THE HEALTH OF THE ARMY
450 he thinks, get very far. They must examine and elucidate their differences of outlook. The younger generation of doctors are showing an interest in the subject, and time will bring about an understanding. Dr. W. S. MACLAY fortified Dr. Bomford’s misgivings. teaching mental health, he said, we should be on firmer ground if we knew what we wanted to teach. " Tell us what to do, and we’ll do it," the public, the health administrators, and the politicians all cry to the psychiatrist ; but he does not know. He knows that people are influenced by their upbringing ; but what is a proper upbringing ? The anthropologists tell us of some cultures in which upbringing produces a peace-loving people, and others in which the upbringing produces people who are warlike and aggressive. Which is " right " ? Or how does one achieve a happy mixture of the two ? Our programme for mental health contains various practical measures. We want to provide enough mental-hospital beds, early diagnosis and treatment for individuals, the means for rehabilitation of patients leaving hospital (links with the local authorities and voluntary organisations), and consultative services (available to courts, resettlement units, remand homes, and the like). We also want to prevent those mental disorders where the aetiology is clear-by means of better obstetrics, better control of venereal disease, control of infections with antibiotics, good nutrition (to prevent those mental disorders, such as pellagra, which are caused by nutritional deficiencies), and even the wider use of crash helmets and the better control of boxing-matches. When it comes to preventing mental disorders with psychological causes we need far more information than we have at present. We need to know, for instance, more about the effects on children of cruelty, broken homes, lack of affection, and separation from parents. In the education of the public, teachers, social workers, and clergy may be more important than psychiatrists : the wives of psychiatrists, he had noticed, have on the whole very little respect for their husband’s views on the upbringing of children. Will it be useful to try to influence the public through radio, television, lectures, discussion groups, plays, and films ? Can behaviour (which may be deeply rooted in the personality) be readily changed through these channels ?‘ We need more research into educational methods. We also need a much fuller study of sound mental health, to determine which infants need cuddling, which schoolboys will benefit from a beating, which adults need marriage guidance, and so on. " Mental health " cannot be applied to a vague mass, " the public," but only to individuals, based on respect and affection.
In
Mr. FRANCOIS LAFITTE, who owned himself to be both non-psychiatric and non-doctor, shared Dr. Maclay’s pessimism about using the press and other media for The first thing surely, he said, is to get mass education. over some simple facts-the psychiatrists to decide which. The press is a part of the public which needs educating, and on the whole journalists are receptive and intelligent : what they need are opportunities to see for themselves what mental hospitals are doing. Films and broadcasting, however, are likely to have a more lasting influence on the general public than newspapers. There is a danger that by harping too much on hospital beds and curative treatment we may create in the public a new demand for psychiatry-an appetite for treatmentwhich we might not be able to meet. He suggested that we might do better by emphasising the factors making for good mental health-such as sensible child management and harmonious marriage relations. Is there a case, he asked, for teaching simple psychology in schools ? The public are semi-ignorant about the body and still more ignorant about the mind : might not both have a place in the school curriculums1
In the ensuing discussion Dr. J. FFOULKES EDWARDS felt we might be optimistic about teaching mental health, and mentioned a postgraduate course in health education now being held by the University of London-the first of its kind-to train people for giving such teaching. Those attending the course are nurses, teachers, or doctors There is a great opportunity, he over the age of 30. thinks, for teaching mental health principally in the schools : the old are hard to change, but there is hope with the young. The value of training ordinary social workers in the principles of mental hygiene was mentioned by another speaker : they can change public opinion indirectly, and save us from the mistakes which may come of tackling it directly. On this note of scientific caution the meeting almost expired ; but a final speaker urged, without much apparent effect, the essence of Miss HornsbySmith’s discourse-that the removal of old miscon. ceptions is surely a task worth tackling.
THE HEALTH OF THE ARMY section of the community may the principles of medicine be so vigorously or effectively in the fighting Services, and the report on the Health of the Army for 1951 and 19521 confirms that full advantage is being taken of this opportunity. Since all but the most trivial conditions are treated in medical reception stations or hospitals, a reasonably accurate index of morbidity is afforded by figures for admissions to Army medical units ; and these, even over the two years covered by this report, show a remarkable decrease. Not surprisingly, each command has a morbidity peculiar to itself: the admission-rate in Korea and Japan in 1952 was nearly 50% higher than that in FARELF-which, in turn, was some 25% higher than in B.A.O.R. During 1951, when the Korean campaign was getting under way, admission-rates there totalled 1121 per 1000 personnel; the following year, when some of the health problems had been successfully solved, the figure dropped to 788 per 1000. The major causes of admission in the United Kingdom were tonsillitis and pharyngitis, skin conditions, and the common cold-in that order. In M.E.L.F., on the other hand, skin conditions greatly exceeded any other condition as a cause of admission. In FARELF, and in Korea and Japan, venereal disease was the principle cause of admission. In the latter command venereal disease accounted for no fewer than 387 admissions per 1000 personnel in 1951, and 262 the following year ; enemy action accounted for only 85-7 (1951) and 42.7 (1952) admissions per 1000 personnel. Of deaths reported from or certified in a medical unit in 1952, 7-1% were due to tuberculosis, 23-2% to neoplasms, 11-0% to cardiac conditions, 9-0% to cerebrovascular lesions, and 5-2% to poliomyelitis or polioencephalitis. Tuberculosis deaths totalled 11, compared with 131 in 1948. Accidents accounted for 329 deaths, and enemy action for 35 deaths. During the two years no major changes were made in the physical standards of entry to the Regular or Territorial Army. Nevertheless, the principle that only a man fit in all respects can make a useful soldier is being replaced by one which recognises that men with appreciable physical limitations can be usefully employed in sedentary duties or under certain strictly defined conditions. As a result of this change of policy, and, more immediately, because of the serious shortage of man-power in the spring of 1951, some men were recruited whose physical category would formerly have debarred them from the Service. IN
no
preventive applied as
1. Report on the Health of the Army, 1951 and 1952. Not but copies have been distributed to learned societies.
on
sale,
In
Mr. FRANCOIS LAFITTE, who owned himself to be both non-psychiatric and non-doctor, shared Dr. Maclay’s pessimism about using the press and other media for The first thing surely, he said, is to get mass education. over some simple facts-the psychiatrists to decide which. The press is a part of the public which needs educating, and on the whole journalists are receptive and intelligent : what they need are opportunities to see for themselves what mental hospitals are doing. Films and broadcasting, however, are likely to have a more lasting influence on the general public than newspapers. There is a danger that by harping too much on hospital beds and curative treatment we may create in the public a new demand for psychiatry-an appetite for treatmentwhich we might not be able to meet. He suggested that we might do better by emphasising the factors making for good mental health-such as sensible child management and harmonious marriage relations. Is there a case, he asked, for teaching simple psychology in schools ? The public are semi-ignorant about the body and still more ignorant about the mind : might not both have a place in the school curriculums1
In the ensuing discussion Dr. J. FFOULKES EDWARDS felt we might be optimistic about teaching mental health, and mentioned a postgraduate course in health education now being held by the University of London-the first of its kind-to train people for giving such teaching. Those attending the course are nurses, teachers, or doctors There is a great opportunity, he over the age of 30. thinks, for teaching mental health principally in the schools : the old are hard to change, but there is hope with the young. The value of training ordinary social workers in the principles of mental hygiene was mentioned by another speaker : they can change public opinion indirectly, and save us from the mistakes which may come of tackling it directly. On this note of scientific caution the meeting almost expired ; but a final speaker urged, without much apparent effect, the essence of Miss HornsbySmith’s discourse-that the removal of old miscon. ceptions is surely a task worth tackling.
THE HEALTH OF THE ARMY section of the community may the principles of medicine be so vigorously or effectively in the fighting Services, and the report on the Health of the Army for 1951 and 19521 confirms that full advantage is being taken of this opportunity. Since all but the most trivial conditions are treated in medical reception stations or hospitals, a reasonably accurate index of morbidity is afforded by figures for admissions to Army medical units ; and these, even over the two years covered by this report, show a remarkable decrease. Not surprisingly, each command has a morbidity peculiar to itself: the admission-rate in Korea and Japan in 1952 was nearly 50% higher than that in FARELF-which, in turn, was some 25% higher than in B.A.O.R. During 1951, when the Korean campaign was getting under way, admission-rates there totalled 1121 per 1000 personnel; the following year, when some of the health problems had been successfully solved, the figure dropped to 788 per 1000. The major causes of admission in the United Kingdom were tonsillitis and pharyngitis, skin conditions, and the common cold-in that order. In M.E.L.F., on the other hand, skin conditions greatly exceeded any other condition as a cause of admission. In FARELF, and in Korea and Japan, venereal disease was the principle cause of admission. In the latter command venereal disease accounted for no fewer than 387 admissions per 1000 personnel in 1951, and 262 the following year ; enemy action accounted for only 85-7 (1951) and 42.7 (1952) admissions per 1000 personnel. Of deaths reported from or certified in a medical unit in 1952, 7-1% were due to tuberculosis, 23-2% to neoplasms, 11-0% to cardiac conditions, 9-0% to cerebrovascular lesions, and 5-2% to poliomyelitis or polioencephalitis. Tuberculosis deaths totalled 11, compared with 131 in 1948. Accidents accounted for 329 deaths, and enemy action for 35 deaths. During the two years no major changes were made in the physical standards of entry to the Regular or Territorial Army. Nevertheless, the principle that only a man fit in all respects can make a useful soldier is being replaced by one which recognises that men with appreciable physical limitations can be usefully employed in sedentary duties or under certain strictly defined conditions. As a result of this change of policy, and, more immediately, because of the serious shortage of man-power in the spring of 1951, some men were recruited whose physical category would formerly have debarred them from the Service. IN
no
preventive applied as
1. Report on the Health of the Army, 1951 and 1952. Not but copies have been distributed to learned societies.
on
sale,