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THE HUMAN CONSTITUTION.
31
repeated offences, he should be confined in some non-penal institution. Other points of professional interest in the report deserve mention. It is suggested that the services of women doctors be freely employed in the medical examination of young girls who are alleged to have been the victims of an offence. It is said that experience shows that where a girl has to be examined after complaint to the police there is less likelihood of causing her further mental disturbance if the examination is made by a woman doctor. As to the are
medical examination of an accused man the Committee moves cautiously. If the charge suggests the communication of venereal disease to the child, medical examination might enable an innocent man to clear himself ; on the other hand, the medical examination may disclose evidence of disease which The Committee would corroborate the charge. rightly gives considerable attention to provisions for child welfare and to possible preventive measures, such as better housing, less overcrowding, more supervision in parks, cinemas, and school precincts, and the training of student teachers with a view to their giving sex instruction to the older children. Perhaps the most important, as well as the most controversial, recommendation is the proposal to raise the age of consent to 17, though on this point there is weightily reasoned dissent on the part of the legal members of the Committee-Mr. J. C. Priestley, K.C. (who replaced the late Sir Ryland Adkins as chairman); Mr. T. W. Fry, the metropolitan policecourt magistrate, and Sir Guy Stephenson, Assistant Director of Public Prosecutions. On the whole the unanimity of the report is striking. It is not easy to reconcile conflicting opinions on vexed topics like these. On the one side are the reformers, supported by a large and sympathetic body of voters throughout the country, and keenly sensible of the harm which sexual offences inflict upon the child victim. The reformers complain that there are too few prosecutions and too many acquittals ; they want to give more jurisdiction to petty sessions, because juries at quarter sessions and assizes bring in so many verdicts of "Not Guilty " ; they press for heavier punishments, a less rigid insistence on corroboration and strict legal proof, the abolition of all technical defences ’’ (such as that of reasonable belief " that the girl was over the prohibited age), and a considerable raising of the age of consent. On the other side are the lawyers, and the judges recruited from the ranks of the lawyers, who insist that nothing must impair the traditions of law and procedure which are properly framed to ensure a fair and impartial trial. There is also what might be described as the Home Office view, sensible of the stronger arguments of both these parties and withal aware that it is undesirable to create innumerable fresh crimes, idle to enact severe punishments which courts will flinch from inflicting, and unsatisfactory to move too far in advance of a slowly instructed public opinion. THE
HUMAN CONSTITUTION. THERE has been for some years past an increasing tendency to direct attention towards what, for want of a more fitting term, is referred to as the human " constitution." The word has a familiar sound for the elders amongst us, and no doubt brings back to their minds memories of the great clinical physicians and surgeons whom they followed years ago. The acumen of these men, the way in which they would put an unerring finger on a patient’s weak spots, seemed at times uncanny. Perhaps they would have found it hard sometimes to explain their grounds for an opinion, right though it proved to be, very much as we might find it almost impossible to say why we recognise with certainty someone whose face we cannot see, and whose garments are not those he wore when we last met him. Clinical instinct and insight retired modestly into the background when the laboratories and the researcher claimed the whole of medicine as their sole province ; but it is
again becoming evident that the human body cannot be explained in the laboratory or the dead-house.
The subtle differences that make or mar an individual are none the less real because they are intangible, and herein lies the necessity for recognising the " constitution " of the individual. But this term has not quite the same meaning as it used to have ; the modern conception is synthetic, it builds itself on measured data, and it cannot yet afford to stand away from a man and take a wide view of him. The fourth. Henderson Trust Lecture,delivered by Prof. W. W. Graves at the University of Edinburgh last October, is an admirable example of the material on which this new study of the individual man can be Prof Graves introduces us here to points based. about the scapula which will be new to many, if not to most, of us ; he shows the hereditary nature of types, their persistence, and their indicatory significance with regard to morbidity and adaptability in general. As he has dealt with some 30,000 subjects, living and dead, his results may be considered fairly definite. Perusal of this interesting and important lecture makes one hope that in the not far distant future some use may be found for those portentous indices which sadden the reader of so many works on physical anthropology, and, if these can be made to show a value like that given to scapular types here, their accumulation, from the point of view of medicine, would be justifiable. The lecture should be read by clinicians ; it cannot be much more than. a rapid survey, within the limits of time of a lecture, but a full bibliographical index gives the reader the means to extend his acquaintance with the subject.
Modern Technique in Treatment. A Series
of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions.
CLIV.-THE
TREATMENT OF CHRONIC MASTITIS. THE treatment of " chronic mastitis " has in the past been somewhat obscured by misunderstanding of its setiology. It cannot be claimed that this is even now fully understood, but it is at any rate clear that the aetiology implied by the name which has so long been given to the condition is not the true one ; consequently treatment aiming at allaying chronic mastitis on the supposition that it is an ordinary inflammation of the breast, due to a subacute infection with a pyogenic organism, such as a staphylococcus, is doomed to failure. Sir Lenthal Cheatle has on many occasions stressed the necessity for a reform in the terminology of the chronic lesions to which the breast is subject, and has " suggested the term " mazoplasia " instead of chronic on the ground that the epithelial changes so constantly found are the essential feature of the condition. Epithelial changesare, however, only one incident in a pathological complex which it is almost impossible to summarise in a single word, and it may be wiser to postpone for the present any attempt to oust a term the use of which has become ingrained by the custom of so many years.
mastitis,"
Chronic mastitis is not a disease of one age or sex, but is found in both sexes and, in its different forms, at all times of life. Its incidence is dependent, not on a bacterial infection, but rather on a disorderly process of secretion and absorption which are going on at all times in varying degree in a gland unprovided with an outlet except during lactation. The pathological and statistical evidence for these statements cf Shoulder Blade Types to Problems of Physical Adaptability. By Prof. William Washington Graves, St. Louis, Mo., U.S.A. London and Edinburgh : Oliver and Boyd. 1925. Pp. 35. Cd.
1 The Mental
Relation and
repeated offences, he should be confined in some non-penal institution. Other points of professional interest in the report deserve mention. It is suggested that the services of women doctors be freely employed in the medical examination of young girls who are alleged to have been the victims of an offence. It is said that experience shows that where a girl has to be examined after complaint to the police there is less likelihood of causing her further mental disturbance if the examination is made by a woman doctor. As to the are
medical examination of an accused man the Committee moves cautiously. If the charge suggests the communication of venereal disease to the child, medical examination might enable an innocent man to clear himself ; on the other hand, the medical examination may disclose evidence of disease which The Committee would corroborate the charge. rightly gives considerable attention to provisions for child welfare and to possible preventive measures, such as better housing, less overcrowding, more supervision in parks, cinemas, and school precincts, and the training of student teachers with a view to their giving sex instruction to the older children. Perhaps the most important, as well as the most controversial, recommendation is the proposal to raise the age of consent to 17, though on this point there is weightily reasoned dissent on the part of the legal members of the Committee-Mr. J. C. Priestley, K.C. (who replaced the late Sir Ryland Adkins as chairman); Mr. T. W. Fry, the metropolitan policecourt magistrate, and Sir Guy Stephenson, Assistant Director of Public Prosecutions. On the whole the unanimity of the report is striking. It is not easy to reconcile conflicting opinions on vexed topics like these. On the one side are the reformers, supported by a large and sympathetic body of voters throughout the country, and keenly sensible of the harm which sexual offences inflict upon the child victim. The reformers complain that there are too few prosecutions and too many acquittals ; they want to give more jurisdiction to petty sessions, because juries at quarter sessions and assizes bring in so many verdicts of "Not Guilty " ; they press for heavier punishments, a less rigid insistence on corroboration and strict legal proof, the abolition of all technical defences ’’ (such as that of reasonable belief " that the girl was over the prohibited age), and a considerable raising of the age of consent. On the other side are the lawyers, and the judges recruited from the ranks of the lawyers, who insist that nothing must impair the traditions of law and procedure which are properly framed to ensure a fair and impartial trial. There is also what might be described as the Home Office view, sensible of the stronger arguments of both these parties and withal aware that it is undesirable to create innumerable fresh crimes, idle to enact severe punishments which courts will flinch from inflicting, and unsatisfactory to move too far in advance of a slowly instructed public opinion. THE
HUMAN CONSTITUTION. THERE has been for some years past an increasing tendency to direct attention towards what, for want of a more fitting term, is referred to as the human " constitution." The word has a familiar sound for the elders amongst us, and no doubt brings back to their minds memories of the great clinical physicians and surgeons whom they followed years ago. The acumen of these men, the way in which they would put an unerring finger on a patient’s weak spots, seemed at times uncanny. Perhaps they would have found it hard sometimes to explain their grounds for an opinion, right though it proved to be, very much as we might find it almost impossible to say why we recognise with certainty someone whose face we cannot see, and whose garments are not those he wore when we last met him. Clinical instinct and insight retired modestly into the background when the laboratories and the researcher claimed the whole of medicine as their sole province ; but it is
again becoming evident that the human body cannot be explained in the laboratory or the dead-house.
The subtle differences that make or mar an individual are none the less real because they are intangible, and herein lies the necessity for recognising the " constitution " of the individual. But this term has not quite the same meaning as it used to have ; the modern conception is synthetic, it builds itself on measured data, and it cannot yet afford to stand away from a man and take a wide view of him. The fourth. Henderson Trust Lecture,delivered by Prof. W. W. Graves at the University of Edinburgh last October, is an admirable example of the material on which this new study of the individual man can be Prof Graves introduces us here to points based. about the scapula which will be new to many, if not to most, of us ; he shows the hereditary nature of types, their persistence, and their indicatory significance with regard to morbidity and adaptability in general. As he has dealt with some 30,000 subjects, living and dead, his results may be considered fairly definite. Perusal of this interesting and important lecture makes one hope that in the not far distant future some use may be found for those portentous indices which sadden the reader of so many works on physical anthropology, and, if these can be made to show a value like that given to scapular types here, their accumulation, from the point of view of medicine, would be justifiable. The lecture should be read by clinicians ; it cannot be much more than. a rapid survey, within the limits of time of a lecture, but a full bibliographical index gives the reader the means to extend his acquaintance with the subject.
Modern Technique in Treatment. A Series
of Special Articles, contributed by invitation, on the Treatment of Medical and Surgical Conditions.
CLIV.-THE
TREATMENT OF CHRONIC MASTITIS. THE treatment of " chronic mastitis " has in the past been somewhat obscured by misunderstanding of its setiology. It cannot be claimed that this is even now fully understood, but it is at any rate clear that the aetiology implied by the name which has so long been given to the condition is not the true one ; consequently treatment aiming at allaying chronic mastitis on the supposition that it is an ordinary inflammation of the breast, due to a subacute infection with a pyogenic organism, such as a staphylococcus, is doomed to failure. Sir Lenthal Cheatle has on many occasions stressed the necessity for a reform in the terminology of the chronic lesions to which the breast is subject, and has " suggested the term " mazoplasia " instead of chronic on the ground that the epithelial changes so constantly found are the essential feature of the condition. Epithelial changesare, however, only one incident in a pathological complex which it is almost impossible to summarise in a single word, and it may be wiser to postpone for the present any attempt to oust a term the use of which has become ingrained by the custom of so many years.
mastitis,"
Chronic mastitis is not a disease of one age or sex, but is found in both sexes and, in its different forms, at all times of life. Its incidence is dependent, not on a bacterial infection, but rather on a disorderly process of secretion and absorption which are going on at all times in varying degree in a gland unprovided with an outlet except during lactation. The pathological and statistical evidence for these statements cf Shoulder Blade Types to Problems of Physical Adaptability. By Prof. William Washington Graves, St. Louis, Mo., U.S.A. London and Edinburgh : Oliver and Boyd. 1925. Pp. 35. Cd.
1 The Mental
Relation and