GASTROSCOPY
1
1019 Observations " contain much which can be read with interest by those who see a future in the study of comparative medicine to-day. The lecturer, in conclusion, suggested the establishment of a branch of the Hunterian Society amongst the graduates and students of the Royal Veterinary College, stating that the veterinary profession owed a great deal to the memory of John Hunter " for the part he played in the start of its oldest veterinary college ; and that, knowing the reputation he bore for thoroughness in all he did for the science he loved so well, it was a great calamity to our progress that he did not live at least some ten years longer." In the remarks which followed the lecture, Dr. Bullock, the registrar and librarian of the Royal College of Veterinary Surgeons, gave interesting . extracts from some unique books in the college library which bore tribute to John Hunter and the part he had played in the foundation of the veterinary profession. AN EMPIRE DAY APPEAL AT the Mansion House meeting held in support of the British Empire Cancer Campaign on May 1st, the Duke of York who presided said the purpose of the meeting was to inaugurate an appeal on Empire Day, May 24th. He recalled the hope he had expressed ten years previously that the shadow of the great fear of cancer was slowly but surely lifting, although much remained to be done. The policy of the campaign all along had been not to husband its resources but to meet every reasonable call made upon it in aid of cancer research. Lord Horder, who proposed a vote of thanks, said he was sure that the solution of the problem of cancer would yield to careful observation and patient research. Sir Hilton Young remarked that cancer now took the second place in the list of fatal diseases and justified the campaign in its primary task of promoting and coördinating research on the causation of cancer. Prof. W. S. Lazarus-Barlow, vice-chairman of the investigation committee and chairman of the appeal committee, spoke of the change in the type of investigation during the 30 years in which he had been associated with cancer research ; it must not be thought, he said, that the paths pursued for 30 years had proved fruitless. The extension of the criterion of success-namely, freedom from the disease- from three to ten years showed a sense of growing mastery over the enemy. The associations and affiliations of the campaign throughout the British Empire and its friendly relations with cancer research organisations abroad entitled the campaign to national and imperial support. It was announced that the King and Queen and other members of the Royal Family had sent donations to head the Empire Day list. In response to the Duke of York’s words the appeal committee of the B.E.C.C. has arranged for appeals at 1000 centres on May 24th. GASTROSCOPY THE flexible gastroscope which was recently described in these pages has made its debut in America, and E. B. Benedict has made a preliminary report 2 on its use in the Massachusetts General Hospital, where 75 gastroscopies have been smoothly carried out. The instrument is in routine employ- ment in many German clinics, but little has yet been heard of it from other countries. The reason is probably a certain hesitation about its value in diagnosis. It is clear from the German experience 1 THE LANCET, 1933, ii., 813, 389. 2 New Eng. Jour. Med., March 29th, 1934, p. 670. that, in general, gastroscopy offers no advantage over radiography in the recognition of gastric ulcer and gastric carcinoma, and it is never likely to become as necessary as cystoscopy. On the other hand it enables inflammatory and atrophic changes in the gastric mucosa to be seen much more clearly than by even the best radiological technique, and chronic gastritis can therefore be defined with greater precision than heretofore. Since the pathogenesis of chronic gastritis may well be the key to the prevention of more serious conditions, a new method for its investigation is to be welcomed. Benedict’s experi- ence so far bears out the German claim that gastro- scopy with the Wolf-Schindler flexible gastroscope is an "easy, harmless, and profitable procedure." CHILD GUIDANCE IN AMERICA SINCE 1922 when the Commonwealth Fund of New York first turned its attention to mental hygiene seven major child guidance clinics have been founded directly through its agency, and support has been given in this country (in the words of the fifteenth annual report) " to finance activities which are still too novel to command full support from the British public." The London Child Guidance Clinic, now in its fifth year, is still liberally supported by the Fund, although as a measure of economy the parent Institute for Child Guidance was closed last summer, after it had offered training during the six years of its existence to 32 psychiatrists, 15 psychologists, and 289 psychiatric social workers. It should be of interest to discover what form the child guidance movement is taking in the land of its origin, and in this we have the help of Dr. D. N. Hardcastle, who has reported after spending three years studying clinics in America. The lines of approach and the goals of treatment he finds still in a state of flux, and wide variations in philosophy are evident ; some clinics are content with a simple evaluation of their problems and are almost didactic in their therapy, others attempt to analyse all their material, whether parents or children. Asked " what is the potential position of the general medical practitioner with regard to the child guidance clinic, and can his services be utilised ? " 10 out of 12 clinics referred to the general lack of psychiatric education, and the practitioner’s inability to cooperate ; 3 clinics thought that when adequately trained the practitioner should treat the bulk of the patients who now come to the clinic, and 2 considered that he could then cooperate in psychiatric treatment. Five replies reported close cooperation on the physical side only of the patient ; only one speaks of all-round cooperation. Three clinics, however, enjoy the cooperation of children’s specialists ; one regards itself as in opposition to medical practice. To the question whether non- medical persons should be able to refer cases, 11 out of 12 clinics definitely said that they should ; 2 of them refrained from treating cases so referred until the practitioner had been informed and his permission given. In another question Dr. Hardcastle embodied the criticism so often heard, that the child subjected to a team of people loses all chance of a personal psychiatric contact. Eight replies point out that the child has a much closer contact with the psychiatrist than he would have in any other form of medical treatment ; the parents are not present, for they are seen by the psychiatric social worker. One detailed reply states that 55 per cent. of cases have dual attention, the psychiatrist treating the 1 Brit. Jour. Med. Psych., 1933, xiii., 328.
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Transcript of GASTROSCOPY
1019
Observations " contain much which can be read withinterest by those who see a future in the study ofcomparative medicine to-day. The lecturer, in
conclusion, suggested the establishment of a branchof the Hunterian Society amongst the graduates andstudents of the Royal Veterinary College, statingthat the veterinary profession owed a great deal tothe memory of John Hunter " for the part he playedin the start of its oldest veterinary college ; and that,knowing the reputation he bore for thoroughnessin all he did for the science he loved so well, it wasa great calamity to our progress that he did not liveat least some ten years longer."
In the remarks which followed the lecture, Dr.Bullock, the registrar and librarian of the RoyalCollege of Veterinary Surgeons, gave interesting
. extracts from some unique books in the college librarywhich bore tribute to John Hunter and the part he hadplayed in the foundation of the veterinary profession.
AN EMPIRE DAY APPEAL
AT the Mansion House meeting held in support ofthe British Empire Cancer Campaign on May 1st,the Duke of York who presided said the purpose ofthe meeting was to inaugurate an appeal on EmpireDay, May 24th. He recalled the hope he had
expressed ten years previously that the shadow of thegreat fear of cancer was slowly but surely lifting,although much remained to be done. The policyof the campaign all along had been not to husbandits resources but to meet every reasonable call madeupon it in aid of cancer research. Lord Horder,who proposed a vote of thanks, said he was sure thatthe solution of the problem of cancer would yield tocareful observation and patient research. Sir HiltonYoung remarked that cancer now took the secondplace in the list of fatal diseases and justified thecampaign in its primary task of promoting andcoördinating research on the causation of cancer.
Prof. W. S. Lazarus-Barlow, vice-chairman of the
investigation committee and chairman of the appealcommittee, spoke of the change in the type of
investigation during the 30 years in which he had beenassociated with cancer research ; it must not be
thought, he said, that the paths pursued for 30 yearshad proved fruitless. The extension of the criterionof success-namely, freedom from the disease-from three to ten years showed a sense of growingmastery over the enemy. The associations andaffiliations of the campaign throughout the BritishEmpire and its friendly relations with cancer researchorganisations abroad entitled the campaign to nationaland imperial support. It was announced that the
King and Queen and other members of the RoyalFamily had sent donations to head the EmpireDay list. In response to the Duke of York’s wordsthe appeal committee of the B.E.C.C. has arrangedfor appeals at 1000 centres on May 24th.
GASTROSCOPY
THE flexible gastroscope which was recentlydescribed in these pages has made its debut inAmerica, and E. B. Benedict has made a preliminaryreport 2 on its use in the Massachusetts GeneralHospital, where 75 gastroscopies have been smoothlycarried out. The instrument is in routine employ-ment in many German clinics, but little has yet beenheard of it from other countries. The reason isprobably a certain hesitation about its value indiagnosis. It is clear from the German experience
1 THE LANCET, 1933, ii., 813, 389.2 New Eng. Jour. Med., March 29th, 1934, p. 670.
that, in general, gastroscopy offers no advantageover radiography in the recognition of gastric ulcerand gastric carcinoma, and it is never likely tobecome as necessary as cystoscopy. On the otherhand it enables inflammatory and atrophic changesin the gastric mucosa to be seen much more clearlythan by even the best radiological technique, andchronic gastritis can therefore be defined with greaterprecision than heretofore. Since the pathogenesis ofchronic gastritis may well be the key to the preventionof more serious conditions, a new method for its
investigation is to be welcomed. Benedict’s experi-ence so far bears out the German claim that gastro-scopy with the Wolf-Schindler flexible gastroscopeis an "easy, harmless, and profitable procedure."
CHILD GUIDANCE IN AMERICA
SINCE 1922 when the Commonwealth Fund ofNew York first turned its attention to mental hygieneseven major child guidance clinics have been foundeddirectly through its agency, and support has beengiven in this country (in the words of the fifteenthannual report) " to finance activities which are stilltoo novel to command full support from the Britishpublic." The London Child Guidance Clinic, nowin its fifth year, is still liberally supported by theFund, although as a measure of economy the parentInstitute for Child Guidance was closed last summer,after it had offered training during the six years of itsexistence to 32 psychiatrists, 15 psychologists, and289 psychiatric social workers. It should be ofinterest to discover what form the child guidancemovement is taking in the land of its origin, and inthis we have the help of Dr. D. N. Hardcastle, who hasreported after spending three years studying clinicsin America. The lines of approach and the goals oftreatment he finds still in a state of flux, and widevariations in philosophy are evident ; some clinicsare content with a simple evaluation of their problemsand are almost didactic in their therapy, othersattempt to analyse all their material, whether parentsor children. Asked " what is the potential positionof the general medical practitioner with regard tothe child guidance clinic, and can his services beutilised ? " 10 out of 12 clinics referred to the generallack of psychiatric education, and the practitioner’sinability to cooperate ; 3 clinics thought that whenadequately trained the practitioner should treat thebulk of the patients who now come to the clinic,and 2 considered that he could then cooperate inpsychiatric treatment. Five replies reported close
cooperation on the physical side only of the patient ;only one speaks of all-round cooperation. Three
clinics, however, enjoy the cooperation of children’sspecialists ; one regards itself as in opposition tomedical practice. To the question whether non-medical persons should be able to refer cases, 11 outof 12 clinics definitely said that they should ; 2 ofthem refrained from treating cases so referred untilthe practitioner had been informed and his permissiongiven. In another question Dr. Hardcastle embodiedthe criticism so often heard, that the child subjectedto a team of people loses all chance of a personalpsychiatric contact. Eight replies point out thatthe child has a much closer contact with the
psychiatrist than he would have in any other form ofmedical treatment ; the parents are not present,for they are seen by the psychiatric social worker.One detailed reply states that 55 per cent. of caseshave dual attention, the psychiatrist treating the
1 Brit. Jour. Med. Psych., 1933, xiii., 328.
