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75 refinement, or extension of present-day methods of spreading information. Subjects which needed con- sideration were discussed at some length, and recom- mendations were made to which the attention of the Royal Society was invited. As the arguments were stated and restated it became evident to some, if not to all, delegates that the sciences represented are so different that procedures suitable to one are by no means always suitable to another. This fact was responsible for some confusion of thought and much vigorous argument, and one of the valuable results of the conference was that the particular needs of many branches of science were stated. When the recommendations are published in their final form, readers will be able’to see how far they can be applied to medicine. In winding up the -conference at the final session, Sir ROBERT RoBINSON referred to the resolution that the Royal Society be invited to set up a standing com- mittee on scientific information services to implement the recommendations made, and added the rider that funds would be needed for this purpose, and that they must presumably come from national sources Mr. SAUNDERSON, on behalf of the Dominions, complimented the Royal Society on the efficiency with which the conference had been conducted, and Mr. D. W. BRONK (representing the U.S. National Academy of Sciences) spoke of the need for internationalism in science and in scientific journals. Tributes were paid to Professor Bernal and the editors of the other sections, whose interest was inspired solely by the desire to advance the cause of science. MEDICAL PRACTICES COMMITTEES THE Minister of Health has appointed the following as members of the Medical Practices, Committee, constituted under the National Health Service Act : Dr. W. E. DORNAN (Sheffield), chairman; Dr. J. A. PRIDHAM (Weymouth) ; Dr. ANNis GILLIE (London) ; Dr. J. F. MURPHY (London) ; Dr. D. T. MACDONALD (Belford, Northumberland) ; Dr. D. B. EvANs (Wrexham) ; Dr. P. V. ANDERSON (Shildon, Co. Durham) ; Mr. HENRY LESSER, chairman of London executive council; and Mr. R. WILBERFORCE (London), barrister-at-law. The committee’s functions include the consideration of applications by general practitioners to join the National Health Service in England and Wales, and to decide whether further doctors are needed in the public service in the area to which the application refers. They will also, on request, advise doctors whether transactions into which they propose to enter comply with the pro- visions of the Act prohibiting the sale of goodwill. The committee’s offices will be at Devonshire House, Mayfair Place, Piccadilly, London, W.I. SCOTLAND The Secretary of State for Scotland has set up, under the National Health Service (Scotland) Act, a similar committee with the following members : Dr. A. F. WILKIE MILLAR (Edinburgh), chairman ; Dr. I. D. GRANT (Glasgow); Dr. W. JorE (High Blantyre, Lanark- shire) ; Dr. J. R. ANDERSON (Fortrose); Sir WILLIAM MARSHALL, chairman of Lanarkshire executive council; and Mr. H. A. SHEWAN (Edinburgh), advocate. The committee’s offices are at 12, Carlton Terrace, Edinburgh, 7. Disabilities 8. PULMONARY TUBERCULOSIS ANY serious long-continued illness such as pulmonary tuberculosis is bound to impose some modification of outlook and of behaviour on even the least impressionable of patients. In the early stages of the disease the consciousness of the fact that one is " T.B." pervades almost every waking thought and imbues the outlook with anxiety or actual fear. In retrospect, I can well remember what an intensive process of adjustment I had to undergo when I was told I was suffering from pulmonary tuberculosis. Career, job, financial prospects, social relationships, and a goodly measure of happiness seemed closely bound up with physical well-being ; and all were being plunged into the melting-pot at a time when I was far from being at my best either physically or mentally and when my knowledge of the true facts regarding my health was fragmentary and even distorted. The tendency at this time is for the patient to speculate endlessly on every possible aspect of his illness. Will he get better ? How long will it take ? Will he become a chronic invalid dependent on others t How long will his salary continue Will he lose his job ? What will other people think ? Has he already infected other members of his family ? What will happen to them now and in the future, &c., &c. ? In short, he is at this time in need of as much material reassurance as he can get- not the " Don’t worry, everything is going to be all right" type of thing but good solid reassurance on specific points such as : " Your salary will continue as before," or " The tuberculosis allowance will be so much a week, supplemented by so much towards rent and other expenses," or " Peter and Marjorie were X-rayed yesterday and they are all right." Even if the outlook is less satisfactory the patient will derive some satisfaction from knowing the worst provided he feels confident that whatever possible is being done to remedy matters. He himself will be glad to escape the actual responsibility of settling family, business, and social affairs. The impulse towards escapism is, indeed, distinctly strong in the early stages and some temporary retreat from reality is not a bad thing; personally I shall always be grateful to the author of a long, rambling, and entrancing novel which swept me off to another world for hours at a time when the real world was grey and full of menace. In the early stages of his illness, therefore, I should say the tuberculous patient requires three things to tide him over his psychological crisis : (1) Material reassurance on specific points which are causing him anxiety and concern. (2) Helpful advice regarding his many problems from someone (preferably his physician) on whom he feels he can rely. (3) Some harmless avenue of escape to divert his attention from his various troubles, both immediate and prospective. When, this first, somewhat intensive, phase of adjust- ment is over, there ensues a period of chronic dissatis- faction. Recovery is still a long way off and apt to recede even further with little or no warning ; problems have had time to harden and the patient time to appre- ciate his own incapacity to solve them while he remains an invalid ; the unpleasant effects of tuberculous toxaemia may still be present, and positive signs of advancement in health are distressingly slow in appearing ; the sense of being " cut off " and " out of things " persists uncom- fortably and the predominant inclination is still to get back as quickly as possible not only to normal life but to the pristine stage of full activity. * * * As time goes on the patient becomes more at ease with his environment and somewhat less impatient with his enforced limitations. Gradually his attention becomes caught up with smaller, more immediate interests. When bigger and more unpleasant issues loom up, and depression threatens to close in, a new departure along some hitherto unexplored path often helps to keep interest fresh and alive. Writing instead of reading, doing something with the hands such as toy-making, rug- making, or even jig-saw puzzles, all help to provide concentration on the immediate and practical to the exclusion of greater but more remote problems. At this
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refinement, or extension of present-day methods of

spreading information. Subjects which needed con-

sideration were discussed at some length, and recom-mendations were made to which the attention of the

Royal Society was invited. As the arguments werestated and restated it became evident to some, if not toall, delegates that the sciences represented are so differentthat procedures suitable to one are by no means alwayssuitable to another. This fact was responsible for someconfusion of thought and much vigorous argument, andone of the valuable results of the conference was that theparticular needs of many branches of science were stated.When the recommendations are published in their finalform, readers will be able’to see how far they can beapplied to medicine.

In winding up the -conference at the final session,Sir ROBERT RoBINSON referred to the resolution thatthe Royal Society be invited to set up a standing com-mittee on scientific information services to implementthe recommendations made, and added the rider thatfunds would be needed for this purpose, and that theymust presumably come from national sources Mr.SAUNDERSON, on behalf of the Dominions, complimentedthe Royal Society on the efficiency with which theconference had been conducted, and Mr. D. W. BRONK(representing the U.S. National Academy of Sciences)spoke of the need for internationalism in science and inscientific journals. Tributes were paid to Professor Bernaland the editors of the other sections, whose interest wasinspired solely by the desire to advance the cause ofscience.

MEDICAL PRACTICES COMMITTEES

THE Minister of Health has appointed the followingas members of the Medical Practices, Committee,constituted under the National Health Service Act :

Dr. W. E. DORNAN (Sheffield), chairman; Dr. J. A.PRIDHAM (Weymouth) ; Dr. ANNis GILLIE (London) ; Dr.J. F. MURPHY (London) ; Dr. D. T. MACDONALD (Belford,Northumberland) ; Dr. D. B. EvANs (Wrexham) ; Dr. P. V.ANDERSON (Shildon, Co. Durham) ; Mr. HENRY LESSER,chairman of London executive council; and Mr. R.WILBERFORCE (London), barrister-at-law.The committee’s functions include the consideration

of applications by general practitioners to join theNational Health Service in England and Wales, and todecide whether further doctors are needed in the publicservice in the area to which the application refers. Theywill also, on request, advise doctors whether transactionsinto which they propose to enter comply with the pro-visions of the Act prohibiting the sale of goodwill. Thecommittee’s offices will be at Devonshire House, MayfairPlace, Piccadilly, London, W.I.

SCOTLAND

The Secretary of State for Scotland has set up, underthe National Health Service (Scotland) Act, a similarcommittee with the following members :

Dr. A. F. WILKIE MILLAR (Edinburgh), chairman ; Dr. I. D.GRANT (Glasgow); Dr. W. JorE (High Blantyre, Lanark-shire) ; Dr. J. R. ANDERSON (Fortrose); Sir WILLIAMMARSHALL, chairman of Lanarkshire executive council; andMr. H. A. SHEWAN (Edinburgh), advocate.

The committee’s offices are at 12, Carlton Terrace,Edinburgh, 7.

Disabilities

8. PULMONARY TUBERCULOSIS

ANY serious long-continued illness such as pulmonarytuberculosis is bound to impose some modification ofoutlook and of behaviour on even the least impressionableof patients. In the early stages of the disease theconsciousness of the fact that one is " T.B." pervadesalmost every waking thought and imbues the outlookwith anxiety or actual fear. In retrospect, I can wellremember what an intensive process of adjustment Ihad to undergo when I was told I was suffering frompulmonary tuberculosis. Career, job, financial prospects,social relationships, and a goodly measure of happinessseemed closely bound up with physical well-being ; andall were being plunged into the melting-pot at a timewhen I was far from being at my best either physicallyor mentally and when my knowledge of the true factsregarding my health was fragmentary and even distorted.The tendency at this time is for the patient to speculate

endlessly on every possible aspect of his illness. Will heget better ? How long will it take ? Will he become achronic invalid dependent on others t How long willhis salary continue ‘ Will he lose his job ? What willother people think ? Has he already infected othermembers of his family ? What will happen to them nowand in the future, &c., &c. ? In short, he is at this timein need of as much material reassurance as he can get-not the " Don’t worry, everything is going to be all

right" type of thing but good solid reassurance on

specific points such as : " Your salary will continue asbefore," or " The tuberculosis allowance will be so mucha week, supplemented by so much towards rent andother expenses," or " Peter and Marjorie were X-rayedyesterday and they are all right."Even if the outlook is less satisfactory the patient

will derive some satisfaction from knowing the worstprovided he feels confident that whatever possible is beingdone to remedy matters. He himself will be gladto escape the actual responsibility of settling family,business, and social affairs. The impulse towards

escapism is, indeed, distinctly strong in the early stagesand some temporary retreat from reality is not a badthing; personally I shall always be grateful to theauthor of a long, rambling, and entrancing novel whichswept me off to another world for hours at a time whenthe real world was grey and full of menace.

In the early stages of his illness, therefore, I shouldsay the tuberculous patient requires three things to tidehim over his psychological crisis :

(1) Material reassurance on specific points which are causinghim anxiety and concern.

(2) Helpful advice regarding his many problems from someone(preferably his physician) on whom he feels he can rely.

(3) Some harmless avenue of escape to divert his attentionfrom his various troubles, both immediate and prospective.When, this first, somewhat intensive, phase of adjust-

ment is over, there ensues a period of chronic dissatis-faction. Recovery is still a long way off and apt torecede even further with little or no warning ; problemshave had time to harden and the patient time to appre-ciate his own incapacity to solve them while he remains aninvalid ; the unpleasant effects of tuberculous toxaemiamay still be present, and positive signs of advancement inhealth are distressingly slow in appearing ; the sense ofbeing " cut off " and " out of things " persists uncom-fortably and the predominant inclination is still to getback as quickly as possible not only to normal life butto the pristine stage of full activity.

* * *

As time goes on the patient becomes more at easewith his environment and somewhat less impatient withhis enforced limitations. Gradually his attention becomescaught up with smaller, more immediate interests.When bigger and more unpleasant issues loom up, anddepression threatens to close in, a new departure alongsome hitherto unexplored path often helps to keep interestfresh and alive. Writing instead of reading, doingsomething with the hands such as toy-making, rug-making, or even jig-saw puzzles, all help to provideconcentration on the immediate and practical to theexclusion of greater but more remote problems. At this

76

stage the sufferer may begin to appreciate that althoughthe larger satisfactions may have to be deferred forsome time at least, life has still a good deal to offer ona somewhat lower plane. When interest is kept alive,even by matters of apparently trivial import, frustrationand depression are largely kept at bay.

During this phase, therefore, the patient needs to beencouraged both to take an interest in his immediateenvironment and to become, as it were, a natural partof it. Hospital competitions, entertainments, and talkson the internal broadcasting system all combine tocreate a community feeling, and if the patient himselfcan take even a minor active role in such things hisinterest will be magnified and he will get to know and bemore at ease with his surroun,dings. Some form of occupa-tional therapy should also be undertaken-preferably ofsuch a nature as to prove a lasting source of interest.As recovery proceeds attention shifts once more from

the comfortable and comforting minutiae of the littlesanatorium world to the realities of life outside. Butthere is no longer an impulse to rush back full tiltinto the turmoil-the outside world now assumes-asomewhat frightening aspect. Depending, of course,on the patient’s temperament, the length of his illness,and the satisfactoriness of- the result obtained, thereis nearly always a lack of confidence, combined with anunwillingness to leave the safety of the harbour for theperils and buffetings of the high seas.The patient now needs to be prompted to increase his

range of activity and interests, and it is well to turnhis gaze more and more in the direction of the outsideworld. Step by step this return towards normal life,modified by suitable precautions, should be encouraged,the patient gradually gaining confidence and losing hissense of incapacity and dependence. ,

After leaving the sanatorium confidence may returnrather too quickly, and the danger then lies in succumb-ing to the temptation to resume full normal activity.In the sanatorium rest-hours and regular habits are

accepted without question ; outside they may lead toa raising of eyebrows, awkward questions, and generalinconvenience. Usually the patient feels too well to

experience any physical need to continue his routine anddoes not realise how thin may be the ice beneath him.There is even a perverse determination to prove tohimself and others that he can do as much or more thanthe next man, in spite of his having had tuberculosis.Advice to go slow is quietly ignored, or may even beresented, according to its source.A sharp lesson is often required at this stage to under-

line the fact that the ex-patient has limitations, and thatit is better to carry part of the burden all the way thanall of it for a short time only. This is not easy to realise ;it may well be only after a relapse has occurred that itsessential wisdom becomes clear.

* * *

From the foregoing it will be apparent that in pul-monary tuberculosis the emotional factor plays a highlysignificant part at all stages of the disease. The difficultylies in securing an acceptance of limitation without

developing an invalid outlook. The limitation may be

relatively little or very considerable, and the optimumlevel of activity has to be determined in each case-largelyby the patient himself regarding day-to-day matters.One rather good way of looking at the problem is to

regard oneself as entirely normal except for requiringconsiderably more rest than other people, and this isbest secured by keeping to a regular routine. Any-thing causing undue tiredness should be noted and notallowed to happen again. Rest hours may not be sacredbut they are certainly very important to the physicaleconomy of the tuberculous patient, and the more hedoes the more important they become.

In England NowA Running Commentary by Peripatetic CorrespondentsAT ’Wimbledon today I studied nervous reaction to

excitement on the Centre Court. A svelte case in frontof me threw her head into her hands with each match-point, and at 40-30 would pull the lobe of herfather’s left ear, until it became quite ragged at the end ofplay. A man on the other side of me lost his chin in hiscollar with every rally. Somebody else stood up in frenziedpassion just when the climax of a match was reachedand yelled a" protracted gibberish which sounded likethe alphabet backwards. In the mixed-doubles I foundmental solace in taking an occasional mouthful of thewhite tulle veil which formed the hat of a beautifulgirl in front of me. By the end of the day her head wasbare and I had acute indigestion.

* * *

Old Joe Honeysuckle, who " does " our garden, is agreat believer in herbal remedies. " There’d be noneed for this loan from Ameriky if people only knowedthe treasures that lay under their feet," he said. " Thatthere dock you’re treadin’ on, for instance. TimGurglethwaite had two boils on the back of his neckand tried all sorts of medicines and went time and againto the doctor, but they wouldn’t go. I told him to digup a dock root, boil it, and drink the water. Theywent, and they didn’t come back. When I was a youngman I once had a boil, and dock root got rid of it, andI’ve never had another since." " But," said I, thinkingon post-hoc-propter-hoc lines,

" I once had a couple ofboils thirty years ago, and whatever I put on themthen, and whatever I didn’t put on them, musthave cured them, because I’ve had none since." " Ah.’’replied Joe wisely, " but, you see, in my case I didn’tput nothin’ on them. I drank the water."

" Then there’s broom tea," he added after a pause." George Puddyphut came along one day to see me withthree new cuts in his boots. ’What’s wrong with yourfeet ? ’ I asked him. ’ I bin in hospital three weeks,’he said, ’and under the doctor afterwards. They tellme I’ve got lumbago and rheumatiz, and they can’t donothin’ for me.’ ’ That’s no lumbago nor rheumatiz,’I told him, ’that’s dropsy.’ And I showed him how tomake broom tea to cure it. He come back a week laterwearin’ proper boots, and a week after that he went towork in leather gaiters."

Joe was a shepherd in his younger days, and it musthave been from watching the vet. that he acquired hisinterest in experiments. Two sheep died, one of gallopingconsumption, the other of pneumonia. Joe put a pieceof lung from each in separate jam-jars, dated andlabelled them, and put them in the sunshine. After awhile the tuberculous lung, according to Joe. was fullof ‘’ little white germs," falling down like a snowstorm,and the lung became smaller and smaller till therewasn’t none left, only water in the bottom of the jar.The other lung, the pneumonia one, stayed hard anddidn’t fall away to nothin’. " That shows," opined Joe," that the two sheep died of different diseases, doesn’tit ? "

On another occasion Joe took a potato infested withwireworm and put it in a glass jar with a metal lid.Long before -the wireworms pupated, many small cocoonsappeared on the walls of the jar, and from these hatchedminute flies. "That," said Joe, "proves there wasflies’ eggs in the potato, don’t it ?

" I pointed out thatthe cocoons were on the sides of the jar and not closeto the potato ; that he had pierced the metal lid with ahole large enough for the fly to enter and lay eggs ; andthat he had probably not sterilised the jar in the firstinstance. Joe looked reproachfully at me for criticisinghis scientific experiment, and stoutly maintained that itproved the folly of using artificial manures.

* * *

Some writers have expressed fears that the NationalHealth Service Act may lead to censorship of medicalarticles. One learned and apparently prolific author has ‘described the fate of his works when on military service.His communication passed from one senior officer toanother in an ascending and vicious spiral ; during this


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