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OPTICAL CRAFTSMEN

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Page 1: OPTICAL CRAFTSMEN

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careful work speaks for Clayton Lane’s theory thatit is due to simultaneous cyclical parturition of thefemale worms; but more work on this matter isneeded. There are several papers dealing withtissue changes caused by parasites, for instance,tumour growth and those caused by kala-azar andClonorchis sinensis, the last furnishing yet another

. instance where the extent of microscopical damageoutstrips the appearance of clinical symptoms.

Finally, Hoeppli furnishes a sympathetic apprecia-tion of Fulleborn. An army medical officer (he waswounded on the Western Front during the Great War),he was naturalist, helminthologist, and brilliantlecturer, had curious and complete incapacity todraw and a literary style which was complicated ; hewas a great conversationalist, fine cook, and per-sistent smoker-a many-sided and very human

personality.DAWSON WILLIAMS. MEMORIAL PRIZE

THE Dawson Williams Memorial Fund was

established by voluntary subscription in 1928 incommemoration of the late Editor of the BritishMedical Journal. Its object is the award of a prizeevery two years, or at longer intervals, in recognitionof work done in connexion with paediatrics. Thefund is administered by the following trustees : thePresidents (for the time being) of the Royal College ofPhysicians of London, the Royal College of Surgeonsof England, the British Medical Association, theRoyal Society of Medicine, and the Section for Diseasein Children of the Royal Society of Medicine, and theEditor of the British Medical Journal. There havebeen two previous awards of the prize-namely,in 1930 to Dr. F. J. Poynton, for his work on behalfof rheumatic children, particularly with regard tothe establishment of special " rheumatic centres " ;and in 1932 to the late Sir Robert Jones for his workin connexion with the psediatric side of orthop2edics.The trustees have decided to make the third awardthis year to Dr. G. F. Still in recognition of his workfor sick children, and with the consent of the councilof the British Medical Association the prize (acertificate and cheque for 50 guineas) will be presentedby the President of the Association on the occasion ofhis presidential address at Bournemouth on Tuesday,July 24th, 1934.

VOMICÆ TREATED CONSERVATIVELY

BEFORE the Medical Society of Davos Dr. F. Bauerhas related his experience 1 of the spontaneousdisappearance of tuberculous cavities in the lung.Speaking after long residence in Alpine sana-

toriums Dr. Bauer has retained his belief in the

ability of the hygienic-dietetic regime to deal withthe severe destructive forms of tuberculosis of the

lung, and he besought his colleagues not to forgetthe wonderful successes attained before the intro-duction of collapse therapy-results still within theclinician’s reach. For himself he could not overlookthe troublesome complications resulting from artificialpneumothorax ; patients who had recovered after

collapse therapy did not, he thought, regain respira-tory function as completely as those who had notundergone any surgical procedure. Dr. Bauer is aWarm supporter of the standpoint of Dr. FernandCardis of Leysin, who demands a period of strictconservative treatment lasting two or three monthsbefore beginning pneumothorax treatment. Evenwith afebrile patients he thought this period was bestspent in absolute rest in bed. It should be long

1 Acta Davosiana, April, 1934.

enough to show whether there was a good tendencytowards fibrosis. In any case it gave time for adiminution of toxic absorption and for improvementin the condition of the remaining foci in the sameor in the other lung. He thought the danger ofhaemoptysis during this period had been very muchexaggerated ; he had very rarely seen it occur. Thelikelihood of the pleura becoming prematurelyadherent-the other objection raised-was veryslight in patients kept strictly quiet in bed. Recentlyhe had occasion to inquire again into the subsequenthistory of the 29 patients with lung cavities, treatedconservatively in the Park (late Turban) Sanatorium,reported on by H. Wohlers 2 four years ago ; 21 ofthese patients now, after an average period of sixyears, had remained well, 18 of them following theirnormal occupation.

OPTICAL CRAFTSMEN

THE last day of the. recent London meeting of theOphthalmological Society of the United Kingdomwas taken up by a tour of inspection of optical work-shops. The Association of Dispensing Opticians hadextended an invitation to the society to inspect twoof the larger factories owned by its associates. Thesetwo firms were obligingly at work over the Saturdayafternoon in order that the congress members mightsee in progress the various processes in the manu-facture of spectacle lenses, safety glass, frames, andophthalmic instruments. In these days of mass

production the visitors must have been refreshedby the extent to which this work remains a craft.It is true, of course, that the ophthalmologist’s pre-scription is translated by the technical and mathe-matical lore of a generation into precise instructionsto a machine, but even so the man or woman incharge of the machine has enough scope to takepleasure in the work. The materials themselves areattractive, consisting primarily of optical glass,emery, and rouge ; the addition of pitch with whichthe lens is fixed firmly into its bed before grindingbegins affords additional pleasure owing to itsplasticity to the younger members of the staff whouse it. It must often have occurred to the unlearnedto wonder how an optical prescription which maycontain both cylinder and prism, as well as twospherical surfaces, can be readily and preciselytranslated on to a spectacle glass. It is interestingto know that where bifocal glass is ordered the workalways begins with differentiating between these twospherical surfaces, the deeper of which is first groundand then filled in with some protective materialwhile the flatter surface is ground. When this hasbeen completed the lens is taken out of its bed andturned over to take the rest of its grinding on theother surface. Checking of the curvatures requiresinstruments of extreme precision, and these are forthe most part designed and made in the same work-shops. The transparency of the working materialhas this advantage, that instruction about the axesof the cylinder can be affixed with white cement tothe surface of the glass which is not being workedat the time, and the white letters stand out vividlyagainst the background of pitch. There must be littleor no occupational risk, as the grinding is all doneon a wet surface ; in the only department in whichthe lenses are clipped to shape the workpeople wearprotective masks. The material for frames alsoaffords much scope for craftsmanship, especially inworking the shell of the turtle, which still remainsthe most popular frame in use in spite of the growing

2 Ann. de Méd., 1930, xxviii., 397.

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variety of more plastic and less expensive materials.The only regret in the ophthalmologist’s mind mustbe that the refractive error and the eye for which itis prescribed are not susceptible to as accurate ananalysis as the spectacle glasses ; in fact, comparedwith the product of the modern optical workshop theeye itself is becoming a little demode.

INTRACRANIAL TUMOURS

A RECENT analysis by Dr. Leonard B. Cox of aseries of 135 cases of intracranial tumour collectedin Melbourne, shows that the same types occur inmuch the same numerical proportions as obtain bothin this country and in the United States. An excep-tion, however, is found in granulomatous tumours,which are much rarer in Victoria. Cox’s series doesnot include any of these tumours ; they form 2-2

per cent. of Cushing’s much larger series and wereundoubtedly far more frequent, in this country, atany rate, during last century. The difference isattributed to the greatly lowered incidence of tuber-culous infection in Australia and to the more efficient

prophylactic and hygienic conditions of the presentday. Most of Cox’s specimens were obtained at

necropsy. This, no doubt, accounts for the factthat metastatic and invasive tumours form 14-1 percent. of the total, whereas they formed only 4-2 percent. in Cushing’s collection, which is essentially thatof a practising surgeon. There can be little doubt, fromconsideration of statistics published elsewhere, thatthe former figure gives a more accurate estimate ofthe incidence of secondary intracranial growths.

The gliomas are analysed at considerable length.Those who are interested in the cytological problemsof this group will find a more detailed account in aprevious article by the same author.2 While adopt-ing the classification of Bailey and Cushing andappreciating its value as a means of dividing thegliomas into groups having a definite clinical and

histological picture, Cox is critical of its theoreticalimplications. He concludes that " a classificationbased on the similarity of the neoplastic cells to thoseobserved in histogenesis does not present an exactpicture of these tumours." Most histologists willagree with him. In practice a certain number ofspecimens present insuperable difficulties to classifica-tion. Amongst the different types of glioma thatknown as glioblastoma (or spongioblastoma) multi-forme was most frequently encountered in theMelbourne series. This tumour arises as a rule inthe deeper parts of the cerebral hemispheres anddisplays a highly malignant character. Cox, there-fore, takes the reasonable view that the surgicalremoval of such tumours is in general impracticable.He lays himself open to challenge, however, in

suggesting that such attempts are never feasible.It occasionally happens that a tumour of this typeis small, superficial, and reasonably circumscribed.Such examples have been successfully removed, butit is not yet known with what ultimate results. Themedulloblastomas, which occur principally in thecerebellum in young children, are also highly malignant tand hence unfavourable from the surgical standpoint ;they are, however, susceptible to X ray treatment.In the Melbourne series a few examples were found inadults, and evidence was obtained that in some ofthese the rate of growth is much slower than is thecommon expectation. The meningeal tumours, ormeningiomas, lend themselves readily to surgicalremoval provided that vigorous measures are taken

1 Med. Jour. of Australia, Feb. 10th, 1934, p. 182.2 Amer. Jour. of Path., 1933, ix., 839.

to prevent the exsanguination of the patient. Coxfinds that recurrence of the tumour often takes placeeven when its removal was thought to be complete.This, again, is a point on which individual experienceis likely to vary. These tumours are almost alwayshistologically benign, and the factors that are

responsible for recurrence are as yet little known.Diagnosis of a metastatic tumour is generally a

signal for inactivity as far as surgical interventionis concerned ; some surgeons hold, however, that ifthe cerebral metastasis is solitary and accessible it

may be worth while attempting its removal. Amongstother guiding principles on treatment Cox suggeststhat " in practice it is wise to do a decompressionoperation over the site where a tumour is consideredto be growing, even if a pessimistic view be takenof its nature..... By an examination of theexposed brain there is less chance of being confrontedat autopsy by a favourable tumour where an unfavour-able one was diagnosed. In each of two cases in thisseries, an operation for carcinoma had been performedprior to the onset of cerebral symptoms. It was

expected that the cerebral tumours would bemetastases, but in each case a glioma was found atautopsy." Even if the tumour should not be whollyremoveable there are substantial chances both ofrelief to the patient and prolongation of his life.

THE PERILS OF THE MILK-SUPPLY

A DEPUTATION from the People’s League of Healthwas received by Sir Hilton Young, the Minister ofHealth, and Mr. H. E. Dale, representing the Ministryof Agriculture, on Wednesday last, April 18th, theobject of the deputation being to urge upon theGovernment the need for efficient protection ofchildren from milk-borne diseases, and especially fromthe danger of contamination with tubercle. The

deputation had its origin in the scheme of the Govern-ment for the provision of milk for children in Stateschools, and the speakers presented the difficultiesunder which medical.practitioners laboured in advisingthe use of cow’s milk with a knowledge that it wasimproperly controlled. The deputation having beenintroduced by Dr. C. 0. Hawthorne, chairman of theCouncil of the League, Lord Moynihan emphasisedthe fact that the existing supply of milk, defined byhim as " almost a perfect food " was not safe, andgave it as his opinion that, while the eradication oftubercle from cattle would lead to a safe supply, itwas impossible to wait for such a reform ; for the

present all milk other than " Certified " and " GradeA " (tuberculin tested) milk should, he said, bepasteurised. Many representative speakers followed,pointing out the wide existence of milk-borne infection,emphasis being laid in more than one quarter on thefact that if pasteurisation is adopted the procedureshould be carefully controlled. Practical evidence ofits utility, however, was afforded by Sir PendrillVarrier-Jones, Sir John Robertson, and others. Theunhygienic methods of milk distribution in Londonand elsewhere came in for notice, and finally Miss OlgaNethersole, the founder of the League, read communi-cations from unexceptionable authorities, all stressingthe dangers of milk-borne disease. Sir Hilton Youngpointed out to the deputation that they were preachingto the converted, while he dwelt on the importance ofeducating the public in regard to milk-supply. Herehe recognised the influentially supported work of theLeague to be of the greatest value. He agreed thatall possible steps to remove infection from herds mustbe taken, but allowed that for the present reliancemust be placed upon further measures for the protec-


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