SEPT.
27, 1941 CORRESPONDENCE
It is nonsense to pretend that the success of the public school
system depends on the social background of its pupils and makes
all the difference between the actual and feared results of com-
munal feeding. If the public schools are closed after the war
it will be because of financial stringency and not because of
psychological or other defects. As to their dysgenic effects on
the nation, of course the cost of educating children at public
schools must limit their production. However, if the nation
wants more children it will have to pay for them, and not only
for those who go to public schools. But a high birth rate does
not seem the remedy for widespread unemployment and frequent
wars, and until these are cured by other means parents will be
prudent in their production of babies.
Dr. D. W. Winnicott (p. 358) admits that" voluntary communal
feeding of children can be successful, not only physically but also
in regard to emotional development." Why he thinks the results
should be worse if made compulsory and permanent is not easy
to see. Perhaps it is one of those " things in heaven and earth not
dreamt of in my philosophy." But let me assure him that I am
not indifferent to " complications arising out of feelings, fan-
tasies, and superstitions," though I beg leave to doubt that any
serious complications of this nature need be feared from school
dinners. I have seen no sign of them at our own school dinners.
In fact, our backward and " difficult" children have shown
marked improvement mentally as well as physically after a course
of school dinners. A little mental as well as physical buffeting is
good for children by helping to prepare them for the much
greater stress and strain they will have to face when earning their
own living.
Undoubtedly a small percentage of the children evacuated
have suffered serious emotional upset from evacuation to strange
homes and strange people, but they form a surprisingly small
part of the total. In any case, emotional disturbance arising
from evacuation cannot be compared with any slight upset which
might arise from compulsory attendance at school dinners,
though why this should cause any more mental trauma than
compulsory attendance at school for lessons is not clear. Further-
more, exceptional children could be excused, but they should not
be allowed to stand in the way of a provision which would
benefit the majority.
To sum up: 11 % of our school children are obviously under-
nourished. How many are suffering from deficient diets we c'on't
know, but Sir John Orr's National Survey published in 1936
suggests that roughly half the population subsist on diets which
are deficient in some or all important constituents. Compulsory
school dinners appear to be the only satisfactory solution of the
nutrition problem in sight. No homes need be burnt down to
provide them, and maternal relief is more likely than maternal
depression.
But fancy all this ado and dark foreboding over an hour longer
in school and a meal less at home. It makes one wonder how
much of it is prompted by genuine anxiety for the welfare of the
mothers and their children.-I am, etc.,
Gosport, Sept. 8. G. W. FLEMING.
A Simple Technique of Intravenous Infusion
SIR,-The following modified method of fixing a cannula in a
vein for the purpose of infusion or transfusion has been found
successful, and it seems worth while making a brief note of the
technique, as the call for intravenous infusion is such a frequent
happening in these days.
After cleaning and anaesthetizing the skin, a small oblique
incision is made over the vein instead of the usual transverse one.
Exposure of the vein is effected by the beak of a haemostat in the
usual way. A careful dissection of the vein from its surgounding
fascia is unnecessary. A curved cutting needle is threaded with
a strand of silkworm gut and is now passed through one skin
edge, beneath the vein and out through the outer skin edge. The
ends of the suture are caught in a haemostat and traction is
exerted in order to obstruct the venous flow. With a pair of
sharp-pointed scissors a small longitudinal nick is made opposite
the silkworm suture in the anterior vein wall and the cannula
quickly inserted. The suture is tied round the vein and
cannula. The suture now fulfils three functions: it occludes
the vein, it keeps the cannula in position, and it closes the skin
incision.
MEDICAL JOURNAL 459
After conclusion of the infusion the suture is cut, the cannula
quickly withdrawn, and a new skin suture inserted to close the
wound, which is covered with a sterile dressing and bandage. As
a prophylactic measure against sepsis sulphanilamide powder
should be rubbed into the wound before tying the suture. The
longitudinal cut in the vein will heal, and, as the vein is not
ligatured, the circulation has a good chance to become re-estab-
lished and the vein could be used again at a later date.
It will be seen from this brief description that this technique
economizes in movements, time, and material, a single strand of
silkworm gut being the only suture necessary. The whole pro-
cedure takes little more than a minute to perform. It is in these
respects that this method has certain advantages over those men-
tioned in textbooks.
I wish to thank Mr. D. Lang Stevenson, F.R.C.S., for his help
in trying out this method.-I am, etc.,
Romford, Essex, Sept. 4. E. FRANKEL.
"Perfect Sight without Glasses "
SIR,-As you rightly point out in your annotation on this
subject (September 13, p. 383), the whole treatment of defective
sight by exercises is based on fallacy. The answer to Dr. J.
Parness's inquiry (p. 389) is, therefore, as follows: No degree of
ametropia is cured by the exercises of Bates or any of his
brethren, and those who seek this treatment hoping to give up
glasses which they genuinely need will be disappointed.
However, in this country the majority of the population buy
their glasses from " practitioners " who have no medical know-
ledge, and it follows that there are thousands of us who are wear-
ing glasses unnecessarily. If one such should fall into the hands
of a Bates practitioner, a " cure " will result, but it should not be
necessary to go to a second unqualified practitioner to be told
that the glasses provided by the first were unnecessary fromn the
start.
If the Bates treatment is given to a person who genuinely needs
glasses, then at the worst he is a sadder, wiser, and poorer man.
But where it is given to patients whose headache or defective
vision is due to general causes-perhaps renal or intracranial-
then the delay caused by the treatment may well have a disastrous
result. If only for this reason it seems a pity that Dr. Huxley
should have given it a free advertisemnent.-I am, etc.,
London, W.l, Sept. 15. SEYMOUR PHILPS, F.R.C.S.
SIR,-Benjamin's book is, of course, complete nonsense, but it
appeals to the belief in magic latent in so many apparently
modern rational people. As only those with no useful work
to do in the world have time to devote to this particular magic,
not much is lost to society if such persons do leave off their
reading-glasses. If myopic they will still see to read, and so
can discuss their magic " cure " in complete honesty of belief.
The world's workers will continue to use glasses when neces-
sary to get on with their job with the least possible strain.
Glasses do not, of course, cure hypermetropia, myopia, or
astigmatism. They simply relieve the strain involved in
trying to concentrate on close work with eyes which are out
of focus.
The only people to whom Benjamin's otherwise comic book
could do any harm, if its advice is followed, are those suffering
from glaucoma, iritis, and corneal ulcers, in which cases failure
to recognize and treat the disease properly leads inevitably to
serious loss of vision or blindness. In this the book is on a par
with many other systems of quack cures-e.g., a fairly well-
known system of "curing" cataract without operation. This
system labels all its clients as cases of cataract, and " treats "
chronic glaucoma, retinal haemorrhages, etc., with complete im-
partiality by means of enormously strong convex glasses, by the
aid of which the victim is encouraged to read for so many hours
a day. As a further aid the lenses are tinted a most convincing
green. How, then, can they fail to " cure"? I imagine that
this system does much more positive harm than Benjamin's
book.
I have known numbers of patients who have tried to follow
Benjamin's precepts, but have yet to encounter a single " cure."
They all relapse and go back to their glasses. I lent the book
some years ago to a man with slowly progressive cataract. He