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schools are not for mental defectives, is very strange indeed.We are merely telling the truth and it is a truth that needstelling as it is not sufficiently widely known.

5. As Dr. Rose is concerned that we are not helping toeducate public opinion in an enlightened attitude towardsmental deficiency, I can reassure him. My letter did notdeal with this, but on meeting children who are ineducableand telling their parents that they will require to be notifiedunder the Education Act, 1944, Section 57/3, some parentsmay show, in addition to intense disappointment, personalshame and hurt pride. It surely goes without saying thatwe do all that we can to help them to develop a healthierattitude to their problems.

Sheffield.M. C. TAYLOR

School Medical Officer.

PERIODIC DISORDERS OF CHILDREN

CHRISTOPHER HAFFNERRONALD MAC KEITH.

Children’s Department andChild Guidance Clinic,

Guy’s Hospital, London, S.E.1.

DAVID MORRIS.

Sm,-In your issue of July 12, Dr. Howells rightlywelcomes Dr. White Franklin’s article (June 28) on

periodic disorders of children. We agree with Dr. Howellswhen he implies a greater place for psychiatric help inmanaging these than did Dr. White Franklin ; but wedisagree with Dr. Howells’s statements (1) that " explana-tion is futile," and (2) that " it is clear that the ...psychiatrist should ... apply the psychotherapy."

Simple exploration and psychotherapy (includingexplanation) by a family doctor or a pediatrician does,in some cases, bring about a cure and not merely sympto-matic improvement. Perhaps the paediatrician will tryto treat some unsuitable cases and thus delay theirarrival at a psychiatrist’s clinic, but it would be imprac-ticable for a paediatrician to send to the psychiatrist allthe children he sees with symptoms of emotional origin ;already at many psychiatric clinics the interval before apatient’s treatment starts is months or years. Is the

general practitioner or paediatrician. to refrain fromtreatment ?

Part of the function of a consultant (perhaps he maybe contrasted with a specialist) is to teach the doctor whosends or brings cases to him. It seems to us importantfor the family doctor and paediatrician to learn whichare the most suitable cases to be referred to the psychia-trist. On occasion it is reasonable for a paediatrician toget help in diagnosis from the child-guidance clinic andthen himself, for a time at any rate, do psychotherapy.

SIR,-The problem of the child so emotionally dis-turbed as to need a visit to the doctor is one of practicalconcern to the assistant medical officer working in thelocal-authority service, the general practitioner, and thepasdiatrician.The recognition of a psychiatric disorder is important,

but Dr. Howells is being unrealistic when he suggeststhat " the child psychiatrist, or, better, family psychia-trist, should explore the psychopathology and apply thepsychotherapy." The frequency of the condition, whichsome have put as high as 50% of all children’s illness,and the disturbing effect on the child, the home, and theschool necessitate action more immediate than is possiblewith the very long waiting-lists of the child-guidanceclinics. Confronted bv these disturbed children inclinics, surgeries, and outpatient departments, a sympa-thetic attitude combined with the will to treat can go along way in helping parents in the understanding of theemotional needs of their child. It is encouraging to seeparents becoming aware, so often for the first time, ofwhat has been wrong and the almost immediate effectthis has on both parent and child. This understandingdiffers fundamentally from " the explanation-the mereinstruction-the mechanical change of technique "which Dr. Howells puts as the only alternative tofull-blown psychotherapy.

In answer to the needs of the patient we must do whatwe can, and in the process of so doing acquire more

skill, experience, and judgment. It is time, however,that psychiatrists made some efforts to bring their specialknowledge to doctors working with children in order thatthey may be better equipped in their work in this field.London, N.W.3.

CAR-DRIVERS WITH DEFECTIVE VISION

J. S. GRANT ROBERTSONHon. Press Officer,

The Motor Schools Association.

SiR,-The statement (July 19) of the Faculty of

Ophthalmologists on the danger of visual disabilities inpeople driving motor vehicles is of great interest tomembers of this association, emphasising as it does theweakness in the present system of issuing driving licences.

This association thinks that the fact that a candidatefor a driving test wears spectacles should be recorded onthe driving licence. This would ensure that, in theevent of such a driver being involved in an accident, itwould be possible to check whether or not he, or she,was wearing spectacles at the time, or, in other words,was properly equipped to be in charge of a vehicle.One of our members has reported that in the past year

he has handled two cases in which elderly people, afterbeing involved in accidents, were convicted of dangerousdriving and had their licences suspended until they passeda driving test. In both cases, the instructor detected

signs of defective vision immediately. On his advice theyconsulted ophthalmologists who advised them both togive up driving. Fortunately, in these cases this advicewas taken.We know of another candidate who failed the test

because of defective vision. After the test she admittedto her instructor that she knew that she had bad eyesight,but said that she did not like to wear spectacles. Shedid, however, get spectacles, entered for the test a monthlater, passed (with spectacles), and has not worn themsince.

London, N.W.3.

HALLUX VALGUS

JESSE W. J. TURVEY.Royal Northern Hospital,

London, N.7.

SiR,-While welcoming the authoritative survey byDr. Hardy and Mr. Clapham (June 14), I am not

entirely happy about the radiographic technique employedin collecting the data.With the technique used, the distortion produced will

tend to show a metatarsus varus, by virtue of the divergenceof the cone of X rays centred, as it was, between the two feet.Furthermore, owing to the lateral direction of the projectionof each foot, as the angle between the first metatarsal and theplane of the film increases, so an increase in the apparentdegree of hallux valgus will be seen in the radiograph. More-over, as the centre of the cone of rays was not directed throughthe apex of the angle formed by the first and second metatar-sals, the angle of the first interspace would be apparentlynarrowed ; and as the dihedral angle between the plane ofthe first and second metatarsals and the plane of the filmincreases, so the angle between these two bones in the

radiograph will apparently decrease.The type, then, with the higher longitudinal arch will tend

to show in the radiograph, taken under these conditions,a greater degree of apparent hallux valgus together with anarrowing of the first interspace. Is this not significantin view of the findings of the survey ?Having spent some thirteen years in radiography

before turning my attention to the foot, I remainunconvinced that radiography affords a suitable mediumfor measuring angles in such a multi-planed structure asthe skeleton of the foot.

I am aware of the almost insurmountable difficultiesinvolved in a mass examination of school-children’sfeet ; but I feel that a more reliable assessment could bemade by direct measurement, particularly with regardto the degree of varus or valgus of the metatarsus asa whole, which is of fundamental importance if thedesign of footwear for the growing child is to be improved.