1400

Register in the ordinary way; (2) to remain

unregistered and convince the General MedicalCouncil if possible that registered practitioners canproperly be allowed to give anaesthetics for them.This, he said, would involve proof of a properminimum standard of medical education and

probably the compilation of a list of osteopathsrecognised for the purpose by the General MedicalCouncil ; and (3) to adopt the position that theregistered medical practitioner is the principalresponsible for diagnosis and treatment, andthe osteopath a technician possessed of specialmanipulative skill whose responsibility is confinedto carrying out manipulative work under thedirection of his principal. That, he said, was asfar as the Ministry of Health could go.

THE EPILEPTIC PERSONALITYTHERE is general agreement that epileptics, as

a class, are more egocentric and more sensitivethan the rest of the community-that they arepoor in ideas and unstable in their emotions. Thus

they are said to possess the epileptic personality.But the place of the personality in the picture ofthe disease is less easy to define. One school of

thought supposes that an inherited psychologicalconstitution is the primary factor, and that thefits themselves are the outcome of the intolerablestresses which result from its contact with an

unfriendly world. Another, and perhaps morewidely accepted view, is that the traits which makeup the epileptic personality develop because anychild liable to fits is regarded as peculiar by thosearound him. The issue is not so simple as this.The relation of the peculiar temperament to thedisease can perhaps only be studied satisfactorilyin individual cases where its development can bewatched over a number of years and can be

carefully correlated with the type and incidenceof fits and change of environment.

Intimate knowledge of home conditions and ofthe family history will be required to make suchobservations of much value, and in view of theneed for appropriate data Dr. EDWARD BRIDGE 1of Baltimore has compiled some detailed reportson a few children under his care. All who haveto deal with epileptics, and who read Dr. BRIDGE’Sinteresting and careful compilation, will appreciatethe clarity with which he presents his picture of thechild’s development under difficulties. But his con-clusions are not so clear-cut. On the strength, indeed,of one remarkable case, he claims that the personalitycan be approximated to the normal by the provisionof a proper environment (using that term in itswidest sense), although the epilepsy is unaffected ;and hence he argues that it is unlikely thatabnormal personality can cause the disease. Ifthis be accepted, defects in personality may,Dr. BRIDGE considers, be attributable to faultyenvironment, to anatomical cerebral defects suchas scarring, tumour or developmental anomaly, qrto some physiological disturbance which at thesame time causes fits. The chance of removingthem must depend on the relative importance of

1 Arch. Neurol. and Psychiat., October, 1934, p. 723.

the contributory factors ; faulty environment iscapable of remedy but anatomical brain defect isnot. The factor of physiological disturbance asa cause alike of attacks and of temperamentaldefects is certainly one that deserves more con-sideration. The irritability which often precedesa fit by hours or even days is explained by such a,conception, and the great improvement in tempera-ment which often follows a cessation of attacks

may well be due to some undetermined physio-logical change which was also the cause of theirstopping. In the same way a common antecedentdisturbance may explain mental abnormalities

following a series of fits, while the importance ofphysiological factors is emphasised by the con-

spicuous influence of recognised physiologicaldisturbances, such as menstruation, on the courseof epilepsy. The lesson of all this seems to be thatdifficulties of personality or even gross mentaldisturbance should not necessarily lead to a

gloomy prognosis-at least until an attempt hasbeen made to find the cause of the difficulties ordisturbance. In some cases, clearly, the cause canbe removed ; though it must always be rememberedthat recurring convulsions may ultimately bringabout gross changes in the structure of the brain.

THE PLACE OF IRON IN HOOKWORMANÆMIA

THE effects of hookworm infection on the bloodof tropical races cannot be interpreted withoutknowledge of their normal blood standards.L. E. NAPIER has reported that the blood of43 apparently healthy Indian members of thestaff of the Calcutta School of Tropical Medicinegave an average of 5,345,000 red cells per c.mm.and a haemoglobin percentage of 105-9 (Hellige).These figures confirm the conclusion that low

haemoglobin values are not normal for dwellers.in the tropics, and show that no anaemic hookwormcase should be considered cured of the effects ofinfection until high haemoglobin figures have beenreached. The great and manifest value of ironin bettering the blood state of victims of thisinfection irrespective of whether the worms areleft or removed has been amply confirmed in

reports published this year from Egypt,2 PortoRico,3 and Brazil.4 4 Nevertheless, when wormshave been left, normal haemoglobin values havenot been reached even by CRUZ, who after carryingon iron administration for six to twelve monthsreached an average haemoglobin percentage of81 only. In comparing the results of ironadministration in those who have been de-wormedand in those who have not, it is unfortunatelynecessary to leave out of account the laborious,Porto Rican hospital work, since the records.

presented 3 offer no evidence that the patientshad been rid of their worms. Indeed the presump-tion is that they had not, for there is no mention

1 Napier, L. E.: Ann. Rep. Calcutta School Trop. Med., for1933, p. 87.2 Biggam, A. G., and Ghalioungui, P.: THE LANCET, 1934, ii., 299.

3 Rhoads, C. P., Castle, W. B., Payne, G. C., and Lawson,H. A.: Medicine (Baltimore), 1934, xii., 317.

4 Cruz, W. O.: Mem. Instit. Oswaldo Cruz, 1934, xxviii., 391;see THE LANCET, Nov. 17th, 1934, p. 1116.