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Meanwhile, apart from black spots, control must

proceed more slowly. Chest physicians should seekincreasingly to discover every case of the disease andto supervise patients indefinitely. Fluoroscopy shouldmake it possible for chest physicians to examine farmore cases after trivial illness, and contact supervisionshould be extended. To enable X-ray departments todeal with the increased work, 5 X 4 in. films, recom-mended by Clarke (1950), should be used. Once thechest physician could be reasonably confident thatevery patient who consulted his doctor for a coughwas referred for X-ray examination, he could expect tofind very nearly every case of tuberculosis-except theelusive " carriers "-within five years ; and he wouldthen be able to pursue, though at a slower pace, a similarcampaign to that outlined for black spots.The abolition of tuberculosis in Britain would not be

a labour of Sisyphus ; it would not even need a Herculesfor its achievement. The aim of the National Associa-tion for the Prevention of Tuberculosis could be fulfilledwithin ten years if public opinion demanded it.

SUMMARY

1. Mass radiography should be concentrated in blackspots with the aim of discovering every case therewithin a year.

2. Evidence is submitted justifying the widespreadadoption of fluoroscopy in diagnosis, to exclude seriouschest disease for general practitioners.

3. Routine tuberculin testing of all school entrantsshould be adopted throughout the school medical service.

4. Until each batch can be proved safe, mass vaccina-tion with B.C.G. is not desirable. Much greater use canbe made of it among contacts. Recruits to the ArmedForces, and school teachers, should be the next largegroups to be offered vaccination.

5. Enough beds for tuberculosis are not likely to beforthcoming. Better use should be made of existingresources ; demands on general hospitals should belimited to making available local beds for chest clinics.Extension of home treatment schemes is necessary.Waiting-lists could be abolished.

6. Aftercare is too often neglected. Chest physicianscan and should do more to help patients to recover sociallyand economically, as well as in a narrow medical sense.

7. Accurate statistical control is essential to a com-prehensive attack on tuberculosis as an epidemiologicalproblem, and should be developed in all clinics, andpossibly on a regional basis.

8. Social workers or almoners are necessary to supervisethe details of financial and economic help which are anintegral part of the control programme.

9. The organisation of the tuberculosis service requiressupervision at regional level by a director of tuberculosis.

10. A vigorous anti-tuberculosis campaign could beplanned in three phases which should result in a sub-stantial fall in tuberculosis mortality within five years.

REFERENCES

Ashwin, C. (1949) Med. & Lab. Progress, 10, 141.British Medical Association (1950) Report on Tuberculosis. London.Clarke, O. (1950) Lancet, ii, 757.Dunlevy, M. (1948) J. med. Ass. Eire, 19, 134.England, N. (1946) Tubercle, 27, 162.Hall, A. S. (1942) Lancet, i, 161.

— Tattersall, W. H. (1950) Ibid. i, 490.Heimbeck, J. (1948) Tubercle, 29, 84.Jones Davies, T. E. (1950) Brit. J. Tuberc. 44, 1.MacDougall, I. A., Mikhail, J. R., Tattersall, W. H. (1951)

Med. Offr, 86, 253.Simmonds, F. A. H., Martin, W. J. (1948) Amer. Rev. Tuberc.

58, 537.Tattersall, W. H. (1947) Tubercle, 28, 85, 107, 123.

— (1948) Lancet, ii, 974.— (1949) Tubercle, 30, 74.— (1951a) Ibid, 32, 16.— (1951b) Med. Illustr. 5, 463.— (1952) In Modern Trends in Tuberculosis, T. H. Sellors and

J. L. Livingstone. London.Toussaint, C. H. C., Pritchard, E. K. (1944) Postgrad. med. J.

20, 143.Zacks, D. (1931) New Engl. med. J. 205, 525.

TOWARDS MATURITY

AT the Conference of Educational Associations, heldat King’s College, London, on Dec. 27, with Prof. P. E.VERNON in the chair, Dr. BROCK CmsnoLM, director-general of W.H.O., gave an address at the invitationof the British Psychological Society, one of theconstituent bodies of the conference.We find ourselves, said Dr. Chisholm, living in a new

kind of world, where the- conditions for mankind’ssurvival have radically changed. We have been fightingone another enthusiastically every 15-20 years since thedawn of history, and killing one another-as individuals.But now we find suddenly that if another world warcomes we shall be killing one another as entire nations:indeed, estimates of the survival-rate of mankind as awhole range from 25% to as low as 5%. Faced with thisprospect, for the first time in history the military expertsthemselves are actively and wholeheartedly in favour ofpeace.With this as a background 79 nations have ratified

the principles of the World Health Organisation, the firstbeing :

Health is a state of complete physical, mental, andsocial wellbeing, and not merely the absence of disease orinfirmity.A further principle of W.H.O. specifically recognisesthe importance of training the child, and it was on thisthat Dr. Chisholm based his address.

TRAINING OF FUTURE CITIZENS

The adult population of the world today, he said,have all been educated to admire local loyalties ; none

of us has been specifically trained for life in this newworld. Here our parents’ teaching is of no value to us,and we must teach our children in a new way. Havingtaught them, we may find the new parent-child relation-ship uncomfortable; for our children will be much wiserthan we are. But we must make that sacrifice if -ourchildren are to live in peace-that is, if they are to live tomaturity at all.

First we must teach our children tolerance ; eachnation has its sacred cows which seem ludicrous to othernations. Our children must learn to tolerate them, how-ever queer they appear. Further, nations are developingat different rates, and development can be, hastened butcannot be side-stepped. If we deplore, for example, theRussians’ tendency to ignore the sanctity of human life,we should remember that it is only 12’0 years since smallchildren in England were regarded as expendable items,essential to keeping chimneys clean. We shall find thatalmost any behaviour that we now deplore in othernations was accepted as normal among our own peoplea few generations ago. If we think some nations too

complacent about their rate of progress, we should recallthat every nation judges itself by what it used to be, notby what other nations are today.To acquire this tolerance every citizen would need a

basic training in the following subjects :(1) Social history-the history of living conditions in other

nations and the various methods adopted in changing them.British social history should be learnt from the history-booksof other countries as well as from British books ; some

familiar events will be scarcely recognisable in the foreignversion.

(2) Psychology, and enough psychopathology to explain themechanism of such personal behaviour patterns as losingone’s temper and resenting orders.

(3) Sociology-how groups act and work, and how tensionsarise between them ; why groups have an urge towards self-betterment, and how these urges are led astray down blindalleys.

(4) Great religions of the world, and their influence on thebehaviour patterns of nations.

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New techniques can be taught to under-developedpeoples. But such peoples adopt new ways not becausethey think them better than the old but because they likethose who bring them. Here it is the personality of theteacher that carries most weight. Every country liasstandards of behaviour that it regards as obviously normal,though they may not be accepted elsewhere. The outsiderseeking to introduce new ideas must recognise and respectthe existing cultural standards, concealing any sense

of superiority he may have. Most countries are quitecontent with themselves as they are ; and we must

recognise that no cultural pattern has yet been shownto be the best possible for all nations. So any innovationmust be regarded as still experimental.In educating our children to face the complicated

situation we must look on ourselves as failures. We have

just fought a destructive war which each of us individuallycould have foreseen and recognised as disastrous. Ifwe had exercised all our knowledge to the full wecould have prevented it-but we didn’t. Perhaps wecan find an explanation in what is known aboutchild behaviour.

DEVELOPMENT OF THE CHILD MIND

The newborn child has no sense of tiiiie. To become a

satisfactory citizen he should acquire very early-beforestarting school-some sense of historical time and of

geological time in the past. He should also grasp theconcept of future time, and be willing to forgo a smallimmediate pleasure in anticipation of a greater one later.By teen-age he should know what he wants to be whenhe grows up and how he intends to live ten years hence :otherwise he will drift aimlessly into the first job thatfalls his way and live an unsatisfactory opportunist life.Through his sense of the future he should be ableto appreciate that his acts may be no less valuablebecause their results will not appear during hislifetime.The newborn child has no sense of prope1’ty. He tries

to engulf and absorb every new thing he meets, and makeit part of himself. Some people never grow out of thisinfantile habit of grabbing everything for themselves ;but the satisfactory citizen can gain pleasure from thepleasure of other people and from things he does notpossess himself.

The newborn child must be free to explore space-all objects and all areas within reach and within reason.The cause of much unhappiness in married people of

today can be traced to their parents’ reprimanding themwhen they were one or two years old for exploringtheir genitalia. This is a natural and proper thingto do, and our parents were wrong to teach us

otherwise.The newborn child eventually discovers his own

personality and other people’s. The child can develop asatisfactory personality on an astonishingly bare minimumof food and shelter, but it must have a generous allowanceof uncritical undifferentiated love. This has beenestablished beyond any question : young children requirenever-failing and invariable friendliness from theirparents. The child so equipped will grow up to expect afriendly reception from other people and will seldom bedisappointed ; on these rare occasions he will recogniselack of friendliness as an abnormality, an exception.But the child from whom love is withheld will tendto grow into a suspicious adult, finding unfriendlinesswherever he goes ; by interpreting neutral phrases andgestures as unfriendly he will encourage enmity fromothers.

If children are brought up on these lines there is hopefor the future. By educating children correctly we canhelp them to develop into people able to live at

peace in an organised world.

PUNISHMENT IN PENAL INSTITUTIONSIIOWAIZI) LFACUE MEETING

AT a meeting in London on Jan. 17, under the auspicesof the Howard League for Penal Reform, punishmentin penal institutions was discussed by Dr. DEsMONnCURRAN, who was a member of the departmental com-mittee which has lately reported on this subject,’ andDr. T. C. N. GIBBENS, senior lecturer in forensic psychiatryat the Maudsloy Hospital. The meeting was wellattended, and the debate was keen. It was evidentthat the report by the departmental committee hadstimulated a great deal of interest, but the generalimpression remained that the committee had failed touse their opportunities for removing outdated practicesand for introducing far-sighted and constructive measuresof reform.

THE PSYCHIATRIST’S ROLE

Dr. CURRAN, who was asked to answer questions basedon the report, disclaimed in his preliminary remarks anyspecial knowledge of prison conditions, apart from hisservice on the committee. He thought that most

psychiatrists talked a lot of nonsense about criminalsbecause they usually saw only the psychiatric cases

among them. He did not think that a psychiatrist wasany better qualified than a layman to advise pn disciplinefor the normal prisoner.

Dr. GIBBENS admitted that psychiatrists might con-centrate unduly on mental abnormality among criminals,but he asked whether there was not at any rate anabnormal response to punishment among a large pro-portion of offenders-otherwise they would never havelanded in prison. Perhaps only 10% were definitelyabnormal, but a larger percentage might be somewhatabnormal, especially of those who were repeatedly com-mitted to prison. During his time as a prisoner-of-war,soldiers under detention on criminal charges were keptin the mental wing of a military hospital for lack of otheraccommodation, and this arrangement seemed to answervery well. He wondered whether prisoners might notcome to rely on a settled routine of punishments. Some-times such a system was self-perpetuating ; in mental

hospitals, for instance, if one took the bold plunge of notputting excited patients into padded rooms one foundthat such cases were far fewer. Might not reduction ofpunishment in penal institutions have a similar effectby lessening breaches of discipline ?

DR. CURRAN did not think that the analogy betweendiscipline in mental hospitals and prisons held good.For one thing, the population of a mental hospital wasnot liable to unite in mutiny. Maidstone prison, however,had been run with hardly any punishments ; the one

punishment was for the recalcitrant prisoner to be trans-ferred to some other prison. One thing the committeehad definitely recommended was better classification ofprisoners, with removal of the " tough guys "-" tobaccobarons," and so forth-to a separate prison, and also ahalf-hospital half-prison for the mentally abnormal.

A DUAL SYSTEM

Dr. GIBBENS felt that there was a discrepancy betweensome of the recommendations of the committee. Theywanted a special institution, half-prison and half-hospital, to be set up for proper treatment of some 5%of adult prisoners and rather fewer of the borstal popu-lation, and psychiatric centres to which boys and girlsfrom approved schools and remand homes could go forproper classification and treatment ; yet they agreed1. Report of a Committee to Review Punishments in Prisons, Borstal

Institutions, Approved Schools, and Remand Homes. H.M.Stationery Office, 1951 ; parts i and 11 : Prisons and BorstalInstitutions, see Lancet, 1951, i, 1399; parts in and iv: :Approved Schools and Remand Homes, see -Lancet, Jan. 19,1952, p. 141.