1432 THE DUODENAL TUBE IN INTESTINAL OBSTRUCTION

At any rate, it is impossible to appraise the finalresult of operative treatment until time has beengiven for any other parasites in the brain to dieoff, and this may mean years of observation. Nonethe less, there are definite and practical advantagesin establishing a diagnosis of cysticercosis. In the

Army this disease if contracted abroad is rightlyregarded as attributable to military service, andtherefore a responsibility of the State. To anypatient and his family the discovery of an organiccause for a supposed idiopathic epilepsy is grati-fying. And further, when mental deteriorationin cysticercosis has progressed so far that the

subject becomes certifiable as insane, it is an

indescribable relief to all his family and connexion-even though the unfortunate victim himself maygain no benefit-to know that any possible slurof familial lunacy has been removed.

THE NURSERY SCHOOL QUESTIONTHE publication of the volume on infant and

nursery schools completes the trilogy known asthe Hadow report ; from the medical standpointit is perhaps the most interesting of the three,for it covers a period, that up to 7 years of age,which is critical both in physical and mentaldevelopment. In the appendices will be foundan account of anatomical and physiologicaldevelopment of children between 2 and 7 yearsby Prof. H. A. HARRIS, and of emotional develop-ment by Prof. CYRIL BuRT and Mrs. SusAN ISAAcs,which should be of real value to medical practi-tioners. As the report wisely points out, the prob-lem of the physical and mental welfare of childrenunder 5 is one in the solution of which the nurseryschool constitutes only one factor. Fundamentallyit depends for its complete solution on better

housing conditions ; child welfare centres have a

part to play, and there is also required efficienteducational work in housecraft and infant care.

Whilst something is being done in all these direc-tions the ground is still inadequately covered.

Housing conditions for many are far from satis-factory ; hygiene teaching is only in its infancy ;and whilst child welfare work is coping efficientlywith the problem of the child up to 1 or even

2 years of age, there is no adequate supervisionof the child from 2 up to the age when he entersschool. Only 13 per cent. of children between3 and 5 years of age are in attendance at school,and the hiatus at this point is large. The schoolmedical service still finds too many entrantchildren suffering from defects which might havebeen ameliorated in whole or in part in earlier

years..

The Hadow Committee have refrained from

expressing any definite opinion how this gapshould be filled, but the tone of the report givesthe impression that a possible solution of the

difficulty lies in the opening of more nurseryschools and classes. They suggest that the nurseryschool should primarily meet the needs of childrenwho live in districts where housing and generaleconomic conditions are below par. This con-

1 Report of the Consultative Committee on Infant andNursery Schools. H.M. Stat. Office. 2s. 6d.

clusion should meet with little opposition, and thefurther suggestion that has been mooted in somequarters that the arrangements for slum clearancemight include the provision of sites for nurseryschools is only the practical application of thecommittee’s recommendation. They also advo-cate the establishment of such schools in districtswhere conditions are more favourable, as centresin which problems connected with the generaldevelopment and nurture of children may be

investigated. In such districts the urgency of theneed on physical grounds is, of course, not so

great, but in view of the better modern under-standing of the factors that affect mental andmoral development in the earlier years there is

surely a case for the extension of nursery schoolseven to what may be regarded as less necessitousareas. The prevention of maladjustment is as

important as the prevention of physical diseaseor defect, and the need for this is not confined to.slum areas.

Practical experience in areas where nurseryschools and classes are already in being shows’that they have a value beyond their immediatepurpose. Their establishment has been found tocreate on the part of parents a greater interestin the development of their children, a greaterdesire for knowledge in matters relating to childcare, and a greater interest in school activitiesgenerally ; teachers can do much to foster theseby establishing regular meetings for mothers atwhich members of child welfare and school medicalstaffs share in the teaching. There are greatpossibilities in the future for nursery schools, notso much as schools in the strict sense but as educa-tive centres for parents and children, linkingtogether the child welfare and the school medicalservice.

THE DUODENAL TUBE IN INTESTINALOBSTRUCTION

ONE of the most formidable complications ofacute intestinal obstruction is the accumulationof enormous quantities of fluid in the stomachand small intestine. After an operation for therelief of obstruction the surgeon often feels thatthe recovery of normal peristalsis is preventedby continuous overdistension of the muscle wallof the gut, while gastric dilatation and persistentvomiting distress and exhaust the patient. Unlesssome means of keeping the stomach empty is

adopted, the patient almost certainly dies. C. H.MAYO is- quoted as having said that he would rathersee a stomach-tube than a stethoscope hanginground the neck of his surgical intern. But howeverenthusiastic one may be about the effects of

repeated gastric lavage, it cannot be describedas ideal from the point of view either of the patientor of the house surgeon and its effect on intestinaldilatation is very slight. Many surgeons nowadvocate the passage of a duodenal tube, whichcan be left in situ for days at a time, and throughwhich the stomach contents can be repeatedlyaspirated. At the British Medical Associationdiscussion on intestinal obstruction in 1932 this