Donald Court

Delayed Speech and Developmental Aphasia

Furthermore, the difference in cost between the two treatments is considerable, as maintenance, even on one tablet a day, is nearly nine times as expensive as one injection of 100 /Ag. of vitamin B12 once a fortnight. So long as the nature and mode of action of intrinsic factor remain uncertain it is clearly preferable to rely on the parenteral administration of vitamin B12 for the routine treatment of pernicious anaemia. Although the majority of patients prefer taking tablets to receiving injections, more detailed investigation is required before oral treatment can be recommended.

Incidence of Intussusception in Newcastle Children

have concerned patients of normal intelligence, all our patients were mentally defective. We suggest that in the genetically determined cases of mental defect, developmental abnormalities of and, in the environmentally determined cases, damage to the basal ganglia, insufficient in itself to produce signs of Parkinsonism, may considerably lower the threshold dosage of dartalan that can cause these signs to appear. As we have stated, none of these patients had previously shown any signs of Parkinsonism, nor were any of them known to have suffered from encephalitis. It is well known, however, that a clear history of encephalitis in patients developing post-encephalitic Parkinsonism is frequently absent, and it seems probable that it would be absent in our cases if, as we suggest, the resulting damage was insufficient to produce postencephalitic Parkinsonism of its own accord.

Speech Disorders in Childhood.

There are many aspects of speech and its disorders which are not fully understood. Although the literature is considerable it is not readily accessible to the busy practitioner, and the variations of expert nomenclature are a further hindrance to general interest and understanding. Mindful of this and of our own diagnostic uncertainties, we thought it would help the family doctor to share some points learnt from the treatment of 1,500 children in this region. The main work has been done by the speech therapist (M. M.), but recently we have studied together in more detail examples of the disorders met with in this series. Their percentage distribution was: stammering 40, dyslalia 26, cleft palate 16, severe or partial deafness 7, defective articulation without evident lesions of the nervous system 5, mental retardation 4, and cerebral palsy 2. This brings out the numerical importance of stammering and dyslalia but fails to reveal the important part played by mental deficiency in the delayed or defective development of speech. We shall not attempt a specialist account of these difficult problems but try to describe the main clinical features of the common disorders, their probable outcome, the degree of investigation possible in the family practice, and the best time to seek specialized help. The development of speech in the normal child has been described by Dr. M. D. Sheridan in the British Medical Journal of May 19, 1945 (p. 707), and will not be repeated here. In fully developed speech there are three main phases: the reception of sounds by the ear and brain, the interpretation and regrouping of these sounds and their associated ideas, and the final expression of these symbolic sounds in speech. For the purpose of this paper we shall refer to these as the receptive, formative, and expressive aspects of speech and group our case histories under these headings. This mechanical simplification and separation of a finely integrated function cannot be pressed too far, as the frontiers between these three divisions are not always clearly defined. Nevertheless this anatomical concept of speech and its disorders is reflected in the clinicians approach to the affected child and justifies its use in an article of this kind.

The Psychological Factor in Rheumatism

SIR,-We should be grateful if we might be allowed to draw the attention of your readers to an inquiry into the causes of infertility which is being promoted by the committee to which we belong. These causes have been much discussed of late in Parliament and elsewhere. It will be recalled that the main object of the Population Statistics Act, which came into effect on July 1, 1938, was to throw further light upon this subject. But there are strict limits to what we may learn from vital statistics. They can tell us nothing, for instance, about how many marriages are involuntarily sterile or sterile by design, or of the extent to which abortion and contraception are practised, or about the numerous motives which restrict parenthood in different regional and occupational groups. These problems can only be clarified by direct inquiry. A questionary has been prepared by our committee. If filled in on a large enough scale it will yield information which is otherwise unobtainable. It has been designed for the use of doctors, midwives, nurses, and other competent investigators, and has been drawn up on the same general lines as were followed by Professor Raymond Pearl in his comprehensive American inquiry. The committee is anxious to obtain records of the attitudes and experiences of as large a sample as possible of married women in this country, irrespective of age and parity. It would therefore be very grateful if those of your readers who are interested in the problems of declining fertility, or in problems allied thereto, would assist it by sending for copies of its questionary and by filling them in when appropriate occasions present themselves. An honorarium of Is. per filled-in questionary is offered. A small manual has been prepared which provides guidance in the use of the questionary. Will those of your readers who are interested kindly communicate with the secretary of the committee?-We are, etc., EARDLEY HOLLAND HENRY BRACKENBURY HORDER C. P. BLACKER. Population Investigation Committee, 69, Eccleston Square, London, S.W.1, June 23.