A Doctor's Journal
Measuring Your VF
By MILES HOWARD pERHAPS the most important characteristic of the human organism is one that is difficult to measure and to study : vital force. It isn't mentioned in the textbooks—just another of those essential features of life that get left out when textbooks are written. When all is said and done, it is vital force (VF for short) that decides whether a man lives or dies after he has been badly wounded or is critically ill; that takes a fraction of a second off the keenly-run mile; that feeds the drive for all creative ability. Books are written every day about all kinds of trivial matters in medicine, yet no one writes a book about VF. Why not? Of course, it can't be isolated and quantified in the way our statistical colleagues would like; but the man in the street can and does make an excellent clinical judgment of the degree or charge or VF in his mates. All kinds of personal and social and biological ob- servations come to mind at once if one begins to think about it. For example, how VF varies with mood : high in elation, low in depression. How it varies in cycles, both in women and in men. (In passing, a brilliant article, in the Lancet, by William Gooddy: 'Time and the Nervous System'; prefaced by a quotation from Einstein and Infeld—'Let us first ask a simple question. What is a clock?) How it distinguishes people from one another : a' gradient of VF—the most fundamental difference of all. How can it be assessed?—I think, as things are now, only by a synthetic judgment; analysing and measuring and working out the blood vanadium in this area lead into a blind alley, as indeed they so often do in the study of man. One aspect of it seems fairly certain—it runs in families : though the sons of men who are high in the scale may turn out to have little effective energy—not that they are low in VF, but their instinctive forces get eaten up in conflict through the struggle for in- dependence. That is if they stay at home. If they have the sense to leave early, say, seventeen to eighteen, they survive and do well. What is the relation between VF and intelligence? I recall someone (was it Spearman?) saying that intelli- gence is energy; and certainly without VF the most admirable brain will achieve nothing. But these two are not synonymous. I know some men and women whose intellect is at the top of the range; yet they have limited drive and tire quickly. Provided they know this, they allow for it and con- serve energy. Some men have a lot of both. What they do with their VF is another matter. I think most of us admire the individual whose 'voltage' is high, even if we are critical of what he does. An- other sign of VF at the upper levels is that the owners live longer : example—Shaw. But the last years of a long life may be uncreative and sad; better to die with a bang at sixty-five, one might Is argue, and to live with zest up to the end of it. A Every so often I hear further news of Dr. It Niemoller, like fragments of a mosaic that is filling itself in. I knew about his chinchilla couch and the fountain in the consulting-room. Some- one told me on Friday that he saw only the occasional male patient; most are women and he is said to be very kind to them. At a reception the other day I heard that he regards his psychiatric colleagues as quacks and had even It, said so in public, but I can't credit this—it is quite out of character. He is much too discreet. I hope that he will soon publish some account of his work; or perhaps one of his special pupils will make a serious study of his methods and write an essay on them for a journal. It has never been my good fortune to meet him in the flesh; I can imagine that he is a modest man who never gets into the headlines.
The tracking down of the source of infection in the recent smallpox case was as fine a piece of detective work as one could wish to see. A child in Tottenham died of smallpox. His grand- mother, in the same house, was found to be suffering from 'chickenpox,' which was really modified smallpox. No immediate contact was evident. The public health authorities took the view that the patient from whom infection first came might have died and the cause. of death have been incorrectly notified. After much thought they decided that a diagnosis of leukmmia was the most likely; returns for the past few months were studied and four cases of leukemia picked out. One of these was a man in Islington who had visited before his death 01 brother in Wembley while the brother had 'chickenpox.' The patient died in a Tottenhani hospital where the grandmother worked as a cleaner. The brother had just come back from Lagos a fortnight before he fell ill. fly The report on this case in the Lancet showed k hit also how many agencies are concerned in the pre.', ahr: vention of infectious diseases : the family doctor,, tht the medical officer of health, the `smallpo ou panel,' the Ministry of Health, the laboratory, the Set isolation hospital. A great deal of hard work J„Awl done in the background which the layman knoV. in little about, and, indeed, many doctors know less th4 than they should about the machinery of preven.',bc tive medicine. The preventive measures against, n smallpox have been so effective as to set up risk that the public may forget about this gray •st, disease and give up being vaccinated, thus pre In; paring the ground for a really serious epidemic.
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