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6th January 1949.
Sir:
My friend Dr. Joan Malleson in her letter of December 11th 1948 invites comments from psychologists on the matter of taking the temperature of children by the rectum as advocated by Professor Moncrieff and Dr. Hussey in an article in the previous number.1
I hesitated before taking up this matter because my first reaction on reading the article was to feel glad that reference was made in it to the psychological side of the matter. Pediatrics is notoriously out of touch with psychology and here was an exception. Also an infant does not feel much from having a thermometer stuck in the rectum, so that the main trouble comes, if at all, from the interest in his rectum which the nurse must take by using this method. In the majority of cases I imagine there is no special difficulty here except where there has already been a good deal of rectal interference by soapsticks, enemas etc. which has roused resistance in the child to that sort of thing.
As Dr. Malleson has raised the matter, however, I can say that I felt that the words “possible difficulties from the point of view of the psychological trauma … are discussed,” which occur in the summary of the article, seemed to promise more than actually appeared in the article itself, which really only dealt with what could be called the human aspect. We hope this is never missing in the management of children, whether by a physician or nurse.
The trouble is that if a matter like this is to be discussed psychologically, there must be a willingness on the part of all to give time to the discussion and to learn about the use of the techniques by which information can be collected. Even this relatively simple matter of the taking of temperatures by the rectum involves considerations that cannot be put in a letter. Dr. Malleson raises wider issues and it can certainly be said that one cannot do justice to the subject of the effects of enemata for worms and for constipation and other gross anal manipulations except