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INFORMAL ADMISSION OF MENTAL DEFECTIVES
431 the diarrhoea, and not that the diarrhoea enables them to flourish ". The fact that serotyping is done today has made things more complicated, but it has not weakened this observation; rather does it confound confusion. Alexander and his co-workers2 too show their perspicacity, when they say: cause
" the progress of an infant with diarrhoea is affected profoundly treatment. In particular, the nature and quantity of fluid and food administered and the route of administration may largely determine recovery. The additional benefit to be derived from a chemotherapeutic agent may be difficult to assess. The drug is being tested, not on the actual disease, but in an illness the’cause of which has been modified by measures directed to replacement of fluid
by
loss."
In other words, the mere isolation of an organism from the stools, however elegant the methods used, from a patient with
diarrhoea does
not
imply that
it is the
cause.
As Giles and
"
all attempts to demonstrate its pathogenicity (even by animal experiment) have failed. The notable absence of serum agglutinins in patients and convalescents would also point to its being a concomitant, although it is difficult to demonstrate these in young infants. The possibility of a symbiosis between this coliform and an unidentified virus must be borne in mind. Alternatively the organisms might conceivably appear as a result of some biochemical change in the
intestinal contents."
The cult of the laboratory can be as dangerous to truth that of the personality. If and when the pathogenicity of Esch. coli be proven beyond doubt, the sceptics like myself will be only too happy to eat humble pie; but even if it is not, its advocates should take heart, in that the serendipity will not have been in vain, for the path of truth often leads us through strange places. I. M. LIBRACH. as
INFORMAL ADMISSION OF MENTAL DEFECTIVES SIR,-Ihave the fullest sympathy both with the worries of Dr. Heaton-Ward and also with his work in mental deficiency. I only regret that in his letter of Feb. 8 he shows no deeper understanding of that public sentiment in regard to compulsory detentions that he tends to scout. Does he appreciate, for instance, how far his " modern " concept " of mental deficiency as a social incapacity " differs from the ordinary member of the public’s concept of mental deficiency-as something based solely on defect
in intelligence ? Does he appreciate the basic tenet of public relations that, to get wholehearted public support and cooperation in the implementation of legislation, it is necessary for this first of all to be in intelligible form and secondly to be explained in easily understood form ? If the community gives powers over the liberty of the individual, it feels itself entitled to understand why it is giving them. The necessity for such explanation does not seem, unfortunately, to have been appreciated in the working of the Mental Deficiency Acts: and the present position is a sorry example of the misunderstanding that It is extraordinary that, in all the debates before both the 1913 and 1927 Acts, and the discussion on mental defectiveness that accompanied them in Parliament, there appears no definition of " mind "-this was left to the experts, the medical profession. They have to date not made a particularly good job of it, for the course of events of which Dr. Heaton-Ward complains shows that a negative definition-a declaration that " defect of mind is not of necessity defect in intelligence "-does not suffice. It immediately, and not without reason, arouses M. B., Benjamin, B., Maslen, L. G. Camb. 1952, 50, 261. 3. Giles, C., Sangster, G. ibid. 1948, 46, 8.
legislation. "
It is, of course, the " psychopathic patient that Dr. Heaton-Ward has in mind: and, in approaching fresh compulsive legislation for this type of person, it seems to me that discussion in Parliament will centre on two things. First towards obtaining adequate and readily understandable definition of a psychopath-nor are M.P.s readily to be appeased by the knowledge that psychopaths have already been detained for years under the pseudonym of high-graded feeble-minded ". Second, in deciding whether, in giving powers of detention, these should be in the form of indefinite sentences, dependent solely on the decision of medical authority, or sentences for definite periods of " preventive detention " by a lay court in circumstances where medical treatment and supervision can be given. Always providing that clear and open decisions emerge from these discussions, Dr. Heaton-Ward will no longer have to wake up on Sunday morning, fearing to open his newspapers. House of Commons, DONALD MCI. JOHNSON. London, S.W.1. "
DERMATITIS CAUSED BY PENICILLIN IN MILK
SIR,-Dr. Vickers and his colleagues (Feb. 15) report interesting cases of dermatitis attributed to penicillin in milk; they remark that although in America penicillin is well recognised as a cause of urticaria they have been unable to find any records of penicillin in milk being responsible for the reactivation of dermatitis in patients previously sensitised. I had intended recording such a two
ensues.
Alexander,
The first is that the medical profession, in exercising its prerogative as to the definition of mental defect, did not appear itself to grasp that it was dealing with two quite separate conditions: that the " social incapacity " of the so-called feeble-minded " patient is something entirely different from the defective intelligence of the mentally subnormal; and consequently needs treating differently and in difference circumstances. A mental-deficiency expert for instance, understands the reasons for an honours B.A. being found as a detainee in a mental-defective colony: but the general public do not; nor, as a matter of fact, do I. The second is that, just as patients differ, so do doctors. Certifying doctors have shown differing opinions as to what they regard as social incapacity to an extent which has, on occasions, defied the common sense. The third is the report of the Royal Commission, with its formal recognition of the difference between the " psychopath " and the" mentally subnormal ". This recognition, which merely expresses the present position in more realistic terms, has come to stay: and is likely to be embodied in coming "
Sangster3 state :
2.
"
suspicion of those whom he terms theCivilLiberty’ Guards ". Till now, this interpretation of the law has worked by virtue of the fact that the lay public in general and Parliament in particular (as was obvious in the recent debate on the Royal Commission’s report) did not understand what was being done. This state of affairs is now, however, altering. There are three main reasons for this, all of which, it seems to me, must be understood if Dr. HeatonWard’s anxiety is to be relieved. the
C., Roden, A. T. J. Hyg.,
case.
A Merchant Navy officer, aged 54, had penicillin dermatitis after a course of penicillin injections four years ago. Last summer he tried a Swedish milk diet and developed dermatitis of the face and arms, which was thought to have been caused by detergents. He improved slowly on prednisone while in hospital in Belfast, but relapsed on returning home and was referred to me with a severe generalised exfoliative dermatitis.
" the progress of an infant with diarrhoea is affected profoundly treatment. In particular, the nature and quantity of fluid and food administered and the route of administration may largely determine recovery. The additional benefit to be derived from a chemotherapeutic agent may be difficult to assess. The drug is being tested, not on the actual disease, but in an illness the’cause of which has been modified by measures directed to replacement of fluid
by
loss."
In other words, the mere isolation of an organism from the stools, however elegant the methods used, from a patient with
diarrhoea does
not
imply that
it is the
cause.
As Giles and
"
all attempts to demonstrate its pathogenicity (even by animal experiment) have failed. The notable absence of serum agglutinins in patients and convalescents would also point to its being a concomitant, although it is difficult to demonstrate these in young infants. The possibility of a symbiosis between this coliform and an unidentified virus must be borne in mind. Alternatively the organisms might conceivably appear as a result of some biochemical change in the
intestinal contents."
The cult of the laboratory can be as dangerous to truth that of the personality. If and when the pathogenicity of Esch. coli be proven beyond doubt, the sceptics like myself will be only too happy to eat humble pie; but even if it is not, its advocates should take heart, in that the serendipity will not have been in vain, for the path of truth often leads us through strange places. I. M. LIBRACH. as
INFORMAL ADMISSION OF MENTAL DEFECTIVES SIR,-Ihave the fullest sympathy both with the worries of Dr. Heaton-Ward and also with his work in mental deficiency. I only regret that in his letter of Feb. 8 he shows no deeper understanding of that public sentiment in regard to compulsory detentions that he tends to scout. Does he appreciate, for instance, how far his " modern " concept " of mental deficiency as a social incapacity " differs from the ordinary member of the public’s concept of mental deficiency-as something based solely on defect
in intelligence ? Does he appreciate the basic tenet of public relations that, to get wholehearted public support and cooperation in the implementation of legislation, it is necessary for this first of all to be in intelligible form and secondly to be explained in easily understood form ? If the community gives powers over the liberty of the individual, it feels itself entitled to understand why it is giving them. The necessity for such explanation does not seem, unfortunately, to have been appreciated in the working of the Mental Deficiency Acts: and the present position is a sorry example of the misunderstanding that It is extraordinary that, in all the debates before both the 1913 and 1927 Acts, and the discussion on mental defectiveness that accompanied them in Parliament, there appears no definition of " mind "-this was left to the experts, the medical profession. They have to date not made a particularly good job of it, for the course of events of which Dr. Heaton-Ward complains shows that a negative definition-a declaration that " defect of mind is not of necessity defect in intelligence "-does not suffice. It immediately, and not without reason, arouses M. B., Benjamin, B., Maslen, L. G. Camb. 1952, 50, 261. 3. Giles, C., Sangster, G. ibid. 1948, 46, 8.
legislation. "
It is, of course, the " psychopathic patient that Dr. Heaton-Ward has in mind: and, in approaching fresh compulsive legislation for this type of person, it seems to me that discussion in Parliament will centre on two things. First towards obtaining adequate and readily understandable definition of a psychopath-nor are M.P.s readily to be appeased by the knowledge that psychopaths have already been detained for years under the pseudonym of high-graded feeble-minded ". Second, in deciding whether, in giving powers of detention, these should be in the form of indefinite sentences, dependent solely on the decision of medical authority, or sentences for definite periods of " preventive detention " by a lay court in circumstances where medical treatment and supervision can be given. Always providing that clear and open decisions emerge from these discussions, Dr. Heaton-Ward will no longer have to wake up on Sunday morning, fearing to open his newspapers. House of Commons, DONALD MCI. JOHNSON. London, S.W.1. "
DERMATITIS CAUSED BY PENICILLIN IN MILK
SIR,-Dr. Vickers and his colleagues (Feb. 15) report interesting cases of dermatitis attributed to penicillin in milk; they remark that although in America penicillin is well recognised as a cause of urticaria they have been unable to find any records of penicillin in milk being responsible for the reactivation of dermatitis in patients previously sensitised. I had intended recording such a two
ensues.
Alexander,
The first is that the medical profession, in exercising its prerogative as to the definition of mental defect, did not appear itself to grasp that it was dealing with two quite separate conditions: that the " social incapacity " of the so-called feeble-minded " patient is something entirely different from the defective intelligence of the mentally subnormal; and consequently needs treating differently and in difference circumstances. A mental-deficiency expert for instance, understands the reasons for an honours B.A. being found as a detainee in a mental-defective colony: but the general public do not; nor, as a matter of fact, do I. The second is that, just as patients differ, so do doctors. Certifying doctors have shown differing opinions as to what they regard as social incapacity to an extent which has, on occasions, defied the common sense. The third is the report of the Royal Commission, with its formal recognition of the difference between the " psychopath " and the" mentally subnormal ". This recognition, which merely expresses the present position in more realistic terms, has come to stay: and is likely to be embodied in coming "
Sangster3 state :
2.
"
suspicion of those whom he terms theCivilLiberty’ Guards ". Till now, this interpretation of the law has worked by virtue of the fact that the lay public in general and Parliament in particular (as was obvious in the recent debate on the Royal Commission’s report) did not understand what was being done. This state of affairs is now, however, altering. There are three main reasons for this, all of which, it seems to me, must be understood if Dr. HeatonWard’s anxiety is to be relieved. the
C., Roden, A. T. J. Hyg.,
case.
A Merchant Navy officer, aged 54, had penicillin dermatitis after a course of penicillin injections four years ago. Last summer he tried a Swedish milk diet and developed dermatitis of the face and arms, which was thought to have been caused by detergents. He improved slowly on prednisone while in hospital in Belfast, but relapsed on returning home and was referred to me with a severe generalised exfoliative dermatitis.