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PSYCHIATRY AND MEDICAL ADMINISTRATION
1432 in any recommendation, report, &c., required to be made for any of the purposes of the Act shall be guilty of an offence.
high time for a directive to be issued to mental hospitals, forbidding illegal compulsory admission of patients under section 29, if the malpractice is as widespread as some of your correspondents admit. It is
St. Crispin Hospital,
Duston, Northampton.
J. J. H. LOWE.
FOLLOW-UP AFTER MENTAL ILLNESS SIR,-In a letter1 in 1961, advocating smaller psychiatric units in the long term, I wrote: " The discharge into the
community of patients with certain residual symptoms really requires intensive and often quite frequent follow-up." Recent reports and letters suggest that follow-up is, in fact, one of the critical gaps in our mental health services today. Numbers of chronic schizophrenic patients now attain a level at which their conduct is socially acceptable and justifies discharge. A significant number of these, however, are predictably vulnerable to recurrence of symptoms. Often these symptoms, which may reach a socially upsetting level, are due to a reluctance to take phenothiazine drugs, or to stopping them. It is in this group that frequent visiting could make the world of difference.
worker, mental welfare officer, or a good relationship with the patient may often be able to persuade him to keep taking the drug in the proper way. They can, in any case, relay storm signals to the psychiatrist so that action can be taken or attempted before the patient’s illness has again reached such intensity that he is causing social upset or has to be sent off to hospital. Visits in the home have the obvious advantage that evidence can be gained from relatives or friends about the patient’s mental state. General practitioners would clearly not be in a position to see all these patients at the same frequency. The need is for greater numbers of follow-up workers. With the present numbers, vulnerable patients just cannot be visited as often as is desirable. Obviously at the moment the frequency of visits can hardly be stepped up because the existing workers seem to be fully stretched in most areas. An increase in psychiatric outpatient services is surely another vital need. It seems that an efficient 20th-century mental health service will certainly require considerably more A
psychiatric psychiatric nurse
social with
staff fvf all kinck
away from the rest of psychiatry. It may then by being the same but by being different. St. Lawrence’s
Hospital, Caterham, Surrey.
HAIRY PINNÆ IN THE BENGALEE FEMALE SIR,-Gates and Vellareported an instance of
argued that we do not want, as Dr. does Payne (June 22), greater uniformity in the " clinical and administrative aspects " of psychiatry. Medicine thrives on diversity. Nor can it be agreed that Dr. Hutchinson’s comment (June 15) reflects an outdated concept. Recent advances in mental deficiency have tended to separate it from general psychiatry and to give more
of
can
Their ages ranged between 10 and 16 years. All 5 girls showed a patch of dark brown to light brown hair at the centre of the pinna; one, aged 11, had a few hairs on the lobe as well. 2 of the 5 girls were abnormally hirsute. The hair of two girls was examined microscopically. The length of the hair varied from 3 to 4 mm., and the diameter at the root-end was 26-4 [i in both girls. There was no medulla, but small pigment granules were present at the cortex. In both the growth on the right ear was greater than that on the left. The father, aged 50, of one girl, aged 10, and her elder brother, aeed 20. showed hvoertrichosis grades 4 and 2.2 S. S. SARKAR Department of Anthropology, Calcutta University, REKHA RANI GHOSH. Calcutta.
THE PRICE OF BOOKS
SiR,ŅYour editorial (May 4) reflects the problem of individual readers and librarians alike. The ephemeral character of most medical publications makes the acquisition of even essential editions almost impossible when funds are short. I suggest that manuscripts of textbooks (not monographs) should be submitted by authors to international panels of authorities. These panels would be set up by recognised bodies, such as relevant international societies (internal medicine, cardiology, surgery) or by the World Health Organisation. These panels could recommend, if they saw fit, that the book be published in a loose-leaf edition. The authors would undertake to issue yearly addenda. Publishers would then be reasonably sure of a large readership. Julius Jarcho Medical Library, Asaf Harofe Hospital, W. J. ALKAN. Zerifin, Israel. Gates, R. R., Vella, F. Lancet, 1962, ii, 357. Sarkar, S. S., Banerjee, A. R., Bhattacharjee, P., Stern, C. Amer. J. hum. Genet. 1961, 13, 214.
Dr.
1. 2.
Appointments
a
be
life of its own, with its
own
interests and its
problems, of which the general psychiatrist knows little. Mental deficiency has suffered as well as gained by being a handmaid. It is true that in some parts of the country the psychiatrist working in mental deficiency has
own
seized
a
12-year-old girl from Malta who had " short fine black hairs on the ear lobes and lower part of the pinnae ". In the course of our routine studies on the ear growth of Bengalee children, we found 5 with hairy ear rims out of a sample of 80 girls. They were students of Calcutta Deaf and Dumb School.
PSYCHIATRY AND MEDICAL ADMINISTRATION
it
JOHN GIBSON.
H. JACOBS.
Colchester.
SIR,-It
thrive, not
chance to work as well in other branches of psychiatry, such as child guidance; but elsewhere interests have been mainly in biological research (biochemical, cytogenetic, neuropathological) and in the training of handicapped people, children and adults; further progress in these directions may bring mental deficiency further a
1.
Lancet, 1961, i,
1055.
COONEY, J. A., wing commander, R.A.F. Cosford. DALL, J. L. C., M.D.
M.B.
N.U.!.,
D.T.M.
&
H.:
senior M.O.,
assistant geriatrician, regional
Glasg., geriatric service, Shieldhall Hospital, Glasgow. HAMER, JOHN, M.D. Lond., M.R.C.P. : assistant director, Institute of Cardiology, and honorary assistant physician, National Heart Hospital, M.R.C.P.GLASG. :
London. K. W. M., M.B. Dubl., D.P.H.: senior M.o. for mental health, Hertfordshire. LEE, J. E., M.R.C.S., D.P.H.: senior assistant county M.o., West Riding of Yorkshire, and deputy M.O.H., Pontefract, Featherstone, Knottingley, and Osgoldcross. MANNING, GEOFFREY C., M.A., M.D. Cantab., M.R.C.P. :-consultant physician, Royal Hospital, Richmond. ODBERT, E. S., group captain, M.B.E., B.A., M.B. Dubl.: senior M.o., R.A.F. Cranwell. ORMISTON, MARGARET, M.B. Aberd., D.P.H. : senior M.O., Leeds. YULE, 1. G., M.B. Manc., D.c.H., D.P.H.: senior M.o., Hertfordshire.
HARBORD,
The Hospital for London:
Sick
CHRISPIN, A. R.,
Birm.,
M.B.
Children,
M.R.C.P., F.F.R., D.M.R.D.,
radiologist.
MICHELL, E. P.
Great Ormond Street, D.OBST.:
consultant
’
G., B.A., Cantab., M.R.C.P., D.c.H.: consultant-incharge, department of psychological medicine. ORCHARD, BARBARA W., M.B. Adelaide, D.C.H. : house-physician. SUBRAMANIAN, SAMBAMURTHY, M.B. Bombay, F.R.C.S.: senior surgical thoracic registrar. WYBAR, KENNETH, M.D., CH.M., B.SC. Glasg., F.R.C.S., D.O.M.S.: consultant ophthalmic surgeon. M.B.
high time for a directive to be issued to mental hospitals, forbidding illegal compulsory admission of patients under section 29, if the malpractice is as widespread as some of your correspondents admit. It is
St. Crispin Hospital,
Duston, Northampton.
J. J. H. LOWE.
FOLLOW-UP AFTER MENTAL ILLNESS SIR,-In a letter1 in 1961, advocating smaller psychiatric units in the long term, I wrote: " The discharge into the
community of patients with certain residual symptoms really requires intensive and often quite frequent follow-up." Recent reports and letters suggest that follow-up is, in fact, one of the critical gaps in our mental health services today. Numbers of chronic schizophrenic patients now attain a level at which their conduct is socially acceptable and justifies discharge. A significant number of these, however, are predictably vulnerable to recurrence of symptoms. Often these symptoms, which may reach a socially upsetting level, are due to a reluctance to take phenothiazine drugs, or to stopping them. It is in this group that frequent visiting could make the world of difference.
worker, mental welfare officer, or a good relationship with the patient may often be able to persuade him to keep taking the drug in the proper way. They can, in any case, relay storm signals to the psychiatrist so that action can be taken or attempted before the patient’s illness has again reached such intensity that he is causing social upset or has to be sent off to hospital. Visits in the home have the obvious advantage that evidence can be gained from relatives or friends about the patient’s mental state. General practitioners would clearly not be in a position to see all these patients at the same frequency. The need is for greater numbers of follow-up workers. With the present numbers, vulnerable patients just cannot be visited as often as is desirable. Obviously at the moment the frequency of visits can hardly be stepped up because the existing workers seem to be fully stretched in most areas. An increase in psychiatric outpatient services is surely another vital need. It seems that an efficient 20th-century mental health service will certainly require considerably more A
psychiatric psychiatric nurse
social with
staff fvf all kinck
away from the rest of psychiatry. It may then by being the same but by being different. St. Lawrence’s
Hospital, Caterham, Surrey.
HAIRY PINNÆ IN THE BENGALEE FEMALE SIR,-Gates and Vellareported an instance of
argued that we do not want, as Dr. does Payne (June 22), greater uniformity in the " clinical and administrative aspects " of psychiatry. Medicine thrives on diversity. Nor can it be agreed that Dr. Hutchinson’s comment (June 15) reflects an outdated concept. Recent advances in mental deficiency have tended to separate it from general psychiatry and to give more
of
can
Their ages ranged between 10 and 16 years. All 5 girls showed a patch of dark brown to light brown hair at the centre of the pinna; one, aged 11, had a few hairs on the lobe as well. 2 of the 5 girls were abnormally hirsute. The hair of two girls was examined microscopically. The length of the hair varied from 3 to 4 mm., and the diameter at the root-end was 26-4 [i in both girls. There was no medulla, but small pigment granules were present at the cortex. In both the growth on the right ear was greater than that on the left. The father, aged 50, of one girl, aged 10, and her elder brother, aeed 20. showed hvoertrichosis grades 4 and 2.2 S. S. SARKAR Department of Anthropology, Calcutta University, REKHA RANI GHOSH. Calcutta.
THE PRICE OF BOOKS
SiR,ŅYour editorial (May 4) reflects the problem of individual readers and librarians alike. The ephemeral character of most medical publications makes the acquisition of even essential editions almost impossible when funds are short. I suggest that manuscripts of textbooks (not monographs) should be submitted by authors to international panels of authorities. These panels would be set up by recognised bodies, such as relevant international societies (internal medicine, cardiology, surgery) or by the World Health Organisation. These panels could recommend, if they saw fit, that the book be published in a loose-leaf edition. The authors would undertake to issue yearly addenda. Publishers would then be reasonably sure of a large readership. Julius Jarcho Medical Library, Asaf Harofe Hospital, W. J. ALKAN. Zerifin, Israel. Gates, R. R., Vella, F. Lancet, 1962, ii, 357. Sarkar, S. S., Banerjee, A. R., Bhattacharjee, P., Stern, C. Amer. J. hum. Genet. 1961, 13, 214.
Dr.
1. 2.
Appointments
a
be
life of its own, with its
own
interests and its
problems, of which the general psychiatrist knows little. Mental deficiency has suffered as well as gained by being a handmaid. It is true that in some parts of the country the psychiatrist working in mental deficiency has
own
seized
a
12-year-old girl from Malta who had " short fine black hairs on the ear lobes and lower part of the pinnae ". In the course of our routine studies on the ear growth of Bengalee children, we found 5 with hairy ear rims out of a sample of 80 girls. They were students of Calcutta Deaf and Dumb School.
PSYCHIATRY AND MEDICAL ADMINISTRATION
it
JOHN GIBSON.
H. JACOBS.
Colchester.
SIR,-It
thrive, not
chance to work as well in other branches of psychiatry, such as child guidance; but elsewhere interests have been mainly in biological research (biochemical, cytogenetic, neuropathological) and in the training of handicapped people, children and adults; further progress in these directions may bring mental deficiency further a
1.
Lancet, 1961, i,
1055.
COONEY, J. A., wing commander, R.A.F. Cosford. DALL, J. L. C., M.D.
M.B.
N.U.!.,
D.T.M.
&
H.:
senior M.O.,
assistant geriatrician, regional
Glasg., geriatric service, Shieldhall Hospital, Glasgow. HAMER, JOHN, M.D. Lond., M.R.C.P. : assistant director, Institute of Cardiology, and honorary assistant physician, National Heart Hospital, M.R.C.P.GLASG. :
London. K. W. M., M.B. Dubl., D.P.H.: senior M.o. for mental health, Hertfordshire. LEE, J. E., M.R.C.S., D.P.H.: senior assistant county M.o., West Riding of Yorkshire, and deputy M.O.H., Pontefract, Featherstone, Knottingley, and Osgoldcross. MANNING, GEOFFREY C., M.A., M.D. Cantab., M.R.C.P. :-consultant physician, Royal Hospital, Richmond. ODBERT, E. S., group captain, M.B.E., B.A., M.B. Dubl.: senior M.o., R.A.F. Cranwell. ORMISTON, MARGARET, M.B. Aberd., D.P.H. : senior M.O., Leeds. YULE, 1. G., M.B. Manc., D.c.H., D.P.H.: senior M.o., Hertfordshire.
HARBORD,
The Hospital for London:
Sick
CHRISPIN, A. R.,
Birm.,
M.B.
Children,
M.R.C.P., F.F.R., D.M.R.D.,
radiologist.
MICHELL, E. P.
Great Ormond Street, D.OBST.:
consultant
’
G., B.A., Cantab., M.R.C.P., D.c.H.: consultant-incharge, department of psychological medicine. ORCHARD, BARBARA W., M.B. Adelaide, D.C.H. : house-physician. SUBRAMANIAN, SAMBAMURTHY, M.B. Bombay, F.R.C.S.: senior surgical thoracic registrar. WYBAR, KENNETH, M.D., CH.M., B.SC. Glasg., F.R.C.S., D.O.M.S.: consultant ophthalmic surgeon. M.B.