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STEROID-INDUCED GASTRIC ULCER
1162 STEROID-INDUCED
GASTRIC
ULCER
SiR,-Last week’s paper by Dr. Hirschowitz and his colleagues is of considerable interest for its record of laboratory findings before, during, and after the appearance of a prepyloric ulcer ; but surely they do not that us to the agree expect corticotrophin they gave the student five days before the appearance of gastric symptoms was the cause of the ulcer. At this centre we have given continuous adrenal-stimulation therapy to 130 patients for an average duration of six months, and have come to the conclusion that one of the important ways in which it is superior to oral steroid therapy is that it does not give rise to epigastric pain or peptic n 1 r.nra.ti nn Sheffield Centre for the Investigation and Treatment of Rheumatic Diseases, 77, Gell Street, Sheffield, 3.
H. F. WEST.
CLINICOSIS
SIR,-Surely the time has come now after much correspondence to make clear the duties of a good general practitioner ?‘ If he is to accept continuous care and responsibility for all his patients, under all circumstances, from the moment they come on his list to the day they depart or die, then it follows that the local-authority services, such as clinics and health visitors, are just one more branch of the team of experts that the practitioner call on or consult. Dr. Warin is very wise when he says, in his letter last week, that the G.P. should be encouraged to take his place as the leader of the team. In that way and that way only can success lie ; where there is duplication of work or responsibility the whole medical structure can split up into anarchy. In conclusion may I ask how the Willink Committee on Medical Man Power can possibly estimate future requirements unless the functions of the largest group of all-namely, the general practitioners-are clearly defined. HAROLD LEESON. Worthing. can
SiR,-However one may apportion praise or blame, success or failure, the tragic fact remains that " the of babies happily on the breast in the fifth month " appears to be getting less and less. L. S. ADAMS. Mitcham, Surrey. ...
COLOUR-BLINDNESS AND INTERSEXUALITY
SIR,-I was interested to read that Polani, Lessof, and Bishop 12 have used colour-blindness as a means of determining the genetic sex in Turner’s syndrome. I agree that this method may be used in all conditions of supposed intersexuality, and I used it in my thesis on hypospadias.3 My material was collected before I knew about sex-chromatin. I used the same methods as Goldschmidt 4 in his experimental studies on intersexuality in the moth Lymantria : (1) sex-distribution Polani, P. E., Lessof, M. H., Bishop, P. M. F. Lancet, July 21, 1956, p. 118. 2. Bishop, P. M. F., Polani, P. E., Lessof, M. H. Ibid, Oct. 20, 1956, p. 843. 3. Sørensen, H. R. Hypospadias: with Special Reference to Etiology. 1.
4.
Copenhagen, 1953. Goldschmidt, R. Bibliogr. genet. 1933, 11,
(3)
offspring;
occurrence
HANS RAHBEK SØRENSEN. S0RENSEN.
Copenhagen.
PREVENTIVE PSYCHIATRY
SiR,-It is something of
SiR,-Several of your correspondents have pointed out the relative advantages of attendance by babies at welfare clinics held by local authorities, and by their own doctors. Wherever many babies are brought in contact with each other, and with adults, they run the risk of catching colds, gastro-enteritis, or worse. Surely, well babies ought not to attend clinics of any sort, but should be examined, immunised, and vaccinated in their own homes, by their family doctor if he has the time, and if not by the staff of the medical officer of health. K. W. LOVEL. Oxford.
proportion
(2) sex-distribution in the sibships; of sex-linked recessive characters in intersex and their parents. Among 104 hypospadians I found 7 cases of colour. blindness. Parents, too, were examined, because the sex of a colour-blind child may be determined if one knows the colour-vision of the parents (except in cases where the father is colour-blind). It was found by this method that patients with hypospadias (whether of slight or, severe degree) had to be genetic males. among
186.
an achievement to have last week a leader on preventive psychiatry and two articles (on an integrated mental-health service and on the relief of mental-hospital overcrowding) without once mentioning that the bulk of everyday psychotherapy, almost the whole responsibility for early diagnosis, and a large part of aftercare are carried out by general practitioners. The neglect is not atypical. Many workers in psychiatry seem to consider the patient’s psyche too fragile for our rough untutored hands and consequently our cooperation in treatment is seldom invited. Surely, a major contribution to integrated preventive outpatient psychiatry would be to allow G.P.S more time for their patients and more cooperation from the psychiatric services, especially from social workers. We would then be able to refer even fewer of our psychiatric patients to the overburdened specialist
published
services. The Caversham
Centre, London, N.W.5.
ANTHONY RYLE.
SIR,-Further to your leading article and Dr. Macmillan’s interesting account of the Nottingham services, who can doubt the urgent need of an integrated mental-health service such as Dr. Macmillan described?g As a medical Member of Parliament, who has achieved a certain amount of publicity in connection with the problems relating to mental illness, proof of this comes to me in my post-bag daily. Over recent months I have received a total to date of some 200 letters from mental patients and ex-patients in all parts of the country. Only a minority of these are from outright psychotics. The majority are from apparently sensible people who, while admitting to some form of mental or nervous disturbance, yet make it clear that their suffering from their original illness is unimportant to them in comparison with the psychic trauma which they have received, or are receiving, through their treatment.
No-one reading these letters could for one moment be satisfied that all is well with the existing state of our There are clearly two main mental-health services. The first is the general failure deficiencies in these. either to treat mental illness, or even attempt to diagnose it, in its early stages at home or in an observation ward, and the consequent tendency to indiscriminateadmissions to mental hospitals, often quite precipitately under certificate--in this connection we are surely excessively naive if we delude ourselves that we benefit a patient’s mental health by subjecting him to methods of removal to hospital which are frequently more reminiscent of those of the Ogpu or Gestapo than those of a therapeutic service. The second is the equal deficiency in arrangements for social rehabilitation into the community, which leads to unnecessarily long stays in hospitalthese stays in the peculiar tempo of mental hospital life, being so often measured by years rather than by
days, weeks,
or
These gaps
months.
only be filled by the establishment of a local-authority service with an adequate force of social workers, not only trained, but properly briefed that the aim of their work is to keep the patient, if possible, can
GASTRIC
ULCER
SiR,-Last week’s paper by Dr. Hirschowitz and his colleagues is of considerable interest for its record of laboratory findings before, during, and after the appearance of a prepyloric ulcer ; but surely they do not that us to the agree expect corticotrophin they gave the student five days before the appearance of gastric symptoms was the cause of the ulcer. At this centre we have given continuous adrenal-stimulation therapy to 130 patients for an average duration of six months, and have come to the conclusion that one of the important ways in which it is superior to oral steroid therapy is that it does not give rise to epigastric pain or peptic n 1 r.nra.ti nn Sheffield Centre for the Investigation and Treatment of Rheumatic Diseases, 77, Gell Street, Sheffield, 3.
H. F. WEST.
CLINICOSIS
SIR,-Surely the time has come now after much correspondence to make clear the duties of a good general practitioner ?‘ If he is to accept continuous care and responsibility for all his patients, under all circumstances, from the moment they come on his list to the day they depart or die, then it follows that the local-authority services, such as clinics and health visitors, are just one more branch of the team of experts that the practitioner call on or consult. Dr. Warin is very wise when he says, in his letter last week, that the G.P. should be encouraged to take his place as the leader of the team. In that way and that way only can success lie ; where there is duplication of work or responsibility the whole medical structure can split up into anarchy. In conclusion may I ask how the Willink Committee on Medical Man Power can possibly estimate future requirements unless the functions of the largest group of all-namely, the general practitioners-are clearly defined. HAROLD LEESON. Worthing. can
SiR,-However one may apportion praise or blame, success or failure, the tragic fact remains that " the of babies happily on the breast in the fifth month " appears to be getting less and less. L. S. ADAMS. Mitcham, Surrey. ...
COLOUR-BLINDNESS AND INTERSEXUALITY
SIR,-I was interested to read that Polani, Lessof, and Bishop 12 have used colour-blindness as a means of determining the genetic sex in Turner’s syndrome. I agree that this method may be used in all conditions of supposed intersexuality, and I used it in my thesis on hypospadias.3 My material was collected before I knew about sex-chromatin. I used the same methods as Goldschmidt 4 in his experimental studies on intersexuality in the moth Lymantria : (1) sex-distribution Polani, P. E., Lessof, M. H., Bishop, P. M. F. Lancet, July 21, 1956, p. 118. 2. Bishop, P. M. F., Polani, P. E., Lessof, M. H. Ibid, Oct. 20, 1956, p. 843. 3. Sørensen, H. R. Hypospadias: with Special Reference to Etiology. 1.
4.
Copenhagen, 1953. Goldschmidt, R. Bibliogr. genet. 1933, 11,
(3)
offspring;
occurrence
HANS RAHBEK SØRENSEN. S0RENSEN.
Copenhagen.
PREVENTIVE PSYCHIATRY
SiR,-It is something of
SiR,-Several of your correspondents have pointed out the relative advantages of attendance by babies at welfare clinics held by local authorities, and by their own doctors. Wherever many babies are brought in contact with each other, and with adults, they run the risk of catching colds, gastro-enteritis, or worse. Surely, well babies ought not to attend clinics of any sort, but should be examined, immunised, and vaccinated in their own homes, by their family doctor if he has the time, and if not by the staff of the medical officer of health. K. W. LOVEL. Oxford.
proportion
(2) sex-distribution in the sibships; of sex-linked recessive characters in intersex and their parents. Among 104 hypospadians I found 7 cases of colour. blindness. Parents, too, were examined, because the sex of a colour-blind child may be determined if one knows the colour-vision of the parents (except in cases where the father is colour-blind). It was found by this method that patients with hypospadias (whether of slight or, severe degree) had to be genetic males. among
186.
an achievement to have last week a leader on preventive psychiatry and two articles (on an integrated mental-health service and on the relief of mental-hospital overcrowding) without once mentioning that the bulk of everyday psychotherapy, almost the whole responsibility for early diagnosis, and a large part of aftercare are carried out by general practitioners. The neglect is not atypical. Many workers in psychiatry seem to consider the patient’s psyche too fragile for our rough untutored hands and consequently our cooperation in treatment is seldom invited. Surely, a major contribution to integrated preventive outpatient psychiatry would be to allow G.P.S more time for their patients and more cooperation from the psychiatric services, especially from social workers. We would then be able to refer even fewer of our psychiatric patients to the overburdened specialist
published
services. The Caversham
Centre, London, N.W.5.
ANTHONY RYLE.
SIR,-Further to your leading article and Dr. Macmillan’s interesting account of the Nottingham services, who can doubt the urgent need of an integrated mental-health service such as Dr. Macmillan described?g As a medical Member of Parliament, who has achieved a certain amount of publicity in connection with the problems relating to mental illness, proof of this comes to me in my post-bag daily. Over recent months I have received a total to date of some 200 letters from mental patients and ex-patients in all parts of the country. Only a minority of these are from outright psychotics. The majority are from apparently sensible people who, while admitting to some form of mental or nervous disturbance, yet make it clear that their suffering from their original illness is unimportant to them in comparison with the psychic trauma which they have received, or are receiving, through their treatment.
No-one reading these letters could for one moment be satisfied that all is well with the existing state of our There are clearly two main mental-health services. The first is the general failure deficiencies in these. either to treat mental illness, or even attempt to diagnose it, in its early stages at home or in an observation ward, and the consequent tendency to indiscriminateadmissions to mental hospitals, often quite precipitately under certificate--in this connection we are surely excessively naive if we delude ourselves that we benefit a patient’s mental health by subjecting him to methods of removal to hospital which are frequently more reminiscent of those of the Ogpu or Gestapo than those of a therapeutic service. The second is the equal deficiency in arrangements for social rehabilitation into the community, which leads to unnecessarily long stays in hospitalthese stays in the peculiar tempo of mental hospital life, being so often measured by years rather than by
days, weeks,
or
These gaps
months.
only be filled by the establishment of a local-authority service with an adequate force of social workers, not only trained, but properly briefed that the aim of their work is to keep the patient, if possible, can