- Email: [email protected]
SUICIDE
1252 and hsematology, but it is becoming more and more obvious that such an arrangement is essential for the good of the patient in any large up-to-date hospital which expects good service from a competent staff. In those
logy,
hospitals where this system operates, the results reveal its iustification.
amplj
-
Department of Biochemistry, University of Glasgow.
J. N. DAVIDSON.
HYALINE MEMBRANE FOLLOWING TOTAL BODY RADIATION
SIR,-According to the preliminary communication ii The Lancet of Nov. 5, patients with far-advanced malig. nancies have been subjected to total body irradiation fo an experimental purpose, and one not related to thei] disease. The effects of such irradiation are severe, and, at the dosage mentioned, lethal. I think these circumstances ought to be remarked narticularlv
as vou
ilmore them in vour editorial comment
J. L. DOBBIE. *** We showed Dr. Dobbie’s letter to Captain King and his colleagues and their reply follows.-ED. L.
support to those who have for a long time advocated the abolition of the existing law. Its background and its effects were fully discussed three years ago.4 On that occasion Batchelor reported on the way the problem is dealt with in Scotland where suicide and attempted suicide are not criminal offences. Dr. Ahrenfeldt’s letter (Nov. 19) about the attitude of the Church to suicide contains no reference to the recent report by a committee set up at the suggestion of the Archbishop of Canterbury for the purpose of examining the law of suicide. The first of the four recommendations made by this committee was that attempted suicide should cease to be a criminal offence. The University, Sheffield.
E. STENGEL.
CIGARETTES IN HOSPITALS
SiR,-Some hospitals issue pamphlets about the risks of cigarette smoking, and many of their doctors, even if they can’t stop the habit themselves, advise patients not to start. Is it not time that these hospitals reversed their illogical decisions to provide cigarette vending machines ? C. ALLAN BIRCH. ADMINISTRATION IN MENTAL HOSPITALS
SIR,-We should like to make the following points and perhaps clear up this misunderstanding: (1) Except for one (who had a kidney transplant) all patients selected for this form of therapy had disseminated malignancies. Conventional therapy had failed in these patients and localised radiation therapy revealed some degree of radiosensitivity. (2) The observations on human lung were incidental to and not the purpose of the therapy. (3) As you will note, the operative mechanisms of plasmin inhibition following total body radiation were worked out in dogs, not humans. (4) As a result of extensive investigations on the subject of total body radiation in animals, the serious effects in the unsupported subject are well appreciated at the National Naval Medical Center, Bethesda. (5) The efficacy of total body radiation will be presented in detail in a future publication.
U.S. Naval Hospital,
Bethesda, Maryland.
WILLIAM H. FLEMING JENO E. SZAKACS THOMAS C. HARTNEY E. R. KING.
SIR,-The changes in the law of suicide foreshadowed by a report from the Criminal Law Revision Committee1 will be welcomed by doctors, magistrates, and police officers alike. It has long been recognised that the existing no
deterrent effect and
I would, indeed, say that treatment includes control of freedom, prescription of social and occupational activities, the amount of pocket-money that a patient is allowed, and many other similar things, but that the actual prescription of these things will vary from patient to patient according to the judgment of the responsible medical officer. Nevertheless the medical superintendent being responsible for the efficiency of the whole hospital, and not only for the efficiency of his own team, has to see that these things are available for prescription ". Also he is responsible for coordinating and controlling new ideas and requests coming from the teams so that chaos does not ensue. It is also his job to see that all suggestions for improvement in the clothing of patients, the standard of catering, furnishing, and architectural improvement, lengthening of visiting hours, or anything else that is agreed upon at the weekly senior-staff meetings are carried out for the benefit of all the teams. All the new ideas coming out of the senior-staff meeting will then be put into practice satisfactorily throughout the hospital and implemented after any necessary "
SUICIDE
law has distress.
SiR,—The Mental Health Act makes it quite clear that responsible medical officer is not responsible or answerable for the patient’s treatment to any other doctor. Therefore, in answer to Dr. Falla (Nov. 12), I would say that I do not need to know anything about those patients which are not directly under my personal care. Hypothetical cases make bad laws, but it follows from what has been said that, as medical superintendent, I would know nothing about the aggressive psychopath mentioned, and therefore the consultant, and he alone, would be called upon to give an explanation of the action of his patient. the
creates a
great deal of
Frequently it makes treatment more difficult by causing patients to deny suicidal intentions for fear of prosecution. Bringing a person who has attempted suicide before a court and placing him on probation under the condition that he receives psychiatric treatment is quite unnecessary. There is no reason whatever why England alone of all countries in the world should require special legal provisions, outside the mental-health legislation, to make people in distress accept medical and social help. As Dr. Casson (Nov. 5) referred to my studies on attempted suicide, or rather to a brief second-hand report of my studies, I wish to state that my observations 23 lend strong
1. Criminal Law Revision Committee: second report (Suicide). H.M. Stationery Office, 1960. See Lancet, Oct. 29, 1960, p. 976. 2. Stengel, E., Cook, N. G. Attempted Suicide. London, 1958. 3. Stengel, E. Medico-legal J. 1959, 27, 114.
consultation between the medical superintendent, chief male nurse, matron, and hospital secretary. I think this really answers Dr. Bardon (Nov. 12), for it will be seen that a medical superintendent responsible for the efficiency of the whole hospital does not in anyway impair the freedom of the clinical teams. In any event, Dr. Bardon has misread the Act. The Act has nothing to say, either specifically or implicitly about how a hospital is adminstered. His idea of an elected chairman might well work and become the pattern of the future, as I suggested in my first letter. But in my view most mental hospitals at present still need a 4. Proc. R. Soc. Med. 1958, 51, 297. 5. Ought Suicide to Be a Crime ? Church Information 1959.
Office, Westminster,
logy,
hospitals where this system operates, the results reveal its iustification.
amplj
-
Department of Biochemistry, University of Glasgow.
J. N. DAVIDSON.
HYALINE MEMBRANE FOLLOWING TOTAL BODY RADIATION
SIR,-According to the preliminary communication ii The Lancet of Nov. 5, patients with far-advanced malig. nancies have been subjected to total body irradiation fo an experimental purpose, and one not related to thei] disease. The effects of such irradiation are severe, and, at the dosage mentioned, lethal. I think these circumstances ought to be remarked narticularlv
as vou
ilmore them in vour editorial comment
J. L. DOBBIE. *** We showed Dr. Dobbie’s letter to Captain King and his colleagues and their reply follows.-ED. L.
support to those who have for a long time advocated the abolition of the existing law. Its background and its effects were fully discussed three years ago.4 On that occasion Batchelor reported on the way the problem is dealt with in Scotland where suicide and attempted suicide are not criminal offences. Dr. Ahrenfeldt’s letter (Nov. 19) about the attitude of the Church to suicide contains no reference to the recent report by a committee set up at the suggestion of the Archbishop of Canterbury for the purpose of examining the law of suicide. The first of the four recommendations made by this committee was that attempted suicide should cease to be a criminal offence. The University, Sheffield.
E. STENGEL.
CIGARETTES IN HOSPITALS
SiR,-Some hospitals issue pamphlets about the risks of cigarette smoking, and many of their doctors, even if they can’t stop the habit themselves, advise patients not to start. Is it not time that these hospitals reversed their illogical decisions to provide cigarette vending machines ? C. ALLAN BIRCH. ADMINISTRATION IN MENTAL HOSPITALS
SIR,-We should like to make the following points and perhaps clear up this misunderstanding: (1) Except for one (who had a kidney transplant) all patients selected for this form of therapy had disseminated malignancies. Conventional therapy had failed in these patients and localised radiation therapy revealed some degree of radiosensitivity. (2) The observations on human lung were incidental to and not the purpose of the therapy. (3) As you will note, the operative mechanisms of plasmin inhibition following total body radiation were worked out in dogs, not humans. (4) As a result of extensive investigations on the subject of total body radiation in animals, the serious effects in the unsupported subject are well appreciated at the National Naval Medical Center, Bethesda. (5) The efficacy of total body radiation will be presented in detail in a future publication.
U.S. Naval Hospital,
Bethesda, Maryland.
WILLIAM H. FLEMING JENO E. SZAKACS THOMAS C. HARTNEY E. R. KING.
SIR,-The changes in the law of suicide foreshadowed by a report from the Criminal Law Revision Committee1 will be welcomed by doctors, magistrates, and police officers alike. It has long been recognised that the existing no
deterrent effect and
I would, indeed, say that treatment includes control of freedom, prescription of social and occupational activities, the amount of pocket-money that a patient is allowed, and many other similar things, but that the actual prescription of these things will vary from patient to patient according to the judgment of the responsible medical officer. Nevertheless the medical superintendent being responsible for the efficiency of the whole hospital, and not only for the efficiency of his own team, has to see that these things are available for prescription ". Also he is responsible for coordinating and controlling new ideas and requests coming from the teams so that chaos does not ensue. It is also his job to see that all suggestions for improvement in the clothing of patients, the standard of catering, furnishing, and architectural improvement, lengthening of visiting hours, or anything else that is agreed upon at the weekly senior-staff meetings are carried out for the benefit of all the teams. All the new ideas coming out of the senior-staff meeting will then be put into practice satisfactorily throughout the hospital and implemented after any necessary "
SUICIDE
law has distress.
SiR,—The Mental Health Act makes it quite clear that responsible medical officer is not responsible or answerable for the patient’s treatment to any other doctor. Therefore, in answer to Dr. Falla (Nov. 12), I would say that I do not need to know anything about those patients which are not directly under my personal care. Hypothetical cases make bad laws, but it follows from what has been said that, as medical superintendent, I would know nothing about the aggressive psychopath mentioned, and therefore the consultant, and he alone, would be called upon to give an explanation of the action of his patient. the
creates a
great deal of
Frequently it makes treatment more difficult by causing patients to deny suicidal intentions for fear of prosecution. Bringing a person who has attempted suicide before a court and placing him on probation under the condition that he receives psychiatric treatment is quite unnecessary. There is no reason whatever why England alone of all countries in the world should require special legal provisions, outside the mental-health legislation, to make people in distress accept medical and social help. As Dr. Casson (Nov. 5) referred to my studies on attempted suicide, or rather to a brief second-hand report of my studies, I wish to state that my observations 23 lend strong
1. Criminal Law Revision Committee: second report (Suicide). H.M. Stationery Office, 1960. See Lancet, Oct. 29, 1960, p. 976. 2. Stengel, E., Cook, N. G. Attempted Suicide. London, 1958. 3. Stengel, E. Medico-legal J. 1959, 27, 114.
consultation between the medical superintendent, chief male nurse, matron, and hospital secretary. I think this really answers Dr. Bardon (Nov. 12), for it will be seen that a medical superintendent responsible for the efficiency of the whole hospital does not in anyway impair the freedom of the clinical teams. In any event, Dr. Bardon has misread the Act. The Act has nothing to say, either specifically or implicitly about how a hospital is adminstered. His idea of an elected chairman might well work and become the pattern of the future, as I suggested in my first letter. But in my view most mental hospitals at present still need a 4. Proc. R. Soc. Med. 1958, 51, 297. 5. Ought Suicide to Be a Crime ? Church Information 1959.
Office, Westminster,