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TOWARDS PREVENTING SUICIDE
531 of personality; men and women are tantalised, then cheated of that which they most hope for ; children suffer the injustice of being born unwanted or without a natural home; women are exploited-in the long run, the woman pays most in societies which loosen sexual morality, and society itself drifts into those very barbaric and subhuman notions which seem to underlie Dr. Tuthill’s letter-that sex is but an appetite analogous to that behind eating and drinking ; that the " tragedy " of the unmarried mother is not " very serious " while the adoption societies cannot meet the demand for all the babies which she can produce (an interesting variant, by the way, from the attitude of your other correspondents for whom the illegitimate child appeared to be the only tragedy in premarital intercourse) ! A healthy society is not ashamed to affirm the basic principles by which it lives. What we want, do, and are depends on what we believe. Church of England Moral Welfare Council, Church House, Dean’s Yard, London, S.W.1.
ENA M. STEEL General
Secretary.
PEDICULOSIS CAPITIS SIR,-As one who looked after the fate of a large part of Dublin’s louse population in dermatological practice during six years, I was interested in the findings of Dr. Nelson and Mr. Cromie (Feb. 23) in regard to the superiority of ’Esoderni ’ over other remedies for pediculosis capitis. As they note, by far the most important aspect of this condition is the frequency of reinfestation. Of my last 500 hospital cases, 20% suffered from pediculosis capitis (apart from any other skin disease) and of these about a third (7%) had become reinfested. The head louse is common among poor families in Dublin and, as a great many of them cannot afford shampoos, a cleansing agent such as esoderm would be extremely useful. But the problem is obviously one to be dealt with principally by improving living conditions, and by education in hygiene, and will not be solved by insecticides. The idea, therefore, that the nursing staff of the school and public-health services should be one is excellent. I may add that it is well recognised that, in young patients from the poor areas of Dublin, dandruff is nearly alwavs mechanised. BETHEL SOLOMONS. TOWARDS PREVENTING SUICIDE SIR,-I was most interested in the letters published in your columns relating to the detection and prevention of
would-be suicides. It has long been a theory of mine that many suicides could be prevented by the creation of a society on similar lines to Alcoholics Anonymous. That is to say,
permanent service would have to be estabto accept calls from any person who was desperate and seeking help. In many cases suicide would be prevented if the would-be suicide could find a a
lished which would be prepared
sympathetic listener and counsellor who would listen to all his troubles and give him assistance and encouragement. Once it became generally known that such advice and help were forthcoming and would-be suicides were urged to get in touch with the society and to suspend any drastic action at least until a member of the society should have time to call on them within the next 24 hours, I believe the psychological effecteven if only a natural curiosity to know how the counsellor would react to the problem-would cause them to hesitate. Of
course
it would be essential that such
a
service should be
night-and-day service, with an easy telephone number to memorise, and voluntary helpers in all the larger towns. Such helpers should not belong to medical or religious bodies, nor should they be trained social workers or psychiatrists, but simply men and women who have themselves known troubles a
and overcome them and who have both experience and understanding. Preferablv. of course, the root cause of the trouble
should be ascertained before sending the counsellor (in such general terms as ill health, money matters, business, love affair) so that a person could be chosen to help who had overcome a similar problem in the past.
of
Could not such a scheme be started under the auspices some interested oraanisation ? A. WATNEY. OLD PEOPLE IN HOSPITAL
Sin,ńI am sure everyone will agree with Dr. Trevor Howell’s remark last week that there is frequently a social problem behind the admission of elderly patients to hospital. Solving this problem is usually difficult, but not impossible : a proportion, however, remain insoluble, at least to me. It is these patients, or rather ex-patients, who constitute the more or less permanent residents to whom Dr. Rang refers (Feb. 23). Of the 32 beds available (only 26 were filled at the time of Dr. Rang’s experiment) over 20 are filled with elderly persons suffering from a profound disability which does not, however, require skilled nursing care. They have no relatives, or none willing or able to take care of them, while the local authority either considers their disability too severe for admission to a welfare home or pleads lack of accommodation. Failing a more generous interpretation of the meaning of Section 21 of the National Assistance Act that " it shall be the duty of every local authority ... to provide accommodation for persons who by reason of age, infirmity or any other circumstances are in need of care and attention which is not otherwise available to them " or the provision of more such accommodation by the local authority, it is difficult to see how this anomaly can ever be remedied. AMULREE. POLYNEURITIS AS A CAUSE OF CONGENITA " a
"AMYOTONIA
SiR,-Dr. Chambers and Dr. MacDermot have rendered service in delineating (Feb. 23) the diagnostic
signal
features of infantile polyneuritis. Less praiseworthy, in my opinion, is their choice of heading. They clearly regard amyotonia congenita as a miscellaneous group of conditions, having in common only their occurrence in infancy or early childhood and the generalised hypotonia exhibited by those affected. This is a distortion of Oppenheim’s original concept and obscures the very real advance which his contribution provided. This consisted in drawing attention to a condition of generalised muscular hypotonia in infants, dating from birth and showing a tendency to gradual improvement. Oppenheim believed it was a disease-entity and due to delayed development of the muscles including their innervation. He anticipated, therefore, that the muscles would appear normal on orthodox histological examination. Much of the confusion
the nature of this condition is the result of other condinow better defined and more easily recognised, having I am been incorrectly diagnosed as amyotonia congenita. particularly referring to cases of Werdnig-Hoffmann disease, of congenital or intra-uterine onset, being mistakenly diagIf there do, in fact, exist nosed as amyotonia congenita. of disease, as suggested by frustes Werdnig-Hoffmann formes Arthuis,l muscle biopsy may be required to make the correct In infantile polyneuritis, as Chambers and diagnosis. MacDermot so usefully point out, an elevated protein content in the cerebrospinal fluid may be sufficient to make the diagnosis clear. It is quite possible that Oppenheim himself wrongly diagnosed as amyotonia congenita infants with one of these other conditions. No-one is infallible. Nevertheless, the fact remains that there is a small group of infants who show all the clinical features of amyotonia congenita, as described by Oppenheim,2 including congenital onset and tendency to improvement, and also yield muscle biopsies entirely free from abnormality over
tions,
1.
Arthuis, M.
L’amyotrophie spinale infantile de Werdnig-HoffParis, 1954. 2. Oppenheim, H. Mschr. Psychiat. Neurol. 1900, 8, 232. mann.
ENA M. STEEL General
Secretary.
PEDICULOSIS CAPITIS SIR,-As one who looked after the fate of a large part of Dublin’s louse population in dermatological practice during six years, I was interested in the findings of Dr. Nelson and Mr. Cromie (Feb. 23) in regard to the superiority of ’Esoderni ’ over other remedies for pediculosis capitis. As they note, by far the most important aspect of this condition is the frequency of reinfestation. Of my last 500 hospital cases, 20% suffered from pediculosis capitis (apart from any other skin disease) and of these about a third (7%) had become reinfested. The head louse is common among poor families in Dublin and, as a great many of them cannot afford shampoos, a cleansing agent such as esoderm would be extremely useful. But the problem is obviously one to be dealt with principally by improving living conditions, and by education in hygiene, and will not be solved by insecticides. The idea, therefore, that the nursing staff of the school and public-health services should be one is excellent. I may add that it is well recognised that, in young patients from the poor areas of Dublin, dandruff is nearly alwavs mechanised. BETHEL SOLOMONS. TOWARDS PREVENTING SUICIDE SIR,-I was most interested in the letters published in your columns relating to the detection and prevention of
would-be suicides. It has long been a theory of mine that many suicides could be prevented by the creation of a society on similar lines to Alcoholics Anonymous. That is to say,
permanent service would have to be estabto accept calls from any person who was desperate and seeking help. In many cases suicide would be prevented if the would-be suicide could find a a
lished which would be prepared
sympathetic listener and counsellor who would listen to all his troubles and give him assistance and encouragement. Once it became generally known that such advice and help were forthcoming and would-be suicides were urged to get in touch with the society and to suspend any drastic action at least until a member of the society should have time to call on them within the next 24 hours, I believe the psychological effecteven if only a natural curiosity to know how the counsellor would react to the problem-would cause them to hesitate. Of
course
it would be essential that such
a
service should be
night-and-day service, with an easy telephone number to memorise, and voluntary helpers in all the larger towns. Such helpers should not belong to medical or religious bodies, nor should they be trained social workers or psychiatrists, but simply men and women who have themselves known troubles a
and overcome them and who have both experience and understanding. Preferablv. of course, the root cause of the trouble
should be ascertained before sending the counsellor (in such general terms as ill health, money matters, business, love affair) so that a person could be chosen to help who had overcome a similar problem in the past.
of
Could not such a scheme be started under the auspices some interested oraanisation ? A. WATNEY. OLD PEOPLE IN HOSPITAL
Sin,ńI am sure everyone will agree with Dr. Trevor Howell’s remark last week that there is frequently a social problem behind the admission of elderly patients to hospital. Solving this problem is usually difficult, but not impossible : a proportion, however, remain insoluble, at least to me. It is these patients, or rather ex-patients, who constitute the more or less permanent residents to whom Dr. Rang refers (Feb. 23). Of the 32 beds available (only 26 were filled at the time of Dr. Rang’s experiment) over 20 are filled with elderly persons suffering from a profound disability which does not, however, require skilled nursing care. They have no relatives, or none willing or able to take care of them, while the local authority either considers their disability too severe for admission to a welfare home or pleads lack of accommodation. Failing a more generous interpretation of the meaning of Section 21 of the National Assistance Act that " it shall be the duty of every local authority ... to provide accommodation for persons who by reason of age, infirmity or any other circumstances are in need of care and attention which is not otherwise available to them " or the provision of more such accommodation by the local authority, it is difficult to see how this anomaly can ever be remedied. AMULREE. POLYNEURITIS AS A CAUSE OF CONGENITA " a
"AMYOTONIA
SiR,-Dr. Chambers and Dr. MacDermot have rendered service in delineating (Feb. 23) the diagnostic
signal
features of infantile polyneuritis. Less praiseworthy, in my opinion, is their choice of heading. They clearly regard amyotonia congenita as a miscellaneous group of conditions, having in common only their occurrence in infancy or early childhood and the generalised hypotonia exhibited by those affected. This is a distortion of Oppenheim’s original concept and obscures the very real advance which his contribution provided. This consisted in drawing attention to a condition of generalised muscular hypotonia in infants, dating from birth and showing a tendency to gradual improvement. Oppenheim believed it was a disease-entity and due to delayed development of the muscles including their innervation. He anticipated, therefore, that the muscles would appear normal on orthodox histological examination. Much of the confusion
the nature of this condition is the result of other condinow better defined and more easily recognised, having I am been incorrectly diagnosed as amyotonia congenita. particularly referring to cases of Werdnig-Hoffmann disease, of congenital or intra-uterine onset, being mistakenly diagIf there do, in fact, exist nosed as amyotonia congenita. of disease, as suggested by frustes Werdnig-Hoffmann formes Arthuis,l muscle biopsy may be required to make the correct In infantile polyneuritis, as Chambers and diagnosis. MacDermot so usefully point out, an elevated protein content in the cerebrospinal fluid may be sufficient to make the diagnosis clear. It is quite possible that Oppenheim himself wrongly diagnosed as amyotonia congenita infants with one of these other conditions. No-one is infallible. Nevertheless, the fact remains that there is a small group of infants who show all the clinical features of amyotonia congenita, as described by Oppenheim,2 including congenital onset and tendency to improvement, and also yield muscle biopsies entirely free from abnormality over
tions,
1.
Arthuis, M.
L’amyotrophie spinale infantile de Werdnig-HoffParis, 1954. 2. Oppenheim, H. Mschr. Psychiat. Neurol. 1900, 8, 232. mann.