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CAPITAL PUNISHMENT
932 in the chain of evidence that leads from suspicion to certainty. A child with intussusception never smiles. Nevertheless not uncommonly the typical facies is absent in an abdominal case. In the late stages of all varieties of acute abdominal disease the face tells the observer much that he ought to know, but is sorry to learn. In chronic tonsillitis with adenoids the facies is so peculiar and distinctive that the condition may be evident at a glance. The expression is dull, heavy, and apathetic, owing partly to the fact that the mouth is habitually left open. In long-standing cases the child looks very stupid, responds slowly to questions, and may be sullen and cross. The lips are thick, the nasal orifices are small and look pinched in, and in the mouth the superior dental arch is narrowed and the roof conChildren with congenital syphilis siderably raised. rarely thrive ; they present a wizened wasted appearance and a prematurely aged face, with the bridge of the nose depressed and its tip retroussi, restricted lines running from the corners of the mouth, and Hutchinson’s teeth. Trousseau (1943) wrote of the peculiar hue of the face, which presents a special shade of bistre. "
is almost like that of the countenance of a I know no disease except delivered woman. in which a child’s skin has this peculiar colour, and consequently when it is well marked, it has more diagnostic value than any other symptom."
The
tinge
recently syphilis
A rare but still more extraordinary bodily state is that of progeria, in which, as though touched with the wand of some malign fairy, the child does not remain infantile but skips adolescence, maturity, and manhood, and passes at once to senility, looking at eleven or twelve years like a miniature Tithonus " marred and wasted," wrinkled and stunted, a little old man among his toys. Ugly defects of the face should always be noted, such as flaring ears, distorted nose, protruding teeth, a mouse jaw, a bad squint, a port-wine mark, an acne rosacea that leaves the face pitted and unattractive and causes much mental torture in boys and girls, and a bad facial scar from a burn. Any such defect that causes lifelong embarrassment and shame is likely to have some warping effect on the mind. Pigmentation of the face is associated with Addison’s disease, which first springs to the mind although the face is not generally affected. Argyria is rarely seen now that silver nitrate is not administered. Haemochromatosis may be evident in the face. In ochronosis the accompanying darkening of the cartilage gives a bluish tint to the ears. The patchy pigmentation in the chloasma of pregnancy, in some cases of cancer and of tuberculosis, in intestinal stasis, in rheumatoid arthritis, and after the prolonged administration of arsenic is as likely to be evident in the face as elsewhere. Pallor is produced in conditions such as the greenishyellow of chlorosis, the lemon-yellow of pernicious anaemia, the ivory-white of chronic nephritis, the pastywhite of nephrosis, and the waxy appearance of lardaceous disease. *
*
*
Many wise and experienced physicians could more richly add to this ensemble of significant observations, but perhaps enough material has been here gathered to
is
show, in the words of Peter Mere Latham that " it
by your
own
ears, and your own heart that you must " (Martin 1878). Thus a cannot be communicated
eyes, and your
minds, and (may I add) your
own
own
observe and learn and profit disciplined use of the senses from one to another ; it is a purely personal acquirement, for the neglect of which no amount of book-learning can compensate, and unfortunately much that can be learned therefrom cannot be conveyed in words. The physiognomy of disease can never be adequately described, and I long remember my old teachers urging us always to remark it and to dwell much on it ; for they
acute observers and had drawn such secrets from I the expression of the countenance that it had been to 1 them in the place of almost all other symptoms. But whatever may be one’s " clinical instinct," or curiosity to observe and look for things, what counts is not only what is found at the bedside but primarily The what is brought to the bedside. andi to a man’s /3Xtt7!"rf of Hippocrates are more essential welfare and comfort than are abstract points of theory, and they naturally acquire a, great Osler (1941), to better our times, wisely said in his inimitable way : " It is an unpardonable mistake to go about among patients with a long face."
were
WCPEÀÛV
predominance.
I wish to thank Prof. H. J. L. Marriott, associate professor of medicine in the University of Maryland, for his scholarly reading of the manuscript, and Lord Horder for placing at my disposal his excellent writings. REFERENCES
Abrahams, A. (1939) Practitioner, 143, 107. Adams, F. (1856) The Extant Works of Aretæus the Cappadocian. London ; p. 295. Alvarez, W. C. (1951) The Neuroses. Philadelphia and London; p. 274. Bell, C. (1844) The Nervous System of the Human Body. 3rd ed., London ; p. 66. Browne, T. (1862) Religio Medici. Boston; pp. 193, 228. Gowers, W. R. (1881) Epilepsy and other Convulsive Diseases. London; p. 39. Hall, M. (1835) The Principles of Diagnosis. New York; p. 50, Heberden, W. (1818) Commentaries on the History and Cure of Diseases. Boston; p. 284. Hilton, J. (1877) On Rest and Pain. London. Horder, T. J. (1921) Medical Notes. London : pp. 2, 29, 102. Horner, J. F. (1869) Klin. Monatsbl. Augenheilk. 7, 193. Martin, R. (1878) The Collected Works of Peter Mere Latham. London ; vol. II, pp. 36, 38. Osler, W. (1911) Canad. med. Ass. J. 1, 919. (1941) Æquanimitas. London; pp. 134, 405. Ryle, J. A. (1948) The Natural History of Disease. 2nd ed., London; p. 28. Trousseau, A. (1943) Lectures on Clinical Medicine. Philadelphia and London ; vol. II. p. 588. Waring, J. J. (1948) Ann. intern. Med. 28, 15. -
CAPITAL PUNISHMENT A PUBLIC meeting of the Howard League for Penal Reform was held in London on Oct. 21, to consider future developments in the light of the recommendations of the Royal Commission on Capital Punishment.1 Lord TEMPLEWOOD, who was in the chair, said that the commission’s report had opened a new chapter in the League’s campaign against the death penalty. He could very well remember the long and bitter debates in both Houses which had preceded the setting up of the commission-debates all the more heated because there was no body of official evidence for either side to produce, The great achievement of the commission had been to amass the requisite volume of evidence, and he felt very grateful to the commissioners-tied down as they were by the terms of their instructions, which debarred them from considering the question of abolition of the death penalty-for the immense amount of valuable material they had brought to light which supported the League’s case. He was particularly impressed by the evidence given by a representative of the Home Office and by the chief executioner as to the way in which the death penalty was administered, as this plainly bore witness to the utterly repulsive nature of the operation, and by the evidence of one of the great luminaries of the United States Supreme Court, Felix Frankfurter, which convincingly stated the case against the diehards advocating the retention of the death penalty. He agreed with the conclusions which the commissioners had reached about raising the age-limit from 18 to 21, and about the official medical examination of everyone condemned for murder. He did not oppose the rather surprising recommendation that the jury and not the judge should be left to decide on the sentence — the fact that the commissioners felt themselves driven 1. See Lancet, Oct. 3,
1953, p. 713.
’
933 to this conclusion showed how impossible it was to find He doubted whether a rigid and irrevocable plan. Parliament would agree to this recommendation ; but if it did he would support it because, judging from the experience of some of the States in the TJ.S.A., this course would lead to a reduction in the number of death sentences passed. With three of the commission’s conclusions he fully agreed : that the abolition of the death penalty does not lead to an increase of murders ; that there are alternative methods of punishment for the crime which are not inhumane ; and, finally, with the passage where the commission states that the law is at present excessively rigorous. Obviously, the commissioners felt that the law should be radically changed, though they The Howard League were debarred from saying so. must now press forward with its campaign for total abolition of the death penalty. Mr. GERALD GARDINER, Q.C., spoke on the legal aspect. The commissioners, he said, had been precluded from considering the question of abolition of the death penalty, so they had approached the problem from the other end by seeking to limit the definition of murder. They had made three specific recommendations : that the English law of constructive malice should be abolished ; that the degree of provocation should be extended to words ; and that one form of suicide pact, in which each party committed suicide, should be excluded from the definition of murder. They did not recommend the exclusion of mercy-killers or of women, but they advised raising the age-limit from 18 to 21. As regards exemption on grounds -of mental condition, they had recommended that mental deficiency should be put on the same footing as insanity, and that the Home Secretary should also take epilepsy and psychopathy into consideration. They considered the MeNaughten Rules, and recommended that these should either be completely abrogated or else extended to irresistible impulse." include the concept of The commission’s consideration and rejection of the idea of introducing various degrees of murder should do much to kill this unrealisitic notion. At first sight there might seem to be two classes of murderers-those who were condemned, and those who were reprievedbut the many factors which the Home Secretary. had to take into consideration in arriving at his decision to reprieve one particular murderer were too varied and complex to lend themselves to rigid rules. The discretionary verdict which the commission recommended was certainly not a task which the judges wished to undertake ; were it to be thrust upon them, the verdicts would vary widely with the judge’s experience and temperament, and we should go back to the bad old days of the " hanging judge." He thought it would be better for the defence, after conviction, to call evidence for extenuation, if the jury were to decide on the sentence, but he himself felt this was best left to the Home Secretary. He could himself see only two arguments for the retention of the death penalty : the ethics of " an eye for an eye, a tooth for a tooth,"-but why should a supposedly Christian country rely on an Old Testament text which was specifically controverted in the New -and the alleged deterrent effect, which had now been proved to be a fiction. The great argument against the death penalty was a moral one-that ordinary citizens in order to show their disapproval of the murderer’s crime were perpetrating the same action on him, not personally but by delegating that task to judges, juries, and hangmen. But behind the impersonal machinery of the law was our collective responsibilityforwha-t-was beingdone in our name. At the time of the publication "
’’
"
of the report, one of the newspapers had come out with banner headline, referring to the discretionary verdict : " Now The Noose Is Passed To You! " This was dramatic but misleading, for the noose had always been in our hands. Apart from France and Spain, we were the only civilised nation where capital punishment was the policy for the whole realm, and there were signs of it falling into disuse in France. It was to be hoped that we would not long compete for the unenviable distinction of being the last stronghold of the death penalty. Mr. CHRISTOPHER HoLLis, M.P., who spoke on the moral aspect, said that one of the most effective deterrents would be for the popular hysteria on the subject of murder to be diminished. He felt that posting notices on the gates of the gaol at the time of an execution fostered this very unhealthy sensationalism, and should be discontinued. The report was extremely valuable for having exhaustively considered the whole matter of the deterrent effect of different penalties, and its carefully marshalled evidence and summary of conclusions effectively disposed of this moral dilemma for those whose main concern was for the sanctity of human life. And if capital punishment did not in fact have an undeniable deterrent effect, there was no moral basis for its retention in the penal code. a
GERM-FREE LIFE FoR a quarter of a century Prof. J. A. Reyniers, of Notre Dame University in Indiana, has been studying His object the problem of rearing germ-free animals. was to produce animals completely free from bacteria or viruses, and for this purpose a supersterility technique had to be used and many technical difficulties overcome. During a brief visit to this country recently Professor Reyniers outlined the results of his work. The animals are reared in completely sealed chambers resembling autoclaves. The foetuses are removed from the uterus by an aseptic operation, and placed in the sterile chambers. The animals are fed and handled by means of long rubber gloves sealed into the chambers. Carefully filtered air is pumped in, and all material, including food, introduced into the chambers is sterilised by steam under pressure in autoclaves attached to the main chamber. The larger rearing units are very elaborate structures consisting of several rooms arranged in two storeys. The three men working in these chambers wear completely sealed diving-suits of plastic material, provided with 40 feet of stainless steel air-lines. On entering the chambers the operators are hermetically sealed in their diving-suits and are then given a shower-bath in antiseptic for fifteen minutes. They are then totally immersed for half an hour in tanks of 3% formalin containing detergent. Any imperfections in the diving-suit soon become apparent either by the escape of of bubbles or by the effect of the formalin on the occupant the suit. The operators then climb a ladder from the antiseptic tank through a trap-door where they are met by a shower bath of sterile water. They are then ready to attend to the sterile animal colony. Diving-suits, with their 40 feet of hose, are a hindrance to the operators when chasing
recalcitrant animals, so cages of animals are transferred intact to the smaller units for further experiments. Animals can be kept completely free from micro-organisms indefinitely under these sterile conditions ; the longest period in actual practice has been eighteen months. There are no bacteria in the intestines and the faeces remain odourless. After death these germ-free animals show no signs of putrefaction, and " cultures " of whole rats embedded in nutrient-agar plates remain sterile. The isolated aseptic animals feed and breed normally without training. Isolated baby rats die a few days after birth because they fail to urinate, but urination begins when the genitals are stroked and thereafter occurs normally. Presumably micturition is normally initiated when the mother licks her young. The largest animals reared in this way were dogs and monkeys, but the isolation involved -had psychological effects.
is almost like that of the countenance of a I know no disease except delivered woman. in which a child’s skin has this peculiar colour, and consequently when it is well marked, it has more diagnostic value than any other symptom."
The
tinge
recently syphilis
A rare but still more extraordinary bodily state is that of progeria, in which, as though touched with the wand of some malign fairy, the child does not remain infantile but skips adolescence, maturity, and manhood, and passes at once to senility, looking at eleven or twelve years like a miniature Tithonus " marred and wasted," wrinkled and stunted, a little old man among his toys. Ugly defects of the face should always be noted, such as flaring ears, distorted nose, protruding teeth, a mouse jaw, a bad squint, a port-wine mark, an acne rosacea that leaves the face pitted and unattractive and causes much mental torture in boys and girls, and a bad facial scar from a burn. Any such defect that causes lifelong embarrassment and shame is likely to have some warping effect on the mind. Pigmentation of the face is associated with Addison’s disease, which first springs to the mind although the face is not generally affected. Argyria is rarely seen now that silver nitrate is not administered. Haemochromatosis may be evident in the face. In ochronosis the accompanying darkening of the cartilage gives a bluish tint to the ears. The patchy pigmentation in the chloasma of pregnancy, in some cases of cancer and of tuberculosis, in intestinal stasis, in rheumatoid arthritis, and after the prolonged administration of arsenic is as likely to be evident in the face as elsewhere. Pallor is produced in conditions such as the greenishyellow of chlorosis, the lemon-yellow of pernicious anaemia, the ivory-white of chronic nephritis, the pastywhite of nephrosis, and the waxy appearance of lardaceous disease. *
*
*
Many wise and experienced physicians could more richly add to this ensemble of significant observations, but perhaps enough material has been here gathered to
is
show, in the words of Peter Mere Latham that " it
by your
own
ears, and your own heart that you must " (Martin 1878). Thus a cannot be communicated
eyes, and your
minds, and (may I add) your
own
own
observe and learn and profit disciplined use of the senses from one to another ; it is a purely personal acquirement, for the neglect of which no amount of book-learning can compensate, and unfortunately much that can be learned therefrom cannot be conveyed in words. The physiognomy of disease can never be adequately described, and I long remember my old teachers urging us always to remark it and to dwell much on it ; for they
acute observers and had drawn such secrets from I the expression of the countenance that it had been to 1 them in the place of almost all other symptoms. But whatever may be one’s " clinical instinct," or curiosity to observe and look for things, what counts is not only what is found at the bedside but primarily The what is brought to the bedside. andi to a man’s /3Xtt7!"rf of Hippocrates are more essential welfare and comfort than are abstract points of theory, and they naturally acquire a, great Osler (1941), to better our times, wisely said in his inimitable way : " It is an unpardonable mistake to go about among patients with a long face."
were
WCPEÀÛV
predominance.
I wish to thank Prof. H. J. L. Marriott, associate professor of medicine in the University of Maryland, for his scholarly reading of the manuscript, and Lord Horder for placing at my disposal his excellent writings. REFERENCES
Abrahams, A. (1939) Practitioner, 143, 107. Adams, F. (1856) The Extant Works of Aretæus the Cappadocian. London ; p. 295. Alvarez, W. C. (1951) The Neuroses. Philadelphia and London; p. 274. Bell, C. (1844) The Nervous System of the Human Body. 3rd ed., London ; p. 66. Browne, T. (1862) Religio Medici. Boston; pp. 193, 228. Gowers, W. R. (1881) Epilepsy and other Convulsive Diseases. London; p. 39. Hall, M. (1835) The Principles of Diagnosis. New York; p. 50, Heberden, W. (1818) Commentaries on the History and Cure of Diseases. Boston; p. 284. Hilton, J. (1877) On Rest and Pain. London. Horder, T. J. (1921) Medical Notes. London : pp. 2, 29, 102. Horner, J. F. (1869) Klin. Monatsbl. Augenheilk. 7, 193. Martin, R. (1878) The Collected Works of Peter Mere Latham. London ; vol. II, pp. 36, 38. Osler, W. (1911) Canad. med. Ass. J. 1, 919. (1941) Æquanimitas. London; pp. 134, 405. Ryle, J. A. (1948) The Natural History of Disease. 2nd ed., London; p. 28. Trousseau, A. (1943) Lectures on Clinical Medicine. Philadelphia and London ; vol. II. p. 588. Waring, J. J. (1948) Ann. intern. Med. 28, 15. -
CAPITAL PUNISHMENT A PUBLIC meeting of the Howard League for Penal Reform was held in London on Oct. 21, to consider future developments in the light of the recommendations of the Royal Commission on Capital Punishment.1 Lord TEMPLEWOOD, who was in the chair, said that the commission’s report had opened a new chapter in the League’s campaign against the death penalty. He could very well remember the long and bitter debates in both Houses which had preceded the setting up of the commission-debates all the more heated because there was no body of official evidence for either side to produce, The great achievement of the commission had been to amass the requisite volume of evidence, and he felt very grateful to the commissioners-tied down as they were by the terms of their instructions, which debarred them from considering the question of abolition of the death penalty-for the immense amount of valuable material they had brought to light which supported the League’s case. He was particularly impressed by the evidence given by a representative of the Home Office and by the chief executioner as to the way in which the death penalty was administered, as this plainly bore witness to the utterly repulsive nature of the operation, and by the evidence of one of the great luminaries of the United States Supreme Court, Felix Frankfurter, which convincingly stated the case against the diehards advocating the retention of the death penalty. He agreed with the conclusions which the commissioners had reached about raising the age-limit from 18 to 21, and about the official medical examination of everyone condemned for murder. He did not oppose the rather surprising recommendation that the jury and not the judge should be left to decide on the sentence — the fact that the commissioners felt themselves driven 1. See Lancet, Oct. 3,
1953, p. 713.
’
933 to this conclusion showed how impossible it was to find He doubted whether a rigid and irrevocable plan. Parliament would agree to this recommendation ; but if it did he would support it because, judging from the experience of some of the States in the TJ.S.A., this course would lead to a reduction in the number of death sentences passed. With three of the commission’s conclusions he fully agreed : that the abolition of the death penalty does not lead to an increase of murders ; that there are alternative methods of punishment for the crime which are not inhumane ; and, finally, with the passage where the commission states that the law is at present excessively rigorous. Obviously, the commissioners felt that the law should be radically changed, though they The Howard League were debarred from saying so. must now press forward with its campaign for total abolition of the death penalty. Mr. GERALD GARDINER, Q.C., spoke on the legal aspect. The commissioners, he said, had been precluded from considering the question of abolition of the death penalty, so they had approached the problem from the other end by seeking to limit the definition of murder. They had made three specific recommendations : that the English law of constructive malice should be abolished ; that the degree of provocation should be extended to words ; and that one form of suicide pact, in which each party committed suicide, should be excluded from the definition of murder. They did not recommend the exclusion of mercy-killers or of women, but they advised raising the age-limit from 18 to 21. As regards exemption on grounds -of mental condition, they had recommended that mental deficiency should be put on the same footing as insanity, and that the Home Secretary should also take epilepsy and psychopathy into consideration. They considered the MeNaughten Rules, and recommended that these should either be completely abrogated or else extended to irresistible impulse." include the concept of The commission’s consideration and rejection of the idea of introducing various degrees of murder should do much to kill this unrealisitic notion. At first sight there might seem to be two classes of murderers-those who were condemned, and those who were reprievedbut the many factors which the Home Secretary. had to take into consideration in arriving at his decision to reprieve one particular murderer were too varied and complex to lend themselves to rigid rules. The discretionary verdict which the commission recommended was certainly not a task which the judges wished to undertake ; were it to be thrust upon them, the verdicts would vary widely with the judge’s experience and temperament, and we should go back to the bad old days of the " hanging judge." He thought it would be better for the defence, after conviction, to call evidence for extenuation, if the jury were to decide on the sentence, but he himself felt this was best left to the Home Secretary. He could himself see only two arguments for the retention of the death penalty : the ethics of " an eye for an eye, a tooth for a tooth,"-but why should a supposedly Christian country rely on an Old Testament text which was specifically controverted in the New -and the alleged deterrent effect, which had now been proved to be a fiction. The great argument against the death penalty was a moral one-that ordinary citizens in order to show their disapproval of the murderer’s crime were perpetrating the same action on him, not personally but by delegating that task to judges, juries, and hangmen. But behind the impersonal machinery of the law was our collective responsibilityforwha-t-was beingdone in our name. At the time of the publication "
’’
"
of the report, one of the newspapers had come out with banner headline, referring to the discretionary verdict : " Now The Noose Is Passed To You! " This was dramatic but misleading, for the noose had always been in our hands. Apart from France and Spain, we were the only civilised nation where capital punishment was the policy for the whole realm, and there were signs of it falling into disuse in France. It was to be hoped that we would not long compete for the unenviable distinction of being the last stronghold of the death penalty. Mr. CHRISTOPHER HoLLis, M.P., who spoke on the moral aspect, said that one of the most effective deterrents would be for the popular hysteria on the subject of murder to be diminished. He felt that posting notices on the gates of the gaol at the time of an execution fostered this very unhealthy sensationalism, and should be discontinued. The report was extremely valuable for having exhaustively considered the whole matter of the deterrent effect of different penalties, and its carefully marshalled evidence and summary of conclusions effectively disposed of this moral dilemma for those whose main concern was for the sanctity of human life. And if capital punishment did not in fact have an undeniable deterrent effect, there was no moral basis for its retention in the penal code. a
GERM-FREE LIFE FoR a quarter of a century Prof. J. A. Reyniers, of Notre Dame University in Indiana, has been studying His object the problem of rearing germ-free animals. was to produce animals completely free from bacteria or viruses, and for this purpose a supersterility technique had to be used and many technical difficulties overcome. During a brief visit to this country recently Professor Reyniers outlined the results of his work. The animals are reared in completely sealed chambers resembling autoclaves. The foetuses are removed from the uterus by an aseptic operation, and placed in the sterile chambers. The animals are fed and handled by means of long rubber gloves sealed into the chambers. Carefully filtered air is pumped in, and all material, including food, introduced into the chambers is sterilised by steam under pressure in autoclaves attached to the main chamber. The larger rearing units are very elaborate structures consisting of several rooms arranged in two storeys. The three men working in these chambers wear completely sealed diving-suits of plastic material, provided with 40 feet of stainless steel air-lines. On entering the chambers the operators are hermetically sealed in their diving-suits and are then given a shower-bath in antiseptic for fifteen minutes. They are then totally immersed for half an hour in tanks of 3% formalin containing detergent. Any imperfections in the diving-suit soon become apparent either by the escape of of bubbles or by the effect of the formalin on the occupant the suit. The operators then climb a ladder from the antiseptic tank through a trap-door where they are met by a shower bath of sterile water. They are then ready to attend to the sterile animal colony. Diving-suits, with their 40 feet of hose, are a hindrance to the operators when chasing
recalcitrant animals, so cages of animals are transferred intact to the smaller units for further experiments. Animals can be kept completely free from micro-organisms indefinitely under these sterile conditions ; the longest period in actual practice has been eighteen months. There are no bacteria in the intestines and the faeces remain odourless. After death these germ-free animals show no signs of putrefaction, and " cultures " of whole rats embedded in nutrient-agar plates remain sterile. The isolated aseptic animals feed and breed normally without training. Isolated baby rats die a few days after birth because they fail to urinate, but urination begins when the genitals are stroked and thereafter occurs normally. Presumably micturition is normally initiated when the mother licks her young. The largest animals reared in this way were dogs and monkeys, but the isolation involved -had psychological effects.