CONFIRMATORY MEDICAL CERTIFICATE BEFORE CREMATION

1418

would be to identify the large number of male heterozygotes who would have to be carrying the gene, and to show beyond a doubt that they can pass on the gene to their progeny. On the other hand, the Fore society presents such a clear-cut possibility for an environmental agent to attack women and children and by-pass adult males, that it would seem difficult to abandon the possibility of an environmental aetiology resulting from a toxin, virus, or deficiency. The anthropological investigations of Berndt6 indicate that, if there is one significant fact about Fore society, at least up to the recent past, it is the marked separation of men on the one hand and women and children on the other, in almost every phase of life, including dwelUns houses. School of Tropical Medicine and

ANN FISCHER.

Public Health.

Department of Sociology and Anthropology, Tulane University, New Orleans, Louisiana.

JOHN L. FISCHER.

A CHLOROFORM SYNDROME?

SIR,-From continued observation of a

case

which has

that there is a " chloroform syndrome ". Repeated exposures to this inhalant aneesthetic for eighteen months or more have gradually produced symptoms and clinical signs which may indicate come to

my notice it

seems

(1) an individual hypersensitivity to the material, (2). a toxic effect primarily on liver, kidneys, and myocardium, but also affecting the pituitary and suprarenal, or (3) a specific ganglion-blocking or even cell-destructive effect on sympathetic ganglia and chromaffin tissue. A year or more may elapse before the case can be presented in full for publication. Meanwhile, Sir, may I ask for details of cases and/or more

the views of your readers who have come across any untoward effects following repeated exposure to chloroform vanour ? ’

59, Walnut Tree Walk, London, S.E.11.

H. A. L. O. LATTA.

A NEW ARTERIAL PROSTHESIS

SIR,-A new type of arterial prosthesis (see figure) has recently become available. It is of British design and

powerful hold for sutures. Pre-clotting of the prosthesis is desirable. Extensive experimental investigation of these synthetic grafts has been carried out. Courlene X3, being a pure polyethylene, causes minimal tissue reaction and loses none of its strength after periods of over 12 months in the body-factors which might be anticipated from its chemical constitution. a

These prostheses are made by P. Davenport Ltd. (Macclesfield) and are now available through the Genito-Urinary Manufacturing Co. Ltd.

Department of Surgery, The University,

B. N. CATCHPOLE.

Sheffield.

CONFIRMATORY MEDICAL CERTIFICATE BEFORE CREMATION endorse Dr. Hinden’s criticism (June 18) of the SIR,-I of the inadequacy confirmatory medical certificate in to 3 which asks " Have you made a postregard question mortem examination? " This is, however, but one of several shortcomings of the statutory form which has led me recently to inquire to what extent an individual cremation authority may be enabled to revise it. There is, for instance, the question on Form B relating to the inspection of the body after death which asks " What examination of it did you make ? " This elicits an extraordinary variety of answers few of which are of material assistance to the referee. There is also a lack of any suitable question which enables a practitioner to insert helpful information in regard to clinical history in support of the stated cause of death. It is, of course, very much easier to point out the inadequacy of a form than to devise a new one, but I would have little doubt that a panel of medical referees could draw up something much simpler and more to the point than the existing one. It seems possible in the meantime for cremation authorities to make provision for additional information to be given, but it would not appear possible for the statutory questions to be altered in any way without amending legislation.

K. O. A. VICKERY Medical Referee, Eastbourne Crematorium Authority.

Eastbourne.

SIR,-Has it occurred to Dr. Hinden that the person best qualified to sign the second part of the cremation certificate is the pathologist performing the autopsy? Pathological Laboratory, Southlands Hospital, Shoreham-by-Sea, Sussex.

K. S. RODAN.

SIR,-I entirely agree with Dr. Hinden. In answer to question 3. " Have you made a post-mortem examination ? " "Not personally, one performed", should suffice. At least it would tell the medical referee that a postmortem was carried out. I. A. KELLOCK. Manchester.

SIR,-There is

an

easy way out for Dr. Hinden. The

pathologist who has performed the postmortem is the best person to complete the second medical certificate. manufacture, being made entirely from Courtaulds highfibre (Courlene’X3’). In order to provide flexibility and slight elasticity, it is woven in the form of a double helical spring and may be autoclaved if the temperature during this process is not allowed to exceed 118"C; boiling or cold sterilisation with any suitable

melting-point polyethylene

solutions are alternative methods of preoperative preparation. The prosthesis must be divided with the cool cautery in order to seal the fabric, but this done, the ends of the tube provide 6. Berndt, R. M.

Sociologus, 1958, 8, 4.

In addition, it has been recommended that the second certificate should be given by a person other than one who has had the deceased in his care. R. C. R. CONNOR. Cardiff.

SIR,-May I suggest two solutions to Dr. Hinden’s problem ? He could ask the morbid anatomist to complete the confirmatory certificate, or he could visit the postmortem room and have a look at the findings. I am sure the morbid anatomist would make Dr. Hinden welcome and assist, if necessary, in interpretation. Dr. Hinden would then be correct in saying that he had performed a

1419

postmortem examination. A knife is useful in exposing organs for examination and helps to determine consistencv, but one can examine with one’s eves. R. H. COWDELL. The Radcliffe Infirmary, Oxford.

Parliament QUESTION TIME " Spiritual Healers " in Hospital Mr. KENNETH ROBINSON asked the Minister of Health what guidance he had given to hospital management committees regarding the admittance of members of the National Federation of Spiritual Healers into hospitals for the purpose of treating National Health Service patients; and how many management committees permitted these activities at the present time.-Mr. DEREK WALKER-SMITH replied: I have not given guidance to hospital management committees, as I consider on present advice that the visiting of patients is a matter which should be left to the hospital authority’s discretion, in the light of the views of the doctor in charge of the particular patient who has asked for the visit. While I do not know the practice of individual committees, they are generally aware of my view. Dr. DONALD JOHNSON: Is the Minister aware that the Federation of Spiritual Healers are making extensive claims in this matter and are saying that they are entering hospitals

give treatment by permission of the regional hospital boards ? Does he not agree that, if this is so, it is a matter for his decision and. not one to be left to the regional hospital boards ? We look to him for guidance and a decision in the matter.-Mr. WALKER-SMITH: I have no responsibility for any claims made by this Federation or any other body. There are two requisites here: first, that the ’patient must ask for any such visit before it can be contemplated, and, secondly, that the hospital authority must exercise its discretion with due regard to the views of the doctor in charge of the case. Mr. ROBINSON: I do not want to express a view one way or the other about the merits of the Federation, but does not the Minister think that this is a matter in which he should give guidance to hospital authorities rather than leave the decision to individual authorities ? Is he aware that these healers are now reported to be present in 50% of the hospitals run by management committees ?-Mr. WALKER-SMITH: If I am right as to the factors governirig- these cases, it must always ultimately be a matter for local decision, in the light of these factors. Therefore, general guidance, beyond what I have already said, would not appear to be appropriate. Dr. EDITH SUMMERSKILL: Did I understand the Minister to say that a regional hospital board can make a decision in favour of these visits but that a doctor can refuse only in a specific ’case. Can a doctor refuse to have a spiritual healer attending any of his cases on the ground of principle?-Mr. WALKER-SMITH: The question does not arise in the first place unless and until the patient concerned asks for the visit. That having been done, it is a matter for the discretion of the hospital authority whether or not the visit will be sanctioned. In coming to that decision the hospital authority will give due weight to the opinion of the doctor in charge of the case. to

Tests’for New Drugs Mr. GEORGE DARLING asked the Minister if he would introduce regulations to require that ?11 new drugs be tested and evaluated by a responsible body before they are offered for sale to the public.-Mr. WALKER-SMITH replied: While there are no existing powers under which, such regulations could be made, I am giving, and will continue to give, all the help and encouragement I can towards improvements in the present arrangements and facilities for clinical trials. The Central and Scottish Health Services Councils have agreed to extend the terms of reference and membership of the Standing Joint Committee on the Classification of Proprietary Preparations to enable this committee to assist.

Obituary ALEXANDER KENNEDY M.D. Lond., F.R.C.P., F.R.C.P.E., D.P.M.

Dr. Alexander Kennedy, whose death on June 11 we announced last week, had held the chairs of psychological medicine at Durham and Edinburgh. He came to both departments at a time of reorganisation, and perhaps his chief contribution to psychiatry was the development of these professorial units in the light of his own ideas, and the integration of the teaching of psychiatry with the other disciplines of medicine. He was born in 1909 and was educated School and St. Thomas’s Hospital, where he qualified in 1932. After holding house-appointments there he took his M.D. and the M.R.C.P. in 1934 and specialised initially in paediatrics. He continued his postgraduate studies at the Johns Hopkins University, and in 1936 he was awarded a Rockefeller travelling fellowship in neuropsychiatry. On his return to this country he became medical officer in charge of the children’s department at the Maudsley Hospital, while the present children’s hospital was being built with the assistance of the Rockefeller Foundation. In 1938 he was awarded the gold medal

of the

Roval

at

the

City of London

Medico-

Psychological Association. During the late war he carried out research into the psychology of parachute and commando training and took part in operations in the Western Desert, Crete, Greece, and Yugoslavia. Later, with the rank of lieut.colonel, he was appointed head of a department dealing with the psychological aspects of military intelligence and subversive operations and was an adviser on scientific intelligence in Germany. After the war he returned to the Maudsley Hospital as senior physician and joined the staff of the Maida Vale Hospital for Nervous Diseases. In 1947 he was appointed to the chair of psychological medicine at Durham. He was also physician to the Royal Victoria Infirmary, Newcastle upon Tyne, and clinical director of psychiatric units in the regional mental health service. In 1949 he was elected F.R.C.P. He was appointed to the Edinburgh chair five years ago. Even a formal biography shows that Kennedy was an unusual man who had an unusual career. Exactly how unusual and how effective is made clear only by the following memoirs from his friends: I first met Alexander Kennedy in 1946 when he had returned the Maudsley Hospital after an exciting, if not lurid, career in the Army. Thenceforth his adventures, his successes, and his life have been a never-failing source of pleasure to me. I have always come away from him feeling happier, amused, and more able to bear with the workaday world of psychiatry. It has been said that he told tall stories. Yet as I became closer to him, I found them confirmed on every side. Life was with him stranger than fiction, the result of his adventurous turn of mind and his zest for new experience. At one time a gambler on the Paris bourse in hectic post-war days, at another the familiar of desert sheikhs, sharing their mutton stews on the road to Mecca, yet again the author of immensely successful radio plays and member of the Brain’s Trust of television-these, were all roles Kennedy had played. He could do these things because there was about him a simple directness which brooked no awareness of " east nor west, border, nor breed, nor birth ", which was his most outstanding characteristic. to