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EUROPEAN LEAGUE FOR MENTAL HYGIENE
458
Conferences and
created
Congresses
WORLD FEDERATION FOR MENTAL HEALTH THE World Federation for Mental Health held its ninth annual on Aug. 12-17 in West Berlin. The theme of the meeting was Mental Health in Home and School. At the inaugural meeting the president, Dr. NILO MAKI (Finland), invested the new president, Dr. EDWARD KRAPF. Dr. Krapf has been appointed director of the mental section of the World Health Organisation, and he therefore resigned his office immediately after his address and installed as his successor Miss MARGARET MEAD, D.SC., the American anthropologist.
meeting
,
-
PSYCHOSOMATIC MEDICINE
of the technical sessions-that on advances in psychosomatic medicine-the opening speakers were Dr. FLANDERS DUNBAR (U.S.A.) and Prof. H. C. RUMKE (Netherlands). Dr. Dunbar said there were no imaginary those of unknown cause. She thought illnesses, only functional " illness was not such a good term as psychosomatic illness. Professor Rumke declared there was great danger in taking an extreme or mechanistic view : the spiritual factor in man needed to be kept constantly in mind. The concept of psychosomatic disorder might be dangerous if the doctor failed to make a physical examination or too easily accepted the psychic factor. This was especially true of endogenous depressions which needed electric-shock treatment and not only In
one
"
"
"
psychotherapy. Dr. DENIS LEIGH did not believe that a doctor should try to play the role of clergyman or anthropologist or philosopher. He felt that the German literature introduced these aspects into medicine to an unreasonable extent. But Dr. DAVID STAFFORD-CLARK disagreed : the doctor, he thought, must take cognisance of moral values, though not enforcing his own on the patient, and the patient must come to terms with his own moral values. We needed to try and find a common language between the psycho-analysts, the psychosomatists, and general medicine. MENTAL HEALTH AND
PUBLIC AFFAIRS
Prof. IRWIN STRANSKY (Austria) said that he had long advocated the psychological investigation of the personalities and character structure of those who aimed at becoming leaders in politics, industry, or any other field which involved the handling of human beings. Only too often those who sought to lead others were motivated by a desire for power which derived from a sense of personal inferiority and inadequacy or were of paranoid tendencies an attitude of aggressive hostility. These to lead unfit and should never be were people quite allowed to do so. Dr. BROCK CHISHOLM (Canada) said that though this was theoretically desirable it was extremely difficult to put into practice. He felt that the most important thing was to understand the motivation of those who desired to be followers. The type of leader chosen would depend on the followers. Would-be leaders secured a following by appealing to anything which the group regarded as a shibboleth. Only people who had a wide enough knowledge and point of view to be world citizens were really fit to solve world affairs.
which produced
DIFFICULTIES IX
Another session health special to
paediatrician,
BERLIN
devoted to problems of mental Berlin. Dr. GrERTRUD SoEKEN, a spoke of the tensions which had been was
by the division of the city and the effect having on children. There was a lack of conce tion for learning among school-children, and the nu of hypersensitive children was very high. She bel there might also be undetectable organic changes would show themselves only in later years. It wa aim to examine and to treat medically every chil were
had difficulties at school or in the home. A inspector, Mr. R. KELLER, said that millions of ch had been brought up in unnatural circumstan many had lost their fathers, and the mothers had out to work to support them. The children saw re arriving daily andthe tragedy that this represe There was a great need to improve the stability family and to try to minimise the threat from al tobacco, bad films, gambling machines, evil liter and other harmful influences. He felt that the un Germany was a problem of mental health. The sphere of distrust and insecurity in the city had effect on the children. Until recently they had completely enclosed within an island and the ch had no opportunity of going out to the countryside The standard of honesty of the parent travel. declined so that the children were brought up wi adequate moral values. The children of one part city had to learn Russian, the other French or En There was a climate of fear and hostility. The was in all ways to create conflicts. The problem w great for those in the East as in the West of Berlin
EUROPEAN LEAGUE FOR MENTAL HYGIENE
THE European League for Mental Hygiene he sixth annual conference in Berlin on Aug. 11 an Dr. DoRis ODLUM presided over the scientific mee The conference was concerned with mental healt modern forms of leisure activities, with special ref to the radio, television, the cinema, and acti
involving speed.
Dr. DENIS LEIGH introduced the subject of telev Hardly a day passed, he said, without a pronounce by some distinguished cleric, politician, author, d or
dentist
on
the effect of television
on
the
man
morals, and mental health of the community.
opinions were mostly unfavourable, but they were s based on any special knowledge and in many cas critics admitted that they seldom watched tele themselves. Dr. Leigh believed that the effects whole were favourable. Adults were chiefly conc with the effects on children, but he believed that tele had its largest impact on the adult. Most of the s literature about it came from educationists but was practically no psychiatric literature. This sugg that psychiatrists had no reason to think that startling effects one way or the other on patients community. It appeared that school learning ha been affected, that parental control over children’ing habits did not appreciably affect their school ac ments, and a careful B.B.C. study last year foun there was very little change in the leisure hab viewers as compared with non-viewers. Dr. THERESE LAMPERIÈRE (France) discussed the of a working party on mental hygiene and the d in France. The conditions under which a film was v played an important part. Would a child react diffe to the same film if he saw it alone or with his p or with a group of other children ? It was foun when spectators formed a homogeneous group, su cine clubs for children or students or special audi spectator reaction was different from that of an or heterogeneous audience. The cinema had a dit effect according to age, sex, and intelligence, the
459 of education, and the character and the state of the emotions. Some scenes terrified young children such as the witch in Sraow White and the burning forest in Bambi. Laws to prevent children seeing unsuitable films would be quite contrary to public opinion, and the best we could hope to do was to try to prevent the production of undesirable films. Dr. Lamperiere also read a paper on leisure activities involving speed. The desire for speed was an expression of man’s dissatisfaction with his limitations and the frustrations of his personal life. The spectator derived In both cases the dt secondhand a similar satisfaction. reaction was one of immaturity, a compensation for their feelinus of inferiority and inadequacy as adults. For -
most people, driving a car undoubtedly liberated compensatory mechanisms against these feelings of inadequacy
largely
and this explained why people who most tolerant and patient in their aggressive and rude when driving a car.
were
daily
normally
life became
Medicine and the Law A Murder Conviction
Quashed Forces, during
AN airman in the United States
in
cafe, stabbed
an
in the abdomen. The affrav man was on within an hour and the mjured operated wound stitched up. He died eight days later. The airman was charged with murder. The jury returned a verdict of guilty with a strong recommendation to mercy. Un an appeal against conviction, on the ground that the bronchopneumonia which caused the injured man’s death did not result from the stab wound, counsel for the airman said that the case was of extreme importance from the medical point of view. It was not now disputed that it was the airman who stabbed the deceased. In view of information received after the trial, it was now submitted that the bronchopneumonia which was the cause of death did not arise as a result of the wound but was due to two other causes : first, the use of terramycin and, secondly, the quantity of fluid which was administered intravenously to the injured man two days before he died. Terramycin was prescribed at the time of the operation. However it was well known that a condition of diarrhoea might occur when a person was given terramycin. In the present case, although no infection ill the sense of sepsis or peritonitis ever occurred, diarrhoea did develop and the terramycin was stopped ; but two dayslater it was ordered to be continued, by - tnuther doctor. The diarrhoea continued and, because of subsequent dehydration, fluid was administered intravenously. The normal amount of fluid in such a case was l00 oz. a day, but 395 oz. was administered to the patient two days before, and 312 oz. the day before, he died. The evidence showed that that would cause bronchopneumonia in a normal person and, accordingly, !T was submitted that that broke the chain of causation which would otherwise have made the airman guilty of fender. Counsel said that it was unnecessary for him ’’; prove negligence ; an error of judgment was sufficient il’l hi" purpose. The court gaveleave to call further evidence and heard Dr. Keith Simpson and Mr. Guy Blackburn. Mr. Justice Hallett said that the court thought that, in the interests of justice, evidence ought to have been before the jury, although, in saying that, the court wished to make it clear that they were not casting any retied tion on anyone. Had the evidence been before the ry it might well have resulted in their coming to the : clusion that the death of the injured man did not result from the stab wound. Mr. Justice Hallett, giving the judgment of the court, said that this was an exceedingly unusual case. As a result of information received after the trial, the defence a
a man
able to put forward further evidence, including tha of two doctors whose standing was unquestioned, Dr Simpson and Mr. Blackburn. An application to ca further evidence was granted only in the most exceptiona circumstances. The trial judge told the jury that the first questio which they had to determine was whether they wer satisfied that the airman caused the deceased’s death b stabbing him in the stomach. On that question the jur had in substance the evidence of one doctor only, th pathologist who carried out the post-mortem, whic was that the cause of death was bronchopneumoni following a penetrating abdominal injury. Looking a that evidence in the light of what the court now knew " following " was ambiguous. It might mean chrono logically, of which there was no doubt ; but the tri judge interpreted it as meaning that bronchopneumoni supervened, all consequent on the stab wound inflicted The further evidence showed that that was not so. I fact, Dr. Simpson and Mr. Blackburn were of the opinio that the death could not be said to have been caused b the wound. It did not occur to anyone at the trial that there coul be any doubt but that the answer to the question whethe the stab wound caused death was in the affirmative. I those circumstances the court thought that this was case where it could be said that the evidence was no truly- available at the trial. The court felt that if th jury had heard two doctors, such as those who had give evidence, say that death was not caused by the sta wound they would have hesitated to take a contrar view. It was most important to emphasise that there wer two things other than the stab wound which were state to have brought about death. The wound had injure the intestine, but that had mainly healed at the tim of death. With a view to preventing infection, it wa thought right to administer an antibiotic, terramycin It was agreed that that was the proper course and th dose was a proper one. Unfortunately some people wer intolerant of it, and the injured man was one of those After he received the initial dose, he developed diarrhoe which was only properly attributable to terramycin Very properly the terramycin was stopped, but it wa continued again two days later. Dr. Simpson said tha to introduce a poisonous substance, after the intoleranc of the patient was shown, was " palpably wrong." Mr Blackburn agreed that it was " palpably wrong " an that that description was justifiable. The other step taken which was also regarded by thos doctors as wrong was the intravenous introduction of wholly abnormal quantity of liquid. It was introduce by three intravenous drips. Mr. Blackburn said that h had never seen three intravenous drips ; he had occa sionally seen two in profoundly shocked patients. Th deceased subsequently developed pulmonary oedem and Mr. Blackburn said that he would not be surprised t see such a condition after the introduction of the amoun of fluid given. Bronchopneumonia followed virtual were
-
automatically.
Whatever the law might be when death resulted fro any normal treatment following a felonious injury, was sufficient to say that in the present case there wa not normal treatment. Not only was one feature wron but two were, which produced the symptoms discovere at -the post-mortem, which were the direct and imme diate cause of death. The court allowed the appeal and quashed th conviction.
Regina v. Jordan.—Court of Criminal Appeal: Hallett, Ormerod and Donovan JJ. Aug. 21, 1956. Geoffrey Veale, Q.c., and R. Rawden-Smith (Payne & Payne, Hull) ; P. Stanley-Price, Q.c., an J. S. Snowden (Director of Public Prosecutions).
C. J. ELLIS Barrister-at-Law.
Conferences and
created
Congresses
WORLD FEDERATION FOR MENTAL HEALTH THE World Federation for Mental Health held its ninth annual on Aug. 12-17 in West Berlin. The theme of the meeting was Mental Health in Home and School. At the inaugural meeting the president, Dr. NILO MAKI (Finland), invested the new president, Dr. EDWARD KRAPF. Dr. Krapf has been appointed director of the mental section of the World Health Organisation, and he therefore resigned his office immediately after his address and installed as his successor Miss MARGARET MEAD, D.SC., the American anthropologist.
meeting
,
-
PSYCHOSOMATIC MEDICINE
of the technical sessions-that on advances in psychosomatic medicine-the opening speakers were Dr. FLANDERS DUNBAR (U.S.A.) and Prof. H. C. RUMKE (Netherlands). Dr. Dunbar said there were no imaginary those of unknown cause. She thought illnesses, only functional " illness was not such a good term as psychosomatic illness. Professor Rumke declared there was great danger in taking an extreme or mechanistic view : the spiritual factor in man needed to be kept constantly in mind. The concept of psychosomatic disorder might be dangerous if the doctor failed to make a physical examination or too easily accepted the psychic factor. This was especially true of endogenous depressions which needed electric-shock treatment and not only In
one
"
"
"
psychotherapy. Dr. DENIS LEIGH did not believe that a doctor should try to play the role of clergyman or anthropologist or philosopher. He felt that the German literature introduced these aspects into medicine to an unreasonable extent. But Dr. DAVID STAFFORD-CLARK disagreed : the doctor, he thought, must take cognisance of moral values, though not enforcing his own on the patient, and the patient must come to terms with his own moral values. We needed to try and find a common language between the psycho-analysts, the psychosomatists, and general medicine. MENTAL HEALTH AND
PUBLIC AFFAIRS
Prof. IRWIN STRANSKY (Austria) said that he had long advocated the psychological investigation of the personalities and character structure of those who aimed at becoming leaders in politics, industry, or any other field which involved the handling of human beings. Only too often those who sought to lead others were motivated by a desire for power which derived from a sense of personal inferiority and inadequacy or were of paranoid tendencies an attitude of aggressive hostility. These to lead unfit and should never be were people quite allowed to do so. Dr. BROCK CHISHOLM (Canada) said that though this was theoretically desirable it was extremely difficult to put into practice. He felt that the most important thing was to understand the motivation of those who desired to be followers. The type of leader chosen would depend on the followers. Would-be leaders secured a following by appealing to anything which the group regarded as a shibboleth. Only people who had a wide enough knowledge and point of view to be world citizens were really fit to solve world affairs.
which produced
DIFFICULTIES IX
Another session health special to
paediatrician,
BERLIN
devoted to problems of mental Berlin. Dr. GrERTRUD SoEKEN, a spoke of the tensions which had been was
by the division of the city and the effect having on children. There was a lack of conce tion for learning among school-children, and the nu of hypersensitive children was very high. She bel there might also be undetectable organic changes would show themselves only in later years. It wa aim to examine and to treat medically every chil were
had difficulties at school or in the home. A inspector, Mr. R. KELLER, said that millions of ch had been brought up in unnatural circumstan many had lost their fathers, and the mothers had out to work to support them. The children saw re arriving daily andthe tragedy that this represe There was a great need to improve the stability family and to try to minimise the threat from al tobacco, bad films, gambling machines, evil liter and other harmful influences. He felt that the un Germany was a problem of mental health. The sphere of distrust and insecurity in the city had effect on the children. Until recently they had completely enclosed within an island and the ch had no opportunity of going out to the countryside The standard of honesty of the parent travel. declined so that the children were brought up wi adequate moral values. The children of one part city had to learn Russian, the other French or En There was a climate of fear and hostility. The was in all ways to create conflicts. The problem w great for those in the East as in the West of Berlin
EUROPEAN LEAGUE FOR MENTAL HYGIENE
THE European League for Mental Hygiene he sixth annual conference in Berlin on Aug. 11 an Dr. DoRis ODLUM presided over the scientific mee The conference was concerned with mental healt modern forms of leisure activities, with special ref to the radio, television, the cinema, and acti
involving speed.
Dr. DENIS LEIGH introduced the subject of telev Hardly a day passed, he said, without a pronounce by some distinguished cleric, politician, author, d or
dentist
on
the effect of television
on
the
man
morals, and mental health of the community.
opinions were mostly unfavourable, but they were s based on any special knowledge and in many cas critics admitted that they seldom watched tele themselves. Dr. Leigh believed that the effects whole were favourable. Adults were chiefly conc with the effects on children, but he believed that tele had its largest impact on the adult. Most of the s literature about it came from educationists but was practically no psychiatric literature. This sugg that psychiatrists had no reason to think that startling effects one way or the other on patients community. It appeared that school learning ha been affected, that parental control over children’ing habits did not appreciably affect their school ac ments, and a careful B.B.C. study last year foun there was very little change in the leisure hab viewers as compared with non-viewers. Dr. THERESE LAMPERIÈRE (France) discussed the of a working party on mental hygiene and the d in France. The conditions under which a film was v played an important part. Would a child react diffe to the same film if he saw it alone or with his p or with a group of other children ? It was foun when spectators formed a homogeneous group, su cine clubs for children or students or special audi spectator reaction was different from that of an or heterogeneous audience. The cinema had a dit effect according to age, sex, and intelligence, the
459 of education, and the character and the state of the emotions. Some scenes terrified young children such as the witch in Sraow White and the burning forest in Bambi. Laws to prevent children seeing unsuitable films would be quite contrary to public opinion, and the best we could hope to do was to try to prevent the production of undesirable films. Dr. Lamperiere also read a paper on leisure activities involving speed. The desire for speed was an expression of man’s dissatisfaction with his limitations and the frustrations of his personal life. The spectator derived In both cases the dt secondhand a similar satisfaction. reaction was one of immaturity, a compensation for their feelinus of inferiority and inadequacy as adults. For -
most people, driving a car undoubtedly liberated compensatory mechanisms against these feelings of inadequacy
largely
and this explained why people who most tolerant and patient in their aggressive and rude when driving a car.
were
daily
normally
life became
Medicine and the Law A Murder Conviction
Quashed Forces, during
AN airman in the United States
in
cafe, stabbed
an
in the abdomen. The affrav man was on within an hour and the mjured operated wound stitched up. He died eight days later. The airman was charged with murder. The jury returned a verdict of guilty with a strong recommendation to mercy. Un an appeal against conviction, on the ground that the bronchopneumonia which caused the injured man’s death did not result from the stab wound, counsel for the airman said that the case was of extreme importance from the medical point of view. It was not now disputed that it was the airman who stabbed the deceased. In view of information received after the trial, it was now submitted that the bronchopneumonia which was the cause of death did not arise as a result of the wound but was due to two other causes : first, the use of terramycin and, secondly, the quantity of fluid which was administered intravenously to the injured man two days before he died. Terramycin was prescribed at the time of the operation. However it was well known that a condition of diarrhoea might occur when a person was given terramycin. In the present case, although no infection ill the sense of sepsis or peritonitis ever occurred, diarrhoea did develop and the terramycin was stopped ; but two dayslater it was ordered to be continued, by - tnuther doctor. The diarrhoea continued and, because of subsequent dehydration, fluid was administered intravenously. The normal amount of fluid in such a case was l00 oz. a day, but 395 oz. was administered to the patient two days before, and 312 oz. the day before, he died. The evidence showed that that would cause bronchopneumonia in a normal person and, accordingly, !T was submitted that that broke the chain of causation which would otherwise have made the airman guilty of fender. Counsel said that it was unnecessary for him ’’; prove negligence ; an error of judgment was sufficient il’l hi" purpose. The court gaveleave to call further evidence and heard Dr. Keith Simpson and Mr. Guy Blackburn. Mr. Justice Hallett said that the court thought that, in the interests of justice, evidence ought to have been before the jury, although, in saying that, the court wished to make it clear that they were not casting any retied tion on anyone. Had the evidence been before the ry it might well have resulted in their coming to the : clusion that the death of the injured man did not result from the stab wound. Mr. Justice Hallett, giving the judgment of the court, said that this was an exceedingly unusual case. As a result of information received after the trial, the defence a
a man
able to put forward further evidence, including tha of two doctors whose standing was unquestioned, Dr Simpson and Mr. Blackburn. An application to ca further evidence was granted only in the most exceptiona circumstances. The trial judge told the jury that the first questio which they had to determine was whether they wer satisfied that the airman caused the deceased’s death b stabbing him in the stomach. On that question the jur had in substance the evidence of one doctor only, th pathologist who carried out the post-mortem, whic was that the cause of death was bronchopneumoni following a penetrating abdominal injury. Looking a that evidence in the light of what the court now knew " following " was ambiguous. It might mean chrono logically, of which there was no doubt ; but the tri judge interpreted it as meaning that bronchopneumoni supervened, all consequent on the stab wound inflicted The further evidence showed that that was not so. I fact, Dr. Simpson and Mr. Blackburn were of the opinio that the death could not be said to have been caused b the wound. It did not occur to anyone at the trial that there coul be any doubt but that the answer to the question whethe the stab wound caused death was in the affirmative. I those circumstances the court thought that this was case where it could be said that the evidence was no truly- available at the trial. The court felt that if th jury had heard two doctors, such as those who had give evidence, say that death was not caused by the sta wound they would have hesitated to take a contrar view. It was most important to emphasise that there wer two things other than the stab wound which were state to have brought about death. The wound had injure the intestine, but that had mainly healed at the tim of death. With a view to preventing infection, it wa thought right to administer an antibiotic, terramycin It was agreed that that was the proper course and th dose was a proper one. Unfortunately some people wer intolerant of it, and the injured man was one of those After he received the initial dose, he developed diarrhoe which was only properly attributable to terramycin Very properly the terramycin was stopped, but it wa continued again two days later. Dr. Simpson said tha to introduce a poisonous substance, after the intoleranc of the patient was shown, was " palpably wrong." Mr Blackburn agreed that it was " palpably wrong " an that that description was justifiable. The other step taken which was also regarded by thos doctors as wrong was the intravenous introduction of wholly abnormal quantity of liquid. It was introduce by three intravenous drips. Mr. Blackburn said that h had never seen three intravenous drips ; he had occa sionally seen two in profoundly shocked patients. Th deceased subsequently developed pulmonary oedem and Mr. Blackburn said that he would not be surprised t see such a condition after the introduction of the amoun of fluid given. Bronchopneumonia followed virtual were
-
automatically.
Whatever the law might be when death resulted fro any normal treatment following a felonious injury, was sufficient to say that in the present case there wa not normal treatment. Not only was one feature wron but two were, which produced the symptoms discovere at -the post-mortem, which were the direct and imme diate cause of death. The court allowed the appeal and quashed th conviction.
Regina v. Jordan.—Court of Criminal Appeal: Hallett, Ormerod and Donovan JJ. Aug. 21, 1956. Geoffrey Veale, Q.c., and R. Rawden-Smith (Payne & Payne, Hull) ; P. Stanley-Price, Q.c., an J. S. Snowden (Director of Public Prosecutions).
C. J. ELLIS Barrister-at-Law.