- Email: [email protected]
GERIATRICS
518 a prevalence of 0-5%. None of the 5 children had a demonstrable organic lesion. We agree that, despite the difficulty and the expense of detecting urinary infections in preschool children, the investigation is worth while and is better undertaken during this period than later at school age. Particularly we think that the preschool period is ideal now that it has been shown that dip slides are satisfactorily inoculated by holding them in the stream of urine 1-an excellent technique for vouns children over the age of about a vear.
pubic aspiration-i.e.,
Queen Elizabeth Hospital for Children, Hackney Road, London E2 8PS.
S. R. SAXENA ANGELA COLLIS B. M. LAURANCE.
GERIATRICS
SIR,-As Dr Longridge (Aug. 10, p. 350) rightly indicates, the
implications and ramifications of your two editorials regarding geriatrics are such that they cannot adequately be dealt with in a letter, although his letter and the preceding correspondence have brought out many important points. Nevertheless one aspect has perhaps not so far been given the prominence it merits-namely, that geriatrics presents an intellectual challenge comparable with that of any other specialty within the continuum of medicine. It is not difficult, in many cases, to diagnose hemiplegia, congestive cardiac failure, or any other common disorders in the elderly, but the problems of treating them in a manner which will make it possible for the patient in continue to live a worthwhile existence outside
question to hospital are
legion. Both the environment and the patient need to be studied, and the activities of both medical and non-medical staff concerned with the patient have to be coordinated. In addition, the scope for research is enormous.22 Of course, one has to deal with many patients for whom little more can be done-but some, at least, of them might not have got into such a condition had adequate attention been paid to prophylaxis (another subject too big to deal with in a letter). Even a casual inspection of geriatric services in the U.K. will reveal that many different approaches to the problems of coping with the elderly sick are being practised, and it will take time and much further intellectual effort-both by geriatricians and by others in hospital and general practice-to produce better solutions. We are all in it-but the geriatricians must be the prime movers. Intellectual challenge provides a positive reason for the next generation, once they have made themselves adequate clinically, to think seriously of a career in a subject which at the moment presents more problems than solutions. But what satisfaction may lie in producing some. Frenchay Hospital, Bristol BS16 1LE.
BRANDON LUSH.
THE CONS OF GROUP PSYCHOTHERAPY
SiR,—In a recent article in The Times Dr William Sargant3 stated that the symptoms of eight patients attending a group psychotherapeutic session are contagious. I could not
agree more. I have been a member of a group for some time. I left eventually because I found the modality totally unacceptable and I also experienced that depression is very catching indeed. The mere fact that four women and four men were thrown together for one hour and a half, thus forming a small " sick " community for that duration once a week, is to me in itself decidedly non-therapeutic. Also I objected 1. 2. 3.
Arneil, G. C., McAllister, T. A., Kay, P. Lancet, 1973, i, 94. Lush, B. Age and Aging, 1974, 3, 1. Times, July 30.
fellow patients telling me how uniquely neurotic I and how desperately in need of treatment. I can accept such devastating news from a first-class therapist. Definitely not from patients in more or less the same condition as myself. I dislike amateurism intensely: and eight patients trying to cure each other is medical amateurism carried out to a ludicrous and dangerous degree. Different social backgrounds, nationality, and age are to my mind all important factors against group psychotherapy. I realise that more patients can be seen, and-if to my was
privately administered-it will be cheaper. .
Unless
one
is
a
bouncing
extrovert
and
fairly well,
a
group may turn out to be useless. To my mind, however, it has only come about out of evil necessity: there are too many patients, too few therapists, and not enough time.
First-class analytical treatment is still and will always be only for the rich. One session a week on the N.H.S. is seldom adequate. What is more useless and negative than two neurotics discussing their symptoms ? Eight of them doing so in a group.
15 The Priory, London SE3 9XA.
CARLA MARKHAM.
D.N.C.B. SKIN TEST IN HEPATITIS
SIR9 The results recorded by Professor Brzosko and his co-workers (July 20, p. 155) in their study of cellmediated immunity by the dinitrochlorobenzene (D.N.C.B.) skin test in children with acute type A or B hepatitis were of great interest to us. We have done a similar study in 73 consecutive unselected children with sporadic acute viral hepatitis. The D.N.C.B. skin test was performed during the first ten days from the onset of jaundice according to the method -of Brown et al. modified as follows: the sensitising dose was 1000 .g. of D.N.C.B. in 0-1 ml. acetone (instead of 2000 ILg.) and the sensitised area was RELATIONSHIP BETWEEN PRESENCE OF HBAg AND SKIN REACTION TO D.N.C.B. DURING ACUTE VIRAL HEPATITIS
covered for twenty-four hours. An immunoelectrophoretic method2 was used for the detection of hepatitis-B antigen (HBAg). The results are shown in the accompanying table. It is obvious that HBAg-positive acute hepatitis is associated with a positive skin reaction to D.N.C.B. All the children who had HBAg in their serum were followed up for one and a half years, and at that time 2 of them were found to be healthy carriers of HBAg. The D.N.C.B. skin test was still positive. Similar findings were observed by Sodomann and Havemann.3 These results are quite different from those of Brzosko et al. We used a sensitising dose of D.N.C.B. of 1000 jg. and Brzosko et al. a dose of 250 {Lg. This difference may account for the discrepancy in the observation in that the smaller dose of D.N.C.B. may be a more effective discriminant in detecting small degrees of impairment of
delayed
cutaneous
hypersensitivity.
Pædiatric Clinic, Aristotle University,
Thessaloniki, Greece.
FLORENCE KANAKOUDI-TSAKALIDIS.
1. Bull. Wld Hlth Org. 1970, 92, 957. 2. Brown, S. R., Haynes, A. H., Foley, H. T., Godwin, A. H., Berard, W. C., Carbone, P. P. Ann. intern. Med. 1967, 67, 291. 3. Sodomann, C. P., Havemann, K. Internist, 1973, 14, 583.
pubic aspiration-i.e.,
Queen Elizabeth Hospital for Children, Hackney Road, London E2 8PS.
S. R. SAXENA ANGELA COLLIS B. M. LAURANCE.
GERIATRICS
SIR,-As Dr Longridge (Aug. 10, p. 350) rightly indicates, the
implications and ramifications of your two editorials regarding geriatrics are such that they cannot adequately be dealt with in a letter, although his letter and the preceding correspondence have brought out many important points. Nevertheless one aspect has perhaps not so far been given the prominence it merits-namely, that geriatrics presents an intellectual challenge comparable with that of any other specialty within the continuum of medicine. It is not difficult, in many cases, to diagnose hemiplegia, congestive cardiac failure, or any other common disorders in the elderly, but the problems of treating them in a manner which will make it possible for the patient in continue to live a worthwhile existence outside
question to hospital are
legion. Both the environment and the patient need to be studied, and the activities of both medical and non-medical staff concerned with the patient have to be coordinated. In addition, the scope for research is enormous.22 Of course, one has to deal with many patients for whom little more can be done-but some, at least, of them might not have got into such a condition had adequate attention been paid to prophylaxis (another subject too big to deal with in a letter). Even a casual inspection of geriatric services in the U.K. will reveal that many different approaches to the problems of coping with the elderly sick are being practised, and it will take time and much further intellectual effort-both by geriatricians and by others in hospital and general practice-to produce better solutions. We are all in it-but the geriatricians must be the prime movers. Intellectual challenge provides a positive reason for the next generation, once they have made themselves adequate clinically, to think seriously of a career in a subject which at the moment presents more problems than solutions. But what satisfaction may lie in producing some. Frenchay Hospital, Bristol BS16 1LE.
BRANDON LUSH.
THE CONS OF GROUP PSYCHOTHERAPY
SiR,—In a recent article in The Times Dr William Sargant3 stated that the symptoms of eight patients attending a group psychotherapeutic session are contagious. I could not
agree more. I have been a member of a group for some time. I left eventually because I found the modality totally unacceptable and I also experienced that depression is very catching indeed. The mere fact that four women and four men were thrown together for one hour and a half, thus forming a small " sick " community for that duration once a week, is to me in itself decidedly non-therapeutic. Also I objected 1. 2. 3.
Arneil, G. C., McAllister, T. A., Kay, P. Lancet, 1973, i, 94. Lush, B. Age and Aging, 1974, 3, 1. Times, July 30.
fellow patients telling me how uniquely neurotic I and how desperately in need of treatment. I can accept such devastating news from a first-class therapist. Definitely not from patients in more or less the same condition as myself. I dislike amateurism intensely: and eight patients trying to cure each other is medical amateurism carried out to a ludicrous and dangerous degree. Different social backgrounds, nationality, and age are to my mind all important factors against group psychotherapy. I realise that more patients can be seen, and-if to my was
privately administered-it will be cheaper. .
Unless
one
is
a
bouncing
extrovert
and
fairly well,
a
group may turn out to be useless. To my mind, however, it has only come about out of evil necessity: there are too many patients, too few therapists, and not enough time.
First-class analytical treatment is still and will always be only for the rich. One session a week on the N.H.S. is seldom adequate. What is more useless and negative than two neurotics discussing their symptoms ? Eight of them doing so in a group.
15 The Priory, London SE3 9XA.
CARLA MARKHAM.
D.N.C.B. SKIN TEST IN HEPATITIS
SIR9 The results recorded by Professor Brzosko and his co-workers (July 20, p. 155) in their study of cellmediated immunity by the dinitrochlorobenzene (D.N.C.B.) skin test in children with acute type A or B hepatitis were of great interest to us. We have done a similar study in 73 consecutive unselected children with sporadic acute viral hepatitis. The D.N.C.B. skin test was performed during the first ten days from the onset of jaundice according to the method -of Brown et al. modified as follows: the sensitising dose was 1000 .g. of D.N.C.B. in 0-1 ml. acetone (instead of 2000 ILg.) and the sensitised area was RELATIONSHIP BETWEEN PRESENCE OF HBAg AND SKIN REACTION TO D.N.C.B. DURING ACUTE VIRAL HEPATITIS
covered for twenty-four hours. An immunoelectrophoretic method2 was used for the detection of hepatitis-B antigen (HBAg). The results are shown in the accompanying table. It is obvious that HBAg-positive acute hepatitis is associated with a positive skin reaction to D.N.C.B. All the children who had HBAg in their serum were followed up for one and a half years, and at that time 2 of them were found to be healthy carriers of HBAg. The D.N.C.B. skin test was still positive. Similar findings were observed by Sodomann and Havemann.3 These results are quite different from those of Brzosko et al. We used a sensitising dose of D.N.C.B. of 1000 jg. and Brzosko et al. a dose of 250 {Lg. This difference may account for the discrepancy in the observation in that the smaller dose of D.N.C.B. may be a more effective discriminant in detecting small degrees of impairment of
delayed
cutaneous
hypersensitivity.
Pædiatric Clinic, Aristotle University,
Thessaloniki, Greece.
FLORENCE KANAKOUDI-TSAKALIDIS.
1. Bull. Wld Hlth Org. 1970, 92, 957. 2. Brown, S. R., Haynes, A. H., Foley, H. T., Godwin, A. H., Berard, W. C., Carbone, P. P. Ann. intern. Med. 1967, 67, 291. 3. Sodomann, C. P., Havemann, K. Internist, 1973, 14, 583.