- Email: [email protected]
INFORMAL ADMISSION OF MENTAL DEFECTIVES
381
The protein metabolism in this disease has not attracted much attention until recent years, and we believe there is increasing evidence that the albumin, at least, is often decreased to some extent. Adlersberg et al.2 report serumprotein determinations in 67 patients with idiopathic steatorrhoea, and in 19% of these the total protein content less than 5 g. per 100 ml. In 60 of these patients the was determined; in 52% it was less than 35 g. per 100 ml. In 16 patients (24%) oedema was present at the time of admission. Medical Department, HOLGER WAHLUND County Hospital, NILS D. WESTAD. Falköping, Sweden. was
serum-albumin
ANOTHER CANCER FALLACY SiR,-Your lucid annotation on the fallacy of the decreasing lung-cancer death-rate with extreme age appears to condone the almost identical fallacy of the latent period of the effects of the cigarette. It states that " those now 65 have been more exposed to this hazard ". It might be preferable to state that they "are being more
exposed ". Although analogies from mice and mule-spinners, and the assumptions implicit in the remarkable strategy of contemporary experimental research, may lead to an expectation of a latency of several decades, the available data on man do not allow the inference that the memory of the lung for tobacco than a few years. The apparent latent period between the imports of tobacco and the consequent deaths is exactly what would be expected if an irritant acting only over quite short periods were to be is
more
being 10-20 times higher in the heavy smoker than in the non-smoker,’ the present virtual restriction of preventive measures to schoolchildren cannot be expected have much influence on the death-rate until almost a million persons have died from this disease in Great Britain alone. Some idea of the appalling risks to which the ageing smoker is increasingly exposed may be conveyed from the calculation that a free issue of cigarettes to old-age pensioners would save the Government the greater part of the cost of the tobacco. The accompanying figure gives some idea of the present pattern of increase in this disease. to
Department of Social Medicine, Medical School, Birmingham.
J. H. EDWARDS.
INFLUENZAL ENCEPHALITIS
SIR,-The letter of Dr. McGill and Dr. Goodbody recording cases of acute hxmorrhagic leucoencephalitis and referring to those reported by Dr. Dubowitz (Jan. 18), prompts us to make it known that three fatal cases of leucoencephalitis have come to necropsy in this area during the past few weeks. The naked-eye appearances of the brain were closely similar to those depicted by McGill and Goodbody. last week,
In addition
we are aware
of other
cases
in which the
patients have apparently recovered completely, and
at
other where the issue is still in doubt. We have not observed a clear association in these cases with an immediately preceding attack of influenza. Nevertheless in view of the foregoing reports we think it desirable to publicise the fact that cases of hxmorrhagic leucoencephalitis are occurring in widely separated parts of the country. It is hoped that every opportunity will be taken by all who observe such cases to search for an infecting virus both during life and at necropsy. JOHN H. STEPHENS Pathology Department, D. F. CAPPELL. of University Glasgow.
least
one
’
INFORMAL ADMISSION OF MENTAL DEFECTIVES
SiR,-I have read with interest Dr. Heaton-Ward’s letter (Feb. 8). While Memorandum H.M.(58)5 recommends the informal admission of suitable cases to mental-deficiency hospitals and the review of the patients already detained, it does not repeal the present Mental Deficiency Acts.
Deaths from lung
cancer
in males in
England
and Wales in 1943-55.
the daily indulgence of a population whose resistance to neoplasia was steadily reduced with advancing age, and whose smoking habits were largely determined in youth. This fallacy is of some importance not only in relation to the relevance of research on animals not liable to spontaneous bronchial neoplasms, but also in that many middle-aged smokers, fearing that their lungs will always carry the scars and memories of past decades, see no reason to protect their bronchi from further irritation.
As the liability to death from lung cancer doubles every 3 to 4 years between the ages of 30 and 70, the basic rate 2. Adlersberg, D., Wang, C. I., Bossak, E. T., in Adlersberg, D.: The Malabsorption Syndrome; p. 32. New York, 1957.
With regard to the review of patients already in hospital, the medical superintendent is asked to submit to the Board of Control the names of patients who might suitably remain on an informal basis without certification and legal detention. It appears, therefore, that we can go ahead and take action to implement the recommendations of the recent Royal Commission as far as these concern bringing mental-deficiency hospitals more into line with ordinary hospitals, and use certification and detention only where absolutely necessary for the protection of the patient or the community. In the case of the majority of our patients the decision will be relatively easy, but there is bound to be a hard core of patients where one would hesitate to dispense with legal control. These cases present great difficulty in any case, but personally I cannot agree that the memorandum will make Indeed I regard this circular as being the encouraging document the mental-deficiency service has received since the report of the first Royal Commission of 1908. our
task harder.
most
T. A. DANBY
Bromham Hospital, nr. Bedford. 1.
Edwards, J.
Medical H. Brit.
J. prev.
soc.
Med.
Superintendent. 1957, 11, 10.
The protein metabolism in this disease has not attracted much attention until recent years, and we believe there is increasing evidence that the albumin, at least, is often decreased to some extent. Adlersberg et al.2 report serumprotein determinations in 67 patients with idiopathic steatorrhoea, and in 19% of these the total protein content less than 5 g. per 100 ml. In 60 of these patients the was determined; in 52% it was less than 35 g. per 100 ml. In 16 patients (24%) oedema was present at the time of admission. Medical Department, HOLGER WAHLUND County Hospital, NILS D. WESTAD. Falköping, Sweden. was
serum-albumin
ANOTHER CANCER FALLACY SiR,-Your lucid annotation on the fallacy of the decreasing lung-cancer death-rate with extreme age appears to condone the almost identical fallacy of the latent period of the effects of the cigarette. It states that " those now 65 have been more exposed to this hazard ". It might be preferable to state that they "are being more
exposed ". Although analogies from mice and mule-spinners, and the assumptions implicit in the remarkable strategy of contemporary experimental research, may lead to an expectation of a latency of several decades, the available data on man do not allow the inference that the memory of the lung for tobacco than a few years. The apparent latent period between the imports of tobacco and the consequent deaths is exactly what would be expected if an irritant acting only over quite short periods were to be is
more
being 10-20 times higher in the heavy smoker than in the non-smoker,’ the present virtual restriction of preventive measures to schoolchildren cannot be expected have much influence on the death-rate until almost a million persons have died from this disease in Great Britain alone. Some idea of the appalling risks to which the ageing smoker is increasingly exposed may be conveyed from the calculation that a free issue of cigarettes to old-age pensioners would save the Government the greater part of the cost of the tobacco. The accompanying figure gives some idea of the present pattern of increase in this disease. to
Department of Social Medicine, Medical School, Birmingham.
J. H. EDWARDS.
INFLUENZAL ENCEPHALITIS
SIR,-The letter of Dr. McGill and Dr. Goodbody recording cases of acute hxmorrhagic leucoencephalitis and referring to those reported by Dr. Dubowitz (Jan. 18), prompts us to make it known that three fatal cases of leucoencephalitis have come to necropsy in this area during the past few weeks. The naked-eye appearances of the brain were closely similar to those depicted by McGill and Goodbody. last week,
In addition
we are aware
of other
cases
in which the
patients have apparently recovered completely, and
at
other where the issue is still in doubt. We have not observed a clear association in these cases with an immediately preceding attack of influenza. Nevertheless in view of the foregoing reports we think it desirable to publicise the fact that cases of hxmorrhagic leucoencephalitis are occurring in widely separated parts of the country. It is hoped that every opportunity will be taken by all who observe such cases to search for an infecting virus both during life and at necropsy. JOHN H. STEPHENS Pathology Department, D. F. CAPPELL. of University Glasgow.
least
one
’
INFORMAL ADMISSION OF MENTAL DEFECTIVES
SiR,-I have read with interest Dr. Heaton-Ward’s letter (Feb. 8). While Memorandum H.M.(58)5 recommends the informal admission of suitable cases to mental-deficiency hospitals and the review of the patients already detained, it does not repeal the present Mental Deficiency Acts.
Deaths from lung
cancer
in males in
England
and Wales in 1943-55.
the daily indulgence of a population whose resistance to neoplasia was steadily reduced with advancing age, and whose smoking habits were largely determined in youth. This fallacy is of some importance not only in relation to the relevance of research on animals not liable to spontaneous bronchial neoplasms, but also in that many middle-aged smokers, fearing that their lungs will always carry the scars and memories of past decades, see no reason to protect their bronchi from further irritation.
As the liability to death from lung cancer doubles every 3 to 4 years between the ages of 30 and 70, the basic rate 2. Adlersberg, D., Wang, C. I., Bossak, E. T., in Adlersberg, D.: The Malabsorption Syndrome; p. 32. New York, 1957.
With regard to the review of patients already in hospital, the medical superintendent is asked to submit to the Board of Control the names of patients who might suitably remain on an informal basis without certification and legal detention. It appears, therefore, that we can go ahead and take action to implement the recommendations of the recent Royal Commission as far as these concern bringing mental-deficiency hospitals more into line with ordinary hospitals, and use certification and detention only where absolutely necessary for the protection of the patient or the community. In the case of the majority of our patients the decision will be relatively easy, but there is bound to be a hard core of patients where one would hesitate to dispense with legal control. These cases present great difficulty in any case, but personally I cannot agree that the memorandum will make Indeed I regard this circular as being the encouraging document the mental-deficiency service has received since the report of the first Royal Commission of 1908. our
task harder.
most
T. A. DANBY
Bromham Hospital, nr. Bedford. 1.
Edwards, J.
Medical H. Brit.
J. prev.
soc.
Med.
Superintendent. 1957, 11, 10.