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Lifeline
DISSECTING ROOM
LIFELINE Gérard Said Gérard Said started his career as a neurologist at La Salpétrière, Paris, France, then moved to the Hospital of Bicêtre in 1972, where he subspecialised in peripheral-nerve disorders. Professor of neurology since 1976, he has been chief of the Service of Neurology of the Hospital of Bicêtre since 1988, and secretary of the European Neurological Society since its foundation in 1986. Who was your most influential teacher? Raymond Garcin, who was an outstanding clinician and teacher. Which research paper has had most effect on your work? Thomas PK, Lascelles RG. Schwann-cell abnormalities in diabetic neuropathy. Lancet 1965; i: 1355–57. This paper illustrates segmental demyelination on teased fibre preparations of nerve biopsy specimens from diabetic patients. The paper prompted me to use this old technique, which I still find extremely useful in the study of peripheral neuropathy. What would be your advice to a newly qualified doctor? Be critical and listen to patients. How do you relax? I stroll in Paris. What is your favourite film? The Name of the Rose, after Umberto Eco’s work. There is everything in this film: Middle-Ages atmosphere, history, philosophy, suppressed sexuality, and its consequences . . . What is your greatest fear? A neurological degenerative disorder. What are you currently reading? Hitler’s Willing Executioners by D J Goldhagen. What is your worst habit? I am too sceptical. What is your greatest regret? Not having enough free time to read more and to learn foreign languages. What alternative therapies have you tried? Did they work? I haven’t tried any alternative therapy and it has worked so far. Who is the greatest love of your life? My wife. How would you like to die? By surprise.
1484
Shrinks in the sack ondon in the 1960s was not just noise, the Beatles, Carnaby Street, and the miniskirt. There was the mental hygiene movement quietly going about its business. Each night, the streets of south London were scoured for ne’er-do-wells, lunatics, weirdos, and drunks. The police found these lost souls cavorting or lying in the street and apprehended them. They must have had some sort of crude screen to separate the mad, bad, sad, and drunk from each other. Having triaged like a Battle of Waterloo surgeon, they then set off to unload their cargo of, roughly speaking, mentally ill people.Their destination was St Francis Hospital in East Dulwich. This was a grim Victorian hospital with the aspect of a workhouse. Not only were the police bringing in their loads regularly throughout the night, but also there were phone calls from airports and railway stations. The caseload between 5 pm and 9 am could be from zero to whatever number the police could cram into their vans. Who was there to greet the would-be inpatients as they arrived at the hospital? Simply put, a lowly house officer (resident), a nurse, and, most importantly, a padded cell. The staff had to examine and sum up each case in double-quick time. If the doctor and nurse failed to formulate accurately, they could be attacked. This is where the padded cell came in. For most of the doctors it was the first and last time they would ever see this device, but, by goodness, they did not object to it at the time. The nurse was remembered as being adept at half-nelsons and sitting at other times reading about the Peloponnesian Wars. Surely some kind of oxymoron. The lowly doctors came from the nearby Maudsley Hospital on a duty roster. This was an elite, postgraduate teaching hospital, with junior staff coming from all over the world and armed with medical degrees, memberships,
L
doctorates, and the like. At St Francis, they were certainly cast into a new role, which was a cross between a pub bouncer, a stakhanovite, and a medical investigator. Throughout the night, they laboured to do physical and mental states, write them up, and treat the patients. Why so assiduous? Well the boss—ie, the chairman—rolled up for ward rounds at 9 am, and everybody had to be on parade. It should be said that eventually one of the brighter doctors discovered that in coming to the psychiatric hospital door the police were trespassing. So ever after they were stopped at the hospital gates and the patients triaged with more expertise, and more self-interest, by the doctor. What did the doctors do when they were not admitting? In a qualified way they were sleeping. The bedroom for this purpose lay in a remarkable spot. It was between the Southern Electric Railway line and the hospital kitchen. Those in the know will remember that this line was (and still is) one of the busiest in the world. It seemed to run within inches of the bedroom window. Likewise, the kitchen came to life at 6 am with a hearty clanging of pots and pans. The saying “between a rock and a hard place” had nothing on this. Was there anything favourable or piquant about this bizarre clinical rotation? Yes—the knowledge that on the shapeless, sack-like bed, which had been there forever, had slept (sort of) most of the to-be famous psychiatrists from the British Commonwealth. All had gone through this rite of passage in their Maudsley training. All had had fevered sleep between the rattling trains, the rendition from the kitchen, and the phone informing of yet another load of patients. The experience might even have lead to another collective noun—a sack of shrinks. Robin Eastwood
THE LANCET • Vol 352 • October 31, 1998
LIFELINE Gérard Said Gérard Said started his career as a neurologist at La Salpétrière, Paris, France, then moved to the Hospital of Bicêtre in 1972, where he subspecialised in peripheral-nerve disorders. Professor of neurology since 1976, he has been chief of the Service of Neurology of the Hospital of Bicêtre since 1988, and secretary of the European Neurological Society since its foundation in 1986. Who was your most influential teacher? Raymond Garcin, who was an outstanding clinician and teacher. Which research paper has had most effect on your work? Thomas PK, Lascelles RG. Schwann-cell abnormalities in diabetic neuropathy. Lancet 1965; i: 1355–57. This paper illustrates segmental demyelination on teased fibre preparations of nerve biopsy specimens from diabetic patients. The paper prompted me to use this old technique, which I still find extremely useful in the study of peripheral neuropathy. What would be your advice to a newly qualified doctor? Be critical and listen to patients. How do you relax? I stroll in Paris. What is your favourite film? The Name of the Rose, after Umberto Eco’s work. There is everything in this film: Middle-Ages atmosphere, history, philosophy, suppressed sexuality, and its consequences . . . What is your greatest fear? A neurological degenerative disorder. What are you currently reading? Hitler’s Willing Executioners by D J Goldhagen. What is your worst habit? I am too sceptical. What is your greatest regret? Not having enough free time to read more and to learn foreign languages. What alternative therapies have you tried? Did they work? I haven’t tried any alternative therapy and it has worked so far. Who is the greatest love of your life? My wife. How would you like to die? By surprise.
1484
Shrinks in the sack ondon in the 1960s was not just noise, the Beatles, Carnaby Street, and the miniskirt. There was the mental hygiene movement quietly going about its business. Each night, the streets of south London were scoured for ne’er-do-wells, lunatics, weirdos, and drunks. The police found these lost souls cavorting or lying in the street and apprehended them. They must have had some sort of crude screen to separate the mad, bad, sad, and drunk from each other. Having triaged like a Battle of Waterloo surgeon, they then set off to unload their cargo of, roughly speaking, mentally ill people.Their destination was St Francis Hospital in East Dulwich. This was a grim Victorian hospital with the aspect of a workhouse. Not only were the police bringing in their loads regularly throughout the night, but also there were phone calls from airports and railway stations. The caseload between 5 pm and 9 am could be from zero to whatever number the police could cram into their vans. Who was there to greet the would-be inpatients as they arrived at the hospital? Simply put, a lowly house officer (resident), a nurse, and, most importantly, a padded cell. The staff had to examine and sum up each case in double-quick time. If the doctor and nurse failed to formulate accurately, they could be attacked. This is where the padded cell came in. For most of the doctors it was the first and last time they would ever see this device, but, by goodness, they did not object to it at the time. The nurse was remembered as being adept at half-nelsons and sitting at other times reading about the Peloponnesian Wars. Surely some kind of oxymoron. The lowly doctors came from the nearby Maudsley Hospital on a duty roster. This was an elite, postgraduate teaching hospital, with junior staff coming from all over the world and armed with medical degrees, memberships,
L
doctorates, and the like. At St Francis, they were certainly cast into a new role, which was a cross between a pub bouncer, a stakhanovite, and a medical investigator. Throughout the night, they laboured to do physical and mental states, write them up, and treat the patients. Why so assiduous? Well the boss—ie, the chairman—rolled up for ward rounds at 9 am, and everybody had to be on parade. It should be said that eventually one of the brighter doctors discovered that in coming to the psychiatric hospital door the police were trespassing. So ever after they were stopped at the hospital gates and the patients triaged with more expertise, and more self-interest, by the doctor. What did the doctors do when they were not admitting? In a qualified way they were sleeping. The bedroom for this purpose lay in a remarkable spot. It was between the Southern Electric Railway line and the hospital kitchen. Those in the know will remember that this line was (and still is) one of the busiest in the world. It seemed to run within inches of the bedroom window. Likewise, the kitchen came to life at 6 am with a hearty clanging of pots and pans. The saying “between a rock and a hard place” had nothing on this. Was there anything favourable or piquant about this bizarre clinical rotation? Yes—the knowledge that on the shapeless, sack-like bed, which had been there forever, had slept (sort of) most of the to-be famous psychiatrists from the British Commonwealth. All had gone through this rite of passage in their Maudsley training. All had had fevered sleep between the rattling trains, the rendition from the kitchen, and the phone informing of yet another load of patients. The experience might even have lead to another collective noun—a sack of shrinks. Robin Eastwood
THE LANCET • Vol 352 • October 31, 1998