- Email: [email protected]
MUNCHAUSEN'S SYNDROME
858 and should appreciate the health problems The postgraduate course in public-health engineering which is now being held in London is recognition of the fact that personnel should preferably be trained rather than that they should learn only from experience gained on the job. R. F. GUYMER London School of Hygiene and Tropical
background involved.
Medicine, London, W.C.1.
Rockefeller Tutor.
IS OBESITY AN ENDOCRINE PROBLEM ?
SIR,—I read with interest your annotation last week. seems the best remedy for obesity, but it is difficult to apply. If indeed overeating is associated with personality factors, the nervous breakdowns that occasionally follow dieting may be due to the same factors. On the other hand, I have seen undesirable gain of weight rectified during prolonged treatment for severe anxiety state, because of the change of habits following the mental improvement ; this implies both less eating and more productive activity. Slimming cures such as those on the television programme and in journals differ from ordinary private dieting through the atmosphere of group therapy involved. S. LOWY. London, N.W.4.
In its statement to the press this committee pointed out that in the present shortage of beds it was a case of choosing how they should be occupied-by normal confinements or the acutely ill. It seems that Professor Nixon has made his choice. He asks the age and con. dition of the patients who died. The conditions were chiefly pneumonia and cardiac failure, and admittedly the age of the majority (though not of all) was over 50. Is Professor Nixon saying "let the old people die?"" If he is saying so, then let him realise that he is advocating
Dieting
BORSTAL FOR GIRLS SIR,—May I add some figures to your footnote on Mr. Bell’s letter last week with regard to the " care and protection " cases that end up in borstal after absconding
from
an approved school ? According to figures given in the House of Commons by the Home Secretary in May, 1949, there were 23 care and protection" cases in the girls’ borstal institutions, excluding those beyond control and those showing criminal tendencies. Considering that the daily average population in the girls’ borstals in 1949 was only 221, this figure is startling. "
The Criminal Justice Act gave the Secretary of State the power to establish special approved schools for absconders, whether " care and protection " cases or delinquents. The above figures show how urgently needed such a school is in the case of girls. Parliament Mansions.
Abbey Orchard Street, London, S.W.1.
W. A. ELKIN Hon. Press Secretary, Howard League for Penal Reform.
MATERNITY AND THE ADMINISTRATOR
F. GRAY Secretary, Local Medical Committee
Tavistock House, London, W.C.1.
for the County of London.
* * * Dr. Gray complains that " unlike the majority of the lay press " we published only a brief extract from the committee’s resolution. The explanation is simple: unlike the lay press, we did not receive a copy.-ED. L.
SIR,—Arising from Professor Nixon’s warning on this subject, in his letter of March 31, I think that thetime has come to measure the maternity services of the country against the ideal visualised by the Royal College of Obstetricians and Gynaecologists, and even against that referred to in section v of the Development of Consultant Services .1 How many of our towns possess any obstetric service worthy of the name ? It would be profitable to learn how many hospital groups have only nominal cover of two or three consultant sessions in order to satisfy the administrator’s statistics, whilst the consultant himself may reside some distance from the area. It is common knowledge that scores of members of the college are without hope of obtaining an appointment suited to their training, whilst their chances of entering general
practice
are
just
as
remote.
J. C. MILLER.
Shirley, Croydon.
SALICYLATES AND CORTISONE IN RHEUMATIC DISEASES
SIR,—In your leading article last week, I
am
quoted
has an effect on healing when wounds in mice. I did not, in fact, say this, and did not give any observations on salicylate at all, as I have never used it. Professor Buttle, however, has tried salicylate, using our technique, and found that it does not inhibit healing. My observations on &ggr;-resorcylate have been quoted
saying that salicylate judged by standard skin as
’
SIR,—It is very diilicult to understand what Professor Nixon means. In his letter (March 31) who is "the administrator Does he think that the secretary dictates the policy and resolutions of the London Local Medical Committee ? Does he know that the majority "
of the members of the committee are engaged in active general practice Does he know that the committee at its meeting in February, "gravely concerned at the number of patients who have died in London this year because hospital beds could not be found for them in time," called on the Minister of Health " to take all possible steps to remedy the bed shortage." (Unlike the majority of the lay press, THE LANCET omitted to quote the main part of the resolution.) Does Professor Nixon also know that the committee has asked the consultants’ organisation to appoint eight representatives, that only four have been appointed, and that the fact that there are no obstetricians on the committee is therefore entirely due to their own neglect ? Even your brief extract made it plain that the committee regards unsuitable housing conditions, when properly established, as warranting the hospitalisation of an obstetrically normal confinement. What about the ,4 other conditions " necessary for a home confinement ? Cannot the hospitals of London supply the full resources of a modern obstetric service, including a " flyingLastly, what evidence has Professor Nixon squad ? that it is better for a normal confinement to take place in hospital rather than at home? "
correctly. St. Thomas’s Hospital, London, S.E.1.
BARBARA E. CLAYTON.
MUNCHAUSEN’S SYNDROME SIR,—I was interested to read Dr. Rosemary Bolam’s account of the second patient described by her in your issue of March 31. This man volunteered that his father, an hotelier, served in the Scots Greys. He at first stated that he himself was a
4th-year medical student, but subsequently revised this estimate to 21/2 years. He said that he had been able to enter Glasgow University " through friends." He " did some hospital work " but was " more or less in laboratories." He could not recall what examinations he took. Dr. Bolam describes him as an ex-Commando, but she omits to mention his transfer from the Royal Artillery to the 1st Airborne Division and his exploits at Arnhem. Attaining the rank of sergeant he served in many theatres, including the Near, Middle, and Far East, not to mention Italy ; but disliking " red tape,""I threw my medal ribbons into the fire." , He said he had travelled to Liverpool from Glasgow by rail via York-an unusually circuitous route, one might think.
Truth is stranger than fiction ; but romance, too, has its charm, even if it only reveals the kind of people we should like to have been, and the deeds we would fain have wrought. S. BARTON HALL. Liverpool. 1. H.M.
Stationery Office, 1950.
background involved.
Medicine, London, W.C.1.
Rockefeller Tutor.
IS OBESITY AN ENDOCRINE PROBLEM ?
SIR,—I read with interest your annotation last week. seems the best remedy for obesity, but it is difficult to apply. If indeed overeating is associated with personality factors, the nervous breakdowns that occasionally follow dieting may be due to the same factors. On the other hand, I have seen undesirable gain of weight rectified during prolonged treatment for severe anxiety state, because of the change of habits following the mental improvement ; this implies both less eating and more productive activity. Slimming cures such as those on the television programme and in journals differ from ordinary private dieting through the atmosphere of group therapy involved. S. LOWY. London, N.W.4.
In its statement to the press this committee pointed out that in the present shortage of beds it was a case of choosing how they should be occupied-by normal confinements or the acutely ill. It seems that Professor Nixon has made his choice. He asks the age and con. dition of the patients who died. The conditions were chiefly pneumonia and cardiac failure, and admittedly the age of the majority (though not of all) was over 50. Is Professor Nixon saying "let the old people die?"" If he is saying so, then let him realise that he is advocating
Dieting
BORSTAL FOR GIRLS SIR,—May I add some figures to your footnote on Mr. Bell’s letter last week with regard to the " care and protection " cases that end up in borstal after absconding
from
an approved school ? According to figures given in the House of Commons by the Home Secretary in May, 1949, there were 23 care and protection" cases in the girls’ borstal institutions, excluding those beyond control and those showing criminal tendencies. Considering that the daily average population in the girls’ borstals in 1949 was only 221, this figure is startling. "
The Criminal Justice Act gave the Secretary of State the power to establish special approved schools for absconders, whether " care and protection " cases or delinquents. The above figures show how urgently needed such a school is in the case of girls. Parliament Mansions.
Abbey Orchard Street, London, S.W.1.
W. A. ELKIN Hon. Press Secretary, Howard League for Penal Reform.
MATERNITY AND THE ADMINISTRATOR
F. GRAY Secretary, Local Medical Committee
Tavistock House, London, W.C.1.
for the County of London.
* * * Dr. Gray complains that " unlike the majority of the lay press " we published only a brief extract from the committee’s resolution. The explanation is simple: unlike the lay press, we did not receive a copy.-ED. L.
SIR,—Arising from Professor Nixon’s warning on this subject, in his letter of March 31, I think that thetime has come to measure the maternity services of the country against the ideal visualised by the Royal College of Obstetricians and Gynaecologists, and even against that referred to in section v of the Development of Consultant Services .1 How many of our towns possess any obstetric service worthy of the name ? It would be profitable to learn how many hospital groups have only nominal cover of two or three consultant sessions in order to satisfy the administrator’s statistics, whilst the consultant himself may reside some distance from the area. It is common knowledge that scores of members of the college are without hope of obtaining an appointment suited to their training, whilst their chances of entering general
practice
are
just
as
remote.
J. C. MILLER.
Shirley, Croydon.
SALICYLATES AND CORTISONE IN RHEUMATIC DISEASES
SIR,—In your leading article last week, I
am
quoted
has an effect on healing when wounds in mice. I did not, in fact, say this, and did not give any observations on salicylate at all, as I have never used it. Professor Buttle, however, has tried salicylate, using our technique, and found that it does not inhibit healing. My observations on &ggr;-resorcylate have been quoted
saying that salicylate judged by standard skin as
’
SIR,—It is very diilicult to understand what Professor Nixon means. In his letter (March 31) who is "the administrator Does he think that the secretary dictates the policy and resolutions of the London Local Medical Committee ? Does he know that the majority "
of the members of the committee are engaged in active general practice Does he know that the committee at its meeting in February, "gravely concerned at the number of patients who have died in London this year because hospital beds could not be found for them in time," called on the Minister of Health " to take all possible steps to remedy the bed shortage." (Unlike the majority of the lay press, THE LANCET omitted to quote the main part of the resolution.) Does Professor Nixon also know that the committee has asked the consultants’ organisation to appoint eight representatives, that only four have been appointed, and that the fact that there are no obstetricians on the committee is therefore entirely due to their own neglect ? Even your brief extract made it plain that the committee regards unsuitable housing conditions, when properly established, as warranting the hospitalisation of an obstetrically normal confinement. What about the ,4 other conditions " necessary for a home confinement ? Cannot the hospitals of London supply the full resources of a modern obstetric service, including a " flyingLastly, what evidence has Professor Nixon squad ? that it is better for a normal confinement to take place in hospital rather than at home? "
correctly. St. Thomas’s Hospital, London, S.E.1.
BARBARA E. CLAYTON.
MUNCHAUSEN’S SYNDROME SIR,—I was interested to read Dr. Rosemary Bolam’s account of the second patient described by her in your issue of March 31. This man volunteered that his father, an hotelier, served in the Scots Greys. He at first stated that he himself was a
4th-year medical student, but subsequently revised this estimate to 21/2 years. He said that he had been able to enter Glasgow University " through friends." He " did some hospital work " but was " more or less in laboratories." He could not recall what examinations he took. Dr. Bolam describes him as an ex-Commando, but she omits to mention his transfer from the Royal Artillery to the 1st Airborne Division and his exploits at Arnhem. Attaining the rank of sergeant he served in many theatres, including the Near, Middle, and Far East, not to mention Italy ; but disliking " red tape,""I threw my medal ribbons into the fire." , He said he had travelled to Liverpool from Glasgow by rail via York-an unusually circuitous route, one might think.
Truth is stranger than fiction ; but romance, too, has its charm, even if it only reveals the kind of people we should like to have been, and the deeds we would fain have wrought. S. BARTON HALL. Liverpool. 1. H.M.
Stationery Office, 1950.