Parliament

1234 not follow to the letter. Your correspondents wish to make bronchitis and emphysema a compensatable industrial hazard of working in dusty occupations. It has been shown in what little research has been done on this problem that town-dwellers generally begin to suffer from chronic bronchitis between the ages of 40 and 50 and breathlessness as a result appears in the next decade, presumably owing to the resultant emphysema. I submit that emphysema is a common autopsy finding in industrial cities in patients who have died at an advanced age; and beyond vaguely inferring the fact that those exposed in dusty occupations may be more prone to chronic bronchitis than others in cleaner trades, one cannot prove anything on this subject from postmortem findings, since the cause of death is usually some other terminal catastrophe. At all events your correspondents’ series of cases appear to be incomplete and they appear to ignore any predisposition due to whooping-cough or other previous pulmonary infection.

ventilation or previous disease? The question is made all the more confused because we are here dealing with a series of symptoms which finally lead to a condition which disables only at the latter end of life. We have as yet only touched by research on the causation of bronchitis and its sequalee by the impurities in the air of our industrial cities; and until much more is known about this I submit we cannot view the question of emphysema as an industrial hazard in its proper perspective. It would be interesting to know how the South

How do your correspondents propose to detect emphysema caused by dust if it cannot be shown radiographically° Suspects can be given repeated clinical examinations for a lengthy period of time whilst in a dusty occupation, but the results of this are if anything more open to human error and misinterpretation than the radiograph showing the dust which accompanies the emphysema. How would one discriminate between this emphysema and that caused through excessive smoking or bad domiciliary

shows towards their problems, and in return, I am sure, will be glad to supply him with the information he desires [" we badly need to learn from parents themselves, in situations which allow them to be truthful, what their If he will get in touch with the needs really are "]. National Society for Mentally Handicapped Children, 162a, Strand, W.C.2 (with a membership of 14,000 parents of such children) I think he will find what he desires. E. HINDEN

Parliament

Salford. Among the projects were a new boiler-house for the Manchester Royal Infirmary and some improvements at the City General Hospital, Sheffield. He was also asking for plans to be prepared for the first phase of some hospital development in Hull, and for additional beds at Ilford or Barking, but details of these two schemes had yet to be worked out with the boards concerned.

Insurance, which I sincerely hope boards do

Hospital Building In

written answer on Dec. 6 Mr. DEREK WALKERSMITH, the Minister of Health, announced that it was proposed to spend £22 million on capital development in the hospital service in England and Wales in 1959-60, compared with £18 million this year and £20 million proposed for next year. Hospital boards were being informed of their individual allocations within this total for the modernisation of mental hospitals, the replacement of obsolete plant, and ordinary capital expenditure. In addition, the programme of major building projects would be continued and extended. As a former Minister explained in July 1955, the original programme, in order to encourage speedy action, included more projects than it would be possible to start in the years to which it was allocated. Projects already in the programme, but not started, and the second phases of some of those for which only the first phases had so far been authorised, were likely to make a considerable claim on the capital available for 1959-60. Mr. Walker-Smith had invited boards to bring to completion the planning of a number of additional major projects. He hoped that all boards would endeavour to complete the planning early in 1959-60. The projects selected included the first phases of new hospitals to be built at Liverpool and Boston, and the second phases of a number of large schemes already in the programme such as the new hospitals at Huddersfield, Swansea and Swindon ; the mental deficiency hospital at Llanfrechfa Grange, near Newport; the development of The Downs Hospital, Sutton, as a medical nuclear physics centre ; and the provision of a new X-ray department and theatres at Lewisham Hospital where the first stage of development was now nearing completion. There were new outpatient departments for the Dudley Road Hospital at Birmingham, the Chester Royal Infirmary, and the North Staffordshire Royal Infirmary, Stoke-onTrent ; an outpatient department and admission unit to serve the Hollymoor and Rubery Hill Mental Hospitals ; and an admission unit and convalescent villas at the Garlands Mental Hospital, Carlisle. A new regional neurosurgical unit was included for the Newcastle General Hospital. Extensions were proposed at the Pontefract General Infirmary, Sharoe Green Hospital at Preston, the Blackpool Victoria Hospital, Blackburn Royal Infirmary, and Bronglaise Hospital, Aberystwyth ; and works of modernisation were included for St. James’s Hospital, King’s Lynn ; the City Hospital, Exeter ; St. Lawrence’s Mental Hospital, Bodmin ; and a

Africans have tackled this nroblem.

J. D. M. HOLT. EARLY ADMISSION TO HOSPITAL OF MENTALLY DEFECTIVE BABIES

SIR,—The parents of mental defectives will be grateful Leys (Nov. 23) for the sympathetic attitude he

to Dr.

Hope Hospital,

First Reactions to the Wolfenden Report IN the course of a debate in the House of Lords on Dec. 4 Viscount KILMUIR, the Lord Chancellor, indicated the Government’s preliminary views on the report. The most far-reaching of the proposals, he said, was, of course, that homosexual behaviour between consenting adults should no longer be a criminal offence. Though the recommendations had attracted considerable support, including some in informed and responsible quarters, it had also been widely criticised, and again some of the criticisms had been well-informed and responsible. There were cases Lord Kilmuir agreed when it might well be the duty of a Government to lead rather than to follow public opinion, but in a matter of this kind the general sense of the community was important, and the Government did not think that it was with the Committee in this recommendation. They thought that the problem required further study and consideration. Certainly there could be no prospect of early legislation.. One of the Committee’s most important recommendations in Lord Kilmuir’s view was that relating to research. So much had been written and so little was really known about the nature and origins of homosexuality, and also of prostitution, that further research, was clearly desirable, and he assured Noble Lords that the Government would give attentive thought to this recommendation which had repercussions far beyond the sphere of criminal law.

Opticians Bill RONALD RUSSELL, in introducing the second reading of this Bill on Dec. 6, said that since it was published he and his co-sponsors had met representatives of ophthalmologists and of dispensing opticians and after discussion of their criticismshad agreed to amend the Bill in some respects if it went to committee. Mr. RICHARD THOMPSON, the parliamentary secretary to the Ministry of Health, said that the Bill followed closely most of the recommendations of the Crook report. The suggestion that the Bill would interfere with the present common practice whereby an ophthalmic medical Mr.

1. See

Lancet, Dec. 7, 1957, p. 1166.

1235 tested sight on the premises of a firm of dispensing opticians was based on a misconception. If it seemed appropriate that a clarifying amendment putting the issue beyond a peradventure should be made in committee, it would certainly have the wholehearted support ofthe Government. The many points of detail in this Bill were, he was sure, capable of being resolved in

practitioner

committee without too much difficulty, and subject to such

improvements,

the Government welcomed the Bill.

Divorce for Insanity On Dec. 6 Mr. W. F. DEEDES moved the second reading of his measure, the Divorce (Insanity and Desertion) Bill, which removes some small anomalies in the present law to which the recent Royal Commission drew attention. The most important amendment is to recognise treatment as a voluntary patient as a ground for divorce for insanity. At present divorce is only available to the spouse of a certified patient. It also proposes that a break of 28 days or less should not be regarded as interrupting a continuous period of care and treatment, and that desertion need not necessarily be deemed to be interrupted by the insanity of the deserting spouse. Sir HARRY HYLTON-FosTER. the Solicitor-General, welcomed the Bill and promised the Government’s support and help to its sponsors. He admitted that a difficulty might arise when a voluntary patient released himself, perhaps unwisely, and remained at liberty for more than the permitted 28 days. But to substitute some standard other than a period of uninterrupted care and treatment as a ground of divorce would be a large change in the law and would have to await legislation arising from the Royal Commission’s recommendations as a whole.

Obituary EDWARD ROLAND THOMPSON M.B. Edin.

Dr. E. R. Thompson, who died on Nov. 20 at the age of 75, had practised in Crewkerne, Somerset, for nearly thirty years. He was born at Amoy, China, where his parents were missionaries, but he returned to England at the age of two and he was educated at Hymers College, Hull, and at Edinburgh University, graduating M.B. in 1906. After holding house-appointments at Wolverhampton General Hospital and at Birmingham Infirmary he became an assistant in a general practice at FarnAfter a trip to the Far East he worth, Lancashire. returned to Farnworth as a partner in the same practice. During the 1914-18 war he served in the R.A.M.C. in Salonika and the Middle East, and after the armistice he was on the staff of General Sir George Milne and was mentioned in despatches. In 1929 he married Mrs. H. M. Hodge, and he moved the following year to Crewkerne, where he worked in general practice in partnership with his stepsons, Dr. R. Sessions Hodge and Dr. G. S. Hodge. Dr. Thompson was M.o.H. for Crewkerne and was on the staff of Crewkerne Hospital. He was a founder member of the West Somerset Medical Club. His wife died last year. R. S. H. writes : Roland Thompson’s salient characteristic was his matchless integrity. In his work and his play-and he had been an outstanding tennis-player before his eyesight began to failhe gave always of his best and expected no less of his associates. He made no distinction between people-folk in need were his care : his uncompromising sense of essential values never deserted him and he had no truck with humbug. A commanding figure in any company, his reserve cloaked a human personality with wide interests. He had the gentleness, neatness, and meticulous care for small things of many big men : he was especially gentle with children and flowers, and a corm of cyclamen brought from the Struma Valley in the 1914-18 war now spreads in the wood of his garden at Crewkerne. His patients trusted him for his skill and unfailing care and loved him for his wisdom and understanding : his flowers throve-possibly for the same reasons. He leaves us with the memory of a man of principle-an upright and a fearless gentleman.

MANFRED SAKEL M.D. Vienna Dr. Sakel, who in 1928 at the Lichterfelde Hospital in Berlin for the first time used insulin shock therapy in schizophrenia, died in New York on Dec. 3 at the age of 57. He was born in Nadvornaya, Austria, into a rabbinical family descended from the philosopher and physician Maimonides. He studied medicine in Brno and in Vienna. where he qualified in 1925. For the next eight years he worked in Berlin, till in 1933 he returned to Vienna as an associate in neuropsychiatry at the University Hospital. Since 1936 he had in the United States. Of Sakel’s original use of insulin shock therapy a colleague writes :

practised

The type and the duration of hypoglycaemia he applied at the time considered a dangerous complication of an overdose of insulin in diabetics. When he discovered that it had a favourable influence on the acute psychotic state, he was bold enough to repeat the treatment daily, to extend it over weeks, and finally to organise it into a well-ordered regime which is still unchanged in principle. He believed that the hypoglyosemia produced by insulin was an unsurpassed method of psychotic therapy. The procedure was entirely empirical, and his own theory of it did not stand up to scientific scrutiny. He tended to over-estimate his results and he made no effort to elaborate its theoretical foundations and the mechanism of its action. This was, however, done by others, and the work of Himwich, Gellhorn, and Hoagland in the United States, and of Georgi and Max Muller in Switzerland, was based on observations of his method. He inaugurated the period of active somatic treatment of the many psychiatric patients from whom the chronic population of our mental hospitals is recruited. Sakel’s is still the therapy of choice in early schizophrenia, shortening the acute attack and improving the quality of remissions in a good number of patients. But it does not prevent relapse and final chronicity, and it is costly and requires a great deal from the doctor and other attendants. Yeteven when we have found a drug which will give as good results as hypoglycsemia, Sakel’s bold use of his discovery will remain a landmark. were

GEORGE CHARLES BERG M.D. Lond., D.P.M. Dr. Charles Berg, consulting psychiatrist to the British for Functional Nervous Disorders, died at his home in London on Dec. 5, at the age of 65. He was born in India, at Simla Hill, and was educated at Bishop Cotton School and at Lausanne. He studied medicine at St. Thomas’s Hospital and qualified in 1915. He held resident appointments there and served during the 1914-18 war as a captain in the R.A.M.C. before he graduated M.B. in 1921. He held clinical assistantships in the mental diseases department at St. Thomas’s and at the Bethlem Royal Hospital before he took the M.D. and the D.P.M. in 1927. Later he joined the staffs of the Institute for the Scientific Treatment of Delinquency and the Tavistock Clinic, as well as of the British Hospital for Functional Nervous Disorders. His writings included Clinical Psychology, Deep Analysis, War in the Mind, The Unconscious Significance of Hair, and The First Interview with a Psychiatrist. This year he published his autobiographical Being Lived by My Life, and during his last illness he was completing a survey of the development of the human mind. P.F. writes: Charles Berg had an insatiable appetite for work. He was a

Hospital

with a dynamic character who had much to give, and gave it without stint. Nervous people have gained from his books much help and insight into the cause of their suffering. His colleagues will remember him as a warm-hearted and generous man, and a skilful and much-loved physician. Dr. Berg married twice; by his first marriage he had a son and a daughter, and by his second, in 1946 to Ruth Santo, two daughters. man

Appointments CUMMING,

R. P., M.B. Shetland Islands.

Aberd.,

FLAVELL, GEOFFREY, F.R.C.s.,

F.R.C.S.F. :

M.R.C.P. :

consultant

surgeon,

consultant thoracic surgeon.