PRESCRIPTION FORMS STOLEN BY DRUG-ADDICTS

176 of the circulation". Here I must point out that local ischaemic cerebral lesions can and very often do reflect a failure of the circulation ", and this is precisely the significance of a reduced cerebral blood-flow during or after cardiac surgery. In other situations necrosis of grey and white matter within a major arterial territory or in the frontier region between two such territories is a well-known sequel of a sudden decrease in cerebral blood-flow. In such lesions the arteries and arterioles are normal. Again, it is certainly "... difficult to interpret obscure ischxmic lesions of the brain without knowing the state of the extracranial cerebral arteries ", providing that such information is relevant to the cases in question. Here, age and any evidence of atherosclerosis in the vascular system as a whole are the pertinent factors. Among the 11 cases that I reported, 9 exhibited geographical lesions, and of these, 3 were aged 51, 45, and 44 years. Only 1 of these showed evidence of atherosclerosis in systemic but not in the cerebral vessels. The other 6 were between 32 and 10 years of age. Of the 22 cases of the larger series that presented geographical lesions, 15 were under the age of 40. Thus disease of the extracranial arteries can be excluded in the majority of cases, and if present among the minority could only increase the extent of cerebral damage but without changing its,, essential nature. Further, my stated conclusion (presented in your article) that none of the possible minor solid emboli could be held responsible for the lesions of geographical type must surely imply that a study of the renal glomeruli, such as you suggest, could throw no light on the pathogenesis of these lesions. Finally, the suggestion that electroencephalography could advise the surgeon of the occurrence of air-embolism can apply only to surgery under moderate hypothermia. Below a temperature of 22-20°C the cortex exhibits electrical silence. M.R.C. Neuropsychiatric Research Unit, Woodmansterne Road, J. B. BRIERLEY. Carshalton, Surrey.

general failure "

PSYCHIATRY IN GENERAL HOSPITALS

SIR,-Your editorial of Nov. 30 describes the proposed reorientation of psychiatry towards the general hospital as something of a leap in the dark." May I remind you that for more than thirteen years Oldham has had a 220bed psychiatric unit in the Oldham General Hospital, together with the community psychiatric services developed by Dr. A. Pool, with the cooperation of the local health authority ? "

There are long-stay patients. They are not banished, but live in the same unit. If a fair number of new units are designed with adequate consultation between architects and psychiatrists and are not too small, patients can beneficially be segregated to the degree needed to suit the best interest of various broad groups of patients, including schizophrenics whose illness does not improve to a level socially acceptable in the outside community. I agree with you that the banishment of the latter group to minimal-care units would perhaps not be a promising augury for future advance in their treatment, quite apart from other considerations. Surely in human terms the herding of large numbers of mentally ill patients, long-term or otherwise, is not desirable, except from the point of view of research alone ? If it were, one wonders why some new patients whose sensibilities have not been dulled by years of habituation express fears at seeing mental illness on a crowd scale, in the large institutions ? Personal contact and reassurance is very important to the mentally ill; in a unit of moderate size they can form relationships and get to know faces which, unlike those in the massive institutions, are not liable to change overnight into completely strange ones; if they have to move to another ward, nurses and doctors will still be reassuringly familiar. Moreover, visits from friends and relatives are easier in units situated in the community they serve; and local social agencies are more readily accessible. In the massive institutions communication between various

levels of medical and nursing staff is more difficult than in the small compact unit. In the smaller unit there are far fewer groupings among all staff concerned, and the entire activity of the unit can bear directly on treating the patient. This seems a factor of considerable importance in getting changes and consultations through quickly and with a minimum of friction and the maximum of participation of all affected. In such a unit continuity of care is even more simple and assured. Colchester,

H.

Essex.

JACOBS.

A COLLEGE OF PSYCHIATRY

SIR,-Members of the Royal Medico-Psychological Association will not expect their officers to make a detailed reply to Dr. Howells’ imputations of bad faith. As chairman of the committee referred to in his letter of Jan. 4, I can say that (subject to Council’s approval) members will have ample opportunity to judge for themselves in the near future. I am confident that members would rather take part in a ballot that allows free expression of their views than in one based on Dr. Howells’ assumption that their wishes have alreadv been made clear. The Royal

Medico-Psychological Association, London, W.1.

ALEXANDER WALK.

WHITE COATS AND UNIFORMS

SIR After recently completing a house-surgeon’s post, it occurs to me that the reasons for wearing a white coat have changed. They were originally worn as protective clothing for the doctor and for reasons of hygiene (probably including psychological associations of cleanliness). A third reason might be a status symbol and sign of

authority. In the hospital today, none of these reasons is still valid. The white coat is hardly protective and still less hygienic, being used in dining-room, common-room, and even as an overcoat or dressing-gown. It is no longer even a status symbol, since white coats are often worn by many other hospital staff. May I suggest that hospital doctors, in particular the residents, wear a suitable uniform, as is common in the U.S.A. White coats would be worn only when visiting the wards, and, incidentally, these should be clearly labelled with the name of the doctor. I believe these rules of hospital dress do exist in some hosnitals in this countrv. Their widesnread adoDtion would be welcome R. MARTIN A. WEINSTEIN. London, N.W.8. PRESCRIPTION FORMS STOLEN BY DRUG-ADDICTS

SIR,-Blank E.c.lO forms are a boon to the drug-addict, for they enable him to forge prescriptions. As the current West End price for a single prescription form is around 5s. there is a lucrative trade in stolen forms. Two methods of stealing forms from doctors’ surgeries have been described to me recently by addicts, and I thin!; that general practitioners should know about them: A " married " couple ask for a joint consultation. After some of the history has been taken, the wife simulates a faint, and, while the doctor attends to her, the husband removes any available prescription pads. Where doctors have two consulting-rooms and take their

evening surgeries alone, two people working together attend as patients and ensure that they are last. Then, while one is seen. the other rifles the vacant consulting-room. How

widespread

these

practices

are

I do

not

know

177

I have encountered one instance of each, while the patient who used the second said it was common in North East London. The

Maudsley Hospital, London, S.E.5.

METHYSERGIDE: DENIAL OF REPORTED ASSOCIATION WITH FŒTAL ABNORMALITY

HOLGATE, medical director of Sandoz Products writes: Limited, On Jan. 2, reports headed prominently " Drug is cause of Dr. H.

"

malformed baby " and " Probe this migraine drug-Doctor were carried by the Daily Telegraph and the Daily Sketch respectively. They.quoted a report implying that the birth, in Switzerland, of a malformed child, who died within fortyeight hours, was associated with the mother having taken the

migraine prophylactic methysergide (’ Deseril ’). Since methysergide is being clinically evaluated on a wide scale, we feel it necessary to inform the medical profession of further facts of the case which are known to us. Discussions between members of the medical staff of Sandoz, the general practitioner, the obstetrician who attended the mother, and the pathologists who carried out the postmortem examination on the infant were immediately arranged. Contrary to the information which Sandoz had received that the patient had had no illness during pregnancy, she was treated by her general practitioner for influenza during the second month of pregnancy. During the early weeks of pregnancy, she had been prescribed various drugs. Methysergide,

however, was never prescribed by either the general practitioner the obstetrician during the pregnancy. From sometime in September to Oct. 30, 1962, methysergide was prescribed for the patient by an internist. The patient’s last menstrual period was, however, on March 8, 1963. A postmortem examination was made in the Institute of Anatomy, which is under the direction of Prof. Gian Tondury, at Zurich University. Professor Tondury, a leading authority on teratology, expressed the view that the malformations were of a kind due to intrinsic factors and not to extrinsic factors such as drugs or viral infections. A detailed report on this matter is being voluntarily submitted by us to the Safety of Drugs Committee. or

Appointments CASELEY, S. W. G., M.M., M.B. Capetown, D.P.M.: principal s.M.o. (mentalhealth service), Essex. JAGGER, D. B., M.B.E., M.B. Birm., D.o.M.s.: S.H.M.O., ophthalmic department, Westminster Hospital, London. MANNING, C. W. S. F., F.R.C.S. : consultant orthopaedic surgeon, St. Bartholomew’s Hospital, London. MURCHISON, MURDOCH, M.B. Edin., D.P.H., D.OBST.: deputy M.O.H., burgh

and county of Inverness. RICHARDS, MYRTLE V., M.B. Edin., D.c.H., D.P.H. : deputy M.O.H., MidWarwickshire Joint Sanitary Committee, and assistant M.o.H., Warwickshire. SELwYN, J. G., M.A., M.D. Cantab.: consultant pathologist, Dumfries and

Galloway Royal Infirmary, Dumfries. consultant psychiatrist and deputy medical superintendent, Aycliffe Hospital, Darlington. CASHMAN, M. D., M.B. Durh., M.R.C.P., D.P.M. : consultant psychiatrist, Cherry Knowle Hospital, Ryhope, Sunderland, and South Shields General Hospital. GRANGER, WILLIAM, M.B. Durh., D.M.R.D. : consultant radiologist, Hartlepools, North Tee-Side and South Tees-side hospital groups. J., L.R.C.P.E., D.A.: consultant anæsthetist, North and South Tees-side hospital groups. HINGORANI, KISHIN, M.B. Calcutta, M.R.C.P.E., D.PHYS.MED. : consultant physician in physical medicine, Gateshead hospital group, and medical superintendent, Dunston Hill Hospital, Gateshead. STEPHENSON, PETER, M.B. W’srand, M.R.C.P.: consultant physician/geriatrician, Gateshead hospital group. North-Eastern Regional Hospital Board, Scotland: DAVIDSON, L. D., M.B. Aberd., F.F.A. R.C.S., D.A.: consultant anaæsthetist, Aberdeen teaching hospitals. GILLA-DERS, L. A., M.B. Glasg., F.F.R., D.M.R.D.: consultant-in-charge, radiological services, based at Aberdeen Royal Infirmary. LATHAM, J. W., M.R.C.S., F.F.A. R.c.s., D.A. : consultant anaesthetist, Aberdeen teaching hospitals. PALMER, J. H., M.B. Aberd., D.M.R.D. : consultant radiologist, Aberdeen teaching hospitals.

HALKETT, S.

IAN NORMAN MacIVER

Durh., F.R.C.S. Mr. Ian Maclver, director of the traumatic neurosurgical department of the regional neurological centre at the General Hospital, Newcastle upon Tyne, died on Jan. 8 at the age of 49. M.B.

BRIAN BARRACLOUGH.

Newcastle Regional Hospital Board: BARLOW, D. J. H., M.B. W’srand, D.P.M.:

Obituary

He spent his first seven years on the Island of Lewis, where his father was a schoolmaster. But he was educated on Tyneside at Dame Allan’s Boys’ School in Newcastle and at the University of Durham, where he qualified in 1937. During the late war he served with a field ambulance in France and was evacuated from Dunkirk. Afterwards he worked with a mobile surgical team in the Middle East and took part in the Battle of El Alamein. In 1944 he returned to this country and was appointed orthopaedic surgeon for the Eastern Command, based on the military hospital at Colchester. On his return to civilian practice his first appointments were in his war-time specialty, and he was lecturer in anatomy in Durham University and senior registrar in orthopxdics at the Royal Victoria Infirmary, Newcastle. But in 1950 he became senior registrar in the department of neurological surgery at Newcastle General Hospital and the following year he was appointed neurological surgeon to the hospital and a deputy

regional neurological

surgeon.

director in 1962 when the opened. His work in these last years had dealt particularly with the treatment of head injuries, and three years ago he discussed in our columns the role of respiratory insufficiency in the mortality of severe head injuries. In another paper, in the British Journal of Surgery, he described rupture of the oesophagus associated with lesions of the central nervous system. But he retained his interest in orthopaedic problems, especially the treatment of low backache, sciatica, and herniated nucleus pulposus. He was greatly concerned with the convalescence, reablement, and resettlement of all his patients, and he was supervisor at Birney Hill Rehabilitation Hospital. Mr. MacIver leaves a widow, a son, and two daughters. He took up his post

regional neurological

as

centre was

HENRY LOVELL HOFFMAN

V.R.D., M.D. Cantab., F.R.C.P. Dr. H. Lovell Hoffman, neurologist to the Royal United Hospital, Bath, and to the Bath clinical area, died on Jan. 4. He was educated at Clifton College, Trinity College, Cam-

bridge, and St. Thomas’s Hospital. After qualifying in 1929 he held house-appointments and a medical registrarship at St. Thomas’s. Later he became an assistant medical registrar at the National Hospital for Nervous Diseases, Queen Square. In 1938 he was appointed assistant physician to the Royal United Hospital. He was a member of the R.N.V.R., and his work at Bath was soon interrupted by five years’ war service with the Royal Navy. On demobilisation he returned to Bath and in 1946 was appointed full physician on the staff of The Royal United Hospital and neurologist to The Royal National Hospital for Rheumatic Diseases. His paper in 1949 on nerve-root involvement in vertebral arthritis was one of the earliest reports on this syndrome. Later papers dealt with sensory neuropathy associated with carcinoma of the oesophagus and with acute necrotic myelopathy. He was elected F.R.C.P. in 1952. C. L. B., lately one of his juniors, sends the following tribute: "

The

ones; for

days in Bath working under his guidance were happy although he was a very able physician, the character-

istic which will be remembered best is his This extended not only to his patients but

kindness. all with whom

extreme to