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PROSTIGMIN AND INTESTINAL MOTILITY
1189 The
REFORM OF THE LUNACY LAWS
To the Editor
of
THE LANCET
SiR,-I have read with great interest the excellent leading article in THE LANCET of May 14th entitled In the discussion Doctors and the Herbert Act. which followed Mr. Latey’s able paper on the medicolegal aspects of the Matrimonial Causes Act, 1937at the April meeting of the Medico-Legal Society to which you refer-I stated that I considered the Act should have been preceded by a Bill for the reform of the existing laws relating to the certification and detention of persons of unsound mind, and putting these laws on a safe, sure, and up-to-date scientific basis. I expressed the opinion that before any person should be certified as of unsound mind and detained in an asylum that person should be examined by a panel of mental experts, not more than five or less than three ; the family doctor being present as a witness, to give evidence only. The decision of the panel would be a majority judgment, signed in the name of the panel. Every twelve months during detention the patient would be examined by a different panel of mental experts, the institutional doctor being present as a witness, to give evidence only; the opinion of the panel as to curability to be stated on each report. In this way errors of diagnosis and prognosis, based on the opinion of one or two medical men in charge of the patient, would be eliminated. The onus and responsibility of giving an opinion as to curability would be placed on the panels of experts appointed by the State. Under the existing lunacy laws
newly qualified medical man practical experience of mental disease a
with can
no
real
certify
a
lunatic and order his detention in an institution, in the case of a pauper, and on an urgency certificate without any other medical certificate except his own. No person, even if he be a pauper, should be certified and detained as a lunatic, even for one week, on the certificate of one medical man. The law in this respect should be amended, requiring in every case two medical certificates from medical men who have been in practice at least three years. This should be done pending a complete reform of the laws relating to certification. The present state of affairs is neither fair to the public nor to the medical profession. I am. Sir. vours faithfurvJ. L. MOIR. Cemaes Bay, Isle of Anglesey, May 15th. person
as
a
MATERNITY CARE FOR UNMARRIED WOMEN OF THE PROFESSIONAL CLASSES
To the Editor
of
maternity home of the Fellowship is situated conveniently in a healthy part of South London, and has recently been enlarged and admirably equipped to satisfy the latest requirements of the Health Department of the L.C.C. Girls are admitted very
THE LANCET
SIR,—May I bring to the attention of all members of the medical profession the work of the Fellowship of St. Michael and All Angels ? This society exists (and it is the only one of its kind) to help girls of the professional classes who are in grave moral difficulties. It maintains three homes-a training home, a maternity home, and a nursery. Doctors realise how difficult life is for many girls from sheltered and comfortable homes (daughters of schoolmasters, clergymen, solicitors, doctors, and so forth) who have to go out into the world unfriended and alone, and they know how many of these, working as hospital nurses, teachers, art students, &c., fall victims to unregulated passion under conditions more pitiable than blameworthy. But sometimes it must often happen that when consulted by such girls, who from their upbringing and position are obviously unsuitable for the care of ordinary rescue homes, they are at a loss how best to advise them.
time before the birth of the child, and remain for 4 months afterwards under the best conditions both physical and spiritual. After that time if the girl has to return to business life the child is sent either to a thoroughly ttustworthy foster-mother, or to the nursery home of the society. I am encouraged to write in this way because doctors who do know about the Fellowship and advise girls to apply to it testify to its admirable work and influence. But we feel that we could be even more useful than we now are if more doctors knew of what we do for this particular class of girls in need. Letters should be the addressed to Hon. some
Secretary, 5, Bloomfield-terrace, London, I
am.
Sir-
vours
S.W.I.
faithfullv.
PERCY BLACKBURN. May 16th. have ascertained that there is accommoda*** We tion for 10 prospective mothers in the maternity home, that the usual fee, inclusive of nursing attention, is 2 guineas a week, and that the fees of the doctor attached to the home, should her services be required,’ are very moderate. Special consideration’ is given to girls quite unable to pay the usual fee.-ED. L. PROSTIGMIN AND INTESTINAL MOTILITY To the Editor
of
THE .LANCET
SIR,—In the annotation on p. 1119 of your last issue it is stated that the doses of Prostigmin employed by the American investigators, Harger and Wilkey, " were similar to those used by Carmichael and his colleagues (namely, 1-2 c.cm. of 1/4000
prostigmin methyl sulphate)." To prevent accidental overdosage, however, permit to point out that the experiments carried out by Carmichael and his colleagues under the auspices of the Medical Research Council, and reported in THE LANCET of May 5th, 1934, were undertaken with the standard 1 c.cm. ampoules, each containing 0-0005 g. prostigmin, or a 1/2000 solution, whereas Harger and Wilkey used ampoules containing a 1/4000 solution, known in America as " prostigmin prophylactic," and corresponding to one-half of the standard prostigmin ampoules with which British practitioners are familiar.-We are, Sir, yours faithfully, ROCHE PRODUCTS LTD. us
Bowes-road, London, N., May 17th.
MEDICAL STUDENTS CONFERENCE. - The second annual conference of representatives of medical student societies has been arranged by the Medical Students Committee of the National Union of Students and will be held in London from July 12th to 15th. The general subject for discussion will be the training of the doctor. Lord Horder will be the guest of honour at the inaugural dinner, which will be held at Pinoli’s Restaurant, Wardour-street, London, W., on July 12th. Sir Henry Brackenbury will be the first speaker at the formal sessions which begin the next morning, and in the afternoon Prof. C. A. Lovatt Evans, F.R.S., will speak on the relation of pre-clinical subjects to the medical curriculum as a whole. On Thursday the first speaker will be Mr. E. Pearce Gould, and in the afternoon Prof. W. W. Jameson will open a discussion on the teaching of preventive medicine. The whole of Friday will be devoted to clinical visits to the Middlesex Hospital, University College Hospital, and the Royal Free Hospital. Further particulars may be had from the secretary of the committee, 3, Endsleigh-street, London, W.C.1.
REFORM OF THE LUNACY LAWS
To the Editor
of
THE LANCET
SiR,-I have read with great interest the excellent leading article in THE LANCET of May 14th entitled In the discussion Doctors and the Herbert Act. which followed Mr. Latey’s able paper on the medicolegal aspects of the Matrimonial Causes Act, 1937at the April meeting of the Medico-Legal Society to which you refer-I stated that I considered the Act should have been preceded by a Bill for the reform of the existing laws relating to the certification and detention of persons of unsound mind, and putting these laws on a safe, sure, and up-to-date scientific basis. I expressed the opinion that before any person should be certified as of unsound mind and detained in an asylum that person should be examined by a panel of mental experts, not more than five or less than three ; the family doctor being present as a witness, to give evidence only. The decision of the panel would be a majority judgment, signed in the name of the panel. Every twelve months during detention the patient would be examined by a different panel of mental experts, the institutional doctor being present as a witness, to give evidence only; the opinion of the panel as to curability to be stated on each report. In this way errors of diagnosis and prognosis, based on the opinion of one or two medical men in charge of the patient, would be eliminated. The onus and responsibility of giving an opinion as to curability would be placed on the panels of experts appointed by the State. Under the existing lunacy laws
newly qualified medical man practical experience of mental disease a
with can
no
real
certify
a
lunatic and order his detention in an institution, in the case of a pauper, and on an urgency certificate without any other medical certificate except his own. No person, even if he be a pauper, should be certified and detained as a lunatic, even for one week, on the certificate of one medical man. The law in this respect should be amended, requiring in every case two medical certificates from medical men who have been in practice at least three years. This should be done pending a complete reform of the laws relating to certification. The present state of affairs is neither fair to the public nor to the medical profession. I am. Sir. vours faithfurvJ. L. MOIR. Cemaes Bay, Isle of Anglesey, May 15th. person
as
a
MATERNITY CARE FOR UNMARRIED WOMEN OF THE PROFESSIONAL CLASSES
To the Editor
of
maternity home of the Fellowship is situated conveniently in a healthy part of South London, and has recently been enlarged and admirably equipped to satisfy the latest requirements of the Health Department of the L.C.C. Girls are admitted very
THE LANCET
SIR,—May I bring to the attention of all members of the medical profession the work of the Fellowship of St. Michael and All Angels ? This society exists (and it is the only one of its kind) to help girls of the professional classes who are in grave moral difficulties. It maintains three homes-a training home, a maternity home, and a nursery. Doctors realise how difficult life is for many girls from sheltered and comfortable homes (daughters of schoolmasters, clergymen, solicitors, doctors, and so forth) who have to go out into the world unfriended and alone, and they know how many of these, working as hospital nurses, teachers, art students, &c., fall victims to unregulated passion under conditions more pitiable than blameworthy. But sometimes it must often happen that when consulted by such girls, who from their upbringing and position are obviously unsuitable for the care of ordinary rescue homes, they are at a loss how best to advise them.
time before the birth of the child, and remain for 4 months afterwards under the best conditions both physical and spiritual. After that time if the girl has to return to business life the child is sent either to a thoroughly ttustworthy foster-mother, or to the nursery home of the society. I am encouraged to write in this way because doctors who do know about the Fellowship and advise girls to apply to it testify to its admirable work and influence. But we feel that we could be even more useful than we now are if more doctors knew of what we do for this particular class of girls in need. Letters should be the addressed to Hon. some
Secretary, 5, Bloomfield-terrace, London, I
am.
Sir-
vours
S.W.I.
faithfullv.
PERCY BLACKBURN. May 16th. have ascertained that there is accommoda*** We tion for 10 prospective mothers in the maternity home, that the usual fee, inclusive of nursing attention, is 2 guineas a week, and that the fees of the doctor attached to the home, should her services be required,’ are very moderate. Special consideration’ is given to girls quite unable to pay the usual fee.-ED. L. PROSTIGMIN AND INTESTINAL MOTILITY To the Editor
of
THE .LANCET
SIR,—In the annotation on p. 1119 of your last issue it is stated that the doses of Prostigmin employed by the American investigators, Harger and Wilkey, " were similar to those used by Carmichael and his colleagues (namely, 1-2 c.cm. of 1/4000
prostigmin methyl sulphate)." To prevent accidental overdosage, however, permit to point out that the experiments carried out by Carmichael and his colleagues under the auspices of the Medical Research Council, and reported in THE LANCET of May 5th, 1934, were undertaken with the standard 1 c.cm. ampoules, each containing 0-0005 g. prostigmin, or a 1/2000 solution, whereas Harger and Wilkey used ampoules containing a 1/4000 solution, known in America as " prostigmin prophylactic," and corresponding to one-half of the standard prostigmin ampoules with which British practitioners are familiar.-We are, Sir, yours faithfully, ROCHE PRODUCTS LTD. us
Bowes-road, London, N., May 17th.
MEDICAL STUDENTS CONFERENCE. - The second annual conference of representatives of medical student societies has been arranged by the Medical Students Committee of the National Union of Students and will be held in London from July 12th to 15th. The general subject for discussion will be the training of the doctor. Lord Horder will be the guest of honour at the inaugural dinner, which will be held at Pinoli’s Restaurant, Wardour-street, London, W., on July 12th. Sir Henry Brackenbury will be the first speaker at the formal sessions which begin the next morning, and in the afternoon Prof. C. A. Lovatt Evans, F.R.S., will speak on the relation of pre-clinical subjects to the medical curriculum as a whole. On Thursday the first speaker will be Mr. E. Pearce Gould, and in the afternoon Prof. W. W. Jameson will open a discussion on the teaching of preventive medicine. The whole of Friday will be devoted to clinical visits to the Middlesex Hospital, University College Hospital, and the Royal Free Hospital. Further particulars may be had from the secretary of the committee, 3, Endsleigh-street, London, W.C.1.