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PSYCHIATRIC SEMINARS FOR GENERAL PRACTITIONERS
736
permit malignant change. Contrariwise, as I have shown with Warburg’s method, the addition of such hormones to already malignant cells does seem to modify their metabolic activity profoundly. I think I was the first to apply this idea in clinical practice, by using the sex hormones to influence local cell growth, the idea being to stimulate oxidation and so rob the malignant cell of its basic energy fermentation. The results obtained at that time have been amply confirmed by other workers, and serve to emphasise the all-important role played by the hormones as the modulators, if not the actual regulators, of all cell enzyme and metabolic activity. ALFRED A. LOESER. London, W.1.
CONSUMER INTERESTS to express my full agreement with the very cogent remarks by Professor Black in his article of March 28. Our partnership of four practitioners is one of those selected for the introduction of students into general practice and I find the 14 days twice a year allotted to final-year students ideal for this purpose. Whatever the eventual destination of the recently qualified doctor-and the statistical 25% entry only into general practice surprised me-I think that this introduction to the G.P.’s work is most beneficial to student and incidentally to general practitioner. The method chosen and the care in selection in Manchester of the right student for the right practice has everything to commend it. I am certainly looking forward to it becoming a permanent institution in medical education. P. T. WEYL. Manchester.
Sirshould like
PSYCHIATRIC SEMINARS FOR GENERAL PRACTITIONERS SIR,-I should like to associate myself with the sentiments expressed by Dr. Lask in his letter of March 21. I was house-physician in the psychiatric department of my teaching hospital, I underwent a year’s training from excellent psychiatrists before being graded as an Army psychiatrist, and I have thirty years’ experience of general practice. None of these disciplines has been of as much value to me in understanding and treating the emotional aspects of my patients’ illnesses as a course of seminars at the Tavistock Clinic. I would emphasise that the seminars do not make family doctors into psychiatrists, but help them to deal with the emotional elements that are present in all illness. It is practically impossible for the student to get this type of experience at present in his undergraduate training. Everyone agrees that the function of the family doctor is to understand and treat the whole man. It appears that doctors who feel the need for further education in psychotherapy must go it alone.
One would have expected the British Postgraduate Medical Federation to give this pioneering effort at a growing-point of medicine their enthusiastic support, and it would be interesting to know why it is denied. SIDNEY ABRAHAMS. London, B.1l.
SIR,-I should like March 21. -
to
support Dr. Lask’s letter of
v
I
the fortunate recipient of a fellowship which allowed attend fourteen of the seminars for general practitioners at the Tavistock Clinic during February, and while a short concentrated course is not ideal, it was very much better than nothing, which was the only alternative to me for geographical reasons. Fuller information about these seminars is contained in Dr. Balint’s very interesting book The Doctor, The Patient and His Illness which I think should be read by every G.P. The advantages to the nation in the reduction *of the drug bill, to the patient in better treatment, and to the doctor in me
was
to
greater satisfaction in his work, makes encouragement of these seminars so important that official recognition is in my opinion inevitable, further delay being pointless. Similar seminars should be started in other teaching centres and G.P.S given every encouragement to attend. E. J. R. PRIMROSE. Brora, Sutherland. MENTAL HEALTH BILL SIR,-Under this Bill it seems possible that there may be an opportunity of reorganising the administrative arrangements in mental hospitals to allow individual consultant psychiatrists full responsibility for their patients, on a basis similar to that already established in general hospitals. This will mean a modification of the present mental hospital medical-superintendent system, although it does not necessarily follow that superintendents will lose in status in any revised arrangement. There are clearly many factors of major clinical significance involved in such a change, and they probably apply to psychiatric work in general hospitals as well as in the mental hospitals. We feel that consultant psychiatrists who are not medical superintendents may welcome opportunities of discussing these factors, and perhaps formulating views which may be put forward more effectively if they represent the results of considered group discussion rather than the views of single individuals. We should therefore like to invite senior clinical colleagues in this category who are interested in taking these questions further to send their names to one of the undersigned. Depending on the results of this invitation we should undertake to try to arrange for occasional discussions on a tentative basis, and if it seemed helpful to report anv conclusions reached. M. F. BETHELL Taunton. Hornchurch. R. W. CROCKET Oxford. JOHN E. DUFFIELD London. A. HARRIS Ipswich. J. G. HOWELLS Coulsdon. JOHN T. HUTCHINSON Warwick. C. TETLOW Sutton. A. S. THORLEY.
SIR,-A few of the letters
on this topic seem to confuse issues which should be treated separately. The first of these is the relationship of the medical superintendent topatients who are compulsorily detained in hospital but are not under his clinical care, but that of another consultant. The second is the question of hospital administration. The Bill "... repeals the principal existing Acts ..." and "... specifies the circumstances in which mentally disordered persons may be compulsorily detained in hospital ... " It does not concern itself with the question of administration of hospitals, and therefore the second issue mentioned above does not fall within the Bill’s reference. As regards the first issue the Bill states that all responsibility for the patients, clinical as well as legal, will rest with the medical officer in whose care the patient is. That means the consultant psychiatrist. I was interested to read Dr. Munro’s statement (March 14) that his Association has taken care to emphasise the definition of the responsible medical officer " in that sense. In the report to the Royal Commission they pleaded for the retention of the legal responsibility in the hands of the medical superintendent. I believe that all _of us who welcome this Bill owe his Association a great deal for their imaginative proposals contained in their report to the Royal Commission. I am glad to see that on this one
two
"
permit malignant change. Contrariwise, as I have shown with Warburg’s method, the addition of such hormones to already malignant cells does seem to modify their metabolic activity profoundly. I think I was the first to apply this idea in clinical practice, by using the sex hormones to influence local cell growth, the idea being to stimulate oxidation and so rob the malignant cell of its basic energy fermentation. The results obtained at that time have been amply confirmed by other workers, and serve to emphasise the all-important role played by the hormones as the modulators, if not the actual regulators, of all cell enzyme and metabolic activity. ALFRED A. LOESER. London, W.1.
CONSUMER INTERESTS to express my full agreement with the very cogent remarks by Professor Black in his article of March 28. Our partnership of four practitioners is one of those selected for the introduction of students into general practice and I find the 14 days twice a year allotted to final-year students ideal for this purpose. Whatever the eventual destination of the recently qualified doctor-and the statistical 25% entry only into general practice surprised me-I think that this introduction to the G.P.’s work is most beneficial to student and incidentally to general practitioner. The method chosen and the care in selection in Manchester of the right student for the right practice has everything to commend it. I am certainly looking forward to it becoming a permanent institution in medical education. P. T. WEYL. Manchester.
Sirshould like
PSYCHIATRIC SEMINARS FOR GENERAL PRACTITIONERS SIR,-I should like to associate myself with the sentiments expressed by Dr. Lask in his letter of March 21. I was house-physician in the psychiatric department of my teaching hospital, I underwent a year’s training from excellent psychiatrists before being graded as an Army psychiatrist, and I have thirty years’ experience of general practice. None of these disciplines has been of as much value to me in understanding and treating the emotional aspects of my patients’ illnesses as a course of seminars at the Tavistock Clinic. I would emphasise that the seminars do not make family doctors into psychiatrists, but help them to deal with the emotional elements that are present in all illness. It is practically impossible for the student to get this type of experience at present in his undergraduate training. Everyone agrees that the function of the family doctor is to understand and treat the whole man. It appears that doctors who feel the need for further education in psychotherapy must go it alone.
One would have expected the British Postgraduate Medical Federation to give this pioneering effort at a growing-point of medicine their enthusiastic support, and it would be interesting to know why it is denied. SIDNEY ABRAHAMS. London, B.1l.
SIR,-I should like March 21. -
to
support Dr. Lask’s letter of
v
I
the fortunate recipient of a fellowship which allowed attend fourteen of the seminars for general practitioners at the Tavistock Clinic during February, and while a short concentrated course is not ideal, it was very much better than nothing, which was the only alternative to me for geographical reasons. Fuller information about these seminars is contained in Dr. Balint’s very interesting book The Doctor, The Patient and His Illness which I think should be read by every G.P. The advantages to the nation in the reduction *of the drug bill, to the patient in better treatment, and to the doctor in me
was
to
greater satisfaction in his work, makes encouragement of these seminars so important that official recognition is in my opinion inevitable, further delay being pointless. Similar seminars should be started in other teaching centres and G.P.S given every encouragement to attend. E. J. R. PRIMROSE. Brora, Sutherland. MENTAL HEALTH BILL SIR,-Under this Bill it seems possible that there may be an opportunity of reorganising the administrative arrangements in mental hospitals to allow individual consultant psychiatrists full responsibility for their patients, on a basis similar to that already established in general hospitals. This will mean a modification of the present mental hospital medical-superintendent system, although it does not necessarily follow that superintendents will lose in status in any revised arrangement. There are clearly many factors of major clinical significance involved in such a change, and they probably apply to psychiatric work in general hospitals as well as in the mental hospitals. We feel that consultant psychiatrists who are not medical superintendents may welcome opportunities of discussing these factors, and perhaps formulating views which may be put forward more effectively if they represent the results of considered group discussion rather than the views of single individuals. We should therefore like to invite senior clinical colleagues in this category who are interested in taking these questions further to send their names to one of the undersigned. Depending on the results of this invitation we should undertake to try to arrange for occasional discussions on a tentative basis, and if it seemed helpful to report anv conclusions reached. M. F. BETHELL Taunton. Hornchurch. R. W. CROCKET Oxford. JOHN E. DUFFIELD London. A. HARRIS Ipswich. J. G. HOWELLS Coulsdon. JOHN T. HUTCHINSON Warwick. C. TETLOW Sutton. A. S. THORLEY.
SIR,-A few of the letters
on this topic seem to confuse issues which should be treated separately. The first of these is the relationship of the medical superintendent topatients who are compulsorily detained in hospital but are not under his clinical care, but that of another consultant. The second is the question of hospital administration. The Bill "... repeals the principal existing Acts ..." and "... specifies the circumstances in which mentally disordered persons may be compulsorily detained in hospital ... " It does not concern itself with the question of administration of hospitals, and therefore the second issue mentioned above does not fall within the Bill’s reference. As regards the first issue the Bill states that all responsibility for the patients, clinical as well as legal, will rest with the medical officer in whose care the patient is. That means the consultant psychiatrist. I was interested to read Dr. Munro’s statement (March 14) that his Association has taken care to emphasise the definition of the responsible medical officer " in that sense. In the report to the Royal Commission they pleaded for the retention of the legal responsibility in the hands of the medical superintendent. I believe that all _of us who welcome this Bill owe his Association a great deal for their imaginative proposals contained in their report to the Royal Commission. I am glad to see that on this one
two
"