- Email: [email protected]
PSYCHIATRISTS AND DETAINEES IN SOUTH AFRICA
128 with the disease
Kaposi’s
activity among patients with SLE4 and, now, with (Gyorkey and colleagues). Of primary interest is
sarcoma
whether these mterferon induced inclusions are cellular in nature or extracellular, perhaps viral. Laboratory Medicine Institute, Center for Laboratories and Research, New York State Department of Health, Albany, N Y 12201, U.S A
STEVEN A. RICH TIMOTHY R. OWENS
Division of Rheumatology, Albany Medical College
LEE E. BARTHOLOMEW
Department of Clinical Immunology and Biological Therapy, M D. Anderson Hospital and Tumor Institute, University of Texas System Cancer Center, Houston
JORDAN U. GUTTERMAN
PSYCHIATRISTS AND DETAINEES IN SOUTH AFRICA
SlR,—I have seen no evidence for psychiatric abuse in South Africa of the type reported from the U.S.S.R. nor have South African psychiatrists been directly involved in the detention or torture of political dissidents. However, South African newspapers last year described six cases in which detainees were alleged to have needed psychiatric help as a result of detention or interrogation. Some aspects of police interrogation have been condemned by the South African professional bodies such as Lawyers for Human Rights, the South African Psychological Association, and the Witwatersrand University Medical Faculty-but not by the individual psychiatrists or by the Medical Association of South Africa. Mr Thozamile Gqweta, president of a free, independent, Black trade union (South African Allied Workers Union) was moved from detention to the psychiatric ward in Johannesburg General Hospital under police guard on Feb. 10, 1982. He had been arrested in December, 1981, under the notorious section 6 of the Terrorism Act-which allows police to hold people for interrogation indefinitely without having to justify it in court. Psychiatric symptoms developed as a result of intense interrogation and solitary confinement, and on admission to hospital he was severely depressed, anxious, and was troubled by nightmares. He had difficulty speaking, had lost a lot of weight and also showed some loss of memory. He remained under psychiatric treatment for at least 4 weeks and Mr Louis Le Grange, Minister of Police, in reply to a parliamentary question, admitted that Mr Gqweta had "psychoses and ulcer". Mr Gqweta was released on March 3 for health reasons but was rearrested the following day by the Ciskei Intelligence Service. He has subsequently received psychiatric care in East London. Dr Liz Floyd, aged 26, common-law wife of Dr Neil Aggett was admitted to the psychiatric ward at the Johannesburg General Hospital on Feb. 5 after transfer from John Vorster Square police station where she had been held in detention for 3 months. She had had long spells in solitary confinement and was thought to be "a suicide risk". She had collapsed after news of Dr Aggett’s death in custody reached her. She received psychiatric care for 7 weeks and was released in March. Mr Sam Kikine, secretary of the South African Allied Workers Union, was transferred from detention to St Augustine’s psychiatric hospital, Durban on Feb. 26. He had been in police custody since November, 1981. His family who visited him in hospital found him under heavy sedation and "in a bad psychological state". On his discharge from hospital on March 3 it was recommended that he should no longer be held in isolation cells. Mr Pravin Gordhan, an executive member of the Natal Indian Congress, was taken into police custody on Nov. 27, 1981. He was transferred to St Augustine’s on March 18. His relatives were refused permission to see him. The Minister of Police said that visitors were not allowed because "at this stage they may detrimentally influence the progress made with his interrogation". Mr D. Farisanz, another political detainee, was admitted twice to psychiatric facilities in Venda bantustan during February. His second admission was with critical head injuries.
Ms Esther Levitan, a 55-year-old Black Sash member, was treated by psychiatrists while in police custody in Johannesburg in February. She required psychiatric care again after her discharge on March 4. The refusal by South African psychiatrists to condemn police malpractice the psychiatric consequences of which they have seen, raises major ethical issues. The detainees parents’ support committee’s demand that detainees should be seen by an independent panel of doctors has been refused by the Minister of Police. The committee subsequently appealed to over 180 South African and overseas medical associations calling for support for their demands to safeguard the detainees’ health. They based their appeal on the 1975 Declaration of Tokyo which was adopted by the World Medical Association. The newspapers referred to are the Rand Dazly Mail, Dazly Dispatch (East London), Sowetan (Johannesburg), and Sunday Times (Johannesburg), and I will supply a list of dates to those interested. See also, Focus on Political Repression in Southern Africa, no. 40 (May-June 1982), International Defence and Aid Fund, Grant Arcade, London N12. M.R.C. Unit for Epidemiological Studies in Psychiatry, University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh EH10 5HF
S. P. SASHIDHARAN
MEASURING SPECIFIC GRAVITY OF URINE
SIR,-We note with interest the comments from Dr Jamison and Robertson, and the reply from Dr Taylor and Dr Walker (Dec. 18, p. 1396). One question raised by the Stanford group related to the performance of the specific gravity strip test in normal controls excreting highly concentrated or very dilute urine. Anticipating this question, and taking a purely empirical approach to compare available methods, local investigators did a study on normal volunteers. Urinary specific gravity was determined in twelve subjects under conditions of the concentration and dilution tests described by Henry et al.Essentially equivalent results were obtained for specific gravity as measured by the strip method, by 2 Dr
hydrometry, and by refractometry (using two methods).2 Miles
Laboratories, Court, Stoke Poges, Slough SL2 4LY Stoke
B. A. ELLIOTT
LABORATORY DIAGNOSIS OF CAPD PERITONITIS
SIR,-We were interested in the article on the laboratory diagnosis and treatment of CAPD (continuous ambulatory peritoneal dialysis) peritonitis by Dr Knight and colleagues (Dec. 11, p. 1301). We too3 have altered our investigation of CAPD infections, using a methods which involves the use of pour plates. It can be done by all our technicians, during on-call hours if necessary. Peritonitis is a potentially lethal complication of CAPD and we feel that the peritoneal fluid should be examined as soon as possible so that the offending organism is isolated and the correct antibiotic given. Over the past year we have isolated 120 strains of which 63 were Staphylococcus albus. Pseudomonas species, which were not found by the Portsmouth workers, accounted for 8 episodes and nearly always resulted in the removal of the Tenkhoff catheter. Our initial treatment is oral cephalexin and intraperitoneal cefuroxime (250 mg per 2 litre dialysis bag) as we believe that oral therapy alone is not sufficient. Much work remains to be done to find the best way to treat peritonitis in CAPD patients but Knight and his colleagues have gone some way to achieving this goal. Department of Bacteriology, Royal Hallamshire Hospital, Sheffield S10 2JF
ROBERT C. SPENCER PATRICIA FENTON
Cannon DC, Winkelman JW, eds. Clinical chemistry principles and Harper and Row, 1974: 1547. 2 Gounden D, Newall RG. Urine specific gravity measurements: Comparison of a new reagent strip method with existing methodologies as applied to the water concentration/dilution tests. Curr Med Res Opin (in press). 3. Fenton P Laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis J Clin Pathol 1982; 35: 1181-84. 1
Henry RJ,
technics New York:
Kaposi’s
activity among patients with SLE4 and, now, with (Gyorkey and colleagues). Of primary interest is
sarcoma
whether these mterferon induced inclusions are cellular in nature or extracellular, perhaps viral. Laboratory Medicine Institute, Center for Laboratories and Research, New York State Department of Health, Albany, N Y 12201, U.S A
STEVEN A. RICH TIMOTHY R. OWENS
Division of Rheumatology, Albany Medical College
LEE E. BARTHOLOMEW
Department of Clinical Immunology and Biological Therapy, M D. Anderson Hospital and Tumor Institute, University of Texas System Cancer Center, Houston
JORDAN U. GUTTERMAN
PSYCHIATRISTS AND DETAINEES IN SOUTH AFRICA
SlR,—I have seen no evidence for psychiatric abuse in South Africa of the type reported from the U.S.S.R. nor have South African psychiatrists been directly involved in the detention or torture of political dissidents. However, South African newspapers last year described six cases in which detainees were alleged to have needed psychiatric help as a result of detention or interrogation. Some aspects of police interrogation have been condemned by the South African professional bodies such as Lawyers for Human Rights, the South African Psychological Association, and the Witwatersrand University Medical Faculty-but not by the individual psychiatrists or by the Medical Association of South Africa. Mr Thozamile Gqweta, president of a free, independent, Black trade union (South African Allied Workers Union) was moved from detention to the psychiatric ward in Johannesburg General Hospital under police guard on Feb. 10, 1982. He had been arrested in December, 1981, under the notorious section 6 of the Terrorism Act-which allows police to hold people for interrogation indefinitely without having to justify it in court. Psychiatric symptoms developed as a result of intense interrogation and solitary confinement, and on admission to hospital he was severely depressed, anxious, and was troubled by nightmares. He had difficulty speaking, had lost a lot of weight and also showed some loss of memory. He remained under psychiatric treatment for at least 4 weeks and Mr Louis Le Grange, Minister of Police, in reply to a parliamentary question, admitted that Mr Gqweta had "psychoses and ulcer". Mr Gqweta was released on March 3 for health reasons but was rearrested the following day by the Ciskei Intelligence Service. He has subsequently received psychiatric care in East London. Dr Liz Floyd, aged 26, common-law wife of Dr Neil Aggett was admitted to the psychiatric ward at the Johannesburg General Hospital on Feb. 5 after transfer from John Vorster Square police station where she had been held in detention for 3 months. She had had long spells in solitary confinement and was thought to be "a suicide risk". She had collapsed after news of Dr Aggett’s death in custody reached her. She received psychiatric care for 7 weeks and was released in March. Mr Sam Kikine, secretary of the South African Allied Workers Union, was transferred from detention to St Augustine’s psychiatric hospital, Durban on Feb. 26. He had been in police custody since November, 1981. His family who visited him in hospital found him under heavy sedation and "in a bad psychological state". On his discharge from hospital on March 3 it was recommended that he should no longer be held in isolation cells. Mr Pravin Gordhan, an executive member of the Natal Indian Congress, was taken into police custody on Nov. 27, 1981. He was transferred to St Augustine’s on March 18. His relatives were refused permission to see him. The Minister of Police said that visitors were not allowed because "at this stage they may detrimentally influence the progress made with his interrogation". Mr D. Farisanz, another political detainee, was admitted twice to psychiatric facilities in Venda bantustan during February. His second admission was with critical head injuries.
Ms Esther Levitan, a 55-year-old Black Sash member, was treated by psychiatrists while in police custody in Johannesburg in February. She required psychiatric care again after her discharge on March 4. The refusal by South African psychiatrists to condemn police malpractice the psychiatric consequences of which they have seen, raises major ethical issues. The detainees parents’ support committee’s demand that detainees should be seen by an independent panel of doctors has been refused by the Minister of Police. The committee subsequently appealed to over 180 South African and overseas medical associations calling for support for their demands to safeguard the detainees’ health. They based their appeal on the 1975 Declaration of Tokyo which was adopted by the World Medical Association. The newspapers referred to are the Rand Dazly Mail, Dazly Dispatch (East London), Sowetan (Johannesburg), and Sunday Times (Johannesburg), and I will supply a list of dates to those interested. See also, Focus on Political Repression in Southern Africa, no. 40 (May-June 1982), International Defence and Aid Fund, Grant Arcade, London N12. M.R.C. Unit for Epidemiological Studies in Psychiatry, University Department of Psychiatry, Royal Edinburgh Hospital, Edinburgh EH10 5HF
S. P. SASHIDHARAN
MEASURING SPECIFIC GRAVITY OF URINE
SIR,-We note with interest the comments from Dr Jamison and Robertson, and the reply from Dr Taylor and Dr Walker (Dec. 18, p. 1396). One question raised by the Stanford group related to the performance of the specific gravity strip test in normal controls excreting highly concentrated or very dilute urine. Anticipating this question, and taking a purely empirical approach to compare available methods, local investigators did a study on normal volunteers. Urinary specific gravity was determined in twelve subjects under conditions of the concentration and dilution tests described by Henry et al.Essentially equivalent results were obtained for specific gravity as measured by the strip method, by 2 Dr
hydrometry, and by refractometry (using two methods).2 Miles
Laboratories, Court, Stoke Poges, Slough SL2 4LY Stoke
B. A. ELLIOTT
LABORATORY DIAGNOSIS OF CAPD PERITONITIS
SIR,-We were interested in the article on the laboratory diagnosis and treatment of CAPD (continuous ambulatory peritoneal dialysis) peritonitis by Dr Knight and colleagues (Dec. 11, p. 1301). We too3 have altered our investigation of CAPD infections, using a methods which involves the use of pour plates. It can be done by all our technicians, during on-call hours if necessary. Peritonitis is a potentially lethal complication of CAPD and we feel that the peritoneal fluid should be examined as soon as possible so that the offending organism is isolated and the correct antibiotic given. Over the past year we have isolated 120 strains of which 63 were Staphylococcus albus. Pseudomonas species, which were not found by the Portsmouth workers, accounted for 8 episodes and nearly always resulted in the removal of the Tenkhoff catheter. Our initial treatment is oral cephalexin and intraperitoneal cefuroxime (250 mg per 2 litre dialysis bag) as we believe that oral therapy alone is not sufficient. Much work remains to be done to find the best way to treat peritonitis in CAPD patients but Knight and his colleagues have gone some way to achieving this goal. Department of Bacteriology, Royal Hallamshire Hospital, Sheffield S10 2JF
ROBERT C. SPENCER PATRICIA FENTON
Cannon DC, Winkelman JW, eds. Clinical chemistry principles and Harper and Row, 1974: 1547. 2 Gounden D, Newall RG. Urine specific gravity measurements: Comparison of a new reagent strip method with existing methodologies as applied to the water concentration/dilution tests. Curr Med Res Opin (in press). 3. Fenton P Laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis J Clin Pathol 1982; 35: 1181-84. 1
Henry RJ,
technics New York: