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THE CINEMA IN PSYCHIATRY
1280
generation. He realised the objection to parttime referees, but pointed out that there is need of referees who are on the spot and are of high professional standard ; in some districts there was not an unlimited supply of medical men and they had consequently to be used for more than one purpose. The question of a possible right of from absolute decision of the referee is the appeal apparently being considered at this moment by the valuable interdepartmental committee over which Judge STEWART presides. The committee, which is investigating several of the problems (including nystagmus) raised in the discussions on the Bill, is taking evidence from all sides, from trade-unions, doctors, lawyers, and officials. It
inevitable that Members of Parliament would prefer to wait till the committee’s conclusions are available. Mr. Mainwaring’s Bill was, he said, revolutionary. The proposal to oust the jurisdiction of the county court and hand all compensation disputes over to a novel non-judicial tribunal was in itself far too startling for the average legislator who thinks that the usurpation of judicial functions by bureaucratic bodies has already gone far enough. The Bill was rejected by a slender but sufficient majority ; it will doubtless reappear anon. Meanwhile the views of its supporters should be pondered, It would be a pity if all trade-unionists were encouraged to believe that the hand of every doctor is against them.
was
ANNOTATIONS THE CINEMA IN PSYCHIATRY
THE life, is
cinema, penetrating every side of everyday being used increasingly in medicine, and has proved serviceable for recording and analysing neurological abnormalities. Broadly speaking, the most useful
text-books are those most profusely illustrated, for the study of many photographs of main-en-griffe, main-de-prédicateur, the various types of dystrophy, and other such problems in differential diagnosis brings home to the reader the essential points in the anatomy and pathology of these disorders. In the allied department of the psychiatry problem is very different. It is on the language that the patient uses or does not use, rather than his appearance, that we form conclusions about his instability, the danger he presents to himself or others, the seriousness of his condition, and its probable duration. Such language may be described but cannot be reproduced effectively in any text-book, and the newly qualified practitioner must chiefly rely on recollections of what he gleaned on a few expeditions to mental hospitals during his student career--expeditions that are not very likely to have left him with clear ideas of the fundamentals of psychological medicine. In such hospitals there is often an immense mass of teaching material, but it can seldom be presented in such a way as to be assimilable. In the talking cinema, we suggest, psychiatry has an instrument not only for entertaining the mentally afflicted, but also for educating the uninitiated. Visits to. mental hospitals will still be necessary, but clinical lectures implemented by cinematograph demonstrations to which all can attend-and not merely the few near the patient in the hospital-must impress the essentials of psychiatry on those who both see and listen. They would see the methods the psychiatrist adopts to reveal the disordered thinking. The lecturer could during the silent course of the film draw special attention to the important points without arousing the absent patients’ antagonisms or sensibilities. Moreover, by presenting in succession a depressive with hypo chondriacal delusions and much affect, a schizophrenic with such delusions and no affect, and an anxiety-laden neurotic with gastric symptoms of a conversion type, certain important points in differential diagnosis could be exemplified. The clinical demonstration of cases of psychoneurosis is a matter of difficulty and delicacy. But a film could well be made to show some of the methods
neurological
of elucidation and persuasion with which the milder forms of these disorders are tackled. Such a film might be of first-class educational value. HELIUM IN THERAPEUTICS
THE low specific gravity of helium as compared with nitrogen (the relation is 2 to 14) has led to the use of this gas as a diluent for oxygen in certain types of dyspnoea. A. L. Barach of New York has recently set out1 the theoretical basis for the use of helium, adding some clinical observations of his own. The substitution of helium for nitrogen in a volume of air provides a respirable gas mixture which is one-third the density of air. During quiet breathing the influence of this substitution is negligible, but with obstruction in any part of the respiratory tract there may be a saving of effort when the lighter gas mixture is substituted. The technical problem is to exclude nitrogen from the apparatus and to control the percentage of helium. For short periods of such as half to three hours, a closed administration, circuit (rebreathing) apparatus has been used with a mouthpiece or mask. At the beginning nitrogen is washed out of the lungs by a rapid flow of the heliumoxygen mixture (about 15 litres per minute), and the first few breaths are exhaled through a two-way valve. After this the apparatus is fed with the helium-oxygen mixture at the rate of about 4 litres per minute. For more prolonged administration a modification of the oxygen tent made with heliumproof fabric has been employed. In the treatment of asthma, particularly for the patient in status asthmaticus to whom adrenaline and other measures have ceased to give relief, the use of the heliumoxygen mixture has given prompt relief both objectively and subjectively, probably because of the decreased respiratory effort required for pulmonary ventilation with the lighter gas. In patients with obstructive conditions of the trachea, larynx, and bronchi, the use of this new gas mixture has also produced beneficial results in some instances thereby averting tracheotomy. The value of helium with oxygen in emphysema, associated with bronchiectasis or fibrosis or both, is shown by certain records which indicate that smaller concentrations of oxygen are necessary to produce similar restoration of pulmonary function when helium is used as the diluent. The cost of helium may at the moment prevent its more general use, but Dr. Barach explains that a Bill has already passed certain stages making Government 1
Jour. Amer. Med. Assoc., Oct. 17th, p. 1273.
generation. He realised the objection to parttime referees, but pointed out that there is need of referees who are on the spot and are of high professional standard ; in some districts there was not an unlimited supply of medical men and they had consequently to be used for more than one purpose. The question of a possible right of from absolute decision of the referee is the appeal apparently being considered at this moment by the valuable interdepartmental committee over which Judge STEWART presides. The committee, which is investigating several of the problems (including nystagmus) raised in the discussions on the Bill, is taking evidence from all sides, from trade-unions, doctors, lawyers, and officials. It
inevitable that Members of Parliament would prefer to wait till the committee’s conclusions are available. Mr. Mainwaring’s Bill was, he said, revolutionary. The proposal to oust the jurisdiction of the county court and hand all compensation disputes over to a novel non-judicial tribunal was in itself far too startling for the average legislator who thinks that the usurpation of judicial functions by bureaucratic bodies has already gone far enough. The Bill was rejected by a slender but sufficient majority ; it will doubtless reappear anon. Meanwhile the views of its supporters should be pondered, It would be a pity if all trade-unionists were encouraged to believe that the hand of every doctor is against them.
was
ANNOTATIONS THE CINEMA IN PSYCHIATRY
THE life, is
cinema, penetrating every side of everyday being used increasingly in medicine, and has proved serviceable for recording and analysing neurological abnormalities. Broadly speaking, the most useful
text-books are those most profusely illustrated, for the study of many photographs of main-en-griffe, main-de-prédicateur, the various types of dystrophy, and other such problems in differential diagnosis brings home to the reader the essential points in the anatomy and pathology of these disorders. In the allied department of the psychiatry problem is very different. It is on the language that the patient uses or does not use, rather than his appearance, that we form conclusions about his instability, the danger he presents to himself or others, the seriousness of his condition, and its probable duration. Such language may be described but cannot be reproduced effectively in any text-book, and the newly qualified practitioner must chiefly rely on recollections of what he gleaned on a few expeditions to mental hospitals during his student career--expeditions that are not very likely to have left him with clear ideas of the fundamentals of psychological medicine. In such hospitals there is often an immense mass of teaching material, but it can seldom be presented in such a way as to be assimilable. In the talking cinema, we suggest, psychiatry has an instrument not only for entertaining the mentally afflicted, but also for educating the uninitiated. Visits to. mental hospitals will still be necessary, but clinical lectures implemented by cinematograph demonstrations to which all can attend-and not merely the few near the patient in the hospital-must impress the essentials of psychiatry on those who both see and listen. They would see the methods the psychiatrist adopts to reveal the disordered thinking. The lecturer could during the silent course of the film draw special attention to the important points without arousing the absent patients’ antagonisms or sensibilities. Moreover, by presenting in succession a depressive with hypo chondriacal delusions and much affect, a schizophrenic with such delusions and no affect, and an anxiety-laden neurotic with gastric symptoms of a conversion type, certain important points in differential diagnosis could be exemplified. The clinical demonstration of cases of psychoneurosis is a matter of difficulty and delicacy. But a film could well be made to show some of the methods
neurological
of elucidation and persuasion with which the milder forms of these disorders are tackled. Such a film might be of first-class educational value. HELIUM IN THERAPEUTICS
THE low specific gravity of helium as compared with nitrogen (the relation is 2 to 14) has led to the use of this gas as a diluent for oxygen in certain types of dyspnoea. A. L. Barach of New York has recently set out1 the theoretical basis for the use of helium, adding some clinical observations of his own. The substitution of helium for nitrogen in a volume of air provides a respirable gas mixture which is one-third the density of air. During quiet breathing the influence of this substitution is negligible, but with obstruction in any part of the respiratory tract there may be a saving of effort when the lighter gas mixture is substituted. The technical problem is to exclude nitrogen from the apparatus and to control the percentage of helium. For short periods of such as half to three hours, a closed administration, circuit (rebreathing) apparatus has been used with a mouthpiece or mask. At the beginning nitrogen is washed out of the lungs by a rapid flow of the heliumoxygen mixture (about 15 litres per minute), and the first few breaths are exhaled through a two-way valve. After this the apparatus is fed with the helium-oxygen mixture at the rate of about 4 litres per minute. For more prolonged administration a modification of the oxygen tent made with heliumproof fabric has been employed. In the treatment of asthma, particularly for the patient in status asthmaticus to whom adrenaline and other measures have ceased to give relief, the use of the heliumoxygen mixture has given prompt relief both objectively and subjectively, probably because of the decreased respiratory effort required for pulmonary ventilation with the lighter gas. In patients with obstructive conditions of the trachea, larynx, and bronchi, the use of this new gas mixture has also produced beneficial results in some instances thereby averting tracheotomy. The value of helium with oxygen in emphysema, associated with bronchiectasis or fibrosis or both, is shown by certain records which indicate that smaller concentrations of oxygen are necessary to produce similar restoration of pulmonary function when helium is used as the diluent. The cost of helium may at the moment prevent its more general use, but Dr. Barach explains that a Bill has already passed certain stages making Government 1
Jour. Amer. Med. Assoc., Oct. 17th, p. 1273.