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THE HUMAN HERITAGE
145
somatotrophin, and prolactin, together with repeated breast-pump application, has led to the expression of colostrum from the breasts of a male transvestist (who, having previously been known8 to father children, may be presumed to be XY!), Foss has in fact succeeded in achieving just that. University College Hospital, London, W.C.1.
G. I. M. SWYER.
MULTIPLE MYELOMATOSIS AND MACROGLOBULINÆMIA
SIR,—We wish to confirm the report by Miss Silberman (July 6, p. 26) of the usefulness of starch-gel electro-
phoresis for the differentiation of multiple myelomatosis from macroglobulinaemia. One of us (A. H. Z.) actually demonstrated this to the Association of Clinical Biochemists at the joint meeting with the Biochemical Society held at Newcastle upon Tyne on June 29. Department, of Pathology, A. L. LATNER Royal Victoria Infirmary, rr ZAKI. ANGEL HABIB r? Newcastle upon Tyne. 1.
SIR,—Following the preliminary communication of Miss Silberman, it is perhaps interesting to recall that we made similar observations using agar-gel electro: phoresis.1 10 We agree with Miss Silberman concerning the effect of size and shape of the protein molecules on their behaviour during electromigration in a gel. Incidentally, agar gel is much more easy to make and handle than starch gel. Laboratory of the Medical Clinic, University of Ghent, Belgium.
R. J. WIEME
EMPLOYMENT OF CHRONIC MENTAL PATIENTS
SIR,—Like Dr. Miller (July 13) we have lately arranged for some of our patients to earn money by work outside the hospital. From their two seasons as potato-pickers we have learnt some useful administrative lessons about methods of payment by farmers and distributing their earnings among the patients. Payment Our aim was that every patient who could benefit from the work should be allowed to join the party. " We realised, however, that many would be " passengers and this might cause some annoyance to the farmer who thought he was paying money for nothing and for this reason payment at so much an hour per man was not a good idea. Our final arrangement with the farmers was that payment should be on a basis of so much an acre and then it did not matter how many patients there were in the party, whether they were good workers or bad, provided they could keep up with the digging machine. Incidentally, in a previous year’s work we had found that 21/2 unselected patients would do one normal man’s work but for reasons of policy it was not wise to ask for payment on this basis because the farmers did not understand.
Earnings During
the second season the patients earned £1160. Transport cost £265, the patients contributed £300 towards the cost of their board at the hospital, and £600 was distributed among them as earnings. If we had followed the method of distribution laid down in the Ministry of Health circular, the patients would have received so little money that we would not willingly have contemplated potato-picking again. As a result of representations the Ministry agreed to our suggestion that after the necessary expenses had been deducted the money should be divided so that two-thirds went to the patients and the remaining third to the hospital. The Ministry agreed to this method because the work was arranged between farmer and hospital and not between farmer and patient ; in addition the patients were not constantly employed. Although the patients might 8. Foss, G. L. J. Endocrin. 1956, 14, 6. 9. Wieme, R. J. Klin. Wschr. 1956, 34, 1264. 10. Wieme, R. J. Rev. beige Path. 1957, 25, 62.
have been given more, I think this settlement not unreasonable. Their earnings ranged, according to the hours they worked, from a few shillings to nearly £9. The rate per day with all deductions was 5s. 6d. When it came to the distribution of the money each patient and his charge nurse were told what he had earned and he was asked how he wished to spend it. He was asked to spend some of it on some article of clothing or footwear so that he could have something whereby to remember his excellent work, but he was under no compulsion to agree to this. As it turned out many bought shoes, slippers, pullovers, and so on. Others wanted to give the greater part of it to their next of kin who faithfully visited them, or had them home on leave, and where the homes were poor this must have been welcome. Some wanted to keep a portion so that they could have a little extra to spend themselves when they went on leave, and nearly everyone was anxious to have a portion set aside so that they might have an all-day coach trip. I have no doubt that the proper place for a patient to work after many years of unemployment is in a normal workshop or place of labour. I do not think that sheltered employment within the hospital is the answervaluable as it may be when the ideal cannot be attainedbecause this is one more way of making life agreeable for the patient within the hospital and perhaps tempting him and his doctor alike to postpone the question of his
discharge. J. A. R. BICKFORD. THE HUMAN HERITAGE takes SIR,—It courage these days for a scientific worker to present an idea based on his clinical observation only. Sir Heneage Ogilvie is, therefore, to be congratulated when, in his Wood Jones lecture (July 6) he makes this striking remark: " He (the patient) is either unhappy because he has got cancer or he is going to get cancer because he is unhappy." Forty-three years ago, Sigmund Freud wrote: " A strong egoism is a protection against disease, but in the last resort we must begin to love in order that we may not fall ill, and must fall ill if, in consequence of frustration, we cannot love." Behind the remarks of each of these writers is a life time of experience, diverse, no doubt, but in each case full of clinical observation. This is what Freud wrote about the importance of
observation : " ...
[a science founded upon constructions arrived at will not begrudge to speculation its privilege
empirically]
smooth, logically unassailable structure, but will itself gladly content with nebulous, scarcely imaginable conceptions, which it hopes to apprehend more clearly in the course of its development, or which it is even prepared to replace by others. For these ideas are not the basis of the science upon which everything rests : that, on the contrary, is observation alone. They are not the foundation-stone, but the coping of the whole structure, and they can be replaced and discarded without damaging it."
of be
a
Both of these quotations come from a paper by Freud called On Narcissism : an Introduction (in Collected Papers, vol. IV) which, though not easy reading, will repay careful study by anyone whose mind is not clogged by a surfeit of statistics. The danger of these is that they enshrine, as holy relics, the observations on which they are based, barring the way (because of their apparent finality) to further observation, which is, as it were, rendered unnecessary. Indeed, is there not a further danger that psychology will fall into the hands of those who, without the personal observation of their own reactions that is obtained through psycho-analysis and without personal observation of those ill people through whom knowledge of the normal is acquired, dazzle the eyes with statistics based on the observations of others? DAVID RUMNEY.
somatotrophin, and prolactin, together with repeated breast-pump application, has led to the expression of colostrum from the breasts of a male transvestist (who, having previously been known8 to father children, may be presumed to be XY!), Foss has in fact succeeded in achieving just that. University College Hospital, London, W.C.1.
G. I. M. SWYER.
MULTIPLE MYELOMATOSIS AND MACROGLOBULINÆMIA
SIR,—We wish to confirm the report by Miss Silberman (July 6, p. 26) of the usefulness of starch-gel electro-
phoresis for the differentiation of multiple myelomatosis from macroglobulinaemia. One of us (A. H. Z.) actually demonstrated this to the Association of Clinical Biochemists at the joint meeting with the Biochemical Society held at Newcastle upon Tyne on June 29. Department, of Pathology, A. L. LATNER Royal Victoria Infirmary, rr ZAKI. ANGEL HABIB r? Newcastle upon Tyne. 1.
SIR,—Following the preliminary communication of Miss Silberman, it is perhaps interesting to recall that we made similar observations using agar-gel electro: phoresis.1 10 We agree with Miss Silberman concerning the effect of size and shape of the protein molecules on their behaviour during electromigration in a gel. Incidentally, agar gel is much more easy to make and handle than starch gel. Laboratory of the Medical Clinic, University of Ghent, Belgium.
R. J. WIEME
EMPLOYMENT OF CHRONIC MENTAL PATIENTS
SIR,—Like Dr. Miller (July 13) we have lately arranged for some of our patients to earn money by work outside the hospital. From their two seasons as potato-pickers we have learnt some useful administrative lessons about methods of payment by farmers and distributing their earnings among the patients. Payment Our aim was that every patient who could benefit from the work should be allowed to join the party. " We realised, however, that many would be " passengers and this might cause some annoyance to the farmer who thought he was paying money for nothing and for this reason payment at so much an hour per man was not a good idea. Our final arrangement with the farmers was that payment should be on a basis of so much an acre and then it did not matter how many patients there were in the party, whether they were good workers or bad, provided they could keep up with the digging machine. Incidentally, in a previous year’s work we had found that 21/2 unselected patients would do one normal man’s work but for reasons of policy it was not wise to ask for payment on this basis because the farmers did not understand.
Earnings During
the second season the patients earned £1160. Transport cost £265, the patients contributed £300 towards the cost of their board at the hospital, and £600 was distributed among them as earnings. If we had followed the method of distribution laid down in the Ministry of Health circular, the patients would have received so little money that we would not willingly have contemplated potato-picking again. As a result of representations the Ministry agreed to our suggestion that after the necessary expenses had been deducted the money should be divided so that two-thirds went to the patients and the remaining third to the hospital. The Ministry agreed to this method because the work was arranged between farmer and hospital and not between farmer and patient ; in addition the patients were not constantly employed. Although the patients might 8. Foss, G. L. J. Endocrin. 1956, 14, 6. 9. Wieme, R. J. Klin. Wschr. 1956, 34, 1264. 10. Wieme, R. J. Rev. beige Path. 1957, 25, 62.
have been given more, I think this settlement not unreasonable. Their earnings ranged, according to the hours they worked, from a few shillings to nearly £9. The rate per day with all deductions was 5s. 6d. When it came to the distribution of the money each patient and his charge nurse were told what he had earned and he was asked how he wished to spend it. He was asked to spend some of it on some article of clothing or footwear so that he could have something whereby to remember his excellent work, but he was under no compulsion to agree to this. As it turned out many bought shoes, slippers, pullovers, and so on. Others wanted to give the greater part of it to their next of kin who faithfully visited them, or had them home on leave, and where the homes were poor this must have been welcome. Some wanted to keep a portion so that they could have a little extra to spend themselves when they went on leave, and nearly everyone was anxious to have a portion set aside so that they might have an all-day coach trip. I have no doubt that the proper place for a patient to work after many years of unemployment is in a normal workshop or place of labour. I do not think that sheltered employment within the hospital is the answervaluable as it may be when the ideal cannot be attainedbecause this is one more way of making life agreeable for the patient within the hospital and perhaps tempting him and his doctor alike to postpone the question of his
discharge. J. A. R. BICKFORD. THE HUMAN HERITAGE takes SIR,—It courage these days for a scientific worker to present an idea based on his clinical observation only. Sir Heneage Ogilvie is, therefore, to be congratulated when, in his Wood Jones lecture (July 6) he makes this striking remark: " He (the patient) is either unhappy because he has got cancer or he is going to get cancer because he is unhappy." Forty-three years ago, Sigmund Freud wrote: " A strong egoism is a protection against disease, but in the last resort we must begin to love in order that we may not fall ill, and must fall ill if, in consequence of frustration, we cannot love." Behind the remarks of each of these writers is a life time of experience, diverse, no doubt, but in each case full of clinical observation. This is what Freud wrote about the importance of
observation : " ...
[a science founded upon constructions arrived at will not begrudge to speculation its privilege
empirically]
smooth, logically unassailable structure, but will itself gladly content with nebulous, scarcely imaginable conceptions, which it hopes to apprehend more clearly in the course of its development, or which it is even prepared to replace by others. For these ideas are not the basis of the science upon which everything rests : that, on the contrary, is observation alone. They are not the foundation-stone, but the coping of the whole structure, and they can be replaced and discarded without damaging it."
of be
a
Both of these quotations come from a paper by Freud called On Narcissism : an Introduction (in Collected Papers, vol. IV) which, though not easy reading, will repay careful study by anyone whose mind is not clogged by a surfeit of statistics. The danger of these is that they enshrine, as holy relics, the observations on which they are based, barring the way (because of their apparent finality) to further observation, which is, as it were, rendered unnecessary. Indeed, is there not a further danger that psychology will fall into the hands of those who, without the personal observation of their own reactions that is obtained through psycho-analysis and without personal observation of those ill people through whom knowledge of the normal is acquired, dazzle the eyes with statistics based on the observations of others? DAVID RUMNEY.