569
convenient, since no court hearing is necessary. Mr Podrabinek is among those (in the postscript to his book) to have called upon the World Psychiatric Conference to investigate Soviet abuse of psychiatry, and he will no doubt welcome the Association’s agreement to establish a committee to monitor instances of psychiatric abuse throughout the world. This move may also please those who believe that the Soviet Union is not the only place where the role of psychiatry in the treatment of those convicted of crime needs closer attention; certainly in Britain charges that prisoners are subjected to unjustifiable drug treatment, and that mentally ill prisoners do not receive adequate psychiatric help, have still to be fully answered. are more
Notes and News ABUSE OF PSYCHIATRY THE World Psychiatric Association which has been meeting in Honolulu agreed for the first time in its history to discuss the misuse of psychiatry for political purposes and, despite fierce opposition and denials from the official Soviet delegation, passed a resolution condemning such practices in the U.S.S.R. A book recently received by Amnesty InternationalPunitive Medicine, a Samizdat monograph by Alexander Podrabinek-claims that there are at least 1000 people confined in the Soviet Union for political rather than medical reasons in special psychiatric hospitals (that is, institutions for "especially dangerous" mentally ill criminals); that there are many more confined for political reasons in ordinary (civil) psychiatric hospitals, and others similarly confined who are not dissenters but who have fallen foul of the bureaucracy in one way or another; and that there are also mentally ill people who are confined to psychiatric hospitals not on the grounds of their illness but because they have expressed views which the State security authorities consider politically threatening. Amnesty, which has prepared a summary of the book (itself published in incomplete form because some material was lost when the manuscript was confiscated by the K.G.B.), believes that Mr Podrabinek’s book is unique not because it has much new information but because it examines methodically the origins of the abuses and the institutional mechanisms by which they operate. Mr Podrabinek traces the history of the political use of psychiatry in the U.S.S.R. to the beginning of the 20th century, or even earlier, but says that it only became the system from the 1940s, and did not receive worldwide publicity until the late 1960s. Punitive medicine in the U.S.S.R. is based on the hard-won principle that the mentally ill may not be punished for their criminal activities, but may be forcibly detained for treatment. But the application of this principle against so-called dissenters depends not only on defining as crimes the exercise of such human rights as freedom of expression and freedom of assembly, but also on the acceptance of a logical inconsistency. A Soviet court can rule both that a person is not accountable for his actions because he is mentally ill, and at the same time that he has committed a crime which by definition has been committed with deliberate intent against the State-for example, flight abroad is labelled treason because it is assumed that those trying to leave possess secret information which they intend to sell to a foreign power. The fate of the political victims of psychiatry is decided not in accordance with the country’s laws, but by the State security authorities, who suborn the psychiatrists to make the appropriate recommendations. There is no doubt, according to Mr Podrabinek, that there are close links between the K.G.B. and the Serbsky Institute of Forensic Psychiatry in Moscow. The basic definition of mental illness in the U.S.S.R., the book asserts, is "absence of social adaptation", and diagnostic terminology and concepts are broad and vague; virtually any behaviour can thus be interpreted as proof of mental illness. Mr Podrabinek’s book contains a list of 102 Soviet psychiatrists known to have practised punitive medicine; only a handful of psychiatrists have spoken out against the system. Conditions inside the special psychiatric hospitals, as described in the book, are extremely harsh: visits, letters, and parcels are strictly controlled; beatings are frequent; and discipline through inappropriate drug treatments (often with no attempt to test for contraindications) is widespread. Drug treatment is also common in the ordinary psychiatric hospitals. Mr Podrabinek believes that confinement in the civil psychiatric hospitals is being used more frequently than previously for dealing with political dissenters as well as those committing unpolitical "crimes"; the procedures for commitment to these hospitals
INDUSTRIAL EXPOSURE TO ULTRAVIOLET ULTRAVIOLET radiations (wavelength band 10-400 nm) are readily attenuated. Exposure hazards lies in the half of the spectrum nearer the visible, and even then the rays cannot penetrate far so that skin and eyes are the organs at risk. The most common hazard of natural ultraviolet radiation is sunburn and the most serious is skin cancer. Fortunately no case of skin cancer associated with artificial ultraviolet is known, but those who work with artificial ultraviolet or are exposed to it may get damage to eyes and skin. Industrially the group most at risk are welders who, without protection, may get a keratoconjunctivitis known as "welder’s flash". Chemical photosensitivity is an unpredictable hazard in a few people, and patients with porphyria face a similar problem. The National Radiological Protection Board has issued a useful pamphletI on avoidance of risks. Maximum permissible exposures are straightforward in the wavelength range 315-400 nm, but below 315 nm calculations must be based on spectral analysis and weighted exposures, unless the source is monochromatic.
HELPING PRESCRIBERS TO USE THE ADVERSE REACTIONS REGISTER
Safety of Medicines has just distributed of edited extracts from the Register of Adverse Reactions. Seven loose-leaf volumes cover the reactions reported up to the end of June, 1976. As before,2 reactions are listed both by drug and by the type of reaction. The sets of volumes will be available in postgraduate centres, medical schools, and hospital pharmacies, so that they should be within reach, though not always comfortable and immediate reach, of every doctor. It would be unrealistic to provide every doctor with the 7-volume set, but the adverse reactions subcommittee might consider sending doctors, or at least those who would like it, the index of the set. This would enable the prescriber to ask his nearest drug information centre, or postgraduate centre for a copy of the pages he needs; it would also help drug-information pharmacists and postgraduate-centre librarians. THE Committee
a new
updated
on
set
DERBYSHIRE CHILDREN’S HOSPITAL CENTENARY
DERBYSHIRE Hospital for Sick Children opened at No. 4, Duffield Road, Derby, on Sept. 1, 1877. It consisted of 7 cots, in the care of a lady superintendent-the only hospital provision for children under 7 years in a town of 70 000 people, where 40% of all deaths occurred in children less than 5 years. Heavy demand led to the construction of a ward block on the North Street bowling-green-the site of the present hospital. Further developments, financed by local appeals, allowed more wards, a nurses’ home (nurse training started in 1883), and a 1. National Radiological Protection Board. Protection against Ultraviolet Radiation in the Workplace. H.M. Stationery Office. 1977. Pp. 16. 40p. 2. See Lancet, 1974, ii, 1363.
570 modern operating-theatre to be opened by the Princess Royal in February, 1938. Since its incorporation into the N.H.S., progress at the hospital has been overseen by the local management committee and lately by the South Derbyshire Health District; the present 106 beds provide most of the children’s medical and surgical specialist services for an area of nearly half a million people. The latest voluntary project is a centenary appeal fund for 30 000 for a physiotherapy unit, with building starting, appropriately, on Sept. 1. Other commemorative events have included a scientific medical meeting, a dinner of past and present medical staff, a historical exhibition, and a civic service. 1977 has been a memorable jubilee and centenary year for the hospital, with jubilee medals being awarded to two staff who have given long service, and the Queen’s visit to confer City status on Derby.
MAILING CONTRIBUTIONS FROM NORTH AMERICA IN the past few months many contributions from North America submitted for publication in The Lancet have been arriving by surface mail, though it is usually clear that they were intended to come by air mail. We are now regularly receiving inquiries about the fate of submissions which have not yet reached us, or have only just arrived, having been in transit for 4-6 weeks. Contributors in North America may therefore wish to take special care when mailing items they want to come by air; only the top copy of a typescript needs to be submitted.
University of Leeds Dr D. B. Morgan has been appointed to
A.B.P.I.
Appeal on Pharmaceutical Imports
The Association of the British Pharmaceutical Industry has asked the Government to help check the continuing increase in pharmaceutical imports, which in the first half of 1977 have risen by over 43%, while exports have risen by only 23%. The Association believes that investment in the British pharmaceutical industry has been driven away because of Government proposals for the public ownership of a sector of the industry; it would also like to see the new Patents Act (which comes into effect in June, 1978) amended to give protection to pharmaceutical products. As it stands the Act excludes existing patents with less than 5 years to run from the additional 4 years of patent protection. -
A meeting on acute and chronic effects of radiation on man is to be held by the Society for Radiological Protection on Tuesday, Jan. 24, at the Middlesex Hospital, London. Details may be had from Prof. J. H. Martin, Department of Medical Biophysics, Blackness Laboratory, University of Dundee, DD14HN.
Correction The Metabolic Homaeostatic Role of Muscle and its Function as a Store of Protein.-In this article by Prof. P. M. Daniel and his colleagues (Aug. 27) the sentence starting on line 6 of the right-hand column on p. 447 should read, "When this happens during fasting the muscle protein is not rebuilt...".
Diary of the Week
the chair of chemi-
cal pathology. ’
from the Welsh National School of Medicine in 1959 and M.D. in 1967; he became M.R.C.PATH. in 1975. He first went to Leeds in 1963 as research assistant in the Clinical Investigation Unit, and he was lecturer in clinical investigation from 1965 to 1969. He then spent two years as chief assistant in the department of pathophysiology, University of Bern, Switzerland, and one year as lecturer in physiology at the University of Nottingham. He returned to Leeds University in 1972 as senior lecturer in chemical pathology, becoming reader in 1976; since 1973 he has been honorary consultant to the Leeds A.H.A. (teaching). His present research interests include potassium metabolism, metabolic responses to surgery, and the role of cell analysis in diagnosis. Dr
Morgan graduated
SEPT. 11
M.B.
,
Normansfield Hospital Inquiry The inquiry into Normansfield Hospital, Teddington, resumed hearings at 10.30 A.M. on Monday, Sept. 5, in the St. James’ Conference Centre, 74 Little James’ Street, London SW1. Among those to give evidence are the hospital nursing, administrative, and medical staff, and officials from the area and regional health authorities. The inquiry hears evidence in
public.
Monday, INSTITUTE 4.30
TO
17
12th
OF
P.M.
OBSTETRICS AND GYNRCOLOGY, Queen Charlotte’s Hospital, Goldhawk Road, London W6 OXG Dr Anne B. M. Anderson: The Endocrine Control of Parturition.
Tuesday, 13th ST. MARY’S HOSPITAL MEDICAL SCHOOL, Praed Street, London W2 INY 5.30 P.M. Dr Arne Serck-Hanssen (Oslo): Experience with Gastroscopic Brush Cytology in over 3000 Cases.
Wednesday, 14th INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD * 6 P.M. Dr C. B. Wynn Parry: General Assessment. 7 P.M. Dr Barbara Ansell: Juvenile Chronic Arthritis. NORTHW1CK PARK HOSPITAL, Watford Road, Harrow, Middlesex HA13UJ 1 P.M. Dr Hillas Smith: Infectious Diseases. ROYAL FREE HOSPITAL, Pond Street, Hampstead, London NW3 2QG 5 P.M. Dr Gillian C. Hanson: Septic Shock.
Thursday, 15th ROYAL COLLEGE OF PHYSICIANS
4.30
P.M.
OF
LONDON
(Medical School, University of Sheffield, Beech Hill Road, SIO 2RX.) Prof. R. F. Mahler: Fat-The Good, the Bad, and the Ugly. (Bradshaw lecture.)
Appointments North-West Thames Regional Health Authority: SAMSON, DIANA M., M.D., B.sc.Lond., M.R.C.P., M.R.C.PATH.: consultant hsemaNorthwick Park Hospital (joint appointment with Medical Research Council). TERRY, D. A., M.B.Lond., M.R.C.PSYCH., D.P.M. : consultant psychiatrist, Watford General Hospital and Napsbury Hospital. TREVES BROWN, C. P., M.B.Lond., M.R.C.PSYCH., D.P.M.: consultant psychiatrist, Bedford General and Fairfield Hospitals. TROWELL, JUDITH A., M.B.Lond., M.R.C.PSYCH., D.C.H., D.P.M. : consultant child psychiatrist, Watford Child and Family Psychiatric Clinic and Watford General Hospital. WARD, JOANNA M., M.B.Lond., M.R.C.P.: consultant dermatologist, Hillingdon Hospital and West Middlesex Hospital.
tologist,
International Prize for Modern Nutrition The prize will be awarded in 1978 for work on milk and milk products in the nutrition of the elderly, and in 1979 for work on the social and psychological aspects of the selection of nutrition. All scientists who have worked in these fields are eligible to enter. Details may be had from Prof. M. Demole, 4 chemin Castoldi, CH-1208 Geneva, Switzerland.
convenient, since no court hearing is necessary. Mr Podrabinek is among those (in the postscript to his book) to have called upon the World Psychiatric Conference to investigate Soviet abuse of psychiatry, and he will no doubt welcome the Association’s agreement to establish a committee to monitor instances of psychiatric abuse throughout the world. This move may also please those who believe that the Soviet Union is not the only place where the role of psychiatry in the treatment of those convicted of crime needs closer attention; certainly in Britain charges that prisoners are subjected to unjustifiable drug treatment, and that mentally ill prisoners do not receive adequate psychiatric help, have still to be fully answered. are more
Notes and News ABUSE OF PSYCHIATRY THE World Psychiatric Association which has been meeting in Honolulu agreed for the first time in its history to discuss the misuse of psychiatry for political purposes and, despite fierce opposition and denials from the official Soviet delegation, passed a resolution condemning such practices in the U.S.S.R. A book recently received by Amnesty InternationalPunitive Medicine, a Samizdat monograph by Alexander Podrabinek-claims that there are at least 1000 people confined in the Soviet Union for political rather than medical reasons in special psychiatric hospitals (that is, institutions for "especially dangerous" mentally ill criminals); that there are many more confined for political reasons in ordinary (civil) psychiatric hospitals, and others similarly confined who are not dissenters but who have fallen foul of the bureaucracy in one way or another; and that there are also mentally ill people who are confined to psychiatric hospitals not on the grounds of their illness but because they have expressed views which the State security authorities consider politically threatening. Amnesty, which has prepared a summary of the book (itself published in incomplete form because some material was lost when the manuscript was confiscated by the K.G.B.), believes that Mr Podrabinek’s book is unique not because it has much new information but because it examines methodically the origins of the abuses and the institutional mechanisms by which they operate. Mr Podrabinek traces the history of the political use of psychiatry in the U.S.S.R. to the beginning of the 20th century, or even earlier, but says that it only became the system from the 1940s, and did not receive worldwide publicity until the late 1960s. Punitive medicine in the U.S.S.R. is based on the hard-won principle that the mentally ill may not be punished for their criminal activities, but may be forcibly detained for treatment. But the application of this principle against so-called dissenters depends not only on defining as crimes the exercise of such human rights as freedom of expression and freedom of assembly, but also on the acceptance of a logical inconsistency. A Soviet court can rule both that a person is not accountable for his actions because he is mentally ill, and at the same time that he has committed a crime which by definition has been committed with deliberate intent against the State-for example, flight abroad is labelled treason because it is assumed that those trying to leave possess secret information which they intend to sell to a foreign power. The fate of the political victims of psychiatry is decided not in accordance with the country’s laws, but by the State security authorities, who suborn the psychiatrists to make the appropriate recommendations. There is no doubt, according to Mr Podrabinek, that there are close links between the K.G.B. and the Serbsky Institute of Forensic Psychiatry in Moscow. The basic definition of mental illness in the U.S.S.R., the book asserts, is "absence of social adaptation", and diagnostic terminology and concepts are broad and vague; virtually any behaviour can thus be interpreted as proof of mental illness. Mr Podrabinek’s book contains a list of 102 Soviet psychiatrists known to have practised punitive medicine; only a handful of psychiatrists have spoken out against the system. Conditions inside the special psychiatric hospitals, as described in the book, are extremely harsh: visits, letters, and parcels are strictly controlled; beatings are frequent; and discipline through inappropriate drug treatments (often with no attempt to test for contraindications) is widespread. Drug treatment is also common in the ordinary psychiatric hospitals. Mr Podrabinek believes that confinement in the civil psychiatric hospitals is being used more frequently than previously for dealing with political dissenters as well as those committing unpolitical "crimes"; the procedures for commitment to these hospitals
INDUSTRIAL EXPOSURE TO ULTRAVIOLET ULTRAVIOLET radiations (wavelength band 10-400 nm) are readily attenuated. Exposure hazards lies in the half of the spectrum nearer the visible, and even then the rays cannot penetrate far so that skin and eyes are the organs at risk. The most common hazard of natural ultraviolet radiation is sunburn and the most serious is skin cancer. Fortunately no case of skin cancer associated with artificial ultraviolet is known, but those who work with artificial ultraviolet or are exposed to it may get damage to eyes and skin. Industrially the group most at risk are welders who, without protection, may get a keratoconjunctivitis known as "welder’s flash". Chemical photosensitivity is an unpredictable hazard in a few people, and patients with porphyria face a similar problem. The National Radiological Protection Board has issued a useful pamphletI on avoidance of risks. Maximum permissible exposures are straightforward in the wavelength range 315-400 nm, but below 315 nm calculations must be based on spectral analysis and weighted exposures, unless the source is monochromatic.
HELPING PRESCRIBERS TO USE THE ADVERSE REACTIONS REGISTER
Safety of Medicines has just distributed of edited extracts from the Register of Adverse Reactions. Seven loose-leaf volumes cover the reactions reported up to the end of June, 1976. As before,2 reactions are listed both by drug and by the type of reaction. The sets of volumes will be available in postgraduate centres, medical schools, and hospital pharmacies, so that they should be within reach, though not always comfortable and immediate reach, of every doctor. It would be unrealistic to provide every doctor with the 7-volume set, but the adverse reactions subcommittee might consider sending doctors, or at least those who would like it, the index of the set. This would enable the prescriber to ask his nearest drug information centre, or postgraduate centre for a copy of the pages he needs; it would also help drug-information pharmacists and postgraduate-centre librarians. THE Committee
a new
updated
on
set
DERBYSHIRE CHILDREN’S HOSPITAL CENTENARY
DERBYSHIRE Hospital for Sick Children opened at No. 4, Duffield Road, Derby, on Sept. 1, 1877. It consisted of 7 cots, in the care of a lady superintendent-the only hospital provision for children under 7 years in a town of 70 000 people, where 40% of all deaths occurred in children less than 5 years. Heavy demand led to the construction of a ward block on the North Street bowling-green-the site of the present hospital. Further developments, financed by local appeals, allowed more wards, a nurses’ home (nurse training started in 1883), and a 1. National Radiological Protection Board. Protection against Ultraviolet Radiation in the Workplace. H.M. Stationery Office. 1977. Pp. 16. 40p. 2. See Lancet, 1974, ii, 1363.
570 modern operating-theatre to be opened by the Princess Royal in February, 1938. Since its incorporation into the N.H.S., progress at the hospital has been overseen by the local management committee and lately by the South Derbyshire Health District; the present 106 beds provide most of the children’s medical and surgical specialist services for an area of nearly half a million people. The latest voluntary project is a centenary appeal fund for 30 000 for a physiotherapy unit, with building starting, appropriately, on Sept. 1. Other commemorative events have included a scientific medical meeting, a dinner of past and present medical staff, a historical exhibition, and a civic service. 1977 has been a memorable jubilee and centenary year for the hospital, with jubilee medals being awarded to two staff who have given long service, and the Queen’s visit to confer City status on Derby.
MAILING CONTRIBUTIONS FROM NORTH AMERICA IN the past few months many contributions from North America submitted for publication in The Lancet have been arriving by surface mail, though it is usually clear that they were intended to come by air mail. We are now regularly receiving inquiries about the fate of submissions which have not yet reached us, or have only just arrived, having been in transit for 4-6 weeks. Contributors in North America may therefore wish to take special care when mailing items they want to come by air; only the top copy of a typescript needs to be submitted.
University of Leeds Dr D. B. Morgan has been appointed to
A.B.P.I.
Appeal on Pharmaceutical Imports
The Association of the British Pharmaceutical Industry has asked the Government to help check the continuing increase in pharmaceutical imports, which in the first half of 1977 have risen by over 43%, while exports have risen by only 23%. The Association believes that investment in the British pharmaceutical industry has been driven away because of Government proposals for the public ownership of a sector of the industry; it would also like to see the new Patents Act (which comes into effect in June, 1978) amended to give protection to pharmaceutical products. As it stands the Act excludes existing patents with less than 5 years to run from the additional 4 years of patent protection. -
A meeting on acute and chronic effects of radiation on man is to be held by the Society for Radiological Protection on Tuesday, Jan. 24, at the Middlesex Hospital, London. Details may be had from Prof. J. H. Martin, Department of Medical Biophysics, Blackness Laboratory, University of Dundee, DD14HN.
Correction The Metabolic Homaeostatic Role of Muscle and its Function as a Store of Protein.-In this article by Prof. P. M. Daniel and his colleagues (Aug. 27) the sentence starting on line 6 of the right-hand column on p. 447 should read, "When this happens during fasting the muscle protein is not rebuilt...".
Diary of the Week
the chair of chemi-
cal pathology. ’
from the Welsh National School of Medicine in 1959 and M.D. in 1967; he became M.R.C.PATH. in 1975. He first went to Leeds in 1963 as research assistant in the Clinical Investigation Unit, and he was lecturer in clinical investigation from 1965 to 1969. He then spent two years as chief assistant in the department of pathophysiology, University of Bern, Switzerland, and one year as lecturer in physiology at the University of Nottingham. He returned to Leeds University in 1972 as senior lecturer in chemical pathology, becoming reader in 1976; since 1973 he has been honorary consultant to the Leeds A.H.A. (teaching). His present research interests include potassium metabolism, metabolic responses to surgery, and the role of cell analysis in diagnosis. Dr
Morgan graduated
SEPT. 11
M.B.
,
Normansfield Hospital Inquiry The inquiry into Normansfield Hospital, Teddington, resumed hearings at 10.30 A.M. on Monday, Sept. 5, in the St. James’ Conference Centre, 74 Little James’ Street, London SW1. Among those to give evidence are the hospital nursing, administrative, and medical staff, and officials from the area and regional health authorities. The inquiry hears evidence in
public.
Monday, INSTITUTE 4.30
TO
17
12th
OF
P.M.
OBSTETRICS AND GYNRCOLOGY, Queen Charlotte’s Hospital, Goldhawk Road, London W6 OXG Dr Anne B. M. Anderson: The Endocrine Control of Parturition.
Tuesday, 13th ST. MARY’S HOSPITAL MEDICAL SCHOOL, Praed Street, London W2 INY 5.30 P.M. Dr Arne Serck-Hanssen (Oslo): Experience with Gastroscopic Brush Cytology in over 3000 Cases.
Wednesday, 14th INSTITUTE OF ORTHOPEDICS, 234 Great Portland Street, London WIN 6AD * 6 P.M. Dr C. B. Wynn Parry: General Assessment. 7 P.M. Dr Barbara Ansell: Juvenile Chronic Arthritis. NORTHW1CK PARK HOSPITAL, Watford Road, Harrow, Middlesex HA13UJ 1 P.M. Dr Hillas Smith: Infectious Diseases. ROYAL FREE HOSPITAL, Pond Street, Hampstead, London NW3 2QG 5 P.M. Dr Gillian C. Hanson: Septic Shock.
Thursday, 15th ROYAL COLLEGE OF PHYSICIANS
4.30
P.M.
OF
LONDON
(Medical School, University of Sheffield, Beech Hill Road, SIO 2RX.) Prof. R. F. Mahler: Fat-The Good, the Bad, and the Ugly. (Bradshaw lecture.)
Appointments North-West Thames Regional Health Authority: SAMSON, DIANA M., M.D., B.sc.Lond., M.R.C.P., M.R.C.PATH.: consultant hsemaNorthwick Park Hospital (joint appointment with Medical Research Council). TERRY, D. A., M.B.Lond., M.R.C.PSYCH., D.P.M. : consultant psychiatrist, Watford General Hospital and Napsbury Hospital. TREVES BROWN, C. P., M.B.Lond., M.R.C.PSYCH., D.P.M.: consultant psychiatrist, Bedford General and Fairfield Hospitals. TROWELL, JUDITH A., M.B.Lond., M.R.C.PSYCH., D.C.H., D.P.M. : consultant child psychiatrist, Watford Child and Family Psychiatric Clinic and Watford General Hospital. WARD, JOANNA M., M.B.Lond., M.R.C.P.: consultant dermatologist, Hillingdon Hospital and West Middlesex Hospital.
tologist,
International Prize for Modern Nutrition The prize will be awarded in 1978 for work on milk and milk products in the nutrition of the elderly, and in 1979 for work on the social and psychological aspects of the selection of nutrition. All scientists who have worked in these fields are eligible to enter. Details may be had from Prof. M. Demole, 4 chemin Castoldi, CH-1208 Geneva, Switzerland.
