new surgical research laboratory in glasgow

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920 avoided all forms of excitement, and he was thought to have died of adrenal excess as a result of the suicidal attempt. The general pattern in this series remains the same as in the sixty-five cases I reported in 1957. A little less than a third had no organic disease, a little less than a third had severe hypertension, and the rest had a wide variety of painful, disabling, or fear-engendering diseases. It is, of course, impossible to assess in each case how far the physical disease contributed to the suicide. What is clear is that the suicides encountered in the Keighley district have been, on the whole, a group of unfit or seriously ill people. I am indebted to Mr. Stephen E. Brown, H.M. Coroner for the Craven District of Yorkshire, for permission to publish details of these cases; and to Prof. Erwin Stengel and Dr. Maria Pfister for their interest and advice. REFERENCES Capstick, A. (1960) Brit. med. J. i, 1179. Stewart, I. (1957) Lancet, i, 1355. MEDICAL PROTECTION SOCIETY Sir Ernest Rock Carling was president of this society for sixteen years and was in its office, going through the annual report, on the day before his death. In his address to the annual general meeting on Oct. 5, Dr. E. HARWOOD STEVENSON, the chairman of council, spoke of the efficiency, the kindness, and the character Sir Ernest brought to the society’s work. The society has found permanent quarters at 50, Hallam Street, London, W. 1, formerly the house of the General Dental Council. On Dec. 31 the membership stood at 35,551 and the financial reserves at 273,157; and the year’s income of S96.575 exceeded expenditure by E22,869. In his financial report, the treasurer, Mr. W. M. Mollison, points out that this surplus must be considered exceptional, and that " during the past year many serious cases have been undertaken on behalf of members and these could eventually involve the payment of substantial sums "; but " there is not", he told the meeting, " the slightest reason why we should increase our annual subscription-rate of £ 2 ". Dr. Stevenson said that things which get doctors or dentists into difficulties often do so not because of the thing itself but because of the way it is handled. For instance, thio- pentone leaks after injection give rise to complaint either because they are not recog- nised, or not dealt with, or because the patient is not given adequate information about what has happened. Radial-nerve palsy from injections in the upper arm can also cause difficulty; and nowadays there is the risk of sepsis following hydrocortisone injections, "vresumablv due to the lowering of local resistance to even the smallest dose of bacterial contamination.", Difficulties can be avoided (1) by recognising the possibilities, (2) by guarding against them, (3) by recognising something wrong as soon as is feasible, and (4) by doing something properly about it. The keeping of good records counts in all these things. Another illustration is the fractured jaw in dentistry, which is now clearly recognised by the courts as not in any way presupposing negligence on the part of the dentist. The ques- tions which arise are whether there was adequate examination beforehand, recognition of the accident, arrangements for treatment at the earliest possible moment, and a plain statement to the patient. " The same pattern runs throughout so many of these instances. If they are recognised, dealt with, and stated, the necessary protection is almost unnecessary as the thing protects itself." Dr. Stevenson also referred to the importance of a case which drew from the Judicial Committee of the Privy Council " not so much a definition of misconduct in the professional respect but certainly a definition of certain aspects of what may be alleged to be infamous conduct in the profession". The Society’s annual report quotes Lord Jenkins as saying that " to make such a charge good there must be in their Lordships’ opinion (generally speaking) some element of moral turpitude or fraud or dishonesty in the conduct complained of or of such persistent and reckless disregard of the dentist’s duty in regard to records as can be said to amount to dishonesty for this purpose ". Mr. W. M. Mollison was re-elected treasurer and Dr. Alistair French secretary. The appointment of a new president is under the council’s consideration. NEW SURGICAL RESEARCH LABORATORY IN GLASGOW ON Oct. 4 the Wellcome Research Laboratory, Univer- sity of Glasgow, was formally inaugurated by Sir Henry Dale, who praised particularly the facilities created for joint research by investigators in human and veterinary medicine possibly for the first time, on a deliberately organised basis, in this country. He recalled the valuable results of earlier exercises in " reciprocal fertilisation of ideas " in the early days of virology, when teams working on projects sponsored by the National Institute for Medical Research and later the Medical Research Council, almost fortuitously using the ferret as host animal, isolated the virus of canine distemper and then that of human influenza. The laboratory was built and largely equipped from funds provided by the Wellcome Trust, in order to provide first-class facilities for research in human and in veterinary medicine. The building is situated in the Garscube estate, reasonably close to the new animal hospital and laboratories of the veterinary division of the faculty of medicine. It is a single- storey structure on three levels, planned with a view to economy on a steeply sloping site. The construction is of the simplest form-load-bearing brick walls, metal roof decking with mineral felt finish, precast concrete floors. The external design harmonises with the existing Veterinary Hospital buildings and with the surrounding woods and parkland. The internal surfaces are mainly painted plaster with linoleum and red asphalt floor finishes. The laboratories, which are heated by hot-water floor panels, are very fully equipped with all services including oxygen, anaesthetic gases, compressed air, and a vacuum exhaust system. The working area of the unit contains two spacious operating- theatres and three laboratories. One of the operating-theatres is of normal orthodox construction, the other has been screened to permit of precise electronic observations and recording without interference. The three laboratories form a unit of two work rooms with a biochemical laboratory between, separated only by benching and glass screening. This area was designed to facilitate multiple continuous observations on gastro-

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920

avoided all forms of excitement, and he was thought to havedied of adrenal excess as a result of the suicidal attempt.The general pattern in this series remains the same as

in the sixty-five cases I reported in 1957. A little less thana third had no organic disease, a little less than a third hadsevere hypertension, and the rest had a wide variety ofpainful, disabling, or fear-engendering diseases. It is, ofcourse, impossible to assess in each case how far thephysical disease contributed to the suicide. What is clearis that the suicides encountered in the Keighley districthave been, on the whole, a group of unfit or seriously illpeople.

I am indebted to Mr. Stephen E. Brown, H.M. Coroner for theCraven District of Yorkshire, for permission to publish details of thesecases; and to Prof. Erwin Stengel and Dr. Maria Pfister for theirinterest and advice.

REFERENCES

Capstick, A. (1960) Brit. med. J. i, 1179.Stewart, I. (1957) Lancet, i, 1355.

MEDICAL PROTECTION SOCIETYSir Ernest Rock Carling was president of this society for

sixteen years and was in its office, going through the annualreport, on the day before his death. In his address to theannual general meeting on Oct. 5, Dr. E. HARWOOD STEVENSON,the chairman of council, spoke of the efficiency, the kindness,and the character Sir Ernest brought to the society’s work.The society has found permanent quarters at 50, Hallam

Street, London, W. 1, formerly the house of the General DentalCouncil. On Dec. 31 the membership stood at 35,551 and thefinancial reserves at 273,157; and the year’s income ofS96.575 exceeded expenditure by E22,869. In his financial

report, the treasurer, Mr. W. M. Mollison, points out thatthis surplus must be considered exceptional, and that " duringthe past year many serious cases have been undertaken onbehalf of members and these could eventually involve thepayment of substantial sums "; but " there is not", he toldthe meeting, " the slightest reason why weshould increase our annual subscription-rateof £ 2 ".

Dr. Stevenson said that things which getdoctors or dentists into difficulties often do sonot because of the thing itself but because ofthe way it is handled. For instance, thio-pentone leaks after injection give rise to

complaint either because they are not recog-nised, or not dealt with, or because the patientis not given adequate information about whathas happened. Radial-nerve palsy from

injections in the upper arm can also cause

difficulty; and nowadays there is the risk ofsepsis following hydrocortisone injections,"vresumablv due to the lowering of localresistance to even the smallest dose of bacterial contamination.",Difficulties can be avoided (1) by recognising the possibilities,(2) by guarding against them, (3) by recognising somethingwrong as soon as is feasible, and (4) by doing somethingproperly about it. The keeping of good records counts in allthese things.

Another illustration is the fractured jaw in dentistry, whichis now clearly recognised by the courts as not in any waypresupposing negligence on the part of the dentist. The ques-tions which arise are whether there was adequate examinationbeforehand, recognition of the accident, arrangements fortreatment at the earliest possible moment, and a plain statementto the patient. " The same pattern runs throughout so manyof these instances. If they are recognised, dealt with, andstated, the necessary protection is almost unnecessary as thething protects itself."

Dr. Stevenson also referred to the importance of a casewhich drew from the Judicial Committee of the Privy Council" not so much a definition of misconduct in the professional

respect but certainly a definition of certain aspects of whatmay be alleged to be infamous conduct in the profession".The Society’s annual report quotes Lord Jenkins as saying that" to make such a charge good there must be in their Lordships’

opinion (generally speaking) some element of moral turpitudeor fraud or dishonesty in the conduct complained of or of suchpersistent and reckless disregard of the dentist’s duty in regardto records as can be said to amount to dishonesty for thispurpose ".

Mr. W. M. Mollison was re-elected treasurer and Dr. AlistairFrench secretary. The appointment of a new president is underthe council’s consideration.

NEW SURGICAL RESEARCH LABORATORYIN GLASGOW

ON Oct. 4 the Wellcome Research Laboratory, Univer-sity of Glasgow, was formally inaugurated by Sir HenryDale, who praised particularly the facilities created forjoint research by investigators in human and veterinarymedicine possibly for the first time, on a deliberatelyorganised basis, in this country. He recalled the valuableresults of earlier exercises in " reciprocal fertilisation ofideas " in the early days of virology, when teams workingon projects sponsored by the National Institute forMedical Research and later the Medical Research Council,almost fortuitously using the ferret as host animal,isolated the virus of canine distemper and then that ofhuman influenza.The laboratory was built and largely equipped from

funds provided by the Wellcome Trust, in order to

provide first-class facilities for research in human and inveterinary medicine.The building is situated in the Garscube estate, reasonably

close to the new animal hospital and laboratories of the

veterinary division of the faculty of medicine. It is a single-

storey structure on three levels, planned with a view to economyon a steeply sloping site. The construction is of the simplestform-load-bearing brick walls, metal roof decking withmineral felt finish, precast concrete floors. The externaldesign harmonises with the existing Veterinary Hospitalbuildings and with the surrounding woods and parkland.The internal surfaces are mainly painted plaster with linoleumand red asphalt floor finishes. The laboratories, which areheated by hot-water floor panels, are very fully equipped withall services including oxygen, anaesthetic gases, compressed air,and a vacuum exhaust system.The working area of the unit contains two spacious operating-

theatres and three laboratories. One of the operating-theatresis of normal orthodox construction, the other has been screenedto permit of precise electronic observations and recordingwithout interference. The three laboratories form a unit of twowork rooms with a biochemical laboratory between, separatedonly by benching and glass screening. This area was designedto facilitate multiple continuous observations on gastro-

921

intestinal physiology. The kennels are in two separate blocks-a quarantine reception block and a

" clean " block.

At the time of its official inauguration, the laboratoryhad been in use for several months and its resources were

already fairly fully committed to research projects-some under the xgis of the two departments of humansurgery and several organised jointly between these

departments and those of the School of VeterinaryMedicine. The facilities of the laboratory will be availablenot only to members of the university departments, bothclinical and preclinical, but also to the clinicians of non-professorial units. The buildings and the site will lendthemselves to extension.Photograph by Mr. A. Finnie, of the University of Glasgow Veterinary

Hospital and School.

The Widdicombe File

LXIV.—A DIVISION OF PATHOLOGISTSDEAR IAN,

It should soon be all over bar the doing. The ten years’shouting, always loud, sometimes bitter, over the projectedCollege of Pathologists is to come to a head at last. Theballot papers for the crucial and we all hope final ballotare now printing, and within the month (saving a possiblePath. Soc. postscript in January) the die should be castat last.

It will, I suspect, be a near thing. But not in the leastin the direction that seemed likely in August, 1959, whenI last wrote to you.* Then we had a majority committedto a College, but also a strong and vociferous minoritywhich seemed determined to oppose it to the last ditch.Now the Physicians have intervened, and the pattern haschanged. The do-nothing dissidents have all but vanished,and action is the cry on all sides. But there are now two

possible forms of action: to go ahead with an independentCollege as originally planned, or to join the College ofPhysicians as a Faculty (or perhaps, since the status of theCollege of Surgeons’ Faculties has made this somethingof a term of abuse among pathologists, a Division).

We had a lively and revealing debate at the recentgeneral meeting of the Association of Clinical Pathologists,which, as you know, has been chiefly handling this matteron the pathological side. It was made very clear that thecouncil of the A.C.P. and many of the older and wiserheads have firmly decided for the Faculty. Most of thespeeches from the floor, however, spoke hotly for thecollege. Apart from a most statesmanlike presidentialaddress, the council handled its case badly, I thought, andmuch of the attack on it was the irresponsible agin-the-government kind that rears up in any society when itsexecutive seems too obviously to be imposing its ownpolicy, however good; but some of it was genuine enough.A ballot at the meeting would certainly have given asubstantial majority for a College, but the bulk of thesociety’s members, who have not much time to spare forannual general meetings in London, may have other

opinions. There is the Pathological Society electorate toconsider also.

Let me rehearse the main arguments on the two sides.Make what allowance you like for my own preference foithe faculty: I think I am being reasonably fair. Accepi

* We published this letter (Lancet, 1959, ii, 231).t See Lancet, Oct. 15, 1960, p. 863.

if you will also that the two main practical objects (i.e.,apart from flag-flying) of any such organisation are

to act as a high-level negotiating body for pathologists,and to provide an examination structure of equal standingto that existing in most other groups of consultantmedicine.

For the independent College, it is agreed that we arethe fourth largest body of consultants, much larger thanthe Obstetricians and Gynxcologists, who already have aCollege. t We stand for the scientific basis of medicine,related uniquely and fundamentally to every other branchof medicine, certainly not to be subordinated to, and

hardly properly to be joined even on equal terms to, anyother one of these branches. If we become our own

masters, we may do what we will: if we join the Physicians,we must dance at least in part to their tune. The

Physicians would have none of us till it was unmistakablydemonstrated that we were resolved to go it alone: now

they seem eager to prevent our setting up a rival establish-ment. However fair the terms of the joining may be, thePhysicians’ persisting majority on the Comitia (not in thepast a notably broadminded or progressive institution)could be used to ensure we do nothing to displease them.Timemus Danaos; and the Physicians (it is said) are notableGreek scholars.The arguments on the other side have in contrast a

distinctly sober-sided look. Financially, an independentCollege would be a cripplingly expensive undertaking, andthough it would probably be able to count on some

benefactions once established, for the first stages wewould have to pay our own way-and we are neither richourselves (though Pilkington assures us we have almostour share of the Awards) nor as often as the clinician arewe the friends of the rich. At best it would be years beforesuch a College had sufficient stature to be accepted as aproper negotiating body (remember that at present to theMinister the College of Physicians is our official mouth-piece). Its examinations, however good, would be equallylong in acquiring the status they would gain at once if theR.C.P. guaranteed them as equivalent to its own Mem-bership. If we committed ourselves to an independentCollege, and it failed (as, from mismanagement, dissension,or bankruptcy it could fail, though it should not), wewould be terribly the worse for it: if after an honest trialof union with the Physicians we found ourselves unableto agree with them, nothing could stop the faculty thensplitting off and going its own way, with all the advantagesof experience and an established organisation to help andnothing lost but a little time. The argument that it isabsurd for a pathologist to call himself a Physician will nothold water: a third of the Physicians already are non-physicians in the narrow sense, and the title Physician, inthe days when the College acquired its name, meant simplya reputable medical man with a degree. And finally, asI have argued before, there are too many Colleges already,and we, who count ourselves a unifying force in medicine,should not bear the reproach of starting yet another

splinter group.

If we were all certain that we could trust the Physicians,I think few would hesitate to accept their offer. For it is a

The Pilkington report gives the following figures for 1958: 1002· general surgeons, 982 general physicians, 855 anesthetists, 744

._ pathologists, 704 psychiatrists, 507 radiologists, and 504’

obstetricians and gynxcologists: of smaller specialised groupssuch as neurosurgeons and paediatricians, 928 in all probablycount as surgeons and 719 as physicians.