1382 D. T. M. writes: " In his work for the child guidance service, which he built up from scratch, John Graham carried for 20 years the clinical and much of the administrative responsibility for all the child guidance clinics in the wide rural areas of Worcestershire and in the industrial north of the - county. He had limited opportunity to pursue outside pro- fessional activities, but he found time to be helpful where he was needed-for instance, on the councils of the National Association for Mental Health, and in the work of the Worcestershire Marriage Guidance Council. " As a colleague, John Graham was always stimulating: his wit was a kindly challenge to put one’s best foot fore- .most, and his joie de vivre and soft humour were contagious. Essentially humble, he was content to provide a service without seeking honours for himself. He enjoyed recrea- :tion, and loved his travels to Italy and Greece." Prof. G. W. HARRIS A. G. M. W. writes: " The tragic death of Prof. Geoffrey Harris at the early age of 58 is a great blow to anatomy, and has left his col- leagues in Oxford with a deep sense of personal bereave- ment. He achieved great distinction for his work on the pituitary gland and neuroendocrinological problems. In- - deed, he gave the Upjohn lecture of the Endocrine Society <vf America in 1964. His hook The Neural Control of the Pituitary Gland, published in 1955, is still regarded as the standard work on the subject. " His period in Oxford was probably one of the most fruit- ful of his life. Not only did he do a lot of research himself, but as honorary director of the Medical Research Council’s Neuroendocrinology Research Unit, which was attached to the department, he had a happy team of workers with him who have themselves made notable contributions to know- ledge. Moreover, the unit was never an appendage to the department. Its members were fully integrated with the university staff, and, apart from administration, it was difficult to distinguish between them. The unit staff assisted with the teaching, and several of the academic staff collaborated in the research undertaken by members of the unit. In this way Geoffrey Harris was able to bring to fruition the changes in teaching methods initiated by Sir Wilfrid Le Gros Clark. Since Geoffrey was both physiologist and morphologist, he found little difficulty in reorganising classes, both elementary and advanced, so that they could become an integral part of the new physiological sciences honour school. His special classes in endocrinology were always oversubscribed, and those lucky enough to get a place never ceased to remember and to be proud of their good fortune, for he was a most stimulating teacher. " As a man, Geoffrey was a sincere friend and a wise counsellor. His kindness to his predecessor, Sir Wilfrid Le Gros Clark, was typical of his generosity, for he insisted that he had a room in the lab.’ to the day of his death. He was a very popular member of the Common Room at Hertford, and took a personal interest in the undergradu- ates of his college. He was until recently a first-class squash-racquets player and senior member of the University dub. This dynamic and kindly man will be greatly missed." Notes and News DRUG EXPLOSION DRUG treatment apart, by far the greatest single pre- occupation of the 5th World Congress of Psychiatry at Mexico City (see p. 1361) was drug abuse. Dr. F. A. Freyhan was particularly concerned about the increase in medical prescribing of psychoactive drugs, which had doubled in the U.S.A. over the past 4 years. Now, he said, one in every three people aged between 18 and 74 was prescribed a tranquilliser sometime during the year. It was psychiatry, not public opinion, which started this off; yet he could see no evidence that better drugs were available than previously, nor that drug-treatable illnesses were increasing. " Medical research ", he said, " ignores the problem of what patients not to treat " ; patients were subjected to a sort of " pharmacological roulette ". Dr. M. B. Balter noted that psychoactive drugs accounted for 17% of all prescriptions, and that 38% of these were new and 62% repeats. 39% were anti-anxiety drugs-mainly diazepam, chlordiazepoxide, and meprobamate-and these accounted for the largest part of the increase. Psychiatrists prescribed a modest 17% of the psychoactives, and were exceeded by general physicians and by general practitioners. In Sweden, too, the prescribing of psychoactive drugs had increased threefold in 10 years. Dr. B. Westerholm’s survey of 816 individuals showed that in the course of 16 months 1 in 3 used psychoactive drugs: 4 of the 816 appeared to be undetected drug abusers, double-scripping between different doctors. Again, the benzodiazepines accounted for 40% of the prescriptions. More attention was given to the epidemics of drug abuse reported during the 1960s from Mexico City, Japan, Austria, Britain, and the U.S.A. The term epidemic was shown to be entirely appropriate by Dr. R. de Alarcon, who illustrated how case-to-case contamination took place and how the curve of incidence was just that of the spread of acute infection, with a flattening-out as the at-risk popu- lation became saturated. The implications were obvious- the need for social support services and special institutions to isolate the infective agents. Though there were some differences in drug-taking and drug-takers according to cultural pattern (e.g., between different areas of Japan), the picture of the heroin addict that emerged was of a disturbed personality from a broken home, close to mother but with an absent, inadequate, or brutal father, relating poorly to others and under-achieving at school. There were believed to be 200,000 of these in the U.S.A.-half of them in New York City, where heroin was now the largest cause of death in adolescence. Most were from poverty areas of high delinquency-rate. About 500 had been followed up from the 1950s; most had kicked the habit from time to time, but only 2% of the group per year had succeeded in staying off altogether. Group therapy, according to Dr. C. M. Rosenberg, was useless because they defaulted; methadone withdrawal led to early relapse; and only methadone maintenance seemed effective, with well over half the addicts still attending the clinic after a year. The pattern of heroin-taking had changed, in that takers had become younger (most started in their teens); what was a single activity had become a social one; and whereas the sexes used to be equal, men now outnumbered women by about 4 to 1. G.M.C. FINANCES THE General Medical Council has proposed that the annual retention fee (which was introduced in May last year in the face of much opposition from the profession) should be increased from E2 to E5 from May 1, 1972. A memorandum from the Council states that the original
Transcript
1382
D. T. M. writes:" In his work for the child guidance service, which he
built up from scratch, John Graham carried for 20 yearsthe clinical and much of the administrative responsibilityfor all the child guidance clinics in the wide ruralareas of Worcestershire and in the industrial north of the- county. He had limited opportunity to pursue outside pro-fessional activities, but he found time to be helpful wherehe was needed-for instance, on the councils of the NationalAssociation for Mental Health, and in the work of theWorcestershire Marriage Guidance Council.
" As a colleague, John Graham was always stimulating:his wit was a kindly challenge to put one’s best foot fore-.most, and his joie de vivre and soft humour were contagious.Essentially humble, he was content to provide a servicewithout seeking honours for himself. He enjoyed recrea-:tion, and loved his travels to Italy and Greece."
Prof. G. W. HARRIS
A. G. M. W. writes:" The tragic death of Prof. Geoffrey Harris at the early
age of 58 is a great blow to anatomy, and has left his col-
leagues in Oxford with a deep sense of personal bereave-ment. He achieved great distinction for his work on the
pituitary gland and neuroendocrinological problems. In-- deed, he gave the Upjohn lecture of the Endocrine Society<vf America in 1964. His hook The Neural Control of the
Pituitary Gland, published in1955, is still regarded as thestandard work on the subject.
" His period in Oxford wasprobably one of the most fruit-ful of his life. Not only did hedo a lot of research himself,but as honorary director of theMedical Research Council’sNeuroendocrinology ResearchUnit, which was attached tothe department, he had a
happy team of workers withhim who have themselves madenotable contributions to know-ledge. Moreover, the unitwas never an appendage to thedepartment. Its members were
fully integrated with the university staff, and, apart fromadministration, it was difficult to distinguish between them.The unit staff assisted with the teaching, and several of theacademic staff collaborated in the research undertaken bymembers of the unit. In this way Geoffrey Harris wasable to bring to fruition the changes in teaching methodsinitiated by Sir Wilfrid Le Gros Clark. Since Geoffreywas both physiologist and morphologist, he found little
difficulty in reorganising classes, both elementary andadvanced, so that they could become an integral part of thenew physiological sciences honour school. His specialclasses in endocrinology were always oversubscribed, andthose lucky enough to get a place never ceased to rememberand to be proud of their good fortune, for he was a moststimulating teacher.
" As a man, Geoffrey was a sincere friend and a wisecounsellor. His kindness to his predecessor, Sir WilfridLe Gros Clark, was typical of his generosity, for he insistedthat he had a room in the lab.’ to the day of his death.He was a very popular member of the Common Room atHertford, and took a personal interest in the undergradu-ates of his college. He was until recently a first-classsquash-racquets player and senior member of the Universitydub. This dynamic and kindly man will be greatly missed."
Notes and News
DRUG EXPLOSION
DRUG treatment apart, by far the greatest single pre-occupation of the 5th World Congress of Psychiatry atMexico City (see p. 1361) was drug abuse. Dr. F. A.
Freyhan was particularly concerned about the increase inmedical prescribing of psychoactive drugs, which haddoubled in the U.S.A. over the past 4 years. Now, hesaid, one in every three people aged between 18 and 74was prescribed a tranquilliser sometime during the year. Itwas psychiatry, not public opinion, which started this off;yet he could see no evidence that better drugs were availablethan previously, nor that drug-treatable illnesses were
increasing. " Medical research ", he said, " ignores theproblem of what patients not to treat " ; patients weresubjected to a sort of " pharmacological roulette ". Dr.M. B. Balter noted that psychoactive drugs accounted for17% of all prescriptions, and that 38% of these were newand 62% repeats. 39% were anti-anxiety drugs-mainlydiazepam, chlordiazepoxide, and meprobamate-and theseaccounted for the largest part of the increase. Psychiatristsprescribed a modest 17% of the psychoactives, and wereexceeded by general physicians and by general practitioners.
In Sweden, too, the prescribing of psychoactive drugs hadincreased threefold in 10 years. Dr. B. Westerholm’ssurvey of 816 individuals showed that in the course of16 months 1 in 3 used psychoactive drugs: 4 of the 816appeared to be undetected drug abusers, double-scrippingbetween different doctors. Again, the benzodiazepinesaccounted for 40% of the prescriptions.More attention was given to the epidemics of drug abuse
reported during the 1960s from Mexico City, Japan,Austria, Britain, and the U.S.A. The term epidemic wasshown to be entirely appropriate by Dr. R. de Alarcon, whoillustrated how case-to-case contamination took place andhow the curve of incidence was just that of the spread ofacute infection, with a flattening-out as the at-risk popu-lation became saturated. The implications were obvious-the need for social support services and special institutionsto isolate the infective agents. Though there were somedifferences in drug-taking and drug-takers according tocultural pattern (e.g., between different areas of Japan), thepicture of the heroin addict that emerged was of a disturbedpersonality from a broken home, close to mother but withan absent, inadequate, or brutal father, relating poorly toothers and under-achieving at school. There were believedto be 200,000 of these in the U.S.A.-half of them inNew York City, where heroin was now the largest cause ofdeath in adolescence. Most were from poverty areas ofhigh delinquency-rate. About 500 had been followed upfrom the 1950s; most had kicked the habit from time totime, but only 2% of the group per year had succeeded instaying off altogether. Group therapy, according to Dr.C. M. Rosenberg, was useless because they defaulted;methadone withdrawal led to early relapse; and onlymethadone maintenance seemed effective, with well overhalf the addicts still attending the clinic after a year. Thepattern of heroin-taking had changed, in that takers hadbecome younger (most started in their teens); what was asingle activity had become a social one; and whereas thesexes used to be equal, men now outnumbered women byabout 4 to 1.
G.M.C. FINANCES
THE General Medical Council has proposed that theannual retention fee (which was introduced in May lastyear in the face of much opposition from the profession)should be increased from E2 to E5 from May 1, 1972. Amemorandum from the Council states that the original
1383
plan had been to set the fee at S3, and that, in the event, thefigure of E2 had proved insufficient. In every year since
1967 the Council’s expenditure had exceeded its income.At the end of 1970 the Council had a bank overdraft of
E62,560, and at July 31, 1971, it owed its superannuationfund around E96.000. If no change were made in thelevel of the annual retention fees or the initial registrationfees it had been estimated that by the end of 1974 thedeficit would amount to E474.720. In estimating expen-diture it was assumed that the size of the Council would beincreased (as recommended by the Brynmor Jones workingparty), that the Council would spend more than in thepast on its responsibilities for undergraduate education,and that the volume, and therefore the cost, of the Council’sdisciplinary business would continue to increase. Of thetotal expenditure estimated for 1971, nearly one-third(E1l6,360) was for general administration, nearly one-thirdfor discipline, education, and the cost of registering overseasdoctors, and the remainder (around E124,000) for main-taining the Registers in the new form which was introducedin 1970 and for collecting and accounting for the annualretention fee. The Council’s income had not been sig-nificantly reduced by the failure hitherto of a small numberof doctors to pay the retention fee. The purpose of intro-ducing the annual retention fee had been to reduce theburden which would otherwise fall on newly qualifieddoctors, and the Council had therefore concluded that theinitial registration fees should remain at their present level.The Council had also accepted that the present fee of E15for temporary registration in respect of any new appoint-ment for more than 2 months and less than 12 could bear
hardly on individual doctors, and it had therefore proposedthat this fee should be reduced to E10. The Council
considered, however, that the fee of E3 now payable onrestoration of a name to the Register after removal fornon-payment of an annual retention fee or for failing toreply to letters sent by the Council should be increased to£10. In fixing the new amount for the retention fee at E5,the Council hoped that there would be some prospect ofmaintaining this figure for at least 3 years, although in factan increase to E6 would have permitted the accumulationof some useful reserves. As it was, with the fee at E5,it was estimated that by 1975 there would be little marginof income over expenditure. In response to the G.M.C.’sstatement, the British Medical Association has decided toask the Privy Council for an inquiry into the Council’sfinancial affairs.
CHILDREN IN INSTITUTIONS
CHILDREN who have to spend the early part of theirlives in institutional care may find themselves in livingconditions which bear little resemblance to a normal homeenvironment; on the other hand, they may be lucky andbe placed under care which is basically child-oriented andwhich seeks to reproduce as well as possible ordinary homelife. In a study of long-stay institutions for children,1 thecharacteristic patterns of child management in differentkinds of institution are described, and an attempt is madeto find ways of quantifying these patterns to facilitatesystematic comparisons between institutions, and to accountfor any differences in the methods of upbringing in socio-logical terms. The authors looked at more than 100
separate establishments. The main part of their field-workwas carried out in two children’s homes and two hospitals,one for mentally subnormal children and one for physicallyhandicapped children. A local-authority hostel and a
voluntary home for the subnormal were also visited, and a
1. Patterns of Residential Care. Sociological Studies in Institutionsfor Handicapped Children. By ROY D. KING, NORMA V. RAYNES,JACK TIZARD. International Library of Sociology and SocialReconstruction. London: Routledge & Kegan Paul. 1971.Pp.255. £3.50.
survey of 16 institutions for mentally handicapped childrenwas carried out. The field studies showed that there wereremarkable differences in child-management practicesbetween types of institution serving different types ofchildren. Children in local-authority homes were broughtup in a child-oriented manner which contrasted markedlywith the institutionally oriented pattern of care in the
mental-subnormality hospital and, to a lesser degree, inthe hospital caring for the physically handicapped children.Investigation showed that these differences could not
plausibly be attributed to the characteristics of the chil-dren. There were, for example, no systematic differencesin patterns of care between low-grade and high-gradewards in the subnormality hospital. In order to quantifydifferences in child upbringing the authors of the studydeveloped a child management scale, which proved to bevery accurate in recording differences in the treatment ofthe children. In most of the homes and hostels the childrenwere accorded respect as individuals. They had opportuni-ties for both privacy and companionship; they were
allowed personal clothing and a share of the possessions ofthe community; they lived in an environment where ruleswere few and exceptions to them readily made, and wherethe staff were friendly and the children had an opportunityto get to know them. In the hospitals, the needs of youngchildren for affection, for individual treatment, for varietyof experience, and for continuity of relationship receivedlittle attention. These differences are explained in thestudy in terms of the social organisation in which thestaff carried out their duties. Many of the areas ofneed outlined in the study are, of course, already wellknown, but it is hoped that the method developed formeasuring differences in patterns of institutional care willbe useful for future research.
TRAVELLING LIGHTLY
SOME research-workers trot the globe with gay abandon- six months here, a year there. Others have an intense
struggle to arrange even a short sabbatical every seventhyear. It is all a question of knowing your way round thegrant-giving organisations. The Association of Common-wealth Universities has provided a valuable service withits index of fellowships, visiting professorships, and thelike available to Commonwealth university staff who wantto teach, study, or do research in another Commonwealthcountry. 313 bodies provide grants for these purposes, andthe terms vary from tenability for any purpose in anycountry to fairly strict conditions of eligibility, subject, andcountry. University staff seeking wider experience inother Commonwealth countries would do well to consultthe A.C.U. handbook when planning their itinerary.
University of BirminghamDr. D. W. Young has been appointed lecturer in
medicine.
University of ManchesterA. C. Crompton has satisfied the examiners for the
degree of M.D.
Royal College of Surgeons of EnglandHallett prizes have been presented to Dr. 0. A. M.
Asaad (University of Cairo) and Dr. P. C. A. Ratnatunga(University of Ceylon). A Hallett prize has been awardedto Dr. W. J. Owen. A diploma of fellowship has beengranted to Arulpiragasam Thavendran.The Council has expressed the view that for the fore-
seeable future a primary fellowship examination should beretained as Part I of the F.R.C.S. examination of the college.
1. Awards for Commonwealth University Staff 1972-74. Obtainablefrom the Association of Commonwealth Universities, 36 GordonSquare, London WC1 OPF. 60p.
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University of LeicesterDr. W. A. Cramond has been appointed dean of the new
Medical School and given the title and status of professorof mental health.
After Army service in India, Dr. Cramond graduated M.B.from the University of Aberdeen in 1947 and M.D. (with com-mendation) in 1954. After a period in general practice andseveral hospital posts he became, in 1955, physician super-intendent of Woodilee Hospital, Glasgow. He moved to Aus-tralia and in 1961-65 he was director of mental health servicesfor South Australia. In 1963 he was appointed foundationprofessor of mental health in the University of Adelaide, and wasdean of the Faculty of Medicine in 1968-69. In Australia herepresented the University Medical Schools on the NationalHealth and Medical Research Council and was a member of itsstanding Research Grants Committee for Clinical Projects;he also advised the Government on psychiatric services forCanberra and the Australian Commonwealth Territory. He isa foundation fellow of the Royal College of Psychiatrists. He isat present principal medical officer in mental health at theScottish Home and Health Department, Edinburgh.
University of SouthamptonDr. K. J. Dennis has been appointed to the chair of
human reproduction and obstetrics.Dr. Dennis, who is 42, graduated M.B. from the University of
Edinburgh in 1952. After house-appointments at several Scottishhospitals and a period of National Service in the R.A.M.C., he wasappointed, in 1961, lecturer in obstetrics and gynaecology at theUniversity of Aberdeen and senior registrar (obstetrics andgynaecology) to the Aberdeen General Hospitals and AberdeenMaternity Hospital. He is at present senior lecturer in thedepartment of obstetrics and gynxcology at Aberdeen and
honorary consultant obstetrician and gynxcologist to AberdeenRoyal Infirmary and Aberdeen Maternity Hospital. He becameF.R.C.S.E. in 1958 and M.R.C.O.G. in 1961.
Dr. Adolf Polak has been appointed to the chair ofrenal medicine.
Dr. Polak was educated at the University of Cambridge andUniversity College Hospital, London, graduating M.B. in 1949and M.D. in 1955. He was medical registrar and house-physicianat University College Hospital and senior medical registrar atSt. Mary’s Hospital, London. He then moved to Portsmouth andbecame consultant physician to the Portsmouth group hospitalsand physician to the Wessex renal unit. He was granted thetitle of honorary professor by the University of Southamptonin 1969. He became F.R.C.P. in 1970.
Royal College of Physicians of EdinburghDr. James Syme has been elected secretary.
Royal College of PathologistsDr. A. J. McCall and Prof. R. A. Shooter have been
elected vice-presidents. The following new members ofcouncil have been elected:
Prof. J. R. Anderson, Prof. E. K. Blackburn, Prof. J. R. Hobbs,Prof. I. M. Roitt, Dr. E. Joan Stokes, Prof. R. E. 0. Williams.
London School of Hygiene and Tropical MedicineThe following have passed the first examination for the
M.sc. in social medicine:C. Adam, C. H. Aqualimpia (Sir Allen Daley memorial prize),
B. R. Bewley, M. E. Boyer, A. G. Brown, J. M. Forsythe (Sir AllenDaley memorial prize), J. W. Gleisner, J. G. Leece, N. P. Melia,R. B. Robinson, G. C. Siegruhn.
London Jewish Hospital Medical SocietyProf. W. W. Mushin will give the annual oration on
Thursday, Dec. 30, at the Medical Society of London,11 Chandos Street, W.1. His subject will be the craftsmanin an intellectual society.
CORRIGENDUM: Radiation Cancers and A-bomb Survivors.-In the letter by Dr. Alice Stewart (Nov. 27, p. 1203) the date inthe penultimate line of the third paragraph should be October,1950.
Appointments
PLATT, H. S., M.D., B.sc.Lond.: consultant chemical pathologist,University College Hospital, London.
ROSEN, E. S., M.D., B.sc.Manc., F.R.C.S.E. : consultant ophthalmologist,United Manchester Hospitals.
thetist, Portsmouth.GOLDING, P. L., M.B.Lond., M.R.C.P. : consultant physician, Ports-
mouth.HARDING, J. C., M.B.Lond., M.R.C.P. : consultant in physical medicine
and rheumatology, Bournemouth and East Dorset.NOBLE, A. D., M.B.Lond., M.R.C.O.G., F.R.C.S.E., D.C.H. : consul-
tant obstetrician and gynxcologist, North Hampshire.
East Anglian Regional Hospital Board:BROWN, J. C., M.D.Newcastle, M.R.C.P., M.R.C.P.E. : consultant
neurologist, Norwich, Lowestoft, and Great Yarmouth H.M.c.and United Cambridge Hospitals.
COOK, M. H., M.R.C.S., F.F.A. R.C.S. : consultant aneesthetist, IpswichH.M.C.
EVANS, W. B., M.B.Lond., F.F.R., D.M.R.D.: consultant radiologist,Ipswich Group H.M.c.
JACKSON, A. W., M.D.Manc., F.F.R., D.M.R.T.: consultant radio-therapist, Norwich, Lowestoft, and Great Yarmouth H.M.c.
MORRALL, A. K., M.B.Durh., D.P.M. : consultant psychiatrist, WestSuffolk H.M.C. and Suffolk Mental H.M.c.
NIXON, J. W. G.,M.B.Belf.,M.R.c.p.i.,M.R.c.pSYCH., D.p.M.: consultantpsychiatrist, St. Andrew’s and Hellesdon H.M.c. and Norwich,Lowestoft, and Great Yarmouth H.M.c.
O’BRIEN, M. D., M.B. N.U.I., D.C.H., D.P.M. : consultant psychiatrist,King’s Lynn H.M.c., Norwich, Lowestoft, and GreatYarmouth H.M.c., and St. Andrew’s and Hellesdon H.M.c.
WILSON, JOHN, M.B.Sheff., F.F.A. R.C.S. : consultant anxsthetist,Peterborough District Hospital.
