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2. Good psychiatric evidence is not always available, sincemany first-rank psychiatrists will not take court cases. Thetime and trouble involved, and the risks of unfavourable

publicity resulting in loss of professional prestige, make manypsychiatrists chary of undertaking such work. Dr. Hobsonremarked that the provisions made for compensating psychi-atric witnesses in legal-aid cases were most inadequate : the

popular belief that there were large rewards for the forensicpsychiatric expert was quite unfounded. Proper examinationinvolved several interviews. In addition, he usually found itnecessary to make inquiries outside the prison, visiting theprisoner’s home, interviewing relatives and workmates, andsometimes arranging with the police for further investigationsto be made. It was always necessary, in addition, to have aconsultation with solicitors and counsel.

3. Psychiatric evidence is also sometimes bad because it isgiven in psychiatric rather than in legal language. It is not

sufficiently realised that there are three languages spoken incourt: that of the psychiatrist or other medical expert, legallanguage, and the layman’s language. According to Mayer-Gross et al. 2 : " The medical witness is embarrassed by hisincapacity to put highly relevant facts about the state of mindof the accused. The debate centres around, not the medicalfacts, but metaphysical issues of which, if they have a meaningat all, the medical man has no direct knowledge. The languageis alien to him.... He is likely to be asked to give yes or noanswers, although he knows full well that he cannot in mostcases be dogmatic, and that in fairness to himself and to thcourt he should explain the significance of his replies to thecase at issue."

The AleNaughten rules had been criticised so often fortheir divorce from reality, their illogical metaphysicalbasis, and the inequality with which they were appliedthat it would be repetitious to discuss them further.Dr. Hobson felt that they were a. serious barrier to the

development of understanding between psychiatrist andlawyer, and that they impeded the lawyer’s under-

standing of the facts of mental illness. He agreed withMayer-Gross et al. : " Psychiatric evidence in Englishcourts will not be measured by a realistic yardstick untiltheM’Naghten Rules are abolished altogether" ; but he didnot think that Mayer-Gross went far enough. He himself

preferred the view of Overholser 3 : ’’ (’apital punishmenthas no place in the modern scheme of penal treatment,and if capital punishment were abolished nearly all ofthe public furor against expert psychiatric testimonywould disappear." Not only would the furor disappearbut there would be very little need of expert psychiatrictestimony. When capital punishment was abolished thepsychiatrist would seldom be called on to give evidence ;and when he did so he would at last be able to talk senseinstead of psycho-legal nonsense.

2. Mayer-Gross, W., Slater, E., Roth, M. Clinical Psychiatry.London, 1954.

3. Overholser, W. The Psychiatrist and the Law. New York, 1953.4. Carroll, R. E., Sinton, W., Garcia, A. J. Amer. med. Ass. 1955,

157, 422.

CALCIUM DEPOSITS IN THE HAND

SUDDEN acute pain in the hand is usually due toinfection or injury. Carroll et awl. draw attention toone of the less common causes-namely, calcium deposits.In most of their cases the patient sought attention soonafter the onset of pain, cradling a swollen and tenderhand. The wrist and digits were flexed and immobile,and there were tender spots around the wrist or in theregion of the finger-joints. Radiographs of the mosttender areas showed calcium deposits ; these depositswere often small, and in the region of the carpus specialprojections were necessary to display them. The depositslay within the muscles and ligaments, most commonlyin the flexor carpi ulnaris in the region of the pisiformbone. If the deposit was surgically exposed, it appearedas a creamy material beneath cedematous and inflamedperitendon or ligament. There is no evidence that traumaplays any direct part in the production of such deposits,and although some patients had similar deposits in otherregions there was no very clear metabolic factor. Radio-

graphy showed that calcium deposits might be confusedwith chip fractures, accessory bones, or small bonydeposits due to periosteal tears. The deposits weretemporary : the disease was acute, severe, and brief, andwithout treatment the pain subsided within three weeks.The radiographic shadows commonly disappeared evensooner : the average time before disappearance wastwo weeks. No deposit persisted for as long as six months.Local injection of procaine relieved the symptoms, andsurgical evacuation of the deposit seemed rarely tobe indicated.

Diagnosis of this disorder should not be difficult.Differential diagnosis from minor fractures may presentproblems, but the more widespread disturbance and themore severe pain from the calcium deposit should bevaluable guides. Clearly the final proof is radiographic,and the early disappearance of these deposits confirmstheir nature.

1. Bull. Wld Hlth Org. 1955, 12, 63.2. Lancet, 1954, i, 244.3. Bull. Wld Hlth Org. 1955, 12, 277.

TUBERCULIN TESTS

THE W.H.O. Tuberculosis Research Office has con-tinued its investigation of the prevalence and cause oflow-grade tuberculin sensitivity in man.l The differencesin the patterns of sensitivity have now been studied intwelve countries, from Denmark, England, and the U.S.A.to Ethiopia, the Phillipines, and Viet Nam. The greaterthe response to large doses of tuberculin in those insensi-tive to smaller ones, the more the reactions to the smalldoses tend to fall within the 6-12 mm. range, and themore the frequency-distribution resembles the normalcurve, with a clear demarcation between the group with

large and the group with very small or no reactions.If it is assumed that only the normally distributed

portion of the curve represents infection with tuberclebacilli, the proportions of infected in the differentcountries can be approximately estimated. Amongschool-children this proportion was found to vary fromnearly 50% in the Sudan to 4% in the White populationof the U.S.A. and a little under 10% in this country.From further assumptions-supported by other observ-tions-it can be calculated that non-tuberculous tuber-culin sensitivity occurs in over 90% of school-children .’in the Phillipines, Viet Nam, and the Sudan, 70-80%in India, about 50% in Ethiopia and Turkey, 20-30%in England and Mexico, and under 10% in Denmarkand the southern part of the U.S.A. The practicalimplication of these investigations, if the hypothesis ofnon-tuberculous reactions is correct, is that only in thenorthern part of the U.S.A. can it be inferred that almostall the children around 10 years of age who have reactionsof 6 mm. or more to 5 T.u. are infected with tuberclebacilli. In southern India the proportion falls to 50% ;and in England it is roughly 85%.As we have previously said,2 the description " non-

specific " used by the W.H.O. workers for this type ofsensitivity is misleading. It implies that the reactionis due, not to sensitivity produced by infection with aparticular organism, but to a general change in thesensitivity of the skin to many stimuli. Moreover, it

implies that the tuberculin reaction to human-typepurified protein derivative is specific for human-typetuberculous infection. This is not true, as the W.H.O.teams have themselves demonstrated. The mean size ofthe reaction to 10 T.u. in adults in Denmark was foundto be related to the past prevalence of tuberculosis incattle, a greater mean size being found in districts witha previously high prevalence and, therefore, in popula-tions subjected to greater risk of bovine Weetion.3Cattle infected with mycobacteria other than Mycobac-terium tuberculosis bovis become sensitive not only totuberculins prepared from the infecting mycobacteria butalso to bovine tuberculin. But the homologous tuberculin

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usually causes a larger reaction than the heterologoustuberculin.4 4 The W.H.O. investigators tested manypeople in India with equal quantities of both human andavian tuberculin.5 5 Those showing a high degree of

sensitivity to human tuberculin, presumed to be infectedwith human tubercle bacilli, gave smaller reactions tothe avian tuberculin. But in the group reacting onlyto large doses of human tuberculin the reactions to aviantuberculin were the larger. It is not suggested at presentthat the low-grade sensitivity is caused by infectionwith avian tubercle bacilli, although disease in man canindeed be caused by these organisms.6 7 The cause ofthe sensitivity may, however, be more closely related toavian than to human 14T. tuberculosis. There are manyother mycobacteria in man’s environment, and theobserved low-grade sensitivity may be due to infectionby several of these at once, the particular agents varyingin different localities. But the sensitivity is neithermore nor less specific to a particular mycobacteriumthan is the sensitivity produced by human tuberculosis.It seems preferable to call these reactions to small dosesof human tuberculin " non-tuberculous." It might, ofcourse, be objected that infection by any type of 111.tuberculosis, including avian bacilli, is a. tuberculousinfection ; but the proposed term certainly has a greaterpractical value, for it implies that the reactions do nothave the same diagnostic and epidemiological significanceas the true " tuberculous " tuberculin reactions.

4. Green, H. H. Vet. J. 1946, 102, 267.5. Bull. Wld Hlth Org. 1955, 12, 85.6. Bradbury, F. C. S., Young, J. A. Lancet, 1946, i, 89.7. Dragsted, I. Ibid, 1949, ii, 103.8. Amer. J. Psychiat. 1955, 111, 595.

HANDWRITING AND THE PSYCHE

READING the character from the handwriting used tobe an elegant parlour game, at which a few intuitivepeople managed to excel. That handwriting may provideclues for psychiatric diagnosis is a more recent idea.

Captain William R. Perl,8 chief clinical psychologist atthe United States Disciplinary Barracks at Fort Leaven-worth, Kansas, says that it is based on the assumption" that an individual is self-consistent, and that such

self-consistency is reflected in one way or the other by allhis behaviour and actions." He adds two facts whichhe holds to have been established experimentally :

(1) that handwriting is both a product and a permanentrecord of a person’s highly individual motions ; and

(2) that " there is an intricate and interpretable relation-ship " between a person’s motions and his emotions.We write (most of us) with some regard for legibility,under the influence of contemporary style, and withinan arbitrary alphabet ; but these limitations apart, weshow a luxuriant variety in the use of the pen. It is notthe hand that writes, however-it is the whole man.

People who lose their hands and learn to write holdingthe pen in the mouth or between the toes go on formingthe letters in their accustomed way. Two specimens ofNelson’s handwriting, reproduced in Perl’s article, showthat his letters sloped forwards while he was still usinghis right hand, and on the whole backwards when he wasobliged to use his left ; but they are essentially the sameletters : the word Battle," which occurs in both

samples, has the same’ capital " B," made like a " 13,"the same interruption after the initial, the same longfirst " t " and smaller second " t," and the same sort ofcross-bar. Captain Perl does not note, as he might havedone, that during the ten years separating the two sam-ples Nelson had acquired a Greek " s "ńan affectationwhich, in adolescents, sometimes signifies an ungratifiedwish for importance. It would be interesting to knowwhat it signified in one who was already a nationalhero.The individual character of handwriting starts early-

from the first writing lesson, in fact. All the children in

a class may learn together from the same teacher, andusing the same fixed copy ; but, Perl says,

" one child

will use up the writing space with a few bold strokes,while another, expressing his personality, will hide hisweakish and wavy lines in one corner of the space. Onewrites with meticulous care, thus displaying compulsiveelements ; while the other will not care for the details,solve the problems carelessly, with untidy result."Pressure in handwriting probably tells something aboutthe psychological state of the writer, though it must notbe considered, Perl suggests, in isolation, but only aspart of a constellation. Strong pressure, often inter-

preted as a sign of energy, may in fact indicate neurotictension ; it may also (though he does not say so here)indicate a mood of anger, or of enthusiasm. He describespressure as

" the graphic record of our reaction to theresistance created by the friction between paper andpen " ; and the way in which we overcome this obstacleof friction may possibly indicate something about ourgeneral method of dealing with obstacles. The writerwho overcomes the friction by driving his pen forcefullyis not necessarily a forceful person : he may be confusedand disorganised by the problem-weak, in fact, ratherthan strong. The man who, instead, moves his penlightly to reduce the friction may not be weak : he maybe one who does not waste energy needlessly but whoadapts himself to his opportunities.

Something of the character of the writer inevitablyappears in his signature, and in the letter " I." Theself-confident " I " of the man who invites inspection isvery different from the mild and unassuming " I " ofthe meeker man. The signature, often expansive anddashing in early youth, settles in time into the form whichthe owner wishes to present to the world : large or small,simple or showy, precise or vague. But it is not, eventhen, beyond change : make a man a dictator and his

signature suffers accordingly. Reproductions of Musso-lini’s signature from the time when he was a fairlyunknown journalist, and wrote a modest schoolboy hand,to the time when he was a fully fledged dictator show thedeplorable inflation of his self-regard.

Physiologically, handwriting is the result of muscularcontraction and release, the balance between them givingrhythm ; and study of this rhythm in patients who arementally sick may prove useful, Perl suggests, in psychi-atric investigation. Disturbances of rhythm are not seenin cyclothymic patients. The manic patient’s hand-writing, though often large and exaggerated, has asmooth, flowing, and even accentuated rhythm; andthe writing of the depressed patient, though it maysink gloomily downwards from the start of the line, andthough the letters may be blunted and toppling, yetflows rhythmically across the page. The hand of the

schizophrenic, however, shows a broken rhythm, suggest-ing a loss of balance between muscular contraction andrelease. Perl suggests that a casual inspection of a

patient’s handwriting may sometimes be enough to sethis doctor on the right diagnostic track, or lead him tocounsel psychiatric investigation. The method, when itis more fully developed, may also, he thinks, throw lighton the psychology of those historical persons who haverashly left us specimens of their handwriting.

F.R.S.

AMONG the twenty-five new fellows of the RoyalSociety we are glad to see the names of three membersof the medical profession-namely, Prof. A. W. Downie,of Liverpool ; Prof. K. J. Franklin, of St. Bartholomew’sHospital; and Sir Harold Himsworth, of UniversityCollege Hospital and the Medical Research Council.

Sir GODFREY HUGGINS, on whom a viscounty has beenconferred, has chosen the title of Viscount Malvern ofRhodesia and of Bexley in the county of Kent.