1186

In conclusion, I have read 1 that a new " security " unit forpsychopaths is to be developed at Hendon. Its purpose needs

urgent clarification. If it is to fill the gap for the type-3 psycho-path alluded to it will be a remarkable advance and it willaffect the admission and treatment regimens of both the othertypes. If it duplicates either the prison or the open-hospitalsetting exactly it will lose much of its potential. It is clear,however, that the whole area of therapeutic endeavour for thetreatment of psychopaths needs reappraisal and that muchmore use should be made of the existing facilities if the visionof the 1959 Mental Health Act is to become a reality.

J. STUART WHITELEY.Henderson Hospital,

Sutton, Surrey.

FIFTY YEARS AFTER FLEXNER

SIR,-It is a matter of some surprise and, I think, ofconcern that Professor Miller’s timely and forceful criticismof our system of medical education and the hospital service(Sept. 24, p. 647) has provoked so little response in yourcolumns. True, eighty-nine signatories (Oct. 22, p. 904)from the upper echelon declared their agreement with hisviews, and Dr. John Walton (ibid.) has told us how things aredone at the Albert Einstein College of Medicine, but it seemsthat no torch has been lit or embers of aggressive discontentfanned into flame. This I had hoped to see, and the non-response is, I fear, symptomatic of the apathy born of longyears of frustration which is now all too common among us.As a member of the staff of a peripheral hospital which is

constantly short of nursing staff of the right calibre, inadequatelyequipped, and with ageing buildings-some of the accommoda-tion is Dickensian-I am painfully aware that our standardsof patient-care are often below the acceptable minimum.But Professor Miller attributes too large a share of blame to

the politicians. Parliament is the servant of the people; anation gets the government it deserves, but it would be unfairto say it gets the health service it deserves, for as he so rightlysays the public is in the main quite ignorant of how far thehospital service falls short of what is possible. It is our res-

ponsibility as a profession to dispel this ignorance by allavailable means of communication and to urge the people todemand of their elected representatives that an adequatehealth service be provided as a first priority. The country canafford it whether or not we have a military presence east ofSuez. (In the ’eighties the excuse will no doubt be the cost oflunar travel.) After all, only 4-11/,, of the National product isspent on the Health Service as compared with 6% in theUnited States.

I hope the indignation of the eighty-nine signatories willcompel them to do more than simply reach for their pens-mayI suggest that they lobby their M.P.s, write to the Press, appearon television, and personally evangelise so as to focus the

spotlight of public concern on the present critical state of thehospital service.

In the meantime the available resources must be used tobetter advantage. There are too many factional interests, toomany empire-builders whose activities are often at variancewith the needs of the corporate whole, too little centralisationof services, and too much research which is ill directed. Thefinancial cake has to provide so many slices that the crumbswaste a not insignificant part. Parochialism and sometimes

extraordinary lethargy prevent efficient planning. For

example, the Hunt Committee on Hospital Supplies, appointedin 1954, published its report in 1958; but its recommendationsfor bulk purchasing, which could save considerable sums,have still not been fully implemented.

I believe that the hospital service desperately needs anoverlord-a Chambers, a Wolfson, or a Beeching-to providethe dynamic and skill of big business. The Minister of Healthcould do worse than act on this suggestion.

GEORGE S. TURNER.

1. Hosp. soc. Serv. J. July 1, 1966, p. 1208.

LEGALISING ABORTIONSIR,-The most potent reason in favour of abortion-law

reform was not touched on in the excellent letter by Dr.Fisher (Nov. 12, p. 1077). I refer to the number of illegalabortions, variously estimated to be between 40,000 and 200,000a year, as described in Paul Ferris’s book The Nameless. Theexsanguinated results of some of these operations providegeneral practitioners with some of their more hair-raisingweekend emergencies and it is therefore not surprising to findmost of them in favour of law reform.

If unqualified operators were conducting any other surgicalprocedure on such a scale under such conditions, the unitedoutcry of the medical profession would be deafening. Now thepublic have every right to question why such an outcry hasnot been forthcoming; while they may realise that the reasonsin some cases are based upon moral and ethical considerations,yet they find the attitude of the Royal College of Obstetriciansand Gynaecologists in defending the present laws astonishing,and cannot be blamed if they suspect it to be based on com-mercial self-interest when they read of the estimated 15,000" legal abortions " a year carried out in West End nursinghomes for large cash payments.To stop illegal operations and to wind up the West End

scandal three changes are necessary: (1) abortion should befreely available under the N.H.S.; (2) unwanted pregnanciesshould be prevented by contraceptive instruction from an

early age; and (3) contraceptive advice and equipment shouldbe freely available under the N.H.S. to all who requestthis.

I think there is a case for a new department in every districthospital to deal with contraception and abortion. It may bethat the consultant gynaecologist would not wish to beassociated with such a department, in which case the hospitalauthority must be free to recruit staff-perhaps from thosedoctors at present staffing family-planning clinics.

BENEDICT HOSKYNS.

SIR,-Mr. Hall (Oct. 29, p. 974) is taken to task by Mrs.Simms (Nov. 5, p. 1029) and Dr. Fisher (Nov. 12, p. 1077)because he reports that in over 40 years of active practice as aconsultant surgeon he has not undertaken a therapeutic abor-tion. His conclusion is: " I cannot recall a single case in whichthe life or health of the expectant mother has suffered thereby."

Mrs. Simms poses the question: " Is this confident conclu-

sion based on long-term psychiatric follow-up studies, or onpious hopes ? " Dr. Fisher cites the findings of an inquiry bythe Abortion Law Reform Association among 750 N.H.S.doctors in the London area to prove that Mr. Hall belongs to ashrinking minority, and asks: " Has Mr. Hall really neverread of a desperate distraught mother driven to suicide

usually by gas-poisoning, because she could not face anotherpregnancy ?

"

These questions imply: (1) that there are reliable studies onthe long-term psychiatric follow-up of non-aborted womenwhich prove conclusively that they would have been betteraborted; and (2), that there is evidence of a substantial numberof suicides by gas-poisoning in multipars. My former researchassistant (Dr. Robert Neisser) and I have searched the publishedreports (English, French, German, and Russian) from 1826 todate and have found no such evidence. Mr. Hall’s behaviourconstitutes sound medical practice, whatever his ethical stand-point.

Dr. Fisher asks another question: " Will Mr. Hall tell uswhere he stands on the prophylaxis of contraception ? " Theimplication here is that those who deny the therapeutic value ofabortion on psychiatric grounds do so because of their religious,presumably Roman Catholic, beliefs, though all religionsattribute the greatest importance to human life after conception.One should be exceedingly watchful of bigotry and prejudicefrom whatever quarter. To imply that because a man holdsreligious beliefs his scientific observations must be suspect isjust as patently wrong as to believe that rationalists and