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To Match the Name

THE LANCETLONDON: : SATURDAY, JULY 21, 1945

To alter the Imme of the thing is not to change itsessence. The agreeable word" asylum," blackenedby its associations,. was discarded thankfully for theterm " mental hospital," but the alias has done littleto rid patients or their relatives of their dread of theactual place. Lieut.-Colonel J. IVISON RUSSELL,speaking on Thursday at the annual meeting of theMental Hospitals Association, suggested that it is themental hospitals themselves that need changing. Itis our duty to make them acceptable.As a medical superintendent, RUSSELL has an

opportunity of judging the causes of public dread ofthese institutions ; and he puts the custom of retain-ing

" settlers " as their most objectionable feature.He recognises four main classes of settlers, amountingto 70% of the hospital population in any largeinstitution. These can be roughly grouped as

follows : recovered but homeless 5%, chronic psycho-tics 45%, seniles 10%, and mental defectives 10%.The first and third groups, and some of the second, hebelieves, could be more suitably housed in subsidiaryhomes, and the congenitally defective would be betterplaced in colonies. The recovered but homeless

patient is at present difficult to cater for : the hospitalauthorities have to decide whether, if they dischargehim, he is stable enough to stand competitive lifeoutside, when he lacks friends, work, and money.If he is not, it seems only a kindness to keep him inhospital. But it may be bad for a recovering orrecovered patient to remain in the company of thosewho are still acutely or chronically ill. RUSSELL

suggests that he. should be transferred to a

: resettlement unit at a distance from the hospital,and that finally, if he cannot be fitted for

ordinary life, he should go on to an aftercare unit.Units of both types would be administered from the.main hospital though placed some thirty miles away.They would each take 20-30 patients and would carryon outdoor and indoor industries. Some. patientsnot fit for full life outside would be able to go flomthe unit daily to work for . employers near at hand.Many patients with chronic psychosis of a mild andinoffensive type could also live happily in a countryaftercare home, and this would help to reduce thepermanent population in the main hospital. Separateinfirmaries for the old people have usually beenopposed, but, given a fair trial with adequate staffand equipment, they might work well.The hospital itself would be in two parts-the main

buildings and (some 300 yards or more away) theannexe. Chronic psychotics unfit for aftercare homes,because of their disorderly or unpleasant behaviour,would go into the annexe. These form about 30% ofthe present hospital population, and would make upabout half the number under RussELL’s scheme. Inthe main hospital the reception wards for anxious ordepressed patients would be in another building fromthose used by the excited or socially disagreeable. Hethinks it important that separate rooms should be

set aside in the main building for separate purposes.At present, in. order to economise space in our over-crowded mental hospitals, one room may be used forseveral purposes. Thus half the occupants of asick-room may be using it merely as a dormitory ; ordormitory beds may be used J3y patients havinginsulin treatment or resting after convulsion therapy.The main buildings should include shock-therapyrooms, narcohypnosis and psychotherapy rooms,

outpatient consulting-rooms, the occupational centre,the operating-theatre, the radiological department,laboratories, and sick-rooms..

Colonel RUSSELL estimates. that his plan wouldhalve the incurables at the main hospital, and sochange the atmosphere that patients and their rela-tives would take much more kindly to the modernpsychiatric treatment offered there. People, talkingtogether about their experiences, quickly publish thepassing of an. unsatisfactory tradition in favour of abetter. Our mental hospitals badly need these andother reforms to bring them up to date. Once theyhave won the good word of patients and their relatives,all stigma will be wiped out in time, - and they willbecome the first, not the last, resources of the mentallysick.

Curare in AnæsthesiaDURING the hundred or so years which have elapsed

since BENJAMIN BRODIE, and then CLAUDE BERNARD,initiated the scientific investigation of curare, thearrow-poison used by South American natives to

paralyse game, pharmacologists and physiologists,perhaps abetted by novelists seeking new means oftorturing their heroes, have maintained its horrid

reputation. As a result, until recently it was nomore than a valuable laboratory tool for renderinganimals immobile, the voluntary muscles being pra-lysed by a block at the neuromuscular junction,without interfering with their nervous system.About ten years ago some sporadic investigationswere made into the possibilities of using curare tocontrol the spasms of tetanus, but these researches,though promising, do not seem to have arousedmore than academic interest. In 1940, however,BENNETT,2 of Nebraska, injected curare to soften theviolent muscular response to electric shock therapy inpsychiatric patients, and it was so effective that alarge number of mental hospitals in the United Statesnow use the drug for that purpose. This success,which revealed curare as a readily controllable drug,may be said to have opened the story of curare inanaesthesia ; for, as Dr. GRIFFITH recalls on anotherpage, it was as a direct result that, still with some mis-givings, he and JoHNSON decided to apply thenew knowledge of the drug in their own specialty.They found that profound muscular relaxation couldeasily be obtained during abdominal operations by atimely dose of curare, thus obviating the need for deepgeneral anaesthesia. This proved particularly valu-able in resistant subjects, for whom the only alter-native would perhaps have been a spinal anaesthetic.GRIFFITH now reports over five hundred cases in whichcurare has been used without a death, while CuLLEN,41. Cole, L. Lancet, 1934, ii, 475 ; Mitchell, J. S. Ibid, 1935, i, 262 ;

West, R. Ibid, 1936, i, 12.2. Bennett, A. E. J. Amer. med. Ass. 1940, 114, 3222.3. Griffith, H. R., Johnson, G. E. Anethesiology, 1944, 3, 418.4. Cullen, S. C. Surgery, 1943, 14, 2.