1258

was
travelling
between
hospitals
in
Brighton;
for
part
of
the time the ambulance was
taking
an infant from one
hospital
to another. Two adults were inside the ambu-
lance for most of the
period,
and
they
were
joined by
a
third for the remainder
(2.49
to 3.00
P.M.,
and 3.19 to
3.30
P.M.).
The
day
was
clear, crisp,
and
sunny,
with a mean
temperature during
the run of 6°C and a wind
speed
of
approximately
7
m.p.h. (about
11
k.p.h.).
Air tem-
perature
in the vehicle was measured
by
a thermistor
suspended centrally.
The internal surface
tempera-
tures of the windows and roof were determined from
thermistors attached to the surfaces
by
adhesive
tape.
The results obtained are
given
in the
figure.
Varia-
tions in the weather are referred to
along
the time-axis
of the
figure,
and in addition the occasions when the
ambulance heater was on or off and when the doors
were
open
or closed are also indicated.
The chief variations in air
temperature
were asso-
ciated with the
opening
and
closing
of
doors,
and with
the
operation
of the heater. The
changes
in air
tempera-
ture
(maximum
minus minimum
172°C)
were
greater
than the variations either of the internal-roof-surface
temperature (maximum
minus minimum
9-4°C)
or of
the window
temperature (maximum
minus minimum
39°C).
The mean air
temperature
over the
period
of
recording
was
16-9°C,
the mean roof
temperature
was
156°C,
and the mean window
temperature
10-8°C.
These
may
be combined to
give
an
"
environmental
temperature ",
which
incorporates
the effects of both
convective and radiant heat
transfer,
of about 16°C.
The
largest component
of environmental variation was
associated with
changes
in air
temperature,
and not with
changes
in surface
temperatures.
These surface
tempera-
tures determined the mean radiant
temperature,
but
this was less than air
temperature.
Considering
now an incubator carried in the
type
of
ambulance
studied,
if the mean environmental tem-
perature
in the ambulance was considered to be 16°C
and the incubator air
temperature 32°C,
the incubator
wall 2 would be at about 25 °C. The mean environmental
temperature
for the
baby
inside the incubator would
therefore be
approximately (32+25)/2-i.e., 28-5°C,
considerably
below the
temperature
indicated
by
the
incubator thermometer.
For
practical purposes,
the ambulance was like a room
at about 16°C
(i.e.,
mean of radiant and convective
effects)
with doors
opening
and
closing
and
letting
in
draughts
of cold air. The effects on adults and on
incubators and the babies inside them would be those
to be
expected
under such conditions-that
is,
not
extreme,
but
perhaps
uncomfortable for the
adults,
and
potentially
serious for babies. In this connection the
high
incidence of
hypothermia amongst
babies with
congenital
malformations of the central nervous
system
3
is
important.
We thank Dr. W. S. Parker and Mr. A.
J. Sumpter
for their interest
and
cooperation.
Air and surface
temperatures
were measured
by
thermistor
probes supplied by Light Laboratories, Brighton.
Requests
for
reprints
should be addressed to T. P.
M.,
Royal
Alexandra
Hospital
for Sick
Children, Brighton
BN1
3JN,
Sussex-
1. Mount, L. E. The Climatic
Physiology
of the Pig. London,
1968.
2.
Hey,
E.
N., Mount,
L. E. Archs Dis. Childh.
1967, 42, 75.
3. Accidental
Hypothermia. Royal College
of
Physicians
of
London, 1966.
Mental Health
THE GAS-LIGHT PHENOMENON
RUSSELL BARTON
J.
A. WHITEHEAD
FROM SEVERALLS
HOSPITAL, COLCHESTER,
AND PRESTWICH
HOSPITAL,
MANCHESTER
THE
play
Gas
Light by
Patrick Hamilton is a classic
piece
of 20th
century
victoriana. Its theme is a husbands
plot
to
get
rid of his wife
by driving
her into a lunatic
asylum.
The medical literature does not
appear
to have
many
accounts of
plots
of this
type.
A select committee
of the House of Commons in 1763 concluded that some
people
were committed to
asylums
as a method of
solving
family
and social
problems.2
Several workers have
put
forward various ideas on
rejection
as a cause of mental
illness;
and in 1965 some concern was shown over misuse
of Section 29 of the Mental Health Act 1959.3-6
We describe here two cases in which there were
definite
plots
to remove an unwanted and
restricting
relative
by securing
admission to a mental
hospital,
and
one case of an old
lady
admitted to a mental
hospital
following
induced incontinence.
Unimportant
details in
the case-records have been
changed
to
prevent
identifica-
tion of the
patients
and their families
by people
connected
with them but unaware of what
happened.
CASE-RECORDS
Case 1
Mr. A. was admitted one
evening
to a
psychiatric hospital
as
an
emergency.
His
general practitioner,
when
asking
for his
admission,
had said he was
mentally
ill and had attacked his
wife. He came into
hospital
as an
"
informal "
patient
but
was
accompanied by
a mental welfare
officer,
who confirmed
the
story
of violence.
On admission the
patient
said he had felt tense and
depressed
for about six months and related this to his wifes
changed
attitude towards him. He said she had become " cold
",
and
he
thought
she
might
have been
seeing
another man. He
denied he had been violent and
thought
he had been sent into
hospital
because of his " nerves ".
He was a mechanic of 48 who had been married for ten
years
and had three children. He had never been ill before and did
not think there had been
any
mental illness in his
family.
He
described
symptoms
of
anxiety
and
depression
which fluctuated
according
to his wifes behaviour. He felt better when she
was affectionate and worse when she was " cold " towards him.
His wife said he had
changed during
the
previous
six months,
and had become
irritable, bad-tempered,
and liable to un-
provoked
violent outbursts in which he sometimes hit her and
once struck her with a hatchet. She also claimed that his
memory
had deteriorated and that he lost his
way
in
places
previously
familiar to him. She denied
having changed
in her
attitude towards him and said there was no truth in his accusa-
tion that she had been
associating
with another man.
When
examined,
the
patient
was found to be rather tense but
otherwise there was no clinical evidence of either mental or
physical
disease.
He remained in
hospital
for twelve
days
and became more
relaxed without
any specific
treatment. No
signs
of
irritability
or violent behaviour were
observed,
and he
appeared
to
function at a
fairly
normal level.
Investigations
were all
normal;
and
psychological testing produced
results within the
normal
range.
1.
Hamilton,
P. Gas Light. London, 1939.
2.
Leigh, D. The Historical
Development
of British
Psychiatry. Oxford,
1961.
3.
Barton, R., Haider,
I. Lancet, 1965, i,
912.
4.
Enoch, M. D., Barker, J.
C. ibid.
p. 760.
5. Whitehead, J. A. ibid. p. 865.
6. Barton, R., Haider,
I.
Medicine,
Sci.
Law, 1966, 4, 147.