732

countries, including Britain, from which the diseasemay be transmitted to man.The treatment of infected individuals is uncertain,

but diethylcarbamazine has in some cases led to

regression of signs and symptoms,2 and in othersthis improvement has coincided with a fall in the titreof the fluorescent-antibody test. 20 The dose recom-mended is 3 mg. per kg. body-weight thrice daily for21 days.9 Infected animals may be effectively treatedby piperazine adipate; 200 mg. per kg. removes themajority of worms even in puppies,17 although fre-quent repetition of treatment during the first sixmonths of life is necessary. There is little doubt thateffective deworming of host animals will do morethan any other single measure to reduce the incidenceof infection in man of a condition which is relativelycommon, difficult to diagnose, and variable in responseto treatment. Deworming should therefore be recom-mended in every home with pets, and particularlyin those homes where pets and children coexist.

THE DOCTOR AS INQUISITOR

HOODING, exposure to a continuous hissing noise,standing for hours in a required posture against awall, prevention of sleep-such are the techniqueswhich have been used to extract information fromreluctant detainees in insurgent British colonies, andlatterly in Northern Ireland. These techniques weredescribed in the Compton report 2 and were supportedby a majority of the Parker Committee. 22 The Govern-ment has preferred the view of Lord Gardiner, thedissenting member of this committee, and has orderedthat such ill-treatment shall be discontinued.

Regrettably the use of these techniques cannot beregarded as an aberration which can be relegated tooblivion. The very fact that brutal treatment wasmeted out for so long in so many countries, with somany (including The Lancet) ignorant or heedless ofwhat was going on, underlines the need for doctorsto learn from the past and to establish a firm line forthe future.

Doctors (as Mr. Lane declares in his letter on p. 748)should have no truck with the methods described byCompton. Firstly, these are incompatible with thestandards which hold the profession together, andsecondly (if a more mundane reason is needed) medicalattendance at intensive interrogation can only lend theproceedings a gloss of restraint and of scientific in-sight which they do not merit. The majority of theParker Committee found the now-banned techniquesacceptable in certain (underlined) circumstances,subject to safeguards. These safeguards were to

include guidelines (not rules) which were to be bothsecret and flexible, the maintenance of skilled inter-rogators, and the constant presence at the interroga-

20. Wiseman, R. A., Woodruff, A. W., Pettitt, L. E. ibid. p. 591.21. Cmnd. 4823. H.M. Stationery Office, 1971.22. Report of the Committee of Privy Counsellors Appointed to

Consider Authorised Procedures for the Interrogation of PersonsSuspected of Terrorism. Cmnd. 4901. H.M. Stationery Office.21p.

tion centre of a doctor with some psychiatric trainingwho " should be in a position to observe the courseof oral interrogation. It is not suggested that heshould be himself responsible for stopping the interro-gation-rather that he should warn the controller ifhe felt that the interrogation was being pressed toofar ... This should be some safeguard for the consti-tutionally vulnerable detainee and at the same timefor the interrogator." But the whole point of theexercise was to bring the detainee to breaking-point;and what distinguishes one man from another is notwhether he will break but when he breaks. It was leftto Lord Gardiner, in his dissenting report, to tell thereader that the Parker Committee was informed bv agroup of medical specialists that " Any proceduressuch as those described in the Compton Report de-signed to impair cerebral functions so that freedom ofchoice disappears is likely to be damaging to themental health of the man. The effectiveness of the

procedure in impairing willpower and the danger ofmental damage are likely to go hand in hand so thatno safe threshold can be set."

Neither the General Medical Council (which existsto maintain minimum educational standards and pro-tect the public against wayward or grossly inefficientdoctors) nor any other single existing organisation isfully suited to decide on the doctor’s relations with allaspects of the modern State. As a safeguard, a jointstanding committee might be set up with representa-tives of the British Medical Association (whoselournalhas already expressed concern 23), the Medical Asso-ciation for the Prevention of War, the Royal Collegeof Psychiatrists, and the National Council for CivilLiberties. A watchdog body of this sort would be

mainly concerned to prevent application of medicalknowledge against certain individuals for the supposedbenefit of others.

NOCTURNAL ANGINA

ANGINA pectoris is usually associated with exerciseand emotion, but it may start at night, wakening apatient from sleep. At the first Japan/British MedicalSymposium, in Tokyo, Prof. S. Murao (Tokyo)described his investigations in 12 patients with noc-turnal angina using all-night electrocardiograms andelectroencephalograms. 58 episodes of ST-T-wave

change corresponding to myocardial ischemia wereobserved, being most frequent in the stage of para-doxical or rapid-eye-movement sleep and least fre-

quent in the stage of deep sleep (stage 4). The electro-cardiographic changes were most often seen in para-doxical-sleep periods between 4 and 6 A.M. Theywere not usually preceded by tachycardia, but thepulse-rate rose, either at the time of or shortly afterthe appearance of electrocardiographic changes. Dr.

Peter Sleight (Oxford) reported a close relation betweenepisodes of increased blood-pressure and paradoxicalsleep in patients with nocturnal angina. He had alsofound that patients with phaeochromocytoma may havesevere hypertensive episodes during periods of para-doxical sleep. These findings emphasise the impor-

23. Br. med. J. March 25, 1972, p. 761.