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ANY QUESTIONS by decree

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									 746         25 September 1965                                   New Appliances                                                                BRITISH
 stant attention is not required, and the cot resuscitation trolley. I am also indebted to the Johnson, B. D. L. (1959). 7. Obstef. Gynaec. Brit.
                                                                                                   Emp.,
 may be immediately converted into a modified Medical Director-General of the Navy for per- Kohorn, E. 66, 492. McVay, D. (1964). Lancet, 1,
                                              mission to publish this account                              I., and
 incubator.                                                                                        312.
                                                                                                       Levis, R. D. (1961). Anaesthesia, 16, 371.
                                                                                                       Newland, M. C. (1962). Med. 7. Aust., 2, 701.
   I wish to express my appreciation to the staff                       REFERENCES                     Perinatal Mortality Survey (1962). Byit. med. 7., 2,
 of the Royal Naval Air Station, Kalafrana,         Allen, L. A. (1962). St Atr. med. Y., 36, 281.
                                                                                                            1187.
 Malta, for their assistance in constructing this   Barrie, H. (1963). Lancet, 1, 650.                 Secher, 0. (1956). Lancet, 2, 341.
                                                                                                       - (1963). Ibid., 1, 29.




 ANY QUESTIONS ?                                                                                       of an entire interview is made, and this the
                                                                                                       learner plays back while with closed eyes he
         We publish below a selection of questions and answers of general interest.                    reclines on a couch.
                                                                                                          Claims have been made by prisoners,
                                                                                                       political and otherwise, that the effects of
   Future Functioning of Ovo-testes in              explained, and the mixed nature of the             cruelty, distress, and deprivation have been
                                                                                                       modified or obliterated by self-hypnosis and
             Hermaphrodite                          gonads, but not of sexuality, should be           by auto-suggestion. Likewise pain due to
                                                    stressed. The future management should be          illness or to accident has been lessened or
  Q.-What is likely to be the future domi-          indicated so far as possible, but without over-
nant functioning of the ovo-testes in a child                                                         removed.
                                                    burdening the anxious parents with details.           Whether or not the selected technique for
 who is a true hermaphrodite with a histologi-         These points have been made dogrnatically.
 cally proved ovo-testis on either side ? There     Detailed management in these cases must take       inducing self-hypnosis " works " depends on
 is no true uterus but a fusion of MiUlerian        into account a variety of individual circum-      its therapeutic suitability for the individual
 cords. There is a rudimentary vagina and           stances in the patient and his family.            patient. It can be of considerable therapeutic
 the usual slightly enlarged clitoris. The                                                            value, but like hypnosis it is not a panacea
 chromosome complement is XO. Since it                                                                nor is it a rapid form of treatment. In certain
 would seem that the tendency will be for the               Septic Tank or Cesspit                    conditions, such as psychical impotence or
 ovarian portion to become dominant, would                                                            excessive smoking, results are easily observed
 it not be better to make the child as female        Q.-W hat is the difference between a             and the efficacy of the treatment is manifest
 as possible ?                                    septic tank and a cesspit? Could sea water          when the symptoms diminish or disappear. A
                                                  be used instead of fresh water to                   feeling of confidence follows the fading of the
    A.-There is no mention of the age of tories draining into a cesspit tank?flush lava-              symptoms and the restoration of normal func-
 the child or its sex of rearing, both of which                                                       tion, and this may give permanent relief.
 are relevant to any decision concerning sex         A.-A septic tank is designed for the             Usually the psychotherapist will help the
 assignment at the present time. Assuming liquefaction by anaerobic bacterial action of               patient to understand why the symptoms
 that there is no very strong contraindication, the solid matter in sewage as the first stage         developed in the first instance, but this is not
 the child should be made as female as possible in certain systems of sewage treatment. It            always necessary. For more detailed infor-
 (from the description, she would appear to does not by itself purify sewage and further              mation the B.M.A. Report, " The Medical
 be quite feminized externally).                  treatment is essential-i.e., aeration of the        Use of Hypnotism,"' should be consulted.
    It is impossible to forecast what the future resulting liquid by percolation through filter
 functioning of this child's gonads might be, beds.                                                                       RmEScz
 but by no means can it be assumed that the          A cesspool (or cesspit) is a watertight tank             Brit. med. 7. Suppl., 1955, 1, 190.
 testes will not function at puberty and result in which sewage accumulates pending its
 in a more or less marked degree of masculin- removal by pump or other means. It is not
 ization. It will probably be impossible satis- in any way a purification plant.                           Modified Measles and Immunity
factorily to remove the testicular tissue only;      Sea water could be used to flush                    Q.-A baby aged 8 months who had been
therefore bilateral gonadectomy will have to lavatories draining to a cesspit, but its                in contact with measles developed what
be contemplated either now or at a later stage. corrosive action on unprotected metals such
 If gonadectomy is delayed the child will have as are found in the usual flushing apparatus           seemed to be an atypical, modified form of
 to be carefully assessed longitudinally for should be borne in mind.                                 the disease. If this were the correct diag-
evidence of masculinization. Prepubertal                                                              nosis would such an attack confer immunity
removal of the gonads will be followed by                                                             to measles?
absent feminine pubertal development, and                        Self-hypnosis                           A.-Such an attack would confer
will require hormone treatment at the right                                                           immunity. Modified measles is an active
time, but gonadectomy is advisable in view          Q.-What is the technique of self-hypnosis,        infection which stimulates the patient's own
of the appreciable risk of a neoplasm arising and how can patients easily be taught how to            immune response. It does not matter
in later life, particularly from the testicular use this? Can the patient practising self-            whether the modification results from the
tissue. It seems that vaginoplasty will be hypnosis determine if his technique is                     injection of gamma-globulin, from persisting
required, but this may be left to a much later "working "?                                            maternal antibody, or from the smallness of
date because of the difficulty of achieving                                                           the infecting dose.
a good growing vagina if treatment is carried       A.-Hypnosis and self-hypnosis are of the
out early.                                       same nature. There are many techniques for
   The chromosome findings are interesting, the induction of either. They vary according
but, especially if they are based on culture to the taste of those using them, and in all                    Radiation Dose from M.M.R.
of peripheral blood, they may not reflect the the susceptibility of the mind to suggestion is            Q.-Is it advisable for people aged 40-50
true picture, which may be one of mosaicism. increased. Auto-suggestion is akin to self-              who have a history of several diagnostic x-
As in all intersexes, it is essential to come hypnosis and is usually begun under the                 ray examinations in the past to submit them-
to an early and firm decision about sex influence if not in the presence of another                   selves to annual mass miniature radiography?
assignment. When the decision, which should person.
be reached in consultation with the necessary       Self-hypnosis is best learned through being          A.-Annual mass miniature radiography is
specialists, is communicated to the parents hypnotized by an experienced psychotherapist,             no longer advised, not because of the radiation
there should be no reservation, hedging, or who will select a technique fitted for the                hazard, but because the results, except in
doubt, and the parents should be explicitly patient. Later the learner (patient) recalls the          groups with symptoms, do not warrant it.
assured that sex inversion will not occur. procedure in private and repeats from                      The radiation dose received from a single
This is a common, unspoken parental anxiety. memory, as near as may be, the words used by             mass miniature exposure is, for all practical
The reasons for gonadectomy should be the psychotherapist. Sometimes a recording                      purposes, negligible.

								
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