Jaundice in Severe Infections.

Correspondence JOURNAL can the patient be given a sense of continuity. in the process of treatment. By such means it is also possible to avoid the sudden last-minute urgent admission of a dying patient to a totally strange hospital for the final few hours of a prolonged illness; this is not terminal care but terminal mismanagement. If patients are to be transferred for terminal care in geriatric units it is desirable that the prognosis should be assessed in weeks or months rather than days. On the other hand, it must also be acknowledged that unexpected remissions can occur when it may be desirable for the patient to return home for a time. There are, among 114 women in this hospital today , two cases of carcinoma of breast admitted for " terminal care" 21 months and 32 months ago. If, as Dr. Morton states, the teaching hospitals fail to set a good example to their students in managing terminal cases of cancer, this particularly thoughtless form of man's mutual inhumanity will bee perpetuated. Role of the Child Psychiatrist SIR,-I wish that Dr. R. L. Moody's submission in his letter (21 August, p. 477), "that the family doctor should be recommended to refer cases of emotional disorder to the child psychiatrist when specialist advice is needed," were possible in all parts of the country. In this borough, with a school population of some 25,000 young people, the opinion of a child psychiatrist cannot be sought easily at the present time. The last child psychiatrist has emigrated, and even when he was with us we could expect only one and a half sessions a week at the most. The difficulties were not of his making, as he served three other areas in addition to this large borough, and his frustrations were not eased by the absence of beds for severely disordered adolescents. Our information suggests that the problem may be eased in two years, but even then provision will be' inadequate for this densely populated area. At the present time there does not seem to be a suitable applicant for the post of child psychiatrist. While we wait in hope for a child psychiatrist , our school psychological service is run by a depleted psychological team helped by school doctors, and when a child's emotional difficulties need specialist help the advice of the local paediatrician is sought. Where he cannot manage, help …