The acme of efficiency

doi:10.1136/bmj.328.7447.1050

BMJ 2004;328:1050 (1 May), doi:10.1136/bmj.328.7447.1050

Filler

The acme of efficiency

The first 150 words of the full text of this article appear below.

In 1955 I was a registrar in a large mental hospital in thenorth of England. Most of the beds were in the old buildings,which had remained largely unchanged for nearly 100 years. Therewas also a modern building in the grounds, to which new patientswere admitted. If these patients needed electroconvulsive therapy,they were anaesthetised and given a muscle relaxant. Electroconvulsivetherapy was also widely used in the chronic wards, where itwas the consequence of disturbed behaviour. There, it was given"straight"—that is, without anaesthetic or relaxant. Thispolicy was defended by the view that the patients had neverknown anything different. However, one day, the medical superintendentcame across an article which showed that a third of patientsreceiving straight electroconvulsive therapy had radiologicalevidence of vertebral compression fractures. He was appalledand immediately decreed that all patients receiving such therapyshould have proper anaesthetic . . . [Full text of this article]