Parkinson is losing now
AUSTRALIAN scientists said at Melbourne on Monday that they had succeeded in developing nerve cells from early human embryos which could lead to a cure for Parkinson's disease and a range of other health problems.

Suicide: a question on answers about life
and death
By Dr Vij, K.
A SERIOUS problem in investigating possible suicide involves the difficulties encountered in obtaining sufficient information or facts about a case to support the inference of suicide. This is probably due to the fact that there still persists an undercurrent of social condemnation of suicide. Frequently, the relatives and friends of persons who committed suicide feel themselves to be not only bereaved, but also stigmatised.

Tercentenary tribute through health for all
“Ekas ke sab barak -- Sarbat da bhala”
by Dr M. L. Kataria

DARBAR Sahib, at Amritsar, was revealed to the divine vision of Guru Arjan Dev, its creator and architect, with an open door in all the four sides, "for divine and noble thoughts to pour in from all directions", as envisioned in the Rigveda, the oldest book of the world. It invited humanity at large to come in from anywhere and everywhere for prayer and peace.

Unusual as it may appear today, the foundation stone was laid by the holy hands of a divine Muslim, Sufi saint Mian Mir from Lahore. The holy Guru Granth Sahib, reigning at the holiest of the holy shrines, also includes divine hymns of 15 Hindu and Muslim saints in their original dialects.

No wonder, when Dara Shikoh was wounded and fell ill, medicines prepared from amla and allied herbal shrubs, routinely administered at the gurdwara at Anandpur Sahib, were also unhesitatingly given to the aides of this fallen "enemy" to help him stand up and fight again.

In the light of these unparalleled glorious traditions of saintly valour of the Khalsa, during this year of its tercentenary celebrations, this is a brief account of a very significant contribution to health-care for all — Hindus, Muslims, Sikhs and Christians, rich and poor, high and low, jhuggi-dwellers as well as those living in mansions around.

Rain or sunshine, winter or summer, this routine "sewa" is being rendered every Sunday for the past decade at Gurdwara Sahib Dasween Patshahib, Sector 8, Chandigarh.

Historical records reveal that Kalgidhar Guru Gobind Singh, during his holy war against the tyranny and religious persecution by the Mughal empire, camped at this very site for some time on his way to Anandpur Sahib.

No wonder, people, not only from Chandigarh but also from far flung villages and slums, from Punjab, Himachal and Haryana, come here full of faith and hope for cure. It is quite common to see the faithful donating money after receiving a prescription or any other service and insisting on any available substitute for a non-available prescribed medicine from the gurdwara dispensary. Faith in HIM heals them more than the doctor's medicine!

At the sacred feet of Guru Granth Sahib, within the range of the serene sanctity of the melody and music of the healing "shabad kirtan", crowds of patients line up with rare patience without a murmur, waiting for their turn. There is not one queue but several queues, one each for the consultant, the dispensary, the laboratory, ECG, X-ray and physiotherapy services, all operating, simultaneously. They are all "sewadars" — the consultant, the nurse, the technician, the pharmacist, the physiotherapist and the social worker.

There is pin-drop silence but for the occasional voice of the administrator "sewadar" calling for the missing links in the queue, who, might have gone for obeisance to the sanctum sanctorum or to partake of the langar.

Eversince its inception, this unique Health-care Centre has rendered creditable service to all sections of society. Nearly 25,000 consultations have been given, supported by a well stocked dispensary service, 5000 X-rays and 6000 ECG examinations, over 6000 complete urine and stool examinations, 7500 blood sugar estimations, 5000 kidneys function tests, 4500 liver function tests, 7500 haemograms, over 5000 lipid profiles, over 2500 pregnancy tests for family planning, nearly 1000 blood smears to detect the malaria parasite, besides a large number of other miscellaneous tests. All services are free.

Donations literally pour in incessantly. The budget has never been a constraint. There is an invisible but very perceptible "force" sustaining this selfless effort. A few years ago, the requirement for a physiotherapy centre was also felt. One wonders who was behind sending Rs 5 lakh for this total project, including accommodation and equipment, as soon as it was conceived. It is a pleasing sight to see the young and the old, the rich and the poor, men and women, all making use of this popular centre, like a health club, day in and day out.

The credit for setting up this unique health-care service goes to a great visionary, philanthropist and social worker par excellence, Sardar Chandan Singh, a retired high level civil servant, who is the permanent chairman of the medical services committee and also the president of this historic Gurdwara Sahib. A team of dynamic secretaries and a dedicated executive committee assist him. He is equally effectively associated with half a dozen more educational and social welfare organisations and institutions. His gradually dwindling eyesight is no handicap for him!

Just as this historic gurdwara has been dedicated to the Tenth Guru, this health-care centre has been named after Bhai Kanhayya, the world's first Red Cross man, appointed by Guru Gobind Singh himself to nurse the sick and the wounded in battlefields. Bhai Kanhayya embalmed the wounds and quenched the thirst of one and all, including the fallen and wounded enemies. When produced before the Guru for this unpardonable gross indiscrimination, the great soul embraced him after Bhai Kanhayya reminded him of his own dictum: Ekas ke sab barak — Sarbat da bhala!

— Dr (Brig) M.L. Kataria is an honorary consultant "sewadar" at the Bhai Kanhayya Health-Care Centre, Chandigarh, since its inception. Devoted to Daridranarayana, he has healed thousands of slum-dwellers in the country from various centres.

Parkinson is losing now

AUSTRALIAN scientists said at Melbourne on Monday that they had succeeded in developing nerve cells from early human embryos which could lead to a cure for Parkinson's disease and a range of other health problems.

The Monash Institute of Reproduction and Development said its research team was the first to achieve the controlled, laboratory development of nerve cells from embryonic stem cells.

"We hope that one day we will be able to produce pure populations of specific types of nerve cells that could be used for screening new medicines or for transplantation to correct specific diseases, senior research fellow Martin Pera said.

Embryonic stem cells are building blocks which can turn into virtually any type of cell in the body.

The Monash team worked in conjunction with the National University of Singapore and Hadassah Medical Centre, where the cells used in the research were developed from human embryos.

"What we are doing is isolating precursors of nerve cells from the embryonic stem cell cultures, growing them on and then getting them to turn into mature nerves," Pera told Reuters. "We are the first to show you can do that in a controlled fashion.”

The University of Wisconsin reported in 1998 that it had isolated and grown human embryonic stem cells, leading to the potential for them to be used therapeutically.

Monash had been working along the same lines and in 1999 focused on characterising the nerve cells that were coming out of the stem cell cultures.

Pera said clinical use of the technology would hinge on how well scientists could manipulate the cells, how quickly they could produce pure populations of specific cell types and evidence that the cells would function effectively in the body.

"I think you will see a lot more effort worldwide in this area, he said.

"The treatment of Parkinson's, Alzheimer's disease, strokes and degenerative heart disorders were among a wide range of potential medical applications for stem cell biotechnology.”

It could also lead to a better understanding of early childhood development disorders and the testing of new medicines could be hastened with the availability of populations of specific cells.

Suicide: a question on answers about life
and death
By Dr Vij, K.

A SERIOUS problem in investigating possible suicide involves the difficulties encountered in obtaining sufficient information or facts about a case to support the inference of suicide. This is probably due to the fact that there still persists an undercurrent of social condemnation of suicide. Frequently, the relatives and friends of persons who committed suicide feel themselves to be not only bereaved, but also stigmatised. They often attempt to persuade or otherwise influence the authorities against the certification of suicide and that is why many suicide deaths are presented as natural or accidental.

I have encountered quite a few cases of such pseudo-presentations, particularly in cases of death due to burns and poisoning.

The incompatibilities were writ large in the "dying declarations" recorded by the magistrates in such cases. I would like to focus on the number of cases of death by burns and poisoning conducted by my department, which appear as follows:

In evaluating a possible suicide, it is highly desirable to have a description of the scene of death, including the position of the body, and to have evidence gathered at the scene such as pills, poisons, weapons and notes.

In addition, it is important to reconstruct the habit of the victims both in connection with the method of death and in regard to the person's general life-style and for this, information may be obtained by interviewing persons who knew the deceased fairly well, such as friends and family members, as well as professional persons such as teachers, physicians and clergymen who had dealt with the deceased individual.

This concept of "psychological autopsy", in addition to producing relevant investigating material, also provides therapeutic value leading to bereavement counselling, the relieving of guilt feelings and the answers to other related questions. The following situations will highlight the importance of such a procedure for conducting psychological autopsy:

There may be circumstances where death due to self-negligence or self-indulgence is not certified as suicide, although there might be some speculations that they should be. For example, deaths resulting from cirrhosis of the liver due to chronic alcoholism, or from lung cancer due to cigarette smoking are by common consensus called natural deaths.

Problems may arise, however, in considering the chronic alcohol abuser who takes a large amount of sleeping pills and who also is depressed and talks about suicide.

When such a person dies, how can one decide whether he or she died of the combination of alcohol and drugs used in order to feel "stoned" or whether

drugs were ingested for a lethal purpose?

In such cases, the evidence must be considered in entirety. If the blood-alcohol level and the amount of blood barbiturates are both insufficient to cause death, the resultant death was, in all probability, due to an unanticipated additive effect and the correct certification would be "accident". In those cases, where there is a high level of hypnotics in addition to alcohol and where the psychological autopsy uncovers a history of recent crises in the life of the person, the evidence would tend towards certification as suicide.

The issue of suicide versus accident sometimes involves a controversy over insurance benefits. The possibility of contest arises from two aspects of insurance contracts. First, many of the life insurance policies contain a time-clause covering period specifying that the claim for death benefits is invalidated if the insured person's death is by suicide. Second, many persons are covered by insurance contracts which specify that a certain amount of money will be paid for deaths due to accident. In such cases, the opinion of some experts can be helpful. However, the expert must be cautious and avoid assuming an overly authoritative or decision-making posture. Most court cases are not clear-cut, otherwise; they would probably not be under litigation. Furthermore, it is the task of the court, not of the expert, to reach a verdict.

Workers' compensation laws that provide for the medical care and support of persons injured in the course of employment have been interpreted by the courts to include the mental as well as the physical consequences of work-incurred injury. Emotional trauma related to the job such as conflicts in loyalties or promotion or demotion can produce anxiety and depression, ultimately leading to the commission of suicide by the incumbent.

If a patient commits suicide, under what circumstances may the doctor and the hospital be liable in law suits alleging negligence? Ordinarily, the general practitioner or the specialist in medicine or surgery is not expected to detect a high suicide risk in usual practice or necessarily to take preventive anti-suicide action. If the patient dramatically calls suicidal tendencies to the attention of the doctor, a reasonable evaluation is necessitated and a consultation with the psychiatrist should be considered.

Common sense dictates that the best precaution against suicide in or outside the hospital is the presence of other people. This may mean a continuous monitoring of a patient by the family and by the staff of the hospital.

Windows and doors should be secured and poisonous materials should not be readily available. However, it should be stated explicitly that there is no certain way to prevent anyone from committing suicide anywhere, if the individual is wholly dedicated to self-death. In two excellent reviews, Perr describes the results of court actions. He stresses that the law requires reasonable care in foreseeable situations. The key words in the cases are "reasonable:, "anticipated", "foreseeable", "preventable" and "controllable".

Concluded

— Dr Vij is the Professor and Head of the Department of Forensic Medicine at Government Medical College, Chandigarh.