| This
chapter
describes
the
research
protocol
submitted
to
Salford
Ethics
Committee
(SEC)
that
was
considered
on
15
January
1986,
and
the
chronology
of
the
brains
obtained
from
Prestwich
mortuary.
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| Sources
of
information |
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| The
chapter
is
based
on
documents
provided
by
Professor
Deakin
and
the
minutes
and
papers
of
the
SEC.
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| Background |
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| Following
the
1974
NHS
reorganisation,
Prestwich
Hospital
became
part
of
Salford
Area
Health
Authority.
The
SEC
had
responsibility
for
consideration
of
research
projects
that
affected
patients
in
Prestwich
Hospital.
(The
designation
Salford
Ethics
Committee
changed
in
1991
to
Salford
Local
Research
Ethics
Committee
(LREC)).
For
consistency,
the
earlier
name
is
used
throughout
the
rest
of
this
chapter.
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| In
1987
Circular
HC(77)28
was
the
most
recent
advice
to
the
NHS
on
the
'Removal
of
Human
Tissue
at
Post
Mortem
Examination',
Chapter
6.
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| Discussions
and
correspondence
preceding
the
application
to
Salford
EC
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| Dr
Som
Soni,
consultant
psychiatrist
at
Prestwich
Hospital,
had
carried
out
research
and
clinical
reviews
of
long-stay
patients
in
Prestwich
Hospital.
His
findings
offered
a
unique
opportunity
to
relate
clinical
features
to
post
mortem
changes.
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| Discussions
in
the
spring
of
1985
with
Dr
Soni
and
other
clinical
colleagues
at
Prestwich
Hospital
had
indicated
that
the
joint
team
would,
in
principle,
be
able
to
obtain
the
brains
of
patients
who
died
in
Prestwich
Hospital
with
neuropsychiatric
diseases.
These
discussions
had
been
on
the
understanding
that
consent
would
be
obtained
from
the
relatives.
As
Chapter
8
documented,
the
Cerebral
Function
Unit
was
already
obtaining
brains
from
Prestwich
hospital
on
the
same
basis.
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| Dr
Soni
wrote
to
Dr
Deakin
on
31
July
1985
enclosing:
'copies
of
the
literature
on
getting
consents
for
post
mortem
studies.
Perhaps
you
would
like
to
go
through
this
and
decide
on
a
protocol,
which
we
can
then
get
printed
for
our
patients
at
Prestwich
Hospital'.
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| Dr
Deakin
replied
on
2
October
1985:
'I
enclose
a
draft
submission
to
the
Prestwich
Ethical
Committee.
Do
you
think
there
might
be
some
mileage
in
meeting
groups
of
relatives
ward
by
ward
to
speed
things
up?'
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| The
version
of
the
protocol
submitted
to
the
SEC
is
no
longer
available.
Annex 31
is
a
copy
of
the
draft
enclosed
with
Dr
Deakin's
letter.
(Two
pages
are
unfortunately
missing
from
this
document).
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| The
title
of
the
project
was:
'Brain
Research
in
Schizophrenia
and
Tardive
Dyskinesia'.
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| This
includes
a
section
headed
'Request
for
Brain
Tissue':
'The
consent
for
postmortem
will
be
obtained
in
advance
from
the
patient
(if
possible)
and
his
relatives.
It
is
not
an
easy
matter
to
make
a
request
of
this
nature,
but
is
vital
if
progress
in
understanding
and
treating
schizophrenia
is
to
be
made.
It
is
important
that
relatives
of
patients
with
schizophrenia
are
involved
in
this
decision;
we
must
safeguard
any
wishes
that
patients
may
have
but
may
not
be
able
to
express.
Where
possible,
the
decision
will
be
discussed
with
patients
and
their
relatives.
Such
requests
have
been
successfully
made
in
areas
of
research
on
other
illnesses
such
as
multiple
sclerosis
and
Parkinsonism.
A
standard
form
has
been
prepared
based
on
the
forms
used
by
the
Multiple
Sclerosis
Society
of
Great
Britain
and
by
the
Parkinsonism
Research
Group
(copies
of
form
and
related
documents
enclosed)'.
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| As
this
research
focussed
on
hospital
inpatients
with
a
diagnosis
of
schizophrenia,
the
draft
protocol
did
not
mention
control
cases
or
refer
to
collection
of
brains
from
Coroners'
post
mortems.
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| The
SEC
meeting
and
minutes
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| The
application
was
considered
by
the
SEC
on
15
January
1986,
as
project
number
8608.
The
title
of
the
proposal
had
not
changed
from
the
draft.
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| The
relevant
minute
reads:
'Brain
research
in
schizophrenia
and
tardive
dyskinesia'
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| 'Dr
Deakin
and
Dr
Soni
attended
the
meeting.
The
protocol
explained
that
a
programme
of
research
has
been
set
up,
at
Manchester
University,
to
investigate
brains
of
schizophrenic
patients
with
a
view
to
elucidating
the
abnormalities
of
biochemistry
relevant
to
the
illness.
Researchers
at
the
university
are
now
able
to
study
the
chemistry
of
brain
cells
in
remarkable
detail.
Very
careful
records
have
been
kept
at
Prestwich
Hospital
of
all
patients
but
especially
those
with
schizophrenia,
(done
in
connection
with
a
separate
study
on
tardive
dyskinesia,
in
progress
since
1981).
The
records
include
not
only
detailed
treatment
profiles
but
also
a
chronological
change
in
the
clinical
picture.
These
records
should
enable
them
to
determine
which
brain
systems
are
involved
in
schizophrenia
but
correlating
the
postmortem
findings
with
the
antemortem
clinical
pictures.
It
may
also
delineate
the
reasons
why
some
patients
develop
dyskinesia
and
not
others.
This
study
is
a
long
term
project
which
will
involve
continuing
clinical
documentation
on
long
stay
patients
at
present
resident
in
Prestwich
Hospital.
This
will
involve
not
only
assessment
of
clinical
parameters
of
schizophrenia
but
also
documentation
of
psychological
and
psychometric
tests
on
the
population.
When
any
of
these
patients
die
from
any
cause,
the
brain
will
be
retrieved
at
postmortem
as
soon
after
death
as
possible.
This
will
then
be
subjected
to
the
research
procedures
at
Manchester
University.
The
consent
for
postmortem
will
be
obtained
in
advance
from
the
patient
(if
possible)
and
his
relatives.
Informed
written
consent
will
be
obtained
on
a
special
form
submitted
with
the
protocol'.
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| The
SEC:
'had
no
ethical
objection
to
the
study'.
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| Features
of
the
SEC's
minute |
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| The
minute
refers
to
patients
with
schizophrenia
but
there
is
no
mention
of
Alzheimer's
disease.
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| The
retention
of
brains
from
'normal'
controls
and
from
cases
of
sudden
death
reported
to
the
Coroner
are
not
mentioned.
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| SEC
minutes
after
January
1986
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| There
are
no
further
references
in
the
minutes
of
SEC
to
research
applications
using
brain
tissue
from
Dr
Deakin
jointly
with
Dr
Soni.
The
SEC
did
not
receive
any
progress
reports
and
no
changes
to
the
protocol
were
notified
to
the
Committee(1).
The
SEC
did
not
receive
any
proposals
from
Dr
Slater.
Dr
Soni
submitted
applications
to
the
Committee
on
other
matters
until
the
1990s.
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|
Chronology
of
brains
obtained
from
Prestwich
mortuary
1985-1989
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| The
Cerebral
Function
Unit
had
been
collecting
brains,
with
the
knowledge
and
consent
of
the
relatives,
from
Prestwich
mortuary
before
the
joint
programme
started.
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| The
first
brain
for
the
joint
programme
was
obtained
from
Prestwich
mortuary
on
1 November
1985.
This
mortuary
was
the
source
of
43
of
the
58
brains
obtained
before
brain
collection
was
suspended
in
May
1987.
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| When
brain
collection
recommenced
in
February
1988,
the
main
source
of
brains
was
the
mortuary
at
North
Manchester
General
Hospital,
Chapter
13.
Five
brains
were
obtained
from
Coroner's
cases
at
Prestwich
mortuary
between
April
1988
and
18 July 1989
when
the
last
brain
was
received.
Three
of
these
were
from
in-patients
with
neuropsychiatric
diseases
whose
deaths
had
been
reported
to
the
Coroner,
and
the
other
two
from
sudden
deaths
in
the
community.
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| Post
mortem
examinations
at
Prestwich
mortuary
ended
in
August
1989.
After
that
date,
further
brains
were
obtained
from
in-patients
who
died
in
Prestwich
Hospital
but
the
post
mortems
were
carried
out
at
Bury
mortuary(2).
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| Analysis
of
all
brains
from
Prestwich
mortuary
|
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| Fifty-three
brains
were
obtained
through
Prestwich
mortuary
between
1985
and
1989.
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| Thirty-four
brains,
including
Mr
Isaacs',
were
obtained
from
Coroner's
autopsies
into
cases
of
sudden
death
in
the
community.
(These
deaths
can
be
easily
distinguished
as
they
are
listed
in
the
Mortuary
Register
of
'Police
Outside
Deaths').
Twenty-one
are
categorised
in
the
brain
books
as
'controls'.
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| Eleven
brains
were
obtained
from
post
mortems
on
in-patients
at
Prestwich
Hospital
whose
deaths
were
reported
to
the
Coroner.
Most
of
these
patients
had
some
pre-existing
neuropsychiatric
disease.
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| Seven
brains
were
obtained
from
post
mortems
on
hospital
cases
without
any
involvement
of
the
Coroner.
In
five
of
these,
the
brain
was
initially
retained
for
the
Cerebral
Function
Unit.
Parts
of
these
five
brains
were
later
transferred
to
the
joint
programme
by
Professor
Mann.
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| The
last
brain
collected
from
Prestwich
was
obtained
on
18
July
1989.
|
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| Brain
collection
in
relation
to
Ethics
Committee
consideration |
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| Five
brains
recorded
as
part
of
the
joint
programme
were
obtained
prior
to
15 January 1986
when
the
SEC
considered
the
protocol
submitted
by
Dr
Deakin
and
Dr Soni.
These
five
were
all
Coroner's
cases,
including
one
in-patient
whose
death
had
been
reported
to
the
Coroner.
In
addition,
there
were
15
other
brains
collected
before
January
1986
which
are
not
included
in
the
list
of
brains
collected
for
the
joint
programme.
These
brains
were
obtained
for
research
without
reference
to
any
Ethical
Committee.
|
|
|
|
| Dr
Slater,
in
commenting
on
the
collection
of
brains
prior
to
consideration
by
the
SEC,
has
stated:
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|
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| 'It
is
a
fact
that
in
making
grant
applications
in
the
UK
one
can
be
in
an
impossible
situation.
No
project
would
ever
get
funded
if
there
is
doubt
about
securing
the
material,
brain
samples
in
this
case,
or
if
no
pilot
study
has
been
made.
I
have
already
said
that
brain
'collection'
was
entirely
random.
Thus
no
brain
samples
and
no
pilot
study
equals
no
funding
and
no
research
on
serious
diseases.
This
is
even
more
true
today'.
|
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| Summary |
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|
|
| A
research
protocol
was
submitted
to
the
SEC
and
considered
by
the
Committee
on
15 January
1986.
|
|
|
|
| The
protocol
referred
to
studies
of
the
brains
of
patients
with
neuropsychiatric
conditions.
|
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|
|
| The
patient
and/or
the
relatives
were
to
be
asked
to
give
consent
to
brain
retention.
|
|
|
|
| The
protocol
did
not
refer
to
collection
of
'control'
brains
or
brains
from
Coroner's
cases.
|
|
|
|
| Five
brains
were
obtained
before
the
SEC
had
considered
the
protocol
and
a
further
15
brains
were
collected
that
were
recorded
in
the
brain
books
but
not
considered
a
part
of
the
joint
programme.
|
|
|
|
| Although
these
brains
were
collected
for
research,
no
Ethical
Committee
had
been
consulted.
|
|
|
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| Thirty-four
brains
were
from
sudden
deaths
in
the
community
of
which
21
are
categorised
as
controls.
|
|
|
|
| Eleven
of
the
brains
from
Coroner's
cases
were
from
in-patients
with
neuropsychiatric
diseases.
|
|
|
|
| Seven
brains
were
obtained
from
hospital
post
mortems,
of
which
five
were
initially
collected
for
the
CFU
programme.
|
|
|
|
| Prestwich
mortuary
provided
43
of
the
58
brains
obtained
for
the
joint
programme
before
collection
was
suspended
in
May
1987.
|
|
|
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| After
brain
collection
resumed,
nine
more
brains
were
collected
before
post
mortems
at
the
mortuary
ended
in
August
1989.
|
|
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| References |
|
|
|
| 1 SEC
minutes
1986-1996. |
|
| 2 Data
provided
by
Mental
Health
Services
of
Salford
NHS
Trust.
|
|
