| This
chapter
describes
discussions
in
1986
that
preceded
and
followed
consideration
of
the
research
protocol
submitted
by
Dr
Deakin
and
Dr
Slater
to
the
North
Manchester
Ethics
Committee
(NMEC).
The
chapter
also
sets
out
the
chronology
of
brain
collection
from
the
mortuary
of
North
Manchester
General
Hospital
(NMGH).
|
|
|
|
| Sources
of
information |
|
|
|
| This
chapter
is
based
on
documents
provided
by
Professor
Deakin
at
a
meeting
on
21 February
2002.
Other
sources
are
the
registers
and
other
documents
obtained
from
NMGH,
and
the
recollections
of
the
pathologists
and
the
mortician
at
the
hospital.
|
|
|
|
| Correspondence
preceding
the
application
to
the
NMEC
|
|
|
|
| Dr
Malcolm
Green,
Consultant
Psychiatrist
at
NMGH,
wrote
to
Dr
A
Theodossiades,
Chairman
of
the
Division
of
Psychiatry,
on
17
February
1986
enclosing
papers
provided
by
Dr
Deakin.
Dr
Green
wrote:
'He
requires
post
mortem
brain
tissue
and
already
has
an
agreement
with
Prestwich
Hospital
to
obtain
this….
Can
we
agenda
this
item
for
the
Division
of
Psychiatry
so
that
it
may
be
forwarded
to
the
Ethical
Committee
if
Division
agrees'.
|
|
|
|
| Dr
W
G
Brown,
Consultant
Histopathologist,
wrote
to
Dr
Deakin
on
20 February 1986
concerning
the
research
programme:
'I
have
already
agreed
to
help
in
a
clinical
pathological
correlative
study
on
patients
dying
with
pre-senile
dementia,
planned
between
the
psycho-geriatricians
in
our
hospital
and
the
department
of
Neuropathology
of
the
University
of
Manchester….
|
|
|
|
| I
would
be
agreeable
to
co-operate
with
your
studies
of
schizophrenia
along
the
lines
you
are
pursuing
with
the
psychiatrists
at
this
hospital'.
|
|
|
|
| The
reference
in
Dr
Brown's
second
paragraph
is
to
the
research
programme
of
the
Cerebral
Function
Unit
(CFU).
|
|
|
|
| Dr
Green
in
a
letter
to
Dr
Deakin
dated
1
April
1986
reported
that
the
research
application
had
the
unanimous
support
of
the
Division
of
Psychiatry.
Dr Green
added:
'you
would
need
to
send
a
detailed
submission
to
the
North
Manchester
Ethical
Committee'.
|
|
|
|
| Dr
Marshall,
Consultant
Psychiatrist
with
special
interest
in
the
elderly,
wrote
to
Dr Deakin
on
18
April
1986
to
point
out
the
overlap
with
the
existing
arrangements
with
the
CFU.
Dr
Marshall
suggested
that:
'the
two
departments
can
collaborate
or
come
to
some
mutual
arrangement'.
|
|
|
|
| Dr
Deakin
replied
to
Dr
Marshall
on
30
June:
'The
mortuary
technician
in
North
Manchester
is
willing
to
ring
us
whenever
a
post-mortem
is
carried
out
on
a
patient
from
psychogeriatric
or
other
department
in
psychiatry'.
|
|
|
|
| 'Perhaps
you
could
clarify
with
me
whether
you
or
your
firm
routinely
ask
the
next
of
kin
after
a
patient
has
died
for
permission
to
brain
material
at
post-mortem.
All
that
is
necessary
is
for
a
standard
post
mortem
consent
form
to
be
signed'.
|
|
|
|
| The
protocol
submitted
to
the
NMEC
|
|
|
|
| Dr
Deakin
wrote
to
Dr
Weller,
Chairman
of
the
NMEC,
on
27 June 1986
enclosing
a
research
protocol.
He
assures
me
this
protocol
was
similarly
worded
to
that
signed
on
17
July
1986,
although
the
latter
document
is
written
on
the
South
Manchester
Ethics
Committee
(SMEC)
form.
|
|
|
|
| In
discussion,
Professor
Deakin
has
emphasised
that
this
was
the
only
protocol
he
sent
to
any
Ethics
Committee,
with
the
exception
of
the
one
submitted
to
the
Salford
Ethics
Committee
in
1985.
(The
title
of
the
protocol
considered
by
the
Salford
Ethics
Committee
is
quite
different
to
that
quoted
by
other
Ethics
Committees,
Chapter
14.)
|
|
|
|
| Features
of
the
17
July
1986
protocol
|
|
|
|
| The
protocol
signed
by
Dr
Deakin
on
17
July
1986
states
'
After
a
patient
has
died
the
Psychiatrists
who
have
been
looking
after
the
patient
will
seek
permission
from
the
nearest
relative
to
remove
the
brain
tissue
at
post-mortem.
This
is
already
in
operation
at
Prestwich
Hospital
and
has
been
approved
by
the
ethical
committee.
A
standard
post-mortem
consent
form
will
be
used'.
|
|
|
|
| The
protocol
also
refers
to
the
collection
of
brains
'of
patients
who
have
died
from
medical
conditions
who
have
not
suffered
from
mental
illness',
but
does
not
mention
how
consent
for
these
will
be
obtained.
These
patients
would
not
have
been
under
the
care
of
a
psychiatrist.
There
is
no
reference
to
collection
of
brains
of
Coroners'
cases.
|
|
|
|
| Although
Dr
Slater's
name
appears
as
an
applicant,
Dr
Slater
states
that
he
was
not
involved
in
seeking
approval
by
Ethics
Committees
and
he
correctly
points
out
that
he
did
not
sign
the
protocol.
|
|
|
|
| Consideration
of
the
protocol
by
the
NMEC
|
|
|
|
| Dr
Deakin's
letter
to
Dr
Weller
dated
27
June
1986
indicates
the
protocol
was
then
circulated
to
all
members
of
the
Ethical
Committee.
|
|
|
|
| The
Chairman
later
asked
Dr
Deakin
to
comment
on
two
matters
raised
by
Dr Joyce Leeson
on
behalf
of
the
North
Manchester
Health
Authority
in
a
letter
to
Mr Brown,
the
District
General
Manager
for
NMGH.
|
|
|
|
| Dr
Leeson
had
commented:'This
does
not
present
any
problems
of
ethics,
if
consent
for
post-mortem
is
obtained…
Are
the
histopathologists
happy
to
collect
and
store
the
specimens?…
What
arrangements
will
be
made
for
collecting
relevant
information
from
the
notes'…
'the
information
must
be
treated
as
confidential'.
|
|
|
|
| Dr
Deakin,
responding
to
Dr
Leeson's
questions,
wrote
on
26
August
1986
to
Dr Weller:
'Information
from
the
notes
is
being
collected
by
myself
and
concerns
age,
diognosis
(sic)
and
drug
treatment.
The
information
abstracted
is
coded…
The
coded
information
stays
in
my
office
and
is
completely
confidential'.
|
|
|
|
| The
NMEC
approved
the
protocol
on
4
September
1986
and
on
11 September
Dr Weller
wrote
to
Dr
Deakin
to
confirm
this.
|
|
|
|
| Dr
Deakin
wrote
to
Dr
Theodossiades
on
30
September
1986
suggesting
that
he
should
attend
a
meeting
of
the
Division
of
Psychiatry
to
explain
the
programme
to
the
consultants
of
the
Division.
|
|
|
|
| Letter
requesting
brain
collection
from
the
NMGH
mortuary
|
|
|
|
| On
17
October
1986
Dr
Deakin
wrote
to
the
Chief
Technician
at
the
NMGH
mortuary,
Mr
Peter
Leatherbarrow.
This
letter
had
a
significant
impact
and
was
to
lead
to
over
130
brains
being
collected
from
the
NMGH
mortuary
for
the
joint
programme.
The
following
features
should
be
noted:
|
|
|
|
| 'I
enclose
a
copy
of
the
ethical
committee
submission
that
was
recently
approved
by
the
North
Manchester
committee'.
|
|
|
|
| 'We
are
keen
to
obtain
brains
from
patients
dying
on
the
psychiatric
wards
or
who
have
a
history
of
mental
illness.
We
also
need
normal
control
brains'.
|
|
|
|
| 'We
collaborate
with
Dr
David
Mann
so
just
continue
sending
him
brains
which
are
for
his
attention
and
let
us
know
of
the
others'.
|
|
|
|
| 'We
can
arrange
payment
of
£10.00
per
brain
before
tax
which
is
deducted
at
source'.
|
|
|
|
| Dr
Slater
states
that
he
had
no
involvement
in
sending
this
letter
to
Mr Leatherbarrow.
|
|
|
|
| Mr
Leatherbarrow's
concerns
about
the
letter
|
|
|
|
|
| When
Mr
Leatherbarrow
received
this
letter
he
was
uncertain
about
his
position.
The
collection
of
brains
by
Dr
Mann
for
the
CFU
research
programme
had
been
in
place
since
1982.
The
brains
for
the
CFU
were
all
removed
with
the
consent
of
the
relatives.
The
planned
collection
of
other
brains
went
further
than
the
CFU
programme.
|
|
|
|
| In
view
of
his
concerns,
Mr
Leatherbarrow
first
asked
for
a
copy
of
the
protocol
that
the
NMEC
had
approved.
He
discussed
this
and
the
letter
he
had
received
from
Dr Deakin
with
the
consultant
pathologists.
Dr
Brown
had
noted
there
was
potential
overlap
with
the
CFU
programme,
as
he
had
referred
to
this
in
his
letter
of
20 February
to
Dr
Deakin.
|
|
|
|
| The
NMEC
had
nevertheless
authorised
the
protocol.
Mr
Leatherbarrow
was
reassured
by
his
discussions
with
the
consultant
pathologists,
as
well
as
by
the
references
in
the
protocol
to
consent
and
to
the
collection
of
brains
of
patients
without
mental
illness.
|
|
|
|
| Referral
of
brains
from
NMGH
mortuary
|
|
|
|
| When
a
suitable
index
or
'control'
case
was
identified,
Mr
Leatherbarrow,
as
requested
in
Dr
Deakin's
letter,
would
telephone
Dr
Slater's
contact
number
in
the
Department
of
Physiology.
In
practice,
he
never
referred
a
brain
without
first
asking
the
pathologist
responsible
for
the
post
mortem.
|
|
|
|
| Mr
Leatherbarrow
has
told
me
that,
with
the
knowledge
he
has
now,
he
considers
he
was
misled
about
the
joint
programme.
He
believed
at
the
time
that
the
brains
collected
had
been
consented
to
in
the
same
way
as
the
brains
obtained
for
the
CFU,
and
that
the
Coroner
was
aware
of
the
brain
collection
programme.
|
|
|
|
| Mr
Leatherbarrow
has
kept
all
the
payslips
from
the
University
for
brains
retained,
Chapter
24.
|
|
|
|
| Differences
between
the
NMGH
and
Prestwich
mortuaries |
|
|
|
| There
were
two
significant
differences
between
the
brain
collection
systems
at
these
mortuaries.
|
|
|
|
| First,
unlike
Prestwich
mortuary,
there
was
no
involvement
of
the
Coroner's
office
in
identifying
suitable
cases
at
the
NMGH
mortuary.
Indeed,
the
Coroner
and
his
staff
were
unaware
that
brains
were
being
retained.
|
|
|
|
| Secondly,
Prestwich
mortuary
received
the
bodies
of
cases
of
sudden
death
in
the
community
referred
by
the
police.
The
NMGH
mortuary
did
not
act
as
a
public
mortuary
or
receive
bodies
referred
by
the
police.
There
were,
however,
some
post
mortems
on
sudden
death
in
the
community
as
the
mortuary
received
bodies
of
patients
who
were
certified
dead
on
arrival
in
the
ambulance
or
at
the
NMGH
Accident
and
Emergency
Department.
|
|
|
|
| Chronology
and
analysis
of
brains
from
the
NMGH
mortuary
1986-1994 |
|
|
|
| Following
the
NMEC
approval,
the
first
brain
(from
a
Coroner's
case)
was
referred
from
NMGH
on
28
October
1986.
Between
that
date
and
the
suspension
of
brain
collection
in
May
1987,
six
brains
were
referred
to
the
programme
from
Coroner's
cases.
Four
of
these
were
categorised
as
'controls'.
|
|
|
|
| When
brain
collection
recommenced
on
29
February
1988,
the
NMGH
mortuary
was
the
primary
source
of
brains
for
the
programme
and
continued
as
such
until
1991.
Between
the
period
1992
and
1994
the
number
of
brains
referred
diminished.
|
|
|
|
| The
total
number
of
brains
obtained
from
the
NMGH
mortuary
was
132,
of
which
100
were
from
Coroner's
cases.
|
|
|
|
| All
but
one
of
the
brains
obtained
from
NMGH
mortuary
in
1988
were
from
Coroner's
cases.
|
|
|
|
| Thirty-two
brains
were
obtained
from
hospital
or
'brain
only'
post
mortem
examinations.
Twenty-eight
of
these
were
retained
in
1989
and
1990.
|
|
|
|
| The
last
brains
obtained
from
NMGH
were
two
Coroner's
cases
in
May
1994.
|
|
|
|
| When
brain
collection
for
the
joint
programme
ceased,
Mr
Leatherbarrow
recalls
he
was
told
that
no
further
brains
were
to
be
collected
as
'there
were
problems
about
the
arrangements'
or
words
to
that
effect.
Mr
Leatherbarrow
was
not
told
the
nature
of
the
problems.
He
does
not
remember
which
member
of
the
team
spoke
to
him
at
that
time.
|
|
|
|
| Summary |
|
|
|
| The
Division
of
Psychiatry
at
NMGH
were
keen
to
support
the
joint
research
programme.
|
|
|
|
| The
potential
overlap
with
brains
collected
for
research
in
the
CFU
was
pointed
out.
|
|
|
|
| The
need
to
collect
information
from
medical
records
in
a
confidential
manner
was
emphasised
by
the
Health
Authority.
|
|
|
|
| The
NMEC
approved
the
protocol
in
September
1986.
|
|
|
|
| Dr
Deakin
wrote
to
the
mortician
on
17
October
1986
asking
for
referral
of
brains
from
patients
who
had
died
with
psychiatric
conditions.
Control
brains
were
also
requested.
|
|
|
|
| A
fee
of
£10
per
brain
was
offered.
|
|
|
|
| The
arrangement
for
collection
of
brains
was
dependent
on
the
identification
of
suitable
index
and
'control'
cases
by
the
mortician.
|
|
|
|
| The
mortician
routinely
asked
the
pathologists
before
any
brain
was
referred
to
the
joint
programme.
|
|
|
|
| The
collection
of
brains
for
two
different
research
programmes
caused
confusion.
|
|
|
|
| From
February
1988
when
the
programme
restarted,
NMGH
provided
index
and
control
brains
from
Coroner's
cases.
|
|
|
|
| One
hundred
and
thirty-two
brains
were
obtained,
the
largest
number
from
any
mortuary,
and
included
100
brains
from
Coroner's
cases.
The
other
32
brains
were
either
hospital
or
'brain
only'
examinations.
|
|
|
|
| Collection
of
brains
from
NMGH
mortuary
ceased
in
May
1994
after
unspecified
'problems'
were
identified.
|
|
