Shape of Snakes

CORONER'S COURT

Medical Report on Miss Ann Butts, submitted to Mr. Brian A. Hooper, coroner, on December 12, 1978, by Dr. Sheila Arnold, CP, FRCP, from the Howarth Clinic, Chicago, Illinois, U.S.A. (Formerly a partner in the Cromwell Street Surgery, Richmond, Surrey.)

(Dr. Arnold left for a twelve-month sabbatical in America on September 10, 1978, and was absent at the time of Miss Butts's death. Although Miss Butts had been assigned to one of Dr. Arnold's partners for the duration of the sabbatical, Miss Butts died before the partner had time to meet and assess her. It was therefore agreed that Dr. Arnold would submit the following report from America. A full set of medical notes relating to Miss Butts has been made available to the Coroner by the Cromwell Street Surgery.)

Ann Butts was my patient from June 1969 until my departure for America on September 10, 1978. She suffered from Tourette's syndrome, a neuropsychiatric disorder characterized by recurrent muscle tics and involuntary vocalizations. It was an inherited condition from her mother who had a complex form of the disorder, which manifested itself as coprolalia, a compulsion to utter obscenities. Ann, who cared for her mother for many years until her death in 1968, had a good understanding of Tourette's syndrome and had learned to manage her own condition successfully. Ann's most noticeable symptoms were 1) motor tics in the face and shoulders; 2) a compulsion to talk to herself; and 3) obsessive behavior, particularly in relation to home and personal security.

I referred her in December 1969 to Dr. Randreth Patel (Middlesex Hospital), who took a particular interest in Ann and was sympathetic toward her firmly held views against the taking of psychoactive drugs, which she felt had worsened her mother's condition rather than improved it. While no one has yet discovered a cure for Tourette's syndrome, the disorder tends to improve with age and Ann was no exception to this. My understanding is that her tics were a great deal more pronounced when she was a teenager (DOB-12.3.36). As a result, she suffered considerable teasing and unkindness from her peers and had few social skills following an early withdrawal from formal education. In recent years Ann's symptoms had been comparatively mild although she was inclined to exacerbate them from time to time through an overindulgence in alcohol. She had an average IQ and had no difficulty leading an independent life, although her obsession with home and personal security meant she shunned the company of others. I made a point of visiting her every six to eight weeks and on my last visit-September 8, 1978-she was in good health, both physical and mental.

Sheila Arnold

Sheila Arnold GP, FRCP