- Email: [email protected]
TREATMENT OF PSEUDO-DIPSOMANIA.
825
Correspondence. "
Audi alteram pa.rtem."
PREVENTION OF HEART DISEASE. To the Editor of THE LANCET. SIR,—The leading article under this title in your issue of April 9th regrets that while much work is being done on the clinical side of heart disease, the preventive aspect is comparatively neglected, and you commend to us the " thoroughgoing campaign " directed towards prevention and inaugurated in Doubtless your advocacy will command America. general sympathy, but at the best any practical In the meantime we I outcome from it will be delayed.
must utilise the
which are at hand. Hence I the proposal that the recognition of rheumatic events in any member of a family ought to be an occasion for warning parents of the risks run by their children even from apparently slight illnesses. The mischief in a large proportion of cases of cardiac disease is effected during the non-arthritic forms of Parents rheumatism-tonsillitis, chorea, febricula, &c. do not know this truth, and only when they know it will they realise the importance of giving their children early and complete rest in the disturbances just named. Were this early and complete rest generally practised there is at least a chance that many children would be saved from the terrible misfortune of organic heart The responsibility rests with the medical disease. profession, and it can be discharged by the universal adoption of the course here proposed. For the " national campaign " we needs must wait. But the individual practitioner has his opportunity here and now, and though it does not pretend to heroic possibilities it lies in the line of duty and is not without the promise of reward.-I am, Sir, yours faithfully, C. O. HAWTHORNE.
repeat
once
measures
more
n.
TREATMENT OF
----_u_---
PSEUDO-DIPSOMANIA.
To the Editor of THE LANCET.
SIR,—Although probably every practitioner meets with cases of alcoholism in his practice, it does not appear to be universally recognised that in practically all such cases the only possible course is complete and total abstinence. I have come across so many of these unfortunate patients who have been advised to take one or two glasses a day and no more, with invariable failure, that I venture to write in the hope of saving some of the others from a like fate. It cannot be too generally known that no case of
suffered for over 20 years having had no relapse for eight and a half years. In others repressions of various kinds seem to be the acting cause, and care follows when they are unearthed, either by hypnosis or psychoanalysis. Many of them unfortunately suffer from pseudo as well as true dipsomania, and, of course, in such cases total abstinence is a sine qua non. Nothing is more pathetic than the struggle against hopeless odds which these unfortunate patients undergo when trying to follow the well meant but fatal advice to take only a limited amount. It is impossible. Their only choice lies between total abstinence and drinking in excess. I am, Sir, yours faithfully, HUGH WINGFIELD.
BROMISM
THROUGH
MATERNAL
MILK.
To the Editor of THE LANCET. SIR,-With reference to an annotation appearing in THE LANCET of April 9th, under the above title, the notes of the following case, which occurred in my practice, may be of interest. A breast-fed infant of 5 weeks was seen by me on April llth, 1912, on account of a rash on the face and scalp which began as a single spot on the left cheek on April 4th, and by April 8th had spread over the face and scalp. On April llth there was a papulo-pustular eruption on the face and scalp, each spot being round, raised on an inflamed base, and covered with a fairly thick dark crust. Most of the places were the size of a threepenny-bit, but three on the scalp were the size of a sixpence. The rash seemed to give the patient pain. Otherwise the child seemed to be perfectly well. The temperature was, and continued to be, normal. On April 13th there was a spot exactly similar to the above on the left wrist. The eruption seemed to me to be a typical bromide rash and difficult to account for, the child being breast-fed. Inquiry, however, elicited the fact that the mother had been taking a mixture of pot. brom. 3 iss aq. vi. in one table-spoonful doses thrice daily for ten days the first appearance of the rash and until April llth. The mother was duly instructed to avoid taking the drug. On the 24th there was a fresh crop of spots similar to the previous, and due apparently to the fact that the mother had, contrary to instructions, been taking the bromide mixture again since the 17th. The diagnosis was confirmed on the 20th by the opinion of a well-known dermatologist who saw the patient, but no examination of the mother’s milk for the discovery of bromine was made. Recovery A noteworthy was not complete until the middle of June. feature of the case was the fact that the dose of bromide was only gr. viiss. taken thrice daily for ten days before the first appearance of the rash. The character of the eruption was exactly that which is not infrequently seen in infants who are taking but previous bromide as medicine by the to this case it had not fallen to my lot to see a case where bromism had been produced apparently by administering bromide to the nursing mother. I am, Sir, yours faithfully,
before
mouth,
pseudo-dipsomania (drinking in bouts) can, as a rule, HARRY E. SMITH. take a single glass without craving following, and that whilst the individual who is liable to chronic alcoholism can for a short time take alcohol in moderation, it is THE DIPHTHERIA SWAB ON DISCHARGE. utterly impossible for him to do so for any length of To the Editor of THE LANCET. time. It is true that some pseudo-dipsomaniacs require a comparatively large amount of alcohol to start an SIR,-There seems to be some confusion between the attack, and that some of these habitually take beer financial and clinical value of the diphtheria swab on with their meals without an attack, though in every discharge. If the cost is not considered, I do not think such case which I have seen their period of immunity anybody would maintain that we should not obtain has been ended by their taking whisky. But in both information from any method that may be available, these two forms total abstinence is the only possible and in this connexion it is well to remember that a line to take to avoid relapse. It is more difficult to positive result, has a clinical as well as an adminisspeak with confidence regarding the true dipsomaniacs, trative value, in enabling treatment to be directed to who get attacks of craving at regular or irregular the infected area. When in charge of the Manchester intervals, whether they take alcohol or not. Some of City Fever Hospital I found that many diphtheria conthem can drink in moderation between their attacks. valescents had positive noses and negative throats, and Some can be radically cured-the only form of that the attention thus directed to the nose enabled one alcoholism which can, though few have so far to adopt useful measures for ridding the patient of the recovered. bacilli. Surgical treatment, both in the throat and nose, In certain cases the attacks always end with a heavy was often necessary and successful. discharge of urates, and I have found that in a few of Financially, the cost of the examination of 200 swabs these a bottle of Contrexeville taken every day for in a central laboratory costs less than the hospital three days running every fortnight, and a saline treatment of one return case. I do not think anyone will purgative once a week will keep off attacks for long deny that-as pointed out by "M.O.H." in your last periods. Six such patients treated in this way have issue-the swabbing of convalescents does sometimes remained well for over six years, one of them who diminish the incidence of return cases, and in my own
Correspondence. "
Audi alteram pa.rtem."
PREVENTION OF HEART DISEASE. To the Editor of THE LANCET. SIR,—The leading article under this title in your issue of April 9th regrets that while much work is being done on the clinical side of heart disease, the preventive aspect is comparatively neglected, and you commend to us the " thoroughgoing campaign " directed towards prevention and inaugurated in Doubtless your advocacy will command America. general sympathy, but at the best any practical In the meantime we I outcome from it will be delayed.
must utilise the
which are at hand. Hence I the proposal that the recognition of rheumatic events in any member of a family ought to be an occasion for warning parents of the risks run by their children even from apparently slight illnesses. The mischief in a large proportion of cases of cardiac disease is effected during the non-arthritic forms of Parents rheumatism-tonsillitis, chorea, febricula, &c. do not know this truth, and only when they know it will they realise the importance of giving their children early and complete rest in the disturbances just named. Were this early and complete rest generally practised there is at least a chance that many children would be saved from the terrible misfortune of organic heart The responsibility rests with the medical disease. profession, and it can be discharged by the universal adoption of the course here proposed. For the " national campaign " we needs must wait. But the individual practitioner has his opportunity here and now, and though it does not pretend to heroic possibilities it lies in the line of duty and is not without the promise of reward.-I am, Sir, yours faithfully, C. O. HAWTHORNE.
repeat
once
measures
more
n.
TREATMENT OF
----_u_---
PSEUDO-DIPSOMANIA.
To the Editor of THE LANCET.
SIR,—Although probably every practitioner meets with cases of alcoholism in his practice, it does not appear to be universally recognised that in practically all such cases the only possible course is complete and total abstinence. I have come across so many of these unfortunate patients who have been advised to take one or two glasses a day and no more, with invariable failure, that I venture to write in the hope of saving some of the others from a like fate. It cannot be too generally known that no case of
suffered for over 20 years having had no relapse for eight and a half years. In others repressions of various kinds seem to be the acting cause, and care follows when they are unearthed, either by hypnosis or psychoanalysis. Many of them unfortunately suffer from pseudo as well as true dipsomania, and, of course, in such cases total abstinence is a sine qua non. Nothing is more pathetic than the struggle against hopeless odds which these unfortunate patients undergo when trying to follow the well meant but fatal advice to take only a limited amount. It is impossible. Their only choice lies between total abstinence and drinking in excess. I am, Sir, yours faithfully, HUGH WINGFIELD.
BROMISM
THROUGH
MATERNAL
MILK.
To the Editor of THE LANCET. SIR,-With reference to an annotation appearing in THE LANCET of April 9th, under the above title, the notes of the following case, which occurred in my practice, may be of interest. A breast-fed infant of 5 weeks was seen by me on April llth, 1912, on account of a rash on the face and scalp which began as a single spot on the left cheek on April 4th, and by April 8th had spread over the face and scalp. On April llth there was a papulo-pustular eruption on the face and scalp, each spot being round, raised on an inflamed base, and covered with a fairly thick dark crust. Most of the places were the size of a threepenny-bit, but three on the scalp were the size of a sixpence. The rash seemed to give the patient pain. Otherwise the child seemed to be perfectly well. The temperature was, and continued to be, normal. On April 13th there was a spot exactly similar to the above on the left wrist. The eruption seemed to me to be a typical bromide rash and difficult to account for, the child being breast-fed. Inquiry, however, elicited the fact that the mother had been taking a mixture of pot. brom. 3 iss aq. vi. in one table-spoonful doses thrice daily for ten days the first appearance of the rash and until April llth. The mother was duly instructed to avoid taking the drug. On the 24th there was a fresh crop of spots similar to the previous, and due apparently to the fact that the mother had, contrary to instructions, been taking the bromide mixture again since the 17th. The diagnosis was confirmed on the 20th by the opinion of a well-known dermatologist who saw the patient, but no examination of the mother’s milk for the discovery of bromine was made. Recovery A noteworthy was not complete until the middle of June. feature of the case was the fact that the dose of bromide was only gr. viiss. taken thrice daily for ten days before the first appearance of the rash. The character of the eruption was exactly that which is not infrequently seen in infants who are taking but previous bromide as medicine by the to this case it had not fallen to my lot to see a case where bromism had been produced apparently by administering bromide to the nursing mother. I am, Sir, yours faithfully,
before
mouth,
pseudo-dipsomania (drinking in bouts) can, as a rule, HARRY E. SMITH. take a single glass without craving following, and that whilst the individual who is liable to chronic alcoholism can for a short time take alcohol in moderation, it is THE DIPHTHERIA SWAB ON DISCHARGE. utterly impossible for him to do so for any length of To the Editor of THE LANCET. time. It is true that some pseudo-dipsomaniacs require a comparatively large amount of alcohol to start an SIR,-There seems to be some confusion between the attack, and that some of these habitually take beer financial and clinical value of the diphtheria swab on with their meals without an attack, though in every discharge. If the cost is not considered, I do not think such case which I have seen their period of immunity anybody would maintain that we should not obtain has been ended by their taking whisky. But in both information from any method that may be available, these two forms total abstinence is the only possible and in this connexion it is well to remember that a line to take to avoid relapse. It is more difficult to positive result, has a clinical as well as an adminisspeak with confidence regarding the true dipsomaniacs, trative value, in enabling treatment to be directed to who get attacks of craving at regular or irregular the infected area. When in charge of the Manchester intervals, whether they take alcohol or not. Some of City Fever Hospital I found that many diphtheria conthem can drink in moderation between their attacks. valescents had positive noses and negative throats, and Some can be radically cured-the only form of that the attention thus directed to the nose enabled one alcoholism which can, though few have so far to adopt useful measures for ridding the patient of the recovered. bacilli. Surgical treatment, both in the throat and nose, In certain cases the attacks always end with a heavy was often necessary and successful. discharge of urates, and I have found that in a few of Financially, the cost of the examination of 200 swabs these a bottle of Contrexeville taken every day for in a central laboratory costs less than the hospital three days running every fortnight, and a saline treatment of one return case. I do not think anyone will purgative once a week will keep off attacks for long deny that-as pointed out by "M.O.H." in your last periods. Six such patients treated in this way have issue-the swabbing of convalescents does sometimes remained well for over six years, one of them who diminish the incidence of return cases, and in my own