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A TABLET-IDENTIFICATION BOX
1254
prolonged diarrhoea, loss of protein through a chronic suppurating focus; and loss of body-fluids as after burns or from protracted diarrhoea, have all been cited as causing pellagra. Mackie et al. (1940) found that in the early stages of vitamin deficiencies there is a disturbance of function, which precedes the structural changes which are found when the deficiency becomes more intense or has lasted a long time. Thus patients with signs of hypovitaminosis have either reversible or irreversible lesions in the may In the present case it was tempting to think gut. that the initial symptoms of hypovitaminosis were due to reversible changes, because the improvement after intense vitamin therapy was so pronounced, and that the relapse was in part due to the ischiorectal fistula. It is impossible, however, to reconcile this idea with the subsequent discovery of Crohn’s disease-a condition which can only be regarded as irreversible. The fact that the patient still has looseness of the bowels and macrocytic anaemia suggests that, though
New Inventions A TABLET-IDENTIFICATION BOX
IN the last few years there has been a steady increase in the number of new drugs in common use. To name only the chief groups, there are hypnotics, antihistaminics, analgesics, antibiotics, aperients, and vitamins : their colours are spectral and their shapes and covering diverse ; tablets may be smooth or grooved, coloured or white, coated or plain ; and pills and capsules come in many sizes and shapes. Some of these are used in the treatment of skin diseases ; and others at times cause
drug eruptions.
there is no reason to believe that a still present, she cannot be regarded
progressive lesion as
is
cured.
SUMMARY
A case of pellagra in a patient with Crohn’s disease is described. Resection of the diseased part of the small bowel was followed by improvement. I am indebted to Mr. R. V. Liddell for the surgical treatment of this patient, to Dr. A. V. Hendry for his advice, and to Prof. A. C. Lendrum, of the University of St. Andrews, for
a
histological report
on
the tissue
removed
REFERENCES
Bean, W. B., Spies, T. D., Blankenhorn, M. A. (1944) Medicine, Baltimore, 23, 1. Blanc, F., Siguier, F. (1947) Bull. Soc. méd. Hôp., Paris, 63, 630. Ferguson, J. W. (1943) Glasg. med. J. 140, 119. Killian, S. T., Ingelfinger, F. J. (1944) Arch. intern. Med. 73, 466. Mackie, T. T., Eddy, W. H., Mills, M. A. (1940) Ann. intern. Med. 14, 28. Nuzum, F. R. (1925) J. Amer. med. Ass. 85, 1861. Simpson, S. L. (1934) Proc. R. Soc. Med. 27, 484.
When
questioning patients attending
a
skin
depart-
ment, it is often difficult to discover what drugs they have been taking, and their doctors do not always give this information in the accompanying letters. If a patient is suspected to be suffering from a drug eruption, the elucidation of this point is most important, and only a few outpatients bring their medicaments with them. The need was therefore felt for a compact tablet-identification box which could be kept in the consulting-room, and from which patients could identify the drugs they have taken. Dr. F. F. Hellier showed one of us such a box used in the skin department at Leeds Royal Infirmary. The box illustrated here is more elaborate and designed for long-continued use. Its chief features are strength and portability, and good visibility and It can be easy recognition of the drugs inside. taken to pieces if necessary for alterations or additions to the contents. A box of this sort is also useful for teaching purposes. The box (see accompanying figure) is made of sheet perspex,’ and weighs 2 lb. The over-all measurements of the box are 1011. X 8111. X 718 in., with a handle projecting for 4/a in. from one of the longer sides, the grip being 21/4 in. wide. The box is built around a central sheet of white opaque perspex which is extended to form the handle. The edges of the box itself are 1/2 in. deep, and it is subdivided into 80 compartments, Both the edges and the each 7/8 in. square. internal divisions are fixed to the opaque sheet by The handle is strengthened by perspex cement. cementing to it a piece of 3/16 in. perspex of similar shape. When not in use the box may be hung on the wall by a hole through the handle. The front and back are formed by two further sheets of perspex which are held in place at the corriers by four brass nuts and bolts.
1/8 in.
Both tablets and capsules can be attached to the opaque sheet withDyrofix’ or a similar glue. They can easily be removed to change the contents if need be. The squares are numbered in rows of ten, while the key# giving particulars of the dosage and nature of the drugs, is typed on quarto-size paper and inserted between the opaque and the back perspex sheets. We wish to thank Mr. J. T. Edwards, of the London Hospital Medical College, who kindly constructed the box to our design.
BRIAN RUSSELL Lond., F.R.C.P. N. A. THORNE M.D. Lond., M.R.C.P. M.D.
Skin Department, The London Hospital
prolonged diarrhoea, loss of protein through a chronic suppurating focus; and loss of body-fluids as after burns or from protracted diarrhoea, have all been cited as causing pellagra. Mackie et al. (1940) found that in the early stages of vitamin deficiencies there is a disturbance of function, which precedes the structural changes which are found when the deficiency becomes more intense or has lasted a long time. Thus patients with signs of hypovitaminosis have either reversible or irreversible lesions in the may In the present case it was tempting to think gut. that the initial symptoms of hypovitaminosis were due to reversible changes, because the improvement after intense vitamin therapy was so pronounced, and that the relapse was in part due to the ischiorectal fistula. It is impossible, however, to reconcile this idea with the subsequent discovery of Crohn’s disease-a condition which can only be regarded as irreversible. The fact that the patient still has looseness of the bowels and macrocytic anaemia suggests that, though
New Inventions A TABLET-IDENTIFICATION BOX
IN the last few years there has been a steady increase in the number of new drugs in common use. To name only the chief groups, there are hypnotics, antihistaminics, analgesics, antibiotics, aperients, and vitamins : their colours are spectral and their shapes and covering diverse ; tablets may be smooth or grooved, coloured or white, coated or plain ; and pills and capsules come in many sizes and shapes. Some of these are used in the treatment of skin diseases ; and others at times cause
drug eruptions.
there is no reason to believe that a still present, she cannot be regarded
progressive lesion as
is
cured.
SUMMARY
A case of pellagra in a patient with Crohn’s disease is described. Resection of the diseased part of the small bowel was followed by improvement. I am indebted to Mr. R. V. Liddell for the surgical treatment of this patient, to Dr. A. V. Hendry for his advice, and to Prof. A. C. Lendrum, of the University of St. Andrews, for
a
histological report
on
the tissue
removed
REFERENCES
Bean, W. B., Spies, T. D., Blankenhorn, M. A. (1944) Medicine, Baltimore, 23, 1. Blanc, F., Siguier, F. (1947) Bull. Soc. méd. Hôp., Paris, 63, 630. Ferguson, J. W. (1943) Glasg. med. J. 140, 119. Killian, S. T., Ingelfinger, F. J. (1944) Arch. intern. Med. 73, 466. Mackie, T. T., Eddy, W. H., Mills, M. A. (1940) Ann. intern. Med. 14, 28. Nuzum, F. R. (1925) J. Amer. med. Ass. 85, 1861. Simpson, S. L. (1934) Proc. R. Soc. Med. 27, 484.
When
questioning patients attending
a
skin
depart-
ment, it is often difficult to discover what drugs they have been taking, and their doctors do not always give this information in the accompanying letters. If a patient is suspected to be suffering from a drug eruption, the elucidation of this point is most important, and only a few outpatients bring their medicaments with them. The need was therefore felt for a compact tablet-identification box which could be kept in the consulting-room, and from which patients could identify the drugs they have taken. Dr. F. F. Hellier showed one of us such a box used in the skin department at Leeds Royal Infirmary. The box illustrated here is more elaborate and designed for long-continued use. Its chief features are strength and portability, and good visibility and It can be easy recognition of the drugs inside. taken to pieces if necessary for alterations or additions to the contents. A box of this sort is also useful for teaching purposes. The box (see accompanying figure) is made of sheet perspex,’ and weighs 2 lb. The over-all measurements of the box are 1011. X 8111. X 718 in., with a handle projecting for 4/a in. from one of the longer sides, the grip being 21/4 in. wide. The box is built around a central sheet of white opaque perspex which is extended to form the handle. The edges of the box itself are 1/2 in. deep, and it is subdivided into 80 compartments, Both the edges and the each 7/8 in. square. internal divisions are fixed to the opaque sheet by The handle is strengthened by perspex cement. cementing to it a piece of 3/16 in. perspex of similar shape. When not in use the box may be hung on the wall by a hole through the handle. The front and back are formed by two further sheets of perspex which are held in place at the corriers by four brass nuts and bolts.
1/8 in.
Both tablets and capsules can be attached to the opaque sheet withDyrofix’ or a similar glue. They can easily be removed to change the contents if need be. The squares are numbered in rows of ten, while the key# giving particulars of the dosage and nature of the drugs, is typed on quarto-size paper and inserted between the opaque and the back perspex sheets. We wish to thank Mr. J. T. Edwards, of the London Hospital Medical College, who kindly constructed the box to our design.
BRIAN RUSSELL Lond., F.R.C.P. N. A. THORNE M.D. Lond., M.R.C.P. M.D.
Skin Department, The London Hospital