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ACUTE LARYNGOTRACHEOBRONCHITIS TREATED WITH CHLOROMYCETIN
748
began
of deprivation when they left Communication of extreme irritability on the sea voyage but got over this when they managed to procure ACUTE LARYNGOTRACHEOBRONCHITIS On arrival at some more ganja from their comrades. TREATED WITH CHLOROMYCETIN their destination all began to suffer from deprivation ; so the Indian hemp plant did not grow Laryngo-tracheo-bronehitis is one or the most.alarmmg widely, and with which the children’s physician has to obtain. emergencies became difficult to ganja deal. Other acute affections of the respiratory tract Each case was known to his comrades as a ganja usually appear to yield to chemotherapy ; but this one, addict ; he was regarded with a certain amount of fear, like atypical pneumonia, has apparently been uninfluenced and was known to be untrustworthy. Irritability such treatment. There is some evidence that it is by increased and culminated in a sudden outburst of violence, caused by a virus. such as stabbing another man, striking out, or shooting Attacking children between six months and three at someone. A common history was that the man had of age, with a sudden onset, the infection leads years been on guard duty and had suddenly begun to blaze to a critical state, often necessitating tracheotomy rapidly with his Sten at an rifle or gun away imaginary enemy. and Of six children, all ill suction. bronchoscopic This sort of conduct resulted in the man being brought enough to require surgical intervention, treated at the under medical observation ; and the strange, and often Children, Great Ormond Street, since dangerous, fact was that by the time he got back to a Hospital for Sick four died. On the admission of the 1947, December, medical unit he had become quiet and apparently seventh case Dr. 1. A. B. Cathie suggested the trial of rational. During this quiet phase, the man seemed Chloromycetin,’ and the result seemed to be dramatic. mildly depressed but was appreciative of attention ; Though one of the youngest of the small series and he took his food and enjoyed a smoke. Patients have been certainly the youngest to survive, this child’s state returned to their units during this quiet phase with changed rapidly from one of extreme seriousness to one disastrous results. After 48-72 hours there was another of easy convalescence. All other adjuvant measures outburst of impulsive violence, followed by an acute were used : the child was nursed in an oxygen tent with psychotic episode lasting 3-6 weeks. This phase was special " nurses ; tracheotomy was performed and characterised by acute excitement ; the patients shouted suction carried out as required. Chloramphenicol and talked at great length, interfered with other patients, (chloromycetin) was given by mouth in 0-25 g. doses and were very quarrelsome. They stripped themselves three times a day for four days, starting a few hours of all clothing and masturbated almost continuously ; after the tracheotomy. The thick, tenacious secretion their habits became filthy, faeces and urine being passed found at tracheotomy in these cases became thin and in the bed or on the floor. Some would sing at the top less profuse than in other cases. Bronchoscopy was only of their voices for hours. On seeing a nursing orderly required once, the temperature reached normal in 48 or a medical officer they would crawl abjectly along the hours, and the tracheotomy tube was removed within floor and beg for some ganja. If offered an ordinary days. cigarette they would snatch it from one’s hand and fiveDetails of the seven cases are : chew it up or smoke it as quickly as possible. At times, Duration of severely most of the patients appeared to be both visually and obstructed breathing Result Case Age aurally hallucinated and the hallucinations were terrifying. before tracheotomy They could understand what was said to them and would start to obey an order, but their attention would flag quickly and they would again start to beg for more ganja. If unsupervised they would fight amongst themselves for a cigarette end. Some cases ate their food in a voracious manner whilst others refused both It will be noted that the children who survived were food and water. those in whom tracheotomy was performed early, and All these cases were treated by sedation with either chloramphenicol must not be regarded as a substitute soluble barbitone or paraldehyde, which were the only for mechanical relief of obstruction at an early stage sedatives available ; they were also given ordinary when required. This preliminary note is intended to encourage others cigarettes. Continuous narcosis was first aimed at, but in 2 cases an intercurrent infection-pneumonia in to try this new drug for a disease with an unfortunately one and malaria in the other-developed while the, high fatality-rate. It is unlikely always to obviate the patients were deeply sedated ; so the other cases were necessity for the skilled assistance of surgical colleagues, not given so much sedative. but it may shorten the whole period of illness and render the infection less virulent. None of the 9 patients died, which surprised me ; A. MONCRIEFF and all emerged from the psychotic phase after a period M.D. Lond., F.R.C.P. of 3-5 weeks ; they then became quiet, cooperative, and Nuffield Professor of Child Health. well-conducted, though all were weak and emaciated, The Hospital for S. D. V. WELLER and required considerable feeding up. All were evacuated Sick Children, M.D. Lond., M.R.C.P. Ormond Great Street, to India. W.C.1. Medical
India ;
to notice 2 showed
signs signs
Preliminary
’
"
-.
-
Registrar.
London,
DISCUSSION
It is clear that some cannabis-indica addicts cannot when deprived of it they manage without the develop a dangerous mental illness. It seemed that the proportion of addicts who developed this illness was comparatively small; certainly there were far more than 9 ganja addicts in Indian units served by the medical unit at which I was stationed. All 9 men smoked ganja continuously when at home in India, and all were of average they came from various unitssome high-grade, others pion-eer-units. Clearly it would be safer if known eannabis-indica addicts were=not employed on foreign service.
drug ;
intelligence :
’
"... Consider medical salaries : a psychiatrist in the prison service has a salary scale of £1000-£1400 a year. A similarly qualified officer in the National Health Service is on a scale of f:1700 (linked to age 32) rising ... to a maxi-
eight years, of £2750. Does this mean that salaries are fixed on a catch as catch can basis ? Or that the Government have decided they do not want psychiatrists in the prison service but lack to announce the fact ? Or that it is Government policy to reduce the medical Civil to a cipher ? One can illustrate this lack of any clearly conceived policy at any and every level."- Mr. STANLEY MAYNE, general secretary of the Institution of Professional Civil Servants, in a letter to the Times, Oct. 18. mum, reached in
courage
...
Service
began
of deprivation when they left Communication of extreme irritability on the sea voyage but got over this when they managed to procure ACUTE LARYNGOTRACHEOBRONCHITIS On arrival at some more ganja from their comrades. TREATED WITH CHLOROMYCETIN their destination all began to suffer from deprivation ; so the Indian hemp plant did not grow Laryngo-tracheo-bronehitis is one or the most.alarmmg widely, and with which the children’s physician has to obtain. emergencies became difficult to ganja deal. Other acute affections of the respiratory tract Each case was known to his comrades as a ganja usually appear to yield to chemotherapy ; but this one, addict ; he was regarded with a certain amount of fear, like atypical pneumonia, has apparently been uninfluenced and was known to be untrustworthy. Irritability such treatment. There is some evidence that it is by increased and culminated in a sudden outburst of violence, caused by a virus. such as stabbing another man, striking out, or shooting Attacking children between six months and three at someone. A common history was that the man had of age, with a sudden onset, the infection leads years been on guard duty and had suddenly begun to blaze to a critical state, often necessitating tracheotomy rapidly with his Sten at an rifle or gun away imaginary enemy. and Of six children, all ill suction. bronchoscopic This sort of conduct resulted in the man being brought enough to require surgical intervention, treated at the under medical observation ; and the strange, and often Children, Great Ormond Street, since dangerous, fact was that by the time he got back to a Hospital for Sick four died. On the admission of the 1947, December, medical unit he had become quiet and apparently seventh case Dr. 1. A. B. Cathie suggested the trial of rational. During this quiet phase, the man seemed Chloromycetin,’ and the result seemed to be dramatic. mildly depressed but was appreciative of attention ; Though one of the youngest of the small series and he took his food and enjoyed a smoke. Patients have been certainly the youngest to survive, this child’s state returned to their units during this quiet phase with changed rapidly from one of extreme seriousness to one disastrous results. After 48-72 hours there was another of easy convalescence. All other adjuvant measures outburst of impulsive violence, followed by an acute were used : the child was nursed in an oxygen tent with psychotic episode lasting 3-6 weeks. This phase was special " nurses ; tracheotomy was performed and characterised by acute excitement ; the patients shouted suction carried out as required. Chloramphenicol and talked at great length, interfered with other patients, (chloromycetin) was given by mouth in 0-25 g. doses and were very quarrelsome. They stripped themselves three times a day for four days, starting a few hours of all clothing and masturbated almost continuously ; after the tracheotomy. The thick, tenacious secretion their habits became filthy, faeces and urine being passed found at tracheotomy in these cases became thin and in the bed or on the floor. Some would sing at the top less profuse than in other cases. Bronchoscopy was only of their voices for hours. On seeing a nursing orderly required once, the temperature reached normal in 48 or a medical officer they would crawl abjectly along the hours, and the tracheotomy tube was removed within floor and beg for some ganja. If offered an ordinary days. cigarette they would snatch it from one’s hand and fiveDetails of the seven cases are : chew it up or smoke it as quickly as possible. At times, Duration of severely most of the patients appeared to be both visually and obstructed breathing Result Case Age aurally hallucinated and the hallucinations were terrifying. before tracheotomy They could understand what was said to them and would start to obey an order, but their attention would flag quickly and they would again start to beg for more ganja. If unsupervised they would fight amongst themselves for a cigarette end. Some cases ate their food in a voracious manner whilst others refused both It will be noted that the children who survived were food and water. those in whom tracheotomy was performed early, and All these cases were treated by sedation with either chloramphenicol must not be regarded as a substitute soluble barbitone or paraldehyde, which were the only for mechanical relief of obstruction at an early stage sedatives available ; they were also given ordinary when required. This preliminary note is intended to encourage others cigarettes. Continuous narcosis was first aimed at, but in 2 cases an intercurrent infection-pneumonia in to try this new drug for a disease with an unfortunately one and malaria in the other-developed while the, high fatality-rate. It is unlikely always to obviate the patients were deeply sedated ; so the other cases were necessity for the skilled assistance of surgical colleagues, not given so much sedative. but it may shorten the whole period of illness and render the infection less virulent. None of the 9 patients died, which surprised me ; A. MONCRIEFF and all emerged from the psychotic phase after a period M.D. Lond., F.R.C.P. of 3-5 weeks ; they then became quiet, cooperative, and Nuffield Professor of Child Health. well-conducted, though all were weak and emaciated, The Hospital for S. D. V. WELLER and required considerable feeding up. All were evacuated Sick Children, M.D. Lond., M.R.C.P. Ormond Great Street, to India. W.C.1. Medical
India ;
to notice 2 showed
signs signs
Preliminary
’
"
-.
-
Registrar.
London,
DISCUSSION
It is clear that some cannabis-indica addicts cannot when deprived of it they manage without the develop a dangerous mental illness. It seemed that the proportion of addicts who developed this illness was comparatively small; certainly there were far more than 9 ganja addicts in Indian units served by the medical unit at which I was stationed. All 9 men smoked ganja continuously when at home in India, and all were of average they came from various unitssome high-grade, others pion-eer-units. Clearly it would be safer if known eannabis-indica addicts were=not employed on foreign service.
drug ;
intelligence :
’
"... Consider medical salaries : a psychiatrist in the prison service has a salary scale of £1000-£1400 a year. A similarly qualified officer in the National Health Service is on a scale of f:1700 (linked to age 32) rising ... to a maxi-
eight years, of £2750. Does this mean that salaries are fixed on a catch as catch can basis ? Or that the Government have decided they do not want psychiatrists in the prison service but lack to announce the fact ? Or that it is Government policy to reduce the medical Civil to a cipher ? One can illustrate this lack of any clearly conceived policy at any and every level."- Mr. STANLEY MAYNE, general secretary of the Institution of Professional Civil Servants, in a letter to the Times, Oct. 18. mum, reached in
courage
...
Service