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LYSERGIC ACID IN MENTAL DEFICIENCY
1090 The card I use is punched to a special design on my own machine. It has 10 groups of 5 holes, a group of 5 holes having many advantages. It is easy to record a vast amount of information on this small card which would not be possible, so far as I am aware, by any other coding method. At the present time the card is used to code (a) the date, (b) the district of the patient’sresidence, (c) the presenting symptom, (d) his personal opinion of his illness (alarming or temporarily inconvenient) and whether I agreed or not, (e) the signs and symptoms, (f) the drug or mixture, (g) disease if diagnosed.
punching
The system has been evolved to meet the ever-growing needs of a 40-year study of the minor ailments in a panel practice, which I feel I can now confidently describe Somt’of the as a "study of the science of morbidity." sequences of this science I have demonstrated graphically over many years. Ever since 1919 I have employed a typist to record the medical histories, at first using shorthand, but for the last fifteen years by means of a ’Dietaphone.’ The punched cards are the link between the sequences shown I further feel on the chart and the history sheets. in in that the future, by these means, justified believing clinical medicine will come to study social health and will seek to interpret the observations in terms of the human cell, thus bringing social medicine into line with all other branches of medical science. With this in view, for the past seven or eight years, after discussing the matter with technicians of the Powers Samas Co., I have sacrificed some of the marginal punching so that the data on these cards can be immediately transferred to central punched cards at any time in the future. Search can then be effected through sorting machinery, and who can foretell what- the speed of that search will be It is a model of simplicity and can be easily worked by any general practitioner who has the necessary enthusiasm. A. GARVIE. Halifax. DEATHS AFTER ANESTHESIA
SiR,—I have read Dr. Lee’s letter of Nov. 5 with the greatest interest, and I would like to congratulate him upon the establishment of a post-operation ward. As a corollary to this, the time has come to ensure that no major operation is carried out except under such ideal conditions. London,
B. WHITCHURCH W.1.$.
HOWELL.
LYSERGIC ACID IN MENTAL DEFICIENCY SiR,—Lysergic acid diethylamide (LSD25) was used as an adjunct in the psychotherapeutic treatment of chronic anxiety tension and obsessional neuroses by Sandison et al.1 Their work led us to treat similarly a series of 16 mental defectives whose symptoms and history suggested that their failure of intellectual and social development may have been due, in no small part, to emotional factors
operating during development. The drug was given orally in doses of from 20 to 400 t4g. in distilled water and was found to stimulate the memories of these patients, but the abreactiveeffects were limited and in spite of fairly prolonged periods of treatment-up to 26 treatments in three months-no lasting benefit has been observed. In 7 instances the patients were more talkative and coöperative for a few days after the treatment but relapsed quite quickly. The majority experienced physical symptoms such as flushing of the face and limbs, tingling in the arms and legs, choking in the throat, and constriction of the chest. The bizarre hallucinatory experiences recorded by others were noted in only 2 of our 16 cases and in these they were mush simpler in character and may well have been the result of inadvertent suggestion on the part of the staff. It was observed that under LSD25, most of our patients were easily influenced by suggestion. This may be of therapeutic value rather than a disadvantage. 1.
Sandison, R. A., Spencer, A. M., Whitelaw, J. D. 1954, 100, 491. Sandison, R. A. Ibid, p. 508.
No instances of post-LSD depression occurred and only 2 patients were apprehensive or fearful during treatment. The majority looked forward t,o it, possibly because of the increased amount of attention which they received from the staff during this period.
Our impression is that while the effects of lysergic acid mental defectives is to stimulate the memory, the general pattern of the resulting experiences is of a very simple order ; but is of value as an aid in the p8yrlu. on
therapeutic approach
to such
cases.
MARGARET E. B. DAVIES T. S. DAVIES.
Hensol Castle, Pontyclun, Glam.
NEPHROSIS AND MALARIA
SiR,—Dr. Gairdner and Mr. Shute (Nov. 5) have performed a useful service in collecting available knowledge about malarial treatment of nephrosis in Britain, Their observations on the pattern of events during induced nephrotic remissions are of great interest. A similar sequence may occur during the spontaneous evolution of nephrotic disease. Thus an adult with the clinical picture of nephrosis, with minimal azotsemia, had been followed for about one year, during which a slight rise of blood-pressure and blood-urea had taken place. For
no
obvious
reason
there
was
then
a
sudden marked
diuresis, resulting in complete clearing of his cedema. Within a few days, the urine, which had consistently given Esbach clear of
readings of 8-12 g. per litre, became almost protein. Unfortunately the diuresis was accompanied by rapid deterioration of renal function, death ensuing from uraemia within approximately one month. Leicester Royal Infirmary.
H. J. GOLDSMITH.
MONILIA ENDOCARDITIS
SiR,-The case reported by Dr. Caplan in your issue ofNov. 5 is probably the first to be proved in this country. Last year,! I described a case which may be of the same type ; the patient had infective endocarditis and nephrectomy was performed for renal-artery infarction. Prof. A. C. P. Campbell kindly examined the removed kidney and found a fibrous granuloma occluding the main renal artery, and other smaller granulomata in the hilum, apparently on the course of the lobar branches of the renal artery. The histological nature of these was, he thought, quite incompatible with a Streptococcus viridans infection, and he found certain structures having the appearance of fungal colonies. He felt compelled to conclude that there had been a fungal endocarditis with embolism of the renal artery caused by an infected vegetation. As the patient recovered, full proof such as Dr. Caplan provides was not obtained. W. A. BOURNE.
Hove, Sussex.
TRANSILLUMINATION OF THE LARYNX
SiR,—Dr. Tate will not be surprised to learn that his observations (Nov. 5) on the value of transillumination when a laryngoscope light fails areconfirmed by the experience of other anoesthetists. Some
twenty-three years ago in similar circumstances I surprised to find the larynx dramatically transilluminated by the theatre skylight. Intubation was carried out with this aid alone. While this was admittedly not within the province of the anaesthetist, it did strike me forcibly at the time that transiliumination might be of value in the diagnosis of some laryngeal diseases. was
Following this first accidental experience of laryngeal transillumination by daylight, I have often demonstrated by means of torches and bedside lamps that external illumination can be a useful alternativemethod for the anmsthetist. I cannot, however, agree that light failure is a common fault in modern laryngoscopes. Bulbs rarely fuse now-
J. ment. Sci. 1. Brit. med. J.
1954, ii, 271.
punching
The system has been evolved to meet the ever-growing needs of a 40-year study of the minor ailments in a panel practice, which I feel I can now confidently describe Somt’of the as a "study of the science of morbidity." sequences of this science I have demonstrated graphically over many years. Ever since 1919 I have employed a typist to record the medical histories, at first using shorthand, but for the last fifteen years by means of a ’Dietaphone.’ The punched cards are the link between the sequences shown I further feel on the chart and the history sheets. in in that the future, by these means, justified believing clinical medicine will come to study social health and will seek to interpret the observations in terms of the human cell, thus bringing social medicine into line with all other branches of medical science. With this in view, for the past seven or eight years, after discussing the matter with technicians of the Powers Samas Co., I have sacrificed some of the marginal punching so that the data on these cards can be immediately transferred to central punched cards at any time in the future. Search can then be effected through sorting machinery, and who can foretell what- the speed of that search will be It is a model of simplicity and can be easily worked by any general practitioner who has the necessary enthusiasm. A. GARVIE. Halifax. DEATHS AFTER ANESTHESIA
SiR,—I have read Dr. Lee’s letter of Nov. 5 with the greatest interest, and I would like to congratulate him upon the establishment of a post-operation ward. As a corollary to this, the time has come to ensure that no major operation is carried out except under such ideal conditions. London,
B. WHITCHURCH W.1.$.
HOWELL.
LYSERGIC ACID IN MENTAL DEFICIENCY SiR,—Lysergic acid diethylamide (LSD25) was used as an adjunct in the psychotherapeutic treatment of chronic anxiety tension and obsessional neuroses by Sandison et al.1 Their work led us to treat similarly a series of 16 mental defectives whose symptoms and history suggested that their failure of intellectual and social development may have been due, in no small part, to emotional factors
operating during development. The drug was given orally in doses of from 20 to 400 t4g. in distilled water and was found to stimulate the memories of these patients, but the abreactiveeffects were limited and in spite of fairly prolonged periods of treatment-up to 26 treatments in three months-no lasting benefit has been observed. In 7 instances the patients were more talkative and coöperative for a few days after the treatment but relapsed quite quickly. The majority experienced physical symptoms such as flushing of the face and limbs, tingling in the arms and legs, choking in the throat, and constriction of the chest. The bizarre hallucinatory experiences recorded by others were noted in only 2 of our 16 cases and in these they were mush simpler in character and may well have been the result of inadvertent suggestion on the part of the staff. It was observed that under LSD25, most of our patients were easily influenced by suggestion. This may be of therapeutic value rather than a disadvantage. 1.
Sandison, R. A., Spencer, A. M., Whitelaw, J. D. 1954, 100, 491. Sandison, R. A. Ibid, p. 508.
No instances of post-LSD depression occurred and only 2 patients were apprehensive or fearful during treatment. The majority looked forward t,o it, possibly because of the increased amount of attention which they received from the staff during this period.
Our impression is that while the effects of lysergic acid mental defectives is to stimulate the memory, the general pattern of the resulting experiences is of a very simple order ; but is of value as an aid in the p8yrlu. on
therapeutic approach
to such
cases.
MARGARET E. B. DAVIES T. S. DAVIES.
Hensol Castle, Pontyclun, Glam.
NEPHROSIS AND MALARIA
SiR,—Dr. Gairdner and Mr. Shute (Nov. 5) have performed a useful service in collecting available knowledge about malarial treatment of nephrosis in Britain, Their observations on the pattern of events during induced nephrotic remissions are of great interest. A similar sequence may occur during the spontaneous evolution of nephrotic disease. Thus an adult with the clinical picture of nephrosis, with minimal azotsemia, had been followed for about one year, during which a slight rise of blood-pressure and blood-urea had taken place. For
no
obvious
reason
there
was
then
a
sudden marked
diuresis, resulting in complete clearing of his cedema. Within a few days, the urine, which had consistently given Esbach clear of
readings of 8-12 g. per litre, became almost protein. Unfortunately the diuresis was accompanied by rapid deterioration of renal function, death ensuing from uraemia within approximately one month. Leicester Royal Infirmary.
H. J. GOLDSMITH.
MONILIA ENDOCARDITIS
SiR,-The case reported by Dr. Caplan in your issue ofNov. 5 is probably the first to be proved in this country. Last year,! I described a case which may be of the same type ; the patient had infective endocarditis and nephrectomy was performed for renal-artery infarction. Prof. A. C. P. Campbell kindly examined the removed kidney and found a fibrous granuloma occluding the main renal artery, and other smaller granulomata in the hilum, apparently on the course of the lobar branches of the renal artery. The histological nature of these was, he thought, quite incompatible with a Streptococcus viridans infection, and he found certain structures having the appearance of fungal colonies. He felt compelled to conclude that there had been a fungal endocarditis with embolism of the renal artery caused by an infected vegetation. As the patient recovered, full proof such as Dr. Caplan provides was not obtained. W. A. BOURNE.
Hove, Sussex.
TRANSILLUMINATION OF THE LARYNX
SiR,—Dr. Tate will not be surprised to learn that his observations (Nov. 5) on the value of transillumination when a laryngoscope light fails areconfirmed by the experience of other anoesthetists. Some
twenty-three years ago in similar circumstances I surprised to find the larynx dramatically transilluminated by the theatre skylight. Intubation was carried out with this aid alone. While this was admittedly not within the province of the anaesthetist, it did strike me forcibly at the time that transiliumination might be of value in the diagnosis of some laryngeal diseases. was
Following this first accidental experience of laryngeal transillumination by daylight, I have often demonstrated by means of torches and bedside lamps that external illumination can be a useful alternativemethod for the anmsthetist. I cannot, however, agree that light failure is a common fault in modern laryngoscopes. Bulbs rarely fuse now-
J. ment. Sci. 1. Brit. med. J.
1954, ii, 271.