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THE DANGER OF OPIUM IN COMBINATION WITH OTHER DRUGS.
1280 on matters connected with lunacy, and his views have not been opposed officially, that if such a condition ever existed it was repealed in the Act of 1913. There is one condition, and one only, to be observed, and it is that the patient should desire to submit to treatment. The procedure is simplicity itself. The patient gives to the medical superintendent the following letter: " Dear Sir,-I desire to be admitted as a voluntary patient to the (name the mental hospital). I am, &c." In other words, a patient entering a mental hospital voluntarily has to express his wish in writing. He has also to give three days’ notice of his intention to leave. A rate-supported patient desiring this form of treatment must have the approval of the officials of the parish council-namely, the medical officer and the inspector. I would appeal to every doctor in Scotland to make this provision known to the poor and to recommend every patient of his requiring treatment in a mental hospital to enter as a voluntary
authority
a
constitutional disturbance and most observers will1
agree that the disturbance is identical. Carditis in children, as far as my experience goes, occurs only
in those who dislike milk, but are fond of acids like vinegar. Nearly all these children have inflamed or puffy gums and many bite their nails. As chilblains occur in the extremities of those persons who have a certain predisposition, by a local interference with the capillary circulation, so beat-knee occurs in a person with the rheumatic predisposition by a local irritation of the capillary circulation over or in the region of the bursa patella. Did friction alone give rise to beat-knee the majority of colliers would suffer from this trouble ; as it is, the percentage is not higher than that of heart disease amongst the same class and depends, like the latter disease, on the presence of the necessary predisposition. I am, Sir, yours faithfully, --
G. ARBOUR June
patient. Only those
STEPHENS, M.D.,
Consulting Cardiologist, King Edward VII. Welsh National Memorial Association. 21st, 1926.
who have seen the distress that medical certificates and sheriffs’ orders occasion to patients THE TITLE OF APOTHECARY. and to their relatives and know how unnecessary they 1’o the L’ditor of THE LANCET. are in the majority of cases, can realise all the good that will result from following the above advice. SiR,-In your editorial remarks anent a letter on The sick in mind and the poor will benefit, and mental this subject in your issue of June 19th you very hospitals will, we hope, be regarded, not as places of rightly draw attention to the dissociation between detention, but as hospitals for medical treatment like the appellation of apothecary and that of general other hospitals. As for doctors they will be relieved practitioner. of a distasteful, a thankless, and a perilous public The Society of Apothecaries grants a licence to service.-I am, Sir, yours faithfully, practise medicine, surgery, and midwifery in the same GEORGE M. ROBERTSON. way that the Royal College of Physicians grants its University of Edinburgh, June 21st, 1926. licence, but the holders of the former are no more apothecaries than the latter are physicians. To become an apothecary it is necessary to be a freeman of the Society which is one of the City Guilds, to BEAT-KNEE AS A FORM OF become a physician entails being a Member or Fellow To the Editor of THE LANCET. of that College. " SiB,—In the following list of ten beat-knee , By a recent regulation any newly qualified licentiate which have come before me consecutively, I have been of the Society of Apothecaries can become a freeman impressed by two factors at least common to most by complying with the requirements and paying a of them-namely, inflamed gums and a partiality modified fine by instalments. The Society of for acids such as vinegar and sauces, whilst the Apothecaries is almost the only one of the City Guilds majority have a liking for meat. Nail-biting is a very which still actively pursues the objects of its charter common habit amongst these men and several suffer granted by James I. (although it no longer manufrom pharyngeal catarrh. Lumbago is, or has been, factures drugs), but being on this account largely present in several, whilst the heart in several cases composed of men in the medical profession, it is not was not normal. necessarily confined to such, any more than, as you A, aged 18. Has slight swelling over the knee ; eyes remark, are the freemen of the Cordwainers Company and pharynx inflamed ; bites nails ; cannot play football composed of merchants in the leather of Cordova. because he is short-winded ; gums inflamed. Heart not I am, Sir, yours faithfully, normal. Very fond of meat and salt. T. VINCENT DICKINSON, M.D., B, aged 49. Had beat-knee of left leg May, 1925, and of June 21st, 1926. Master of the Society of Apothecaries. had three months
RHEUMATISM.
casesI
right leg eight years previously ; ago lumbago. Is very fond of vinegar and meat. Gums inflamed. Takes
no
milk.
C, aged 57. Has had rheumatism, and the heart is not normal ; gums inflamed. Very fond of pickles.
THE DANGER OF OPIUM IN COMBINATION WITH OTHER DRUGS.
To the Editor of THE LANCET. Complains now ofpharynx inflamed ; SIR,-Happening to pick up an old number of heavily. Very fondl THE LANCET, I came across a paragraph on aspirin of vinegar. E, aged 43. Haspyorrhoea. Heart not normal. Very fondl tablets with Dover’s powder. May I say that in of meat. Pale. my experience Dover’s powder should not be comF, aged 37. Is subject to indigestion tongue very pounded with aspirin ? In most cases it acts well, furrowed ; heart not normal ; short of breath ; gums; but in some cases susceptible to opium it retards the action of aspirin as regards secretion and causes inflamed ;bites nails. G, aged 27. Bites nails ; gums inflamed. Very fond ofE serious danger. Caffeine gr. i. (instead of the Dover’s sauce. powder) and followed by hot toddy is far safer and Small doses of H, aged 23. Very fond of vinegar and dislikes milk. better in pneumonia, influenza, &c. Heart not normal ; pyorrhoea ; throat inflamed ; bitesmorphia act capriciously, and morphia should always beat-knee in 1925. D, aged 28. Had " " strained back." Has a "cold"; bites nails. Heart not normal. Smokes
"
o
.
nails.
Had beat-knee six years ago on the other? leg ; gums inflamed. Fond of vinegar and dislikes milk. Throat inflamed. K, aged 19. Gums and throat inflamed ; heart not normal. Very fond of vinegar. Bites nails.
I, aged 36.
’
’
Cases Band D of beat-knee and
be given in a single dose, and for a definite purpose. I have seen iodism from gr. ii. of potassium iodide when combined with tr. camph. co. in small doses. If a sudorific does not set up free perspiration it becomes dangerous, the most striking example perhaps being the hyperpyrexia of acute rheumatism from sodae salicylate retention, when perspiration
interesting as showing a sequence lumbago, for compensation purposes; stops. ’
are
called " strained back." Cases B and I show the knees; affected alternately. There is no doubt that beatknee, like rheumatism, is the expression locally of -
In my
view, morphia should always be used I am, Sir, yours faithfully,
Newcastle-upon-Tyne, June 19th.
alone.
T. M. ALLISON.
authority
a
constitutional disturbance and most observers will1
agree that the disturbance is identical. Carditis in children, as far as my experience goes, occurs only
in those who dislike milk, but are fond of acids like vinegar. Nearly all these children have inflamed or puffy gums and many bite their nails. As chilblains occur in the extremities of those persons who have a certain predisposition, by a local interference with the capillary circulation, so beat-knee occurs in a person with the rheumatic predisposition by a local irritation of the capillary circulation over or in the region of the bursa patella. Did friction alone give rise to beat-knee the majority of colliers would suffer from this trouble ; as it is, the percentage is not higher than that of heart disease amongst the same class and depends, like the latter disease, on the presence of the necessary predisposition. I am, Sir, yours faithfully, --
G. ARBOUR June
patient. Only those
STEPHENS, M.D.,
Consulting Cardiologist, King Edward VII. Welsh National Memorial Association. 21st, 1926.
who have seen the distress that medical certificates and sheriffs’ orders occasion to patients THE TITLE OF APOTHECARY. and to their relatives and know how unnecessary they 1’o the L’ditor of THE LANCET. are in the majority of cases, can realise all the good that will result from following the above advice. SiR,-In your editorial remarks anent a letter on The sick in mind and the poor will benefit, and mental this subject in your issue of June 19th you very hospitals will, we hope, be regarded, not as places of rightly draw attention to the dissociation between detention, but as hospitals for medical treatment like the appellation of apothecary and that of general other hospitals. As for doctors they will be relieved practitioner. of a distasteful, a thankless, and a perilous public The Society of Apothecaries grants a licence to service.-I am, Sir, yours faithfully, practise medicine, surgery, and midwifery in the same GEORGE M. ROBERTSON. way that the Royal College of Physicians grants its University of Edinburgh, June 21st, 1926. licence, but the holders of the former are no more apothecaries than the latter are physicians. To become an apothecary it is necessary to be a freeman of the Society which is one of the City Guilds, to BEAT-KNEE AS A FORM OF become a physician entails being a Member or Fellow To the Editor of THE LANCET. of that College. " SiB,—In the following list of ten beat-knee , By a recent regulation any newly qualified licentiate which have come before me consecutively, I have been of the Society of Apothecaries can become a freeman impressed by two factors at least common to most by complying with the requirements and paying a of them-namely, inflamed gums and a partiality modified fine by instalments. The Society of for acids such as vinegar and sauces, whilst the Apothecaries is almost the only one of the City Guilds majority have a liking for meat. Nail-biting is a very which still actively pursues the objects of its charter common habit amongst these men and several suffer granted by James I. (although it no longer manufrom pharyngeal catarrh. Lumbago is, or has been, factures drugs), but being on this account largely present in several, whilst the heart in several cases composed of men in the medical profession, it is not was not normal. necessarily confined to such, any more than, as you A, aged 18. Has slight swelling over the knee ; eyes remark, are the freemen of the Cordwainers Company and pharynx inflamed ; bites nails ; cannot play football composed of merchants in the leather of Cordova. because he is short-winded ; gums inflamed. Heart not I am, Sir, yours faithfully, normal. Very fond of meat and salt. T. VINCENT DICKINSON, M.D., B, aged 49. Had beat-knee of left leg May, 1925, and of June 21st, 1926. Master of the Society of Apothecaries. had three months
RHEUMATISM.
casesI
right leg eight years previously ; ago lumbago. Is very fond of vinegar and meat. Gums inflamed. Takes
no
milk.
C, aged 57. Has had rheumatism, and the heart is not normal ; gums inflamed. Very fond of pickles.
THE DANGER OF OPIUM IN COMBINATION WITH OTHER DRUGS.
To the Editor of THE LANCET. Complains now ofpharynx inflamed ; SIR,-Happening to pick up an old number of heavily. Very fondl THE LANCET, I came across a paragraph on aspirin of vinegar. E, aged 43. Haspyorrhoea. Heart not normal. Very fondl tablets with Dover’s powder. May I say that in of meat. Pale. my experience Dover’s powder should not be comF, aged 37. Is subject to indigestion tongue very pounded with aspirin ? In most cases it acts well, furrowed ; heart not normal ; short of breath ; gums; but in some cases susceptible to opium it retards the action of aspirin as regards secretion and causes inflamed ;bites nails. G, aged 27. Bites nails ; gums inflamed. Very fond ofE serious danger. Caffeine gr. i. (instead of the Dover’s sauce. powder) and followed by hot toddy is far safer and Small doses of H, aged 23. Very fond of vinegar and dislikes milk. better in pneumonia, influenza, &c. Heart not normal ; pyorrhoea ; throat inflamed ; bitesmorphia act capriciously, and morphia should always beat-knee in 1925. D, aged 28. Had " " strained back." Has a "cold"; bites nails. Heart not normal. Smokes
"
o
.
nails.
Had beat-knee six years ago on the other? leg ; gums inflamed. Fond of vinegar and dislikes milk. Throat inflamed. K, aged 19. Gums and throat inflamed ; heart not normal. Very fond of vinegar. Bites nails.
I, aged 36.
’
’
Cases Band D of beat-knee and
be given in a single dose, and for a definite purpose. I have seen iodism from gr. ii. of potassium iodide when combined with tr. camph. co. in small doses. If a sudorific does not set up free perspiration it becomes dangerous, the most striking example perhaps being the hyperpyrexia of acute rheumatism from sodae salicylate retention, when perspiration
interesting as showing a sequence lumbago, for compensation purposes; stops. ’
are
called " strained back." Cases B and I show the knees; affected alternately. There is no doubt that beatknee, like rheumatism, is the expression locally of -
In my
view, morphia should always be used I am, Sir, yours faithfully,
Newcastle-upon-Tyne, June 19th.
alone.
T. M. ALLISON.