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USE OF TRANQUILLISERS IN THE U.S.A.
358 cor pulmonale will be the outcome. In previous cases I have treated, anticoagulant therapy was discontinued as soon as the patient was fully mobile, and only in those not fully mobile did further emboli occur. The dilated venules on the legs, the oedema, and the cyanosis of the feet continue to improve : does this indicate recanahsation of the deep veins If so, perhaps anticoagulant therapy should be continued until maximal improvement has taken place in the legs. There seems to be a good case in favour of ligation of the inferior vena cava, and this was being considered when the patient developed an active peptic ulcer. But the ulcer fortunately responded to medical measures, the
patient remaining
on
anticoagulants. ANTHONY CHURCHER.
Eastbourne.
AMYOTONIA CONGENITA
SIR,-I read with great interest Dr. Walton’s article.]I noticed with regret that he failed to include pathological discussion of the disease. His extensive clinical material might provide occasion for a study of the pathology. In my opinion such an investigation is especially important because in this ill-comprehended clinical syndrome only the anatomical findings could help in classifying the disease. I should like to draw attention to a case2 in which I found destruction of the anterior-horn cells of the spinal cord similar to that in progressive spinal muscular
atrophy (Werdnig-Hoffma,nn type). István Hospital, Budapest, Hungary.
T. LEHOCZKY.
HEAVY FEET IN THE WARD
SiR,—Miss Hutchinson, in her letter (Aug. 4), draws attention to the heavy-footed walking of nurses in wards. I have long known that a great many nurses do not know how to walk, but I never could do much about it. It is a disability which they share with a high proportion of modern city-dwellers. We have abolished cobblestones and we do not allow people to walk on the grass. It is assumed that all road and floor surfaces must be smooth and free from irregularities. If ail accident can possibly be attributed to roughness in a floor there is likely to be an action for damages. In such circumstances an organ so complicated as the human foot is not necessary, and many people use their feet as if they simply had hinge-joints at the ankle. The foot does not react well to the treatment and a great deal of trouble results. It is quite difficult to walk well, but it must be very seldom that anyone is taught the art. HENRY H. MACWILLIAM. Liverpool.
hospital
BURNS AND SCALDS
followed with interest the discussion your leader of May 19, may I recommend the I treatment of burns and scalds with bile ointment ?‘ use a cream containing the equivalent of 75% of deodorised fresh ox-bile,3 and in my experience its effect on burns and wound infections has been striking. It appears to prevent further skin damage, limit the infection, and accelerate healing. The beneficial effect of bile in these conditions, as clinically observed and suggested in my investigation,4 is explained (a) by its bacteriolytic and bacteriostatic action against pathogens, (b) by its detoxifying action, and (c) by its being an essential co-enzyme factor in the tissues. NAJIB-FARAH. Alexandria, Egypt.
SiR,—Having
opened by
1. Walton, J. N. Lancet, 1956, i, 1023. 2. Lehoczky, T. Arch. Psychiat. Nervenkr. 1924, 71, 491 3. An ointment of this constitution is made under the name of
’Bylobalm’ by Bylox Laboratories, Twyford, Berkshire. 1956, suppl. no. 312, p. 596.
4. Najib-Farah. Acta med. scand.
USE OF
IN THE U.S.A.
TRANQUILLISERS
SiR,—The publication (Aug. 4) of an extract from the American Psychiatric Association’s warning on the abuse of these drugs is timely and generally applicable to this country. The casual use of tranquillisers for trifling emotional upsets is widespread among the public and needs control as they possess dangerous toxic and side effects. The cost of prescribing these preparations under the National Health Service is stated to be causing anxiety, and recently questions were addressed to the Minister of Health suggesting that they should be restricted to hospital practice.’ Three years’ experience of these drugs has impressed me with their great potentialities in psychiatric practice, but they are definitely not a substitute for either electroconvulsive or deep insulin therapy. To avoid accidents or the risk of denying patients a more valuable remedy, practitioners would be wise to secure a specialist’s opinion when they intend to employ these preparations. It would be a great pity if the pendulum was allowed to swing against these valuable drugs or we were limited in their prescription by reason of their excessive cost to the health service. D. FENTON RUSSELL. BYakefield. EARLY DIAGNOSIS OF BONE LESIONS
SiR,-In his letter of Aug. 4, Dr. Lack suggests that staphylococcal infection comes into the differential diagnosis, particularly of a lesion of the spine, and in doubtful cases it is worth measuring the staphylococcal antitoxin level of the patient’s serum weekly for a few weeks." My own experience suggests that it is often not necessary to estimate the titre
more than once, and in a report on staphylococcus toxoid,2 I cited two cases in one of which the differentiation between a tuberculous and a staphylococcal lesion had been made on the basis of the very much raised blood titre. Following that, a number of other cases were similarly diagnosed, and in all of the cases Staphylococcu8 aureus was obtained from the lesion. With the advent of penicillin this estimation appeared to fall into disuse, or rather it was never really much used ; and it was interesting to see that it had now been found of value at the Royal National Orthopaedic Hospital. I write only to emphasise that with the apparent increasing number of infections due to strains of staphylococci resistant to antibiotics, there may be an increase in bone lesions from this organism. In that case this diagnostic pointer would be well worth trying.
Kingston Hospital, Kingston-upon-Thames, Surrey.
D. STARK MURRAY.
ERYTHEMA NODOSUM AS A MANIFESTATION OF SARCOIDOSIS
SiR,—I have read with great interest the article (Aug. 4) by Dr. James, Dr. Thomson, and Dr. Willcox, for I had a similar of this year.
case
in
general practice at the beginning
A very stout unmarried young woman, aged 24, presented herself to me one morning saying that she had a pain in her knee. On examination she was perfectly normal and extremely well, and the knee showed no localising signs. She was given a mild application and told to return in a couple of days if it did not improve. She came again next day saying that the pain had gone and she now had a pain in her wrist. By this time she had an undoubted erythema nodosum on both her legs. She insisted that she felt extremely well, her temperature and pulse were normal, there were no localising signs in any of the joints, and the heart and lungs appeared to be quite normal. But the erythrocyte-sedimentation rate (Westergren) was 90 mm. in one hour. I made a provisional diagnosis of rheumatic fever and with great difficulty persuaded her to enter hospital, where she was treated as a rheumatic fever until chest X-ray showed 1. See Lancet, July 28, 1956, p. 207. 2. Murray, D. S. Ibid, 1935, i, 303.
patient remaining
on
anticoagulants. ANTHONY CHURCHER.
Eastbourne.
AMYOTONIA CONGENITA
SIR,-I read with great interest Dr. Walton’s article.]I noticed with regret that he failed to include pathological discussion of the disease. His extensive clinical material might provide occasion for a study of the pathology. In my opinion such an investigation is especially important because in this ill-comprehended clinical syndrome only the anatomical findings could help in classifying the disease. I should like to draw attention to a case2 in which I found destruction of the anterior-horn cells of the spinal cord similar to that in progressive spinal muscular
atrophy (Werdnig-Hoffma,nn type). István Hospital, Budapest, Hungary.
T. LEHOCZKY.
HEAVY FEET IN THE WARD
SiR,—Miss Hutchinson, in her letter (Aug. 4), draws attention to the heavy-footed walking of nurses in wards. I have long known that a great many nurses do not know how to walk, but I never could do much about it. It is a disability which they share with a high proportion of modern city-dwellers. We have abolished cobblestones and we do not allow people to walk on the grass. It is assumed that all road and floor surfaces must be smooth and free from irregularities. If ail accident can possibly be attributed to roughness in a floor there is likely to be an action for damages. In such circumstances an organ so complicated as the human foot is not necessary, and many people use their feet as if they simply had hinge-joints at the ankle. The foot does not react well to the treatment and a great deal of trouble results. It is quite difficult to walk well, but it must be very seldom that anyone is taught the art. HENRY H. MACWILLIAM. Liverpool.
hospital
BURNS AND SCALDS
followed with interest the discussion your leader of May 19, may I recommend the I treatment of burns and scalds with bile ointment ?‘ use a cream containing the equivalent of 75% of deodorised fresh ox-bile,3 and in my experience its effect on burns and wound infections has been striking. It appears to prevent further skin damage, limit the infection, and accelerate healing. The beneficial effect of bile in these conditions, as clinically observed and suggested in my investigation,4 is explained (a) by its bacteriolytic and bacteriostatic action against pathogens, (b) by its detoxifying action, and (c) by its being an essential co-enzyme factor in the tissues. NAJIB-FARAH. Alexandria, Egypt.
SiR,—Having
opened by
1. Walton, J. N. Lancet, 1956, i, 1023. 2. Lehoczky, T. Arch. Psychiat. Nervenkr. 1924, 71, 491 3. An ointment of this constitution is made under the name of
’Bylobalm’ by Bylox Laboratories, Twyford, Berkshire. 1956, suppl. no. 312, p. 596.
4. Najib-Farah. Acta med. scand.
USE OF
IN THE U.S.A.
TRANQUILLISERS
SiR,—The publication (Aug. 4) of an extract from the American Psychiatric Association’s warning on the abuse of these drugs is timely and generally applicable to this country. The casual use of tranquillisers for trifling emotional upsets is widespread among the public and needs control as they possess dangerous toxic and side effects. The cost of prescribing these preparations under the National Health Service is stated to be causing anxiety, and recently questions were addressed to the Minister of Health suggesting that they should be restricted to hospital practice.’ Three years’ experience of these drugs has impressed me with their great potentialities in psychiatric practice, but they are definitely not a substitute for either electroconvulsive or deep insulin therapy. To avoid accidents or the risk of denying patients a more valuable remedy, practitioners would be wise to secure a specialist’s opinion when they intend to employ these preparations. It would be a great pity if the pendulum was allowed to swing against these valuable drugs or we were limited in their prescription by reason of their excessive cost to the health service. D. FENTON RUSSELL. BYakefield. EARLY DIAGNOSIS OF BONE LESIONS
SiR,-In his letter of Aug. 4, Dr. Lack suggests that staphylococcal infection comes into the differential diagnosis, particularly of a lesion of the spine, and in doubtful cases it is worth measuring the staphylococcal antitoxin level of the patient’s serum weekly for a few weeks." My own experience suggests that it is often not necessary to estimate the titre
more than once, and in a report on staphylococcus toxoid,2 I cited two cases in one of which the differentiation between a tuberculous and a staphylococcal lesion had been made on the basis of the very much raised blood titre. Following that, a number of other cases were similarly diagnosed, and in all of the cases Staphylococcu8 aureus was obtained from the lesion. With the advent of penicillin this estimation appeared to fall into disuse, or rather it was never really much used ; and it was interesting to see that it had now been found of value at the Royal National Orthopaedic Hospital. I write only to emphasise that with the apparent increasing number of infections due to strains of staphylococci resistant to antibiotics, there may be an increase in bone lesions from this organism. In that case this diagnostic pointer would be well worth trying.
Kingston Hospital, Kingston-upon-Thames, Surrey.
D. STARK MURRAY.
ERYTHEMA NODOSUM AS A MANIFESTATION OF SARCOIDOSIS
SiR,—I have read with great interest the article (Aug. 4) by Dr. James, Dr. Thomson, and Dr. Willcox, for I had a similar of this year.
case
in
general practice at the beginning
A very stout unmarried young woman, aged 24, presented herself to me one morning saying that she had a pain in her knee. On examination she was perfectly normal and extremely well, and the knee showed no localising signs. She was given a mild application and told to return in a couple of days if it did not improve. She came again next day saying that the pain had gone and she now had a pain in her wrist. By this time she had an undoubted erythema nodosum on both her legs. She insisted that she felt extremely well, her temperature and pulse were normal, there were no localising signs in any of the joints, and the heart and lungs appeared to be quite normal. But the erythrocyte-sedimentation rate (Westergren) was 90 mm. in one hour. I made a provisional diagnosis of rheumatic fever and with great difficulty persuaded her to enter hospital, where she was treated as a rheumatic fever until chest X-ray showed 1. See Lancet, July 28, 1956, p. 207. 2. Murray, D. S. Ibid, 1935, i, 303.