Letters to the Editor
Running Commentary by Peripatetic Correspondents
DID The Lancet unwittingly hasten the death of Robert Louis Stevenson ? In 1884 R. L. S. was-for him-in tolerably good health, and living at Hyeres on the Cote D’Azur. His stepson, Lloyd Osbourne, in a preface to the South Seas edition of Prince Otto has described how happy, healthy, and contented R. L. S. was there-until The Lancet changed " I often think", wrote Osbourne, " it was everything. a mistake he ever left Hyeres; it was so entirely congenial and suited him so well, though the last word must be used in a relative sense. The reason was absurd. My mother [R. L .S.’s wife], with a view of keeping up with the advance of medicine and gaining some hints that might help R. L. S., subscribed to The Lancet-the well-known medical weekly. It was the worst reading in the world for her, as it is for any layman who
trespass on a highly technical domain. himself and wiser, left it severely alone. But my mother glued herself to it, and began to fill her mind with all sorts of bogeys. Vinegar was discovered to be full of perils; salads carried the eggs of tape-worms; salt hardened your arteries and shortened your days; heaven only knows what she discovered in the way of lurking dangers, previously undreamed of; and when the climax came in an outbreak of cholera in the old part of the town, with a terrible death-roll amongst its poor, dirty, neglected inhabitants, she fell into a panic and began to work on R. L. S. to abandon Hyeres as a place too dangerous to live in. Had it not been for The Lancet I doubt if R. L. S. would ever have left Hyeres." To be sure, R. L. S. did not die until 1894, but he never again achieved the serenity of those days at Hyeres--so in a roundabout fashion The Lancet did indeed have some share in the poor fellow’s untimely end ...
Forty-eight crowded hours away from the practice in midweek has upset my balance of time. The lumbago seen on Tuesday is still in pain on Thursday, and I think darkly of discs and worse. Tuesday’s boil is nothing like healed on Thursday. I’ve obviously missed a nasty diabetic. Worse still the lassie whose membranes went as I was leaving home is not yet in labour. She’ll be lucky if she has a live child. But something is wrong somewhere. The patients aren’t worried. After all to them forty-eight hours are only two days and these things won’t be hurried. Once again I’ve forgotten the relativity of time, and once again it’s taken forty-eight hours away from home or thirty minutes waiting for a placenta to hammer the fact home. *
It is time something was done about this fellow F. C. Path. A couple of years ago he insinuated his name between mine and that of my pxdiatric colleague at the head of what we thought was rather a classy paper. Fortunately it was only the proof, and an eagle eye spotted him and sent him back to the pavilion. Now he is at large again, and lately again claimed to be co-author of an article.If we are not careful this interloper will be pinching some of our reprints. *
Now that the age of the computer is upon us, should the
Ministry of Health not install one to solve the vexed question of distinction awards ? Appropriate scores could be devised, based on diagnostic ability, outpatient waiting-times, promptness in writing letters to general practitioners, and so on. Surgeons could be assessed on their postoperative results. Not only the number of publications, but also their quality, would be assessed; and there would be a negative score for papers which contained inaccuracies
wasted the reader’s
might reduce the chronic shortage of journal space dramatically. There could be one possible risk. Unless rigidly programmed, the computer might distribute the best time.
its satellite computers. of Great Britain, May, 1966, p. 336 (footnote).
1. Modern Medicine
DRUG ADDICTION SIR,-Ihave just returned from a tour of narcotic-addiction centres in the United States and am struck by the utter complacency that surrounds the problem in this country. Nothing has been done since the Interdepartmental Committee report in 1961, except that another Government report has been issued in 1965.1 Some writers even oppose any further action being taken.2 I met American addicts and learnt that the idea is widespread in the United States that narcotic drugs are distributed free in England. This false notion arises from the fact that it is possible for tourists to buy drugs outside certain all-night chemists around midnight in the centre of London. Many young people from all parts of Britain travel at the weekend to acquire drugs in the same way. Surely it is time this international scandal was stopped. It is gratifying to hear that Lord Parker has introduced a Bill for the Registration and Control of Unlicensed Clubs to bring these clubs under control.3 All-night clubs, often under shady management, are a feature of the night-life of London and other large cities; at many of these places drugs can be bought, and there seems to be no control over the age of entrants.
Moreover burglaries and infiltrations of chemists’ shops are the increase, and the conventional locked receptacle" a small wooden seems (usually cupboard) woefully inadequate to protect the large stock of dangerous drugs that many chemists now carry. We should surely operate the World Health Organisation’s proposals for the control of drugs of addiction. Legislative measures can only deal with minimal controlswhile essential they are the negative side of the present epidemic of drug abuse. It is time that all those concerned with the future of young people should carefully consider what preventive measures should be taken. The appropriate authorities should also be concerned with an educational " programme to inoculate " those exposed to the spread of this social disease. Many of the measures outlined could have been operated long ago. Conventional phrases stating that the matter is "under active consideration" or that there is no need for " panic legislation " should not be used to mask inactivity. Doctors in America pointed out to me the similarities between our present epidemic and that in Japan, which was also preceded by a wave of amphetamine addiction, and which continued with a pandemic of narcotic addiction. It seems to me that the Government should take its responsibilities much "
St. John’s Hospital, London S.W.11.
P. A. L. CHAPPLE.
LIVING RECORDS SIR,-Mr. Small (May 21) is to be congratulated on his cogent reasoning for improved recording for his duodenalulcer patients. While we appreciate, however, that the policy advocated is aimed at satisfying academic standards, we must challenge the views expressed by Mr. Small because of the practical implications for the patient and the profession. Very few patients would attend for the rest of their lives one followup clinic only, for other major illness could make equal or even greater claims on the grounds of the need for living records. Imagine the absurdity of the situation which the general implementation of such a policy would create! The accompanying table shows that during only a five-year spell, most patients with duodenal ulcer have other conditions for which they attend various clinics: to attempt to foster lifelong 1. Interdepartmental Committee on Drug Addiction: Second Report. H.M. 2. 3.
Stationery Office, 1965. See Lancet, 1965, ii, Prince, I. World Medicine, May 17, 1966, p. 64. Daily Telegraph, May 23, 1966.