research accommodation would of course have to be provided. At present when our professors in medical schools are not going round with begging bowls to the U.G.C. they are in orbit around the world giving as much help as they can to overseas schools. A few more full-time professors and our students and future overseas teachers could be taught by them. There would also be enough for those who wanted to continue research, instead of having to organise their departments or beg for subsistence. Of course, this would be expensive; but instead of the enormous capital investment in concrete that the Health Service is about to make, some of this money might be invested in brains and equipment. Our new hospitals will be out of date in twenty years. Could we not produce something which is cheaper but functionally satisfactory and not meant to last ? Our present hospital exoskeletons are so troublesome because they are so permanent. I do not know who will respond to Sir Selwyn Selwyn-Clarke’s call-it touches such large issues that perhaps the Presidents of the Royal Colleges might initiate action. Wolverhampton,
P. W. HUTTON.
DRUGS AND DRIVING
SIR,-Dr. Norman’s letter (Aug. 22) draws attention to a very vital issue: when any of the drugs he listssedatives, tranquillisers, anti-histamines, &c.-are prescribed for a patient, should that person be allowed to drive ? If the drug does the job for which it is intended, the alertness of the patient will inevitably be dulled. I myself have had this experience when taking even small quantities of anti-histamines. Dr. Norman states " the number of road accidents due to the drivers having taken drugs is small ", but a great many road accidents may be due to one or other of these drugs-the number of proven cases is very small. If the consequences of a road accident were weighed against the patient’s need for the drug, and if the patient were not permitted to drive whilst taking the drug, the number of drugs prescribed and the number of road accidents would be less. J. K. BOWMAN. Plymouth, Devonshire. DRUG ADDICTION treatment of drug addiction
SIR,-By Lady Frankau (Aug. 15) presumably means by treatment of drug addiction addicts who are being disintoxicated and not merely provided with the drug to which they are addicted. I cannot appreciate therefore the advantage of reporting such cases to the Home Office since they must tend to be mainly in the category of established addicts whose identity would most probably be known to the Home Office in any event or
become known in due
However, I do consider it important that the name of any person to whom a prescription for a dangerous drug has been given or who has been supplied with dangerous drugs or to whom a dangerous drug has been administered because they addicts should be communicated to the Home Office. The Home Office, of course, has no power of veto over the provision of dangerous drugs by doctors who have not offended against the regulations, and cannot help addicts other than by advising them to go to hospital or to practitioners whom they know to have special experience of addiction. A doctor should ensure that his patient is an accredited addict before providing him with any drugs, and the drug should not be supplied in greater quantities than necessary. I have already advocated in these columns the establishment are
of clinics to which new applicants for dangerous drugs could be referred for the purpose of deciding the amount of drug they require to keep them free from deprivation symptoms, and the provision of a drug logbook, containing an officially stamped photograph of the holder, in which a record of the amounts supplied could be noted. I cannot appreciate why any addict should be deterred from seeking medical help because he had such a document, unless he is trying to get larger supplies of drugs than those which had already been decided were adequate. Nor can I appreciate how the possession of a drug logbook would necessarily engender fear of discovery of their addiction by employers, friends, and associates. For one thing, addicts do not seem particularly anxious to conceal their addiction, and their employment is much more likely to be terminated for reasons other than the accidental discovery of a document
relating to drugs. There has latterly been a heavy proportionate increase in drug addiction, particularly in young people, and I do not believe that the present regulations are adequate in dealing with the problem. Under existing conditions it is far too easy for anyone to obtain dangerous drugs, and so long as there are more dangerous drugs in circulation than addicts require so long will recruits be attracted to addiction.
Lady Frankau, with her unique experience of drug addicts, should be in a good position to suggest positive measures directed against the mounting incidence of addiction. ELLIS STUNGO.
ASPECTS OF ALCOHOLISM IN THE ELDERLY
SIR,-Dr. Droller’s finding (July 18) that most of his elderly alcoholics took to alcohol relatively late in life is not
Most of the 200 male alcoholic patients seen at Warlingham Park Hospital (1952-56) began drinking in their teens and had become alcoholics in their thirties.1 There was a smaller group of elderly alcoholics, however, some of whom had begun much later in life-often, as in Dr. Droller’s series, after severe environmental or emotional strain and stress. Thus, of the total of 200 male alcoholics, it was not until they had reached the age of 50 that 20% were first admitted to hospital for some manifestation of alcoholism; that 10% had lost control over their drinking; and that 7-8% had
begun solitary or morning drinking or gone on prolonged drinking bouts.1 Moreover, 6 of Dr. Droller’s 7 patients were women, and women alcoholics seem generally to start heavy drinking and to develop alcoholism later in life than men. Of the 200 male alcoholics at Warlingham Park, about 5% were in the age-group 61-70, as against 10% of 68 women alcoholics; of 320 male alcoholics
years at St. Bernard’s
Hospital, just over 5% were over 60 years of age-and among 261 female alcoholics, over 12%. Elderly alcoholics, from a preliminary review seen in alcoholic units and geriatric departments, seem to fall into two different groups. There are those who have been heavy drinkers, and sometimes even " alcohol addicts " for many years, but who live on and continue to drink into old age. The second group, on the other hand, contains people who were non-drinkers or moderate drinkers until late in life when they took to heavy drinking after severe emotional stress, such as bereavement, an increasing feeling of social isolation, &c. In a very simplified way it may perhaps be said that in the first group psychopathology (e.g., personality inadequacy) may often be the most important factor underlying their (long-standing) alcoholism; in the second group, social pathology. Thus, old people, often living alone (of Dr. Droller’s 7 patients 5 were widows apparently on their own), may take to drink as being almost the only living " friend " and pleasure left to them. They begin to drink too much, eat too little, neglect themselves, deteriorate mentally and physically, and when this state is finally detected they may refuse treatment until it is too late. For example, two elderly 1. Glatt, M. M. Acta
psychiat. scand. 1961, 37, 88.