841

is still not known. They are not limited to haemolyticanaemias ; the Glasgow workers reported them in severalother anaemias including pernicious anaemia, but theyare not then so numerous. ,

Of the two groups of staining-reaction studies discussedhere, the one dealing with ribonucleic- acids seems to

be, so far, the most likely to add to our knowledge of thephysiology and pathology of erythropoiesis. They bothshow that interest in staining reactions is far from dead ;and with new or differently applied techniques, freshinformation about their significance is emerging.

THE MAKE-UP OF THE ALCOHOLIC

IT is so much easier to blame the alcoholic than to

study him dispassionately that for long the only treat-ment of his condition was by exhortation. Dr. A. E.Carver, in a lecture 1 to the Society for the Study ofAddiction on Oct. 21, argued that alcoholism, like otheraddictions, must be considered as expressing a failure ofadjustment of the personality as a whole, and not asdue either to moral dereliction or material disease.Behaviour, he pointed out, in both its physiological andpsychological aspects, is always an attempt of theindividual to adjust himself to his environment. Whenhe fails he seeks some situation, or some substance, torestore the balance. Some drugs relieve distressingsymptoms, and, if his anguish is severe, a patient is likelyto take them without pausing to consider or correct theunderlying disorder. If the disturbance is transitorythe drug will tide him over ; if not, the drug will in timecause its own symptoms. Even a euphoriant withnone of the disadvantages of alcohol would merely bringthe doctor into competition with the publican, withoutcuring the patient.

Dr. Carver makes an interesting comparison, fromthe psychosomatic aspect, of alcoholism with asthma.In both he recognises a constitutional trend associatedwith psychological factors. In asthmatics, " the vago-insulin component of the autonomic system preponder-ates over the sympathetico-adrenal partner." Hence thebronchial mucosa is hypersensitive and liable to react toirritations which do not upset ordinary people. But the

sensitivity varies ; there are periods of complete freedomfor the asthmatic, just as there are for the dipsomaniac.

" An asthma personality," Dr. Carver says, " seems

to be so constituted as to enable him to use as

detonator ... a multitude of substances and situationswhich nature has ready to hand in profusion ; whereasthe alcoholist... cannot attain the end after whichhis being is striving unless his tissue reactions aremodified by one particular substance...."

But the fact that a constitutional factor is present doesnot entitle the doctor, Dr. Carver thinks, to adopt afatalistic attitude, or the patient to sit back in the

complacent belief that he is made that way.There are also reflex factors in both diseases. Thus

the alcoholic experiences reflex irritations-for example,the "aching void" in the stomach at opening time-which drive him to take a drink; while asthmaticattacks may be reflexly provoked by causes in the

respiratory or other bodily systems. Psychologically,the alcoholic is sensitive, touchy, and self-indulgent,with strong inferiority feelings, while the asthmatic is

intelligent, irritable, aggressive, quick to respond, butalso over-anxious and insecure. The asthmatic childmakes great demands on his mother, being intelligentenough to get his own way and anxious enough toexact continual attention. It may reasonably be argued,Dr. Carver suggests, that it is just as

" sinful " to takeair to excess as to take alcohol to excess. ** The creatureas a unity reaps the consequences." What shouldinterest the doctor are the reasons which impelled thecreature to such inadequate behaviour ; and treatment

1. Published in the British Journal of Addiction, October, 1947.

should be directed to helping him " to face reality, andif possible to attain his legitimate wishes by more adequateand socially acceptable means." -

FATAL POISONING WITH AMINOTHIAZOLE

THE antithyroid substance aminothiazole, one of thoseintroduced by Astwood in 1943, was studied in Franc&by Perrault and Bovet,l who found that its toxicity inmice was relatively low, though fatal poisoning mightresult from a cumulative effect. They observed no bloodchanges, eyanosi4, jaundice, or albuminuria in patientsreceiving the drug for thyrotoxicosis; but Himsworthand Morgans,2 who treated 13 thyrotoxic patients withaminothiazole, found a considerable reduction of the

granular cells in 5 cases, and in their view the drug is.far more liable to produce toxic reactions than thiouracil.The complications noted in patients receiving 0. 6 g. dailyincluded drug fever, rashes, enlarged lymph-glands, toxiajaundice (2 cases), nausea and vomiting, and halitosis.The first fatal case of poisoning with aminothiazole

in human beings has lately been reported by Schwoband others 3 in a woman of 33, not thyrotoxic, who triedto procure abortion by taking fifty tablets, each -con-taining 0-1 g. of aminothiazole. A few hours later shevomited, and she did so again next day, when her mensesreappeared. She consulted several doctors, who put heron a milk diet and gave her some sedatives. On thethird day she developed a headache, which rapidly gotworse. She was then given insulin, and her vomitingceased; but she soon lapsed into unconsciousness, withextreme restlessness and occasional spasms of opistho-tonos, culminating in coma and death. Laboratoryinvestigations revealed uraemia and hypocalcæmia, andthe necropsy showed hepatitis and nephritis. ’ Thethyroid contained localised zones of congestion andnecrosis. There was no agranulocytosis. The patientweighed about 55 kg., making the lethal dose a little,less than 0-1 per kg. (ignoring elimination by vomiting).In a non-fatal case of poisoning recorded by Gaultier 4

the aminothiazole was again taken in an attempt toprocure abortion. A healthy woman of 26 took nine,tablets at 8 A.M., noon, 4 P.M., and 9 P.M., making a totalof 3-6 g. in thirteen hours. About midnight she began to.vomit and she did so repeatedly through the night. Nextmorning Gaultier noted white powder in the vomit, andthe patient confessed her attempt at abortion. Clinicalexamination showed no fever and normal blood-pressure,pulse-rate, blood-count, and urine. She was given notreatment. Complete gastric intolerance lasted twenty-four hours, and then the patient swiftly recovered ;two days later, when she was doing her usual work, hermenses reappeared. She was kept under medical observa-tion for a year, during which there were no signs ofliver, kidney, or thyroid trouble.

CUTTING THE COATIN a white-paper issued at the beginning of this week 5

the Government announce their proposals for reducingcapital expenditure next year by £180 million; theformer gross estimate was E1600 million. So far as

the health services are concerned, the Government takethe view that some large water projects can no longerbe safely postponed, and that the work of increasingrural water-supplies should go forward ; and there is,to be a limited additional amount of work on hospitals,mental institutions, and other medical installations.The labour force engaged on all this work, which was18,783 last June, will rise to 24,000 by next June.

1. Perrault, M., Bovet, D. Lancet, 1946, i, 721.2. Himsworth, H. P., Morgans, M. E. Ibid, p. 800. Morgans, M. E.

Ibid, 1947, i, 519.3. Schwob, R. A., Derobert, L., Malzevin. Bull. Soc. méd. Hôp.

Paris, 1947, 63, 817.4. Gaultier, M. Ibid, p. 877.5. Capital Investment in 1948. Cmd. 7268. H.M. Stationery

Office. 6d.