1247 Letters to the Editor PROGNOSIS FOR ALCOHOLICS SIR,-Alcoholics comprise many different personalities, predominance or otherwise of certain p...

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SIR,-Alcoholics comprise many different personalities, predominance or otherwise of certain personality types (e.g., of psychopaths) in a given group of cases makes it almost impossible to compare the results obtained by different observers with different methods.12 However, the results and the prognostic pointers reported by C. G. Berglin on the basis of disulfiram therapy in Swedish alcoholics (May 7, p. 1033) bear a very close resemblance to findings in English alcoholics treated by a a more comprehensive psychological-physical approach,2 which often incorporated disulfiram (’Antabus ’).4 and the

Thus, older, married alcoholics had in general a better prognosis than the young, unmarried, or divorced ones. Indifference to their alcoholic problem, criminal and poor work record, and methylated-spirit drinking 5 were by and large also pointers to a poorer prognosis. Among the Swedish as well as among,the English alcoholics it was the abuse of alcohol at a young age which was of prognostic significance but not (as reported in your review of Berglin’s findings) the mere " history of drink before the age of 21 ". In a carefully planned investigation of American hospitalised alcoholics, comparing the results of four different treatment methods, Wallerstein et al.found disulfiram " the most helpful to the most patients ". Yet the number of patients in whom disulfiram failed, and that of those helped by other therapeutic methods, was large enough " to preclude the blanket prescription of Disulfiram as the optimal hospital treatof the chronic alcoholic patient ". In view of these findings and having regard to the different types of personalities among alcoholics, a more comprehensive therapeutic approach based on the evaluation of the needs of the individual patient seems in theory preferable to the method of relying on one and the same approach in each patient. Berglin’s results are therefore all the more remarkable. But perhaps more important is that this Swedish study indicates once more that, provided the problem is tackled systematically and constructively, the prognosis in alcoholics is much more hopeful than generally assumed by the medical and the lay ment

public. St. Bernard’s Hospital, Southall, Middlesex.



SIR,-Ihave taken the opportunity of a visit to Rio de Janeiro to inquire about the local incidence of Perthes’ disease among Negro children admitted to the hospitals of the Brazilian ex-capital. I am obliged to Prof. Dagmar Chaves for the figures of Perthes’ in the Hospital Escola Anchieta, which fills about half of its beds with Negro children. Of the 55 patients diagnosed both clinically and radiologically as Perthes’ disease, 54 were white and 1 was a mulatto. Dr. Oswaldo P. Campos kindly gave me the figures collected in the Hospital Jesus, also in Rio de Janeiro; more than half the admissions to this hospital are Negro children. From 1935 up to the present time they have treated 232 cases of Perthes’ disease: of these, only 9 were Negro. These figures show that if the condition is not unknown even among Brazilian children of African origin, its occurrence is rare. Adding up the cases which have been seen at both Brazilian hospitals, only just

over 3% are of African stock. In my initial letter of Jan. 13, my reference to the alleged 1. Williams, L. Lancet, 1952, i, 787. 2. Glatt, M. M. Brit. J. Addict. 1955, 52, 55. 3. Glatt, M. M. Lancet, 1959, ii, 397. 4. Glatt, M. M. J. ment. Sci. 1959, 105, 476. 5. Glatt, M. M. Lancet, 1956, i, 752. 6. Wallerstein, R. S., Chotlos, J. W., Friend, M. B., Hammersley, D. W., Perlswig, E. A., Winship, G. M. Hospital Treatment of Alcoholism; p. 176. London, 1957.

rarity of Perthes’ among children of African origin was mentioned to suggest an anatomical explanation, perhaps now only valid for some of the Negro population-namely, that the blood-flow to the upper femoral epiphysis may be secured in those groups of population resistant to Perthes’ by the presence through childhood of the vessels entering the epiphysis through the ligamentum teres, a factor which does not occur in the white child. It may be of interest to note that in 6 well-injected specimens of femoral heads from African (Bantu) children and 1 Brazilian which I have been able to examine, under the age of 4, all but 1 African had the round-ligament vessels permeable to the injected mass deep into the epiphysis. I am grateful to Dr. S. Schulman of Johannesburg and Dr. Nova-Monteiro of Rio for their collaboration. I must state my appreciation to Dr. Cockshott and Dr. Palmer and to Mr. Golding for their constructive contributions; and to Prof. W. W. Davey of University College Hospital, Ibadan, for arranging a fuller investigation of the blood-supply of the femoral head in Africans during growth. Nuffield Orthopædic Centre, TRUETA. Oxford.


MEDICAL ASPECTS OF ROAD SAFETY SiR,—The second of Dr. Norman’s extremely interesting Milroy lectures (May 7 and 14) reminds me of a further type of disability which poses similar problems. On several occasions during recent years I have been asked to report on the fitness to drive of men of low intelligence, and in some instances the decision is indeed a difficult one. As a general rule those certified under the Mental Deficiency Acts are not allowed to hold a licence, though it is known that some engaged on farm work have driven a tractor in the field. After their discharge from Order they may feel entitled to answer " No " to question 15 of the application form which reads " Are you suffering from any disease, mental or physical...", and within my experience several have become drivers. Others have never been certified under the Acts, but have been on statutory or voluntary supervision. Again, while under supervision, they have difficulty in obtaining a licence, and the assessment of their fitness for discharge so that they can obtain one calls for careful consideration of many factors. Ability to drive cannot be equated with degree of intelligence, and most of us know of men of superior intellect who, because of inattention or introversion, are not the most capable drivers. If my memory serves me aright, men of selection grade iv were regarded as suitable for driving in the Army. Thus it is difficult to fix an intelligence-quotient limit beneath which a man should not hold a licence, though certain generalisations

permissible. By and large, those with an i.Q. of 70 or over have the potential to become good drivers, though if illiterate they need special tuition to recognise road signs. The holocaust on the are

roads is so great that those with an i.Q. of below 50 should not be given a licence. Even if they are physically fit, their comprehension is so limited, and their cerebration so slow, that they are likely to prove a menace on the roads. It is with those between these limits that the chief difficulty arises. Some may lose their employment as farm labourers unless allowed to drive a tractor; and, if they are emotionally and temperamentally stable, some are capable of handling such a slow-moving vehicle competently and should be allowed to do so. Whether such a person should be permitted to drive a car or motor-cycle calls for judgment based on long experience, and each must be judged as an individual on his performance and aptitude. Undue apprehension that such men should be driving on the road may be allayed if I mention that I have on occasion noted one of my ex-patients controlling a road block with his red and green flags, and that lie waved on the lines of traffic as ably as any other roadman. The Royal Hospital, D. PRENTICE. Starcross, Devon.