3 DECEMBER 1977
BRITISH MEDICAL JOURNAL
nioxythiolin-free control. A 10-[u sample from each tube was plated on blood agar at 0, 1, 1, 2, 4, and 24 h. The results for one of the organisms tested with 10" bacteria added to 1 ml of solution are shown in the table. It can be seen that 2 h exposure -was required for killing by a 10 g 1 solutioni of noxythiolin, although the N\BC as prexviously determined was 2 g 1. Two other organisms (MBC 1 g 1) when tested with 10' organisms ml showed complete killing by 20 g 1 in 1 h, by 10 g 1 in 2 h and by both 5 g 1 and 2 5 gl1 in 4 h.
Presence of pertsistl iug Bacteroides fragilis aftetr exposuire to nloxythiolinl Timc of exposure
Noxvthiolin concentration (g 1) ---
(hours" 0
20
-.10 _
5
+ + +++ + ++ + + t _+ + + + ++ + +
2-5 + ++ + + + + +
0
1 25 -I
++
+
+
+ t1+0 + -
1479
non-organic approach-for examplc, family coun- mention that their trial is not complete and selling. This typc, oftcn a middle-class minority, that a significant effect of cimetidine "has yet has traditionally and, I feel, most unfortunately to emerge." This statement worries us because been confused with the follow,ing categories. (Ib) Those "normals" for whom sociopsycho- usually it is assumed that the results of a logical measures alone are insufficient and who randomised trial are not known until the thercfore need pharmacological help wvhile their completion of the study. Otherwise it may be undcrlving stress continues. A relevant analogy is difficult to decide when to stop the trial. the snmoker who starts smoking much more when We agree very much with Mr R S Arnot subjected to stress. Both may continuc to indulge (15 October, p 1022), who states that treatment out of habit whcn the stress is removed, but not with cimetidine may lead to an increased to excess any more. This group can return to incidence of missed gastric carcinomas if the 'social" drinking, as an increasing number of patients are not examined sufficiently early. studies is now showing.7 (II) The "core" alcoholics needing long-term K GOTLIEB JENSEN drug help in their effort at tcnsion-discharge. S RUNE They typically suffcr from chronic physical and/or psychiatric illncss. Female alcoholics are overH R WULFF represented hcre in that they tcnd to be more Ribe County Hospital, psychologically disturbed.' Glostrup University Hospital, Herlev Unliversity Hospital, Oral medication is usually unsuitable for Denimark
maintenance treatment.9 The obvious answer is the depot phenothiazine,'" 11 which is not only our most effective anti-aggressive agent but may ev-en block a possible toxic-addictive The results of our own studlies on B frag,ih'S complex of dopamine with a tetrahydroand those of Dr Chattopadhyay on P's isoquinoline derivative of ethanol. If this tension-reduction approach should aenwZlinosa lead us to believe that the disc sensitivity test or determination of MIC or prove scientifically fruitful we will havre lSIBC as routinely applied to the study of achieved a breakthrough in the exorcism of a antbiotics may be of i'mited v-alue. We feel very nasty "demon." The bell may toll only that assessment of the rate of killing is the only for those not given the chance of treatment method likely to give a meaningful result for with a depot neuroleptic. H G KINNELL topical agents which may otherwvise be instilled for too short a period of time, with long Northgate Hospital, periods of time between treatments during Morpeth, Northumbcrlaind which regrowth could occur. We douibt, Benjamin, I S, Inrie, C W, anid Blumgart, L H, in howc,en er, whether laboratories could devrote Alcoholistn: New_, Knowledge and .'Vew Responses, ed G Edwards and MA Grant, p 198. London, of the time needed to assess the rate killing Croom Helm, 1977. in envery case. 'W"orldc Health Statistics Annzual, 1973-1976. Geneva, WHO, 1976. R H CJEORGE Galambos, J T, in Progress in 1lie7cr Diseases, ed D E HEALING H Popper and F Schaffncr, vol 4, p 567. New York, 24 _
_
~~~+ +
1 + + +t
' +,
D)epa(rtment o f Mwicro)biology,
Birniiiiglham
Birminlghaml
C,hildren's Hospital,
Halcr, ID, and Aebi, A, Naturer, 1961, 190, 734.
Drinking behaviour SIR,-Your leading article entitled "Drinking behaviour" (8 October, p 914) is rather misleading in its emphasis. Alcohol is rarely a main cause of the conditions attributed to its abuse' 3; only a tiny minority of British drinkers (perhaps 0-05-0 1 `0) develop serious complications. Where there is an association with cirrhosis, marital strife, dementia, worktime lost, etc, the alcohol ingestion may well be a correlate or even a consequence rather than a cause. Mental, physical, and social illnesses cause alcoholism rather than the other way round. Thus even when alcoholics abstain totally they tend to be overtly disturbed.' If nuclear alcohol dependency is usually a symptomatic phenomenon the crucial lesson is that we must search exhaustively for underlying, often treatable, pathology. If alcoholism is diseasebased the present expensive educational drive by David Ennals in the north-east to reduce the Geordies' intake is doomed to failure. Excessive drinkers might wreak even more havoc on themselves or society without the refuge of the bottle) 'i which serves as a "sinister but effective" peacemaker. This pain-relieving model suggests a more heuristic, treatment-oriented typology than the rather ineffective WHO restatement of Jellinek's excellent descriptive classification: (la) Those "normals" wAhose life problems,
Grunc and Strattoin, 1972. Gerard, I) L, Saenger, G, and Wile, R, Archives of General Psygchiatrv, 1962, 6, 83. .Sulndav x xpresss, 18 September 1977, p 21. Proudfoot, A I, and Park, J, in Alcoholismn: .New Knowlc.dgc and New, tz Rcsponlses, cd G Edwards and iM Grant, p 224. Lonidon, Groom Helm, 1977. Litman, G K, Once anz Al-oholic, Alz,ays atn Alcoholic: A Reviezw anid Critiquie
BRITISH MEDICAL JOURNAL
nioxythiolin-free control. A 10-[u sample from each tube was plated on blood agar at 0, 1, 1, 2, 4, and 24 h. The results for one of the organisms tested with 10" bacteria added to 1 ml of solution are shown in the table. It can be seen that 2 h exposure -was required for killing by a 10 g 1 solutioni of noxythiolin, although the N\BC as prexviously determined was 2 g 1. Two other organisms (MBC 1 g 1) when tested with 10' organisms ml showed complete killing by 20 g 1 in 1 h, by 10 g 1 in 2 h and by both 5 g 1 and 2 5 gl1 in 4 h.
Presence of pertsistl iug Bacteroides fragilis aftetr exposuire to nloxythiolinl Timc of exposure
Noxvthiolin concentration (g 1) ---
(hours" 0
20
-.10 _
5
+ + +++ + ++ + + t _+ + + + ++ + +
2-5 + ++ + + + + +
0
1 25 -I
++
+
+
+ t1+0 + -
1479
non-organic approach-for examplc, family coun- mention that their trial is not complete and selling. This typc, oftcn a middle-class minority, that a significant effect of cimetidine "has yet has traditionally and, I feel, most unfortunately to emerge." This statement worries us because been confused with the follow,ing categories. (Ib) Those "normals" for whom sociopsycho- usually it is assumed that the results of a logical measures alone are insufficient and who randomised trial are not known until the thercfore need pharmacological help wvhile their completion of the study. Otherwise it may be undcrlving stress continues. A relevant analogy is difficult to decide when to stop the trial. the snmoker who starts smoking much more when We agree very much with Mr R S Arnot subjected to stress. Both may continuc to indulge (15 October, p 1022), who states that treatment out of habit whcn the stress is removed, but not with cimetidine may lead to an increased to excess any more. This group can return to incidence of missed gastric carcinomas if the 'social" drinking, as an increasing number of patients are not examined sufficiently early. studies is now showing.7 (II) The "core" alcoholics needing long-term K GOTLIEB JENSEN drug help in their effort at tcnsion-discharge. S RUNE They typically suffcr from chronic physical and/or psychiatric illncss. Female alcoholics are overH R WULFF represented hcre in that they tcnd to be more Ribe County Hospital, psychologically disturbed.' Glostrup University Hospital, Herlev Unliversity Hospital, Oral medication is usually unsuitable for Denimark
maintenance treatment.9 The obvious answer is the depot phenothiazine,'" 11 which is not only our most effective anti-aggressive agent but may ev-en block a possible toxic-addictive The results of our own studlies on B frag,ih'S complex of dopamine with a tetrahydroand those of Dr Chattopadhyay on P's isoquinoline derivative of ethanol. If this tension-reduction approach should aenwZlinosa lead us to believe that the disc sensitivity test or determination of MIC or prove scientifically fruitful we will havre lSIBC as routinely applied to the study of achieved a breakthrough in the exorcism of a antbiotics may be of i'mited v-alue. We feel very nasty "demon." The bell may toll only that assessment of the rate of killing is the only for those not given the chance of treatment method likely to give a meaningful result for with a depot neuroleptic. H G KINNELL topical agents which may otherwvise be instilled for too short a period of time, with long Northgate Hospital, periods of time between treatments during Morpeth, Northumbcrlaind which regrowth could occur. We douibt, Benjamin, I S, Inrie, C W, anid Blumgart, L H, in howc,en er, whether laboratories could devrote Alcoholistn: New_, Knowledge and .'Vew Responses, ed G Edwards and MA Grant, p 198. London, of the time needed to assess the rate killing Croom Helm, 1977. in envery case. 'W"orldc Health Statistics Annzual, 1973-1976. Geneva, WHO, 1976. R H CJEORGE Galambos, J T, in Progress in 1lie7cr Diseases, ed D E HEALING H Popper and F Schaffncr, vol 4, p 567. New York, 24 _
_
~~~+ +
1 + + +t
' +,
D)epa(rtment o f Mwicro)biology,
Birniiiiglham
Birminlghaml
C,hildren's Hospital,
Halcr, ID, and Aebi, A, Naturer, 1961, 190, 734.
Drinking behaviour SIR,-Your leading article entitled "Drinking behaviour" (8 October, p 914) is rather misleading in its emphasis. Alcohol is rarely a main cause of the conditions attributed to its abuse' 3; only a tiny minority of British drinkers (perhaps 0-05-0 1 `0) develop serious complications. Where there is an association with cirrhosis, marital strife, dementia, worktime lost, etc, the alcohol ingestion may well be a correlate or even a consequence rather than a cause. Mental, physical, and social illnesses cause alcoholism rather than the other way round. Thus even when alcoholics abstain totally they tend to be overtly disturbed.' If nuclear alcohol dependency is usually a symptomatic phenomenon the crucial lesson is that we must search exhaustively for underlying, often treatable, pathology. If alcoholism is diseasebased the present expensive educational drive by David Ennals in the north-east to reduce the Geordies' intake is doomed to failure. Excessive drinkers might wreak even more havoc on themselves or society without the refuge of the bottle) 'i which serves as a "sinister but effective" peacemaker. This pain-relieving model suggests a more heuristic, treatment-oriented typology than the rather ineffective WHO restatement of Jellinek's excellent descriptive classification: (la) Those "normals" wAhose life problems,
Grunc and Strattoin, 1972. Gerard, I) L, Saenger, G, and Wile, R, Archives of General Psygchiatrv, 1962, 6, 83. .Sulndav x xpresss, 18 September 1977, p 21. Proudfoot, A I, and Park, J, in Alcoholismn: .New Knowlc.dgc and New, tz Rcsponlses, cd G Edwards and iM Grant, p 224. Lonidon, Groom Helm, 1977. Litman, G K, Once anz Al-oholic, Alz,ays atn Alcoholic: A Reviezw anid Critiquie
