1301 MORPHINE AND MUSCLE SPASM

SIR,-Mr Young (May 29, p. 1190), concludes that, in clini-

cally useful doses, morphine can produce spasm of striated muscle. His evidence for this is a 27-year-old Russian sailor, of whom no mention is made of any muscle spasm even after repeated injections, and a 24-year-old waiter after a single injection of morphine. Both patients experienced continued pain after morphine had been given. These limited observations would be better explamed by the action of morphine on intrabiliary pressure which is much increased after morphine administration. 1The increase in pain and apparent "spasm" of the rectus muscle in the second case would follow from this rise in intrabiliary pressure and also lead to epigastric tenderness-both symptoms being seen, although to a lesser degree, in acute cholecystitis due to a similar rise in pressure. Administration of diazepam would act both as a voluntary muscle relaxant and also may have some action in reducing the contraction of smooth muscle3 in the gallbladder, so reducing the pain and apparent "spasm" which is secondary to the high

intrabiliary pressure. This, I believe, is

plausible explanation

a more

of the facts

reported. Middlesex Hospital Medical School, London W1P 7PN

LAURENCE WALE

EAR-DROPS

SIR,-We support your view (April 24, p. 896) that "earbe prescribed", but feel there is a further hazard not commented on in your editorial-namely, antibiotic resistance associated with the topical use of antimicrobial agents. We have examined the sensitivity to gentamicin of Pseudomonas ceruginosa isolated in our laboratory from clinical specimens taken in three different hospitals. One hospital is a district general hospital (D.R.H.), the other two being specialised hospitals dealing with ear, nose, and throat and skin diseases. The sensitivity of the organisms to gentamicin, determined by

drops should seldom

GENTAMICIN RESISTANCE AMONG PS. AERUGINOSA ISOLATES IN THREE HOSPITALS to gentamicin of ceruginosa

17c sensitivity Ps.

Hospital

No. of isolates

Gentamicin

prescribed/mo.

—————,-——————.——————.——————-,——————

Fully sensitive

Moderately

Resistant

resistant

Cream/ ointment

(g)

Ear-drops (ml)

General

(D.R.H.) E.N.T.

Skin

1133 800 54

93.8 72.5 51.8

5.3 22.5 27.8

0.9

5.0 20.4

Ear-drops.

1301 MORPHINE AND MUSCLE SPASM SIR,-Mr Young (May 29, p. 1190), concludes that, in clini- cally useful doses, morphine can produce spasm of striated...
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