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A hundred years ago
23 Jun 2016
WITH SIR CLIFFORD ALLBUTT as its high priest, bleeding, with restraint, is in the process of coming by its own again. I first heard Sir Clifford Allbutt speak in praise of blood-letting in 1907, and I find this view confirmed in his recently published book. Blood letting has been advocated during the last fifteen years by those best qualified to speak of it from experience, namely, the general practitioners. However, they speak furtively, shamefacedly, and in the fear of the pseudo-scientific superman. These gentle counsellors have been assailed with such vociferous energy by the pseudo-scientist, that their timid voices have scarcely been heard.
23 May 2016
As soon as the acute stage has passed off, usually in a week or two, it is inadvisable to prolong the Weir-Mitchell treatment. The course usually prescribed is six weeks, but this is, in very many cases, harmful. The ennui and monotony are prejudicial, and will engender a feeling of helplessness, feebleness, and dependence upon others. I believe the majority would be far better to begin in a fortnight or three weeks to interest themselves in some pursuit or hobby. It is an interest in life that these people need. This will prevent them from drifting into the chronic stage from which it is so difficult to remove them. In neurasthenia, it is the person rather than the disease that demands treatment.
Practitioner 2011;255 (1736): 10
Deaths from methadone overdose fall
24 Jan 2011
The introduction of supervised methadone administration was followed by a reduction in deaths due to methadone overdose in England and Scotland. Deaths related to methadone declined four-fold in both countries, while methadone prescribing increased substantially, between 1993 and 2008.The past two decades have seen rapid growth in methadone prescribing for the management of heroin dependence and widespread adoption of supervised administration of methadone by pharmacists. The authors took the total quantity of methadone prescribed annually, and divided this by 60 mg (the approximate average daily dose) to give an estimate of the number of daily dispensed doses in a given year. This figure was then analysed with the number of deaths identified by coroners as involving methadone (both as the only drug involved, and when methadone was one of a number of substances), between 1993 and 2008. 'The study found that the OD4 index decreased substantially in both Scotland and England despite large increases in methadone prescribing. In England, for example, the OD4 for methadone-only deaths fell from 27.1 in 1993 to 5.8 in 2008, in a period when methadone prescribing increased seven-fold. In Scotland the respective values fell from 19.3 to 3.0 over the same period and methadone prescribing increased 18-fold. The study does not address any other potential cause for the decrease in fatal overdose rates apart from the introduction of supervised methadone dosing. However, it provides good evidence that methadone prescribing has become increasingly safe with the adoption of supervised administration. The OD4 provides a useful tool for monitoring any future changes.'