570
Journal of the Royal Society of Medicine Volume 84 September 1991
and I was a subscribing member of the Institute of Economic Affairs from 1957 (some 23 years before my retirement in 1980). As for my second myocardial infarct in 1977, this occurred prior to the last 2% years of my 3 years as PRCS and well before most of the events alluded to in your reviewer's second paragraph. Therefore, in no sense, as he implies, were those very busy and happy years responsible for an infarct which largely preceded them. SIR REGINALD MURLEY Cobden Hill House Radlett WD7 7JN
Accident proneness and rnness proneness Engel's review of accident proneness and illness (March 1991 JRSM, p 163) suggests that many frequent accident victims may be suffering from a congenital diathesis, however, it would seem likely that a far more common cause of accidents within an industrial context would be the side effects of medicines prescribed to the workers. Recent research in Australia (Starmer G, personal communication) suggests that up to 29% ofroad traffic accident victims have detectable levels of psychoactive compounds, excluding alcohol, in blood samples taken at the time of the accident. As there is no evidence to suggest otherwise, it is reasonable to assume that industrial workers involved in accidents would have a similar incidence of psychoactive drugs in their blood. Femoral fractures have been shown to be associated with the use of barbiturates and tricyclic antidepressants, sedative benzodiazepines and phenothiazines have been shown to be contributing factors to falls in the elderly" 2. Furthermore, apathy, drowsiness, blunting of facilities and disorientation have been reported following nocturnal doses of some benzodiazepine hypnotics3. Short-term memory, sensorimotor coordination, information processing skills and mental abilities have all been shown to be disrupted by many antidepressants, minor tranquillizers, hypnotics and several antihistamines4'5. The role of prescribed medicines in industrial accidents is poorly understood. However, it is known that many popular psychoactive agents are behaviourally toxic in producing severe impairment of patients' psychological and cognitive abilities. The interaction of such agents with congenitally accident prone individuals could be serious and life threatening, but it is also time that occupational health physicians addresed the problem of iatrogenic accidents in the non-accident prone population. General practitioners should also demand to know the nature of their patients' employment or habitual daily activities before prescribing psychoactive drugs with a known potential to impair and disrupt skilled
performance. I HINDMARCH
Human Psychopharmacology Research Unit Robens Institute of Health and Safety University of Surrey, Guildford GU2 5XH
References 1 McDonald JB. The role of drugs and falls in the elderly. Clin Geriatric Med 1985;1:621-36 2 McDonald JB, McDonald ET. Nocturnal femoral fracture and the use of barbiturate hypnotics. BMJ 1977;ii: 483-5 3 Evans JG, Jarvis EH. Nitrazepam and the elderly. BMJ 1972;4:487
4 Hindmarch I, Barwell F, Alford C. Behavioural toxicity of antidepressants. In: Leonard B, Spencer P, eds. Antidepressants 30 years on. London: Clinical Neuroscience Publishers, 1991:403-9 5 Hindmarch I. The effects of psychoactive drugs on carhandling and related psychomotor ability: a review. In: Drugs and driving. London: Taylor & Francis, 1986:71-9
Arthur Conan Doyle I was pleased to see the erudite comparison of medical with Sherlockian reasoning (March 1991 JRSM, p 151). Another article (March 1991 JRSM, p 165), related to Arthur Conan Doyle's lack of patients, contains, however, fallacious assumptions. There is no evidence that the author ever used cocaine'. He did experiment with gelseminum, a non-narcotic, and depicted Holmes as a cocaine user in a 1890 story. However, he had Watson admonish that it would destroy his brain cells and lead to loss of his great powers. This was about a decade before the dangers of cocaine became widely accepted. The title of the article is more striking than it is accurate. After an initial 6 months, Conan Doyle developed a steady practice for 8 years in Southsea, Portsmouth (1882-1890). He also received training at its Eye and Ear Hospital. Misleading is the reference to Conan Doyle's failure as an ophthalmologist in London, as it provides no time frame. His consulting room was open only from 6 April to 4 May 1891, after which time he came down with a severe case of influenza. On recovery, he made writing his full-time vocation. Conan Doyle's interest in spiritualism began several years after his graduation, and related activities were independent of rather than "in conjunction with Professor Oliver Lodge". The implication of the statement that he wrote 'a number of other works' is erroneous. In fact, he published many times more novels and short stories than the 60 Sherlockian adventures2. The inaccuracies in the article constitute an injustice to a physician author who has provided and is still providing enjoyment for millions. A E RODIN 3041 Magin Drive Xenia, Ohio 45385, USA
References 1 Rodin A, Key JD. Medical casebook of Arthur Conan Doyle. Malabar Florida: Robert E Krieger, 1984 2 Green RL, Gibson JM. A Bibliography ofA Conan Doyle. Oxford: Oxford University Press, 1983
The attack on Sir Arthur Conan Doyle (March 1991 JRSM, p 165) is unjustified. Not contentjust to attack Doyle, Watts gratuitously attacks Freud as well. Doyle was not a doctor with no patients. He had a successful general practice for nearly a decade. He did not 'move' to Vienna, but attended lectures at the Krankenhaus for less than a month'. Oscar Wilde's enthusiasm' about Doyle's stories did not influence Doyle's literature2. Doyle pursued spiritualism, not theosophy3. 'Letters of insult and abuse' were not the reason Doyle resurrected Sherlock Holmes. His publisher prevailed4. Doyle was not boastful. He was modest about his detective. He did not 'propound mediocrity' but recognized he had created a popular hero. We do not need to 'speculate as to the influences that led Conan Doyle along his pathway to fantasy'.
Journal of the Royal Society of Medicine Volume 84 September 1991
and I was a subscribing member of the Institute of Economic Affairs from 1957 (some 23 years before my retirement in 1980). As for my second myocardial infarct in 1977, this occurred prior to the last 2% years of my 3 years as PRCS and well before most of the events alluded to in your reviewer's second paragraph. Therefore, in no sense, as he implies, were those very busy and happy years responsible for an infarct which largely preceded them. SIR REGINALD MURLEY Cobden Hill House Radlett WD7 7JN
Accident proneness and rnness proneness Engel's review of accident proneness and illness (March 1991 JRSM, p 163) suggests that many frequent accident victims may be suffering from a congenital diathesis, however, it would seem likely that a far more common cause of accidents within an industrial context would be the side effects of medicines prescribed to the workers. Recent research in Australia (Starmer G, personal communication) suggests that up to 29% ofroad traffic accident victims have detectable levels of psychoactive compounds, excluding alcohol, in blood samples taken at the time of the accident. As there is no evidence to suggest otherwise, it is reasonable to assume that industrial workers involved in accidents would have a similar incidence of psychoactive drugs in their blood. Femoral fractures have been shown to be associated with the use of barbiturates and tricyclic antidepressants, sedative benzodiazepines and phenothiazines have been shown to be contributing factors to falls in the elderly" 2. Furthermore, apathy, drowsiness, blunting of facilities and disorientation have been reported following nocturnal doses of some benzodiazepine hypnotics3. Short-term memory, sensorimotor coordination, information processing skills and mental abilities have all been shown to be disrupted by many antidepressants, minor tranquillizers, hypnotics and several antihistamines4'5. The role of prescribed medicines in industrial accidents is poorly understood. However, it is known that many popular psychoactive agents are behaviourally toxic in producing severe impairment of patients' psychological and cognitive abilities. The interaction of such agents with congenitally accident prone individuals could be serious and life threatening, but it is also time that occupational health physicians addresed the problem of iatrogenic accidents in the non-accident prone population. General practitioners should also demand to know the nature of their patients' employment or habitual daily activities before prescribing psychoactive drugs with a known potential to impair and disrupt skilled
performance. I HINDMARCH
Human Psychopharmacology Research Unit Robens Institute of Health and Safety University of Surrey, Guildford GU2 5XH
References 1 McDonald JB. The role of drugs and falls in the elderly. Clin Geriatric Med 1985;1:621-36 2 McDonald JB, McDonald ET. Nocturnal femoral fracture and the use of barbiturate hypnotics. BMJ 1977;ii: 483-5 3 Evans JG, Jarvis EH. Nitrazepam and the elderly. BMJ 1972;4:487
4 Hindmarch I, Barwell F, Alford C. Behavioural toxicity of antidepressants. In: Leonard B, Spencer P, eds. Antidepressants 30 years on. London: Clinical Neuroscience Publishers, 1991:403-9 5 Hindmarch I. The effects of psychoactive drugs on carhandling and related psychomotor ability: a review. In: Drugs and driving. London: Taylor & Francis, 1986:71-9
Arthur Conan Doyle I was pleased to see the erudite comparison of medical with Sherlockian reasoning (March 1991 JRSM, p 151). Another article (March 1991 JRSM, p 165), related to Arthur Conan Doyle's lack of patients, contains, however, fallacious assumptions. There is no evidence that the author ever used cocaine'. He did experiment with gelseminum, a non-narcotic, and depicted Holmes as a cocaine user in a 1890 story. However, he had Watson admonish that it would destroy his brain cells and lead to loss of his great powers. This was about a decade before the dangers of cocaine became widely accepted. The title of the article is more striking than it is accurate. After an initial 6 months, Conan Doyle developed a steady practice for 8 years in Southsea, Portsmouth (1882-1890). He also received training at its Eye and Ear Hospital. Misleading is the reference to Conan Doyle's failure as an ophthalmologist in London, as it provides no time frame. His consulting room was open only from 6 April to 4 May 1891, after which time he came down with a severe case of influenza. On recovery, he made writing his full-time vocation. Conan Doyle's interest in spiritualism began several years after his graduation, and related activities were independent of rather than "in conjunction with Professor Oliver Lodge". The implication of the statement that he wrote 'a number of other works' is erroneous. In fact, he published many times more novels and short stories than the 60 Sherlockian adventures2. The inaccuracies in the article constitute an injustice to a physician author who has provided and is still providing enjoyment for millions. A E RODIN 3041 Magin Drive Xenia, Ohio 45385, USA
References 1 Rodin A, Key JD. Medical casebook of Arthur Conan Doyle. Malabar Florida: Robert E Krieger, 1984 2 Green RL, Gibson JM. A Bibliography ofA Conan Doyle. Oxford: Oxford University Press, 1983
The attack on Sir Arthur Conan Doyle (March 1991 JRSM, p 165) is unjustified. Not contentjust to attack Doyle, Watts gratuitously attacks Freud as well. Doyle was not a doctor with no patients. He had a successful general practice for nearly a decade. He did not 'move' to Vienna, but attended lectures at the Krankenhaus for less than a month'. Oscar Wilde's enthusiasm' about Doyle's stories did not influence Doyle's literature2. Doyle pursued spiritualism, not theosophy3. 'Letters of insult and abuse' were not the reason Doyle resurrected Sherlock Holmes. His publisher prevailed4. Doyle was not boastful. He was modest about his detective. He did not 'propound mediocrity' but recognized he had created a popular hero. We do not need to 'speculate as to the influences that led Conan Doyle along his pathway to fantasy'.
