406 15 August 1970 Correspondence BRITISH
MEDICAL JOURNAL

well, flatly denied that a patient with a par-
ticular condition was in the hospital. The
administrator, however, after several calls,
agreed that such a patient was there but
that premature publicity might cause her
anxiety and hazard her health. I therefore
agreed not to write anything. When I
challenged the doctor with this information
he said, "I just wanted to throw you off the
scent."

This sort of experience makes the plea
that journalists should treat doctors more
gently seem rather hollow. Doctors with ex-
perience of reputable journalists will know
that reporters frequently are asked and
agree to keep confidence about something,
even if it is only to preserve a doctor's
identity to protect him from charges of
advertising.
But if a doctor has a grievance about in-

accurate reporting or unethical behaviour by
reporters he has the remedy in his own
hands. A complaint to the newspaper or
perhaps to the Press Council can have a
very sobering effect on the journalist
involved. It is significant that the Press
Council confirms that complaints from
doctors about medical matters are extremely
rare.-I am, etc.,

JAMES WILKINSON,
Science Correspondent, Daily Express.

London S.W.I.

SIR,-I was interested to read the letter of
Mr. J. Roper (18 July, p. 161). There is a
great deal to be said for more understanding
on both sides between the profession and
the press. Taking, however, the current
problem of drug addiction among young
people, there is much irresponsibility
among certain journalists-.although cer-
tainly not all.
At the Harrogate meeting (Supplement,

11 July, p. 48) it was pleasing to see that at
last a more realistic attitude to drug abuse
was shown by the motions accepted. We as
a profession have individually and generally
failed to prevent over-prescribing. May I as
a neurologist who uses amphetamines for
narcoleptics say that I consider this is the
"only" indication for the use of this highly-
addictive drug. Dr. F. 0. Wells (9 May, p.
361) has shown the way in Ipswich by his
ban on amphetamines, which is working so
well. Narcolepsy is not a common disease,
and the drug could quite satisfactorily be
prescribed only in hospital.
May I once more plead for support for

organized lectures at schools about the danger
of drug addiction, so that the impressionable
young may be forewarned about what they
face by drug-taking? J. D. Wright' in an
interesting article points out that 75 0 of
schoolchildren in Wolverhampton that he
interviewed had learnt about drugs from
television and newspapers. Is is too much
to ask for responsible help from the press,
and from the teaching profession who often
try to push this problem under the carpet?
It would also be fair to ask for more help
from the Church; many bishops could use
their talents by organizing counter-
propaganda to drug-taking-an evil at their
own front door.

Lastly may I turn to the stream of pro-
grammes on drugs on radio and television.
Only recently I saw a programme on B.B.C.2
called "The Timeless Moment" in which

various people were interviewed about their
experiences under the influence of drugs.
One speaker did mention that one L.S.D.
taker had become acutely psychotic and
attacked his relatives. This unfortunate
person has remained psychotic. However, this
danger of L.S.D. was hidden by a great deal
of emotional and pseudo-scientific talk about
the pleasures of trips. The very sordid side
of drugs, with its utter concentration on self
and the domination of the mind by a
chemical, is forgotten. These programmes
can do nothing but harm to young viewers.
I consider there is a strong case for banning
all drug programmes on the mass media.
Producers forget that these programmes are
seen by a very uncritical audience, many of
whom are not adult and cannot assess the
risks at all.
The medical profession needs the help of

all decent men of every profession to try and
stop this evil disease.-I am, etc.,

A. M. G. CAMPBELL,
Vice-Chairman,

Bristol University Advisory Committee
on Drug Addiction.

Bristol.

REFERENCE
Wright, J. D., Proceedins's of the Roval Societv of

Medicine, 1970, 63, 725.

George III and the Mad-business
SIR,-Having recently been stimulated by

student nurses' questions to re-read some of
the literature about George III's "insanity,"
I feel that, although the evidence adduced
by Drs. I. Macalpine and R. Hunterl 2 that
the King's physical symptoms were due to
porphyria is most iinpressive and convinc-
ing, the suggestion that his mental symp-
toms, including "incessant talking" and
"hurry of spirit," were also only of toxic
origin and not due to an associated manic
state seems much more royalistic than real-
istic (see also B.M.7., 8 November 1969,
p. 352).

I wonder if any of the world's leading
porphyriologists would care to assess the
likelihood, in their experience, that a patient
with a toxic delirium due to porphyrins
would (a) survive this not once but
repeatedly, (b) stay in a "certifiable" state
for five months, (c) make a complete mental
recovery without any significant evidence of
brain damage, (d) thereafter have a remis-
sion lasting twelve years, and (e) live on to
the age of 82?
Without wishing to recast any slur on our

monarchy's ancestors, I feel the facts sug-
gest that George III (whose granddaughter,
Queen Victoria, certainly had a classical and
prolonged depressive breakdown after the
death of Prince Albert) was unfortunate
enough to suffer from both porphyria and
manic-depressive psychosis; the latter being
brought on acutely at the climacteric and
becoming chronic in senescence.-I am,
etc.,

M. M. SALZMANN.
" .,s Cctt Hospital,

!okc, Hants.

REFERENCES
Mtac.,..c,! I., Hunter, R., and Rimington, C.,

British Medical 7othrnal, 1968. 1. 7.
Macalpine, I., and Hunter, R., George III and the

Mad-Busincss, London: Allen Lane, The
Penguin Press. 1969.

Tarsal-tunnel Syndrome in Rheumatoid
Arthritis

SIR,-Drs. K. Lloyd and A. Agarwal
report a case of tarsal-tunnel syndrome as a
presenting feature of rheumatoid arthritis (4
July, p. 32), which responded to cortico-
steroid injections beneath the retinaculum.
They draw attention to the possibility of
this condition being not infrequent in
rheumatoid arthritis, but that its detection
may be masked by the many other causes
of pain in the foot in this disease.

Dr. A. L. Wilson and I reported three
cases of this syndrome1 and drew attention
to certain similarities between the tarsal-
tunnel syndrome and its carpal counterpart.
One of the cases we reported responded
very well to the local injection of steroids
under the retinaculum. We also noted that
the symptoms could be reproduced by forc-
ible dorsiflexion of the ankle. The addition
of a raise to the heel of the shoe of the
affected foot also helps by relaxing the ten-
sion on the posterior tibial nerve behind the
medial malleolus. Since then we have seen
two other cases of tarsal-tunnel syndrome
associated with rheumatoid arthritis. One of
these cases was treated by bilateral surgical
decompression of the nerve, and the other
by three injections of corticosteroid given
locally under the flexor retinaculum at
weekly intervals. Both cases responded well
to treatment.

It is interesting to note that Yamaguchi2
and his colleagues reviewed over 1,200 cases
of carpal-tunnel syndrome and found that
318 of these cases were associated with sys-
temic diseases. The commonest systemic
diseases associated with the carpal tunnel
syndrome were rheumatoid arthritis (93),
myxoedema (77), and diabetes (69).-I am,
etc.,

E. H. CHATER.
Orthopaedic Department,

Merlin Park,
Galway.

REFERENCES
l Chater, E. H., and Wilson, A. L., lournal of the

Irish Medical Association, 1968, 61, 326.
2 Yamapuchi, D. M., Lipscomb, P. R., and Soule,

E. H., Minneso?a Medicine, 1965, 48, 22.

Therapeutic Abortion
SIR,-Dr. S. E. Josse is reported (Sup-

plement, 11 July, p. 52) as saying at the
recent Annual Representative Meeting that
"The report of the Royal College of Obstet-
ricians and Gynaecologists printed in the
British Medical Journal of 30 May showed
that 94 ', of consultants replying to a
questionnaire had no objection to termination
of pregnancy."

This is not correct. The questionnaire to
which Dr. Josse refers was sent with a cov-
ering letter from the president of the Royal
College of Obstetricians and Gynaecologists
to all consultant obstetricians and
gynaecologists employed in the National
Health Service. The first question read as
follows: "Do you have a conscientious
objection to the termination of pregnancy in
all circumstances (my italics)?" In reply 424
(94 A',) of the consultants replying answered
"No."

If Dr. Josse has been reported correctly
his statement is erroneous and misleading.-
I am, etc.,

ANTHONY W. PURDIE.
North Middllesex Hospital,

Lonidon N.18.

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