Articles

The New Wonder Drugs That Fight Insanity

Cheap and apparently safe, though no cure in themselves, two new discoveries are leading a revolution that’s taking the word “hopeless” from more forms of mental illness. They also help to conquer allergies, high blood pressure and pain. But even the doctors don’t know why they work

SIDNEY KATZ November 12 1955
Articles

The New Wonder Drugs That Fight Insanity

Cheap and apparently safe, though no cure in themselves, two new discoveries are leading a revolution that’s taking the word “hopeless” from more forms of mental illness. They also help to conquer allergies, high blood pressure and pain. But even the doctors don’t know why they work

SIDNEY KATZ November 12 1955

The New Wonder Drugs That Fight Insanity

Articles

Cheap and apparently safe, though no cure in themselves, two new discoveries are leading a revolution that’s taking the word “hopeless” from more forms of mental illness. They also help to conquer allergies, high blood pressure and pain. But even the doctors don’t know why they work

SIDNEY KATZ

FOR THE past decade the biggest news in medicine has been about wonder drugs such as penicillin, aureomycin and streptomycin. They worked undreamed-of cures in a variety of infectious diseases, ranging from pneumonia to tuberculosis. Today the most exciting talk in medical circles concerns an entirely new group of drugs — these have the power to control mental and psychological illnesses.

The new drugs will be a blessing to everybody but the greatest beneficiaries will be the sixty thousand patients in Canadian mental hospitals. Until recently many of them had no hope of ever

returning home. Because they allay tensions, fears and anxieties, the new drugs promise to bring relief to many of Canada’s half a million neurotics. The drugs will also be a boon to anyone suffering from such ailments as asthma, high blood pressure, nausea and vomiting, narcotic and alcoholic addiction, skin diseases and headaches—all of them

Some of the new drugs— Meratran, Frenquel, hydergine, LSD and others— are still in the early stages of investigation. But two, chlorpromazine and reserpine, have already clearly demonstrated their far-reaching usefulness. They are plentiful, cost less than ten cents a dose and look as innocuous as ordinary aspirin tablets. But they are potent enough to have started a revolution in medical therapeutics.

physical conditions having emotional overtones.

Because of reserpine and chlorpromazine, longterm patients have been resurrected from the back wards of mental hospitals. Patients are getting well in weeks, instead of months or years. Ex-mental patients are staying out of hospital by swallowing a few pills a day. The drugs protect them from a mental breakdown much the same as regular injections of insulin safeguard the diabetic.

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THE NEW WONDER DRUGS THAT FIGHT SPAN IT Y continued

“Allaying tensions and anxieties, the new drugs promise relief to many of Canada’s half million neurotics”

The fact that the drugs have also achieved gratifying results in other ailments graphically points up the close partnership between the mind and the body in physical illness. Chlorpromazine, for example, even without sedatives or narcotics, makes it easier for cancer patients to bear pain. As one patient observed to Dr. Roger Dufresne, of the Montreal Cancer Institute, “My mind isn’t always on the pain now. It doesn’t worry me. I can concentrate on reading again.” When chlorpromazine is administered along with such conventional pain

killers as demerol and morphine, it has a “potentiating” effect—that is, it makes them fifty to seventyfive percent more effective. Thus, the danger of narcotic addiction is lessened. As far as it is known, the new drug itself is not habit-forming.

Chlorpromazine usually puts a speedy end to chronic hiccuping. One patient arrived at hospital, weakened and emaciated by eight months of hiccuping. Even the desperate surgical measure of crushing the phrenic nerve to his diaphragm failed to remedy the situation. Chlorpromazine did the job in three minutes. It also helped Pope Pius XII through the same condition during his recent illness. Chlorpromazine has been lauded for its “powerful effect against nausea and vomiting” by Dr. Dale G. Friend and Dr. J. F. Cummins of the Harvard

Medical School. One of their patients was hardly able to eat for twenty-two weeks because of a complicated pregnancy. Within twenty-four hours after going on the drug she was enjoying regular meals.

Reserpine also has an impressive list of uses according to recent clinical experiences. It brings dramatic relief to many who suffer with high blood pressure; soothes overactive infants, enabling them to sleep and eat better; banishes certain types of headaches; and lessens the irritability of old people who are quarrelsome and difficult to live with.

Although over one thousand scientific papers have been published about chlorpromazine and reserpine, nobody seems to know exactly how they work. However, because they’re effective in so many conditions, it is assumed that they somehow control the “master switch” of the human body, the central nervous system. They somehow manage to tone down the messages sent from the brain centres which transmit news of pain and emotion. Dr. Heinz Lehmann, clinical director of the Verdun Protestant Hospital, speculates, “The drug strips the disturbing experience of its emotional content, thus leaving the patient intact emotionally.”

A great advantage of chlorpromazine and reserpine as compared to commonly used sedatives and narcotics is that they don’t put the patient in a stupor. Even large doses only result in a light sleep from which the patient can be easily aroused. Once awake, he retains all his mental and physical faculties. This makes it easy for psychiatrists to remain in constant contact with their patients.

The new drugs have been described by Dr. R. A. Cleghorn of McGill’s Allan Memorial Institute of Psychiatry as “spectacular, even lurid.” Like other authorities, he has cautioned the public that the drugs by themselves won’t cure anything—the underlying disease still remains. But, by pacifying the patient and bringing him back to reality, it is now possible for the psychiatrist, social worker, occupational therapist and others to help him. The patient, as it were, is granted a breathing space during which he can mobilize his inner resources. Dr. Nathan A. Kline of Rockland State Hospital, Orangeburg, N.Y., says, “It will take at least five years to fully assess the drugs’ usefulness.” Dr. E. Johnson, superintendent of the Hospital for Mental Diseases in Selkirk, Man., sees the drugs as “valuable additions to our therapeutic procedures,” but he does not believe that they will succeed in significantly reducing the mental hospital population.

The background and history of chlorpromazine and reserpine could hardly be more different. Chlorpromazine is a synthetic compound developed in a French laboratory in 1951. Reserpine, on the other hand, has been known to man for thousands of years. It is manufactured from the long, tapering snake-like roots of Rauwolfia serpentina, a pinkblossomed plant which grows in India and other parts of Asia. For centuries Asiatic healers have lyricized the magical curing powers of their snakeroot potions. Only in the past five years have sophisticated Western scientists realized that these extravagant claims were made with some justification.

For Many Home is Closer Now

Thanks to these two drugs dramatic changes are taking place within the walls of some of our mental hospitals. A case in point is the sixteen-hundredbed Verdun Protestant Hospital, in the suburbs of Montreal. The clinical director, Berlin-educated Heinz Lehmann, a slightly built, blond man who is also an assistant professor of psychiatry at McGill University, was one of the first doctors in North America to experiment with chlorpromazine. That was in April 1953. When I visited the Verdun hospital recently, Lehmann reviewed what had been accomplished during the past thirty months.

Scores of patients, who for years have failed to respond to all other types of therapy, have been discharged since being treated with the help of the drug. “The average patient’s chance of improving enough to go home was never brighter,” says Joan Smith, chief psychiatric social worker. Lehmann heartily concurs.

There was, for example, the girl who was in the ward for unruly patients for five years. Goaded by imaginary voices, she would break down doors and assault nurses and doctors. She is now working in Montreal as a domestic. Before receiving the new treatment another woman was for eight years so absorbed in her world of fantasy that she forgot her husband. Recently she wrote him an affectionate letter, asking to see him. She now visits him on week ends and will soon be permanently reunited with him.

At one time there were always about twenty patients in the Verdun hospital who were so agitated that they had to be restrained by physical means; today there are no patients under restraint. The patients are quiet and co-operative. They have formed their own council that plans the housekeeping chores to be done on the wards, puts out a mimeographed newspaper and makes recommendations to the doctors. The occupational therapy workshops are now crowded by day and attendance at movies and dances is now almost one hundred percent.

Patients brought into the admitting ward, shrieking and gesticulating, can usually be brought quickly under control by chlorpromazine. The locks have been taken off the doors of some of the wards and two hundred patients—instead of the former fifty now have the privilege of wandering freely around the grounds. The number of patients permitted to visit their homes every week end has increased from ten to seventy. Dozens of discharged patients are able to stay out of hospital, thanks to the stabilizing effect of small daily doses of chlorpromazine. Every two weeks they attend a chlorpromazine clinic at the hospital where they receive a fresh supply of drugs and talk over their problems with Dr. R. deVerteuil and social worker Joan Smith. One of these outpatients, a man who was formerly excitable, aggressive and belligerent, was caught smack in the middle of the Richard hockey riot in front of the Montreal Forum last March. He was taunted, shoved and pelted with rubbers and ice. Undisturl>ed, he went quietly on his way. Encouraged by the improvement of so many patients, staff morale at Verdun has soared. Patients once abysmally lost in their world of madness can now be reached and thus be helped. The drugs are replacing other forms of treatment. At Verdun the number of shock treatments has heen cut in half. The insulin ward, with a top capacity of eight, was always full with a waiting list; today there are usually empty beds available. The prefrontal lobotomy—a brain operation designed to relieve extreme cases of agitation is being used less frequently.

Continued on page 113

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Psychiatry Turns a Corner

The growing popularity of the new drugs thirty million reserpine pills alone were manufactured in Canada last year—gives impetus to a new trend in psychiatry. Since the beginning of this century, the predominant thinking has been (as exemplified by Sigmund Freud) that mental illness is the end product of emotional stresses and conflicts. Particular emphasis was placed on childhood experiences. Therefore, to cure the illness it was believed necessary to uproot the festering conflicts of the past which caused the breakdown.

I his approach was successful mostly with psychoneurotics. It usually failed with patients who were more seriously ill—the psychotics. As a result, with the passing of years our mental hospitals became jammed with a backlog of uncured psychotics. The majority of our sixty thousand mental patients in

Canada today are suffering with chronic cases of schizophrenia, paranoia and manic-depressive psychoses.

Discouraged by the psychological approach to the psychotic, doctors turned to physical treatments: electric and insulin shock and brain surgery. Scientists began investigating the possible physical causes of mental illness. They suspected that the trouble was being caused by the faulty functioning of the glands, which upset the biochemical balance of the body. "If we knew the exact nature of that imbalance,” they reasoned, "we might be able to correct it by injecting an appropriate drug into the body.” As a result, a long procession of drugs have been tested in attempt to restore order to disordered minds.

Paradoxically, chlorpromazine was not developed with mental illness in i mind. The French pharmaceutical firm of Rhone-Poulenc was searching for an antihistamine drug (used to combat j allergic ailments) that didn’t cause drowsiness. Late in 1951 they were testing their 4,560th formula. The results were disappointing: it seemed to ! make people drowsier than ever. Howj ever it had an interesting effect on ! laboratory rats that had been conditioned to be neurotic: it calmed them down. This led Rhone-Poulenc to send quantities of formula 4,560—to be called chlorpromazine—to mental hospitals in France, Austria and lingland for experimental work. The clinical reports they received back were exciting.

Rhone-Poulenc then made copies of the reports in French and sent them to various North American centres, along with samples of their new product. Knowing the French language, Heinz Lehmann of the Verdun Protestant Hospital was able to read the reports without having to wait until they were

The woman slipped into a gentle doze. Chlorpromazine didn’t “knock her cold”

translated. He immediately became interested in the new tranquilizer. Assisted by Dr. Gorman Hanrahan, he launched an experiment with the drug in April 1953. "Within a week,” recalls Lehmann, "we both realized that we had something.”

What excited Lehmann was the extraordinary effect the drug had on patients who were agitated and disturbed— regardless of the underlying disease. One of his early patients habitually shouted, upset her bed, and tore the doorknob off her door. After the first few injections she became drowsy and went off to sleep. But, unlike under the effects of a narcotic, she was not "knocked cold.” When Lehmann touched her lightly on the shoulder or called her by name, she would wake up, explaining, "I was only dozing.” When a psychologist tested her reactions, he found that her ability to carry on a conversation, to think and to remember was almost normal.

After a few days of the drug the drowsiness wore off and the patient, looking somewhat pale and peaked, reported that she felt "washed out,” as though she had been through an exhausting illness. But she said that the pressure was gone; that she felt relaxed. "I lost the feeling that I had to live my whole life in one day,” she said. Another patient observed, "It was like a chairman taking control of a meeting where, previously, everyone had been shouting at once.”

In using any new therapeutic substance, doctors keep a sharp lookout for undesirable side effects. Lehmann noticed that there were some with chlorpromazine but none of them were serious. For the first few days, patients complained of a slight fever, dryness of the mucous membranes and nasal congestion. Some patients developed skin rashes but it was usually possible to avoid this condition by giving antihistamine along with the chlorpromazine. A very small proportion of the patients developed a minor form of jaundice, which usually disappeared when the dosage was decreased or discontinued. Some patients who had to be taken off treatment because of the side effects were able to go back on it again after a few weeks without a recurrence of the physical symptoms previously experienced. Their bodies were evidently able to develop a tolerance of the drug. In a few cases chlorpromazine brought on a condition not unlike Parkinson’s disease— a wooden-like expression on the face, a shifting gait and some rigidity of the limbs. But this too was only temporary. Because of these side effects, chlorpromazine is only available on a doctor’s prescription.

Lehmann has concluded that chlorpromazine is a remarkably safe drug. So have other investigators. Millions of patients throughout the world have taken chlorpromazine, some for as long as two or three years. Yet there is little evidence in the vast medical literature that it is dangerously toxic and, evidently, it’s impossible to take a lethal dose. At least three people have attempted to commit suicide by swallowing chlorpromazine; they were all unsuccessful. One of them munched thirty tablets at once.

After two years of experience with the drug, Lehmann has been able to gather some statistics on its efficacy. One study concerned 63 patients, most of whom had been in hospital for a year or more and had failed to benefit

from the standard treatments. After several months, with the aid of chlorpromazine, 13 were rated as recovered, seven much improved, 27 improved and 12 completely unchanged. In addition, it was felt that the drug headed off an impending mental breakdown in four patients. Lehmann found that the longer a patient had been ill, the smaller his chances of improving sufficiently to go home. The most favorable results were obtained with the acute manic-depressive psychoses. Patients with this disease intermittently become agitated for periods ranging from a few weeks to a few months. With chlorpromazine the duration of their attacks was cut exactly in half.

Even when it didn’t "cure,” the drug often modified the patient’s symptoms. A man who almost constantly heard loud angry voices, reported that now they were softer and at times they were only a buzz. A woman who thought she was queen and savagely insisted that she be treated with the appropriate respect, still thought she was queen, but had become a warm and pleasant personality.

Lehmann has found that he is now able to discharge patients that formerly he would have had to keep on. Small daily doses of chlorpromazine keep them on an even emotional keel. Their families are trained to watch for signs of an impending attack. Depending on the patient, these may include irritability, loss of sleep and appetite, lack of interest in their surroundings. When these warning signals appear, the patient is put to bed and given extra heavy doses of chlorpromazine for three or four days, which keep him quiet and asleep. At the end of that time, the danger has usually passed. "The new drugs,” says Lehmann, "are a blessing to the patient’s family.”

300,000 Doses a Year

Other Canadian hospitals besides Verdun have taken eagerly to the new drugs. The oldest mental hospital in Ontario, the Ontario Hospital located at 999 Queen St. in Toronto, is now using three hundred thousand doses of chlorpromazine a year. One of their patients, who huddled in a corner for two years without uttering a word, underwent treatment with the drug. He escaped from the hospital to his home. Later he explained rationally and fluently, "I wanted to see my family.”

Because women patients are nowtaking pride in their appearance, business at the hospital beauty parlor is booming. An encouraging result of the drug is that almost one hundred patients are now able to board out with private families. Looking back on his thirty-five years of mental health study, superintendent Dr. D. O. Lynch says, "I have never seen a drug that provides so much relief from the frighteningsymptomsof mental illness.’

At the Victoria General Hospital in Halifax, Dr. R. O. Jones reports that sixty percent of all psychiatric patients are now getting chlorpromazine or reserpine. At the Hospital for Mental Diseases in Brandon, Man., Dr. Stuart Schultz states that during 1954 the drugs have led to the discharge of several long-term patients. The drugs had succeeded where electric and insulin shock and even brain surgery had failed. "We expect to show even

better results by the end of 1955,” he says.

Many hospital authorities outside Canada are also enthusiastic about chlorpromazine. Dr. Vernon KinrossWright of Baylor University, Houston, Texas, gave the treatment to one hundred and eight schizophrenics. "At the end of a year,” he reported, "eighty-eight percent of them are at home, half of them working at their former employment or better.” Dr. B. Broussolle of the Vinatier Psychiatric Hospital, Lyons, France, has already given chlorpromazine to over four thousand patients with encouraging results.

Will the new drugs completely replace the older types of treatment? In actual practice, the number of shock treatments being given has been drastically reduced because the drugs have certain advantages. They can be administered more quickly and by fewer people. Furthermore, electric shock carries a risk with it when given to older people and people with heart trouble or other organic defects. Shock also leaves a patient confused for hours after the treatment. In some cases, doctors don’t have to make a choice between drugs or shock: they use both because it has been found that some patients who don’t respond to either treatment alone will benefit when they are given both. But in certain types of emotional depression electric shock by itself is still the most effective treatment.

What is true of electric shock also holds for insulin shock. Drugs are simpler to give. Patients undergoing the prolonged insulin sleep have to be watched by doctors and nurses since the dangers of pneumonia and cardiovascular collapse exist. But again, many doctors claim that insulin shock alone is the most effective in some cases of schizophrenia. In others, it is most beneficial in combination with chlorpromazine or reserpine.

It is possible that the new drugs will all but relegate to oblivion brain surgery designed to relax mental tensions because the drugs bring about the same result. Doctors have never been too enthusiastic about brain surgery for mental illness. Often it has done a too thorough job of flattening out the emotional life of the patient, leaving him as passive as a vegetable. Then too, once an operation is performed, nothing further can be done for the patient. On the other hand, there’s nothing irreversible about a drug like chlorpromazine: the dosage can be

increased or decreased to get the desired result. At the Ontario mental hospital in Toronto only one surgical operation has been performed in the past six months. In the past about a dozen such operations were done each year.

In working with chlorpromazine, doctors soon realized that it had many uses outside the mental hospital. It was a godsend to the alcoholic, for example. Chlorpromazine cuts short the alcoholic’s agonies that usually set him off’ on a hinge. Often, within an hour of the first injection, he goes off to sleep. When he wakes he’s calm and can take light nourishment. Within a few days he has a feeling of well-being and he’s able to enjoy his meals. Dr. John Armstrong, medical director of the Ontario Alcoholism Research Foundation, says, "We can quickly bring them to the point, physically and mentally, where we can begin treating the underlying causes of the patients’ drinking.” Similarly, chlorpromazine is also being used to ward off the agonizing withdrawal effects of drug addiction.

But a much commoner use for the drug is for the control of nausea and

vomiting. According to Dale Friend and J. F. Cummins of the Harvard Medical School, it is usually effective no matter what the cause of the nausea. Typical was the case of a thirty-fiveyear-old woman suffering with uremia. She hadn’t been able to eat in more than a week. After two doses of chlorpromazine she was taking—and enjoying—regular meals. For three months her stomach was kept on an even keel with the drug. When a placebo (a fake pill) was substituted, her nausea would return within forty -eight hours.

Chlorpromazine has proven itself valuable as a pain killer. Dr. Max S. Sadove of the University of Illinois tells of a group of twenty-eight patients whose pain could no longer be controlled even by large doses of sedatives and narcotics. When they were given two injections of chlorpromazine, twenty-two of them reported that they were now "relaxed and comfortable.” In another study of eighteen patients it was found that, with the addition of chlorpromazine, it was possible to cut down on such pain killers as morphine, dromoran, codeine and demerol by as much as seventy-four percent and still achieve the same effect.

Chlorpromazine seems to be peculiarly suited to handle the problem of pain in cancer. It evidently has the power of taking the emotional content out of pain—an important factor in cancer. "Pain from cancer, coming mysteriously from deep within the body, is the source of great worry and anxiety,” says Dr. Roger Dufresne of the Montreal Cancer Institute. "The patient wonders what’s going to happen next. This sense of dread is as difficult to bear as the pain itself.” Given chlorpromazine, the patient seems to acquire a sense of detachment from his troubles. A New York hospital reports, "One patient in the last stages of cancer lived out his final five weeks without pain.”

Dufresne has found that it is now possible to send many cancer patients home who would otherwise have had to remain in hospital. Chlorpromazine can be taken by mouth and does not require the attendance of a physician several times a day. A patient in Oshawa, Ont., with secondary cancer, was able to go home from hospital and resume doing housework. She felt strong enough to travel by train to London, Ont., to receive cobalt bomb therapy. In the summer she made a long trip to Winnipeg, managing to get by comfortably thanks to the chlorpromazine pills she carried in her purse.

That wasn’t the first time an Oshawa citizen had benefited from the new drug. Recently a group of Oshawa physicians gave a report to the Toronto Academy of Medicine on how chlorpromazine was being used in their community. It was given to children about to have their tonsils removed. "They woke up much happier and didn’t complain nearly as much about sore throats,” said the doctors.

Chlorpromazine was also being given to some Oshawa mothers about to deliver babies, in addition to other anesthetics. "The babies were nice and pink, breathing immediately,” the study reported. "None of them appeared to cry so violently and with such distress as when the drug was not given. In difficult cases of delivery, it seemed to slow down the contractions and make them less forceful.” It was valuable, too, for treating accident victims suffering shock. Given chlorpromazine immediately, accident victims with head concussion are now only taking one or two days to recover instead of three or four; patients with actual brain damage show remarkable improvement in four or five days instead of two or three weeks. In France the confidence in chlorpromazine to counteract shock is so great that accident emergency squads alwayscarry around a supply with them.

Slow Down and Live

One of the present standard uses for chlorpromazine is in artificial hibernation or the so-called "deep freeze” operation. This type of surgery is now being conducted in some Toronto hospitals in complicated heart cases. The originator of artificial hibernation was the Paris surgeon Dr. Henri Laborit. He observed that shock claimed thousands of victims every year. When a person undergoes a major surgical operation or is involved in a violent accident, the entire body works like fury to defend itself and to restore its normal functioning. It reacts so violently that it soon expends its reserves and wears itself out. Breathing, blood pressure, and heart action steadily slow down until some vital organ collapses and the person dies of shock.

In the past the only recognized treatment for shock was to keep the patient warm and give him heart stimulants. Laborit adopted a different approach. "Instead of stimulating the body’s defenses,” he reasoned, "let’s slow them down and conserve its energy.” To those about to undergo major surgery,

An ancient shrub yields a drug that helps control snake bite and senility

Laborit administers a "lyctic cocktail” made up of chlorpromazine and a number of other drugs such as pethidine, phenergan, diparcol and procaine. In about an hour the patient is calm and relaxed. Ice packs are applied to the stomach, groin, armpits, heart and spine. The vital processes of the body now begin to slow down. When the body is in a state of torpor at a temperature of about 91 degrees Fahrenheit, surgery commences. From time to time, the patient is given additional doses of chlorpromazine to block off nerves and glands that normally marshall the body’s defenses against external attacks.

In 1952, using artificial hibernation, Laborit operated on sixty-seven terminal cancer cases. They required the most drastic type of surgery. Yet, miraculously, two out of three survived the operation. The ice and lyctic cocktail procedure was also used on seriously wounded soldiers in the Indo-China war. In one six-month period it cut down fatalities by one third.

The new drugs are helpful in asthma. This is not too surprising since many doctors have long claimed that the emotions play an important part in this condition. When Dr. Maurice S. Segal and Dr. Ernest O. Attinger, of Tufts Medical College in Boston, added reserpine to the treatment being given to asthma patients, they found that the result was beneficial in at least half the cases. The doctors reported that the patients had "a greater sense of security and relaxation which made them less jittery and disturbed.” Another American physician used chlorpromazine on a large number of asthmatics and found that "in practically all cases of severe asthma there was improvement.”

Since antiquity Indian and Chinese physicians have prescribed the reserpine-rich root of the shrub Rauwolfia serpentina for insanity, epilepsy, snake bites, fevers, blindness, headaches and insomnia as well as a host of other afflictions. The Western world virtually ignored this remedy until October 1949. That was the month Dr. Rustom Jal Vakil, of Bombay’s King Edward Hospital, published a study on the use of reserpine in treating high blood pressure, in the British Heart Journal. Not only did the drug bring about a dramatic drop in blood pressure in his patients, Vakil reported, but by continuing them on the drug he was able to keep their blood pressure down for as long as five years. "Even with patients who had organic defects there have been no ill effects of a serious, disabling or permanent nature,” he observed.

This report touched off a series of events which culminated in the manufacture of reserpine by the world-wide pharmaceutical house of CIBA, whose headquarters are in Basel, Switzerland. Cl BA’s reserpine is about a thousand times more potent than the drug in crude root form. The drug is available in Canada without a prescription, although it should not be taken without the advice of a physician.

Strangely enough, although the British Heart Journal enjoys a high reputation in medical circles, nobody in England paid much attention to Vakil’s article. It remained for Dr. Robert W. Wilkins, chief of the Hypertension Clinic of the Massachusetts Memorial Hospital in Boston, to introduce the drug to the Western world. He

read Vakil’s article in a Boston library one night and sent away to India for a supply of reserpine tablets. They arrived in June 1950. After testing them on some of his more serious hypertensive patients, he wrote, "Vakil’s claims were on the conservative side.”

Wilkins’ high hopes for reserpine as a relief from high blood pressure have been justified by a dozen clinical studies which followed his own. Dr. Warren Hughes of Baylor University, for example, administered reserpine to sixty-two patients for periods up to seven months and found that "half obtained a significant reduction in blood pressure.” The side effects of the drug were limited to drowsiness and blocked noses—unpleasant but not serious, and they either vanished by themselves or when the drug was reduced or discontinued.

Because hypertension is so common in the aged, it was inevitable that reserpine would soon be tested in homes for old people. Dr. Raymond Harris of Albany Medical College administered the drug to twenty-six of his patients in the Ann Lee Home for the aged in Albany, N.Y. Their average age was almost seventy. In addition to high blood pressure, they had the usual ailments and complaints associated with elderly people not in the best of health. After several weeks of reserpine, the twenty-six patients experienced a drop in blood pressure and even when the drug was discontinued it sometimes stayed down for three weeks or longer.

Itches Between the Ears

Just as significant was the effect the drug had on the old people’s attitude toward life. Their complaints grew fewer. Quarreling and depression subsided.

At the Mental Health Institute in Cherokee, Iowa, Dr. Anthony A. Sainz gave reserpine to sixty-three patients in the senile wards. They became so sociable and relaxed that the man-hours spent on their care by doctors, nurses and attendants were cut in half. . Reserpine may well prove one of the most useful tools yet discovered for coping with the problem of the aged in hospital and home.

Skin specialists became interested in reserpine because they have long known that many types of skin disorders "come from between the ears.” Dr. Victor Panaccio, dermatologist of Montreal’s Hôtel-Dieu hospital, told me that he has used the drug with particular success on psoriasis. This condition is characterized by painful and ugly red patches and lesions which spread to all parts of the body. It has stubbornly resisted most kinds of known treatment. Panaccio gave reserpine to fifteen psoriasis patients. Nine of them showed marked improvement; in fact, after four months, in five patients ninetyfive percent of the lesions had vanished. To maintain the improvement it was necessary to keep the patients on a small regular dose of the drug. Panaccio also had remarkable success with a less serious form of skin disease, urticaria. One man who suffered with urticaria for two years was completely cured of it in a week.

Reserpine may be of particular value to women, according to preliminary investigations that have been carried out by Dr. Robert B. Greenblatt, professor of endocrinology at the Medical College of Georgia. Many women com-

I plain of extreme irritability, depression and emotional upset for a week or so I before their menstrual periods. Greenblatt gave reserpine to eighteen women with this complaint for ten days before their period started. It had a calming effect on thirteen of them.

Greenblatt went on to test reserpine on women who were frigid and women who were nymphomaniacs. It was beneficial in both conditions although nobody can explain why. In five frigid women the desire for sex did not increase but "receptivity” was so improved that in two of them they were quite willing to accept their mates. On the other hand, in two women with strong nymphomaniacal tendencies, reserpine definitely lessened their constant sex urge. Greenblatt then administered the drug to sixteen women suffering with the familiar emotional upset of the menopause. It had a tranquilizing influence on only six. "But,” he observed, "it enhanced the value of estrogen—a hormonal substance we frequently prescribe for this condition.”

The surprising usefulness of chlorpromazine and reserpine in ailments of an emotional nature has given impetus to the search for new drugs. One of them is Meratran (manufactured by the Wm. S. Merrell Company), with the imposing chemical name of alpha-2piperidyl benzhydrol hydrochloride. Preliminary reports show that it is particularly good for persons suffering with emotional fatigue and depression. It is better suited to the type of patient the doctor sees in his office, rather than in the mental hospital. It is said to give the older person, worried about retirement, deterioration or death, a new zest in life. It boosts the morale of the obese person and helps him stick to his reducing diet. Like benzedrine, dexedrine and similar drugs, Meratran stimulates the central nervous system. But it has certain advantages: it does the job without "hopping up” the patient or raising his pulse rate or blood pressure.

A host of other new drugs are now being investigated. Frenquel, a derivative of Meratran, is being tested in Halifax hospitals. A controlled experiment is now in progress at the Brandon Hospital for Mental Diseases with a substance identified as Hydergine. LSD—lysergic acid diethylamide —is a substance that can create temporarily a schizophrenic-like psychosis in a normal person. (See Maclean’s, Oct. 1, 1953.) Because LSD has a different reaction on normal people, neurotics and psychotics, it is now being used as a tool in making diagnoses. It is also being tagged with radioactive carbon and carefully scrutinized as it gathers in the adrenal glands and liver. Scientists theorize that the schizophrenic is made ill by LSD-like substances which form naturally in his body and upset his metabolism. "If we can find out exactly what LSD does in the human body, it will give us an important clue to the cause of schizophrenia,” they reason.

It must be emphasized that the new drugs are not the final answer to mental illness. They don’t cure the disease that underlies the neurosis or psychosis. Furthermore, our knowledge of the drugs is still slight. We don’t know exactly how they work, how they can best be used or what benefits they will ultimately yield.

On the other hand, the new pills have proven that they often control tensions, emotional strains, fears, anxieties and, in some cases, even severe mental disturbances. In the challenging battle against mental illness we seem to have established a firm beachhead. It may not be too long before our scientists will make a major breakthrough. ★