John Shipman

Training of surgeons.

on the letter by Dr. F. N. I. Fawzy and others (8 April, p. 114). It would be unfortunate if we once more became rigid in our treatment methods, long a problem in psychiatry. The treatment of six patients with dosages of 75 mg per week hardly constitutes a refutation of other statements of the efficacy of higher dosages. I have patients who receive 12-5 mg every two weeks and are maintained on this, but also have a patient who requires 125 mg each week, and if this is spaced to 10 days his chronic hallucinations interfere completely with his functioning. I have also seen an acutely excited patient who, owmg to a misinterpretation of an order, received 100 mg four times daily for four days, at which time his mental status had improved markedly and he showed no side effects whatsoever. These facts are mentioned to emphasize the wide dosage range that may be employed. The ever-increasing interest in tardive dyskinesia suggests that the most desirable treatment is the least amount of medication spaced as far apart as possible. However, patients who have failed to respond to orthodox treatment do merit a trial on high dosages of phenothiazines whether orally or parenterally.-I am, etc.,