CERTAIN IMPLICATIONS OF AMERICAN PSYCHIATRY: IATROGENIC DISEASESIatrogenic diseases are disorders caused by the medical profession itself. Today the medicines for many diseases create symptoms which are frequently only slightly preferable to those of the original disease. It is in fact common practice to accept drugs which ameliorate syndromes but which create new symptoms themselves.One such occasionally occurring disorder, tardive dyskenisia (TD), may be mentioned. TD is a disorder arising in conjunction with many neuroleptic drugs which sometimes produce only marginal improvement of psychotic states. TD is potentially irreversible, involuntary or choreathoid movements which develop even after short term treatments (Kessler and Waletzky, 1981). Forty percent of elderly chronic patients now get it.Even medical practitioners see some hallucinations as tolerable relative to the TD side effects (Janson et al., 1985). A recent report in Psychiatric News (May 17, 1986), lists several dozen drugs which carry TD side effects. These are Serentil, Moban, Innovar, Inapsine, Iositane, Haldol, Triovil, Taractarn, Navane, Mellarille, Thorazine, Sparine, etc.*7\227\8*

HYPERACUTE BACTERIAL CONJUNCTIVITISHyperacute bacterial conjunctivitis is a severe sight-threatening ocular infection primarily caused by Neisseria gonorrhoeae. Gonococcal ocular infection may present in neonates (a cause of ophthalmia neonatorum) or in sexually active young adults. Transmission of the organism to infants occurs during vaginal delivery, and affected infants develop ocular discharge 3 to 5 days after birth. In adults, the organism is usually transmitted from the genitalia to the hands and then the eyes.Hyperacute bacterial conjunctivitis has an abrupt onset and is characterized by purulent discharge that re-accumulates rapidly after being wiped away. The discharge often accumulates in the lashes and runs down the patient’s cheek. The conjunctiva is bright red, tender, and edematous (called chemosis), and an inflammatory membrane of leukocytes and fibrin may develop on the palpebral conjunctival surface. Preauricular lymphadenopathy is often present. One eye is usually involved first, but within several days, the second eye becomes involved through autoinoculation. As the conjunctival swelling and reaction increases, a peripheral corneal ring ulcer can develop because of compression of the corneal vessels.Gram-negative intracellular diplococci can be identified on Gram stain of the discharge. Patients with hyperacute bacterial conjunctivitis require immediate ophthalmologic referral. If a gonococcal ocular infection is left untreated, rapid progression to corneal perforation and permanent loss of vision can occur. Since gonococcal conjunctivitis is a sexually transmitted disease, clinicians should inquire about concomitant urethritis or vaginitis and ask about sexual partners who might be infected.*28/348/5*

THROAT: LARYNGITISInflammation of the vocal cords may follow overuse of the voice, irritation by chemical substances, or infection. Men, who are more frequently subjected to exposure to irritant substances in their occupations and who indulge more than women in deleterious habits, suffer more from laryngitis than do women. Contributing causes to inflammation of the larynx include the swallowing of hot or spicy foods, the abuse of alcohol and tobacco and similar irritants. Occasionally the larynx becomes inflamed because there is an infection in the throat or the lungs. In fact, any condition that blocks breathing through the nose helps to cause laryngitis, because large amounts of air then pass directly to the larynx without having been modified, as is usual, in passing through the nasal tract.In serious cases of laryngitis it is customary to go to bed and keep quiet. Nothing helps the vocal cords under such circumstances as much as continuous rest, speaking only in a whisper. The application of an ice bag or ice collar or moist compresses to the throat is soothing. Some people prefer warmth, which seems to be equally effective in its soothing action. A measure which comes down from ancient history is the inhaling of steam to which various aromatic oils can be added. Apparently the chief benefit is derived, however, not from the aromatic oils but from the moisture and the warmth. Nowadays many special devices have been developed that use electrical heat in order to produce such steam for inhaling. These devices are usually much safer than the old-fashioned dish or kettle of hot water. Many instances have been known of severe burns from accidents with open kettles of exceedingly hot water used in this way.For serious laryngitis, particularly that complicated by inflammation or infection, the physician may prescribe many drugs that are helpful in securing rest and in soothing the area concerned.*22/318/5*