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TO THE EDITOR.— A 34-year-old former heroin addict was hospitalized with a three-day history of nosebleeds and swelling of the right arm after injecting 30 mL of Donnagel (ingredients include kaolin, pectin, opium, and belladonna alkaloids) intravenously. On admission, he had a temperature of 40 °C, pulse rate of 110 beats per minute, respiratory rate of 22/min, and blood pressure of 140/70 mm Hg. There was fresh blood in the nasal cavities. Initial laboratory data included the following values: WBC count of 6,100/cu mm with normal differential; hemoglobin, 14.6 g/dL; hematocrit, 43.2%; prothrombin time, 22 seconds; partial thromboplastin time, 120 seconds; fibrinogen, 35 mg/ dL; and platelet count, 60,000/cu mm. Factor VIII level was 77% and fibrin degradation products were 40 μg/mL. Microscopic hematuria and occult blood in stools were present. Cultures of blood, urine, and an aspirate from the swollen arm were negative. The patient was treated with 4

Letters to the editor concerning the articles "Our Mutual Joy" by Lisa Miller, "The Religious Case for Gay Marriage" from the December 15, 2008 issue, and "How to Fix the World" by Fareed Zakaria from the December 8, 2008 issue are presented.