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					    Canadian
Family Physician
Editorial Director                                         Editorial Advisers                               Infectious Diseases
Donald I. Rice, MD                                         D. C. Brown, MD, Halifax                         Dr. Pierre Viens, Montreal
                                                             (Chairman)                                     Neurology
Editor                                                     John Anderson, MD, Kingston                      Dr. T. J. Murray, Halifax
Margaret McCaffery                                         Marie-Dominique Beaulieu, MD,
                                                              Qu6bec                                        Obstetrics/Gynecology
Associate Editor                                           Omer Doiron, MD, Moncton                         Dr. F. E. Bryans, Vancouver
Terry Murray                                               N. J. Ficzycz, MD, Regina                        Pediatrics
                                                           John Lewis, MD, St. John's                       Dr. K. Ross Parker, Hamilton
Editorial Assistant                                        Gary Lindsay, MD, Brandon
Alison Quaggin                                             Kandice McKee, MD, London
                                                                                                            Prevention/Community Medicine
                                                                                                            Dr. Ronald E. M. Lees, Kingston
                                                           D. T. Powter, MD, Vernon
Art Director
                                                           Consultant Editorial Advisers
                                                                                                            Psychology/Psychiatry
Bill Woods                                                                                                  Dr. Fernand Blondeau, Quebec
                                                           Biostatistics                                    Dr. Judith H. Gold, Halifax
Director of Communications                                 Dr. Moira Stewart, London
                                                                                                            Radiology
George Ackehurst                                           Cardiology                                       Dr. H. F. Morrish, Calgary
                                                           Dr. Paul Tanser, Hamilton
Advertising Manager (Montreal)                             Dr. Jean de L. Mignault, Sherbrooke              Research in Family Medicine
Jack Hayes                                                                                                  Dr. Martin J. Bass, London
                                                           Dermatology
                                                           Dr. Lewis P. Stolman, Hamilton                   Sports Medicine
Advertising Production/                                                                                     Dr. J. A. Bullard, Calgary
Circulation Manager                                        Emergency Medicine                               Therapeutics
Nancy Tughan-Kent                                          Dr. G. Powell, Calgary
                                                                                                            Dr. John Ruedy, Vancouver
                                                           ENT
Translation                                                Dr. G. M. Novotny, Halifax
Computex Enr.                                              The Family                                       The CFPC grants a maximum of
                                                           Dr. Yves Talbot, Montreal                        25 hours study credit for
Annual Subscription Rates                                  Family Medicine                                  independent learning
Canada and United States: $18                              Dr. Ian McWhinney, London                        activities-all or part of which
All other countries: $25                                   Geriatrics                                       may come from reading
Single copies: $1.50                                       Dr. David Skelton, Edmonton                      CANADIAN FAMILY PHYSICIAN.
                 ------
                          ---------




                                                           claritv and conformity with the journal's          Illustrations should be either black and
Information for Authors                                    style.                                           white glossy photographs or India ink
CANADIAN FAMILY PHYSICIAN is                                  Articles should be typed double spaced        drawings. Unless previously agreed with
distributed to all family physicians,                      and the author should retain one copy,           the editor, color illustrations can be
non-certified specialists, family practice                 sending three to the editor. American            published only at the author's expense.
residents and some final year medical                      spelling should be used, and
students in Canada-a circulation of                        measurements must be given in correct            References
approximately 19,000. Articles on clinical,                metric abbreviations, e.g.                       References should be numbered according
academic, research, philosophical, political               mg = milligram(s), cm = centimeter(s).           to their appearance in the text and should
or business topics of direct relevance to the              Drugs shoud be referred to generically,          be limited to work cited in the article,
practicing family physician are welcomed.                  with the usual trade name following in           rather than a bibliography of the subject.
Letters to the editor are also welcomed;                   brackets. Articles may be submitted in           Personal communications are not
they should be brief and should contain                    English or French. A title page should be        acceptable as references; unpublished
precise references to quoted material.                     submitted with the article, listing the title,   material should be included only if an
CANADIAN FAMILY PHYSICIAN is                               authors' names, their current positions, an      address can be given from which a copy is
listed in Current Contents/Clinical Practice               address for reprints and a 100 word              available.
and FAMLI.                                                 summary. Do NOT send first drafts.                  Authors are responsible for accuracyi of
                                                                                                            references, which should be in keeping with
Manuscripts                                                Illustrations and Tables                         the Uniform Requirements for
Material for publication is reviewed by an                 All illustrations and tables should be           Manuscripts Submitted to Biomedical
editorial advisory board of practicing                     included separately from the manuscript          Journals.
family physicians. Manuscripts should be                   and should be clearly identified in Arabic
sent to the editor at 4000 Leslie St.,                     numerals, showing which is the top of the        Proofs and Reprints
Willowdale, ON., with a covering letter.                   illustration if this is not obvious. Legends     Galley proofs of the edited article will be
CANADIAN FAMILY PHYSICIAN                                  for illustrations (which should be referred      sent to the author and should be returned
accepts only original material which is not                to as 'Figures') should be typed separately.     within three days. Major changes cannot
under consideration by any other                           Tables must supplement the text without          be made on alley proofs; proofreading
publication and which may not be                           duplicating it. They should be numbered          should therelore be for accuracy only.
reprinted without the consent of both the                  in Arabic numerals and should include an            Authors will receive 50 reprints of their
author and the editor. The editor reserves                 appropriate title.                               articles plus an order form and price list
the right to edit manuscripts for length,                                                                   for further reprints.
                                        ----------------




                                                                                                                 CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
                                                                                     Capsules




The family medicine literature is            Incontinence                            107 +5 to 138 +4 ml per liter) after in-
wide and varied-and not all to be                                                    domethacin, but coronary blood flow
found in Index Medicus. On this              Vetter NJ, Jones DA, Victor CR:         fell significantly, from 181±29 to
page, our librarian Dorothy                  Urinary incontinence in the elderly     111+14 ml per minute (P<0.05).
Fitzgerald provides synopses of              at home. Lancet 1981; 2:1275-1277.      Thus, despite an increase in myocar-
articles from the current literature,           It is estimated that over 2 million  dial oxygen demand, coronary blood
full texts of which can be obtained          people in Britain suffer from some de-  flow fell and coronary vascular resis-
from the Canadian Library of                 gree of urinary incontinence. The ma-   tance increased. This coronary
Family Medicine, Medical Library,            jority of these people are of retirementvasoconstrictor effect may have been
University of Western Ontario,               age. Incontinence is as much a social   due to blockade of vasodilatory pros-
London N6A 5C1. Alternatively,               as a medical problem, for it is a major taglandin synthesis or to a direct drug
local medical libraries or hospital          cause of the breakdown of care by rel-  effect. Whatever the mechanism, in-
libraries may be able to help.               atives. It has been estimated that in-  domethacin should be used with cau-
                                             continence is a contributory factor in  tion in patients with severe coronary-
                                             up to one fifth of geriatric admissions artery disease.
                                             to hospital. This study examines the
                                             prevalence in two general practices of Laetrile
                                             urinary incontinence, and its relation-
Cancer                                       ship to physical, mental and social dis- Moertel CG, Fleming TR, Rubin J,
                                             ability.                                  Kvols LK, Koch R, Currie VE,
Rosenberg L, Slone D, Shapiro S,                                                       Young CW, Jones SE, Davignon
Kaufman DW, Helmrich SP,                     Indomethacin                              JP: A clinical trial of amygdalin
Miettinen OS, Stolley PD, Levy M,                                                      (Laetrile) in the treatment of
Rosenshein NB, Schottenfeld D,               Friedman PL, Brown EJ Jr,                 human cancer. N Engl J Med 1982;
Engle RL Jr: Breast cancer and               Gunther S, Alexander RW, Barry            306:201-206.
alcoholic-beverage consumption.              WH, Mudge GH Jr, Grossman W:                 One hundred and seventy-eight pa-
Lancet 1982; 1:267-271.                      Coronary vasoconstrictor effect of        tients with cancer were treated with
   The relation between breast cancer        indomethacin in patients with             amygdalin (Laetrile) plus a 'metabolic
and alcohol consumption was                  coronary-artery disease. N Engl J         therapy' program consisting of diet,
evaluated in a case-control study of         Med 1981; 305:1171-1175.                  enzymes, and vitamins. The majority
1,152 women with breast cancer and               Prostaglandins may be important of these patients were in good general
two groups of control women-5 19             regulators of coronary blood flow. To condition before treatment. None was
with endometrial or ovarian cancer,          investigate this possibility, the effect totally disabled or in preterminal con-
and 2,702 with non-malignant dis-            of blockade of prostaglandin synthesis dition. One third had not received any
orders. With allowance for all poten-        by indomethacin in nine patients with previous chemotherapy. The pharma-
tial distorting factors, the relative-risk    coronary-artery disease was studied. ceutical preparations of amygdalin, the
estimate of breast cancer for women           Coronary-sinus blood flow (deter- dosage, and the schedule represented
who had drunk alcoholic beverages             mined with the thermodilution tech- past and present Laetrile practice. No
relative to those who had never drunk         nique) was recorded, together with substantial benefit was observed in
was 1.4 (95% confidence interval,             mean arterial blood pressure and the cure, improvement, or stabilization of
 1.0-2.0) when the comparison group           myocardial arteriovenous oxygen dif- cancer, improvement of symptoms re-
had endometrical or ovarian cancer            ference from simultaneously obtained lated to cancer, or prolongation of life.
and 1.9 (1.5-2.4) when the controls           arterial and coronary-sinus blood sam- The hazards of amygdalin therapy
had non-malignant disorders.                  ples, before and 20 minutes after an in- were evidenced in several patients by
    The association was evident for           travenous dose of indomethacin symptoms of cyanide toxicity or by
beer, wine, and spirits. The associa-         (0.5 mg per kilogram of body blood cyanide levels approaching the
tion was not explained by any of the          weight).                                 lethal range. Patients exposed to
major known risk factors for breast              There were significant increases amygdalin should be instructed about
cancer, but the authors had no infor-         (P<0.05) in mean arterial pressure the danger of cyanide poisoning, and
 mation on dietary factors. The findings       (from 99±4 to 118+5 mm their blood cyanide levels should be
 suggest that alcohol consumption, or         Hg[+S.E.M.] ), coronary vascular re- carefully monitored. Amygdalin is a
 related dietary factors, increase the        sistance (+73%), and myocardial ar- toxic drug that is not effective as a
 risk of breast cancer.                       teriovenous oxygen difference (from cancer treatment.
CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982                                                                                   1125
Oral    Contraceptives                      there are complications such as mas- of 12,205 non-diabetic, non-asthmatic
                                            toiditis, or ear discharge continues women were analyzed, to evaluate the
Linn S, Schoenbaum SC, Monson               beyond 14 days.                          relation between coffee consumption
RR, Rosner B, Ryan KJ: Delay in                                                      and adverse outcomes of pregnancy.
conception for former 'pill' users.
JAMA 1982; 247:629-632.
                                            Postnatal Care                           Low birth weight and short gestation
                                                                                     occurred more often among babies of
                                            Henningsson A, Nystrom B,                women who drank four or more cups
   Interview data from 3,214 married        Tunnell R: Bathing or washing
women having planned pregnancies                                                     of coffee a day and among the babies
and singleton deliveries were ana-          babies after birth? Lancet 1981;         of smokers. After controlling for
lyzed. The women had no history of          2:1401-1403.                             smoking, other habits, demographic
fertility treatment and conceived more         One group of healthy fullterm new- characteristics, and medical history by
than two weeks after cessation of con-      born babies was washed after birth and standardization and logistic regres-
traception. The interval from cessation     another was bathed, to remove vernix sion, no relation was found between
of contraception to conception was 13       caseosa and clean the skin. A few in- low birth weight or short gestation and
months or greater for 24.8% of prior        fections-none of them serious-oc- heavy coffee consumption. Further-
'pill' users compared to 10.6% for for-     curred in both groups. Bacterial colo- more, there was no excess of malfor-
mer users of all other methods. Pill        nization of the umbilical cord on the mations among coffee drinkers. These
users had a notably lower monthly per-      third day was similar in both groups. negative results suggest that coffee
centage of conceptions for the first        The rectal temperature fell further and consumption has a minimal-or no-
three months and a somewhat lower           more infants cried during washing than effect on the outcome of pregnancy.
percentage from four to 10 months.          during bathing. Thus bathing after
Results were not altered when poten-        birth causes less heat loss and makes
tial confounding variables were con-        the baby calmer, quieter, and more Toxic Shock Syndrome
trolled by logistic regression.             comfortable than washing.                Reingold AL, Dan BB, Shands KN,
   At least 15 months of unsuccessful          Clinical signs of infection and bac- Broome CV: Toxic-shock syndrome
trials might be a more appropriate          terial colonization rates are no higher not associated with menstruation.
working definition of infertility for       after bathing than after washing.        Lancet 1982; 1:1-4.
previous pill users rather than the 12-                                                 An increasing proportion of re-
month interval generally accepted for       Pregnancy                                ported cases of Toxic Shock Syndrome
this purpose.                                                                        (13.2% of reported cases with onset in
                                            Rubin PC: Beta-blockers in
                                            pregnancy. N Engl J Med 1981;            1981) are not associated with menstru-
                                            305:1323-1326.                           ation. The 54 cases of Toxic Shock
Otitis Media                                                                         Syndrome (TSS) not associated with
                                               Research on drug therapy during menstruation reported through the
van  Buchem FL, Dunk JH, van't              pregnancy is often limited by ethical U.S.A. national surveillance system
Hof MA: Therapy of acute otitis             and practical considerations. As a re- between January 1980, and June 1981,
media: Myringotomy, antibiotics,            sult, decisions about management are were either associated with Staphylo-
or neither? A double-blind study in         frequently made with incomplete coccus aureus infections (cutaneous or
children. Lancet 1981; 2:883-887.           data.                                    subcutaneous lesions, infected surgical
  In a double-blind study, 171 chil-           The published information on beta- wounds, bursitis, mastitis, adenitis,
dren with acute otitis media (239 af-       blockers in pregnancy now equals or lung abscess, or primary bacteremia)
fected ears) were treated by four dif-      exceeds that on other drugs likely to be or followed childbirth by vaginal de-
ferent methods: neither antibiotics nor     considered for the treatment of hyper- livery and cesarean section.
myringotomy; myringotomy only; an-          tension. The conclusion to be drawn         Patients with TSS not associated
tibiotics only; or both antibiotics and     from the current evidence is that beta- with menstruation differed signifi-
myringotomy. All received sympto-           blocker treatment of hypertension in cantly in age and racial distributions
matic treatment. There were no signif-      pregnancy appears to improve the like- from those with menstruation-asso-
icant differences in clinical course        lihood that the fetus will be normal. ciated TSS, and 17 of them were male.
(pain, temperature, duration of dis-        However, it is still not clear whether The clinical features of TSS not asso-
charge, otoscopic appearances, audi-        such therapy specifically improves the ciated with menstruation and the
ography, recurrence rate) between the       outcome in patients with hypertension characteristics of the S. aureus strains
four groups. In the groups treated          induced by pregnancy.                    isolated from these patients were simi-
without antibiotics, the ears dis-             The generally favorable outcome in lar to those observed in TSS related to
charged for slightly longer and the ear-    the studies reported so far should en- menstruation. The median incubation
drums took a little longer to heal; these   courage further investigation.           period of the disease in the post-surgi-
differences were not significant. No                                                 cal cases was two days.
complications were seen.                    Linn S, Schoenbaum SC, Monson               TSS can occur in many clinical set-
   Symptomatic therapy with nose-           RR, Rosner B, Stubblefield PG,           tings in patients of both sexes and of
drops and analgesics seems a reason-        Ryan KJ: No association between          all ages and racial groups.
able initial approach to acute otitis       coffee consumption and adverse
media in children. Myringotomy and          outcomes of pregnancy. N Engl J
antibiotics can be reserved for cases in    Med 1982; 306:141-145.
which the cours.e of otitis is irregular,      Interview and medical record data
1126                                                                                      CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
   |M-                                                                           Caisniar



Send all information on courses to Calendar, 4000             16-20 Group Approaches in the Treatment of Children
Leslie St., Willowdale, ON. M2K 2R9, at least three              and Adolescents. Eastham, MA., U.S.A. Information:
months before the date of the course. Readers wishing            Office of CME, Albert Einstein College of Medicine,
to register or get further information on courses should         Montefiore Hospital and Medical Center, 111 East 210
write to the address listed under 'Information', and             Street, Bronx, NY. 10467, U.S.A.
NOT to CANADIAN FAMILY PHYSICIAN.                             22-27 9th International Congress of Hypnosis & Psycho-
                                                                 somatic Medicine. Glasgow, Scotland. Information:
                                                                 Conference Travel of Canada Inc., 102 Bloor St. W.,
                                                                 Suite 620, Toronto, ON. M5S 1M8
                                                              23-27 16th & 17th International Congress of Internal
                                                                 Medicine. Prague, Czechoslovakia, Information: Con-
                     AUGUST                                      ference Travel of Canada Inc., 102 Bloor St. W., Suite
                                                                 620, Toronto, ON. M5S 1M8
                        S    M     T     W    T    F    S
                                                              23-27 Psychoanalytic Psychotherapy with Borderline
                        1    2     3      4   5    6     7       and Narcissistic Patients. Eastham, MA., U.S.A. In-
                       8     9    10     11   12   13   14       formation: Office of CME, Albert Einstein College of
                                                                 Medicine, Montefiore Hospital and Medical Center, 111
                       15   16    17     18   19   20   21       East 210 Street, Bronx, NY. 10467, U.S.A.
                       22   23    24     25   26   27   28    28-Sept. 2 XIIIth International Congress of Chemo-
                                                                 therapy. Vienna, Austria. Information: Secretariat of
                       29   30    31                             the XIIIth International Congress of Chemotherapy, c/o
                                                                 Wiener Medizinische Akademie, Alser Strabe 4, A- 1090
   Approved Courses                                              Vienna, Austria
6-8 Annual Scientific Assembly of the Ohio Academy of         29-Sept. 4 6th International Congress on Burns. San
   Family Physicians. Cleveland, OH. Information: Ohio           Francisco, CA., Information: Conference Travel of Can-
   Academy of Family Physicians, 4075 North High St.,            ada Inc., 102 Bloor St. W., Suite 620, Toronto ON.
   Columbus, OH. 43214, U.S.A.                                   M5S 1M8
20-22 Clinical Management of Coronary Disease and             30-Sept. 3 Conference on Road Safety. Canadian Society
   Dual-Mode Exercise Testing. Hyatt Regency, Mon-               of Forensic Sciences, Chateau Halifax, Halifax, NS. In-
   treal, PQ. Information: Dr. Stephen D. Mattingly, Inter-      formation: CSFS, 171 Nepean Street, Ottawa, ON.
   national Medical Education Corporation, 64 Inverness          K2P OB4
   Drive East, Englewood, CO. 80112, U.S.A. (13 hours)        30-Sept. 3 Clinical Hypnosis. Eastham, MA., U.S.A. In-
                                                                 formation: Office of CME, Albert Einstein College of
   Other Courses                                                 Medicine, Montefiore Hospital and Medical Center, 111
2-7 Biopsychosocial Medicine. Eastham, MA., U.S.A. In-           East 210 Street, Bronx, NY. 10467, U.S.A.
   formation; Office of CME, Albert Einstein College of
   Medicine, Montefiore Hospital and Medical Center, 111
   East 210 Street, Bronx, NY. 10467, U.S.A.
9-12 3rd General Practice Congress: Family in Crisis.
                                                                                  SEPT7EMBER            S
                                                                             S   M    T    W     T  F
   Sun City, Bophuthatswana. Information: The Secretary,
   GP Congress Steering Committee, P.O. Box 23195,                                         1 2 3 4
   Joubertpark 2044                                                          5 6 7 8 9 10 11
10-14 Therapeutic Paradoxes: Milan-Style Approach to
   Family Therapy. Eastham, MA., U.S.A. Information:                        12 13 14 15 16 17 18
   Office of CME, Albert Einstein College of Medicine,                      19 20 21 22 23 24 25
   Montefiore Hospital and Medical Center, 111 East 210                     26 27 28 29 30
   Street, Bronx, NY. 10467, U.S.A.
15-20 11th International Conference on Health Educa-
   tion. Hobart, Tasmania, Australia. Information: Confer- Approved Courses
   ence Travel of Canada Inc., 102 Bloor St., W., Suite 6-10 Medicine in Old Age. Saskatoon City and University
   620, Toronto, ON. M5S 1M8                               Hospitals, Saskatoon, SK. Information:- CME Office,
CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982                                                                              1131
Mogadon®                                                                              University of Saskatchewan, 408 Ellis Hall, Saskatoon,
                                                                                      SK. S7N OWO
Rx Summary                                                                         7-11 Medicine in Old Age. Saskatoon City and University
Indications                                                                           Hospitals, Saskatoon, SK. Information: CME Office,
Useful for the short-term management of insomnia and also for the manage-             University of Saskatchewan, 408 Ellis Hall, Saskatoon,
ment of myoclonic seizures.                                                           SK. S7N OWO
ContraindicatIons                                                                  7, 14, 21, 28 Family Practice Rounds. St. Paul's Hospital
Patients with myasthenia gravis or known hypersensitivity to the drug.                Lab. Conference Room, Vancouver, BC. Information:
Safety and effectiveness as a hypnotic in children not established.
                                                                                      Dr. Arthur D. Van Wart, Dept. of Family Medicine, St.
Wamings                                                                               Paul's Hospital, Vancouver, BC. (40 hours or portion)
Use in elderly: elderly, debilitated and those with organic brain disorders
more prone to CNS depression or paradoxical reactions. Use with great              13-14 Geriatrics for Practicing Physicians. Holiday Inn,
caution in these patients; inftiate treatment with lowest possible dose to            Ottawa, ON. Information: Dr. Bill Burwell, P.O. Box
decrease possible excitement, agitation, excessive sedation or ataxia.
Potentiation of drug effects: caution patients about possible additive effects        56, Renfrew, ON. (10 hours)
if combined with alcohol or other CNS depressants.
Physical and psychological dependence: known to occur in patients taking
                                                                                   16 Fifth Annual Seminars in Current Practice-Family
benzodiazepines so caution should be exercised with patients with a known             Medicine 1982-1983. Auditorium, Mount Sinai Hospi-
history of drug misuse or who may increase the dose on their own initiative.
To avoid possible symptoms of withdrawal, the drug should not be abruptly
                                                                                      tal, Toronto, ON. Information: Dr. N. N. Levinne,
discontinued after prolonged use.                                                     Mount Sinai Hospital, 600 University Avenue, Toronto,
Use in pregnancy: safety in pregnancy has not been established; not rec-              ON. M5G lX5 (3 hours)
ommended for use during pregnancy or while nursing infants; because of
risk of congenital malformations associated with minor tranquilizer use            19-22 Disability and Quality of Life (Cerebral Palsy and
during first trimester, if prescribed for women of child-bearing potential,           Developmental Medicine). Park Plaza Hotel, Toronto,
patients should be warned to consult their physician regarding discontin-             ON. Information: 350 Rumsey Road, Toronto, ON. (16
uation if intending to become or suspect they are pregnant.
Anterograde amnesia: known to occur after administration of benzodiaze-               hours)
pines.                                                                             20-24 Canadian Medical Association Annual Meeting.
PrecautIons                                                                           Bessborough Hotel, Saskatoon, SK. Information: CME
Caution against engaging in activities requiring complete mental alertness            Office, University of Saskatchewan, 408 Ellis Hall, Sas-
or physical co-ordination after ingesting 'Mogadon'. Use with caution in
patients with depression, particularly when suicidal tendencies may be                katoon, SK. S7N OWO
present. Usual precautions in impaired renal and/or hepatic functions.             22 Assessment and Management of Chronic Asthma.
Adverse reactions                                                                     Holiday Inn, Kent St., Ottawa, ON. Information: Dr.
Most common are fatigue, dizziness, lightheadedness, drowsiness, leth-                R. N. Rivington, Ottawa Civic Hospital, 1053 Carling
argy, mental confusion, staggering, ataxia and falling. Also reported have
been, depressed dreaming, nightmares, paradoxical reactions, hangover,                Ave., Ottawa, ON. KlY 4E9 (11/2 hours)
disorientation, hypotension and cutaneous reactions. In rare instances,            24 Controversies in Respiratory Medicine. The Montreal
adverse effects related to gastrointestinal and cardiovascular systems                General Hospital, Montreal, PQ. Information: Ms. Carol
have been noted. Excessive sedation, particularly in elderly, can be
avoided by reduction in dose (see also Warnings).                                     Zaman, Postgraduate Board, The Montreal General Hos-
Symptoms and treatment of overdosage                                                  pital, Rm. 10827 LH, 1650 Cedar Ave., Montreal, PQ.
Symptoms: cardinal signs are those of CNS depression with cardiopulmon-               H3C 1A4
ary signs following large doses. Jitteriness and overstimulation may appear        24 Heart Disorders in Healthy Infants and Children.
when drug effects wear off.
Treatment: immediate lavage may be beneficial soon after ingestion. Moni-             Hospital for Sick Children, Toronto, ON. Information:
tor pulse and respiration and maintain with general supportive measures.              Toronto, 114 FitzGerald Building, Toronto, ON. (5
Dialysis of little value. Suspect presence of other CNS depressants if respi-
ratory depression and/or coma are present.                                            hours)
Dosage and administration
                                                                                    24 Internal Medicine for Family Physicians. Toronto
Individualize for maximum beneficial effects.                                          Western Hospital, Toronto, ON. Information: Dr. J.
Insomnia: adults - usual dose is 5 or 10 mg before retiring. In elderly or debi-
litated initiate with 2.5 mg until response is determined. More than 5 mg
                                                                                       Heathcote, CME, University of Toronto, 114 FitzGerald
usually not recommended in the elderly.                                                Building, Toronto, ON. M5S 1A8 (6 hours)
Myoclonic seizures: children - usual dose for children (up to 30 kg body
weight) is between 0.3 and 1.0 mg/kg/day in three divided doses. In order
                                                                                    24-26 Auricular Medicine and Pain Therapy. Hampton
to determine tolerance and response initiate treatment with dosage lower               Court Hotel, Toronto, ON. Information: Doris M.
than usual recommended. Higher dosage may be gradually attempted if                    Sweetnam, RR 2, Box 3, Stittsville, ON. KOA 3G0 (21
additional control required. Higher doses may cause excessive drowsiness.              hours)
When possible, give three equal doses but when not feasible, larger dose
should be given before retiring. Tolerance develops in some patients. If           28-29 "Current Concepts" Seminar. Holiday Inn, Bar-
'Mogadon' added to existing anticonvulsant regimen, may result in increase            rie, ON. Information: Miss Olive Robertson, Royal Vic-
in CNS depressant effects.
                                                                                       toria Hospital, Barrie, ON. L4M 2E4 (10 hours)
Supply
White, cylindrical biplane scored tablet imprinted MOGADON on one side
                                                                                   30-Mar. 31 Thursday Evening Lecture Series. McIntyre
and ROCHE above score and C below on other side: 5                                     Medical Building, Faculty of Medicine, McGill Univer-
each containing 5 mg nitrazepam.
White, cylindrical biplane scored tablet imprinted MOGADON on one side
                                                                                       sity, Montreal, PQ. Information: Dr. Isaac Tannenbaum,
and ROCHE above score and C below on other side: 10                                    Centre for CME, McGill University, 1110 Pine Ave.
each containing 10 mg nitrazepam.                                                      W., Montreal, PQ. H3A 1A3 (50 hours)
Product monograph available on request.
 )Reg.Trade Mark
References:
1. Priest, R.G. et al, ed. Sleep Research: Proceedings of the Northern
   European Symposium on Sleep Research, Basle, Sept. 26-27, 1978.
   MTP Press, Lancaster, England.                                                     Other Courses
2. Kales, A. et al, Rebound Insomnia: A New Clinical Syndrome, Science,
   201:1039-1040, 1978.                                                            3-S Respiratory Pathophysiology. Royal Victoria Hospi-
                                                                    Can. 1068         tal, Montreal, PQ. Information: Postgraduate Board,
 /   Hoff mann-La Roche Limited                                            IAB
                                                                                                            CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
\2 4 Vaudreuil, Quebec J7V 6B3                                             i1srm
   Royal Victoria Hospital, 687 avenue des Pins ouest,       3-6 Concurrent Seminars on Terminal Care and 4th In-
   Montreal, PQ. H3A lAl                                        ternational Seminar on Terminal Care. Queen Eliza-
7-9 VII International IRCOBI Conference on the Bio-             beth Hotel, Montreal, PQ. Information: Dr. Balfour M.
   mechanics of Impact. Koln, Fed. Rep. of Germany. In-         Mount, Royal Victoria Hospital, 687 Pine Avenue W.,
   formation: IRCOBI Secretariat, ONSER, 109 Avenue             Montreal, PQ. H3A lAl (26 hours)
   Salvador, Allende, F-69500, Bron, France.                 3-6 Ontario Chapter CFPC, 20th Annual Scientific and
8-15 13th International Cancer Congress. Seattle, WA.           Business Meeting. Inn on the Park, Toronto, ON. Infor-
   Information: Conference Travel of Canada Inc., 102           mation: Ontario Chapter, CFPC, 4000 Leslie St., Wil-
   Bloor St. W., Suite 602, Toronto, ON. M5S 1M8                lowdale, ON. M2K 2R9
13-18 30th International Congress on General Practice.       4-5 Infectious Diseases Conference. Theatre in the Mall,
   Klagenfurt (University), Austria. Information: General       University Hospital, Saskatoon, SK. Information: CME
   Secretary of the SIMG, Mrs. Sigrid Taupe, A-9020 Kla-        Office, University of Saskatchewan, 408 Ellis Hall, Sas-
   genfurt, Bahnhofstrasse 22/1                                 katoon, SK. S7N OWO
17-19 Disaster: No Safe Place. Le Chateau de L'Aeroport      5, 19, 26, Nov. 2 Family Practice Rounds. St. Paul's Hos-
   Hotel, Montreal's International Airport,   Mirabel, PQ.      pital Lab. Conference Room, Vancouver, BC. Informa-
   Information: Dr. Helene Lamontagne, 1110 Pine Ave.           tion: Dr. Arthur D. Van Wart, St. Paul's Hospital, Van-
   W., Montreal, PQ. H3A 1A3                                    couver, BC. (40 hours or portion)
19-25 14th European Conference on Psychosomatic Re-          6 GI Day 1982. Plains Health Centre, Regina, SK. Infor-
   search. Holland, Netherlands. Information: Conference        mation: Dr. A. W. Juckes, CME, Regina General Hos-
   Travel of Canada Inc., 102 Bloor St. W., Suite 602,          pital, 1400-14th Avenue, Regina, SK. S4P 0W5
   Toronto, ON. M5S 1M8                                      7-8 Nutritional Support '82-Current Concepts and
20-23 Roads and Transportation Association Annual               Controversies. Auditorium, 18th fl. Mt. Sinai Hospital,
   Conference. Nova Scotia Hotel, Halifax, NS. Informa-         Toronto, ON. Information: Dr. Elizabeth Bright-See, 92
   tion: RTAC Annual Conference Section, 1765 St.               College St., Toronto, ON. M5G 1L4 (13 hours)
   Laurent Blvd. Ottawa, ON. KIG 3V4                         20 Obstetrical Anesthesia. Women's College Hospital,
28-Oct 2 The 3rd Annual Canadian Association of                 Toronto, ON. Information: Dr. R. J. Gall, Women's
   Emergency Physicians Scientific Meeting. Calgary             College Hospital, 76 Grenville Street, Toronto, ON.
   Convention Centre, Calgary, AB. Information: Dr. Rob-        M5S 1B2 (4 hours)
   ert Abernethy, Emergency Dept., Foothills Hospital,        21-23 Family Medicine Review 1982. Regina General
   Calgary, AB.                                                  Hospital, Regina, SK. Information: Dr. A. W. Juckes,
29 Aspartame-Sugar Substitute Breakthrough. Aca-                 CME, Regina General Hospital, 1400-14th Avenue, Re-
   demy of Medicine, Toronto, ON. Information: Ms. Kris-         gina, SK. S4P OW5
   tine Kerenyi, Burson-Marsteller, 1505-80 Bloor St. W.,     21-23 17th Conjoint Assembly, Maritime Chapters of
   Toronto, ON. M5S 2V1                                          the College of Family Physicians of Canada. Confed-
30 Third Annual Seminar Relating to the Multi-Handi-             eration Centre, Charlottetown, PEI. Information: Mrs.
   capped. Holiday Inn, Brantford, ON. Information: Dr.          Jean Wood, Division of CME, Sir Charles Tupper Medi-
   Robert Eddy, 72 Brant Ave., Brantford, ON.                    cal Building, Dalhousie University, Halifax, NS.
                                                                 B3H 4H7
                                                              22 Community Management of the Respiratory Patient.
                                                                 Old Mill Restaurant, Toronto, ON. Information: Miss A.
                                                                 Ollikainen, York-Toronto Respiratory Care Society,
                                                                 2867 Yonge St. #17, Toronto, ON. M4N 2J6 (7 hours)
                                                              24 Update in Psychiatry. Inn on the Park, Toronto, ON.
                                                                 Information: Gina Shochat, 600 Sherbourne St., #203,
                                                                 Toronto, ON. M4X 1 W4 (4 hours)
                                                              28-29 An Update in Allergy and Clinical Immunology.
                                                                 The Montreal General Hospital, Montreal, PQ. Informa-
                                                                 tion: Ms. Carol Zaman, Postgraduate Board, The Mon-
                                                                 treal General Hospital, Room 10827 L.H., 1650 Cedar
                                                                 Avenue, Montreal, PQ. H3C 1A4




                                                                 Other Courses
                                                           1-2 Frontiers in Medicine-Implications for the Future.
                                                              Beverly Hilton Hotel, Los Angeles, CA. Information:
    Approved Courses                                          Rina Mark, UCLA Continuing Education in Health
 1-2 Medical   Bioethics in Human Reproduction. Health        Sciences, 10995 LeConte Ave., Los Angeles, CA.
    Sciences Centre, University of Ottawa, Ottawa, ON. In-    90024, U.S.A.
    formation: Ms. Nancy E. Austin, Aesculapean Society, 3-4 Canada Safety Council. Westin Hotel (Calgary Inn),
    University of Ottawa, c/o Faculty of Medicine, Alta       Calgary, AB. Information: CSC, 1765 St. Laurent Blvd.
    Vista, Ottawa, ON.                                        Ottawa, ON. KIG 3V4
                                                                                                                    1133
 CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
4-6 American Association for Automotive Medicine. Ot-
   tawa, ON. Information: AAAM Secretariat, P.O. Box                               NOVEMBER
   222, Morton Grove, IL. 60053, U.S.A.                                              S     M     T    W     T    F     S
7-8 Low Back Pain and Industrial and Social Disable-
   ment. Royal College of Physicians, Regents Park, Lon-                                1       2 3         4 5 6
   don, NW1. Information: Mrs. Stephanie Saunders, 20                                7 8        9 10       11 12 13
   Ailsa Road, Twickenham, Middlesex, TWi 1QW, Eng-                                 14 15       16 17      18 19 20
   land.
9-15 33rd International Congress on Alcoholism & Drug                               21 22       23 24      25 26 27
   Dependency. Tangier. Information: Conference Travel                              28 29 30
   of Canada Inc., 102 Bloor St. W., Suite 620, Toronto,
   ON. M5S 1M8
17-22 10th World Congress of Gynecology & Obstetrics.            Approved Courses
   San Francisco, CA., Information: Conference Travel of       4 Cardiology 1982. The Montreal General Hospital, Monc-
   Canada Inc., 102 Bloor St. W., Suite 620, Toronto, ON.         ton, PQ. Information: Ms. Carol Zaman, Postgraduate
   M5S 1M8                                                        Board, The Montreal General Hospital, Room 10827
                                                                  L.H., 1650 Cedar Avenue, Montreal, PQ. H3C 1A4
17-22 1982 National Convention of the Royal Australian         4-6 Annual Meeting of Saskatchewan Medical Associa-
   College of General Practitioners. Lennons Plaza                tion. Regina, SK. Information: CME Office, University
   Hotel, Brisbane, Australia. Information: B. Kruttschnitt,      of Saskatchewan, 408 Ellis Hall, Saskatoon, SK.
   Executive Officer, The Royal Australian College of             S7N OWO
   General Practitioners, Queensland Faculty, 3rd Floor,       5-6 Women and Illness. Park Plaza Hotel, Toronto, ON.
   Sigma Data House, 49 Sherwood Road, P.Q. Box 37,               Information: Dr. E. Borins, Edith Cavell Wing IB, Dept.
   Toowong 4066                                                   of Psychiatry, Toronto Western Hospital, 399 Bathurst
17-24 11th Congress of International Association of Al-           St., Toronto, ON. (12 hours)
   lergology. London, England. Information: Conference         10-12 Annual Refresher Course for Family Physicians.
   Travel of Canada Inc., 102 Bloor St. W., Suite 620,            Park Regent Hotel, Montreal, PQ. Information: Dr. S.
   Toronto, ON. M5S 1M8                                           Glaser, Post Graduate Board, Royal Victoria Hospital,
19-22 National Safety Council. Chicago, IL. Information:          687 Pine West, Montreal, PQ. H3A lAI (20 hours)
   NSC Congress Planning Department, 444 Michigan              11-13 Foundations of Family Medicine. CFPC Section of
   Ave., Chicago, IL. 60611, U.S.A.                               Teachers, Vancouver, BC. Information: Dr. Paul Rains-
                                                                  berry, College of Family Physicians of Canada, 4000
19-24 34th Annual Workshops and Scientific Program                Leslie St., Willowdale, ON. M2K 2R9
   of the Society for Clinical and Experimental Hyp-           18 Fifth Annual Seminars in Current Practice-Family
   nosis, Inc. Sheraton West Hotel, Indianapolis, IN. In-         Medicine 1982-1983. Auditorium, Mount Sinai Hospi-
   formation: Ms. Marion Kenn, Administrative Director,           tal, Toronto, ON. Information: Dr. N. N. Levinne,
   SCEH, 129A Kings Park Drive, Liverpool, NY. 13088,             Mount Sinai Hospital, 600 University Avenue, Toronto,
   U.S.A.                                                         ON. M5G lX5 (3 hours)
20-24 18th Annual Meeting of the Society of Prospective        19-20 Preop Anesthesia. Plains Health Centre, Regina,
   Medicine. Hotel le Concorde, Quebec City, PQ. Infor-           SK. Information: Dr. A. W. Juckes, Continuing Medi-
   mation: Dr. Fernand Landry, Laboratoire des sciences de        cal Education, Regina General Hospital, 1400-14th
   l'activite physique, Universite de Laval, Quebec, PQ.          Ave., Regina, SK. S4P OW5
   GIK 7P4
22 York-Toronto Respiratory Update. Old Mill Restau-
    rant, Toronto, ON. Information: York-Toronto Lung As-         Other Courses
    sociation, 157 Willowdale Ave., Willowdale, ON.            3 Update on the Thyroid. Holiday Inn Downtown,
   M2N 4Y7                                                        Toronto, ON. Information: Dr. Robert Volpe, Dept.
25-29 2nd Australian International Congress on Con-               Medicine, The Wellesley Hospital, 160 Wellesley St.
   temporary Acupuncture. Melbourne, Australia. Infor-            E., Toronto, ON. M4Y 1J3
   mation: Conference Travel of Canada Inc., 102 Bloor St.     4 Michigan Family Practice Research Day VI. University
   W., Suite 620, Toronto, ON. M5S 1M8                            Club of Michigan State University, East Lansing, MI.
                                                                  Information: Dr. Blake W. H. Smith, Coordinator, Mi-
26-30 Horizons in Health Communications: Continuing               chigan Family Practice Research Day VI, Michigan
   Education in Medical Writing-42nd Annual Confer-               State University, East Lansing, MI. 48824, U.S.A.
   ence American Medical Writers Association. Biltmore         5-7 Autism 1982. Pontin's Wick Ferry, Christchurch, Dor-
   Hotel, Los Angeles, CA., U.S.A. Information: Ameri-            set, England. Information: The Conference Organizer,
   can Medical Writers Association, 5272 River Road,              Portfield Road, 14 Stour Road, Christchurch, Dorset,
   Suite 370-E, Bethesda, MA. 20816, U.S.A.                       BH23 lPS, England.
28-31 3rd Asian-Asia Pacific Medical Acupuncture               10-17 International Diabetes Congress. Nairobi, Kenya.
   Convention. Bombay, India. Information: Conference             Information: Conference Travel of Canada Inc., 102
   Travel of Canada Inc., 102 Bloor St. W., Suite 620,            Bloor St. W., Suite 620, Toronto, ON. M5S 1M8
   Toronto, ON. M5S 1M8                                        12 Update on Digestive Diseases. Mount Sinai Hospital,
1134                                                                                     CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
  Toronto, ON. Information: Dr. Alvin Newman, Mount 18-19 New Brunswick Symposium on Safety. Informa-
   Sinai Hospital, Suite 433, 600 University Ave.,       tion: Gladys E. Beattie, 364 York St. Fredericton, NB.
  Toronto, ON. M5G 1X5                                   E3B 3P7
12-13 Highway Safety Research Center Meetings. 21-27 19th International Congress Medical Women's In-
   Chapel Hill, NC. Information: B. T. Orr, Program Man- ternational Association Manila, Philippines. Informa-
   ager, HSRC, University of North Carolina, CTP 197A,   tion: Conference Travel of Canada Inc., 102 Bloor St.
   Chapel Hill, NC. 27514, U.S.A.                        W., Suite 620, Toronto, ON. M5S 1M8



                                                                          Approved Courses
                                                                        2-4 Management of Neurological Problems. Theatre in
                        DECEMBER                                           the Mall, University Hospital, Saskatoon, SK. Informa-
                             S   M      T    W         T   F   S
                                                                           tion: CME Office, University of Saskatchewan, 408
                                                                           Ellis Hall, Saskatoon, SK. S7N OWO
                                              1 2 3 4                   2-5 Auricular Medicine and Pain Control. Sheraton
                         5 6 7                8 9 10 11                    Mount Royal, Montreal, PQ. Information: Doris M.
                                                                           Sweetnam, MED Servi-Systems Canada Ltd., R.R. 2,
                        12 13 14             15 16 17 18                   P.O. Box 3, Stittsville, ON. KOA 3GO (28 hours)
                        19 20 21             22 23 24 25
                                                                          Other Courses
                        26 27 28             29 30 31                   6-8 Conference on Medical Device Technology. Toronto
                                                                           Harbour Castle Hilton, Toronto, ON. Information:
                                                                           Canadian Association of Manufacturers of Medical De-
                                                                           vices, 480 Garyray Drive, Weston, ON. M9L 1P8




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CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982                                                                                       1135
                                                                                   Medical Digest

THIS MONTH:
* Allergy * Staff meetings * Impotence * Therapeutic nihilism * Cancer
operations * Carcinogenicity of bait dye * Teenage suicide * Allergic
rhinitis * Rape * Incentives for healthy habits * Telephones in
hospital * Footnotes * Blood pressure cuffs * Rotator cuffs * Baldness * Prescriptions
and patient satisfaction


                                                           I


Read anything in the overseas              tive of hypersensitivity pneumonitis      brief, earnest conversation. The callee
medical literature that you think is       after driving his air-conditioned car for strides out purposefully, not to return.
worth quoting on these pages? Send         six hours. Pulmonary function studies     Users of this method have, of course,
a copy along to Medical Digest.            of this man revealed hypoxia and a re-    scheduled the call (usually from home)
This column reviews all                    strictive defect. The air conditioner in  or, serendipitously receiving any call
non-Canadian English language              his car grew Thermoactinomyces can-       whatever, hit upon it as a cause to
medical journals for items of              didus, and cleanup of the unit was fol-   leave. The same doctors seem to get
interest to the Canadian family            lowed by resolution of symptoms and       the same call at the same time during
doctor. Extracts should preferably         improved pulmonary function. "            each meeting. In fact, one of our for-
be not more than one column in                                                       mer members was called away regu-
length and should be accompanied           Kumar P, et al: Mold in car air con- larly by his wife for 17 years in this
by the correct Index Medicus               ditioners may evoke respiratory al- manner.
reference to the journal.                  lergies. Am Fam Physician 1982               The Page-A variation of the Tele-
                                           Mar; 25:215.                              phone Gambit, this method requires an
                                                                                     intrahospital page to extricate the doc-
                                           Now You See 'Em,                          tor from a staff meeting. It is more dif-
Allergy Trigger                            Now You Don't                             ficult to orchestrate and often occurs
On Wheels                                                                            fortuitously. However, a good rela-
                                           ( As my hospital-staff presidency tionship with the telephone operator
  - Contamination of air conditioners      neared its end, my awareness of the helps. The adaptable staff member,
in vehicles is cited as a source of exa-   expertise of some of the medical staff once out, does not return.
cerbation of symptoms associated with      in prematurely departing from meet-          The Indignation Ploy-This re-
respiratory allergies. This relationship   ings had crystallized. During ascen- quires a certain amount of brazenness.
has been noted in a preliminary study      dancy to this position, one cannot fully The staff member professes ire at an
of mold growth from 14 air condi-          appreciate the extent of this sort of in- educational program or movie, advises
tioners in cars owned by 16 individ-       genuity. As secretary, one is too busy the president that he expected to use
uals. Various molds, all capable of ag-    trying to record the minutes. As vice- his valuable time to transact hospital
gravating respiratory allergies or         president, one has an understudy's en- business, and strides off. This allows
producing hypersensitivity pneumon-        grossment in the president's predica- for the Pilot-Fish (Coattail) variation,
itis, were grown from the vents and        ments and can observe little else. But, as opportunists, nodding in righteous
condensation water of 11 of the air        ah, after the torch is passed and, agreement, cruise off with their out-
conditioners. While eight of the 16        upright, he faces his seated colleagues spoken colleague. To the cocktail
subjects were asymptomatic, seven          at staff meetings, he has a talent lounge.
had symptoms of respiratory allergies      scout's view of attendance-abbrevia-         The Parliamentary Ploy-Those
and one individual had symptoms of         tion finesse.                              versed in the bylaws, and able to quote
hypersensitivity pneumonitis. Three of        The Telephone Gambit-This clas- them, may exercise this one. It can be
the people with respiratory allergies      sic method merits mention as the ven- regarded as an intellectualized form of
reported an increase in symptoms after     erable forerunner of those more inno- the Indignation Ploy and requires spe-
being in the air-conditioned cars for 15   vative techniques. Shortly into the cial situations which test one's ability
minutes. One man developed intermit-       meeting, the phone calls begin, each to improvise. The parliamentarian may
tent fever, cough and dyspnea sugges-      summoning a specific physician to a state that, if a special meeting is in
CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982                                                                                   1205
progress, the president is out of order      Elmner HJ: The fine art of disappear- emphasizes the importance of a thor-
in transacting hospital business.            ing from meetings. JAMA 1982; ough diagnostic workup to determine
Therefore, after the special phase of        247:508.                                  whether organic or psychogenic fac-
the meeting is over, he will leave. It                                                 tors are involved, a point that has been
can be exercised along with the Indig-
nation Ploy, but this constitutes over-
                                             About Face                                made by other investigators as well.
                                                                                          If the
kill and should be beneath the artist's      6 During a recent year as a hospital factors, impotencenotes thattoa organic
                                                                                                 Scarzella
                                                                                                             is traced
                                                                                                                         variety
dignity.                                     staff president, I, too, observed the of implantable prostheses are avail-
   The Fidgetary Finesse-In this ma-         clever means by which many members able. He favors the inflatable prosthe-
neuver, escape velocity is gradually         exited meetings early. It was also evi- sis (because it 'mimics the normal
achieved by the more timid members.          dent that most staff members crowded act').
One of them will stir restlessly. Then       and congregated at the back of the           Scarzella says he welcomes inqui-
he will make repeated visits to the cof-     room to facilitate easy egress, leaving ries about the support group (Suite
fee urn near the door. A final effort        the front rows unoccupied. Faced with 219, 8630 Fenton St, Silver Spring,
will propel him through the portal           this usual situation at a meeting of re- MD 20910, [301]-588-5777). He em-
when escape velocity is reached. As          quired attendance, I opened the meet- phasizes that not every formerly impo-
the year progresses, an individual staff     ing-then abruptly asked all in atten- tent man in the group has recovered
member gains confidence and gener-           dance to stand up, turn their chairs in function through implantation of a
ally requires fewer coffee-urn visits to     the opposite direction, and be re- prosthesis, however; one staunch sup-
achieve departure. He may eventually         seated. I proceeded to the back of the porter recovered by giving up some-
omit the formality of a stop at the urn.     room, slid out a second lectern pre- thing-his excessive consumption of
   The Direct Approach-The direct-           viously placed there, and resumed the alcohol. "
approacher stands, may glance at his         meeting-squarely in front of the only
watch (optional), purposefully inclines      exit. This exposed those previously in Medical news, JAMA 1982;
the head slightly forward and down-          back to the full aversion of being in 247:1545.
ward, and exits.                             front. I explained that this maneuver
                                             brought me closer to the staff that I re-
   The Intermission Exit-For those
too reticent for the Direct Approach, it
is necessary to remain until the half-
                                             presented as well as disclosing anyone
                                             leaving early to the scrutiny of all      Therapeutic
time hiatus and to exercise a modicum
                                             those in attendance.
                                                The maneuver worked, at least for
                                                                                       Nihilism
of timing. The delay is compensated          that one meeting, but created an un- 6 A medical journal has, on two oc-
by refreshments, conversation, and           ease as to whether it would be repeated casions, recently devoted considerable
fellowship. After these have been en-        from then on.                             space to warnings and discussions of
joyed, but at the first sign of the recall      I offer this shifting-lectern gambit the minuscule amounts of sugar in ant-
to order, one oozes out the nearby           for the possible use of other hospital acids. Calculating the actual number
door.                                        staff presidents. "                       of calories involved shows that the
   Early Surgery-This is a special sit-                                                'risk' to diabetics ranged up to 9.6 cal-
uation, necessitating a breakfast meet-      Douglass RC: Disappearance from ories per dose or an average added
ing. The surgical schedule is tradition-     meetings. JAMA 1982; 247:1938.            caloric intake of 38.4 calories per
ally set back to allow the staff to meet.                                              day-calorically equal to one-half
The practitioner of this maneuver, in                                                  slice of bread. Whether the proved
one recalled instance, claimed to have       Psst-Now There's                          benefits of antacids for ulcers should
gotten a patient with a hip fracture at
an inconveniently late night hour.           'Impotence Anon.'                         be withheld for risk of adding 38.4 cal-
                                                                                       ories to the daily diet seems highly
From his bed he scheduled emergency           " In this sexually explicit age, im- questionable.
morning surgery. Then he came to the         potence still can be hush-hush. How-         As a clinician I believe that today
meeting, had a leisurely breakfast,          ever, in Silver Spring, Md, a suburb of we may 'Strain out a gnat while swal-
arose, preempted the scheduled cases,        Washington, DC, 'Impotence Anony- lowing a camel' (Matthew 23:24).
and did his 'emergency'. (After 3'/2         mous' hopes to do something about            At a time when the American Heart
hours of waiting to do my 9 a.m. case,       that.                                     Association states that there are
something began to tell me I'd been             Described as a support group for 100,000 fewer deaths per year from
had.)                                        men who have or are considering hav- heart disease and stroke, at a time
   The foregoing summarizes only the         ing a penile prosthetic implant, 'Impo- when the American Cancer Society
basics in a field where there is great       tence Anonymous' seeks to 'alleviate states that the cancer death rate for per-
opportunity for those of talent and          fears of preoperative patients and help sons younger than 50 years has
imagination. Doubtless, much has             postoperative patients adjust to their dropped from 21.8/100,000 to
been omitted. The field of staff-meet-       potency', says urologist Giulio I. Scar- 14.7/100,000, a drop of almost 33%,
ing attendance-abortion is one in            zella, MD, leader of the group. Pre- at a time when newer therapies have
which knowledge is not freely shared.        sently, there are 40 patients participat- played a part in decreasing the popula-
Each practitioner has his own style.         ing in the group's meetings.              tion of our mental hospitals by 40%-
Methods must be studied in order to             Scarzella disagrees with the often- not to mention ueclsssntratao demise
                                                                                                         the unlamented eea
arrive at those which best serve an in-      heard comment that impotence is psy- of tuberculosis sanatoria tat a genera-
dividual's needs. "                          chogenic in 90% or more of cases. He tion ago dotted the countryside-at
1206                                                                                       CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
such a time should we be undermining         'say what you mean', and it was good      since 1875, it has been manufactured
the faith of patients in modem ther-         advice. The expression 'curative re-      on a large scale for a variety of appli-
apy? How many people will die un-            section' should be replaced by a term     cations, such as dyeing textiles. Or-
necessarily because of reluctance to         which accurately describes the proce-     ganic salts have found uses in medi-
accept therapy for fear of 'the risk of      dure. We suggest 'macroscopically         cine.
side effects'? In my 25 years of prac-       complete resection'. "                      The carcinogenicity of chrysoidine
tice I have rarely seen any adverse ef-                                                was considered by a working group at
fects half so toxic as death.                Gough IR, Furnival CM: Describing the International Agency for Research
   I conclude with a quote from the          operations for cancer. Lancet 1982; on Cancer in 1974. Evidence that it is
director of the National Cancer Insti-        1:570.                                   carcinogenic derives almost entirely
tute in response to a newspaper series                                                 from mouse feeding tests done in Wro-
(Boston Globe, Oct 20, 1981, p 1) on                                                   claw in the 1950s, at a time when
the 'Dangers of Cancer Treatments'.
After quoting eight major factual
                                             Fishy Hazard:                             chrysoidine was used in some coun-
                                                                                       tries as a food dye. One hundred and
errors in the article, Vincent De Vita
said: 'It will be tragic if those who will
                                             Switch and Bait                           twenty mice were fed a diet containing
read this article and those which fol-       6 In Britain there are about four 0.2% chrysoidine forin1357% of 51Liver
                                                                                       tumors were found
                                                                                                                 months.
                                                                                                                           sur-
low will turn away from further treat-       million anglers, many of whom en- viving males and in 87% of 53 surviv-
ment'.                                       gage in coarse fishing on inland water- ing females. Most of the tumors were
   I believe the most hazardous 'ad-         ways. They use maggots (gentles) pro- carcinomas; in three female mice
verse drug therapy' in today's anti-         duced at maggot farms and sold for had metastasized to the lungs, and they    they
intellectual society is that thousands of    bait, and up to a gallon of maggots were transplantable to other mice.
untreated patients may die or be disa-       may be needed for a day's fishing. It is Chrysoidine thus seems to be an effec-
bled by treatable diseases-when              common practice for the maggots to be tive liver carcinogen in the mouse. We
treatment is available that could cure       dyed bronze with chrysoidine Y (chry- have found no reports of any subse-
or ameliorate their illness.                 soidine hydrochloride). Since this dye quent animal tests or of tests in pro-
   I believe we must move out of the         is somewhat toxic to the maggots it is gress, but chrysoidine is a potent mu-
dark ages of therapeutic nihilism and        usually purchased separately by the tagen in Salmonella typhimurium
into the era of hope."                       dealers and mixed with the bait shortly TA 1538 in the presence of a microso-
                                             before sale. A dealer may buy several mal metabolizing system.
Soule RM: Straining out gnats.               thousand gallons of maggots and over
JAMA 1982; 247:1407.                         10 kg of chrysoidine in a year. The at Chrysoidine should thus be regarded
                                                                                          least as potentially carcinogenic for
                                             popularity of this use of chrysoidine man. Nevertheless, it is being used on
                                             has risen greatly in the past five a very large scale in sport under condi-
Say What You Mean                            years.                                    tions involving widespread contamina-
                                                Chrysoidine Y readily contaminates tion and by people who use the dye
i Operations for cancer are often            the angler's hands and could be trans- often from a very early age and for
described as either 'palliative' or          ferred to food or cigarets. On the many years. We believe that this use
'curative'. While a surgeon may be           dealers' premises contamination is dif- of chrysoidine should be discouraged.
confident of the palliative nature of an     ficult to avoid even when gloves are If maggot bait does have to be dyed, it
operation because of obvious unresect-       worn. That this practice could be a should be possible to find dyes freer
able cancer, the term 'curative' im-         health hazard does not seem to have from suspicion and safer handling
plies a potential result and does not ac-    been considered. The matter was methods .
curately describe what was done.             brought to our attention by a local          In his 1950 Hunterian lecture,
   At a recent scientific meeting we         dealer who had become alarmed by the Henry quoted the case of a railway
heard the self-contradictory term 're-       realization that he knew of three Mid- director whose fatal skin carcinoma
cure' used on several occasions to de-       lands anglers who had had tumors of was attributed to handling tarred ropes
scribe resection of recurrent colonic        the urinary bladder. We confirmed the on his yacht, and Henry recommended
cancer. Recurrence after so-called cu-       diagnoses. One of the men had been that cancer patients should always be
rative surgery is reported frequently in     asked at the hospital whether he had asked about their hobbies as well as
the literature on colonic cancer-for         had any contact with dyes at work, and their work. Information on recrea-
example, 'after curative surgery for         later realized that there might be a con- tional activities of cancer patients
carcinoma of the large bowel . . . 39%       nection between his disease and his might indicate quite quickly whether
developed recurrent carcinoma' and           use of dyed bait. In the West Midlands certain bait dyes are indeed hazardous;
'five patients developed subsequent          area the median age of registration of our preliminary inquiries suggest that
CEA elevations after curative resec-         bladder papilloma in males is 61.9 records suitable for formal epidemio-
tions at second-look surgery . . . re-       years. All three men had first had evi- logical analysis may be difficult to ob-
section of recurrence was again pos-         dence of the disease when under the tain. "
sible in two'.                               age of 40; none had worked in the
   The biology of colorectal carcinoma       chemical or rubber industries.
and the results of surgical intervention        Chrysoidine Y (also known as chry- Searle CE, Teal J: Chrysoidine-
are so well known that it is surprising      soidine R, color index no. 11270, and dyed bait: A possible carcinogenic
that this terminology persists.              CI basic orange 2) is 2,4-diaminoazo- hazard to anglers? Lancet 1982;
   The March Hare advised Alice to           benzene monohydrochloride. Known 1:564.
1 208                                                                                          CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
The Bald Facts
About Hard Hats
( Male pattern alopecia is a heredi-
tary type of hair loss that usually has a
sudden onset in early adult life and
progresses rapidly until the genetically
determined pattern of baldness has          Answer to Dermacase
been established. I know of no scien-
tific studies that implicate any com-
mon form of headwear in the accelera-       2. Seborrheic dermatitis
tion or aggravation of the condition. It       Seborrheic dermatitis is an inflammatory disease of the
is unlikely that either wearing or not      skin that is quite common in infancy. The rash has a
wearing a 'hard hat' at work would          predilection for certain sites, such as the scalp, where it
make any appreciable difference in the      may produce considerable redness and heaped up
end result or in the period of time         scale-the so called 'cradle cap'. Other frequent areas of
taken to complete the process. Cer-         involvement include the retroauricular areas of the scalp,
tainly many male workers continue to        the neck folds, the axillae and the antecubital as well as
wear 'hard hats' throughout their           popliteal fossae. In these latter areas the skin frequently
working lives with no apparent pro-         takes on a bright red glazed appearance. Despite the
gression of the baldness, once the pat-     intensity of the inflammation, most children with
tern is complete. The scalp is quite        seborrheic dermatitis seem to be quite comfortable.
thick' and extremely vascular. Al-          Scratching and picking at the skin is usually not a clinical
though it is possible to occlude the cir-   feature. The use of bland low potency topical steroids,
culation in small areas, as with head       such as simple hydrocortisone, is an appropriate way to
bands during surgical operations, the       manage the disease. Parents should be reassured that it is a
pressure alopecia that may follow re-       benign disease process that will spontaneously resolve over
sults from an acute inflammatory reac-      a period of weeks and occasionally months.
tion in the area of tissue hypoxia. I          Infantile eczema is the one diagnostic possibility that is
have never seen that type of reaction       frequently confused with seborrheic dermatitis. Infantile
from wearing a 'hard hat'. "                eczema is an intensely pruritic skin disease that usually
Steck WD: Wearing a 'hard hat'              results in a very irritable child. While seborrheic dermatitis
does not accelerate baldness. JAMA          commonly begins during the first three months of life, it is
1982; 247:1345.                             unusual for infantile eczema to begin then. Although
                                            infantile eczema tends to localize in the antecubital and
                                            popliteal fossae in childhood and adulthood, it is
Prescriptions                               uncommon for these particular sites to be affected during
Don't Always                                the first six to 12 months of life. The extensor aspects of
                                            the extremities rather than the flexural aspects seem to be
Pacify Patients                             the preferred distribution sites.
                                               Histiocytosis X is a rare neoplastic disease that involves
( Doctors who think patients want a         the lymph nodes, as well as the liver, spleen and skin. The
prescription as proof that something's      cutaneous eruption can be rather eczematous in appearance
being done for them may be in for a         and may involve sites similar to seborrheic dermatitis or
surprise. In a recent Baltimore study,      infantile eczema, but usually there are areas of purpura to
patients who received prescriptions         tip the physician off that one is dealing with something
were much less likely to describe their     other than a routine inflammatory skin disease. A child
visits with doctors as very satisfactory    affected with histiocytosis X frequently has
than were patients for whom no medi-        lymphadenopathy and hepatosplenomegaly and is not
cation was prescribed. The study sug-       thriving.
gests that a more important consider-          Monilial infections are common in infancy, but usually
ation for patients is effective             spread in a-characteristic satellite fashion, with
communication: Those who received           erythematous papules and pustules beyond the margin of
prescriptions usually saw the doctor        the bright red inflamed skin.
for less than 15 minutes. They also
were less satisfied with the interest the
doctor showed in them, the manner in
which their questions were answered,
and the explanation provided of their
problem and treatment.
Patients want more than treatment
(Professional briefs). Med Econo-
mics 1982 Jan 18, p 11.
CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982                                                                       1213
Suicide an Outlet                           leaving home an hour or two later, by
                                            which time they have subsided. I re-
                                                                                         crime against women. The San Jose
                                                                                         Rape Crisis Center director said that
For Angry Teens?                            corded the usual symptoms of sneez-
                                            ing, palatal pruritus, and overall dis-
                                                                                         rape is a 'crime against people'. In
                                                                                         1979 and 1980, men accounted for 6%
 - Suicide among teenagers aged 15          comfort during this period, as well as       of the rape victims at the San Fran-
to 19 increased by 84% between 1968         pruritus at the time of taking the cap-      cisco Sexual Trauma Center. Most
and 1978, according to Maggie               sules and degree of alertness after          male rape victims are 18 to 35 years
Gilead, assistant professor of nursing      awakening.                                   old and are abused by more than one
at Emory University, Atlanta. Ms. Gi-          There was a significant difference        man or by a weapon-carrying assail-
lead and other teenage-suicide experts      between caffeine and placebo in the          ant. Neither the attacker nor the victim
believe that the increase results from      number of sneezes (p < 0.05, Wil-            is necessarily homosexual, according
the loss of an accepted outlet for feel-    coxon two-sample test) and in the            to Donald Cotton, PhD, clinical psy-
ings of aggression, hopelessness and        overall discomfort (p < 0.05). De-           chologist at Kern County Mental
isolation-. One theory is that during the   creased pruritus was noted from the          Health Service, Bakersfield, Calif. Dr.
Vietnam war, teenagers expressed            time the capsules were taken until the       Cotton explained that men often expe-
their anger through war protests but        period after arising, with both caffeine     rience the same problems as women
now such feelings of anger are directed     and placebo, but was more marked on          in coping with rape. 'They feel the
inward. Suicide is most probable when       the caffeine mornings (not signifi-          same kind of helplessness, depression,
the adolescent can't resolve feelings of    cant). Side-effects of caffeine (e.g.,       anxiety and guilt. In addition, male
isolation and hopelessness. "               increased alertness), which would            victims are likely to question their
                                            have invalidated the double-blind for-       masculinity. There is the feeling that
News briefs. Am Fam Physician               mat, did not occur.                          not only has the physical self been vio-
1982 April; 25:232.                            Caffeine's ability to decrease aller-     lated but that manhood has been taken
                                            gic symptoms more than placebo can           away.' "
                                            be due to the mechanism discussed
                                            above, although if such were the case        News briefs. Am Fam Physician
Caffeine an                                 one might have expected a greater ef-        1982 April; 25:228-232.
Alternative Tx for                          fect on pruritus, which is the symptom
                                            closely linked to histamine. Despite
Allergic Rhinitis?                          the theoretical grounds for trying caf-      Stamping Out
                                            feine, its use for allergic rhinitis has
 " Many people with allergic rhinitis
avoid antihistamines because of their
                                            not been described, though it has been       Unhealthy Habits
                                            reported to be useful in the treatment       ( One of the most frustrating tasks
sedative side-effects. Caffeine may         of the related disorder, atopic derma-
provide an alternative. I incidentally      titis. Theophylline, another xanthine,       many of us face is getting patients to
noted relief of my allergic symptoms        is used to treat asthma, which, like al-     comply with our recommendations for
after ingestion of two analgesic tablets    lergic rhinitis, is a type I allergy; how-   developing healthy and safe lifestyles.
containing paracetamol (acetamino-          ever, bronchial smooth-muscle relax-         In my small-town pediatric practice,
phen) 97 mg, salicylamide 130 mg,           ation rather than inhibited mediator         the problem is parents. But I've come
aspirin 194 mg, and caffeine 65 mg          release is its alleged mechanism of ac-      up with a new gimmick for encourag-
per tablet ('Exedrin') for a headache       tion, and theophylline is not used to        ing good habits: trading stamps.
and suspected that the effect was due       treat allergic rhinitis.                        For the past two years, I've been of-
to the caffeine. Xanthines, including           While this experiment involved only      fering parents in my well-child coun-
caffeine, inhibit cyclic nucleotide         one subject and the mechanism of ac-         seling sessions Top Value Stamps as
phosphodiesterase and thereby in-           tion is unclear, perhaps caffeine and        an incentive for following certain ben-
crease intracellular levels of cAMP.         other xanthines deserve closer scrutiny     eficial procedures in the care of their
This leads to decreased release of his-      as possible treatment for allergic rhin-    children. For example, I give 50
tamine and reduced mast cell degranu-       itis. After all, is not caffeine's elation   stamps at each visit during the time a
lation.                                     preferable to the antihistamines' seda-      mother is breast-feeding her infant. I
   To evaluate the ability of caffeine to   tion? "                                      also give 50 stamps if the parents tell
relieve allergic rhinitis I did the fol-                                                 me that they use an approved, crash-
lowing experiment on myself. Eight Shapiro P: Caffeine for allergic                      tested infant car seat or that they
doses of approximately 140 mg caf- rhinitis. Lancet 1982; 1:793.                         always use seat belts for their older
feine ('NoDoz'), packed into two                                                         children. If either parent is on a doc-
no. 2 gelatin capsules, and eight doses                                                  tor-prescribed and supervised weight
of placebo (sucrose), similarly packed,                                                  control program, I give 10 stamps per
were taken in a random double-blind
fashion on 16 consecutive mornings.
                                            Rape Now a Crime                             pound lost. I offer 20 stamps if no one
                                                                                         in the family smokes, but in this
The capsules were taken upon momen-         Against People                               tobacco-growing state, unfortunately,
 tary interruption of sleep one hour be-
 fore my regular time of awakening so
                                            Not Just Women                               I haven't had to hand out many stamps
                                                                                         for that accomplishment.
 that blood caffeine levels would be - The incidence of rape among men                      We work on an honor system, since
 greatest for the period from awaken- is increasing to the extent that it is no          there's obviously no way of confirm-
 ing, when my symptoms begin, until longer accurate to consider rape a                   ing a patient's claim-except for the
1214                                                                                         CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
weight loss. During each counselling        by allowing the presentation of rele-          exceeding 34.0 cm in circumference.
session, I question the parents to deter-   vant and interesting historical or anec-       To ensure 75% coverage of the cir-
mine if they're eligible for any stamps,    dotal material that might otherwise be          cumference, this range should be shor-
then make a note on the chart. My re-       excluded from a scientific article.            tened by 7.0 cm. Patients with large
ceptionist checks the chart and distrib-       In a recent Op-Ed piece in The New           arms who are 'undercuffed' have sys-
utes the stamps as the parents              York Times, Zerby recalled the critic           tolic and diastolic readings that are
leave .                                     who once wrote that 'a writer's foot-           falsely elevated 5 to 10 mm Hg on the
   Of course, I have no way of deter-       notes ran along the bottom of his pages         average, leading to overdiagnosis and
mining the effectiveness of the stamps,     yapping at the text'.2 However, the             overtreatment of hypertension.
but I like to think that they've had        late scholar Geoffrey Tillotson had a              The problem can be remedied by re-
some positive impact. I was en-             much higher regard for the footnote.           marking, with an indelible marker, the
couraged recently at a party when I         He is said to have written, 'The lay-          right border of the range on a cuff at a
saw the mother of one of my small pa-       man sometimes wonders why one                  point where 75% of the arm's circum-
tients starting to light a cigaret. She     cares so much about a small detail, but        ference is covered by the bladder. This
noticed me watching her and put it          the footnote represents to the scholar         is most easily done by multiplying the
 away, saying sheepishly to those           an attitude towards truth. With a foot-        bladder length by 4/3, then marking a
 around her, 'I guess I better not smoke    note he pledges that he has checked the        vertical line on the cuff at this distance
 or Dr. Payne will stop giving me           accuracy of his source-not just tran-          from the left border of the cuff. Thus,
 stamps'.                                   scription, but fidelity to context-and         when the cuff is applied snugly to the
   A small victory, but gratifying          invites his reader to retrace his course       arm, one will know (without measure-
 nonetheless. "                             of reasoning.'3"                               ment) whether the cuff size is appro-
                                                                                           priate: if on closure the left border
Payne JV: An incentive program for          1. In many law journals, footnotes occupy      meets a point to the left of the new
healthy habits. Med Economics 1982          more space than the text.                      line, the cuff is adequate; if the left
                                            2. Zerby CL: Endangered species is not         border meets a point to the right of the
April 26; p 750.                            incarcerated at the end of the book. New
                                            York Times, August 23, 1981. Page #21.         new line, a larger cuff is required.
                                            3. Levenson JD: Personal communica-               Given the awkwardness of the older
Telephonic                                  tion. Tillotson's remark remains elusive;
                                            although Prof. Levenson is firm in his re-
                                                                                           recommendations regarding cuff size,
                                                                                           it is little wonder that most physicians
Therapy                                     collection, this note indicates that neither
                                            he nor I have yet turned up the source, and    and nurses do not employ objective
                                            that we are still searching. Dr. Levenson is   criteria (manufacturer's marking or
 " A federal court has ordered HHS          a professor of English at the University of    others) in selecting a size. Strict ad-
to reimburse Chicago's St. James Hos-       Virginia.
pital for the bedside telephone service                                                    herence to the 1980 criteria can be ea-
it supplied to Medicare patients. HHS Shaw A, Shaw IA: In praise of foot-                  sily accomplished and will save many
considers telephones patient-comfort notes. N Engl J Med 1982; 306:181.                    large-armed patients from inappro-
items, not covered by Medicare. But                                                        priate antihypertensive treatment. "
the hospital proved, with a detailed                                                       Manning DM: Avoiding sphygmo-
study, that patients who had bedside
telephones suffer less anxiety, less        Off the Cuff                                   manometer-cuff 'hypertension'. N
                                                                                           Engl J Med 1982; 306:108-109.
depression, and have slower heart - In view of the importance of an
rates. "                                  appropriate cuff size in the indirect
                                          measurement of blood pressure, the
It's therapeutic to reach out and more simplified recommendations of
touch someone. Med Economics the American Heart Association                                Of the Coif
1982 April 26; p 14.                      (1980) are very welcome. Making sure              " I hope that (a recent author) will
                                          that the inflatable bladder covers ap-           allow me . . . to correct him on the
                                          proximately 80% of the arm's circum-             term rotator cuff. I regret that I cannot
In Praise                                 ference is more readily accomplished             recall the original article and modern
Of Footnotes                              than ensuring that the bladder's width
                                          exceeds the arm diameter by 20%-
                                                                                           medical dictionaries add 'etym dub'.
                                                                                           However, it is clear that the muscles
 " We would like to suggest that edi- the previous recommendation (1967).                  arising from the glenoid do not sur-
tors of medical journals encourage the       The Association's criteria accept co-         round it as a cuff but spare the lower
use of footnotes by contributing verage of the circumference by the                        part. Thus when the joint is exposed
authors. Footnotes may be used to illu- bladder that is as low as 75% before               and the muscles are divided the ap-
minate, expand, support, explain, they advocate the 'large adult' or                       pearance is that of the old-fashioned
clarify, or illustrate points made in the 'thigh' cuffs. According to this stan-           feminine head dress or coif. The mis-
text, without disrupting the rhythm dard, the 'range' imprinted on many                    take is easily understood and perhaps
and flow of the text itself. Judicious cuffs is overly generous. For example,              one of your readers may recall who
use of the footnote mechanism' would one standard-size adult cuff with a                   first used this charming descrip-
make some articles more readable by bladder 12.5 by 25.5 cm is marked                      tion. "
shifting selected statistical and explan- with a range of air circumference up to
atory matter to footnote status and 41.0 cm. Under the new standards,                      Bot GL: Milwaukee shoulder. Br
would make others more stimulating this cuff should not be used on any arm                 Med J 1982;284:277.
1216                                                                                            CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
The College of Family Physicians of Canada
APPLICATION FOR MEMBERSHIP
(Please print or type)
Name in full .....................................................................................
Office address ......           ..        ....... City    .      .          Prov . ..... Postal Code .......
Residence address ......          ..       ....... City   .      .          Prov . ..... Postal Code .......
Place and date of birth .............................................................................
Sex      Male .........      Female.
Medical Education-Medical School ....................................................................
Date of graduation         .           ............            Degree
                                                                    .

Licensed to practice in . .                  .          .             .         .                 province(s)
Other qualifications and diplomas .....................................................................


Internships-Hospitalsp......................................Year...                                                                                                                                                                                                                                                                                                                                                                                               ..................

and/or                                    ................................................YYear..
Residencies-Universities                                                 Year .
                                              ................................................

                                  .   .   .   .   .   .   .   .   .   .
                                                                         Ye r
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Are you in active family practice?      YesEl NoE
If "yes", how long have you been engaged as a family physician? ..............................................
If "no", what is your present activity? ..................................................................
Are you a member of a hospital staff(s)? YesL NoO
In what category?-Honorary E Active L Associate E Consulting El Courtesy a
Name of hospital(s) ................................................................................

                                                  Member
                                                      of
                                                ............                 medical society
             .......................................................................... m edical society
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Declaration
I hereby make application for membership in The College of Family Physicians of Canada.
I am enclosing my fees for a 12-month period in the class of Active 0 Senior O Associate O Sustaining O Retired O
Ufe-Active O Ufe-Retired 0 membership, in accordance with present membership fees. See "Conditions of Eligibility for Membership."
 I understand that the money will be refunded if my application is not approved.
In submitting this application, I hereby agree to abide by the regu.ations of The College of Family Physicians of Canada.
References: (Must be members of the College of Family Physicians of Canada).
                                          NAME                                                                                                                                                                                                                                                                                                                                ADDRESS
1. ...........................................................................................................
2. ...........................................................................................................
Date    .                                                                                                                                                                                                             ........................................................
                                                                                                                                                                                                                                                                                                                                                          Signature of Applicant

Membership Certificate: I wish to have my membership certificate in the French language ( )                                                                                                                                                                                                                                       English language

Membership applications should be sent to:
The College of Family Physicians of Canada
4000 Leslie Street
Willowdale, Ontario M2K 2R9

                                                          This application form supersedes all similar forms previous to January 1978

1224                                                                                                                                                                                                                                                                                                                                                                                                  CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
   Faculty Position, University of Louisville,              Fulltime Position Available-Ile-a-la-                Medecin Requis pour travailler dans la clini-
Department of Family Practice-seeking medi-              Crosse, Saskatchewan, northern Saskatchewan         que des Services m6dicaux-CN, a Vancouver.
cal faculty to fill vacancies in university and          practice. Private physician/contractual agree-      Position a temps plein, 5 jours par semaine. Les
community hospital based residency program.              ment with Department of Northern Saskatch-          candidats(es) doivent etre interesses(es) a pour-
Responsibilities may include teaching with grad-         ewan. Terms of contract $80,000 per year. Of-       suivre une carriere en medecine industrielle et
uate and undergraduate programs. Opportunities           fice and other expenses included, plus four week    preventive. Postuler aupres du Dr. G. C. Pretty,
available for research and private practice.             paid vacation and two week paid education leave     Medecin-chef regional-CN, 10004104e ave-
Board certification required. Interest in obste-         per annum. Good air ambulance connections to        nue, Edmonton, AB. T5J OK2, ou aupres du Dr.
trics preferred. Academic appointment and re-            tertiary centres. Well-equipped 38-bed hospital.    M. T. Stephen, Directeur-Services me'dicaux et
muneration negotiable. Address inquiries to:             Three doctor clinic. Relocating expenses. Full-     de sante, 935 ouest, rue Lagauchetiere,
Chairman, Department of Family Practice, Uni-            time positions-locums also-available. Forfur-       Montrial, PQ. H3B 2M9.
versity of Louisville, School of Medicine, 801           ther inforrnation contact: Medical Clinic, lIe-a-
Barret Ave., Louisville, KY. 40204. University           la-Crosse, SK. SOM ]CO, Attention: Dr. Lacny.          Family Physician-Large, active multispe-
of Louisville is an equal opportunity/affirmative        (306) 833-2144 collect.                             cialty group close to Toronto requires additional
action employer.                                                                                             fulltime family physician. Liberal salary and
                                                            Medecin Requis pour travailler dans la clini-    fringe benefits. Early opportunity for partner-
   You Are Invited to apply to a growing mod-            que du Siege social, Services medicaux-CN,          ship. Please write to: Medical Director, Oshawa
em medical centre in north-central Toronto. A            Montreal. Position a temps plein, 5 jours par se-   Clinic, 117 King St. E., Oshawa, ON.
family practitioner is needed to join a health care      maine. Les candidats(es) doivent avoir une          LIH IB9.
team including: doctors, a nurse practitioner, a         bonne connaissance des deux langues, anglais et
                                                         francais, et etre interesses(es) a poursuivre une       Wanted-An FP willing to accept the full re-
registered nurse and office support staff. The           carriere en medecine industrielle et preventive.    sponsibilities of a rural general practice within
centre provides general practice and preventive          Postuler aupres du Dr. R. G. Milet, Me'decin-       45 miles of Ottawa. Shawville is located in the
medicine through a variety of methods: clinics,          chef re'gional-CN, 935 ouest, rue Lagauche-         Pontiac County on the Quebec side of the Ot-
speakers, etc. This position provides regular            tiere, Montreal, PQ. H3B 2M9.                       tawa River. Area of 20,000 people. Hospital of
hours and fringe benefits. This is a salaried posi-                                                          84 beds, staffed by surgeon, pediatrician and
tion open to negotiation. Please send your re-              Wanted-Family Practitioner to join mixed         five family practitioners. Bilingualism a neces-
sume with experience and qualifications to Mr.           FP/specialist group of 13 physicians. Full equal    sity. Physician recently left, leaving a busy prac-
N. Gurr, Personnel Chairman, Lawrence                    partnership after a six month period. 100-bed       tice. Office available at a reasonable rent. Please
Heights Medical Centre, 3 Replin Rd., Toronto,           acute care hospital in the town with active OR      direct enquiries to: Dr. Thomas O'Neill, P.O.
ON. M6A 2M8. Telephone: (416) 787-1661.                  and intensive care unit. Anesthetic experience      Box 610, Shawville, PQ. JOX 2Y0.
                                                         helpful. A town of 13,000 with a catchment area
    Family Physician Required immediately to             of 30,000. Excellent summer and winter outdoor          Physician Wanted-seek board eligible or
-join group of three other FPs and six consultants       recreational opportunities. Reply to: E. M. Gar-     certified family practitioner to join established
 in medical facility in a town in southeastern On-       diner, Kirkland Medical Group, Kirkland Lake,        group of four family practitioners in central
 tario with fully accredited hospital. Good recrea-      ON. Telephone: (705) 567-5331. Position avail-       Georgia. Beautiful community-excellent com-
 tional facilities are available in area. For further    able July, 1982. Summer locum tenens position       pensation. For further infornation call (collect)
details please contact the Secretary, T.M.A .L.,         also available from June 15 to September 15,        (912) 272-7411 or write Ernest F. Jones, Jr.,
Box 521, Trenton, ON.                                    1982.                                               P.O. Box 927, Dublin, GA. 31021.




The College of Family Physicians of Canada
 CONDITIONS OF ELIGIBILITY FOR MEMBERSHIP
ACTIVE MEMBER-$175                                       (d) Active certificants will be required to pay     LIFE MEMBER-ACTIVE-No fee
(a) Active members In this Coilege shall be                  an additional $10 per year for the mainte-          Is a physician who has attained age sev-
    duly elcted members whos status has                      nance of certification program.                     enty. The life member who is actively en-
     been confirmed by the Executive Director,                                                                   gaged in or concerned with the practice of
    and whose dues to this College have been             ASSOCIATE MEMBER-$20                                    family medicine Is not required to pay the
    paid.                                                (a) Associate membership may be granted to              annual membership fee(s) but Is required to
                                                             any intern or resident in training for family       comply with the other components of the
(b) The requirements for active membership                   medicine.                                           Active membership classification.
     shall be:                                           (b) Associate members shall be entitled to the
       i. To be engaged in active family practice            floor at general meetings but shall not vote     LIFE MEMBER-RETIRED-No fee
          or to qualify for certification as a
                                                             nor hold office.                                    Is a physician who has attained age sev-
          residency-eligible candidate.                  SUSTAINING MEMBER-$110                                  enty. The retired life member is not required
      ii. To have conducted practice according           (a) Sustaining membership may be granted to             to pay the annual membership fee(s) and
          to the Code of Ethics of the College.              any physician who is not engaged in the ac-         need not submit evidence of a program of
     iii. To undertake to complete fifty (50)                tive practice of medicine, and who has en-          postgraduate studies.
          hours of approved postgraduate study               tered another field of endeavor but desires
          during each one (1) year period.                   to keep his affiliation or become affiliated    NONRESIDENT-$75
 (c) Active members shall be elected initially for           with the College.                                  Nonresident membership is granted to
      a probationary period of one year. There-          (b) Sustaining members shall have no post-             members who are resident outside Canada.
      after they shall be eiigible for re-election for       greduate study requirements.                       The rights, dutlie and requirements of
      two-year periods if so recommended by the          (c) Sustaining members shall have the privi-           Nonreddent members are determined by
      Credentials Committee after a review of the            lege of the floor at general meetings, but         the membership classification to which
      postgraduate studies completed in the pre-             may not vote nor hold office.                      they belong.
      vious requisite period. No member shall be          SENIOR MEMBER-$110
      re-elected to membership who has not                (a) Senior membership shall be granted to ac- PROVINCIAL CHAPTER FEE is an additional
      completed during the preceding two (2)                  tive members past the age of sixty-five (65), fee set by certain chapters to provide for fur-
      year period a minimum of one hundred                    who have been engaged in active family ther activities at the provincial level. Those
      (100) hours of postgraduate study of a na-              practice more than thirty (30) years.         chapters having a provincial fee include:
      ture acceptabie to the Board of Directors.
                                                          (b) Senior members shall have no post gradu-
                                                              ate study requirements.                          ALBERTA                                $65
                                                          (c) Senior members shall have the privilege of       BRITISH COLUMBIA                       $35
  CERTiFICANT MEMBER                                          the floor at general meetings, may vote and      MANITOBA                               $30
 (a) Certification shall be granted to eligible               may hold office.                                 NEW BRUNSWICK                          $15
     candidates following the satisfactory com-                                                                NEWFOUNDLAND                           $20
     pletion of an appropriate examination set            RETIRED MEMBER-$55                                   SASKATCHEWAN                           $25
     by the College.                                          Is a physician who is no longer practicing       ONTARIO-Active                         $45
 (b) Certificants shall be entitled to the same               family medicine on a fulltime or part-time                 -Senior                      $45
     privileges, rights, duties and requirements              basis and who is no longer engaged In pro-                 -Sustaining                  $20
     as active members.                                       fessional activities. The retired member is                -Retired                     $15
 (c) Certificants shall be desiqnated "Certifi-                required to pay the annual membership                     -Associate                   $20
     cant of the College of Family Physicians of               fee(s) but need not submit evidence of a         NOVA SCOTIA                           $20
     Canada", or abbreviated, "C.C.F.P.".                      program of postgraduate studies.                 OUEBEC                                $15

CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982                                                                                                                     1225
   Assistant/Locum-well established and rap-
idly growing practice of three family practi-
tioners seek a fourth as locum tenens starting
July 1st through September 30th, 1982. View to
partnership. New 25-bed hospital. Excellent
                                                          ith COLUM
recreational facilities for the outdoors person.
Obstetrics a necessity. Please reply to: Dr. Rich-
ard How, Box 1619, Port Hardy, BC. VON 2PO
or call (604) 949-6514.
                                               Seen any good misprints lately?                   cause they may have been distributed
 For Sale or Rent                              Heard any good lines from                         under several brand names, the cans
   Doctors Office, will sublet, 57 Division patients? We're interested-a laugh
                                                                                                 involved can be identified only by the
Street, Welland, Ontario. Furniture and equip- a day keeps the doctor away. Send                 code stamped on the end of the can,
ment for sale. Reply: CANADIAN FAMILY PHY- items to The Fifth Columnist, 4000                    and the declaration "Product of USA"
SICIAN, Box 1140, 4000 Leslie St., Willowdale,                                                   on the label.
ON. M2K 2R9.                                   Leslie St., Willowdale, ON.
   Office Space, Mississauga/Scarborough. M2K 2R9.
                                                                                                    The release points out: "Salmon
 Suitable for FP/specialist. Established areas. Ex-                                              canned in Canada, which will have
 cellent potential for medical centre or separate
 practices. Contact: Bob Fox (416) 222-115            It Wasn't Apparent...                      'CANADA' embossed on one end of
                                                                                                 the can, is NOT implicated in this
days or (416) 222-3728 evenings.
                                                      A release accompanying a recent issue problem. "
    Family Practice For Sale in plaza area, next      of JAMA directed our attention to a let-
 to pharmacy at Scarborough Golf Club Road and
 Lawrence Avenue, Toronto. Annual gross at            ter to the editor. The letter told of an Ah, the Maple Leaf forever.
 least $120,000. Asking $60,000. Reply: (416)         anatomy student who discovered on
294-4392.
                                                      the first day of dissection that her great
    Family Practice For Sale located at 4125          aunt was in the same class-as a ca- On the Wagon
Lawrence Avenue East, Toronto. Located in
 store level of medical building next to phar-        daver.
 macy. Annual gross of $135,000. Asking                  The letter noted that the student and A South Wales milkman, banned from
$65,000. Reply: (416) 294-4392.                       her aunt at one time had discussed the driving his delivery truck because of a
   Practice For Sale. Georgian Bay, Ontario.
Well-established young practice in pleasant
                                                      "relative merits of body donation to drinking conviction, now plans to de-
community. Excellent on-call. Returning to spe-       medical science"-"no pun in- liver his milk by horse and cart.
cialize. Anesthesia an asset. Reply: CANADIAN         tended", the release writer hastened to       Using a $440 cart purchased from a
FAMILY PHYSICIAN, Box 1110, 4000 Leslie St.,          add.                                       local scrap dealer, and his 12-year-old
Willowdafe, ON. M2K 2R9.                                                                         stallion Tonto, he figures that delivery
Doctor's Office Furniture: three large desks,                                                    to his 400 customers will take. eight
chairs, three examining tables, two scales, two
treatment cabinets, gooseneck lamps, etc. Tele-
                                                      Creative Anatomy                           hours-double his usual time.
phone: (705) 765-5370 after five o'clock or           The newsletter of the Ontario Public
write: Box 290, Port Carling, ON. POB IJO.
                                                      School Men's Teachers' Federation Heigh-ho Silver, and thank-you very
   Very Lucrative Practice For Sale, located          (say that five times fast) recently car- much, milk.
downtown Calgary. Walking distance from two           ried an item about a Grade 5 teacher
major hospitals. X-ray, lab and pharmacy in the       who gave his students a lesson on the
same building. Owner planning retirement.
Reply: CANADIAN FAMILY PHYSICIAN, Box
1080, 4000 Leslie St., Willowdale, ON.
                                                      human body.
                                                         All the students passed, except for
                                                                                                 Just Playing
M2K 2R9.                                              one who wrote: "The human body is "The concert was a great success.
    Doctor's House For Sale in village, beautiful     composed of three parts-the Brain- Special thanks are due to the vicar's
rural area east of Toronto, within easy reach of
the city. Garden, swimming pool, air-condition-       ium, the Borax and the Abominable daughter who laboured the whole eve-
 ing. Well-equipped office in house, potential for    Cavity. The Brainium contains the ning at the piano, which as usual fell
 lucrative practice. Reply: CANADIAN FAMILY           brain. The Borax contains the lungs, upon her."
PHYSICIAN, Box 1120, 4000 Leslie St., Willow-
dale, ON. M2K 2R9.                                    the liver and. the living things. The                              -Palm Leaves
                                                      Abominable Cavity contains the                           (Dubai parish magazine)
         Business Opportunity                         bowels, of which there are five: A, E,
                                                      I, 0, and U."                              That's what she gets for tickling the
  Medical clinic located in west end                                                             ivories.
  Montreal for sale. Interested parties               That kid should write press releases for
  please direct inquiries to                          the AMA.
       CANADIAN FAMILY PHYSICIAN                                                                 Just Pulling His Leg
       Box 1130                                       Damn Yankees                               "His friends will be very sorry to learn
       4000 Leslie St.
       Willowdale, ON. M2K 2R9                        While we're on the subject of news re-     that he had an operation last Wednes-
                                                      leases, we just got another one-this       day and had his leg removed. All
                                                      time from Health and Welfare Canada,       going well he should be back on his
                                                      on the subject of topical fish.            feet by the end of November."
                                                         Seems the federal health department            -Cobar Age, New South Wales
                                                      is recalling all 73/4 oz. cans of salmon
                                                      produced by an Alaskan canner. Be-         Hope he gets off on the right foot.


1228                                                                                                  CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982

				
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