Editorial Director Editorial Advisers Infectious Diseases
Donald I. Rice, MD D. C. Brown, MD, Halifax Dr. Pierre Viens, Montreal
Editor John Anderson, MD, Kingston Dr. T. J. Murray, Halifax
Margaret McCaffery Marie-Dominique Beaulieu, MD,
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
Dr. Ronald E. M. Lees, Kingston
D. T. Powter, MD, Vernon
Consultant Editorial Advisers
Bill Woods Dr. Fernand Blondeau, Quebec
Biostatistics Dr. Judith H. Gold, Halifax
Director of Communications Dr. Moira Stewart, London
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
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
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
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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
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and FAMLI. summary. Do NOT send first drafts. Authors are responsible for accuracyi of
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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
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CANADIAN FAMILY PHYSICIAN for illustrations (which should be referred sent to the author and should be returned
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CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982
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
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-
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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.
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)
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.
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.
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
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
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
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
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
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
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
BEC:AUISE NO MATFER HO HEY TRAWL,
THEY OUIGHT 10 TRAVELWELL
Trepared by Pfizer Canada Inc., (R.U.)
Pfizer Inc. T M Owner
CAN. FAM. PHYSICIAN Vol. 28: JUNE 1982 1135
* 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
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.
kill and should be beneath the artist's 6 During a recent year as a hospital factors, impotencenotes thattoa organic
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, -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
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
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 .....................................................................
Residencies-Universities Year .
. . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................Yer
Teaching appointments .............................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
* . . *.**.***..
** * . . . . . . . . . .
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) ................................................................................
............ medical society
.......................................................................... m edical society
.......................................................................... medical society
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).
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
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
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.
All the students passed, except for
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