MALCOLM S. M. WATTS, MD, Editor
LLOYD H. SMITH, JR., MD, Assoctate Editor
THE WESTERN DAVID GREER, Managing Editor
BARBARA T. ROONEY, Assistant Managing Editor
Journalof Medice
Since 1902 Formerly California Medicine
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CONTRIBUTIONS OF SCIENTIFIC AND ORIGINAL ARTICLEs
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J. David Bristow, Portland Leon J. Epstein, San Francisco nal Articles-Authors are responsible for all statements,
conclusions and methods of presenting their subjects. These
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wide latitude as the general policy of the Journal and the
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revise or reject any manuscript is always reserved.
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Neurology effort will be made to return unused manuscripts.
Pierre M. Dreyfus, Davis Length of Articles-Ordinarily articles should not ex-
Radiology ceed 3,000 words (approximately 5 printed pages). Under
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words be published.
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Ralph W. Hale, Honolulu References-Should conform to the following order: name
Albert Starr, Portland of author, title of article, name of periodical with volume,
Ernest W. Page, San Francisco inclusive pages, month and year-i.e.: Lee GS: The heart
rhythm following therapy with digitalis-In theory and
Ophthalmology Urology practice. Arch Int Med 44:554-562, Dec 1942. They should
be listed in the order in which they are cited in the text,
David 0. Harrington, San Francisco Thomas F. Conroy, San Mateo numbered in sequence and punctuated as aboive.
Ruben F. Gittes, La Jolla Reprints-Reprints must be pald for by the author at
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Orthopedics
Consultants in Medical Services CONTRIBUTIONS OP "LErrERs TO THE EDrrOR"
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"'Entered as second class matter at the post office in San Francisco and additional mailing offices under the Act of March 3, 1879."
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HEWETEN OUNA O D I
2 THE WESTERN JOURNAL OF MEDICINE
EPITOMES-NUCLEAR MEDICINE
Role of Liver and Bone Scanning mal findings on skeletal survey with normal re-
in Evaluation of Possible sults on bone scan are rare. Abundant recent
Metastatic Disease literature supports the conclusion that the bone
scan is the diagnostic method of choice for skele-
IN SPITE OF continuing improvements in equip- tal evaluation. The bone scan is particularly useful
ment and radiopharmaceuticals, the detention in carcinoma of -the lung, breast and prostate, as
efficiency of the liver scan for liver metastasis well as in lymphomas.
remains in the 70 to 80 percent range. However,
this lack of improvement in accuracy must not be Though the bone scan is highly sensitive, its
lack of specificity must be noted. To avoid the
taken as an indication that the scan is not effica-
cious. A recent National Institutes of Health study problem of false positive readings on bone scans,
a single x-ray film of the area shown to be abnor-
again indicates that liver scanning may be more mal on bone scan should be obtained to exclude
sensitive than the usual clinical or laboratory
measurements-serum glutamic oxalic trans-
nonneoplastic causes of increased osteoblastic
aminase (SGOT), serum glutamic pyruvic trans- activity such as trauma and metabolic, inflamma-
aminase (SGPT), lactic dehydrogenase (LDH), tory or degenerative abnormalities. Initial use of
the bone scan for skeletal evaluation will avoid
bilirubin, alkaline phosphatase-in detecting he- diagnostic overkill, reduce the cost of having both
patic metastases. a complete skeletal survey and bone scan and
The evaluation of the bony skeleton has pre-
viously been accomplished by the radiologic still ensure the highest degree of diagnostic ac-
skeletal survey. However, the bone scan, aided by curacy available in the pretreatment evaluation of
newer bone-seeking radiodiagnostic agents, has
neoplastic disease.
been found to be a more sensitive diagnostic THERON BROWN, MD
modality. In the face of metastatic disease, re- REFERENCES
sults in patients who are given both a bone scan Levenson SM, Ingle JN, Richman SD, et al: Liver scanning in
metastatic carcinoma of the breast. J Nucl Med 16:545-546, Jun
and a skeletal survey will be positive on the scan 1975 (Abstract)
and normal on x-ray studies. Conversely, abnor- Bisson J, Vickers M, Fagan WT: Bone scan-In clinical per-
spective. J Urol 111:665-672, May 1974
ADVISORY PANEL TO THE SECTION ON NUCLEAR MEDICINE
PAUL B. HOFFER, MD, Section Editor, San Francisco
JOHN R. WHITE, MD JORGE FRANCO, MD WILLIAM BLAHD, MD
CMA Section on Nuiclear Medicine CMA Section on Nuclear Medicine CMA Scientific Board
Chairman Assistant Secretary West Los Angeles
Torrance San Jose
PAUL B. HOFFER, MD
RICHARD C. RIPPLE, MD WILLIAM L. ASHBURN, MD University of California, San Francisco
CMA Section on Nuclear Medicine University of California, San Diego
Secretary JAN SIEMSEN, MD
Sacramento CARL JANSEN, MD University of Southern California
Loma Linda University Los Angeles
KENNETH LYONS, MD
University of California, Irvine JOSEPH P. KIuss, MD ROBERT KRAFT, MD
California College of Medicine Stanford University Burlingame
L. ROBERT BENNETT, MD GERALD DENARDO, MD NANCY TELFER, MD
University of California, Los Angeles University of California, Davis Los Angeles
392 NOVEMBER 1975 * 123 * 5
t-The Perfect
>-iHoliday Gift-
and one that lasts each and
every month of
u~~~~~~~ the year
l,
A subscription to
THE WESTERN
Journal of Medicine
12 issues ........$8.00
1 year
Foreign countries $9.00
(After December 31, 1975, rates will be
$10 domestic, $11 foreign)
a most informative
and useful journal
We will be pleased to send a gift card to recipient with your greeting
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30 THE WESTERN JOURNAL OF MEDICINE
CONTINUING MEDICAL EDUCATION
California, Hawaii * Oregon * Washington, Montana, Alaska, Idaho
November 19-21-Respiratory Failure. USC. Friday-Sunday.
CALIFORNIA and HAWAII November 20-22-West Coast Allergy Society. Royal Inn at
COMMITTEE ON CONTINUING MEDICAL EDUCATION the Wharf, San Diego. Thursday-Saturday. Contact: Harvey
THIS BULLETIN of information regarding continuing educa- 0. Randel, MD, WCAS, 2164 SW Park P1., Portland, Ore.
tion programs and meetings of various medical organiza- 97205. (503) 226-1555.
tions in California and Hawaii is supplied by the Committee November 22-Nuclear Cardiology. UCSF. Saturday.
on Continuing Medical Education of the California Medical
Association. In order that they may be listed here, please November 22-Management of Respiratory Failure in Infants.
send communications relating to your future meetings or See Pediatrics, November 22.
postgraduate courses two months in advance to Committee November 22-Flexible Bronchofibroscopy. See Surgery, No-
on Continuing Medical Education, California Medical Asso- vember 22.
ciation, 731 Market Street, San Francisco 94103; or phone
(415) 777-2000. Note: For a list of organizations approved for December 4-6-Rheumatic Diseases-4th Annual Western Re-
Category I Credit toward the CMA Certificate in Continuing gional Conference. UCSF at Claremont Hotel, Oakland.
Medical. Education, please write to the above address. Thursday-Saturday.
December 5-6-Diabetes Mellitus. STAN and Santa Clara
County Diabetes Assn. at Rickey's Hyatt House, Palo Alto.
CANCER Friday-Saturday. Contact: STAN.
November 22-Practical Oncology. UCD. Saturday. December 5-6-Invitational Seminar: Clinical Aspects of Com-
mon Infectious Disease. See Of Interest To All, December
December 7-Seminar on Head and Neck Tumors-Semi- 5-6.
Annual. California Tumor Tissue Registry, Hyatt Hotel, San
Francisco. Sunday. Contact: Weldon K. Bullock, MD, Exec.
Dir., Calif. Tumor Tissue Registry, 1200 N. State St., Box 40, KEY TO ABBREVIATIONS AND SYMBOLS
Los Angeles 90033. (213) 226-4614. Medical Centers and CMA Contacts
January 16-17-Childhood Cancer: Major Clinical Advances for Information
and New Problems in Family Adjustment Children's Hospital CMA: California Medical Association
of L.A. and American Cancer Society at Children's Hospital, Contact: Continuing Medical Education, California
Los Angeles. Friday-Saturday. Contact: Daniel M. Hays, MD, Medical Association, 731 Market Street, San Francisco
94103. (415) 777-2000.
Children's Hospital, P.O. Box 54700, Los Angeles 90054. DREW: Charles R. Drew Postgraduate Medical School
(213) 660-2450, ext. 2675. Contact: Duane Dillman, PhD, Director, Office of
January 16-18-Gynecologic Oncology. Women's Hospital Med- Continuing Education, Charles R. Drew Postgraduate
Medical School, 1621 East 120th Street, Los Angeles
ical Center at Memorial Hospital Medical Center-UCI Center 90059. (213) 564-5911, ext. 391.
for Health Education, Long Beach. Friday-Sunday. 15 hrs. LLU: Loma Linda University
$200; $100, residents. Contact: Margaret Frederick, Exec. Contact: John E. Peterson, MD, Associate Dean for-
Sec., Ctr. for Health Education, 2801 Atlantic Ave., Long Continuing Medical Education, Loma Linda University
School of Medicine, Loma Linda 92354. (714) 796-7311.
Beach 90801. (213) 595-3823. PMC: Pacific Medical Center
January 19-23-Cancer. STAN. Monday-Friday. Contact: Allen J. Enelow, MD, Chairman, Education
Committee, Pacific Medical Center, P.O. Box 7999. San
January 28-Lung Cancer. Hospital of the Good Samaritan, Los Francisco 94120. (415) 563-4321.
Angeles. Wednesday. Contact: Janie Sternal, Coord., CME, STAN: Stanford University
Hospital of the Good Samaritan, 1212 Shatto St., Los Angeles Contact: Edward Rubenstein, MD, Associate Dean for
Postgraduate Education, Stanford University School of
90017. (213) 482-8111. Medicine, 300 Pasteur Drive, Stanford 94305. (415)
497-5594.
February 27-Breast Cancer. UCSF at Childrens Hospital and UCD: University of California, Davis
Medical Center, San Francisco. Friday. Contact: Neil C. Andrews, MD, Chairman, Depart-
ment of Postgraduate Medicine, University of California,
Davis, School of Medicine, Davis 95616. (916) 752-0328.
MEDICINE UCI: University of California, California College of Medicine,
Irvine
November 15-Pediatric Dermatology. Childrens Hospital of Contact: Robert Combs, MD, Associate Dean, Con-
Orange County, Orange. Saturday. Contact: Merl J. Carson, tinuing Medical Education, University of California,
MD, Med. Dir., CHOC, 1109 W. La Veta Ave., Orange Irvine-California College of Medicine, Irvine 92664.
(714) 833-5991.
92668. (714) 633-6030. UCLA: University of California, Los Angeles
November 15-18-Gastroenterology: Current Topics with Em- Contact: Martin D. Shickman, MD, Director, Con-
tinuing Education in Medicine and the Health Sci-
phasis on Peptic Ulcer. UCLA at Kona Kai Hotel, San ences. P.O. Box 24902, UCLA, Los Angeles 90024. (213)
Diego. Saturday-Tuesday. 825-7241.
November 16-Heparin-Thrombosis Seminar. American Heart UCSD: University of California, San Diego
Contact: David Allan, MD, Associate Dean for Con-
Assn. Council on Thrombosis; American Heart Assn., Greater tinuing Medical Education, 1309 Basic Sciences Building,
Los Angeles Affiliate, at Hilton Hotel, Los Angeles. Sunday. University of California, San Diego, School of Medicine,
La Jolla 92037. (714) 452-3708.
$30. Contact: Symposiums International, 130 El Camino Dr., UCSF: University of California, San Francisco
Beverly Hills 90212. (213) 273-2157. Contact: Malcolm S. M. Watts, MD, Associate Dean
and Director, Extended Programs in Medical Education,
November 16-Hypertension. UCLA and Granada Hills Com- School of Medicine, University of California, San Fran-
munity Hospital at Calif. State University, Northridge. cisco 94143. (415) 666-2342.
Sunday. USC: University of Southern California
Contact: Phil R. Manning, MD, Associate Dean, Post-
November 17-21-American Heart Association. Disneyland graduate Division, University of Southern California
Hotel, Anaheim. Monday-Friday. Contact: William W. School of Medicine, 2025 Zonal Avenue, Los Angeles
90033. (213) 226-2047.
Moore, Exec. V. P., AHA, 44 E. 23rd St., N.Y. 10010.
36 THE WESTERN JOURNAL OF MEDICINE
December 6-Advances in Diabetes Meilitus, Calcium and November 22-Management of Respiratory -Failure in Infants.
Water Disorders. Daniel Freeman Memorial Hospital at Harbor General Hospital, Torrance. Saturday. 6 hrs. $45.
International Hotel, Los Angeles. Saturday. $35. Contact: Contact: Ellen Woolfson, Cont. Ed. Coordinator, Torrance
Joan Covell, Med. Staff Sec., Daniel Freeman Memorial General Hospital, 1124 W. Carson A-19, Torrance 90502.
Hospital, 333 N. Prairie Ave., Inglewood 90301. (213) 672- (213) 775-7711, ext. 1373.
0112, ext. 206. December 6-American Academy of Pediatrics, California
December 6-What Patients and Friends Ask About Asthma. Chapter 1, District IX. San Francisco. Saturday. Contact:
UCLA. Saturday. Melvin H. Schwartz, MD, 2219 Santa Clara Ave., Alameda
94501.
December 6-11-American Academy of Dermatology. Hilton January 8-1 1-Winter Ski and Study Symposium-First An-
Hotel, San Francisco. Saturday-Thursday. Contact: Betty nual. American Academy of Pediatrics, Calif. Chapter 2, at
Suor, Exec. Dir., AAD, 1116 S. Fifth, Tacoma, Wa. 98405. Mammoth Mountain. Thursday-Sunday. 141/2 hrs. $125.
(206) 572-4747. Contact: AAP, Calif. Chapter 2, P.O. Box 2134, Inglewood
December 7-9-Advances in Heart Disease-1976. American 90305.
College of Cardiology at Fairmont Hotel, San Francisco. January 23-25-Pediatric Anesthesiology. See Surgery and Anes-
Sunday-Tuesday. Contact: Mary Anne McInerny, Dir., Dept. thesiology, January 23-25.
of Cont. Ed. Programs, ACC, 9650 Rockville Pike, Bethesda, February 18-The Pediatrician's Obligation in the Atheroscle-
Md. 20014. rosis Epidemic. American Heart Assn., Greater L.A. Affiliate,
December 10-Colloquia in Cardiology-No. 8: Stress and the and L.A. Pediatric Society at Hyatt Regency Hotel, Los
Heart-The Influence and Management of Stress in Heart Angeles. Wednesday. Contact: Nancy Brown, AHA, Greater
Disease. American College of Cardiology at Ambassador L.A. Affiliate, 2405 W. 8th St., Los Angeles 90057. (213)
Hotel, Los Angeles. Wednesday. Contact: Mary Anne 385-4231.
Mclnerny, Dir., Dept. of Cont. Ed. Programs, ACC, 9650 February 26-28-Pediatric Hematology-Annual Winter Meet-
Rockville Pike, Bethesda, Md. 20014. ing. Children's Hospital Medical Center of Northern Calif. at
December 10-12-Respiratory Failure. USC. Wednesday-Friday. Sahara Tahoe Hotel, South Lake Tahoe. Thursday-Saturday.
Contact: Inetta Carty Calori, CHMC, 51st & Grove Sts.,
January 16-Current Concepts in Management of Thyroid Dis- Oakland 94609.
orders. Cedars-Sinai Medical Center at Mt. Sinai Hospital,
Los Angeles. Friday. Contact: Linda Alperstein, Coord., PSYCHIATRY
CME, Cedars-Sinai Medical Center, 4833 Fountain Ave.,
Los Angeles 90029. (213) 662-9111, ext. 206. December 10-13-Development of Techniques for Family
Counseling. See Of Interest To All, December 10-13.
January 16-18-Third Neonatal Respiratory Symposium. See
Surgery and Anesthesiology, January 16-18. January 7-March 17-Intensive Review of Psychiatry and Neu-
rology. USC. Wednesdays, 10:00 a.m.-12:00 noon.
February 5-6-Contact Dermatitis. STAN. Thursday-Friday.
February 1-6-Psychiatry Update: 2nd Annual Mid-Winter
February 14-Annual Cardiology Symposium. Fresno Commun- Program for Psychiatrists. UCD at Bear Valley. Sunday-
ity Hospital. Saturday. Contact: Joanne Ellis, Fresno Com- Friday.
munity Hospital, P.O. Box 1232, Fresno 93715.
February 16-21-Topics in Internal Medicine. UCSD at Town RADIOLOGY AND PATHOLOGY
and Country Hotel, San Diego. Monday-Saturday. December 3-7-California Society of Pathologists-Annual
February 26-27-Dermatology for Internists and General Prac- Meeting. Hyatt Regency, San Francisco. Wednesday-Sunday.
titioners. UCSF at St. Francis Hotel, San Francisco. Thurs- Contact: Mr. Richard E. Hall, CSP, 1225 8th St., Suite 590,
day-Friday. Sacramento 95814. (916) 446-6001.
February 26-28-Pediatric Hematology. See Pediatrics, Feb- December 11-14-Fluid and Electrolytes. USC at Tennis Club,
ruary 26-28. Palm Springs. Thursday-Sunday.
February 27-28-Pulmonary Artery Catheterization. PMC. December 13-Principles and Procedures of Blood Gases. PMC.
Fri.-Sat. Saturday. $65.
January-May-Ultrasound - Comprehensive Lecture Series.
OBSTETRICS AND GYNECOLOGY USC. Weekly, 7:00-9:00 p.m., 20 consecutive weeks. Con-
December 13-14-Birth and Rebirth. UC Extension, Santa tact: Robert L. Wilson, MD, P.O. Box 1961, 1200 N. State
Cruz. Saturday-Sunday. 15 hrs. $40. Contact: Darla Chadima, St., Los Angeles 90033.
Cont. Ed. Specialist, UC Extension, Santa Cruz 95064. (408) January 30-February 1-Midwinter Radiological Conference-
429-2971. 28th Annual. L.A. Radiological Society at Century Plaza
January 16-18-Third Neonatal Respiratory Symposium. See Hotel, Los Angeles. Friday-Sunday. Contact: Los Angeles
Surgery and Anesthesiology, January 16-18. Radiological Society, 15107 Vanowen St., Van Nuys 91405.
January 16-19-Basic Laparoscopy: Current Principles and SURGERY AND ANESTHESMOLOGY
Practice. UCSD at Sea Lodge, La Jolla. Friday-Monday.
November 15-Current Concepts in Ophthalmic Plastic Surgery:
January 17-24-Perinatal Medicine. USC at Royal Lahaina, The Eye Lid. UCLA. Saturday.
Maui, Hawaii. One week.
November 15-Anesthesia and the Blood. UCD at Woodlake
February 7-8-Obstetrical and Gynecological Forum. Los Inn, Sacramento. Saturday.
Angeles Obstetrical & Gynecological Society at Beverly Hilton
Hotel, Los Angeles. Saturday-Sunday. 14 hrs. $45. Contact: November 21-23-Common Problems-Acute Hand Injuries.
Miss Dee Davis, Exec. Sec., L.A. Ob & Gyn Society, 5410 UCLA. Friday-Sunday.
Wilshire Blvd., Los Angeles 90036. (213) 937-5514. November 22-Flexible Bronchofibroscopy. PMC. Friday. 6
February 18-20-Neonatal Medicine. USC. Wednesday-Friday. hrs. $300.
February 24-26 Ob Infectious Diseases. USC. Tuesday-Thurs- December 3-5-Hereditary Disorders of the Eye-Annual
day. Ophthalmology Course. UCSF. Wednesday-Friday.
December 5-Cataract Surgery and Intraocular Lens Implanta-
PEDIATRICS tion Workshop. Jules Stein Eye Institute, Los Angeles. Friday.
November 15-Pediatric Dermatology. See Medicine, Novem- $150. Contact: Jules Stein Eye Institute, 800 Westwood
ber 15. Plaza, Los Angeles.
ADVERTISING * NOVEMBER 1975 n
December 5-6-Invitational Seminar: Clinical Aspects of Com- DARVOCET-N® 100
mon Infectious Disease. See Of Interest To All, December propoxyphene napsylate with acetaminophen
5-6. Indication: For the relief of mild to moderate pain, either alone or accompanied by
December 5-7-Electronystagmography. PMC at Regency Hyatt, fever.
San Francisco. Friday-Saturday. Contraindications: Hypersensitivity to propoxyphene or to acetaminophen.
December 5-9-International College of Surgeons, U.S. Section Warnings: Drug Dependence-Propoxyphene can produce drug dependence
-Annual Meefing. Sheraton Waikiki, Honolulu. Friday-Tues- characterized by psychic dependence and, less frequently, physical dependence
and tolerance. Propoxyphene will only partially suppress the withdrawal syndrome in
day. Contact: Mr. William A. Houser, Admin. Dir., ICS, 1516 individuals physically dependent on morphine or other narcotics. The abuse liability
N. Lake Shore Dr., Chicago. Ill. 60610. (312) 642-3555. of propoxyphene is qualitatively similar to that of codeine although quantitatively
less, and propoxyphene should be prescribed with the same degree of caution
December 8-12-Postgraduate Institute for Emergency Phy- appropriate to the use of codeine.
sicians. See Of Interest To All, December 8-12. Usage in Ambulatory Patients-Propoxyphene may impair the mental and/or
December 11-12-Phaco-Fragmentation. UCSF. Thursday-Fri- physical abilities required for the performance of potentially hazardous tasks, such
as driving a car or operating machinery. The patient should be cautioned accord-
day. ingly.
January 7-March 17-Intensive Review of Psychiatry and Neu- Usage in Pregnancy-Safe use in pregnancy has not been established relative to
rology. See Psychiatry, January 7-March 17. possible adverse effects on fetal development. Therefore, propoxyphene should not
be used in pregnant women unless, in the judgment of the physician, the potential
January 8-9-Phaco-Fragmentation. UCSF. Thursday-Friday. benefits outweigh the possible hazards.
Usage in Children-Propoxyphene is not recommended for use in children, be-
January 9-Vitreal and Retinal Surgery Workshop. Jules Stein cause documented clinical experience has been insufficient to establish safety and a
Eye Institute, Los Angeles. Friday. Contact: Jules Stein Eye suitable dosage regimen in the pediatric age group.
Institute, 800 Westwood Plaza, Los Angeles. Precautions: Confusion, anxiety, and tremors have been reported in a few patients
January 9-10-Phacoemulsification Conference. St. Mary's Hos- receiving propoxyphene concomitantly with orphenadrine. The central-nervous-
pital and Medical Center, San Francisco. Friday-Saturday. system depressant effect of propoxyphene may be additive with that of other C.N.S.
depressants.
Contact: J. Albert Sarrail, MD, 450 Sutter St., San Fran- Adverse Reactions: The most frequent adverse reactions are dizziness, sedation,
cisco. (415) 397-1500. nausea, and vomiting. These effects seem to be more prominent in ambulatory than
January 11-17-Otologic Surgery Course. Ear Research Insti- in nonambulatory patients, and some of these adverse reactions may be alleviated if
tute, Los Angeles. One week. 48 hours. $550; $350 for resi- the patient lies down.
dents. Contact: F. H. Linthicum, Jr., MD, Dir. of Education, Other adverse reactions include constipation, abdominal pain, skin rashes,
lightheadedness, headache, weakness, euphoria, dysphoria, and minor visual dis-
Ear Research Institute, 256 S. Lake St., Los Angeles 90057. turbances.
(213) 483-4431. The chronic ingestion of propoxyphene in doses exceeding 800 mg. per day has
January 16-18-Third Neonatal Respiratory Symposium. Cali- caused toxic psychoses and convulsions. 1011375]
fornia Society of Anesthesiologists at Marriott Hotel, Los
Angeles. Friday-Sunday. Contact: Perinatal Anesthesia, P.O.
Box 54508, Los Angeles 90054. (213) 226-3311.
DARVON® COMPOUND-65
propoxyphene hydrochloride, aspirin, phenacetin, and caffeine
January 23-25-Pediatric Anesthesiology-14th Clinical Con- Indication: For the relief of mild to moderate pain.
ference. Childrens Hospital of L.A. at Marriott Hotel, Los Contraindication: Hypersensitivity to propoxyphene, aspirin, phenacetin, or caf-
Angeles. Friday-Sunday. 15 hrs. $100. Contact: Wayne feine.
Herbert, MD, CHLA, P.O. Box 54700, Los Angeles 90054. Warnings: Drug Dependence-Propoxyphene can produce drug dependence
(213) 663-3341, ext. 2262. characterized by psychic dependence and, less frequently, physical dependence
and tolerance. Propoxyphene will only partially suppress the withdrawal syndrome in
January 25-30-Postgraduate Institute on Emergency Medicine. individuals physically dependent on morphine or other narcotics. The abuse liability
See Of Interest To All, January 25-30. of propoxyphene is qualitatively similar to that of codeine although quantitatively
less, and propoxyphene should be prescribed with the same degree of caution
January 26-30-Topics in Emergency Medicine. See Of Interest appropriate to the use of codeine.
To All, January 26-30. Usage in Ambulatory Patients-Propoxyphene may impair the mental and/or
January 28-30-Advances in Neurology. UCSF. Wednesday- physical abilities required for the performance of potentially hazardous tasks, such
as driving a car or operating machinery. The patient should be cautioned accord-
Friday. ingly.
February 1-4-Theodor Billroth Course in Surgical Anatomy. Usage in Pregnancy-Safe use in pregnancy has not been established relative to
LLU. Sunday-Wednesday. possible adverse effects on fetal development. Therefore, propoxyphene should not
be used in pregnant women unless, in the judgment of the physician, the potential
February 5-6-Phaco-Fragmentation. UCSF. Thursday-Friday. benefits outweigh the possible hazards.
Usage in Chi/dren-Propoxyphene is not recommended for use in children be-
February 6-Photocoagulation Therapy Workshop. Jules Stein cause documented clinical experience has been insufficient to establish safety and a
Eye Institute, Los Angeles. Friday. Contact: Jules Stein Eye suitable dosage regimen in the pediatric age group.
Institute, 800 Westwood Plaza, Los Angeles. Salicylates should be used with extreme caution in the presence of peptic ulcer or
coagulation abnormalities.
February 11-13-Clinical Applications of Vitreous Surgery. Precautions: Confusion, anxiety, and tremors have been reported in a few patients
USC. Wednesday-Friday. receiving propoxyphene concomitantly with orphenadrine.
February 12-15-Symposium on Controversial Areas in Surgery The central-nervous-system depressant effect of propoxyphene may be additive
of the Head and Neck-5th Annual. UCSD. Thursday-Sun- with that of other C.N.S. depressants.
Phenacetin has been reported to damage the kidneys when taken in large
day. Contact: UCSD or Alan M. Nahum, MD, University amounts for a long time.
Hospital, 225 W. Dickinson, San Diego 92103. Salicylates may enhance the effect of anticoagulants and inhibit the uricosuric
effect of uricosuric agents.
February 13-14-Phacoemulsification Conference. St. Mary's Adverse Reactions: The most frequent adverse reactions are dizziness, sedation,
Hospital and Medical Center, San Francisco. Friday-Satur- nausea, and vomiting. These effects seem to be more prominent in ambulatory than
day. Contact: J. Albert Sarrail, MD, 450 Sutter St., San Fran- in nonambulatory patients, and some of these adverse reactions may be alleviated if
cisco. (415) 397-1500. the patient lies down.
Other adverse reactions include constipation, abdominal pain, skin rashes,
Orthopaedic Audio-Synopsis Foundafton. A non-profit service lightheadedness, headache, weakness, euphoria, dysphoria, and minor visual dis-
for Orthopaedic Surgeons publishing monthly recorded turbances.
teaching programs which include summaries of pertinent The chronic ingestion of propoxyphene in doses exceeding 800 mg. per day has
literature and excerpts from national and international ortho- caused toxic psychoses and convulsions. [011375]
paedic meetings. Monthly c-60 cassette tapes. Annual sub-
scription rate $75 ($37.50 for residents). Contact: A. Harris, Additional information available
to the profession on request.
Man. Ed., OASF, 1510 Oxley St., So. Pasadena 91030. (213)
682-1760. EliLilly and Company, Inc.
(Continued on Page 40) 500389
Indianapolis, Indiana 46206
38
(Continued from Page 38) Training of Physicians in Modern Concepts of Pulmonary Care.
LLU. Four weeks or more, by arrangement. Diagnostic and
OF INTEREST TO ALL PHYSICIANS therapeutic methods in medical chest disease, physiological
November 15-16-Crises Intervention-Part L. UCLA. Satur- methodology of modem pulmonary care programs, use of
day-Sunday. new instrumentation in the field. 160 hrs. Contact: John E.
Hodgkin, MD, Chief, Section of Medical Chest Diseases,
November 20-22-American Association for Automotive Medi- LLU.
cine. Sheraton Harbor Island, San Diego. Wednesday-Satur-
day. Contact: Albert Carriere, 801 Green Bay Rd., Lake Bluff, Training for Physicians in Nephrology. LLU. Four weeks or
Ill. 60044. more, by arrangement. Hemodialysis, peritoneal displays,
renal biopsy, and kidney transplantation. 160 hrs. Contact:
November 30-December 4-American Medical Association- Robert E. Soderblom, MD, LLU.
29th Clinical Convention. Sheraton Waikiki, Honolulu. Sun-
day-Thursday. Contact: AMA, 535 N. Dearborn St., Chicago Preceptorships in Cardiology. PMC. By arrangement. $200 per
60610. (312) 751-6000. mo.; $500 for 3 mos. Contact: Arthur Selzer, MD, PMC.
December 4-6-Rheumatic Diseases- 4th Annual Western Preceptorships in Practical Office Dermatology. PMC. Wednes-
Regional Conference. UCSF at Claremont Hotel, Oakland. days or Fridays, 9:00 a.m.-12:00 noon, for 10 weeks. Periods
Thursday-Saturday. begin Oct., Jan., or April. $100. Contact: Harold M. Schneid-
December 5-6-Invitational Seminar: Clinical Aspects of Com- man, MD, Dept. of Dermatology, PMC.
mon Infectious Disease. Eisenhower Medical Center, Palm Preceptorships in Infectious Disease. PMC. Full time for four'
Desert. Friday-Saturday. 8 hrs. $50. Contact: Office of Medi- weeks. To be arranged. $250. Contact: Rodney J. Valentine,
cal Education, Eisenhower Medical Center, Palm Desert MD, Chief, Div. of Infectious Diseases, PMC.
92260. (714) 346-3911.
December 8-12 Postgraduate Institute tor Emergency Physi- Preceptorships in Basic Sciences, Biochemistry and Biophysics,
cians, Symposium L. UCSD. Monday-Friday. Dermatology, Echocardiography, International Health, Mi-
crobiology, Neurological Surgery, Obstetrics and Gynecology,
December 10-13-Development of Techniques for Family Pediatrics, Pharmacology and Experimental Therapeutics,
Counseling. UCLA at Marina City Club, Marina Del Rey. Physiology, Psychiatry, Urology. UCSF. By special ar-
Wednesday-Saturday. rangement.
December 13-14-Crises Intervention-Part H1. UCLA. Satur-
Traineeships in Renal Dialysis. UCSF. By special arrangement.
day-Sunday.
January 8-9-New and Old Antibiotics. USC. Thursday-Friday.
January 21-24-The Physician and the Hospital. USC at Can-
yon Hotel, Palm Springs. Wednesday-Saturday.
January 23-24-Management of Stress in the Middle Years.
Vista Hill Foundation at Hilton Inn, San Diego. Friday-
Saturday. Contact: Virginia Everett, Dir., Public Relations,
Vista Hill Foundation, 7798 Starling Dr., San Diego 92123.
OREGON
January 25-30-Postgraduate Institute on Emergency Medicine. COUNCIL ON MEDICAL EDUCATION
UCLA at Beverly Hilton Hotel, Beverly Hills. Sunday-Friday.
January 26-30-Topics in Emergency Medicine. UCSF. Mon- THIS BULLETIN of information regarding continuing educa-
day-Friday. tion programs and meetings of various medical organiza-
tions in Oregon is supplied by the Council on Medical
February 6-11-California Medical Association-105th Annual Education of the Oregon Medical Association. In order
Session. Hyatt Regency Hotel, San Francisco. Friday- that they may be listed here, please send communications
Wednesday. relating to your future meetings or postgraduate courses
two months in advance to Council on Medical Education,
February 10-14-Autogenics Training Techniques Workshop. Oregon Medical Association, 2164 S.W. Park Place, Port-
UCLA at Lake Arrowhead. Tuesday-Saturday. land, Oregon 97205; or phone (503) 226-1555.
February 13-14-Diving Medicine for Practicing Physicians.
UCSF at Holiday Inn-Union Square, San Francisco. Friday- MEDICAL GRAND ROUNDS
Saturday.
Providence Medical Center, Auditorium, Providence Hall, 700
February 15-19-Sports Medicine for Primary Physicians. N.E. 47th Avenue, Portland, 97213
Hawaii Medical Association at Lihue, Kauai, Hawaii. Mon- November 19-Constipation and Laxative Abuse.
day-Thursday. Contact: HMA Emergency Medical Service November 26-The Difficult Patient.
Program, 1301 Punchbowl St., Honolulu 96813.
December 10-Grans vs. Scans in Diagnosis of Pulmonary
February 28-29-Infectious Disease and Pulmonary Disease Thromboembolic Disease.
for Family Practitioners. UCLA. Saturday-Sunday. December 17-Hepatitis A, Hepatitis B, and Thee.
Audio-Digest Foundation. A non-profit subsidiary of CMA. University of Oregon Medical School, Family Practice Center,
Twice-a-month tape recorded summaries of leading national 3181 S.W. Sam Jackson Park Road, Portland 97201:
meetings and surveys of current literature. Services by sub-
scription in: Family Practice, Surgery, Internal Medicine, Every Thursday, 8:00 a.m. to 9:00 a.m.-Family Practice
Ob/ Gyn, Pediatrics, Psychiatry, Anesthesiology, Ophthal- Grand Rounds. Contact: David D. Smith, MD, Depart-
mology, Otorhinolaryngology. Catalog of lectures and panel ment of Family Practice, University of Oregon Medical
discussions in all areas of medical practice also available. School.
$90 per year. Contact: Mr. Claron L. Oakley, Editor, Suite
700, 1930 Wilshire Blvd., Los Angeles 90057. (213) 483-3451. FAMILY PRACTICE
PRECEPTORSHIPS AND TRAINEESHIPS Every Thursday, 8:00 a.m. to 9:00 a.m.-Family Practice
Grand Rounds. Family Practice Center, University of Ore-
Training for Physicians in General Internal Medicine. LLU. gon Medical School, Portland. Contact: David D. Smith, MD,
Four weeks or more, by arrangement. Bedside and classroom Department of Family Practice, University of Oregon Medi-
training, practical aspects of clinical care and management. cal School, 3181 S.W. Sam Jackson Park Road, Portland
160 hrs. Contact: John E. Peterson, MD, LLU. 97201.
40 40THE WESTERN JOURNAL OF MEDICINE
(Continued from Page 34)
OFFICES FOR LEASE QR RENT
SITUATIONS WANTED 600 ACRE RANCH FOR RENT: The newest and largest professional
IN SECLUDED VALLEY building in the South San Diego community of
Imperial Beach, suites available can be custom-
UROLOGIST, 29, completing top university resi- Ized to suit tenant. This is excellent opportunity
dency July, 1976, seeks solo, group, or partner- In the hills just 7 miles west-the cooler side for pediatrics, gynecology, dermatology, oph-
ship. All situations considered. Box 9449, West- -of Healdsburg in picturesque Sonoma thalmology, general surgery, general practice,
ern Journal of Medicine, 731 Market St., San County. Convenient 75 miles north of San internal medicine and psychiatry. Photos and
Francisco, CA 94103. Francisco over scenic Redwood Highway 101 particulars available upon request from John
INTERNIST WITH PULMONARY SUBSPECIALTY. Freeway. Nearby shopping Healdsburg and E. Geis, DDS, 1340 Coronado Ave., Suite 201,
Extensive training in fiberoptic bronchoscopy and Santa Rosa, yet secure and out of the way. Imperial Beach, CA 92032; office (714) 424-3931.
setting up and operating P.F.T. lab, respiratory Scattered meadows, oaks, redwoods and
therapy unit. Board/eligible. Flexible. California firs. Superb views. Wallace Creek flows MEDICAL SUITE AVAILABLE, NOVEMBER 1,
licensed. Seeks hospital based clinic appoint- through. Several springs, fine underground
water. Fenced and cross fenced. Main ranch 1975, in the Foothill Medical Building, 21297
ment preferably with academically stimulating Foothill Blvd., Hayward, CA 94541. It consists of
group on coastal California. Write Box No. 9453, house 6 rooms, barn, corrals, manager's
Western Journal of Medicine, 731 Market St., cottage, and lake. Deer, wild pig and other 850 sq. ft., 3 treatment rooms, waiting room,
San Francisco, CA 94103. game. Perfect hide-a-way for troubled times nurses station and private doctor's office. The
ahead. Only $600 per acre-compare with building has an x-ray and medical laboratory,
PEDIATRIC LOCUM TENENS WORK WANTED. Sierra and desert property values. Contact and a pharmacy. It is currently occupied by
36-year-old board certified pediatrician licensed owner (415) 453-3805, or your broker. Family Practice Physicians predominantly. For
California, Alaska. Available March 1976. T.
McCabe, MD, 530 Webster St., Palo Alto, CA information call (415) 582-8942.
94301.
CALIFORNIA-SAN FRANCISCO-Unique, new
professional building in central, beautiful, grow-
PRACTICES FOR SALE OFFICES FOR LEASE OR RENT ing suburb of Bay Area. Custom design your
own suite in modern facility with 15 general
MEDICAL SUITE FOR GROUP PRACTICE-Up to practitioners and specialists. Space available
EENT practice established 54 years ago, for 4,000 sq. feet to be available In January, 1976.
sale in Vallejo, California, 1727 Sonoma Blvd., Located in South San Francisco. Reply Box No. immediately. Contact Westborough Professional
94590. Telephone (707) 643-4415, John W. 9431, Western Journal of Medicine, 731 Market Center, Suite 204, 2400 Westborough Boulevard,
Green, MD. St., San Francisco, CA 94103. South San Francisco, CA 94080; (415) 873-8286.
OF INTEREST TO ALL PHYSICIANS December 4-5-Pacific Northwest Chapter, American College
November 12-Geriatric Psychiatry. University of Oregon of Chest Physicians: Scientific Program. Thursday-Friday.
Health Sciences Center, School of Medicine Hospital, Lec- Virginia Mason Medical Center Auditorium, Seattle. Con-
ture Room 8B60. Contact: Judith A. Scholz, Health Center tact: Kenneth Wilske, MD, Dir. CME, Virginia Mason Medi-
for the Elderly, 1710 N.E. 42nd Avenue, Portland, 97213. cal Center, 1111 Terry Ave., Seattle 98101. (206) 223-6898.
November 19-A Transactional View of the Aging Process. December 12-13-Clinical Problems in Endocrinology. Friday-
University of Oregon Health Sciences Center, School of Saturday. Virginia Mason Medical Center Auditorium, Seattle.
Medicine Hospital, Lecture Room 8B60. Contact: Judith A. 9 hrs. $50. Contact: Kenneth Wilske, MD, Dir. CME, Virginia
Mason Medical Center, 1111 Terry Ave., Seattle 98101. (206)
Scholz, Health Center for the Elderly, 1710 N.E. 42nd Ave- 223-6898.
nue, Portland, 97213.
November 26-Clinical Geriatrics. University of Oregon Health January 9-10-Laboratory Investigations in Gastrointestinal
Disease. Friday-Saturday. Virginia Mason Medical Center
Sciences Center, School of Medicine Hospital, Lecture Auditorium. Hours and fee to be determined. Contact: Ken-
Room 8B60. Contact: Judith A. Scholz, Health Center for neth Wilske, MD, Dir. CME, Virginia Mason Medical Center,
the Elderly, 1710 N.E. 42nd Avenue, Portland, 97213. 1111 Terry Ave., Seattle 98101. (206) 223-6898.
January 22-23-Pediatric Allergy and Immunology. Thursday-
Friday. Univ. of Wash., Child Development and Mental Re-
tardation Center, Seattle. Hours and fees to be determined.
Contact: Richard L. Reimer, Asst. Dir. CME, T287 HSB,
WASHINGTON, MONTANA, SB-62, Univ. of Wash. Sch. of Med., Seattle 98195. (206)
543-1050.
ALASKA and IDAHO January 30-31-Tax, Estate and Financial Planning for Phy-
sicians. Friday-Saturday. Olympic Hotel, Seattle. Limited to
In order to have future activities listed here or to receive 50 physicians and spouses. 12 hrs. $75. Contact: Richard L.
information on these and other activities, please write Ms. Reimer, Asst. Dir. CME, T287 HSB, SB-62, Univ. of Wash.
Joan M. Kelday, Information Specialist, Continuing Medical School of Med., Seattle 98195. (206) 543-1050.
Education, WAMI Program, University of Washington School
of Medicine, Health Sciences Building, SC-45, Seattle, February 5-7-Stroke Symposium. Thursday-Saturday. Wash-
Washington 98195. Phone: (206) 543-6995. ington Plaza Hotel, Seattle. 12 hrs. Physicians, $40; others,
$25. Contact: Northwest Hospital, 1551 North 120th, Seattle
November 13-14-Current Concepts in Drug Therapy. Thurs- 98133. (206) EM 4-0500.
day-Friday. Univ. of Wash. Health Sciences Center, Seattle. February 6-12-Critical Care: Maternal and Perinatal. Friday-
12 hrs. $50. Contact: Richard L. Reimer, Asst. Dir. CME, Thursday. Sun Valley, Idaho. 21 hrs. MDs, PhDs, $100;
T287 HSB, SB-62, Univ. of Wash. Sch of Med., Seattle 98195. others, $75. Contact: Richard L. Reimer, Asst. Dir. CME,
(206) 543-1050. T287 HSB, SB-62, Univ. of Wash. Sch. of Med., Seattle
November 14-15-Annual Cancer Conference. Friday-Saturday. 98195. (206) 543-1050.
Virginia Mason Medical Center Auditorium, Seattle. 7 hrs. February 12-13-14th Annual Symposium on Respiratory Dis-
No fee. Contact: Kenneth Wilske, MD, Dir. CME, Virginia ease. Friday-Saturday. Olympic Hotel, Seattle. 14 hrs. $15.
Mas3n Medical Center, 1111 Terry Ave., Seattle 98101. (206) Contact: Ms. Jo Senters, Washington Lung Association, 216
223-6898. Broadway East, Seattle 98102. (206) 322-7110.
December 4-5-Life Saving Measures for the Critically Injured. February 18-19-Treating the Untreatable-Univ. of Washing-
(A.C.S.) Thursday-Friday. Washington Plaza Hotel, Seattle. ton School of Medicine's Western Washington Circuit Course.
Limited to 200. 15 hrs. Practitioners, $150; interns, residents, Longview, 18; Olympia, 19. 4 hrs. Physicians, $25; others,
$75. Contact: Richard L. Reimer, Asst. Dir. CME, T287 $10. Contact: Richard L. Reimer, Asst. Dir. CME, T287 HSB,
HSB, SB-62, Univ. of Wash. Sch. of Med., Seattle 98195. SB-62, Univ. of Wash. Sch. of Med., Seattle 98195 (206)
(206) 543-1050. 543-1050.
ADVERTISING * NOVEMBER 1975 41
BOOKS RECEIVED Index to
Books receiv ed by THE WESTERN JOURNAL OF MEDICINE are
acknowledged in this column. Selections will be made for more The Western Journal of Medicine
extensive review in the interest of readers as space permits.
Advertising
INFECTIOUS DISEASES: Epidemiology and Clinical Practice-Second Audio-Digest Foundation .................. 21
Edition-A. B. Christie, MD, FRCP, FFCM, DPH, DCH, Senior Consultant
Physician in Infectious Diseases, Fazakerley Hospital, Liverpool, Con- Ayerst Laboratories
sultant in Smallpox, Department of Health and Social Security, President, Premarin ....... ........... 42, 43
Association for the Study of Infectious Disease. Churchill Livingstone,
Edinburgh, London and New York, 1974. Distributed in the USA by Long- Books Received ........... 44
man Inc., 72 Fifth Avenue, New York City (10011). 1,095 pages, $42.00.
Burroughs Wellcome Co.
IS IT WELL WITH THE CHILD?-A Parent's Guide to Raising a Mentally Empirin Compound with Codeine ..... ......... 13
Handicapped Child-Susan Strauss. Doubleday & Company, Inc., 245 Park
Avenue, New York City (10017), 1975. 152 pages, $7.95. Neosporin Topical ........... ............... 29
MEDICAL EXAMINATION REVIEW BOOK-Volume 7A-Textbook Study Classified ............................. 32, 34, 41
Guide of Psychiatry-James R. Allen, MD, Associate Professor of Psy- CMA-105th Annual Session and
chiatry and Behavior Science, Associate Professor of Human Ecology; and
Barbara Ann Allen, MSW, PhD, Formerly, Instructor in Psychiatry, Uni- Western Scientific Assembly
versity of Oklahoma, Health Sciences Center, Oaklahoma City. Medical Hotel Accommodations ........ .............. 33
Examination Publishing Company, Inc., 65-36 Fresh Meadow Lane, Flush-
ing, NY (11365), 1975. 144 pages, $7.50. Dairy Council of California ....... ............. 35
NON-INVASIVE METHODS IN CARDIOLOGY-Edited by Samuel Zoner- Geigy Pharmaceuticals
aich, MD, Associate Professor of Medicine, State University of New York Butazolidin .............................. 17, 18
at Stony Brook Health Sciences Center, School of Medicine; Head, Divi-
sion of Cardiology, Queens Hospital Center, The Long Island Jewish-Hills- Eli Lilly & Company
dale Medical Center. Charles C Thomas, Publisher, 301-327 East Lawrence Nebcin .............................. 14, 15, 16
Avenue, Springfield, IL (62703), 1975. 583 pages, $35.50. Keflex .................................. 28
NUCLEAR MEDICINE IN CLINICAL PEDIATRICS-Edited by Hirsch Darvon-N 100 and Darvon Compound-65 .... 38, 39
Handmaker, MD, Director, Nuclear Medicine, Children's Hospital of San Medical Ancillary Services Inc ................ 19
Francisco; and Jerold M. Lowenstein, MD, Chairman, Department of Nu- .
clear Medicine, Pacific Medical Center, San Francisco. Publishing Sciences Merck Sharp & Dohme
Group, Inc., 411 Massachusetts Avenue, Acton, MA (01720), 1975. 296 Aldomet ............................... 4, 5, 6
pages, $22.50.
Triavil .............................. 22, 23, 24
PHYSICAL EXAMINATION OF THE SURGICAL PATIENT-An Introduc- Obetrol Pharmaceuticals
tion to Clinical Surgery-Fourth Edition-J. Engelbert Dunphy, MD, Profes-
sor of Surgery, University of California, San Francisco; and Thomas W. Obetrol .................................. 25
Botsford, MD, Associate Professor of Surgery, Harvard Medical School, Pharmaceutical Manufacturers Association .... 10, 11
Surgeon, Peter Bent Brigham Hospital, Boston. W. B. Saunders Company,
West Washington Square, Philadelphia (19105), 1975. 414 pages, $16.00. Presto Food Products Inc.
PRACTICAL MANUAL OF PEDIATRICS-William W. Waring, MD, Profes- Mocha Mix ................................. 3
sor of Pediatrics and Chief of Section of Pulmonary Diseases, Department PVO International
of Pediatrics, Tulane University School of Medicine, New Orleans; Louis
0. Jeansonne lll, MS, MD, Instructor, Department of Pediatrics, Tulane Saffola .................................. 7
University School of Medicine, Chief Resident, Department of Pediatrics, Roche Laboratories
Charity Hospital of Louisiana, New Orleans. The C. V. Mosby Company,
Publishers, 3301 Washington Boulevard, St. Louis, MO (63103), 1975. 343 Gantanol ................................. 8, 9
pages, $5.95. Valium ................ 2nd Cover and Page 1
PRACTICE OF SURGERY-Current Review-Volume II-Walter F. Bal- William H. Rorer, Inc.
linger, MD, Bixby Professor of Surgery and Head of the Department, Wash- Maalox ..... ........... 4th Cover
ington University School of Medicine, St. Louis; and Theodore Drapanas,
MD, Henderson Professor and Chairman of the Department of Surgery, G. D. Searle & Co.
Tulane University School of Medicine, New Orleans. The C. V. Mosby Lomotil ................. 12, 13
Company, 3301 Washington Blvd., St. Louis (63103), 1975. 500 pages,
$29.50. Smith Kline & French
THE RIGHTS OF HOSPITAL PATIENTS-The Basic ACLU Guide to a Dyazide ..... ........... 3rd Cover
Hospital Patient's Rights-George J. Annas, Director of the Center for Wyeth Laboratories
Law and Health Sciences, Boston University School of Law. Avon Books, Bicillini Wycillin ........ ......... 26, 27
959 Eighth Avenue, New York City (10019), 1975. 246 pages, $1.50 (Paper-
back). Ovral ................ 31
STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION as re-
quired by the Act of August 12, 1970: Section 3685, Title 39, United States 6. Paragraphs 4 and 5 include, in cases where the stockholder or
Code for THE WESTERN JOURNAL OF MEDICINE, published monthly at security holder appears upon the books of the company as trustee or in
San Francisco, California, for September, 1975. any other fiduciary relation, the name of the person or corporation for
1. Location of known office of publication: 731 Market Street, San Fran- whom such trustee Is acting, also the statements In the two paragraphs
cisco, California 94103. show the affiant's full knowledge and belief as to the circumstances and
2. Location of the headquarters or general business office of the pub- conditions under which stockholders and security holders who do not
lisher: 731 Market Street, San Francisco, California, 94103. appear upon the books of the company as trustees, hold stock and securi-
ties in a capacity other than that of a bona fide owner. Names and ad-
3. Publisher: California Medical Association, 731 Market Street, San dresses of individuals who are stockholders of a corporation which itself
Francisco; Editor, Malcolm S. M. Watts, M.D., 731 Market Street, San is a stockholder or holder of bonds, mortgages or other securities of the
Francisco; Managing Editor, David Greer, 731 Market Street, San Fran- publishing corporation have been included in paragraphs 4 and 5 when
cisco. the interests of such individuals are equivalent to 1 percent or more of
4. Owner: (If owned by a corporation, its name and address must be the total amount of the stock or securities of the publishing corporation.
stated and also immediately thereunder the names and addresses of stock-
holders owning or holding 1 percent or more of total amount of stock. If 7. Average number of copies each issue during preceding 12 months:
not owned by a corporation, the names and addresses of the individual Total, 31,470: paid circulation by mail subscription, 29,783; sales through
owners must be given. If owned by a partnership or other unincorporated dealers and carriers, street vendors and counter sales, 0; free distribu-
tion (including samples) by mail, carrier or other means, 1,296; total distri-
firm, its name and address, as well as that of each individual must be bution, 31,079; office use, leftover, unaccounted, spoiled after printing,
given.) California Medical Association, 731 Market Street, San Francisco, 391; total net press run, 31,470. Single issue nearest to filing date, Septem-
California 94103 (an unincorporated association). ber, 1975; Total, 30,137; paid circulation by mail subscriptions, 29,323;
5. Known bondholders, mortgagees, and other security holders owning sales through dealers and carriers, 0; free distribution (including samples)
or holding 1 percent or more of total amount of bonds, mortgages or other by mail, carrier or other means, 517; total distribution, 29,840; office
securities. There are no bondholders, mortgagees, or other security use, leftover, unaccounted, spoiled after printing, 297; total net press run,
holders. 30,137. David Greer, Managing Editor.
44 THE WESTERN JOURNAL OF MEDICINE