Canad. Med. Ass. J.
Sept. 5, 1964, vol. 91                                                                    LETrERS TO THE JOURNAL       569

                 Letters are welcomed and will be published as space permits. Like other material submitted
                 for publication, they should be typewritten, dou          ace , should be of reasonable length,
                 and will be subject to the usual editing. The accuracy of statements of fact contained in
                 these letters is the responsibility of the correspondent.
                 Views expressed in Letters to the Journal are those of the writers concerned and are NOT
                 to be interpreted as the opinions of The Canadian Medical Association or of the editors.

          VENIPUNCThRE AND PLASMA                                    It is certainly reasonable that increasing the degree
          ELECTROLYTE DETERMINATIONS                              of constriction used would cause a larger degree of
                                                                  error. In an uncomplicated simple venipuncture the
To the Editor:                                                    error would, however, tend to be quite small. In
   In a recent article (Canad. Med. Ass. J., 90: 1105,            circumstances in which the venipuncture is more diffi-
 1964) Drs. T. P. Broome and J. M. Holt stated that               cult, increasing degrees of constriction are commonly
tourniquet-induced venous stasis and forearm exercise             used as well as leaving the tourniquet on for a longer
produced significant changes in certain plasma electro-           period, both factors tending to increase the degree of
lyte values. They also expressed surprise at a different          error.
conclusion drawn from a similar study (Mull, J. D. and               It was this fact that we were attempting to stress.
Murphy, W. R.: Amer. I. Gun. Path., 39: 134, 1963).                                T. P. BROOME, M.D., G.M., F.R.C.P.[C]
Drs. Broome and Holt did not mention, however, that               10951-124th Street,
the method of inducing stasis in each of the two studies          Edmonton, Alta.
was different.
   To produce stasis, Broome and Holt used a blood
pressure cuff inflated to a pressure of 100 mm. Hg.                         DRUG THERAPY IN DYSMENORRHEA
In our study, however, we used a piece of rubber tubing           To the Editor:
applied with just enough pressure to distend the
superficial veins, since this is the technique most                  I read with interest the article on "Drug Therapy in
commonly used in the routine collection of blood. A               Dysmenorrhea" by Dr. Elinor F. Black in the Journal
comparison between the subjective effects of these two            of May 16 (Canad. Med. Ass. 1., 90: 1169, 1964) and
techniques may be made by simply applying a tourni-               am surprised at the omission of the use of diuretics in
quet of rubber tubing to one arm and a blood pressure             treatment of dysmenorrhea.
cuff at 100 mm. Hg to the other. After less than one                 It is well known that prior to the menstrual period,
minute, numbness, tingling, and a sensation of fullness           high levels of progesterone and estrogen occur asso-
are felt in the arm with the blood pressure cuff; in              ciated with fluid retention giving rise to congestion
contrast, one is hardly aware of the presence of the              of the uterus, breasts and brain, with resultant ab-
rubber tubing.                                                    dominal and breast discomfort associated with head-
   Our explanation for the difference is that with the            ache, a triad so commonly seen in this condition.
rubber tubing venous occlusion is incomplete, whereas                The administration of diuretics such as chlorthiazide
with the blood pressure cuff there is occlusion of the            0.5 to 1 g. daily in morning, four to five days prior to
deep veins. In the latter situation complete stasis and           period, up to one day after flow, can give dramatic
anoxia will result, with accumulation of metabolites,             relief to these patients.
including lactic acid which will lower the plasma pH.                Certainly it is the best consistent method which I
Increased plasma potassium may result from migration              have employed in patients with dysmenorrhea who
of this ion from cells, from destroyed platelets, and from        have no underlying gynecological pathology.
hemolyzed erythrocytes.                                              Further, the danger of drug addiction is nil.
   It may be concluded that, if one routinely uses a
blood pressure cuff at 100 mm. Hg, abnormal elevations                                    PETER K. LEWIN, M.B., M.R.C.S.
of certain blood values are to be expected. But, if one           The Hospital for Sick Children,
uses only a rubber tubing tourniquet, just tight enough           555 University Avenue,
to distend the veins, there will be no signfficant altera-        Toronto 2, Ont.
tions. Comparison of the.e values after stasis has been
brought about by each technique will reveal that they                      FAREWELL TO HONOUR
may be different; and so it does not seem reasonable
to compare directly the results obtained by these two             To the Editor:
methods.                                                             Now it happened at that time that a traveller and
                                    JOHN D. MULL, M.D.,           child set out on a journey and the child, conceived in
                                   Cancer Training Fellow,        love of which it was at once the image and the ful-
                                  supported by U.S.P.H.S.         fillment, was full of promise, a flower not yet unfolded,
Department of Pathology,                                          a tale as yet untold.
The University of Michigan,                                          In their journey they came upon a large jungle
Ann Arbor, Mich., U.S.A.                                          which was known as the Jungle of Fear, for in it dwelt
                                                                  three ogres, Death, Disease and Unhappiness, and the
To the Editor:                                                    ogres preyed upon the unwary and unprotected. The
  We appreciate the comments of Dr. John D. Mull                  jungle was dark and densely overgrown, and the
concerning our article.                                           whispering wind and subtly changing shadows formed
570   ASSOCIATION NEWS                                                                             Canad. 1964, vol. J.
                                                                                                   Sept. 5, Med. Ass. 91

the framework of illusions to which the imagination            And so a law was framed and it was called the "Law
of the traveller lent form and substance.                   of the Jungle" and its first precept was "The young,
   Because of the ogres, a band of knights had gathered     the innocent, the dependent and the defenseless, thou
to guide those who passed by that way. The knights          shalt NOT protect." And the knights cheered the law.
belonged to a proud and noble profession and had               But the proud tomb of Hippocrates crumbled and
sworn a great oath to protect all under their care.         from its age-dried dust there welled fresh tears of
   So it happened that as the knight led the traveller      shame.
                                                               For the traveller was a woman and her child was
and child through the jungle they chanced upon an           unborn.
ogre and the ogre menaced them mightily and the                                               C. P. HARRISON, M.D.
traveller was sorely afraid. But with ready courage the     1691 West 41st Ave.,
brave knight sprang forward and, drawing his sword,         Vancouver 13, B.C.
sank it to the hilt in the soft belly of the child. And
innocence was sacrificed to the ogre and the ogre was       The Editor comments:
appeased and the traveller and knight continued on             From time to time, communications such as "Fare-
their way.                                                  well to Honour" are submitted to the Journal, which
   Now when the people heard of this, there were some       sees to convey a message in allegorical terms, in this
who murmured against the treatment of the child. But        instance about therapeutic abortion. .Although to some
the newspapers called them unprogressive and the            readers such material may seem obscure, the special
knights said that they were impractical and the lawyers     nature of allegory is considered to warrant publication
said "There should be a law."                               of these letters as submitted.

                                         SOC                        iu:w
          QUESTIONNAIRE ON SMOKING HABITS                   fallacies would affect any conclusions drawn from the
          OF CANADIAN DOCTORS                               returns presently available. Those most willing to com-
                                                            plete the questionnaire will be those who do not smoke
   The smoking questionnaire that was circulated in         and those who have successfully broken the habit. This
June jointly by the National Cancer Institute of Canada     would represent an expression of a strong feeling con-
and the C.M.A. to all members of The Canadian               cerning cigarette smoking or a sense of satisfaction
Medical Association has given rise to several questions     arising from successful efforts to discontinue the use of
concerning which further explanation appears desir-         cigarettes.
able. These relate to the purpose of the questionnaire         On the other hand, those who remained confirmed
and the necessity for a high rate of return on these        cigarette smokers would tend to ignore the question-
questionnaires.                                             naire and not "waste their time" answering it. Without
   First, the questionnaire is not intended to represent    a high response from current smokers, however, the
an exhaustive enquiry into the smoking habits of            final results would reflect bias and the analysis would
Canadian doctors. It deals only with a single aspect of     be completely invalid.
this habit: it is designed to discover whether cigarette-      Some physicians may also have chosen not to reply
smoking doctors have stopped smoking completely,            because the questionnaire implied an investigation into
significantly reduced their cigarette consumption, or       their private lives. There is of course no such intent
switched to pipes or cigars.                                because the questionnaire is confidential and the results
   The C.M.A. has taken a strong official stand in this     will be reported as a group study rather than in any
matter and is represented on the Technical Advisory         individualized fashion.
Committee on Health Education concerning Smoking               Since the validity of the study depends on returns
and Health at the Federal level. This Committee be-         from approximately 100% of the physicians to whom
lieves that the strongest plank in any educational pro-     questionnaires were circulated, all doctors who are
gram in Canada would be provided if it could be             members of the C.M.A. and who have, therefore,
shown that Canadian doctors, having studied the             received a questionnaire are urged to complete the form
evidence, viewed it with such concern that many, if         as soon as possible.
not a majority, had given up cigarette smoking. It is          At the present time Dr. Alex Phillips estimates that
postulated that the public could not remain long un-        he and his staff at the National Cancer Institute will
moved by such an indication that those who know             spend approximately two to three months coding the
most about matters of health believe that this is a risk    information, transferring it to punch cards, and sub-
too great to be ignored.                                    sequently analyzing it for statistically valid determina-
   To date over 8000 replies have been received (better     tions. This effort, conscientiously applied and generously
than 50% of the total survey) but the returns are now       given, should not be permitted to go to waste.
accumulating much more slowly. As stated in the cover-         The reasons for requesting this information from the
ing letter, which accompanied the questionnaire,            individual physician appear proper and the require-
statistical validity can only be achieved if all doctors    ment of complete reporting is obvious. It remains for
participate.                                                the individual member of the G.M.A. to make a worth-
   Human nature being what it is, certain obvious           while analysis feasible.

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