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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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