Western University Scholarship@Western
University of Western Ontario Medical Journal Digitized Special Collections
12-1968 UWOMJ Volume 39, Number 2, December 1968 Western University
Follow this and additional works at: https://ir.lib.uwo.ca/uwomj Part of the Medicine and Health Sciences Commons
Recommended Citation Western University, "UWOMJ Volume 39, Number 2, December 1968" (1968). University of Western Ontario Medical Journal. 210. https://ir.lib.uwo.ca/uwomj/210
This Book is brought to you for free and open access by the Digitized Special Collections at Scholarship@Western. It has been accepted for inclusion in University of Western Ontario Medical Journal by an authorized administrator of Scholarship@Western. For more information, please contact [email protected], [email protected].
Epilepsy ••• a baadlcap oa tile waae with THE PARKE-DAVIS FAMILY OF ANTICONVULSANTS for grand m I d for petit b1 psychomotor lzures Zarontin· Dilantin· (ethosuximide) (diphenylhydantoin sodium) ilontin· (phensuximide) ~ Dilantin witb pbe ltal (diphenylhydantoin sodium, 0.1 Gm.; for statu pilepticus phenobarbital, lfil gr.) and seizure control ~ Phelantin ., during neuro urgery (diphenylhydantoin, 0.1 Gm.; phenobarbital, lfz gr.; desoxyephedrine hydrochloride,.2.5 mg.) Dilantin Steri-Vi for psychomotor seizure (diphenylhydantoin sodium) and the petit mal triad FUU lnfonn avail a oo nquut
Celontin· I PARKE-DAVIS I (meth·suximide) PAfUf.L DAVIS. C:OI'IP' ... hY. LtD. M O Nf•( .-.L, water-dispersible, hypoallergenic, pleasant-tasting OSTOCO~ROPS Children relish the flavour of multivitamin OSTOCO Drops, and welcome their administration directly on the tongue, thus ensuring the most effective absorption. OSTOCO Drops provide the vitamins which are most important to infants and young children. Equally acceptable in formula, fruit juice or milk. E•ch 5-drop dose (0.25 cc.) cont•ins : Vitamin A .... 2500 I.U. Vitamin B1 ...... 1 mg. Riboflavin (vitamin B2) . . . 0.6 mg. Vitamin 0 ...... 400 I. U. Niacinamide ...... 4 mg. Vitamin C ...... 30 mg. I Vitamin Ba ...... 0.6 mg. D osage : Infants and children under 6 years of age, 5 drops da ily; children 6 years and older, 8 to 1 0 drops daily. Bottles of 8, 15, 30 and 50 cc., each with calibrated dropper for waste-free dosage.
Full inform•tion on request. 8~£AJ::&ili Q MONTitiUl CA. ...AOA 'Ot.ltNDCD M CANADA II- ESTABLISHED 1883 A PSYCHIATRIC HOSPITAL FULLY ACCREDITED
... for the diagnosis, care and treatment of all types of psychi atric disorders - with more than 80 years of reputation and experience. An unusually high ratio of doctors to patients en ables our staff specialists to study each patient's individual needs and prescribe treatment accordingly. The Sanitarium is surrounded by 55 acres of open and wooded parkland in the City of Guelph. All types of modem therapy are available; together with excellent, dietitian-super vised meals; attractive rooms, and personal attention of trained nursing staff. A large and well-planned building, embracing the latest in modem Occupational therapy facilities, has recently been added. Entertainment, Motion Pictures, Bowling Alleys, Bad minton and other Games, are among the Recreational activities being carried on. Benefits, under Ontario Hospital Insurance and other group insurance plans are available to patients - depending on the nature of the illness and other factors. For information write, or telephone Guelph 824-1010. HOMEWOOD SANITARIUM OF GUELPH, ONTARIO, LIMITED G. S. BURTON, M.D.C.M. Medical Superintendent. MEDICAL
J{) lJ Fl ~ A L______v _o _L. _3_9._N_o_._2 _DE_c_E_MB_E_R_._•~ - THE UNIVERSITY OF WESTERN ONTARIO
EDITOR Martin J. Inwood
ASSOCIATE EDITOR Ron Wexler '70
SUMMER RESEARCH EDITOR Peter Nichol '70
NEWS AND VIEWS EDITOR Pat Porte '70
BOOK REV IEW EDITORS Dave Scheifele '69 ; Doug Holder '69 ; Re id Finlayson '69 ; Jim Laing '69
ASSISTANT EDITORS Bob Page '71; Dave Peachey '71 ; Robert Burrows '69; Al iver Robinow '69
PROOF READERS Steve Pearl '70 ; Park Parry '70 Sandra Witherspoon '72
CIRCULATION MANAGER Dave Blaine "69
CIRCULATION ASSISTANTS Brian Bloomfield '70 ; Sue Ball '69
ADVERTISING MANAGER Art Kushner '70
ADVERTISING ASSISTANTS Gerry Brown '70; Brian Kelly '70
BUSINESS MANAGER Mike Simmons '70
ASSISTANT BUSINESS MANAGER Bill Payne ' 71
PHOTOGRAPHERS Dave Carswell '70 ; Ross Cameron '72
ARTISTS Ann Breckenridge '69; Earl Dobkin '69 ; Bob Yovanovitch '70
FACULTY ADVISORY BOARD Dr. C. Buck, Dr. E. Plunkett, Dr. M. Smout, Dr. B. Squires, Dr. J. Thompson
THE UNIVERSITY OF WESTERN ONTARIO MEDICAL JOURNAL is published four limes per year by the undergraduate students of the UWO Medical School. Est. In Oct. 1930. Subscription rates $5.00 per year. Notify any change of address promptly. All editorial, advertising and circulation correspondence Is to be addressed to the editor, advertising mgr., and circulation mgr. respectively, UWO Medical Journal, Health Sciences Centre, U.W.O., London, Canada. Printers: Hunter Pri nting London Ltd., London, Canada.
CONTRIBUTIONS will be accepted with the understanding that they are made solely to this publication. Articles should be of practical value to students and medical practitioners. Original research work Is most welcome. Articles should not be longer than 3,000 words, and we will more readily accept those of shorter length. Introduction and summary of conclusions, should be Included. Drawings and photographs will ba accepted, the former to be In black ink and drawn clearly on wh ite cardboard.
All artic les submitted must be typewritten, on one side of paper only, with double spacing and two Inch margins on each side. Canadian Press (American) spelling must be adhered to. The format for references Is as follows: For books: Author(s) : title of book, publisher, place, year. For Journals: Author(s): title of article, name of Journal (abbreviated as in the World List of Scientific Periodicals), volume: page, year.
No part of the content of this Journal may be reproduced without the written authorization of the Editor. PRoVIODINE OvuLES
FUNGICIDE • TRICHOMONACIDE • BACTERICIDE
*Polyvinylpyrrolidone· Iodine 10% ...... 500 mg, (50 mg. Available Iodine) per ovule in a vehicle rapidly soluble - diffusible - miscible with vaginal secretion$ ADMINISTRATION Insert 1 ovule. high into the vagina (Use of applicator is optional) 20 consecvfive Joy treatment (even during mtnsfru•. otion). Repeat if necessary CONTRAINDICATION : None, except sensitivity to Iodine SECONDARY EFFECTS :, At the very beginning of treatment there may oe a sensation of mild local irritation. This sensation usually disappears less than Y2 hour or after 2nd or 3rd administration. If intolerance persists, .slop freofmenf N.l . - Calor ..,sily removed with water from natural fabrics or skin; from synthetic fabrics, by washing in dilute ammonia solution. Box of 20 ovules (applicator and instructions)
FULL INFORMATION IS AVAILABLE ON REQUEST
Truly Canadian in Research RDUGIER INC. and Development
3878-2e Contents
35 Editorial-Ron Wexler '70
36 Trends in Medical Education
A Description of the Curriculum at three Medical Schools-W. F. Clark '70
The Major Problems As We See Them-F. C. Bryans '70
Proposed Curriculum at a New Medical School--.1. Cox '70
Dr. J. Wendall MacLeod-H. So/tan '70
49 The Tooth Pullers Palace--Martin J. Inwood '69
50 The Production of Medical ETV-Dr. H. J . Thurlow
53 Camsi Summer Field Clinics-.lamaica '68
Paediatrics-University Hospital, Kingston-V. Pakulis '69
Children Hospital-Jamaica '68-N. Leal '70
Rural Jamaica-A. Breckenridge '69
58 Summer Research
Fibrinolytic Activity and Thrombo-Embolic Disease--H. M. Rubenstein '70
Research in the Netherlands- W. Wassener '70
60 Letters to the Editor
64 Departmental Roundup
Department of Psychiatry-D. Peachey '71
Department of Physiology-R. Page '71
66 Alumni Section
66 Diphenylhydantoin-Or. R. Ludwig '66
70 News and Views-P. Porte '70
77 Book Reviews-D. Scheifele '69 'The direction in which education scans a man will determine his future life.'' Plato
TO PARENTS You may obtain detailed information about the fine educational facilities of this university by writing to:
THE REGISTRAR THE UNIVERSITY OF WESTERN ONTARIO LONDON. CANADA
THE UNIVERSITY OF WESTERN ONTARIO
Bank of Montreal ANYTOWN1 CAIIADA
8 &8 ..... uuoo-oo ~·: 0000•0001"?~ BHDcordcheK the guaranteed cheque with builtin credit • Good for goods and good for cash. • Provides$500-or more -instant credit when you need it. • Guaranteed by Bank of Montreal. See your local branch soon. ~ Bank of Montreal Canada's First Bank Editorial
Greetings and welcome back to part two a total background in their disciplines, in our continuing verbal meanderings. We sometimes to the extent that the student hope that this one will be better than ever gains no perspective at all. Clinicians, on with more pictures, fascinating reading and the other hand expect the student to know another colour for those of you who took all of the necessary surface anatomy, drug offence at the last issue's cover. doses and applications of physiology which the student has not sorted out when he This issue will concern itself to a large reaches third year. Possibly less 'academic extent with education, and it would be freedom' and greater planning by the faculty wonderful to be able to distill for you on as a whole as to what shall be taught is this page the essence of the great thoughts the answer. cerebrated by the many minds who have spoken and written to great length on this I can't agree with the desire for abolition problem, and to have a concrete answer of exams. Until someone can prove which will provide students, teachers, conclusively that one method of evaluation administrators and the profession as a whole is better than another, my opinion will stand with minimal suffering , enough time and that I have never seen anyone who understood personnel, perfectly organized schedules and a subject fail because of an exam, nor have maximally trained physicians so as to I seen someone in medicine fail who satisfy everyone. But I can't. honestly tried to learn. One genius in Weekend Magazine a few weeks ago said On one side the vanguard of all that is that companies hiring people should set new, different, radical and, therefore good, their own exams; this idiocy is self evident. cry for core curriculum, aims and objectives, Dr. lan McWhinney informs me that in more time for 'personal development', and England, where you are either satisfactory the abolition of such psyche-destroyers as or unsatisfactory, appointments are based examinations, standings and competition strictly on personal opinion of the department in general. Defenders of the ancient bulwarks head and that brown-nosing (my words) is containing what is old, experienced, proven a most highly developed art. Personally, and (again) therefore good, shout lack of I would rather be graded by my medical funds and manpower, student laxity, the ability than by my 'con' ability. need to 'cover it all' at least once, and that if it works why disturb it. In the middle lies That's how things stand, and I hope each the aspiring physician who shouts only for and everyone will devote at least some guidance and a photographic memory. subliminal thought to the subject. The editors will appreciate hearing by way of Many important points have been aired letter or article the opinions of all by both sides. If everyone knew just what a enlightened pedagogues. graduating M.D. needs in order to treat sick people (and that is still the reason we're Here's hoping that this issue and the here, gang) over half of our problems would Christmas break finds one and all in the be solved. But even here no one seems to best of 'spirits'. May I also take this agree. One eminent physician says that opportunity to invite anyone interested in when you have finished Harrison's Textbook working in any capacity for our literary of Medicine to check with him for further endeavours to contact any of the illustrious references. Basic science people try to give personages listed in the masthead.
Associate Editor
35 "Trends m Medical Education
Saturday, October 5th, 1968, Talbot College Theatre, University of Western Ontario, London, Ontario
In the past few years, the going concern Participants: in medical schools all over this continent J. L. Caughey, Associate Dean, Case has been the study and revision of under Western Reserve School of Medicine, graduate medical education. Here at Western Cleveland, Oh io. we have been very fortunate in many respects E. A. Sellers, Professor of Pharmacology in having a small student body, an interested and Co-ordinator of Period 1 of the and sympathetic administration and one of Curriculum, University of Toronto the closest student-faculty relationships Faculty of Medicine, Toronto, Ont. of any school in Canada. D. Socking, Dean, U.W.O., G. H. Valentine, Professor of Paediatrics, U.W.O., F. R. One cannot say that we are in the forefront Calaresu, Associate Professor of of radical change; our lack of core curriculum Physiology, U.W.O. and systemic teaching shows that. But as you read through the following pages, I Chairman: am sure you will notice that many of the W. F. Clark, (Medicine, 1970). things lauded by the speakers are already in effect here at Western. We have students Second Session: Student Panei-" The on Faculty Council, on the Curriculum major problems as we see them." Policy Committee, and involved in course evaluation. Interdisciplinary conferences, Participants: which we take for granted, are looked upon Student representatives from Ontario and as great advances in integration of knowledge neighbouring American medical schools. by students in other schools. Lectures have been cut to a minimum in third year and Chairman : abolished in fourth. Fourth year itself has F. C. Bryans, (Medicine, 1970). become an extended rotating clinical clerkship, and nine weeks of much-pri zed Third Session: A discussion of the proposed elective time has been added. curriculum at a new medical school. Main Speaker: Western students and faculty can consider themselves fortunate in having had on this W. B. Spaulding, Associate Dean, Faculty campus such people as Dr. Spaulding, Dr. of Medicine, McMaster University, Caughey, Dr. Sellers and Dr. Macleod. It Hamilton, Ontario. is unfortunate that the press of 'examination Discussants: studying' did not permit more of the student J. A. F. Stevenson, Professor of Physiology, body to attend this edifying and unique U.W.O., a Faculty Member from one of discussion. However, it is to be hoped that the Clinical Departments, U.W.O., J. M. H. many of the ideas discussed will be Inwood, (Medicine, 1969). H. R. Wexler, incorporated in the efforts of the Cu rriculum (Medicine, 1970). Policy Committee in the outlining of a core curriculum and designing a new and Chairman : (hopefully) better system of producing N. F. Lefcoe, Associate Professor of new physicians. Medicine and Chairman of the Committee on Medical Education, Faculty of The following sections are devoted to Medicine, U.W.O. a report of the Education Seminar sponsored by the Hipprocratic Council. Fourth Session: Guest Speaker; J. W. R. Wexler '70 Macleod, Executive Secretary. The Association of Canadian Medical PROGRAM OUTLINE Colleges, Ottawa, Ontario. Opening Remarks: Chairman : 0 . H. Warwick, Vice-President (Health Sciences), U.W.O. R. U. Johnston, President, H. C. Soltan, (Medicine, 1970). Hippocratic Council, (Medicine, 1969). Closing Remarks: F. J. Rounthwaite, Professor of Otolaryngology and First Session: A description of the curriculum Chairman of the Curriculum Policy at three medical schools. Committee, Faculty of Medicine, U.W.O.
36 A Description of the Curriculum at Three Medical Schools W . F. Clark '70
The opening session of the seminar that the student committee performed an 'Trends in Medical Education', centered important service in this regard. Last spring about the curricula of the medical schools a curriculum policy committee which is at the University of Western Ontario, Case composed of eight faculty and 3 students, Western Reserve in Cleveland and was appointed to take a look at the University of Toronto. This article is an whole curriculum. attempt to capsulize these well prepared summaries-Mission Impossible! Dr. Calaresu outlined the integrated neurological science course and discussed Dr. Sellers (University of Toronto) led off its function and formation. The course is the opening session and discussed the new centered around twelve major topics and curriculum being presented at the University the number of student hours has been of Toronto next September. The four year decreased. Dr. Calaresu apologized that the programme will be divided into three methods of teaching were traditional but periods-period 1, normal biology, period 2, they were working within a very rigid study of disease process and period 3, scheme within the existing timetable and clinical clerkship. the long range or ideal course would incorporate new methods. Three major The presentation of periods 1 and 2 will impressions seem to have arisen from this be by systems teaching and the formal new programme in terms of the organizing teaching time will be cut from 35 hours a body. 1. The co-ordinated type of course week to 25 hours in order to provide more is much more demanding in terms of faculty time for student study. Another major time and effort. 2. Integration doesn't take change in the curriculum was the place on paper-more time is necessary incorporation of courses in the behavioral to rehearse the presentations. 3. We are on sciences i.e., sociology, social anthropology the right track. We learned a lot about other and social psychology throughout the four disciplines in preparing this programme year programme. These courses would and we hope the students enjoy attempt to educate the future physician the course better. about the impact of disease processes on the individual, his family and the community. Dr. Valentine explained that the clinical years were like Rosemary and her baby Dr. Sellers stated that " There is no ideal he won't be held responsible for the end curriculum but flexibility and change are product. Many areas were touched on in most important". The major advance at his presentation. He mentioned the the University of Toronto in providing a less difficulty of providing more responsibility for structured curriculum with more opportuni students who were so conditioned by ties for electives; " self-learning versus lectures that they prefer to be instructed note learning in the classroom". than instruct themselves due to the unholy Western was represented on the panel bogey of the examinations. Clinical work by Dean Socking , Dr. Calaresu and Dr. could not be scrutinized and discussed as Valentine. Dean Socking provided the thoroughly as it should be, due to the fact historical background for the present that the clinical staff were too busy curriculum and an outline of the time attending meetings, trying to make a living tables. In 1962 when the new curricula was and desperately trying to keep up implemented, the idea of integrated co on their own study. ordinated teaching similar to Western " Overall" Dr. Valentine stated, " the Reserve was not possible in terms of money A.M.A. recommendations of 1959 have been and the number of faculty. Since 1962, met on a Canadian Budget; the only major interdisciplinary conferences have been difficulty seems to be the fact that we haven't incorporated into the curriculum as well examined our objectives". " Is the public as the new integrated programme in satisfied with our product? The answer must neurological sciences. Dean Socking con certainly be no. " Unless we produce some cluded that there needed to be continual thing new we are just presenting a mish-mash reassessment of the curriculum and felt of the old curricula. Dr. Valentine expressed
37 the view that the division of the medical would be free time for the students to do profession and the educational process as they pleased. Also, each student was would seem to be the answer. An example provided with laboratory space which of such division were community doctors, would be his own and he could make use academic doctors, highly specialized doctors. of this space at any hour of the day or night for study or research. Dr. Caughey (Assoc. Dean Case Western Reserve) was the last panel member to They also changed the system of examina speak and prefaced his remarks with a tions limiting them to five or six per year recommendation that Paul's Epistle to the instead of the previous 25 to 30 and also Hebrews would be a good standard text for dropped the system of class ranking and medical education, particularly Chapter 13, provided the grades of excellent, satisfactory Verse 8. " Jesus Christ the same yesterday and unsatisfactory. The papers were and today and forever." available for the students to peruse for comments so that the examination could Dean Caughey felt that Western Reserve be a more efficient learning experience. has proven that faculties can change their curricula if they want to and dispelled the When questioned as to how this system theory of inertia in a large medical faculty. removed the pressure of examinations and Three major barriers faced the faculty at his their. relevance to future residencies and medical school in 1952, in terms of change. research grants, Dr. Caughey replied that 1. The course content and examinations were since 1956 they have gotten along without controlled by a tight little group of class ranking. They write recommendations Department Chairmen and he likened it to for their graduates who don't have difficulty the U.N. Security Council in which every in getting residency posts and research major group had powers of veto and grants. He continued by saying that " It nothing got done. 2. They had not gotten was utterly stupid to base internships on together collectively to define the objectives class ranking since you are not picking of their curriculum. 3. The system of an intern to write examinations". It was examinations and class ranking which caused pointed out that these recommendations the students to allocate their time on the were written by the Dean of Student basis of fear instead of enthusiasm. Affairs or by the student's preceptors which They decided to wipe the slate clean and was quite possible, since the faculty student rid the traditional pressure system. The ratio was a little over 1 to 1. course incorporated system teaching and Dr. Caughey concluded his remarks by was divided into three phases. saying that the system of education they had Phase 1. Normal structure and function attempted to create was that of a graduate -1 year school in which students got accustomed Phase 2. Abnormal structure and to setting standards for themselves. He function-1 '!. years admitted that self assessment is difficult for students coming through the traditional Phase 3. Diagnosis- 1 'h years educational system but felt it was better The overall emphasis was on trying to to occur during medical school than in the create a graduate school atmosphere in a busier times afterwards. He compared the medical school. They felt though that talking graduate school type of education at about giving a student initiative and Western Reserve with the more traditional responsibility was useless without giving form they had previously to the old adage them time to exercise it. The timetable treat a young person as a child and he was composed of 11 half days a week and will act as a child. Treat him as an adult they decided that one half day would be and you will be surprised how an elective period and that three half days adu It he can become.
The Major Problems as We See Them F. C. Bryans '70
The following section is devoted to the presentations by the members of the student panel.
Steve Moore (U.W.O.) school. First is, What do we want to turn "There are three problems to consider out? Second is, How are we going to do in formulating the policy of a medical it and the third is money .. . "
38 " . .. I think that four years of medical there was a day freshman called Black school plus one year of internship is Monday. Within four hours a student would insufficient training to-day to prepare a doctor go through something like 175 stations to handle any kind of patient contact (during neural and gross anatomy practicals}. practice . . . " " . . . alternatives mentioned Now this is not a learning experience." are the teaching system in which not all students in the medical school receive " Another problem with faculty is that exactly the same education. Presently in many are traditionalists who are willing to most Canadian medical schools " all students rest with the status quo; they say, ... get the same lectures, the same seminars, " I know best." the same disappointments and the same " How are we going to solve some of joys. As Dr. Caughey mentioned, with the the administrative problems . . . In selecting marked interests and backgrounds of a new Dean it is very important that you students entering medical school, it is .. select a man who is sensitive to the students' unrealistic to expect that the optimum needs, who is willing to listen to your anger results can be attained by a spray-gun and your frustrations, as our Dean did ..." approach to students." " Another solution is the formation of a " ... I think that when a student student-faculty committee .. . In the com graduates from medical school, the best we mittee that we have formed, we have equal can hope to have attained is to have given representation between faculty and students him a direction in which he will want to . . . the students can (now} voice their pursue (further knowledge} ... and therefore criticisms and they are heard." it should not be considered the responsibility of medical schools to prepare physicians " The second area is that of curriculum. for primary patient contact. It is their So many times we are taking courses that responsibility to give, I would say, a certain are need less and repetitious ; courses that core of knowledge . . . " we have had in college, now that in the States we have a four year pre-med pro " ... This core should constitute what gramme ... prime examples of these are is . . . traditionally called pathology and microbiology and histology. Many times the patho-physiology, an understanding of courses that you take in medical school are disease and its processes plus the ability not as good as the ones that you took in to examine; to evaluate the health . . . of college. On the other hand, why can't we the patient. In addition to this, I think a take courses that are not offered now, medical school should provide various courses there is a great need for (such as) directions in which a student can pursue sex education ... Masters and Johnson his particular interests." . .. (noted} ... the relative ignorance of " . . . The next area of concern is how are people in matters of sex . . . this you going to do it ... right now in Canadian includes doctors." schools there are two methods of doing this " Now in solving some of these curriculum .. . the lecture system and the self-education problems ... the first step that we took system. Self-education is taken here to mean last year was developing a student written seminars, small group discussions, and course analysis .. . We've gotten some rather a guided reading program" ... Another interesting and favourable results." question is " Do you educate (a physician} best by teaching Physiology, Pathology, " The next step . .. is developing a core Anatomy and Biochemistry, (the disciplinary curriculum. Faculty and students together approach} or do you educate him best by should decide (what is a core curriculum}. teaching respiratory system, Gl system" The faculty know from experience what the (the systems approach}. medical student should leave school with. In turn the student who has taken many " I would tend to favour a form of educa courses in the past knows more or less tion which combined . .. self-education .. . what courses are needless and repetitious." with the systemic approach " " This core curriculum, I propose, should Kenneth Burling (Buffalo} : extend throughout the entire four years, " As I see it, the two major problem leaving ample and adequate time for electives areas today, are those of administration and .. . We want 1/3 of the first, second and curriculum .. . As far as the faculty is third years for electives and maybe the concerned, wouldn't it be a better idea if all entire fourth year ... it's so important to faculty members were M.D.'s or even M.D. realize that some students are interested in Ph.D's . .. Other problems with the faculty are things other than medicine. They'd like to the scheduling of exams . .. up until this year take courses in the Humanities, perhaps a
39 course in community medicine . . . or do sort of product (is being produced) and a research elective. Participation of the what the public will feel about them . . student in determining his own medical I feel that it is the responsibility of the education is and will be an important faculty of medicine to make sure that factor in the future." (physicians) have some sort of rounded education . . . there is more to medicine Kenneth Parsons (Univ. Michigan) than learning about a diseased liver . . . " We've heard the terms core curriculum you are going to be working with people and and integrated programmes mentioned I feel that we are missing a lot with regard today ... integrated programmes that include to the Humanities. basic sciences, pathological sciences and clinical sciences." " ... I applaud the changes that are being made (with regard to) electives .. " . .. Why do we want integrated programs? Dr. Sellers mentioned, they are initiating So that we can concentrate on really basic in Toronto, courses in anthropology and areas of understanding and knowledge and sociology in pre-meds. The present process provide generalizations that can be used of medical education seems to neglect this when new specific knowledge comes fact by total exclusion of the medical student along .. . " from any meaningful and worthwhile contact with people. I think if you take courses " ... What period in time are we preparing outside the faculty of medicine, outside of our medical students for, is it for their your scientific ones, you will have a far graduation in 1970, or are we preparing better understanding of how to deal with them to be physicians and intellectually these people and with some of acute in the year 1985? their problems." " . . . Certain heads of departments, Arnold Schoichet (Univ. Toronto) certain teachers who have always taught this " I would like to deal with a weakness in course insist on teaching their courses in undergraduate medical education I would the same old way. We have just gone describe as a lack of a sound systematic through a curriculum revision and the first method for designing curricula and making major step and probably the one that hurt and reviewing curricula decisions. In the most was to cut all basic sciences across inadequate 'system' the designers of the the board by 40% of their classroom and curriculum have a concept of a physician laboratory time . .. Well, instead of stream and a page description of that concept lining their programs, I think they just becomes the essence of the medical condensed them and so now we get the school and its objectives ... Each of these same old material in 40% less time." men has his own concept of what medical We are trying to arrive at two forms of education should be based on his own teaching in the first two years, that I would experience in medical school, not on any call conjoint teaching and concurrent teach particular training in education . . . The ing. By conjoint teaching, I mean one course ultimate outcome of this is that the with one name and one exam covers several curriculum is designed with many different areas that would normally be covered by philosophies evident at different points in separate courses. For example in Neural the curriculum .. . the student receives the Behaviour several disciplines are studied at brunt of these many differing ph ilosophies once with an attempt to integrate the which ultimately leads to tremendous information and pass it along in a more stress on the student. memorable form. Unfortunately, we haven't been able to resolve the clashes between Let's look at the remedy . . . Certainly the physiology department and the bio the first necessary step is definition of school chemistry department so the best we've objectives. This list of objectives has to been able to come up with is a concurrent be inclusive to the point where any decision approach . .. " about curriculum can be evaluated in terms of whether or not it agrees with the " ... Next year we are going to try to objectives .. . These objectives will be set up a series of seminars to be given by worded in terms of knowledge that the members of the basic science and clinical student is to possess, abilities he is to science (departments) together on the same have, and perhaps attitudes. stage, to talk about clinical problems that have very important and obvious basic I have a different concept of core and science implications." elective . . . Most people refer to a core as a set of 'musts'- something a student John Latter (Queens) should know-and an elective as those " This morning we have heard a lot about experiences he can make choices about. I the objectives of medical education, what think a medical school should define itself
40 and its objectives in terms of what is core; su its each of them. It's a vital part of any that is, every objective must be medical curriculum that it caters to the met by every student. individuality of students so that there is The next step in designing a curriculum choice in methods of learning--<>r a choice is outlining philosophy. In essence, philosophy as to exactly how he'll go about attaining is all those statements the curriculum the defined objectives of the curriculum." designers feel are relevant to any decisions Jerry Mcilroy (Ottawa) they are going to make. It must be fairly " .. . It might benefit those who give all-inclusive or else the decisions will end quite a few of those lectures to take a look up being made on the basis of a personal around during their session at the state appeal to a parti cular man on one com of those listening and observe the fact that mittee and once against the entire they really aren't grasping every word and curriculum will not be consistent. extrapolate that to the entire lecture One must also design a set of operating system . . . principles-a set of precise decision rules. Medicine is a very introverted science If in your philosophy you state a student In the United States, there's a phrase shall not be so overburdened with academic 'Physician heal thyself or Uncle Sam is responsibilities that he can't do justice to going to do it for you' . . . We should evaluate them all, then you'll design a principle of whether we're training physicians who will operation for example, which states there be able to adapt to the social environment will be a set maximum didactic time and a set as it's going to exist six, seven, eight years minimum total free time for each student. from now. Let's look at some of the pertinent Western Reserve has stated its philosophy changes in our social system. and has a set of operating principles. From Class structure is changing . .. the level what I've seen of Ontario schools, the of knowledge of the general public is number of such rules is at such a minimum certainly increasing . . . Automation is that any particular tyrant in one department increasing ... Medicare will be here soon or another can suppress the students as they in Canada. This means we are going to pass through in a manner inconsistent with have an increased number of patients. the philosophy and objectives of the Further, our population is growing, but we curriculum. Similarly, philosophical state do not have a growth in doctors .. . ments such as " students should become Company medicine is taking over ... we independent learners and self critical," must have regionalization taking place in Canada. be accompanied by rules such as " the amount of didactic control over students will What does this mean to our medical diminish over the years to force the student education system? Our doctors are going to become an independent learner." to have to be trained in the management of people ... At the moment in our society, The next step is to consider all the the doctor is the key man in the medical methods of attaining the objectives. Most structure, but maybe he won't be ten years of the curricula I've seen fail to do this. from now . . . Medical costs are rising For example, it seems the men in charge astronomically. We don't have the facilities decide lectures or seminars appeal to them and we don't have the people. We're just and they design the curriculum with lectures going to have to manage them better, but or seminars without ever assessing whether our doctors aren't being trained to do this. or not there are perhaps better methods to Learning by experience and watching others achieve the same objectives. may be only perpetrating practices Certainly there must be some co-ordinating less than optimum. committee-some committee responsible for How does the doctor handle new setting philosophy, translating it into . information? There were 369 new drugs issued principles of operation so that the comm1ttees in Canada last year, yet I'm sure no one formulating the details of the curriculum can in this room knows the first thing about all make decisions consistent with the philosophy of those 369. We're not attacking this and constructive in achieving the objectives. problem. We in the medical world should One further point on designing a curriculum. look around and see how other people do Students when they enter vary in many ways, things. For example, IBM who spends over particularly in their personalities. The way $100 million annually on education, uses they react to stress, and the methods by programmed learning instead of lectures ... which they prefer to learn. Now if the A comment I heard at the University of designers themselves differ in their prefer Ottawa about anatomy went something like ences as to how the curriculum should be 'Anatomy, why you learn that in the library constructed, it is safe to assume that the -you never learn it in the lectures or labs. students differ in the curriculum which best They're just a waste of time.'
41 Proposed Curriculum at a New Medical School
J. Cox '70
Dr. W. B. Spaulding (McMaster Medical will not be an expert but closer to the School). The proposed curriculum for position of the student. McMaster is as follows: -after phase 3, there is a 6 week Admission Requirements elective period. -Minimum of three years university work -Phase 4-clinical clerkship of forty which includes courses in behavioural weeks made up to 4 blocks: science, biochemistry and cell biology. 1. Medicine -Student who is accepted into medicine 2. Ped iatrics & Obstetrics after three years of a natural science program, will be eligible for a Bachelor of Science 3. Psychiatry and Surgery degree in medicine after completion 4. Family Medicine of 1st year medicine. Evaluation of students will be to a consid -Students admitted from variety of able extent, dependent on frequent evaluation educational backgrounds lacking the by facu lty tutors and a simple grading requisites will take a 6-8 week preliminary system of above average, average and summer course which would be an intensive unsatisfactory, to minimize competitive rivalry tutorial experience in cell biology, inter and still permit the student who is recognized mediary metabolism biochemistry and usually by outside sources like benefactors some behavorial science. and drug companies, when prizes are awarded to the best in a certain field. Course Outline -Total duration-3 years. The following are some of the questions asked Dr. Spaulding by the panel: -Phase 1-14 weeks, entitled " Normal Structure & Function" . Dr. Stevenson: With regard to your business of evaluation, not having examinations and -This phase deals with subjects including that the tutor will do the evaluating, I think anatomy, histology, embryology, genetics, this comes down to a real philosophical physiology, physical examination, normal problem that's been running throughout human behaviour and its examination, today, and that is, the students suggesting professional ethics and attitudes. that there be much less emphasis on -Phase 2-6 week block entitled examinations. I think this is a very, very " Abnormal Biological Mechanisms" . good thing and a great many of examinations -includes general features of cellular or tests should be done away with. But response to injury, infection, to certain major on the other hand, one of the things the drug groups and drug actions, the response students sometimes suggest and you seem of cells in inflammation, in immunological to have suggested here is the personal reactions and a further understanding of opinion of one or two individuals. And genetics, this time in terms of certain one wonders how, after a few years of that, disease states. the students would feel about this informal, almost secret, evaluation by one or two -also includes abnormal behaviour. individuals who are their tutors, so to speak, -Phase 3--40 weeks divided into 8 blocks and I wonder how you are going to get of 5 weeks duration. around that, to retain an objectivity of evaluation so that the students get a fair -the systems approach to mechanisms break, he gets at least a decent jury of disease and understanding of major to evaluate him. symptoms and signs in a scientific way, basic way, and also relevant aspects of Dr. Spaulding: The student evaluation microbiology, of pharmacology, psychology, function, the function of the students to epidemiology and a number of other subjects. evaluate the curriculum and the faculty, I -the students, divided into groups will be related to an individual faculty member • for the proposed curriculum, re ad " The Revolution", R. Wexler, U.W.O. Med Journal, Vol. 38, No. 1, who will act as a catalyst or tutor and who pp. 3-5, October, 1967.
42 haven't alluded to. At the present time, one to some degree and also for faculty. Now of our men who's with Hilliard Jason in one thing that I believe will happen is Lansing, is working on this and I think this that any student who is a potential applicant will help. We want a major feedback from and reasonably perceptive is going to hit students. It isn't just a matter of one or on just the point you are talking about two tutors evaluating, we're running this in and he'll either go for it or he'll run our family practice residency course right miles in the opposite direction. This we now and by the end of the year you've got find in recruiting and other contacts. They quite a stack of cards to run through and either like what you are talking about or at least at that level and just one person's they say, " This is nonsense" and you never opinion, this is a satisfactory evaluation. see them again. During this first phase we You can identify the items, you could of are aiming at achieving a transition period, course, change you r items of evaluation and so that we'll help the students to affect you would for the appropriate block of the this change in behaviour that you're talking course. I would like to say only one other about, to learn how to educate himself, thing that I believe most exams are almost which I agree, is a foreign concept to many individualistic and highly subjective par people and I believe one of the most ticularly the essay type that we've been important liabilities in continuing medical associated with so long. It ends up one education. This is an experiment, you know; person writing the exam for a whole if you and I chatted in two or three years bunch of students. you might find me talking quite differently. Th is is what I call the hot air phase of ou r Dr. Stevenson: What will be your probable operation. We haven't done anything yet, faculty-student or student-faculty ratio when but we're kind of interested to see what you are at your full complement of 64 happens. There may be others in the students? audience who would like to comment Dr. Spaulding: Well, we're planning a full on this. time faculty of something like 105 and so it would be in the neighbourhood of 1.8 to 1. Dr. McCready: We had a lot of discussion At the moment I think it would be about this morning about options and the feeling 2 to 1 if we had a few students around. is that the final product should take on different forms. Do you agree with this Mr. Inwood: On being a student, one philosophy or not? Now would you have in would have to imagine that the McMaster your last year the ability to branch out into student going into your new curriculum will different specialized fields? I gather from be a very keen young man. I think the your presentation that you're going to turn dilemma with most of us entering medical out almost identical products. school at the moment, is that everybody assumes we are keen young men, wanting Dr. Spaulding: We have only six weeks to get on with the process of curing people, elective in the clerkship and this I think only laying on hands, etc. However, the problem to a limited degree would meet the point is of getting sufficient knowledge into us that you 're raising. I believe there are two before we start dealing with the public. I ways of looking at tracking at least; one of am of the opinion, because I am by nature of them is, does it start as in engineering a lazy person, that the average medical schools early on in the undergraduate student will not go ahead under his own career and leave more time for tracking, steam, unless somebody is behind him with post M.D. Well, this has been our philosophy. rather a large boot, preferably with a point on the end of it. In other words, you can't Mr. Wexler: One of the things that does expect the average Canadian medical bother me, Dr. Spaulding, is that the student to go ahead for three years saying, evaluation process is done by the tutors in " Well, I have no worries because my tutor oral fashion. When are you going to give says I am doing fine". In the present method your students the experience necessary of education, which goes way back to to write examinations, which I take it they kindergarten, he is or she is, unfortunately, will still have to write? There will always evaluated by means of examinations and I be councils who will have to have such don't see how you are going to make this things as standing for residencies, for miraculous change as soon as they enter internships? Hospitals want to know, people the new systems teaching or non-examination in residency programmes want to know just system. where did this student stand and just to say he was adequate or above adequate some Dr. Spaulding: It's a very important point. times just may not be enough. I don't believe in miracles. I think these things are more or less painful transitions, Dr. Spaulding: I suppose the prerequisite they are going to be painful for the students that is never referred to in any medical
43 school calendar is that every student has Dr. Spaulding: No. to have spent at least 12 years demonstrating that he is a good examination passer, in The following are questions from the floor: fact an unusually good examination passer. Now if you were to say to me, " Well, Question: How do you get rid of the maybe we should help the student learn how lemons? to become a better one", I would say, " I don't consider that a very sensible objective Dr. Spaulding: How do you get rid of the of a medical school". I'm not worried lemons, which lemons do you mean? about this point. Students, faculty, what lemons are we Dr. Lefcoe: Well, Dr. Spaulding, this is most talking about? interesting about evaluation. We've tried in our department in the past 2 years to Question: Competitive rivalry- reduction of. correlate the marks that we give the Is it such a good thing? students on the wards, and one instructor will spend a fair amount of time with a small Dr. Spaulding: This is a difficult thing to group of students. At the end of the session comment on in a few words. Many people he handed in the blue book, the famous feel that this aspect of western society Toronto blue book, with a mark in it, an is pathogenic and that it goes back to actual number, and at the end of the year even pre-school days. Now I have no idea we quietly assembled these numbers and what your views are, I have a vague idea compared them to marks they got on the what my own are. That's point one. I'd objective tests, in 'Councils', and also with say something like these exams have been the oral marks. As you might expect, the so indoctrinated with competitive rivalry mean mark that the students got, and they're that I wouldn't be naive enough to think marked by 10 or 12 separate staff members, that in th ree years of medical school you're the mean for the entire group .is very going to change that way of viewing things, close to the objective mark, but the spread you 've got to evaluate yourself, not in is negligible. All the students get 71 and terms of some idealistic standard which may 72, practically, a spread of about 3 or 4 be very different from what's existing in your marks, whereas in the exams, they have a community or you may be in the situation nice wide spread so you can really dif where there is nobody else in the same field ferentiate. I think this is a general experience. and I think really that you'll also find the student, as I mentioned previously, looking Dr. Spaulding: So what did you conclude at our situation, looking at the lack of exams from that? and if this appeals to him he'll apply, Dr. Lefcoe: The conclusion is, you don't if he feels, like I guess you may feel, that get the same sort of discrimination Sammy's not going to run under these among students. circumstances and he feels he has to run, he is going to go somewhere else. Dr. Spaulding: Why do you want this dis crimination? Supposing you know you've got an outstanding group and we've got a Well, I'm certainly not very knowledgable group that need a lot of help or a little help, about non-human biology but I gather that coming up, but that's all we really even wolves have far less competitive rivalry want to know. as a species and a group than the human. And I would say tliat this is one of the Dr. Lefcoe: That's your view, you would major problems of our time and if we feel that it really isn't important to make can't solve this question of competitive these fine discriminations. rivalry we're all going to blow up.
Dr. J. W endall MacLeod
H . Soltan '70
... It is apparent that we are in an era has been presented today and there is still of rapid change in medical education; some more of it to be found in the journals of would say revolutionary change, I would medical education, in the records of faculty say it was revolutionary. Evidence for this meetings and in the reports of surveys of
44 almost every aspect of the medical education tries and our graduates will be playing in process in the American and Canadian this increasingly precarious global situation medical schools. that surrounds us.... The third force, I would say, is that the findings of educational . . . First I would ask, as some have asked science are shifting the spotlight onto the already, what are the institutional goals of student, the learner. He is crowding the the medical school? What is it trying to teacher off the centre of the stage and we do? ... Secondly, I'd want to learn more cannot keep him down any longer. As larger about the faculty's learning goals, not numbers of students compete for entry to teaching, but learning goals, spelled out in classes and as universities compete for a educational terms, that is specified knowledge dwindling supply of teachers, there will be to be gained and types of understanding, more and more examples of the class in specified skills to be mastered, attitudes which quite a few of the students are actually to be strengthened, habits to be inculcated brighter than quite a few of the teachers. etc. . .. Finally I'd want to find out what Just another reason for our paying attention the learners feel about this experience and to the reactions of students to their one of the very successful aspects of experience. today has been the quite frank comment by the consumers of medical education. . ... In ... Now I'd like to mention some of the this morning's discussion I am sure we things that turned up in the curriculum were all impressed by the statement of change survey, wt:Jich has just been com students, both from the panels and from the pleted. (Dr. Macleod, representing the floor. One of the most significant develop Association of Canadian Medical Colleges, ments of this decade, in North America, is participated in a Survey of Curriculum the emergence of the voice of students, Change conducted by the Association of often strongly expressed, usually articulately American Medical Colleges.) One hundred expressed and so often expressing highly seventeen questionnaires were sent out to the relevant opinions about the live issues medical schools of Canada and the United of society and of our universities. States, including the completely new ones, . . .. Educationally the curriculum those that have faculties and administrators represents all of the arrangements made but no students, like McMaster. Then twelve deliberately by the faculty to attain specified fairly intensive site visits were conducted. goals, goals which lie in what the student The site visits were distributed around does or is able to do, not what the teacher institutions of different categories and to does. It implies knowledge of the students balance the total group, the two Canadian starting point on the part of the faculty and schools that were chosen for visitation were it demands suitable precision in measuring the University of Alberta and the University the extent to which the specified roles of Sherbrooke, one an example of an old have been attained. school undergoing some change, the other an example of a new school with a ... What are the forces underlying present chance to do many things afresh. trends in the curriculum? There are at least three: one is the escalation of scientific The following are some of the statistics advance with distortion of the boundaries of change and these are descriptive; there of all the classical disciplines, changing the is no value judgment attached to them. educational task and the professional role At the November meeting, I am sure that an of the graduate in many fields. Therefore, effort will be made to evaluate some of objectives are changing, for example the these trends and to see to what extent mastering of an approach to problem solving they are relevant to the expectations on is replacing the mastery of encyclopaedic the part of society, of the medical schools knowledge with swift recall. A second force of Canada and the United States. So when is the social pressure mounting to lessen I cite some changes, I am not sponsoring the handicaps of the disadvantaged. Hence these as obviously good things, but I'm just access to a level of health care is now telling you what is happening. being looked on as a right, rather than a class privilege. And globally of course, Eighty-eight per cent of all the ques we are in a world with rising expectations, tionnaires were returned, which is a good rising costs, rising populations and nothing response. Nearly all the schools have on the other side of the ledger keeping up changed or are planning to do so. Nineteen with it. We live in a fool 's paradise, in this schools have shortened the duration of study respect, and it's really very hard to confine from high school to the M.D. degree. Forty our considerations in education to what is per cent give earlier admission than before going on in our most affluent institutions, or give advanced placement so you have wi thout thinking of the role that our coun- the security of knowing what will happen
45 (very much like the pre-med situation in little less from five to nine hours a week the Ontario schools). Two thirds have in years three and four. defined a core of common required experience, almost always reducing the Interdepartmental committees are responsi amount of that experience, in terms of time, ble for portions of the curriculum organization and the released time is used for elective and content in ninety percent of the schools. courses, for multiple track arrangements and In years one and two, where it's traditionally for official free time. One third of the entire difficult to get this thing working, it is group of schools report multiple tracks or present in one quarter of the schools, in pathways, allowing for differentiation among which seventy per cent of the curricular time the students. In one half of these schools is handled in this matter. And I should say the differentiation starts in first year. to Frank Calaresu, who raised an important question, " What's the purpose in replacing So you see what has happened. Our one possible dictatorship by another?," medical curriculum, not very many years wherever the Western Reserve pattern of ago, was a vocational curriculum designed interdisciplinary teaching has been adopted, to produce people who could practice it is a very democratic committee. If the medicine right off the bat and one learned, chairman got uppity, he would be voted for example, the prescriptions for the diseases down first and I am sure that if he continued of the skin as well as for the child with to disregard the democratic process, he asthma, etc. And then we recognized that would be ousted. I think that's the difference that was a crippling and indaquate thing between a department head and a committee educaNonally and we decided that the made up of people of all ranks who may medical course should be a better educational have as a chairman an assistant professor experience. So we said the curriculum should rather than a full professor. produce the undifferentiated doctor, following which a period of post-graduate training A basic clerkship, interdisciplinary in nature, as an introduction to medicine is would be necessary whether one were going present in half of the schools. In one third into general practice, or a specialty or of these, that is fourteen out of forty, it is teaching and research. Now we're into in the first year. In these fourteen schools earlier career selection, as in Russia. It the students are being introduced to the will be interesting to see what happens. approach to the patient, to interviewing, to lncidentially the schools that are into multiple history taking and physical examination as track don't worry too much about how the early as the first year. Eighty schools give licensing authorities will view this. I think patient contact in the first year. Compre in both United States and Canada there is hensive clinics or family care clinics are a feeling that the licensing authorities are being given in fifty schools out of the ninety very eager themselves to try to groom their four; in one half of these this is an elective. regulations, when it becomes possible, so There is an overall decrease in lecture that people will be licensed to do what they hours and laboratory hours. are prepared for and without permission should not move into other kinds of practice. The trend is to use only two or three It raises also the question of re-classification, passing grades in the new curricula. In five hopefully not by examination, to determine schools there is only a pass or fail rating. the continued competence of practitioners just as in the case of people who pilot the I won't say anything about the other Boeing 707's and so on. things that are being looked into in the survey, but they have to do with an enquiry Only three schools reported no electives, into the dynamics of change. How does so any school that has no electives is in change take place in different kinds of this group of three. The amount of elective institutions? Who are the change agents? block time increases each year, from first This is a new phrase for medical educators in 1968-69. A change agent is somebody year to fourth, from a median of fou r and who is carrying the ball and converts other one half weeks in first year. It may stretch peop!e to his view of the change that up to twenty five weeks in fourth year. This should take place. of. course, means that some schools have an entirely elective fourth year, and at .... The final section of my remarks Duke University an entirely elective third deals with what lies ahead for us in Canada. year, the latter in basic sciences and the Canadian medical faculties are now respond fourth in clinical work. Free time is reported ing clearly to new dynamic movements in by all but three schools and the mode of medical education. And I would say that free time distribution is from ten to fourteen if I were to spend my entire time now hours a week in years one and two, and a describing what is going on between
46 Vancouver and Halifax, you would all be and that some of our most costly efforts encouraged because the variety of progress look to outsiders very much like is revealing a capacity for innovation. occupational therapy for ourselves. Changes are being undertaken for a deliberate pu rpose, some changes are . .. We're in an era when considerations copying other changes but for the most of quantity of service for a large number of part this is a fullsome kind of people are challenging those of quality for development in Canada. a very few. We may lose support too, because in both medical education and . ... We're engaged now in a prodigious practice we run expensive enterprises expansion of our medical schools. Taking without carrying out the operational research 1961 as a base line, we will have added by on our task that is normal today in a boot the end of this decade, four schools to and shoe factory or in a sales programme. the twelve that we had. Looking at the intake We do so little quantitative analysis of ou r of students into first year, the first profes own operations that we often lack the sional year, it'll be an increase from 1,006 data to defend ourselves. in 1961 to 1,725 or 1,750 by 1976. This is a seventy per cent increase within a fifteen . . . Research on the health care delivery year period. This is keeping up with the system, with exposure of students and projections called for by the CMA study and faculty to this on the horizon. This is essential, by the Royal Commission on Health Services not only to improve the quality of care, but in the early 60's. . . . To get teachers for also to economize on the time and effort of the expansion we shall have to provide key personnel, who's training is lengthy the facilities that modern scientists require. and who are in short supply. We can For the majority this means expensive assume that there will never be enough equipment and large research budgets. But doctors to meet the needs of the future by of course, not all teachers should attempt the present pattern of what some would to be successful in research and I don't call non-organization of health care. So our think we face that issue squarely either, curriculum must keep pace with the findings partly because we have not great conviction of studies on such things as group practices, that we can publish from the housetops the responsibility among doctors, nurses, about our objectives in teaching. Most social workers, clinical psychologists and important of all we will need to convince certain kinds of therapists and technicians, our governments, and this means our public, and the use of automation in a host of ways. the citizenry of this country, that our efforts This will call for monitoring the health needs are genuinely and visibly directed to promote and expectations of the family and com the welfare of our society. Our educational munity, of the region and of the nation, a process should be shaping our medical task that cannot be carried out well in my students to become all the different kinds opinion, without the scientific resources of physician we need. We should show and the political neutrality of the university. them that we are preparing them to work in The implications of all this for under a vastly different world from yesterday's, as graduate medical education are pretty clear was so well put today by Mr. Mcilroy. if we admit that learning takes place most Today's world is already pressing for a effectively when it is centred around problems better distribution of the benefits from our that are real, and pressing and meaningful scientific advances. It is pressing for more to the learner. This means that he must personalized care that is more readily see them at first hand and take part available, not waiting three months to see responsibly in seeking solutions to the an orthopaedic surgeon or six months for an problems. The key word is responsibility, eye doctor. I'm afraid that tomorrow's world personally involved, involved intellectually may, I know it will, ask that we accomplish in the experiment and involved morally in all this at lower cost, relatively, than now, the application of the outcome. in order to pay for other programmes that offer a better payoff. I don't say this is true, but this is what we hear from very SPONSORS OF THE SEMINAR intelligent people who are in the upper Canadian Premier Life Ortho Pharmaceuticals echelons of governmental administration. Geigy (Canada) Limited We're in an era of cost benefit analysis, Parke. Davis and Co. ltd. when we have to justify increases in budget Abbott Drugs on the basis of additional benefit accruing. I suggest that unless we broaden our * * * educational responsibilities effectively we It's easy to spot a psychiatrist at a nudist may lose some of the public confidence we colony. He's the guy who's listening instead of enjoy on the ground that we are expensive, looking.
47 1. The Credo 4. The Teeth
2. The Assembled Populance
3. Dr. Dymond needs a haircut 5. The wide expanse of glass
Photos by Ross Cameron '72
48 The Tooth Pullers Palace
Friday, October 25th, 1968, saw the The official program contained this opening of the Dental Science Building and description of the Dental Building: as the London Free Press wrote: "Dean Wesley J . Dunn, flashes a toothy smile as Western's Dental Science Building is the he beams over the sophisticated laboratory fourth of an eventual five-building complex equipment, boasting about the brilliant colour forming the Health Sciences Centre. It has schemes and reminding you that this nine levels, with the first floor of the $7,430,000 edifice is the first dental school building because of the fall in land, being built in Ontario outside of Toronto. in the middle. The building provides All of us in the Medical School sincerely accommodation for teaching and research wish the dental faculty the very best of in Basic and Clinical Sciences, the latter success in their future tooth-pulling including extensive clinical resources in endeavours. An immense amount of effort wh ich dental treatment is rendered. The has gone into the building and the 'Dents' Basic Science Department-Anatomy, have every reason to be proud of their new Bacteriology, Biochemistry, Pathology, abode. Of course, to the more conservative Pharmacology, and Physiology-are housed eyes of the medical fraternity, there are on the second, third and fourth floors and certain differences between the new part of this space is an extension of the departmental the Health Sciences Building and the main accommodation in the Medical Sciences Medical School portion. Naturally, the Building. The first floor consists, essentially, average medical undergraduate will say that of the largest lecture room, the main surroundings are unimportant and indeed administrative office, the dental hygiene not condusive to the quiet thought and facility and the Graduate Clinic. Several patient research which characterizes the faculty offices are also located here. Tl:le medical profession. However, it is hoped ground floor, except for a few offices, that our own hallowed halls of beige and laboratories, and seminar rooms, consists fumed oak will be ultimately changed to almost entirely of the dental undergraduate match the 'Mod' mood of the dentists. clinical facilities. From the main patient reception area directional guides lead to It is not unappropriate to mention that the Oral Diagnosis and Dental Radiology the " Dents' have already made a profound Clinic, to Oral Surgery and to the Main impression on the campus and much to our Clinic. The Main Clinic, consisting of 104 dismay, they have excelled the Medical cubicles of modern design, is served by a School in several extra curricular events, large central dispensary, five peripheral albeit unimportant ones. The Dental Journal operatories, a dental technicians' laboratory was started in the faculty's first year of and a student laboratory. The equipment inception (or would conception be more both in design and arrangement permits appropriate), and it has already done much the application of contemporary methods of to increase the presitige of U.W.O. and practice and is completely flexible for provide increased impetus to the staff of either right or left-handed students and the venerable and most respected publication for two or four handed dentistry. The lower already emanating from the Medical School. ground fl oor houses the pre-clinical student Of course as a casual and entirely uninvolved laboratories, the laboratory of the Division observer, one must comment on the prowess of Dental Materials Science, the Dental of the tooth-pullers playing ping-pong in Stores, three shops, and faculty and the student locker room. No doubt this student locker rooms and lounges. Plans degree of excellence may be easily explained, have already been advanced to create a because, whilst the medical student is Health Sciences Students' Centre on the spending his or her entire waking day in lower, ground floor. The credo has diligent study, the 'dents', by virtue of a a prominent place in the lobby where it is limited but sufficient curriculum, have more hoped that no student or no member of than ample time for practice. faculty will ever read it without being The opening ceremony was attended by impressed with the truth of the words a vast concourse of celebrities and members it contains. of the dental profession and The Honourable M. B. Dymond was heard to say as he What more can one add than to wish them sn ipped the ribbon, that the dental students well in their oral probing and hope that the must feel very honoured to be in such close present good fellowship which exists between proximity to their senior counterparts- the two faculties will blossom forth and the medical undergraduates. grow in the years to come. M. J. I.
49 The Production of Medical ETV H. ]. Thurlow, M.A., M.D.*
"Producer, 1969 Medical TV Series.
For the past three years, Western's conversation, a party, on a TV screen and Medical Faculty has been involved in against every backdrop. Most of us, I would producing medical television programmes guess, can stimulate attention in some over commercial TV channels for the contexts, and initiate slumber in others. consumption of graduate physicians. Although obviously important, selection of participants, per se, had about as much to The venture has had several intriguing do with the boredom index as choice of twists. It emerged as a co-operative the overall topic. enterprise between Western's Committee on Graduate and Continuing Education and CFPL-Television. This meant that the medical The Format team was working with complete commercial The panel, the lecture, the formal debate, television facilities and production personnel. the informal dialogue, the dramatization, It also meant that a commercial television the documentary are all formats from which station was producing a technical series one may choose, and the principle involved beamed at a definite and restricted minority is a simple one: an interesting format group. This was a curious and rather worked to death becomes dull and unique alliance. uninteresting. Furthermore, a series to be presented The vehicle must change from programme " open-circuit" encounters some hazards not to programme, and preferably within found in " closed-circuit" presentations. programmes as well. This seems to awake some kind of vague interest in the On open-circuit, the audience is not unexpected. The 100% unpredictable is captive, and release from boredom is as chaotic; the shifting format is interesting. close as the " off" switch. The element of surprise doesn't have to Open-circuit continuing education is be immense to rekindle the viewer's obviously competitive--with another channel, appetite. A short film clip, a shift to humour, with another activity, or with another a quick transition from monologue to hour's sleep. dialogue may hopefully alert his curiosity. Why presentations are at times boring The alarming mortality in many commercial at times fascinating-has occupied the television series bears witness to the good thoughts of the production team for the past idea worked, without relief, to death. three years. Often we still don't know . . . but at least occasionally we do. The Framing Good things come in nice packages. The The Topic television research people claim that the Ou r first thought, naturally enough, was first three and the last three minutes of that the content area dictated the amount the half hour are the most important, the first three determining if the viewer will stay for of interest, and we thought we could dismiss a tedious half-hour as simply a " dull topic". the programme, and the last three This proved not to be the case as we found determining if he will be with us next week. over and over again that an important or The programme opening and closing, and should-be-interesting topic was a definite the titles, may need as much effort as the help, but provided no panacea for tedium. whole main body of the programme. The The topic we thought might be uninteresting frame around the picture obviously needs could become the most interesting as much care as the selection of the painting. of the series. Publicity and promotion are a part of a wider " framing". It's possible to have one's The People interest aroused before the programme starts, The ability to arouse interest is but some restraint is in order. It is best to situation-specific, which is just another way " undersell" the product a trifle--the best of saying most people are interesting in element of surprise in any context is to some context or other, and conversely few find something a bit more interesting and people are scintillating in a lecture, a quiet involving than one expected.
50 The Complexity The participant who does best on television Complexity, it seems, produced boredom, is usually the one who finds the whole even if the recipient is given ample time experience enjoyable and stimulating. If to assimilate it. A simple diagram, an rehearsals are dull, the production will be uncomplicated statement adds to the interest, a difficult one. The experience of participating provided it moves quickly enough. in educational television must be enjoyable, and this must be put high in the order of It would come as ·no news to the educators production priorities, or other efforts that we have found the most interesting may well be lost. way to present a complex idea or diagram is to break it into a series of fairly simple It is easy to tell when something captures components, and then move· quite swiftly your interest, but it is often hard to tell through them. In the first years we may why. In television, determining the why is have made the mistake of thinking the a matter of sheer survival. progression of ideas should be at about the speed used on a platform. It seems that It occurred to us that some of these more, but simpler, concepts can be packed observations on the parameters of interest into one-half hour of television. or boredom must obviously apply to things other than half-hour medical ETV pro grammes. Since the same production team The Pace happened to be involved in setting up a It is a curious fact that when a person conference-symposium on medical television,* is talking he talks in a constant meter from it seemed that this endeavour might follow one minute to the next, as if keeping perfect some of the same rules of the game and be time to some inner metronome. The subject to the same pitfalls. accented syllables fall in a steady rhythm, with a variable number of syllables or even So, quite deliberately, the format was words slipped through in between. A pause altered from a " conference" to a " festival" may occupy several " beats", but the person and the framing included presentation in a will resume in almost perfect measure. fully equipped theatre at Talbot College The number of syllables or words sandwiched instead of the traditional conference room. between the beats will help determine the There was an attempt to vary the format speed of the speech, but the time of the throughout the day from videotape accents determines the tempo. presentations to monologue to panel By simply tapping a finger in synchroniza discussion to an informal open forum. tion with the accented syllables you can Additional effort was poured into the virtually " take the pulse" of the talker. opening three minutes of the festival which were stolen from a combination of "This Sections of videotape or rehearsal that is Cinerama" and Lanterna Magica. We most of us found to be boring would made an almost desperate effort to execute consistently run a " pulse" of somewhere extremely swift transitions (e.g. from video between 80 and 120 " beats per minutes" . tape to discussion to live monologue). We We found that most of the interesting gave nearly everyone 25% less time than parts were running a rate of over 130, they thought would be needed on the or as high as 180. We began to quip about assumption that " anything good, done long the " boredome threshold" of 130. enough, becomes dull" . Finally, and perhaps most important, we tried to ensure that If the participant were more informal, and everyone working on the project enjoyed more enthusiastic about his ideas or the participation, which seemed to effect presentation, the programme could become the overall " pace" and tempo of the festival. more interesting, and we would usually find that the " tempo" had gone over 130. It would seem that interest is interest, no matter where you find it. It would seem Enthusiasm and Informality that there is more to interest than just Enthusiasm is, it seems, infectious. The the content and the speaker. Open-circuit person interested in what he is saying has continuing education, with its relative a greater chance of arousing interest in successes and failures from programme to the viewer. Perhaps he drags his " tempo" programme and from minute to minute, if he finds what he is saying to be dull. can provide a way of looking at "interest" as it shifts with format, framing, informality, We have found that formal presentations pacing and even the enjoyment and are by and large less interesting than enthusiasm of the participants. The "off informal ones, possibly because informal button" is just an arm's reach away. conversation is less predictable, less formatted, and moves at a quicker " tempo". •see u.w.o. Medical Journal, Vol. 38, No. 2 , p. 57.
51 1969 MEDICAL EDUCATION TELEVISION SERIES
1. " ITCH, SCRATCH, ITCH: A VICIOUS CYCLE" Sun., Jan. 5 Dr. John Albers, Dr. Peter Kursell Wed., Jan. 8 Faculty of Medicine, University of Western Ontario 2. " ALLERGY REPORT" Sun., Jan. 12 Dr. John Toogood, Dr. Paul Stein, Dr. Herschel Keidan Wed., Jan. 15 Dr. Peter Rechnitzer, University of Western Ontario Dr. Allan Knight, University of Toronto. Dr. Bram Rose, McGill University Dr. Abraham Eisen, Montreal Children's Hospital Dr. Lawrence Lichtenstein, Johns Hopkins Hospital 3. " OXYGEN THERAPY" Sun., Jan. 19 Dr. Wolfgang Spoerel, Dr. Barry Shaw, Dr. Neville Wed., Jan. 22 Lefcoe, Faculty of Medicine, University of Western Ontario 4. " CARDIAC PACEMAKER I" Sun., Jan. 26 Dr. Hilmon Castle, Dr. Richard Hughes Wed., Jan. 29 University of Utah College of Medicine 5. " CHEST PROBLEMS IN CHILDREN " Sun., Feb. 2 Dr. Warren Whelen, Dr. Deiter Rajic Wed., Feb. 5 Faculty of Medicine, University of Western Ontario 6. " PREPARATION OF THE CHILD FOR THE HOSPITAL" (1968) Sun., Feb. 9 Dr. Ben Goldberg, Dr. Robert Greenway, Dr. James Collyer Wed., Feb. 12 Faculty of Medicine, University of Western Ontario 7. " VASCULAR SURGICAL EMERGENCIES" Sun., Feb. 16 Dr. John Coles, Faculty of Medicine Wed., Feb. 19 University of Western Ontario 8. " PREVENTIVE MEDICINE" Sun., Feb. 23 Dr. Carol Buck, Dr. William Scrimegeour Wed., Feb. 26 Faculty of Medicine, University of Western Ontario Dr. Cortland MacKenzie, University of British Columbia 9. " BLEEDING DISORDERS" Sun., Mar. 2 Dr. Daniel Deykin, Dr. Edwin Salzman, Harvard Medical School Wed., Mar. 5 10. " OBSTACLES IN THE MANAGEMENT OF HEMATURIA" Sun., Mar. 9 Dr. Lionel Reese, Dr. Lloyd McAninch, Wed., Mar. 12 Faculty of Medicine, University of Western Ontario 11 . " PROBLEMS OF THE EYE" Sun., Mar. 16 Dr. Charles Dyson, Dr. Donald Mills, Dr. Robert Collyer Wed., Mar. 19 Faculty of Medicine, University of Western Ontario 12. "INTERVIEWING" Sun., Mar. 23 Dr. John Walker, Dr. William Tillman Wed., Mar. 26 Faculty of -Medicine, University of Western Ontario 13. " PROLONGED LABOR" Sun., Mar. 30 Dr. Sidney Effer, Dr. John Collins Wed., Apr. 2 Faculty of Medicine, University of Western Ontario 14. " OBSTETRICAL EMERGENCIES" (1967) Sun., Apr. 6 Dr. J. H. Walters, Dr. R. R. H. Kinch, Dr. D. 0 . Manners, Dr. H. H. Wed., Apr. 9 Allen, Dr. G. W. Prueter, Faculty of Medicine, University of Western Ontario 15. " EPIDURAL ANAESTHESIA" (Colour) Sun., Apr. 13 Dr. Wolfgang Spoerel, Dr. Frank Walker, Dr. Patrick Clancy, Wed., Apr. 16 Dr. Earl Russell, Dr. Alexander Gerrard, Faculty of Medicine, University of Western Ontario
The programs will be shown SUNDAYS at 9:00 a.m. , and again following the last program.
Also on WEDNESDAY at 8:00a.m., CFPL-TV Channel 10, LONDON
52 Camsi Summer Field Clinics Jamaica '68
Valdis Pakulis '69 Nancy Leal '70 Harry Bergen '70 Anne Breckenridge '69
The Jamaican summer field clinics were per class, were allowed five delegates; those the first of their type to be conducted by with more than a hundred, seven delegates. CAMSI (Canadian Association of Medical Students and Interns). It was felt that the Each delegate was required to provide previous summer schools conducted in Haiti, $100 towards the expenses of the trip. The 1966, and N.W.T., 1967, should be altered rest of the project was generously sponsored from a lecture programme to one involving by the Canadian government and a number clinical work and assistance to local medical of private sources. organizations of the host country. The areas of work in Jamaica were largely Richard Irvin (68), the fifth delegate is externships in hospitals in the Kingston presently in residency at Hamilton Civic area A lesser percentage of the delegates Hospital. were scattered elsewhere throughout the A three day orientation programme in island in small local hospitals. The Canadian Toronto preceded the three weeks in Save the Children Fund was a project Jamaica, August 11th-September 1st, 1968. undertaken by CAMSI, in which during their The weekends were free for sightseeing and stay twenty of the delegates conducted enjoying the island, as were the last three thorough physicals on approximately fifteen days before departure. hundred Jamaican children in Kingston area schools and clinics. This latter project Sixty-nine delegates attended, representing was strikingly successful. twelve Canadian Medical Schools. All schools with less than a hundred students H. Bergen '70
Paediatrics-University Hospital, Kingston, Jamaica
Valdis Pakulis '69
When I first learned that I was to be seeing as much pathology as possible. assigned to Pediatrics I was somewhat In spite of an extremely busy Out-Patient disappointed. I had requested Medicine or Department, the students are responsible for Emergency because one of my aims for the a complete workup on every new patient. trip was to learn something about tropical medicine. As is turned out, however, The Pediatric ward was clean, well-staffed Pediatrics was probably the service wh ich and adequately equipped. Probably the saw the most of " tropical" diseases. main type of admission was for malnutrition. This includes kwashiorkor (protein deficiency) For th ree weeks, I worked with three other marasmus (a deficiency of all classes of Canadian and about ten Jamaican medical food), as well as malnutrition secondary to students at the University Hospital in Kingston. parasitic infestations, usually worms. A very The Canadians were never alone with any high proportion of all admissions have Sickle responsibility but always accompanied by Cell anemia, which was present in the most a Jamaican student. Th is was profitable bizarre manner, including intractable priapism from a cultural as well as a medical stand in a two year old child, hemoglobins of point because we learned many things less than 2 gm.% , reticulocyte counts of merely from discussions with each other. 62% as well as leg ulcers or practically Because of the shortage of general practi anything else. For this reason, a Sickle cell tioners in the Caribbean, much greater pre paration is a routine order on admission. emphasis is placed on Pediatrics than there is in Canada. Each morning is spent in the A few years ago, there was an entity Out-Patient Department concentrating on known as " The Vomiting Sickness of
53 Jamaica" . The etiology was a complete had sprains or dislocations-usually mystery until an association was found with acquired on weekend outings. ackee, a fruit which is very common in Jamaica and several other Caribbean Islands, Whereas in Canada, the esteem of the but for some reason is eaten only in Jamaica. medical profession has decreased consid The University of the West Indies finally erably during recent years, we found quite recognized that the unripe fruit contains the opposite in Jamaica Doctors- there are Hypaglycin A and B which work independently highly respected both in and out of hospital. of insulin to produce a severe hypoglycemia When four of us tried to rent a car for a with coma and death. Today, most people weekend, we were told by some seven or are aware of the danger and wait for the eight rental agencies that none was available fruit to split open on the tree for several weeks. Finally, I called up one before picking it. of those agencies and said I was a Canadian surgeon and that I simply had to have a Although it is now improving, the car for the weekend. A few minutes later immunization rate in Jamaica is quite low. the manager phoned back and said a car Therefore, tetanus is much commoner than would be brought to the University the next in Canada. Dr. E. H. Back, Head of Pediatrics, day. In addition, we could have it from has studied it thoroughly and has had Friday evening until Monday morning for remarkable success in treating Tetanus. Of the price of two days as well as an automatic his last 46 cases he has lost only one. The for the price of a standard. secret he believes is in the meticulous We wanted the car for visiting some slums nursing care and in keeping the patient, which were too dangerous to simply walk as he says, "severely alone" to decrease through. Even the taxi drivers refuse to pick the frequency of spasms. This is, of course, up passengers in West Kingston, although in addition to the usual sedation and they may drop a fare off there. We drove other medications. through some of the worst parts of the City, such as the ominous sounding "Trench I must admit to some surprise, at how Town" early in the morning so we could up to date the clinicians were. They could take some pictures before the streets would just as easily held posts at any University be too crowded with people. However, even in Canada as in an underdeveloped country. at six a.m. the streets were quite busy and Unfortunately, the hospital was frequently whenever we took our cameras from their unable to keep up with the doctors. For hiding places under the seats, someone example, there was not one EEG machine would spot us and shout " Snapping! on the island! Another problem is the short Snapping!", and we would quickly leave supply of some of the more expensive drugs, that area. We had put on our white interns most notably Ampicillin. We all know how jacket hoping that this would draw less freely and heavily it is dispensed in Canada. antagonism but we still heard many crude While in Jamaica, it is left almost as a oaths sent our way even when our cameras last resort. lndocin is not available in were nowhere in sight. Most comments Jamaica at any price. were regarding our white skin. Shortly after, we had put our stethescopes around our Ou r clinic group was quite surprised at necks hoping to look even more like doctors, what diseases are not found in Jamaica. we saw one reason why these people hated In Canada, a prolapsed rectum in a child the whites. Scrawled in black paint on a immediately brings to mind cystic fibrosis. fence we saw: " Birth Control-White Plan to However, in the Cadbbean, this disease is Kill Black People." almost unheard of. There was a suspected case once within recent memory but an I am unable, obviously, to give in such a autopsy could not be obtained. Instead of short article, a very complete picture of cystic fibrosis in this case, one thinks of the medical and social conditions of Jamaica. parasitic worms. Congenital dislocation of In three weeks, I saw only a few of the the hip similarly is very rare and multiple problems and so have tried to present only sclerosis almost never occurs. my main impressions. Certainly, the poverty of Kingston and of the inland towns in Many Canadian students had their own contrast to the wealth of the tourist areas medical problem and these were mainly of the north coast, must be the most striking related to their feet. Nearly everyone had of contrasts. The need for medical specialists athlete's foot merely because we were not in the Caribbean is almost critical. I can used to such high temperatures. Most were only hope that this and future CAMS! cured quite simply by sandals although projects will stimulate enough interest and some, including, this writer, had to see a enthusiasm in future medical doctors that dermatologist. Several persons got infections they will want to volunteer to serve in these in their feet from minor trauma and a few underdeveloped countries.
54 Children's Hospital- Jamaica '68
Nancy Leal '70
My first impression of Jamaica, as we drove in the bus from the airport to the University residence where we stayed, was one of extreme contrasts. Bright, painted houses in neat earth yards were situated right next door to unpainted corrugated metal shacks with junk strewn in the yard. This initial impression of great contrasts pervaded my stay.
I worked at " Ch ildren's Hospital" , a 200 bed, government run paediatric hospital. Patients coming to the hospital went to the " Casualty Department" which acted as an emergency and an admitting service. Th is Vacation Hotel part of the hospital was what I had envisioned when I thought of a hospital in an under developed, tropical country. The heat, with associated gastro-entritis, meningitis, crowded conditions and numbers of people respiratory infections, rheumatic fever, were phenomonal. There was a porch on sickle cell anemia and tetanus. The two the front of the building and entrance to surgical wards, however, were relatively quiet. the department through the parents holding Only emergencies were handled in the major their sick children was possible, only by and minor operating rooms because there virtue of a white coat and stethoscope, at were not enough anaesthetists to run a full the sight of which the people squeezed schedule. (It was the general concensus together to produce a path. Emergency care of opinion that they had all immigrated to and short term treatment were provided in Canada. Immigration to Canada is a very the casualty department. Only the very sick popular concept to many in Jamaica, although were actually admitted to the hospital. equally unpopular to those who have to deal with the gaps left in the work force). The differences in temperature of various wards was extreme. Even within a ward the tempo varied. There was a power shortage in Kingston and since the hospital had no auxilary power source, the power was turned off for specified periods each day. This turned off everything from suction lines to the fans. Although such things as the suction and oxygen lines were obviously more important, it was amazing how slowly rounds proceeded with no fans. Everyone wilted without them! There were six Canadian students at the hospital. We worked in pairs, attending Free Rum on Arrival ward rounds in the morning and helping the intern with admissions and laboratory specimens in the afternoon. We were the Those admitted passed into another only students at the hospital, and the world. The wards, except for a few tropical clinicians and interns spent a lot of time modifications such as fans in the ceiling and helping us. It was because of them that we constantly open windows (which admitted learned so much and that our stay at a number of very unhospital-like odours), Children's Hospital was so worthwhile. might well be found in Canada. The two medical wards, each with an associated The last three days of our trip to Jamaica contagious ward, were very busy dealing with were spent in a tourist area on the North such cases as the following: Kwashiorkor Shore. We were wined and dined in typical
55 tourist fashion. The differences between a it is hard to believe they could both take life such as we lived those three days and place on so small an island. Jamaica is the life held by the average Jamaican who an island of contrasts-in colour, in beauty, attended the hospital were so extreme that in standards of living, in every aspect of life.
Rural Jamaica
Anne Breckenridge '69
My experiences were not in the major remarkably efficient. This team effort is hospitals, but in the out-lying areas of Jamaica responsible for the sharp decline in the where I gained a highly varied and in incidence of the major venereal diseases restrospect, quite personal series of syphilis, lymphogranuloma venereum and impressions. Those of other students, granuloma inguinale. The VD problem in working in other areas, were often Jamaica today is not unique to a tropical surprisingly different. or underdeveloped country; it is largely gonorrhea. In general, doctor-patient relationships are more haphazard than in Ontario. Only I was surprised to discover that the a small percentage of the population has a drug of choice for gonorrhea in penicillin private physician. Most medical problems sensitive patients is Chloramphenicol. I was are treated in government clinics or in the told that this drug has not been reported casualty departments of " country" hospitals. as a cause of blood dyscrasia in the colored people. Whether this is actually a racial My first week was spent in the Compre resistance or merely an example of hensive Health Clinic in Kingston working inadequate follow-up and reporting is with three students from the University of difficult to say. the West Indies who were interviewing clinic patrons in an attempt to find ways of The Family Planning Clinic was one of improving clinic facilities and administration. several such clinics about the island, all The clinic consisted of five sections constructed within the last few years. Oral medical, dental, VD , family planning and contraceptives are distributed for two shillings immunization-all operating separately. In a package. Reg istered nurses are available the medical clinic, patients arrived very early at most centres for explanation of the (5 :30 to 8:00 a.m.) registered, and awaited concept of birth control and acquainting the afternoon arrival of the doctor. All the women with the available contraceptive surgery, however minor, was referred to a methods. A doctor visits regularly for the major hospital-a practice resulting from insertion of IUD 's. This apparent government lack of time, space and facilities rather than preoccupation with the dissemination of inability or inexperience of the doctor in birth control information is just beginning charge. In fact, I was continually inspired to give results. Last year, for the first time by the knowledge and experience, efficiency in Jamaican history, the birth rate and dedication of all of the medical and showed no increase. para-medical personnel with whom I was in contact. The VD section was most remarkable I had an enlightening experience one day in this respect One doctor acted as overseer while making visits with the public health for both male and female sections and the nurse to many of the crowded and poverty remaining hierarchy of staff was truly foreign stricken mu lti-family dwellings of the Kingston to a Canadian student. Nurses and tech slums. The need for contraceptive education nicians, specially trained in the cytology, and active measures to control the birth hematology and treatment of VD took rate was most obvious. As usual, the problem complete charge of these areas. Higher was not simply one of finances and staff. on the scale there was an investigator whose A great barrier to progress was written in chief function was the examination of new big black letters over many of the corrugated and non-routine cases as well as the tracing iron sidings along the streets, " BIRTH of contacts. This investigator was not an CONTROL, A WAY TO KILL OFF THE M.D.; he was a medical technician who had BLACK PEOPLE". Actually, this delusion become highly skilled through years of is somewhat misleading. Prejudice in training and experience. The system was Jamaica is not simply one of black versus
56 white-there are many shades of whiteness all surgery, registered nurses assisted; and and blackness. The prejudices seem more the matron acted as anesthetist. Surprisingly closely linked to socio-economic status than enough, the bulk of medical problems to colour. I recall the words of a very dark consisted of disease we see in medical and very successful Jamaican acquaintance, school in Canada, with maybe a preponder "The higher I go on the economic scale, ance of chronic leg ulcers, VD and the whiter I become in the eyes of the malnutrition. dark Jamaicans". My biggest revelation--medicine is For five days I lived in a country hospital medicine, and it is probably the same all in Buff Bay, a picturesque little town on over the world. It is the practice of medicine the north shore of Jamaica. Of the 100 that varies as the people vary, and it is beds, only 70 were filled, unfortunately due in this realm that I feel I gained, in a to an acute shortage of staff rather than strong intangible sort of way. I will always an unsually healthy population. The doctor remember the polyglot of colour and variety in charge was a part-time government in my Jamaican acquaintances and employed MD, a Jamaican, fully qualified in colleagues, their laughter, and their truly medicine and surgery. The doctor performed genuine philosophy of life.
* * *
Gems from the Faculty
Dr. B. D. V-r. Re : Euthanasia; When in doubt, rub it out.
Dr. M. L. B--r. Re : Neurology: This laboratory has been a cerebral disaster.
Dr. L. R. R--e. 1. A urine should be treated with the same care as a liquid biopsy. 2. Re : Prostatic Carcenoma: You must not take a guy's k--s off without first getting a tissue diagnosis. Otherwise you might be sued for loss of the family jewels.
Dr. W. 0--d. Re: Congenital lateral discoid Meniscus: If the noise of the click bothers the neighbours, then you can remove it.
Dr. G. L-t. Re: Dieting: Unless one is touched by the hand of God it is impossible to make fat from a zero calorie intake.
Dr. J. W. W-r. A gastrectomy is like sexual intercourse. When you are young you try as many ways as possible. However, as you get older you rely upon one method which works.
..,_ • ;> * * The Power of the Press
On the front of the U.W.O. Medical Journal office in the Medical School, is a notice which simply states: U.W.O. Medical Journal-Staff Only. This was put on to discourage sundry workmen from eating their lunch in there and also to satisfy ou r inherent egoism.
Imagine our surprise when last week an admirer had turned the notice over and written, " Gods House--(so these people think)". The staff welcomes such unsolicited praise and would like to inform our unknown admirer that anytime he wishes to walk upon water, please do not hesitate to contact any member of the staff who would be delighted to render the necessary instructions! M. J.I.
57 SUMMER RESEARCH P. ichol '70
Fibrinolytic Activity and Thrombo-Embolic Disease
- a preliminary tudy to the therapeutic use of a fibrinolytic enzyme, CA-7.
H . M. Rubinstein , '70
It has long been assumed that natural To study the incidence of defective fibrinolysis is an important protective fibrinolysis among patients known to have mechanism against thromboembolic vascular active thrombo-embolic disease, a population occulsion. It would thus seem logical to of such patients was investigated, and their attempt to enhance natural fibrinolysis; or fibrinolytic activity compared with that to use exogenous fibrinolytic agents in of two control populations. One control the treatment of thromboembolic diseases. population was composed of " Normal" This summer research project was concerned subjects visiting the Family Practice Clinic with the clinical trail of such an exogenous of St. Joseph's Hospital, while the second agent; a fibrinolytic enzyme isolated from control population was composed of Aspergillus and prepared by the Connaught in-hospital patients. Blood fibrinolytic Laboratories, called CA-7. In particular, activity was estimated on at least two this project attempted to obtain conclusive separate occasions using the dilute-blood evidence supporting the role CA-7 in the clot-lysis-time of Fearnley (1 964). The treatment of pulmonary embolism and thrombo-embolic group (ages 18-92) included other occlusive vascular diseases. 11 patients; 6 with pulmonary emboli (with or without active thrombophlebitis), 2 with In the treatment of these disorders active thrombophlebitis alone, 2 with (especially pulmonary embolism) heparin femoral artery thrombosis and 1 with retinal is currently the drug of choice. It allows the artery thrombosis. The outpatient control patient's endogenous fibrinolytic mechanism group consisted of 25 volunteers ages 20-73. to operate while reducing further clotting This was a carefully selected out-patient and preventing further embolic episodes. population composed of individuals who, in Other beneficial actions may also be the opinion of the examing physician were claimed for heparin in treating pulmonary " normal, healthy subjects". Specifically embolism such as its anti-serotonin and eliminated from this group was any patient anti-inflammatory effects. Nevertheless, with: an active bleeding disorder, active clinical experience has shown that certain phlebitis or any history of thrombo-embolic patients fail to improve with heparin therapy. disease, diabetes, ischemic heart disease, It was our view that such patients who do not respond to heparin, fail to do so because a diastolic pressure above 100, or neo their endogenous fibrinolytic system is in plastic disease. The in-hospital control group some way severely defective. We therefore consisted of four patients (ages 54-69) measured fibrinolytic activity in several with the diagnosis of duodenal ulcer (without patient populations so as to identify those active bleeding). Here we sought to establish patients with defective fibrinolytic activity. a group of patients who were confined to That is, by measuring fibrinolytic activity, hospital, but who might otherwise be expected this study attempted to identify the " high to show " normal" fibrinolytic activity. For risk" patient who because of greatly all subjects in this project, a careful record decreased fibrinolytic activity would benefit was made of all medications, particularly most from CA-7 therapy. the use of oral contraceptives.
58 To date, the results indicate that defective Another clear indication for the use of fibrinolysis is much more common among CA-7 was also established during the course those with thromboembolic disease than of this summer project. Data was gathered among those in either control group. Only and evaluated concerning the use of CA-7 4 out of 25, (16% ), showed defective to open clotted shunts in patients on the fibrinolysis in the out-patient control group; renal dialysis program of St. Joseph's none in the in-hospital group-versus 10 out Hospital. During the course of this project of 11 (91%) in the thrombo-embolic group. CA-7 was used successfully to open Nevertheless, the etiological significance of occluded shunts in five documented cases. this finding remains to be established. It In all cases where CA-7 was tried, it was is not yet possible to tell whether this successful with only minimal adverse defective fibrinolysis predisposed the patient reactions observed. At least for the present, to his thrombo-embolic disease or is a CA-7 may find its greatest use in this field. consequence of it. A prospective approach is being considered for future research. As Acknowledgement: well, this project is being continued in an Th is project was conducted under the attempt to match the composition of these guidance and supervision of Dr. B. L. three groups by age and sex. Hession, St. Joseph's Hospital. Valuable With regard to CA-7, this study has advice was also contributed by Dr. J. M. helped to establish at least one indication Parker, Department of Pharmacology. The for its use. It is now possible to assess co-operation of Drs. J. A. Collyer and C. T. the fibrinolytic activity of a given patient Lamont, Family Practice Clinic, St. Joseph's suffering from a thrombo-embolic disorder. Hospital is sincerely appreciated. If this patient fails to respond to heparin therapy and if his fibrinolytic activity is of References: exceptionally low magnitude, then the Dalen, J . and Dexter, l. (1967). Diagnosis and administration of an exogenous fibrinolytic Management of Massive pulmonary embolism. enzyme is a logical therapeutic step, Disease-a-Month. Year Book Medical Publishers, Chicago. especially for massive or recurrent Feamley, G. Measurement of spontaneous fibrinolytic pulmonary emboli. activity. J . Clin. Path 17:307, 1964.
Research 1n the Netherlands W . Wassener '70
Last summer I took the opportunity of neurosurgeons and two neurosurgical combining medicine and pleasure on the residents. European Continent. Since this is a medical journal, I shall use proper restraint and My summer research was a study of tell you about my job at the St. Ursula Clinic, temporal epilepsy. I collected hospital Wassenaar, The Netherlands. charts on operated epilepsy cases and struggled through the Dutch with some The St. Ursula Clinic is a small psychiatric, difficulty. The temporal epilepsy patients neurosurgical and neurological treatment were considered operative candidates only center, located in surburban Wanenaar, if medical treatment no longer controlled approximately six kilometers from the Hague. their symptoms and if on E.E.G. a localized It was started in 1930 as the St. Jacoba focus of activity could be found. The patients Institution for the Mentally Ill. Then five were then operated on, and, by aid of years later, the present day St. Ursula Clinic electric corticography with both surface and for neurological and neurosurgical patients depth electrodes, the lesion was further only was set up. The St. Jacoba localized. Various amounts of cortex and Institution still exists as the psychiatric white matter were excised until all portion of the hospital. pathological activity was gone or until It was also in 1935 that Dr. A. C. deVet, further removal would result in a major Hollands first neurosurgeon came to the neurologic deficit. Tissue so removed, was clinic. Since that time, Dr. DeVet has logged taken to the pathology lab and the histologic in excess of 9,000 neurosurgical operations diagnoses ranged from normal cortex to and has headed the only recognized non-specific gliosis and tumour. Some of non-university neurosurgical training center the post-operative results were gratifying but in Holland. Presently, the clinic has three others less so.
59 At about the time when my project got suturing and tying knots-in themselves underway, one of the residents went on easy but baffling if one has never done them vacation, and I was asked to assist Dr. before. Assisting at operations also afforded DeVet. The summer previous to this, Dr. me the opportunity of seeing good surgery J. P. Girvin at Victoria Hospital had very unobstructed by a maze of internes, patiently taught me some of the do's and fourth and third year students. don'ts of suction and retraction. With this knowledge and the ability to keep quiet for For a very educational experience in at least one hour at a time (not really very neurosurgery, I am very grateful to Dr. difficult when you cannot speak the language A. C. DeVet, Dr. P. Hanraets, Dr. M. Van anyway), I made a reasonable assistant. Duinen and residents. Furthermore, I wish to thank the Franciscarressen Sisters and For the rest of the summer, I spent the hospital staff for the very pleasant majority of the time assisting at one to surroundings and the many lessons in three operations a day. Gradually, I became conversational Dutch. Someday I may even familiar with the simpler techniques of learn to write it.
* * .-'•..
Letters to the Editor
The Journal welcomes letters from its readers on any subject under the sun provided the Postmaster General will allow it to be sent through the mail. Provocative, scurrilous and image shattering letters are particularly welcome.
Premature Quasi Seriousness
Dear Sir: introduction and part of the Layman's piece. Reading the previous issues of your I do not think you need worry about copy journal I have felt that perhaps they have right since no acknowledgement was given suffered from an excessive premature quasi in these two printings I mention. The seriousness, rather too common this side author's name I give 'D. Daws' is that on of the Atlantic. I think if you read the better the Edinburgh copy I have. He was and is old world medical students' journals you unknown to me. I have since heard the will see that they try to steer a middle author confidently cited as A. A. Milne, course between the juvenile triviality of a Somerset Maugham and Ogden Nash school magazine and the heavy pompousness on occasions. and embarrassing facetiousness, not to speak of hypocrisy, of some poorly edited I hope you can make use of this trade and company magazines. The majority contribution, second hand though it is, since of medical students are not juveniles nor it seems worthy of wider publication especially seriously earnest, and their amongst medical students in this country. publications should perhaps honestly reflect the in-between state. Editor's Note: Unfortunately the signature of the writer could not be deciphered but the May I suggest that you need a greater Journal staff agree wholeheartedly with his leavening of humour, preferably biological, comments. It gives us great pleasure to Rabelaisian but not crude. I am sending you be able to publish .. . . • . .. in toto. For your therefore a copy of an old favourite, information the editor dimly remembers .. . • • •" which I heard and read first in parts of this epic poem being recited in Edinburgh in 1948 and which was circulated the saloon bar of the Paviours Arms. This in medical school there. I have since heard was a pub, oft visited by itinerant medical parts of this poem recited and seen parts personnel in London, England. It was printed in at least two British medical thought that this small but important piece students' publications. These fragments have of information would be useful in order to usually been the second section-the Doctor's produce the correct mood for reading disquisition, with sometimes part of the the poem.
60 H* * * ,
When men of good taste are gathered together, Certain matters are always discussed. A word or a few on sport and the weather, And the trouble of making a crust. But of far greater interest; more dear to our hearts, Is the subject of sex as you know. Though perhaps you have felt when we mention the parts, That '!"e often some crudity show. So in reference to this aspect of very close connection, I'm sure you'd all be interested to hear, Of a recent panel talk with a so to speak dissection, On the naming of the female sexual gear. The members of this panel for discussion of the subject, Were a doctor and a layman and a girl , And these as expert, casual user and owner of the object, Successively will each their views unfurl.
THE DOCTOR: Now the portions of a woman which appeal to man's depravity, Are constructed with considerable care, And what appears to you to be a simple little cavity, Is actually a most elaborate affair. We doctors of distinction who've examined the phenomena, In a number of experimental dames, Have given to these parts of the fem inine abdomina, A collection of exquisite Latin names. There's the vulva, the vagina and the little perineum, And the hymen, sometimes found in brides. And lots of little things which you 'd love if you could see 'em, The cl itoris and God knows what besides. Thus it seems to me a pity that when common people chatter, Of these mysteries of which you've just heard; That they give to such a complicated matter, Such a short and unattractive little word.
THE LAYMAN : This em inent authority who's studied the geography, And features of this often promised land, Has been able to indulge a taste for intimate topography, And view the scenic wonder close at hand. We ordinary mortals, though aware of the existence, Of complexities beneath the public knoll, Are more or less content to regard them from a distance, And to treat them broadly speaking as a whole. For when we laymen probe into the secrets of virginity, We exercise our simple sense of touch. We do not cloud the issue with meticulous Latinity, But call the whole affair a 'such and such'. I do not wonder though that man has made this curious commodity, The subject of innumerable jibes; For though the name he uses is not without its oddity, Yet it somehow fits the object it describes!
THE GIRL You erudite philosophers are really somewhat comical, Despite your pseudo-scientific facts. For all your long discussions on these matters philological, Have very little bearing on your acts. You may politely bicker and make learned dissertations, On the relative importance of a name; But when you come to favour us with intimate relations,
61 Your actions are essentially the same. In any case, when you aver the title to be frivolous, Which designates ou r simple little vent; You forget indeed the labels, so rude and so ridiculous, Which charactertise the gadgets of a gent. Perhaps it is because you find your emblems of virility, So very, very difficult to hide, That you' re induced to scoff, since you envy our ability, To tuck away our privacies inside! D. Daws (1948?)
Internship In British Columbia DEPARTMENTS Medicine: Do you want a good general practice A large number of excellent clinicians intemeship with a nice climate, atmosphere including cardiologists, a gastroenterologist, and setting, coupled with good fringe hematologists and neurologists-most of benefits? If so, try St. Joseph's Hospital, whom are interested in teaching. The Victoria, B.C. Coronary Care Unit and Intensive Care Unit are well equipped and well run. In spite of the increased proportion of Formal teaching consists of a medical the population over sixty-five years of age, " grand rounds" once a week and th ree St. Joseph's is an active treatment hospital to four hour long teaching rounds per with an unusually large number of general week plus informal rounds with clinicians. practitioners on its staff plus an excellent The staff are of as high quality as you specialist and " super-specialist" staff. will find anywhere. A twenty bed medical teaching unit allows you to select the Some points of interest: elective patients you want to admit, work Pay: them up and follow them in consultation with the staff. Therefore there are no $300 admitting nights with three to ten Food: histories and physicals to do. You work at your own speed and interest. Free--excellent. Rating: Good to excellent. Living Accommodations: Surgery: One or two bedroom deluxe apartments in a new building 100 yards from the Good teaching staff of general surgeons, hospital provided free of charge (furnished urologists, cardiovascular surgeons, $25 per month). The hospital has duty orthopods, and plastic surgeons. Formal rooms and a lounge. rounds are held weekly and teaching rounds daily. Uniforms: A good opportunity here to actually do Supplied and laundered. some surgery- hernia repairs , appendec tomies, breast biopsies, hemorrhoids, Holidays: T&A's, varicose veins, etc., plus first Two weeks plus five days at Christmas assisting (not retracting) on almost all or New Years. other surgery.
Extras: Again a teaching unit is set up and the Membership at Y.M.C.A. (1 1/z blocks from interne picks the cases wh ich he wishes hospital) to work up, order on, scrub and assist Steaks for dinner on Thursday on and follow post-op. Therefore an Phones supplied average of two to three histories and physicals per day, with much actual Due to the fact that the residence is so surgical experience. c lose to the hospital, you are only required to be in the hospital while on Rating: Good to excellent. emergency call at night-about one day in four to five. Su rgery and obstetrics Pediatrics: calls can be taken while at home. This service is perhaps the least well Interne quota eight next year (six organized and very little formal teaching presently) which makes scheduling easy is available. Approximately seventy beds and should cut down night work. are available and a good cross section
62 of general pediatrics is seen. The general Pathology and Laboratory: practitioners are very good at letting you The interne is expected to attend PM's have the patient and the specialists are in his cases and do several during his available for problems. Formal rounds interneship. The Laboratory (including every three weeks. radioisotopes) provides adequate diagnostic Rating: Fair to good. tests. Rating: Good. Obstetrics and Gynecology: A well run department with excellent Comment: practical experience and good teaching, St. Joseph's offers a good interneship. particularly with the Head of the The problems of administration and red Department. Formal rounds every three tape are not as prevalent here as they are weeks with a 1112 hour teaching session in the large university hospitals. Great weekly. The number of deliveries by latitude in the amount of time spent in each interne in the two month period on the department is available. This hospital service would average 100 to 120. cannot offer large series of " rare birds" as Assisting on Gyn. surgery is on the same can the university hospitals but a good basis as on the surgery program. The knowledge of general practice can be proximity of the residence to the hospital obtained here. A good schedule of rounds enables night calls to be taken at home. and informal teaching sessions is available. Rating: Good to excellent. What about after internship? Many of the previous internes are doing locum General Practice: tenums here in Victoria, others have set up This department is encountered in every practice here or on the Island. What about service. However, besides this contact, post-graduate work? Because the Admitting arrangements are made to spend time Department keeps a record of every patient in various G.P.'s offices. These visits you work up or assist with, you are provided prove to be valuable. Also a great number with a comprehensive and extensive of patients are seen in the Emergency reference of your experience. Previous Department and treated by the interne internes have gone on to post-graduate after consultation with the patient's doctor. programs. This evidence of work completed Elective Program: plus the wide background (and connections) of the staff, make acceptance in a post This is a one month program when the grad. program realistic. interne decides on his interests (medically) and pursues extra time on one of the Want more information? Speak to Dr. AI services or spends some time in: Mclean in the Anatomy Department or at Radiology C.F.B. London or write to me, c/o St. Anaesthesiology Joseph's Hospital. Pathology The above has been entirely unsolicited Dermatology (out of hospital) by the hospital. Psychiatry (out of hospital), etc. Larry J. Kelly, M.D., Radiology Department: Meds '68 Three competent radiologists working with some of the most up-to-date equipment available provide an excellent accessory * * * service in diagnosis. Internes read Emergency x-rays at night and on An Interesting Thought Sundays. A good feedback of all those During a recent heat wave a lady kept x-rays read is given pointing out missed showing up at the doctor's office asking or additional features-good experience. Formal rounds every three weeks. A one plaintively, " Why am I so tired doctor" ? hour teaching session (excellent) is Finally the doctor gave her an answer: held weekly. " In the last 24 hours you've had a very busy Rating: Good. day. Your heart beat 103,389 times; your blood travelled 168 million miles; you Anaesthesiology: breathed 23,040 times; you inhaled 438 cu. ft Good opportunity is offered by this of air; you ate 3.5 pounds of food; you department on basic anaesthesia and this drank 2.9 pints of liquid; you perspired 1.43 will allow the interne to become competent pints; gave off 85.6 of heat; generated 450 in " passing gas" and endotracheal tubes tons of energy, spoke 4,800 words, moved as well as gaining experience in the 850 major muscles; grew .000046 inches of basis and use of anaesthetic agents. fingernail, and lost 7 million brain cells. Rating: Good. -Lady, no wonder you are tired".
63 Departmental Roundup
The object of this section is to present two departments of the Medical Faculty per issue in order that the general student populance (or for that matter, the faculty members of the department concerned), may be acquainted with what is happening in the ivory towers of medical research and education. The assistant editors responsible for this section are using a haphazard approach in the hope that the various departments will eventually vie with one another to produce bigger and better reports of their cerebral activity. Department of Psychiatry Dave Peachey '71
A journey down the hall off which are opposed to the general Psychiatry of the found the offices and laboratories of the certified psychiatrist. Departments of Community Medicine and Biophysics leads one past the research office In 1952, the Psychiatry Department was of the Department of Psychiatry and directly joined with the Department of Preventive into the office of the Head of the Department Medicine and Statistics, with the head of of Psychiatry, Dr. G. Edgar Hobbs. This this joint department being Dr. Hobbs. This latter office is divided into a small reception union was broken one year ago with the area and a private office. It is perhaps Department of Psychiatry becoming an larger than most offices around this school, autonomous body. All diligent readers of however, the typical rows of books, pictures, the last Journal are sure to recall that the and diplomas do not enable a visitor to PMS department is now linked with Family really distinguish between it and the office Medicine in the Department of Community of any other department head. Regardless, Medicine. Since the Psychiatry department the distinction can be made on the basis was established, about forty-five trained of a certain leather couch with pillow psychiatrists have done their graduate at one end. work using its facilities. Presently there are seven medical graduates training for The different members of this department certification associated with this department are located at several sites. The focus of although normally there are two or three this department is in the medical school in each of the four years of the program. itself; however, this office will be moved This training involves a rotation through the eventually to the University Hospital. The various facilities, the centre of activity other members of the department are being in the medical school itself. distributed among Victoria Hospital, St. Joseph's Hospital, the C.P.R.I., and the Dr. Hobbs, a former President of the London and St. Thomas Psychiatric Hospitals. Canadian Psychiatric Association, received (N.B. The term " Ontario Hospital" has been his M.D. at the University of Toronto and declared taboo and its use will result in did graduate work at Toronto, Harvard, and , the guilty party copying out the " American Michigan. Although reluctant to release the Handbook of Psychiatry" under the careful year of his graduation from medical school, observation of Dr. Hobbs.) These units are he did admit to being in his third decade by no means separate entities. Quite the as a faculty member. For about the past contrary, the Department of Psychiatry is a four years, Dr. Hobbs' research project has highly unified body. Dr. Hobbs feels that been a study of the outcome of five in terms of facilities and staff, his department hundred schizophrenics in terms of variables is undoubtedly of high quality. All of the in the clinical picture and background. units mentioned take part in the teaching This study, which is almost complete, program with clinics for third year medical hopefully might suggest whether schizophrenia students and to a much lesser degree for · is just one disease or a whole group of second year medical students. Presently diseases. As a part of the project, a study the fourth year students have a two week has just been completed on the changing clinical clerkship in Psychiatry, but this will pattern of hospital discharge over a be increased to three weeks starting next twenty year period, relative to the influence year. With respect to the undergraduate of modern treatment. The newest research program, it is the aim of the department project in the department has been started to teach Psychiatry for use in the practice by Dr. G. Johnson at Victoria Hospital who of medicine. This is basic Psychiatry as is studying suicide in the community.
64 Department of Physiology
Robert Page '71
The majority of research that is being This degree of integration is also carried out in the Department of Physiology noticeable in the courses taught by the right now is generally concerned with department. The past summer the first year elucidating the internal and external controls Physiology course underwent a great deal of behaviour. These encompass such varied of modification. The stress in the course topics as: the role of the Hypothalamus has now been placed on learning to read visceral brain system in the control of physiology rather than memorizing facts. internal and external behaviour, particularly Consequently the lecture time has been cut relating to energy, water, and salt exchange; by about one-half. In place of these lectures the role of the Limbic system in the control the time is spent in seminars discussing of the internal and external behaviour; the material presented in the lecture. interrelationships of Pituitary and other After the topic has been introduced in polypeptide hormones; etc. These topics by lectures, the students write a " mini-test" no means represent the entire interests of wh ich is marked by computer and which the department but they do express the does not count toward any final standing. largest single co-operative interest. Other The purpose is to give the student an idea topics of a more individual nature are: the of how well he or she knows the topic before Cardio-vascular system in hypoxia and it is discussed in the seminar groups. The exercise; oral physiology and its relation to discussions are led by a staff member and intake regulators; temperature regulation; a graduate student and are meant to discuss neurophysiological mechanisms of tremor; in detail the work presented in the lecture. foetal nutrition. This approach was likened by Dr. Stevenson to programmed learning. This wide variety of interests reflects the This feeling of change has also moved wide background of the members of the into the teaching of the second year course department. As one looks over the list of in Neurological Sciences. The course departmental appointments one notices, previous to this year was taught in four among other things, the large number of distinct sections: neuro-anatomy, neuro joint-appointments with other disciplines, physiology, neuro-biochemistry and for example: neuro-pharmacology. This year all four are being taught together. For example, in Dr. G. Mogenson--Physiology and J. studying the peripheral nerves, the anatomy Psychology is given first followed then by physiology, biochemistry, and pharmacology. The course Dr. J. P. Girvin-Physiology and then moves on to an examination of the Neurosurgery spinal cord. This method of integration has allowed all the information on one part of Dr. P. G. R. Harding-Physiology and the course to be given at the same time. Obstetrics and Gynaecology It has also permit1ed the introduction of a good number of clinical examples. Dr. J. A. F. Stevenson, head of the department, felt that there were two main Thus we see that not only is the depart benefits to be obtained from this setup: ment of Physiology experimenting with animals to determine the internal and external 1. The teaching at1itude of the department controls of behaviour but also with teaching is tempered by the clinical outlook of methods to determine the best way to turn some of these men. out good physicians. According to Dr. Stevenson, both courses, though there have 2. This allowed some men to at1ain a been a few problems, are working out fairly combination of two disciplines which might well. Presumably we could say the same be beneficial to their work. for basic research. * ....-'• * The Delicate Balance
Though shalt not kill, yet need not strive officiously to keep alive. A. H. Clough, Modern Decalogue
65 Alumni Section
This month we are very pleased to be able to publish a paper sent to us by a member of the Medical Alumni. Please think of the Journal when you have any interesting news and cases. Your contemporaries and the present undergraduates are eager to hear from you. Diphenylhydantoin R. Ludwig '66
A review of adverse effects illustrated by a case report of Exfoliative Derm atitis, Pyrexia, Lymphadenopathy and Hepatitis.
In the preface to the second edition of his Propylene Glycol is the solvent of the book Diseases of Medical Progress, Dr. Sodium diphenylhydantoin as used for R. H. Moser states: "We have reached a parenteral administration. The optimal point in medical history when we must concentration of solute to solvent in the reappraise the status of drugs and patients." treatment of cardiac rhythm disturbances has Similarly, other authorities feel that " the not yet been determined, but excessive problem of drug toxicity has increased and dilution in the propylene glycol solvent is is now considered the most critical aspect known to be hazardous." More specifically, of modern therapeutics" .' In the following disturbances of cardiac rhythm, fall in blood pages I will attempt to underline these pressure and alterations of ECG complexes statements using as an example a widely have been attributed to that solvent. employed and relatively "safe" drug, However, these effects are largely overcome Diphenylhydantoin or Dilantin. by slow intravenous administration of the solution and Dilantin itself." " The time-honored therapeutic effectiveness of Dilantin lies in the treatment of certain The Therapeutic dosage is influenced by types of epilepsy (primarily centrencephalic several factors. As with other drugs the grand mal, focal cortical seizures and age and body weight of the patient have psychomotor seizures}, and more recently to be taken into account in deciding on a the drug has been valuable in the manage dose. The route of administration is ment of specific types of cardiac arrhythmias. important since with the oral preparation Still under investigation is the use of five to fifteen days may pass before a stable Dilantin in the differential diagnosis of the blood level is attained." In addition, gas inappropriate ADH syndrome. trointestinal upset may be a problem with undivided daily dosage. Although absorption Dilantin is also a chemical substance of the compound from the gastrointestinal that occasionally affects living protoplasm tract is usually adequate, two patients with in an undesired fashion. This reputable poor absorption and inadequate therapeutic compound then joins all other drugs in their blood levels have been described .~ ' On the universal potential of producing untoward other hand the parenteral route presents effects. Despite the rarity with which severe difficulties as well. Rapid intravenous manifestations occur during therapy with infusion of Dilantin has resulted in fatalities" Di lantin, it is desirable that physicians and should therefore proceed at a slow using the drug should be aware of these 2 rate. (50 mgm of DPH or less per minute} ' adverse effects. For this reason I have outlined some pertinent properties, several The fate of Dilantin after either oral or biochemical and physiological effects, as parenteral administration depends on the well as considerations in attaining therapeutic amount of Dilantin detoxified by the liver and non-toxic levels of Diphenylhydantoin. and excreted by the kidney; under ideal conditions this amount equals the main PHYSICAL AND CHEMICAL PROPERTIES: tenance dosage. Toxicity may result in Sodium Diphenylhydantoin is an alkaline the adult patient: salt that is structurally related to other hydantoins (Ethotoin, mephenytoin} and -when the intake of Dilantin exceeds barbiturates. The alkalinity is thought to 300 mgm/ day, contribute to the nausea and vomiting -when Diphenylhydantoin parahydroxyla occasionally observed with oral preparations, tion deficiency is present, (e.g. while the structural similarity to Mesantoin congenital enzyme deficiency} and other compounds has led to cross -when liver disease is present initially reactions in cases of hypersensitivity. or arises later during treatment,
66 --or when the simultaneous administration function25 and diminishing pituitary hypo of some other drugs causes metabolic thalamic response to stress.26 This effect is interference with Dilantin detoxification. not clinically significant but may upset laboratory tests and may lead to a Kutt et al, described Dilantin toxicity misdiagnosis. developing in 10 per-cent of patients on an antituberculosis regimen of NH and PAS.' A tabulated summary of reported com (This effect was not observed when folic plications associated with Dilantin Therapy acid was added to the therapy.) Diphenyl follows. Unfortunately, a definite etiological hydantoin metabolism is less frequently relationship between Dilantin and the impaired by the simultaneous administration untoward effects cannot always be 22 of anticoagulants?• disulfiram, , phenyra established. midol hydrochloride, sedatives, (Compazine, Thorazine, Librium) and estrogens." CNS: Reversible intoxication usually starts at a (normally toxic manifestations) blood level of 20 mgm/ liter as described by cerebellar incoordination and degeneration' Lund et al. A correlation between Central nystagmus Nervous System signs of Dilantin intoxication hemiplegia21 has recently been studied: Nystagmus develops with DPH blood levels of 20 ug/ ml, extraocular palsy22 gait ataxia ensued nearer 30 ug/ ml, and meningeal irritation with pleocytosis and constant lethargy at levels of over 40 ug/ ml.21 elevated protein in CSP 0 Even when all of the above factors are peri pheral neuropathy" taken into consideration and constant amount of DPH is administered the actual blood GIT: level may exceed, by a factor of two, gingival hyperplasia'-(20% ) the predicted level.'• This variability nausea may explain the appearance of DPH toxicity years after Dilantin therapy was begun. abdominal pain The above toxic manifestations usually CVS: respond to dosage reduction of Dilantin. ECG changes A multitude of other side effects have been shock and death following ra pid encountered which do not seem to be dosage intravenous infusion re lated. Among them are gingival hyperplasia, Congestive Heart Failure skin rashes, blood dyscrasias, reticuloendo Periarteritis Nodosa thelial complications, and metabolic changes. RESPIRATORY TRACT: Metabolic interference includes an untoward influence DPH exerts on folic acid Pu lmonary fibrosis-disputed metabolism, possibly by a competative SKIN : inhibition mechanism. As folic acid is necessary for the incorporation of amino From Morbilliform rash (2-5% of patients) acids into DNA a possible explanation offers to fatal hemorrhagic erythema multiforme itself for cases with polyneuropathy" and Hypertrichosis" cerebellar degeneration (proved histologic BONE MARROW: ally).' In addition, the subnormal serum folate Infectious mononucleosis like blood concentration might be responsible for picture incidences of RBC macrocytosis and megaloblastic anemias as well as other Pancytopenia-two cases manifestations of bone marrow suppression, ABC-macrocytosis, megaloblastic anemia, including leukopenia, th rombocytopenia and methemog lobinemia" methemoglobinemia.". The unavailability of WBC-Leukopenia folic acid in cellular metabolism may play Eosinophilia (in hypersensitivity reactions) a causative role in abnormal Vit. B,2 absorption and subsequent posterolateral PLATELETs-Thrombocytopenia column involvement which reversed on Folic acid treatment. " RETICULOENDOTHELIAL COMPLICATIONS: Lymphadenopathy" -mimics Hodgkins Oppenheimer"• points out a competition disease leading to administration of existing between Di lantin and PBI for the alkylating agents. binding sites of Thyroxin-binding globulin, which has led to the incorrect diagnosis and Hepatitis-has led to death in some cases treatment of non-existing hypothyroidism." before relationship with DPH was 2 Similarly, Dilantin may cloud other endocrine recognized. ' • ",. investigations by depressing adrenal cortical Hepatosplenomegaly
67 METABOLIC COMPLICATIONS: Therapy) with the chief complaint of a competative inhibition with PBI generalized intensely pruritic rash. The depressed hypothalamic-Pituitary and rash had begun suddenly on the day of discharge and had spread from her buttocks adrenal laboratory tests to involve the trunk, the extremities and interference with synthesis of DNA the face with periorbital edema. Accompany Hyperglycemia" ing symptoms were a high fever and interference with detoxification of DPH by a dry, unproductive cough. other drugs; PAS, INH, some sedatives, anticoagulants and other compounds On repeat physical examination the patient was uncomfortable with the rash. The vital In conclusion, some side effects of the signs indicated fever (104°F), sinus tachy drug can be tolerated (e.g. gingival hyper cardia (128/ min), a normal blood pressure trophy), whiie toxic manifestations require and a respiratory rate of 24/min. a reduction in dosage schedule and hypersensitivity reactions demand the discon A disseminated maculopapular eruption tinuation of Dilantin or related compounds. with edematous hyperemic eyelids were evident. The lids blanched on pressure and One such case is described below. the ECG suction cup left traces of abnormally extensive capillary fragility. Hepatomegaly without splenomegaly was demonstrated at CASE REPORT two fingerbreadths below the RCM. (A Mrs. A. P. is a 56 year old Ch inese Normal upper border was demonstrated on housewife who was admitted to St. Francis percussion.) Neurological examination Hospital in Honolulu in the beginning of disclosed almost normal fundi and minimal May, 1967. Her presenting complaint was in spasticity and weakness of the left the left-sided extremities. arm and leg. She had been in her normal state of health The patient's hospital course was a until two months prior to admission when complicated one. Striking non-tender cervical she noted the gradual onset of left and axillary lymphadenopathy appeared with hemiparesis, blurred Vision, grand mal slight further liver enlargement some three seizures, and severe headaches. days after the onset of the rash. The reticuloendothelial involvement subsided In the past the patient had been in a gradually after two weeks, when jaundice chronic ambulatory schizophrenic state had been a feature for several days already. with religious overtones for which she had Concurrently, the skin rash developed neither wanted nor received drug therapy. hemorrhagic and exfoliative characteristics. She also had a past history of skin allergy The spiking fever finally resolved by lysis to detergents and Penicillin. after seventeen days of illness.
On physical examination the patient was Laboratory investigation included several confused and had evidence of muscular normal Hemoglobin determinations. Platelet weakness and some spasticity of the left counts were at the lower border or normalcy. extremities as well as a Babinski sign on A persistent leukocytosis was most pro that side. Bilateral papilloedema without nounced on the ninth day of illness (51 ,800 exudate or hemorrhages was also observed. WBC with an Eosinophil count of 30-35% ). At that time 50-60 WBC/ hpf were seen in An EEG, a brain scan and a carotid tl)e urinary specimen but no further possible angiogram were all suggestive of an evidence of infection was found. Blood intracranial space-occupying lesion in the cultures were negative throughout. The right postero-frontal and parietal regions. electrolytes Na, K, Cl , Ca as well as C02, Subsequent crainiotomy delivered successfully BUN, and glucose levels were all within a very large encapsulated Meningioma. the normal ranges. Post-operatively, the patient was treated with Dilantin 200 mgm p.o., b.i.d. for Liver function tests were grossly abnormal, prevention of further seizures. With the however, SGOT elevations were in con help of physiotherapy she made rapid cordance with the SGPT abnormalties with progress. During that hospitalization the the highest readings towards the end of patient had one bout of PAT which responded the second week of illness. (440 K.U. and to Digoxin. The patient terminated ingestion 223 units respectively.) The total serum of that compound on her own accord proteins increased steadily from 5.9 Gm % upon discharge from hospital. on admission to 8.6 Gm % on discharge, while the serum albumin remained constar.t. She was re-admitted two days later on Similarly, the alkaline phosphatase increased June 14, 1967 (after two weeks on Dilantin gradually from 15 to 45 K.A.U. The total
68 9. Kutt, H., M.D.: Winters, W.; McDowell, F. H.; bilirubin level was greater than 10 mgm% Depression of Parahydroxylation of DPH by at the fourteenth day of illness and then antituberculosis Chemotherapy, Neurology, Vol. showed improvement. Cephalin flocculation 16 No. 6, 594-602, June, 1966. tests and thymol tu rbidity were also 10. Ynnis, A. A. , et at ; Biochemical lesion in Dilantin lnduced Erythroid aplasia, Blood, Vol. 30, No. grossly abnormal. 5, 587-599, Nov., 1967. 11 . louis, S. et at ; The Cardiocirculatory changes The most important single act of treatment caused by t.V. Dilantin and its solvent: Amer. consisted of the discontinuation of Dilantin Heart Journal, 523-529, October, 1967. on the day of admission. A supportive topical 12. Helfant, R. H. et at , Diphenylhydantoin Toxcity, JAMA, Vol. 201 , No. 11 , 894, Sept. kk, 1967. regimen for her skin problems consisted of 13. Harinasuta, U.; Zimmerman, H. J.; DPH Sodium antihistamines, Aveeno oatmeal baths, Hepatitis; JAMA 203: 1015-1018, March 18, 1968. Burrow's solution, 'I•% Menthol in a washable 14. Svensmark, D.; Sh iller, P. J.; Buchthal, F.: 5, 5 base. The adrenocorticosteroid compound DPH Blood levels after oral or t.V. dosage in (Medrol 10 mgm q.i.d.) was given for several man; Acta Pharmacal. (Kobenhawn) 16:331 , 1960. days, when the patient's deteriorating 15. Klein, J. P. ; DPH Intoxication Associated with Hyperglycemia: The Journal of Pediatrics 69 : 463- schizophrenic traits led to its discontinua 465, 1966. tion. Antibiotic coverage was not indicated. 16. Kutt, et at., 1964; Familial or Genetic Defect in Hepatic Parahydroxylation, An Enzymatic or The afebrile patient was discharged on Genetic Defect. July 4, 1967, free of neu rological signs, and 17. Hawkings, C. F.; Meynell, M. J.; Macrocytosis and macrocytic Anemia caused by Anticonvulsant without medication, but with marked derma Drugs; Quarterly Journal of Medicine 27: 45, 1958. tological improvement, reduced lymphaden 18. Sparberg, M.: Diagnostically Confusing Complica opathy and improving hepatic function tests. tions of DPH Therapy, Annals of Internal Medicine, Personal communication with the patient's Vol. 59, No. 6, 923, Dec. 1963. private physician revealed continued bio 19. Unger, A. H.; Sklaroff, J. H.; Fatalities Following t.V. use of Sodium Diphenylhydantoin for Cardiac chemical improvement. Unfortunately, the Aohythmias, JAMA, 200:335-336, April 24 , 1967. patient would not consent to further 20. Hansen, J. H. et. at : Dicoumarol induced DPH diagnostic studies. The probable Dilantin intoxication, lancet 2:265-266, July 30 , 1966. intoxication and/ or hypersensitivity remains 21 . Kutt, H.; McDowell; Management of Epilepsy therefore unproved. with Diphenylhydantoin Sodium, JAMA, 203:167- 170, March 11 , 1968. 22. Olesen, D. V.: The influence of Disulfran and Calcium Carbimide on Serum Di phenylhydantoin; Acknowledgement Arch, Neural, 16:642-644, June, 1967. 23. Solomon, J. M. , and Schrogie, J. J.: The Effect Words are inadequate to express my of Phenyramidol on the Metabolism of DPH ; Clinical Pharma. of Therapeutics, 8:554-556, gratitude to Dr. Bernard J. B. Yim for allowing July-August, 1967. me to report his patient, for being a wise 24. Oppenheimer, J. H.; Fisher, L. V.; Nelst>n, K. M.; teacher and a continuous stimulus toward Jailer, J. W.: Depression of Serum Protein-bound my further education. Iodine level by Diphenylhydantoin; Journal of Clinical Endocr., 21 : 252, 1961 . 25. Costa, P. J. Glaser, G. H.; Bonnycastle, D. D.: Effects of Dilantin on Adrenal Cortical Function: References ARCH. Neural. Psychiatry, Chicago 74 :88 , 1955. 26. Krieger, D. T.: Effects of DPH on Pituitary 1. The Pharmacological Basis ol Therapeutics, Good adrenal Interrelations; Journal of Clinic, Endocr. man and Gilman, 3rd ed .. 219-224, 1965. 22 : 490 , 1962. 2. Bajoghli, M.; Generalized Lymphadenopathy and 27. Finch, E.; Lorber, J.: Methemoglobi naemia in The Hepatosplenomegaly Induced by DPH, Pediatrics Newborn. Probably due to Phenytoin excreted in 28:943, 1961 . Human Milk; Journal Of Obstetrics and Gynecol ogy, Brit, Comm., 61 : 833, 1954. 3. Gropper, A. L.; DPH sensitivity Report of a fatal case with Hepatitis and Exfoliative Dermatitis, 28. Morris, J. F.; Fisher, E.; Bergin, J. T.: Rare New England Journal of Medicine. Complications of Phenytoin Sodium Treatment: British Medical Journal 2: 1529, 1956. 4. Chaiken, B. H.: Goldenberg, G. 1. : Segal, J. P.: 29. Manadaz, J. S.; Abducens nerve palsy in Dilantin Dilantin Sensitivity: Report of a case of Hepatitis intoxication: Jour. of Pediatrics, 55: 73, 1959. with jaundice, pyrexia, and exfoliative dermatitis, New England Medical Journal 242:897, 1950. 30. Dutton, P.; Phenytoin toxicity with associated Meningeal reaction. Jour. of Mental Science, 5. Van Wyk, J. J. and Hoffman, C. R.; Periarteritis 104:1165, 1958. Nodosa, Case of fatal exfoliative dermatitis result ing from " Dilantin Sodium '" sensitization, Archives 31 . Livingston, S.; Petersen, D.; Boks, L. L: Hyper of Internal Medicine 81:605-538, 1953. trichosis occurring in association with Dilantin Therapy; J. Pediatric. 47: 351, 1955. 6. R. E. Lovelace, M. B., MRCP and S. J. Horwitz, 32. Carlen, S. A.: Congestive Heart Failure caused M. B., New York: Peripheral Neuropathy in Long by sensitivity to Dilantin; Canadian Medical term Diphenylhydantoin Therapy, Archives Neurol Assoc., Journal 80 : 725, 1959. ogy, Vol. 18, 69-77, Jan., 1968. 33. Rosenfeld, S.; Swiller, 1.; Shendy, Y. M. W.; 7. Utterback, R. A. ; Ojerman, R.; and Malek, J.: Morrison, A. N.; Syndrome Simulating lympho Parenchymatous Cerebellar Degeneration with sarcoma induced by Di phenylhydantoin Sodium; Dilantin Intoxication, J. Neuropath Exp. Neural, JAMA, 176:491 , 1961 . 17: 516-419, 1958. 34. Duma, R. J.; Hendry, C. N.; Donahoo, J. S.: 8. Klipstein, F. A.: Subnormal Serum Folate and Hypersensitivity to DPH : A case report with Toxic Macrocytosis Associated with Anticonvulsant Thera Hepatitis; Southern Medical Journal, 59 :168-170, py; Blood 23 : 68~6 . 1964. February, 1966.
69 News and Views P. Porte '70
Pat Porte would be most grateful for any succulent pieces of gossip or prestigious events occurring in and around the Medical School environments. It was considered that publishing Pat's telephone number would not be a good idea as apparently the line is always busy with sundry male admirers presenting their various advances or causes.
RECENT FACULTY CHANGES AND W. K. Coulter, Clinical Lecturer to Clinical APPOINTMENTS Assistant Professor (Victoria Hospital); A. Kertesz, Lecturer to Assistant Professor PROMOTIONS (St. Joseph's Hospital); J. L. Loudon, Lecturer to Assistant Professor (Victoria Department of Anatomy Hospital); N. W. Rodger, Lecturer to M. J. Hollenberg, Assistant Professor to Assistant Professor (St. Joseph's Hospital); Associate Professor; F. R. Sergovich, J. M. Thompson, Lecturer to Assistant Lecturer to Assistant Professor; Evelyn L. Professor (St. Joseph's Hospital); D. F. Shaver, Lecturer to Assistant Professor; White, Clinical Lecturer to Clinical Assistant R. P. Singh, Lecturer to Assistant Professor. Professor (Victoria Hospital). Department of Bacteriology and Immunology Department of Otolaryngology J. E. Zajic, Honorary Lecturer to G. M. LeBoldus, Instructor to Clinical Associate Professor. Assistant Professor (St. Joseph's Hospital). Department of Biochemistry Department of Paediatrics K. K. Carroll, Honorary Lecturer to G. H. Valentine, Associate Professor to Professor; B. A. Gordon, Instructor to Professor (Victoria Hospital); J. S. McKim, Lecturer; D. S. M. Haines, Instructor to Clinical Lecturer to Clinical Assistant Lecturer; W. L. Magee, Assistant Professor Professor; J. E. Vincent, Clinical Lecturer to Associate Professor. to Clinical Assistant Professor.
Department of Pathology Department of Pathological Chemistry G. M. Abdelnour, Instructor to Clinical W. B. Barton, Associate Professor to Assistant Professor (Westminster Hospital); Professor; Y. S. Brownstone, Associate M. Daria Haust, Associate Professor to Professor to Professor; L. L. de Veber, Professor; D. M. Mills, Clinical Associate Assistant Professor to Associate Professor; Professor to Clinical Professor. (St. D. B. Meltzer, Assistant Professor to Joseph's Hospital). Clinical Associate Professor; S. Prakash, Department of Physiology Lecturer to Assistant Professor. G. J. Mogensen, Associate Professor Department of Surgery to Professor. D. W. B. Johnston, Clinical Associate Department of Biophysics Professor to Clinical Professor; H. W. K. P. B. Canham, Lecturer to Assistant Barr, Clinical Lecturer in Surgery (Neuro Professor; Margot R. Roach, Assistant surgery) to Clinical Assistant Professor Professor to Associate Professor. of Neurosurgery; J. C. G. Coles, Clinical Associate Professor of Surgery (Cardio Department of Diagnostic Radiology vascular Surgery) to Clinical Professor and W. W. J. Wilkins, Clinical Assistant Chairman of the Division of Cardiovascular Professor to Clinical Associate Professor, and Thoracic Surgery; C. G. Drake, Clinical Acting Chairman; E. E. Johnston, Clinical Associate Professor of Surgery (Neuro Lecturer (St. Joseph's Hospital) to Clinical surgery) to Clinical Professor and Associate Professor (Victoria Hospital), Chairman of the Division of Neurosurgery; Chief of Diagnostic Radiology at J. C. Kennedy, Clinical Associate Professor Victoria Hospital. of Surgery (Orthopaedic Surgery) to Clinical Professor and Chairman of the Department of Medicine Division of Orthopaedic Surgery; L. N. S. P. Ahuja, Lecturer to Assistant McAninch, Clinical Associate Professor Professor (Victoria Hospital); D. E. of Surgery (Genito-urinary Surgery) to Aikenhead, Clinical Lecturer to Clinical Clinical Professor and Chairman of the Assistant Professor (Victoria Hospital); Division of Urology; R. M. McFarlane,
70 Clinical Associate Professor of Surgery 88% got their first or second choices and (Plastic Surgery) to Clinical Professor and 20 students were unplaced. Most of these Chairman of the Division of Plastic last students applied but then found places and Reconstructive Surgery. on their own. For the first time this year, the applications will be handled by computer DR. A. T. HUNTER, who has been the under the direction of Ray Osbourne from Director of Continuing Education, Faculty the University of Toronto. of Medicine since Jan. 1, 1966, has had his appointment title changed to Assistant Regarding the student summer exchange to the Dean-Continuing Education, Faculty program, 45 Canadian students found work of Medicine, effective Sept. 15. in European centres, while 51 European medical students were placed in Canada. DR. J. H. WATSON has been appointed There is a $10 application fee but the service Assistant to the Dean, Faculty of Medicine. was considered very good for any student He was appointed Assistant Professor in who wishes to work in Europe for the summer. the Department of Community Medicine on Aug. 1, 1968. He has held a part The following recommendations were time appointment with this department presented to C.A.M.S.I. by the C.M.A. since 1946. and were accepted. Dr. Watson completed his premedical 1. That C.A.M.S.I. hire a full-time studies at Memorial University, received executive director. his M.D.C.M. from Dalhousie University in 2. That the C.M.A. grant to C.A.M.S.I. 1942 and his D.P.H. from the University $10,000 for the next two years to help pay of Toronto in 1954. From 1942 to 1968, for this director. This was on the under he was a member of the Canadian Forces standing that C.A.M.S.I. match the grant Medical Services, serving in Korea and dollar for dollar. holding numerous medical staff appoint ments in Canada. His last appointment was 3. That C.A.M.S.I. elect a responsible that of Base Surgeon, Canadian Forces finance committee; this last recommendation Base, London, from which he retired seems to have been heartily accepted. with the rank of lieutenant Colonel. The C.A.M.S.I. summer clinic held in MR. W. S. McBEAN has been appointed Jamaica last summer was a complete Administrative Officer in the Office of the success. The people who attended were Dean of the Faculty of Medicine, effective introduced to many cases which they would Oct. 1. He is a native of London and has be unlikely to see in Canada. In 1969, the recently retired with the rank of Major clinic will probably be held in Jamaica after thirty years service with the Canadian again. The first choice of the conference Armed Forces (Army). was the Canadian North, but some problems seems to have come up. The site is by no In 1945, he returned from the Canadian means definite yet. Army Overseas and was appointed Adjutant of the Canadian Officers' Training Alan Gauthier of Montreal, co-director of Corps, U.W.O. Contingent until 1946. the drug appeal with Ann Breckenridge of Since World War II , he has seen service U.W.O., reported that 5 tons of drugs were in Korea, Germany, the Middle East and collected and sent to the mission hospitals the U.S.A. Prior to retirement, he held in Haiti last year. Dalhousie and U.B.C. the appointment of Commanding Officer, had the largest shipments. Western had a Canadian Forces Recruiting Centre, London. poor response but is trying to remedy this under the direction of Greg McGregor '71 . THE HALIFAX CONFERENCE Dick Johnston announced that the 33rd Annual conference will be hosted by U.W.O. Sunday evening, Nov. 3, Dick Johnston, next year. Tentative plans were discussed President of the Hippocratic Council and Greg McGregor was elected Conference presented a report on the 32nd Annual Chairman. Louis Tusz was elected a National C.A.M.S.I. Conference held this year at Vice-President of C.A.M.S.I. Dalhousie Medical School in Halifax, N.S. Twenty-three persons represented eleven There are approximately ten months until medical schools across Canada. Two schools the delegates arrive in London for the were not represented (McGill and Sher conference. A lot of planning and work brooke). Regardless of the number of must go into this conference if it is to be delegates each school had two votes. worthwhile. This means that a lot of people will be needed so don't sit back and let The Canadian Intern Placement Service someone else do it, volunteer your services. was discussed. It was reported that 72% of Canadian students participated. Of these Robert Page
71 Class News opacities in our knowledge of the 4th year arrangement both pecuniary and academic. MEDS '69 The annual Meds picnic did provide for Suddenly, life is prom1smg to be for us some controversial social activity though. more than just books, exams, empty pocket A barbecue under Ken (Primary) Shonk's books, London and being called " student"! . direction resulted in a potpourri of culinary Fantastic! We're going to Vancouver next products whose texture and quality really year-Montreal, Edmonton, Victoria! We're didn't matter at that stage in the picnic going to have an income, a degree; buy anyway. The evening dance was preceded clothes, a new car (have responsibilities? by a contaminating, fetid first-year attempt pay off loans?). Yet, before that happens, at a customary skit. The uncouth, vulgar there's lots of details to take care of and display somewhat 'dampened' the remainder the past few months have found us all of the evening for several couples as frantic-sending for internship application Mr. and Mrs. Glen Gibson will attest. forms and transcripts; going for interviews, asking for reference letters, getting signatures Hugh Soltan, Frank Bryans, John Cox, from the Dean, getting our Grad pictures Bill Clark, John Evans, Pat Porte, Joe Krepp, taken, having our friends yuk over them Roy Blackshaw, et al. were responsible for and pick the best and then, on the nights an exceptionally well-organized Seminar on when we're not healing the sick at the Medical Education held on October 5th. hospital, we might open a book, first Student attendance was disappointing blowing the dust from it. considering the quality of guests and material.
I guess life was different last year Pat Porte and Roy Blackshaw have when we had time for electives and announced (I hope) their engagement with extracurricular things. As a matter of fact, impending matrimonial ceremonies in the fruits of those activities are just coming February of '69. Once again the intra-class out-Gary Koop's wife, David Iseman's and compatibilities are demonstrated. Pete Clark's wife all had baby girls just Hamilton's General and Henderson recently. Even a member of the class had Hospitals hosted a week-end visit by several a baby-congratulations to Meredith Maier potential residents and interns on Sept. 28. on the birth of her second child, also a From the class of Meds '70 were Marilyn girl! (The boys are also doing their share Clysdale, Tereasa de Jong, Barb Leask, of filling the medical world with the Nancy Leal, Joyann Baxter, Rachel Waugh, fair sex). Congratulations also to Nancy Dennis Hall, and Ken Shonk. Accommodation Moser, now Nancy Ort, who took time out was provided at the hospitals and the to get married secretly! itinerary involved rounds and lectures at the General and a tour of the Intensive But hush! At this moment, all the hustle Care set-up at the Henderson Hospital. bustle has stopped. Even the very air Participants agreed that the meal-time was bristles with excitement. Books have been rem iniscent of the now-historical dropped, wives and girlfriends neglected, Parke-Davis dinners. even thoughts of internship fade in importance. The sixty-niner has risen to David Taylor was the victim of an the very highest call-TACHYCARDIA!! unfortunate accident early in November With feverish intensity, all effort is con when cooking oil he was heating exploded centrated into making another smash hit! conferring burns to his face, hands, and Some of us are found oblivious to our legs. The class extends to David wishes for surroundings, muttering and gesturing in a rapid and complete recovery. This accident hospital corridors and washrooms, or is no doubt one of the perils of bachelorhood. suddenly bursting into song. Only time and more rehearsals will give us the outcome so turn in to the same page next time for a MEDS '71 line-by-line run-down of London's most Congratulations are in order for Bev and exciting theatrical production. Ted Kassel, who are now the proud parents of a baby girl. Jennifer Louise weighed in Linda A. Richardson '69 at 7 pounds, 10 ounces, 23 inches long.
Sue and Pete Mitchell also have an addition MEDS '70 to the family, a kitten named Stokeley. Sue Much of the attention and activities of has several battle scars, but as yet is showing Meds '70 have been focused on 4th year none of the symptoms of Cat Scratch Fever. curriculum problems. The class must thank Larry Olsson, Henry Rubinstein and others Marriage is in the offing next summer who have attempted to elucidate the previous for the following members of '71 :
72 Dave Fisher and Chris Foreht Dave Peachey and Peg O'Brien John Reason and Carol Ann Sutton Keith Rose and Fran Marshall The Meds '71 Hockey League meets every Thursday at midnight. The Homecoming Float was constructed this year by the members of '71. Our inimitable Merrymaker, Jim Hicks, was in charge, assisted by Bob Page and John Reason. No prizes were won, but, as is usually the case with our class parties, a good time was had by all. Ruth Nelles '71 'Having a Great Time' MEDS '72 Having managed to keep our heads above water in the boat races at the beginning of the year and having maintained our equilbrium with little more than a few queasy stomachs after our first exposure to the Anatomy labs, the class of '71 now appears to be well launched on its course. Following the example of our most hallowed predecessors, the class of '71, but expressing our class individuality to the extent of changing the menu from spaghetti to chili, the class held a wine and chili party on October 9 at the rambling country abode of Judy Wyatt. Having departed again from last year's affair by declining to invite our professors (members of the class were 'Having a Great Time' stimulating company enough!) the gathering lent itself to a wide range of freedom of expression!!! A smashing success by all accounts. A special note of thanks goes to Carol Colthart who arranged the party and to the girls who helped her out in the kitchen. General appreciation was more than adequately expressed during the evening to those who helped to provide the liquid refreshments. Congratulations are in order for Grant Peck, who decided after two weeks of classes to tie the bonds of matrimony, and for Paul Odegard, whose wife recently gave birth to a baby girl. Best wishes also go to several members of the class who became engaged during the last two months. With the first quarter and the inevitable mid-term tests behind us, the class of '72 is looking forward to an exciting and productive year. Marilyn Hopp '72 'Having a Great Time'
THE MED'S PICNIC 1968 Th is year's extravaganza, organized by The main social event of the London Social Vice John Evans, was held at Skee-Hi, season was, of course, the Med's Picnic on a great improvement over Dorchester's Saturday, Sept. 21 . (trumpets and the clatter ill-reputed Dreamland Casino. As usual, of plastic forks and SO 's in the background). the format for the picnic was a " cocktail
73 hour or two" preceeding the barbecued Dr. B. DeVeber-Oepartment of Pediatrics weiners and hamburgers. Everyone knows Dr. G. Goth-Pastor, Metropolitan Church, food is just a front but still the salads London prepared by the Med's Wives Club, gourmet Mr. V. Vere-Lawyer division, were greatly enjoyed, except the portion containing Mary Jane MacKay's J. Laing-'69 finger and Martin Inwood's undershirt. The F. Bryans-'70 shortage of "forks" was duly noted by Birnie, who commented, " Fork, fork, fork, doesn't As the meeting finally closed at midnight, anybody eat anymore?" After eating, Meds this must itself be an indication of the '72 staged the traditional skit which was interest and controversy engendered by this subject. really no worse than might be expected a contrived affair with the emphasis on The Society is grateful for the large toilet training and sexual perversion, only turnout and due to a large number of reaffirming our fears of first year's typical requests, will be holding similar informal immaturity and oral-anal fixation. discussion meetings during the school year. Oh well, on to the dance and a lighter Betty Lawrence '69 element with a really swinging band-The President Soul Agents from London. Some merry makers danced, others drank, and the most energetic combined all three activities. It's ALPHA KAPPA KAPPA even rumoured that a few blithe spirits The fall activities at AKK proved to be went for a moon-lit swim but it's not known very lively and productive. The active if Frank Bryans actually got his pants wet members were most gratified at bringing in in the pond. Most of the senior students, a pledge class of twenty-four--{)ne of the typified by Harry Bergen and Juho Kreep, largest and most enthusiastic groups we were exemplary in their behaviour, unlike have had in recent years. We were pleased, the '71 and '72 crew who weren't. Most as well, to see that the pledges cared important, however, all present had a enough about the health of the actives to bangup time; thus in the words of the invite them on several early morning immortal Thorn, " It was a good bun!" walks in the country-alone!
Pat Porte '70 Dr. Marty Robinson gave us a most enlightening talk on a subject about which CRYOPRECIPITATE DRIVE he has a vast knowledge-wines. Many First, second and third have completed of us wished we had selected from some their first session donating blood to the Red of the vintage products he mentioned after Cross for the production of Cryoprecipitate suffering through three or four days' acute (Factor 8 Concentrate). The classes will gastritis from drinking the " vin du jour" donate again in March and the award will at our Wine and Spaghetti Party. Dr. J. A. F. be presented to the class with the largest Stevenson provided us with an interesting number of units donated. look into university policy and the governing bodies on another evening. Our Homecoming Class organisers are: Party drew a very large number of recent John Taylor '72 alumni-from as far away as Montreal whom we were most delighted to see. Bob Bourne '71 Upcoming events include the informal and Larry Olsson '70 formal initiations, Nov. 20 and 21 , our The Hippocratic Council wishes the Annual Christmas Party, and the Formal, participating classes the best of 'bleeding which will be held Feb. 7. luck' and may the class with the most Roy Musgrove '70 red blood cells win. President Martin J. Inwood '69 SPORTS With two month gone in the intramural OSLER SOCIETY schedule, meds athletes have fared well. Over fifty students and faculty attended Sports which have now been completed the October meeting which was entitled include football, golf, tennis singles and 'Abortion-are you for it or against it'? doubles, track and field, and harrier. Water polo and volleyball are just getting underway The subject was introduced by a panel and Meds has a strong entry in each. of speakers who presented their particular viewpoints with a great degree of facility Meds came up with a surprise second and conviction. The panel consisted of: place finish in the track and field this year-
74 the best placing in the last five years. We '70. Regular games start after Christmas. managed maximum participation in almost Basketball practices begin after the New Year. all events contested and each member of Graeme Gair, Sports Rep. '70 the team should be congratulated for his efforts. MEDS WIVES CLUB We also finished second in the harrier, Meds Wives is again in full swing. We thanks to a strong contingent from the had a highly successful opening meeting North End and some fine individual efforts. and were very pleased to welcome a large number of new dentistry wives along with However, the major disappointment came ou r old and new medical wives. (Second when the Meds 8-man football squad failed hand ones, too?) We again plan to donate to make the championship playoffs. The a Christmas basket of food, clothes and team ended with three wins against two toys to a needy family in London. (Ed. losses and the consolation title. I feel that note: Do needy medical students' families every member of the team did his best, and qualify?) Some of our upcoming events but for a few bad breaks and a tough draw include a fascinating evening devoted to in the scheduling, we could easily have " Female Self Defense"; a Dutch auction; an taken the title for the fourth straight year. 'Engaged' evening with meds fiancees and mistresses invited. With the emphasis on a Volleyball and water polo are underway social evening away from studying or a -for anyone interested there's still lots of working hubby who screams that he wants places open. Coming up are S-pin bowling to be left alone, we warmly encourage all on Nov. 18-25 and 10-pin bowling newly married meds and dents wives to join on Nov. 25-30. us once a month at the Cancer Clinic Hockey practices are starting-if interested Linda Rubenstein, get in touch with Coach Brian Kelly, Meds President
Home Coming Again the Medical School saw the Annual look that old), was called upon to bail out Homecoming weekend arrive with the certain members of the Class of '58 from eminent members of the medical alumni the city jail. This must be treated as purely giving forth with their memories of the past a fictitious rumour because we all know and their aspirations for the future. that the '58'ers are renowned for both their sobriety and conservative approach to life. Nevertheless, as far as the average student was concerned, we saw little of them except As always, the focal point for all the from their attendance at the Medical celebrations were the class dinners held Conference, and of course, the football on Saturday night. However, the Eighth match where the 'Slangs' proved victorious. Annual Homecoming Medical Conference Rumour has it that Dean Socking, who was was the pacesetter and the program celebrating the '43 reunion (he doesn't was as follows:
MORNING SESSION Chairman: A. E. Mowry '28 WELCOME: Vice President (Health Sciences) 0 . H. Warwick CHROMOSOMES AND MEDICINE-M. L. Barr '33 FAMILY MEDICINE (A New Concepi)-A. Hunter '53 COFFEE (Room 106) ORGAN TRANSPLANTATION-MEDICAL AND LEGAL ASPECTs-A. Lansing '53 TREATMENT OF TERMINAL RENAL FAILURE BY INTERMITTENT HEMODIALYSIS AND RENAL TRANSPLANTATION-A. G. Ramsay '48
AFTERNOON SESSION Chairman: H. G. Fletcher '23 MEDICAL EDUCATION-What's Ahead-D. Socking '43 CANCER RESEARCH-RENT ADVANCES WITH A PROMISING OUTLOOK A.C. Wallace '48 VEINS AND VENOGRAPHY-A. B. Holmes '43 THE MANAGEMENT OF MASSIVE CHEST TRAUMA-G. J. Welsh '58
75 DRAMATIS PERSONAE Dr. Murrary L. Barr, '33 Professor of Anatomy, U.W.O. Internationally renowned in the field of cytogenetics and discoverer of sex chromatin and the Barr Body.
Dr. A. T. Hunter, '53 Assistant Professor of Family Medicine, U.W.O.
Dr. A. lansing, '53 Chief of Cardiovascular Surgery, School o( Medicine, University of louisville, Kentucky.
Dr. A. G. Ramsay, '48 Professor of Medicine, University of Alabama Medical School.
Dr. D. Socking, '43 Dean, Faculty of Medicine, U.W.O.
Dr. A. C. Wallace, '48 Professor and Head, Department of Pathology, U.W.O.
Dr. A. B. Holmes, '43 Professor and Chairman, Department of Radiology, University of Toronto.
Dr. G. J. Welsh, '58 Surgeon, Royal Oak, Michigan. Has been involved in the forming of the National Regional Trauma Division.
It is hoped that all the members of the 5 year reunion classes enjoyed their stay and we all hope that their tired legs and grey hair will carry them through another five years before they can indulge themselves in the Western spirit again. M. J. I. * * * A Sobering Thought Poisons and Medicine are often-times the same substance given with different intents.
~ till More Illness The obvious truth is that every medical success in prolonging life tends to increase the amount of sickness there will be in the community.
Home Truth
An Egoist is a man who tells you those things about himself which you intended to tell him about yourself.
What Is the Clinician Is he a biochemist, a biologist, a pathologist, a phychiatrist, a social scientist, a statistician? He is none of these, and yet something of all of them. Something like a chemical change must take place, a new compound, a new entity must be formed. The primary loyalty of any scientist, whether chemist or clinician, is to his material. The clinician must learn that which is central and obligatory to him as a clinician, not as a biochemist or as a social scientist. Romano, J. And leave for the unknown. JAMA 190: 282, 1964.
76 Book Reviews D. Scheifele '69
CHRISTOPHER'S TEXTBOOK OF SURGERY, illustrated and the new sixth edition adds 9th edition electron micrographs to its illustrations. The text is quite lucid, with a minimum of Ed ited by Loyal Davis anatomist's bafflegab. This should be an This is a textbook commonly used by early acquisition of every opthalmology third and fourth year students. To give a resident. The average medical student fair review of this spanking new 9th edition, would benefit from a quick scan of the it is first necessary to point out that there pictures. are two types of student readers, i.e., avid readers and non-readers. At the end of W. B. Saunders Company, Toronto, 1968. each year, the non-readers can be seen 529 pages. $20.55 massively underlining superconcentrated D. S. booklets. Christopher's is not for these (it has 1 ,493 pages-with writing on TUMORS OF THE LARGE BOWEL every page!} by Jackman and Beahrs The avid reader, bless him, is likely Volume VIII in the Series to read in depth and detail throughout the " Major Problems in Clinical Surgery" school year. He insists that each statement of fact be accompanied by full why's and This is an excellent review! The authors are from the Mayo Clinic and they approach wherefore's. To these I strongly recommend Christopher's. the subject with surgical authority and literary dash. The book is a review of all The book is well designed. There are the tumor and tumor-like states of the large several chapters to introduce basic bowel from a highly clinical point of view. surgical concepts, i.e. wound healing, Dealt with in detail are: infections, shock, surgical metabolism. The (a} polyps of the large intestine new edition adds discussions of trauma, (b) benign and malignant tumors oncology, degenerative and congenital diseases. (c) surgical procedures on the large bowel, and The major clinical areas are each (d) premalignant and malignant lesions presented by an expert in that area. For of the anus instance, the chapter on " Heart and Great Vessels" is written by Norman Shumway. The book is well illustrated with drawings Each area is approached by reviewing its and photomicrographs. There are sections anatomy, physiology and pathology. Each on " how to do" sigmoidoscopy, intestinal pathological condition is then considered biopsy, etc. Radiographs are profusely in terms of conservative and operative correlated wi th clinical material. approaches to treatment and why these procedures work. Again, th is is a clinically-oriented discourse. It is well worth an evening to read it, The ninth edition has been extensively whether you are a senior student, a resident rewritten. Several new authors have re-done in surgery or a practitioner. areas and authors retained from the 8th edition, have extensively revised their own W. A. Saunders Company, Toronto 1968. chapters. Many new illustrations have been 377 pages. $14.60 added. Many of the weak spots of the D.S. eighth edition have been nicely repaired. FUNDAMENTALS OF NEUROLOGY This book will be of immense value to the susceptible host. Ernest Gardner, M.D. W. B. Saunders, Toronto, 5th edition, W. B. Saunders Company, Toronto, 1968. 367 pages 1 ,493 pages. $23.25 D. S. This small, highly readable hardcover book combines the same style and illustrative material as Dr. Gardner used in his popular WOLFF'S ANATOMY OF THE EYE AND anatomy text. It is one of the few texts ORBIT-6th edition which combines both anatomy and physiology Revised by R. J. Last of the nervous system in an understandable This is a superb text~ertainly the " Gray's manner without causing hopeless Anatomy" of the eye. It is beautifully confusion with obscure verbiage.
77 The organization is exceptional. The here, but the classical derivation of the initial sections deal with the general words showed this reviewer that what he anatomy, embryology, histology, chemistry felt was medical gobbledygook in actuality and physiology of the nervous system and has a sane raison d' etre. nervous tissue. Much of the detail is wisely left for functional considerations The index is quite complete and useful, in which all phases of such topics as and I had no trouble pinpointing various motor activity, sensation, receptors, and topics I wished to cover. visceral activity are discussed. This This book is not a course in neurology completed, he then proceeds to a discussion in itself. It deals very superficially with of structure and function of the brain by clinical pathology of the nervous system areas, starting with the spinal cord and and is not useful past the basic science working up through the midbrain, cerebellum level. However, as a primer to give the and ending with the learning and behavioral student a basis on which to build his functions of the forebrain. knowledge of the complicated and confusing Another very rewarding feature of this discipline of clinical neurology, I would book is a Glossary of New Terms. Not only highly recommend it. is much of the more confusing terminology H. R. W. * * Prizes for 1968-69 *
THE DR. T. H. COFFEY MEMORIAL PRIZE IN PHYSICAL MEDICINE AND REHABILITATION This Prize of $50.00 and a book has been established by Dr. M. G. P. Cameron in memory of the late Dr. T. H. Coffey. It will be awarded to a third or fourth year medical student for the best essay in the field of clinical investigation or research related to Physical Medicine and Rehabilitation. Essays are to be submitted to the office of the Dean of Medicine on or before March 31st of each year.
THE DR. R. A. H. KINCH PRIZE IN COMMUNITY MEDICINE This Prize of $150 established by Dr. R. A. H. Kinch will be awarded annually to the final year medical student who demonstrates the greatest competence in the clinical and research aspects of Community Medicine. * * * OVERHEARD IN MEDICAL ROUNDS AT ST. JOSEPH'S HOSPITAL: Dr. I. B-a: " I've got this information right from the horses mouth-that is Toronto of course. Dr. B. S-w. " If it came from Toronto, it must have come from the other end of the horse." * * * Inching Along A stack of 25,000 red blood corpuscles fall short of an inch thick.-News item. Twenty-five thousand corpuscles piled One on top of another, Twenty-five thousand, each of them red, Each of them like the other. little by little, little by little, Upward the pile would rise, Making a pillar of cellular sort, Sight for a scientist's eyes. Twenty-five thousand, piled in a stack, Still wouldn't reach an inch, And piling those corpuscles, one by one, Hardly would be a cinch.
78 INTRODUCING THE NEW CLASSIFIED
ADVERTISING DEPARTMENT
with the following list of heads available-however new
classification can be added if necessary
Courses Fellowships Locum Tenens Available Locum Tenens Wanted Positions Vacant Positions Wanted Practice Residencies & lnterships
For Best Results USE Classified Section U.W.O. Medical Journal
Rates: $7.00 for first 40 words, 10c each additional word.
CLASSIFIED ADVERTISEMENTS
THE CHICAGO MEDICAL SCHOOL AND MOUNT SINAl HOSPITAL MEDICAL CENTER OF CHICAGO, offer approved internships-straight medical, straigh surgical, straight pathology, dental, and rotating (all AMA approved types available); approved residencies-internal medicine (with special training in cardiology), pathology, surgery, anaetheosiology, psychiatry, 08-GYN, pediatrics, urology, phyical medicine and rehabilitation; Mount Sinai is a 426 bed Hospital with a new wing of 200 beds now under construction. It is the Base Teaching Hospital of The Chicago Medical School; the chairmen of all departments are either chairman or full professors in their respective departments at the medical school ; stipends: Interns, $5,750 ; Residents, 1st year $6,000; 2nd year $6,500 ; 3rd year $7,000; 4th year $7,500; 5th year $8,000. Modern on campus living accommodations are available for interns and residents and their families. Kindly direct inquiries to: Doctor Jules L. Whitehill, Medical Director, Mount Sinai Hospital, Medical Center and Associate Dean, The Chicago Medical School, California Avenue at 15th Street, Ch icago, Illinois 60608 (277-4000). THE U.W.O. ALUMNI ASSOCIATION
PRESENTS
WORLD FAMOUS ARTISTS
1968 October 3 Duke Ellington and his 1968-69 Famous Orchestra October 18 Ramsey Lewis jazz ensemble November 6 Bavarian Symphony of Munich ALUMNI Rafael Kubelik, Conductor HALL December 3 Rudolph Serkin, pianist 1969 January 18 Vienna Boys' Choir GREAT February 8 Moscow State Symphony Orchestra with soloists *March 22 Toronto Symphony ARTISTS' Seiji Ozawa, Conductor *March 23 Toronto Symphony Seiji Ozawa, Conductor CONCERTS Lorin Hollander, pianist April 18 Hal Holbrook in Mark Twain Tonight • Spring Festival weekend
* * * SINGLE TICKETS ($5, $4, $3) FOR ALL CONCERTS WILL BE AVAILABLE AT WORDS AND MUSIC, EXCLUSIVE BOX OFFICE, 426 RICHMOND STREET, LONDON. NO TELEPHONE ORDERS, PLEASE London's Professional Diamond Consultant
TOPS in Honesty- Va lue - Service
" A Safe Place STUDENT to Buy Diamonds" DISCOUNTS TED DILTS
credit available to students 402 Richmond St. Opposite Simpson's Phone 433-2111
ETHICALLY SERVING THE PROFESSION All types of equipment for STUDENT, PHYSICIAN and HOSPITAL
• Olympus Student and Laboratory Microscopes • Welch Allyn Diagnostic Instruments • Tycos and Baunmanometer, Manometers • Mitchell M.D. Bags • Dissecting Kits & Instruments PHONE: 433-9268
RussELL LIMITED SURGICAL AND PROFESSIONAL EQUIPMENT
~-1-8_7_H_Y_M_A_N__ s_T_R_E_ET ______LO--ND_O __ N,__ O_N_TA_R_I_o __ _ )
MEDS-AT- HOME
HOTEL LONDON
FEBRUARY 1, 1969
Cocktails
Followed by Dinner and Dance SPURRELL DIAMONDS THE TAILOR FINE JEWELLERY SILVERWARE COMPLETE FORMAL WEAR OIL PAINTINGS
+
Special Student Discount NASH JEWELLERS
Tuxedos for the
Meds-At-Home
Reg. Jewellers American Gem Society
146 Wortley Rd. 439-4351 Telephone: 924-8314 or 636-3169
RALPH M. CUMMINS OPTICAL
Specializing in
FILLING EYE SPECIALIST'S PRESCRIPTIONS CONTACT LENSES
Offices
219 Queens Ave. at Clarence 438-8522 400 Central Ave. at Colborne 432-8811 THE UNIVERSITY MOST MEN DO NOT PLAN TO BOOK STORE FAIL, THEY SIMPLY FAIL TO A Book Display Assembled PLAN. Especially For -Students LET ME SHOW YOU HOW TO PLAN YOUR FUTURE SECURITY -Faculty THROUGH LIFE INSURANCE. -Alumni
+ Playing Cards, Glassware, Mugs, Jewellery, etc. with U.W.O. Crest HARRY STEIN, C.LU. Senior Representative, Sun Life of Canada, 1263 Bay St., Toronto 5, Ont. Somerville House - Mon. to Friday- 9:00 a.m. - 4:45 p.m.
Telephone: 924-8314 or 636-31 69 Phone 679-3531
LONDON CENTRE Gifts From Birks DRUGS Always Opened First + Adelaide and Huron
L. I. Kurtzman, Phm.B. Diamonds • Watches Silver • China All Day Motorized Delivery Leather • Handbags 432-1809 Fashion Jewellery • Crystal
Prescriptions Called For and Gifts For The Home Delivered +
Serving Northridge, Kipp's Lane Huron Heights and North London BIRKS JEWELLERS HARTZ \J) Hartz Professional Planning Department
The Hartz Professional Planning Department is a service offered to the medical profession, those starting out in practice, relocating or enlarging present facilities.
Specialists in the Hartz Professional Planning Department are available to provide counsel in every phase of planning . • . plumbing and mechanical installation . . . interior layout leasing and accounting systems.
Take advantage of the personal assistance offered by Hartz Professional Planning Department. Contact the Hartz office in your area
BRANCHES ACROSS CANADA
PAUL MANEY fine pharmaceuticals
TRIFLURIN (trifluoperazine HCL) LACO TABLETS (blsacodyl) TOLBUTONE (tolbutamide) BANLIN (propantheline bromide USP) NIFURAN (nitrofurantoin) CHLOR-PROMANYL (chlorpromazine HCL) BUTAGESIC TABLETS (phenylbutazone BP) PROMANYL (promazine hydrochloride) manufactured by
PAUL MANEY LABORATORIES
TORONTO, CANADA A new CIBA 222 full-color plates Collection of by Frank H. Netter, M.D. Medical Descriptive text by thirty internationally Illustrations known authorities
VOLUME 4 CONTENTS The Hypophysis (Pituilar)' Gland), The Pineal Gland 3$ plates The Thyroid Gland, The Parathyroid Glands 33 plates ENDOCRINE The Suprarenal Glands (Adrenal Glands) 28 plates SYSTEM Sex Differentiation, The Gonads 27 plates The Pancreas (Endocrine AND Function), Carbohydrate Metabolism 31 plates SELECTED Metabolic Bone Diseases, Vitamin D Deficiency 19 plates Lipid Metabolism, Lipidoses, METABOLIC Atherosclerosis, Obesity IS plates Protein Metabolism, Genetics, DISEASES Growth, Hormones and Cancer IS plates Inborn Errors of Metabolism II plates Selected Vitamin Deficiencies 8 plates
Comprehensive cross Matching volumes referenced index and Volume 1 , Nervous System $10.00. Volume 2. Repro bibliography ductive System $0.00. Volume J, hrt 1, Dlvestlve System: Upper Dlvestive Tr.ct $15.00. Volume J, P•rt II, Divestive System: Lower Dlvestlve Tr•ct Sold at cost $22.00 StS.OO. Volume J, P•rt Ill, Dl'l•stive System: Liver, lill•ry Tr•ct •nd hncre•s Stz.OO.
For complete information and order forms. please write to CIBA Company Ltd .. Dorval. Que.
CIBA - DORVAL, OUEIIEC