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1995 UWOMJ Volume 65, No 1, Winter 1995-96 Western University

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Please see enclosed product summery BIONICHE INC. CYSTISTAT- London, Ontario EDITORIAL STAFF 'TI'IHIIE NIEU II§§lUJE Editor Advertising MEDICAL Jay athanson, Meds '96 View An Ad Jordan Solman, Med '98 IMAGING Associate Editors Ripan Chaudry, Meds '98 Cindy Hawkins, Meds '97 Paul Collins, Meds '99 Jordan Solman, Meds '98 Jenny Hankins, Meds'99 SUBMISSIO DEADLINES Copy Editors Class Representatives Sonny Bhalla, Meds '97 Jay athanson, Meds '96 Maureen Gottsman, Med '97 Cindy Hawkins, Meds '97 ARTICLES ...... April 9, 1996 Jordan Solman, Meds '98 ARTWORK ...... April 9, 1996 Artwork Jenny Hankins & Joe Kim, Meds '96 Paul Collin , Med '99 Rami Croitoru, Meds '97 COVER ART: Sudeep Gill, Meds '97 Printer Sangiv Kaila, Meds '97 Willow Press Limited Pen and Ink: Ancient physicians believed that health pre ailed if the four ••••••••••••••••••••••••••••••• "humours" (blood, phlegm, black bile and yellow bile) were in balance. The UWO MEDICAL JOURNAL ADVISORY COUNCIL observation of urine or uroscopy, was used as a 1 Jay athanson, Editor reflection of humoral Cindy Hawkins, Associate Editor balance. A basic diagnostic Jordan Salmon, Associate Editor tool for centuries, uroscopy Dr. J. Silcox, Assistant Dean, Student & Faculty Affairs2 was refined to the point that Dr. D. Colb the Breslau Codex of Dr. M. Inwood4 Salernitan Medicine devoted Dr. J. iske~ forty pages to the practice, and eighteen different ' Chairperson colours of urine were 2 Deparbnent of Obstetrics and Gynecology, St. Joseph's Health Centre described. ' Deparbnent of Medical Microbiology, niver ity Ho pi tal • Department of Haematology and Oncology, St. Joseph's Health Centre Sudeep Gill, Meds '97 ' Deparbnent of Obstetrics and Gynecology, University Ho pitaJ •••••••••••••••••••••••••••••••••••••••••••••

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••••••••••••••••••••••••••••••••••••••••••••• U. W .O. Medica/Journal 65 {1) 1995------3 GUIDELINES TO AUTHORS

The purpose of the UWO Medical Journal is to References are indicated numerically in the text' and provide a single forum for original articles ba ed on listed as endnotes in order of appearance.2 Do not use clinical or research medicine of topical or historical the 'endnote' feature of your word processing program; interest. Since readers hip of the Journal is list references as part of the text on a separate page interdisciplinary, articles published will attempt to reflect immediately following the body of the document. a wide range of medical interests. In this regard, Punctuation comes before reference numbers and submissions should be directed towards the general sentences are separated by one space only. Examples of medical reader. Articles which do not pertain to the Journal reference format follow below: feature topic will be given lower priority as will tho e with excessive technical jargon. Please restrict submissions to 1. Douglas J, Thomas S, Jan MA. Clinical value of polysomnograplly. under 2,000 words. l.Jmcet 1992; 339(2):347-50. Informal peer review is required, i.e., non-specialist 2. Dement WC. Carskadon MA. Riclzardso 11 G. Excessive daytime sleepiness author are encouraged to collaborate with, or at i11 tile sleep ap11ea syndrome. In: Guil/emi11a u/t C. Deme11t WC. eds. minimum, have their work reviewed for content by a Sleep Apnea Sy11dromes. ew York: Ala11 R Liss, 1978:23-46. specialist in the field. This individual, if not a co-author, is to be acknowledged at the end of the paper. In addition, it Please direct submissions, including return address, is recommended that all submis ions be proof-read for phone and fax number, to: UWO Medical Journal, significant stylistic or grammatical errors. The editors will Health Sciences Building, University of Western not assume responsibility for corrections of this nature Ontario, London, Ontario, 6A 5Cl. Tel: (519) 661-2076. and articles requiring such revisions will be returned to Fax: (519) 661-3797. Please do not contact the editorial the author. staff at home. All inquiries should be directed to the Submissions are to include a cover letter, two double class representatives or sent to the Journal's e-mail spaced paper copies, and the fuJI text on 3.5" computer address: [email protected]. diskette in Microsoft Word or WordPerfect format. The cover letter should be signed by all authors and indicate Submissions which do not follow these guidelines that the manuscript has not been published previously. will not be accepted for publication. Figures should be professionally drawn; photocopying of illustrations from texts, without the permission of the publisher, is copyright infringement. Figures and tables should each be submitted on a separate page and any illustration with a grey-scale should be in the form of a photograph. Two copie of figures or tables should be included with labels on the back indicating number as well as the first author. Legends, which are to be included at the end of the text, should start on a separate page with arabic numerals corresponding to the figures and tables. Submissions and disks become the property of the Journal. The Journal reserves the right to correct errors of punctuation and spelling. Short biographical notes on the authors are to be included at the beginning of each paper. Affiliation with UWO is not a prerequisite for authorship. "To life" means that we constantly innovate high quality therapies. The U. W.O. Medical Journal is an interdisciplinary For society, it means better medical science publication, established in 1930. The and more cost-effective health care. Journal is published twice each academic year: Winter, & Spring. Subscription is $17.00 per year. ©All For you it means a healthier life. material published in the U. W.O. Medical Journal is copywright protected-no section of the U. W.O. Medical Journal may be reproduced without the G~ expressed written permission of the Editor. Ph armada

4 ------U.W .O. Medica/Journal 65 Ill 1995 CONTENTS EDITORIALS Editorials ...... 6 Letters ...... 7 FACULTY NEWS Obituary Murray Llewellyn Barr ...... 8 ARTICLES Active Compression-Decompression CPR Sara Gray and Terry Skoretz ...... 9 Air Management in the Trauma Patient with a Cervical Spine Injury Yellow Brick Road Bioetllics Qasim Raza Alikhan ...... 11 (P. 23) Omega Nina Singh ...... 14 Animals, Autonomy, and Right--A Moral Justification for Animal Experimentation Jay A. athanson ...... 15 Militarism, Its Interface with Health, and the Role of the Physician Ripan Chaudhary ...... 19 Yellow Brick Road Bioethics Cassie Lin ...... 23

lFlEA'TI'UJIE.lE §JEC'TI'IT(Q)N~ HISTORY OF MEDICINE Albucasis (936-1013) History of Ontario Qasim Raza Alikhan ...... 25 Asylums (P. 27) History of Ontario Asylums Caroline King ...... 27 An Alarming History of Breast Cancer Treatment in Times of Old Mary Ann McKnight ...... 30 Alexis Carrel: Innovator of Surgical Vascular Anastomosis Paolo Campisi ...... 31 What's In a Name? Canadian Medical Eponyms Brian Christopher Misiaszek ...... 33 The History of The Discovery of DNA as The Material of Heredity Jordan B. Solman ...... 37 An Eerie Glow: The Story of Radium Dial Painters in the 1920's David R. Martell ...... 42 Feature Section: Alexis Carrel: Innovator of The New Eugenics Surgical Vascular Sophia Khan and Sindu Kanjeekal ...... 45 Anastomosis (P. 31) !!MEDICAL HUMOUR!! Stitches in Time ...... 47 PROBLEM SOLVING Historical Medical Vocabulary ...... 49

U. W .O. Medica/Journal 65 (1) 1995------5 The Soul of Medicine: The Medical Humanities

look at the pas t will s how that the An education in the medical humanities is philosophie of one age become the indispensable on two levels. On a basic level (one A absurdities of the next, and the foolishness that will appeal to medical school administrators) it of ye terday becomes the wisdom of tomorrow. 1 directly strengthens the physician's ability to care In his extensive writings, Sir William 0 ler for patients. To effectively appreciate medical emphasized the necessity for medical tudents and history, we mu t first accept the paradox that "the physicians to have a ound appreciation for the beliefs and knowledge of antiquity have been history of their profession and for the humanities. superseded only by the more rational ignorance of He encouraged his students to be well rounded today."1 Then, through knowledge of the influencing individuals, to expand their intellectual horizons forces, general trends, flaws, and controversies beyond the medical textbook , and epitomized the within modern medicine and that of antiquity can idea of the physician as scholar. we control the destiny of our profession. 4 An Unfortunately, the information-age mindset appreciation of the history of our profession, of the prevalent in contemporary undergraduate science achievements and of the shortcomings, permits us to programmes and schools of medicine discourages discern the forces at work, and what is to come. such enlightenment, requiring early dedication to Of course, there is a higher, less tangible reason the scientific aspects of medicine to the exclusion of for appreciation of the medical humanities, indeed everything else. To receive grades which are the humanities in general: learning the humanities suitable for acceptance to medical school, mo t for persona I enrichment rather than for voca tiona I students enrol in primarily science-based courses purposes. It may not be the responsibility of a (where grades in the 90's are commonplace) rather school of medicine to instill a love of the humanities than ris k mediocre (i.e., anything less than an " A") in their s tudents. However, in curricula where the marks in the courses centring on the humani ties. humanities are given the recognition and respect The trend continues when the student enters they deserve, these qualities may develop on their medical school; science predominates over the own. It will then become self-evident to all involved humanities once again. As a result, modern medical that the pursuit of human enlightenment through practitioners have concentrated their sphere of the study of philosophy and history will not only knowledge to a pinprick. Physicians know o nly create better physicians, it will create better human how to treat diseases, have focused competence and beings. general ignorance. 2 It seems fitting, then, to close with the words of Medical humanities, such as the history of Sir William Osler: medicine and medical ethics, have all but Every day do some reading ... apart from your disappeared from today's medical school curricula. profession. I fully realize, no one more so, how Considered extraneou in the pursuit of a medical ab orbing is the profe sion of medicine ... but you career b y administrators who stress utility over will be a better man and not a worse practitioner for enrichment, humanities-based instruction has been an avocation. I care not what it may be: literature or supplanted by science and technology domina ted history or. .. any of which will bring you into contact courses, on the fallacious principle that only what is with books.' ' factually relevant' is of importance. As the medical knowledge base expands unrelentless ly, Jay JVatfianson, :Meds '96 representatives from the various medical departments vie for the precious and continuously 'Editor diminishing course hours, upholding their ins truction as indispensable. Unfortuna tely, the REFERE CES medical humanities are little match for anatomy, pathology, hist ology, and the like and are 1. Osler W. Tlze Student Life. In : Roland CG, ed. Sir William Osler 1849- invariably the first to be sacrificed to make room 1919: A Se/ectio11 for Medical Students.Toro11to: Hannah /nstit11te for tire History of Medici11 e 1982; 27-48. for the ' necessary' basic facts of a medical 2. Prioreschi P. Physicians, historia11s a11d tlze history of medicine. Medical education. I am, by no means, nega t ing the Hypotlzesis 1992; 38:97-101. importance of the above courses in the training of a 3. Cole FJ. A History of Compara tive Anatomy from Aristotle to the physician; rather I am proposing that the value of Eiglztee11tlz Cent11re. Londo11: Macmillan & Co. Ltd. 1944; 3. the humanities has been significantly 4. McClure LW. Who 11eeds history? Letter. Academic Medici11e 1995: underestimated to the detriment of the medical 70(6); 461-2. profession.

6 ------U. W.O. Medica/Journal 65 (1) 1995 u @

To the editor,

Paolo Campisi's article (Rapid Sequence Induction: These contraindications exclude all but the mos t Airway Establishment and Management in the experienced persons in airway management from Emergency Department, UWO Medical J 1995: 64; 83-86) performing RSI in the ER setting. Furthermore, the use is an excellent review of the topic. However, I have of lidocaine spray topically to the v oca l cords is serious reservations about the u se of rapid seque nce controversiaL It elicits a strong cough re fl ex initially induction (RSI) in the eme rg ency room b y non­ w hich may be detrimental with an unstable C-spine or anesthesiologists. raise intracranial press ure and also lidocaine spray Although Mr. Campis i discussed the anatomica l o btunds the protectiv e airway reflexes which may problems that may be associated with difficult intubation, prevent aspiration. Atracurium and vecuronium (table he failed to mention other contraindications to RSI which 2) are not sufficiently rapid acting to be used for RSI and include: sho uld not be used. The atropine dose suggested for 1. inexperience with endotracheal intubation adults is incorrect and is rarely u ed for RSI in adults. 2. inexperience with anaesthetic induction agents The dose of thiopental suggested (table 2) may be too and muscle relaxants high for the elderly and is relatively contraindicated in 3. inexperience with rapidly obtaining a surgical hypovolemic patients. airway In the case of a failed intubation, if the patient 4. immediate availability of equipment for cannot be ventilated, immediate cricothyrotomy must be cricothyrotomy performed. Waiting for the help of a surgical team will 5. facial trauma likely prove disas trous. Ev ery person capable of 6. C-spine injury inducing anaesthesia must be able to perform 7. retropharyngeal abscess cricothyrotomy. 8. epiglottitis The use of RSI in the ER is extremely dangerous in 9. laryngeal trauma or tumour, tracheal trauma the hands of persons not expert in airway management, 10. Zenker's diverticulum pharmacology or anaesthetic agents, muscle relaxants 11. potential difficulty to ventilate (e.g., chest wall and pathophysiology. The use of muscle relaxants in the trauma, tension pneumothorax, or ER causes more problems than it may solve. RSI of bronchopleural fistula) anaesthesia rarely has a place in the ER. 12. active vomiting 13. lack of suctioning equipment immediately Steven Dain, MD., FRCPC available Assistant Professor, University of Western Ontario 14. cardiovascular disease Department of Anaesthesia 15. hypovolemia 16. anaesthetic drug contraindications MfDICAL~ SCHOOL~ IS~ JUST~ TH£~B£GINNING

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U W.O. Medica/Journal 65 (1) 1995------7 he passing of Murray Dr. Barr then returned Barr on May 4, 1995 to Western as a member of Tconcludes an epoch in the Department of the development of medical Anatomy where he began science in Canada and in research on cytological the evolution of the changes in nerve cell Department of Anatomy at bodies following nerve Western, which he joined injury. He soon became nearly 60 years ago. In totally engrossed in addition to carrying out his neurocytological research personal scientific work and and decided to pursue an his duties as a teacher and academic career. He was administrator of a promoted and became a department, Dr. Barr department head in 1953. occupied a vital po ition in The most renowned the advancement of discovery re ulting from anatomical sciences and Dr. Barr's research wa that genetics in Canada through the ordinary cells (somatic his involvement in the cells) of males and females national granting agencies exhibit a distinct difference and scientific societies. As a in the pattern of the teacher of neuroanatomy, distribution of D A in an advisor, and a friend, he their nuclei. Th.i discovery will be remembered by was the result of research generations of grateful carried out in collaboration medical students. The with hi graduate student, E. G . Bertram. A small students of the Vet's classes Murray Llewellyn Barr 1908-1995 were particularly attached mass of D A wa present to him, since he was also in cells of females, but not one of them, a Veteran from the Air Force, and not much in cells of males. This they called the "sex chromatin". older than they were. Further re earch by Dr. Barr and his colleagues showed Murray Barr was born in 1908 on a farm not far from that the sex chromatin represented the stainable London, in Belmont, where he went to elementary school. chromatin of one of the two X chromosomes of the In London he completed his secondary chooling. In 1926 female, ab ent in the male where only one X chromosome he enrolled in the B.A., M.D. cour e at We tern, is present. Its discovery was almost immediately applied graduating with an M.D. in 1933. Along the way he took to clinical medicine, particularly in the study of abnormal a leading role in student activities, especially in student sex development and of mental retardation. It government (he was president of the Un.iver ity Student's significantly advanced the study of the new field of Council), in medical history (with Dr.Crane in the 0 ler human cytogenetics, especially the study of human Society), and in athletics. chromosome abnormalities. Dr. Barr did his internship at Erie, Pennsylvania, This discovery, and the continued work by Dr. Barr in decided to become a neurologist, and returned to cytogenetics, earned him a well deserved international Western, joining the anatomy department in 1936 for the reputation, and he received many honours, including purpose of enhancing his knowledge of the anatomy of many honourary degrees, fellowships in pre tigious the nervous system. During the summers he studied in societies, and awards. He was perhaps most pleased to Minnesota under A. T. Rasmussen, a renowned american be awarded the Joseph P. Kennedy Jr. Foundation Award, neuroanatomist. However, he did not complet his presented to him by President John F. Kennedy and also studies in the States because at the outbreak of the war he to be made a Fellow of the Royal Society of London, the joined the R.C.A.F. as a medical officer, serving in Canada first recipient of this honour among Western graduates. and in England. He had great aptitude for In addition to his research papers Dr. Barr was the administration, and was made President of the R.C.A.F. author of a highly respected textbook of neuroanatomy medical Board in London, England for a period of two which is used world-wide. Dr. Barr's long standing years. When he left active service in 1945 he held the interest in historical matters led the Faculty of Medicine rank of Wing Commander. to invite him to compile a history of the medical school for the 1978 celebration of the Centenary of the ABOUT THE A UTHOR: University. His book, "A Century of Medicine at Dr. Robert Buck is Professor Emeritus of Anatomy at tl1e University Western", which was written largely after his retirement, of Western Ontario and was a friend and colleague of Dr. Murray Barr for provides a vivid portrait of the evolution of a prestigious nearly 40 years. Dr. Buck was Editor of the UWO Medical ]oumal in 1946. medical school from humble beginnings.

8 ------U. W .O. Medica/Journal 65 (1 ) 1995 Active Compression­ Decompression CPR

by Sara Gray and Terry Skoretz

tandard cardiopulmonary resuscitation (SCPR) is an guidelines for force and depth provided by the American interim technique designed to artificially maintain Heart Association.8 Therefore, the compressions are ventilation and systemic perfusion until spontaneous calibrated to the size of the patient: a woman, a man, or a S 7 cardiopulmonary function can be re-initiated. SCPR in its large man. current form was developed in the 1960's, and has The original anecdote was published in October 1990, changed very little since that time. SCPR maintains and produced a spate of empirical investigations. Cohen, systemic circulation by compressing the heart between Tucker, Lurie eta!. (1992) demonstrated that ACD CPR the sternum and the vertebrae and by rhythmically improved haemodynamics in ten human subjects, in increasing intrathoracic pressure. These techniques addition to increasing a measure of cardiac output and replicate the systolic phase of the cardiac cycle, while the end tidal carbon dioxide (ETC0).2 Both of these measures diastolic phase occurs passively. Despite the prevalence are reliable indicators of coronary perfusion pressure of this technique, SCPR has a success rate of only ten to 15 (CPP); increasing CPP is an important factor in improving percent, even when performed on patients who arrested rates of resuscitation.7 To support their hypothesis that while in-hospital. 1 Furthermore, SCPR only produces one ACD CPR could increase perfusion pressure, Cohen, third of the normal cardiac output. Therefore it is a poor Tucker, Redberg et al. measured haemodynamic substitute for a heart in normal sinus rhythm.2 properties in eight non-ventilated dogs with induced Due to the lack of overwhelming success, ventricular fibrillation. They replicated their improvements upon the current method are continually haemodynamic results from the human study, by directly sought. As reported in JAMA (1990), a patient was assessing coronary perfusion pressure using ascending successfully revived after chest compressions were aortic and right atrial pressures. The dog's minute performed with a toilet plunger applied to the anterior ventilation was approximately doubled during ACD thoracic wall. 3 In theory, a plunger may provide (p

U. W .O. Medica/Journal 65 (1) 1995------9 M.fT/CieS

ACD provided increa ed arterial blood pressure during ACKNOWLEDGEMENTS compressions (p<0.03), coronary perfusion pre ure (p<0.02), minute ventilation (p<0.001) and negative The authors would like to thank Dr. J. Dreyer and inspiratory pressure (p<0.04). By directly mea uring Sharon Baker R. ., of Victoria Hospital, for their right atrial pressure in human patients, this study proved information and constructive suggestions. that ACD CPR improves coronary perfusion pressure. 5 Lurie, Schultz et al. investigated 77 out-of-ho pita! REFERENCES cardiac arrest patients. Although they did not find that ACD provided a statistically significant benefit to 1. Tucker Kj, Savitt MA, Jdris A & Rt>dberg RF. Cardiopulmonary pontaneous recovery of circulation or s urvi a! to Resuscitation: ilistorical perspectives, physiology and future directions. hospital discharge, their results indicated trends in that Archives of Internal Medicine, 154:2141 , 1994. direction. They conclude that larger studies are required 2. Coilt'll Tj, Tucker Kf, Redberg RF, Lurie KG, Cl1in MC, Dutton JP, Scheinman MM. Sc/1iller B & Callaham ML. Active compression­ to provide more definitive results.'" Most rece ntly, decompression resuscitation: a novel method of ca rdiopulmonary Tucker, Galli, Savitt et al. performed an outcome tudy resuscitation. American Heart journal, 124:1145-1150, 1992. which compared ACD CPR to SCPR in 53 in-ho pita! 3. Lurit' KG, Lindo C, Chill f. CPR: the P stands for plumber's helper. patients. They found that ACD improved the prevalence JAMA. 264:1661 , 1990. of circulatory return and 24 hour survival rates. ACD 4. Halperin HR & Weisfeld! ML. ro~ approaches to CPR: fo ur hands, a also showed a trend for improving survival to ho pita! pilmger, or a vest. JAMA, 267(21 ):2940-2941, 1992. discharge, al though as yet no study has found a clinically 5. Schult: If, Coffeen P, Sweeney M , Detloff B, Kehler C. Pint>da E, Yakshe ignificant re ult on this outcome measure. " P, Adler SW, Chang M , Lurie KG. Evaluation of standard and actiz>e compression-decompression CPR in an acute illmwn model of ventricular Further alternatives to SCPR include interpo ed fibrillation. Circulation, 89(2),:84-693, 1994. abdominal counterpulsation, and an inflated vest device. 6. Ontario ACD CPR Trial. Information for Hospital Staff (London). 1993. However, both methods require further clinical t sting 7. Cohen Tf, Tucker Kf, Lurie KG , Redberg RF, Dutton JP , Dwyer KA, before their use becomes widespread. Interpo ed Schwab TM, Chin MC, Gelb AM, Schei111 11 a11 MM. Schiller B & abdominal thru ts have been tudied in a small human Callaham ML. Active compression-decompression: a 11 ew method of population; the initial results were promising however cardiopulmo11ary resuscitatio11 . jAMA, 267(21):2916-2923, 1992. they need to be clinically validated in a large sample.12 8. American Heart Association. Sta11da rds and g uidelines for The inflatable vest technique has been extensively te ted cardiopulmonary resuscitatio11 (C PR) a11d emergency cardiac care (ECCJ. JAMA, 255:2905-2973, 1986. in animal . While it provided a haemodynamic benefit, 9. Cohen Tf, Goldner BG, Maccaro PC, Ardito AP, Tra::era S, Cohen MB no results from studies using human subjects have been & Dibs SR. A comparison of act ive compression-decompression performed. In contrast, ACD is simple to learn and cardiopulmonary res uscitation with standard cardiopulmonary inexpensive as compared to other CPR methods such as resuscitation for cardiac arrests occurring i11 the hospital. ew England the vest device. Therefore, if it is found to be effective in journal of Medicine, 329:1918-1921 , 1993. improving urvival rates it may be the best alternati e.• 10. Lurie KG , Schultz Jj , Callaham ML, Schwab TM, Gisc/1 T, Rector T. The current Ontario ACD CPR trial is expected to be Frascone Rj & Long L. Evaluation of active compression-decompressio11 completed in September 1995, and the re ults will be CPR in victims of out-of-hospital cardiac arrest. jAMA, 271(18):1405, available in the spring of 1996 at the earliest. The tudy 1994. 11. Tucker Kj, Galli F, Savitt MA, Kahsai D, Bresnahan L & Redberg RF. began in May 1993 and is unique due to its large sample Active compression-decompressio 11 resuscitation: effect on resuscitati011 size (expected N=1500). The experiment is designed to success after in-hospital cardiac arrest. joumal of the A merican College of determine whether long and short term urvival rat can Cardiology, 24:201-209, 1994. be improved by the use of ACD CPR compared to SCPR. 12. Sack jB, Kesselbrenner MB & Bregman D. Survival from in-lwspital For patients who suffer cardiac arrest, the method of cardiac arrest with interposed abdominal counterpulsat ion duri11g resuscitation is determined by a sealed study container, cardiopulmonary resuscitation. jAMA, 267:379-385, 1992. which has a SO percent chance of containing an ACD CPR apparatus. If the box is empty SCPR is performed; therefore the patient has a randomly assigned equal chance of entering either the ACD group or the SCPR group. Both methods of resuscitation follow the HA guidelines for compressions and ventilation. All • LAL • QILA • personnel who perform chest compressions have been INDIAN TANDOORI RESTAURANT INC trained in ACD CPR so that they can perform either IN DIA N CUISINE LONDON'S LARGEST INDIAN RESTAURANT method effectively. The same randomization procedure OUR SPECIAlTY • TANDOORI / CURRY I VEGETARIAN 1 NON·VEGETARIAN FULLY LICENCED t CATERING FOR PARTIES & MEETINGS is also followed for out-of-hospital cardiac arrest patients; TAKE OUT AVAILABLE Thames Valley Ambulances begin CPR by opening one of AS SERVED AT THE MOGHUL BANOUETS OF ·w OILA' OPEN 7 DAYS A WEEK study containers, which determines their method of LUNCH SPECIAL MON·WED 11:30 AM TO 2:30 resuscitation. As in previous ACD CPR studies, patients LUNCH BUFFET THURS-FRI. 11 ::¥) AM TO 2:30 DINNER 5:00 PM - 11:00 PM who are under age 16 are excluded from the experiment. DISCOUNT FOR SENIORS & STUDENTS ln addition, the Ontario ACD CPR trial does not include 748 RICHMOND FLR.1 acute trauma patients." The results of this study are 433-1658 (AT OXFORD) expected to affect the treatment of cardiac arrest patients FREE PAR NG IN CITY PARK LOT BEHI 0 worldwide. ~ ~

10 ------U. W .O. Medica/Journal 65 (1) 1995 Arttcles Ai rway Management •1n the Trauma Patient with a Cervical Spine lniury

by Qasim Rnza Alikhan, B.Sc, M eds '97

INTRODUCTION or an interference with gas exchange because of injuries and hemorrhages, (iv) there must be efficient and speedy rauma patients usually pre ent a complex clinical control of the airway, and (v) the patient must be scenario in terms of airway management. Unlike the considered to have a full stomach and thus at ri k for Tpatient undergoing elective or planned surgery, the aspiration.4 trauma patient is unprepared for surgical intervention.' The trauma patient must be immobilized as soon as It is imperative that airway control be the central is ue in possible until cervical spine pathology is ruled out. The the tabilization of the patient. 7 Suspecting and use of a oft collar i unsatisfactory and a hard collar is recognizing a spinal injury i important to prevent marginally better.2 The best method for immobilization is econdary injury that may occur if the diagnosis of CSI is to secure the patient to a hard board from head to toe delayed.8 with sandbags on either ide of the head and a rigid collar In the United States, spine injuries occur at an around the neck. 2.s incidence of about 280 per million people' accounting for 9 10 two to three percent of all trauma patient . • CSis are AIRWAY SUPPORT re ponsible for about 6000 deaths and 500 cases of paraplegia annually." Considering that the cervical spine Airway obstruction may be relieved in a relatively is the most mobile and lea t upported portion of the non-invasive manner by one of three potential methods: vertebral column,' it is not surprising that this part of the chin-lift, jaw-thrust, and na al/oral pharyngeal airway body i susceptible to an exce ive amount of movement in ertion.2 Even though oxygenation is the highest and injury during impact. In addition, up to 90 percent of priority, CSI is still a major concern/ and both chin-lift all traumatic cervical s pine injuries are uns table .'" and jaw-thrust may move the neck and cause irreparable Therefore, normal movement and load have the potential damage.2 However, both are generally accepted for use in to disrupt anatomical relationships resulting in the trauma patient.4 neurologic deficits.17 Chin-lift is performed by grasping the anterior base Etiologies of CSJ incl ude hyperextension, of the mandible and gently lifting upward to move the hyperflexion, compression, rotation, and penetrating chin forward while di placing the lower lip to open the trauma. 2 In general, motor vehicle accidents are mouth. While performing this technique, an assi tant is re ponsible for most cases of CSI followed closely by falls, recommended in order to prevent any neck movement. 4 2 sports injuries and non-penetrating injuries. ' · " · " The alternative to the chin-lift i the jaw-thrust which Knowing the mechanism of injury is important as it involve using both hands to push forward the angles of allows for a more focu ed treatment plan to be the mandible.4 As in the chin-lift, the patient's lower lip e tablished." It has been e timated that up to 25 percent can be imultaneou Iy displaced downward to avoid of patients with CSJ suffer exacerbation of their injurie clo ure of the mouth. because of a delay in diagnosis or unwarranted Adjuncts to both techniques, such as an manipulation.9 Thus, proper evaluation of the patient oropharyngeal or nasopharyngeal airway insertion can be mu t occur before any treatment is initiated, including a u ed to aid ventilation.u It has been noted that the hi tory, physical, and a radiologic examination.2.18 nasopharyngeal airway may be inferior to the oropharyngeal airway; however, the responsive patient GENERA L CONSIDERATIONS usually tolerates the former better.5 Unfortunately, long term ventilation cannot be maintained with bag and mask The trauma patient present with a complex scenario and more secure methods of airway control will for the proper management of the airway.4 This is becau e ultimately be required.2 Complications of the above (i) the patient usually undergoes numerous therapeutic techniques include an increase in agitation, retching, and diagnostic testing concurrently with the assessment coughing, vomiting and bleeding.' and management of the airway, (ii) traumatic injuries themselves may interfere with routine management ENDOTRACHEAL INTUBATION techniques, (iii) there may be increased oxygen demand Indications for endotracheal intubation in the trauma patient include head injury with a Glasgow Coma Scale ABOUT TilE AUTHOR: less than or equal to nine, shock, airway obstruction, Qasim Raza Alikhan is presently a third year medical student at the combative patient requiring sedation, general anesthesia University of Western Ontario. Mr. Alikhan holds a B.Sc.(Hon ) from the employed, chest trauma with hypoventilation, post­ University of ew Brunswick - Saint john. resuscitation hypoxia, and cardiac arrest.'5 Endotracheal

U. W.O. Medica/Journal 65 (1 ) 1995------11 M r r r t. r t: ;, intubation can be performed in the awake patient either SURGICAL AIRWAY INTERVENTION by (i) oral or nasal route via direct laryngoscopy or (ii) by blind nasal intubation. In addition, intubation may be The only indication for creating a surgical airway i performed under general anesthesia. the inability to intubate the trachea in an apnoeic or The method of awake tracheal intubation reliably everely distressed patientY Surgical cricothyrotomy is a secures the airway, and is appropriate if an urgent airway rapid but invasive technique to control the airway.2 If is required.2 The awake tracheal intubation was found to long-term tracheal intubation is required, the be a safe method of airway management in patients with cricothyrotomy may be replaced with a tracheostomy at a CSis." later date.5 Blind nasotracheal intubation is a technique which is This procedure is performed by making a skin successful in more than 50 percent of patients.2 It is useful incision extending through the cricothyroid membrane for urgent intubations when mouth opening or neck and then inserting a small endotracheal or tracheostomy movement is limited or prohibited.19 Topical anesthesia of tube through the opening.5 With the use of one of the the nose and oropharynx and appropriate sedation is available cricothy rotomy kits, an inexperienced important in this procedure. Transtracheal local phy ician should be able to successfully perform this anesthesia i especially useful. procedure. Blind nasotracheal intubation is a relatively slow Cricothyrotomy should be avoided in patients technique which usually requires a breathing pa tient, younger than 12 years of age.5 Complications include multiple attempts, and has a higher complication rate asphyxia, aspiration, cellulitis, subglottic stenosis or than oral intubation. Specific complications include edema, laryngeal stenosis, haemorrhage or haematoma trauma to the nose or pharynx/A nosebleeds, and nares formation, laceration of the oesophagus or trachea, necrosis and sinusitis with prolonged intubation.• this. mediastinal emphysema, and vocal cord paralysis.5 Blind nasotracheal intubation is contraindicated in the patient with mid-face or basilar skull fracture because OTHER TECHNIQUES 2 of the risk of entry into the cranial cavity. .4 Thus, it is not usually attempted in the multiply injured tra uma The fibre-optic bronchoscope assisted intubation patient unless neuromuscular blockade is unavailable.20 allows relatively easy intubation in patients who are This technique, however, is appropriate in a subset of cooperative, have a secretion and blood-free airway, an trauma patients who are cooperative, and h ave unres tricted pharyngeal space, and adequate topical sufficient ventilation to allow time for a nasotracheal supra- a nd infra-glottic anesthesia. 2 However, this attempt.' In many trauma centres, orotracheal intubation is the technique of choice for endotracheal intubation.• Preparation for an awake oral intubation involves the use of substances such as drying agents, sedation, topical You turn it on. anesthesia and/ or nerve blocks.19 Direct laryngoscopy is the fastest and surest non-surgical manner of intubating the trachea.2 Oral intubation under general anaesthesia is You turn it off. well conducted and be performed without spinal cord damage provided that (i) the direct laryngoscopy and Adrop, or more. intubation is performed in a gentle and non-traumatic manner, (ii) precise cervical immobilization is maintained throughout the procedure, and (iii) a rapid sequence Whenever you need it intubation technique with the use of neuromuscular blockade is employed.20 Introducing the Brain Money $5.000*Student line of Credit Cervical stabilization during intubation ca n be adequately performed with manual immobilization of the The Brain Money Student Line of Credit can provide the head and neck on a long spine board by a process named additional financing you need during your medical school years. 13 15 manual in-line axial traction (MIA T).'· · In MIAT, one Unlike traditional bank loans, a Brain Money Student Line of person applies cricoid pressure and holds the Credit means you can withdraw the money you need, when endotracheal tube while the intubator opens the patient's you need it, and only pay interest on the amount used. mouth with the right hand and holds the laryngoscope in the left. Concurrently, a third person, on the other side of VISit your nearest branch for more details. the intubator, is responsible for stabilizing the victim's 4 15 head while the intubation is proceeding. • Pharmacologic 15 agents are frequently u sed during this technique. M Preoxygenation of the patient increases the safety margin - B <~nk o f M o ntH~

12 ------U. W.O. Medica/Journal 65 (1) 1995 e s technique may be more difficult in patients confined to a REFERENCES s upine position. In this position, the tongue and pharyngeal tissue may obstruct the posterior pharynx 1. Grande GM, Steue JK , Bernhard W . Airway management: and thus make endoscopy difficult to perform in patients Considerations in the trauma patient. Critical Care Clinics 1990; 6(1): with suspected CSis. 37-59. Transtracheal jet insufflation of the airway (or 2. Hastings RH, Marks JO . Ainvay management for trauma patients with potential ceroical spine injuries. Anesth Analg 1991; 73:471-482. percutaneous needle cricothyrotomy) is a relatively 3. Crosby ET, Lui A. The adult cervical spine: lmplicati01rs for ainvay safe, and extremely effective procedure which can mmwgement. Can/ Anaesth 1990; 37(1): 77-93. tem porarily bypass the need for s urgical 4. Cicala RS, Grande CM, Stene JK et a/. Emergency and elective ainvay cri cothy rotomy. z...s .t• It is an emergency method of management for trauma patients. In : Grande CM ed. Textbook of trauma ventilating the patient and not a method of securing an mresthesia mrd critical care. Toronto: Mosby, 1993:344-380. airway. The use of jet insufflation can provide 30 to 45 5. Advanced Trauma Life Support Program. Committee 011 Trauma. minutes of extra time so that intubation may proceed at American Collage of Surgeons. 1988. an urgent, rather than emergent, pace.5 This technique is 6. Shearer VE, Giesecke AH. Airway management for patients with penetrating neck trauma: A retrospective study. Anestlr Analg 1993; 77: performed by placing a 14 or 16 gauge cannula through 1135-1138. the cricothyroid membrane and then a ttaching it to a 7. Eggen JT, Jorden RC. Ainvay management, penetrating neck trauma. 5 19 high pressure oxygen source. · This technique is likely, Joumal of Emerg M ed 1993; 11: 381 -385. at least on a temporary basis, to provide more expedient 8. Crosby, ET. Tracheal intubation in the ceroical spine injured patient. Can oxygenation and ventilation in comparison to the more I Anesth 1992;30(2): 105-109. invasive surgical airways.V·'• Complications of this 9. Dm>is JW, Phreaner DL, Hoyt DB et a/. Tire etiology of missed ceroica/ technique include asphyxia, aspiration, cellulitis, spine injuries. J Trauma 1993; 34(3): 342-346. oesophageal perforation, exsanguinating haematoma, 10. Lindsey RW, Dilberti TC, Doht'rty Bj t't a/. Efficacy of radiog raphic p osterior tracheal wall perforation, emph ysema roaluation of tire cervical spine in emergency situations. Soutlr M ed j (s ubcutaneous and / or mediastinal), thyroid 1993; 86(11): 1253-1255. 11. Huelke OF, O'Day J, Mendelsohn RA. Cervical injuries suffered in perforation, and the possibility of inadequ ate 5 automobile crashes./ Neurosurg 1981; 54(3): 316-322. ventilations leading to hypoxia and death. A more 12 . Sudt'rman VS, Crosby ET, Lui A. Elective oral tracheal intubation in definitive airway must soon be established. ~.s This can cervical spine-injured adults. Can J Anaesth 1991 ; 38(6): 785-789. be accomplished b y t racheostomy, endotracheal 13. Scamrell G, Waxman K, Tominaga G et a/. Orotracheal intubation in intubation or waking-up the patient (with resumption trauma patients with cervical fractures. Arch Surg 1993; 128: 903-906. of the normal airway).'·'• 14. Mesclrilro A, Devitt JH , Koch JP et a/. Tire safety of awake tracheal intubation in ceroical spine injury. Can J Anaestlr 1992; 39(2): 114--117. CONCLUSION 15. Stene JK , Grande CM. Anesthesia for trauma. In : Miller RD, ed. Anesthesia. 4th edition. New York: Churchill Livingstone, 1994: 2157- Fifteen percent of patients who are admitted to a 2174. Canadian hospital with major or multi ple trauma have a 16. Wright SW, Robinson GG, Wright MB. Ceroical spine injuries in blunt trauma patients requiring emergent endotracheal intubation. Am I Emerg critical CSI. '~ Therefore, a CSI should be assumed in any M ed 1992; 10: 104-109. patient s u ffering from a multi-system tra uma, in 5 17. Wlrite AA, Southwick, WO, Panjabi MM. Clinical instability in tht' particular victims with a blunt injury above the clavicle. lower ceroical spine: A rroiew of past and current concepts. Spine 1976; Patients with CSI may be treated adequa tely by 1: 15-27. many types of management plans.2 As such, airway 18. Hasseinzadeh K, and Pelz, D. "Title? " UWO Medical jounral 1992; managem e nt should not be dicta ted b y s t rict 61(3): 80-84. algorithrns. '2 There is now good evidence that suggests 19. Stone OJ, Gal Tj. Airway Management. In : Miller RD ed. Anesthesia. careful clinical assessment and management will result 4th edition. New York: Churchill Livingstone, 1994: 1403-1436. in consistently good outcomes and low incid ence of 20. Walls RM. Airway management. Emerg M ed Clin North Am 1993; secondary inju ries. 8 The clinician in ch arge sh ould 11(1): 53-60. Q evaluate the cervical spine and estimate the chances of pathology in that area. Roentgenograms sho u ld be utilized in the a ppropr iate situa tio n . However, overrelian ce on the rad iographs should n o t take PARTIES CARTED FOR (519) 434-9268 precedence over clin ical ju dgement. 2 In addition, if intubation is indicated, it should be determined by the J~W£1 of Gfndie clinician's experience and skilllevel.8 Thus, optimal care is not based upon a "cookbook" paradigm, but many ~teurnnt different parad igms w here the essential elements are FULLY LICENSED & AIR CONDITIONED 8 390 Richmond Street preserved. 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U. W.O. Medical Journal 65 (1) 1995------13 Arr1c1es OMEGA by Nina Singh, Meds '97 he Organization for Medical Gender Awareness fellow tudent, yet grateful that it was not them on the (OMEGA) met for the first time on September 28, examination table. This student, obviously, was very T1995. Approximately 25 to 30 people attended. uncomfortable and embarrassed. As he was removing his They included medical students from all years, a few shirt quite reluctantly, one female in the group residents, and some faculty members: Dr. Garcia, Dr. commented loudly "whoa, nice bod, we should get him Lent, Dr. McMurtry, Belle Potts, and Dr. Silcox. to volunteer everytime." The evening began with a brief introduction to The second clip hawed a female physician yelling at a OMEGA. Furthermore, the organization's mi sian lab technician for not having completed a C&S that he had statement was illustrated: " to discuss gender-r lated ordered for a patient. When she left the room, 3 medical i ue while keeping an open-mind, and to allow aU to students who overheard the conversation were quick to express their thoughts and ideas freely." As most people comment on the doctor's unnecessary rudeness. One male realize, many such issues exist which require discussion student said, "What a bitch." And a female student added, and delicate handling. OMEGA allows everyone to "Yah, those testosterone levels must really be surging." express their opinions regarding these issues without The second male student replied, " ah, it's just PMS." imp diment. The third clip depicted a group of three medical It wa uncertain a to whether a group di cussion on student (one female and two males). One of the males everyday medical issue would work; however, the wanted to tell a joke, but he warned the female that she friendly and informal approach used by Drs. Silcox and would probably be offended. But, before she had the Lent kept everyone intere ted and involved. The meeting chance to comment, he began, "There's this hot blonde lasted for two very relaxing and stimulating hours. Most babe ... " The female student cut her colleague off, importantly, everyone had something to say, and a few expressing her desire not to be exposed to that ort of shared orne interesting stories that directly related to humour. The second male student exclaimed that it was OMEGA's mission statement. To conclude, three video only a joke and ridiculed her for "always taking clip were viewed and discu ed; they depicted scenarios everything so seriously." that are all too familiar in medical school. One can only imagine the interesting opinions that The first video showed a group of eight students and were sparked by these scenarios. The room turned into a a clinician in a clinical methods teaching session. The mini-talk show, with Dr. Silcox reminding one of doctor asked for a volunteer to take off his or her shirt so Donahue, and Dr. Lent being more like Oprah! If you the respiratory exam could be demonstrated. No one have opinions that you would like to share with others, would volunteer, so the physician chose a particularly please do come out to the next meeting. EVERYONE is shy, male student who was blushing and making all welcome! Watch your mailboxes and the " All Years" kinds of excuses. The class felt bad for their helpless oticeboard for details.

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14 ------U. W.O. Medical Journal 65 (1 ) 1995 Art i cles Animals, Autonomy, and R i g h t s A Mo ra I Justificatio n for Animal Ex peri mentation

by jay A. Nathanson , Meds '96

"Plants exist to give subsistence to animals, and There are many reasons why animals are u ed in animals to give it to men. Animals, when they are scientific re earch. Animals, especially primates and domesticated, serve for use as well as for food; wild other mammals, have remarkably close neurological, animals, too, in most cases if not in a/{, serve to immunological, reproductive, physiological, and furnish man not only with food, but also with other behavioral similaritie to humans. In many cases, comforts, such as the provision of clothing and similar animals are simpler models than humans, allowing aids to life. Accordwgly, as nature makes nothing researchers to study biological functions with greater purposeless or in vain, all animals must have been ea e. Since animals have much horter lifespans than made by nature for the sake of men'." humans, developmental and genetic effects of treatments can be studied more efficiently on animals. As well, a n the Politics, Aristotle pre ents his view of man's laboratory setting allows the experimenter to gain po ition in the natural order; animal do not share complete control over the conditions the animal is I equal moral status with man and, consequently, expo ed to. Researcher can observe animal subject of may be used as a means to man's ends. Today, similar age and background in sufficient numbers to animals not only provide man with food and clothing, ensure that scientific findings are consistenf. but are often used as biological model in scientific experiments. There has been much di cussion in THE INADEQUACY OF ALTERNATIVES recent years with respect to animal rights, and the public and media are taking a growing interest in the lf appropriate replacements to animals could be found debate 2.1.•. for use in research, there would be no need for their use in How is one granted rights? What rights, if any, do any further experiments. Isolated cells or ti ues have animals po sess? What are the consequence of been proposed a an alternate source of information. gran ting or denying animals right ? If animal Unfortunately, organs and organ system have properties experimentation is morally acceptable, what should which could not pos ibly be discovered through the be the limits of the research? In thi essay, I will analy is of their constituent tissues and cells. As well, the attempt to answer these complex questions and organs of the body are intricately linked and such formulate a justification for the use of animals in interactive functioning can only be studied in a whole research through an exploration of the principles of organism. Computer simulation has also been autonom y and beneficence . I will also discu s investigated as a replacement for animals in research. methods of en uring that, if research involving However, the use of computers rai e a seriou paradox; animals is performed, it is carried out as responsibly in order to have a computer accurately simulate a living as possible. organism, an immense amount of data about the organism would have to be established experimentally (through BACKGROUND extensive animal research) prior to programming the 7 computer • Unless this is done, any computer model The United States Department of Agriculture would be immeasurably unreliable. Finally, it has been estimates that there are 20 million animals used in suggested that organ systems be studied by way of post­ laboratories each year. Of these, 90 percent are mortems. Although this may be useful for studying the rodents, two percent dogs and cats, and less than one basic anatomy of an organism, a deceased animal could percent non-human primates. The remainder include never replace a living one when trying to ascertain the 5 pigs, frogs, sheep, chickens, pigeons, and reptiles • It animal's response to a given treatment. is estimated that 40 percent of the animals are used in Unfortunately, a scientifically acceptable alternative basic and applied research, 30 percent in drug has yet to be found whkh will allow for the successful development and testing, 20 percent in the production replacement of animals in many areas of medical of biological products and toxicity testing, five research. Therefore, the use of live animals currently percent in the diagnosis of disease, and five percent remains the only effective method of studying disease or are used for teaching purpose •. testing drugs, procedures, or vaccines. Our options are limited; if animal experimentation is morally ABOUT TilE A UTHOR: unacceptable, a very large portion of our medical research jay atlmnson is a 4th year UWO medical student who contributes will have to stop It is this lack of alternatives that makes regularly to the jounml on tile topic of medical bioethics. the debate over animal rights so acute.

U. W .O. Medica/Journal 65 {1) 1995------15 A r t i cles

ARGUMENTS FRO M AUTO NO MY If one adheres strictly to Kant's definition of autonomy, it is clear that some humans would also not Autonomy is central to most moral theories8 and it be considered autonomou , and, consequently, would is from autonomy that rights are derived. Immanuel be excluded as full members of the moral community. Kant's theory of autonomy, as found in his work, These " marginal cases" 11 include infants, as well as Fundamental Principles of the Metaphysic of Morals, is those who are senile, comatose, severely mentally perhaps the most influential of all philosophies challenged, brain-damaged, or mentally ill. Proponents regarding rights. Humans are unique in the possession of animal rights contend that some animals may be of the ability to deliberate what their moral duty is and more self-reflexive or have a greater ability to reason to lay down moral laws for themselves and for others. than the marginal human cases. Therefore, they argue, Man, therefore, is self-legislative, morally a uto­ if it i morally unacceptable to use marginal humans in 9 nomou • re earch, it should also be wrong to use higher animals. Once a being possesses autonomy, he or she also This argument fails in that significant differences becomes a moral agent, that i , one entitled to moral between the humans and the animals are overlooked. right . The reasons for thi are twofold. Firstly, Infants, if properly cared for, will eventually develop autonomous beings have the capacity for independent, into fully autonomous adult humans. Those who are deliberative, responsible actions and have the required brain damaged, comato e, senile, or mentally ill have awarene to appreciate that these acts are an integral previously achieved autonomy, but have lost it due to part of their existence. Secondly, autonomous beings uncontrollable circumstance . have the capacity to recognize autonomy in others and There is a dilemma, however, in establishing the to participate fully in the moral community. status of those who have never achieved and never will Consequently, "without a moral capacity, actually or achieve autonomy, such as the mentally handicapped. I potentially, there can be no moral entitlement, no moral propose that merely being human (i.e., a member of an authority, no moral exercise or waiving of a moral right, autonomous species) is ufficient for granting special and hence no moral rights pos e sed by mammal that rights. The ability to act morally is not a test to be given 10 lack moral autonomy, actually and potentially" • to each and every human individually. If, for whatever rea on, a human lacks the ability to moralize, he or she i not excluded from the moral community.

ARGUMENTS FROM BENEFICENCE

Man has a moral obligation to his fellow man to The more we share, improve his health and livelihood and to rid his life of di ea e and unnecessary pain and suffering. Sometimes, this goal only be achieved through the use of animals. In the better healthcare order to advance our scientific knowledge, diseases must be investigated and treatments must be studied. Indeed, the principle of beneficence, would suggest that, in many can be manag~. case , it is immoral not to use animals in scientific experimentation. Man has gained an abundance of medical and • Patient and Caregiuer Support Materials scientific knowledge from research on animals. Most of the great medical advances have been brought to • Continuing Education for Healthcare Practitioners fruition through animal research, including treatment for rabies, cholera, diphtheria, tetanus, pneumonia, • Medical Research and Clinical Studies polio, measles, and viral hepatitis. In pharmacology, animal experimentation has been central to the Our Purpose development and testing of drugs such as antibiotic , an tiparasitics, antiallergenics, antiinflamma tories, We will improve the quality of human life by dedicating analgesics, and drugs for heart and renal diseases. ourselves to a spirit of innovation as we discover, develop Animals have been used in the advancement of surgical and deliver pharmaceuticals. techniques such as organ transplantation and cardiac To our customers, we pledge to treat you with integrity surgery, the control and management of haemorrhagic and fairness and become your partners as shock, and the development of artificial organs and we strive to improve human health. nuclear medicine. If man ceases to experiment on animals, incredibly grievous consequences to medical research will result. DUPONT Medical advancement will cease completely, leaving us to fall succeptable to the courge of disease. All hope of PHARMA ever finding cures for AIDS, cancer, Alzheimer's disease, and the multitude of illnesses that afflict mankind will be lost.

16 ------U. W .O. Medica/Journal 6511 )1 995 Art i cles SPECIES ISM: CAN DISCRIMINATION BE JUST? a form of discrimination, it is one based on differences that are of extreme relevance -- the animals' lack of The belief that humans (or other autonomous beings, autonomy and moral agency. Failure to distinguish should they ever be encountered) are morally superior to between unjust forms of discrimination and speciesism animals is known as speciesism. Speciesism can exist on trivializes the legitimate cases of those who are truly several hierarchical levels: Absolute speciesism is the oppressed. belief that any human interest outweighs (the sum of) any non-human interests. Resolute speciesism, a weakened THE LIMITS OF ANIMAL EXPERIMENTATIO N version of absolute speciesism, holds that any significant human interest outweighs any non-human interest (no Since animals are our only viable source of medical matter how large). Weak speciesism holds that when information, it is our moral duty to ensure that when they human and animal interests are equivalent, the human are used in research, they are cared for to the fullest 12 interests prevail • extent possible. Establishing committees for animal 14 Critics of speciesism, such as Animal Liberation experimentation , similar to those that govern research author, Peter Singer, call it a form of discrimination that is on human subjects, will ensure that explicit guidelines akin to racism or sexism: exist and facilitate the creation of an environment that is "Ra cists violate th e principle of equality by giving as hospitable as possible. Research guidelines should be grea ter we ight to th e interes ts of members of their own based on the "three Rs" of animal welfare as forwarded · race when there is a clash between their interests and th e by Russell and Burch in 1959: (i) replacement of animals interests of those of another ra ce. Sexists violate th e where feasible alternatives exist, (ii) reduction in numbers principle of equality by favouring the interes ts of th eir where possible, and (i ii) refinement of techniques to own sex. Similarly, speciesists allow the interes ts of their minimize pain by seeking the least traumatic techniques own spec ies to override the greater interests of members of feasible. other species. Th e pattern is identical in each caseu." Researchers planning to use animals in an experiment This analogy between speciesism and racism and should consult a veterinarian and administer the sexism is a faulty one. Racist and sexist beliefs have necessary anaesthetics and pre- and post-operative care. absolutely no rational basis; differences in race, religion, It also is essential to ensure that as few animals as or sex are not tenable ground for which to claim possible are used in scientific research. Unnecessary superiority of any kind. Although speciesism is indeed repetition of experiments should be curtailed to the

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U. W .O. Medical Journal 65 (1) 1995------17 Art1cles

greatest extent possible. As well, the animals should be community altogether. Higher animals, because they kept in comfortable, enriched environments in order to have the capacity to suffer, should be given a form of 15 ensure mental well-being • Finally, cientists performing limited moral status -- that of moral patient. Man, studies of tumour growth, toxicity, or infectious processes therefore, as a moral agent, is not free to do wi th animals should euthanize the animals rather than letting th m die as he pleases; w henever possible, we m ust treat other slow deaths. It must be realized, however, that there comes species with respect and minimize the pain and suffering a time when our efforts to ensure the animals' well-being inflicted. In other words, because they are sentient interferes with the experiment, causing inaccuracies in the being , we have an obligation to treat animals humanely - results. It is important that an experiment be -although not as humans. compassionately performed, but it is also essential that it be Ingrid ewkirk, director of People for the Ethical scientifically sound. Treatment of Animals, states "Animal liberationists do not separate out the human animal, so there is no rational CONCLUSION basis for saying that a human being has special rights. A rat is a pig is a dog is a boy."'. Ye t, the metaphysical We have derived a moral ju tification of animal belief that there is no moral difference between a person experimentation from the principles of autonomy and and a rat amounts to the ethical and moral debasement of beneficence. Only human are capable of applying or man. The belief that the value of animal life i the arne reciprocating moral claim . Moreover, only humans are as that of human life can lead to ludicrous conclusions. It capable of free and self-restricting moral judgements. is clearly inappropriate to ask: 'Does a lion have a right to Therefore, only humans are autonomous and possessive eat a baby zebra? Does a baby zebra have a right not to 9 of rights. In addition, the principle of beneficence be eaten?' • This reductio ad absurd um of the case for supports animal experimentation, through its animal rights highlights the necessity of a distinction requirement that man m.inimize the effects of disease on between animal and humans based on morality. An and relieve the uffering of his fellow man. unwillingness to acknowledge the moral chasm that Where, then, do animals tand in the moral separates animals and humans would set a dangerous hierarchy? Some animals (e.g., shellfi h, piders, insects, moral precedent that could only lead to catastrophe. e tc.) should perhaps be placed outside the moral WORKS CITED AND REFERENCES

1. Aristotle. Barker£, editor and translator. The Politics . 1256b 11 -12, 1958.

2. jolmston C. Resea rchers, animal rights activists figl!t public relations s GHsARNIA GENERAL war at Western. Can Med Assoc f 1993; 148(8): 1349-53. HOSPITAL 3. Pothier R. Animal tests saved my life. ewsweek 1993; February 1: 18.

4. Wallace B. A wooly debate. Maclean 's 1995; 108 (21 ): 38-40.

5. McCabe K. Wl10 Will Live, Who Will Die? The Washillgtollian 1986; Sarmia General Hospital is a fully accredited 25(11 ): 113-8, 153-7.

166 bed community hospital serving Samia 6. Ta nnenbaum f, Rowan A. Rethinking the morality of animal research. and district. Our acute care services will be Hastings Center Report 1985; 15(5): 32-43. expanding over the next few years and 7. Gallup Jr . GG, Suarez SO. Altematives to the use of animals ill specialists will be needed in: psyclwlogica/ research. American Psychologist 1985; 40(10): 1104-11. 8. Frey RG. Autonomy alld the Value of Allimal Life. The Mollist 1987; General Surgery 70(1) : 50-63. Paediatrics 9. Cohen C. Tl1e case for the use of animals in biomedical research. ew Psychiatry Eng/ f Med 1986; 315(14 ): 865-70. Opthamology 10. M cCloskey Hf The moral case for experimentation on animals. The Monist 1987; 70(1) 64-82.

For details, contact: 11 . Na rveson f. On a case for animal rights. TI1e Monist 1987; 70(1): 31-49.

12. Becker, Lawrence C. Tl1e Priority of Humall Interests. Animals and Dr. Richard Cheong, MD, FRCPC Ethics. 1983. Chief of Staff 13. Singer P. Animal Liberation. 21ld edition. Lalldon: Thorsolls, 1991 : 9. Samia General Hospital 220 N. Mitton Street 14. Allderson W. A new approach to regulating the use of animals ill sciell ce. Bioethics 1990; 4(1): 45-54. Samia, Ontario N7T 6H6 (519) 383-8180 15. Dresser R. Standards for animal research: Looking at the middle. joumal of Medicine and Philosophy 1988; 13: 123-143.

18 ------U. W .O. Medica/Journal 65 (l) 1995 Articles Militarism, I t s Interface with Health, and the Role of the Physician

by Ripan Chaudhary, Meds' 98 he ultimate goal of the medical profession viewed The little Canadian boy "knows" that the mere idea in its broadest sense, and in an idealistic light, of adults knowingly harming children is too silly to T could perhaps best be understood as that of even think of - and so do we. We know from our ensuring the preservation and promotion of health and instincts, and we know from research on human well being of the global community. The daily efforts of development, that childhood needs to be a protected physicians in their local communities represent the time. In recognition of this, we have agreed to impetus towards this ideal. However the greater ideal is international standards to protect children (Santa often "the forest" that is lost among the trees. Practical Barbara, 1995). concerns of everyday practice further distance physicians from any such "idealistic" ponderings. This is however INTERNATIONALLY" AGREED UPON" at the peril of not achieving an understanding of the STANDARDS OF CONDUCT: complex network of social, political, and economic factors that impact upon society's health, particularly In 1959, governments of the world unanimously that of the "have-nots" of the world. For instance, adopted the Declaration on the Rights of the Child at although the ill effects of war, particularly on children, the U. . General Assembly. It stated that children have been vaguely realized for decades, they have been had " the right to be brought up in the spirit of poorly understood and often understated. In the past few universal peace and brotherhood". This declaration years this has begun to be remedied with active research was then shaped into a Convention on the Rights of into the area as well as active participation of an the Child, adopted by the General Assembly in 1989. extremely small group of physicians towards the Most countries of the world signed this Convention. prevention of war. If indeed militarism, leading to armed The United States of America until 1995 had not! conflict, is a rapidly growing factor adversely affecting The convention states that "No child under 15 years human health, then it falls well within the realm of the may be recruited into an army" and "States will do mandate of the medical profession. As s uch, this all they can to protect and care for children affected interface of politics (of which conflict is an outpouring) by war." In 1990 at the Summit for Children, world and health must be appreciated and the relevance of the leaders made similar pledges to protect children physician's active role in preventing armed conflict from the scourge of war and to take measures to better understood. This essay attempts to illustrate the prevent further armed conflicts. Finally, UNICEF preceding premise b y attempting to achieve an has been promoting the idea of "children as zones of understanding of the impacts of armed conflict, and the peace" to emphasize their right to protection from mechanism of their exertion on civilian populations, war (UNICEF, 1985). particularly children. In doing so, I hope to imply a role for the physician in the prevention of armed conflict in REALITY: the world. At this point it must be noted that all the research currently being conducted is by independent What actually happens however to large numbers of researchers and that there is no international children all over the world is in complete contrast to the organization specifically studying the impact of war on standards that we set for ourselves and to the profound human populations. truth that the six year old's statement represents.

Conversation between Canadian father and six-year- Conversation with an eleven-year-old Mozambican old son during war against Iraq: boy, 1990: Father: What happens in wars? "The bandits (Renamo fighters ) came to our house Brennan: People get injured and dead. and told mother to give them food. My mother told them Father: Do children get hurt? we didn't have any. They beat her until she died. They Brennan: Daddy, adults wouldn't be so stupid! took my father and killed him. (Santa Barbara, 1995) I was alone with my younger sister and four brothers. I couldn't get other people to help get us food because nobody had any. I began to go farther and farther into the bush and search for roots that I brought back to feed ABOUT THE A UTHOR: my sister and brothers. While I was away, my sister Ripan Oraudhary is a second year medical student at UWO. Prior to died. Then my brothers began to die one by one. Then medicine, he completed three years of a combined biology and psychology my last brother died. I left that night .. . " (Boothby et program at McMaster Uniuersity. al, 1992)

U. W .O. Medica/Journal 6511 } 1995------19 Art1cles

EPIDEMIO LOGICAL INFORMATION: shortage of medicines, intravenous fluids, infant formula , needles, syringes, and bandages. Stores of heat Truth may be 'the first ca ualty of war, but children sensitive vaccines had been depleted because of the lack are undoubtedly the second. Little comparative of electricity. Despite the coalition's claims that medical epidemiological research is available on the subject of the s upplies have always been exempt from sanctions, effect of war on child health however, with most research between August 1990 and August 1991, less than one and analysis of past wars being carried out b y the thirtieth of Iraq' medicinal import requirements was met military for purposes of planning (Garfield et al, 1991). (Doyle, 1991). Whatever the nature of the bottleneck - This is ironic a the proportion of civilian casualtie have political, legal, logistic, or economic, it is effectively risen considerably, from 5%-19% in World War I to 48%- inhibiting access to necessary goods. 50% in World War II. In the more than 150 declared and As a consequence, there wa an alarming increase in undeclared wars since World War II, it is estimated that the incidence of water borne diseases, including cholera, 80% of the 20 million killed and 60 million wounded have ty phoid, and severe gastroenteritis, particularly in been civilian , most of them children (Schaller, J.G et a!). children. The mortality rate for children with A reported by the Global Child Health ews and gastroenteritis was twice that of before the war (Hoskins Review, 1.5 million children have been killed in war et al, 1991) . The incidence of these diseases reached zones in the past decade alone. In addition, more than 4 epidemic proportions, and neither the hospitals nor million children have been disabled by war in the last health centres had the capability to treat them decade and 17 million have lost their homes (UNICEF, appropriately (Lee et al, 1991). Lack of food supplies 1992). Million of land mines throughout present and combined with the 1000% inflation, resulted in severe former war zones, some purposefully designed to be malnutrition in children being a common occurrence. attractive to children, are re ponsible for a large number There was also an increase in the incidence of polio, of injuries to children. meningitis, and hepatitis. The Harvard team estimated conservatively that child mortality had doubled, with a INDIRECT IMPACTS: further 0,000 - 200,000 under 5 year olds expected to die in the year following the war, as a result of the war. The Gulf war amply demonstrates that in addition to Ironically, on closer examination of the costs of the war the above presented, "direct" impacts of war, there are including millions of refugees, hundreds of thousands devastating indirect effects. Lee and Haines (1991) dead and injured, and the serious environmental damage e timate that de pite the high number of Iraqi military one discovers that there were many more people killed or casualties in the Gulf war, more deaths occurred there after hostilities ceased, through lack of food, clean water, medical care and adequate help of refugees. Indeed it is estimated that 80-90% of the civilian casualties, a large proportion of which were children, occurred after the war ended. Before the Gulf crisis, Iraq was an industrializing nation that had experienced major changes in its ocial One-stop banking structure and health care system, with a network of 131 hospitals and 851 community health center , providing comprehensive health services to over 90% of the for your personal population (Lee et al, 1991). Child mortality had been reduced to 42 per 1000. As an urbanized (75%) and and business needs. mechanized ociety, Iraq depended on electrical power for water purification and distribution, sewage treatment, and the functioning of hospitals and health care centers. Bank Professionals Service gives you preferred Iraq also depended on imported foodstuffs for 70% of its food. (Ahitsaari, 1991). access co all of che resources of Canada's leading financial In the first days of the war, 13 of Iraq's 20 power­ services provider, wich one-scop banking for your personal and generating plants were incapacitated and only two plants business financial needs. As you would expect, your banker is remained operational, producing less than 4% of the prewar output (The Harvard Study Team). As a result, available seven days a week. Also, as a VI.P. professional, you water purification and distribution came to a virtual deserve all che benefits of VI.P. Service* for Professionals, our standstill. Most Iraqis now lacked clean drinking water, and murky pools of water and drainage ditches became premier package of personal banking services. the only source of water for much of the popula tion. Sanitation was extremely poor throughout the country, with city streets blocked by pools of foul-smelling water ROYAL BANK and piles of uncollected garbage. Many hospitals and community health centers were severely damaged and C.D. (Cyril) Walters lacked adequate running water fo r standard sanitary procedures such a cleaning, flushing toilets, or bathing Manager, Professionals Banking • London patients (Harvard Study Team). There was also a (519) 661-1459, Mobile (519) 878-2961

20 ------U. W .O. Medica/Journal 65 (l) 1995 Artt c l e s eriously affected by the war than were at risk in Kuwait military budget! Furthermore, it has been estimated by from the Iraqi regime (to protect whom was the stated the IPPNW that the combined annual cost for funding aim of the coalition forces) (Lee et al, 1991). global programs aimed at solving the major human needs Another, often overlooked form of indirect impact of and environmental problems including population war on health involves the horrendously high economic stabilization would be approximately 25% of the world's cost of war, particularly to poorer countries. For total annual military budget (World Game Institute, instance, the cost of the Gulf war ran over $200 billion 1991). While the developed countries spend an average dollars whereas humanitarian goals adopted at the World 5.4% of their G Ps on military, only 0.3% is allocated in Summit for Children require an estimated $20 billion aid to developing countries. This, despite 800 million dollars. The world collectively spends almost a staggering starving people in the world (a large proportion of them, $1 trillion dollars on military expenditures a year (of children), 3 out of 5 in the third world with no access to which $350 million is in the US) (International Physicians safe water, and 3 out of 4 with no sanitation. At the rate for Prevention of War, 1992). This amounts to $1.7 of present military spending, 35 seconds could build million a minute. To gauge these economic costs of classrooms for 30,000 children or feed 20,000 people for a warfare in terms of health impact, Lee and Haines (1991) year (Barnaby, 1988). One would hope our willingness to note that as a direct result of the Gulf war, 40 low income spend $200 billion on the Gulf war contrasted with our and middle income countries have suffered the economic unwillingness to spend $34 billion towards ensuring the equivalent of a natural disaster. The direct cost to these health and well being of the world's children, is not countries - including Ethiopia, Sudan, Mozambique, and representative of the moral and ethical standards, or the Liberia, where millions already face starvation is over $12 ability for critical and logical thought that pervades billion. Also, following the war, Third World exports contemporary consciousness! dropped $6 billion (Lee and Haines, 1991). The 1995 State of the World's Children report from PSYCHOLOGICAL IMPACTS: UNICEF says that we need to kindle a sense of absurdity at the idea that the world cannot afford to meet the need The psychological trauma and subsequent of all the world's children for adequate nutrition, basic psychopathology caused in children, by war related stress health care, primary education, and clean water. Indeed is potentially devastating and ensures the self­ the total annual cost of this obviously desirable (yet perpetuation of violence. The following accounts might perhaps politically inconsequential) goal is estimated to help gain a passing appreciation of the extent of be 34 billion dollars, a mere 3.4% of the annual world psychological trauma that children might be subjected to: "Some Cambodian children have been so successful at extinguishing all former ties that they were able to kill their own parents" (Eibedour et al, 1993). "My father fought in World War II shortly after I was born. When he went to Korea, I was nine .... I was traumatized by his leaving, couldn't retain any food and was hospitalized .... I was fed by intravenous for nearly a year.. .. I decided the only way to get to see my parents was to die. So I tried. And they brought my father home from the front. When I saw both my parents, my recovery was so miraculous I was discharged two days later, only to end up deathly ill after he went back." (Quinn S., 1991). "Come on, come on, plunge on. Those who step on mines will go to Paradise"" Marching chant of a column of 15,000 Iranian children on their way to the front with Dedicated Iraq, ahead of "more valuable" trained soldiers (Children and war, 1986). As is evidenced throughout the essay, most war to Respiratory zones lie in poor, third world countries who even under conditions of peace are unable to provide adequate health care for children. The situation is of course further Care exacerbated by the breakout of conflict. For this reason, any modern war must be considered a war on children. As citizens of the western world who, willingly or unwillingly, support the war system of our nations, and in particular as health professionals, we must carefully Boehringer consider the consequences of waging war on children and lngelheim perhaps reconsider our role, implicit or explicit, in such outrageous endeavors. To further elucidate this point, it Boehringer lngelheim {Canada) Ltd .lltee 5180 South Service Rd ., Burlington, Ontario L7L 5H4 must be noted that the major (and in most cases, the only!) source of weapons for these warring parties in the

U. W .O. Medica/Journal 65 (1 ) 1995------2 1 Arrtcles third world are the western countries (particularly, the nations, will seek to acquire, at enormous cost, both the US, England, France, and other "western allies", who American-style ''brilliant" weaponry, and the technology generally consider themselves to be not only with which to defeat it. The increasingly sophisticated and technologically but also morally of higher standing than costly militarization of the Third World will divert large the rest of the world) (Kiefer, 1992). Not only are we in sums that might have been used for health promotion. A the West, suppliers of the military hardware responsible recent World Bank study reports that Third World health for the kind of heinous crimes against children expenditures have been shrinking, as a percentage of documented above, but we also provide the third world national budgets. Under such circumstances, the health with examples and ideologies that tout military power professional, working within the military or foreign (or in case of some western countries, close alliances with relations policies of his government would see much of his such powers) as perhaps the single most important work undone by the effect of those policies. determinant of national or societal success. (Despite Finally, a few useful conclusions relating to the role shallow rhetoric to the contrary, all concrete examples of the health care professional emerge. Firstly, a true since World War II have implicitly yet cle arly realization that the military and foreign policies of our demonstrated this principle.) governments directly impact upon health not only within Further, as Kiefer (1992) notes, this trend tow ards but also beyond the physical boundaries of our country. militarization of the developing countries, at the cost of These policies thus become as much a part of the larger constructive social programs is likely to accelerate as the health environment as local health policy, or the presence liberalization and decentralization of the former Warsaw of disease agents. Secondly, considering the devastating Pact countries, leads the arms manufacturers in the West to affect of war on health and well being of the global look toward the developing world as a major market. society, particularly the vulnerable, it becomes the work Also, the growing dependence of the industrial economies of health professionals, assuming a proactive role, to on the Third World labor, commodities, and markets has document in a reliable fashion, the specific effects of this created an incentive for militarily advanced nations to factor on health, to disseminate this information, and establish hegemony, by arms transfer and/ or war, in less perhaps most importantly, to promote prophylactic developed nations. The Gulf war presents a graphic measures to reduce the presence of militarism. illustration, as Rochlin and Demchak (1991) note, due to the apparent success of the coalition being attributed to REFERENCES: sophisticated electronic technology, lesser developed 1. Santa Barbara f. (1995) The psychological effects of war on children . Americmz Public Health Association. 2. Tile Convention of the Rights of the Child. Adopted by tile General Assembly of the UN, Nov. 20, 1989. UNICEF (1985) Children in Situations of Armed Conflict. UNICEF, Ne-w York. CIBC 3. Boothby N. , Upton P. , Sultan A. (1992) Children of Mozambique: the cost of survival. Special Issue Paper, U. S. Committee for Refugees, PERSONAL Washington, O.C 4. Garfield R.M., Neugut A. I. (1991) Epidemiological analysis of warfare: a LINE OF historical re-<1iew. JAMA 266: 688- 692. 5. Schaller f.G. , Nightingale E.O. (1992) Children and childhoods: Hidden CREDIT casualties of war and unrest. JAMA vo/.268, No.5 6. UNICEF. The State of the World's Children (1991), (1992) UN ICEF, New York, New York. CIBC offers a special financing 7. LAst f. (1991) War and tile health of children. Am f. Prev Med. 7(4). 8. Lee /., Haines A. (199 1) Health costs of the Gulf war. BMJ 303: 303 - program for eligible medical students 306. 9. Allitsaari M. (1991) Report to the Secretary- General on humanitarian who require financial assistance needs in Kuwait and Iraq in the immediate post-crisis environment by a during their school years. mission to the area led by Mr. Mariti Ahitsaari, Under-Secretary-General for Administration and Management. For details visit 10. The effect of the Gulf crisis on the children of Iraq: The Harvard Study Team . N Eng/ J Med. (1991); 325: 977- 980. C.!. B.C. 11 . Doyle L. , (1991) Iraq facing fa mine if UN sanctions stay. Independent 228 Oxford Street East Ju ly 3. London, Ontario N6A 1T7 12. Hoskins E., Bauman C., Harding S. (1991) Gulf Peace Tea m special mission to Iraq: health assessment team. London: Gulf Peace Team. or Call Evelyn Dodds 13. Rosenblatt R. (1983) Children of Wa r. Ga rden City, NY: Anchor (519) 661-8110 Press(Ooubleday. 14. Elbedour S., Bensel R.T., Bastien D.T. (1993) Ecological integrated model of children of war: individual and social psychology. Child Abuse and Neglect vo/.17 pp.805- 819. 15. Quinn S. (1991) Sending mothers to fight in wars is unthinkable. The Toronto Star, March 12. 16. 1986/ Children and Wa r Action for Children, 1, 3:7 UN ICEF, N.Y. 17. Kiefer C.W. (1992) Militarism and Wo rld Health. Soc. Sci. Med. cmc Vol. 34 No.7 Q

22 ------U. W.O. Medica/Journal 65 (1) 1995 A r ttctes Yellow Brick Road Bioethics by Cassie Lin, Meds '97 The Waiting Room: Mrs Forgiveness-from-heaven husband. In Victoria's oppressive world, women were (Angela Wong, Meds 96), Wanda (Allyson Koffman , not allowed to liberate their minds by learning or their Meds 97) and Victoria (April Price, Meds 98 ) get bodies by enjoying sex or intimacy. In contrast, in acquainted in a doctor's Waiting Room (play by Lisa Wanda's world, women, have been liberated in one Loomer, songs by Allyson Koffman and Jeff Nisker sense, yet are still burdened because they must compete · M.D.) for th e Yellow Brick Road Bioethics Series. in a world where people are judged by appearance, where physical beauty is appreciated and valued, and he hushed silence of over 150 medical students and where big breasts are considered attractive. faculty sitting in the dark, was broken by waves of The evening's excitement was followed by a Tapplause as the lights came on to the Waiting Room, discussion mediated by Dr. Jeff isker, Professor of a medical student and faculty production, created to Obstetrics and Gynaecology and Kate McBurnie, surface bioethical issues. This was the first of a series of Assistant Director of the Westminster Institute of Ethics. Student Affairs Committee sponsored Monday ight Students articulated their opinions on the role of arratives: Yellow Brick Road Bioethics forums. Ba ed physicians in society, the responsibilities that have been on characters from Lisa Loomer's play, The Waiting entrusted to them, and the society-imposed expectations Room depicts the life stories of with which they have been three extraordinary women from burdened. We -recognized that three different historical eras with the pressures coming from three different society-imposed society that affect physicians and medical problems. Through these patients may not necessarily be in three endearing and engaging the best health interest of the women, who bravely accepted patient. Did Wanda's breast their lot in life without protest, the augmentation really augment her societal pressures that women and self-esteem and allay her doctors of every century insecurities? Was Wanda's need experience are explored in a of plastic surgery really a cry for medical context. This play help because she lives in a society demonstrates how doctors can act in which the laws are survival of as pawns inflicting society's the fittest, in which she must expectations on women. As the struggle to compete for her every three women waited patiently for success in an unfair world that the doctor (who never actually arrives), an extraordinary can't help but to judge a person by her appearance before thing happens. What began as the idle chatter of giving her merit for her accomplishments? Although strangers in a waiting room becomes a sharing of physicians can't change the rules of society, a recognition profoundly personal details of their lives. By confiding in of the pressures experienced by our patients may help us each other, they gain insight into how society-imposed to make recommendations that guide them ultimately in medical problems have affected their lives. their best interest. Mrs. Forgiveness-from-heaven, a timid 18th century The Yellow Brick Road Bioethics Series will be held Chinese woman, whose foot binding at age six so on Monday evenings and will continue for all of trimester crippled her that she could hardly walk, presents to the I. Each narrative presentation, prepared by medical Waiting Room with severe necrosis of the foot, holding students and faculty, will serve as a focus from which one toe to sew back on. Mrs. Victoria Smoot, an exploration of ethical issues will be generated. Yellow intelligent 19th century, truly Victorian woman was Brick Road Bioethics will use a variety of formats such as diagnosed with h ysteria, "a disease of the ovaries" story-telling (either by the audience or by actors), because she, a lady ahead of her time, was far too watching movies, performing short plays or reading interested in science, literature, theatre and sex to suit poems. Best of all, after each presentation, there will be her husband. Lastly, Wanda, a brash and honest woman an opportunity to discuss our feelings and thoughts about of the 90's, whose forthrightness imparted to us her the issues. Other medical bioethical issues that will be decisions regarding breast augmentation, was now presented this trimester are euthanasia (Oct. 16), domestic seeing the doctor in fear of breast cancer. Each woman violence (Oct. 30), death and dying ( ov. 6), when accepted their fates until they began to understand that doctors make mistakes ( ov. 20) and ethical issues in Mrs. Forgiveness's necrotic feet, Victoria's psychiatric psychiatry (Dec 11). All students and faculty are invited problems and Wanda's breast lesions, were not just their to have fun by exploring bioethical issues in interesting personal medical problems, but were, in fact, the and creative ways. symptoms of a larger societal disease. Mrs. Forgiveness If you would like to contribute to this program this lived in a world where women were expected to be year or next year (promotions, props/ costumes/ sets, humble, where having small feet was desirable and acting/ singing, drawing, writing/ directing), contact Dr. where the day was governed by her duty to please her Jeff Nisker at 663-3735, University Hospital. Q

U. W.O. Medica/Journal 65 (1) 1995------23 FEATURE SECTION

II A look at the past will show that the philosophies of one age become the absurdities of the next and the foolishness of yesterday becomes the wisdom of

tomorrow. II Sir William Orser

24 ------U. W .O. Medical Journal 65 (1) 1995 eature ect1on Albucasis (936-1013)

by Qasim Raza Alikhan ven though only a very small number of books from This book described the medical preparations obtained antiquity are known to have survived the centuries, from minerals, plants and animals. It represents a very EArabic medical literature is relatively extensive.' It early example of practical pharmacology and is estimated that over the 500 years (850-1350 A.D.) of pharmacognosy. 5 In 1140, Nicolaus Salernitanus Muslim rule, more than 4000 medical titles were written incorporated much of this discourse into his own by physicians utilizing the Arabic language.' Any notion Antidotariurn without ever giving credit to Albucasis.7 that Arabic medicine contributed little to the "treasure it Of all the discourses in AI-Tasrif, number 30 on inherited from antiquity"2 is incorrect. surgery had the widest influence.6 Some modern The contribution of physicians from the Eastern historians imply that Albucasis took his surgery from the 5 10 (Baghdad) Caliphate, 749-1258 A.D., is well known. classic writers (in particular Paulus Aegina) • but others Examples of eminent physicians from that era include are not in agreement. Haddad even states " .. .I do not Rhazes (860-932), Haly ben Abbas (d. 994), and the think those who hold this opinion have compared the " prince of physicians", Avincenna (980-1037). 3 The works of the two men.''8 Spink, the English translator of Western Caliphate ran from 655 to 1236 A.D./ was based Albucasis' surgery, stated that it (discourse 30) in Cordoba, Spain, which was once called the "most " ... contains a surprising amount of genuine original civilized city in Europe." 4 The total number of great material."" Since Albucasis always stated his physicians produced by the Cordovan Caliphate was bibliography at the beginning of every paragraph,8 and much smaller than the Eastern Caliphate;• nevertheless, there is no mention of Paulus Aegina in his discourses/ ·' 0 their influence on the Latin world was far-reachingY this author tends to concur with the school which stresses Deemed to be the greatest surgeon of Islam: Abul­ the originality of Albucasis' work. Qasirn Khalaf Ibn Abbas Al-Zahrawi, known in the West Discourse 30 covers all branches of surgery, including as Albucasis or Abulcasis, was one of the physicians of dentistry.' This discourse is comprised of three books; the Western Caliphate. He was born in the Andalusian Book I on cauterization, Book Il on surgery and Book III town of Alzahra, just outside Cordoba.3.6 Very little is on orthopaedics. This text became the standard surgery known about the life of Albucasis. The most widely textbook throughout Europe'0 from the Middle Ages to accepted dates of his lifespan are 936-1013Y What is Saliceto.3 In fact, it aided in raising the state of surgery in known about him is that he studied at the famous seat of Christian Europe5 and almost all authors of surgical texts learning of Cordoba, attaining the position of a classicist, from the 12th to 16th century referred to Albucasis.' The physician and surgeon8 and that he was the personal popularity of Al-Tasrif was so extensive that, in Medieval physician of the great Omayyad Caliph Abd-ar-Rahman times, Albucasis became more frequently quoted than rr (912-961): .5 Galen himself.• One of the reasons for its immense Although his biographical details are sketchy, the popularity was the practical manner in which it was legacy of his work is not. His chief work was his Kitab al­ written. 10 tasrif li-man 'ajiza 'an al-ta'lif: meaning 'The Book of The surgical discourse was the first individual enabling him to manage who cannot cope with the illus trated work on surgery5 and many of the compilation.'9 Written in Arabic, it was an encyclopedia approximately 200 surgical instruments depicted in the o f medicine and surgery, but the AI-Tasrif's Latin surgery were devised by Albucasis himself." It was the tra nslation exerted its greatest influence in Europe.• firs t authentic description on the surgery of the Section I of the encyclopedia dealt with medicine, section abdomen'2 and the first on the treatment of deformities of II with pharmacology, and section III with surgery. Of the the mouth and dental arches.3 He was the first to 30 discourses in total, numbers 1, 2, 28 and 30 were the recommend the reimplantation of teeth using a most important.• prosthesis. 13 In addition, Albucasis was the first to use fine Discourses 1 and 2 were translated into Latin as Liber s uture extracted from animal gut for intestinal Theoricae." In it, Albucasis classified 325 diseases and anastomosis'2 and he introduced the modern surgical discussed their symptomology and treatment. It contains, technique of varicose vein excision through small spaced a mong other things, the first medical description of incisions.7 He also introduced some of the many surgical hemophilia, noting it is passed from unaffected women to uses of cotton such as in surgical dressings, the control of their male children." haemorrhage, as padding in the splinting of fractures, as Discourse 28 is called Liber Servitoris in Latin and v ag inal packing in pelvic bone fractures, and in was the fourth medical book ever printed [Venice, 1471].6 dentistryY Other surgical contributions by Albucasis include descriptions of Pott's disease, Kocker's method of hip dislocation reduction, Trendelenburg position, ABOUT THE AUTHOR: Walcher's position for obstetrics, vaginal uretero­ Mr. Qasim Razn Alikhan is presently a third year medical student at lithotomy, and extraction of a dead fetus with the aid of tire University of Western Ontario. He has an interest in the history of obstetrical forceps.'·• He also described the classical Arabic Medicine. operation for breast cancer, warned against the dangers of

U. W. O. Medica/Journal 65 (1) 1995------25 Feature Section metastasis, advised the ligation or cauterizatio n of bleeding vessels.' At a time w hen a physician was considered to be a universal scholar, Albucasis advocated specialization (and tended to adhere to the practice alone).6 Al-Tasrif was a comprehensive mectico-surgical encyclopectia' and the above are examples of only some of the numerous contributions Albucasis made to the field of surgery. His Co mp LimentrJ influence on the field of medicine is so fundamental that he helped surgery become a separate specialty.7 Modern surgeons practicing today all over the world perform numerous surgical procedures unaware that Albucasis 6 7 of introduced them more than 1000 years ago. • Thus, there is little doubt as to why Albucasis is considered to be the greatest surgeon of his time and even the greatest Arab surgeon of all time.'' ACKNOWLEDGEMENTS: Fisher Many thanks to Dr. Farid Haddad, Department of Scientific Urology, Phoenix, Arizona, for stylistic advise and for research material pertaining to this article. Also, I would like to thank Dr. David Colby, Departmen t of Microbiology, University Hospital, for reviewing thi work.

REFERENCES:

1. Haddad FS. Surgical firsts in Arabic Medical Literature. Studies in History of Medicine and Science 1986-1987; 10-11:95-103. London Regional Cancer Centre

2. Zimmerman LE, Veith I. Great Ideas in the History of Surgery. Second The UNIVERSITY of WESTERN ONTARIO Edition. New Yo rk: Dover Public Inc. , 1967. Faculty of Medicine • Department of Oncology 790 Commissioners Road East, 3. Garrison FH. History of Medicine. Fourth Edition. Philadelphia: WB London, Ontario N6A 4L6 Saunders, 1929. (519) 685-8600 4. Major RH. A History of Medicine. Volume I. Illinois: Charles C Thomas, 1954. Dr. Leslie Levinl, MD, FRCP(C) Chief Executive Officer 5. Ca mpbell 0. Arabian Medicine and Its Influence on the Middle Ages. London Regional Cancer Centre Volume I. ew York: AMS Press, 1926. Professor and Chair Department of Oncology 6. Haddad FS . Abulcasis. Abottempo Book 1968; Book 3:22-25. The London Regional Cancer Centre is a modem, 7. Haddad FS. Zahrawi (936?-1013) Tlze Great Arab Surgeon. XXI Congr well-eguipped, ambulatory treatment facility. StorMed Siena, 1970; 2:1600-1607. The opportunity exists to participate in clinical 8. Haddad 51. History of Arab Medicine. Beirut, Lebanon, 1975. and basic research programs.

9. Spink MS, and Lewis GL. A lbucasis: On Surgery and Instruments. Los The Department of Oncology offers postgraduate training Angeles: University of California Press, 1973. in Medical and Radiation Oncology.

10. de Moulin 0. A History of Surgery. Boston: Martin us ojhoff, 1989. For details, contact: Dr. Walter Kocha, MD, FRCPC 11 . Spink MS. Arabian Gynaecological, Obstetrical and Genito-urinary Practice Illu strated from A lbucasis. Proc Roy Soc Med 1937; 30:653-671. Residency Prog ram Director Department of Medical Oncology 12. A I Fallouji M . History of Surgery of the Abdominal Cavity: Arabic (5 19) 685-8638 Contributions. International Surgery 1993; 78:236-238. Dr. Barbara Fisher, MD, FRCPC 13. Haddad FS. re: Reimplantation of Tee th (letter]. J Ku wait Med Assoc Residency Program Director 1967; 1: 328. Department of Radiation Oncology (5 19) 685-8650 14. Haddad FS. re: Endoscopic Tra nsvesical Extramura l Ureterolithotomy (letter/. British journal of Urology 1990; 66:668 Q The Ontario Cancer Treatment and Re earch Foundation

26 ------U. W .O. Medico/Journal 65 (1) 1995 t-eature ~ect1on A History of Ontario Asylums

by Caroline King, Meds '96

hanges in the treatment of the mentally .ill, more than in any other branch of medtcme, are Cprofoundly affected by social and political developments. With the current controversies over deinstitutionalization and the continuing closure of p ychiatric facilities, it is useful to look at the history of asylums for the mentally ill in Ontario to see where we have come from and where we are going. In this article, I will briefly outline 1) asylum reform in Europe; 2) the establishment of insane asylums in Ontario; 3) physical features and treatment philosophies of these institutions; and 4) the fate of these asylums.

CARE OF THE IN SANE PRIOR TO THE 1800'S

In ancient civilizations and through to the Renais ance, people with mental illness were left to the care of family and friends. There were no special institutions for their treatment.' In the sixteenth and seventeenth centuries in Europe, partly as a result of a ASYLUMS IN ONTARIO rise in unemploy ment and population growth, the mentally ill and other "vagrants" were kept in custodial The early care of the insane in Upper Canada was institutions such as the Hopital General in Paris and the provided by families or custodial institutions. With the workhouses of England. Conditions in these increasing population, however, there was an increase in institutions were dismal and there was no separation the numbers of the mentally ill requiring care. The between the poor, the insane, and criminals. The insane movement towards the building of insane asylums in were often mingled together in cold, damp cells and Canada in the middle of the nineteenth century is thought sanitation was at a minimum. Furthermore, the public to have been provoked by three main sociopolitical and exhibition of " lunatics" was commonplace and in economic factors: 1) during the 1830s and 1840s, an elitist England trips to see them perform were popular group of reform-minded physicians, judges, clergymen weekend diversions.2 and politicians encouraged the idea of providing In response to the inhumane treatment of the therapeutic care for the mentally ill in planned, non­ mentally ill, reforms were made in the eighteenth custodial institutions/ 2) the fiscal status of the century almost simultaneously by William Tuke and the government at this time was very strong; and 3) Society of Friends in England and by Phillipe Pinel in restructuring of the welfare state, especially after Paris. These first modern asylums were based on the confederation, gave control and funding responsibility of principles of 'social psychiatry' or 'moral treatment' prisons and asylums to the provinces, such that the that asserted a link between mental illness and the social mentally ill became wards of the state.5 By the late 1800's environment. The notion was that individuals were there were 11 separate mental institutions in Canada, susceptible to the corruptions of society (such as war, including ones in Toronto (1843), London (1870), poverty and disease) " hence if mental illness was Hamilton (1875) and Kingston (1867). induced by conditions of society, then mental health could be encouraged by removal of the sufferer from the TREATMENT PHILOSOPHIES AND PHYSICAL source of irritation."3 This involved a more humanitarian FEATURES approach, avoiding the use of mechanical restraints and improving living conditions with good food and The concept of occupational therapy was not comfortable bedding. This was the model (and ideal) unknown to the Victorian era psychiatric caretakers. In upon which the nineteenth century asylums in North fact, part of moral treatment included occupying the America were based. patients time and energy with work, as well as the avoidance of mechanical restraints. In the 1880's, Daniel ABOUT THE A UTHOR: Hack Tuke (a great-grandson of asylum-reformer Caroline King is a fourth-year UWO medical student with an interest William Tuke) visited many asylums in North America in the history of psydziatry. Size has a Bachelor of Arts and Science degree and wrote an account of his findings in an 1885 work from McMaster University and her interest in psyclzilltry dates back to her entitled, "The Insane of the United States and Canada." work as a summer student at the Hamilton Psydziatric Hospital in 1991 . Of the Ontario asylums, Londons seems to have had the best reputation, due to the influence of its

U. W.O. Medica/Journal 65 (1 ) 1995------27 rearure Je er/Oil

superintendent Richard Maurice Bucke, who The site of the asylum should be elevated, discouraged all forms of mechanical restraint. Likewise, commanding an extensive prospect of surrounding sedatives were rarely given. Tuke remarks, "When Dr. scenery from which the patients may look down on the Bucke is asked how he employs a man in a state of acute surrounding countryside without being too near, so as mania, he replies, 'Oh, I make him break stones." • to be incommoded from the too frequent approach of That is to say, the main form of treatment was work - the imprudent and thoughtless stranger or visitor. It in fields, farms, gardens, carpentry, masonry, sewing should contain land sufficient to employ the whole and knitting. Recreation therapy was in vogue as well, number of insane in some interesting and profitable with regular poetry readings, concerts and plays being occupation as well as afford each class a large yard available to residents as a past-time as well as an entirely separated from the yards of other classes ... 7 effective form of treatment. Tuke found the London Tom Brown, the author of " Architecture as facilities, with its low patient to attendant ratio, to be Therapy" states, "The asylum, then, was to be situated clean and the patients well-fed with daily servings of in the country, and yet be near an urban centre, meat or fish. command a pleasant prospect to divert the lunatic Likewise, Tuke reported little mechanical restraints mind, a nd have ample grounds for both patient used in the Toronto asylum and most of the patients recreation and occupation." 8 were employed in some meaningful work. However, Many Ontario asylums employed this design several years earlier, Tukes brother had visited the principle. For example, the asylum in Hamilton was asylum, which was then under a diffe rent located on the iagara escarpment overlooking Lake superintendent, and found conditions to be horrible, Ontario. It was separated topographically, being 2 with starvation and treatments such as bleeding and miles away and 200 feet above the city centre. It also cupping commonplace. Thus, the conditions of an had ample grounds for farming. Tuke note that it asylum probably very much depended on who was was originally designed a an inebriate asylum, "but running it. the needs of the insane were justly deemed more The architectural features and treatment pressing and practical than those of dipsomaniacs."• philosophies of these institutions cannot be separated, as The Toronto asylum, located at 999 Queen St. West form was meant to follow function. In his review of and completed in 1850 was originally thought to be American asylums in 1836, Or. Duncombe comments: one of the most technically advanced buildings of its

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28 ------U. W .O. Medical Journal 65 (1) 1995 Feature 5ecfton kind in North America. However, w ithin a decade, REFERENCES problems with the new heating and ventilation system became evident and quite soon the expanding urban 1. Dear, M .J. and S.M. Taylor. Not on Our Street: Community Attitudes limits of Toronto encroached on the buildings to Mental Health Care. London, Ontario: Pion Limited, 1982. grounds. This led superintendent Dr. C.K. Clarke in 2. Frankenburg, F.R. The history of confinement of the mentally ill in 1906 to remark: Ontario. The Psychiatric journal of the University of Western Ontario "In stead of the desirable two or three hundred acres, 1982; 7(4): 240-243. 26 acres are en closed within gaol-like walls ... Queen 3. Dear and Taylor p.41 Street, one of the busiest thoroughfa res in the city, is directly to the north. The smoke from the many trains and 4. Roberts, C.A. Viewpoint: Development of mental health services and factories in the neighbourhood, pollutes the air. A more psyd1iatry in Canada: Lessons from the past: Problems of the present; and undes irable site for a hospital could not be selected. " 10 the f uture. Canadian Joumal of Psychiatry 1989; 34(4): 291 -298. 5. Dear, M .j. and j.R. Wolch. Landscapes of Despair: From THE FATE OF ONT ARl O ASYLUMS Deinstitutionaliwtion to Homelessness. Princeton: Princeton University Press, 1987.

One ca n see that there are many s imilarities 6. Tuke, Daniel Hack. Tile Insane of the United States and Canada. London: between the type of therapeutic environment that H.K.Lewis, 1885. p.217. early asylums in Ontario were trying to create and the current concepts of occupational and recreational 7. Brown, Tom. Architecture as Therapy. Arcilivaria 1980; 10: 99-123. p. 113. therapy. If one is to believe Daniel Tukes account, Victorian era asylums enjoyed a time of success in the B. Ibid care of the mentally ill . It was optimistically believed 9. Tuke p.227 that mora l treatment would increase the cure rate to over 90 percent and eliminate mental illness as a major 10. Brown p.123 societal problem. The optimism was short-lived however, as Canadian cities became larger and the population in need of mental health care increased. The asylums which were built to hou se only a few hundred patients contained tho usands by the 1940's. The more familiar conditions of overcrowding and imperson ality associated with large institutions becam e apparent. The d eclinin g conditio n s in provin cial psychiatric hospitals, alon g wi th new advances in psychopharmacology sparked yet another HOP1TAL ~OT'R£-'DAM£ reform in mental health care in the 1950's and 1960's HOSPITAL - deinsituti onalization. However this has brought HEARST (Ontario) new problems including the " revolving door" syndrome, w he reby m entally ill people experience requ ires a: many repea ted admissions and discharges from general hospital psychiatry wards a nd longer-term psychiatric facilities. The increase in the numbers of ex-psychiatric patients among the homeless and in the F amll~t bDdDr with criminal justice system also suggest that instead of Db6tdrlcal pt-actlce being institutionalized in asylums, these people are now marginalized in the community. Perhaps b y looking to the past and understanding how the Permanent position political, social a nd economic forces of the time Dynam ic medical team affected changes in mental health care, we can learn M ultidiscip linary care from mistakes tha t were made, and try not to repeat Modern general hospital them. Fully accredited 60-bed Popu lati on-1 0,000 ACKNOWLEDGEMENTS: 85% francophone Lumbering and tourist area This article came out of a presentati on originally given at the fi rst Hannah Symposium for the History Excell ent recreational fac ilities of Medicine in 1993. Many thanks to Dr. Potter for his Excellent educati onal system ongoing support and encouragement, and to Brian Misiaszek for his useful comments. Call col lect at (705} 362-4291 extension 124

U. W .O. Medica/Journal 65 (1) 1995------29 I C'UIUIC' o.JCI.. II V II • An Ala r m 1 n g History of Breast Cancer Treatment • • 1 n T 1m e s of Old By Mary Ann McKnight, Meds '96 This paper was presented by Ms. McKnight, in a similar If the above treatments failed, a they often did, one form at the 'Hannah History of Medicine Day', on April 1, could pray. And conveniently, the Catholic Church has 1995, in Halifax, NS. no less than thirteen saints of breast disease alone. The most famous of the e is St. Agatha. Her fame stems not t is frightening to think of having malignant brea t from divine cure of her own brea t ailment, but from disease in the twentieth century. What we take for martyrdom. She wa a beautiful, but chaste woman who I granted nowadays, uch as surgery, radiation, devoted her life to God. Refusing the advances of a chemotherapy, sterile technique, antibiotics, and Roman official landed her in a brothel as puni hment. analgesia are techniques that were not heard of in ages However, she remained a v irgin while there. Thi past. So, what could be done in antiquity, the middl ages infuriated the Roman, and he showed his displeasure by and renaissance about a growing, worrisome intrusion in having Agatha' breasts sheared off and having her the breast? This brief survey takes a look at some of the thrown in prison. St. Agatha's day is still celebrated in "serious" and folk medicines used in the treatment of Catania, Sicily, where Agatha is said to have li ved. The brea t disea e. occasion is marked by a proces ion through the town to We begin w ith a familiar name, our endeared her shrine with two large breast effigies leading the way" Hippocrates. He lived and worked in and about 480 BC. Othe r trea tme nts used for their m agical value He wa well aware of brea t 'karkinoma', and thi wa included laying raw meat on an ulcerated breast cancer. explained b y his well known humoural theory. The idea was that the disease would be transferred to the Hippocrates believed tha t the imbalance of the four warm, freshly slaughtered kitten or puppy, and when the humours, in particular, Judging within the breast, meat cooled , a fre h s la b was to be applied. This accounted for the rn a , and was the re ult of sugge tion from DaVigo, a Renaissance docto r to the amenorrhea. He state that occult can cers should be left Pope/ may have temmed from the notion that heat untreated, for treatments uch as surgery would ha ten attracted coagulation and inflammation, and hence would death.' purge the d isease out. This theme of cure by forcing Galen, of about 150 AD, u ed Hippocrates' theorie disease out of the body, such as in phlebotomy, rather and expanded on them. The e ideas lasted well into the than having the body deal with it, was used throughout 1800's. Galen also maintained that a thickening or Western medicine until the age of microscopic biology sludging of humour would produce a 'scirrhu ', a allowed us to know of and aid in the body's own defenses. hard, heavy tumour, fi xed and painless . This was Meat consumption was the treatment of choice for St. thought to be different from a malignancy, which was Comas and St. Damian, physicians who instructed a caused by congestion of black bile. Treatment was Jewish woman with breast cancer to eat pork. As her either purging or bleeding, to prevent over­ religiou conviction would not allow this, she instead accumulation of the bile, or restarting menstruation in laid the pork on her breast and was thus cured.' As well, young women, if it had stopped, with hot baths, walk , other d ietary con iderations were in vogue for the and other external therapy. Galen al o recommended ailments of the brea t. It was thought that avoiding hot local application of strychnos (nightshade) juice, or food and drink would decrease internal heat, which pompholyx, which contained zinc oxide, especially for predisposed to inflammation and thickening of humor in ulcerated lesions. If the cancer was hidden or the breast. ' It was also important for the unfortunate soul unulcerated, chalcites, which contained copper, were to keep up her spirits, for it was believed that a depressed used. If the mass was large, then surgery was the only mood lead to melancholic humor and coagulation within option left. Surgery began by purging the tumour. the breast. Then, one would cut away the diseased part, let the This overview of beliefs and practices with regard to blood flow, and cauterize.' breast cancer in remote times is by no means complete. It Few women with breast disease in these time had is alarming to think of how far medical knowledge has Galen's methods of treatment available to them. Thus, come, and yet so many women still die each year from the there existed magic, divine intervention and animal same cancer that plagued women of antiquity. sacrifice for the betterment of health. For instance, from ancient times right up into the renaissance, one could try REFERENCES: to cure cancer with a crawfish or crab. One recipe was to burn the crab to ashes, or cook it in milk. The belief was 1. De Mouli11 D. A Short History of Breast Ca11 cer. Bos to11: Marti11u s that a cancer, with swollen veins like the legs of a ujhoff Publishers, 1983:2-20. shellfish, could be cured by using a natural object which 2. Kissin M. The patron sai11t s of breast disease. Australia11 and ew Zealand journal of Surgery 1991; 61 :452-453. resembled it. This is known as the doctrine of signatures.' So developed the crab symbol for cancer.

30 ------U. W .O. Medica/Journal 65 (1)1995 Feature Sect i on Alexis Carrel: Innovator of Surgical Vascular Anastomosis

By Paolo Campisi , M.Sc. , Meds '97 "... Doctor Alexis Carrel was one of the most extraordinary offer a scientific explanation for the child's and controversial figures of his generation. Bearing a fame that apparent cure. Perplexed by the occurrence, Carrel spread around the planet, he was decorated and damned, often innocently described this experience to his by the same people." colleagues in Lyon. Unwittingly, Carrel had Charle A. Lindbergh exposed himself to the merciless critic ism of envious colleagues. n June 24 1894, the Pre ident of the Virtually overnight, French Republic, M. F. Sadi Carnot, Carrel 's reputation 0 was viciously stabbed by a political became embroiled in anarchist. The wounded President was controversy. He was rushed to Lyon's Hopital Antiguaille where ostracized by the Lyon his injuries, a lacerated liver and severed medical community and portal vein, were attended to by the senior was advised to abandon urgeons. In an attempt to control the his surgical studies for he massive internal hemorrhage, the portal would never be v ein was ligated. The efforts of the permitted to complete his surgeons were futile; President Carnot died surgical residency. the next day. A young intern, Alexis Carrel Disheartened by his (Figure 1), was greatly moved by the tragic predicament, Carrel death of the French President and was contemplated inspired to develop surgical techniques that abandoning his career in would lead to the birth of modern vascular medicine altogether. urgery. Upon reflection, he Alexis Carrel's first endeavour was to decided to dedicate his olve the m ystery of vascular anastomosis, life purely to research . a surgica l technique that had eluded his However, it was predecessors. Carrel was successful in painfully evident to identifying and addressing the technical Carrel that these plans for his future could only be hortcoming of previously described methods: a) realized outside of France. In May of 1904, at the the surgical in truments u ed at the turn of the age of 31, Carrel sailed from Bordeaux to Montreal, century were too crude for the suturing of delicate Canada to present a paper on vascular anastomosis arterial and venous walls; b) early methods of at the Second Medical Conference of the French anastomosis did not ensure that the free edges of a Language in orth America. After a brief stay in joined blood vessel were uniformly sutured about Montreal, Carrel wa offered a permanent research their circumference; and c) the suturing process position at the University of Chicago. itself inevitably damaged the intima of vessels and precipitated thrombus formation. Carrel's theories regarding vascular anastomosis, published in 1902, became widely recognized by the international medical community. Hi rapid rise to fame , however, was not well received by senior physicians immovably entrenched in their conservative ways. In 1903, Carrel participated in a religiou pilgrimage to Lourdes during which he witnessed an unexplainable healing of a young girl afflicted with tuberculous peritonitis. As a scientist, he found it exceedingly difficult to accept this event as a miracle. On the other hand, he was unable to

ABO liT 1HE AUTHOR: Paolo Campisi is a third year medical student at the University of Western Ontario. He lias recently submitted for publication tile results of a retrospective study on the outpatient management of spontaneous pneumotlwrax will! tile Heimlid1 flutter valve.

U. W.O. Medica/Journal 65 (1) 1995------31 reature ::>ectton While working in Chicago, Carrel was joined by a young researcher named Charles Guthrie. Over a two year period this team published 21 paper that CYSTISTAT™ indisputably laid the foundation for modern ~ vascular and cardiac surgery. Indeed, they established principles that are followed in the STERILE SODIUM world 's operating rooms to this day. Carrel and HYALURONATE SOLUTION

Guthrie's major achievement was the refinement of For 1emporary replacemenl of !he glycosa· the ' triangulation method' of vascular anastomosis, ninoglycan (GAG) layer on bladder

introduced by Carrel in 1902. For this work, Carrel DESCRIPTION: The glycosaninoglycan (GAG) was recognized by the Karolinska Institute of layer on !he lurnnal sur1ace of !he blaclcler wallos beheved 10 provide a prolective barroer agaonsl Stockholm and awarded the obel Prize in rricroorganiSITlS, carcanogens. crystals and other Physiology or Medicine in 1912. This achievement agents present 1n the urine1 and has been Kienu­ foed as !he primary defense mechanism on prolecl· marked the first obel Prize to be awarded for ang the transttionaJ eprthelium from unnary m tants 2 medical research completed in the United States of Defoaencoes in !hiS GAG layer of !he bladder epo· lheloum may destroy oiS barroer funcloon and allow America. Moreover, Carrel became the youngest !he adherence .of bacleria. nicrocryslals. proleons and tons. or the movement of tOme and non-tome obellaureate at the age of 39. solule residues (i.e .. urea) across !he epolhelium' Alexis Carrel went on to make many further CYSTISTAT"' has been developed lo l ~anly repleniSh !he defocien l GAG layer on !he bladder significant contributions to the advancement of epilhelium. The aclive subslance is a specofoc surgical medicine. His theories of o r gan hyaluronic acid fraclion of def.,ed molecular chain fenglh (combi'oed average of 500.000 • 730.000 transplantation, coronary artery bypass, wound Oal!ons) wilh a high degree of purily debridement and organ culture have been de cribed Eaoch Cystistal"' voal conlains as being fifty to a hundred years ahead of their 40 mg sodium hyaluronale time. In spite of his brilliant research career, the DIRECTIONS: The Cyslislal"' kol provides equop· unexplainable event at Lourdes and his men! needed lo admonosler Cysloslal' " The controversial beliefs in extrasensory perception and approproale size of calhele< lubong will need Ia be oblaoned separalely lnslill !he enlore volume of supernatural powers of the human mind have made lhos solulion inlo !he bladder aile< any residual Alexis Carrel one of the most celebrated and urine has been removed Oo scard any unused portion For besl resuiiS, Cystoslal"' should be criticized scientists in medical history. The li fe of relained on !he bladder for as long as possoble this extraordinary man cannot be adequately (a ninomum of 30 rrMnules) chronicled in this brief introduction. Interested There IS evidence !hal !he GAG layer IS defocoenl in conditions such as an &ersbtJal cyshttS ' In such readers are encouraged to review the biographies silualions. 11 is recommended !hal CystiSial"' be noted at the end of this article. instilled weekly for four treatments and then mon lhly unul symploms resolve

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Friedewald VE, Crossen C. Vascular anastomosis. Scientific American 1 X 50 mL voal of CystiSial"' 40 mg 1 slenle 60 mL synnge Science and Medicine 1994; Sept/Oct :68-77. 1 stente catheter adaptor 1 sle

2 Chelsky. M et a/ Bladder permeabolily on t n ~ers uua l cysuus ts Similar to tha t ol normal measurement by transvestcal absorptiOn ol 99m techn euum-d te thylenetrtamtne penta aceloc acod J Ural 151 346 1994

3 Brandl. K 0 The elf eel of synovoa l hyaluronale on the tngestK>n of monosodium urate crystals by ieuccocytes C io n Chem Acla 55 30 7 1974

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32 ------U.W.O. Medica/Joumal 65 (1) 1995 Feature Sec t io n What's In a N am e? Canadian Med i c a I Eponyms

By Brian Christopher Misiaszek, Med '97

anada, despite being a relatively youthful nation, Murray L. Barr (1908-1995). Dr. Barr is best known has made substantial contributions in the sphere for his discovery of the condensed sex chromatin of the C of medical and scientific research. Some of these female cell nucleus that bears his name, "Barr Body", but achievements are historically reflected in medical terms he made many other fundamental contributions in the being derived from the name of their Canadian field of cytogenetics and neuroanatomy. Born in Belmont, discoverer or originator in an eponymic fashion. It Ontario, Dr. Barr graduated from the University of may be surprising and gratifying for many to learn that Western Ontario in 1933. After interning for a year in some of the terms that make up the medica l lexicon Pennsylvania, he returned to London, Ontario, where he were in fact coined by individuals residing in our own spent two years in general practice until he joined the country. Ironically, such accomplishments and their Department of Anatomy at Western in 1936. With the originators are often better known to the workers in a outbreak of the Second World War, he joined the Royal given speciality in countries far from Canada than they Canadian Medical Corps, and served with them until the are at home. This article is an attempt to, at least in end of the war in 1945. After the war, he returned to part, rectify this situation. London where, working in his lab at Victoria Hospital on The word eponym is a compound word made up of a shoestring budget, Dr. Barr and his graduate student two Greek words; -onym or name, and -ep or upon; E.G Bertram made the discovery of sex chromatin, which therefore eponyms are those words which are stuck on was first published in 1949. He became a professor of top of another name; in other words, a nickname . Anatomy in 1951, was chairman of the Department of Medical vocabulary is crowded with eponyms- terms Microscopic Anatomy from 1953-1964, and chairman of derived from the proper names of persons, families and the Department of Anatomy from 1964 until his places, be they real or imaginary. Ra ther than being re ignation in 1967 to devote more time to research and designations made to h onour their discoverer, teaching duties. His a reas of interes t included epon y m s were adopted to provide a con venient neurocytology and a nomalies of human sex identifying label to describe a particular phenomenon chromosomes; he also helped to identify the genetic associa ted with that person. Some examples of condition 48 (XXXY);XXY, also known as Barr-Shaver­ commonly used eponymic medical terms include Bells Carr Syndrome. Beyo nd his many scientific Palsy, Cushing's Disease, Tinels Sign, the Heimlich accomplishments and various scientific awards, Dr. Barr Manoeuvre and Munchausen's Syndrome, among was also very interested in medical history, penning an others. account of the history of the UWO Medical School, "A One of the ironies of Canadian medical research is Century of Medicine at Western", in 1978. that the decline in the u se of e pony mic te rms to identify new and important discoveries coincided with Norman Bethune (1889-1939). An intense, complex the g rowing influence and contributions Canadians and passionate m a n, orman Bethune's medical have made in these areas. Hence, there are no humanitarian efforts have only recently become known to epon yms in the medical literature reflecting the Canadians (in contrast to China, where he is considered a achievements made by such giants as Banting, Best, national hero). Born in Gravenhurst, Ontario, he Collip and Penfie ld. Des pite this, many Canadians graduated with the medical class of 1917 from the have left their stamp on the medical vocabulary. Below University of Toronto (one of his classmates was Sir is a brief (and by no means exhaustive) li s ting of Frederick Banting, the co-discoverer of insulin). After medical terms associated with Canadian physicians discovering he h ad TB in 1926, and being treated and medical investigators. Following each is a brief successfully by an artificial pneumothorax, Dr. Bethune biographical vignette. Part of the charm of medical devoted himself to work in the field of tubercular eponyms is that they not only identify the item their research and surgery. After joining the staff at Montreal's originator firs t described, but they also provide a Royal Victoria Hospital in 1928, he invented a number of fasci nating glimpse into the life and history of the surgical instruments to enhance thoracic surgery, which person attached to the term itself. became widely u sed throughout North America . Although, time has rendered many of his devices obsolete, his curved Bethune Rib Shears are still used today. ABOUT THE AUTHORS: While in Montreal, the flamboyant Dr. Bethune Brian Misiaszek is a third year medical student at the University of became first interested in socialist medicine, and then left­ Westem Ontario, with an avid interest in medical history and literature. He wing causes in general. In 1936, he became involved with is a member of the newly revived Osler Society at that institution. the Loyalist forces in the Spanish Civil War, where he created the worlds first organized blood transfusion

U. W. O. Medica/Journal 65 (1)1995------33 rearure ;:,ecr1on

service. By 1938, after declaring himself a member of the Sir William Osler (1849-1919). Arguably the greatest Communist Party, he was in China, providing medical physician since Hippocrates, William Osler gained his aid for the Communist forces of Mao Tse-Tung, who were fame not as much for his scientific accomplishments as then fighting off the invading Japanese army. In China, he for his invention of the system of modern medical developed the mobile army medical team, forerunner to education used today. Born in Bond Head, Ontario, the MASH units used in subsequent armed conflicts. He died prankish and mischievous young William was diverted in a tiny peasant hut in China on November 12 1939, as a from a life of religious study towards a We of science by result of a surgically derived infection. After his death, two influential persons; the Reverend W.A. Johnson Mao Tse-Tung wrote about Dr. Bethune in a memorial who introduced him to a microscope and a drop of essay, which included this line: "We must all learn the dirty pond water, and Dr. James Bovell who convinced spirit of absolute selflessness from him." him to switch from the religious training program at Trinity College in Toronto, to the Toronto School of Maud Menton (1879-1960). One of the first Canadian Medicine. He spent the first two years towards hi s women to receive a medical degree, Maud Lenora medical degree there, but then transferred to McGill, Menton was born in Port Lambton, Ontario. She received completing his degree in 1872. The next several years her medical degree from the University of Toronto in he spent abroad, studying medicine in London, Berlin, 1907. She went abroad to further her studies and, while Leipzig and Vienna, until 1874 when he was appointed in Germany, her collaborative efforts with Leonor professor of medicine at McGill University at the age of Michaelis on the mathematical description of enzymatic 26. He spent ten years a t McGill, where he began to action and kinetics, led to the derivation and publication make a name for himself as a stellar clinician and a in 1913 of what is now known as the Michaelis-Menton superb teacher, his youthful enthusiasm and charisma Equation, a fundamental theory of biochemistry. After energizing the students and faculty alike. From 1884 to receiving her Ph.D. degree in biochemistry from the 1889 he was p rofessor of clinical medicine at the University of Chicago in 1916, she accepted the position University of Pennsylvania, following which he was the of pathologist at the University of Pittsburgh in 1918. first professor of medicine at the new Johns Hopkins Besides teaching pathology to untold numbers of University and Hospital, a post he held until 1904. It students and residents, she made important contributions was while he was at Hopkins that Osler established his to the understanding of scarlet fever, and performed international reputation as the most influential medical kidney and haemoglobin research. Dr. Menton became educator of all time, aided by the publication of the first professor emeritus at the University of Pittsburgh in 1950, edition of his famous textbook, The Principles and and afterwards returned to Canada where she worked in Practice of Medicine, in 1892. In 1905 he was appointed the field of cancer research until her death. Regius Professor of Medicine at Oxford, and he was 8 The New England Journal of Medicine

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34 ------U. W.O. Medica/Journal 65 (1) 1995 Feature Section created a baronet in 1911. Sir William Osler died of pneumonia in 1919, and his ashes lie in the library created from the priceless collection of books he donated to McGill University. After his death, his widow, Lady Osler, asked his friend Harvey Cushing (known today as the father of neurosurgery) to pen his biography; fi ve We have wrapped years in the writing, The Life of Sir William Osler won Cushing the Pulitzer Prize in 1926. a banking package ... For a person unschooled in medical matters, it may be difficult to under tand the reason for Osiers enduring influence. While he did make a number of scientific for your future medical discoveries, mostly in the area of cardiovascular disease: making the first observations of platelets, describing polycythemia vera (Osler-Vaquez Disease), hereditary haemorrhagic telangiectasia (Osler-Weber­ Rendu Disease) and identifying some of the clinical signs of infective endocarditis (Osler odes). Such discoveries alone are not enough to explain why Osler left such a vast impression on his medical peers and contemporaries. What the facts cannot show is the engaging personality of the man himself which made him both the most famous and most beloved physician of his day. Words alone cannot show the infectious enthusiasm towards the study of medicine that William Osler radiated from all his being and infected all whom he carne in contact with. He was an odd chimera of medical sobriety and audacious prankster, and he delighted and entertained small children, students and medical Consider your current Personal colleagues alike with his wit and compassion. Osiers students adored him for the compassion, encouragement and Practice Banking arrangements and inspirational advice freely shared, and he attracted many converts to his novel methods of teaching. Osler's The TD Medical Group Banking Program could very well be the philosophy of medical education stressed the bedside best banking plan in Canada and that means TO's best rates on personal and practice financing and daily banking services. teaching technique, as stated in his oft-quoted clinical aphorism, "Medicine is learned by the bedside, not in the • Pre-negotiated best practice and personal customer rates to give you classroom." He introduced the concept of the clinical lower banking account, loan and mongage co ts clerkship, and created the system of ever increasing • Time saving and co !-effective TO Payroll and Cash Management Services acquired responsibilities - from clerk to resident to house officer - that is the hallmark of the transition of • Interest on credit balance student to doctor still in use today. His highly readable • Dedicated Commercial. Personal and Private bankers to serve you through convenient bank locations textbook, an instant classic, and was the metre by which all other textbooks would be measured for the next 40 • Investment management and trust service through TO specialists at TO Trust. TO Evergreen lnve tor Service ®Inc. and Green Line years and is still worth reading even today. It was so lnve tor Services Inc. popular that is was translated widely into languages as • Higher return on TO GIC RRSP I RRIF's diverse as German and Chinese. He emphasized the concept of continuing medical education, had a life long For funher information. interest in literature, the humanities and medical history, call the TO Medical Group Banking Information Specialists at ... and was a prolific writer in his own right. He was a role 1-800-387-2092 model for an entire generation of physicians throughout the world, and the "Oslerian Tradition" -a virtuous and THE TD MEDICAL GROUP BANKING PLAN idealistic approach to both medicine and We - exerts a Practice banking • ~rsonal Banking strong influence on many even today. This is by no means an entire listing of Canadian medical eponyms. Space forbids providing biographical information on the following Canadians who have lent their names to medical science: William Mustard [Mustard Operation], Robert Salter [Salter Operation, Salter-Harris Fracture Grading], John C. Steele & J. Clifford Richardson [Steele-Richardson-Olszewski Syndrome], Arthur Vineberg (Vineberg Operation], as • Trade Mark otTO Bank well as many others who might very likely have been inadvertently omitted in this account.

U. W .O. Medica/Journal 65 (1) 1995------35 rearure ;:,ecr~on

ACKNOWLEDGMENTS: REFERENCES

I would like to thank Dr. Paul Potte r fo r his Charles S. Bryan " What is the Oslerian Tradition? " in contagious enthusiasm for this subject and for the many Annals of Internal Medicine, Volume 120, o. 8 15 helpful suggestions that proved invaluable during the (Apri/1994). 682-687. creation of this article. I would also like to thank Dr. Dor/ands Illustrated Medical Dictionary (28th editio11 ) W.B. Sau11ders Co., Philadelphia. 1994. David Colby, Dr. Bertha Garcia, Dr. Martin Inwood, B.C. Firki11 a11d f. A . Whitwortlz, Dictio11ary of Medical Caroline King and David Martell for their suggestions Eponyms. The Parthrnon Publishing Croup, J, USA. and input as well. 1987 Donald Jack. Rog ues, Rebels and Geniuses: The Story of Canadian M edici11e . Doubleday Canada Limited , Toronto. 1981. M . Leider and M Rosenblum, A Dictionary of Dermatological Words , Terms and Plzrases. McGraw-Hill Book Co., Toro11to, 1968. H.E. M cDermot, One Hu11dred Years of Medicine in Canada: 1867-1967. McClelland a11d Stewart Limited, Toro11to. 1967. S. Magalini et a/. Dictionary of Medical Sy11dromes (Third Medicine in the 21st Century: Edition). f.B . Lippincott Compa11y, Philadelphia. Marcel f. Rhea/u/t "Pierre Masson: His lnflumce on tlz e Teachi11g of Pathology in Canada ", in The Cmzadian Will you be ready? foumal of Surgery, Volume 28, No.5 (September 1985). 456-457 Thomas A. Seemayer "Tize Life a11d Legacy of Professor Pierre Practisi ng medicine is not simply about patient care. Today' Masson ", in The America11 foumal of Surg ical Pathology. Volume 7, umber 2 (March 3 1983). 179- reality i that physicians also have to be political activists, 183 economists and knowledgable in health-care management. Roderick Stewart. The Mind of orman Bethune. Fitzhenry and Whiteside, Toronto. 1977. Marvin f. Stone "The Wisdom of Sir William Osler", The Our challenge is to ensure that those directly affected by Americanfoumal of Cardiology, Volume 75, February 1 changes to the health-care sy tern - patient and their doctors 1995. 269-276 - are involved in developjng en ible strategie for change. We' ve experienced the harm done by hort-sighted unilateral action on the part of government. Being informed and involved i the only way to have a hand in shaping your own future.

Your $25 OMA membersrup fee entitle you to receive several publications wruch will keep you informed about what's hap­ pening. As a member of the Student Section of the Ontario Medical As ociation (SSOMA) you will have representation on variou key committees.

We can build a stronger and more efficient health-care sy tern. Together, we will be ready for the 21st century. For more information about becoming a member of the OMA, please call or write:

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36 ------U.W.O. Medica/Joumal 65 (1) 1995 Feature Sect i o n The History of The Discovery 0 f DNA as The Material of Heredity

by jordan B. Salmon, Meds '98

hroughout the history of humankind, few question hi tochemistry, and went to work in the laboratories of have been as omnipresent and as intriguing as that Felix Hoppe-Seyler. Luckily, Hoppe-Seyler himself was a T of what is life? Vastly different interpretations of reductionist, who advocated that a deeper under tanding this query have inspired throngs of inve tigators to of the molecular forces which regulated cell life could be employ diver e strategie in order to discover the ecret attained by studying the physical and chemical propertie w hich is the essence of life as we know it. Predictably, of individual cellular component .2 Miescher chose to the many distinct pursuits, ranging the gamut from study wrute blood cells, wruch could be readily obtained religiou demagoguery, to philosoprucal rationalization, from the pus found on the discarded bandages of surgical to scientific examination, have yielded various dogmata. patie~ts. Cells were easily sedirnented and preserved by Of the available paths of inquiry, perhaps the most washmg the bandages with a dilute sodium sulfate empirical was that of deducing the physical and chemical olution, whereas if they were washed with a basis for biological life. Specifically, by identifying the concentrated salt solution (as was done by Hoppe-Seyler), structure and the function of the macromolecule which is the cells swelled to form a gelatinous mass, which to a quintessential component not only to the creation of life, many workers resembled myosin, the known protein of but to it perpetuation over generation , and its muscle cells. 3 This uncritical, purely qualitative evolution, an adequate and awe-in piring olution was ob ervation was the first instance in establisrung the long­ indeed revealed. Deoxyribonucleic acid (D A) was the held stigma that protein was the genetic material. As was scientific community's answer, which simultaneou ly often the case, researchers tended to find what they rendered the age-old question suddenly less esoteric, yet expected, and proteins, which had been found thirty demanded a newfound veneration for the artistry and the years earlier, by Gerardus Johannes Mulder, were ingenuity of the ultimate Forces of Creation, whatever considered to be the most significant material in cells/ they may be. The magnitude of the endeavor to make thus, Miescher was seeking to identify and describe the thi di covery should imply that nurnerou researcher , proteins which formed tissue in pus cells. Miescher from several nations, over a period of decades, concluded that the substance he had isolated did not participated in the proce . Yet, popularization of the exhibit properties wruch conformed to any known group, history of this fantastic event ha served only to glorify and hence he called it nuclein because he believed it to be James Watson and Francis Crick, who eventually fitted derived from the nucleusY Miescher analyzed nuclein the pieces of the puzzle together. While the enormous for its elemental composition, finding that it contained accompli hrnents of Watson and Crick are by no means 2.5% phosphorus.' Previously in Hoppe-Seyler's negligible, neither should they be understood in isolation. laboratories, lecithin had been discovered, and was Early on, chemistry had a vital role to play, yet deemed to be unique because it contained phosphorus as progres was limited by the state of chemical knowledge well as the other elements usually found in organic (biochemistry was, in the nineteenth century, a new molecules: 2 had Mie cher not been fortunate enough to discipline, and molecular biology was still unborn), and have made his finding amidst this excitement, his work the lack of technological analytical apparatus. The first might never have received the attention that it did. principle, which would enable later workers to imagine Although Miescher had isolated nuclein in 1869, his work macromolecules, was postulated by Friedrich Kekule was n~t published until 1871, after Felix Hoppe-Seyler (1829-96), who, following his discovery of the had, himself, reluctantly confirmed Miescher's novel quadrivalency of carbon atoms, conceived the carbon­ observations. 2 carbon link.1 His realization that all atoms in a particular Walther Flemming, who had observed and molecule were not in contact with one another, that in understood the process of mitosis in detail, introduced fact each (carbon) atom was joined only to a few other , the term chromatin, in 1879, to denote the darkly stained made possible the idea of long polymers. nuclear material which he had observed during mitotic Friedrich Miescher was born in Ba el, Switzerland, on division.2 Furthermore, Flemming speculated that August 3, 1844. By 1868, Miescher had earned a degree in chro~atin was identical to nuclein, much to the chagrin of M1escher, who denied this possibility as late as 1890. As early as 1884, Hertwig, a zoologist, is quoted as having ABOUT THE AUTHOR: declared "I believe [that it is] highly probable that nuclein The 1995 winner of the second place Rowntree Prize in Medical is the substance that is responsible not only for History is jordan B. Solmon. Mr. Solmon is a second-year medical student fertilization but al o for the transmission of hereditary with a Bachelor of Science degree from the University of Toronto. He is 3 interested in surgery. characteristics". Miescher was almost a visionary, but his keen speculation was spoiled by his bias and

U. W. O. Medica/Journal 65 (1) 1995------37 Featu r e Sect i on predisposition. In 1892 Miescher had proposed that upposition which persisted until 1929 was given voice, heredity was derived from the "stereo-architecture of in 1914, by Walter Jones, who stated that plant nucleic only a few very large, complicated molecules", but was acids contained a pentose sugar, while animal nucleic clearly referring to proteins, whose biological specificity acids contained a hexose s ugar. By 1935, Levene's was moderately well-known to the scientific community colleagues had concluded that the sugar was a pentose in at this time .~ In 1895, American cytologi t E.B. Wilson animal cell s as well as in plant cells, and Tip on and wrote that chromatin was similar to, if not identical to Levene modified the pre-existing tetranucleotide nuclein, and that heredity may be effected by the physical structure appropriately. Ultimately, Levene did ascribe transmission of a particular chemical compound from the D A polymer the phosphodiester bond. A for the parent to offspring.3 Biochemist Richard Altmann, with structure of D A as an entirety, several novel guesses Miescher's approval, renamed the substance in question were made, but none were supported by experimental nucleic acid, to disting uis h it from the protein­ evidence. The matter of structure would not be resolved contaminated samples that Miescher had obtained. for decades, but the chemical foundations had been laid. Eduard Strasburger, a botanist, and a contemporary Simultaneous to the elucidation of the composition of authority to Wilson on mitosis, in 1909, repudiated the nucleic acids, scientist debated the meaning of heredity, notion that nucleic acid could play any role in heredity.3 and pondered the mechanism of genetic transmission. Despite the debate which had clearly ari en as to the Dr. Archibald Garrod, a pediatrician in London, had identity of the hereditary substance, worker continued to observed a condition in infants which he called examine nucleic acids, which finally led to the alkaptonuria.' Alkaptonuria i an essentially harmless establishment of the structure of the nucleotide. condition, in which the afflicted patient excretes copious Albrecht Kassel, born in September, 1853, in Ro tack, amounts of homogentisic acid in their urine, which reacts Germany, worked in the new Hoppe-Seyler laboratory in with air to tum dark red.2 Garrod rebuked the arguments Strasbourg, where his objective was to determine whether of his peers who insisted that the condition was caused or not nucleins extracted from different cell s actually by intestinal bacteria which produced homogentisic acid/ possessed the same chemical composition.2 While the Garrod countered that bacterial intestinal populations existence of guanine was apparently known, Kassel, in had insufficient time to become established in newborn 1885, de cribed the preparation of a new base, termed infants who had alkaptonuria. He compiled pedigree of adenine, from animal organs and yea t. Along with his several of his patients' families, and saw a pattern in co-worker eumann, in 1893, Kassel reported another which other relatives had the disease, while parents of the previously unidentified cleavage product of nuclein, proband were frequently normal. The year was 1902, and which they called thymine, since calf thymus tissue wa the source of their nuclein. Soon after, they identified cytosine. Finally, in 1900 Kosse! and eumann i alated the fifth base which occurred in large quantities, uracil.2 Emil Fischer, by 1898, had synthesized adenine and f:1~ FAMILY PRACTICE guanine, in classic retrosyntheses, from reagents of MEDICAL CENTRES known chemical structure, and called this class of compounds p u rines.2 Pyramidine was a term used by 200 Ontario physicians have 'discovered the benefits of MCI's Adolf Pinner to designate the single-ringed bases thymine, cytosine, and uracil as a class; Fischer and management expertise. Build Roeder synthesized uracil in 1901, and Wheeler and ur family practice from a high Johnson synthesized cytosine in 1903. 2 All that remained, tvolume patient base. so far as nucleotides were concerned, was to assemble the components into a plausible configuration which would yield a monomer that could be elongated. There are • No financial risk several ways in which the three components (sugar, • No investment phosphate, base) could be connected, and thi led to • No lease to sign several incorrect structures, including the ether linkage • High income between sugar groups proposed by Jacob and Levene • Locum coverage 2 (1912). His wrong guess notwithstanding, it was • Independence Phoebus Aaron Levene who succeeded in providing the • No administration headaches structure of the nucleotide. In 1909, Jacobs and Levene were able to crystallize the sugar constituent of the • Full or part time nucleotide, and called it deoxy-ribose.2 In 1909, Jacobs and Levene fo u nd the order of the phosphate­ Twenty-six locations in the Greater Toronto Area. carbohydrate-nitrogenous base linkage . During the following decades, popular belief, based IICIIIEDICAL CLINICS INC. on crude results, became that the four bases were present 40 Eglinton Ave. East, Suite 802 in equal proportions in nucleic acids, and this led to the Toronto, Ontario M4P 3A2 erroneous tetranucleotide hypothesi . Levene gave the Heidi Rodrigues basic form of the tetranucleotide structure in 1921, using (416) 440·4040 Ext. 425 hexoses as the sugar components. 2 An incorrect Internet [email protected]

38 ------U. W .O. Medical Journal 65 (l) 1995 Feature Section Mendelian genetics had been confirmed. Garrod laboratory in the Ministry of Health. He was examining characterized the pattern which emerged as that of an different strains of the bacteria Streptococcus pneumoniae autosomal recessive allele;5 moreover, he asserted that to try to account for the increased incidence of one type of the affliction was caused by an alteration in the patient's pneumonia in the Smethwick area in England/ when he biochemistry which caused a metabolic block, due to an di covered two distinct strains. He deemed the first the inherited deficiency of some specific enzyme acti vity. S strain, ince the bacteria were shiny and smooth with a That the amorphous hereditary factors which were the polysaccharide coat tha t ca used it to be virulent; the basis of Mendel's theories of heredity could be equated second s train, the R strain, was rough, lacking a with heritable diseases that were wrought by biochemical polysaccharide coat, and avirulent.5 He concluded that differences in the metabolic pathway of afflicted there must be some sort of transforming factor in the individual was an idea of such incredible magnitude, killed S strain which reverts li ve R strain to live S strain. that it is of tantamount importance to the tructural work Griffith never committed to any particular substance a done by the researchers of the 1960's, for Garrod, by being the transforming fac tor, and certainly never virtue of his innovative thinking and his meticulo us uggested nucleic acid as a possibility, although a sembling of pedigrees, was able to hypothesize that nucleoproteins had been discussed in his laboratory in inheritance of traits was necessarily fused to processe at relation to the phenomenon.2 Griffith was scrupulousl y the molecular level. hone t, and genuinely unsure, which prevented him from Garrod's ideas were confirmed, and the impressive arriving at the correct explanation; he had little idea of work of George Beadle and E. L. Ta tum verified that the how the transformation came about, or its significance, production of every enzyme is regulated by one gene. In and his discovery wa an instance of pure serendipity.' order to demon trate their one gene-one enzyme Confirmation and continuation of Griffith's work wa hypothesis, Beadle and Tatum, in the 1940's set up a done by Oswald Avery, a Canadian born in ova Scotia, ystem in which they would cultivate eurospora in who was working in ew York. Avery performed a various media, which systematically Jacked certain amino eries of experiment , which were extremely elegant in acids or certain vitamins. They revealed two mutant their simplicity and design. By 1944 he had shown that forms.' 0 A was the tran forming factor. Despite this rigorous The effort to prove that 0 A was the m a terial proof that 0 A was capable of being the material of re ponsible for heredity was started, inadvertently, by heredity, with the capacity to regulate chemical Frederick Griffith, in 1923. Griffith was a con ervative production within the cell, many keptic doubted British civil servant who worked in the pathology Avery's conclusion. Allegedly, the scrutiny was the direct result of nothing more than the prevalent belief in the gene tic primacy of proteins. 2 At firs t, Avery, a con ervative, would not trust in his own results. Along DYNACARE LABORATORIES with his co-workers, he was unsure of the nature of hi A D ovosoon of ~ The Dynac.re Hea lth Group Inc. di covery; he did not know which contemporary theory of 0 A activity wa most applicable -whether 0 A was behaving as a gene, as a mutagen which caused D ynacare LaboratOri es utilize highly mutation of the genetic material in the recipient cell, or as automated laboratOry technolog y tO en ure a virus. Another rea on which exacerbated the reluctance accuracy and the timely delivery of test results. of o thers to accept Avery's res ults was that it was ufficiently understood that bacterial chromosomes were different than those of plants and humans/ o Avery' Biochemistry. Hematology. Microbiology. Cytology. conclusions might be limited to the bacterium. Dmg Testing. Pulmonary Function. ECG/Hofter Eight yea rs later, AI Hershey and Martha Chase Monitoring. Home Specimen Collection erv1ce. sought to lay to rest the debate over the identity of the genetic material. In 1952, in California, they took Report Delivery Service. advantage of the T2 bacteriophage as an experimental ubject. James Watson, in a 1952 paper, said of the experiment that it was "a powerful new proof that 0 A LONDON TORONTO is the primary genetic material". ' Meanwhile, in ew York, at Columbia University, (519) 679-1630 (4 16) 790-3000 from 1948-9, Erwin Chargaff was conducting a chemical 1-800-265 -5 946 1-800-565-5 72 1 investigation. His objective was to determine the basis of the specificity that was present in nucleic acids. One of the possibilitie wa the sequence of nucleotides in OTTAWA EDMONTON the molecule.• Chargaff noted some quantitative (613) 729-0200 (403) 451-37 02 relationships between base pair ratios, which he 1-800-267 -951 4 1-800-661-987 6 dismissed as being relatively trivial.2 Chargaff had indeed found that total percent purines equaled total percent p yramidines, and that adenine Other laboratories in: Burling ton, Peterboroug h, equaled thymine, while cytosine equaled guanine. It is Oshawa and Lloydminster, Saskatchewan. noteworthy at this juncture to stress the good luck which

U. W.O. Medical Journal 65 (1) 1995------....;....------39 reature ::>ect 1 on

Chargaff had in not selecting E. coli for his initial bacterial assemblage of polynucleotide chains, arranged so as to analysis, as would have been typical. In bacteria and have the phosphate groups on the outside, accessible to viruses, the cytosine/ guanine content ranges from 20% to water.7 The X-ray pictures made by Wilkins and Franklin 75%, but in E. coli happens to be 50% to 52%. If Chargaff show that DNA is a helix of two or three chains, held had chosen to work first on E. coli, the lack of variation together by hydrogen bonding between identical ba e in his results could have caused him to disregard his pairs.8 Franklin found that the B form helix had an axial whole investigation as meaningless. and the information repeat of 34A, and an axial spacing between nucleotides he uncovered would have remained undisclosed. of 3.4A.7 Workers in both the United States and Britain were in Linus Pauling, the American chemist-physicist, had pursuit of the structure of DNA which could satisfy the discovered the a-helical structure of proteins, which was criteria of accounting for the reproduction and stabilized by hydrogen bonds, and was awarded a obel transmission of genetic information. Ro alind Franklin Prize for his work in 1953. He had communicated to and Maurice Wilkins worked meticulously, at King's some English colleagues that he was becoming interested College in England, on the structure of D A, utilizing a in working out the structure of D A using similar model­ method known as X-ray crystallography. Wilkins was making methods to those which had aided him in ambitious, and was willing to always share his work with discovering the a-helix. The Cavendish team was at war the "scientific brotherhood", while Franklin is with Pauling who had beaten them to the a-helix,S and remembered as being more introspective and an ar dent thus, they were at war with the United states as well. observer.6 Rosalind Franklin made crucial contributions Amidst this climate of urgency and anticipation, two to the solution of the structure of D A, but died of cancer young workers who shared an office at the Cavendish, in 1963, five years after the decisive work of Watson and and who coincidentally shared an interest in the riddle of Crick. The importance of Franklin's work has been lost D A, began their quest for its structure. The degree of sight of/ partly because of her untimely death at age 37. coincidence which abetted them, and the fact that good Franklin began her work in 1951. She was to undertake a luck was their constant ally, was as important to their systematic investigation of DNA fibers/ and was an eventual success as was their perseverance and creativity. accredited specialist at X-ray crystallography.6 Franklin James Watson, born in Chicago in 1928, moved to took her pictures at different humidities, and found two England , w here he worked in Cambridge, at the different structures, which she called A and B. She Cavendish, where he met Francis Crick. While Crick worked tirelessly on A, and eventually Wilkins, her possessed the expertise in crystallography, and Watson supervisor at the Cavendish, was given permission to the expertise in phage genetics, their collaboration was work on B, much to Franklin's dismay. The structural not simply the sum of their abilities; rather, the nature of changes between the two forms led Franklin to believe their partnership was molded by the nature of their that the fundamental structural unit of DNA was an problem1 -they had to guess what the structure of DNA The future doesn't CADE FRASER • INSURANCE BROKERS LTD JUSt "PRRfESSK>NAl.S PROVIDING PROfESSIONAl. SERVICE TO OTHER PROfESSIONALS• • MALPRAGICE • BUSINESS • RESIDENTIAL happen. • AUTOMOBILE • UFE

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THE FUTURE S TART S H E RE

40 ------U. W.O. Medical Journal 6511) 1995 Feature Sect i on was, and show that it conformed to exi ting evidence. and Wilkins were awarded the obel Prize. Irorucally, Having been introduced to John Griffith by a mutual Franklin, whose work Watson and Crick had exploited, friend, Crick found himself in line for tea with him in the was not named since the award cannot be give spring of 1951, where, in the course of their banter, posthumously. Griffith told Crick that he had calculated the preferential Watson and Crick immediately saw that their model attraction of adenine to thymine, and of cytosine to could account for the two functions requisite to D A: guanine.' Watson and Crick met Erwin Chargaff when he that it could encode the genetic information needed for visited Cambridge in July of 1951, and they became polypeptide synthesis, and that it could replicate itself. acutely a ware of his one-to-one ratios.' After Watson and Crick also suggested that the autocatalytic consideration of the problem, Crick ruled out the base­ function of D A would be a likely mechanism for pairing of like to like, as was suggested by Franklin, mutation in accordance with the Darwinian school of because it wa inconsistent with the crystallographic evolution and variation.' evidence, and because it provided no explanation of The first function of D A was demonstrated first by Chargaff's rule.8 Nonetheless, Watson and Crick were Marshall irenberg, and then independently by Har unable to ameliorate the situation, and were still unsure Gobind Khorana throughout the 1950's and 1960's. of how the structure could be held together. By this time, irenberg devised a cell-free system in whlch proteins they had grown friendly with Peter Pauling, the son of could be synthesized in vitro. By making artificial Linus, who had arrived at the Cavendish to work. mRNA, he was able to ob erve the products that were Incredibly, Peter Pauling shared the details of hls father's obtained from different redundant me ages, and began progress with hls English colleagues, yet did not report to decipher the genetic code. 5 Khorana developed a any of the goings on at the Cavendish to his father. 8 system which could utilize slightly more complicated Linus Pauling had written to Wilkins, asking for X-ray message . This system was not able to distinguish photographs. Although Wilkins was a proponent of between reading frame (i.e. GUG or UGU), but it sharing, he didn't dare send Franklin's photographs, permitted further examination and refinement of the aware that she was extremely possessive. Some time later, genetic code. By 1969, most of the details of the genetic Pauling wa to visit Cambridge personally. ews of code had been solved. 2 irenberg and Khorana were Linus Pauling's impending visit frightened Watson and awarded the 1968 obel Prize for their pioneering efforts. Crick, and they were understandably relieved when the Evidence for the semi-conservative nature of D A U.S. State Department revoked hls pas port, preventing replication, as proposed by Watson and Crick, was him from making the journey. The next fantastic bit of provided in 1958 by Me elson and Stahl, who illustrated fortune was made po sible by Max Perutz, who was both that one strand of parent D A is u ed as a template, a colleague of Francis Crick, and a member of a while the complimentary daughter strand is synthesized committee that had been appointed by the Medical anew.2 Re earch Council to monitor the activities of Sir John Clearly, many resourceful and clever workers, from Randall's labs at King's College. Randall had instructed various cientific field , participated in the discovery of his re earchers to provide summaries of their works, D A as the material of heredity. Watson and Crick, whlch he mimeographed and circulated to all committee lauded for their crowning achievement, were great members to demonstrate hls labs' productivity. As soon problem-solvers who employed knowledge and as Perutz saw the section by Wilkin and Franklin, tempered it with imagination. Watson and Crick were unbeknown t to them, he brought them to Watson and also the fortunate beneficiaries of fate, whlch more than Crick for examination.8 Watson and Crick decided to once seemed to intervene and protect them from being build a model, as Linus Pauling had done when working derued their ultimate glory. The discovery of the structure on hls a-helix. They built two helices, with the phosphate and the function of D A whlch endow it with the ability groups oriented to the outside, and they were in the keto, to direct the growth of, and perpetuate life, continues to and not the enol, form .8 Wat on redrew the diagrams he challenge both the intellectual and spiritual capacity of had been playing with, and in a moment of epiphanel h urnankind. realization, found that thymine and adenine were bound by two hydrogen bonds, and that cytosine and guanine REFERENCES were capable of joining together by three hydrogen 1 Olby, Robert. 111e Path To 1111' Double Helix. Grmt Britain: Mnanillm1, 1974. bonds. Moreover, he knew that thls would account for 2 Portugal, F. H., and j. 5. Cohen. A Century Of DNA. Cambridge: The the constant diameter of 2nrn whlch Franklin had written MIT Press, 1977. of.' Remarkably, Watson and Crick had succeeded, in the 3 Mirsky, Alfred E. The Discavery of D A. Scieutijic American 1968; 218: winter of 1952, in deducing the structure of DNA. It i 76-88. obvious that Watson and Crick never performed a single 4 Pollack, M. R. 111e Discovery Of D A: An Ironic Tale of Chance, Prejudice original experiment, nor did they even refine the work of and lnsigltt. joumal ofGmeral Microbiology 1970; 63: 1-20 any of their predecessors, and for this they were 5 Filosa, Michael. Unpublished 1991. 6 jackson, Mick, producer. The Race For 111e Double Helix. A & E clumnel criticized. Despite their lack of new research, their 1988. tremendou feat cannot be understated, for they were 7 Klug, A. Rosalind Franklin and the Discavery of the Stmcture of D A, able to synthesize the work of many o thers into a alltre1968; 808-844. plausible, functional, and verifiable structure, when their 8 Lwoff. Andre. Trut/1 , Truth, What Is Truth (about how the structure of contemporaries lacked the creativity and open­ D A was discavered? ). Scientific American 1968; 219: 133-38. rnindedness to do so themselves. In 1962, Watson, Crick, 9 Watson, james. 111e Double Helix. London: Weidenfield and Nicolson. Q

U. W.O. Medica/Journal 65 {I) 1995------41 teature ::>ect t on An Eerie G I ow: The Sto ry of Radium Dial Painters I n the 1920s

By David R. Martell, Meds '97 e are now closing in on the lOOth anniversary of radioactivity was used to destroy di eased tissueY The the discovery of radium. Purified between 1899 new phenomenon showed great promise in medicine and W and 1903 by Marie and Pierre Curie (for which many were quick to exploit its "therapeutic effects" (real they shared a Nobel Prize), radium was been a very or imagined). It soon became apparent that this new important element in the early history of radiation material had enormous business potential. Patent technology, particularly in the field of medicine. The medicines containing radium soon became quite popular. story that follows focuses primarily on the ev ents People began drinking it (in alarming quantities!), surrounding the discovery of major health problems in a bathing in it, and some doctors were even injecting it into group of women related to industrial exposure to radium their patients. The rationale for the use of radioactivity in large American watch factorie in the 1920s. It took internally was based on the belief that it activated diligence on the part of an astute medical examiner and enzymes, relieved pain, and reduced blood pre sure. The concern on the part of a few key public official to bring drinking of radioactive spa waters was advised as a this occupational hazard to light. In retrospect, it is therapy for, among other diseases, liver disea e and difficult to ascertain whether the plight of radium-dial rheumatic sicknesse Y painters in the United States represents a triumph or A key discovery in the early year • of the "Radium defeat for the field of medicine. What affected the health Craze" was that when radium was mixed with a of these people could not be undone and offered little fluorescent compound and formed into a paint it glowed hope. Important lessons were learned howe er in in the dark- like Roentgen's Screen.7 This became a quite identification of the effects of radioactive compounds a novelty and the paint was used in many commercial have on the human body. These les ons came with a price venture . The most notable of the e, the practice of as many lives were lost before anything was even painting figurines and clock and watch faces, began suspected. around 1913 in the U.S. The principle figure in this In modern times when someone utters the word particular venture wa a physicist named Sabin A. von radioactivity one conjures up images of mu hroom Sochocky. Later he was to become one of the early clouds, bizarre anatomic mutation and objects that glow victims of the poisoning effects of his invention. Radium in the dark. From the enormous publicity given the paint oon came into great demand during the World dropping of atomic bombs on Hiroshima and agasaki at War I. The armed forces would benefit greatly from the end of World War II and the carnage they cau ed, it is aircraft and submarine dials and gauges that glowed in understandable that the e first two images have been the dark, not to mention watche and compasses.9 When ingrained in our minds over the past fifty years and for the war ended the industry developed quickly. Before many years to come. Historically however, the idea that long there was a market for glowing door knobs, light radioactive substances glow in the dark dates back to well switches, and novelty items. Many people got quite rich before the outbreak of World War II. in this industry. In the decade preceding the great Lumine cence, the natural phenomenon that causes a depression working in a watch factory seemed like fairly compound to glow in the dark, had been observed for decent work for the time and it all seemed fairl y centuries by the time Henri Becquerel decide d to harmless. 10 This was all to change by the late 1920s. inve tigate its source toward the latter half of the 19th The women who worked in the e factories painting century. His efforts led to the discovery and, perhaps things with radium paint did so fully blind to the dangers more importantly, a published description of the they faced . Few complained about the work- it was quite phenomenon of radioactivity. 1 Soon after, in 1898, Marie light. They worked by commission according to how Curie began to separate Radium from Uranium using the many objects they could paint in a day, and the pay was radioactivity as a measure of purity. By 1903 she and her reasonable. 11 The women were told by their employers husband, Pierre, succeeded in purifying and describing that the substance would "put roses in their cheeks, curls the new element Radium and shared the obel Prize for in their hair and generally improve health."12 The only their efforts. Very early on radium came to be used in annoyance the dial-painters really had to deal with were much the same way as therapeutic x-rays - its powerful the fine brushes they used, which would not keep a point. It became necessary to learn how to point the tips of their fine, camel's hair paintbrushes at the corner of their ABOUT THE AUTHOR: mouth. It was later estimated that this practice led to the David Martell is a third year Medical Student at the University of ingestion over a five year period of about one thousand Westenr Ontario. Mr. Martell has recently revived the 0 ler History of grams of radium - ten thousand times the modern Medicine Society. standard for radium ingestion. 13 There were other sources

42 ------U. W .O. Medica/Journal 65 (1) 1995 Feature Section of radium exposure at these factories. Women would authoritie - many involved the teeth and jaws. At one often get paint of their hands, wipe it on their clothing point dentists began to refuse to see patients who worked and, thinking it was harmless, intentionally wear the at the factory for fear they would cause some of these paint as make-up to social events. One Halloween horrendous conditions by tampering with their teeth.17 14 workers were rumoured to have painted their teeth. When approached by a ational Consumers League Radioactive waste material was so poorly disposed of at spokesperson, the company responded that the problems thi factory that long after the factory wa torn down the were due largely to poor dental hygiene. 18 That same earth around it (which wa by this time wa a residential year, the company requested that someone from the a rea) was found upon inspection to be astoundingly Harvard School of Public Health visit the plant to sort out radioactive - enough so to warrant proper disposal of the problem. On inspecting the premises, the official 1 many tons of soil. ' found (and later reported) paint all over the work areas, The first medical case of radium poisoning was arms and clothes (even underwear) of the dial painter . described in 1922 by a ew Jersey physician. The young He also learned that the company had issued a warning woman was a worker at a Radium Dial Company factory to the painters to stop the practice of pointing the brushes in Orange County, ew Jersey. It wa a case of jaw on their lips- a request that was largely ignored.19 A necrosis attributed to phosphorous ingestion. The patient report published the following year implicated radium as had worked as a radium-dial painter for two and a half the cau e of the illnes e .20 The official pleaded with the years. Theca e wa in investigated by local and state company to institute a afety program. The president of health department as the worker sought compensation. the company responded teadfa tl y that radium could Their findings were that the jaw necrosis must have been not be the cause of the problem, he told the official that due to the radium component of the paint because it did "Radium in small dose i a stimulant".21 The company not contain pho phorous. The case was closed and the president promptly sought a second opinion from Dr. F. B. worker was denied compensation (radium poisoning had Flinn at Columbia University. This time he got the not yet been defined and as such violated no existing response he initially ought. Dr. Flinn stated in an tate laws) . Within the following two years seven more ensuing publication: "I believe we are justified in arriving radium-dial painters died. The e deaths were attributed at the conclusion that an industrial hazard does not exist 16 to various disease and since there was no suspicion of in the painting of luminous dials."22 Two years later he foul play autop ies were not performed. Often it was the reversed his position after two other young women died community dentist that reported the illnesses to the who worked in a plant in Conneticut.23 This opened the door for lawsuits against the company for damages related to radium exposure in the workplace. ln 1927, five ailing young women brought the case before the courts. The case dragged on to the point that the lawyer repre enting the young women worried that one of them might not live to hear the court's decision. The ca e got wide pread publicity. Madame Curie even extended her sympathy to the young women and offered them advice on how to counteract anemia.24 Ultimately, the women ettled out of court. But word had now spread about the evils of radium. To avoid further lawsuits the company closed its doors in 1934. Soon after, another company - Organon Canada Ltd./Ltee run by the same president - started up using the same 200 Consilium Place, Suite 700 staff and facilities and making the same product . The company, called Luminous, is till thriving today as a Scarborough, Ontario multinational conglomerate with offices around the M1H 3E4 world. Tel: (416) 290-613 1 The e first few medical problems were due to the Fax: (416) 290-6133 direct effects of radia tion exposure to tissues. Cancer would claim many more lives in the years and decades that followed. A key figure in the definitive study of the ailing radium dial painters was the local Medical Manufacturer and Distributor of Examiner, Dr. Harrison S. Martland, who performed Marvelon® autop ie on some of the earliest cases and published his findi ngs in 1929.2> In this publication he definitively described the health hazards of radiation ingestion and Andriol® Froben® their likely pathophysiology. Radium is peculiar in that, Humegon® Cotazym® even in minute quantities, is that it deposits in bone and can reside there literall y for years. Thi fact quickly Norcuron® Zemuron® became evident when one group attempted to study a group of dial painters who had passed away as m.any as 2 five years previously. • Bodies were exhumed (w1th the permi ion of the family of course) and exposed to

U. W.O. Medica/Journal 65 (1) 1995------43 reat u re :>ectton

radiographic plates. The residual radium in their bones status symbol). His new radium paint could be produced much more were quite evident on these artificial x-rays. cheaply and he made a lot of money in tire years that were to follow as a No longer was this a phenomenon that "put roses in part owner of a watch factory in ew Jersey. 9. Peter V. C. Dingman, " Waterbury and the Hazards of Prolonged their cheeks, curls in their hair and generally improve Radiation," Orthopaedic Review, May 1987, 16 (5): p.113. health". It was ever after labelled a fearful concoction that 10. Early colleagues of Roentgen and tile Curies tried to warn people of tire caused cancer and painful medical conditions. The glow dangers of the materials they were working with to no avail. Both Marie that emanated from a painted watch or knick-knack no and Pierre Curie ultimately died from illnesses arising from tlr eir longer represented a passing fad, it represented death exposure to radioactive substances during tlreir scientific work. and one of the worst industrial accidents of the 20th 11. At that time work was beginning to become fairly scarce for rmskilled century. How people viewed nuclear technology changed labor - a persan took whatever work was offered. dramatically from this point on, but most of the historical 12. Anna Mayo, "We Are All Guinea Pigs," Village Voice, December 25, 1978. significance of this story is lost in the haze of Hiro hima. 13. Wassernmn, Ibid, p.152. It is important to emphasize that not everything about 14. Frederick B. Flinn, "Controlled Radium Hazards," American Journal of radium was necessarily bad. While these events were Industrial Hygiene, October 1941. taking place radium was being applied with great success 15. M . Donald Blaufox, ·· Radioactive Artifacts: Historical Sources of Modem 27 to treat cancer - a practice that continues in an altered Contamination," Seminars in Nuclear Medicine, January 1988, 18 (1): form to this day as brachytherapy. p.46. 16. Ulcerative stomatitis, syphilis, gingivitis, primary anemia, sepsis, Vincent's angina, and plrosplrorous necrosis of the jaw to name a fe-w. REFERENCES 17. Slrarpe, Ibid, p. 564. 18. Roger f. Cloutier, "Florence Kelley and the Radium Dial Painters, " 1. William D. Sharpe, ''Tile ew Jersey Radium Dial Painters: A Classic in Health Physics, 39, p.712. Occupational Carcinogenesis, " Bulletin of History of Medicine, 52 (4): 19. Cloutier, Ibid, p.712 . 560-570. 20. W. B. Castle, K.R. Drinker, and C.K. Drinker, " ecrosis of tire Jaw in 2. Harvey Wasserman and orman Solomon, Killing Our Ow n: Tile Workers Employed in Applying a Luminous Paint Cantaining Radium," Disaster of America's Experience with Atomic Radiation, Delacorte Press, Journal of Industrial Hygiene, 7: 371 -382. ew York, 1982, p. 132. 21. Cloutier, Ibid, p.712 . 3. Coincidentally, November 8, 1995 is tire 100th anniversary of tire 22. F. B. Flinn, "Radioactive Material an Industrial Hazard ?, " fouma/ of the discovery of x-rnys by Willrelm Roen tgen. Americmr Medical Association, 87: 2078-2081. 4. R. De Wit and T. De Roo, "Description of an Antique Radium Goblet; A 23. F.B . Flinn, "Some of the ewer Industrial Ha zards," Boston Medical and Dangerous Curiosity, " Medical History 1974, 18: 299-302. Surgicalfoumal, 197: 1309-1314. 5. F. Proesdrer, "Intravenous Injection of Soluble Radium Salts," Radium, 24. Cloutier, Ibid, p.714. 1913, 1:9. 25. Harrison S. Mart/and, "Occupational Poisoning in lite Mmlllfacture of 6. It is difficult to establish exact dates for many of the discoveries involving Luminous Watch Dials," Journal of the American Medical Association, radium that have been used in industry largely because they were deemed 1929, 92: p. 466. "trade secrets" and were never actually disclosed. 26. f. Goldmark, Impatient Crusader, Greenwood Press, Conneticut, 1976, 7. Wassemran, Ibid, p.132. p.202. 8. Von Soc/rocky was a physicist who studied under a Canadian, Lord 27. This idea lmd first been conceived by a Canadian, Alexander Gralram Bell, Rutherford, at the Cavendish Laboratory. He came to the U.S. from while teaching at Harvard Medical School Vienna where radioactive watch painting lmd already been practiced for a few years (these Swiss watches were very expensive and considered .quite a Required Reading throughout your career

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------U. W .O. Medica/Journal 65 (1) 1995 r-eature ::>ecrton The New Eugenics

By Sophia Khan and Sindu Kanjeekal, Meds '97 n the 1900's, Sir Frances Galton founded the Eugenics enjoyed a favourable and uncritical reception in the US Movement, which sought to improve the human and Canada. Drawing support from the progressive era, I condition through social reforms. These social reforms the Eugenics Movement began as a scientific reform in an were based on scientific principle and the laws of natural age of reform. In 1911, the American Breeders' selection. Eugenic ideals were met with tremendous A sociation successfully lobbied the government for excitement and gained acceptance much like the sterilization legislature. The legislation was passed out of excitement being generated by today's scientific the fear that mentally retarded persons would transmit advance . However, as in Galton's day, we have a similar their defects to offspring and be incompetent parents. By naive faith in science which often allows science to evolve 1937, 31 states had adopted eugenic laws. without moral constraint. In Canada, the Alberta Sterilization Act was created Galton based his ideas for the Eugenics Movement in 1928 and was repealed only as recently as in 1971. In from the study of pedigrees, from Darwin's Origin of the that time, 2822 cases were recommended for sterilization; Species, and from Mendel's di covery of simple genetics. 55 received the operation. Consent was not required and This movement was defined by three major principles: decisions from the board could not be appealed. Besides that character was based on inheritable traits, that sterilization, the Eugenic Movement influenced successful people had innate abilities that unsuccessful Canadian policy regarding immigration, education, people lacked, and that inferior members were breeding intelligence testing, public health, and integration of the faster than superior members. Eugenicists also felt that disabled. Thus, eugenic ideal pervaded many aspects of like the upper class, the superior white race should Canadian society. replace the inferior coloured race . Thus, racist ideals In the 1940's and 1950's eugenics fell out of favour in were introduced into the movement. Canada, a ociety reacted against the azi experience, as Eugenicists argued that traits such as mental we adopted welfare policies, and promoted reproduction retardation, criminality, poverty, and various social through the influence of the Catholic church. The defects were exclusively hereditary and therefore should Eugenics Movement eventually failed for both scientific be eliminated. Thus, the human race could be improved and ocial reasons. The cientific community rejected by breeding in good traits and by breeding out bad traits. eugenic becau e it wa ba ed on false assumptions Like Galton, Darwin believed that if the various checks regarding how traits are determined and failed to do not prevent the otherwise inferior members of society recognize the impact of the environment on character. from increasing at a quicker rate than the better class of Scienti ts realized that selective breeding would eliminate men, the nation will retrograde. Thu Darwin suggests a hybrid vigour and that genes required for human eugenk solution, though much less vigorously than his survival could be lost. Socially, eugenic philosophy wa contemporaries. Through the e remarks, Darwin did flawed because it was based on racist ideology. It much to aid the cause of eugenic in England, United blatantly violated human rights and there wa a States, Canada, and Germany. questionable societal benefit from discouraging In Germany, the eugenic ideals were carried to reproduction in certain populations. extremes with programs of planned reproduction, sterilization, and extermination. The azis defined the Aryan race as desirable and the Jewish race as undesirable. From the program of planned reproduction AND NOW came a maternity cult called Lebensborn. Lebensborn, meaning "fountain of life", wa an institution aimed at TO THE breeding an Aryan super race. Meanwhile, concentration camp were established to carry out the planned CHALLENGES extermination of six million Jews. The discovery of the azis' horrific experiments cau ed a harp reaction against eugenics in the post-war OF TOMORROW period. But before the war, the eugenics movement I t tJJiJM1 ABOUT THE AUTHOR: f)tJl' (!eJ ·J.!t fjj}tt· Sophia Khan is a third year medical student at UWO. She has a JfltJ!l&i tf strong interest in the history of medicine and is a member of the Osler Society. "Tilade' • " Intal • " Pediapred Sindu Kanjeeknl is a third year medical student at UWO. She Ira a r'Opticrom • r'Rynacrom strong interest in internal medicine. Both authors presented this paper at Flsons Corporation Limited 2235 Sheppard Avenue East. Penntuss' • ®Tussionex tire 1994 History of Medicine Symposium a/the University of Dalhousie. Atna II. 18th Floor. North York. Ontano M2J 565 Omni-Tuss

U. W.O. Medico/Journal 65 (l) 1995------45 lt::UIUit:: ..Jt::l.IIUfl

Presently, the word Eugenics has fallen out of favour because of the negative connotations as ociated with it. But ironically, eugenic p culation remains with u today. We share Galton's goal to influence the inborn qualities of a population to use them to an advantage. Carrier Screening, pre-natal diagnosis, sex selection, in vitro fertilization (IVF), and perm donation are just a few of the medical options we now offer to the public. Each of these has potential benefit as well as significant eugenic implications. For example, carrier screening programs have been met with both ucces and failure. In the 1970' , the Ashkenazic Jewish community in the U.S. was screened for the Tay-Sachs gene. This program was successful because the initiative came from within the community, and proper pre and po t test counselling was offered. A similar carrier creening program was established for the African American population to detect carriers of the sickle cell gene. In sharp contrast to the Tay- achs Thousands of Canadian experience, this program failed because testing was involuntary and perceived to be racist. The result were not confidential, and there was inadequate counselling Health Care Practitioners about what the tests meant. Positive carriers were left stigmatized and misinformed. Pre-natal diagnosi has now made it possible to Count on KPMG test fetu es for conditions ranging from Duchenne Muscular Dystrophy to cystic fibrosis to cleft palate. ·For over 14 years, sinc e 4th year dental school, On the one hand, this information may be invaluable KPMG has guided me through the growth of my as it gives parents the choice whether to terminate or practice. From financial planning and practice continue the pregnancy . On the other hand, pre­ management to tax, accounting and computer natal diagno is i not 100 per cent accurate. systems, the KPMG people have kept me on track.· Consequently, parents could be making crucial -Todd Stewart. D.D.S. decisions based on a false positive result. lso, Dr. T. L Stewart & Associates parents may make ha ty decisions about terminating a pregnancy because of their own inexperience and pre-conceptions of having an unhealthy child. The ·1 get more than assistance with accounting and tax. fear is that as tests like these become more sen itive Sandy and his colleagues at KPMG regularly help me and readily available, parents, like eugenicists, will with practice management, and investment and be tempted to terminate pregnancies that are financial planning.· a sociated with any undesirable trait. Extreme acts, - Dr. Jack Sales, Urologist. such as aborting fetuses simply becau e they are St Joseph's Health Centre female have already occurred within Canada. Sperm donation has given parents unprecedented power in choosing the kind of children they want. KPMG has established a National Health Care Presently, a woman can go to a sperm bank and choose a Practitioners Network to ensure that our clients receive donor based on race, hair colour, height, build, the comprehensive care and attention they need in occupation and even athletic ability. There is a s rious today's economy. Our London health care team consists risk that parents will try to create the ideal child through of more than 15 partners and professional staff and unregulated access to this technology. Market forces includes Sandy Wetstein, Chair of our National Network. could also open the door to abuse as higher quality perm would fetch a higher price. In Canada, physicians are forced to act as the gate­ keepers. The potential for abuse is great because there is a lack of formal legislation regulating genetic technology. Currently we wait until a line is crossed before a public outcry calls for action. In other countries where health care is governed by market force , the potential for abuse is even greater. We must carefully THE ADVISORY FIRM scrutinize the ethical implications of the scientific advances we enjoy today in order to avoid an era of the new eugenics. Chertered Accountents • Manegement Consulting n 1400-130 Dufferin Ave., London N6A SR2 (519) 672-4880

46 ------U. W .O. Medica/Journal 65 (1) 1995 0 0 STITCHES IN TIME VI AM I KIDDING?

By W.O. Colby, MSC, MD, FRCP(C) uring Medical School, I considered many make his way up to the Ward, pick up the medication different career paths and choices, some of requisition and saunter down to the Pharmacy. The D which challenge the reader to find any threads of Pharmacist would fill the order and the porter would commonality. General Practice, General Surgery, reverse the procedure and deliver the drug to the Ward. General Internal Medicine and General Pathology were Under the most extreme circumstances of urgent rush, all generally unsatisfactory. I considered becoming a the whole procedure took about 30 minutes- an eternity scholar of the History of Medicine, an Ophthalmologist, when a child is undergoing an asthma attack. Radiation Oncologist, Diagnostic Radiologist, in fact That night I had an admission or, more correctly, several kinds of 'ologists. For a long time, I considered the admission had me. The procedure went something Psychiatry. There is one medical specialty that I never like this: Parents would get the idea that their child considered for an instant: Paediatrics. The reader was sick and would take them to the Emergency Room should not get the wrong idea here-I love children. of the Renowned Paediatric Hospital. There, they That is why Paediatrics is so repugnant to me. It has would be seen by the intern assigned to Emergency, always been my Achilles' heel in Medicine. I would who would do a complete history and physical have graduated on the Honour Roll if it were not for examination. If the intern thought that this case was Paediatrics. Three instances in Medical School were serious enough to warrant admission, he or she would responsible for a disproportionate amount of anxiety, discuss the case with the Casualty Officer. If the cower and abject loathing. In order of increasing Casualty Officer, after repeating the complete history unpleasantness, these were a) getting stuck between and physical examination, concurred with the opinion stations in the subway and being late for m y first of the Emergency intern, the Junior Admitting Resident biochemistry exam (this cost me all my fingernails, right to the cuticles plus three packs of Rolaids); b) discovering that I had mistaken a rabid Alsatian dog for my examiner half way through my third year Clinical Medicine oral; and c) my Paediatrics rotation during F or every dollar earned, Clinical Clerkship. we invest a significant I tried to maintain my composure as I walked through the doors of the Renowned Paediatric Hospital percentage in clinical research on the first day of my eight week rotation. One of my and development. In fact , best buddies was in second year residency and he told me," Relax, Colby, you'll cruise this as long as you don't let your mouth get you into trouble and as long as you don't end up on 4-C." As I gathered in the room with my Al~~:;:::::,~:~ colleagues, my sense of dread increased. My worst fears t:::a.lu 1.J among the came true when the roster list was distributed. H 1 Colby "Ward 4-C" I immediately felt C-sick. I remember nothing of Investment ~:~::~: Orientation but afterwards I was greeted by the smiling pharmaceutical industry. faces and glassy eyes of the housestaff from Ward 4-C. I was later to realize that this type of countenance is Because we 've always common among cult members. believed in putting our I was assigned seven patients, four of which were in irreversible vegetative coma. The other three had money where it matters most extremely rare genetic syndromes. Just the right type of - behind the efforts of patients for an undergraduate student to learn General Paediatrics. The residents explained that because of a Canada's healthcare recent (and famous) medical/ legal problem with the professionals and the hospital, all medications were kept in the Central Pharmacy. If a child had an asthma attack, you rang for breakthroughs of tomorrow. the porter while filling out a medication requisition form (press hard because you are making seven copies). After the porter finished his coffee, cigarette and the round of cards that he was currently playing, he would

U. W .O. Medica/Journal 65 (1) 1995------47 !!Mea /c al numour !! was summoned. The Junior Admitting Resident would the child. According to the legend, someone arranged to perform a complete history and physical examination have him perform his magic in a Psychiatric Observation and phone the Senior Admitting Resident who would Room equipped with a one-way mirror. To their horror, also come and do a complete history and physical he was performing an aortic puncture. Despite the fact examination before admitting the patient. After the that he had never lost a patient, his medical career came Senior Admitting Resident conferred with the Staff to an abrupt end (a it well should have). Physician On-Call (who would sometimes come in to do I can only recall one enjoyable day in the entire two a complete history and physical), the Clinical Clerk was month Paediatric rotation. We had an outpatient clink then told to report to the hapless family and do a which was run by the only jovial paediatrician in the complete history and physical examination to learn. By entire hospital. He was good for a few laughs and treated this time, a few hours had elapsed. eedless to say, the us like human beings. This was such an incredible parents and the child were hardly in the mood for this contrast to the degrading, dehumanizing drudgery and and were openly hostile. I don't think violence was out intellectual starvation to which we were subjected to on of the question. evertheless, this was the atmosphere our day-to-day rotation that it made the agony of to which we were subjected, hour after hour, day after returning to Ward 4-C ever the more acute. I shall always day, week after week, for two months. remember that bright Spring day when I left the Then there were the educational seminars. W were Renowned Paediatric Hospital for what I hoped would be suppo ed to have one hour for lunch. One time the last the last time. I remember the ecstasy as the morning sun lecturer before lunch finished late at 12:30 and the next hit my face and I bent down to kiss the sidewalk, free at lecturer was scheduled to begin at 1:00 pm. We had last of the most hated specialty of them all. planned to visit a nearby restaurant and it was Year later, when one of my own children required a impossible to make the round trip in less than an hour. highly specialized paediatric diagnosis, I had to enter the So we wrote on the blackboard, "The 1:00pm lecture will portals of that dreaded institution once again. My legs be delayed until 1:30", and left. When we returned, the tingled, my heart pounded, and my pupil narrowed as air was so thick you could cut it with a knife, which is we approached the building. It took a great deal of exactly what the irate surgeon wanted to do to us. We strength to go in there, but it's amazing what one will do were grilled about the origin of the words on the for one's children. To this day, I will go blocks out of my blackboard and, of course, we admitted nothing. Being way to avoid driving by the place where I sustained the honest, we simply said that the notice was already on the most abject misery of my generally unenjoyable blackboard before we left. This was the truth. During undergraduate medical education. the subsequent retelling, these exploits were enhanced The Paediatrics rotation of my internship year, far and elevated to the status of urban legends in that away in the Hospital for Six Children, was not in the least hospital, right up there with the legendary story of the unpleasant, except for the continuous attacks of upper resident who could obtain blood samples from any child, respiratory infection and gastroenteritis courtesy of our regardless of the availability of peripheral blood vessels. little patients. This was the most astounding contrast of His only condition was that he had to be left alon with my entire medical career, but that is another story.

48 ------U. W .O. Medica/Journal 65 (1) 1995 Pr o blem Solving HISTORICA L MEDICAL VOCABULARY Dr. Paul Potter

1. Horror Vacui 11. Homunculus a. Fear of open spaces. a. Achondroplastic dwarf. b. Boyle's law. b. Cerebral centre of movement. c. Principle of attraction. c. Familial pederast. d. Fear of housework. d . Spermatozoon.

2. Magic bullets 12. Phoenician disease a. Cobalt bomb. a. Purpura. b. Antibiotics. b. Elephantiasis. c. Laser therapy. c. Cunnilingus. d . Chemotherapeutic agents. d . All of the above.

3. Empirical tripod 13. Hydrophobia a. Surgical instrument. a. Fear of drowning. b. British camping utensil. b. Osmotic principle. c. Book by Francis Bacon. c. Fear of electricity. d . Medical epistemology. d. Rabies.

4. Animal Magnetism 14. Dysmorphophobia a. Theory of muscle function. a. Fear of morphine overdose. b. Mesmerism. b. Fear of personal deformity. c. Early form of NMR. c. Fear of freak-shows. d. Excessive physical attractiveness. d . Aberrant WBC reaction.

5. Non-naturals 15. Nervous ether a. External factors influencing the body. a. Cause of muscle action. b. Mutant microorganisms. b. Hysterical flatulence. c. Category of genetic abnormalities. c. Factor produced by Golgi cells. d. Rock group. d . Rooky anaesthetist.

6. Vis medicatrix nature 16. St. Vitus' dance a. Unnatural vice. a. Sydenham's chorea. b. Tendon of the lower arm. b. Huntington's chorea c. Instrument to measure physical strength. c. Convulsion caused by tarantula bi te. d . Healing power of nature. d . Sicilian folk custom. 7. Vegetable soul 17. St. Antony's Fire a. Factor isolated from tomatoe . a. Measles. b. In utero C S pathway. b. Byzantine alcoholic drink. c. Centre in rhinencephalon. c. Gonorrheal urethritis. d . Factor controlling nutritive functions. d. Ergot poisoning .

. Innate heat 18. English sweat a. Physical principle of entropy. a. Febrile epidemic disease. b. Black's theory. b. Intertrigo. c. Life principle. c. Miliaria. d . Aphrodisiac drink. d . Tuberculosis.

9. Phlogiston 19. Vapours a. Principle of respiration. a. Borborygmus. b. Hypothetical component of fire. b. Volatile esters used as anaesthetic. c. Russian instrument of torture. c. Condition of feeblemindedness. d. Flagellum. d. Hypochondriasis.

10. Humour 20. Archeus a. Fluid element of the body. a. Genus of medicinal plants. b. Hormonal agent. b. Principle of organized life. c. Personality type. c. Bone of the foot. d. Synovial fl uid . d. Hypothetical element of the body.

U. W.O. Medica/Journal 65 (l) 1995------49 · P r oblem ::>olv1ng ANSWERS TO MEDICAL VOCABULARY

1. Horror Vacui 11. Homunculus a. The movement of material into an empty space was d. Antony van Leeuwenhoek (1632-1723) examined the explai ned in antiquity and the middle ages by the human spermatozoon under his 300x single-lense principle that ature abhors a vacuum: horror vacui. microscope, and believed he saw a " tiny man", a homunculus. 2. Magic bullets b. Paul Ehrlich (1854-1915) called the class of drugs he 12. Phoenician disease was seeking magic bullets because they were to spare the d. The Phoenician disease is mentioned in the Hippocratic host but hit the micro- organisms. treatise Prorrhetic II, but interpreters from Galen on have argued indecisi ely about its meaning, the three most 3. Empirical tripod likely po sibilities being those mentioned. d . The Empirical School of Medicine (I B.C.) proposed three sources of medical knowledge: personal experience; 13. Hydrophobia the experience of others recorded in medical literature; d . The disease rabies was known to the ancients as reasoning by analogy from experience. hydrophobia [fear of water] because patients fear to drink anything, since this is likely to bring on convulsions. 4. Animal Magnetism b. Franz Mesmer (1733-1815) "disco ered" his ability to 14. Dysmorphophobia heal by drawing disease out of patients with a personal b. The Italian neurologist and psychiatrist Enrico Morselli phy ical force he called animal magnetism. (1852-1929) fir t described this neurotic fear of one's own deformity in 1891. 5. Non-naturals a. Health and disease were attributed by Hunayn ibn 15. Nervous ether Ishaq (809-877) to three types of factors: the natural (i.e. a. Friedrich Hoffmann {1660-1742) explained life as a the components of the body); the counter-natural (i.e. response of the muscles to nerv ous ether which was abnormalities in the body); the non-natural (i.e. external secreted by the brain and moved through the nerves in a influences such as food, weather, exercise, leep, slow systolic/ anastolic flow. Medications to increase the evacuation, and passions of the mind). secretion of thi ether got the name "tonics", since they increase the body's tone. 6. Vis medicatrix naturae d. The most popular principle of therapy from the time of 16. St. Vitus' dance Hippocrate (V B.C.) down to the 18th century was the a. The involuntary dance-like movements of victims of healing power of ature. rheuma tic fever were first described medically by Thomas Sydenham (1624-1689); before that the condition 7. Vegetable soul was called St. Vitus' dance. d. Galen of Pergamon (129-199) di ided physiological functions into three categories, each of which he 17. St. Anthony's Fire attributed to a specific soul: vegetable [gastro-intestinal d. St. Anthony's Fire is a skin eruption caused by eating and nutritive]; vital [pulmonary and cardiovascular]; rye infected with the fungus ergot. St. Anthony of Padua animal [conscious and voluntary]. was thought to protect against this condition.

8. Innate heat 18. English sweat c. In the Hippocratic writings life is often explained as the a. Between 1485 and 1551 England was visited by several result of an inborn heat acting on nutritive elements. waves of an acute epidemic disease characterized by fever and sweating. The disease, which had considerable 9. Phlogiston mortality, may have been a variety of influenza. b. Georg Stahl (1660-1734) explained combustion as the escape of phlogiston, a hypothetical substance present in 19. Vapours all materials that burn. d . In 18th century France and England "the vapours" was a frequent complaint of upper class females. It was 10. Humour supposed to be caused by vapours rising from the spleen a. The Hippocratic treatise ature of Man reduces the to the brain, which produced morbid anxiety and body to four fluid elements, or humours: phlegm, blood, melancholy. yellow bile, black bile, whose imbalances explain diseases. This theory was very popular down to the 18th 20. Archeus century, and has left us with the personality types: b. Paracelsus (1493-1541) and J.B. Van Helmont (1577- phlegmatic, sanguine, choleric and melancholic. 1644) considered the archeus, an immaterial principle located at the upper end of the stomach, to be the "intelligent" force that regulates all bodily functions.

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