Long*serving International Grenfell Association physicians share $50 000 Royal Bank award

SHEILA GUSHUE Two physicians, who have devoted medicine and a past president of lauded for their work. In 1976, Dr. their lives to service in northern CMA; Miss Mary Pack, pioneer or- Paddon received an honorary doctor- Newfoundland and , are the ganizer of the Canadian Arthritis and ate of science degree from Trinity 1977 corecipients of the prestigious Rheumatism Society; Paul-Emile Car. College, Connecticut, where he ob- Royal Bank award. dinal Leger, prince of the church tained his BSc many years ago. Dr. Dr. W.A. (Tony) Paddon, 62, and turned simple priest; and agricultural Thomas holds an honorary doctorate Dr. Gordon Thomas, 57, share the scientists Dr. Ruth Downey and Dr. in civil law, conferred in 1969 by $50 000 award, which is presented Baldur Stefansson, who in 1975 were Nova Scotia's Acadia University, and annually to a Canadian citizen or the first corecipients. in 1970 became an officer of the resident "whose outstanding achieve- This year's winners, chosen from a . ment is of such importance that it is field of 78, were selected unanimous- The lives of the two doctors paral- contributing to human welfare and ly by a committee whose members leled and yet in many ways were dif- the common good." had no connection with the Royal ferent, reflecting the individual ap- A gala award dinner at Memorial Bank. It also marks the first time the proach to life and work which each University in St. John's, Nfld., July 6, award has gone to someone east of had exhibited as they carried on the paid tribute to the work of the two . work of Sir doctors, who have a combined 63 Grenfell was committed to uplift- years with the International Grenfell W. Earle McLaughlin, chairman and ing the medical, spiritual and eco- Association (IGA), a mission-oriented chief executive officer of the Royal nomic lives of the people of the three organization founded in 1912 by Dr. Bank of Canada, referred to the rare cultures living in northern Newfound- Wilfred Grenfell (later Sir Wilfred dedication exhibited by Drs. Paddon land and Labrador - the Indian and Grenfell). and Thomas as being ----- the some- Inuit natives and the white settlers The Royal Bank award was estab- times difficult decision for a man or - since first visiting the region in lished in Centennial Year, and its 11 woman to persevere in the face of 1892. recipients to date read like a who's. many obstacles, often to forego re- CMAJ conducted special interviews who of Canadian greats: the late wards that might otherwise come with Drs. Paddon and Thomas in an Dr. was the first their way, and not to falter or swerve attempt to dIscover the motivations, recipient, and others have included from the high goals they have set obstacles, rewards, or lack of them - Dr. , internationally for themselves." the raison d'.tre In their lives and known authority on rehabilitative Both doctors have been previously careers.

For Tony Paddon, it came naturally on the Maraval, a 20 m diesel motor- considered to be the death knell." to be a doctor "on the Labrador" (as sailer, plying the fiord-indented coast- Bad case-selection of terminally ill local parlance has it). As the eldest of line runhing from Mary's Harbour to patients who had been sent south by four sons of the region's beloved pio- Hebron. visiting medics to hospitals where they neering physician, Dr. Harry L. Pad- "This training was to prove invalu- died alone, in many cases not able to don, the coast's first "real" doctor, able," Dr. Paddon said. "I was ex- communicate with those around them, Tony had always tacitly understood pected to do a little bit of everything, had contributed to the widely held be- that following in his father's footsteps including extracting teeth. This latter lief about the evils of medicine and was precisely what was wanted for him, experience my father considered ex- hospitals. and of him. However, there was never cellent public health work, since a Dr. Paddon noted that, at last count, any pressure to conform and a decision painful tooth brought you the patient, he had pulled somewhere in the vici- taken in undergraduate days to become albeit a reluctant one. However, that nity of 15 000 teeth. In the early days a bacteriologist was greeted with patient soon became a relieved ally, he had become "very handy" at doing equanimity. amenable to further medical advice or a dozen patients at a time. He learned As a medical student in the 1930s, treatment, even hospitalization, which to work fast, pulverizing the procaine the young Tony served with his father then was greatly feared; in fact, it was (Novocain) tablets with the plunger of CMA JOURNAL/AUGUST 20, 1977/VOL. 117 389 a 20 ml syringe, drawing up boiling fishermen and their families who Dr. Tony Paddon's medical practice water from a kettle through boiled swarmed to the Labrador each summer in the North began just after World needles, then anesthetizing and extract- for the abundant cod. War II - "the Hitler unpleasantness" ing in quick succession before the "Showing great good taste and sense he calls it, with characteristic under- "charge" wore off, doing the uppers my father married the competent, ad- statement. first, then the mandibles. venturesome and pretty Canadian, Following graduation from New "Since this procedure could be done Mina Gilchrist, who had come out to York State Medical College in 1940 almost anywhere - in a boat, a house, Labrador as Indian Harbour's head and a 2-year residency in surgery in even in a snow igloo or by a camp- nurse, intending to stay 1 year. He New York City, he joined the Royal fire - dental care to Indian, Inuit and changed her mind." Tony Paddon Canadian Naval Volunteer Reserve settler alike frequently was the doctor's chuckled appreciatively, no doubt re- (RCNVR). initial calling card," he commented. lishing the thought that he himself did He arrived back in St. Anthony in the same thing years later when the the fall of 1945, coming to the Grenfell lovely and competent volunteer nurse, mission headquarters at the eastern tip In father's footsteps Sheila Fortescue, arrived from England of Newfoundland's Great Northern Dr. Paddon insists that only against in 1950 at his newly built hospital in Peninsula. From here he was appointed the backdrop of his father's life and North West River, appropriately named to Cartwright and North West River work can his own work be fully com- The Paddon Memorial Hospital. (NWR). prehended. The elder Dr. Paddon had The Paddons formed a medical team In the eight-bed hospital which his arrived in Labrador from England in for which their name became legion father had built there, his mother had 1912. Born in Sussex, schooled at Rep- the length and breadth of Labrador. A valiantly struggled on after her hus- ton and Oxford, with a medical degree monument to them both, built by the band's sudden death, on Christmas Eve from 's St. Thomas's Hospital people of Labrador,- stands in North 1939, during a visit to New York. She and experience in surgery and medicine West River near the site of the hospital had succeeded in providing manage- as house officer at a Midlands hospital, he built, near the first school they ment, had acted as head nurse and had he was well prepared medically to care started in 1925, near the gardens they'd maintained most of the previous work for the people living in the hamlets and cultivated and the children's home and except surgery. For all this she was villages scattered within the 320 km orphanage. to be later made an officer of the Order of the British Empire, an honour radius of Mud Lake, located at the Without antibiotics mouth of the Hamilton (now Churchill) she "richly deserved", her son declared River. "Working without antibiotics, with- in his own Royal Bank award accept- However, it was a stint of three sum- out any of the paraphernalia now con- ance speech. mer vacations working as a volunteer sidered essential in setting up a first- Virtually Dr. Paddon's first experi- with the Royal Mission to Deep Sea aid station, let alone a hospital or clin- ence during the winter of 1947 was to Fishers, ministering to the men who ic, my father nevertheless managed cement forever his relationship with his fished the North Sea, that was to round successfully many who otherwise would homeland, the quiet telling of which, out his training for what was to be- have died from infections and wounds; in his soft-spoken voice, is for the come his life work. he did appendectomies, tonsilectomies listener a moving experience. It was in those ships that he learned and cesarean sections, with my mother, He, his driver and the dog team to become a first-class sailor; even an excellent practical anesthesist, giving were returning to NWR after a 1920 more important, he learned first-hand the open drop ether (his anesthetic of kin, 6-week visitation to the isolated of the deprivations, the hardships and choice) until Virothen came on the livyers. Weather at -400C, ice rough the physical pain and suffering of or- scene - later it was viewed as cardio- as sandpaper and blinding, drifting dinary working men. It was here also toxic, but literally thousands were given snow slowed their progress, until fi- that he developed the genuine, easy- in his 30 years with no serious com- nally, in a howling nor'easter, the going camaraderie which later gave him plications. Without x-rays, he none the driver, new to the area, lost his way. entr6e to any home in Labrador, no less instinctively knew now how to re- Having spent a horrendous night in matter how poor. It's interesting to duce fractures and dealt successfully the shelter of only a sparse clump of note that in this experience he was with all the long bones, even spines and trees they travelled 16 km the next emulating Dr. Grenfell, who had been jaws. Years later I was to marvel at his day to a small wooded cove with one moved to work for others following his skill; x-rays showed that few of his tiny shack that could shelter them until summers spent with the Royal Mission former patients required orthopedic the storm abated. to Deep Sea Fishers in the 1 880s. treatment because of an error of judge- So Dr. Harry L. Paddon set to work ment." No tea.., no grub with a will, showing indefatigable ener- All this was accomplished while gy, drive and enthusiasm. He moved coping with rampant tuberculosis, se- When they went inside there were alternately between winter quarters at vere nutritional deficiencies resulting in two people there, an Inuit man and Mud Lake to the summer "hospital" at beriberi, scurvy and rickets, with the his wife, both past middle age, both Indian Harbour, about 290 km to the ever-present spectres of poverty, de- sitting quietly in the freezing, damp, east at the mouth of the Hamilton privation and lack of education. dark room. Inlet. In winter he made patrols over- It is not surprising then that the first- The man came forward when they land by dog sled, often going far off born son of parents such as these, a entered and said he was sorry he hadn't the main course to visit an isolated child born in Indian Harbour in 1914, been able to go out to help them un- family. At first it was within a radius should himself choose a life which harness and that he was sorry, too, of 320 km or so, but in time these emulated theirs, a life to which he re- that he couldn't offer them a cup of expanded to 3200 km round trips from fers, with twinkling good-humour, as tea, "because there is no tea.., and Mary's Harbour to Hebron, until one which was "absolutely great fun, there's no grub, either, Doctor. But eventually he knew personally every great excitement - so far removed you're welcome to use the stove and family on the coast, the livyers (per- from a suburban practice that it's im- boil the kettle." manent settlers) as well as a goodly possible to compare them, but a life After all had eaten from the doctor's number of the thousands of summer which has been just right for me." supplies the story unfolded. 390 CMA JOURNAL/AUGUST 20, 1977/VOL. 117 The man and his wife had come to be in hospital five or six times with from the military base at Goose the a bad pneumonia in its first 2 years *Hydergine previous fall with $2500 saved in a of life. paper bag. The man gave the money "We spend our time dragging these to the trader at the post, explaining little ones back from death, only to in the treatment that he would be back later for winter send them home to damp, cold houses, of diffuse supplies. where the water for cleaning comes cerebral insufficiency But when he returned the trader from surface draining and pools, where told him that the $2500 was not in the beer may be the only liquid "pure" safe; it was all used up to cover his enough to drink, where sewage is PRESCRIBING INFORMATION debts, and his father's debts too. In thrown outside the doors. fact it was only after he returned with "My policy is, and has always been, DOSAGE 27 partridges that the trader gave him to change the social conditions first; a half-sack of flour, some tea and some then the disease conditions will be E. 1VII. for4 weeks food for the dogs. easier to handle." On the return journey the supplies Since 1947, through the Grenfell or- G.P.ll. for6 weeks were lost through the ice. ganization, Dr. Paddon has been trying Afterward the daily dose can, if When Dr. Paddon and his driver ar- to change the social conditions in which warranted, be reduced to 2 rived, the Inuit couple were doing most Labradorians were trapped and in tablets. the only thing left to them, to sit quiet- which most, unfortunately, still are. ly, wait and keep their energy until He began with trying to improve the Patients should be convinced of the storm died down, and then try to housing situation, pressing for running the necessity and importance of reach relatives 30 km away. water, sewage and insulation to be in- taking their medication regularly stalled. He aimed at improving the every day, preferably with their The stonn inside system of trade, which kept most peo- meals and at bedtime. The ple in a state of serfdom; he got in- difference between success and For 24 hours, Dr. Paddon holed up volved in farming and gardening to failure is often directly related to in that little shack, also waiting for the demonstrate how to improve devastat- the way the patient follows the storm to abate. But the storm raging ingly inadequate diets. dosage schedule. inside him was far, far worse. For Simultaneously, he tried to raise gen- weeks he had seen nothing but utter eral knowledge through the expansion Composition - Tablets: Each 1 poverty, malnutrition, drunkenness, the into high school grades of the boarding mg tablet contains the school system methanesulfonates of ravaged faces of people whose main begun in his father's d ihydroergocorn me, object in life was to keep from freezing time, with the hope that Labradorians dihydroergocristine and or from starving to death. would manage their own communities dihydroergokryptine in equal Little wonder then that he thought: and affairs. proportions. Ampoules: Each 1 ml "My God, what am I doing here, what ampoule contains 0.3 mg can anyone do here? It's too immense, Child care urgently needed Hydergine consisting of the too much to tackle." methanesulfonates of It was to be the lowest point of his Augmenting this is the boarding dihydroergocornine, life. school and infants' home in NWR for dihydroergocristine and Looking back now, it proved to be seriously deprived small children and dihydroergokryptine in equal the point of no return - no return a foster care home for elementary proportions. to a life of relative ease in more gentle school age children who urgently need climes to the south. care. About 25% of these children Side Effects - Hydergine is Like his father before him, he re- suffer from health problems, such as usually well tolerated even in turned to North West River and stayed congenital heart disease, metabolic dis- larger doses. Side effects are few on. He dug in his heels in earnest, into orders, mental retardation and emo- and very slight. In addition to the soil of his native Labrador. The tional disturbances, so that here again nasal stuffiness, there may be results are both tangible and intangible, there is an overlap in providing health nausea, gastric pressure, a monument to his courage and insight, care and education. anorexia, and headache, planning and plodding. In addition, of course, from the very especially in patients with (Incidentally, the Inuit man is still beginning, was the all-out assault on autonomic lability. In such cases, hale and hardy - a call to the justice the problem of tuberculosis, from it is advisable to reduce the dose of the peace from Dr. Paddon on his or administer it during or after which Labradorians were dying in meals. return to North West River resolved the great numbers. difference between him and the trader.) During summer 1947 he personally ContraIndications - Severe paid for an x-ray machine installed at bradycardia and severe Must look at health Maraval and had another installed in hypotension. the hospital at North West River. By Dr. Paddon sees medicine as very 1948 annual x-rays of everyone on the Supply: Bottles of 100 and 500 broad. He states frankly that he finds Labrador were carried out routinely. tablets; Boxes of 6 and 100 the medical profession's increasing pre- For the first time the enormity of ampou les. occupation with disease frightening. the problem was appallingly visible. "I've dealt with di.ease all my life; In Hebron, the most northern Inuit Full prescribing information is available upon we all have to in the course of our settlement, one-third of the population request. work. But we must look at health as had cavitary tuberculosis; the other SANDOZ a way of life, not at disease in isolation two-thirds had some other form of the DORVAL from peoples' lives." disease. While other settlements along Sandoz Phamaceuticals To illustrate his point he said the coast were Division of Sandoz(Canada) Limited that not as terrifyingly af- Dorval, Duebec it is absurd that an Indian child has flicted, all were seriously so. CMA JOURNAL/AUGUST 20, 1977/VOL. 117 393 Until 1950 Paddon himself had done slum conditions add to the incidence a number of artificial pneumothorax and in some cases would literally drive Metamucil and thoracoplasty procedures; in many one to drink." cases patients survived, especially when In Labrador the problem is immense. Prescribing Information followed up with chemoprophylaxis. The war and postwar years brought Then, in 1950, with the advent of practically unlimited alcohol to a peo- INDICATIONS: For the relief of chronic, atonic, isonicotinic acid hydrazide (INH), he ple with little real experience with it. spastic and rectal constipation and for the con- wrote an impassioned letter to Hoff- As might be expected, those most fam- stipation accompanying pregnancy, convales- mann-La Roche Ltd., informing the iliar with it, the Caucasians, have prob- cence and advanced age. For use in special pharmaceutical company of the disas- ably gotten into the least trouble, but diets lacking in residue and as adjunctive trous situation in Labrador. He sug- the Inuit and Indian people were really therapy In the constipation of mucous and ulcerative colitis and diverticulitis. Also useful gested that it might be an excellent taken off guard. Untold suffering and in the management of hemorrhoids and follow- place for the company to test the drug's much actual acute illness and injury ing anorectal surgery. efficacy, especially since many of the have resulted, not the least of which cases were in native peoples. (Then, as is the suffering of the children, Dr. CONTRAINDICATIONS: Presence of nausea, vomiting, abdominal pain or symptoms of an now, there is a lot of debate about the Paddon explained. acute abdomen or fecal impaction. Metamucil pathogenicity and increased virulence Unexpectedly, however, there has Instant Mix is contraindicated in patients who of TB in native people.) been cooperation and community in- must severely restrict their dietary sodium intake. terest in all three groups. The Indians, Drop in TB deaths in particular, have shown great interest PRECAUTIONS: For patients, such as those in solving the problem of alcohol and suffering from diabetes mellitus, where rigid dietary calorie control is required: Hoffmann-La Roche responded by are building a sound social program sending more than 300 000 tablets of toward this end. Already, the level of Powder - 1 dose furnishes 14 calories. social disruption and personal tragedy Instant Mix - 1 dose furnishes 3 calories. INH, which lasted for years. Used with streptomycin and aminosalicylic acid, has been reduced, as has been the DOSAGE: Powder - one rounded teaspoonful the drug finally stopped people from number of children in need of emer- of powder 1 to 3 times daily depending on the gency care or with acute health prob- condition being treated, Its severity and individ- dying of TB. ual responsiveness. The teaspoonful of powder The disease is now under control. lems. is stirred into an 8 oz. glass of cool water or From 1947 to 1957 the death rate Smiling gently at the question that if other suitable liquid and should be taken im- dropped from a staggering 130:100000, every one in the North drinks, then did mediately. to 15:100 000. In 1973 it was he? Dr. Paddon responded that while Instant Mix - one packet 1 to 3 times daily 3.2:100 000. he enjoys making a little homemade depending on the condition being treated, its Dr. Paddon warns of the necessity wine, he has never had the inclination, severity and individual responsiveness. The con- nor the time, to make drinking a habit. tents of the packet are poured Into an 8 oz. for continued vigilance, however. For glass to which cool water is then slowly added. one thing, another curse of the North, Nor has there ever been a time in his The resulting effervescent mixture should be alcohol, is having an unexpected side 32 years as a doctor on the Labrador taken immediately. effect in the eradication of TB. Newly that he felt unfit to go on duty if SUPPLIED: Powder - a refined, purified and diagnosed patients (and old flare-ups), required. concentrated vegetable mucilloid, prepared from especially those in their 5th or 6th ..... and since I was in charge of the mucilaginous portion of Plantago ovals, decade of life, who present clinically health services for Labrador that meant combined with dextrose as a dispersing agent. 24 hours a day, every day," he Each rounded teaspoonful contains approxi- with no apparent signs of hepatic im- mately 3.1 g of psyllium hydrophilic mucillold pairment, promptly become jaundiced commented. per dose, a negligible amount of sodium, and when put on INH therapy, presumably As for family life, he and Mrs. furnishes 14 calories. because of their livers' increased sensi- Paddon have enjoyed a "most happy" Available in 6 and 12 oz. plastic bottles. tization, related to a lifetime of high relationship; first as a doctor and Instant Mix - premeasured unit-dose packets. alcohol consumption. nurse, when Miss Fortescue frequently Each unit-dose packet contains 3.6 g of psyllium Yet another manifestation is inter- had to clear out all her furniture and hydrophilic mucilloid with effervescent and flav- ruption of chemotherapy during drink- belongings from her double windowed, ouring excipients, 0.25 g of sodium as bicar- well-lit bedroom, to scrub it and make bonate, and furnishes 3 calories. ing bouts. Available in boxes of 15 unit-dose packets. Another alcohol-related problem pre- it ready for emergency surgery (there sented frequently is in patients hospital- usually being six tubercular patients in the operating room); after their mar- NATURAL BOWEL MANAGEMENT THAT ized for acute care - appendectomies BENEFITS MANY KINDS OF PATIENTS. for instance. Involuntary withdrawal riage she continued for a while as head from alcohol precipitates convulsions nurse, often giving anesthetics like her mother-in-law before her; now they Complete prescribing information avail- in the Inuit population, and delerium able on request (or in C*P*S.). tremens in the Indians and Caucasians. are the proud parents of a daughter, Why there is this differing reaction is Elizabeth, also a nurse, David, a com- not yet understood, but, be that as it mercial pilot, and Michael and Thomas, may, either result, postoperatively, is in school in Sussex, England. a complication, even for wound repair. Addressing himself again to the al- Lean years cohol problem, Dr. Paddon empha- tically stated that it is not peculiar only There've been many lean years, fi- to Labrador. In all the world's circum- nancially. Until a few years ago income polar regions - Siberia, Scandinavia, was nowhere near that of physicians Greenland, northern Canada and Alas- of similar status elsewhere in Canada ka - it is a major problem. and the US. But that aspect has never "The farther north you go, the bothered Tony Paddon too much, nor greater the problem," he said. "It is his wife and family. not racial and does not seem to relate "I've never wanted to be a rich man; very precisely with poverty, although liking what I'm doing is far more im- Searle Pharmaceuticals Oakvilie, Ontario CMA JOURNAL/AUGUST 20, 1977/VOL. 117 395 portant to me than money. Mind you, Dr. Thomas, "Young people who will stay for a life of altruistic medicine there had to be a lot of juggling at give of themselves not just for the short (with the assurance that a place for times, especially in educating the chil- term, but for the long haul." him was ever ready at the MNI should dren, so it helped to be on good terms He sees serious fractures developing he change his mind), Gordon Thomas, with the bank manager. in the Canadian family, not only be- his wife, the former Patricia Lister "And although I'm retiring soon, and tween anglophones and francophones, (distant relative of Lord Lister) and there's some criticism of me, I think but as a result of regional disparities, their infant daughter, Patty, arrived on most people are reluctant to see me plus the attitude of central .Canada and the wharf in St. Anthony one day in go. Generally speaking, I've found the policymakers toward those who the fall of 1946. people to be wonderful and if I've done live in remote areas on the country's Why did he stay? something to make their lives happier periphery. "It may sound vain but primarily it's and healthier, then I'm happy." He feels that in the North it is still because of a sense of Christian calling. The criticism he referred to concerns not too late to develop something There has never been anything in my the general criticisms of the IGA, fre- unique that will preserve the character life which has seemed to me to be quently made by people who do not and strength of Canada. more worthwhile, more challenging. always understand the whole story, who "We must be prepared to develop accuse the organization and its people the right policies for the whole country. Appeal of the North of taking a paternalistic, non-egalitarian For instance, while pledges have been approach. made repeatedly that Indians and Es- "And I've loved the life - this kimos of the North are equal partners North appeals to me, the openness, the Early retirement with other Canadians, policies are then exhilaration. There is no way in de- implemented that serve only the tran- scribing it, fully, but Newfoundland Those criticisms and the years of sient whites." poet E.J. Pratt put it best, I think when constant work and worry have taken He is incensed, too, that policies he said: 'Here the tides flow and here their toll. Retiring next year, 2 years have been developed that place Cana- they ebb; not with that dull, unsinewed early for health reasons, Dr. Paddon dians in these areas in a second-class- tread of waters held under bonds to now looks forward to healthy good citizen group. move around unpeopled shores, moon- years with his wife and family. "Over the years, I've sensed the at- driven through a timeless circuit of in- His greatest regret is that in the titude that persons prepared to work vasions and retreat, but with a lusty 65 years of Paddon (senior and junior) and stay in the North, in remote areas, stroke of life, pounding at stubborn administration, in spite of their em- are somehow second-class themselves gates, that they might run within the phasis on improving education, in spite - dropouts." sluices of men's hearts'." of all urgings, inducements, scholar- But the rocky, barren coastline, the ships etc., Tony Paddon is the only No dropout isolation from family, from familiar native-born Labradorian who has gone urban inducements, the long winters into medicine or dentistry. Nurses have Gordon Thomas, who now is enter- and short summers, with springs a been graduating and returning to work ing his 32nd year in St. Anthony, is no seemingly endless succession of days at home since 1930. dropout, no second-class citizen. His of rain, drizzle and fog, can be de- The record deeply grieves Dr. Tony academic record is first class and his vastatingly hard on those who do see Paddon: of the 109 professional or achievements stand as a monument to the beauty and majesty of the North, paraprofessional jobs available within a man of enterprise and ambitious but do not see any sense in their the Grenfell organization, only 10 are vision. staying. held by Labradorians. Born in Ottawa in 1919, one of three Dr. Thomas feels, however, that He understands why. It's a cultural sons of the late F. Russell Henry and those who leave often do so in vain thing for the most part. Labrador fam- M. Florence Thomas (who attended her hopes of finding an elusive happiness ilies are closeknit; they fear that if the son's award dinner), he was brought and many are chasing a will o'the wisp. children leave for extended education, up in a home where Christian duty was He acknowledged, however, that it they will never return. So offspring paramount. He had completed a Mc- is especially hard on some wives. His are urged instead to opt for the rewards Gill honours degree in economics and own children now are grown and have of short-term training, for jobs as 2 years at Toronto's Osgoode Hall law left St. Anthony - Patty, now mar- tradespeople instead of in the pro- school before deciding to go into med- ried to a geophysicist in New York; fessions. icine, then graduated from McGill's Leonard, a lawyer in , medical school in 1943, just in time to Newfoundland; and Pamela, married Qualified staff needed serve 2 years in the Royal Canadian and a secretary in Gander, Newfound- Army Medical Corps. land. This dearth of committed people is Following this he did postgraduate a major worry as well to Dr. Paddon's training at the Montreal Neurological Old school volunteer colleague and corecipient, Dr. Gordon Institute, where Dr. Wilder Penfield Thomas, who, as executive director of took an interest in the young man who For Mrs. Thomas, there's been an the IGA, fully comprehends its conse- had yearnings to go to the China mis- overabundance of work, and she's still quences. Dr. Thomas, who is also chief sions, in his family traditions. Penfield busy. of staff and chief of surgery at the in fact was preparing him for the "She's of the old school - all work Charles S. Curtis Memorial Hospital, Peking mission, but politically China is volunteer - and she's done it ex- St. Anthony, is well aware of the urgent was changing and the northern missions ceedingly well," he said. need for qualified people to stay in the of Canada beckoned. This ran the gamut of guides, church North. In fact he views it as the Grenfell had been a boyhood hero and community work and running the single most important problem facing of Gordon Thomas - a prize won at IGA clothing store (which had dis- not only the IGA, but all the public age 10 for a Sunday school project tributed to needy families tens of thou- services. attests to that. So with the admonition sands of items donated to the Grenfell "We need committed, dedicated, in- from Dr. Penfield to go to the North mission from the US, Canada and the telligent, well-educated people," said and either get it out of his system or UK, in the days when the coast was 396 CMA JOURNAL/AUGUST 20, 1977/VOL. 117 very poor). She now manages the 100- Harbour Deep in Newfoundland to It is now affiliated with Dalhousie plus housing units for professional and Nain in Labrador. University for the training of nurse paraprofessional staff in the extensive It has its own communications and interns in the midwifery program and Grenfell enterprise. air ambulance system, of vital impor- since 1970 has had formal affiliation Since Dr. Thomas arrived in St. An- tance in this part of Canada (albeit aids with Memorial University. This has thony, the IGA influence has narrowed that had to be fought for vigorously provided for part-time faculty appoint- considerably. Then it was the major with the government departments in- ments for the IGA staff actively in- employer, involved in operating the volved). A radiotelephone network now volved in undergraduate, graduate and shipyard and the dry dock, now it connects all IGA stations with master continuing medical and nursing edu- limits its nonmedical involvement to units at St. Anthony and North West cation. the Grenfell crafts store, which pro- River; two Turbo Beaver aircraft and The Curtis Memorial Hospital at St. duces the famous Grenfell coats, parkas a nine-passenger Piper Chieftain move Anthony has full approval by the royal and mitts. This cottage industry, sub- patients to and from hospitals and staff college for postgraduate training for sidized for years by the IGA so that to their posts, as well as providing air- residents in medicine, surgery, pedia- people would not lose their handicraft line connections at Deer Lake, Gander trics and pathology. The hospital also skills, this year turned a profit for the and St. John's. Only the Saskatchewan has accreditation for rotations of in- first time, an impressive $¾ million. government service and the Australian terns through part of their intern years flying doctor service are as compre- and for elective periods for clinical Sense of satisfaction hensive. clerks and students. Employing 800 people, the IGA has What gives Dr. Thomas the greatest an operating budget of $14.5 million, Satellite communications sense of personal satisfaction is the 98% of which comes from the provin- development of a totally integrated, cial government. Continuing medical education courses regionalized medical service. Far re- Dr. Thomas also is proud that his are ongoing. Now being assessed is the moved from the days of Grenfell, and organization is deeply involved with 12-week experiment with the commu- Dr. Harry Paddon, there are no dog- medical and health education. This is nications satellites, Hermes, in which sled or marine visitations now. an involvement that goes back many three IGA hospitals (a fourth is in Instead the IGA plant is comprised years, to the early days when there was Stephenville on Newfoundland's west of a fully equipped, modern, 170-bed close affiliation with Harvard and Yale coast) were linked with each other, to general hospital at St. Anthony, auxi- and later Johns Hopkins universities; MUN and the General Hospital in liary hospitals at North West River, it has developed into a training pro- St. John's. The future of CME course Happy Valley-Goose Bay and Labrador gram with a large number of students programming may well be influenced City, and 15 nursing stations and com- coming to St. Anthony, mainly from by this experiment and possibly by the munity health centres located at 150 to the UK, but also from Canada and newer technology of Anik B in 2 years 300 km intervals along the coast from other parts of the US. time. (For a more detailed discussion of this project, see article on page 386). Another facet of continuing medical education within the Grenfell scheme of things is its policy that long-term staff take every 4th year away from the coast to study, work and relax. Dr. Thomas has always acceded in this, terming these leaves of absence "essential" in helping a physician main- tain high standards professionally, ethically and personally. "Peer review and exchange of new ideas and techniques are as important for the physician as meeting new peo- ple and seeing new places is for his family," he said. "Combining sabbati- cals and surgery is a sure-fire way to keep one humble." Reputation as surgeon It has been during these leaves of absence from St. Anthony that Dr. Thomas built his international reputa- tion in surgery. He has been invited to the University of Toronto as a teach- ing fellow, working with Dr. W.G. Bigelow of the Toronto General Hos- pital and the late Dr. Gordon Murray whom he regards as perhaps the great- est Canadian surgeon of all time. He has also worked with the late Dr. Archie Wilkie of the Royal Victo- na Hospital and Dr. Frazer Gurd, formerly of the Montreal General. He notes that it was through the encour- Sharing hard times and good: Thomas (at left) and Paddon agement of the American pioneer in M.tcrodantin@ thoracic surgery, Dr. John Steele, of mission as nothing has been set down (Nitroturantoin Macrocrysrals) Marquette University, Milwaukee, that in an organized fashion since Dr. References he learned the developing techniques Grenfell died in 1941. 1. Roth, R.B. et al. The Ruined Kidney, Filmstrip produced with that were opening new avenues in tack- Thomas also plans to practise as "a the cooperation ot the Hess Urological Foundation, Inc. Erie, country doctor" Pa., U.S.A. ling pulmonary tuberculosis. He is in and around Mabou, 2. Kunin, C.M.: Detection, Prevention and management ot urinary grateful, too, to Dr. Clarence Crafoord, NS, and will also continue his commit- tract Infections. Philadelphia, Lea & Febiger, 1972 pg. 188 11. the pioneer in cardiovascular surgery ments on the council of the Royal 3. Kalowski S., Ra.tford N., Kincaid-Smith P: New Eng. J.M 290: 386, 1974 at the Karolinska Institute in Stock- College of Physicians and Surgeons of 4. Shirley SW. a.d Ozog L.S.: Urology Digest 9:8-10, 1970 holm, Sweden, who accepted Dr. Canada and as a governor of the Amer- Action: Thomas in his clinic and remained a ican College of Surgeons, a level of The large crystal size ot Macrodantin (nitorturantoin macrocrystals) friend. He was greatly influenced too activity that excites him, now that he provides the proven clinical efficacy ot Furadantin (nitrofurantoin) by the late Dr. Charles S. Curtis, Har- claims to be past his prime in the OR. hut with increased gastro intestinal tolerance. In a comparative clinical study the incidence of nausea and/or emesis was appreci- vard graduate and Yale professor, who In late June of this year a number ably less with Macrodantin than with Furadantin. Patients unable to came to St. Anthony for 1 year in of experts in northern health and med- tolerate Furadantin reported good tolerance ot Macrodantin. 1915 and stayed until his death in icine assembled in Corner Brook, at Indications: 1963, whom Dr. Thomas calls ..... a a conference chaired by Dr. John Macrodantin is indicated for the treatment of pyelonephritis, surgeon of exceptional judgement and Evans, president of the University of pyelitis and cystitis caused hy sensitive organisms. common sense." Toronto, and sponsored jointly by the Contraindications: But it is to Dr. Wilder Penfield, whom IGA and MUN. Anuria, oliguria or extensive impairment of renal function. Infants he acknowledges as the person who Proposals were made that, if im- under one month. most influenced his life, in the choice plemented, will have far-reaching im- Warnings: of career, location and now in his plications for the delivery of health Haemolytic anaemia, which disappears on cessation of drug choice of retirement. care to the North, not only in New- therapy has been reported in sensitive individuals. Usually defined as the 100/0 of negroes and lower percentages ot people of Mediter- "Dr. Penfield told me years ago to foundland, but possibly elsewhere. ranean and near Eastern origin who exhibit glucose -6 - phos- get a second career before I'm 60. I'm Dr. Grenfell once said that life was phate dehydrogenase deficiency of the red blood cells. Safety obeying him," he said. either an "arena of competition" where during pregnancy and lactation has not been established. Due to retire in 18 months as execu- one seeks to do battle at the expense Precautions: tive director of the IGA, and already of one's fellows, or it is "a field of Peripheral neuropathy has been reported with nitrofurantoin. This may become severe and irreversible and one fatality has been resigned as chief of staff and chief of honour" where one gives of oneself in reported. Therapy should be discontinued if numbness and tingling surgery at the Curtis Memorial Hos- service to others. occur. pital, Dr. Thomas does not intend se- Only time will tell the direction the Macrodantin should not be co-prescribed with drugs which impair vering his connections entirely with Grenfell organization will now take. renal function. IGA. Time has already shown how Dr. Tony Adverse Reactions: High on his list of priorities is the Paddon and Dr. Gordon Thomas have Nausea, emesis, and less frequently, diarrhea may occur; reduc- writing of 'a history of the Grenfell chosen to live their lives.E tion in dosage may alleviate these symptoms. Sensitization appearing as an erythematous, maculopapular cutaneous eruption, urticaria, eczematoid eruption or pruritus has occurred. Hypersensitivity reactions resulting in nonfatal anaphylaxis, an- gioedema, pulmonary infiltration with pleural effusion, and eosinophilia have been reported. Dther possible reactions are chills, fever, jaundice, asthmatic symptoms, and hypotension. Occasional minor reactions such as headache, dizziness, nystag- mus, vertigo, drowsiness, malaise, and muscular aches have oc- curred. Transient alopecia has been reported. Leukopenia, including granulocytopenia has been reported rarely. Return of the blood picture to normal has followed cessation of therapy. As with other antimicrobial agents, superinfections by resistant organisms may occur. With Macrodantin, however, these are li- mited to the genitourinary tract because suppression of normal bacterial flora elsewhere in the body does not occur. Les CLSC exemple, l'hygi.niste dentaire qui nous est pr&. par le d6partement de Administration and Dosage: suite de Ia page 386 sante Dosage: Adult: 50 to 100 milligrams four times a day. communautaire estime que ce n'est que Children: Should be calculated on the basis of 5 to 7 milligrams per CLSC n'a pas . en assumer seul 1'ins- dans 10 ans qu'on pourra se rendre kilogram (2.2 to 3.2 mg per Ib) of body weight per 24 hours, to be tauration. compte des r.su1tats de la pr6vention given in divided doses four times a day (contraindicated under one month of age). "Si tous les m.decins du quartier qu'il fait. Alors, que penser de 1'.valua- Administration: Macrodantin (nitrofurantoin macrocrystals) may s'engageaient & participer & un tel ser- tion de nos cours sur la sexualit6, par be given with tood or milk to further minimize gastric upset. vice, le tour de chacun reviendrait exemple. Dans un quartier comme le Therapy should be continued for at least one week and for at least 3 beaucoup moms souvent que pour notre n6tre, avec des probl.mes comme ceux days after sterility of the urine is obtained. Continued infection indicates the need for re-evaluation. It the drug is to be used for .quipe de sept m.decins (deux autres poses par les families monoparentales long-term suppressive therapy, a reduction of dosage should be m6decins se sont joints au groupe). oti les femmes sont, dans la plupart des considered. Nous ne serions pas pr&s & d6laisser cas, en charge de la famille, nous ap- How Supplied: nos programmes de pr6vention pour pr.cions les ressources diversifi6es aux- Macrodantin is available in opaque white imprinted capsules of 25 transformer le Centre en un ,mini- queues le CLSC nous donne acc.s. mg. (Eaton 007) in bottles ot 30, 100 and 500 capsules: opaque yellow/white imprinted capsules of 50 mg. (Eaton 008) in bottles of h6pital. "En tant que m6decin, c'est encou- 30, 100, and 500 capsules; opaque yellow, imprinted capsules of rageant de voir des gens se prendre en 100 mg. (Eaton 009) in bottles of 30, 100, and 500 capsules. Les objectifs de prevention mains plut6t que de constater sans pou- Product monograph available on request. voir intervenir, la perp6tuation ou 1'ag- "Nous sommes souvent en bute aux gravation de certains probl.mes intime- Originators and Developers of the Nitrofurans critiques quant & nos objectifs de pr6- ment reli6s aux conditions de vie par vention: ii faudrait comprendre que de exemple, qu'il s'agisse de la vie fami- . . EATON LABORATORIES tels programmes ne se chiffrent pas hale ou de la vie au travail ou de Division of Norwich Pharmacal Company LId. ha Paris, Ontario. comme les performances curatives. Par vie de quartier."E CMA JOURNAL/AUGUST 20, 1977/VOL. 117 399