I M.

C. Stuart Houston, MD Dr. John Richardson: Arctic Doctor SUMMARY RESUME Dr. John Richardson was foremost among Le Dr John Richardson fut l'une des figures a special breed of men, the dominantes de cette categorie d'hommes un peu surgeon-naturalists, one of whom speciale que sont les chirurgiens-naturalistes et qui ont participe a toutes les expeditions organisees accompanied every exploration party sent par la Grande-Bretagne. En plus de s'acquitter de out by Great Britain. In addition to ses fonctions medicales, le chirurgien-naturaliste performing medical duties, the devait identifier et ramasser des specimens de surgeon-naturalist was expected to identify differentes especes vegetales, animales et and collect specimens of plants, animals, minerales. Le Dr Richardson fut membre de deux and rocks. Dr. Richardson was a member expeditions organisees dans les regions arctiques par John Franklin et a participe aux recherches de of two of the arctic expeditions led by Sir la troisieme expedition Franklin qui avait subi un John Franklin, and participated in the retard considerable. search for the long-overdue third Franklin expedition. (Can Fam Physician 1988; 34:1616-1620.) Key words: Franklin expedition, Dr. John Richardson, __R_R__l~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-----surgeon-naturalist Dr. Houston is Head of the by Great Britain. When he attended nologist. He was also a competent ich- Department of Radiology, Edinburgh University in 1803-1807, thyologist and mammologist, but he did University Hospital, Saskatoon, all medical students were given a good not become an expert at identifying Sask., and a Professor in the grounding in Botany. Herbal remedies birds until the second Franklin expedi- Department of Diagnostic were important, for doctors could not tion of 1825-27. Radiology at the University of treat dropsy unless they could recog- Richardson wintered at Cumberland Saskatchewan, Saskatoon. nize the foxglove, Digitalis purpurea. House, on the Saskatchewan River, Requests for reprints to: Dr. C.S. Zoology was important in the study of just west of the present Saskatchewan- Houston, Department of Medical comparative anatomy. With few excep- Manitoba boundary. In 1819-20, his Imaging, University Hospital, tions, only doctors had access to these assistant in collecting natural history Saskatoon, Sask. S7N OXO courses. specimens, Midshipman Robert Hood, Only select doctors, those who had tells us of an operation performed by I T IS FITTING that an issue of Ca- shown the greatest aptitude in natural Richardson in that winter. nadian Family Physician devoted to science, might obtain an appointment The guns trafficked with the Indians Northern and Native Health should with an exploring expedition, on the by the Companies, are of very bad contain an account of the first medical recommendation oftheir Professor, Sir quality, and occasion accidents doctor to visit the Athabasca and Mac- William Jardine. Although a surgeon every year. A poor man whose hand kenzie regions, and the first to travel was necessary to suture wounds, lance had been dreadfully shattered by the along the northern continental coast- boils, and set fractures, a surgeon-natu- bursting of his gun, the year before line. Dr. John Richardson, LRCS, Edin- ralist was also expected to identify and our arrival, was brought down from burgh, 1807, MD, Edinburgh, 1816, collect specimens of plants, animals, Carlton House to Dr. Richardson, visited the area three times: in and rocks. Geology and Botany to- who amputated it above the wrist 1819-1822 and 1825-1827 with ex- gether were the best indicators of the and restored the use of his arm. He ploring expeditions led by Sir John future economic prospects of a new bore the operation with an unchang- Franklin, and in 1848-1849 to search land. ing countenance, and afterwards for the long-overdue third Franklin ex- Richardson's hand-written diary of manifested much gratitude. pedition. the first overland expedition led by Dr. John Richardson was foremost John Franklin in 1819-1821, to find a Richardson's important description among a special breed of men, the sur- northwest passage to the Orient, shows of the unusual prevalance of iodine-de- geon-naturalists, one of whom accom- that Richardson was already a remark- ficient goitre at Fort Edmonton has panied every exploration party sent out ably competent botanist and liche- been quoted by many subsequent 1616 CAN. FAM. PHYSICIAN Vol. 34: JULY 1988 authorities. Dr. Richardson did indeed mula), and suckling it successfully at one week, time or faith or the ministra- 'examine several ofthe individuals af- his breast. Richardson was not a gulli- tions of the doctor had affected a cure flicted with it," but he examined them ble victim of a Wentzel hoax, as two of whatever ailed him. By contrast, on at Fort Carlton or at Cumberland reputable historians, Margaret Arnett November 23, 1821, another Copper House, not at Edmonton, as at least one Macleod and Richard Glover, have Indian named "The Fop", when his historian has suggested. Goitre af- claimed. We now know that males, as gun exploded and "wounded him fected chiefly the Metis women at Ed- well as females, have the hormone slightly on the wrist", did not stay for monton, who drank river water, prolactin and can produce milk (inap- care from the weakened doctor but hur- Richardson reported. It was less com- propriate galactorrhea or inappropriate ried on alone to Akaicho's camp. mon among those who left the fort for lactation). Indeed, in some parts of Af- Richardson tells ofthe malignant ro- periods, and it could be "cured" by a rica it is common for grandmothers, up dent ulcer on the face of the wife of visit to the seacoast at York Factory or to 50 years of age, to put their grand- Cascathry. He describes the severe by ingestion of burnt sponge. child to the breast if a daughter dies chafing ofthe inside ofthe men's thighs Richardson was told that a single year's soon after giving birth. There are also a as they pulled heavy loads on the ice of residence at Edmonton was sufficient few well-documented cases of men Point Lake. Although nine of 11 voya- to cause goitre, and that the children of successfully nursing infants, including geurs died of exposure and starvation, women afflicted with goitre were that ofa Black male wet nurse who was no one lost a foot, toe, or fingertip from sometimes cretins. The inhabitants of displayed before a medical class in frostbite, thus offering good evidence Rocky Mountain House, upstream Maryland in 1827; milk from the male of the adequacy of moccasins and fur from Edmonton, were said to be af- breast is nourishing. mittens in extreme cold. fected even more severely. Dr. Richardson's reputation pre- Richardson sometimes provides de- Richardson's is a remarkably per- ceded his arrival at Fort Providence on tails that Franklin's published journal ceptive and correct account of iodine- Great Slave Lake. Hood says that the of 1823 does not. Franklin spares his deficient thyroid enlargement, almost Indians believed this "medicine chief' readers the gory and intimate details of unknown at sea level, but common in had the power to "prevent any person the incisions to relieve Adam, the inter- mountainous areas before the advent of from dying." It is less plausible that preter, on October 30, 1821. Franklin iodized salt. Indeed, the first results of they believed, as Franklin put it, that simply says that "The Doctor having treatment ofgoitre with iodine were re- Dr. Richardson "was able to restore scarified the swelled parts of Adam's ported on 25 July 1820, after the dead to life." In striking contrast, body, a large quantity of water poured Richardson had left Europe. Medical however, to the experience of the Indi- out." Richardson is more specific: "I theory ofthe time suggested that goitre ans in other winters in this harsh cli- made several scarifications in his scro- might be caused by drinking snow mate, not a single Indian died while Dr. tum, abdomen and legs and a large water, since goitre was endemic in sub- Richardson lived among them during quantity of water flowing out he ob- alpine districts. Richardson points out the winter of 1820-1821. tained some ease." Adam, as well as that those North American Indians who When Richardson's advance party Franklin, Peltier, and Semandre, had drank much snow water but rarely left Fort Enterprise on June 4, 1821, a been eating "large quantities of salt, a drank river water were free from Copper Indian, Akaiyazza or Little- barrel of that article having been left in goitre, thus refuting the theory. He foot, who was ill, hurried after him to the house." Because of their severe adds: receive medical attention. In exactly protein deficiency, this excess salt in- gestion probably contributed to fluid I could not learn whether it was nec- retention (edema). Franklin and essary that both parents should have Figure 1 Richardson both tell how the starving goitres, to produce cretin children; Dr. John Richardson l.-D I .rll wwrR ~~~~~~~~~~~~Imen had sores in their mouths from eat- indeed the want of chastity in the ing acrid soup, made from the bones of Metis women would be a bar to the the previous winter's camp. deduction of any inference on this The fragility ofthe doctor-patient re- head. lationship was evident from two events Richardson was the first medical at Fort Enterprise. On January 5, 1821, doctor in the Northwest to record the Richardson gave medicine to old Cas- extreme susceptibility of the Indians, cathry for his ailing wife. As he especially children, to the "white watched Cascathry wrap the drug with men's" diseases, whooping cough and extraordinary care, Richardson could measles. One of these children died in not help smiling. As medication was January 1820, at the gates of the North supposed to be a serious business, this West Company fort of Cumberland smile aroused the suspicions of the old House. Indian and, in turn, destroyed his Richardson, with great medical in- wife's confidence, and so medicine terest, reported fur trader Willard-Fer- failed to produce the customary and de- dinand Wentzel's story of the Chipe- sired effect. wyan Indian who had raised his infant Richardson describes how an old after his wife died in childbirth, feeding Copper Indian, the father of Thovee- the infant meat broth (perhaps one of yorre and Petit Chasseur, suffered the earliest records of meat-base for- from acute urinary obstruction. After 1617 CAN. FAM. PHYSICIAN Vol. 34: JULY 1988 the doctor administered a drug, prob- The fire being too hot, although it plate the approach ofdeath, and our ably paregoric, the old man passed a was regulated by my sensations at feelings were excited only by the large stone in his urine. Too honest to the time, the skin of the left side of idea of the grief of our relatives. take full credit for the man's relief, my body which was most exposed to Richardson describes how Joseph Richardson spoiled the scenario by tell- the heat, was deprived of feeling, Peltier and Francois Semandre suf- ing the old Indian that there might well and it did not regain its proper tone, fered slow lingering deaths from mal- be a second stone yet to come. The nor did that side become as strong as nutrition in the buildings of Fort Enter- Copper Indian medicine man then took the other, for five months after- prise and finally passed away on No- over management of the case, with a wards. vember 1 and 2. Concerning the effect frenzied and exhausting night ofchant- Later, when he wrote a letter to his wife of malnutrition on ability to withstand ing in a conjuring house. The old man in April 1822, cold, Richardson adds: his wife, from Fort Resolution survived his ordeal, for he and Richardson tells how he experienced During the whole of our march we together with Akaicho's wife's par- similar to those of ten- detached sensations experienced that no quantity of ents, served Richardson selected others who have been rescued at the clothing would keep us warm whilst der morsels of meat when he arrived at very moment of death: on the outpost Indian camp five months we fasted, but on those occasions . . .as the waves closed over me, which we were enabled to go to bed later. with full stomachs, we passed the Richardson's biographer, Dr. and I was losing the sight ofthe light of day, as I thought for ever, your night in a warm and comfortable Robert E. Johnson, a physiologist, manner. notes that Richardson's happiness and that of my mother was my principal concern, and the The day after the Indians had brought ... clinical descriptions are classics last moments of recollection were food to the starving men at Fort Enter- for protein-calorie malnutrition in spent in breathing a prayer for the prise on November 7, Richardson re- working men under cold stress. The temporal and eternal welfare of two marks that food progression through the stages ema- so deservedly dear to me." enables us to resist the cold, infi- ciation, famine, oedema, asthenia, Richardson describes how voyageur nitely better than before, and it is decubitus ulcer, dementia, and fi- Registe Vaillant fell exhausted in the difficult for us to believe otherwise, nally cardiovascular collapse and snow on October 6, 1821, unable to rise than that the season has become death is well described. and scarcely able to speak, shortly be- milder, instead of growing more se- Richardson superintended the treat- fore freezing to death. Midshipman vere as the winter advances. ment of Solomon Belanger's severe Robert Hood was shot by Michel, an Speaking of extreme cold, hypothermia after prolonged immer- Iroquois voyageur turned cannibal, on Richardson provides new information sion in the frigid waters ofthe Burnside October 20. Richardson himselfnearly on how the Indians, assisting Franklin River on September 14, 1821. Belan- perished. On October 28, he became and Richardson in their southward trek ger was instantly stripped of his wet exhausted in the attempt to reach a from Fort Enterprise towards clothing and then rolled up in blankets clump ofspruce trees about a mile from Akaicho's camp on November 17, in close contact with the naked bodies Dogrib Rock, only a day's walk north helped them to prevent frostbite. They oftheir previous winter's abode at Fort of two of his fellow voyageurs. . . .halted frequently to chafe our Richardson gives us a good clinical Enterprise. It was dusk, and the last hands or countenances when they description of his own experience, on few hundred yards, he tells us, were affected by the cold. Their in- September 29, with severe hypother- lay over some large stones, amongst stant care preserved Mr. Franklin mia, while malnourished. He begins by which I fell down upwards oftwenty from being severely frost-bitten as telling us how he "would have had little times, and became at length so ex- several parts of his face became re- hesitation in any former period of my hausted that I was unable to stand. If peatedly white. life, ofplunging into water even below Hepburn had not exerted himselffar Richardson also mentions the effects 380F." Yet on that September day beyond his strength, and speedily of a sudden indulgence in food follow- when he tried to carry a line across the made the encampment and kindled a ing a long period of starvation. These Coppermine River at Obstruction fire, I must have perished on the ''sufferings from repletion" consisted Rapid, having already lost much of his spot. in mainly of abdominal distention. insulating body fat, he found himself Previously, Richardson had written of Franklin more delicately spoke of "in- difficulty. He sustained a deep punc- "Hepburn", but after this experience digestion", but in a footnote remarked ture wound ofhis foot when he stepped had brought them together, he usually that the first bowel movements were on a dagger. Part way across the river an that had been tried to spoke of him as "John". painful, experience he lost the use of his arms. He In writing to the father of Robert shared by Samuel Hearne under similar complete the swim on his back and al- These "disorders ofthe his also Hood, Richardson gave a description circumstances. most succeeded, but then legs of his own reactions to starvation: stomach" continued for at least five became powerless. The voyageurs to restrict Our were never acute days and caused the Indians dragged Richardson back to their side sufferings the amount ofmeat they allotted, an ac- of the river, pulling on the line round during the march, the sensation of ceased after the third day of tion that Dr. Richardson, on November his middle. They rolled him in a blanket hunger 10, was ready to approve: placed before a good fire of willows. privation, and with the decay of Richardson's journal describes his ex- strength, the love of life also de- This restriction is favourable to the perience of warming up: cayed. We could calmly contem- recovery of our health, and is neces- 34: 1988 1618 CAN. FAM. PHYSICIAN Vol. JULY sary, from the little government we stronger boats of mahogany and ash. described 43 still-accepted genera and are able to exercise at present over Finally, the second expedition used the over 200 new species of fish, he was our appetites. eminently navigable Mackenzie River, also a key member of the Strickland Lake trout caused less discomfort than rather than the difficult ascent of the Committee, which set the rules ofzoo- did meat. Yellowknife system and the descent of logical nomenclature that are still fol- No symptoms of scurvy appeared, the raging Coppermine River. lowed today. even though the naval officers no During the second expedition, In 1848, when the return of John longer had naval rations of lemon or Richardson, in 1825 and 1826, travell- Franklin on his third and final attempt lime juice. They ate fresh meat with a ing by canoe and ice sledge mapped to complete the Northwest Passage, low but adequate vitamin C content, oc- most of the shoreline of Great Bear this time by ship, was overdue, casionally supplemented by berries Lake, the fourth largest lake in North Richardson and fellow doctor John Rae rich in ascorbic acid. There is also a America. In 1826, after parting with made the fastest canoe trip on record, slight antiscorbutic property in "Indian Franklin at the mouth of the Mack- leaving Sault Ste. Marie on May 3 and tea", Ledum, as claimed by McGregor enzie, Richardson's party turned eastto arriving at the mouth of the Mackenzie in 1828, and confirmed by Brown in explore and map 863 miles ofunknown on August 3. After a month of futile 1954. Scurvy was unknown among Na- coastline as far as the Coppermine search along the familiar Arctic shore, tives and those Europeans who fol- River, thus linking up with the coastal Richardson, now 60, kept up with the lowed a Native diet of fresh meat and survey conducted to the east of that younger men on the 15-day overland berries. river during the first Franklin expedi- march back to Great Bear Lake. When they left Fort Enterprise, tion. He then made one of the most re- In his medical career Richardson be- Richardson was the weakest ofthe four markable journeys of any birdwatcher came the chief doctor at Haslar Hospi- survivors at the Fort, still suffering before or since: in order to join his as- tal, then the largest hospital in the from swollen feet and ankles, the result sistant naturalist, Thomas Drummond, world and the largest brick building in of nutritional edema. On November in time to study the spring bird migra- the British Empire. He consulted with 19, after four days travel with adequate tion on the Saskatchewan, Richardson Florence Nightingale, raised the qual- food, Franklin and Hepburn had the left Great Slave Lake on Christmas Day ity of nursing care in the navy, im- swelling in their feet and ankles disap- and walked over 900 miles through the proved the treatment of mental disease pear, but Richardson recuperated more snow, to arrive at Carlton on February in sailors, and introduced general anes- slowly. 12, 1827. thesia into naval surgery. For a naturalist, Richardson's expe- New bird species noted on the sec- Richardson was knighted in 1846, riences on the first expedition were ond expedition included the Trumpeter was made Companion of the Bath in sometimes heartbreaking. He found Swan, White-tailed Ptarmigan, 1850, received the Royal Medal of the and preserved new species, and carried Forster's Tern, Black-backed Wood- Royal Society of London in 1856, and them "for many days through the pecker, Olive-sided Flycatcher, Clay- was granted the degree of LL.D. from snow", only to leave them behind, un- colored Sparrow, and Smith's Trinity College, Dublin, in 1857. He sung and undescribed, everyone's Longspur. Descriptions were recorded died near Grasmere on June 5, 1865, "strength being completely ex- of seven forms now recognized as sub- and is buried near William hausted." As he said: species. Wordsworth. His name is perpetuated Richardson wrote three of the four by numerous plants, fish, birds, and . . . the disasters attending our re- volumes of Fauna Boreali-Americana, mammals (including Richardson's turn across the Barren Grounds contributed most of the plants for ground squirrel), and by such geo- from the sea-coast, caused us to Hooker's Flora Boreali-Americana, graphical features as the Richardson leave behind the whole collection and edited zoological appendices for Mountains and Richardson River. As made during the summer of 1821, the voyages of Parry, Ross, Back, the late Dr. David A. Stewart of with the exception of a few plants Beechey, Kellett, and Belcher. Besides Ninette Sanatorium fame said at the collected during the descent of the being a formidable ichthyologist who Copper-Mine River, which were in- trusted to Mr. Wentzel's care when Figure 2 Figure 3 he left us. The part ofthe collection, Northern Hawk-Owl Yellow-Billed Loon which is lost, contained some plants, which I deemed to be new or curious. Richardson's achievements in natu- ral history were even more noteworthy during the second Arctic Land Expedi- tion. By this time the Hudson's Bay Company and the North West Com- pany had amalgamated and, since they ..4 ...I were no longer fighting each other, I could offer all the supplies the second The Northern Hawk-Owl was sighted Dr. John Richardson provided the expedition needed. Most of the crew by Dr. John Richardson near Fort En- first accurate description of this bird. were disciplined naval men rather than terprise. Sketch by the late H. Albert voyageurs, and they travelled in larger, Hochbaum.

CAN. FAM. PHYSICIAN Vol. 34: JULY 1988 1619 E4aprox: British Empire Medical Association meeting in Winnipeg in 1930: iNizoraI* Indications. (noproxen sodium) Relief of mild to moderately severe Here is one who traversed our coun- ketoconazoecream 2% try in three laborious expeditions, TOPICAL ANTIFUNGAL AGENT pain, accompanied by inflammation such as musculoskeletal trauma, post-dental ACTION lived nearly eight years in it, and In vitro studies suggest that the antifungal properties of NIZORAL (keto- extraction, relief of post-partum cramp- spent a lifetime in working over its conazde) may be related to its ablity to impair the synthesis of ergosterol, ing and dysmenorrhea. a component of fungal and yeast cell membranes. Without the avail- Contraindications. natural history. Plants of western ability of this essential sterol, there are morphological alterations of the Patients who have hypersensitivity to Canada named by and for Ri- fungal and yeast cell membranes manitested as abnormal membra- nous inclusions between the cell wall and the plasma membrane. The it or in whom ASA or other non- chardson would make a garden of inhibition of ergosterol synthesis has been attributed to interterence steroidal drugs induce asthma, rhinitis with the reactions involved in the removal of the 14-s-methyl group of or urticaria; in active peptic ulcer or respectable size; and birds and ani- the precursor of ergosterol, lanosterol (1). inflammatory disease of G.I. tract. mals named by and for him a consid- INDICATIONS Warnings. erable zoo. He had in his life many NIZORAL cream 2% may be indicated for the topical treatment of tinea Not recommended in children under of the conventional honours and pedis, tinea corporis and tinea cruris caused by Trichophyton rubrum, 16 years of age, pregnant or lactating mentogrophrtes and Epidermophyton floccosum; and in thetreatment some special marks of distinction as of tinea versicolor (pityriasis) caused by Molassezia furfur (Pityrosporum women, because safety and dose sched- orbiculare). ule have not been established. well. His was perhaps, a life of in- CONTRAINDICATIONS Precautions. dustry more than a life ofgenius, but NIZORAL cream 2% is contraindicated in persons who have shown Caution is advised, in patients taking hypersensitivity to the active or excipient ingredients of this formulation. a coumarin-type anticoagulant. hydan- it was a full, good life, and in many WARNINGS toin, sulfonamide or sulfonylurea. Use ways a great life. It is not every day NIZORAL cream 2% should never be employed for the treatment of with caution in patients with impaired that we meet in one person - sur- infections of the eye. renal function, compromised cardiac geon, physician, sailor, soldier, ad- PRECAUTIONS function and patients whose overall If a reaction suggesting sensitivity or chemical irritatior should occur, ministrator, explorer, naturalist, use of NIZORAL cream 2% should be promptly discontinued. intake of sodium is markedly restricted. Limited short term studies in animals and in human volunteers on whom IEach tablet contains approximately author, and scholar, who has been limited quantities of NIZORAL cream 2% were tested have failed to 25mg of sodium.)* eminent in some roles and com- demonstrate absorption of ketoconazole in detectable amounts. Due *Probenecid increases Anaprox plasma to the teratogenic nature of the active ingredient, ketoconazole, mendable in all. U caution should be exercised when NIZORAL cream 2% is administered levels and half-life. to pregnant or nursing women. Adverse Reactions. Cross sensitivity with miconazole and other imidazoles may exist and G.1.: nausea, heartburn, abdominal caution is suggested when NIZORAL cream 2% is employed in patients discomfort, vomiting, constipation, dys- with known sensitivities to imidazoles. pepsia. stomatitis, diarrhea. melena, gas- For Further Reading ADVERSE REACTIONS trointestinal bleeding (occasionally Short-term studies indicate that NIZORAL cream 2% is well tolerated by severe) and hematemesis. 1. Franklin J. Narrative ofa Journey to the the skin. During clinical trials, 43 (5.0%) of 867 patients treated with the Shores ofthe Polar Sea in the Years 1819, cream and 3 (1.8%) of 167 patients treated with placebo reported side C.N.S.: dizziness, headache, drowsi- effects consisting mainly of severe irritation, pruritus and stinging. One ness, mental confusion, lightheadedness, 1820, 1821, and 1822. London: John Mur- of the patients treated with NIZORAL cream 2% developed a painful vertigo, inability to concentrate and ray, 1823. allergic reaction (swelling of the foot). depression. 2. Hooker WJ. Flora Boreali-Americana, SYMPTOMS AND TREATMENT OF OVERDOSAGE Special Senses: tinnitus. visual distur- Brit- There has been no experience with overdosage of NIZORAL cream 2%. bances. and hearing disturbances. or the Botany ofthe Northern Parts of Treatment should include general supportive measures. Skin: itching (pruritus), skin erup- ish America. London: Henry G. Bohn, DOSAGE AND ADMINISTRATION tions, sweating. ecchymoses. skin rashes, 1840. When clinically warranted, therapy with NIZORAL cream 2% may be initiated while results of culture and susceptibility tests are pending. urticaria and purpura. 3. Houston CS. Arctic Ordeal: the Journal Treatment should be adjusted according to the findings. Cardiovascular: edema, palpitations, of John Richardson, Surgeon-Naturalist NIZORAL cream 2% should be applied to the affected and immediate and dyspnea were reported. In this class with Franklin. Montreal: McGill-Queen's surrounding area in patients with the following conditions of drugs, other reactions seen include University Press, 1984. CONDITIONS FREQUENCY DURATION congestive heart failure, pyrexia, acute Tinea pedis once daily 4-6 weeks renal disease. hematuria, jaundice. angio- 4. Houston CS. To the Arctic by Canoe, Tinea corporis once daily 3-4 weeks neurotic edema. thrombocytopenia. 1819-1821: The Journal and Paintings of Tinea cruris once daily 2 4 weeks eosinophilia. agranulocvtosis. aplastic Robert Hood, Midshipman with Franklin. Tinea versicolor once daily 2 - 3 weeks anemia, hemolytic anemia and peptic Montreal: McGill-Queen's University More resistant cases may be treated twice daily depending on patient ulceration with bleeding and or Press, 1974 response. perforation. The full course of therapy should be followed to reduce the possibility of 5. Johnson RE. Sir John Richardson, Arc- recurrence. If however, there is no response within the recommended Availability. treatment period, the diagnosis should be re-evaluated. Anaprox (naproxen sodium) is avail- tic Explorer, Naturalist Historian, Naval Thesatetyof NlZORALcream 2% has not been established with treatment able in blue filmcoated tablets of 275mg Surgeon. London: Taylor and Francis, periods exceeding those recommended, therefore, treatment must not in a bottle of 100 tablets. 1976. exceed the recommended duration of therapy indicated above. Dosage. 6. Richardson J. Fauna Boreali-Ameri- DOSAGE FORM Initial dose: 2 tablets. NIZORAL cream 2% is a white odourless cream containing 20 mg cana, or the Zoology ofthe Northern Parts ketoconazole per gram and is supplied in 30 g tubes. Thereafter: I tablet everv 6-S hours as required. of British America. Part First: The Mam- Full Product Monograph available on request. Maximum daily dose: 5 tablets. mals. Part Second: The Birds (with William REFERENCES: 1 Product Monograph 2 Stoppie P An Autoradiographic Swainson). London: John Murray, 1829, Study of the Penetration of A 2% Ketoconazole Cream Formulation Into References. 1831. Part Third: the Fish. London: Human Skin. Data On File. 3 Swanson N Woestenborghs R Systemic L. Diiligelder J. Primiari' dl'.%ttetionrrheca Absorption Following Dermal Application of 2% Ketoconazole Cream. treatmnent wiith prostlIaicIitli inihibitory: Richard Bentley, 1836. Data on File. 4 Taplin D Double-Blind Comparison of 2% Ketoconazole A re,iew: Amn J Obstet Gi-necol 1')81: Cream and Placebo in the Treatment of Fungal Infections of the Feet. 7. Stewart DA. Sir John Richardson: sur- Ketoconazole 140}:874-87'). natural- Data On File. 5 Taplin D Double-Blind Comparison of 2% 2. L. s.odi'um i1i dv-s- geon, physician, sailor, explorer, Cream and Placebo in the Treatment of Tinea Corporis and Tinea Cruris. Smiith Vap'ro.ven ist, scholar. Br Med J 1931; 1:1 10-2. Data on File. 6 Savin RC Double-Blind Comparison of Ketoconazole 2% menorrhea: A Canadian ch/in,t(alt/tial. Cream and Placebo in the Treatment of Tinea Versicolor. Data On File. Proceedings: Telemedical Svtnposi7unit 7 Cauwenbergh GF Degree H Verhoeve LS Topical Ketoconazole in Pi-o.stag^landcinls atild Dv.istnenorheva. Dermatology: A Pharmacological and Clinical REeview. MYKOSEN 1984 Sep7t. PA} 19)80. C'anada. Aug; 27(8):395-401. IPA Product monogra7ph oavl/able on request. ©JANSSEN cPJ *Trademarkc 1988 5YNTEX g JANSSEN 6A705EMillaraeekcDince a L5N 5M4 .Xi.ssi.ssauga. Oult. .Alont,e3wal. (2ue.- niu.1(Sf1'o ll 5t,ade,nla,kAs. Icr-.p I 1620 CAN. FAM. PHYSICIAN Vol. 34: JULY 1988