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At the Ninety-Seventh Annual Meeting of The Canadian Medical Association, held during the summer in Vancouver, Jesse D. Rising speaking on "The General Practitioner in a Changing World" made the following observation: "People, unable to obtain the services of a general practitioner, have turned to specialists, Christian Science practitioners, chiropractors, and assorted quacks;"

In this issue of the Journal some of the psuedomedical cults are examined more closely to find out more about their philosophy of disease, their methods of treat­ ment, and their success in treating sick people. And success they have, as many a former patient of a chiropractor, an osteopath or the like will readily testify. This poses the question why do they succeed, sometimes even in cases where the medical profession apparently failed? Could it be that the medical profession is becoming too scientific and is making the error which Plato warned against two thousand years ago: "For this is the greatest error of our day that physicians separate the soul from the body"?

Also, in this issue, we have a review of the literature on vitamin E as a therapeutic agent. Over the years much has been said about vitamin E but its action and its uses still are shrouded in ignorance. Many claims and counter-claims have been made but few appear to be based on truly objective evidence. Recognizing that any improvement in the patient's condition is desirable even if it can be measured in terms of the subjective only, the need for objective evaluation of therapeutic agents is obvious. The literature on vitamin E indicates a need for more Science and less Art in the evaluation of therapeutic agents and procedures.

G.J. M. T.

JANUARY, 1965 41 Homeopathy

EMIUE NOVAK, '66

INTRODUCTION "Homeopathy is a branch of the science and art of therapeutics. It deals with the investigation and application of the similia phenomenon--that phenomenon of similarity between symptoms (both functional and structural) which a physio­ chemical agent produces in healthy organisms and those symptoms for which it is applicable in d isease organisms".2 This definition is one which was derived by the American Institute of Homeopathy in 1939; yet it does not differ in its funda­ mental idea from that formu lated by the founder of homeopathy, C. F. Hahnemann, more than one hundred-fifty years ago.

HISTORY succussion, a method of mixing medicines Hahnemann was a widely acknowledged which Hahnemann invented; it consisted German chemist and physician who, of successively striking a vial containing among other scientific activities, carried the above tincture against a stationary firm out extensive systematic research in the de­ cushion. tection of metals in minute quantities and From 1796 onwards, he published many in the preparation and properties of pure books describing his work and his new medicinal compounds. In the course of his practice of medicine; homeopathy (homo­ work in 1790, he suddenly realized that ios meaning like or similar; pathos mean­ quinine produces in healthy people the ing disease). same symptoms as malaria which is cured Before forming an opinion of Hahne­ by quinine. This phenomenon of "similia mann's work, one must realize that the similibus curentur" had been recognized era of the Scientific Method had just be­ by previous physicians, notably Hippoc­ gun; the contemporary practice of medi­ rates, who said that "sick people are cured cine (which Hahnemann termed allopathy by remedies which produce analogous dis­ meaning "other diseases" characterized by eases". Hahnemann proceeded to investi­ "contraris contrariis curentur") consisted gate the matter systematically and in as of "shotgun" mixtures of medicines, pur­ scientific a method as possible. He gave gatives, laxatives, emetics, blood-letting, serial dilutions of pure drugs which he large doses of opium, mercury, arsenic, prepared himself, to healthy subjects and belladonna, etc., all based on personal un­ carefully recorded their physical, mental, systematic observations of patients. Hahne­ and emotional symptoms as well as their mann's theories of minute dosages of social environment, the weather, the time single pure drugs, based on repeated ex­ of day, amount of exercise taken, and periments, careful histories and observa­ other factors which he considered signifi­ tions of symptoms and signs, were in di­ cant. He concluded that high concentra­ rect contrast to existing practices. Small tions of drugs did not give the best clin­ wonder then, that he and his adherents ical results and advised that a single drug were vigorously criticized, their papers be administered in a dose just strong censored by medical societies, and even enough to produce distinct symptoms of legislation passed against them in Austria. the expected illness. He discovered that by Nonetheless, in 1811, Hahnemann found­ trituration (grinding in a mortar and pes­ ed a school of homeopa_thy in Leipzig, and tle) with milk sugar, insoluble inert sub­ by the time of his death in 1843, there stances such as gold, were rendered soluble were homeopathic physicians in most Euro­ and displayed active powers; these pro­ pean countries. cesses he called "potentialization" or "dynamisation". Soluble substances were In the next few years, several studies dissolved in ethyl alcohol and treated by were undertaken by government commis-

42 U.W.O. MEDICAL JOURNAL sions to compare the results of homeo­ school course including at least two years pathic and allopathic treatment. In Vienna of Latin, or a permanent teacher's certifi­ during the cholera epidemic of 1854, it cate, or the passing of an examination held was found that in allopathic hospitals two­ by the state board of medical registration. thirds of cholera cases died, whereas in Its curriculum consisted of the regular homeopathic hospitals, only one-third of medical course with the addition of the cases died. 6 These results were borne out homeopathic pharmacopoeia; its graduates by other surveys at other times in the received an M.D. degree plus a degree of nineteenth century; they all concluded that Doctor of Homeopathy. Several universi­ homeopathic mortality was significantly ties, for example those of Michigan, Iowa, lower than allopathic mortality. In the Ohio, were forced to add homeopathic latter half of the nineteenth century, courses to their medical schools. The Flex­ homeopathy climbed to its peak in Europe nee Report of 1910 stated that fifteen of and only began to decline in the 1930's. the one hundred and fifty medical schools The United States was introduced to in the United States were homeopathic. homeopathy in 1825 by Dr. Gram, an The rise of homeopathic schools was ac­ American-born homeopath who was edu­ companied by the building of homeopathic cated and lived in Copenhagen. He came hospitals. In 1916, there were 101 purely to the United States on a visit, did not homeopathic hospitals and another 153 in­ have enough money to return to Denmark, stitutions which allowed homeopathic phy­ and so set up a homeopathic practice in sicians to admit patients. In that same New York City. Many allopathic physi­ year, it was estimated that 35.5% of the sians who came into contact with him American population employed - homeo­ were converted to homeopathy and spread pathic treatment while another 48.5 % it into other states, notably Pennsylvania were "kindly disposed towards home­ which became the second main centre of opathy."3 homeopathy in America. In 1840, the first American institution for homeopathic in­ Homeopathy began its decline in the struction was founded in Pennsylvania as United States during the early 1900's. At the time of this writing, there is no home­ the Allentown Academy; it, however, last­ ed only six years. By 1850, there were opathy being taught in any American med­ ical school. The requirements for a home­ enough homeopaths to form the American opathic practice are an M.D. degree with Institute of Homeopathy for the purpose of establishing boards of examination, a post-graduate course in homeopathy and standards of practice, and information out­ homeopathic prescribing, sponsored by the lets to both laymen and physicians. As in American Institute of Homeopathy. There Europe, homeopaths did not have full are two main journals published: the Jour­ privileges as physicians due to the political nal of the American Institute of Home­ pressures of allopathic societies, but, as an opathy and The Hahnemannian. organized group, they finally forced legis­ Homeopathy never caught on in Canada lation to make homeopathy "legal" in 1857. as much as in the U.S.A. In the latter part The first permanent teaching institution of the nineteenth centry, there was a fifty­ was the Homeopathic Medical College of bed Homeopathic Hospital in Montreal, Philadelphia in 1848; because of personal­ but it soon disappeared from view. There ity differences among the faculty, it split are not more than half a dozen homeo­ up in 1867 and became the Hahnemann pathic physicians in Ontario presently. Medical College. Initially, it had a co­ In the rest of the world, Germany, educational three-year course which was France, India, and Brazil have the most made into four years in 1894. Entrance adherents, and have established homeo­ requirements consisted of a degree in pathic colleges either separately or as part science or letters, or a four-year high of their medical schools.

JANUARY, 1965 43 --Homeopathy------­

PRESENT THEORY holic solution, and so, beyond the fifteenth Present homeopathic practice is basically dilution, ethanol is used as the diluent. that prescribed by Hahnemann, namely the One may wonder how there can be any single remedy given alone, the similar rem­ effect with such great dilutions which may edy, the minimum dose or the smallest contain none of the original material. It dose necessary to have a curative action. is not the number of molecules which is Disease is considered a patient's reaction important, but the energy which was gain­ to some point of disturbance; the reaction ed by the solution during succussion. Thus is natural, either modified or unmodified the greater the dilution, the more succus­ by some therapeutic agent. It is known sions it has undergone, the greater is its that an untreated disease goes through cer­ potency. tain characteristic stages in response to the natural healing powers of the patient; the New homeopathic drugs are tested on closer the action of a medicine is to the large groups of volunteers, each of whom signs and symptoms before he takes it, keeps a record of his daily health, both the closer may its action match the action objective and subjective. One half of the of the natural healing powers of the body. group is given the unknown medicine; the On a cellular level, it is said that the other half, a placebo. Daily records are finely-divided drug molecules pass by the kept and at the end of the trial, physical healthy cells because they have no attrac­ and laboratory examinations are repeated. tion for them; the sick cells are less resist­ After many such trials, the drug is entered ant and so are more responsive to the into the homeopathic materia medica stimuli provided by the drug. Thus the which now consists of over one thousand homeopathic dose stimulates the cells to a drug preparations. normal reaction.'' Homeopathic medicines are extracted and purified, usually from natural sources HOMEOPATHIC TREATMENT (plants, animals, bacteria, insects, snake It has been said that the allopathic phy­ venom) ; several are made by exposing an sician uses a deductive approach to treat­ inert substance to Roentgen radiation or to ment i.e. from particular patients with the north and south poles of a magnet. particular symptoms, he arrives at a type They are mixed by the Hahnemannian patient who has symptoms in common methods of trituration with milk sugar, with the majority of patients with that ill­ serial dilutions with ethanol (either deci­ ness. This patient he labels with a disease mal, i.e. one part of solution to nine parts "name" and treats the name. In contrast, alcohol, or centesimal, i.e. one part to the homeopathic physician uses a deduc­ ninety parts) and succussion, either ten or tive approach first, and then an inductive on~ hundred times with each dilution. The one, i.e. he tries to individualize his desired stage of dilution is impregnated patients and his treatment according to into milk sugar tablets which are taken by their own particular symptoms. Thus, either letting them dissolve on the patient's symptoms such as fever, chills, cough, tongue or by dissolving them in a small pain, swelling, are termed "common", viz. amount of clear water. those found in many patients with many If a substance is insoluble in either eth­ ailments; and "characteristic" such as anol or water, it is triturated with milk periodicity, circumstances under which sugar in the correct ratios and diluted with they get better, emotions felt at the time, nine or ninety-nine parts of fresh milk viz. symptoms which are unique to that sugar until the fifteenth decimal dilution. patient. The remedy of choice is the one At this stage, the most insoluble substances which fits best with the aggregate of transfer their medicinal action to an alco- symptoms, signs, history, etc. A simple

44 U.W.O. MEDICAL JOURNAL example may help clarify the above state­ CONCLUSION ments: the common symptoms of dysen­ At its inception, homeopathy taught tery are bloody mucus and painful tenes­ medical men two badly-needed lessions: mus. One patient may have the character­ the necessity of accurate observation, ex­ istic symptom that "every drink of cold amination and history-taking, and the fact water causes a chill and is followed by a that the extent of cure is not directly pro­ hurried stool". Another patient may be portional to the quantity of medicine in­ "routed out of bed at 5 a. m. and the stool gested. The men who laid down the is preceded by rectal fullness and heavi­ basics of homeopathy observed the natural ness and colic, and every attempt to pass courses of diseases and recorded them ac­ flatus is accompanied by a spurt of feces". curately in order to know what drugs to The first patient has a totality of symp­ administer. These homeopathic works are toms most consistent with those produced the only complete detailed descriptions of by Capsicum (Cayenne pepper), hence he natural disease in modern medicine with­ will receive homeopathic doses of Capsi­ out drug interference. It is not improbable cum; the second, for a like reason, will that in the late 1700's and 1800's, a better receive Aloe.• If these are the correct brand of medicine was practised by homeo­ remedies according to a good text of paths than by allopaths, simply by allow­ homeopathic materia medica, the symptoms ing the body to defend itself by its own disappear in the reverse order of their immune and physiological mechanisms. original occurrence and the visceral symp­ toms are relieved before the peripheral At the present time, it is true that many ones. patients are helped or entirely cured by homeopaths; most of these are in the If the symptoms are relieved but the chronic illness group with a marked cure is not completed, a new remedy must psychogenic overlay. The homeopathic be chosen which will cover the remaining physician takes much time to talk to his symptoms. However, one must beware of patients, to probe their emotional make­ remedies such as Causticum following up; his cures may be due to the physio­ Phosphorus, which interfere with each logical action of the medications taken, or, other's action; these should never be given one the other hand, due to the attention in succession. The chosen drug should be that he receives, a belief in the medications administered until improvement is noted taken, viz. a placebo effect, or just Nature and then it is stopped or given with taking her course. lengthening intervals between doses. When it is evident that the patient is pro­ gressing favourably, the treatment is con­ REFERENCES tinued with a placebo.• 1. Ameke Wilhelm, Hhtory of Homeopathy, E. Gould and Son, London, England, 1885. The disorders treated by homeopathy 2. (The ) American Institute of Homeopathy, are the same as those treated by allopathy, Directory of Homeopathic Physicians in the the range including dysmenorrhoea, false United SlMedical Education of the Ameri­ ritis, tonsillitis, bronchitis, diphtheria, can Institute of Homeopathy, Hospitals and measles, angina; it is generally agreed that Sanatoriums of the Homeopathic School of homeopathic medicines do not correct i\fedicilu, 1916. mechanical conditions such as fractures, 4. Farringtn, H .; Post-Graduate Course in hemorrhoids and foreign bodies. Many Homeopathy a11d Homeopathic Prescribing, homeopathic physicians believe that Pools Press Inc., Glenview, Illinois, 1954. chronic diseases such as rheumatoid ar­ 5. Hodges, Paul C. ; "Homeopathy and Christian thritis are the most likely to be helped by Friedrich Samuel Hahnemann", Post-Gradu­ homeopathy. ate Medicine, pp. 666-8, June 1964.

JANUARY, 1965 45 ---Homeopathy------

6. Holcombe, W . H .; The Scientifi~ Ba.rh of Rollo Campbell, Montreal, 1846. Homeopathy, H . W . Derby and Co., Cincin­ nati, 1852. 10. Stephenson, James, Homeopathi~ Pharma­ ~ognosy, Pharm a~y, and PharmModynamiu, 7. King, W. H.; HhtMy of Homeopathy and Its Homeopathic Information Service, Chestnut Instit11tions in Ameri~a, Vols. I, II, II, Lewis Hill, Mass., March 4, 1958. Publishing Co., New York, 1905. 11. Stephenson, James; Homeopathi~ PharmMo­ 8. Marth, E. A.; Personal Comm11n i~ation , Lon­ therapy, Homeopathic Information Service, don, Canada, 1964. Chestnut Hill, Mass., March 11, 1958. 9. Rosenstein, J . G.; The Co mparative Merits of 12. Thomson, David M. P.; "Physicians, Patients, Alloeopathy, The Old M edi~a/ Pra~ti~e; and and Placebos", U. W.O. Medi~a/ Jot~rna/, Homeopathy, the Reformed Medical PrMii~e. 34:99-104, October, 1964.

Naturopathy

EDWIN FRANCZAK, '66

DEFINITION: era, the Egyptians practised massage and Naturopathy is a therapeutic system, body manipulation. The Chinese devel­ embracing a complete physianthropy (com­ oped to a high degree the use of herbs, plete study of the constitution and dis­ plants and roots in the treatment of dis­ eases of man and their remedies) which ease and the preservation of health. Con­ employs Nature's agencies, forces and pro­ tributions to natural healing were also cesses except major surgery. made by the Israelites, Greeks, Romans, Russians and Bulgarians.

FIELDS OF PRACTICE EMBRACED: Hippocrates is believed to be the real 1. Corrective nutrition; diets, food sup­ foundation of the movement. He declared plements, botanicals, vitamins and min­ "Nature is the healer of all diseases" and erals and other natural preparations. "let foods be your Medicine and your 2. Body Mechanics; body manipula­ Medicine your foods". tions, remedial exercises and supports. 3. Physio - therapy; natural physical agents including electricity. PHILOSOPHY AND AIMS OF 4. Applied Psychology; Psychosomatics NATIJROPA TiflC MEDICINE: and counselling. Naturopathic philosophy is based on the premise that nature is a sensitive agent HISTORY: possessing the faculty of making her own Primitive man was familiar with a way cures. This philosophy instructs that one of living called Nature Cure before the should use only such preparations and time of Hippocrates. Before the Christian doses that act in harmony with the body

46 U.W.O. MEDICAL JoURNAL economy in order to alter perverse body A galvanic current applied within physi­ functions. If the body is nourished only ological toleration to a part of the body with the ingredients that it requires, and surface increases circulation due to vaso­ if inessential and harmful ingredients, e.g. motor stimulation. The improvement of smoking, are excluded, diseases can be circulation may act to speed up the reso­ avoided. Thus, the body can fight off dis­ lution of inflammatory products. ease by its own effort without recourse to The high frequency current causes a drugs and surgery if it has not been ex­ thermal effect and has a sensory and motor posed to harmful stimuli. From this the nerve sedation effect as well as increasing naturopathic health criteria is seen to be circulation. This current has been used to two-fold: relieve pain and spasm. 1. the consumption of natural and Low frequency current is mildly thermal whole foods that are unadulterated, non­ and stimulates sensory and motor nerves. artificial and consumed as close as pos­ It has been used to exercise weak and sible to their natural or raw state is desir­ paralyzed muscles. able. Manipulation may be used to alleviate 2. a healthy mode of life consisting of pain due to a bone or nerve displacement. fresh air, a minimum of psychological For example, pain in the coccyx ( coccydy­ pressures and anxiety, and exercise is de­ nia) may sometimes be relieved by man­ sirable. ipulation of the back joints. Naturopathy stresses the use and appli­ The stress on adherence to a good diet, cation of all natural agencies and pro­ fresh air and healthy exercise is to elimi­ cesses. These include physiotherapy, nate toxic substances from the system. If hydrotherapy, electrotherapy, herbal reme­ this regime is followed a sound constitu­ dies and manipulative technique. Hydro­ tion will follow. As a result, most dis­ therapy, for example, may be considered orders (e.g., headaches, rheumatism, indi­ here. It is the scientific application of an gestion) will regress or will be cured since agency of nature, that is, water. Some the body, now healthy, will be able to cope therapeutic effects of hydrotherapy are as with them by its natural means. follows: Naturopaths, as a rule, refer bacterial (a) brief hot tub baths may relieve and infectious cases that they may encoun­ fatigue of the body ter to medical doctors for chemotherapy. (b) warm tub baths may be used to alleviate insomnia due to their hypnotic effect NATUROPATillC TRAIING: (c) chest compresses (hot and cold) The National College of Naturopathic may be used in pneumonia to give a stimu­ Medicine requires 4,670 class hours for lating and tonic effect and also may have graduation. a calming influence on cough A resume of the cours in hours is as (d) hot steaming baths "relax tissues" follows: and skin capillaries and draw blood from 1. Department of Anatomy - 756 class deeper tissues, possibly relieving pain. hours Medicated whirlpool therapeutic baths 2. Department of Psychiology- 306 class are also used as part of hydrotherapy. hours Electrotherapy is the use of a natural 3. Department of Chemistry - 396 class physical force, electricity. hours

JANUARY, 1965 47 --Naturopathy------

4. Department of Bacteriology, Public unnecessary disease. Naturopathic aims Health and Preventive Medicine- 162 with respect to better diets, less smoking class hours and drinking and a lessening of the abuse of the human body are stressed as a way 5. Department of Pathology - 306 class of life. In other words, both naturopathy hours and orthodox medicine stress prevention 6. Department of Diagnosis - 720 class of disease in varying degrees. Howeve r, hours the main differences lie in the therapeutic approach with respect to methods and the 7. Department of Roentgenology - 126 extent to which radical means of therapy class hours may be employed. 8. Department of Clinical Therapeutics- 1412 class hours BffiLIOGRAPHY 9. Department of Naturopathic Medicine 1. In formation supplied by the Ontario 1atur­ - 504 hours opathic Association. At present there are slightly over 200 2. Inglis, Bria n; Fringe Medicine. Faber and Naturopaths registered in Ontario. Many Faber, London. 1964. of these are also practising chiropractors. 3. Personal Interviews.

4. Kovacs. R.; Electrotherapy and Light Ther­ CONCLUSION: apy, Lea and Febiger, Philadelphia, 1942. The aim of naturopathy parallels that 5. Baruch, .; H ydrotherapy, W . B. Saunders of orthodox medicine, that is, to prevent Co., Philadelphia, 1920.

Herbalism

KATHLEEN J. ARMITAGE, '66 C. ELIZABETH MUSCLOW, '66

.. Better to hunt in fields for health unbought, Than fee the doctor for a nauseous draught ... - John Dryden (1631-1700) INTRODUCTION Some of us may tend to smile quietly to ourselves at the devotees of herbal medicine. Perhaps we have a basis to do so. In our world of multi-million dollar drug companies with their host of pure synthetic compounds which are d ispensed with at least some knowledge of tlteir mechanism and site of action, it seems only right to us to question the wisdom of using plant concoctions as remedies for serious disease. Yet, it is not true to say that there probably_ is no practising physician in orth America who ha.s not at sometime or other used digitalis which is derived from the beautiful foxglove? Other familiar examples are dicumarol from sweet clover, reserpine from the rauwolfia, curare from StrychnoJ loxifera, the narcotic sedative, coninine, from hemlock, castor oil from the castor bean, atropine from the Deadly Nightshade, strychnine from ux 11omica, quinidine for malaria from the ci nchona tree, opium alkaloids from the unripe capsule of the poppy, and the drug for leprosy, chaulmoogra oil from the TaraklogenoJ kurzii.

48 U.W.O. MEDICAL JOURNAL HISTORY: the belief that God had put a plant on the Herbs are regarded by herbalists as "use­ earth to cure every illness. Some of these ful weeds". This includes thousands of plants were easy to distinguish because plants which are used either for medicinal they would resemble the part of the body or for culinary purposes. In the realm of which they could cure: e.g. heart shaped herbal medicine, the recipes for making ones were for heart disease and yellow the many remedies are included in books ones were for jaundice. Legend also claims called Herbals. In the introduction to Sir that the roots and seeds of the peony are the most potent herbal cure of all because John Hill's The Family H erbal, written in 1812, we read, "When we consider the Asclepius, physician of the gods, used study of plants as the search of remedies them. for diseases, we see it in the light of one In the early 1500's herbs were regarded of the most honourable sciences of the as "the most infallible remedies for many world . . . " • of the ills that flesh is heir to, from the Probably the use of plants as medicine rumbling of 'wicked winds' in a man's could be said to date from the beginning innards to worms in a man's ear." The of time. The earliest known written record astrological relationships between plants of herbal recipes is the Ebers Papyms dated and stars as quoted from Pliny's time real­ about 1552 B.C., which was found be­ ized its peak with Nicholas Culpepper in tween the knees of a disinterred mummy the 1500's who attributed the healing ac­ from the Theban Necropolis. A forty vol­ tion of herbs to the planet or constellation ume Chinese herbal with about 1000 of stars that governed them. At that time, authors dates to pre-Christian times. The "Drogue" meant a dry herb, and when Greek influence in medicinal remedies is administered in accordance with ritual evidenced in the writings of Pliny, who astrological consent and belief in magic, stated that the first herborist and apothe­ affected a cure in many afflictions. cary was Chiron, the son of Saturn and Phylliria. He was the brother of the fore­ The dispensers of remedies were not bears of Hippocrates in whose era modern immune to being impaled on the spear of medicine and pharmacy may be said to be­ satire. This is clearly seen in the follow­ gin. The Arabs held the limelight of ing quotation from Fo11r Thormmd Y ears of medicine during the dark ages in Western Pharmacy: Europe from the 6th to 13th Centuries The medicamentia prtrgantia are the A.D., because in this early Christian era genuine fires of purgatorium; the bar­ the practice of herbalism was considered bers are the devils, and the drug shop heresy. It is believed that many valuable is a diminutive Hades, whilst the manuscripts were destroyed during these patient represents the poor lost con­ years. However, the monks, regarded as demned soul. The druggists display healers of mind and body, began to culti­ in their shops slips of paper covered vate herbs and write of their worth in such with strange and wonderful hiero­ glyphs that no one can decipher. The terms as Herbamm Ap11leii Platonici about directions on these papers are uni­ the lOth Century. A remedy in it for versally preceded by Rec. which in headache is amusing: "For headaches take fact stands for per decem, and means a vessel full of leaves of g reen rue, and that one prescription out of ten may a spoonful of mustard seed, rub together, help, or more properly speaking that, add the white of an egg, a spoonful, that of 10 patients, one may escape. They the salve may be thick. Smear with a call drugs by strange names to tempt feather on the side that is not sore." the patient's cur"iosity and induce him to pay an extra price for the same. Along in the history of medicine came Their mixtures are frequently so the "Doctrine of Signatures" . This was loathsome as to taste and odor that

JAN ARY, 1965 49 --Herbalism ------

one would expect to see the worst long rap roots of the alfalfa and the tame disease leave the body in haste to and wild carrot; or alternatively, by the escape the contamination."7 drinking of a brew derived from the steep­ Beginning with the Renaissance and the ing of celery seeds in boiling water over­ Age of Enlightenment, scientific thought night. The banana is a fruit that has evolved so rapidly in comparison with its served as a specific food for patients with history that refinement in administration celiac disease since 1920, and it is used of medical therapy was inevitable. Conse­ also in the special diets of patients with quently, specialties arose so that one man typhoid and colitis. Compounds from the could not longer be barber, physician, daffodil are being studied relative to their apothecary and pharmacist. The result was possible aid in treating myasthenia gravis that the pharmacist prepared and dispens­ and multiple sclerosis. It is said too that ed remedies as prescribed. This practice extract from lady slipper exerts an effect has continued to today although the cur­ on high blood pressure and derivatives rent trend is for pre-packaged medicine from the snowdrop have given relief to with the advantage of quality control. glaucoma patients. Buttercup juice has shown bactericidal qualities in some Our modern drug companies have been studies. Mrs. Kreig, author of Green able to isolate and synthesize many life­ Medicine, states that "we may have the saving, almost magical remedies, but we starting materials for tomorrow's wonder are reminded by the author of Grem drugs growing in our windowboxes."5 Medidne that "we are going back to na­ ture, because good as the test tube is, it Not only are herbs used to cure physical hasn't abolished man's greatest killers and ailments, but also as remedies for abnormal cripplers - cancer, cardiovascular disease mental states. Herbs which produced extra­ and mental illness."5 In this connection, ordinary states include a toxic Scandina­ Dr. R. L. Noble, formerly of the Univer­ vian mushroom from which the local hero sity of Western Ontario, discovered vinca­ of mythology, Berserk, is said to have ob­ leukoblastine from the periwinkle plant as tained his reckless courage; and peyote, a an effective treatment for leukemia. Simi­ Central American cactus which yields the larly syringopine and its relative, reser­ hallucinatory drug, mescaline. The peyote pine, from rauwolfia are used for hyper­ cult, still active, derives its adherents be­ tension and as tranquilizers. It should be cause of its ability to give strength, allevi­ noted too, that in the opinion of Professor ate fear, protect from danger, negate hun­ Robert B. Woodward of Harvard, the in­ ger and thirst, and because of its ability to vestigation of medicinal plants will be an cause persistent visual illusions and hallu­ active field for many years to come.5 cinations culminating in heightened in­ sight of seeming eternal duration. Thus the herbalist philosophy through the ages, HERBAL MEDICINE IN AC110N: may be stated as follows: "There is no While scientists sought synthetic cures, disease for which there is not a cure, and the laiety, especiaHy those living in rural everything on the earth has a purpose." areas, continued to practice herbal medi­ cine as their forefathers did. Current med­ Modern mockery of herbalism is a re­ ical herbalism advocates the application of sult of bizarre concepts such as that lemon a wet plantaine leaf to draw the poison of will cleanse the blood, but, beware of tak­ infections and insect bites; the eating of ing too much because it will thin the dandelions for their iron content and rose blood. Another reason for ribaldry is that hips for Vitamin C. Because arthritis is a in addition to the pharmacological effect difficult disease to treat scientifically, of the herb, other cures were attributed to much folk medicine has surrounded it. it. A proverb, "why should a man die Benefit is claimed from the chewing of the whilst sage grows in his garden?" illus-

50 U.W.O. MEDICAL JOURNAL trates the omnipotence of this herb. principle or its synthetic replacement is Amongst other remedies, sage reportedly that it is predictable, potent in small doses, was brain food, muscle strengthener, tonic and effective in cases of varying severity. for stomach, heart and nerves; remedy for However side effects should be predictable ague, epilepsy, palsy, fevers ; protection and antidotes available, in the administra­ against plague; for strong gums, white tion of large doses. But for less severe teeth, and in the treatment of laryngitis, manifestations of disease, some herbs un­ bruises and sprains, as well as a flea repel­ doubtedly are sufficient remedies and can lant. Such a panacea! be self-administered without difficulty be­ cause of the wide margin of safety. Can you imagine the reaction of a mod- ern patient to the following prescription: As a profession, medical herbalism bare­ ly exists in Canada. At best it is a side Take the root of the wild nep and the feature of culinary herbalism which is a root of the wild dock sodden by it­ self, and cut them in thin /ieces and growing facet of modern cooking art. Did pare away the outer rio and cut you know that mint, parsley, thyme, dill, them in quarters; then boil them in garlic, rosemary and mustard, besides their clear water two to three hours; then domestic uses, each have known medicinal stamp them in a mortar as small as properties? Parsley, used as a decorative thou can ; then put thereto a quantity herb today, once was used against freckles, of soot of a chimney, then temper head and body lice, flatulence, stomach them up with the milk of a cow that ache, cough and snake bite. Herbs for is of one colour; then take the urine medicinal purposes may be purchased as of a man that is fasting and put there­ to and make a plaster thereof and ready made remedies or as the fresh or boil it and lay it to the sore as hot as dried herb itself. No government license the sick may suffer it and let it lie is required to dispense herbs, but a local still a day and a night and do so nine vending permit is. The herbalist never times and thou shalt be whole on legally prescribes; the patron tells the her­ warranty by the grace of God.6 balist which herb he believes will cure his ailment. Notably, as a result, the support­ ers of herbal medicine come from rural MODERN CONCEPT: Europe where there is both a longer his­ Current medical sophistication regards tory of and a great dependence on folk these ancient herbal recipes with amuse­ medicine. To obtain herbs, an individual ment similar to the obsolete concept of the may cultivate them himself, buy them from four bodily humours which, incidentally, a local herbalist, a traveling herbalist or had their counterput in herbalism by de­ by mail. Some medicinal herbs are even grees of hot, cold, moist and dry herbs. sold in modern drug stores: e.g. the car­ Paralleling the evolution of pharmaco­ minative Hungarian Camomile used as an logical thought, medical herbalism also ad­ emetic, anti-inflammatory agent, antihista­ vanced so that today the modern advocates minic and in the treatment of asthma and of herbalism tend to be purists in compari­ dermatitis. It is interesting to read the son with their predecessors. Few herbs claims of cures for compounds based on are blended and fewer still are prepared balsam bark, strawberries, and licorice. with the aid of astrology and superstition. Take a moment sometime and read the It is the belief of one wise herbalist that labels found on the bottles and boxes of the true value of herbal medicine is that herbal medicines on the open shelves of each plant is a perfect blend. The active most drug stores. Then you will realize principle is present in sufficient quantity that until the past fifty years, these were to be effective, and the other constituents the type of compounds available to treat prevent deleterious side effects. The ad­ all diseases. What strides medicine has vantage of the commercially purified active made since then in the realm of chemo-

JANUARY, 1965 51 --Herbalism

therapy! No longer is Herbalism taught herbs. Some herbs have acknowledged to pharmacy students, and one wonders medicinal action and perhaps further re­ how often the once widely consulted search will reveal more natural remedies, Parke-Davis publication Organic Medica of thus verifying some of our forefathers' be­ 1880 is used today. lief in herbal medicine. Claims of cure, however, warrant carefully controlled ex­ Yet Herbalism will not die. It is kept perimentation to eliminate the artefacts­ alive by ardent supporters and more re­ principally the " placebo-effect". cently by the large drug firms themselves. Realizing the potential value both humani­ It is difficult to gauge the extent of tarian and commercial, these companies practice of herbalism in Canada, but it are engaging in a systematic chemical sur­ does exist. However, when applied to dis­ vey analysis of plant species in order to eases for which there is a recognized scien­ isolate an effective active principle. An tific cure, one suspects that even the herbal revival on a scientific basis may be devotees of herbalism regard their cure imminent. with a "grain of salt". The main commercial supplier of herbs in Canada is the Thuna company in To­ Acknowledgements ronto. The largest company in the world The authors wish to thank Professor is the S. B. Penick and Company in New Charles W. Gowdey, Head of the Depart­ York. This latter company has extensive ment of Pharmacology of the University botanical enterprises throughout the world of Western Ontario Medical School, and using modern agricultural and business Mr. W. Atkinson, Herbalist, of The Wee methods in the cultivation, harvesting and Garden, Caledon, Ontario, for their kind dispersal of herbs, thereby maintaining assistance in the preparation of this paper. herbal medicine on an international scale. BIBLIOGRAPHY An illustration of the current use of 1. Ferrier, W . J.; Culpepper's Complete Herbal herbs is offered in the following excerpt (1 6 ~3) , W . Foyle Ltd ., London, 1938. from the Corresponding Secretary of the 2. Fluckigir, F. A., and Hanbury, Daniel ; A Massachusetts Horticultural Society of History of the Pri1uipal Drugs of Vegetable America: Origin Aiel JVith in Great Britain and British India, Macmillan and Co., London, 1879. " I obtain my plants from Barbados. This plant (Aloe Socotrina) is being 3. Grier, James; A History of Pharmacy, The used commercially in this country Pharmaceutical Press, London, 1937. (Florida) where lotion for the skin is 4. Hill, Sir John; The Family Herbal. C. Bright­ made. It is used medicinally for burns ly and Co., London, 181 2. and very effectively in hospitals. 5. Kreig Margaret B.; Gree11 Medici1ze--T he Many times I burn my finger while Search fo r Plants that Heal, Rand McNally cooking. I immediately cut a piece of and Co., Chicago, 1964 . the succulent fleshy leaf and wrap my 6. Larkey and Pyles (Editors), An Herbal finger in it, the pain goes quickly and ( 15 2 ~), Scholars Facsimilies and Reprints, healing starts quickly." 10 New York, 1941. 7. LaWall, Charles H., Four Thousand Y ears of Pharmacy, J. B. Lippencott Co., London, CONCLUSION 1927. The authors have endeavoured to present 8. Lehner, Ernst and Johanna, Folklore and briefly the history and role of herbs as re­ Ody11eys of Food and Medical Plants, Tudor lated to medical practice through the cen­ Publishing Co., ew York, 1962. turies. We do not advocate fadism to­ 9. Peters, Herman, Pictorial History of Ancient Pharmacoloy, G. P. Englehard and Co., ward herb remedies, nor do we suggest Chicago, 1889. that scientific Medicine adopt a smug su­ 10. Ryan, Mrs. Edgar; Coree ponding Secretary of periority attitude by ignoring the lowly the Herb Society of America, Boston, 1964.

52 u.w.o. MEDICAL JOURNAL Chiropractic and Osteopathy

DAVID KORN, '67

INTRODUCTION Proliferation of technical knowledge in the field of health has resulted in the development of many medical specialties, and in a variety of aides and technical a.ssistants ancillary to the profession of medicine. But there have also developed health practitioners who are independent of the medical profession. One such g roup of health practitioners attempts to treat nearly the entire range of bodily functions and disorders, but because they employ forms of therapy unacceptable to orthodox medical practice, they are considered marginal practitioners. The main members of this group are the chiropractors and osteopaths. O ften referred to as members of sects or cults ,they tend to reject such basic tenets of modern medicine as that disease is caused by bacterial agents which can be treated by drugs or prevented by inoculation; or they espouse a mono-casual theory of illness and therapy. Because they ad vocate therapeutic principles contrary to those of medicine, they constitute a threat to medical Jractitioners. Thus an unstable relationship has developed be­ tween osteopaths an chiropractors on one hand, and the area of orthodox medicine on the other.

Chiropractors are the best known mar­ position taken by even "enlightened" ginal practitioners, although osteopaths chiropractors and osteopaths. have historically also been considered as cultists. As well, there are several other lesser known groups of marginal practi­ OSTEOPATIIY: tioners, such as: naturopaths, neuropaths, The founder of osteopathy (literally napropaths, vitopaths, mechanotherapists, "bone suffering") was an American med­ and sanipractors. All share a traditional ical doctor, A. T . Still, who in the late hostility to the medical profession's liberal eighteenth century renounced the use of use of drugs, regarded as "foreign" or drugs in therapy and substituted a manipu­ "poisonous" substances. lative system in its place. Still's basic hypothesis, which he claimed was God­ In the United States this hostility to­ given, was that all disease was caused by wards drugs has by now been almost com­ spinal maladjustment, either involving the pletely abandoned by osteopaths and has blood vessels or nerves of the area. These greatly weakened among those chiroprac­ types of lesions resulted in the body losing tors who are designated as "mixers". But its ability to maintain its normal, healthy in Canada the attitude of chirapractors homeostasis. These notions were stated by and osteopaths towards drugs and surgery the founder almost one hundred years ago. is somewhat different from that of their Since that time osteopathy has evolved colleagues in the United States. Here in continually. Today it represents an entire Canada, both chiropractors and osteopaths spectrum of medical thought; ranging (as well as optometrists) are licensed un­ from those practitioners who continue to der The Drugless Practitioners Act. This be literal followers of Still's basic teach­ act makes it illegal for those groups ings, to those who possess a most sophisti­ licensed under it to carry out their occu­ cated g rasp of the teachings and methods pation aided by the use of drugs or sur­ of modern orthodox medicine. gery. This leaves very little scope of prac­ tice in which to treat illness besides the In the United States today (where much use of manipulation and auxiliary forms of more data is available), osteopaths practise therapy such as heat, diet, hydrotherapy as unlimited, nearly orthodox medical and mechanotherapy. This legal point may practitioners, in at least 37 states. Their help to explai n the anti-drug, anti-surgery scope of practice includes diagnosis of dis-

JANUARY, 1965 53 --Chiropractic and Osteopathy------

ease and treatment by osteopathic manipu­ and London by 1900. Because of small lation, operative surgery and drug therapy numbers of practitioners their influence in (including antibiotics). A few states still the healing arts has been undramatic. do not permit osteopaths to use certain They function as a group of practitioners drugs or to perform major surgery, while. separate and independent of the orthodox some states have two types. of osteopathiC medical practice. licenses, one of which permits the licensee to perform major surgery. In 1960, there were 14,109 qualified osteopathies prac­ CHIROPRACTIC: tising in the United States. Professional Since its beginning in 1895, chiropractic competency of doctors of osteopathy is bas been beyond the medical pale. Whe­ established by graduation from one of the ther or not it was "stolen" from Andrew six accredited osteopathic colleges in the Taylor Still's osteopathy, as has been United States, all of which offer a four­ charged is still a moot point. Its founder and-a-half-year course of professional was David B. Palmer, a Davenport, Iowa training, leading to a degree of doctor of grocer who, around the turn of the cen­ osteopathy and surgery (D.O.). Almost tury, announced to the world a separate, all graduates take a one-year internship at distinct and independent science, art and one of the 379 approved osteopathic hos­ philosophy of life, viz: chiropractic. His pitals. revelation came after he had successfully restored hearing to a man who had been The osteopathic profession is organized deaf for many years, by "adjusting" a into the American Osteopathic Associ­ lump on his back. ation (A.O.A.). This association is a fed­ eration of societies organized within each To-day the chiropractic profession is state. The A.O.A. publishes several tech­ deeply divided into two distinct groups, nical professional journals, and holds reg­ "the straights", who practise therapy only ular meetings and conferences in an at­ by manipulation; and the "mixers" whose tempt to strengthen its position and stan­ practice consists of treatment by manipula­ dards. At the present the American Medi­ tion supplemented by the use of various cal Association is in the process of wel­ mechanical and electrical devices (e.g. coming osteopaths into the fold. This ac­ electrical massage, whirlpool baths and ceptance, it should be remembered, is con­ various other modalities. ditional on the osteopaths' acceptance of At the present time there are 18 chiro­ the tenents of orthodox medicine. practic colleges functioning in the United States and only one in Canada (The Cana­ In Canada, the osteopathic profession dian Memorial Chiropractic College in To­ has developed along somewhat different ronto). Only six are recognized by the lines. The Drugless Practitioners Act, dis­ National Chiropractic Association (an cussed above, has served to limits their American group), and none have univer­ scope of practice quite sharply. Doctors of sity or college affiliation. The courses in osteopathy practising in Canada in 1961, these schools parallel those in medical and numbered only 124, of which 68 were osteopathic schools in subjects studied, in practising in Ontario. There are no osteo­ textbooks used, and in hours of instruc­ pathic hospitals in this country, so that the tion, yet at the same time the quality of osteopath maintains an entirely office­ instruction and the adequacy of facilities based practice. Osteopathic colleges are are highly questionable. non-existent here. Early graduates of American schools located in Canada at the Since the chiropractic profession does turn of the century. Records show that not have the use of hospital facilities, all osteopathic physicians were practising in clinical experience is obtained in the out­ Manitoba as early as 1899, and in Toronto patient clinics of the chiropractic schools.

54 U.W.O. MEDICAL JoURNAL The type of cases handled in these clinics other hand, the disappearance of osteo­ are mainly of a physiotherapeutic nature. pathy as a separate profession might bring Thus the doctor of chiropractic goes into about a gradual upgrading of the more practice without the necessary skill to rec­ progressive chiropractors. ognize and diagnose many complicated, pathological lesions. This is a serious b) Canada: The future status of chiro­ shortcoming. practors and osteopaths is at a very crucial point. A Royal Commission on Health In 1962, there were slightly over one Services, has, for several years now, been thousand chiropractors practising in Can­ studying the general state of health ser­ ada. They are all licensed under the Drug­ vices in Canada with the hope of passing less Practitioners Act with ali its restric­ some form of legislation which will better tions. Alberta was the first province to suit the needs of the Canadian people. recognize chiropractors and legalized their Fundamental to both groups is whether right to practise in 1923. Since then chiro­ they will be included in future health legis­ practors have gained legal recognition m lation. If excluded, their future as active all provinces in Canada except Quebec. members in the healing arts looks grave Since the founding of chiropractic, or­ indeed. If included in legislation, their ganized medicine has stated its disapproval. future existence appears assured, even if Dr. Harvey Cushing is quoted as saying: the number of practitioners is small enough "There is no pathological basis what­ not to represent an actual threat to ortho­ soever for the theory of chiropractic and it dox medicine. is silly to allude to it as a science". To­ day, the dilema faced by organized medi­ Most Canadians are aware that we are cine and by legislators is whether to con­ in the midst of an acute shortage of tinue to fight a rearguard action against the personnel in the health services. The legal and social recognition of chiropractic future looks even grimmer if present stat­ or to sanction legislation which would istics are projected into the next quarter help the chiropractic profession to raise century. Since the doctor in our society has educational standards and to limit incom­ a primary obligation to the people he petent practitioners. The American Medi­ serves, the onus should be upon him to cal Association acts as though chiroprac­ attempt to improve the standard of treat­ tors are non-existent, or, if their existence ment offered by marginal practitioners must be recognized, as though they are such as chiropractors and osteopaths. Doc­ out and out quacks, rendering nothing, tors must support all groups of health but incidental psychological benefits to the practitioners who express a desire to patient. Oraginzed medicine thus loses the provide the community with excellent ser­ good will of many patients who have re­ vices and who at the same time are capable ceived other than merely psychological of doing so. Benefits to the community benefit from the chiropractor; for example, should be kept foremost in mind and con­ patients with sacro-iliac strains. flicts of interest put to the background. Means of upgrading the standards of edu­ cation and practice, as well as retaining courses and new licensing legislation for PROGNOSIS FOR CHIROPRACfiC chiropractors and osteopaths are both AND OSTEOPATHY: within the physician's grasp and necessary. a) United States: Medical acceptance of The easy alternative is to destructively osteopathy might have the effect of im­ criticize and exclude. Doctors of medicine peding acceptance of chiropractic, for there have to do more than this if all people would be experts in manipulative therapy are to receive the high standards and effec­ within the medical profession. On the tive service which they deserve and need.

JANUARY, 1965 --Chiropractic and Osteopathy------

BIBLIOGRAPHY 3. Anderson, D ewey; H ealth Service!. Public

I . Brief to Royal Commission on Health Ser­ Affairs Institute, 1960. vices by the Canadian Chiropractic Associa­ tion. 1962. 4. Wordell, Walter 1. ; Limited, Marginal and 2. Canadian Association of Medical Students Quasi-Practitioners. Handbook of Medical and Internes Journal, Vol. XII, N o.4, 1963. Sociology. Prentice-Hall, 1963.

Chinese Medicine THOMAS AUSTIN, '64

INTRODUCfiON The present day practise of medicine in China combines ancient tradition with modern science. This is a recent amalgamation, precipitated by necessity . eventy thousand trained physicians were unable to look after the health of six hundred million people and so a crash program was instituted to achieve a better ratio . This has resulted in lowering of medical standards in that country and has been popularily termed "The Great Leap Backwards".

Recorded medicine in China goes back not the palpation of a radial artery as approximately four thousand years to Em­ carried out by Westerners but rather an peror Shen Nung who compiled the first elaborate process requiring 2-3 hours, util­ herbal or list of drug preparations. A cul­ izing numerous spots on the body. To ture which produced such quaint (to our learn this are requires a sound philosophi­ eyes) practices as acupuncture, moxibustion cal background and fourteen months of and pulse taking ,also practised small-pox training under a Buddist monk. vaccination hundreds of years before the Therapy consists of acupuncture or moxi­ West. The use of molds (precursors of bustion along with such drugs as rhubarb, antibiotics) to treat infected wounds was sulphur, mercury and opium. The thera­ also carried out by the ancients. One is pist believes that there are meridians or startled to find a reference to the produc­ 'chi channels' through which the life forces tion of steroids by the fractional distilla­ pass. These are to be differentiated from tion of urine in a text dated 1025. The the nerves of Western physiology as they potent analgesic, opium, came from China. are not discreet structures. As discussed Traditional medicine can be considered earlier, these forces must be in harmony or under diagnosis and treatment. First we illness follows. One learns the channels, in should be aware of the philosophical basis particular those points on the surface of of this practise. Health is considered to the body which coincide with the chan­ reflect a balance between two forces 'yin' nels. The point for any particular organ and 'yang'. 'Yin' is reflected in things need not be in the vicinity of the structure, "dark, dry, passive or female" while 'Yang' for example the appendix's point is on the is "light, moist, active or male". Illness right leg. By tapping these channels one indicates disbalance. can restore balance to the life forces and Diagnosis rests on 'pulse taking'. This is the patient consequently regains his health.

56 U.W .O. MEDICAL JOURNAL To achieve this by moxibustion, burning of traditional methods. The school period grasses are applied to the point while acu­ has been shortened from six to five years puncture consists of inserting needles. while we in the West talk of lengthening Acupuncture is more commonly employed, ours. Physicians who graduated previous to probably because it is less painful, the the synthesis are required to take courses needles need only be inserted deep enough in such practises as acupuncture, this re­ not to fall out. While diagrams and models quiring up to an additional 2V2 years. The show the general location of the points attempt to teach the traditionalists Western one requires a sixth sense to know the methods had little success, although they exact spot. The Chinese consider acupunc­ did eagerly take up the use of antibiotics. ture primarily a form of disease prevention The party exerts control over the physi­ but use it as well in the treatment of cian. He must spend six nights a week at cirrhosis, leprosy and measles. party rallies as well as work in field or Although acupuncture enjoyed a certain factory if the commune decides that extra wave of popularity, particularly in France, help is required. Prescribing rest as part of at the beginning of this decade, this has therapy is discouraged as quotas are held since waned. To be conscientiously prac­ to be a greater good than health. In diag­ tised requires a philosophical training the nosis one avoids an illness which reflects busy Western doctor would not undertake. on the state. For example liver disease, Also its use in disease prevention is alien secondary to malnutrition is a common to our concepts. problem, but can not be labelled as such Western medicine had its beginning for this would imply the state is at fault. with the Jesuit missionaries who went out At present the would-be physician enters to China in the 17th century. The 19th Medical School at age 17 after six years century saw Protestant missionaries, the of primary and five of secondary school. Rockefeller Foundation and the building The entrance exams. are in chemistry, of Peking Union Medical College. At the physics, sociology, political science and time of the Communist take-over there Chinese literature. About 40% of those were 13,500 Western trained physicians in entering are women. In addition there are China. These practitioners were centered numerous intermediate schools producing in urban communities, the peasants utili z­ sub-professional workers who form the ing the traditionists. bulk of medical personnel. In the 1920's and 30's the government It is difficult for a Westerner to fairly discouraged traditional medicine, even at evaluate the present standards of medicine one point considered outlawing it. With in China. Any information is usually Mao more emphasis was placed on the biased, depending on its source, and so traditional. He felt it had many valuable perplexes one as to forming conclusions. contributions to make to medicine and There is no doubt that an increased num­ envisaged China as a world medical leader. ber of practitioners have been made avail­ Thus in 1957 it was decreed that each able. In a populous country, such as China, medical group was to learn from the other, this must be considered a good thing. resulting in the 'Great Leap Backwards'. BIBLIOGRAPHY Although the move was ostensibly one of I. Barondes, China Lore Legends & Politics: advancement, in reality it was dictated by Philosophical Library, 1960. necessity. There were simply not enough 2. Durdin, P. ; Medicine in China: New York Times Mag., Feb. 28, 1960, p. 17. trained doctors to look after the country. 3. Gonzalez, A. F.; Red Chinese Medicine: To­ day's Health, Apr., 1962, p. 22-3 . This action has radically altered the 4. Chinese Medicine, Antibiotics & Acupunc­ teaching and practise of medicine in China. ture: M.D . of Canada, Vol. 4, o. 11 , Nov. Peking Union along with the other excel­ 1963 . 5. Medieval H ormone Chemistry: Scientific lent schools are now used for the teaching American, Feb. 1964, p. 68.

JANUARY, 1965 57 Faith Healing R. MORRISON HURLEY, '65

INTRODUCriON The term "faith healing'' to some people creates vi sions of "miraculous cures", to others it smacks of fraud and the occult. To discuss this subject some median must be found between these two extremes through thorough definition of terms and investigation of its various methods and ramifications. Medicine in the last century bas strived to become a science of healing and perhaps some of the art of healing has been neglected. As Sir Henry Cohen says, "Medicine is not all science. There are many medical problems which defy measure­ ment. Human life is full of imponderables, for man is not a ph.y sica! being only. He has emotions and appetites which cannot be measured, though they profoundly influence his physical welfare. Bodily disturbances may be, and commonly are, the expression of his loves and hates, his passions and fears, his worries and anxieties; the thumping heart, the cold sweat, the weak and tremulous knees of fright are but simple examples of this unity of body and mind. The greatest danger to which medicine in the scientific era has been exposed is that of overlooking that men, both patients and doctors, are sentient social beings, and forgetting that, however sensitive and specific our laboratory tests, and however elaborate and complicated our instrumental methds of investigation may be, they are not ends in themselves".

DEFINITIONS Will must act. The patient must do all he Healing is the process by which a living can to cooperate with the physician and organism, whose functions are disordered, carry out the regime, or cure might evade returns to complete functioning. Since per­ him. fect health is rarely attained and complete Thus faith may be a rational belief, healing rarely achieved, the healing of a trust, confidence, hope in God, a physician, disorder is a relative matter. As well, the therapist or "healer". criterion of healing varies, that is, to the patient healing is freedom from symptom­ HISTORICAL DEVELOPMENT atic illness, whereas, for the physician AND PRESENT STATUS the restoration, as far as possible, of Even primitive man suspected that the normal anatomic structure and physiologi­ ills of the body were related to the mind cal function is the standard. and the soul. In Grecian history the tem­ Faith, on the other hand, is more dif­ ples of AEsculapius were the first hospi­ ficult to define. For many faith means, in tals. Harmless yeiiow snakes (the symbol practice, believing without evidence. Thus of the the gods) glided about the temple reason plays no part according to this area and were trained to lick the sores of definition. For others faith is the knowing, patients and so it was believed to heal feeling and willing by which man comes them. Hippocrates who came into a world into a conscious, personal relationship with full of superstition and the ascription of God. These three factors in the latter disease to astrological and supernatural definition may be exemplified in medicine. causes was the first to deny this and at­ A patient's faith in his physician is increas­ tempt to approach disease rationally. These ed if he finds that his doctor has good newer Greek scientific methods, did not academic qualifications of which he was effect Jewish medicine at first since there formerly ignorant, or that he was called in still flourished the belief that Jehovah to see some important person, or that he gave sickness as a result of His disfavor has cured cases like the patient's before. and as punishment for sin. Clouded by Knowing his abilities and virtues increases this, though, was the whole philosophy of faith. A feeling of affection and trust in­ demoniac possession and the use of sor­ creases faith as also does the feeling that cerers. These same beliefs recurred later on he cares about the patient's case. Also the as well in the Christian era.

58 U.W.O. MEDICAL JOURNAL A great upsurge in healing began with stand the dynamics of their patients per­ the healing miracles of Christ. Weather­ sonality and so may use prestige suggestion head, after an exhaustive psychological at wrong times and to the wrong people analysis of Christ's healings states, "Psy­ i.e. those who will not benefit lastingly chological theories can illumine, but cannot from suggestion. Also by the public nature explain, Christ's healing work". After of these meetings there may tend to be a Christ came the healing of the Apostles. greater selection of emotionally unstable Some followers, however, later became con­ people who attend more for the sensation tent to lay all the onus for recovery on the rather than "cure". Another serious mis­ patient and the formula, "In the Name of take is made of misleading the patient and Jesus", became a charm rather than a means the audience regarding the nature of faith. of conveying power through faith. Then The patient either concludes that he had throughout the Dark and Middle Ages the faith for he is better or that he had insuf­ rise of demonology reappeared. People ficient faith since he is no better. This is again in order to explain the unknown illogical since there can be faith without reverted to the primitive superstitions such healing and healing without faith . Also if as evil spirits and witches. no recorded cases of cure are reported from these gatherings the mas~ suggestion About mid-eighteenth century more of illness, disease and sin with the accom­ direct healing trappings and suggestion of panying guilt feelings often outweighs the Mesmer and the appeal to the unconscious suggestion of recovery made by the healer. by James Braid through hypnotism. Emile Coue (1857-1926) was the greatest expon­ ent of direct suggestion. Every morning CRITIQUE OF FAITH HEALING and evening he exhorted his patients to METHODS say, "Every day in every way I am geting Very little scientific evidence can be better and better". This litanized sugges­ given for the efficacy or futility of faith tion he modified to suit the particular healing, thus most of the following will illness. attempt to clarify the mental mechanisms From this direct suggestion method involved in faith healing practice and the evidence for and against faith healing with there has been a rapid development of only few conclusions drawn. psychological theories until now, when there remain four main remnants of "faith According to the British Medical Associ­ healing"; the laying on of hands, the ation two categories of illness are said to phenomena at shrines, Christian Science be cured by spiritual healing: healing, and the healing revival meetings. (A) Psychogenic and Psychosomatic dis­ Both the laying on of hands and the orders phenomena at shrines when put into their (B) Organic Conditions. proper perspective have an excellent role in the healing of disease especially psycho­ (A) Psychogenic and Psychosomatic physiological. Christian Science, however, disorders comes in conflict with modern medicine by attributing disease to "falling out" with Most cures attributed to faith healing God for which the obvious cure is re­ fall in this category. Many methods of instatement in God's graces. Also there treatment affecting the patient's mind and may be a tendency to deny the existence emotional state have been used such as of organic disease entirely. faith healing, analytic treatment, sugges­ tion, persuasion, explanation, voodoo etc. The healing meetings are different in The relief of psychogenic disorders appears that though most "healers" are probably to depend partly on the individuality of well intentioned, they do not fully under- the patient and on his capacity to respond,

JANUARY, 1965 59 --Faith Healing------

partly on the personality of the healer with (a) MiJtake in DiagnoJiJ his power of suggestion, and to some ex­ This may arise by overlooking the tent on the method of treatment. Reports organic condition and ascribing the symp­ from various American clinics give almost toms to psychological causes or conversely identical cure rates whether cu res were by treating as organic that which is psycho­ obtained by faith healers, psychiatrists, logicaL This can occur more readily when social workers or psychologists. Basically the physician is biased against the psycho­ the same supportive psychotherapeutic pro­ genic causation of symptoms simulating cesses occur without, however, some of the organic disease. healers knowing exactly how they are using (b) MiJtake in PrognoJiJ the various psychotherapeutic techniques This is more likely to occur than false or towards what goal they are heading. An diagnosis since the course of a disorder interesting and satiric account of a com­ suggested by past experience does not parison between a psychiatrist and a Guate­ necessarily mean that the same disorder in malan curandero (medicine man) has been this individual will progress as forecast. reported by Masserman which demon­ If a remission or "cure" occurs and if just strates in two different cultures the curing before this the patient has been to a healer, of a psychosomatic illness by basically the then the "cure" will naturally be ascribed same methods even though the one culture to his ministrations. uses some more exotic projective tech­ niques like breaking eggs and studying the (c) Alleviation yolks and whites rather than using Ror­ The alleviation of the symptoms may be schach test. Results of these methods are mistaken for cure. Symptoms like pain are both good, however ,those of the curandero indications of illness but from the absence seems to be somewhat more lasting! of symptoms we can not argue that there is no ilnness. A toothache may be alleviated There is a danger, though, in the treat­ by plugging the socket with an analgesic, ment of the psychogenic disorders in that by Christian Science, by hypnotic sugges­ treating symptoms may do nothing to help tion or even by diverting the attention, the underlying disorder and may only serve but the decay remains to pursue its course to aggravate the condition, that is, differ­ even more disastrously because there is no ent symptomatology may return to replace pain to make the patient aware of the the 'cured" symptoms. This is, however, a decay. disputed point among psychiatrists. (d) RemiJJion Some conditions are subject to remis­ (B) Organic Conditions sions, that is, the symptoms may disappear It is from this area where most contro­ giving an apparent cure only to again vesry arises about the efficacy of faith blossom forth at a later time. Since the lay heaiing. Sometimes there is an apparent healer has no diagnostic tools these remis­ cure of an organic disorder "which doctors sions may be regarded as a permanent cure have said are incurable" or in which "doc­ by the healer, the patient and his relatives. tors gave only six months to live". Most of This cure then may be given extensive these cures come under one or other of press coverage, however, the relapse re­ the following categories. ceives no publicity. Only the patient and relatives are left with morale and hopes (a) Mistake in Diagnosis shattered. (b) Mistake in Prognosis (c) Alleviation (e) SpontaneouJ C11reJ (d) Remission There are reports of illness which should (e) Spontaneous Cures prove fatal, however, inexplicably resolves. (f) Combined treatment These cures take place apart from medical

60 U.W.O. MEDICAL JOURNAL treatment and without special ministrations background and when backed by belief in of the faith healer. It at such a time any Divine aid. To suggest that God will give extraneous factor is present, such as new the patient strength and courage in the diet, charm etc., it is natural to attribute hour of suffering is more potent in its "cause" to the cure. Spontaneous cures do effect than the suggestion of confidence occur rarely but are not necessa rily caused alone provided that the therapist himself by an external factor. believes in his suggestions and that the patient can accept this. (f) Combined Treatment Often a faith cure is reported when the As a morale builder clergymen may be patient was at the same time continuing in a better position to do so more effec­ medical treatment. That medical treatment tively than the practitioner since they may was continued is generally not reported devote more time with the patient for and only on deeper investigation is this these ends. discovered. Thus a false impression is given publicly that spiritual heali ng by itself has cured the patient. SUMMARY Faith heali ng has been with us from When all the above possibilities have antiquity and will probably remain since been considered it leaves little room for man when faced by illness or unknown miraculous cures of organic disease by the stress will grasp at any possible source of methods of spiritual healing. Spontaneous comfort. As medicine advances perhaps or unexpected cures which cannot be ex­ some of this will lessen, however, there plained are few. These may be miraculous will always be the unknown cause and or just that with our present scientific cure. Though we may consider ourselves knowledge inexplicable. much more sophisticated than our ancestors the surface of the psychic component of illness has barely been exposed. ROLE OF REUGIOUS MINISTRATION IN ILLNESS The British Medical Association Com­ There is considerable evidence as to the mission concluded that, "We can find no value of religious ministration in the treat­ evidence that there is any type of illness ment of many medical disorders. Though cured by 'spiritual healing' alone which not curative in a literal sense they are of could not have been cured by medical great value in the emotional life of the treatment which necessarily includes con­ patient. Through a conversion in which sideration of environmental factors". there is a complete upheaval of the emo­ Though patients with psychogenic disor­ tional life of the patient, his whole way of ders may be cured by various methods of life may be reoriented and some neuroses, spiritual healing just as they are by meth­ alcoholism and other functional disorders ods of suggestion and other form of cured. Conversion basically operates through psychological treatment, there can be found a remotivation process by which a personal no evidence that organic diseases are faith in God can satisfy the patient's needs, cured solely by such means. Many of the gives purpose to life and supports him in cases claimed to be cured are likely to be time of trial. W ith organic illness conver­ either instances of wrong diagnosis, wrong sion can create courage, cooperation and if prognosis, remission or possibly spontan­ the condition is fatal, the patient may be eous cures. easily resigned to and peaceful at death. However, there are multiple factors both Even though many of the cures affected physical and emotional which just as they by medicaliy unorthodox means are mainly may precipitate illness may be conducive due to suggestion, such suggestion is likely to a restoration of health. As physicians, to be more effective when it has a religious we can not afford to neglect the use of jANUARY, 1965 61 --Faith Healing------

any means which may lead to the restora­ 2. Di1Ji11e Healing 4nd Co-oper4tion Betweetz tion of health. Religious ministration may Doctors 4nd Clergy, British Medical Assoc., have an important bearing upon the emo­ Fisher, Ko.ights and Co. Ltd., London, 1956. tional and spiritual life of the patient and 3. Martin Benard: Divine Healing and Medical so contribute to his recovery. Science, The Healing Ministry in the Church, The dangers implicit in the healing mis­ Butterworth Press, London, 1960. sion are those of dday on the patient's part 4. Masserman, J . H.: The Contrib11tions of Ex­ for seeking medical attention, of inducing perimental Psychiatry to the Art of Healing, guilt and depression by telling the patient The Third World Congress of Psychiatry, that the illness was due to sinfulness, lack Vol. I, McGill University Press, Montreal, of faith and inadequate prayer, and of 1961. making the role of both doctor and clergy­ 5. Rae, ]. B. ; Divine He4ling as a Doctor Sees man more difficult, that is, that the It, The Wonder of Divine Healing, A. A. patient's faith in both doctor and God Jines ed., Arthur James Ltd., Evesham, 1958. have been shattered by the failure or 6. Rawcliffe, D . H .; l1111sions and Del11sions of "permanent cure" by the "healer". the St~p ernatMral and Occult, Dover Publica­ As a physician one should not automat­ tions Inc., New York, 1959. ically disregard claims of cure by medically 7. Sudre Rene; Tre4tise on Parapsychology, unorthodox methods but should perhaps George Allen and Unwin Ltd., London, 1960. spend more time with these types of ~ - The Church's Ministry of Healing (Report of patients in order to better understand the the Archbishops' Commission ), The Church emotional component of their illness and Information Board, Westminster, 1958. recognize their cry for help. 9. Weatherhead, L. D .; Psychology, Religion The author is greatly indebted to Dr. and Healing, Adler and Stoughton Ltd., Lon­ B. Goldberg and Canon C. G. Gardner for don, 1963. their ready assistance and criticism in the preparation of this article. 10. Ziboorg, G.; A History of Medical Psychol­ ogy, W . W. Norton and Co. Inc., New York, 1941. BffiLIOGRAPHY 11. ZiJboorg, G.; Some Denials and Affirmations 1. Appel, K. E.; Religion, A Handbook of of Religious Faith, Faith, Reason and Mod­ Psychiatry, Vol. II, Basic Books, Inc., New ern Psychiatry, F. J. Braceland ed., P. J. York 1959. Kenedy and Sons, ew York, 1955.

In a patient with left ventricular Jtrain due to hypertemion, aortic valve diJeaJe, or myocardial infarction, there are early .evidenceJ of myocardial weakneJJ and imuf­ ficiency that are often neglected with reJulting hazard of acute pulmonary edema before treatmeJt iJ Jtarted: Juch evidence includeJ apical gallop rhythm, accentuation of the pulmonary Jecond Jound, the appearance of a new apical JyJtolic murmur, puhuJ alternanJ (eaJily demonJtrated by 1phygmomanometry), the development of dyJpnea on effort not previouJly cauJing it, unexplained imomnia, decreaJing vital capacity, and increaJed lung hiluJ X-ray JhadowJ. Paul D. White, M.D., U.W.O. Med. J., 16: 189, 1946.

62 U.W.O. MEDICAL JOURNAL Midwifery M. C. HICKEY, '65

INTRODUCTION The head-hunters of Borneo, called D ayaks, ha,·e a legend which tells how midwifery began. Kelili had a wife called Teburi who was pregnant. One day, Kelili went into the jungle to hunt. He came to the place of the big monkeys where he observed for the first time a young female with a great belly calling out with pain. She crouched upon the ground, her mate beside her. Kelili marvelled for he saw how the husbands among the big monkeys, the maias, assisted their wives in childbirth. Remembering all he had observed, when the birth pains came to Teburi, he helped her, doing what the maias did. Midwifery simply means the work of a woman who attends women in con­ finement. The midwife dates back to primiti ve times. As the practice of medicine advanced and declined, the practice of midwifery followed a similar course. The discussion presents the status of midwifery today with sidelights into the past.

HISTORICAL DEVELOPMENT Through the middle ages, only the most The Midwife is a heritage of the long ignorant of women were employed in past. In prehistoric times probably the confinement cases; men were excluded. actual work was assigned to the women In the 16th Century in Germany and of the tribe who received instructions from Switzerland ,there was some discrimina­ the medicine man. The women applied the tion in selecting midwives-the wife of the remedies while the sorcerer busied himself Chief Magistrate of the village was dele­ with incantations. gated to select them from the unemployed Greek midwives had to be mothers. old women. The first midwife in the They had to be past the age of child­ U.S.A. was the wife of Dr. Samuel Fuller bearing themselves. This was the law in who came over on the Mayflower. Athens 400 B.C. Originally there were no midwives in Athens since slaves and wo­ The struggle persisted for generations men were prohibited from practicing any between physicians and midwives espec­ branch of the art of healing. ially in England, Germany and France. Herophilus (335-280 B.C.) was one of Two famous names in this struggle were the most brilliant teachers of midwifery Elizabeth Nikell for midwives and Wil­ at Alexandria. liam Smellie, a prominent obstetrician of the 17th Century in Scotland and event­ Rome got its midwives from Greece. ually London. It was only in complicated The period beginning with Hippocrates cases that the doctor was called in and ( 460 B.C.) and continuing to the time of even then the physician just acted as an Ambroise Pare (1550 A.D.) was an age of assistant to the midwife. empirical obstetrics. In those days the expectant mother was comforted by priests The French midwives learned the art by and superstitions but she had no anes­ being apprentices to the Hotel Dieu of thetics, antiseptics or knowledge of the Paris or by working three years with a processes of labour. She had only the licensed midwife. assistance of the wise women . . . the In England in the 18th Century there lowest and most ignorant of females. was rivalry between men-midwives and Little is known of Medieval obstetrics, women midwives. In the mid 1600's Mid­ but in the renai.;sance during normal wifery was in an unsatisfactory condition. labour, a woman had but an even chance The Chamberlens had invented the forceps to live- because of the prevelance of which were held as a family secret for one puerperal fever and eclampsia. hundred year. They were partly responsible

JANUARY, 1965 63 --Midwifery------

for opposition between male and female in Greece has a three year course and a one obstetrics. Because of men like Smellic year internship in a maternity hospital. and William Hunter, and the establish­ The midwife then serves three years in a ment of lying in hospitals (1749-1765), rural region where medical help is short. men were gradually accepted. (Queen The nurse-midwife of the U.S.A. is a Victoria was the first queen of England graduate of a nursing school who has taken to be delivered by a man called J. Y. special courses in maternal and infant care, Sampson.) By 1800 men, called accoucheur, obstetrics and midwifery. At present, the largely replaced women among the well­ practice of midwifery has declined sharply to-do, while women, having lost much of in the past thirty years. Nearly all babies their earlier prestige, practiced among the are born in hospitals in the United States. poor. They are strictly regulated now-In the In 1872 the Board of Examiners was set U.S.A. there are 400 to 500 trained mid­ up in England. In 1887, the Central Mid­ wives. Canadian midwives are found in wives Board was organized to raise the St. John's Newfoundland, Alberta, and efficiency and improve the status of mid­ Saskatchewan; Japan has 40,000 or more wives. Under the Midwives Act of 1936, on staff at the community health centres; the Central Board revised training in Mid­ Brazil once had 15 but now has only two wifery so that for the State registered midwifery schools resulting in 80% of all nurse, training was extended from six deliveries being unattended. Chile has 640 months to one year, and for the girl just midwives for a population of over seven taking midwifery, from one to two years. million.

EDUCATIONAL REQUIREMENTS METHODS, PRACTICES, Early in the 19th century there was no INSTRUMENTS formal teaching of midwifery to medical In the U.S.A. at Kings County Hospital students except in Edinburgh. In the mid in Brooklyn, New York, the director of 1800's all the London and provincial medi­ the Midwifery program reveals that the cal schools had lectures on midwifery. In expectant mother is first examined by an 1886, an Act passed by the General Medi­ obstetrician. If her pregnancy is normal cal Council of England made midwifery a and no trouble is expected at birth, the compulsory subject for medical under­ mother may choose to be cared for by a graduates. Today, instruction is given in nurse midwife and is examined on her midwifery and gynaecology along with subsequent prenatal visits to clinic by a clinical teaching on the wards and out­ nurse midwife. When the mother goes patient department. A student must also into labour, the nurse midwife remains observe the conduct of 25 cases of labour with her awaiting the birth. She watches and conduct five cases under supervision. for any complications, and if they arise a Often the student goes out in the district physician takes over. The midwife assists with the midwife frequently learning from at a normal delivery and gives post natal her. care; Nurse-midwives attended in 20 % of By 1936, the majority of pupils entering 7,000 births at the Kings County Hospital England's schools of Midwifery were State in 1962 without aid. The results are exceed­ Registered Nurses. The first period of ingly good and the nurse-midwife has a training was designed to provide a sound nearly 100% record of live deliveries. In theoretical and practical introduction to Sweden midwives examine each pregnant midwifery with a written and oral exam. woman 10 times; they lecture on female The second period was to be an apprentice­ anatomy and sexual relations; conduct ship with practical experience and instruc­ classes of calisthenic~ ; explain delivery pro­ tion on public health and social services. cedure, council expectant fathers.

64 U.W.O. MEDICAL JOURNAL Miss Vera Keane, a research associate at ed by midwives. In 1935 when more than the Yale University School of Nursing says half the babies were not born in hospitals a nurse-midwife does not set herself up in in the U.S.A. midwives and other non­ private practice. She cares for mothers-to­ medical persons delivered 13 % of the total, be with the collaboration and consultation today it is 2% . There is at present a grow­ of a physician. She is prepared to deliver ing interest in the use of midwives in pre­ a baby if the birth is expected to be nor­ natal obstetric and infant care; this interest mal. For the trai ned midwife in England, maily centres on the nurse-midwife. Some there is an outline to follow in prepara­ doctors still oppose them today, trained tion for delivery in the Patient's home. and untrained, and feel the management of 1. The Midwife should be aware of the labour and delivery should be in the hands Maternity benefits paid under the of a physician. Still there are a growing National Insurance Acts. number of obstetricians who believe nurse­ 2. The room for the confinement must be midwives do have a role in obstetrical large enough to work in, well ventil­ practice under medical supervision. This ated, near to a bathroom, and contain change in attitude is due to a rising num­ a single bed with a fairly hard mattress. ber of births that are straining hospital 3. The midwife must see that a reliable facilities and spreading medical staffs over person has been engaged to attend to a greater number of patients. the patient during the lying in period. Nurse-midwives are used in 2 principal 4. At an earl y visit the midwife should areas-in large city hospitals and in isola­ enumerate the requirements necessary ted rural situations. Some go into service for the confinement and see they are in foreign countries especially Africa. provided not later than the 28th week. The nurse midwife's aim is perfection They are often regarded as a sort of with emphasis on strict asepsis and cleanli­ medieval social curiosity on par with the ness during labour and the lying-in-period. fortune teller. This idea is partly deserved She is equipped with 2 bags, one for the because a generation ago, for example, all delivery, and the other for dai ly puerperal moroccan births were handled by the tribal visits. The delivery bag contains instru­ midwife whose actions were inspired more ments such as scissors and artery forceps, by superstition than by science. If the new­ drugs as prescribed by law, and apparatus born infant cried loudly the midwife sliced to give trilene, nitrous oxide and oxygen­ the child's thorax to let out bad blood. very similar to a doctor's bag. The nursing About 80% of the noisy infants died. bag is like the one for delivery. However There is a move in the U.S.A. to rectify­ it should be pointed out that the work of ing the situation of poor prenatal and post domiciliary midwifery has certain maternal natal care for mother and child among the risks from inadequate facilities to deal with lower socio-economic classes. President unexpected problems of labour. The mid­ Kennedy's Panel Report states there are wife has unrealistic rules about the man­ large numbers of expectant mothers in agement of the 2rd stage of labour. She rural and urban areas who receive little or cannot manually remove a placenta and no care whatsoever. This problem is re­ a struggling mother may eventually be flected in New York City where it is assisted by the Flying Squad who are an reported that the number of births without emergency obstetric team and on call at all prenatal care is incerasing by 2% a year times. and it is estimated that by 1965 one-half of all women delivering in Manhattan will be EVALUATION medically indigent. Midwifery is a respected profession in many parts of the world. In England, for Reid and Jacobson at Harvard Medical instance, 70% of the deliveries are attend- School propose to introduce a person called

JANUARY, 1965 65 --Midwifery------the Family Nurie Practitiotler who would visiting nurses to take he place. Our provide most of the medical supervision in obligation is to train her properly. the prenatal and postnatal periods in a The plea of Peter Chamberlen, inventor community-centered clinic keeping in mind of the obstetric forceps, made to the State that every pregnant woman has the right in 1646 applies also to our own time. and should be delivered in hospital with a "Shall want of precedent be here objected? physician in attendance. Women found to Because there was never any want for to be of "high risk" (about 20%) would instructing and governing midwives, there­ be managed by a physician. The family fore must there never be? Because multi­ nurse practitioner would care for the 70- tudes have perished therefore must they SO%of normal patients in the satellite still perish? Because our forefathers have clinic as long as the patient remained provided no remedy, nor knew any there­ normal or until she entered the hospital for must we provide none. though we in labour. This would enable the physician know it?" to devote nearly all his time to inhospital duties when the acute and complicated With the progress of medical science, cases should be managed. the midwife of European. North American and Far Eastern countries have been com­ The family nurse practitioner would be pelled to advance along with medicine. a regular staff member of an obstetric­ She may attend confinement but only in gynaecologic hospital service and would strictly normal cases. Such is the practice have much of the obstetric responsibility in Europe, and in certain areas in the of a maternity clinic previously regarded U.S.A. as solely confined to the physician. She must also have additional instruction in genua! medicine, psychiatry, pediatrics and REFERENCES obstetrics, plus public health nursing to 1. Findley, Dr. Palmer: The Story of Childbirth, enable her to function effectively in the Doubleday, Down and Company Inc., Garden community. Less emphasis would be put City, N.Y., 1934. on the methods of delivery and more on 2. Graham Harvey: Eternal Eve, Doubleday and creating an idea of the changes that occur Company, Inc., Garden City, N.Y., 1951. in the patient's physical and emotional 3. il Good Housekeeping: JPhen a Midwife needs in the various stages of pregnancy. Delivers the Baby, 158:162, May 1964. Also she would act as advisor to the family 4. il Newsweek: 48:54 August 20, 1956. concerning total health needs. 5. Kerr, Johnston, PhiUips: Historical Review of British Obstetrics and Gynauology, E & S SUMMARY Livingstone Ltd., Edinburgh and London, Gradually a skilled professional corps 1954. of midwives is being built up to care for 6. Reid, Duncan E.: High-Risk Pregnancy, The those who still must have babies at home New England Journal of Medicine, 271 :302- and those who, for emotional and psycho­ 307, 1964. logical reasons prefer to have them there. 7. Spencer, Herbert R.: The History of British In localities such as sparsely settled dis­ Midwifery from 1650 to 1800, John BaJe, tricts where she acts as doctor and nurse, Sons and Danielson Ltd., London, 1927. her services cannot be dispensed with until 8. Time: 1\fedidne-Suond Oldest Profession : there are enough maternity centres and 76:99017, 1960.

66 U.W .O. MEDICAL Jou.RNAL Special Anicle Review of the Therapeutic Uses of Vitamin E GERALD J. M. TEVAARWERK, '65

INTRODUCfiON Although vitamin E was discovered more than forty years ago there is still much confusion and ignorance concerning its role in human physiology. Even less is known about its value in therapy. Much research has been done and in 1960 more than eight papers a week were published on this subject. It is claimed by some investigators to be of significant therapeutic value in conditions such as mental retardation, various vascular co nditions, infertility, gastric ulcers, congenital heart defects, squamous cell carminoma, sunburn, menopausal conditions, and many other risease conditions. · 11 This paper is an attempt to evaluate some of these claims. SOURCES 1. Each trial had to be any of the follow­ The author has considered 825 publica­ ing: tions; 14 of these were full length articles a. A double blind trial. or reviews, and 811 were abstracts of orig­ b. A trial without a control group but inal articles or reviews. The latter were done in a group where the psycho­ published in the Annotated Bibliography of logical effects of medication are Vitamin E for the years 1940 to 1960. minimal, such as newborns and in­ fants. c. A trial without a control group but HISTORY done on a group where the improve­ 20 In 1920 Mattill and Conklin observed ment due to vitamin E therapy was that rats fed cow's milk were incapable of evidenced by definite objective im­ bearing young. Others noted the same and provement in the condition treated. it was soon found that wheat-germ oil was An example of this would be a de­ rich in some factor which restored fertility crease or disappearance of edema, in both male and female rats. The active an increase in hemoglobin, the re­ principle in the wheat-germ oil was named gression or disappearance of cancer, vitamin E. and the like. Evans et al. discovered vitamin E inde­ 2. Vitamin E had to be given alone with­ pendently and isolated the active factor out any other type of medication being from wheat-germ oil in 1936. They named given at the same time. it tocopherol (Gr. tokos, childbirth; phero, to bear; oi, an alcohol) . 20 3. The degree of improvement had to be significant, that is it should not be at­ Seven different tocopherols have been tributable to variations that occur with found in nature. They do not differ in time in certain disease processes such as their action except for degree. Alpha­ multiple sclerosis. tocopherol is the most widely distributed in nature and exhibits the greatest degree 4. Other independent investigators must of biological activity. In therapy, alpha­ be able to repeat the trial and obtain tocopherol is the most widely used. similar results.

CRITERIA. DISEASES IN WHICH VITAMIN E Before a clinical trial was considered to TIIERAPY HAS BEEN USED. have value the following criteria had to be A. Diseases of infants and premature met: babies.

JANUARY, 1965 67 --Vitamin E------

1. Scleredema: cular dystrophy and dermatomyositis Although not effective in all even in very high dosages. cases, it was reported that 10 to 15 C. Disorders of the N ervous System. mg.j day of alpho-tocopherol in a None of the trials met the criteria out­ large percentage of cases caused the lined above although claims were made disappearance of scleredema. This is for Jtl bjective improvement in polio­ of considerable importance as this myelitis victims treated with vitamin E. disease carries a high mortality 4 16 D . Disorders of the Abdominal Viscera. figure. - Vitamin E was not proven to be of 2. Cerebro-meningea.l haemorrhage: value in the treatment of abdominal The administration of 300 mg. of disorders. alpha-tocopherol to the pregnant E. Diabetes mellitus. mother, at the start of delivery of a Vitamin E is of no proven value in premature baby, greatly reduced the diabetes mellitus. incidence of cerebro-meningeal hae­ F. Menopausal syndromes. morrhage. In the control group the Blatt et al. report that apha-tocopherol incidence was 13.5% while in is no more effective in treating meno­ the vitamin E treated group the pausal symptoms than placebo therapy.3 incidence was 2.0%. Investigation showed that premature infants had G. Blood dyscrasias. low and variable capillary resistance Evidence for and against vitmain E which was raised in those babies therapy has been reported but none of whose mother had had vitamin E the clinical evidence met the criteria outlined above. administered before delivery .~ - 1 5 - 16 H. Cardiovascular diseases. 3. Oxidative haemolysis: Only in patients with intermittent In premature infants the oxida­ claudication was vitamin E therapy tive haemolysis of red blood cells in shown to be useful. Patients who had hydrogen-peroxide was significantly femeropopliteal occlusions combined increased. The degree of haemolysis with a poor distal bed showed great was inversely proportional to the improvement when treated with daily tocopherol concentration of the blood. doses of 600 to 1600 mg. for at least Addition of alpha-tocopherol to the 6 months.t9 Three independent double blood decreased the degree of hae­ blind trials, one of which had thirty­ molysis. The authors suggested that three patients in it, reported similar excessive haemolysis and the conse­ favorable results. This is of particular quent jaundice in the newborn are significance as reconstructive vascular due to a lack of alpha-tocopherol surgery has little to offer such patients in the blood and that vitamin E at the present time. In similar trials in should be supplemented to artificial which the results were less favorable 1 14 feeding diets. - either the dosages were less than 300 B. Disorders of Muscles, Bones, Joints, mg.jdaily, or the trial was not contin­ 1 3 Connective tissue, and Collagen. ued past three monthS. - ' 9 Although claims were made for im­ J- Other diseases. provement in various conditions, such Vitamin E was not shown to be of as Peyronie's disease (fibrous infiltra­ value in other diseases in trials that met tion of the intercavernous septum of the criteria outlined above. Among the the penis) and Dupuytren's contracture, diseases considered were the various none of the trials met the criteria out­ endocrine disorders, allergies and dis­ lined above. Alhpa-tocopherol was not eases of the skin, obstetrical and gyn­ proven to be of value in human mus- acological disorders, sterility, ophthal-

68 U.W.O. MEDICAL JOURNAL mological, otological, dental, and oral 4. Gerloczy, F. : Vitamin E Deficiency Statt!J i11 disorders. It was not proven to have ewbom and NurJing TnfantJ. inth Inter- national Congress of Paediatrics, July 19-25, value in cutaneous ulcers. 19 59. Montreal, Canada. p. 73 . 5. Gordon, H. H., De Metry, J . P., and Csapo, No syndrome due to hypervitaminosis E G.: Haemoly1i1 in Hydrogm-peroxide of Ery­ has been reported in human beings. throcyte! of Premature ln/antJ. Effect of alpha-tocopherol. American Journal of Dis­ eases of Children. 84: 472 , 1952. DISCUSSION 6. GroHman, A.: Pharmacology and Therapeu­ tiC! , Lea and Febiger, Philadelphia, fifth The status of alpha-tocopherol as a edition, 1962 therapeutic agent rests on an extensive but 7. Gyorgy. P., Cogan, G., and Rose, C. S.: decidedly controversial literature. Out of At,ailability of Vitamin E i11 the ewborn the conflicting evidence there emerges the !11jant. Proceedings Society Experimental Bi­ ology and Medicine, 81 : 536, 195 2. indication that in certain disease processes 8. Harris, P. L. , and Kujawski, W .: Medical there may occur more or less local metab­ and Therapeutic Uu. Annotated Bibliography olic disturbances which may lead to in­ of Vitamin E; p. 115-159, 1940 to 1950. creased needs for tissue tocopherol. Vita­ 9. Harri s, P. L., and Kujawski, W .: Medical min E is believed to act by virtue of its and Therapeutic Uu. Annotated Bibliography antitoxidant properties but in what way of Vitamin E; p. 54-89, 1950 and 1951. that is related to the relief of signs and 10. Harris, P. L., and Kujawski, W .: Medical a11d Therapeutic Uu. Annotated Bibliography symptoms in the various conditions is not of Vitamin E; p. 126- 169, 1952-1954. known. II. Herting. D . C. Kujawski, W . F., Ludwig, M. L., and Harris, P. L. : Medical and Thera­ peutic Uu. Annotated Bibliography of Vita­ minE; p . 158-199 1955-1957. CONCLUSION 12. Herting, D . C., Ku jaw~ki, W . F. Ludwig, Although much is available the quality M. L., and Harris, P. L. : Medical and Thera­ of the clinical trials with vitamin E are not peutic Uu. Annotated Bibliography of Vita­ such that much can be said about its use­ min E: p. 137-165, 1958-1960. 13 . Li vingstone, P. D., and Jones, C. : Treatment fulness as a therapeutic agent. Apart from o/ llllermillent Claudication u·ith Vitamin E. the conditions described above alpha­ Lancet I I : 602, 1958. tocopherol has as yet not justified the 14 . Mackenzie, ). B.: Role of Vitamil1 E. Pro­ claims of some of the investigators con­ ceedings Second Scientific Conference; Assoc­ cerned with it. At the present time it must iation for Aid to Crippld Children, 91, 1954. be concluded that some of the beneficial 15 . Minkowski, A.: 011 the Prevention of Cere­ bromeningeal Haemorrhage! in PrematureJ by results claimed for Vitamin E mav well be AdminiJtration of Anti-vauular Fragility due to inaccurate evaluation of clinical Compound to the Mother During Labor. improvement, or to the psychological effect Arch. Franc. Paediatrics, 6: 276, 1949. that every drug exerts on the patient re­ 16. Minkowski, A.: Tocopherol in In/ant Metabo­ liJm. W orld Health Organization, Infant ceiving it, or to other treatment including Metabolism Seminar. Leyden, Oct. 15-30, bed-rest and change of environment, given 1950. concurrently with Vitamin E therapy. 17. ebrell, W . M., and Harri , R. S.: The Vita­ mini. Volume III, Academic Press, Inc., Publishers. ew York, 1954. REFERENCES 18. The Summary. Special Abstract Supplement. hute Foundation for Medical Research, Sup­ I. Aitken, F. C. and H ytten, F. E.: lnfa11t Feed­ plement to Volume 13: ovember, 1961. ing: CompariJo n of Breast and Artificial Feeding. utrition Abstracts and Reviews, 19. Williams, H . T . G., Clein. L. J . and Mac­ 30: 341, 1960. Beth, R. B.: Alpha-tocopherol in the Treat­ me/It of lntermillt!llt Claudication. Canadian 2. Beckmann, R.: Vitamil1 E in PaediatriC! . Medical Association Journal, 87 : 538, 1962. Archives Kinderheilklinik, D7: 7, 1958. 20. White. A.. Handler, P. L., Smith, E. L., and 3. Blatt, M. G . H ., Wiesbader, H ., and Kupper­ DeWitt Stetten: Principlt!J of BiochemiJirJ, man, H. S.: Archives of Internal Medicine, McGraw-Hill Book Comp. Inc., ew York, 91 : 792, 195 3. 1959.

JANUARY, 1965 69 Dr. Ian Bell, 5707 25th Rd. N., Arling­ Alumni News ton, Virginia 1919-Dr. E. M. Watson-In the October Dr. F. W. E. Brown, Toronto General issue of the journal we reported that Dr. Hospital Watson graduated from the University of Sheffield with a gold medal in Medi­ Dr. E. L. Burran, Bristol Eye Hospital, cine. This is an error on our part. Dr. Bristol, England. Watson graduated from Western in Dr. I. H. Fiddes, 121 Duke St., Ingersoll 1919 winning the silver medal in medi­ cine. From 1920 to 1924 he was a mem­ Dr. R. M. Ford, 535 5 Walkley Ave., ber of the faculty of the University of Montreal 28, Quebec Sheffield. Our apologies to Dr. Watson. Dr. S. A. Gasewicz, Shaughnessy Hospi­ 1949-Dr. Paul Schneller is Director of tal, Vancouver, B.C. Psychiatry at the Metropolitan State Hospital in Massachussets and is Senior Dr. Bernard Glass, 159 Godfrey Drive, Clinical Instructor at Tufts University London Medical School in Boston. Dr. J. G. Gorvette, 1 Mountain Avenue, 1957-Dr. J. G. Goodwin interned at St. Hamilton Joseph's Hospital in London, following Dr. W. B. Hoggarth, 89 Masterson Dr., which he spent three years in the RCN. St. Catherines In 1961 he spent a year as a senior in­ terne at Hamilton General Hospital. He Dr. T. C. Johnston, 2815 lOth Ave., is now a member of the Fisher Clinic in Port Huron, Michigan Gravenhurst, Ont. He is married and Dr. D. W. Killinger, 5047 Cavendish has three children. Blvd., Montreal, Quebec 1959-We reported that Dr. E. M. Dundas Dr. S. W . Klein, University Hospital, resides at 6867 Parkway Circle in Dear­ Ann Arbor, Michigan born Heights, Michigan. This is the address of Dr. E. M. Dundas Sr., who Dr. J. Langer, 1587 Victoria Ave., Wind­ graduated in 1926. Dr. E. M. Dundas Jr. sor, Ontario resides at 901 North York Ave., Dear­ Dr. R. Gene MacDonald, 30 Drew Ave., born, Michigan. Galt, Ontario 1961-Dr. E. M. Biagioni interned at Ham­ Dr. B. H. Mayall, The Wistar Institute, ilton General Hospital and is now a resi­ 36th at Spruce St., Philadelphia 4, Penn. dent in medicine at the Cleveland Clinic. He is married and has two daughters. Dr. I. B. Pless, Camp Carowanis, St. His present address is 462 Clearview Agathe des Monts, Quebec Drive, Euclid 23, Ohio. Dr. P. R. Polak, Box 81 , Fort Logan, Colorado Editor's Note: We would like to hear from you about yourself or other graduates in Dr. K. P. Smith, St. Luke's Hospital, your aquaiotance. Please write to us. Cleveland, Ohio The following alumni can no longer be Dr. G. W. Squire, Sunybrook Hospital, reached at these addresses. Would any­ Toronto one knowing their present whereabouts, please let us know:-

70 U.W.O. MEDICAL JoURNAL The Class of 1939

Dr. Charles D. Anderson, of 4016 Tilden General Hospital. He spent one year as Lane, Lafayette, California, interned at a demonstrator in Anatomy and in 1941 St. Joseph's Hospital in London. He joined the R.C.N.R. Corvette and was a studied anaesthesiology for three years guard for the Atlantic meeting of Chur­ at the Mayo Clinic, Rochester, Minne­ chill and Roosevelt, in Ireland. He is sota, and was awarded his Fellowship in married and has four children. Anaesthesiology. He then spent four years in the RCAMC. Following this he Dr. Donald R. Campbell, interned at Vic­ toria Hospital, London. He is not prac­ was appointed Chairman of the Depart­ ment of Anaesthesiology at Presbyterian tising now because of illness. Hospital in Chicago, Illinois, and Assoc­ Dr. Alfred E. Conley, 75 Pine St. North, iate Professor of Anaesthesiology at the Thorold, Ontario interned at Ottawa College of Medicine, of the University Civic Hospital following which he went of Illinois. At present, he is in private overseas with the RCAMC. He was a practice. He is married and has four resident in Anaesthesiology at St. Mich­ children. ael's Hospital in Toronto and is now in Dr. Norman Boyd, of 16 Thompson Road, private practice in Thorold. He is mar­ Windsor, Ontario, interned at Victoria ried and has three children. Hospital in London. Following a year Dr. Nelles J. England, 429 Wortley Road, of private practice in Markdale, Ont., he London, interned at Hotel Dieu Hospi­ spent the next several years in industrial tal in Windsor. He was with the RCAF medicine with Otis-Fenson Elevator Ltd., after interneship, following which he in Hamilton, and with Border Cities In­ did post-graduate work in Montreal. He dustries in Windsor. He is now in pri­ received his FRCP(C) in Internal Medi­ vate practice in Windsor. He is married ci ne and is now practising in London. and has four children. His eldest daugh­ He is a Clinical Lecturer in the Dept. of ter graduated frim Western last year and Medicine at UWO Medical School. He his eldest son is now in his first year of is married and has two children. medicine at U.W .O. Dr. Kenneth G. Calvert, 2917 Wolfe St. Dr. and Mrs. Bernard R. Goldberg (nee West, Calgary, Alberta, interned at Tor­ Ruth V. Berney, M'39) reside at 153 onto Western Hospital. In 1940 he went Harding Drive, South Orange, New overseas as a Flight Lieutenant in the Jersey. She interned at Albany General RCAF. He is now in private practice in Hospital and later did a residency in Calgary specializing in Obstetrics and Pediatrics in Boston. He studied Psychi­ Gynaecology. atry after graduation. They have three children. Dr. William M. Cameron, 1448 Corley Ave., London, interned at Royal Victoria Dr. and Mrs. Morris G. Hill (nee Margaret Hospital, Montreal. After completing his Gastle, M'39) reside at 120 Norman St., interneship, he joined the RCAF medical Sarnia, Ontario. She interned at St. corps. He received his FRCP(C) in Joseph's Hospital in Hamilton and spent Internal Medicine and is at present a one year at Royal Victoria Hospital in Clinical Lecturer in Medicine at U.W.O. Montreal. She is now an Associate MOH Medical School. He is married and has and School Health Officer for East three children. York. Dr. Bruce A. Campbell, 42 Albert Street, Dr. Robert Horowitz: 2769 Hudson Blvd., Stratford, Ontario, interned at Hamilton Jersey City, New Jersey.

JANUARY, 1965 71 Dr. Hugh C. Knox: deceased. Director of Surgery at Cedars of Leban­ on Hospital in Los Angeles, California. Dr. J. Osler Lockhart: 632 King St. East, He is now a professor of Surgery at the Hamilton, Ontario. Albert Einstein College of Medicine of Dr. Bernard Meth: New Westminster, B.C. Yeshiva University in New York City. Dr. Hugh McAlpine of 889 Richmond St., Dr. Robert N . Storey: Collingwood, Ont. London, Ont., specialized in endocrin­ Dr. George J. Wayne resides at 1704 N. ology and is on staff at UWO Medical Edgement Street, Los Angeles 27, Cali­ School as a clinical lecturer in medicine. fornia. He interned at Lincoln Hospital Dr. Ronald J. McCallum: Delhi, Ont. in New York City and from 1941 to 1945 he served as Flight Surgeon and Dr. R. G. McGugan: 191 Highland Rd., London, Ont. Psychiatrist in the USAF. He is medical director of Edgemont Hospital and is Dr. Daniel C. McVicker: Deseronto, Ont. associate clinical professor of psychiatry Dr. Jack C. MacWilliam: 44 Third A ,-e., at the University of California at Los Chatham, Ont. Angeles. Dr. Gerson Nonas, 404 E55th St., New Dr. Delbert Wallin: 1206 Johnston Street, York, N.Y. Kingston, Ont. Dr. Hertha F. Pasner, Fort San, Saskat­ Dr. and Mrs. Ralph Young (nee Elizabeth chewan. Escott-Beal, M'39) : 64 Eldomar Ave., Dr. Leo Roszell: Reedsville, Pennsylvania Brampton, Ont. Dr. William D. Sharpe: 24621 W . Mc­ Editor's Note: The graduating class of Nichols Road, Detroit 19, Mich. 1939 have celebrated their 25th year Dr. David State lives at 93 Greenhaven reunion during the Homecoming festiv­ Road, Rye, New York. He was fo rmerly ities in October.

A casual remark made to me by that feiiow-cormtryman of yo11rs, who with F. G. Banting discovered insulin, harmts me. It was something like this: If doctors treated their diabetic patimts as carefuiiy as I treat my diabetic dogs, do you think their patients tvortld have as many complications? And so I ask of you-Do you treat yortr diabetic child, diabetic woman and diabetic man as weJJ as Professor Charles H. Best treats his diabetic dogs? Elliott P. Joslin, M.D., U.W.O. Med. J. , 17: 49, 1947.

72 u.w.o. MEDICAL JOURNAL The Class of 1914

Dr. George William Aitken lives in Grand cians and Surgeons in 1944 and m Bend, Ontario. He interned at Victoria Ophthalmology in 1946. Hospital and served as a major in World War I and World War II. Dr. William A. Jones, FRCP(C), a radi­ ologist, now lives at 251 University Ave., Dr. Herbert Charles Allison lives at 444 Kingston, Ont. He was a Colonel during Washington Road, Grosse Pointe 30, World War II serving as Director of Michigan. Medical Services at Valcartier Camp. He has held the positions of Head of the Dr. Samuel J. T. Bean, of 527 English St ., Department of Radiology, Queen's Uni­ London, had been in general practice in versity, and Past-President of the Ontar­ London until the outbreak of the 2nd io Medical Association {1939). World W ar. During the war, he was a member of the Canadian Armed Forces, Dr. Clifford M. Keillor resides in Ottawa, and remained with them until 1959 Ontario (Room 409, Daly Bldg.). He when he retired from active duty. Early served on the Canadian Pension Com­ in his career he spent three years in mission for thirty years. During World Pharmacology research at UWO Medical War I he was Medical Officer with the School. At the present, his hobbies arc 1st Surrey Rifles in France, Salonica, and horticulture and wood·work. Palestine. Dr. Keiller again served as a Medical Officer in World War II. Dr. Malcolm D. Campbell resides at 3339 West Grand Avenue, Detroit, Michigan. Dr. Frederick W. Luney: 223 Base Line Road, London, Ontario. Dr. Charles Cornish: King St., Ingersoll, Ontario. Dr. John R. McPherson of Duart, Ontario has been coroner for Kent County. He Dr. William P. Freeman: Springfield, Ont. has been active in Rotary International serving as President of the Ridgetown Dr. James S. Hudson: 17443 East Jefferson Rotary Club in 1933, and District Gov­ Ave., Grosse Pointe 30, Michigan. ernor in 1960-61. In 1958, Dr. McPher­ son was elected Warden of Kent County.

Dr. George H. B. Ingram resides at 113 Dr. Wilfred E. Wright: Cincinnati Sana­ William St., Stratford, Ontario. Dr. In· torium, Cincinnati 24, Ohio. gram did postgraduate work in 1921 and 1922 at the Manhattan Eye, Nose ,and The following members of the Class of Throat Hospital , New York, and at 1914 are deceased : Roosevelt Hospital, New York. While practising in Stratford, Ontario, he serv­ Dr. Arthur A. Anderson ed on the Stratford Board of Education Dr. Ernest L. Graves from 1929 to 1935 and was its chairman in 1934. He is also a past-president of Dr. Freeman Guest the Stratford Rotary Club. During Dr. Thomas R. Guilfoyle World War II, he was a major in the RCAMC serving as a consultant in Dr. James E. Mason Ophthalmology and Otolaryngology. He Dr. Edward W . McBain obtained his certification in Otolaryn­ gology from the Royal College of Physi- Dr. John K. McBane

JANUARY, 1965 73 Dr. Albert C. Nixon Dr. Ivan D. Wilson Dr. Albert Phelps Dr. Harold S. W ismer Dr. Adelard L. Paisson Editor's Note: The graduating class of 1914 celebrated their 50th year reunion Dr. William D. Sorensor during the Homecoming festivities last Dr. Elmore L. Steele October.

Student Research

SWEAT CHLORIDE LEVELS IN produce sweat of high electrolyte concen­ CYSTIC FIBROSIS CARRIERS tration in spite of normal levels of aldo­ sterone. It was speculated then that per­ General haps the heterozygotes or carriers of the Much time and effort have been given disease, when subjected to similar condi­ without success in devising a diagnostic tions of salt deprivation, might be unable test for the carrier state of Cystic Fibrosis, to conserve salt and present a picture much generally believed to be a homozygous the same as that shown by the affected expression of a recessive disease. Children children. This conjecture became the basis with Cystic Fibrosis have an abnormally of our research project. high sweat chloride level; the range vary­ ing from 50-140 mEq/ Litre with a mean of 100 mEq. In spite of the genetic nature Outline of Investigation of the disease, the parents of Cystic Fibro­ Parents of known proved patients with sis patients have sweat electrolyte values Cystic Fibrosis were canvassed and urged quite comparable to levels of normals in to participate in this research project, and the same age category. Hence, a routine were asked to choose friends to act as con­ sweat test is of no value in attempting to trols who were not blood-relatives and detect carriers of the gene for Cystic who did not knowingly have a child with Fibrosis. Cystic Fibrosis. In this way, ten sets of parents and eleven controls were obtained. It is known that normal individuals Each set of parents and corresponding depleted of salt will produce sweat of low controls were subjected to a low (250 mg.) electrolyte concentration because of the sodium diet for a period of four days. At salt-conserving influence of aldosterone. the commencement of each test and each Children with Cystic Fibrosis however, twenty-four hours thereafter for the next under the same conditions, continue to four days, an Iontophoresis sweat test was

74 U.W .O. MEDICAL JoURNAL performed. The chloride value only was had bilateral lesions placed in the ventro­ estimated according to the method stand­ medial area of the hypothalamus. These ard in the laboratory of War Memorial pituitaries were found to be significantly Children's Hospital. lighter than those of intact controls, al­ though the predominant effect of the Results lesion had been hyperphagia. Thus the Mean sweat chloride values were calcu­ lesions could have interfered with control lated for day 0 (initial sweat test) and for or release of a pituitary hormone ,or with day 4 of the diet for each group: female the vascular integrity of the pituitary. parent, female control, male parent, male Next was investigated the possibility of control. The mean differences (day 4 - day hypothalamic control of Growth Hormone 0) in each group were quite similar. It was secretion. Significant stunting in the young hoped that there would be a significant rat following the placement of bilateral mean difference in sweat chlorides only in lesions in the hypothalamus had been noted the control groups and no mean difference by other workers in the Department. In in the parent groups as the diet progressed. our study, lesions were made in the pre­ Age of the subject did not play a part in optic area. Parameters related to growth sweat chloride values either initially or were studied continuously in order to throughout the diet. All results and calcu­ determine whether a true Growth Hor­ lations were subjected to statistical analysis mone deficiency had been produced. and there appeared to be no significant difference in the mean absolute change in Bilateral hypothalmic lesions were made sweat chlorides of control and parent from in Sprague-Dawley rats at twenty-five days commencement of the diet to termination. of age. These animals were compared with intact controls of the same age, and also Summary with a group hypophysectomized at twenty­ The sweat chlorides of twenty parents of five days of age. All groups were followed children with Cystic Fibrosis and eleven until autopsy at ninety days of age. Ani­ controls have been studied throughout a mals with preoptic lesions were signifi­ four-day low sodium diet. A drop in sweat cantly retarded in both body weight and chloride levels has been witnessed not only length compared with intact controls, but in the controls but also in the parents. grew well compared with hypophysectom­ Hence, the study of sweat electrolyte levels ized controls. The retardation could not be in people under conditions of salt depriva­ explained by changes in food or water tion is believed to be of no value in diag­ intake. Carbohydrate metabolism (blood nosing the carrier state of Cystic Fibrosis. glucose, insulin sensitivity, and cardiac Michael F. Myers, Meds. '66, glycogen), nitrogen balance, oxygen con­ Department of Paediatrics, sumption, and body temperature were Summer of 1964. similar to control levels. Spontaneous acti­ vity was increased in the lesioned animals, and body fat was found to be decreased. At autopsy, the weights of endocrine HYPOTHALAMIC CONTROL OF organs did not differ significantly from GROWTH the controls. During the summer of 1964 investiga­ tion was made in the Department of We thus established that ablation of this Physiology of problems relating to the area of the hypothalamus caused retarda­ hypothalamus. tion of growth. Evidence of a deficiency of Growth Hormone in these animals was In a preliminary study, pituitaries were not found, and it may be that a part of the removed and weighed from rats which had reduction of weight gain was consequent

JANUARY, 1965 75 upon increased acttvtty, with use of fat ated growth patterns in children have been reserves to provide energy. We also estab­ suspected to be related to lesions in the lished a useful experimental working hypothalmic area. model for future experiments. Summer 1964 These studies have an interesting clinical Carol Hindmarsh, correlate in that both retarded and acceler- Meds '67.

"THE GE ERAL PRACTITION ER" He must not walk his rormds for fear his patients thi11k him poor, And dearly do they love to see a carriage at the door; And if his horse is fat, "He must have lillie work to do," And if it's lean the reason is, "He starves the poor old crew."

Shortld he call upon his patients every day when they are ill His motive plainly is "to make a great big doctors bill," If he visits them less frequently-thtu less'ning their expense­ The chances are he'll be acmsed of wilful negligence.

He m11st work all day and half the night, and never say he's tired; For the public look upon him simply as a servant hired; And short!d he take a holiday, he'll find when he comes back Some patients have resented it by giving him "the sack."

Concerning money he mmt seem indifferent to be, And folks will think he practises from pure philm1throp]'; When we hear abotll him boasting of the dollars that he earns IJV e wonder if they all appear in his income tax retrmu.

About his own afflictions he must uever say a word; The 110tion of a doctor being ill is so absurd! And when, perhaps from overwork, he's laid upon the shelf, His sympathizing patients say, " Physician, heal thyelf!" - Dr. J. Johnston.

76 U.W.O. MEDICAL JouRNAL News and Views

MEDICAL PRACTICE knew I was there within a week. So I set IN NORTHERN ALBERT A up my first office in a converted granary. A couple of boxes of staple drugs, my This is the substance of an address, few instruments, a block of wood for a delivered at the Fourth Annual Home­ chair, another one for the patient, my own coming Medical Conference, by Dr. Marg­ cot for a couch, a coal oil lamp for light. aret Strang Savage, Meds '29. She received, It's amazing how little you can start with at its conclusion, a standing ovation. - and how much you can do with it.

"To each is given a bag of tools, a span "Then ,some means of transportation. of years, and a set of rules. That bag of This country was too huge for walking tools-the fundamentals of medicine in the and my legs were too short. Horse and 1920's - was our armamentarium. How saddle were the best for those early years. variously we have built with them through the years. For myself, I have no degrees to "Frontier people are a hardy and re­ add to the laurels of Med '29. I have been, sourceful lot. But inevitably, there are and still am, a general practitioner, prac­ accidents, pneumonias, toothaches, broken tising my own particular brand of medi­ bones, new babies, measles. And not only cine as adapted by the Canadian frontier. the people, but the horses and cows had their troubles. The li vestock was mighty "I started practice on that frontier in the important to the family economy. Now one fall of 1931, in the Peace River country of thang Western Medical School did not Alberta. Settlers from all over the map provide, was some veterinary knowledge, were rapidly filling that country. The so I had to swat some up in a hurry. I settlers were clearing bush and getting simply couldn't let it be said that the bally established in their log cabins. There was cow died because the doctor didn't know one main graded dirt road; the rest were her business. trails. Resources were few and money scarce. We didn't operate on the gold "All my early obstetrical practice was standard, but on the standard of moose­ done in the home, of course. But it was meat, pails of lard, wild berries, frozen truly remarkable how uncomplicated most wheat, and green lumber. Our nearest of my cases were. These frontier women source of supply was at a crossroads. Here were very active people. On obstetrical was a store that sold everything. And had cases, I went as soon as I was called, and a Post Office in one co rner. stayed till the case was over. I rested where I could--on a bench--on the floor. "Arriving in this huge country about I was chary of beds in some houses, for the tail end of the last wave of settlers, bedbugs found me a tasty morsel. But I discovered a few things for myself. First, during those prolonged visits, I got acquain­ there was absolutely no medical competi­ ted with the family, and its history, and its tion. And second, the nearest hospital was livestock. For anesthetic, I used a mixture 50 to 80 miles away, depending on where of chloroform and ether, and Papa was I was in my huge district. usually pressed into service as anesthetist.

"It was late October. My first business "Even in that scattered community, an was to find a place to live and work­ amazing variety of common, as well as likely a log house. But I couldn't wait for critical problems, arrived at my door. The the house. The moccasi n telegraph is most carpenter one winter night- from 25 miles efficient and everybody for miles around north. Both hands enormously swollen.

JANUARY, 1965 77 He was wild with pain and half-starved, had an epidemic of diphtheria, a disease so for he coudn't feed himself. The one­ rare that I never saw a case as a student. legged maildriver, who developed osteo­ And poliomyelitis; we had many cases. myelitis in the femur of his good leg. The sheep herder with tuberculous pleurisy. If "Then a new multimillion dollar RCAF he'd had shells for his gun, he would have base began abuilding right on our door­ been a suicide before I reached him. step. We became a boom town. Our old cottage hospital was simply unable to cope "There were numerous aching teeth­ with the tide of patients. A new one was some dillies! A big Norwegian arrived one on the way. There were innumberable day with a horrible toothache. He was an items on which the matron and I had to enormous man. I had to about crawl up on make decisions. Then the move from the his lap to get hold of that tooth. old hospital to the new one, without break­ "And the sawmill man with the tremen­ ing step in admitting new patients. This dous laugh and no front teeth. Smith had sort of thing is another course not provid­ gone deaf in one ear. Sure enough, it was ed to student doctors. Presently, another plugged soHd with wax and dirt. I had no doctor arrived in the area, and now, there syringe with me, so we rigged one up, and are three. Medicine became for me a less went to work on that ear. FinaJly, the a lone and lonely responsibility. plug loosened and out it came. Smith "For thirty-three years I have played a could hear! He let out a roar, the syringe dual role. I went to the Peace River as a went spinning across the room. He gave medical missionary. Through these years, me a slap on the back that nearly knocked my vocation has been medicine; my avoca­ me down. 'Ye're a man after me own tion, church work. A doctor's business is heart', he shouted. to know and treat disease and human ills Now of course, cases like this are very of every sort. But the horizon of that effort routine. The thing that makes them mem­ has widened so rapidly, it leaves me breath­ orable is that they occurred on the frontier less and frustrated. But my avocation open­ and had to be handled in frontier fashion . ed for me new avenues of resource, where­ And that is not always orthodox practice. in the frustrations have faded. Now it's not treating only disease, but people. Liv­ "The years rolled along. During the ing among them, understanding them, Second World War, we moved to Cold sharing their struggling, finding in them Lake-in the northeastern part of Alberta. qualities of priceless worth. Pills and pow­ We were still 20 miles from Edmonton, ders and the thrust of the knife are right the nearest large medical centre. Here was and good and mighty in our armamentar­ a small mission outpost hospital, and here ium. But a handclasp, a word, a prayer, sprang up a whole host of new problems. sometimes does more than them all." The first week, there was a man very ill with Tularemia from mink bite. Then we -. Paul Newell, '66

Duodenal Ulcer is not a local disease. It is a local manifestation of a constitutional fault. There is no medici treatment for a duodenal 11lcer: there is no surgical treatment for a dudenal ulcer. There is, however, a management of a patient who suffers from a duodmal ulcer which will combine the highest in the scimce and art of both physician and surgeon. Roscoe R. Graham, M.B., U.W.O. Med. ]., 16: 166, 1946.

78 U.W.O. MEDICAL JOURNAL Book Review

FRINGE MEDICINE. By Brian Inglis, Modern drug therapy is criticized, be­ 4o doth, 288 pp, with Index. London: cause of the frequency of toxic side effects Faber and Faber, 1964, $4.40. of new drugs, supposedly employed with­ out sufficient support from evaluation by This recent book deals with many of the proper clinical trails. This may be a valid subjects discussed in this number of the criticism, but of the therapist, not of the Journal. The author is an English magazine drug. The best methods available would columnist who attempts to present the view not have predicted the Thalidomide trag­ point of an interested and intelligent lay­ edy. The author contends that the efficacy man. Fringe medicine is described as those of new drugs is often due to a powerful "theories" or practices not taught in any placebo effect in both the doctor and the standard medical cirriculum, but practiced patient. This is more difficult to refute, by laymen and some qualified doctors. It and the placebo effects of a new drug or depends on the "vis medacatrix naturae" treatment is always considerable, especially of Hippocrates, a life force which is to be after it has been published in the popular elicited from the patient to hasten his press. recuperation. The practices under discussion, forming From doubtful evidence such as this, the the main part of the book include those thesis is developed that the British public, concerned with the body: Naturopathy, in the past 10 years, has become critical of Herbalism, Homeopathy, Osteopathy, Chir­ orthodox medicine and has begun to look opractic and Acupuncture; those of the at Fringe medicine. mind: Yoga, Psychotherapy ,Hypnotherapy and Auto-Suggestion; those of the spirit: To illustrate the authors approach, Brit­ Christian Science, Faith Healing and Rad­ ish Medical Association Committee of in­ iesthesia. The history and "status" of these vestigation in 1924 even went so far as to is described in Britain, in biased but pro­ report that "no more convincing explana­ vocative and entertaining terms. tion of the reality of the phenomena could reasonably be desired" from the quasi The author is very critical of modern electrical "black box" devised by Albert orthodox medicine in Britain. He admits Abrams, a San Francisco neurologist. The its success in controlling the major infec­ gadget was used for diagnosis and treat­ tious diseases, but he castigates it for doing ment. "Magic", you may say, "and I don't so little against the rheumatic diseases, believe in magic". "Well", replies Mr. cancer, atherosclerosis and the neuroses--a Inglis, "do you accept water divining and fair criticism, but the false implication is ESP? They exist too, you know." made, that scientific medicine has no hope of treating these successfully in the future. Despite all this, it is a very readable He believes that research grants tend to go book, intended to be taken seriously, but only to orthodox established organizations not critical enough to succeed from a scien­ which then proceed, according to Parkin­ tific point of view. There is however a son's Law, to find projects to investigate. useful six page bibliography. To anyone In fact, such funds for medical research interested in the articles of this Journal are almost everywhere meagre in the face issue, it will make good reading. of the problems to be tackled. It would be a good point if it were true, but there is Books Received no evidence that it is true, actually just the The receipt of the following books is opposite. acknowledged. The books that appear to

JANUARY, 1965 79 be of particular interest wi ll be reviewed Pathophysiology of Peptic Ulcer. Editor as space permits. Stanley C. Skoryna, M .D., M.Sc., Ph.D. (Bioi.), F.A.C.S., Director and Associate Function of the Human Body. By Arthur Professor Gastro-Intestinal Research Lab­ C. Guyton, M.D., professor and chairman oratory, Department of Experimental Sur­ of the Department of Physiology and Bio­ gery, McGill University, Montreal, Canada. physics, University of Mississippi School of Result of Second World Congress of Gas­ Medicine. Second Edition. 4° cloth, 7 + troenterology. 4o cloth, 22 + 497 pp. no 417 + 18 pp. with many illustrations. Phila­ index, with many illustrations. Montreal: delphia: W. B. Saunders Company, 1964. McGill University Press, 1963. 20.00. $8.40. Available in Canada through Mc­ Ainsh & Co. Ltd. of Toronto and Van­ pH and DiJJociation: A Learning Program couver. for Str1dents of the Biological and Medical Scimces. By Halvor N . Christensen, Ph.D., Clinical Neurology. By Lord Brain, D.M., Professor of Biological Chemistry and F.R.C.P. (Lon d.) , Consulting Neurologist Chairman of the Department, The Univer­ to the London Hospital and Consulting sity of Michigan. Second Edition. 4o paper, Physician to the Maida Vale Hospital fo r 9+ 107 pp. Philadelphia: W . B. Saunders Nervous Diseases. Second Edition. 4° cloth, Company, 1964. 9+ 384+ 16 pp. with 69 photographs. N ew York, London, Toronto: Oxford University Press, 1964. $6.85.

The sigm and symptoms of peripheral vasc11lar disease may be varied br1t the chief ones are as follotvs: Discoloration, coldt7eJJ of the part, paraesthesia, perhaps loJJ of ftmctiotl, and pain. Pain may be continuous or come only after exercise. Rest pain, botvever, has an rmfavourable progosis. Dr. F. S. Brien, U.W.O. Med. J., 18 : 147, 1948.

Ju conclusion, in the differential diagnosis of jaundice isolated laboratory findings are of little val11e and 11S11ally not concl11sive tvithout clinical data. A careful history and physical examination, coupled tvith a period of observation dr1ring tvhich simple tests are serially repeated, tvill usually lead to the correct diagnosis. F. S. Brien, M.B., U.W.O. Med J., 18 : 31, 1948.

80 U.W.O. MEDICAL JOURNAL I ought not to pronounce judgment on a fellow creature until I know all that enters into his life; until I can measure all the forces of temptation and resistance; until I can give full weight to all the facts in the case. In other words, I am never in a postion to judge another. William W . Mabie

In cirrhosis of the liver, treatment should be directed toward the prevention of decompensation. In this connection a diet rich in carbohydrates probably is important, with restriction of fluids, meats, extractives and condiments. Alcohol should be avoided. Leonard G. Rowntree, M.D., U.W.O. Med J. 1: 109, 1931.

Compliments o{

VI~TOBIA HOSPITAL

.C... J.,.

J ANUARY, 1965 81 UNIVERSITY OF WESTERN ONTARIO MEDICAL JOURNAL

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