dissecting aneurysm of the hepatic artery. Arch intern Med 13: 471. 1974 3. MANLEY G: Histology of aortic media in dissecting aneurysms. .F Clin Pathol 17: 220, 1964 4. LAYMAN TE, WANG Y: Idiopathic cystic medionecrosis and aneurysmal dilatation of the ascending aorta. Med Clin North Am

52: 1145, 1968

5. Osasuansor'i





Postgrad Med 49: 132, 1971

Chronic otitis media in Indian children To the editor: Otitis media is a very common problem among Indian children in western Canada. Numerous studies have been carried out investigating diet, hygiene, treatment and public health problems on reserves. No conclusions have been drawn, but poor sanitation, lack of cleanliness and poor dietary habits have been incriminated. Until recently my treatment of Indian and M6tis patients with chronic otitis media has been unsuccessful, whether local, system or operative. Antibiotics are of some benefit in early acute otitis media, but in my experience they are of no value for the chronically infected, draining ear, which will start and stop draining in its own good time with or without antibiotics. In fact, the condition is often made worse by antibiotics. Such procedures as local mopping, drying, insufflation of powders and cortisone theiapy, with or without neosporin (polymyxin B-neomycinmethoxamine hydrochloride), make the parent happy and the physician more comfortable. However, these forms of treatment do not improve the patient's condition, as the following case shows. A baby. boy was born, with my assistance, in September 1961. There were no delivery problems and he appeared normal. The mother had received no prenatal care, which was usual at that time. He was one of five children. The parents both stated that the boy had had "running ears" at least once a month since infancy. He had been hospitalized with measles, bronchopneumonia and a draining right ear in July 1963. In May 1964 he was treated in a nursing home for left segmental pneumonia and left otitis media with antibiotics and ear toilet. In January 1968 he was treated in hospital for postauricular abscess and chronic discharging right otitis media by lancing, penicillin therapy and ear toilet. In March 1968 I performed tonsillectomy and adenoidectomy. (In those days I thought chronic otitis media and large tonsils were an absolute indication for this operation. My views have changed considerably since, and I now believe recurrent quinsy is the only indication for tonsillectomy. He was treated in the nursing home for acute and chronic left otitis media and infected sores all &ver his head in July 1970, for chronic otitis media and externa in January 1971, and for left postauricular abscess and infected sores all over the scalp in August 1971. I did not see him again until April

1974, when he had a stinking discharge from the lelt ear. The right drum was thickened and dull, but there was no perforation or discharge. There was some bilateral hearing loss. The mother stated that discharge had been occurring periodically but she had never consulted another physician for any treatment. At this time I started giving immunizing doses of a bacterial vaccine concentrate, as described by Dr. K.A. Baird.1 Baird used Staphlo-Strepto Serobacterin Vaccine (Merck, Sharp & Dohme), containing 8000 million organisms per millilitre, which is no longer on the market. Hollister-Stier makes a preparation containing 5000 million organisms, including Staphylococcus albus and aureus, Streptococcus pyogenes, viridans and faecalis, Diplococcus pneumoniae, Hemophilus in! luenzae, Kiebsiella pneumoniae, Neisseria ca,tarrhalis, Escherichia coli and Pseudomonas. Ideally the material is injected subcutaneously twice a week during the 16-week build-up penod, then once each week or two until the dose is 5 ml; the patient then comes in once every 4 to 6 weeks. In this patient I started injections of 0.2 ml on Apr. 1 and by Apr. 14 was giving 0.4 ml; the left ear was then draining slightly. By Apr. 26 I was giving 0.8 ml and the left ear was nearly dry. By May 24 the dose was 1.5 ml and the ear was dry. On June 7, I gave 2 ml; on July 15, 4 ml; and on Aug. 20, 6 ml; then I gave 5 ml each month through September 1974 and subsequent doses in

January, February, April and June 1975 - that is, about every 6 weeks: The boy complained of some localized soreness and fatigue for 2 days after the injection, but is able to go to school. Baird treated acute otitis media by this method, and the chronic state seen so frequently in this province did not develop in his patients.1 (It is not uncommon to see a baby on a check-up at 6 weeks of age with a running ear and the mother will say it started at about 2 weeks of age.) The dose required varies, as do the patients. Overdose symptoms are chills, fever, a flulike syndrome and extensive redness and swelling about the injection site. If the next dose is reduced and there is no reaction the overdose can be tried again; most often it will be tolerated well. This method of treating chronic otitis media could easily be studied under controlled conditions on an Indian reservation. The health nurse and Indian health workers could give the injections after the diagnosis has been established. If the treatment was given on the reserve the follow-up injections and record-keeping would be managed better than is now possible. Frequently the patient gets one or two injections and

.0 A





*A -








0* 0*S.







CMA JOURNAL/JANUARY 24, 1976/VOL. 114 111

SEPTRA (Trimethoprim + Suifamethoxazole)

* sequentially blocks two different bacterial enzymes (both vital for bacterial survival) * double blockade activity discourages development of resistance * achieves rapid, high blood levels; significant levels in lung tissue and sputum * well tolerated by most patients * convenient b.i.d. tablet dosage * licorice-flavored suspension well accepted by children .SEPTRA f.(Summary INDICATIONS AND CLINICAL USES: Indicated for the following infections when caused hy susceptihie organisms: URINARY TRACT INFECTIONS - acute, recurrent and chronic. GENITAL TRACT INFECTIONS - uncomplicated gonococcal uret hrif is. UPPER AND LOWER RESPIRATORY TRACT INFECTIONS particularty chronic hronchitis and acute and chronic otitis media. GASTROINTESTINAL TRACT INFECTIONS. SKIN AND SOFT TISSUE INFECTIONS. SEPTRA is not indicated in infections caused hy Pseudomonas, Mycoplasma or viruses.This drug has not yet heen fully evaluated in streptococcal infections. CONTRAINDICATIONS: Patients with evidence of marked liver parenchymal damage, hloud dyscrasias, known hypersensitivity to frimethoprim or sulfonamides, marked renal impairment where repeated serum assays cannot he carried out: premature or newhorn hahies during the first few weeks of life. For the time heing SEPIRA is contraindicated during pregnancy. If pregnancy cannot he encluded, the possihle risks should he halanced against the enpected therapeutic effect. PRECAUTIONS: As with other sulfonamide preparations, critical appraisal of henefit versus risk should he made in patients with liver damage, renal damage, urinary ohstruct ion, hloud dyscrasias, allergies or hronchial asthma. The possihility of a superinfection with a non-sensitive organism should he home in mind. DOSAGE AND ADMINISTRATION: Adults and children over 12 years. Standard dosage: Two tahiets twice daily (morning and evening). Minimum dosage and dosage for long-term treatment: One tahlet twice daily. Mavimum dosage: Overwhelming infections: Three tahlets twice daily. Uncomplicated gonorrhea: Two tahlets four times daily for two days. Children 12 years and under. Young children should receive a dose according to hiological age: Children under2 years: 2.5 ml pediatric suspension twice daily. Children 2 to 5 years: One to two pediatric tahlets or 2.5 to 5 ml pediatric suspension twice daily. Children 6 to 12 years: Two to four pediatric tahiets or 5 to 10 ml pediatric suspension or one adult tahlet twice daily. In children this corresponds to an approvimate dose of 6 mg trimethoprim/kg hody weight/day, plus 30 mg sulfamethonazole/kg hody weight/day, divided into two equal doses. DOSAGE FORMS: SEPTRA TABLETS, each containing 80 mg trimethoprim and 400 mg sulfamethonazole, and coded WELLCOME Y2B. Bottles of 100 and 500, and unit dose packs of 100. SEPTRA PEOIATRIC SUSPENSION, each teaspoonful (5 ml) containing 40 mg trimethoprim and 200 mg sulfamethovazole. Bottles of 100 and 400 ml. SEPTRA PEDIATRIC TABLETS, each containing 20 mg trimethoprim and 100 mg sulfamethonazole, and coded WELLCOME H4B. Bottles of 100. Product monograph availahle on request

. Burroughs Weilcome Ltd. L. LaSalle, Que. .Trade Mark


you do not see him again for months. I have fl.W treated several patients, with a s.2cess rate never before achieved. Should this method prove successful in other hands, it would be possible to reduce the morbidity and the social stigma of otitis media. It would also minimize hospital care and surgery.

a combination of vitamin B12 and trifluoperazine is effective when there is an unsatisfactory response to the vitami. alone. R. DENSON, M Sc, MD, CM, FRCP[C]

MacNeill Clinic 912 Idyiwyld Dr. Saskatoon, SK



Prince Albert, SK

Reference 1. BAIRD KA: The Human Body and Bacteria, Riverside, NJ, Bruce, 1968

Vitamin B12 in late-onset psychosis of childhood To the editor: I have recently found vitamin W2 to be effective in treating children with late-onset psychosis. An 11 year-old girl, referred because of inability to get along with her peers, which had led to expulsion from a Girl Guides camp, showed typical features of lateonset psychosis.1 She had heard voices calling her name in the basement of her home and had attributed them to "somebody playing tricks" on her. She claimed that other children were preparing to attack her and saying "bad things" behind her back. On passing a total stranger in the street she asserted that she knew from his facial expression that he hated her. At home she was irritable, moody and uncooperative. She read the same fairy stories repeatedly and her drawing of a human figure was that of a queen in crown and robes. Her academic record was excellent and her intelligence quotient was 145 on the Peabody Picture Vocabulary Test. Because she refused to take any medication apart from vitamins, I prescribed vitamin B12 in an easily ingested form, not expecting that it would influence the psychosis. The plan was to substitute trifluoperazine when the habit of taking drugs twice daily had been established. On follow-up, after she had taken crystalline vitamin B12 (Redisol), 75 .g bid for 4 weeks, the delusions and hallucinations had ceased. Her mother described the results of treatment as "amazing" and said "It's like having a different child in the house. I used to dread her coming in but now it's a happy home." This striking improvement has been maintained for more than 12 months and vitamin B12, 75 to 125 .tg bid, is the only medication that has been administered. When the drug has been discontinued or the dosage much reduced, the parents have observed that the patient becomes moody and irritable within a few days. Patients with late-onset psychosis usually respond to long-term treatment with phenothiazines, but since vitamin B12 produces no side effects or toxic reactions a trial of this drug for 2 or 3 weeks is recommended. Recent experience with other patients suggests that

1. KoLVIN I: Studies in the childhood psychoses - diagnostic criteria and classifications. Br J Psychiatry 118: 381, 1971

CMA archives To the editor: The editorial "CMA Archives" by A.W. Andison, curator of archives (Can Med Assoc J 113: 602, 1975), is an excellent summary of certain activities of the regional subcommittee of past presidents in the field of archives and history. As Dr. Andison points out, the CMA collection of volumes on Canadian medical history should be much more comprehensive than it is, and it is my purpose to emphasize his plea for donations to fill the yawning gaps. It is quite possible that on the bookshelves of readers of the Journal are dusty volumes relating to the medical history of this country and its regions, many of them written by Canadian physicians. Out of print or otherwise unobtainable, these books would be welcome additions to the archives. To illustrate, we require such classics as "Aequanimitas and Other Essays", "Life of William Osler" by Harvey Cushing, "Notes pour servir . l'histoire de la m6decine dans le Bas-Canada depuis la fondation de Quebec jusqu'au commencement du XIXe si.cle" by Michael Joseph Ahern, "History of the Montreal Clinical Society" by Mordecai Etziony, "A History of the medical profession of the county of Ontario" by Thomas Kaiser, "The scalpel and the sword: the story of Dr. Norman Bethune" by Ted Allan, "Henry Norman Bethune" by Roderick Stewart, and "Wilfred Grenfell; his life and work" by J. Lennox Kerr. The above list is by no means comprehensive, and it should be clear that the appeal does not relate to your old textbooks on anatomy or physiology but to historical works with significant Canadian content. Also, it is not our desire to accumulate duplicate volumes. Enquiries and offers should be addressed to Dr. A.W. Andison, CMA House, P0 Box 8650, Ottawa, ON KiG 0G8. Such a worthy cause might even persuade me to part with a few treasures. A.D. KELLY, MB Honorary secretary

CMA committee on archives

CMA JOURNAL/JANUARY 24, 1976/VOL. 114 113

Letter: Chronic otitis media in Indian children.

dissecting aneurysm of the hepatic artery. Arch intern Med 13: 471. 1974 3. MANLEY G: Histology of aortic media in dissecting aneurysms. .F Clin Patho...
721KB Sizes 0 Downloads 0 Views