Genetic hazards from the environment To the editor: I would like to emphasize two points in the report (Can Med Assoc J 112: 1460, 1975) on the recent international symposium "Genetic hazards to man from environmental agents", cosponsored with the Genetics Society of Canada and the International Association of Environmental Mutagen Societies by the health protection branch of Health and Welfare Canada. The two objectives of the symposium are mentioned. The first was to promote a scientific exchange that would help to create a basis for scientific decision; the second, of equal importance, was to promote public awareness in the area of genetic and mutational hazards. It is the belief of this department that these objectives are inseparable: the need for scientists to inform one another goes hand in hand with the essential need for the public to be informed of these hazards. Only in this way can a collective informed opinion be developed on the risks society is willing to incur in payment for chemical benefits. As with other health hazards the health protection branch will continue to play a role in educating the public, but the task is too important to be left to a single agency. It is also noted in the report that the theme of the symposium was consistent with the philosophy expressed in the minister of health's 1974 working paper entitled "A New Perspective on the Health of Canadians". We believe that this symposium illustrates very well the value of the "New Perspective" philosophy. In this instance there is a complex genetic interaction of chemical and physical agents that pose direct health hazards, together with lifestyles oriented around the use of these agents, and societal, especially economic, forces that promote more widespread use of more numerous agents. This branch is concerned that scientists and the public become well informed in all areas of growing importance, including genetics and genetic disease. A.B. MORRISON, PH D
Assistant deputy minister Health protection branch Health and Welfare Canada Ottawa, ON
Interpretation of PPD skin test To the editor: I would like to caution readers against a faulty interpretation of the data presented in our paper "Interpretation of the PPD skin test in BCG-vaccinated children" (Can Med Assoc J 113: 127, 1975). I recently received a letter in which the author suggested that our results
(loss of skin reactivity 1 year following BCG vaccination at birth) and our case reports (pulmonary tuberculosis in two of three BCG-vaccinated children) clearly meant a lack of effectiveness of the vaccine. I thought that our discussion of the results would prevent such a misinterpretation. I would first like to mention that the patients described in the case reports do not belong to any of the PPD test groups. These two children were surprisingly well despite their disease. We have not ourselves tested in prospective studies the degree of protection afforded by BCG vaccination at birth. In retrospect, those whom we see at Sainte-Justine Hospital with pulmonary tuberculosis or even tuberculous meningitis despite BCG vaccination at birth have no record of a postvaccination PPD test that would prove that they had converted and that the vaccination had been successful. The protective efficacy of BCG at birth in prospective studies1'2 is 75 to 89%. In infants born of tuberculous mothers BCG is also very effective.3 Our findings can only help in the interpretation of the PPD test after BCG vaccination and cannot in any way be used to evaluate the efficacy of BCG vaccination. JEAN H. JONCAS, MD
Institut de microbiologie et d'hygiene de Montreal Ville de Laval, PQ
References 1. ROSENTHAL SR: Standardization and efficacy of BCG vaccination against tuberculosis. JAMA 157: 801, 1955 2. Idem: BCG vaccination against tuberculosis, 1st ed, London, Churchill, 1957 3. KENDIG EL: BCG vaccine in management of infants born of tuberculous mothers. N Engi J Med 281: 520, 1969
Muscular dystrophy in Hutterites
To the editor: The letter "Unusual type of muscular dystrophy" by Shokeir and Kobrinsky (Can Med Assoc J 113: 179, 1975), drawing attention to a slowly progressive type of muscular dystrophy affecting 11 members of a Hutterite family, reminded me of an epidemiologic study of mental illness among the Hutterites in which I participated in 1950-51.. As of Dec. 31, 1950 there were 8542 persons living in the Hutterite colonies in South Dakota, Montana, Alberta and Manitoba. This population was divided into three separate, self-contained clans, the members of which rarely intermarried. There were only 15 family names among all the Hutterites in 1951. The historical background of the Hutterites is alluded to by Shokeir and Kobrinsky. It may be relevant to their report to mention a few census data.
816 CMA JOURNAL/NOVEMBER 8, 1975/VOL. 113
New Tofranil-SD tablets of 75mg and 150mg one dose lasts from bedtime to bedtime
Brief Prescribing information Tofranhi® Geigy Antidepressant/Anti-Enuretic indications 1 Depression: Neurotic or psychotic depressions including: reactive depression, endogenous depression, involutional melancholia, senile depression, the depressive phase of manic-depressive psychosis, depression associated with organic diseases, depression associated with other psychiatric disorders (i.e.: schizophrenia, alcoholism, mental deficiency) 2 Persistent functional childhood enuresis Dosage The following dosage recommendations should be used as a guide. Depression Except in elderly patients, adolescents or children: one tablet (25 mg) three times daily initially, increased up to six tablets daily, if necessary. Dosage in excess of eight tablets (200 mg) daily is not recommended for office patients. More severe and hospitalized cases may require up to 300 mg daily. In elderly patients and adolescents: 30-40 mg daily, initially, increased by 10 mg daily to a maximum of 100 mg in the elderly. In suitable subjects, the maintenance dose may be administered in a single dose before bedtime. Enuresis For persistent, functional enuresis which has not responded to other forms ot management, a therapeutic trial with Tofranil may be considered for children between 5 and 15 years old, who are not mentally defective, and in whom organic causes of enuresis have been excluded. The recommended dosage for such a trial is 10-25 mg one hour before bedtime for children 5 years or over. tf there is no response, the dosage may be increased up to 50 mg, in children 12-15 years old. The trial period should be 2-4 weeks. If there is a relapse, the treatment can be repeated but the drug should not be given for more than two months without discontinuing its administration and assessing the need for further drug therapy. Because the margin of safety is lower in children, the recommended dose should not be exceeded and the minimum effective dose should be used at all times. Tofranil is not otherwise recommended in children. Contraindlcations Concurrent use of monoamine oxidase inhibitors is an absolute contraindication. Two weeks should elapse before Tofranil is prescribed for patients who have received MAQI drugs. Precautions Utmost caution is recommended when Tofranil is used in patients with corc,nary thrombosis, angina pectoris, congestive heart failure, disorders of cardiac rate or rhythm or conduction, prostatic disorders with potential urinary retention, and glaucoma. If any patient develops fever, sore throat, and stomatitis, the drug should be discontinued and a complete differential white cell count performed. As with any drug, Tofranil should not be used during the first trimester of pregnancy unless in the opinion of the prescribing physician, the potential benefits outweigh the possible risks. Side effects Most are related to its anticholinergic action, such as, serostomia, disturbances of accommodation, tachycardia, constipation and sweating. Some cases of hypotension and changes in atrioventricular conduction time have been reported. Although rare, tremor, skin rashes and blood dyscrasias may occur. Avaiiabliity Each coral sugar-coated round tablet branded . in white, contains 25 mg imipramine ff01 Geigy Standard. In bottles of 100 and 1,000. Also supplied in 10 mg triangular and 50 mg round, coral sugar-coated tablets branded . in white. Available in bottles of 50 and 100. Also supplied in 75 mg and 150 mg round, coral, sugarcoated tablets branded . in white. Available in bottles of 30 and 500. Full information is available on request.
Geigy Dorval, Quebec H9S 1 Bi
o-tsai
Assistant deputy minister Health protection branch Health and Welfare Canada Ottawa, ON
Interpretation of PPD skin test To the editor: I would like to caution readers against a faulty interpretation of the data presented in our paper "Interpretation of the PPD skin test in BCG-vaccinated children" (Can Med Assoc J 113: 127, 1975). I recently received a letter in which the author suggested that our results
(loss of skin reactivity 1 year following BCG vaccination at birth) and our case reports (pulmonary tuberculosis in two of three BCG-vaccinated children) clearly meant a lack of effectiveness of the vaccine. I thought that our discussion of the results would prevent such a misinterpretation. I would first like to mention that the patients described in the case reports do not belong to any of the PPD test groups. These two children were surprisingly well despite their disease. We have not ourselves tested in prospective studies the degree of protection afforded by BCG vaccination at birth. In retrospect, those whom we see at Sainte-Justine Hospital with pulmonary tuberculosis or even tuberculous meningitis despite BCG vaccination at birth have no record of a postvaccination PPD test that would prove that they had converted and that the vaccination had been successful. The protective efficacy of BCG at birth in prospective studies1'2 is 75 to 89%. In infants born of tuberculous mothers BCG is also very effective.3 Our findings can only help in the interpretation of the PPD test after BCG vaccination and cannot in any way be used to evaluate the efficacy of BCG vaccination. JEAN H. JONCAS, MD
Institut de microbiologie et d'hygiene de Montreal Ville de Laval, PQ
References 1. ROSENTHAL SR: Standardization and efficacy of BCG vaccination against tuberculosis. JAMA 157: 801, 1955 2. Idem: BCG vaccination against tuberculosis, 1st ed, London, Churchill, 1957 3. KENDIG EL: BCG vaccine in management of infants born of tuberculous mothers. N Engi J Med 281: 520, 1969
Muscular dystrophy in Hutterites
To the editor: The letter "Unusual type of muscular dystrophy" by Shokeir and Kobrinsky (Can Med Assoc J 113: 179, 1975), drawing attention to a slowly progressive type of muscular dystrophy affecting 11 members of a Hutterite family, reminded me of an epidemiologic study of mental illness among the Hutterites in which I participated in 1950-51.. As of Dec. 31, 1950 there were 8542 persons living in the Hutterite colonies in South Dakota, Montana, Alberta and Manitoba. This population was divided into three separate, self-contained clans, the members of which rarely intermarried. There were only 15 family names among all the Hutterites in 1951. The historical background of the Hutterites is alluded to by Shokeir and Kobrinsky. It may be relevant to their report to mention a few census data.
816 CMA JOURNAL/NOVEMBER 8, 1975/VOL. 113
New Tofranil-SD tablets of 75mg and 150mg one dose lasts from bedtime to bedtime
Brief Prescribing information Tofranhi® Geigy Antidepressant/Anti-Enuretic indications 1 Depression: Neurotic or psychotic depressions including: reactive depression, endogenous depression, involutional melancholia, senile depression, the depressive phase of manic-depressive psychosis, depression associated with organic diseases, depression associated with other psychiatric disorders (i.e.: schizophrenia, alcoholism, mental deficiency) 2 Persistent functional childhood enuresis Dosage The following dosage recommendations should be used as a guide. Depression Except in elderly patients, adolescents or children: one tablet (25 mg) three times daily initially, increased up to six tablets daily, if necessary. Dosage in excess of eight tablets (200 mg) daily is not recommended for office patients. More severe and hospitalized cases may require up to 300 mg daily. In elderly patients and adolescents: 30-40 mg daily, initially, increased by 10 mg daily to a maximum of 100 mg in the elderly. In suitable subjects, the maintenance dose may be administered in a single dose before bedtime. Enuresis For persistent, functional enuresis which has not responded to other forms ot management, a therapeutic trial with Tofranil may be considered for children between 5 and 15 years old, who are not mentally defective, and in whom organic causes of enuresis have been excluded. The recommended dosage for such a trial is 10-25 mg one hour before bedtime for children 5 years or over. tf there is no response, the dosage may be increased up to 50 mg, in children 12-15 years old. The trial period should be 2-4 weeks. If there is a relapse, the treatment can be repeated but the drug should not be given for more than two months without discontinuing its administration and assessing the need for further drug therapy. Because the margin of safety is lower in children, the recommended dose should not be exceeded and the minimum effective dose should be used at all times. Tofranil is not otherwise recommended in children. Contraindlcations Concurrent use of monoamine oxidase inhibitors is an absolute contraindication. Two weeks should elapse before Tofranil is prescribed for patients who have received MAQI drugs. Precautions Utmost caution is recommended when Tofranil is used in patients with corc,nary thrombosis, angina pectoris, congestive heart failure, disorders of cardiac rate or rhythm or conduction, prostatic disorders with potential urinary retention, and glaucoma. If any patient develops fever, sore throat, and stomatitis, the drug should be discontinued and a complete differential white cell count performed. As with any drug, Tofranil should not be used during the first trimester of pregnancy unless in the opinion of the prescribing physician, the potential benefits outweigh the possible risks. Side effects Most are related to its anticholinergic action, such as, serostomia, disturbances of accommodation, tachycardia, constipation and sweating. Some cases of hypotension and changes in atrioventricular conduction time have been reported. Although rare, tremor, skin rashes and blood dyscrasias may occur. Avaiiabliity Each coral sugar-coated round tablet branded . in white, contains 25 mg imipramine ff01 Geigy Standard. In bottles of 100 and 1,000. Also supplied in 10 mg triangular and 50 mg round, coral sugar-coated tablets branded . in white. Available in bottles of 50 and 100. Also supplied in 75 mg and 150 mg round, coral, sugarcoated tablets branded . in white. Available in bottles of 30 and 500. Full information is available on request.
Geigy Dorval, Quebec H9S 1 Bi
o-tsai
