causes small amounts of bleeding from the gastric mucosa. ASA-induced occult gastric or gastrointestinal bleeding is usually a local effect resulting from contact of ASA particles, or of the saturated solution of ASA surrounding these particles, with the mucosa.8 Gastroscopic examination has disclosed hemorrhagic erosions immediately adjacent to undissolved ASA tablets.9 To alleviate this undesirable side effect, various forms of buffered, coated or soluble ASA and ASA substitutes have been marketed, but the "plain tablet" dosage form continues to be the most popular. It is therefore imperative that physicians who prescribe ASA or ASA-contaming tablets, and pharmacists who dispense them, give patients the following simple instructions to minimize the occult gastrointestinal bleeding: 1. The tablets may be chewed and swallowed with an adequate amount of water. 2. The tablets may be crushed to a fine powder and the powder taken as a suspension in orange juice. 3. When chewing or crushing is not possible, the tablets should be taken with a large amount of water so as to help dissolve the crystals and prevent the formation of a saturated solution in the stomach. 4. Tablets taken with warm water are better and faster absorbed than those taken with cold water. P.L. MADAN, PH D Associate professor of pharmaceutics St. John's University Jamaica, NY
References 1. Lais. ER, BANWELL JG: Products containing aspirin. N Engi J Med 291: 710, 1974 2. DRESER H: Pharmakologisches uber Aspirin (Acetylsalicylsaure). Pfluegers Arch Gesamte Physiol 76: 306, 1899 3. wOHLGEMUT J: Uber Aspirin (Acetylsalicylsaure). Ther Monatsh (Halbmonatsh) 13: 276, 1899 4. WITrHAUER K: Aspirin, em neues Salicylprepart. Ibid. p 330
men of urine assayed for estrogen and 1 7-ketosteroid content. In each, the ketosteroid value was within the normal range for males, while the estrogen content was within, or close to, the normal range for females. I suggest that in cases of impotence this test may be of value before referral to a psychiatrist. J.C. EDWARDS, SM, S CH Community Health Center
3765 Sherwood Dr. Regina, SK
Sudden death in infants
To the editor: The editorial "Sudden death in infants" (Can Med Assoc J 113: 809, 1975) raised the troublesome question whether this was intended to be a comprehensive article pointing out the more significant theories of sudden infant death syndrome (SIDS), which have been put forward in recent months. Gunther's theory of an immunologic mechanism for SIDS was discussed in 19701 and the evidence supporting this theory was seriously questioned then. Gunther's latest paper2 does not present any new statistical evidence to support her theory, which one would expect to have been obtained in the intervening 5 years. It remains a hypothetical issue, especially in view of several studies that argue against such a theory.34 The important recent advances in the study of neural control of cardiorespiratory function and the physiologic aspects of infant sleep are merely alluded to by the references to the case report of Salk, Grellong and Dietrich.7 Yet these studies8'9 constitute one of the most important advances in SIDS research. I hope this letter will serve to place the current theories of SIDS in a more reasonable perspective. i.E. SMIALEK, MD Project codirector Wayne County S.I.D.S. Center 400 East Lafayette St. Detroit, Ml 48226
5. LANGE HF: Salicylates and gastric hemorrhage. I. Occult bleeding. Gastroenterology
33: 770, 1957 6. Scorr JT, PORTER IH, Lawss SM, et al: Studies on gastrointestinal bleeding caused by corticosteroids, salicylates, and analgesics. Q J Med 30: 167, 1961 7. CUDDSGAN JHP, SWEETLAND C, Cs.ovr DN: Assessment of drug-induced occult bleeding. Rheumatol Phys Med 11: 36, 1971
8. LEONARD JR, LEVY G: Biopharmaceutical aspects of aspirin-induced gastrointestinal blood
loss in man. J Pharm Sci 58: 1277, 1969 9. waiss HJ: Aspirin - dangerous drug? JAMA 229: 1221, 1974
References I. GUNTHER M: in Proceedings of the Sir Samuel Bedson Symposium, Cambridge, Engi, Apr 17, 1970, Dorchester, Engl, Dorset Pr, John Wright & Sons, pp 15-16 2. Idem: The neonate's immunity gap, breast feeding, and cot death. Lancet 1: 441, 1975
3. JOHNSTONE JW, LAWREY HS: Role of infection in cot death. Br Med J 1: 706, 1966
Estrogen and impotence To the editor: During my last 12 months of general practice I have had only three patients who complained of impotence. I had been taught that, in such patients, when no physical abnormalities were to be found, psychiatric referral was indicated. However, for these three I had a 24-hour speci-
4. GOLD E, ADELSON L, GOLDEK G: The role of antibody to cow's milk proteins in the sudden death syndrome. Pediatrics 33: 541
1964 5. COE 31, PETERSON RDA: Sudden unexpected death in infancy and milk sensitivity. J Lab Clin Med 62: 477, 1963 6. VALDES-DAPENA M, FILIPE RP: Immunofluorescent studies in crib deaths: absence of evidence of hypersensitivity to cow's milk. Am J Clin Pathol 56: 412, 1971 7. SALK L, GRELLONO BA, DiamicH J: Sudden
infant death: normal cardiac habituation and poor autonomic control. N Engi .1 Med 291: 219, 1974
8. McGINTY Di, HARPER RM: Sleep physiology and SIDS: animal and human studies, in
498 CMA JOURNAL/MARCH 20, 1976/VOL. 114
Proceedings of The Frances E. Camps national Symposium, Toronto, May 1974, Toronto, Can Foundation for of Infant Deaths, pp 201-29 9. STEINSCHNEIDER A: The concept of apnea as related to SIDS, ibid
Inter15-17, Study sleep
Rubella in Canada
To the editor: In the recent article by R.S. Faulkner and D.A. Gough entitled "Rubella 1974 and its aftermath, congenital rubella syndrome" (Can Med Assoc J 114: 115, 1976) the opening statement that "rubella was made a notifiable disease in Canada in 1969" is misleading. Rubella has been a notifiable disease in Canada since 1924, with the exception of the 10-year period 1959-68, during which only Alberta and Quebec maintained this system.1 Notification was reinstituted in 1969 in all the other provinces except British Columbia, which reintroduced the system in 1971, and Prince Edward Island, which has never recognized rubella as a notifiable disease. The epidemic variability of rubella in terms of interprovincial variation, longterm trends and seasonal variation has not been widely appreciated. FRANK wHITE, CM, M PAUL VARUGHESE, MD, B V SC, M Sc sc Bureau of epidemiology Laboratory Centre for Disease Control Health and welfare Canada Ottawa, ON
Reference 1. Rubella in Canada 1924-1974. Can Dis Wkly Rep 1: 61, 1975
Hazards in laboratories To the editor: From time to time it is devastating to learn that routine laboratory techniques and chemicals impose serious health hazards on both diagnostic and research personnel. Two recent pertinent examples can be cited. The first concerns the hazards from polychlorinated biphenyls in a variety of microscope immersion oils.1 Experiments have shown that these substances are toxic at much lower concentrations than was previously indicated and cause a variety of skin disorders. In addition to the immediate hazard to the user, there is growing concern regarding the ultimate disposal of the immersion oils containing these chemicals. The practice of rinsing microscope slides with solvents and subsequently disposing of the waste solution containing polychlorinated biphenyls in sewage may result in substantial amounts of these substances contaminating potable water supplies and ending up in the food chain. The other example concerns the use of gas chromatographs insulated with
(amoxicillin)
The new generation broad-spectrum penicillin INDICATIONS AND DOSAGE Infections of the ear, nose and throat due to streptococci, pneumococci, and penicillinsensitive staphylococci; infections of the upper respiratory tract due to H. influenzae; infections of the genitourinary tract due to E. coli, P. mirabilis, and S. faecalis; infections of the skin and soft tissues due to streptococci, penicillin-sensitive staphylococci and E. coil: USUAL DOSE: ADULTS 250 mg every 8 hours CHILDREN 25 mg/kg/day in divided doses every 8 hours In severe infections or infection associated with organisms where sensitivity determinations indicate higher blood levels may be advisable: 500 mg every 8 hours for adults, and 50 mg/kg/day in divided doses every 8 hours for children may be needed. This dosage should not exceed the recommended adult dosage. Infections of the lower respiratory tract due to streptococci, pneumococci, penicillinsensitive staphylococci and H. influenzae: USUAL DOSE: ADULTS 500 mg every 8 hours CHILDREN 50mg/kg/day in divided doses every 8 hours This dosage should not exceed the recommended adult dosage. Urethritis due to N. gonorrhoeae: 3 g as a single oral dose. CONTRAINDICATION In patients with a history of allergy to the penicillins and cephalosporins. Product Monograph available on request. SUPPLIED AMOXIL-250 Capsules-each contains 250 mg amoxicillin (as the trihydrate) AMOXIL-SQO Capsules-each contains 500 mg amoxicillin (as the trihydrate) AMOXIL-125 Suspension- 125 mg amoxicillin per 5 ml, in 75 ml & 100 ml bottles AMOXIL-250 Suspension-250 mg amoxicillin per 5 ml, in 75 ml & 100 ml bottles AMOXIL Pediatric Drops-is ml (50 mg/mI) in dropper bottle
Ayerst . AYERST LABORATORIES Division of Ayerst, Mokenna & Harrison Limited Montreal, Canada Made in Canada by arrangement with BEECHAM, INC. .Regd
-
asbestos.2 After temperature-programed operations, when the oven lid shuts forcefully, or during maintenance and repair procedures, visible amounts of asbestos dust can be observed. Moreover, the carcinogenic potential of such dust has been repeatedly demonstrated in animals.3 Thus, the daily use of gas chromatographs with asbestos-containing insulation may expose personnel to asbestos fibres and thus increase their risk for asbestos-related disease. It is not practical or feasible to predict the possible or potential health hazards of the countless techniques and chemicals used in research or diagnostic laboratories since many of the effects are manifested only after lengthy exposure. Nevertheless, some of the hazards could be minimized if more complete statistical studies were conducted on the incidence of cancer and teratologic and related disorders among laboratory workers. Such statistical information might then identify a reasonable number of health hazards before they are discovered by researchers by chance, as was the case with the excessive incidence of bladder cancer in beauticians.4 C.L.B. LAVELLE, D SC, MDS, PH D A.D. LANDMAN, PH D
Department of oral biology Faculty of dentistry University of Manitoba Winnipeg, MB
References 1. MoRRIsoN AB: Microscope immersion oils,
information letter no 456, Health and welfare Canada, health protection branch, 1976 2. WOLFF MS, LANOER AM, SHIREY SB: Gas chromatographs: health effects. Science 191: 339, 1976 3. Booovsscs P, TIMBRELL V, GsLsot. JC, et al:
Biological ejiects of asbestos, Lyon, Interna-
tional Agency for Research on Cancer-World Health Organization, 1973 4. MENKART J: Excess bladder cancer in beauticians. Science 190: 96, 1975
Problems of breast-feeding To the editor: I would like to comment on your editorial "Women physicians and breast-feeding" (Can Med Assoc J 114: 10, 1976). I was raised in a country where breast-feeding was natural and normal and I never heard of a husband feeling insecure because his wife was breastfeeding their baby. My advice to women married to immature husbands - still in their oral stage of personality development - is the following: give them a bottle with a nipple to suck while you are breastfeeding your baby. Later on, as you wean your baby you may also wean your husband from the bottle. However, it seems to me that the real problem today for Canadian mothers who want to breast-feed their babies lies elsewhere - in the necessity for working mothers to obtain part-time
jobs and the leave of absence necessary to give them the opportunity and the time to feed their babies at the breast. Besides, isn't breast-feeding the natural method of contraception? LolA MARIA ADAMKIEWICZ, MD
5507 C6te St. Antoine Montreal, PQ
The great imitator To the editor: The reference and information staff of this library has vainly attempted to find the source of the often-cited characterization of syphilis as "the great imitator". Thomas Parran, when surgeon general of the United States Public Health Service, attributed it to Sir William Osler. He stated: Sir William Osler called syphilis the "Great Imitator" because in its late stages it simulates almost every disease known to man. He added, "Know syphilis and the whole of medicine is opened unto you."' In an address given at the New York Academy of Medicine in 1897, entitled "Internal medicine as a vocation", Osler said: So, too, with syphilis, which after the first few weeks I claim as a medical affection. I often tell my students that it is the only disease which they require to study thoroughly. Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you.2 The text resembles Parran's quotation but nowhere in the address does Osler refer to the disease as "the great imitator". The staffs of the Osler Library at McGill University and the rare book room of the New York Academy of Medicine, after thorough searches, were unable to find evidence that Osler had used this phrase, nor could they attribute it to anyone else. Just before his sudden death we consulted Dr. Bruce Webster, professor emeritus of Cornell University Medical College and an acknowledged authority on venereal diseases. He also believed that Osler was the author but was not able to give us a specific reference in Osler's writings. We are now addressing a larger public to find an answer to the query posed to us. ERIcH MEYERHOFF
Librarian Samuel J. wood Library Cornell University Medical College 1300 York Ave. New York, NY 10021
References 1. PARRAN T: Shadow on the Land - Syphilis, New York, Reynal and Hitchcock, 1937, p 15 2. OSLER w: Aequanimitas, 3rd ed, Philadelphia, Blakiston, 1932, p 134
CMA JOURNAL/MARCH 20, 1976/VOL. 114
503
References 1. Lais. ER, BANWELL JG: Products containing aspirin. N Engi J Med 291: 710, 1974 2. DRESER H: Pharmakologisches uber Aspirin (Acetylsalicylsaure). Pfluegers Arch Gesamte Physiol 76: 306, 1899 3. wOHLGEMUT J: Uber Aspirin (Acetylsalicylsaure). Ther Monatsh (Halbmonatsh) 13: 276, 1899 4. WITrHAUER K: Aspirin, em neues Salicylprepart. Ibid. p 330
men of urine assayed for estrogen and 1 7-ketosteroid content. In each, the ketosteroid value was within the normal range for males, while the estrogen content was within, or close to, the normal range for females. I suggest that in cases of impotence this test may be of value before referral to a psychiatrist. J.C. EDWARDS, SM, S CH Community Health Center
3765 Sherwood Dr. Regina, SK
Sudden death in infants
To the editor: The editorial "Sudden death in infants" (Can Med Assoc J 113: 809, 1975) raised the troublesome question whether this was intended to be a comprehensive article pointing out the more significant theories of sudden infant death syndrome (SIDS), which have been put forward in recent months. Gunther's theory of an immunologic mechanism for SIDS was discussed in 19701 and the evidence supporting this theory was seriously questioned then. Gunther's latest paper2 does not present any new statistical evidence to support her theory, which one would expect to have been obtained in the intervening 5 years. It remains a hypothetical issue, especially in view of several studies that argue against such a theory.34 The important recent advances in the study of neural control of cardiorespiratory function and the physiologic aspects of infant sleep are merely alluded to by the references to the case report of Salk, Grellong and Dietrich.7 Yet these studies8'9 constitute one of the most important advances in SIDS research. I hope this letter will serve to place the current theories of SIDS in a more reasonable perspective. i.E. SMIALEK, MD Project codirector Wayne County S.I.D.S. Center 400 East Lafayette St. Detroit, Ml 48226
5. LANGE HF: Salicylates and gastric hemorrhage. I. Occult bleeding. Gastroenterology
33: 770, 1957 6. Scorr JT, PORTER IH, Lawss SM, et al: Studies on gastrointestinal bleeding caused by corticosteroids, salicylates, and analgesics. Q J Med 30: 167, 1961 7. CUDDSGAN JHP, SWEETLAND C, Cs.ovr DN: Assessment of drug-induced occult bleeding. Rheumatol Phys Med 11: 36, 1971
8. LEONARD JR, LEVY G: Biopharmaceutical aspects of aspirin-induced gastrointestinal blood
loss in man. J Pharm Sci 58: 1277, 1969 9. waiss HJ: Aspirin - dangerous drug? JAMA 229: 1221, 1974
References I. GUNTHER M: in Proceedings of the Sir Samuel Bedson Symposium, Cambridge, Engi, Apr 17, 1970, Dorchester, Engl, Dorset Pr, John Wright & Sons, pp 15-16 2. Idem: The neonate's immunity gap, breast feeding, and cot death. Lancet 1: 441, 1975
3. JOHNSTONE JW, LAWREY HS: Role of infection in cot death. Br Med J 1: 706, 1966
Estrogen and impotence To the editor: During my last 12 months of general practice I have had only three patients who complained of impotence. I had been taught that, in such patients, when no physical abnormalities were to be found, psychiatric referral was indicated. However, for these three I had a 24-hour speci-
4. GOLD E, ADELSON L, GOLDEK G: The role of antibody to cow's milk proteins in the sudden death syndrome. Pediatrics 33: 541
1964 5. COE 31, PETERSON RDA: Sudden unexpected death in infancy and milk sensitivity. J Lab Clin Med 62: 477, 1963 6. VALDES-DAPENA M, FILIPE RP: Immunofluorescent studies in crib deaths: absence of evidence of hypersensitivity to cow's milk. Am J Clin Pathol 56: 412, 1971 7. SALK L, GRELLONO BA, DiamicH J: Sudden
infant death: normal cardiac habituation and poor autonomic control. N Engi .1 Med 291: 219, 1974
8. McGINTY Di, HARPER RM: Sleep physiology and SIDS: animal and human studies, in
498 CMA JOURNAL/MARCH 20, 1976/VOL. 114
Proceedings of The Frances E. Camps national Symposium, Toronto, May 1974, Toronto, Can Foundation for of Infant Deaths, pp 201-29 9. STEINSCHNEIDER A: The concept of apnea as related to SIDS, ibid
Inter15-17, Study sleep
Rubella in Canada
To the editor: In the recent article by R.S. Faulkner and D.A. Gough entitled "Rubella 1974 and its aftermath, congenital rubella syndrome" (Can Med Assoc J 114: 115, 1976) the opening statement that "rubella was made a notifiable disease in Canada in 1969" is misleading. Rubella has been a notifiable disease in Canada since 1924, with the exception of the 10-year period 1959-68, during which only Alberta and Quebec maintained this system.1 Notification was reinstituted in 1969 in all the other provinces except British Columbia, which reintroduced the system in 1971, and Prince Edward Island, which has never recognized rubella as a notifiable disease. The epidemic variability of rubella in terms of interprovincial variation, longterm trends and seasonal variation has not been widely appreciated. FRANK wHITE, CM, M PAUL VARUGHESE, MD, B V SC, M Sc sc Bureau of epidemiology Laboratory Centre for Disease Control Health and welfare Canada Ottawa, ON
Reference 1. Rubella in Canada 1924-1974. Can Dis Wkly Rep 1: 61, 1975
Hazards in laboratories To the editor: From time to time it is devastating to learn that routine laboratory techniques and chemicals impose serious health hazards on both diagnostic and research personnel. Two recent pertinent examples can be cited. The first concerns the hazards from polychlorinated biphenyls in a variety of microscope immersion oils.1 Experiments have shown that these substances are toxic at much lower concentrations than was previously indicated and cause a variety of skin disorders. In addition to the immediate hazard to the user, there is growing concern regarding the ultimate disposal of the immersion oils containing these chemicals. The practice of rinsing microscope slides with solvents and subsequently disposing of the waste solution containing polychlorinated biphenyls in sewage may result in substantial amounts of these substances contaminating potable water supplies and ending up in the food chain. The other example concerns the use of gas chromatographs insulated with
(amoxicillin)
The new generation broad-spectrum penicillin INDICATIONS AND DOSAGE Infections of the ear, nose and throat due to streptococci, pneumococci, and penicillinsensitive staphylococci; infections of the upper respiratory tract due to H. influenzae; infections of the genitourinary tract due to E. coli, P. mirabilis, and S. faecalis; infections of the skin and soft tissues due to streptococci, penicillin-sensitive staphylococci and E. coil: USUAL DOSE: ADULTS 250 mg every 8 hours CHILDREN 25 mg/kg/day in divided doses every 8 hours In severe infections or infection associated with organisms where sensitivity determinations indicate higher blood levels may be advisable: 500 mg every 8 hours for adults, and 50 mg/kg/day in divided doses every 8 hours for children may be needed. This dosage should not exceed the recommended adult dosage. Infections of the lower respiratory tract due to streptococci, pneumococci, penicillinsensitive staphylococci and H. influenzae: USUAL DOSE: ADULTS 500 mg every 8 hours CHILDREN 50mg/kg/day in divided doses every 8 hours This dosage should not exceed the recommended adult dosage. Urethritis due to N. gonorrhoeae: 3 g as a single oral dose. CONTRAINDICATION In patients with a history of allergy to the penicillins and cephalosporins. Product Monograph available on request. SUPPLIED AMOXIL-250 Capsules-each contains 250 mg amoxicillin (as the trihydrate) AMOXIL-SQO Capsules-each contains 500 mg amoxicillin (as the trihydrate) AMOXIL-125 Suspension- 125 mg amoxicillin per 5 ml, in 75 ml & 100 ml bottles AMOXIL-250 Suspension-250 mg amoxicillin per 5 ml, in 75 ml & 100 ml bottles AMOXIL Pediatric Drops-is ml (50 mg/mI) in dropper bottle
Ayerst . AYERST LABORATORIES Division of Ayerst, Mokenna & Harrison Limited Montreal, Canada Made in Canada by arrangement with BEECHAM, INC. .Regd
-
asbestos.2 After temperature-programed operations, when the oven lid shuts forcefully, or during maintenance and repair procedures, visible amounts of asbestos dust can be observed. Moreover, the carcinogenic potential of such dust has been repeatedly demonstrated in animals.3 Thus, the daily use of gas chromatographs with asbestos-containing insulation may expose personnel to asbestos fibres and thus increase their risk for asbestos-related disease. It is not practical or feasible to predict the possible or potential health hazards of the countless techniques and chemicals used in research or diagnostic laboratories since many of the effects are manifested only after lengthy exposure. Nevertheless, some of the hazards could be minimized if more complete statistical studies were conducted on the incidence of cancer and teratologic and related disorders among laboratory workers. Such statistical information might then identify a reasonable number of health hazards before they are discovered by researchers by chance, as was the case with the excessive incidence of bladder cancer in beauticians.4 C.L.B. LAVELLE, D SC, MDS, PH D A.D. LANDMAN, PH D
Department of oral biology Faculty of dentistry University of Manitoba Winnipeg, MB
References 1. MoRRIsoN AB: Microscope immersion oils,
information letter no 456, Health and welfare Canada, health protection branch, 1976 2. WOLFF MS, LANOER AM, SHIREY SB: Gas chromatographs: health effects. Science 191: 339, 1976 3. Booovsscs P, TIMBRELL V, GsLsot. JC, et al:
Biological ejiects of asbestos, Lyon, Interna-
tional Agency for Research on Cancer-World Health Organization, 1973 4. MENKART J: Excess bladder cancer in beauticians. Science 190: 96, 1975
Problems of breast-feeding To the editor: I would like to comment on your editorial "Women physicians and breast-feeding" (Can Med Assoc J 114: 10, 1976). I was raised in a country where breast-feeding was natural and normal and I never heard of a husband feeling insecure because his wife was breastfeeding their baby. My advice to women married to immature husbands - still in their oral stage of personality development - is the following: give them a bottle with a nipple to suck while you are breastfeeding your baby. Later on, as you wean your baby you may also wean your husband from the bottle. However, it seems to me that the real problem today for Canadian mothers who want to breast-feed their babies lies elsewhere - in the necessity for working mothers to obtain part-time
jobs and the leave of absence necessary to give them the opportunity and the time to feed their babies at the breast. Besides, isn't breast-feeding the natural method of contraception? LolA MARIA ADAMKIEWICZ, MD
5507 C6te St. Antoine Montreal, PQ
The great imitator To the editor: The reference and information staff of this library has vainly attempted to find the source of the often-cited characterization of syphilis as "the great imitator". Thomas Parran, when surgeon general of the United States Public Health Service, attributed it to Sir William Osler. He stated: Sir William Osler called syphilis the "Great Imitator" because in its late stages it simulates almost every disease known to man. He added, "Know syphilis and the whole of medicine is opened unto you."' In an address given at the New York Academy of Medicine in 1897, entitled "Internal medicine as a vocation", Osler said: So, too, with syphilis, which after the first few weeks I claim as a medical affection. I often tell my students that it is the only disease which they require to study thoroughly. Know syphilis in all its manifestations and relations, and all other things clinical will be added unto you.2 The text resembles Parran's quotation but nowhere in the address does Osler refer to the disease as "the great imitator". The staffs of the Osler Library at McGill University and the rare book room of the New York Academy of Medicine, after thorough searches, were unable to find evidence that Osler had used this phrase, nor could they attribute it to anyone else. Just before his sudden death we consulted Dr. Bruce Webster, professor emeritus of Cornell University Medical College and an acknowledged authority on venereal diseases. He also believed that Osler was the author but was not able to give us a specific reference in Osler's writings. We are now addressing a larger public to find an answer to the query posed to us. ERIcH MEYERHOFF
Librarian Samuel J. wood Library Cornell University Medical College 1300 York Ave. New York, NY 10021
References 1. PARRAN T: Shadow on the Land - Syphilis, New York, Reynal and Hitchcock, 1937, p 15 2. OSLER w: Aequanimitas, 3rd ed, Philadelphia, Blakiston, 1932, p 134
CMA JOURNAL/MARCH 20, 1976/VOL. 114
503
