Synalar Available in a wide range of presentations: Synalar Cream Moist or weeping lesions Synalar Ointment Dry, scaly lesions Synalar Solution Intertriginous or hairy sites Neo-Synalar Cream Synaform Infected dermatoses Synalar Bi-Otic Otitis extema
A classic topical corticosteroid The standani of effectiveness for ten years Abridged Prescribing Information Indications: for topical use in management of corticosteroid responsive dermatoses. Contraindications: tuberculous, fungal and most viral lesions of the skin individuals with a history of hypersensitivity to the components. Not for ophthalmic use. Precautions: should sensitivity occur, the agent should be discontinued. In the presence of infection, the use of an appropriate antifungal or antibacterial agent should be instituted. In pregnant patients, topical steroids should not be used extensively, in large amounts, or for extended periods of time. Prolonged use of Neo-Synalar Cream may result in overgrowth of susceptibleorganisms; if so, appropriate therapy should be instituted. Dosage: apply sparingly to affected areas two or three times a day. Presentation: Synalar Regular (fluocinolone acetonide 0.025%)-15g and 45g tubes and 425g jars of cream and ointment. Synalar Mild (fluocinolone acetonide 0.01%)-20g and 60g tubes of cream and ointment. Synalar H.P. (fluocinolone acetonide 0.2%)-5g tubes of cream. Neo-Synalar (fluocinolone acetonide 0.025% and neomycin sulfate 0.5% equivalent to neomycin base 0.35%) -15g and 45g tubes and 425g jars of cream. Synaform (fluocinolone acetonide 0.025% and iodochlorhydroxyquin 3%) -15g and 45g tubes. Synalar Solution (fluocinolone acetonide 0.01%)-20m1 and 60m1 bottles. Synalar Bi-Otic (fluocinolone acetonide 0.025%, neomycin sulfate 5.Omg/mlequivalent to 3.5mg/ml of neomycin base and polymyxin B sulfate, 10,000 units/ml)-5m1 bottles with dropper. . Syntex Ltd. 5Yr.i.Montreal, Quebec
group that should have special attention. If a personal note will be excused, my brother and I both have professional and personal reasons for an interest in this matter. He is the radiologist who observed the skin cancer in the male patient and the breast cancer in the female x-ray technician. My own work has been in the field of preventive medicine and research in tuberculosis, as well as in medical education. We have had two sisters who had pulmonary tuberculosis, one in the mid-1920s and the other 10 years later. Both had pneumothorax treatment that extended over several years. One is a 5-year survivor of a radical mastectomy for mammary cancer, but has just had the other breast removed. The other died 2 years ago after mastectomy and radiation therapy, which produced an excessively severe skin reaction. C. B. STEWART, MD
Vice-president, health sciences Daihousie University Halifax, NS
Alternative to abortion To the editor: It has been suggested that artificial contraception and acceptable family planning are alternatives to abortion. However, contraception and abortion are in the same package you can't buy one without the other. The promotion of contraception inevitably leads to the promotion of abortion. One evil (abortion) cannot be replaced by another, albeit lesser, evil (contraception). One must replace evil with good. I believe that if I do not respect the sex act in which the creation of life is involved, I will not respect the consequence of this act - new life. The alternative to abortion is selfmanagement; this means sex control and not birth control. KEVIN CX TOAL, MB, B CH
St. Albert, Alta.
Unwanted pregnancies To the editor: The contributions on unwanted pregnancies in the November 16 issue of the Journal are instructive. If the papers had been circulated among the authors before publication perhaps they would have rewritten them. Dr. Grauer states that his study provides good evidence that a previous abortion does not motivate patients to adopt a more effective method of birth control. The only evidence presented comes from 25 women who had more than one abortion - an inadequate sample for his generalization. Dr. Grauer also states: "It seems that once we commit ourselves to perform-
ing abortions for psychiatric reasons we must be prepared to repeat this procedure when conception again occurs." Since he does not tell us what proportion of first abortions are performed for psychiatric reasons we are left to wonder how he reaches this conclusion. G. W. PIPER, MB, BS
Director and medical health officer Saskatoon Rural Health Region 516-2nd Ave. N. Saskatoon, Sask.
To the editor: I must agree that our sample of 25 repeaters was small and that possibly my conclusion was too broad. Yet these were the only cases available to us over a 3½-year period at the hospital. Since 3 women had 3 abortions there was a total of 28 repeated abortions. It seemed significant to me that in this group, despite the fact that in each case, after her initial and subsequent abortion, the woman was given instruction about more effective means of contraception, the use of contraceptive measures did not change. All the abortions, both in the control group and in the index group, were performed for psychiatric reasons. Initially abortions were undertaken because of psychiatric disorders. Since a high percentage of the women who had repeat abortions had primary psychiatric illness and did not undergo psychiatric treatment, the psychiatric illness that prompted their initial abortion was still present when they presented themselves for subsequent abortions. One therefore has no choice but to repeat the procedure. H. GRAumI, MD 4333 C6te Ste-Catherine Rd. Montalal, Qu6.
To the editor: In his article "A study of contraception as related to multiple unwanted pregnancies" (Can Med AsSoc J 111: 1083, 1974) Dr. H. Grauer states: "This study provides good evidence that a previous abortion does not motivate patients to adcpt a more effective method of birth control." The study does not provide such evidence because it is a retrospective study for which the study group was selected on the basis of multiple abortions. To demonstrate that premise, a prospective study of patients having abortions would be required with follow-up over several years to determine subsequent use of contraception. Dr. Grauer' s study only provides evidence that women who have repeated abortions did not use effective contraception rather circular reasoning, it seems to me. In the article "Applications for abortion at a community hospital" (Can Med Assoc J 111: 1088, 1974) Dr.
GMA JOURNAL/JANUARY 25, 1975/VOL. 112 145
-me
Tin modifier of digestive behaviour
Classification: MAXERAN5 (metoclopramide monohyd rochioride) is a modifier of upper gastrointestinal tract motility. Indications: Sub-acute gastritis, chronic gastritis, gastriG sequellae of surgical procedures such as vagotomy and pyloroplasty. Under these conditions, when gastric emptying is delayed, Maxeran may relieve such symptoms as nausea, vomiting, epigastric distress, bloating, etc. Small bowel ,ntubation: Maxeran may facilitate and accelerate small bowel intubation. Side-effects: Drowsiness and, more rarely, insomnia, fatigue, headaches, dizziness and bowel disturbances have been reported. Parkinsonism and other extra-pyramidal syndromes have been reported infrequently. An increase in the frequency and severity of seizures has been reported in conjunction with the administration of Maxeran to epileptic patients. Precautions: Drugs with atropine-like action should not be used simultaneously with Maxeran since they have a tendency to antagonize effect of this drug on gastrointestinal motility. Maxeran should not be used in conjunction with potent ganglioplegic or neuroleptic drugs since potentiation of effects might occur. Maxeran should not be used in patients with epilepsy and extrapyramidal syndromes, unless its expected benefits outweigh the risk of aggravating these symptoms. In view of the risk of extrapyramidal manifestations, metoclopramide should not be used in children unless a clear indication has been established. The recommended dosage of Maxeran should not be exceeded since a further increase in dosage will not produce a corresponding increase in the clinical response. The dosage recommended for children should not be exceeded. Contraindications: Maxeran should not be administered to patients in combination with MAO inhibitors, tricyclic antidepressants, sympathomimetics and fcods with high tyramine content, since safety of such an association has not yet been established. As a safety measure, a twoweek period should elapse between using Maxeran and administration of any of these drugs. The safety of use of Maxeran in pregnancy has not been established. Therefore Maxeran should not be used in pregnant women, unless in the opinion of the physician the expected benefits to the patient outweigh the potential risks to the fetus. Dosage and administration: For delayed gastric emptying Adults
Tablets:
'/2 to 1 tablet (5 - 10 mg) three or four times a day before meals. 5-10m1(5-lOmg)threeorfour
Liquid: Injectable:
Children:
Liquid:
times a day before meals. When parenteral administration is required, 1 ampoule (10 mg) IM. or IV. (slowly) to be repeated 2 or 3 times a day if necessary. (5 to 14 years):
2.StoSml(2.5-Smg)
For small bowel intubation: Adults: One ampoule (10 mg) l.V. - 15
minutes before intubetion. Other
routes (oral or IM.) may be used but with a greater period of latency. (5 to 14 years):
Children:
2.StoSml(2.5-Smg) Availability: Tablets: Each white scored compressed tablet
contains 10 mg of Meto.lopramide Monohydrochloride. Bottles of 50 & 500 tablets. Each ml contains 1 mg of Metoclo-
Liquid:
Injectable:
pramide Monohydrochloride. Available in bottles of 110 ml and 450 ml. Each 2 ml ampoule contains 10 mg of Metoclopramide Monohydrochloride in a clear colourless solution. Keep away from light and heat.
Available in boxes of 5 and 50 ampoules.
Product monograph available upon request.
gjf.JORDIC Biochemicals Ltd. Laval, Que.
Canada
Marlene Hunter states that "it seems unreasonable and, in the author's opinion, irresponsible to continue an active sexual life without attempting to ensure that pregnancy will not occur" if pregnancy is not desired. I wonder what is Dr. Hunter's opinion of physicians who have their patients discontinue their oral contraceptives for a few months every 2 or 3 years to re-establish their cycles - an unnecessary practice, in my opinion - but do not ensure that these women have an adequate replacement method of contraception. If such a woman, used to relying on effective contraception, becomes pregnant during her "rest period", who is irresponsible, the patient or her physician? Lou E. MASON, MD
Women's College Hospital Toronto, Ont.
The physician and Canadian law To the editor: In his review of the book "The Physician and Canadian Law" (Can Med Assoc 1 111: 1279, 1974), Dr. T. L. Fisher has weighed the evidence and, as one might expect from someone of his experience and position, has acted as a fair and impartial judge of its content. But when he begins to pass sentence on the book's syntax his wig is decidedly askew. In noting, for example, that "twice in the book 'transpires' is - to quote the 'Shorter Oxford English Dictionary - 'misused for: to occur, happen'" and that "these are the kind of things that... are annoying", Dr. Fisher lays himself open not only to the charge of misinterpreting the laws of language, but to that of negligence in using it. My dictionary, published by Random House, offers as its first definition of transpire "to occur, happen", while acknowledging that many (including, one assumes, Dr. Fisher) regard this definition as "incorrect or vulgar". The "Oxford English Dictionary", on the other hand, dismisses Dr. Fisher's "these kind of things" as being "grammatically incorrect" and Fowler's "Modem English Usage" rates the expression a "sturdy indefensible". For the defence, M'Lud, I merely point out that a reviewer, especially one well versed in the law, should not use faulty evidence to make his case in this instance, that the book is "annoying" to read. When he does it more than once (and Dr. Fisher also appears to be unaware that "practice" can be spelled that way even as a verb) maybe it's time to call for a retrial. DAVID Wooos
Medical Communication Services 8849 Roosevelt Ave. Niagara Falls, Ont.
More on the cold war To the editor: As the name implies, the common cold is probably the most frequently seen entity in a physician's office. But I daresay our knowledge of this condition has very little in common with the treatment it receives. By way of review, "common respiratory disease" includes the common cold, grippe, acute bronchitis and tracheobronchitis. There are over 200 antigenically different causative agents known and rhinovirus alone has 30 serologic types. This certainly explains the frequent recurrences. According to Conn's "Current Therapy", 1974 edition, the treatment is symptomatic, and antibiotics should be used only to prevent secondary infection in patients with low pulmonary and cardiac reserves, and to treat complicating secondary infections when they occur; secondary bacterial invasions are uncommon and the routine use of antibiotics should be avoided. However, there are probably more antibiotics prescribed for the upper respiratory infection than for any other disease entity! And we all know that the number of symptomatic remedies for it is almost limitless; the common cold has generated a multimillion dollar pharmaceutical industry! In a survey I conducted at one of our university health services, staffed by conscientious physicians, 24 out of 33 different visits for upper respiratory infections resulted in treatment with antibiotics - 13 with penicillin and 11 with tetracycline! How common this is in a busy general practitioner's office can only be guessed, but 50% would be a conservative estimate. What are we actually propagating with this kind of therapy? The drug industry, for one thing. We are also exposing patients to drugs to which most of their illnesses won't respond. These people become susceptible to all the potential side effects and idiosyncratic reactions of the antibiotic family. Physicians are promoting return visits for a self-limiting disease to give patients a prescription that is in most cases valueless and possibly harmful. Certainly there is a good case to be made for giving some kind of treatment to please the patient as well as the physician. This may take the form of information about the problem, vitamin C, 4 to 6 g/d (which has been shown to have some effect on the severity and duration of symptoms), inquiry into dietary habits and emotional circumstances, especially in cases that have been lingering for more than a week, and finally, simple symptomatic relief if not a ripe old woollen sock. If this letter encourages just a few physicians to rethink their treatment
CMA JOURNAL/JANUARY 25, 1975/VOL. 112 147
A classic topical corticosteroid The standani of effectiveness for ten years Abridged Prescribing Information Indications: for topical use in management of corticosteroid responsive dermatoses. Contraindications: tuberculous, fungal and most viral lesions of the skin individuals with a history of hypersensitivity to the components. Not for ophthalmic use. Precautions: should sensitivity occur, the agent should be discontinued. In the presence of infection, the use of an appropriate antifungal or antibacterial agent should be instituted. In pregnant patients, topical steroids should not be used extensively, in large amounts, or for extended periods of time. Prolonged use of Neo-Synalar Cream may result in overgrowth of susceptibleorganisms; if so, appropriate therapy should be instituted. Dosage: apply sparingly to affected areas two or three times a day. Presentation: Synalar Regular (fluocinolone acetonide 0.025%)-15g and 45g tubes and 425g jars of cream and ointment. Synalar Mild (fluocinolone acetonide 0.01%)-20g and 60g tubes of cream and ointment. Synalar H.P. (fluocinolone acetonide 0.2%)-5g tubes of cream. Neo-Synalar (fluocinolone acetonide 0.025% and neomycin sulfate 0.5% equivalent to neomycin base 0.35%) -15g and 45g tubes and 425g jars of cream. Synaform (fluocinolone acetonide 0.025% and iodochlorhydroxyquin 3%) -15g and 45g tubes. Synalar Solution (fluocinolone acetonide 0.01%)-20m1 and 60m1 bottles. Synalar Bi-Otic (fluocinolone acetonide 0.025%, neomycin sulfate 5.Omg/mlequivalent to 3.5mg/ml of neomycin base and polymyxin B sulfate, 10,000 units/ml)-5m1 bottles with dropper. . Syntex Ltd. 5Yr.i.Montreal, Quebec
group that should have special attention. If a personal note will be excused, my brother and I both have professional and personal reasons for an interest in this matter. He is the radiologist who observed the skin cancer in the male patient and the breast cancer in the female x-ray technician. My own work has been in the field of preventive medicine and research in tuberculosis, as well as in medical education. We have had two sisters who had pulmonary tuberculosis, one in the mid-1920s and the other 10 years later. Both had pneumothorax treatment that extended over several years. One is a 5-year survivor of a radical mastectomy for mammary cancer, but has just had the other breast removed. The other died 2 years ago after mastectomy and radiation therapy, which produced an excessively severe skin reaction. C. B. STEWART, MD
Vice-president, health sciences Daihousie University Halifax, NS
Alternative to abortion To the editor: It has been suggested that artificial contraception and acceptable family planning are alternatives to abortion. However, contraception and abortion are in the same package you can't buy one without the other. The promotion of contraception inevitably leads to the promotion of abortion. One evil (abortion) cannot be replaced by another, albeit lesser, evil (contraception). One must replace evil with good. I believe that if I do not respect the sex act in which the creation of life is involved, I will not respect the consequence of this act - new life. The alternative to abortion is selfmanagement; this means sex control and not birth control. KEVIN CX TOAL, MB, B CH
St. Albert, Alta.
Unwanted pregnancies To the editor: The contributions on unwanted pregnancies in the November 16 issue of the Journal are instructive. If the papers had been circulated among the authors before publication perhaps they would have rewritten them. Dr. Grauer states that his study provides good evidence that a previous abortion does not motivate patients to adopt a more effective method of birth control. The only evidence presented comes from 25 women who had more than one abortion - an inadequate sample for his generalization. Dr. Grauer also states: "It seems that once we commit ourselves to perform-
ing abortions for psychiatric reasons we must be prepared to repeat this procedure when conception again occurs." Since he does not tell us what proportion of first abortions are performed for psychiatric reasons we are left to wonder how he reaches this conclusion. G. W. PIPER, MB, BS
Director and medical health officer Saskatoon Rural Health Region 516-2nd Ave. N. Saskatoon, Sask.
To the editor: I must agree that our sample of 25 repeaters was small and that possibly my conclusion was too broad. Yet these were the only cases available to us over a 3½-year period at the hospital. Since 3 women had 3 abortions there was a total of 28 repeated abortions. It seemed significant to me that in this group, despite the fact that in each case, after her initial and subsequent abortion, the woman was given instruction about more effective means of contraception, the use of contraceptive measures did not change. All the abortions, both in the control group and in the index group, were performed for psychiatric reasons. Initially abortions were undertaken because of psychiatric disorders. Since a high percentage of the women who had repeat abortions had primary psychiatric illness and did not undergo psychiatric treatment, the psychiatric illness that prompted their initial abortion was still present when they presented themselves for subsequent abortions. One therefore has no choice but to repeat the procedure. H. GRAumI, MD 4333 C6te Ste-Catherine Rd. Montalal, Qu6.
To the editor: In his article "A study of contraception as related to multiple unwanted pregnancies" (Can Med AsSoc J 111: 1083, 1974) Dr. H. Grauer states: "This study provides good evidence that a previous abortion does not motivate patients to adcpt a more effective method of birth control." The study does not provide such evidence because it is a retrospective study for which the study group was selected on the basis of multiple abortions. To demonstrate that premise, a prospective study of patients having abortions would be required with follow-up over several years to determine subsequent use of contraception. Dr. Grauer' s study only provides evidence that women who have repeated abortions did not use effective contraception rather circular reasoning, it seems to me. In the article "Applications for abortion at a community hospital" (Can Med Assoc J 111: 1088, 1974) Dr.
GMA JOURNAL/JANUARY 25, 1975/VOL. 112 145
-me
Tin modifier of digestive behaviour
Classification: MAXERAN5 (metoclopramide monohyd rochioride) is a modifier of upper gastrointestinal tract motility. Indications: Sub-acute gastritis, chronic gastritis, gastriG sequellae of surgical procedures such as vagotomy and pyloroplasty. Under these conditions, when gastric emptying is delayed, Maxeran may relieve such symptoms as nausea, vomiting, epigastric distress, bloating, etc. Small bowel ,ntubation: Maxeran may facilitate and accelerate small bowel intubation. Side-effects: Drowsiness and, more rarely, insomnia, fatigue, headaches, dizziness and bowel disturbances have been reported. Parkinsonism and other extra-pyramidal syndromes have been reported infrequently. An increase in the frequency and severity of seizures has been reported in conjunction with the administration of Maxeran to epileptic patients. Precautions: Drugs with atropine-like action should not be used simultaneously with Maxeran since they have a tendency to antagonize effect of this drug on gastrointestinal motility. Maxeran should not be used in conjunction with potent ganglioplegic or neuroleptic drugs since potentiation of effects might occur. Maxeran should not be used in patients with epilepsy and extrapyramidal syndromes, unless its expected benefits outweigh the risk of aggravating these symptoms. In view of the risk of extrapyramidal manifestations, metoclopramide should not be used in children unless a clear indication has been established. The recommended dosage of Maxeran should not be exceeded since a further increase in dosage will not produce a corresponding increase in the clinical response. The dosage recommended for children should not be exceeded. Contraindications: Maxeran should not be administered to patients in combination with MAO inhibitors, tricyclic antidepressants, sympathomimetics and fcods with high tyramine content, since safety of such an association has not yet been established. As a safety measure, a twoweek period should elapse between using Maxeran and administration of any of these drugs. The safety of use of Maxeran in pregnancy has not been established. Therefore Maxeran should not be used in pregnant women, unless in the opinion of the physician the expected benefits to the patient outweigh the potential risks to the fetus. Dosage and administration: For delayed gastric emptying Adults
Tablets:
'/2 to 1 tablet (5 - 10 mg) three or four times a day before meals. 5-10m1(5-lOmg)threeorfour
Liquid: Injectable:
Children:
Liquid:
times a day before meals. When parenteral administration is required, 1 ampoule (10 mg) IM. or IV. (slowly) to be repeated 2 or 3 times a day if necessary. (5 to 14 years):
2.StoSml(2.5-Smg)
For small bowel intubation: Adults: One ampoule (10 mg) l.V. - 15
minutes before intubetion. Other
routes (oral or IM.) may be used but with a greater period of latency. (5 to 14 years):
Children:
2.StoSml(2.5-Smg) Availability: Tablets: Each white scored compressed tablet
contains 10 mg of Meto.lopramide Monohydrochloride. Bottles of 50 & 500 tablets. Each ml contains 1 mg of Metoclo-
Liquid:
Injectable:
pramide Monohydrochloride. Available in bottles of 110 ml and 450 ml. Each 2 ml ampoule contains 10 mg of Metoclopramide Monohydrochloride in a clear colourless solution. Keep away from light and heat.
Available in boxes of 5 and 50 ampoules.
Product monograph available upon request.
gjf.JORDIC Biochemicals Ltd. Laval, Que.
Canada
Marlene Hunter states that "it seems unreasonable and, in the author's opinion, irresponsible to continue an active sexual life without attempting to ensure that pregnancy will not occur" if pregnancy is not desired. I wonder what is Dr. Hunter's opinion of physicians who have their patients discontinue their oral contraceptives for a few months every 2 or 3 years to re-establish their cycles - an unnecessary practice, in my opinion - but do not ensure that these women have an adequate replacement method of contraception. If such a woman, used to relying on effective contraception, becomes pregnant during her "rest period", who is irresponsible, the patient or her physician? Lou E. MASON, MD
Women's College Hospital Toronto, Ont.
The physician and Canadian law To the editor: In his review of the book "The Physician and Canadian Law" (Can Med Assoc 1 111: 1279, 1974), Dr. T. L. Fisher has weighed the evidence and, as one might expect from someone of his experience and position, has acted as a fair and impartial judge of its content. But when he begins to pass sentence on the book's syntax his wig is decidedly askew. In noting, for example, that "twice in the book 'transpires' is - to quote the 'Shorter Oxford English Dictionary - 'misused for: to occur, happen'" and that "these are the kind of things that... are annoying", Dr. Fisher lays himself open not only to the charge of misinterpreting the laws of language, but to that of negligence in using it. My dictionary, published by Random House, offers as its first definition of transpire "to occur, happen", while acknowledging that many (including, one assumes, Dr. Fisher) regard this definition as "incorrect or vulgar". The "Oxford English Dictionary", on the other hand, dismisses Dr. Fisher's "these kind of things" as being "grammatically incorrect" and Fowler's "Modem English Usage" rates the expression a "sturdy indefensible". For the defence, M'Lud, I merely point out that a reviewer, especially one well versed in the law, should not use faulty evidence to make his case in this instance, that the book is "annoying" to read. When he does it more than once (and Dr. Fisher also appears to be unaware that "practice" can be spelled that way even as a verb) maybe it's time to call for a retrial. DAVID Wooos
Medical Communication Services 8849 Roosevelt Ave. Niagara Falls, Ont.
More on the cold war To the editor: As the name implies, the common cold is probably the most frequently seen entity in a physician's office. But I daresay our knowledge of this condition has very little in common with the treatment it receives. By way of review, "common respiratory disease" includes the common cold, grippe, acute bronchitis and tracheobronchitis. There are over 200 antigenically different causative agents known and rhinovirus alone has 30 serologic types. This certainly explains the frequent recurrences. According to Conn's "Current Therapy", 1974 edition, the treatment is symptomatic, and antibiotics should be used only to prevent secondary infection in patients with low pulmonary and cardiac reserves, and to treat complicating secondary infections when they occur; secondary bacterial invasions are uncommon and the routine use of antibiotics should be avoided. However, there are probably more antibiotics prescribed for the upper respiratory infection than for any other disease entity! And we all know that the number of symptomatic remedies for it is almost limitless; the common cold has generated a multimillion dollar pharmaceutical industry! In a survey I conducted at one of our university health services, staffed by conscientious physicians, 24 out of 33 different visits for upper respiratory infections resulted in treatment with antibiotics - 13 with penicillin and 11 with tetracycline! How common this is in a busy general practitioner's office can only be guessed, but 50% would be a conservative estimate. What are we actually propagating with this kind of therapy? The drug industry, for one thing. We are also exposing patients to drugs to which most of their illnesses won't respond. These people become susceptible to all the potential side effects and idiosyncratic reactions of the antibiotic family. Physicians are promoting return visits for a self-limiting disease to give patients a prescription that is in most cases valueless and possibly harmful. Certainly there is a good case to be made for giving some kind of treatment to please the patient as well as the physician. This may take the form of information about the problem, vitamin C, 4 to 6 g/d (which has been shown to have some effect on the severity and duration of symptoms), inquiry into dietary habits and emotional circumstances, especially in cases that have been lingering for more than a week, and finally, simple symptomatic relief if not a ripe old woollen sock. If this letter encourages just a few physicians to rethink their treatment
CMA JOURNAL/JANUARY 25, 1975/VOL. 112 147
