2. PETERS W: Current concepts in parasitology. Malaria. Ibid, p 1261 3. WILLIAMS
WE,
BEUTLER
E
(eds):
Hematology, McGraw, New York, 1972, pp 395, 1363 4. Chemoprophylaxis of malaria. Morb Mortal Wkly Rep 27 (suppi): 81, 1978 5. WESTERN KA, BENSON GD, GLEASON
NN, et al: Babesiosis in a Massachusetts resident. N Engl J Med 283: 854, 1970 6. ANDERSON AE, CASSADAY PB, HEALY
GR: Babesiosis in man. Sixth documented case. Am J Clin Pathol 62: 612, 1974 7. DESFORGES JF, QUIMBY F:
Babesia
abroad. N EngI J Med 295: 103, 1976 8. AMA Drug Evaluations, 3rd ed, Publishing Sci, Littleton, Mass, 1977, pp 839-49
Invitation to contribute to aspects of national immunization policy To the editor: The National Immunization Policy Committee extends an invitation to interested parties to submit written briefs for study and consideration. The committee, established by the Conference of Deputy Ministers of Health "to formulate and prepare national policies which will assure the effective and efficient development, production, supply and use of immunizing agents in the control and prevention of disease in Canada", has already met with some manufacturers representatives, certain learned societies and professional associations. It is possible that other interested groups may wish to comment on the issues under consideration; for example, security and continuity of supply; vaccine costs; the legal aspects associated with the development of new immunizing agents and the use of existing immu?Iizing agents; and uniform systems of keeping records of immunization. These comments should be in the form of written briefs and sent to the undersigned for distribution to committee members. Each submission will be acknowledged; should further discussions or meetings with representatives be deemed necessary, appropriate arrangements will be made. A.G. JESSAMINE, MB, CH B
Secretary, National Immunization Policy Committee Bureau of epidemiology Laboratory Centre for Disease Control Health and Welfare Canada Tunney's Pasture Ottawa, Ont. KiA 0L2
Health care for chronic alcohol abusers To the editor: I was recently quoted, in an article by J.M. Weiler, as saying that the two detoxification units at St. Paul's Hospital in Vancouver have "substantially reduced the number of alcohol abuse cases at the emergency department (Can Med Assoc 1 119: 633, 1978). Unfortunately, this conclusion was not verified by a recent sampling of our records. We are encountering as many, if not more, alcoholics than previously. There are many reasons why we have not seen the hoped-for decrease: Alcohol consumption is increasing. The volume of sales of liquor in British Columbia has doubled in about 6 years. There is an increasing tendency by alcoholics to use supportive services rather than to attempt spontaneous withdrawal. Not only do intoxicated patients have many illnesses, but also they are difficult to assess. Few police officers or workers in detoxification centres are able, or even willing, to take the responsibility for a potentially undiagnosed disorder. We at St. Paul's Hospital appreciate the capability of early discharge of patients to detoxification units. Without these centres we would encounter even more alcoholics than we do at present. However, their main function is rehabilitation; they are not equipped to provide 24-hour medical assessment and therapy.
conditions; it is known that the increase in the venous return to the chest, in addition to the external load produced by submersion, causes a decrease in vital capacity and an increase in the work of breathing by approximately 60% .1 Fascinating though these changes are, we will have learned nothing from this tragedy if we have failed to conclude that cold water can be a killer. The accounts of the incident by two of the surviving children (Toronto Sun, June 16, 1978, p 2) are classic descriptions of hypothermia. But gradually we could feel the sensation going out of our limbs. And we heard some of the boys starting to get paranoid about being in the water. Some started to talk nonsense... And then, one by one, their voices faded away as they lost consciousness. Our expedition leader told us to keep moving. But there was less and less power in my legs and my kicks got smaller and smaller. I guess it was about 15 minutes before I passed out.... After I came to I realized that a fire had been built. Hypothermia has been a significant factor in most drownings in Canada; even in the South Pacific the water can be cold enough to reduce body temperature substantially after a time. Education needs to be directed to the use of clothing that can reduce heat loss during submersion, and the public must be made aware of the risks of hypothermia. J.F. EDMONDS, MB, FRcP[cJ
Associate director Intensive care unit Hospital for Sick Children Toronto, Ont.
A.P. SCHOLTZ, MD
Chief emergency physician St. Paul's Hospital Vancouver, BC
Change in design of life preservers may save lives To the editor: In a recent letter Dr. Solomon Garb commented on the drownings of 12 students and an instructor in Lake Timiskaming (Can Med Assoc 1 119: 308, 1978). Dr. Garb wondered whether a change in the design of life jackets would save lives. He suggested that a horizontal position should be maintained, thus reducing the work of breathing when one is immersed to the neck in water. Considerable work has been carried out on lung volumes and the mechanics of respiration under these
132 CMA JOURNAL/JANUARY 20, 1979/VOL. 120
Reference 1. HONG 5K, CERRETELLI P, CRUZ JC,
et al: Mechanics of respiration during submersion in water. J App! Physic! 27: 535, 1969
Relation between the use of artificial sweeteners and bladder cancer [correction] In the letter to the editor on this topic (Can Med Assoc 1 119: 408, 1978) an oblique stroke was inadvertently omitted from the formula in the table. The footnote should read: - . (observed - expected)2! expected." - Ed.
WE,
BEUTLER
E
(eds):
Hematology, McGraw, New York, 1972, pp 395, 1363 4. Chemoprophylaxis of malaria. Morb Mortal Wkly Rep 27 (suppi): 81, 1978 5. WESTERN KA, BENSON GD, GLEASON
NN, et al: Babesiosis in a Massachusetts resident. N Engl J Med 283: 854, 1970 6. ANDERSON AE, CASSADAY PB, HEALY
GR: Babesiosis in man. Sixth documented case. Am J Clin Pathol 62: 612, 1974 7. DESFORGES JF, QUIMBY F:
Babesia
abroad. N EngI J Med 295: 103, 1976 8. AMA Drug Evaluations, 3rd ed, Publishing Sci, Littleton, Mass, 1977, pp 839-49
Invitation to contribute to aspects of national immunization policy To the editor: The National Immunization Policy Committee extends an invitation to interested parties to submit written briefs for study and consideration. The committee, established by the Conference of Deputy Ministers of Health "to formulate and prepare national policies which will assure the effective and efficient development, production, supply and use of immunizing agents in the control and prevention of disease in Canada", has already met with some manufacturers representatives, certain learned societies and professional associations. It is possible that other interested groups may wish to comment on the issues under consideration; for example, security and continuity of supply; vaccine costs; the legal aspects associated with the development of new immunizing agents and the use of existing immu?Iizing agents; and uniform systems of keeping records of immunization. These comments should be in the form of written briefs and sent to the undersigned for distribution to committee members. Each submission will be acknowledged; should further discussions or meetings with representatives be deemed necessary, appropriate arrangements will be made. A.G. JESSAMINE, MB, CH B
Secretary, National Immunization Policy Committee Bureau of epidemiology Laboratory Centre for Disease Control Health and Welfare Canada Tunney's Pasture Ottawa, Ont. KiA 0L2
Health care for chronic alcohol abusers To the editor: I was recently quoted, in an article by J.M. Weiler, as saying that the two detoxification units at St. Paul's Hospital in Vancouver have "substantially reduced the number of alcohol abuse cases at the emergency department (Can Med Assoc 1 119: 633, 1978). Unfortunately, this conclusion was not verified by a recent sampling of our records. We are encountering as many, if not more, alcoholics than previously. There are many reasons why we have not seen the hoped-for decrease: Alcohol consumption is increasing. The volume of sales of liquor in British Columbia has doubled in about 6 years. There is an increasing tendency by alcoholics to use supportive services rather than to attempt spontaneous withdrawal. Not only do intoxicated patients have many illnesses, but also they are difficult to assess. Few police officers or workers in detoxification centres are able, or even willing, to take the responsibility for a potentially undiagnosed disorder. We at St. Paul's Hospital appreciate the capability of early discharge of patients to detoxification units. Without these centres we would encounter even more alcoholics than we do at present. However, their main function is rehabilitation; they are not equipped to provide 24-hour medical assessment and therapy.
conditions; it is known that the increase in the venous return to the chest, in addition to the external load produced by submersion, causes a decrease in vital capacity and an increase in the work of breathing by approximately 60% .1 Fascinating though these changes are, we will have learned nothing from this tragedy if we have failed to conclude that cold water can be a killer. The accounts of the incident by two of the surviving children (Toronto Sun, June 16, 1978, p 2) are classic descriptions of hypothermia. But gradually we could feel the sensation going out of our limbs. And we heard some of the boys starting to get paranoid about being in the water. Some started to talk nonsense... And then, one by one, their voices faded away as they lost consciousness. Our expedition leader told us to keep moving. But there was less and less power in my legs and my kicks got smaller and smaller. I guess it was about 15 minutes before I passed out.... After I came to I realized that a fire had been built. Hypothermia has been a significant factor in most drownings in Canada; even in the South Pacific the water can be cold enough to reduce body temperature substantially after a time. Education needs to be directed to the use of clothing that can reduce heat loss during submersion, and the public must be made aware of the risks of hypothermia. J.F. EDMONDS, MB, FRcP[cJ
Associate director Intensive care unit Hospital for Sick Children Toronto, Ont.
A.P. SCHOLTZ, MD
Chief emergency physician St. Paul's Hospital Vancouver, BC
Change in design of life preservers may save lives To the editor: In a recent letter Dr. Solomon Garb commented on the drownings of 12 students and an instructor in Lake Timiskaming (Can Med Assoc 1 119: 308, 1978). Dr. Garb wondered whether a change in the design of life jackets would save lives. He suggested that a horizontal position should be maintained, thus reducing the work of breathing when one is immersed to the neck in water. Considerable work has been carried out on lung volumes and the mechanics of respiration under these
132 CMA JOURNAL/JANUARY 20, 1979/VOL. 120
Reference 1. HONG 5K, CERRETELLI P, CRUZ JC,
et al: Mechanics of respiration during submersion in water. J App! Physic! 27: 535, 1969
Relation between the use of artificial sweeteners and bladder cancer [correction] In the letter to the editor on this topic (Can Med Assoc 1 119: 408, 1978) an oblique stroke was inadvertently omitted from the formula in the table. The footnote should read: - . (observed - expected)2! expected." - Ed.
