Apparently, few ophthalmologists use the applanation tonometer, a far more accurate and sensitive instrument than the handheld Schiotz tonometer in measuring intraocular pressure, albeit far more expensive. Furthermore, it seems that in some cases mydriatics are administered during routine examination without subsequent administration of miotics. This is potentially an extremely risky procedure as it can precipitate acute angle-closure glaucoma in a patient with an undetected narrow iris! corneal angle. This is particularly so in patients taking corticosteroids, anticholinergics, phenothiazines or atropine-containing medicaments such as commonly used antidiarrheal emulsions, and in patients taking drugs that increase intraocular pressure. Routine use of mydriatics in patients over 40 years of age, and particularly those taking the drugs mentioned above, would seem to be contraindicated, and, in any case, should surely be preceded by gonioscopic visualization of the iris/corneal angle. Perhaps they should not be used at all unless the presence of retinal lesions or cataracts makes their administration diagnostically advisable. In conclusion, precipitation of acute angle-closure glaucoma is an ophthalmologic emergency that often requires immediate surgical intervention and frequently, despite all efforts, leads to blindness. It is surely time that clinics for mass screening for glaucoma were set up, much as mass roentgenography clinics were set up, and surely it is time that general practitioners employ routinely the Schiotz tonometer to measure intraocular pressure instead of leaving such a procedure in the hands of optometrists. P.C. WHITEHOUSE, BA, LL B, DL

P0 Box 822 London, Ont.

Child abuse by child abuse committees? To the editor: I write to raise a question through the Journal: is there abuse of power by child abuse committees? There is no doubt that children are abused, that this was sometimes

not recognized in the past, and that, when possible, it should be prevented. But there is no doubt either that the parent-child bond is unique, that it cannot be replaced fully by a foster parent, and that separation of child from parent, even for a short time and for the best of reasons, is to some extent damaging. For example, a 16-month-old boy is noted by his mother to have a painful shoulder; he is promptly taken to the local hospital, a fractured clavicle is detected, strapping is applied and the child returns home. A few days later a fever develops, the boy is taken to a children's hospital, is admitted and within a few days is better. However, his mother is not allowed to take him home. Investigation of the child's background shows that the parents were not married, though the mother's consort was registered as the father. They had separated 3 months after the child was born and the mother had obtained legal custody of the child and the right to child support payments. One of the reasons for the separation was violence by the father, which was witnessed by a neighbour; the police were called once. The father is bitter about the separation judgement and has shown that he means to reverse it if possible, thereby putting the child in the care of his sister. The mother is terrified because the hospital will not release the child to her now that he is well. The investigation of such a case, in which the question of child abuse may be raised maliciously and for ulterior motives, is entrusted in part to a social worker, who is zealous and devoted, of course, but who is perhaps not free from prejudice. The parents are forced to cooperate. The hospital may seem the only place to which they can entrust their child, and it is only later that the investigation becomes inquisitorial. The parents give permission, under some duress, for the release of all medical records, which may contain private information about their difficulties and quarrels that they never dreamed could be used against them; indeed, such information could only rarely be used in a truly legal procedure. What began as the medical care of their sick child has turned into a quasilegal

1448 CMA JOURNAL/DECEMBER 8, 1979/VOL. 121

enquiry into their right to continue to act as parents. In similar cases that have come to my attention, including those from the two children's hospitals in Montreal, the parents fell short of providing the ideal home. They were usually poor and not very skilful in asserting their legal rights. However, that they turned to me as an outsider showed that they cared. I ask on the one hand if other physicians outside the system are aware of similar abuses of power, and on the other hand for assurance from those inside the system that they are aware of the possibility of abuse and are doing their best to prevent it; I mean, of course, the abuse of parents and children by their own committees.

ELLIorr EMANUEL, MD 352 Dorval Ave., Ste. 201 Dorval, PQ

Preoperative electrocardiography: its cost-effectiveness in detecting abnormalities when a previous tracing exists [correction]

In the article by Drs. Simon W. Rabkin and John M. Home (Can Med Assocl 121: 301, 1979) a line of type was inadvertently omitted and replaced with another. The third sentence of the last paragraph should read (with the correct line in italics): "Had this protocol been applied to the study population 89.1% (147/165) of all patients with new abnormalities and 78.1% (25/32) of all patients with new relevant abnormalities would have been detected and the volume of preoperative tracings would have been reduced by 22.2% (Table VI)." We thank Dr. Rabkin for bringing this error to our attention. - Ed. Progressive loss of consciousness in a 78-year-old man with long-standing dyspnea [correction] Dr. W.K.C. Morgan has recently brought our attention to an error that appeared in the Sept. 22 issue of the Journal (121: 727, 1979). The last sentence in the caption for Fig. 3 should read (with the correction in italics): "Reprinted from Morgan and Seaton8 courtesy of W.B. Saunders Company. - Ed.

Child abuse by child abuse committees?

Apparently, few ophthalmologists use the applanation tonometer, a far more accurate and sensitive instrument than the handheld Schiotz tonometer in me...
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