CORRESPON DENCE
St. Patrick's Day disease To the editor: A 7-year-old boy was referred to me because he had asymptomatic hematuria. When I asked if there had been any change in the colour of his urine I was surprised to learn that it had been green one day. The boy had not taken any "medicines" containing such ingredients as methylene blue; however, he had consumed two "shamrock shakes" on the day of the incident. The milk shakes were coloured green for St. Patrick's Day and contained tartrazine and brilliant blue FCF, both of which are food colourings that have been determined safe for human consumption, as indicated in the Food and Drugs Act. St. Patrick's Day disease should be considered in the differential diagnosis of green urine. R. MORRISON HURLEY, MD, M SC, FRCP[C] Pediatric nephrologist Department of pediatrics McMaster University school of medicine
Hamilton, Ont.
Geriatrics as a medical specialty To the editor: In this timely editorial Dr. CI. Gryfe describes the role of the specialist in geriatric medicine as a medical teacher and a clinical consultant (Can Med Assoc J 120: 259, 1979). It is worth emphasizing that specialists in geriatric medicine do not seek to engage in primary care of Contributions to the Correspondence
section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
the elderly. Because there are only a dozen or so specialists in Canada at this time, it would be imprudent to use such a scarce resource in this way. Maximum impact on the health care of the elderly will be achieved by teaching undergraduate and postgraduate students in medicine and related health professions the special features of ageing and the management of disease in the elderly. A number of Canadian universities have responded to the need of an ageing population by including geriatric medicine in the medical curriculum. At the University of Saskatchewan, for example, medical students participate in a teaching program of seminars, didactic lectures and supervised clinical experience. The total time allocated to geriatric medicine is approximately 40 hours. We are encouraged by the enthusiastic approach of our students towards geriatric medicine. When specialists in geriatric medicine are available they should become involved at the time of breakdown of health or independent living, not later, when long-term institutional placement presents a problem. Early assessment, appropriate investigation, rehabilitation and appropriate use of community supporting services may make possible the return to the community of elderiy persons who would otherwise be kept in an institution. The elderly are a rapidly growing segment of the Canadian population and are heavy consumers of health care services; all physicians, partic-
ularly family physicians and internists, will encounter more and more aged persons in their practices. The specialist in geriatric medicine is available as a consultant to family physicians and other specialists in the management of older patients whose many problems are not easily accommodated within other medical specialties. DUNCAN ROBERTSON, FRCP[C] Associate professor of geriatric medicine University of Saskatchewan Saskatoon, Sask.
Salaried medical services To the editor: I am aware that the topic of salaried medical services is not original, but over the past few years have been thinking about it in spare moments. I have never seen the suggestion that salaried medical services would result in increased quality of medical care along with benefit to the life of the physician who now works 60 to 70 hours per week, and therefore am presenting my views on such a system. A salaried medical service should be based on the established precedent of the wage received by a medical officer of health, which includes holiday pay, sick pay, a contributory pension plan and, very important, periodic sabbatical leave with pay, similar to that received by teachers, to enable physicians to keep abreast of medical progress by encouragement. I believe that through this system the general public would understand the medical profession better and therefore be more likely to give it their full support.
CMA JOURNAL/MAY 5, 1979/VOL. 120 1053
St. Patrick's Day disease To the editor: A 7-year-old boy was referred to me because he had asymptomatic hematuria. When I asked if there had been any change in the colour of his urine I was surprised to learn that it had been green one day. The boy had not taken any "medicines" containing such ingredients as methylene blue; however, he had consumed two "shamrock shakes" on the day of the incident. The milk shakes were coloured green for St. Patrick's Day and contained tartrazine and brilliant blue FCF, both of which are food colourings that have been determined safe for human consumption, as indicated in the Food and Drugs Act. St. Patrick's Day disease should be considered in the differential diagnosis of green urine. R. MORRISON HURLEY, MD, M SC, FRCP[C] Pediatric nephrologist Department of pediatrics McMaster University school of medicine
Hamilton, Ont.
Geriatrics as a medical specialty To the editor: In this timely editorial Dr. CI. Gryfe describes the role of the specialist in geriatric medicine as a medical teacher and a clinical consultant (Can Med Assoc J 120: 259, 1979). It is worth emphasizing that specialists in geriatric medicine do not seek to engage in primary care of Contributions to the Correspondence
section are welcomed and if considered suitable will be published as space permits. They should be typewritten double-spaced and, except for case reports, should be no longer than 1½ manuscript pages.
the elderly. Because there are only a dozen or so specialists in Canada at this time, it would be imprudent to use such a scarce resource in this way. Maximum impact on the health care of the elderly will be achieved by teaching undergraduate and postgraduate students in medicine and related health professions the special features of ageing and the management of disease in the elderly. A number of Canadian universities have responded to the need of an ageing population by including geriatric medicine in the medical curriculum. At the University of Saskatchewan, for example, medical students participate in a teaching program of seminars, didactic lectures and supervised clinical experience. The total time allocated to geriatric medicine is approximately 40 hours. We are encouraged by the enthusiastic approach of our students towards geriatric medicine. When specialists in geriatric medicine are available they should become involved at the time of breakdown of health or independent living, not later, when long-term institutional placement presents a problem. Early assessment, appropriate investigation, rehabilitation and appropriate use of community supporting services may make possible the return to the community of elderiy persons who would otherwise be kept in an institution. The elderly are a rapidly growing segment of the Canadian population and are heavy consumers of health care services; all physicians, partic-
ularly family physicians and internists, will encounter more and more aged persons in their practices. The specialist in geriatric medicine is available as a consultant to family physicians and other specialists in the management of older patients whose many problems are not easily accommodated within other medical specialties. DUNCAN ROBERTSON, FRCP[C] Associate professor of geriatric medicine University of Saskatchewan Saskatoon, Sask.
Salaried medical services To the editor: I am aware that the topic of salaried medical services is not original, but over the past few years have been thinking about it in spare moments. I have never seen the suggestion that salaried medical services would result in increased quality of medical care along with benefit to the life of the physician who now works 60 to 70 hours per week, and therefore am presenting my views on such a system. A salaried medical service should be based on the established precedent of the wage received by a medical officer of health, which includes holiday pay, sick pay, a contributory pension plan and, very important, periodic sabbatical leave with pay, similar to that received by teachers, to enable physicians to keep abreast of medical progress by encouragement. I believe that through this system the general public would understand the medical profession better and therefore be more likely to give it their full support.
CMA JOURNAL/MAY 5, 1979/VOL. 120 1053
