surely extend to the counselling of the patient to dispose of the firearm voluntarily. Any police force in Canada will gladly cooperate in instances of voluntary surrender of firearms. Should the patient refuse to voluntarily give up the firearm, the psychiatrist must, at the very least, seriously consider whether it is in the patient's best interest to be required by the law to give up the firearm. This, as Mr. Geekie correctly pointed out, involves the question of medical ethics, and as such is a subject for consideration by the Canadian Medical Association. If I can be of any assistance in providing further information I would be delighted to do so. I only ask that when this question is considered, the association keep in mind that each year some 1800 Canadians are murdered or commit suicide with firearms, and even larger numbers are seriously injured by the misuse of guns. JAMES HAYES
Coordinator, working group on gun control Solicitor General's Office Ottawa, Ont.
Attending physician's (wage-loss) statement forms To the editor; The member insurers of the Canadian Association of Accident and Sickness Insurers (CAASI) express their thanks to the Council on Medical Services of the Canadian Medical Association (CMA) and the staff of the CMA for helping CAASI develop the 1978 version of the attending physician's (wage-loss) statement forms. Drs. R.G. Wilson and N.P. Da Sylva, in particular, provided invaluable help. One of the prime objectives of CAASI was that the two new attending physician's statement forms, SD-3 and SD-4, which will replace the previous versions, SD-i and SD-2, would represent an improvement from the points of view of both medical professionals and insurers. The "initial" (SD-i) and "supplementary" (SD-2) short-term disability forms used by most carriers have fulfilled their roles reasonably well, but some modifications of these forms have come into being and have led to complaints from physicians. However, there were then complaints about the provision of longterm disability income benefits. Group and individual coverage for long-term wage-loss protection has
developed as a major insurance product in a relatively short period. Insurer claims personnel, however, have not had the benefit of having standard CAASI-approved forms to use when processing long-term claims. The result was the development of a multiplicity and diversity of forms by the various insurers. Late in 1976, throughout 1977 and early in 1978, members of the claims committee of CAASI surveyed member insurers and medical professionals active both in the insurance industry and in private practice, and members of the Medical Group Management Association. In October 1977 CAASI presented to the CMA two new forms that could be used by insurers providing long-term benefits. The initial form is a comprehensive one called the LD-1. This form would be presented for completion by a physician only once when benefits were claimed by the insured individual for the first time. The disability benefits that may be provided to an insured individual are substantial when considered over his or her potential lifetime. The form contains a note to the attending physician that we believe is important: This form has been specifically designed with the Physician in mind. By being comprehensive, it will hopefully reduce the physician's administrative workload. Please complete the sections relating to your patient and stroke out non-applicable areas. In order to help the claimant, sufficient details of History, Investigation, Findings and Treatment are essential. This form may be mailed directly to the Insurer or given to the patient at the physician's discretion. When claims are for an ongoing disability a new, brief, attending physician's statement of continuing disability benefits form (LD-2) has been developed to complement LD-1. This new form should provide an insurer with details sufficient to administer a long-term claim on a continuing basis. While carriers require more detailed medical information in longterm than in short-term situations, the total number of active long-term disability claims is very low; the exposure of any one physician to these forms should be limited. I hope the efforts of all persons concerned with the development of these forms will be rewarded in terms of time saved by both physicians
1390 CMA JOURNAL/DECEMBER 23, 1978/VOL. 119
and insurer claims administrators when each are fulfilling their special and respective obligations to insured claimants. J.E. STEPHENS President Canadian Association of Accident and Sickness Insurers 55 University Ave. Toronto, Ont.
Infection of humans with Campylobacter fetus To the editor: Several points in the article by Dr. Barbara L. Robinson (Can Med Assoc 1.118: 1087, 1978) should be clarified. Campylobacter fetus subsp. fetus is a cause of abortion in cattle and is transmitted venereally.1 Abortion in sheep is caused by C. fetus subsp. jejuni and occasionally subspecies intestinalis; transmission of the organism is fecal-oral and there is no evidence to indicate a venereal route.1 Differences in subspecies are imp?rtant for the clinician as well as the veterinarian. C. fetus subsp. fetus rarely causes illness in humans. However, subspecies intestinalis most frequently causes disease in debilitated or immunosuppressed individuals. Infection with subspecies jejuni results in gastroenteritis or, less often, asymptomatic carriage.' Healthy persons are most commonly affected with subspecies jejuni, but bacteremia is infrequent and death is rare.4 The features of infection with subspecies jejuni - diarrhea, abdominal pain and fever - are characteristic.' Various illnesses are caused by subspecies intestinalis, including septicemia, endocarditis, thrombophlebitis and meningitis. The infections are indolent and have features specific to the organ system involved. Finally, C. fetus subsp. jejuni is a far more common pathogen than subspecies intestinalis. In the past 2 years more than 3000 cases of diarrhea attributable to subspecies jejuni have been reported from Europe,5 North America6 and Africa.7 In every study of patients with diarrhea this organism has been cultured from 3% to 8% of patients.' In many patients the infection has been transmitted by contact with animals or contaminated water.' MAR .IN BLASER, MD
W.L. WANG, PH D Division of infectious diseases University of Colorado Medical Center Denver, Colorado
References 1.SMITH T: Spirilla associated with disease of the fetal membranes in cattle (infectious abortion). J Exp Med 28: 701, 1918 2. FIREHAMMER BD: The isolation of vibrios from ovine feces. Cornell Vet
55: 482, 1965 3. SKIRRoW MB: Campylobacter enteritis: a "new" disease. Br Med J 2: 9, 1977 4. Campylobacter infections in Britain 1977. Br Med J 1: 1357, 1978 5. LAUWERS S, DE BOECK M, BUTZLER
6. 7. 8. 9.
JP: Campylobacter enteritis in Brussels. Lancet 1: 604, 1978 Campylobacter enteritis - Alberta. Can Dis Wkly Rep 4: 6, 1978 DE MOL P, BOSMANS E: Campylobacter enteritis in Central Africa (C). Lancet 1: 604, 1978 WANG WL, BLASER MJ, CRAVENS J: Isolation of Campylobacter. Br Med 1 2: 57, 1978 Waterborne Campylobacter gastroenteritis - Vermont. Morb Mortal Wkly Rep 27: 207, 1978
Paramedics, chiropractors and health planners To the editor: Some current sociopolitical health planning experts envisage the physician as the villain in health care. They suggest that the substitution of paramedical personnel for physicians would result in considerable savings. I examined two patients consecutively in September whose cases lead me to question such a concept. Case 1 A 29-year-old nurse had been complaining of headaches and pain in the neck, left shoulder and low back for 10 years, ever since she received a neck and back sprain injury in a car accident. Since that time she had been "adjusted" by various chiropractors more than 300 times. She had received 100 "adjustments" from a chiropractor in the previous year. Examination disclosed a tense woman who had full movement of the cervical, dorsal and lumbar spine, no muscle spasm and no significant local tenderness. Neurologic function was normal. The diagnosis was neck and back pain accentuated by unnecessary chiropractic treatment. Case 2 A 55-year-old woman had been complaining of low back pain for 2 months. She had been referred by her family physician to a physiother-
*
apist, who used "sonic waves.' and "adjusted" her spine. The low back pain was aggravated by this treatment. Many years ago the patient had consulted a chiropractor for midback pain. After her visit she stated: "The chiropractor showed me the x-rays. There was a dark shadow at the side of the spine. I asked him what it was. He replied 'It's inflammation; treatment will clear it.'" The patient suffered severe pain following adjustment. In one sense the chiropractor was correct: the shadow was inflam-
mation. However, the inflammation was a tuberculous abscess from a tuberculous dorsal vertebra. She recovered after 1 year's treatment in hospital and an operation on her spine. .y examination of the patient in September disclosed limitation of forward flexion and specific tenderness to the left of the fifth lumbar vertebra. There was a very long laminectomy scar, and a scar on the crest of the left ilium. I gave her advice about. her posture and prescribed extension exercises.
Nausea and vomiting of pregnancy... Bendectin Antinauseant Merrell
Prescribing information available upon request. Each delayed-release tablet contains: Doxylamine succinate (Decapryn®) 10 mg Pyridoxine hydrochloride 10 mg Dicydomine hydrochloride (Bentylol®) 10 mg
Merrell
TheWM Division of Richardson-Merrell (Canada) Ltd. Weston Ontario. M9L 1 R9 8-053 (W314A) . PP Printed August, 1978.
CMA JOURNAL/DECEMBER 23, 1978/VOL. 119 1391
Coordinator, working group on gun control Solicitor General's Office Ottawa, Ont.
Attending physician's (wage-loss) statement forms To the editor; The member insurers of the Canadian Association of Accident and Sickness Insurers (CAASI) express their thanks to the Council on Medical Services of the Canadian Medical Association (CMA) and the staff of the CMA for helping CAASI develop the 1978 version of the attending physician's (wage-loss) statement forms. Drs. R.G. Wilson and N.P. Da Sylva, in particular, provided invaluable help. One of the prime objectives of CAASI was that the two new attending physician's statement forms, SD-3 and SD-4, which will replace the previous versions, SD-i and SD-2, would represent an improvement from the points of view of both medical professionals and insurers. The "initial" (SD-i) and "supplementary" (SD-2) short-term disability forms used by most carriers have fulfilled their roles reasonably well, but some modifications of these forms have come into being and have led to complaints from physicians. However, there were then complaints about the provision of longterm disability income benefits. Group and individual coverage for long-term wage-loss protection has
developed as a major insurance product in a relatively short period. Insurer claims personnel, however, have not had the benefit of having standard CAASI-approved forms to use when processing long-term claims. The result was the development of a multiplicity and diversity of forms by the various insurers. Late in 1976, throughout 1977 and early in 1978, members of the claims committee of CAASI surveyed member insurers and medical professionals active both in the insurance industry and in private practice, and members of the Medical Group Management Association. In October 1977 CAASI presented to the CMA two new forms that could be used by insurers providing long-term benefits. The initial form is a comprehensive one called the LD-1. This form would be presented for completion by a physician only once when benefits were claimed by the insured individual for the first time. The disability benefits that may be provided to an insured individual are substantial when considered over his or her potential lifetime. The form contains a note to the attending physician that we believe is important: This form has been specifically designed with the Physician in mind. By being comprehensive, it will hopefully reduce the physician's administrative workload. Please complete the sections relating to your patient and stroke out non-applicable areas. In order to help the claimant, sufficient details of History, Investigation, Findings and Treatment are essential. This form may be mailed directly to the Insurer or given to the patient at the physician's discretion. When claims are for an ongoing disability a new, brief, attending physician's statement of continuing disability benefits form (LD-2) has been developed to complement LD-1. This new form should provide an insurer with details sufficient to administer a long-term claim on a continuing basis. While carriers require more detailed medical information in longterm than in short-term situations, the total number of active long-term disability claims is very low; the exposure of any one physician to these forms should be limited. I hope the efforts of all persons concerned with the development of these forms will be rewarded in terms of time saved by both physicians
1390 CMA JOURNAL/DECEMBER 23, 1978/VOL. 119
and insurer claims administrators when each are fulfilling their special and respective obligations to insured claimants. J.E. STEPHENS President Canadian Association of Accident and Sickness Insurers 55 University Ave. Toronto, Ont.
Infection of humans with Campylobacter fetus To the editor: Several points in the article by Dr. Barbara L. Robinson (Can Med Assoc 1.118: 1087, 1978) should be clarified. Campylobacter fetus subsp. fetus is a cause of abortion in cattle and is transmitted venereally.1 Abortion in sheep is caused by C. fetus subsp. jejuni and occasionally subspecies intestinalis; transmission of the organism is fecal-oral and there is no evidence to indicate a venereal route.1 Differences in subspecies are imp?rtant for the clinician as well as the veterinarian. C. fetus subsp. fetus rarely causes illness in humans. However, subspecies intestinalis most frequently causes disease in debilitated or immunosuppressed individuals. Infection with subspecies jejuni results in gastroenteritis or, less often, asymptomatic carriage.' Healthy persons are most commonly affected with subspecies jejuni, but bacteremia is infrequent and death is rare.4 The features of infection with subspecies jejuni - diarrhea, abdominal pain and fever - are characteristic.' Various illnesses are caused by subspecies intestinalis, including septicemia, endocarditis, thrombophlebitis and meningitis. The infections are indolent and have features specific to the organ system involved. Finally, C. fetus subsp. jejuni is a far more common pathogen than subspecies intestinalis. In the past 2 years more than 3000 cases of diarrhea attributable to subspecies jejuni have been reported from Europe,5 North America6 and Africa.7 In every study of patients with diarrhea this organism has been cultured from 3% to 8% of patients.' In many patients the infection has been transmitted by contact with animals or contaminated water.' MAR .IN BLASER, MD
W.L. WANG, PH D Division of infectious diseases University of Colorado Medical Center Denver, Colorado
References 1.SMITH T: Spirilla associated with disease of the fetal membranes in cattle (infectious abortion). J Exp Med 28: 701, 1918 2. FIREHAMMER BD: The isolation of vibrios from ovine feces. Cornell Vet
55: 482, 1965 3. SKIRRoW MB: Campylobacter enteritis: a "new" disease. Br Med J 2: 9, 1977 4. Campylobacter infections in Britain 1977. Br Med J 1: 1357, 1978 5. LAUWERS S, DE BOECK M, BUTZLER
6. 7. 8. 9.
JP: Campylobacter enteritis in Brussels. Lancet 1: 604, 1978 Campylobacter enteritis - Alberta. Can Dis Wkly Rep 4: 6, 1978 DE MOL P, BOSMANS E: Campylobacter enteritis in Central Africa (C). Lancet 1: 604, 1978 WANG WL, BLASER MJ, CRAVENS J: Isolation of Campylobacter. Br Med 1 2: 57, 1978 Waterborne Campylobacter gastroenteritis - Vermont. Morb Mortal Wkly Rep 27: 207, 1978
Paramedics, chiropractors and health planners To the editor: Some current sociopolitical health planning experts envisage the physician as the villain in health care. They suggest that the substitution of paramedical personnel for physicians would result in considerable savings. I examined two patients consecutively in September whose cases lead me to question such a concept. Case 1 A 29-year-old nurse had been complaining of headaches and pain in the neck, left shoulder and low back for 10 years, ever since she received a neck and back sprain injury in a car accident. Since that time she had been "adjusted" by various chiropractors more than 300 times. She had received 100 "adjustments" from a chiropractor in the previous year. Examination disclosed a tense woman who had full movement of the cervical, dorsal and lumbar spine, no muscle spasm and no significant local tenderness. Neurologic function was normal. The diagnosis was neck and back pain accentuated by unnecessary chiropractic treatment. Case 2 A 55-year-old woman had been complaining of low back pain for 2 months. She had been referred by her family physician to a physiother-
*
apist, who used "sonic waves.' and "adjusted" her spine. The low back pain was aggravated by this treatment. Many years ago the patient had consulted a chiropractor for midback pain. After her visit she stated: "The chiropractor showed me the x-rays. There was a dark shadow at the side of the spine. I asked him what it was. He replied 'It's inflammation; treatment will clear it.'" The patient suffered severe pain following adjustment. In one sense the chiropractor was correct: the shadow was inflam-
mation. However, the inflammation was a tuberculous abscess from a tuberculous dorsal vertebra. She recovered after 1 year's treatment in hospital and an operation on her spine. .y examination of the patient in September disclosed limitation of forward flexion and specific tenderness to the left of the fifth lumbar vertebra. There was a very long laminectomy scar, and a scar on the crest of the left ilium. I gave her advice about. her posture and prescribed extension exercises.
Nausea and vomiting of pregnancy... Bendectin Antinauseant Merrell
Prescribing information available upon request. Each delayed-release tablet contains: Doxylamine succinate (Decapryn®) 10 mg Pyridoxine hydrochloride 10 mg Dicydomine hydrochloride (Bentylol®) 10 mg
Merrell
TheWM Division of Richardson-Merrell (Canada) Ltd. Weston Ontario. M9L 1 R9 8-053 (W314A) . PP Printed August, 1978.
CMA JOURNAL/DECEMBER 23, 1978/VOL. 119 1391
