To err is human,... To the editor: It sets one's teeth on edge and conjures up visions of Alaric the Goth and Attila the Hun when one who has received a humanistic education reads atrocities like "per viam naturalis" (Can Med Assoc J 111: 1004, 1974). If an author commits such a solecism, does nobody at the editorial office notice it? Of course it should read "per vias naturales" or, if the singular is used, "per viam naturalem". In his article in the same issue (page 991), "Castro remodels the system", Dr. Edmond Boyd commits the error universally perpetrated in North America of calling health centres "polyclinics". The word is "policlinic"; such institutions are not named because they are clinics where many (pol5's) things are done, but rather because they are located in the community (pdlis, the same root as for "politics"). A. F. PF.RL, MD 1944 Lakeshore Rd. Samia, Ont.

... to forgive divine. - Ed.] Wilful exposure to unwanted pregnancy To the editor: I would like to comment on Dr. C. A. Cowell's editorial "Wilful exposure to unwanted pregnancy" (Can Med Assoc J 111: 1045, 1974), particularly because she neglects an important aspect of so-called unwanted pregnancy, which leads her to certain superficial and, therefore, inaccurate conclusions. The term "unwanted pregnancy" is ambiguous because, psychologically speaking, it is only a partial truth and neglects the importance of the unconscious conflict that helps bring about the complicated state of pregContributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.

nancy. Indeed, one could postulate that in every pregnancy there are, to a greater or lesser degree, considerable mixed feelings and that if a woman becomes pregnant, then a part of her wanted this to happen. The relations between a young woman and her parents are always complicated, the more so if the young woman becomes pregnant without going through the usual formality of legalized marriage. I believe Dr. Cowell neglects the enormous impact of guilt feelings, conscious and unconscious, and the various attempts of these young women, by means of neurotic and psychotic mechanisms, to deal with both their individual guilt and their relations with their parents. The nonuse of contraception is then easily understood in terms of rationalization (the process by which a course of action is given ex post facto reasons that not only justify it but also conceal its true motivation - in this case pregnancy). Further, these young women have very mixed motives and feelings in having brought about their state of pregnancy. It also follows that they have very mixed feelings about having their baby destroyed in the traumatic event called induced abortion. I would refer Dr. Cowell to the work of Dr. Helene Deutsch,' who over many years has written with sensitivity and understanding (in-depth) about these highly charged issues of pregnancy, mothering and unwanted (so-called) pregnancy. R. A. FORRESTER, MD, CRCP[C] Department of psychiatry University of Toronto Toronto, Ont.

Reference I. DEUT5CH H: Psychology ol Women. Vol II. Motherhood. New York, Grune, 1967

To the editor: I'm sorry that Dr. Forrester considers the term unwanted pregnancy ambiguous. I use the term simply to denote a pregnancy in a pa-

274 CMA JOURNAL/FEBRUARY 8, 1975/VOL. 112

tient who does not want a baby. I must admit that I am not qualified to go into the psychodyrnimics of the unconscious, but the crisis of an unwanted pregnancy in a juvenile is a very "conscious.. event. Dr. Forrester suggests that the nonuse of contraception is easily understood in terms of mechanisms that appear fuzzily defined. If he is implying that some of these patients use pregnancy as a club with which to beat their parents over the head, I would certainly agree. However, I and others in my discipline who are called upon in this crisis deal with the here and now. We have little time and less help to delve into the unconscious as we try with, I hope, kindness and empathy to advise these young people and their parents. The "wilful exposure to unwanted pregnancy' syndrome certainly must be one of psychodynamic origin. Now that we've had the explanation, when are our psychiatric colleagues going to come forward with positive, practical steps to help alleviate it? CAROL A. COWELL, MD, FRCS[CJ

Division of pediatric and adolescent gynecology The Hospital for Sick Children Toronto, Ont.

Medical school enrolment To the editor: In her reply to Dr. K. H. Young's comments on medical school enrolment (Can Med Assoc I 111:1048, 1974) Dr. Bette M. Stephenson raises the questions "Are Canadian citizens aware of the proportion of their taxes directed toward the education of native-born and foreign-born university students? If they are aware, do they consider the proportions realistic and desirable?" What does it matter how many foreign-born students are admitted into Canadian universities, provided they intend to stay in Canada after graduation and serve the Canadian people? The whole purpose of education is to train people to serve the future com-

Lasix

for the long term

Composition: Each tablet containa 40 mg or 20 mg furoxemide. Each 2 ml ampoule contains 20 mg furosemide; each 4 ml ampoule contains 40 mg. indications - Oral: Mild to moderate hypertension or with other hypotensives in severe cases. Edema associated with congestive heart tailure, cirrhosis of the liver, renal disease including the nephrotic syndrome, as well as other edematous states, e.g., premenstrual tension. Parenteral: Acute pulmonary, cardiac, hepatic or renal edema. Contraindications: Complete renal shutdown. Discontinue if increasing azotemia and oliguria occur during treatment of progressive renal disease. In hepatic coma and electrolyte depletion, do not institute therapy until the basic condition is improved or corrected. Until further experience has been accumulated, do not administer parenterally to children. Warnings: Sulfonamide diuretics have been reported to decrease arterial responsiveness to presser amines and to enhance the effects of tubocurarine. Exercise caution in administering curare or its derivatives during Lasis therapy. Discontinue week prior to elective surgery. Cases of reversible deafness and tinnitus have been reported when Lasix Parenteral was given at doses exceeding several times the usual therapeutic dose of 20 to 40 mg. Transient deafness is more likely to occur in patients with severe impairment of renal function and in patients also receiving drugs known to be ototoxic. Precautions: Inject Lasix Parenteral slowly [1 to 2 minutes] when i.v. route is used. Sodium intake should not be less than 3 g/day. Potassium supplements should be given when high doses are used over prolonged periods. Caution with potassium levels is desirable when on digitalis glycosides, potassium-depleting steroids, or in impending hepatic coma. Potassium supplementation, diminution in dose, or discontinuation of Lxxix may be required. Aldosterone antagonists should be added when treating severe cirrhosis with ascites. Reproduction studies in animals have produced no evidence of drug-induced fetal abnormalities. Lasix has had only limited use in pregnancy and should be used only when deemed essential. Check urine and blood glucose as decreased glucose tolerance has been observed. Check serum calcium levels as rare cases of tetany have been reported. Patients receiving high doses of saucylates with Lasix may experience salicylate toxicity at lower doses. Adverse reactions: As with any effective diuretic, electrolyte depletion may occur especially with high doses and restricted salt intake. Electrolyte depletion may manifest itself by weakness, dizziness, lethargy, leg cramps, anorexia, vomiting and/or mental confusion. Check serum electrolytes, especially potassium at higher dose levels. In edematous hypertensives reduce the dosage of other antihypertensives since Lasix potentiates their effect. Asymptomatic hyperuricemia can occur and gout may rarely be precipitated. Reversible elevations of BUN may be seen especially in renal insufficiency. Dermatitis, pruritus, paresthesis, blurring of vision, postural hypotension, nausea, vomiting, or diarrhea may occur. Anemia, leukopenia, and thrombocytopenia [with purpura] and rare cases of agranulocytosis have occurred. Weakness, fatigue, dizziness, muscle cramps, thirst, increased perspiration, bladder spasm and symptoms of urinary frequency may occur. Overdosage: Symptoms: Dehydration and electrolyte depletion. Treatment: Discontinue drug and institute water and electrolyte replacement. Dosage and administration - Orai: Hypertensipn: Usual dosage is 40 to 80 mg daily. Individualize therapy and adjust dossge of concomitant hypotensive therapy. Edema: Usual initial dossge ix 40 to 80 mg. Adjust according to response. If diuresis has not occurred affer 6 hours, increase dosage by increments of 40 mg ax frequently as every 6 hours if necessary. The effective dose can then be repeated 1 to 3 times daily. A maximum daily dose of 200 mg should not be exceeded. Maintenance dosage must be adjusted individually. An intermittent dosage schedule of 2 to 4 consecutive days each week may be utilized. With doses exceeding 120 mg/day, clinical and laboratory observations are advissble. Parentersi: Usual dossge is 20 to 40 mg given as a single dose, injected i.m. or i.v. The i.v. injection should be given slowly (1 to 2 minutes]. Ordinarily, a prompt diuresis ensues, If diuresix ix not satisfactory, succeeding doses may be increased by increments of 20 mg 2 hours after the previous dose, until the required diuresis is obtained. The maximum recommended daily dosage ix 100 mg. Acute pulmonary edema: Administer 40 mg immediately by slow i.v. injection. May be followed by another 40 mg ito lA hours later. Pediatric use: Institute Lasix orally under close observation in the hospital. Single oral dose ix 0.5 to 1 mg/kg. The daily oral dose should not exceed 2 mg/kg in divided doses. In newborns and prematures, the daily oral dose should not exceed 1 mg/kg. Particular caution with potassium levels is desirable. Do not administer to jaundiced newborns or infants suffering from diseases with the potential of causing hyperbilirubinemia and possibly kernicterus. Suppi. Yellow, round, scored 40 mg tablets [Code DLI] in bottles of 50 and 500. White round 20 mg tablets [Code DLF] in bottles of 30. Amber ampoules of 2 ml in boxes of 5 and 50; 4 ml in boxes of 50. Complete information on request.

HOECHST Heechst Pliarmaceaticals Division at canadian Hsechst Ltd Montreal

1.68/7084/E

EReg Hoechst TM

munity, and that is what Canadian taxpayers are paying for. As landed immigrants, these students have shown their desire to stay in Canada and to serve the people of this country. After these prospective citizens have proved themselves able to qualify for admission, is it not fair to treat them the same as native-born students? WILLIAM C. YEUNG, MB, aS

Fort McMurray, Alta.

To the editor: To impute racism to Dr. Bette Stephenson's remarks regarding admissions to the Toronto medical school is unfair. But the three questions posed by her provoke further considerations, which, though not racist, do have a bearing on the status of the immigrant student. Dr. Stephenson asks whether the admission policies at Canadian medical schools are sufficiently closely related to the needs and expectations of Canadian society. I am sure Dr. Stephenson includes landed immigrants as part of Canadian society, so this entitles them to a fair share of the admissions to medical schools. If, however, they are being given an unfair advantage so that they are encroaching on the opportunities for "Canadian" students, the immigration department would be quite justified in restricting prospective immigrants whose immediate plans are towards admission to medical school. But how are the immigration authorities to know which prospective immigrant of high-school age will one day encroach on the opportunity for a Canadian? Even if they knew, could they do anything about it? The question, then, is whether Canadians are entitled to the best talent available within the country for admission to medical schools. It would be interesting to know how many, if any, of the letters to which Dr. Stephenson refers were from the families of unsuccessful applicants to medical schools. LAURENCE M. BRAGANZA, MD

270 Dutch Village Rd. Halifax, NS

To the editor: It seems to me that in her comments about medical school enrolment Dr. Bette Stephenson's main concern about the numbers of Chinese students accepted in the firstyear class in medicine at the University of Toronto is that their families are not in Canada and are therefore not contributing to support medical school operations through taxes. It should not be forgotten, however, that not so long ago Chinese immigrants were treated as second-class citizens

and were not allowed to bring their families to Canada for many years. They were hired as cheap labourers to meet the needs of the country as railroad builders, laundry men and restaurant help. Their families did not share the prosperity of the nation even though they paid their taxes. How many of the families of these students are in Canada and how many are not? And of the latter, how many are not here by choice and how many as a result of the immigration policy? In the autumn 1974 newsletter from the College of Physicians and Surgeons of Manitoba the following figures are given for the percentages of medical practitioners in Manitoba as to country of training in 1974: Manitoba, 51.4%; Canada, 9.9%; United Kingdom, 21.1%; other, 17.6%. Thus, 38.7% of Manitoba's physicians were trained outside Canada. I wonder what Dr. Stephenson's solution would be to the problem of the graduates of Canadian medical schools who have taken advantage of training here and who have chosen to practise outside Canada. She states that she is not concerned about the colour of the skin or the racial background. She would be equally concerned if these people came from western Europe and had blue eyes, fair skin and blonde hair. But I wonder who would really notice or be concerned if all the students had blue eyes, fair skin and blonde hair. Only the people with racial prejudice would be concerned. I believe that as long as they are landed immigrants and are willing to stay in Canada and become Canadian citizens they all have the same rights as a Canadian-born student. It is unfortunate that, as president of The Canadian Medical Association, Dr. Stephenson's comments were taken as a position of the CMA rather than her own personal opinion. J. Du, MD, FRCP[C]

Winnipeg Clinic Winnipeg, Man.

[Neither Dr. Stephenson nor the CMA has taken any formal position wit/i regard to this matter. As president of the association Dr. Stephenson simply asked that Canadian society provide answers to valid questions posed by dozens of students, and the parents of students, who have been denied access to Canadian medical schools. Indeed, the questions go much beyond the question of foreign or landed immigrant students being admitted to Canadian medical schools. Are the admission policies at Canadian medical schools sufficiently closely related to the needs and expectations of Canadian society? Do Canadian government immigration policies regarding foreign-born students

CMA JOURNAL/FEBRUARY 8, 1975/VOL. 112 277