UIiUhIhhIL..d.

comprehensive and continuous control of gastrointestinal problems COMPOSmON: Each 'Stelabid' Tablet No.1 provides 1 mg of Stelazine (trifluoperazinet SK&F) and 5 mg of Darbid. (isopropamide SK&F). Each 'Stelabid' Tablet No. 2 provides 2 mg of 'Stelazine' and 5 mg of 'Darbid'. Each 'Stelabid' Forte Tablet provides 2 mg of 'Stelazine' and 7.5 mg of 'Darbid'. Each 'Stelabid' Ultra Tablet provides 2 mg of 'Stelazine' and 10 mg of 'Darbid'. Each 5 ml (1 teaspoonful) of 'Stelabid' Elbdr provides 1 mg of 'Stelazine' and 5 mg of 'Darbid'. INDICATIONS: 'Stelabid' is effective in the treatment of a wide range of gastrointestinal disorders - particularly where anxiety, tension, worry or other emotional factors are present-including peptic ulcer, hyperchlorhydria, gastritis, duodenitis, pylorospasm, gastrointestinal spasm, biliary dyskinesia, chronic cholelithiasis, initable colon, functional diarrhea. CONTRAINDICATIONS: 'Stelabid' is contraindicated in comatose states and in the presence of glaucoma, pyloric obstruction of organic origin, prostatic hypertrophy, bladder neck obstruction, obstructive intestinal lesions and/or ileus. ADVERSE REACTIONS: Possible anticholinergic side effects are constipation, dryness of the mouth, blurred vision and urinary hesitancy. Because of the low dosage of the 'Stelazine' component, neuromuscular (extrapyramidal) symptoms are not to be expected, but such reactions may occur in patients sensitive to phenothiazine compounds. PRECAUTIONS: Should be used with caution in elderly patients and in patients suffering from cardiac impairment and, in pregnant patients, especially during the first trimester. Because 'Stelabid' has a potent antiemetic effect, it may mask signs of overdosage of toxic drugs and may obscure diagnosis of such conditions as intestinal obstruction and brain tumor. ADMINISTRATION AND DOSAGE: Tablets No. 1, No. 2, Forte, Ultra-One 'Stelabid' tablet twice daily (every 12 hours). Elixir-One teaspoonful (each 5 ml teaspoonful is equivalent to one 'Stelabid' tablet No. 1) twice daily (every 12 hours). SUPPLY: Tablets: Maize-coloured, monogrammed tablets. No. 1 and No. 2 available in bottles of 100, 500 and 1000. Forte available in bottles of 100 and 500. Ultra available in bottles of 100. Elixir: available in 6 fi. oz. (170 ml) bottles. Monogrammed: Tablets No. 1-SKF P90; No.2-SKF P91;Forte-SKF P92;Ultra-SKF P93. Full Information available on request. REFERENCES 1. Blake, A. D., Jr.: Treatment of Gastrointestinal Disorders with a Combination of Trifluoperazine and Isopropamide, Clin. Med. 7&1461 (Aug) 1963. 2. Shutkln, M. W.: Clinical and Experimental Observations in Peptic Ulcer with a New Prolon.-Acting Anticholinergic Drug, Am. J. Gastroenterol. 29585 (June) 1958. 3. Grossman, NI. L: Inhibition of Salivary and Gastric Secretion by 'Darbid', Gastroenterology, 35312 (Sept) 1958. 4. Bennett, E. J.: Tranquilizer Anticholinergic Therapy in Functional Gastrointestinal Disorders, AppI. Ther. 4:828 (Sept) 1962. 5. Hoffmann, C. R.: A Preliminary Evaluation of a New LongActing Anticholinergic in Peptic Ulcer and Other Digestive Diseases, Am. J. Gastroenterol 28.446 (Oct) 1957.

.KSmith Kline & French Canada Ltd. Montreal, Quebec H4M 2L6 Reg Can. TM. Off. tPat. 612,204-trifluoperazine

SB2sI15CA

impinge in any way upon opportunities for qualified Canadian students? Are Canadian citizens aware of the proportion of their taxes directed toward the education of native-born and foreignborn university students? If they are aware, do they consider the proportions realistic and desirable? - Ed.] Allergy and psychosis To the editor: It is very discouraging, especially for anyone with teaching responsibilities, to read a statement such as the one that appeared in Dr. Glaisher's letter "Allergy and psychosis": "There is no need for a doubleblind trial in these patients" (Can Med Assoc J 111: 1048, 1974). Since Dr. Glaisher does not mention other methods he is using to control the clinical trials he makes in his office practice, I can only assume that there are no controls over other possible variables in his experiments and that he is therefore indulging in a kind of post hoc deception. In effect he is telling Dr. Green and other readers of the Journal: "My mind is made up; don't confuse me with the facts." P. C. S. HOAKEN, MD

Psychiatrist-in-chief Hotel Dieu Hospital Kingston, Ont.

To the editor: It is most encouraging to see that other people actually take the trouble to read letters and reply. I would like to point out to Dr. Hoaken that my previous letter was abbreviated and this may have been the cause of some confusion. First, I would like to say that when in England I was one of the first to use double-blind techniques in largescale surveys, using the dermatology department of three Lancashire hospitals, and became most discouraged with the usefulness and the results obtained by these studies. I would like to refer Dr. Hoaken to two copies of the British Medical Journal of many years ago. Unfortunately, I have no references but I am certain that anybody who is interested enough to verify this can easily do so. For 2 weeks running, the British Medical Journal was devoted in its entirety to large-scale double-blind trials of phenoxymethyl penicillin. One week was devoted to a large series of trials by reputable institutions proving conclusively that this was the drug of choice. The other week was confined to an equally large series from equally impressive institutions proving conclusively that this drug was absolutely useless. I would also like to mention, again

without references - but I am certain that these could be found - doubleblind trials in ragweed pollinosis performed at two famous eastern American universities, one proving conclusively that injection therapy for ragweed poilinosis was hopeless and the other proving conclusively that this therapy was the treatment of choice in ragweed pollinosis. The original letter that I submitted for publication was a challenge. I challenged Drs. Garfinkel and Golombek, not Dr. Green. I challenged their reply to Dr. Green as being extremely dogmatic and lacking in understanding, and I became dogmatic in my letter to stress the point and to make the challenge stronger. The last two sentences that were deleted from my original letter were: "If Dr. Golombek and Dr. Garfinkel are at all interested, I will very gladly demonstrate on patients and confirm the statements that I am making. This I consider in fact a challenge." My mind, very definitely, is not made up. I am now doing things that 2 or 3 years ago I would have considered impossible. My views are fluid and changing on a continuing basis. The results I am obtaining are such that all who have been in my office and have seen for a period of 1 week what is happening go away as convinced as I am that, although we do not yet have all the answers, certainly we are getting enough answers to make us realize that we have something very different and much better than the usual therapy for these conditions. I do not challenge Dr. Hoaken because I believe his letter was due to the abbreviation of my first letter. However, if he is interested, I welcome him to my office, and if in 1 week I cannot convince him of the validity of my statements, I will write to the Journal and apologize for my discouraging, dogmatic views. IVOR L. GLAISHER, MB 900 Midtown Centre Regina, Sask.

The unwanted pregnancy To the editor: Surely the study "The unwanted pregnancy" by S. H. Stone and K. E. Scott (Can Med Assoc J 111: 1093, 1974) was conceived in haste and the conclusions were reached in equal haste. The authors state the study was carried out to answer four questions. The fourth question was "whether these infants compose the majority of the beaten and neglected children in the community". The study then proceeded to ignore this question. To the casual reader such an oblique association of

CMA JOURNAL/FEBRUARY 8, 1975/VOL. 112 279

unwanted pregnancy and beaten and neglected children in the community might be interpreted as fact rather than fancy. Indeed, the authors fall into their own trap and conclude: "Thus the unwanted pregnancy, contributing to continuing population growth and possibly to child neglect.., places a heavy burden on the community." KEVIN J. TOMPKINS, MD

165 Plymouth Rd. Welland, Ont.

A 59-year-old man with chronic lymphocytic leukemia was admitted to hospital Nov. 2, 1974 with a temperature of 390C, weakness and malaise. He was receiving chiorambucil (Leukeran), 4 mg/ day and prednisone, 25 mg/day. Because of suspected sepsis he was given penicillin G, 2 million units intravenously q4h, carbenicillin, 2 g IV q4/i and gentamicin, 120 mg IV q8Ii. He remained intermittently febrile, his temperature spiking to 39.40C. The antimicrobials were discontinued Nov. 11. Two days later cloxacillin, 2 g IV in 100 ml of 5% glucose and water, was administered because of suspected osteomyelitis of the spine. After the infusion, rigors occurred for approximately 30 minutes, associated with a temperature spike to 39.8 0C. The patient received two additional infusions of cloxacillin at 4hour intervals and had a similar reaction after each. The only chills this patient had during his hospitalization were associated with the cloxacillin infusions.

To the editor: We would like to assure Dr. Tompkins that our study was not conceived in haste and that the labour was extremely difficult. The fourth objective of the study was in fact to determine if there are sufficient numbers of unwanted pregnancies that these infants may make up the majority of the beaten and neglected children in the community. We were astonished and disturbed to find A 75-year-old man was admitted to that in our own hospital 100 infants hospital June 3, 1974 with pain in the every year are unwanted during preg- hip containing a Moore's prosthesis. He nancy and are still unwanted after was afebrile. Infection of the prosthesis delivery, and that these are infants of was suspected. On June 5, because the married women with families. A pro- patient was anemic, a unit of packed red jection of these figures suggests that blood cells was transfused over a 5-hour approximately 500 such infants are period with no adverse effects. Ninety born in Nova Scotia every year, and minutes later cloxacillin, 2 g in 150 ml of 5% glucose and water, was infused. many thousands across Canada. There Approximately 1 hour later shaking chills certainly are, then, sufficient numbers occurred for about 10 minutes and his of unwanted pregnancies resulting in temperature was elevated for the first time unw.tnted infants to presume that they in this admission, to 38.60C. The next may make up the majority of the beat- day a similar episode occurred after the en and neglected children. We did not third infusion of cloxacillin. However, prove that they did make up the ma- intravenous administration of the drug jority of these children but, as stated was continued for 14 days with no further episodes of chills. The drug was then in the conclusions, it is a likely pos- given orally, 1 g q6h for an additional 7 sibility. A long-term study of the fate days. On June 27, because of increasing of these unfortunate children should pain in the hip, intravenous administrabe undertaken. tion of cloxacillin, 2 g q4h, was again started. On July 1 he had another similar KENNETH E. Scorr, MD SHARON H. STONE, RN episode of shaking chills. The drug was Grace Maternity Hospital continued for an additional 7 days withHalifax, NS out any further reactions. Febrile reactions after cloxacillin To the editor: We wish to report febrile reactions associated with cloxacillin in nine male patients, seen on five different hospital wards; shaking chills and fever developed soon after the intravenous infusion of cloxacillin in each patient. The first reaction was observed in a patient in 1972; however, it was not until January 1974, when a second such reaction was observed in another patient, that an association with cloxacillin was raised. In August 1974, after observing additional reactions, we returned our supply of cloxacillin to the manufacturer (Ayerst Laboratories). A new supply of the drug with a different lot number was received, but similar reactions have been observed with the new supply. We describe the cases of two of the nine patients.

The reaction to intravenous administration of cloxacillin was striking in our nine patients. Shortly after the infusion each patient had chills that became uncontrollable and lasted for 20 to 30 minutes. In some patients these reactions occurred after each dose of cloxacillin, but in others they occurred intermittently. It appears that the preparation and mode of administration of cloxacillin are not responsible for these reactions because other patients receiving cloxacillin on the same ward at the same time did not have such a reaction. It is, of course, possible that occasionally the method of preparation of the drug might have varied. Febrile reactions have also been reported after methicillin administration.' We report these cases to alert physicians to the possibility of these reactions in patients and to encourage the re-

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

porting of such reactions to the drug adverse reaction program of Health and Welfare Canada and to the manufacturer. At present the cause of these reactions has not been uncovered and requires further investigation. J. PORTHOY, MD, FRCP(CJ A. TORCHINSKY, B SC PH, L PH, DPH J. MENDELSON, MD, FRCPIC] E. KAGAN, RN Division of infectious diseases Jewish General Hospital Montreal, Qu6.

Reference I. SPENGLER RF, MELVIN VB, LIETMAN PS, et at: Febrile reactions after methicillin (correspondence). Lancet 1: 168, 1974

Management of convulsion To the editor: Two wooden spatulas or tongue depressors bound together at one end with surgical tape and stuck to the head of the patient's bed are traditional signs in neurologic and other wards that the patient is liable to grand mal epileptic seizures or is suspected of having had them. Advice published by epilepsy associations over the years has tended to suggest to the first aider who sees the patient having a seizure that he should, if possible, attempt to put something in the mouth of the convulsing patient in order to preserve the airway. Whether or not this does any good is open to question. The potential harm of the procedure, however, is undoubted. The grand mal convulsion begins sometimes with a cry, which is followed by a brief tonic phase of total muscular contraction involving every voluntary and autonomically innervated muscle of the body. Extreme pressure exerted by the teeth, one against another, during the tonic phase makes it completely impossible to separate the jaws unless levers of great mechanical advantage are employed. The power of such implements as jaw separators is probably more than sufficient to break the teeth even if it were possible to insert the instrument between them - but it is not. If they are placed behind the teeth the power they can exert is sufficient to cause extensive soft tissue damage to the mucosa overlying the mandible and the maxilla. In the clonic phase extreme manual dexterity would be required to insert any such instrument between the teeth when the mouth is open, whereas in the succeeding flaccid phase such a maneuver would be simple. The value of opening the jaws is said to be twofold: first, the tongue will not be bitten; and second, it can be pulled forward so that the airway is not obstructed. In the tonic and clonic phases it is highly unlikely that there is any ventilation: air will certainly not flow into