The present Hutterite population originated from a small contingent of immigrants who arrived in the United States between 1874 and 1879. In 1880 the US census enumerated 443 Hutterites living in four colonies in South Dakota. By 1974 Hutterites living within colonies numbered approximately 21 521.2 Thus, in about 100 years the Hutterite population increased almost 50-fold. This rapid population increase is explainable by the high fertility rate of this "unique population"3 and is due solely to internal increase, for there is practically no migration into the colonies. In the process of evaluating signs and symptoms of psychiatric disorders we screened the total population for the presence of psychological as well as physical disorders by contacting mental hospitals, physicians, public agencies in the vicinity of the colonies and general hospitals to which Hutterites were referred. We interviewed the leaders and many hundreds of members of the Hutterite society. The symptoms of a slowly progressive type of muscular dystrophy would not likely have escaped us. The three patients, now over 30 years of age, described by Shokeir and Kobrinsky were probably at the time of our study still asymptomatic. In our search for disorders no mention was made in the family histories of symptoms similar to those .lescribed. After our epidemiologic study a team of scientists initiated an extensive investigation of health and genetic problems among the Hutterites.2 ROBERT J. WElL, MD
2625 Dutch Viliage Rd. Halifax, NS
References 1. EATON JW, WaIL RJ: Culture and Mental Disorders, Glencoe, IL, Free Pr, 1955 2 HOSTETLER JA: Hutterate Society, Baltimore, MD, Johns Hopkins Pr, 1974, p 265 3. EATON JW, MAYER AJ: Man's Capacity to Reproduce: The Demography of a Unique
Population, Glencoe, IL, Free Pr, 1954
The Morgentaler case To the editor: In his letter "The Morgentaler case" (Can Med Assoc J 113: 181, 1975) Dr. Peter N. Coles fails to appreciate that the jury is but a part of our judicial system, not the whole. Why should an unreasonable jury have the unchecked power to make decisions against the law and the evidence? In my view the court's power to order a new trial may be inadequate to control a perverse jury. Would justice be served by the unchecked power of juries in Eire refusing to convict IRA murderers, or of all-white juries in the southern United States refusing to convict whites of murdering blacks,
or of juries in Sicily regularly discharging members of the Mafia? There would probably be juries in some parts of Qu6bec that would refuse to convict FLQ members of crimes in the face of overwhelming evidence of guilt. In my view the court's power to reverse a jury's verdict is an effective means of ensuring equality before the law regardless of a person's political or economic power. The Supreme Court of Canada shares the opinion of Dr. Coles that the reversal of a jury's verdict is a serious matter. Speaking for the majority in the Morgentaler case, Mr. Justice Pigeon stated: Needless to say that this is obviously a power to be used with great circumspection; however, it is hard to conceive of a case in which it could be used, if not here. There cannot be any doubt concerning the commission of the offence by the accused. He had admitted the fact and denies his guilt only on the basis of some defences which the Court of Appeal rightly held unavailable, one of them because it was unfounded in law, the other because there was no evidence to support it.
It is interesting to compare the tactics of the proabortion forces in the Morgentaler case and in the Edelin case in the United States. Dr. Edelin was found guilty by a jury of manslaughter for aborting a 24-week pregnancy. The proabortion forces in Canada criticized the Supreme Court for exercising its powers to reverse Morgentaler's acquittal, whereas in the United States the proabortion forces demanded that the jury's verdict be set aside by an appeal court on the grounds that the jury ignored the directions of the judge. It is not difficult to appreciate the dangers of the unchecked jury regardless of one's stand on abortion. Morgentaler, I believe, has been justly imprisoned. In his judgement Mr. Justice Dickson of the Supreme Court summarized the nine conditions that must be satisfied before an abortion is permissible. Morgentaler could satisfy only two of the nine - one being that he was a qualified medical practitioner, the other that he was not a member of an abortion committee. In my view Mr. Justice Dickson summarized the case in a nutshell when he stated: The plain fact is that appellant made no attempt to bring himself within the bounds of legality in deciding to perform this abortion. Morgentaler is not a martyr or folk hero. He violated the law and must pay his debt to society like any other criminal. In my view the interests of justice would not be served by Mor-
818 CMA JOURNAL/NOVEMBER 8, 1975/VOL. 113
gentaler obtaining his release before serving the lawful and just term of imprisonment to which he was sentenced. GEORGE CARRUTHERS, BA, LL B
635 East windsor Rd. North Vancouver, BC
Therapeutic abortion
To the editor: In his letter concerning the ethics of abortion (Can Med Assoc J 113: 276, 1975) it is ironic that Dr. Halliday should accuse some of his colleagues of making "confusing state. ments" on the subject. Dr. Halliday states that abortion for "psychosocial" reasons "allows a variety of conditions to be included within an ethical medical framework" and goes on to say that "abortion on demand" has no ethical medical basis. This poses the question "What is meant by an ethical medical framework?" A framework of ethics determines the morality of individual acts on a systematic basis. The abortion controversy is essentially a conflict of ethical systems over the rights of the fetus. If continuation of the pregnancy threatens the life of the mother unless the pregnancy is interrupted, both fetus and mother are doomed. A threat to the life of the mother constitutes the only permissible grounds for abortion under the traditional system of ethics. Abortion for reasons of maternal health is always unethical under this system. The alternative ethical system applicable to medicine is the "utilitarian ethic", first systematically developed by Jeremy Bentham (1748-1832), a working definition of which is "the right action is determined solely on the basis of the consequences of the action", or more familiarly, "The greatest good for the greatest number".1 Since the objective of the individual is to try to satisfy his desires and promote his welfare or happiness, so the objective of society should be to try to advance the satisfactions of those who belong to the society; a society is best arranged when its institutions maximize the net balance of satisfaction. It could be that in order to maximize the satisfactions of the majority, a minority might have to suffer deprivation2 (in this case the fetus). Under this system of ethics, abortion is therefore permissible whenever requested. Clearly, abortion for "psychosocial" reasons and "abortion on demand" are permissible under the utilitarian ethic but never under the traditional ethic. Dr. Halliday's assertion that there is a fundamental ethical distinction between abortion for "psychosocial" reasons and "abortion on demand" is incorrect. Both may be ethical under a utilitarian
Lasix
for the long term
medical ethic. The fundamental ethical distinction, involving the use of different ethical systems, is between abortion because of a threat to the mother's life and abortion because of a threat to her health (however trivial that threat may be).
Hamilton. We are delighted to learn that its owner has been identified and that the brain has been studied with the latest and most sophisticated technique. C.P. SHAH, MD, rRCP[C] M. CHIPMAN,
MA Department of preventive medicine University of Toronto Toronto, ON
RICHARD N. OUGH, MB, BS
Composition: Each tablet contains 40 mg or 20mg furosemide. Each 2 ml ampoule containa 20 mg furosemide; each 4 ml ampoule containa 40 mg. Indications - Oral: Mild to moderate hypertension or with other hypotenaivea in aevere caaea. Edema associated with congeative heart tailure, cirrhoaia ot the liver, renal diaeaae including the nephrotic ayndrome, aa well aa other edematoua atatea. Parenteral: Acute pulmonary, cardiac, hepatic or renal edema. Contralndlcatlona: Comptete renal ahutdown. Diacontinue if increasing azotemia and oliguria occur during treatment ot 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 parenteralty to children. Warnings: Sulfonamide diuretics have been reported to decrease arterial responsiveness to pressor amines and to enhance the effects of tubocurarine. Exercise caution in administering curare or its derivatives during Lasix therapy. Discontinue 1 week prior to elective surgery. Cases ot reversible deafness and tinnitus have been reported when Lasix Parenteral was given at doses exceeding several times the usual therapeutic dose ot 20 to 40 mg. Transient deatness is more likely to occur in patients with severe impairment ot renat 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 Lasix 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 sslicylates with Lasix may experience saticytate toxicity at lower doses. Advarse reactions: As with any effective diuretic, electrolyte deptetion 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 agranutocytosis 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 - Oral: Hypertension: Usual dosage is 40 to 80 mg daily. Individualize therapy and adjust dossge of concomitant hypotensive therapy. Edema: Usual initial dossge is 40 to 80 mg. Adjust according to response. If diuresis has not occurred after 6 hours, increase dosage by increments of 40 mg as frequently as every 6 hours if necessery. 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. Parenteral: Usual dosage 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 diuresis is not sstisfactory, succeeding doses may be increased by increments of 20 mg 2 hours affer the previous dose, until the required diuresis is obtained. The maximum recommended daily dosage is 100 mg. Acute pulmonary edema: Administer 40 mg immediately by slow iv. injection. May be followed by another 40 mg ito 11/2 hours later. Pediatric use: Institute Lasix orally under close observation in the hospital. Single oral dose is 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. Supply: Yellow, round, scored 40 mg tablets [Code DLI] in bottles of 50 and 500. White round 20 mg tablets [Code DLFJ 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.
6668 Fraser St. Vancouver, BC
References LYONS D: Forms and Limits of Utilitarianism, Oxford, Clarendon Pr, 1965 2. 1 Med Ethics 1: 104, 1975
To the editor: Dr. Ough correctly points out that "the abortion controversy is essentially a conflict of ethical systems" and acknowledges that one may practise within either a "traditional" or "utilitarian" ethic. The latter, as expounded by Bentham (who, incidentally, anticipated Freud in his assertion that pleasure and pain are man's dominant motivating forces), was essentially based on Bentham's attempts to codify legal measures necessary for social management. I believe that the laws relating to therapeutic abortion fall within these provisions. The medical ethic, however, provides a systematic basis of practice in respect of the investigation, prevention and treatment of disorders and diseases that affect the life and health of the individual. Pregnancy is not such a condition (it is essentially a normal and healthy condition) and the physician has no ethical medical basis for involvement with the pregnant woman unless he is acting within the limits noted. Abortion on demand does not fall within these limits and those who advocate it make no pretence that it does. A utilitarian ethic, or a social ethic, may lead to legalization of abortion on demand, in which case my recommendation that society then train abortionists to effect this requirement would provide a logical solution towards meeting such a demand. However, I do not believe the medical ethic embraces the concept of abortion (or hysterectomy, or providing narcotics, or commitment to a mental hospital) on demand. We are medical practitioners, not agents or practitioners for a theory of social engineering. R. HALLIDAY, MB, DPM
123 East 13th St. North Vancouver, BC
Slips that pass in the type
H HOECHST Heechni Pharmaceuticals, Divisien at canadian Hsechst Ltd.. Mentreal
1 229/7065/E
E Rag Hoechat TM
To the editor: Our attention was arrested by the title of the article "Computer tomography of the brain in Hamilton" by Banna and colleagues (Can Med Assoc J 113: 303, 1975). We never expected to see Hamiltonians admit that there is only one brain in
[In our penchant for precision we were guilty of separating the head from the body. Dr. Banna has been gracious in not suggesting that we might benefit from study by this new technique. Ed.]
Les services medicaux militaires da Canada
Monsieur le r.dacteur: J'ai parcouru avec int.r.t les articles sur les services
m.dicaux militaires du Canada; l'utilisation des programmes de prevention et de recherche pourrait &re developp.e pour le profit des Forces Arm.es
et des populations au milieu desquelles celles-ci sont cantonn.es. Ii nous semble regrettable que l'Arm.e Canadienne soit autre chose qu'un service m6dical et que d'aussi larges budgets soient octroy6s pour tuer ou d&ruire, ce qu'un petit groupe essaie de sauver. CHRISTIAN FIscH,
MD Centre Hospitalier Universitaire de Sherbrooke Sherbrooke, PQ
Chiropractic
To the editor: I was interested in the article "Chiropractor in medical school sees value in interdependence" (Can Med Assoc J 113: 454, 1975). When I was a student at the University of Alberta a group of students and a teacher from Palmer College lectured on two subjects: organization and exploitation of spinal manipulation. Chiropractors have excelled in organization. I am unable to conceive of any great advancement in spinal manipulation in over 50 years. The profession of medicine is a custodian of accumulated knowledge for the benefit of humanity. One of the obligations assumed on entering the profession is that the physician use every honourable means to uphold the dignity and honour of his vocation, to exalt its standards and to extend its sphere of usefulness. A committee of the National Institutes of Health in the United States was assigned to conduct research into chiropractic. The neurosurgeons and orthopedic surgeons asked for more time in their endeavour to show that chiropractors are making a worthy scientific contribution to medicine. It can only be a political adjustment. Even if government places chiropractors on the same plane as physicians,
CMA JOURNAL/NOVEMBER 8, 1975/VOL. 113 821
2625 Dutch Viliage Rd. Halifax, NS
References 1. EATON JW, WaIL RJ: Culture and Mental Disorders, Glencoe, IL, Free Pr, 1955 2 HOSTETLER JA: Hutterate Society, Baltimore, MD, Johns Hopkins Pr, 1974, p 265 3. EATON JW, MAYER AJ: Man's Capacity to Reproduce: The Demography of a Unique
Population, Glencoe, IL, Free Pr, 1954
The Morgentaler case To the editor: In his letter "The Morgentaler case" (Can Med Assoc J 113: 181, 1975) Dr. Peter N. Coles fails to appreciate that the jury is but a part of our judicial system, not the whole. Why should an unreasonable jury have the unchecked power to make decisions against the law and the evidence? In my view the court's power to order a new trial may be inadequate to control a perverse jury. Would justice be served by the unchecked power of juries in Eire refusing to convict IRA murderers, or of all-white juries in the southern United States refusing to convict whites of murdering blacks,
or of juries in Sicily regularly discharging members of the Mafia? There would probably be juries in some parts of Qu6bec that would refuse to convict FLQ members of crimes in the face of overwhelming evidence of guilt. In my view the court's power to reverse a jury's verdict is an effective means of ensuring equality before the law regardless of a person's political or economic power. The Supreme Court of Canada shares the opinion of Dr. Coles that the reversal of a jury's verdict is a serious matter. Speaking for the majority in the Morgentaler case, Mr. Justice Pigeon stated: Needless to say that this is obviously a power to be used with great circumspection; however, it is hard to conceive of a case in which it could be used, if not here. There cannot be any doubt concerning the commission of the offence by the accused. He had admitted the fact and denies his guilt only on the basis of some defences which the Court of Appeal rightly held unavailable, one of them because it was unfounded in law, the other because there was no evidence to support it.
It is interesting to compare the tactics of the proabortion forces in the Morgentaler case and in the Edelin case in the United States. Dr. Edelin was found guilty by a jury of manslaughter for aborting a 24-week pregnancy. The proabortion forces in Canada criticized the Supreme Court for exercising its powers to reverse Morgentaler's acquittal, whereas in the United States the proabortion forces demanded that the jury's verdict be set aside by an appeal court on the grounds that the jury ignored the directions of the judge. It is not difficult to appreciate the dangers of the unchecked jury regardless of one's stand on abortion. Morgentaler, I believe, has been justly imprisoned. In his judgement Mr. Justice Dickson of the Supreme Court summarized the nine conditions that must be satisfied before an abortion is permissible. Morgentaler could satisfy only two of the nine - one being that he was a qualified medical practitioner, the other that he was not a member of an abortion committee. In my view Mr. Justice Dickson summarized the case in a nutshell when he stated: The plain fact is that appellant made no attempt to bring himself within the bounds of legality in deciding to perform this abortion. Morgentaler is not a martyr or folk hero. He violated the law and must pay his debt to society like any other criminal. In my view the interests of justice would not be served by Mor-
818 CMA JOURNAL/NOVEMBER 8, 1975/VOL. 113
gentaler obtaining his release before serving the lawful and just term of imprisonment to which he was sentenced. GEORGE CARRUTHERS, BA, LL B
635 East windsor Rd. North Vancouver, BC
Therapeutic abortion
To the editor: In his letter concerning the ethics of abortion (Can Med Assoc J 113: 276, 1975) it is ironic that Dr. Halliday should accuse some of his colleagues of making "confusing state. ments" on the subject. Dr. Halliday states that abortion for "psychosocial" reasons "allows a variety of conditions to be included within an ethical medical framework" and goes on to say that "abortion on demand" has no ethical medical basis. This poses the question "What is meant by an ethical medical framework?" A framework of ethics determines the morality of individual acts on a systematic basis. The abortion controversy is essentially a conflict of ethical systems over the rights of the fetus. If continuation of the pregnancy threatens the life of the mother unless the pregnancy is interrupted, both fetus and mother are doomed. A threat to the life of the mother constitutes the only permissible grounds for abortion under the traditional system of ethics. Abortion for reasons of maternal health is always unethical under this system. The alternative ethical system applicable to medicine is the "utilitarian ethic", first systematically developed by Jeremy Bentham (1748-1832), a working definition of which is "the right action is determined solely on the basis of the consequences of the action", or more familiarly, "The greatest good for the greatest number".1 Since the objective of the individual is to try to satisfy his desires and promote his welfare or happiness, so the objective of society should be to try to advance the satisfactions of those who belong to the society; a society is best arranged when its institutions maximize the net balance of satisfaction. It could be that in order to maximize the satisfactions of the majority, a minority might have to suffer deprivation2 (in this case the fetus). Under this system of ethics, abortion is therefore permissible whenever requested. Clearly, abortion for "psychosocial" reasons and "abortion on demand" are permissible under the utilitarian ethic but never under the traditional ethic. Dr. Halliday's assertion that there is a fundamental ethical distinction between abortion for "psychosocial" reasons and "abortion on demand" is incorrect. Both may be ethical under a utilitarian
Lasix
for the long term
medical ethic. The fundamental ethical distinction, involving the use of different ethical systems, is between abortion because of a threat to the mother's life and abortion because of a threat to her health (however trivial that threat may be).
Hamilton. We are delighted to learn that its owner has been identified and that the brain has been studied with the latest and most sophisticated technique. C.P. SHAH, MD, rRCP[C] M. CHIPMAN,
MA Department of preventive medicine University of Toronto Toronto, ON
RICHARD N. OUGH, MB, BS
Composition: Each tablet contains 40 mg or 20mg furosemide. Each 2 ml ampoule containa 20 mg furosemide; each 4 ml ampoule containa 40 mg. Indications - Oral: Mild to moderate hypertension or with other hypotenaivea in aevere caaea. Edema associated with congeative heart tailure, cirrhoaia ot the liver, renal diaeaae including the nephrotic ayndrome, aa well aa other edematoua atatea. Parenteral: Acute pulmonary, cardiac, hepatic or renal edema. Contralndlcatlona: Comptete renal ahutdown. Diacontinue if increasing azotemia and oliguria occur during treatment ot 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 parenteralty to children. Warnings: Sulfonamide diuretics have been reported to decrease arterial responsiveness to pressor amines and to enhance the effects of tubocurarine. Exercise caution in administering curare or its derivatives during Lasix therapy. Discontinue 1 week prior to elective surgery. Cases ot reversible deafness and tinnitus have been reported when Lasix Parenteral was given at doses exceeding several times the usual therapeutic dose ot 20 to 40 mg. Transient deatness is more likely to occur in patients with severe impairment ot renat 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 Lasix 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 sslicylates with Lasix may experience saticytate toxicity at lower doses. Advarse reactions: As with any effective diuretic, electrolyte deptetion 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 agranutocytosis 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 - Oral: Hypertension: Usual dosage is 40 to 80 mg daily. Individualize therapy and adjust dossge of concomitant hypotensive therapy. Edema: Usual initial dossge is 40 to 80 mg. Adjust according to response. If diuresis has not occurred after 6 hours, increase dosage by increments of 40 mg as frequently as every 6 hours if necessery. 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. Parenteral: Usual dosage 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 diuresis is not sstisfactory, succeeding doses may be increased by increments of 20 mg 2 hours affer the previous dose, until the required diuresis is obtained. The maximum recommended daily dosage is 100 mg. Acute pulmonary edema: Administer 40 mg immediately by slow iv. injection. May be followed by another 40 mg ito 11/2 hours later. Pediatric use: Institute Lasix orally under close observation in the hospital. Single oral dose is 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. Supply: Yellow, round, scored 40 mg tablets [Code DLI] in bottles of 50 and 500. White round 20 mg tablets [Code DLFJ 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.
6668 Fraser St. Vancouver, BC
References LYONS D: Forms and Limits of Utilitarianism, Oxford, Clarendon Pr, 1965 2. 1 Med Ethics 1: 104, 1975
To the editor: Dr. Ough correctly points out that "the abortion controversy is essentially a conflict of ethical systems" and acknowledges that one may practise within either a "traditional" or "utilitarian" ethic. The latter, as expounded by Bentham (who, incidentally, anticipated Freud in his assertion that pleasure and pain are man's dominant motivating forces), was essentially based on Bentham's attempts to codify legal measures necessary for social management. I believe that the laws relating to therapeutic abortion fall within these provisions. The medical ethic, however, provides a systematic basis of practice in respect of the investigation, prevention and treatment of disorders and diseases that affect the life and health of the individual. Pregnancy is not such a condition (it is essentially a normal and healthy condition) and the physician has no ethical medical basis for involvement with the pregnant woman unless he is acting within the limits noted. Abortion on demand does not fall within these limits and those who advocate it make no pretence that it does. A utilitarian ethic, or a social ethic, may lead to legalization of abortion on demand, in which case my recommendation that society then train abortionists to effect this requirement would provide a logical solution towards meeting such a demand. However, I do not believe the medical ethic embraces the concept of abortion (or hysterectomy, or providing narcotics, or commitment to a mental hospital) on demand. We are medical practitioners, not agents or practitioners for a theory of social engineering. R. HALLIDAY, MB, DPM
123 East 13th St. North Vancouver, BC
Slips that pass in the type
H HOECHST Heechni Pharmaceuticals, Divisien at canadian Hsechst Ltd.. Mentreal
1 229/7065/E
E Rag Hoechat TM
To the editor: Our attention was arrested by the title of the article "Computer tomography of the brain in Hamilton" by Banna and colleagues (Can Med Assoc J 113: 303, 1975). We never expected to see Hamiltonians admit that there is only one brain in
[In our penchant for precision we were guilty of separating the head from the body. Dr. Banna has been gracious in not suggesting that we might benefit from study by this new technique. Ed.]
Les services medicaux militaires da Canada
Monsieur le r.dacteur: J'ai parcouru avec int.r.t les articles sur les services
m.dicaux militaires du Canada; l'utilisation des programmes de prevention et de recherche pourrait &re developp.e pour le profit des Forces Arm.es
et des populations au milieu desquelles celles-ci sont cantonn.es. Ii nous semble regrettable que l'Arm.e Canadienne soit autre chose qu'un service m6dical et que d'aussi larges budgets soient octroy6s pour tuer ou d&ruire, ce qu'un petit groupe essaie de sauver. CHRISTIAN FIscH,
MD Centre Hospitalier Universitaire de Sherbrooke Sherbrooke, PQ
Chiropractic
To the editor: I was interested in the article "Chiropractor in medical school sees value in interdependence" (Can Med Assoc J 113: 454, 1975). When I was a student at the University of Alberta a group of students and a teacher from Palmer College lectured on two subjects: organization and exploitation of spinal manipulation. Chiropractors have excelled in organization. I am unable to conceive of any great advancement in spinal manipulation in over 50 years. The profession of medicine is a custodian of accumulated knowledge for the benefit of humanity. One of the obligations assumed on entering the profession is that the physician use every honourable means to uphold the dignity and honour of his vocation, to exalt its standards and to extend its sphere of usefulness. A committee of the National Institutes of Health in the United States was assigned to conduct research into chiropractic. The neurosurgeons and orthopedic surgeons asked for more time in their endeavour to show that chiropractors are making a worthy scientific contribution to medicine. It can only be a political adjustment. Even if government places chiropractors on the same plane as physicians,
CMA JOURNAL/NOVEMBER 8, 1975/VOL. 113 821
