pattern for this commonest of all ailments, then it has accomplished its purpose. GERD SCHNEIDER, MD
1303 Richmond Rd. Ottawa, Ont.
What is a specialist? To the editor: I wonder what the opinions of my colleagues are about the criteria needed to call oneself a specialist. Is it simpiy interest in a specialty? Or special training? Or having completed an approved training program and then successfully completing a series of examinations? In the United States any physician who has successfully completed an approved training program becomes a "board-eligible" specialist in that discipline, e.g. pediatrics. Only after he has passed the examinations offered by the American Board of Pediatrics Inc. can he call himself a "board-certified" pediatrician. If he subspecializes the same is true, e.g. for pediatric cardiology. Only if he has passed the written and oral examinations of the appropriate board can he call himself a "certified" specialist. In the US, however, one can charge specialist fees even when one is only "board-eligible" and not "board-certified". There are no exceptions to this rule; even famous university professors must complete written and oral examinations successfully to attain "certified" specialist status. Traditionally in Canada a specialist is one who is certified by examination, both Written and oral, by the Royal College of Physicians and Surgeons of Canada (or by the Province of Quebec). One who has failed these examinations may not practise his specialty, or if he does (at the discretion of the community where he works) he usually charges fees at a generalist's rates. However, there are some interesting perturbations. Some university professors who have not written Canadian examinations have 'been given Royal College fellowships. They are not certified by examination but can call themselves specialists - and collect specialist fees. Why shouldn't a community hospital remote from a teaching centre be able to hire someone on the same basis? Would they wish to? Or would they prefer to maintain higher standards than universities do? As already noted, in the US even full professors must take board examinations to have a "certified" specialist status. I believe there is a need to discuss current procedures for granting and recognizing specialty status. The current system is inconsistent and therefore unjust. I know of individuals who, hay-
ing completed approved training programs but having failed the Canadian specialty examinations, cannot practise their specialty. I know of individuals who, not having tried the Canadian examinations, are given "specialist" status by the Royal College and therefore automatically by the provincial college of physicians and surgeons (and also by government insurance schemes). Surely this is inappropriate. Perhaps we should abandon the present system and adopt the American system, which is fairer and more equitable. KEITH L. MELOFF, MD 123 Edward St. Toronto, Ont.
Hallucinations associated with dantrolene sodium therapy To the editor: We wish to draw attention to hallucinations as a possible side effect of dantrolene sodium (Dantrium) therapy. A 37-year-old man with spastic paraplegia was started on a small dosage of dantrolene, 25 mg bid. This was gradually increased to 75 mg qid over a 17-day period, at which time the first symptoms appeared. He complained of drowsiness and was noted to be slightly confused and disorientated. The dantrolene was decreased to 50 mg qid and he appeared to improve over the next 12 hours. Thereafter he developed acute auditory and visual hallucinations. Dantrolene was discontinued and he was treated with chlorpromazine. The hallucinations persisted for 36 hours. It required a further 24 hours for him to return to his former mental state and alertness. The manufacturer's literature makes no reference to hallucinations being associated with dantrolene therapy. Another physician has personally told us of hallucinations associated with the use of this drug in one of his patients; these subsided on its withdrawal. LESLIE G. ANDREWS, FRCP[CJ ASHOK S. MUZUMDAR, MB A. C. PINKERTON, FRCP[C] G. F. Strong Rehabilitation Centre Vancouver, BC
Graduates of BJ. Medical College To the editor: I am interested in organizing a reunion of B.J. Medical College graduates. Through the Journal I would like to invite all those who have graduated from B.J. Medical College, Ahmadabad, India since 1955 to contact me with a view to establishing an "Overseas B.J. Medical Club".
148 CMA JOURNAL/JANUARY 25, 1975/VOL. 112
PRAFUL A. PATEL, MD 192 Union St. Junction Newcastle, NSW 2291 Australia
Pro-BanthTne for more than peptic ulcer INDICATIONS Pro-Banthine is indicated in peptic ulcer, functional gastrointestinal disturbances, ulcerative colitis, bil iary dyskinesia, chronic hypertrophic gastritis, pylorospasm, acute and chronic pancreatitis, hypermotility of the small intestine not associated with organic change, ileostomies, irritable colon syndrome, diverticulitis, ureteral and urinary bladder spasm, hyperhidrosis.
CONTRAINDICATIONS Gtaucoma Obstructive disease of the gastrointestinal tract Obstructive uropathy due to prostatism Intestinal atony of elderly or debilitated patients Toxic megacolon complicating ulcerative colitis Hiatal hernia associated with reflux esophagitis Unstable cardiovascular adjustment in acute hemorrhage
PRECAUTIONS Patients with severe cardiac disease should be given this medication with caution if even a slight increase in heart rate is undesirable. Fever and heat stroke may occur due to anhidrosis. Varying degrees of urinary hesitancy may occur in elderly patients with prostatic hypertrophy. In such patients urinary retention may be avoided if they are advised to micturate at the lime of taking the medication. A decrease in bronchial secretion may lead to inspissation by these secretions and formation of mucus plugs especially in the elderly or debilitated with chronic pulmonary disease.
ADVERSE EFFECTS Varying degrees of drying of salivary secretions may occur as well as mydriasis and blurred vision. In addition the following adverse reactions have been reported: nervousness, drowsiness, dizziness, insomnia, headache, loss of the sense of taste, nausea, vomiting, constipation, impotence and allergic dermatitis. Some of these effects are dose related.
DOSAGE AND ADMINISTRATION Oral: Dosage should be individualized Pro-Banthine tablets (7.5 mg and 15 mg): the usual adult dosage is 7.5 mg to 15 mg of propantheline bromide with meals and 15 mg to 30 mg at bedtime. Patients with severe manifestations may require increased dosage up to 30 mg four limes a day. Pro-Banthine PA. (30 mg): the usual adult dosage is one tablet in the morning and one at night. Occasionally patients may require one tablet every 8 hours. Parenteral: Initial parenteral dose may be 30 mg or more every 6 hours intramuscularly or intravenously, depending on the condition for which it is administered and the requirements for prompt action. IM. solution - prepared by sterilizing the rubber cap with alcohol and injecting 1 ml of U.S.P. sterile water for injection into the ampoule. IV. solution - recommended that the contents of the 30 mg ampoule be dissolved in 10 ml of U.S.P. sodium chloride injection.
COMPOSITION AND AVAILABILITY Pro-Banthine 7.5 mg: each white, round, convex,
sugar-coaled tablet imprinted "Searle" on one side and "611" on the other contains 7.5 mg of propantheline bromide. In bottles of 100 tablets. Pro-Banthine 15 mg: each peach-coloured, sugarcoated tablet imprinted "Searle" on one side and '601" on the other contains 15 mg of propantheline bromide. In bottles of 100, 1000 and 2500 tablets. Pro-Banthlne P.A. (Prolonged ActIng): the core of each capsule-shaped, compression-coated, peach-coloured tablet, impressed "Searle" on one side and '651" on the other contains 30 mg of propantheline bromide in the form of sustainedrelease beads, about half being released within one hour of ingestion and the remainder released slowly as earlier increments are metabolized. In bottles of 50 and 500 tablets. Pro-Banthine VIALS: each vial contains 30 mg of propantheline bromide as a dry sterile powder for parenteral therapy following reconstitution. In boxes of 10 vials. Full prescribing information available on request or in C.P.S.
Searle Pharmaceuticals Oakville. Ontario
1303 Richmond Rd. Ottawa, Ont.
What is a specialist? To the editor: I wonder what the opinions of my colleagues are about the criteria needed to call oneself a specialist. Is it simpiy interest in a specialty? Or special training? Or having completed an approved training program and then successfully completing a series of examinations? In the United States any physician who has successfully completed an approved training program becomes a "board-eligible" specialist in that discipline, e.g. pediatrics. Only after he has passed the examinations offered by the American Board of Pediatrics Inc. can he call himself a "board-certified" pediatrician. If he subspecializes the same is true, e.g. for pediatric cardiology. Only if he has passed the written and oral examinations of the appropriate board can he call himself a "certified" specialist. In the US, however, one can charge specialist fees even when one is only "board-eligible" and not "board-certified". There are no exceptions to this rule; even famous university professors must complete written and oral examinations successfully to attain "certified" specialist status. Traditionally in Canada a specialist is one who is certified by examination, both Written and oral, by the Royal College of Physicians and Surgeons of Canada (or by the Province of Quebec). One who has failed these examinations may not practise his specialty, or if he does (at the discretion of the community where he works) he usually charges fees at a generalist's rates. However, there are some interesting perturbations. Some university professors who have not written Canadian examinations have 'been given Royal College fellowships. They are not certified by examination but can call themselves specialists - and collect specialist fees. Why shouldn't a community hospital remote from a teaching centre be able to hire someone on the same basis? Would they wish to? Or would they prefer to maintain higher standards than universities do? As already noted, in the US even full professors must take board examinations to have a "certified" specialist status. I believe there is a need to discuss current procedures for granting and recognizing specialty status. The current system is inconsistent and therefore unjust. I know of individuals who, hay-
ing completed approved training programs but having failed the Canadian specialty examinations, cannot practise their specialty. I know of individuals who, not having tried the Canadian examinations, are given "specialist" status by the Royal College and therefore automatically by the provincial college of physicians and surgeons (and also by government insurance schemes). Surely this is inappropriate. Perhaps we should abandon the present system and adopt the American system, which is fairer and more equitable. KEITH L. MELOFF, MD 123 Edward St. Toronto, Ont.
Hallucinations associated with dantrolene sodium therapy To the editor: We wish to draw attention to hallucinations as a possible side effect of dantrolene sodium (Dantrium) therapy. A 37-year-old man with spastic paraplegia was started on a small dosage of dantrolene, 25 mg bid. This was gradually increased to 75 mg qid over a 17-day period, at which time the first symptoms appeared. He complained of drowsiness and was noted to be slightly confused and disorientated. The dantrolene was decreased to 50 mg qid and he appeared to improve over the next 12 hours. Thereafter he developed acute auditory and visual hallucinations. Dantrolene was discontinued and he was treated with chlorpromazine. The hallucinations persisted for 36 hours. It required a further 24 hours for him to return to his former mental state and alertness. The manufacturer's literature makes no reference to hallucinations being associated with dantrolene therapy. Another physician has personally told us of hallucinations associated with the use of this drug in one of his patients; these subsided on its withdrawal. LESLIE G. ANDREWS, FRCP[CJ ASHOK S. MUZUMDAR, MB A. C. PINKERTON, FRCP[C] G. F. Strong Rehabilitation Centre Vancouver, BC
Graduates of BJ. Medical College To the editor: I am interested in organizing a reunion of B.J. Medical College graduates. Through the Journal I would like to invite all those who have graduated from B.J. Medical College, Ahmadabad, India since 1955 to contact me with a view to establishing an "Overseas B.J. Medical Club".
148 CMA JOURNAL/JANUARY 25, 1975/VOL. 112
PRAFUL A. PATEL, MD 192 Union St. Junction Newcastle, NSW 2291 Australia
Pro-BanthTne for more than peptic ulcer INDICATIONS Pro-Banthine is indicated in peptic ulcer, functional gastrointestinal disturbances, ulcerative colitis, bil iary dyskinesia, chronic hypertrophic gastritis, pylorospasm, acute and chronic pancreatitis, hypermotility of the small intestine not associated with organic change, ileostomies, irritable colon syndrome, diverticulitis, ureteral and urinary bladder spasm, hyperhidrosis.
CONTRAINDICATIONS Gtaucoma Obstructive disease of the gastrointestinal tract Obstructive uropathy due to prostatism Intestinal atony of elderly or debilitated patients Toxic megacolon complicating ulcerative colitis Hiatal hernia associated with reflux esophagitis Unstable cardiovascular adjustment in acute hemorrhage
PRECAUTIONS Patients with severe cardiac disease should be given this medication with caution if even a slight increase in heart rate is undesirable. Fever and heat stroke may occur due to anhidrosis. Varying degrees of urinary hesitancy may occur in elderly patients with prostatic hypertrophy. In such patients urinary retention may be avoided if they are advised to micturate at the lime of taking the medication. A decrease in bronchial secretion may lead to inspissation by these secretions and formation of mucus plugs especially in the elderly or debilitated with chronic pulmonary disease.
ADVERSE EFFECTS Varying degrees of drying of salivary secretions may occur as well as mydriasis and blurred vision. In addition the following adverse reactions have been reported: nervousness, drowsiness, dizziness, insomnia, headache, loss of the sense of taste, nausea, vomiting, constipation, impotence and allergic dermatitis. Some of these effects are dose related.
DOSAGE AND ADMINISTRATION Oral: Dosage should be individualized Pro-Banthine tablets (7.5 mg and 15 mg): the usual adult dosage is 7.5 mg to 15 mg of propantheline bromide with meals and 15 mg to 30 mg at bedtime. Patients with severe manifestations may require increased dosage up to 30 mg four limes a day. Pro-Banthine PA. (30 mg): the usual adult dosage is one tablet in the morning and one at night. Occasionally patients may require one tablet every 8 hours. Parenteral: Initial parenteral dose may be 30 mg or more every 6 hours intramuscularly or intravenously, depending on the condition for which it is administered and the requirements for prompt action. IM. solution - prepared by sterilizing the rubber cap with alcohol and injecting 1 ml of U.S.P. sterile water for injection into the ampoule. IV. solution - recommended that the contents of the 30 mg ampoule be dissolved in 10 ml of U.S.P. sodium chloride injection.
COMPOSITION AND AVAILABILITY Pro-Banthine 7.5 mg: each white, round, convex,
sugar-coaled tablet imprinted "Searle" on one side and "611" on the other contains 7.5 mg of propantheline bromide. In bottles of 100 tablets. Pro-Banthine 15 mg: each peach-coloured, sugarcoated tablet imprinted "Searle" on one side and '601" on the other contains 15 mg of propantheline bromide. In bottles of 100, 1000 and 2500 tablets. Pro-Banthlne P.A. (Prolonged ActIng): the core of each capsule-shaped, compression-coated, peach-coloured tablet, impressed "Searle" on one side and '651" on the other contains 30 mg of propantheline bromide in the form of sustainedrelease beads, about half being released within one hour of ingestion and the remainder released slowly as earlier increments are metabolized. In bottles of 50 and 500 tablets. Pro-Banthine VIALS: each vial contains 30 mg of propantheline bromide as a dry sterile powder for parenteral therapy following reconstitution. In boxes of 10 vials. Full prescribing information available on request or in C.P.S.
Searle Pharmaceuticals Oakville. Ontario
