complications that may result from the prenatal screening of a "normal" expectant mother. The practice of selective feticide involves the destruction (one could more accurately say murder) of the fetus to assuage the distressed and anguished response of the mother and father (and society) to the birth of a handicapped child. If this is not a eugenic procedure, then the word has lost all meaning. It was a pleasure to receive Dr. McCreary's thoughtful reply to my article. There is indeed bright, new promise that we will be able to provide effective treatment for those with Down's syndrome. However, the anticipated birth of such a child does present the mother and her physician with awesome decisions. I remain unable to find any distinction between selective abortion carried out now - in terms of intent or practice - and the procedures used by German physicians in the 1 920s and 1930s. If Dr. Tuttle cannot differentiate between the thousands of abortions resulting from the emotionally charged situation of unplanned and unwanted pregnancy in this country and the deliberate searching out of handicapped unborn individuals with the intent of carrying out their abortion, then I am unable to carry on a logical argument with him. I agree with Tuttle that the dilemma so clearly enunciated by Malthus nearly a century ago is relevant to this discussion. To express it in terms of "people pollution" seems to depart from the high view of the dignity of man individually and as a group that has formed the very foundation of our Western civilization. I fully agree with the sentiments expressed by Dr. Thomas Settle. However, Tuttle's use of Settle's definition begs the question under discussion in my paper. To suggest that our identity
as human beings is established only when "the imprinting of language has been achieved" seems fatuous. We would be best served by accepting that what is conceived by man and woman is human. Surely, the potential for all the attributes of life and existence are resident in the fetus within the receptive maternal womb from the time of conception and implantation. Dr. de Bellefeuille, like Dr. Welch, has drawn the assumption from my paper that I sanction and condone abortion for noneugenic reasons. Nothing could be further from my own sentiments or from the intended objective of the misleading paragraph. I sincerely apologize to anyone who may have been similarly confused by my inept phraseology. Malcolm N. Beck, MD, CM, FRCPC 279 Richmond St. Charlottetown, PEI
Women in medicine: practice patterns and attitudes members of the planning committee for the 100th anniversary of the enrolment of the first woman at Dalhousie University Faculty of Medicine we read with interest the article by Dr. A. Paul Williams and colleagues (Can Med Assoc J 1990; 143: 194-201) and would like to echo the last sentence: "Therefore, the extent and effects of the progressive increase in the number of women in Canadian medicine should be documented and assessed on an ongoing baA
s
sis."
We were somewhat surprised that the authors (four men and one woman) didn't realize that women entering practice today have very few role models to assist them in establishing medical practice while fulfilling their bio-
logic role as childbearers. Once these roles have been integrated additional changes may occur in medical practice. There may also be changes if women, with their longer life expectancy than men, choose to remain in practice longer, even if they maintain their current patterns of practice. Another reason for alterations in medical practice may be that men are now refusing to continue the patterns established in previous generations. We were surprised to read in the article that the sample of men surveyed worked on average only 45 hours per week, which is well below the traditional estimate of 60 to 70 hours. We sincerely hope that the authors will continue this work and provide regular updates on their data. We suspect that medicine is changing because of many factors, not only the gender ratio described in this article. Jean Gray, MD For the Women in Medicine Committee Faculty of Medicine Dalhousie University Halifax, NS
Tennis elbow and computers W re have recently encounx tered two cases of a syndrome closely resembling tennis elbow that were clearly related to computer keyboarding. One occurred in our chief of service and one in a data entry person. The latter case was quite severe, with pain, swelling and disability necessitating a week off work. Both cases seemed to be related to the use of standard keyboards at nonstandard heights. Both people are relatively light users and experienced this syndrome during occasional heavy use. A search of the literature yielded one entry in the FukuCAN MED ASSOC J 1991; 144 (1)
13
shima Journal of Medical Sci- cal team from the National Deence.' Have there not been other fence Medical Centre has been cases closer to home, possibly not assigned to the 1000-bed hospital reported because they are so pro- ship USNS Mercy. saic? The question is not trivial: the condition is not widely recognized by workers' compensation boards because there is a lack of literature on it, unlike the documentation on carpal tunnel syndrome and computer use. We appeal, therefore, to the readers of CMAJ. We would be happy to receive information regarding either references we have missed or cases that have been treated but not reported. Henry M. Taylor, MD Chief of clinical pathology Bruce L. Bender, MD Chairman Department of Laboratory Medicine The Moncton Hospital 135 MacBeath Ave. Moncton, NB E lC 6Z8
Reference 1. Shimai S, Iwasaki S, Suzuki H et al: Survey on subjective symptoms in office workers using video display terminals. Fukushima J Med Sci 1988; 34 (1): 45-54
Military MDs used to peace prepare for war
In addition, considerable effort was required of our health care personnel across the country to introduce the right equipment, such as cooling vests for aircrew, and the appropriate drugs, such as those required to counter the biologic warfare threat. Thanks to this combined effort our troops are being provided excellent medical support. In case the article left some CMAJ readers wondering, no, we have not returned, nor do we intend to return, to three separate medical services. The Canadian Charles M. Godfrey, MD Medico) Forces Medical Services was (CARE 109-484 Church St. formed in 1959 as a triservice Toronto, Ont. health care system. It has withstood the test of time and other Reference acid tests, such as the present 1. Aga Khan Foundation: conflict. Maj.-Gen. J.J. Benoit, MD Surgeon general Canadian Forces
Funding medical aid to the Third World D_
r. Michael Hall's article "Orthopaedics Overseas: First World MDs can make a difference in the Third World" (Can Med Assoc J 1990; 143: 304-305) gives full recognition to the immense work done in the Third World by orthopods. However, it must be realized that those in other specialties can serve with CARE Medico, CUSO and other such organizations. But granting agencies such as CIDA and USAID have decided that the major emphasis in medicine should be on prevention and primary health care. Thus, there is little support for a specialist physician who wants to work over-
T n he article by Deborah Jones (Can Med Assoc J 1990; 143: 770-773) gives a good account of the medical planning and preparation involved in supporting Canada's naval contribution to the Persian Gulf crisis. However, it fails to mention other elements of the medical support infrastructure. For example, a Canadian medical team made up of medical personnel stationed in Europe has been deployed with the CF-18 fighter squadron, a joint aeromedical seas. evacuation system has been estabAlthough this decision by lished with US forces, and a surgi- funding bodies may have some 16
CAN MED ASSOC J 1991; 144 (1)
long-term benefits, there remains an urgent need to teach and treat the Third World sick now. The Aga Khan Foundation' pointed out clearly that in striving to have health for all by the year 2000 it is necessary to provide backup services at the secondary and tertiary levels in addition to the primary level. The time is appropriate for physicians and surgeons who have worked in the Third World to let the funding agencies know that supporting primary and preventive medicine initiatives is not sufficient to take care of the health needs of the Third World.
The Role of Hospitals in Primary Health Care. A Report of a Conference. Sponsored by the Aga Khan Foundation and the World Health Organization, 22-26 November 1981, Karachi, Pakistan, Aga Khan Foundation, Geneva, 1980
La raison d'etre de notre belle profession licitations a votre photographe Francois Proulx (voir la page couverture du JAMC du ler oct., 1990). Devant le regard de l'homme ainsi photographie j'ai redecouvert, en quelques secondes, la raison d'etre de notre belle profession: l'aide a celui qui, demuni par la maladie ou la decheance, n'est pas toujours attrayant au point de vue medical, mais qui appelle a l'aide. A nous de ne pas oublier, au travers de la medecine d'aujourd'hui, perdue dans les techniques nouvelles et les reglements de nos technocrates
gouvernementaux. Pierre Beauchemin, MD
4100, 3e ave. ouest Charlesbourg, QC
as human beings is established only when "the imprinting of language has been achieved" seems fatuous. We would be best served by accepting that what is conceived by man and woman is human. Surely, the potential for all the attributes of life and existence are resident in the fetus within the receptive maternal womb from the time of conception and implantation. Dr. de Bellefeuille, like Dr. Welch, has drawn the assumption from my paper that I sanction and condone abortion for noneugenic reasons. Nothing could be further from my own sentiments or from the intended objective of the misleading paragraph. I sincerely apologize to anyone who may have been similarly confused by my inept phraseology. Malcolm N. Beck, MD, CM, FRCPC 279 Richmond St. Charlottetown, PEI
Women in medicine: practice patterns and attitudes members of the planning committee for the 100th anniversary of the enrolment of the first woman at Dalhousie University Faculty of Medicine we read with interest the article by Dr. A. Paul Williams and colleagues (Can Med Assoc J 1990; 143: 194-201) and would like to echo the last sentence: "Therefore, the extent and effects of the progressive increase in the number of women in Canadian medicine should be documented and assessed on an ongoing baA
s
sis."
We were somewhat surprised that the authors (four men and one woman) didn't realize that women entering practice today have very few role models to assist them in establishing medical practice while fulfilling their bio-
logic role as childbearers. Once these roles have been integrated additional changes may occur in medical practice. There may also be changes if women, with their longer life expectancy than men, choose to remain in practice longer, even if they maintain their current patterns of practice. Another reason for alterations in medical practice may be that men are now refusing to continue the patterns established in previous generations. We were surprised to read in the article that the sample of men surveyed worked on average only 45 hours per week, which is well below the traditional estimate of 60 to 70 hours. We sincerely hope that the authors will continue this work and provide regular updates on their data. We suspect that medicine is changing because of many factors, not only the gender ratio described in this article. Jean Gray, MD For the Women in Medicine Committee Faculty of Medicine Dalhousie University Halifax, NS
Tennis elbow and computers W re have recently encounx tered two cases of a syndrome closely resembling tennis elbow that were clearly related to computer keyboarding. One occurred in our chief of service and one in a data entry person. The latter case was quite severe, with pain, swelling and disability necessitating a week off work. Both cases seemed to be related to the use of standard keyboards at nonstandard heights. Both people are relatively light users and experienced this syndrome during occasional heavy use. A search of the literature yielded one entry in the FukuCAN MED ASSOC J 1991; 144 (1)
13
shima Journal of Medical Sci- cal team from the National Deence.' Have there not been other fence Medical Centre has been cases closer to home, possibly not assigned to the 1000-bed hospital reported because they are so pro- ship USNS Mercy. saic? The question is not trivial: the condition is not widely recognized by workers' compensation boards because there is a lack of literature on it, unlike the documentation on carpal tunnel syndrome and computer use. We appeal, therefore, to the readers of CMAJ. We would be happy to receive information regarding either references we have missed or cases that have been treated but not reported. Henry M. Taylor, MD Chief of clinical pathology Bruce L. Bender, MD Chairman Department of Laboratory Medicine The Moncton Hospital 135 MacBeath Ave. Moncton, NB E lC 6Z8
Reference 1. Shimai S, Iwasaki S, Suzuki H et al: Survey on subjective symptoms in office workers using video display terminals. Fukushima J Med Sci 1988; 34 (1): 45-54
Military MDs used to peace prepare for war
In addition, considerable effort was required of our health care personnel across the country to introduce the right equipment, such as cooling vests for aircrew, and the appropriate drugs, such as those required to counter the biologic warfare threat. Thanks to this combined effort our troops are being provided excellent medical support. In case the article left some CMAJ readers wondering, no, we have not returned, nor do we intend to return, to three separate medical services. The Canadian Charles M. Godfrey, MD Medico) Forces Medical Services was (CARE 109-484 Church St. formed in 1959 as a triservice Toronto, Ont. health care system. It has withstood the test of time and other Reference acid tests, such as the present 1. Aga Khan Foundation: conflict. Maj.-Gen. J.J. Benoit, MD Surgeon general Canadian Forces
Funding medical aid to the Third World D_
r. Michael Hall's article "Orthopaedics Overseas: First World MDs can make a difference in the Third World" (Can Med Assoc J 1990; 143: 304-305) gives full recognition to the immense work done in the Third World by orthopods. However, it must be realized that those in other specialties can serve with CARE Medico, CUSO and other such organizations. But granting agencies such as CIDA and USAID have decided that the major emphasis in medicine should be on prevention and primary health care. Thus, there is little support for a specialist physician who wants to work over-
T n he article by Deborah Jones (Can Med Assoc J 1990; 143: 770-773) gives a good account of the medical planning and preparation involved in supporting Canada's naval contribution to the Persian Gulf crisis. However, it fails to mention other elements of the medical support infrastructure. For example, a Canadian medical team made up of medical personnel stationed in Europe has been deployed with the CF-18 fighter squadron, a joint aeromedical seas. evacuation system has been estabAlthough this decision by lished with US forces, and a surgi- funding bodies may have some 16
CAN MED ASSOC J 1991; 144 (1)
long-term benefits, there remains an urgent need to teach and treat the Third World sick now. The Aga Khan Foundation' pointed out clearly that in striving to have health for all by the year 2000 it is necessary to provide backup services at the secondary and tertiary levels in addition to the primary level. The time is appropriate for physicians and surgeons who have worked in the Third World to let the funding agencies know that supporting primary and preventive medicine initiatives is not sufficient to take care of the health needs of the Third World.
The Role of Hospitals in Primary Health Care. A Report of a Conference. Sponsored by the Aga Khan Foundation and the World Health Organization, 22-26 November 1981, Karachi, Pakistan, Aga Khan Foundation, Geneva, 1980
La raison d'etre de notre belle profession licitations a votre photographe Francois Proulx (voir la page couverture du JAMC du ler oct., 1990). Devant le regard de l'homme ainsi photographie j'ai redecouvert, en quelques secondes, la raison d'etre de notre belle profession: l'aide a celui qui, demuni par la maladie ou la decheance, n'est pas toujours attrayant au point de vue medical, mais qui appelle a l'aide. A nous de ne pas oublier, au travers de la medecine d'aujourd'hui, perdue dans les techniques nouvelles et les reglements de nos technocrates
gouvernementaux. Pierre Beauchemin, MD
4100, 3e ave. ouest Charlesbourg, QC
