·"HE UNIVERSITY OF WESTERN ONTARIO 1) lk_...eW\ ~<1... ~ - VOL. 42, NO. 2

MAY 51912

MEDICAL JOURNAL

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Contents

17 The Home of Hippocrates-C. L. Scott, M.D.

18 Jung and the Twentieth Century Myth-George R. Garner

26 A Day in the Country-K. Acheson , '73

26 James C. Paterson , a beloved teacher and gentle man­

W. Thomas, M.D.

28 Pathological Photo Quiz-D. J. Carroll , M.D.

28 University Hospital-0. H. Warwick, M.D.

29 Acupuncture (Part 11)-Cho-Yuk Leung , Ph.D.

44 London Free Health Clinic-1. Vinger, M.D.C.M.

46 The Pineal Body-V. VanHooydonk, '73

48 List of Junior Internship, a Review-J . Lam, '73 and R. Corrin , '73

52 Fourth Year Electives-D. Munroe, '73

54 Class News

55 Scholarships and Prizes

McMaster University Faculty of Medicine INTEGRATED POSTGRADUATE PROGRAMME

YEAR I (INTERNSHIPS)

(A) Basic Programm&-specially designed on individual basis to meet the needs of the uncommitted physician, the physician with unique career goals or the physician that requires a rotating internship.

(B) Specialty Programmes-a straight internship that represents a first Residency year in the specialties mentioned below.

YEAR II ON (RESIDENCIES)

Training is offered in the specialties of ; Anesthesia, Family Medicine, Internal Medicine, Laboratory Medicine, Obstetrics and Gynecology, Pediatrics, Psychiatry, Physical Medicine and Rehabilitation , Radi­ology and Surgery. This educational programme employs the facilities and personnel of a large network of hospitals in the Hamilton district and the exten­sive new multi disciplinary health sciences complex incorporating the McMaster University Medical Centre on the university campus.

McMaster University Faculty of Medicine

For more details, please write OFFICE OF POSTGRADUATE STUDIES Faculty of Medicine McMaster University Hamilton, Ontario, Canada

FAMILY MEDICINE PROGRAMME

The Department of Family Medicine presents a three year post­graduate programme designed specifically to prepare graduates from medical school to enter family practice. Residents will complete the programme when they achieve the educational objectives of the course ; for most residents this has taken about 3 years. The resi­dents spend some 14 months of three years in modern office surroundings at the McMaster University Clinic in the Henderson General Hospital. Here they assume the responsibility of family physicians under graded supervision. Opportunities for experience in teaching and research are present. The family is emphasized both in health maintenance and treatment of illness. The symptom approach is basic throughout the entire programme.

Please apply to Postgraduate Studies, McMaster University, Hamilton, Canada.

The Home of Hippocrates

It is safe to say that no University of Western Ontario medical student graduates without learning much of the great Sir William Osier. It was my good fortune when entering practice to be associated with one of his students, Dr. C. W. Anderson , McGill '03. When he graduated, Osier arranged for him and his classmate, Dr. John McCrae to become the first pathologists at Montreal General and Royal Victoria Hospitals. Dr. McCrae was killed in 1918 in the first World War, but not before he penned " In Flander's Fields . . . . " Dr. Anderson , after his pathology service, went to Europe where he studied clinical mircroscopy, heard Wasserman deliver his report on complement fixation , and pursued further courses in surgery and gynecology.

During our many talks , I absorbed much knowledge about Osier, the doctor and Osier the man. One point Osier seemed to reiterate was the great influence on, and stimulation to , modern medical teaching by Hippocrates, truly the father of medicine.

To learn more of this man at what must be considered the fountainhead of medicine, it seemed that a visit to his island of Kos was indicated, and an opportunity arrived when participating in an 'Odyssey to Antiquity' with an archeological group from my first alma mater, U.C.L.A.

Kos (or Cos) is a small island of the Dodecanese group in the southeastern Aegean. It is just over 100 square miles in area, with some rugged hills and many fertile valleys which produce grapes, oranges, olives, and pomegranates. Most of the inhabitants live in the capital of Kos. In the Iliad , it was mentioned as a Grecian ally, but like most Mediterranean islands, it had many masters of differing races, finally being transferred from Italy to Greece in 1947.

Kos boasts many attractive seaside resorts that are as ,popular with budget-minded vacationers today as they were with the Ptolomies and Egyptians centuries ago. Here Cleopatra kept her treasures, and here Pierre de Soisson was Grand Master of the Knights of St. John until driven out by the Turks.

Of the many distinguished men purportedly from this island, the most famous was Hippocrates with a birth date circa 462 B.C. He was part of the Golden Age of Pericles, with such associates as Herodotus,

C. L. Scott, M.D.

Sophocles, Democritus, and Socrates. He was possibly a descendant of, and certainly a student of Aesculapius, the god of healing, who probably was not a mythological character inasmuch as Homer spoke of him in writing about the Trojan War. Thanks to the brilliant work of Michael Ventris in 1952 in deci,phering the so-called Tripod tablets in the script Linear-B, we now recognize that Homer's writing was an archaic form of Greek, so his works have gained great credence as facts of history. We also know for a certainty that Aesulapius was worshipped after the advent of Christianity when most of the other gods were forgotten .

In that pre-Christian era, knowledge of sickness and suggested cures was an occult mystery handed down in great secrecy from father to son, or from a teacher to a carefully selected pupil. Hippocrates was different. He made copious notes, he rejected ignorance and superstition in favor of observation and study, and actually was the stimulus that introduced science to medicine. By his writings he passed on his findings to personnel throughout his world , His observations on changes of facies are as accurate today as they were then. He wrote of diets, of fresh air and exercise, of the effects of climate on body and mind. Religious causes of diseases were discarded and supplanted by rational study.

Early writings, the Hippocratic collection , are reported to have been published in book form by a dealer in Alexandria in the 3rd Century, B.C. Some of the known titles were 'The Sacred Disease' (epilepsy) , Epedemics, and Aphorisms. Included in the latter are such fami liar sayings as 'Desperate diseases need desperate remedies ', 'One man 's meat is another man 's poison ', and 'the treatment shall at least do no harm'.

It is impossible in this short article to cover much of his work, but anyone interested might consult a definitive treatise of ten volumes by Emile Litre, Oeuvres compli~tes d' Hippocrate.

In commemoration of his devoted teaching the Hippocratic Oath is administered to all doctors graduating from medical schools. Also, every two years in Kos, the International Federation of Medicine honors him by re-enacting scenes and dialogues as they were supposed to have happened in his day.

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The old town of Aesculapia suffered an earthquake in 412 B.C. and another in 155 A.D. Still another eruption in 1932 exposed some of the older city, so that much of the earlier construction was available for rehabilitation .

The Shrine of Hippocrates is but a short distance from the city and is on three levels. First, is the Temple of Aesculapius with its altar for sacrifices. Second, designed by Praxiteles, is the Temple of Apollo. Third and highest, is the 4th Century Temple with a contiguous sacred cypress grove where malefactors could obtain asylum. The hospital is to the rear and side of this copse. The sacred fountain of heal ing water still exists with an unchanging and apparently unending supply.

In the main part of town where also Hippocrates taught, stands a large plain tree. It is huge, almost hollow in the center, and many of the branches require propping up. A statue here commemorates his previous presence, and of course, bust facsimiles of him are hawked by the score so that tourists may bring back a souvenir.

For those not interested in medical history there is a Castle of the Knights Hospitallers of St. John of Jerusalem, a mosque built during the Turkish occupation, ancient ruins , early Christian churches, and Byzantine monuments.

All of these latter however, will soon be relegated to the limbo of forgotten experiences, while the remembered reality of the contributions of Hippocrates will endure in an immortal niche in the medical hall of fame.

Jung and the Twentieth Century Mythology George R. Garner, Appendix in collaboration wi th Bohdan S. Kurylo

I. MYTH AND MYTHOLOGY

Most people today, when hearing the terms " myth" and " mythology" would be inclined to think of Greece or Rome, possibly even of Nordic myths as they are expressed through R. Wagner-few only would consider our own mythology. A mythology has always given a framework to man 's actions and thoughts. Defined in this context it would be a "vision of society" ' which gives meaning and purpose to life. A myth on the other hand according to the Shorter Oxford Oictiona;y is :· ... a narative .. . embodying some popular 1deas, concerning natural or historical phenomena". Our western society is rooted in two primary mythological constructions. One is institutional Christianity, derived from Biblical and Aristotelian sources, the other is modern psychology. ' A mythological system such as institutional Christianity is what N~rthrop Frye termed a " closed mythology". It IS a system which requires proof of th~oretical belief, and a show of allegiance. This mythology, which reached its peak dur.ing the middle ages, also brought about an el1t1st class of clerics who could inst ruct and surpress. In present day Marxism (another closed mythology) the elitist class is made up of party workers who understand the principles of Marxism and realize the way the power structure wants Marxism rationalized .' A closed system of mythology is further more highly dogmatic and thereby not necessarily ' creatively inspiring. Christian mythology has,

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since the middle ages, however, been steadily losing its audience. Intellectuals have turned to philosophical and psychological ideas. The founding stone for this reversal was self­analysis. Although our century is the first to analyse itself objectively, the roots for this analysis are as far back as the French Revolution. In the older mythology we saw the world as a reflection of the symbols of the mythology. (Consider Plato's concept of ideals, which showed that things on earth are a reflect ion of ideals of a higher realm.

Similarly from Christianity we get the idea that a " heaven " is no more than an improved earth.) Around the time of the French Revolution it became apparent that human life was not derived from the myth, but rather the myth from human life. Voltaire exclaimed : " If God didn 't exist, it would be necessary to invent him." (Enitres xovi, A !'Auteur du Luvre des Trois lmposteurs.) The implication was clearly that man had become aware that he was the creator of his own culture and of his mythology. This conviction was the basis of self-analysis.

At the beginning of the twentieth century the Ger.man poet Gottfried Benn (doctor by profess1on, poet by vocation) wrote in the poem " Lost Ego":

The world thought to pieces. And space and time

and what weighed and wove mankind , function only of infinitives-and the myth has lied. Whither, whence-not night not morning , no Evoe, no requiem, you would like to borrow a slogan­but from whom?'

In this poem we can see one of the results of self-analysis , the result of man 's objective look at himself. As the title depicts, it deals with man 's alienation from the world. Man has become a sacrificial animal fragmented by stratospheres and gamma rays. He has lost his hold on the church. His world has collapsed. The poem also shows a new body of myths , which are the result of philosophical thought from the time of Rousseau and Voltaire.

The primary modern myth , which permeates our lives is the myth of progress. It originates from a belief held by Bolinbroke and Rousseau that " the natural and reasonable society of the future was buried beneath the accumulated injustices and absurdities of civilization , and all man had to do was to

release it by revolution."' The myth of progress has, however, taken on negative meaning. The cliche " that's progress for you ", seldom refers to a positive achievement. This concept has created two further connected ideas: the myth of concern for our future , and the myth of anxiety. Professor Frye believes that the present collapse of belief in progress reinforces the sense of anxiety which is rooted in the consciousness of death .• In earlier times the sense of alientation and anxiety was projected as the fear of hell. T. S. Eliot takes up this image in The Wasteland when speaking of the alientation of the people in London:

Unreal city, Under the brown fog of a winter dawn, A crowd flowed over London bridge, so

many, I had not thought that death had undone

so many. Sighs, short and infrequent, were exhaled .,

And each man fixed his eyes before his feet. '

Today, this fear is not attached to the world following , but to the future of our own world. " I had not thought death had undone so many" is a quote taken from Dante, originally referring to the Inferno-now it refers to our own world . Man is alienating himself from his prime myth , while trying to believe in it.' There is probably a correlation between the negative connotation of the myth of progress and the phenomenae of depression and disillusionment brought about by self-analysis. The disi l lusionment expressed in the Benn

poem is a natural result of man 's fi rst objective glances at himself. It we take this development fu rther we realize that two other products of this frame of mind , although unrelated , are anguish and absurd ity. The myth of anguish is probably best displayed by the younger generation in their frantic outcry that they won 't have a world left for their children . Their act ions are accordingly those of anguish-they are actions of the last resort , to save with fo rce what they feel would otherwise be destroyed. (It was the force of the myth of anguish that probably lent expression to Benn 's poem.) The myth of absurdity is basically nothing else than man 's attempt to change the angle of his objective view. It is a side development of the myth of progress. Nature will only make a reasonable whole if looked at through the eyes of a scientist. Yet if we view nature with eyes other than those of reason , with emotion, or desire, or to answer needs other than those of reason , nature becomes a vast unthinking indifference, with no evidence of meaning or purpose. It becomes senseless and at times cruel.• Perhaps in this light t11e existence of an absurdist tradition in literature and the

arts becomes more understandable. Man accepts the unreal and irrational , not because he cannot distinguish any longer, but rather because he is seeking new modes of experience. In the absurdist tradition art remains an imitation of nature, but of a nature seen through different spectacles.

Some of the above mentioned myths are new creations , others old ideas in new form. The myth of anxiety in its connection to "hell " is certainly not new-only the concept of hell has changed. Similarly the negative connotation of the myth of progress recalls in my mind the Sisyphus myth (the myth of futility, but this might be only a personal associative process) . Basically all of these myths have rooted in the philosophical thought which makes up our contemporary mythology. Mythology today is connected with philosophy, since philosophers are usually the ones that exert the prime influence upon the shaping of our " vision of society". Our contemporary mythology is again made up of two basic strands. One is our " social mythology", which is a watered-down Christian mythology, and consists of cliches about the American way of life , the value of progress, and the value of our present way of life.'0 " Idea mythology", the second strand of our contemporary mythology on the other hand , lends a coherence and contextual framework to our views of the world today. It is coined by thinkers such as Marcuse, Brown, Sartre, Buber, McLuhan, Toynbee, etc. People of this calibre not only influence our vision of society, they also inspire us to new thoughts , while giving us guidelines for

19

the present. Our idea mythology is the starting point for an "open mythology" ." Modern psychology is not only a part of this idea mythology it is a stepping stone. The reasons for this I hope to make clear in the last part of the paper.

An open mythology is actually too fluid a structure to apply the metaphor " mythology" to it. " It basically differentiates itself from the closed mythology mentioned earlier by its openness to new ideas. In this type of mythology an idea remains to be a half truth unless it has opposites, no thought is ever closed ; it is a constantly expanding structure inco~porating evermore ideas. The idea of hell , which I mentioned earlier, has driven us into a myth of anguish and anxiety because of our fear of the future-an overly technological dehumanized hell. It is the same myth which has also driven us towards modern psychology. Psychology, here, should not be considered in the Skinnerian sense of behaviour, conditioning and motivation , but rather in the philosophical sense as mans attempt to understand and cope with a situation. It is more of a Nietzchean psychology, in which man is trying to raise himself to a higher level by discovering and also releasing the spiritual and creative powers within him.

At a time when more and more ideas bombard us, the existence of an open mythology is of greatest importance, since it allows us to deal with these ideas and probe them for relevance to our age. In the next two sections of this paper I will try to show the importance of Jungian psychology in this open mythology, why his psychology is actually a mythology, and just what place a system such as his (and there are many

• others of just as great relevance) takes within an open mythology.

II. JUNG AND LITERATURE

The literary critic stands between the author and his audience. It is his job to critcally interpret to the audience the authors words. Some critics have found , that in order to understand any literary work one must first try to understand the characters , their relations to each other, and sometimes also the author. While this is easy in some novels or plays, it is a problem of great complexity in other works. Psychological interpretation then becomes a stepping stone for in depth analysis of literature. Critics and educators in literature have in the past leaned more and more towards Jung rather than Freud, Maslow, Roger, Fromm or theological teachings.

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Psychology, as already mentioned earlier is the second major mythology of our society. As theological teachers lose their audiences, psychologists and psychiatrists gain them. Theological teachings (the Christian mythology) have fallen into scholarly disrepute, unless treated completely symbolically (in which case they approach psychology again) , since they would otherwise be too simplistic, and provide an easy escape hatch for problems which should be analysed and understood rather than dogmatically explained away. Freud, on the other hand, has destroyed his own reputation -his system is too closed . The moment the literary critic as lay-psychologist treats all towers as phallic symbols, all ponds, lakes, and waters as female and mother representations, and all mountains as father representations , his interpretive system will no doubt be narrowed considerably. Freud laid a foundation in psychology. His teachings were used by Adler (who, as if in a pendulum swing went into the opposite direction, discredited the unconscious and emphasized social adaptation and normalization) , H. Marcuse, Erich Fromm and others. Without Freud 's interpretive work Jung 's ideas might have been formulated in a quite different way. Psychologists and philosophers like Fromm, Brown or Marcuse needed a Freud as a basis for their teachings. Psychologists like Jung , von Franz, Jacobi , or A. Jaffe, needed a Freud to be able to react to his teachings . For some he was a stepping stone, for others he was a touchstone ; his writings remain to be of great heuristic value. The discipline of psychology to the layman is a battlefield of action and reaction , of formation , counterformation and reformation . It is first and foremost a race in which a torch of knowledge is passed from one eminent figure to the other. For this reason I find it important to view psychology as a continuum and to avoid a sense of finality which evokes obstinacy and peripheral blindness.

Jung has presented us with a very precise system of symbolism and iconagraphy. The majority of his books touch upon this subject in one way or another. He has given us a mythology, while at the same time being part of a much greater all embracing open mythology. His symbolic vision of man 's mind has contributed to a symbolic vision of society. Through his psychology we can obtain a better understanding of myth and mythology, in its compensatory action , as it is used in literature or in society at large.

A psychologist 's view of looking at a literary work may differ fundamentally from a literary critic 's view of a work. What is important for the psychologist usually bears little relevance for the literary critic . Often works of inferior

quality are psychologically much more revealing than works of lasting quality. Jung cites the example of the " psychological novel ", which leaves little to do for the psychologist since all problems are usually self evident , their reasons already explored and interpreted by the characters." For this reason it is necessary to distinguish between two modes of literary works, the " psychological " and the " visionary" ." Whatever the particular genre of the " psychological " work of art may be, the material is taken from the vast realm of the conscious human experience, from the vivid foreground of life. The psycho logical work of art is basically understandable, it comprises the greater body of popular literature and visual or auditory art. In literature we find Hemingways work (as example), just like the best selling authors of the seventies to belong to this group. In popular-modern music we find the compositions of the Beatles or Rolling Stones also belonging to this type of art. But then we come to the much disputed Beatie song " Number Nine"-a totally irrational and confu sing work, on the whole not very well received by the teenage population. Schoenberg 's music had a similar disconcerting effect upon the listeners of his time, or upon us for that matter. In literature we have Joyce 's Finnegan's Wake and Ulysses, Hess 's Demian and Steppenwolf, Blake 's poetry or Goethe's Faust II. This second group of works is diametrically opposed to the first group--it is a small sampling of " visionary" works. The experience that furnishes the material for this type of artistic expression is no longer familiar. It is a primordial experience which surpasses man 's understanding, and to which he is therefore in danger of succumbing." It is the very obscurity of the source of the material used , that has puzzled c ritics and has caused them to look towards psychology.

It has become the aim of the modern artist to give expression to his inner vision O·f man, similarly as it is the aim of some modern dramatists to find the chthonic basis of life , to reveal unearthly life dwelling behind everything , to break the illusion , so that we may face life. Andre Breton asked whether dreams could not be used to solve the problem of life. He believed that the antagonism between reality and dream­reality would be solved in a kind of absolute reality-a surreality. For this reason modern art has often been criticized as neurotic or psychotic. Freudian commentators in particular have been the ones to point out the schizophrenic or neurotic qualities of modern visionary literature or art. This is relatively simple to explain if we consider Freud 's assumption that a personal experience might lie beneath the shadowy visions; that the visions in fact are a hidden

expression of the artists personal experience. The next step in the assumption would be that the poet or artist has purposefully concealed the intense personal experience, with the result that the problem suddenly becomes " pathological " . At the time when psychological interpretations became necessary and modern, Freud had the advantage of being the only known psychologist who had made a " scientific " attempt at an explanation of visionary works . The novel ideas and resultant publicity of Freud 's theory undoubtedly gave it a powerful impetus in the literary world. (As is known, his ideas were not that readily accepted in the medical world .) As a consequence, all " visionary" works were, for a period of time interpreted by means of a new closed system which provided acceptable-even if perhaps wrong-answers.

Jung 's interpretation of the visionary work of art differs from Freud insofar as he feels it is not a symptom of some underlying hidden experience. The very moment we call a vision a symptom, we strip it of its abnormal qualities and allow the chaos to return to a well ordered cosmos. (Symbolism in the visual arts shows man 's need for an ordered cosmos ; he has even gone so far as to shape his cities like mandalas-outward expressions of a security and order which he needed within the psyche.)" Man as Jung sees him , is a creature who protects himself during the day by means of reason and science, while desperately trying to uphold his faith against the fear of chaos that overtakes him at night. " Yet it is not only the creator of visionary works that is in touch with the night side of life, but also the seers, prophets and enlighteners. This dark side is a definite part of our own picture of the cosmos -e·•en though at times we are reluctant to admit it. We attempt to surpress it, since superstitions are in conflict with our knowledge of science, and because we strive to construct a world that is " safe" and manageable. Yet in our very midst-the poet, or the artist watches a glimpse of the chthonic properties of life, of the demonic or spiritual undercurrents, he observes for moments incomprehensible happenings in the spiritual universe, in the pleroma. He sees something of that psychic world which strikes terror into the hearts of primitive men." The poet 's visions are part of an inner landscape. In order to express them outwardly, he either has to create new symbols for these psychic happenings or use existing and established symbols-sometimes in modified form . If one looks at children 's art one sees that symbols are not always copied , they are sometimes manifestations of psychic happenings, direct psychic outpourings. For a poet it is natural to resort to a mythology to give his experience a fitting expression. Yet this

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mythology is not second-hand material , it is rather a familiar but fancy dress, giving form to a primordial experience." It is in the primordial experience that the poet finds the source of his creativity. In itself it offers no words or images, for it is a vision seen "as in glass darkly". The expression, however, can never present the vision accurately, it can never exhaust the vision. For this reason it is necessary that the poet has a huge store of mythological materials at his disposal , in order to communicate at least some aspects of his vision . He must , moreover, use a mythological framework which allows him a realm of imagery that is difficult to handle and full of contradictions, in order that he may express the complexity and paradoxicality of his vision .'0 Dante 's framework consisted of the Christian mythology of heaven and hell , Goethe used the myths of the Blocksberg (part of German folk-lore) and of Greek antiquity for his Faust I and Faust II. Wagner required the whole body of nordic mythology together with music ; Nietzsche, writing his Zarathustra in the style of Luther's Bible translation, returned to the myth of the seer and religious reformer. Blake invented weird and indescribable figures, Joyce used celtic and classical mythology. Schoenberg, who left the " normal " musical system, used a five tone scale and composed by colours; and the Beatles went on a "Mcluhan Trip ", played their tapes at different speeds and backwards when recording "Number Nine". All of these people tried to find a suitable means of expressing the psychic happenings they had witnessed.

Psychology can do little more in the field of literary criticism than point out symbols and archetypes, bring them together for comparison and offer a terminology. Archetypes , as defined by Jung are

• physiological urges, perceived by the senses and manifested in visions, dreams or phantasies. They are part of the psyche, which has gone through a prehistoric and evolutionary development ; they cannot be explained by anything in the individual 's own life, and for this reason occur at any time in any part of the world. It is the function of dreams to bring back to us memories of the prehistoric evolutionary development, to show us our primitive instincts. Dreams are an expression of the compensatory action of the psyche. There is a definite relationship between the symbolism used in dreams and the symbolism used in myths.'' One possible explanation that springs to mind immediately is that dreams are for the individual what myths are for the masses. It is , in my opinion, one of the advantages of the Jungian system , that while it consistently points to the importance of archetypes it does not attempt to interpret these archetypes except in the

22

environment of the psyche (internal landscape). According to Jungian terminology, that which appears in the visionary work of art is part of the collective unconscious. The collective unconscious in turn is the psychic disposi tion shaped by the forces of heredity, from which consciousness has developed. (This point has been much disputed, it is perhaps best explained as such: All men have roughly simi lar bodies . Can we then not assume that the make-up of their minds also share a certain similarity?) Jung states that in the physical structure of the body we find traces of earlier stages of evolution, and that we may expect the human psyche also to conform in its make-up to the law of phylogeny. If the state of consciousness is suspended, as in dreams, narcotic states, and cases of insanity, there come to the surface psychic products that show all the traits of primitive levels of psychic development.''

Of particular importance to the study of literature is the fact that these manifestations of the collective unconscious are compensatory to the conscious attitude. Visionary literature thereby brings a one-sided abnormal or dangerous state of consciousness into equilibrium in an apparently purposive way. An age such as our own modern age, is in many ways like an individual , it has its own " limitations of conscious outlook",'1 and therefore requires a compensatory adjustment. The poet , or artist, is guided by the unexpressed desire of his times, and leads people towards the fulfillment of this desire, whether it is good or evil , and whether it results in the destruction or construction of that age.'' As a result, the poet does not speak for himself, he is in one respect the mouthpiece of a segment of society. In another respect he is like a precise measuring instrument, trying to express his own vision of the times (which is really not his own, but society's) . He tries to do this by placing his vision into a mythological framework familiar to his own society, " foretelling changes in the conscious outlook of his time".'5

Jungian psychology, as an interpretative system, can only bring us to a point at which we understand a phenomena such as this. It cannot explain it, since our knowledge of the mind is still too limited.

Literature is a measuring instrument of the values and thoughts of a society on one side, it is a balancing force on the other. Jungian psychology if used in connection with literature (or today, with changing mediums, w1th film or television) becomes highly relevant since it explains both actions. It shows us more precisely what the poet sees to be society 's values, and what values in turn need to be compensated . In this way literature becomes, if interpreted properly

through the Jungian system (at least at this level) a free psychotherapeutic session for the reader.

It would be quite senseless to argue that Jungian psychology is the only interpretive system that gives us a vision of society, or a mythology. This view is highly personal. Freudian psychology could do the same thing , but as mentioned earlier it is (for the purpose of literary criticism) too narrow a system, dogmatic, and basically unimaginative. Every interpretive system is in danger of becoming a closed mythology, a mythology which potentially includes answers and questions. The narrower the outlook of the system is, the more grave this danger becomes. Jung was never dogmatic , but always ready to change a hypothesis if convincing proof could be presented. The same cannot be said of Freud. Since Jung's death his psychology has taken on some of the qualities of a closed mythology, simply because it is not being expanded. His disciples interpret and apply his writings , but do not add new material which would go beyond the set guide I i nes.

The Jungian mythology is at midpoints between an open mythology and a closed mythology. It is a system which although giving only one answer to a question allows for more, possibly even opposites. Yet like every large one man system it is all comprehensive and thereby tends towards the closed mythology in its latent dogmatism. Like a closed mythology it also brings with it an elitist class structure for those who are in some way involved with it. (This takes, under the circumstances, the form of intellectual one-up-manship) . It is basically a mythology, which by explaining all other "mythologies" (in the Greek-Roman sense) in a satisfactory way, can raise itself to self-enforcing status.

Ill. PSYCHOLOGY, A TWENTIETH CENTURY MYTHOLOGY

Psychology has become a surrogate religion. At one time people eased their conscience by going to a Roman Catholic confession , or by attending some other type of confession ritual. Today, they go to a psychiatrist. Psychiatry has, thereby, become a ritual and a cult. Perhaps one of the reasons for this change-over is the fact that religion is a totally imaginative sysem which therefore has only imaginative consistency: Psycho logy on the other hand can be backed up and is therefore given a different validity factor. People are finding more and more, that their minds are what they know least about; they are turning , therefore, to different interpretive teachings that clarify to them the actions of their minds. This can be Zen Buddhism, yoga, western philosophy, or different schools of psychology. I am always surprised at the

eagerness of the first year student when he walks into his first psychology class-and the disappointment with which he walks out again after finding that psychology to him does not have the same meaning as to the instructor. Yet all psychologies give us a mythological structure, since all give us a vision of society. It is only the type of vision that changes , since that depends upon the comprehensiveness of the structure. I think as a very general statement one could assume that a psychology aids us in trying to understand and cope with other people. Whereas, some sciences give us an understanding of society at large, psychology tries to give us an understanding of the individual first and society second.

Increasingly, our mythology is orienting itself towards the undercurrent of life , the chthonic and spiritual part of man. This part has certainly always been there, it is just that during the past it has been ignored. This is not to say that visionary art did not exist during the Age of Reason, or the Age of Enlightenment, it had to, since a society must always try to maintain a balance. Yet it seems that today there is less need for the artists to re-express their spiritual visions in mythic form . Their vision of man has changed. Artists today realize that the only way they can reach the essence of man is by breaking the mirror of illusion and by getting right at the chthonic and daemonic part of man. With this trend in art it is understandable that people have shown a greater interest in psychoanalytic teachings , since they too aim at the deeper part of man, the below-surface structure. Both, Freud 's ego, super-ego and id , and Jung 's animum or anima, shadow, collective unconscious, ego, unconscious and conscious level , have satisfied the needs of people to get beyond the surface structure of man deeper into the mystic workings of cause and effect of the psyche. Through Jung or Freud we have been able to explain some of the deeper workings of the human psyche as ii expresses itself in art or literature-the barometers of society. (Although it is obvious that with the modern artistic movement towards the spiritual nature of man, Freud 's concept of visionary art as a cover for a "human-all too human" emotional experience would not remain popular very long.)

Jungian psychology, as mentioned before, gives a symbolic and at times almost mystic vision of society. Jung himself, reminds one of a mystic with a clinical basis. The connection between mysticism and Jung is less absurd than it sounds if we remember that visionary activity stems from the collective unconscious. A mystic like Jakob Boehme was perhaps not aware of this , but certainly acted accordingly. A mystic like

23

Jung probably educated his vision and imagination by carefully watching and emphasizing unconscious activity. The longer we look at Jungian psychology, the more it takes on the appearance of a spider's web. As a psychology it gives us an interpretive system, a vision of society. As a mythology it it presents us with symbols which occur in our own lives. At the same time it also e><;plains other mythologies. As a mystic revelation it compensates and points towards values which have been ignored for too long. (yet, to make the web complete, as a psychology it explains the idea and need of compensatory forces) . The intricacy of its structure is therefore ideal as a guideline, as a closed mythology. Although Northrop Frye feels that only people with neurotic !endencies want or need a closed mythology, 1t seems to fulfill an apparent need for the pre-electronic generation. Through the medium of print we have been conditioned to think of information as units where the beginning necessarily anticipates an end." This type of conditioning might have created a possible need for closed mythologies. The electronic generation (the generation that is growing up with television and films as basic educational medium) might make a much greater use of an open mythology. Their minds are not trained to think in a linear fashion. The potential wealth of information wit_hin ~!?tally open mythology is probably qUite s1m1lar to the potential associations of a mind that was not raised and educated by travelling over thousands of miles of print.

Finally I would like to give one more reason, which I feel could account for a great deal of Jung's present popularity. Hermann Hesse, the author of Demian, The Steppenwolf and Magister Ludi was a man with grave psychological adjustment problems. He enjoyed some popularity during

• his life, but only by a select group of sophisticated readers. He was re-discovered in America at the time of transition from the Beatnik-cult to the Hippy and Flower Children movement. Today, most bright teenagers see themselves in the role of the Steppenwolf, the intellectual who has been ostracized from society ; most adolescents experienceing problems with their ,parents are familiar with Demian, which treats a young man~s ~ystic initiation into the world. The fasc1natmg thing is that Hesse wrote Demian when he was forty-two, while he was undergoing Jungian analysis. The whole book (to a greater degree than his other works~ . is _a dict_ionary of Jungian symbols. It IS the pnmor~1al experience" of the poet or seer, dressed mto mythological and symbolic terms. One of the reasons why Hesse ~nd~r.went Jungian analysis is because of his m_ab1l1ty at the time to understand and deal With th1s experience.

24

Jung has, therefore, undergone a double popularity surge, Literary critics have looked towards him for answers for the increasing problems with visionary works of art, while at the same time the sub-culture of Hippies and Flower Children has become increasingly interested in him.

Throughout the paper I have tried to rationalize Jung 's existence and popularity. I have tried to show his connection to our own contemporary mythology and to literature. Finally I hope to have shown how Jung's interpretive system can make up a mythology of its own. Yet, is there not another reason for his popularity, similar to the reasons behind the existence of visionary works? Daniel P. Moynihan, the chief White House advisor on urban affairs claims that the United States " exhibits the qualities of an individual going through a nervous breakdown. "" A Toffler writes: "The assertion that the world has "gone crazy " , the graffiti slogan that " reality is a crutch ", the interest in hallucinogenic drugs, the enthusiasm for astrology and the occult, the searth for truth in sensation, ecstasy and " peak experience", the swing toward extreme subjectivism, the attacks on science, the snowballing belief that reason has failed man, reflect the everyday experience of masses of ordinary people who find they can no longer cope rationally with change. "" It is improbable that the mere existence of Jung's mythology will compensate for these problems. He certainly makes us aware in his work of their importance. And just perhaps, some solutions can be found through his mythology for the conflicts that confront us all .

Appendix, by Bohdan S . Kurylo

THE TWENTIETH CENTURY'S LEGACY OF REASON

Supersition and symbols were an intricate part of the pre-twentieth century conscious mind :

In earlier ages, as instinctive concepts welled up in the mind of man, his consc_ious mind could no doubt integrate them mto a coherent psychic pattern."

ln~ian " nature" religion , and in fact any rel1g1on embodies a coherent conscious psyc_hic _p_attern-mythology. In effect, reason and IntUitiOn harmonized in the conscious. Fact and myth were acceptable and functionally valuable to the pre-twentieth century man.

But_ our modern society, because of technical progress and skepticism, is tending away ~rom any conscious ability to form psychic patterns. Instead , there is a tendency to accept only facts or signs, which contain fewer associations of uncertainty. Man's

technological advances-mass media and machines-have supplied a reservoir of facts. People no longer speak to rocks or feel the anger in thunder, but instead consider mostly electrical conduction and stable states. Supported by science and skepticism , reason is the only impliment with which man is becoming familiar. The "ego-conscious" incorporates only facts and disregards nature as an non-mystic personality on entity, but instead labels nature as an eco-system. Irrefutable statements are the order of the day. Away flows man on his static changes between negative and positive poles ; rationale is alive and well. Reason thrives today, while psychic elements are consciously diminished. Superstition and irrational elements have little place in the contemporary conscious.

Most tragically, instincts are screened out or submerged by the conscious. Psychological characteristics , as feelings and intuition are coldly maninpulated as units of a programmed behavioural pattern. Most extensions of man are achieved through the machines to which he is becoming subservant. Instincts are, therefore , unfortunately becoming unsuitable conscious avenues for any of man's extensions in his dehumanized civilization. That which is our basic character (instincts) is losing its expression in mechanical man.

The Goddess of Reason reigns. Mythologies are becoming harder to formulate and less tangible because our conscious is rejecting most symbols and each symbol is in turn discarded or becomes unstable. The relationship between any symbol and man is shaky:

In art, as in language we are racing towards imperamanence. Man's

relationships with symbolic imagery are growing more and more temporary.30

With this loss and instability, the conscious will lose the ability to form psychic patterns (mythologies); the repercussions that emerge from the subconscious may become dangerous:

Modern man does not understand how much his "rationalism" (which has destroyed his capacity to respond to numerous symbols and ideals) has put him at the mercy of the psychic "underworld"."

The subconscious according to Jungian psychology, functions as a compensatory mechanism. Where today , symbols and instincts are ignored in the conscious , the psyche attempts to reconcile and re-unite opposites within the psyche. If the surface continues to be stripped away from superstition and irrational elements, then symbols and consciouness will loose c_ont~ct. This loss will cause increased express1on m the psyche. The troubled result caused by the

imbalance is manifested psychologically as neurosis and unaccountable moods. Because the consciousness cannot functionally form coherent psychic patterns it also cannot balance the psyche. The psyche will reach an unbalanced state, and not be able to compenstate if this present trend of consciousness continues.

If doubt can again be accepted symbolically it will prove valuable ; first by returning to man a greater ability to form mythologies, and secondly by giving :

" ... a meaning to his life and enabling him to find a place for himself in the universe. He can stand the most incredible hardships, when he is convinced that they make sense ; he is crushed when, on top of all his misfortunes he has to admit that he is taking part in a 'tale by an idiot'.""

George R. Garner, Department of German, University of Western Ontario. Bohdan S . Kurylo, Department of Zoology, University of Western Ontario.

NOTES

1. Northrop Frye, The Modern Century, (Oxford University Press ; Toronto, 1967} , p.105.

2. Ibid, p.1 06. 3. Ibid, p.88. 4. Patrick Bridgwater (ed.). Twentieth Century German

Verse, (Penguin Books Ltd. , Harmondsworth; England, 1963, p.100.

5. Frye, op . cit ., p.43. 6. ibid, p.35. 7. T. S. Eliot , Collected Poems, 1909-1962, from The

Wasteland, (Faber and Faber Limited ; London, 1963). p.65.

8. Frye, op. eft., p.41 . 9. Ibid, p.46.

10. Ibid, p.111. 11 . Ibid, p.113. 12. ibid, p.115. 13. C. G. Jung , Modern Man In Seach of a Soul,

(Harcourt, Brace and Company; New York, 1933} , p.154.

14. Ibid, p.155. 15. ibid, p.157. 16. C. G. Jung (ed.} Man and His Symbols, from A.

Jaffe , Symbolism In the Visual Arts, (Dell Publishing Co. Inc., New York, 1964). p.270.

17. C. G. Jung , op. cit., p.162. 18. Ibid, p.163. 19. ibid, p.164. 20. ibid, p.164. 21. C. G. Jung (ed .} , op. cit ., from J. L. Henderson,

Ancient Myths and Modern Man, pp.95-156. 22. C. G. Jung , op. cit., p.165. 23. ibid, p.166. 24. ibid, p.166. 25. ibid, p.167. 26. See : M. McLuhan , The Gutenberg Galaxy,

(University of Toronto Press; Toronto , 1962} for a full t reatment of the problem.

27. Alvin Toffler, Future Shock, (Bantam Books Canada Ltd.; Toronto, 1970}, p.365.

28. ibid, p.365. 29. C. G. Jung (ed.}, op. eft. p.84. 30. Alvin Tattler, op. cit. , p.177. 31 . C. G. Jung (ed.} , op. eft., p.84. 32. ibid, p.76.

25

A Day In The Country

Thirty members of Meds '73 were given the opportunity to correct any misconceptions they might have had about family practice when they spent a day with several members of the Ontario Chapter of the College of Family Physicians of Canada in Kitchener­Waterloo on November eighteenth.

The group convened in the lounge at K-W Hospital at nine-thirty that morning . Each student was assigned to a doctor, to assist with and observe what he could of the normal day's activities including hospital rounds , the occasional tonsillectomy and the inevitable sore throats of office hours.

Dinner at the Westmount Country Club and a vigorous student-doctor discussion climaxed the experience. One of the problems discussed was the confusion resulting from student clinical experience under the tutelage of specialists. Their understanding of the role and abilities of a G.P. wavered between that of a Marcus Welby who can diagnose Rocky

* *

Mountain Spotted Fever over the phone and that of an informed referral agency who can recommend an expert on rashes. Training programmes for a specialty in family practice came under fire as well, and opinions were varied about their eventual value to doctor or patient. All agreed however that continued reading and refresher courses combined with experience were the way to provide patients with responsible medical care. This goal of continuing education is specifically sponsored by College of Family Physicians of Canada. In order to qualify for membership a G.P. must spend a minimum number of hours in refresher courses each year.

The free expression of opinion between student and non-teaching practitioner was encouraging and enlightening for all concerned. This twelve-hou r apprenticeship was repeated in January for another group from Meds '73.

Karen Acheson '73

*

JAMES CHARTERIS PATERSON, M.D., O.B.E. BELOVED TEACHER AND GENTLE MAN

W endi A. Thomas, M .D. , '69

Thou must be like a promontory of the sea, against which , though the waves beat continually, yet it both itself stands, and about it are those swelling waves stilled and quieted.

Long before I ever met Dr. Jim Paterson , as I dreamed of one day studying to become a doctor, Osier's Aequanimitas was a familiar companion. In his writings , Sir William Osier demanded much of the physician and student. " A calm equanimity is a desirable attitude", he said . It was not until I came face to face with Dr. Paterson that I could conceive of Oslerian philosophy being an attainable goal in a physician 's life.

On the afternoon of January 13th, 1972 a quiet calm descended on and moved among the medical community of London, Ontario. Dr. James Charteris Paterson, Professor of Pathology, had passed away in his 70th year.

26

Marcus Aurelius

Born in Chesley, Ontario on January 27th , 1902, the son of a Presbyterian minister, Dr. Paterson was educated in Sarnia. He received his M.B. from the University of Toronto in 1925 and his M.D. in 1928. In 1936 he gained a B.Sc.(Med.). Following an interneship at Wellesley Hospital , Toronto ; appointments at Regina General Hospital and the Ottawa Civic Hospital , Dr. Paterson joined the armed services as a pathologist.

This was indeed an humble man and I know that he would be the last person to permit the long list of his achievements and publications in the fields of Pathology, particularly with respect to the study of atherosclerosis, and in Tropical Medicine. The humility of this man is exemplified in the notation attached to his

Biographical Record as a Faculty Member at U.W.O. " on September 13, 1955 Dr. Paterson mentioned that he had an O.B.E." Space would not permit even a satisfactory summary of his personal and professional accomplishments.

In my Pathology notes dated December 7, 1966- January 6, 1967 there are sixty pages which mark the beginning of a cherished relationship between student and teacher. This man seemed to create in his lecturing and laboratory teaching a one-to-one bond between himself and each individual. " Knowledge comes, but wisdom lingers"-1 shall never forget the fervour with which this man lectured on Diseases of the Vascular System and Helminthic Diseases of Man. He had just returned from Australia where he had studied and lectured. We as students , delighted in those extra tid-bits of unpublished material resulting from his studies.

Already very ill and suffering much pain , Dr. Paterson calmly and with strong conviction stood and lectured at times for ninety minutes without ceasing . His enthusiasm was contagious , his sense of humour never lost. He was always ready and willing to discuss a point with one of us or answer the endless questions of second year medical students impatient to get into the clinical application of knowledge at hand.

What more can a student require of a teacher-knowledge, enthusiasm and understanding! One of Dr. Paterson 's proudest possessions was the Class of '62 Award to the teacher who contributes the most both academically and personally throughout the four years of a class 's life at U.W.O. Medical School. The class of '67 honoured Dr. Jim Paterson with his Award . We have lost a wise and empathetic teacher.

In Jean Vanier's recently published writings , Tears of Silence selected lines will always remind me of the man of whom I write , and bring forth my love and respect for this gentle person.

* POISE: Raising only your eyebrows on your

first trip to a nudist camp.

HOMOGENEOUS: A wise old queer.

POT HOLDER : What you don 't want to be when the fuzz arrive.

PATIENCE: The difference between rape and seduction.

SUICIDE: The sincerest form of self-criticism.

*

and

" maturity of the heart : accepting myself

with my limits" " . .. That my hope gives hope

that I communicate in some silent way the spirit living in me

not by what I say but how I say it

a deep concern a way of listening

to the faint heart beats of your existence and life "

Soon after my year under Dr. Paterson, the teacher, came to an end a personal illness with its limitations became mine to accept. This man 's hope gave me hope. The way in which he accepted his own disability with aequanimity and "maturity of heart" served as a model which many have found in their own lives most difficult to reproduce. Dr. Paterson 's concern for the individual was in evidence as he constantly and consistently enquired of my friends and classmates how I was doing. He shared my joys and despaired with my disappointments BUT his hope as exemplified in his own life gave me hope and strength. I know for a fact my e:x;perience is not unique. I have often wondered how many students , colleagues and friends must have drawn on that hope and strength. We have lost a courageous and dear friend.

We have lost a wise and gentle man-and yet, he has left with us a legacy of knowledge and wisdom-above all his aequanimity.

Dr. James Charteris Paterson is survived by his wife Mary Elizabeth , a stepson and daughter-and, by hundreds of students and colleagues who cannot help but have become the stronger as a result of their contact, however brief, with this beloved teacher and gentle man.

* The magazine, " The Secretary", " swears "

that secertaries swear less than any other job-holders. This fact was determined after a two year study at Wayne State University in Detroit. Even when not near a customer secretaries may not use one profane w~rd in 200. Factory and construction workers average one in five. The statistics were compiled by 150 students who eavesdropped on more than 3,000 people.

27

Pathological Photoquiz D . J. Carroll, M.D.

Photomicrograph of structure found within lumen of apppendix. Answer on page 38.

* University Hospital

For over half a century a group of public spirited citizens , incorporated as the London

• Health Association , have run the affairs of the Beck Memorial Sanatorium, in Byron, which at one time had over six hundred patients and now has about thirty or forty , some of whom have non-tuberculous chest disease. Members of this association were quite aware in the late 'fifties and early 'sixties of the progressive control of tuberculosis and decided to sell their property and facilities in Byron to the Provincial Government, which now uses most of the buildings for the Children 's Psychiatric Research Institute. The London Health Association , in turn , wi shed to use the funds accruing from the sale of this property to assist the University in its educational efforts. About 1960 a plan was developed to build a one-hundred bed hospital , which could be eventually enlarged , on the grounds of Brescia College just to the north of the long present laneway. This plan was abandoned however, in favour of putting resources and support into a University

28

* *

0 . H. W arw ick , M .D . Vice-President (Health Sciences)

Hospital which would be a direct part of the Health Sciences Centre. Accordingly, the University sold some thirty acres on the " flats" to the London Health Association for a nominal sum of one dollar and it is on this ground that the new University Hospital stands.

It should be made clear that University Hospital is not University owned and operated. Rather, it is an independent institution administered by the London Health Association . The University is represented on the Board of Directors of University Hospital and there is a formal and detailed agreement of affiliation between University Hospital and the University of Western Ontario. Similar agreements of affiliation exist with our other affiliated teaching hospitals.

The total cost of the hospital will be just short of forty million dollars. Of this amount, over three million have been given by the London Health Association and over two million dollars by the Richard lvey Foundation of London , while the remainder has come

from government sources shared provincially and federally.

The purpose of the hospital is to comple­ment the teaching facilities we already have in our other affiliated teaching hospitals. A particular function will be to afford facili t ies for a more active program in c linical research for which over 43,000 sq. ft. of space will be available.

There will be nothing st rikingly new in the design of the hospital. The total of 450 beds can be extended to about 600 at the time four new floors are added to the top of the hospital. The four base floors , housing primarily services, can likewise be expanded towards the embankment behind the hospital. It will have been noted that the hospital does not fit tightly against the Dental Sciences building. This has been done purposely to allow for additional research space in the future. In all , the hospital is designed to allow for an increase in size of approximately fifty percent.

Each of the floors in the tower will have two nursing units of thirty beds each. There will be special areas for medical and nursing teaching , and staff physicians will have their offices and research facilities on the same floor as their service responsibility. Again , rather than having a conventional , large, out-patient department for all services on the ground floor, it has been decided to have on each patient floor an ambulatory, or out­patient facility serviced by separate elevators.

On the third floor, easily accessible from the University Medical-Dental complex, will be a large teaching area with three lecture rooms of 325, 110 and 55 seats respectively. In the basement there will be special facilities for the University programmes in physical therapy and occupational therapy.

All clinical services will be represented in the hospital with several exceptions. Although there will be a department of obstetrics and gynaecology no deliveries will be done at University Hospital. A family practice unit was

Acupuncture Part (I I) ABSTRACT FROM LAST ISSUE:

planned, but this has been removed upon the recommendation of a hospital consulting firm which reviewed all of London 's plans for the future. Again , in keeping with the practise of centralizing radiation therapy fac ilities, all patients requiring such care in London will be referred to the Cancer Clinic of the Ontario Cancer Foundation at Victoria Hospital.

The estimated time for construction of the hospital was two and a half years and this will be exceeded by several months because of strikes, and changes requested by Government. The present plans are that the building will be completed August 1, 1972 and that the first patients will be accepted October 1, 1972. The services in the hospital will be opened gradually in accordance with a definite plan, and will probably not be functioning at full capacity until the early autumn of 1973. The patients admitted to the hospital will be expected to participate in our teaching programme and the active staff of the hospital , eventually, will almost all be full-time members of the teaching staff of the Faculties of Medicine and Dentistry.

Undergraduate medical students will be interested in knowing the plans for intern and resident training . As has been mentioned , University Hospital will not be fully functional until the autumn of 1973. For the first year of operation, 1972-73, a few straight internships in medicine will be available, but no rotating internships. Residency programmes, coordinated by the University, will operate as required , during this first year of activity.

The development of University Hospital has been a fine example of cooperative effort. Physicians, surgeons, and dentists, the Faculty of Nursing , the University as a whole, government and private citizens have all worked with the planning committees and Board of the London Health Association in making possible this essential component which will complete our new Health Sciences Centre.

Cho-Yuk Leung, Ph.D.

The language of Acupuncture was compared to the computer language which hardly seems to bear any real correlation of the internal functions in the former and that of the computer in the latter. The history of Acupuncture was traced back over 4,000 years. The principle of Chinese physiology based upon an analogue language applied to the correlations between organic functions , the flow of life energy and the law of Yin and Yang was discussed. The correlations amongst the organs are analogous to the correlations amongst the five basic elements. This is discussed in the following .

THE LAW OF FIVE ELEMENTS the law which governs the Five Elements

As mentioned before, the ancient Chinese believed that WOOD, EARTH, WATER, FIRE and METAL are the fundamental elements in the universe. Consequently they believed that

would also govern all other things. Knowing this law would enable one to understand the behaviour and correlation of all things if we could find their one to one correspondence to the five elements. Table II.

29

The Law of Generation (or Procreation) and Subjugation The five fundamental elements exert

influences on one another. When the influence of element A enchances that of element B, or that the action of B is only significant because of the influence of A, then we say A generates B. When the malfunctioning of A betrays directly the function of B, or if A is causative to the damage in B, then B is said to be subjugated by A. It is true that our visceral organs influence one another in both

benevolent and antagonistic ways. Whether organ A is procreative or subjugative to organ B depends on the balance between the benevolent and antagonistic influences. The arrangement shown in Fig. I was most probably arrived at through empirical means. Though individual case record was seldom systematically kept, except by the words of mouth in the olden days, the clinical and therapeutic support of the correctness of the above law is overwhelming, especially in recent years .

FIGURE 1

generates

subjugates

CORRELATIONS amongst the 5 ELEMENTS

and their

RELATIONSHIP to the ORGANS Referring to Fig . 1, we can see the

generation and subjugation relationship between organs by looking at the correlation amongst the five elements.

The law of generation for the five elements states :

WOOD generates FIRE (this is logical) FIRE gives birth to EARTH (Our earth was

once a fire ball)

EARTH gives birth to METALS (metals come from mines)

METAL begets WATER (a change from solid to liquid state)

WATER gives life to WOOD

The law of subjugation for the five elements states :

30

WOOD subjugates the EARTH (for upon the earth wood flourishes and breaks the ground)

EARTH subjugates WATER (we do that in a flood)

WATER quenches the FIRE FIRE melts the METAL METAL cuts WOOD

In what follows, an attempt is made to bring forth some evidence from modern physiology and pathology in support of this ancient law of generation and subjugation which is really a modified version of human physiology written in an analogue language.

Chinese physiology has always put strong stresses on the correlation of the functional

Continued on page 39

BEHIND

THE

SCENES

FIRST YEAR

LITTLE BIG MAN

SECOND YEAR

A CHRISTMAS CAROL

N

u R

s E

s

THIRD YEAR- FANTASTIC JOURNEY

Answer to Pathological Photoquiz

Appendix contains an adult female Enterobius vermicularis (pinworm). The appendix was removed incidentally during urinary tract surgery on a child with meningomyelocele and neurogenic bladder. Gravid females, containing about 11 ,000 eggs, migrate at night to the peri-anal and perineal regions for the purpose of oviposition under the stimulus of lower temperature and aerobic environment.

The females are larger than the males. Pinworms are often found incidentally in appendices removed from children.

1 .. Photomicrographs of structure found within the lumen of the appendix.

Appendix contains a large parasite within the lumen. It is surrounded by numerous round ova. H1stolog1call~ th1s IS an Ascaris lumbricoides. The mucosa of the appendix is Intact and there 1s no ev1dence of an Inflammatory process. This was an incidental finding at appendectomy.

Continued from page 30

viscera in our body and it is true that ve ry seldom only one part of the our body is malfunctioning in sickness. All concerns must be taken care of in an effective treatment.

The neural system in our body is equivalent to the electronic network in a giant computer. It is logical , therefore, to have control routes set up for keeping the individual sections in proper functioning conditions. Interconnections among these control routes form the communication channels that enable all these different sections to work together. It is not at all surprising , therefore, to find that Chinese physiologists had designated twelve meridians as the control circuits for the twelve most important viscera and there are also intercommunicating meridians to effect over all control of all the internal functions .

1. Liver Generates Heart Liver supplies nutriment to blood which is pumped by the heart, in other words the goodness of the pumping heart is really generated by the liver.

2. Heart Generates Spleen The flow of blood to the spleen as a result of the pumping action of the heart enables the spleen to contribute to our circulating system. The spleen supplies lymphocytes, takes part in antibody formation and is important as a defensive organism. Thus we can say that the action of the heart procreates that of the spleen.

3. Spleen Generates Lung The combined action of the spleen and pancreas purifies and replenishes nutrients to the blood content complementing the respiratory gas exchange action of the lung in revitalizing the circulating blood, part of which flows through the bronchial arteries to nourish the lung parenchyma; thus in a way the action of the spleen contributes directly to the welfare of the lung.

4. Lung Generates Kidney The circulating system is the transport system that supplies substances absorbed from the gastrointestinal tract and o, to the tissues , returns CO, to the lungs and other products of metabolism to the kidney. Here we can see that the lung , besides supplying the kidney with oxygenated blood (about 25% of the cardiac output) , also helps to finish the cleaning up process making more meaningful the work done by the kidney.

5. Kidney Generates Liver Liver has many complex functions including the formation of bile, metabolic functions , protective functions , the production of heat and the activation and inactivation of hormones, etc.

The kidney regulates , on behalf of the body tissues , (1) the water content , (2) the acid-base balance, (3) the salt content, both qualitatively and quantitatively, and thereby the osmotic pressure. Consider from a broad standpoint, the function of kidney is the preservation of the normal composition of the circulating blood. This is important for the proper functioning of the liver and makes more meaningful the contribution of the liver to the circulating blood.

6. The liver is , however, subjugated by the Lung. (It is well known that the liver cell is extremely vulnerable to anoxia and our blood is oxygenated through the lung.)

7. The pancreas considered by ancient Chinese as part of the black-box-organ called spleen is also closely affected by the heart and liver as shown by the intense congestion and edema in the pancreas during cardiac failure or disease in the liver with attendant portal hypertension.

8. While the spleen (and pancreas) complements the action of the lung in providing new oxygenated blood to all organs including the kidney, the malfunctioning of the spleen and/ or pancreas does affect the functional well being of the kidney. One example is Nodular Glomerulosclerosis which is taken as a specific histologic lesion diagnostic of diabetes.

9. The heart is subjugated by the kidney. (Renal disease predisposes to heart failure.) We recall that one of the most frequent findings in chronic congestive heart failure is abnormal retention of sodium and water, which may be due to the malfunctioning of the renal system. Other examples include renal . hypertension and malignant hypertension, etc .

10. The lung is , however, subjugated by the heart. It is well known, for example, that heart failure is the most common cause of increased pulmonary venous pressure, sodium retention and anoxia leading to congestion and edema in the lung . In fact the influence of the heart on the l un~ could not be over stressed.

THE TWELVE MERIDIANS We have often used the term " mental

clock" which governs quite effectively the functions of our internal system. The proper coordination of all our internal functions is necessary to ensure our normal state of health. This coordinated function like the carrier wave of the radio signal from a broadcasting station carries the information represented by the modulations on the carrier

39

wave. The carrier wave is represented by CHI (or the life energy) which continually circulates within our body. Its path-way is represented in the Chinese way of thought by the " TWELVE MERIDIANS" which are bilateral and incorporate the nervous system and therefore represent the controlling network to the internal functions. The controlling network must also be the communication system in the human body ; its action can be carried out by nerves, muscles, endocrines, through electro-chemical reactions .

If we choose a starting point at a certain time of the day and ride along with this carrier wave over the twelve meridians, we will find that the round trip takes exactly 24 hours.

The ancient Chinese choose to start early at 3 a.m. with the " Lung Meridian" . (As we mentioned before LUNG is yin or negative.) The lung meridian begins from within the body at an area corresponding to the superior mesenteric ganglion. It links the large intestine as it descends then turns upwards towards the stomach. It passes through the diaphragm to the lung , emerges at its first acupuncture point near the brachial plexus at the upper part of the thorax. It ascends and turns to run along the anterior of the upper arm, down along the outer side of the anterior surface of the forearm , to a point by the outside base of the thumb nail. It sends off a branch to the meridian of the large intestine. The Chi takes two hours to cover the lung meridian (3 a.m. to 5 a.m.).

At 5 a.m. the " Chi " flows into the large intestine meridian which is the Yang partner for lung (Yin) . The large intestine meridian begins at a point by the outside base of the nail of the first finger. It travels along the outer border of the arm, turns at the shoulder

• to race along the lateral side of the neck, cuts across the cheek, crosses above the lip and ends by the side of the contralateral nostril.

The " Chi " then goes to the stomach meridian at 7 a.m. Notice here that the change from big intestine meridian to the stomach meridian is from Yang to Yang. The peculiarity in the change over would be explained later after all the meridians are described.

The stomach meridian begins at a point on the upper corner of the hair line near the temple. It runs down the cheek in front of the ear to the jaw where it meets the other branch which starts from the eye and runs down by the side of the nose to the corner of the mouth and turns along the base line of the jaw. Thus joined, the stomach meridian runs downwards by the throat, along the

40

front of the thorax, down the side of the abdomen, passes over the tront side of the thigh and along the outside front of the leg onto the upper part of the foot and ends on a point at the base of the second-toenail. Like all other journeys through the meridians, it takes two hours to complete.

At 9 a.m. the " Chi " goes over the spleen meridian which is " Yin " . This change over is, therefore, Yang to Yin. The first " point" on the spleen meridian locates on the outside edge of the big toe. The " Chi " journeys upwards along the inside of the leg, up the side of the abdomen, over the side of the chest, and finally ends at a " point " a little under the arm-pit.

At 11 a.m. the "Chi " goes over to the heart meridian, which begins at a "point " on the inside of the upper arm, a little below the arm-pit. This change over from the spleen meridian to the heart meridian is a case of Yin to Yin . This is quite a short journey. The " Chi " goes right along the inside of the anterior surface of the whole arm to a " point" on the inside tip of the little finger. Short though this journey is, it still takes two hours to complete.

Now the Yang partner of the Heart is small intestine. So, the " Chi" goes over to the small intestine meridian, whose starting point is on the outside tip of the little finger. This time it is a case of Yin to Yang. This meridian goes right up the side of the small finger, along the inside of the posterior surface of the hand, up along the forearm , to the posterior surface of the upper arm , along the back of the shoulder, up the neck turning to end finally at a position on the side of the face, in front of the ear. The journey again takes two hours to complete-from 1 p.m. to 3 p.m.

From 3 p.m. to 5 p.m. the " Chi " travels through the urinary bladder meridian, which is Yang. This is a case of Yang to Yang transition . The urinary bladder meridian begins with a "point" on the upper end of the bridge of the nose and near the medical corner of the eye. It goes up, passes the tip of the eyebrow, and straight up the hair line of the forehead , zig-zaging a little , it then travels along the entire length of the scalp from front to back down to the nape of the neck to the side of the spine, passes along the side of the sacrum and goes down the back of the thigh, back of the leg and when it reaches the back of the heel it goes along the outside of the foot right to the outside tip of the little toe.

From 5 p.m. to 7 p.m. the "Chi " goes through the kidney meridian. Kidney is Yin. So the change over is from Yang to Yin. This meridian starts off at a point in the middle part of the sole. It slides up the inside ankle , up the inside of the leg, along the inside of the

thigh , up to the abdomen by the side of the navel, and straight up the chest, where it ends below the collar bone.

From 7 p.m. to 9 p.m. the " Chi " goes along the pericardium (also called circulation sex) meridian. Pericardium is Yin. So, it is from Yin to Yin. It is a short journey but it also takes two hours for the "Chi" to travel. It begins from the "point" on the side of the nipple and goes up to turn into the inside of the arm and down twisting slightly to pass the middle right part of the wrist, through the median of the palm and end at the tip of the middle finger.

From 9 p.m. to 11 p.m. the " Chi " changes over to the San Jiao meridian, which is the Yang partner of the pericardium. It is therefore a change from Yin to Yang This meridian begins near the outside nail base of the fourth (or ring) finger. Then it goes straight up the posterior of the hand, then the arm to the back of the shoulder, up along the neck, slides up behind the ear, goes around the top of the ear, then down the cheekbone, turns up again and finally ends up at a point at the end of the eyebrow.

From 11 p.m. to 1 a.m. the " Chi " travels along the gall bladder meridian, which is Yang. This is then a change from Yang to "point" at the end of the eye. It slides over to the front of the ear, over to the cheek. Then it shoots up to the temple inside the hair line, goes back along the line above the ear to a point at the back of the head at the end of the hair line. It then ascends and courses to the front of the head and from the edge of the front hair line it goes up to near the top of the head and again drops back to the nape of the neck. This time it goes down to the shoulder and courses along the front of the thorax. It twists to the side of the body under the arm pit. Then it switches its path, zigzags on the front and along the side of the body, down to the hip and passes over the outside of the thigh and leg till it reaches

the heel when it turns to travel on the posterior of the foot and ends on the inside tip of the small toe.

From 1 a.m. to 3 a.m. the " Chi " goes along the liver meridian, which is the Yin partner of the gall bladder meridian, a switch from Yang to Yin. This meridian begins with a " point " on the inside tip of the big toe. It goes straight up the top of the foot, up the inside of the leg, the inside of the thigh. Then it shoots up the side of the abdomen to a point on top of the rib, a little below the nipple.

This completes the round trip for the " Chi " in our body, and it takes exactly 24 hours. The "Chi" would then start again its daily trip around the twelve meridians of ours.

The switching over between Yin and Yang

meridians would seem much more logical and easier to follow if we look upon the " Chi " as a sinusoidal wave with each of the meridians representing a quarter wave length along its course; the frequency of this same wave is three cycles in a day. Fig. 2.

There are eight strange meridians, so called because they are not confined to the hours. They are called MO to distinguish them from the meridians above. They function as ballast, sink and moderator for the 12 regular meridians to effect better balance of our internal system.

The routes of the MO 's are as follows :

1. Ren Mo. It controls all the Yin meridians and is called the sea of the Yin meridians. It signifies conception and nurture and is also referred to as the vessel of conception . It begins from a point between the anus and the scrotum. It goes straight up to the navel , and along the middle anterior surface of the body, up to the throat and finally stops at a point on the lower lip.

2. Du Mo It starts at the lower end of the spine, goes up along the spine, over the top of the head, down the forehead and finally ends up at a " point" on the top of the upper lip. It governs all the Yang meridians and is called the sea of Yang meridians. The Du Mo is referred to as the Governing Vessel.

The following six MO's do not have acupuncture points of their own, but spread themselves to form a huge mesh of connecting net among the other meridians.

3. Dai Mo Dai means belt and it goes around the waist.

4. Chong Mo Chong Mo is called the sea of the meridians. It links Ren Mo, Du Mo and Dai Mo to the 12 meridians. It spreads itself all over the body, following a rather complicated trajectory.

5. Yen Mo Yen Mo starts from the heel , up the inside of the legs to the abdomen, rises over the chest along the neck to the temple.

6. Yang Qiao Mo Yang Quao Mo starts from the heel , up the outside of the legs and ends by the back of the neck.

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3a.m.

E ci

(1)

,o~ ·

\ \>~ ·

3p.m.

+ Positive = Yang~ Posterior Surface

= Negative = Yin ~ Anterior Surface

CYCLIC SCHEDULE of the

MERIDIANS

12

7. Yin Wei Mo Yin Wei Mo travels amongst the Yin Meridians. It begins at the inside of the legs goes up the abdomen, past the nipple, turns to join the Adam 's apple.

8. Yan Wei Mo Yang Wei Mo mingles with all the Yang Meridians. It starts at the heels over along the outside of the legs, up the side of the back, turns along the shoulder up the neck, passes over the head and ends at the eye-brows.

There are also 12 cross meridians which enhance the relationship amongst the meridians and the organs. Twelve muscle meridians spread all over the skeleton of our body linking the function of all joints. They follow rather a similar course as the 12 regular meridians. Then there are LOCK MO 's which are the grid-net works connecting Yin and Yang meridians and can be classified into :

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i) Cross Lock , all 15 of them. The 12 meridians and the Yin MO, Du Mo each associates with a cross lock Mo. The spleen has an additional large Lock Mo. These add up to 15 cross Lock Mo.

ii) Fu Lock is the cutaneous net.

iii) Siu Lock are the tributaries. They are the smallest and spread like a fine net.

ACUPUNCTURE AND THE CAUTERY WITH MOXA

It is rare for Chinese to speak of Acupuncture without mentioning moxabation or the cautery with moxa. While Acupuncture has the effect of renormalizing the functions of the meridians for the proper flowing of Chi , the life energy, its efficiency is markly enhanced by the use of moxabation. The main effect of moxabation is to tonify the meridians. ll was found that applying the heat of the burning moxa into appropriate acupuncture points has the effect of

enhancing the generation of anti-bodies and the rate of generation of new blood cells by moxabation is second only to blood transfusion. The proper administration of moxa is an art on its own and is as important a therapy as Acupuncture. It is a great pity that Western Acupuncturists have neglected the moxa therapy entirely. The Japanese spent years in studying the thera,py of moxabation , but gained very little head way. The wherefore as to how moxabation can effect such phenomenal biological action is still obscured and awaits careful investigation in future research . How acupuncture works is by no means easier to explain . An attempt is made in the following to postulate a model for the mechanism of Acupuncture.

It is well known that our genes hold the pattern of our matured body. Development of our body carries on from the day of conception till the last detail dictated by the pattern in our genes is fulfilled. When this happens inhibition sets in and further development other than normal metabolism is curbed. This is fine but for the fact that once further development ceases the effect of degeneration is felt some by natural causes, some due to sickness. Degeneration or abnormalities result in having our physicial states deviate from the patterns set by the genes. Such discrepancies are detected by the servo or automatic-control system within our body as an error signal. This erro·r signal after analysis by the brain commands a reparative action to be taken to remedy the situation. Unfortunately, in sickness, the communication system within our body weakens and the corrective signal finds it difficult to get through , and even if the corrective signal did get through it might not be strong enough to lift the inhibition that sets in after maturity to allow further growth or development to make up for the loss.

Acupuncture stimulates the communication elements in the inner system (which incorporates the nervous system) lowering the apparent threshold for passage of error signal, lifting the inhibition, allowing the corrective measure to be carried out. This hypothetical picture might seem over simplified but it serves as a logical model explanation for the action of Acupuncture and hopefully might give inspiration to further research in this field.

In almost all acupuncture literature the techniques of tonification and sedation were mentioned. But not too many acupuncturists know what it all really means. Tonification of a point on the acupuncture meridians is meant to fortify the organ controlled by such a point, while sedating the same point is supposed to give the opposite effect and drains away the excessive energy on that point. How can the insertion of a needle

produce such markedly different effects say on the nervous system, which comprises the greater part of the meridian? To get the answer let us see what the needle really does when it hits the nerve. Nerve impulses, or action potential can be stimulated by mechanical , electrical or chemical means. When a needle hits a nerve mechanically stimulated impulses would be generated. In general the nerve bundle involves more than one nerve fibre and the intensity of the induced impulse depends on how many nerve fibres in the nerve-bundle were excited. When all the fibres in the nerve bundle are stimulated we will get a strong impulse and only a small impulse when only one or a few nerve fibres in the bundle are excited. Both the strong impulses and the weaker ones can represent sedation or tonification. This really depends on the need of the organs or parts governed by the meridians. But the acupuncturist must decide if the condition of the patient admits strong stimulation or if it is better to have a mild one. Because of the difference in abundance of nerve fibre and their ramification , the act of tonification or sedation can be effected to different degree at different acupuncture points. The important fact to remember it that needling the right point on the appropriate meridian would bring about the desired balance and renormalization of the system.

Clinical records in China and some countries in Europe prove beyond doubt the effectiveness of Acupuncture but the complete understanding in scientific terms , of this ancient therapy still eludes us. Only research can bring the answers we seek. Let us hope that the united efforts of the East and West would one day unlock the secret of this ancient miracle from the Orient.

A list of references is included for the interest of the reader, though the contents of some leave a lot to be desired, either because of the difficulty involved in understanding classical Chinese or the lack of precise information as described by the author; they should help to stimulate further interest in this ancient art of therapy.

BIBLIOGRAPHY Akupunktur und Raucherung mit Moxa, by Dr. Leung

Tit Sang . Fung Yu Lan , A History of Chinese Philosophy,

Princeton 1952. Princeton University. U. G. Wogralik, Osnowy Kitaiskogo. Lechebrogo Metoda

Schsenb-Tsegu. Zhenjiu Jiangyi (Lectures on Acupunctu re Moxibustion) . Ed ited by: Acupuncture Research Section of the Shanghai Academy of Traditional Medicine. Shanghai 1960.

Zhenjiu Jingxue Gaiyao (Outline of Acupuncture Meridians and Points). Edited by: Dung De-mou. Peking 1960.

Jianming Zhenjiuxue (Elementary Acupunctu re and Moxibustion) . Edited by: Acupuncture Research Section of Nanking Academy of Traditional Medicine. Kiangsu 1959.

Jing Lo Xue Jushuo {Illustrated Explanations of Meridians) . Chief Editor : Lu Shou-yen. Shanghai 1959.

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Zhenjiu Zi Sheng Jing by Wang Zhi-Zhung (Sung Dynasty) . Shanghai 1959.

Zhenjiu Ge Fu Xuanjie (Elucidated Selections from the Acupuncture Rymes) . Peking 1959.

Zhungguo Zhenjiuxue (Chinese Acupuncture and Moxibustion) by Cheng Dan-an.

Zhenjiu Jicheng (Collection of Achievements In Acupuncture and Moxibust ion) by Liao Run-hong (of Ching Dynasty) . Peking 1958.

Zhenjiu Jiayi Jing (Treatise on Acupuncture and Moxibustion) by Huang Fu-m1 of Chm Dynasty) . Peki ng 1957.

Xin Zhenjiu Xue (Modern Acupuncture and Moxibustion) by Chu Lien. Peking 1958.

Zhenjing Zhe Yin J l (Elementary Book o~ Acupuncture) by Du Si-jing of Yuan Dynasty) . Pekmg.

Zhenjing Jle Yao (Manual of Acupuncture) by Du Si-jing. Peking.

Xin Kan Buzhu Tong Pen Sho Xue Zhenj iu Juj ing (Acupuncture , Moxibustion Points ~llustrated) by Wang Wei-yi of Sung Dynasty. Pek1ng.

* *

REFERENCES ON ACUPUNCTURE Crozier, R. C.: "Traditional Medicine In Modern

China", Harvard University Press, Cambndge, Mass., 1968.

Hashimot, Mme. Dr. M.: "Japanese Acupuncture" , T. Larsons Publishers , Ltd ., (c) Ph1hp M. Chancellor, Dec. 1966, Garden City Press, England.

Mann , F. : " Acupuncture, the Ancient Chinese Art of Healing" , W. Heinemann Med1cal Books, Ltd ., London 1962.

Mann F · " Atlas of Acupuncture, Points and Meridians 1~ R~fation to Surface Anatomy", W. Heinemann Medical Books, Ltd ., London 1966.

Mann , F.: " The Meridians of Acupuncture" , W. Heinemann Medical Books, Ltd. , London 1964.

Moss, Dr. Lou is : " Acupuncture and You", Elek Books Ltd ., Ryerson Press, Toronto 1964.

Rich , Maj . Dr. Norman M.: " Acupuncture in Viet Nam" , Military Medic ine, October 1967.

Veith , Dr. Elza : " Acupuncture Therapy, Past and Present", Journal of the American Medical Association , May 12, 1962.

*

The London Free Health Clinic Irving Yinger, M.D .C.M ., C.C.F.P.

Lecturer, Division of Family Medicine, Victoria Family Medical Cestre

It is not uncommon to have, in any institution, a significant number of your colleagues unaware of your accomplishments. This opportunity to address the student body and Faculty of Medicine is thus very appreciated and I hope will rectify at least one such situation. Let me then describe for you an extremely exciting program initiated

• by medical students at the University of Western Ontario.

In February 1970, a free. health clinic was opened at Kinsmen House, a drop-in centre in London, Ontario. The idea was conceived by a third year student. Michael Noble in conjunction with the street worker staff of Kinsmen House. Mike's initial stimulus was a desire to look at health care systems for a project in community medicine. With this objective in mind , a health care need was identified for the alienated youth which frequented this drop-in centre. In talking with the street worker staff and with the youth and seeing actual problems, it became evident that alienated youth did not contact the established health care system until the problems became so severe that they required hospitalization and even then many would not go. Reasons for this outcome, expressed by the kids, were as follows :

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They felt put down by the establishment, specifically in that they were constantly being pigeonholed as speed or drug freaks because of long hair and unkept clothes , whether they did drugs or not.

They also felt that because of this they are not treated as whole persons but great emphasis is placed on their psychological makeups with almost total disregard to their physical factors. These youth are alienated not because of drugs but because they have challenged society 's attitudes to education, to work and to inter-personal relationships and many are looking to alternatives without drugs and have never used drugs

Many other reasons suggested were an inability to cope with authority which were mostly projections by the youth onto the system, an inability to cope with appointments, a lack of knowledge related to health, a lack of medical insurance, an inability to cope with postponement of immediate gratification.

Armed with the above information and with a desire to learn more Mike and a group of five other third year medical students , John Taylor, lan McLeod, Rick McLachlan, Paul

Odegaard, Norm McClintock, and Ralph Hellens initiated the free health clinic in one room at Kinsmen House to be open Saturday afternoon 3:00-6:00 p.m. weekly. After a few weeks of operation, developing relationships and strengthening their credibility with the kids. they became aware that they were functioning as health advocates taking kids to emergency facilities and facilitating their entrance to the system and as resources of information. They identified groups of problems such as kids with sore throats, cough, colds , infections who required some investigation but certainly not emergency room care. Thus, in order to free up the emergency staff and to provide more adequate health care, the group felt that they required the support and supervision of some community physicians. At this time I was contacted to act as an advisor to the free health clinic. In addition, the full time physicians at the Victoria Family Medical Centre, Dr. Glenn Pratt, Dr. Michael Brennan, Dr. Frank Butson, who are my partners and are all full time geographic with the Division of Family Medicine offered support in the form of being on call for the patients coming into the clinic. Dr. Paul Newell and myself have spent a number of Wednesday evenings at the Kinsmen House observing and being involved with the students in one to one teaching experience.

In addition to the previously stated objective, I envisioned a number of exciting educational opportunities with involvement of a larger group of community and faculty physicians. A roster could then be drawn up which would allow on site supervision of the medical student 's relationship with youth whose background, attitudes and means of coping with conflict may be quite different from theirs. It would also facilitate assessment of their problem solving abilities and notably improve the total health care given because of increased accessibility of medical care through the physicians. The most important effect would be the potential for the student to provide continuing health care and thus to become aware of another way of life with more extensive exposure. Educationally, the physicians involved would have the opportunity to learn from the youth as well as the medical students.

Since the opening of the free health clinic in February 1971 , up to August 1, 1971, there has been an average of three patient visits per clinic, approximately 100 visits in total. These visits were produced by approximately 40 people. Six of these patient visits ended in a referral to the hospital and six to the Victoria Family Medical Centre. Before becoming involved with the supervisory physicians, 50% of the patient visits culminated with a visit to the emergency room. At the present time, (December 1971)

the clinic is open each Wednesday night from 7:30 p.m. to 9:30 p.m. and the two medical students present at each session have been seeing five to six patients together.

For the first six months of operation the problems seen were as follows :

1. Four visits for skin rashes. 2. Two visits for skin lacerations.

3. Two visits for skin infections. 4. Two visits for eye complaints. 5. Fifteen visits for upper respiratory

complaints. (7 pharyngitis, 3 tonsillitis) 6. Six visits for hepatitis . 7. Two visits for abdominal pain. 8. Three visits for venera! disease. 9. Three visits for urinary problems.

10. Two visits for muscle strain. 11. Six visits for complaints of

anxiety I depression. 12. Five visits for a general examination.

The above records conclusively show that alienated youth present with a wide variety of problems, most of which are not drug related . The credibility of the medical students as helping persons to talk to and as advocates of the youth for health care is clearly established. There was a moderate slowdown during the summer months and early fall some of which coincided with the youth migration to Grand Bend but mostly with the change-over from the previous group of seven to a group of twenty-one from the present third year class and the need for credibility to be re-established with the help of the street worker staff. The collective concept with street worker and medical student sharing thoughts and ideas with the ultimate aim to reach out to the alienated youth with information and help to involve him in a health care system, has been most rewarding and has proven itself invaluable.

The collective concept and operation has given birth to an idea for a Treatment Hostel for alienated youth which would function as a short term (3 to 4 weeks) recuperative centre where one would be able to rest and eat properly. These youth would be referred to this Hostel following some significant illness (physical or emotional) if they had no home to go to. Referral would be made by community agency such as hospital , community physicians and by the free health clinic. The staff would include street workers and medical students, volunteers , lawyers, social workers, public health nurses and laymen to provide followup of problem and to facilitate entry, through their knowledge of resources , into some organized continuing care system if necessary or to help modify the situation which might have affected the illness so that the youth would have insight into alternatives.

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A Grant request is now with the Federal Government, the office of the non-medical use of drugs, directorate and we have recently had an optimistic on site visit by one of their representatives. Once again , when this becomes a reality, there will be a need for increased medical student and faculty participation.

The Pineal Body

The pineal body has been regarded as perhaps the last great mystery in the physiology of mammalian organs. A great variety of possible functions has been attributed to it. At one extreme it has been regarded simply as an interesting anceste ral vestigial organ, probably homologous to the " third eye" of reptiles-while others think of the pineal body as an intricate and sensitive " biological clock " which converts cyclic nervous activity generated by light in the environment into hormonal information.

In the mammal , the pineal is a small whi te structure located nearly in the centre of the brain . It arises from the roof of the third ventricle under the posterior end of the corpus callosum, and is connected by a stalk to the posterior commissure.

In man, the pineal body is about a quarter of an inch long and weighs about one tenth of a gram. The organ is histologically complex, being composed of ependymal cell s

• and neuroglia embedded in a framework of connective tissue. Signs of secretory activity occur in at least some cells. In young an imals and infants, the pineal is large but it begins to involute before puberty, and in the adu lt small concretions of calcium and magnesium phosphate and carbonate (pineal sand) appear in the tissue. Pineal calcification with age has been shown to be unrelated to various parameters of pineal function . As a matter of fact , ultrastructural studies have given evidence that neurosecretory activity of the gland actually increases during adult life.'

On reviewing the literature of the pineal body, it seems that research in this field can very conveniently be divided into three periods :

i The metaphysical state: the time befo re 1898 when the pineal body was thought of in terms of theoretical philosophy.

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In conclusion , I hope that I have achieved my prime objective which was to make the student body and faculty aware of an exciting community program intiated by third year medical students . Secondarily, if many of you have been stimulated to learn more about the free health clinic and the Treatment Hostel or would like to become actively involved , please contact Matthias Gysler or myself.

V. Van Hooydonk '73

ii The clinical period : from 1898 to the late 1950's. iii The period from the late 1950 's in which the pineal body was beginning to be thought of as an endocrine organ.

According to the writings of Galen, the existence of the pineal body had been known for at least 2,000 years. Galen believed that the pineal body served as a valve which regulated the flow of thoughts from the lateral ventricles of the brain. Descartes in the 17th century believed that the pineal body was the seat of the rational sou 1.'

An observation by Heubner in 1897 started the clinical era in pineal. He published a case report of a young boy who had shown precocious puberty and was also found to have a pineal tumour. In a review article of pineal tumours , Kitay (1954)' concluded that the cases of precocious puberty resulted from reduced pineal function due to disease of the surrounding tissues , whereas delayed sexual development in children with true pineal tumours was a consequence of increased pineal activity. Therefore, pineal hyperfunction is associated with delayed pubescence, and pineal hypofunction is associated with advanced puberty. It seems therefore that the pineal contains a factor that inhibits the gonads.

The discovery of melatonin by Lerner and his co-workers (1958)4 can be regarded as the beginning of the endocrine era of pineal body research . They were originally looking for a neurogenic agent as the possible factor responsible for depigmentation in vitilgo and isolated from beef pineals an active factor that could lighten skin color and inhibit melanocyte stimulating hormone (MSH). They suggested at that time that the substance be called " melatonin" which was found to be N-acetyl-5methoxytryptamine. The biochemical pathway for the production of melatonin has

been worked out in detail and it has been found that the pineal body contains all the biochemical machinery to make melatonin

Hoh.-n w N

CH,CHNH 2

COOH

H 5-hydroxytryptophan

decarboxy lati ng -------)>-

enzyme

from an amino acid precussor 5-hydroxytrypto-phan , which it obtains from the bl.ood.

Ho f}.., w N H

Serotonin

CH,CH, NH

HO ~ CH,CH,NHCOCH, w acetylating

-------)>-enzyme

N H

N-acetylserotonin

As the biochemical aspects of pineal function were being worked out, some interesting observations regarding its anatomy and nerve innervation were being made.

It was found that pineal cells of cold­blooded vertebrates contained light-sensitive elements that were similar to cone cells of the retina, however, no such elements were found in mammalian pineal glands. In the course of evolution, the mammalian pineal body has developed a new type of cell , the pinealocyte which has a secretory function . Also, it receives a direct sympathetic innervation from neurons whose cell bodies lie in the cervical ganglia and enter the pineal to terminate in the vicinity of, or directly on the pineal parenchymal cells. A portion of the optic tract has become diverted to form a special nerve bundle , the inferior accessory tract, which carries the portion of the light input that ultimately reaches the pineal (via the superior cervical ganglia) .'

The magnitude of the impulses that the mammalian pineal receives from its sympathetic nerves depends on envi ronmental lighting. Therefore, although the mammalian pineal is no longer responsive to light, its functional activity continues to be controlled by light via an indirect neural route. Light exposure diminishes the amplitude of the sympathetic nervous input and causes a corresponding decrease in the synthesis of the pineal hormones.'

CH,O OJ I I ~

N H

methoxylating ------)>-

enzyme (H IOMT)

CH,CH,NHCOCH,

MELATONIN

It has also been established that the visual system utilizes limbic pathways to influence neural activities in the septum , hypothalamus and upper brainstem. Since the human pineal body receives fibers from the habenula and posterior commissure, there is reason to suspect that light may influence pineal secretion by pathways other than the sympathetics . If this is the case, the pineal body may be considered a specialized functional part of the limbic system.•

Melatonin is now rightfully called a hormone, since it is produced uniquely by a simple gland (the pineal body) it is secreted into the bloodstream and has an affect on a distant target organ, the gonads. The effects of melatonin are mainly inhibitory. It decreases ovarian weight, delays puberty in immature females, reduces the weight of seminal vesicles in males.' Melatonin has been studied most but it is likely that the pineal body produces and secretes a variety of compounds , most of which are inhibitory to the endocrine system.

It is now believed that the antigonadatropic activity of the pineal hormones may be manifested at the CNS level where they inhibit the synthesis as well as the re lease of both LH and FSH, while melatonin only inhibits LH.'

The effect of the pineal body upon the gonads is well established and although some

47

effects have been reported on bodily growth , the pituitary gland, the adrenal glands, and the thyroid gland most of these experimental observations are merely suggestive at this time although future research will probably show a close relationship between the pineal and the other endocrine organs.

The synthesis of melatonin varies according to a diurnal ryhthm and one probable consequence of this ryhthm is to provide the body with a circulating time signal. This "biological clock" depends upon the variation of concentration of serotonin and HIOMT (see biochemical pathway) content within a 24 hour cycle. The serotonin content is greatest at noon, whereas the HIOMT activity is greatest at midnight. The cyclic nervous activity generated by light in the environment is converted by the pineal gland into cyclic hormonal information. The pineal gland has there.fore been called the fourth neuroendocrine transducer, the other so-called neuroendocrines transducers being 1) hypothalamic-posterior pituitary system

which secretes antidiuretic hornone (ADH) and oxytocin.

2) pituitary-releasing factor system in the hypothalamus, which secretes polypeptides that control the pituitary gland.

3) the adrenal medulla, whose cells respond to nervous input by releasing epinephrine.'

To summarize the various functions of the pineal body. It has, at one time or another, been regarded as :

1. a vestigal organ, probably homologous to the third eye found in reptiles.

2. the seat of the soul. 3. the source of a growth inhibiting factor.

4. the source of a compound that "cures" schizophrenia.

5. the source of a hormone that antagonizes the secretion or effects of ACTH.

6. the source of a substance that inhibits the onset of puberty.

7. the source of a substance which causes lightening of the skin in frogs.

8. the source of two factors, one stimulatory and one inhibitory, which regulate the adrenal secretion of aldosterone.

More recently, it has been regarded as:

9. a fourth neuroendocrine transducer, and

10. an intricate and sensitive "biological clock".

REFERENCES 1. Relkin , R. The New England Journal Of Medicine;

274 :944,1966 " The Pineal Gland " 2. Wurtman, R. J. and Axelrod , J . Scientific

American; 213 :50,1965; " The Pineal Gland ". 3. Kitay, J. I. J. Clin. Endocrine and Metab.;

14:622,1954; " Pineal lesion and precocious puberty" .

4. Lerner, A. B. et al J. Am. Chern . Soc.; 80 :2587,1958; " Isolation of melatonin , pineal gland factor that lightens melanocy1es".

5. Moore, R. Y. et al Arch . Neural. (Chicago); 18:208 ,1968; "Central control of the pineal gland: Visual pathways" .

6. Wurtman , R. J., Axelrod , J. and Phillips , L. Science; 142:1071 ,1963; "Melatonin , a pineal substance : effect on the rat ovary.

7. Wurtman , R. J., Axelrod, J. and Chu, E. W. science ; 141 :277 ,1963; "Melatonin synthesis in the pineal gland ".

8. Reiter, R. J . and Fraschini , F. Neuroendocrinology; 5 :219,1969; " Endocrine aspects of the Mammalian Pineal Gland : A Review".

List Of Junior Interneships U.W.O. Class Of '72

48

Received and reviewed by: James Lam, '7 3; Ray Corrin, '73

Fifty-seven of the eighty-three graduates of Meds '72 will be doing rotating interneships. Thirteen will do straight interneships (4 Medicine, 3 Ob/ Gyn, 2 Surgery, 2 Family Practice, 1 Path, 1 Psychiatry) . The remaining thirteen will do mixed interneships, i.e. half rotating, half selective.

Thus it appears that 59 graduates (57 rotating plus 2 Straight Family Pract.) are definitely headed toward Family Practice. It is also likely that the eleven selecting straight programs will enter specialties directly. Presumably those doing mixed interneships are as yet undecided.

Assuming the above, 71% will enter family practice, 13% a specialty, and the remaining 16% have yet to make up their minds.

London and Hamilton account for more than one half of the placements (London 34, Hamilton 15). All but one of those going to Hamilton selected St. Joseph's Hospital. Fourteen others will stay in the province of Ontario (Toronto 7, Ottawa 6, Kingston 1). The remaining twenty will venture to other parts of Canada (Vancouver 9, Montreal 7, Alberta 2, Calgary 1, Newfoundland 1 ).

NAME

Allotey-Pappoe, Victoria Cecilia

Armour, Paul William

Armstrong , Peter Frederick

Bains, Margaret Amare

Balinson, Alex Paul

Balogh , Lajos (louis)

Berger, Jayson Milton

Blacklock, Sharon Marie Stephens (Mrs.)

Boekhoud, Johannes Willem Frederik Gerrit (John)

Bowman, John Lachlin

Boyd , Ann Kathryn Usher (Mrs.)

Boyd, David Barry

Brock, Carol Anne Colthart (Mrs.)

Bromberg, Evertje (Evelyn) Van Eck (Mrs.)

Bruce, Barry Wesley

Bruce, Carol Elizabeth Summers (Mrs.)

Cameron, Ross Graeme

Clark, Edmond Howard

Cooper, Thomas James

Crawford, John Walter

Cripps, Mary Christine (Mrs.)

Devitt, Neil Gordon

Dunkerley, Robert Kenneth

Esseltine, Dixie-Lee Winfred

INTERNSHIP ADDRESS

(Rotating lnterneship unless otherwise stated)

St. Joseph 's Hospital , Hamilton, Ontario Royal Columbian Hospital , New Westminster, British Columbia

St. Joseph 's Hospital , London 11 , Ontario St. Joseph 's Hospital, London 11 , Ontario St. Joseph 's Hospital , Hamilton , Ontario

St. Joseph's Hospital , Hamilton , Ontario McGill University, Montreal , Quebec (Mixed lnterneship)

St. Joseph's Hospital , London 11 , Ontario

Victoria Hospital , London 15, Ontario (Rotating and Selective Internship) Wellesley Hospital , Toronto, Ontario St. Joseph 's Hospital, Hamilton, Ontario St. Joseph 's Hospital , Hamilton, Ontario Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship)

St. Joseph 's Hospital , London 11 , Ontario (Rotating and Selective lnterneship)

Ottawa Civic Hospital , Ottawa, Ontario Ottawa Civic Hospital , Ottawa, Ontario Kingston General Hospital , Kingston , Ontario (Straight Pathology) Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship)

University of Western Ontario, London 72, Ontario (Straight Medicine)

Ottawa General Hospital , Ottawa, Ontario

Ottawa Civic Hospital , Ottawa, Ontario

Royal Alexandra, Edmonton, Alberta

Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship)

Queen Elizabeth Hospital , Montreal , Quebec

49

Fraser, Robert Blair

Garrett , Rex Michael

Gerace, Rocco Vincent

Gordon, Willis Earl

Green, Larry Thomas

Hammerich , Paul

Harper, Kathleen Mary

Hartwick, Karl Robert

Hartzell , Walter Garth

Hay, Robert Fraser

Hellens, Ralph Gordon Boyne

Henry, James Paul

Hopp, Marilyn Henderson

Hyatt-Williams, Mary Geraldine (Mrs.)

Inkster, John Robert

Irvine, Richard Alexander

Jones, Robert Andrew Bryan

Kadrie, Hytham Ali

Kellerman, Barbara Esther

Lacy, Richard Allan

Lang , Robert Gilmer Ross

Lauge, Sarma

Little, Albert Warren

Luton , Robert George

McClintock, Norman Hugh

Mclachlan, Richard Scott

50

St. Joseph 's Hospital , London 11, Ontario St. Joseph's Hospital , London 11 , Ontario St. Joseph 's Hospital , London 11, Ontario

Ottawa Civic Hospital, Ottawa, Ontario St. Joseph 's Hospital , Hamilton, Ontario St. Joseph 's Hospital , London 11 , Ontario

McMaster University, Hamilton, Ontario (Straight Medicine)

St. Joseph 's Hospital , London 11 , Ontario Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship)

St. Joseph's Hospital , London 11 , Ontario St. Joseph 's Hospital , Hamilton, Ontario Royal Alexandra Hospital , Edmonton, Alberta Sunnybrook Hospital , Toronto, Ontario (Family Practice)

Queen Elizabeth Hospital , Montreal , Quebec

Victoria Hospital, London 15, Ontario (Rotating and Selective lnterneship)

St. Joseph 's Hospital, Hamilton, Ontario

St. Joseph 's Hospital , Hamilton, Ontario

University of Western Ontario Integrated Prog. London 72, Ontario (Straight Medicine)

Victoria Hospital, London 15, Ontario (Rotating and Selective lnterneship) Ottawa Civic Hospital , Ottawa, Ontario

Vancouver General Hospital , Vancouver, British Columbia (Straight Surgery)

St. Joseph's Hospital , London 11 , Ontario

St. Joseph 's Hospital , London 11 , Ontario

Victoria Hospital, London 15, Ontario

North York General Hospital, Toronto, Ontario

Montreal General Hospital, Montreal , Quebec

Mcleod, lan Douglas

Marchuk, Jon Blair

Marsden, Robert Jay

Mayberry, Thomas Richard

Miller, Robert Taylor

Mok, Lawrence Man-Suen

Moore, James William

Ndiyob, Joseph Ambe

Noble, Michael Allan

Odegaard , Paul Raymond

Ogunmola, Olufemi Babatunde

Patterson, James Clarence

Peek, Corbett Grant

Piche, Lawrence Conrad

Pigeon, Michel Bernard Joseph

Potter, Charles Peter

Quigley, Malachy Edward

Rieger, John Charles

Sfreddo, Louis Charles

Shier, John Dougall

Stewart, John Irvine

Taylor, John Charles

Turner, Timothy John

Vaisler, Barry Jay

Vallely, John Francis

Montreal General Hospital , Montreal , Quebec Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship) Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship)

Faculty of Medicine Integrated Program, Memorial University of Newfoundland, St. John 's, Newfoundland Royal Columbian Hospital , New Westminster, British Columbia University of Western Ontario Integrated Prog. London 72, Ontario (Straight Surgery)

St. Joseph 's Hospital , Hamilton, Ontario St. Michael 's Hospital , Toronto, Ontario Toronto Western Hospital , Toronto, Ontario Royal Columbian Hospital , New Westminster, British Columbia St. Joseph 's Hospital , Toronto, Ontario (Straight Ob . & Gyn.) St. Joseph 's Hospital , London 11 , Ontario St. Joseph 's Hospital , Hami lton , Ontario St. Joseph's Hospital , London 11 , Ontario St. Joseph 's Hospital , Hamilton, Ontario St. Joseph 's Hospital , Hamilton, Ontario University of Western Ontario Integrated Prog. London 72, Ontario (Straight Ob. & Gyn.) Montreal General Hospital , Montreal , Quebec Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship)

Sunnybrook Hospital , Toronto, Ontario (Family Practice)

St. Joseph 's Hospital , London 11 , Ontario St. Pauls Hospital , Vancouver, British Columbia

University of Western Ontario Integrated Prog. London 72, Ontario (Straight Psychiatry)

Jewish General Hospital , Montreal , Quebec

University of Western Ontario Integrated Prog . London 72, Ontario (Straight Ob. & Gyn.)

51

Walton , John Craig

Warren, Kenneth George

Webster, Randall James William

Witherspoon, Sandra Ellen

Wong , Kuo Lem (Norman Richard)

Yoshy, Judith Lynn Wyatt (Mrs.)

Zickler, Albrecht Paul

Zurbrigg , Sheila Hope

* * Fourth Year Electives

We thought an article on electives chosen by fourth year medical students would be interesting . Also it could possibly help the thi rd, second and first year medical students in reaching some decision on where to go by the time they reach fourth year.

Each student in fourth year medicine is required to put in 48 weeks of the year. However he will have 9 weeks free time in which 1 week will be allowed for travel and the other 8 weeks will be spent doing whatever he wants pertaining to medicine wherever he wants to do it. The rest of a fourth year medical student's time is spent rotating through the faculties of Medicine (9 weeks) , Surgery (7 weeks) , Anaesthesia (1 week) , Diagnostic Radiology (1 week),

• Obstetrics and Gynecology (4 'h weeks), Pediatrics (4'h weeks) , Community Medicine (3'h weeks) , Psychiatry (3 weeks) , Opthamology (1 week) , Otolaryngology (1 week) and Therapeutic Radiology ( 'h week).

The fourth year class is divided into 5 groups each with approximately 16 or 17 students. There are 5 terms and the 5 groups rotate through the 5 terms which this year begin on June 28, August 30, November 1, January 10 and March 13. The class of 1972 has 83 members and letters were sent asking them the following questions about their chosen electives.

1. Where you plan to go or have gone on your elective?

2. Why you chose this place (or these places)-e.g. money, good weather, particular prospect there, etc .?

3. What you did, or are hoping to do there?

52

Calgary General Hospital , Calgary, Alberta University of Western Ontario Integrated Prog. London 72, Ontario (Straight Medicine)

St. Pauls Hospital , Vancouver, British Columbia

St. Pauls Hos,pital , Vancouver, British Columbia

Victoria Hospital , London 15, Ontario (Rotating and Selective lnterneship) St. Joseph 's Hospital , London 11 , Ontario Royal Columbian Hospital , New Westminster, British Columbia Royal Columbian Hospital , New Westminster, British Columbia

*

D . Munroe, '7 3

4. How you liked it, if already gone? 5. Were you paid , and if so, how much? 6. Were board and lodgings provided free

or did you pay? 7. Any comments.

Sixteen students are on the elective time now and possibly out of town. Therefore this possibly cut the total number of students who could respond at this time down to 67 assuming they are all out of town. However by January 12, 1972, when most of them would have returned to London, the total number of replys was only 27 (about 40% ). The following results were obtained.

Question 1-of the 27 replies 21 were leaving London and 6 were staying in London. The best term for leaving London was the one beginning on January 10, 1972. All 5 students that answered in this term were leaving London. They seemed to be heading for the warm climate as indicated by the places they were going to-Barbados, Jamaica in the West Indies (Saranna-La-Mar Hospital), Vellere in South India, Pondicherry in India and 1 student was going to Moose Factory.

The 2 students of the term beginning on March 13, 1972, were both going to stay in the London area. This may be due to approaching Canada Councils. Some of the other places chosen were:

Klagenfu rt, Austria. Kitchener, Ontario. London, England (Westminster Hospital in

Horseferry Road) . Liverpool , England (Walton Hospital -

neurosurgical dept.). Glasgow, Scotland.

Mound Bayou , Mississippi (Tufts Delta Health Centre).

England-Stratford and Aberdeen. Scotland-University of Aberdeen-Dept. of

General Practice; University of Edinburgh­Dept. of General Practice.

Woodstock, Ont. St. Thomas Psychiatric Hospital. Cochrane, Ont. London, England (Middlesex Hospital) . Moose Factory, Ont. Hollywod, California (Cedars of Lebanon

Hospital) . Hazelton, British Columbia (Wrinch

Memorial Hospital) . Seaforth , Ont. Windsor, Ont.

The comments about some of these places are as follows:

GROUP A 1. Tufts Delta Health Centre--Mound

Bayou , Mississippi -can enquire by writing to Director of

Training at the Centre can read " Health Centre in Mississippi " by H. Jack Geiger in Hospital Practice 4:68-81 , 1969. Opportunities there in ambulatory pediatrics and internal medicine mainly. Rating by student-a most valuable experience. Occasional student subsidized. Clinical staff would like more Canadian students.

2. Klagenfurt, Austria. No pay or lodgings. Beautiful city-very enjoyable. Contact 471-8890 for further information.

3. St. Mary's Hospital , Kitchener, Ont. Ob. and Gyn. Rated as very enjoyable. Large number of deliveries and surgical experience. Free room and board but no pay.

4. Victoria Hospital, London, Canada. No pay or board. General surgery and gastroenterology. Comments-enthusiastic encouragement to those planning to leave London.

5. Westminster Hospital , London, England. Opthalmology. Very good elective. Board and lodgings but no pay.

6. Walton Hospital , Liverpool , Engrand. Neurosurgery.

Excellent chance for basic experience in history, physical and neurological . examination and experience of learmng in another country-also some assisting in surgery. Contact 672-3001 if interested.

7. Glasgow, Scotland. Neurology. Liked it very much. Free board and lodgings but no pay. Study of neurological diseases and practical medicine.

8. Stratford and Aberdeen, England. Experience in British medicine. Very enjoyable and worthwhile. No pay or board and lodgings.

GROUP B 9. University of Aberdeen, Scotland-Dept.

of General Practice, University of Edinburgh, Scotland.

Wanted to see socialized medicine in action. Arranged by Dr. McWhinney. These are teaching areas and patients readily accept students. Execllent elective. No pay-board and lodgings free for one half of time.

10. Woodstock, Ontario. Experience and practical information in General Practice outside a teaching hospital-more realistic setting.

I.C.U. and L.P.H., London, Ontario. No pay.

11 . St. Thomas Psychiatric Hospital. Opportunity to attend psychiatric conferences as well as assist consultantes in medicine, surgery, etc . Good elective. No pay but free board and lodgings.

12. Cochrane, Ontario. Practical experience in general practice in small town very enjoyable elective. Paid but charged for board and lodgings.

13. Middlesex Hospital, London, England. Experience in British Medicine. Most enjoyable and highly recommended. No pay-small charge for board and lodgings during summer.

14. St. Joseph 's Hospital Emergency Dept., London, Ontario. Excellent experience--this type of experience indispensable in students ' training . No pay or lodgings.

15. London, Ontario-Local Family Practice. Opportunity to solidify knowledge and learn mechaniscs of Gen. Practice. Learn procedures done in Drs. office. Rated by student as excellent No pay or lodgings.

GROUP C 16. Wrinch Memorial Hospital, Hazelton, B.C.

50 Bed United Church of Canada Mission Hospital serving mostly Indians. Rated by student as an execllent elective with up to date equipment and

53

I

I

opportunity to assume responsibility­efficient operation. No pay-board and lodgings free.

17. Cedars of Lebanon Hospital , Hollywood , California.

Extern-especially surgery. Good experience. Location and weather good. No pay-board and lodgings provided.

18. Moose Factory, Ontario. Opportunity to see medicine in the North among Indians and Eskimos. No pay but board and lodgings provided. Rated by student as enjoyable­experience limited during freeze-up as medical facilities not used as much­also staff of medical personnel more than adequate.

19. Seaforth Medical Clinic. St. Joseph 's Hospital Dept. of Radiology , London, Ont.

Paid in Seaforth with rooms and board provided. Great experience.

20. St. Joseph 's Hospital Emergency Dept. , London, Ontario. London Psychiatric Hospital. Windsor Ca. Clinic. Windsor, Ontario-Family Practice.

Chosen for convenience and interest. St. Joseph 's Emerg. rated by student as excellent. No pay or lodgings.

GROUP D 21. Barbados.

Opportunity to observe in Dept. of Medicine. No pay but free board and lodgings. Weather a factor in choice.

22. Savanna-La-Mar Hospital , Jamaica, West Indies.

Highly recommended by other students as tremendous learning experience in less affluent surroundings. No pay but room and lodgings subsidized.

23. Vellore, South India. Chosen for adventure and O.B. experience not possible in Canada. No pay and fee charged for board and lodgings.

24. Pondicherry, India. Chosen as opportunity for experience in another culture. No pay and minimal charge for board and lodgings.

25. Moose Factory, Ont.

54

Chosen for practical experience in General Medicine and Obstetrics. Oppotrunity to see the North. No pay but board and lodgings provided.

26. St. Joseph 's Hospital Emergency Dept. , London, Ontario.

Chosen for experience in areas of acute medicine.

GROUPE Strathroy, Ontario-Family Practice.

Chosen for exposure to primary care outside urban centre.

27. Victoria Hospital , London, Ontario. St. Joseph 's Hospital , London, Ontario.

Chosen for convenience and choice of teaching materials available.

From the replies received most students who have returned from their electives rated their choices as satisfactory to excellent. Those who had the opportunity to work in England and Scotland were particularly enthusiastic. People going to England are advised to look for a locum as the amount of responsibility, experience and pay are better. You should get in touch with Dr. McWhinney. January to March is a poor time to go to England however as it is fairly cold and damp at that time of year and the heating is not that good. Outlying areas such as India, Barbados, Jamaica and the Far North etc. were chosen as an opportunity to work in a different culture and in areas which were less affluent. The choice of smaller towns in Ontario, etc . afforded practical experience in areas outside teaching centres . For the most part, no pay was received but board and lodgings were provided in about 50% of the choices. Recommendations included that students be given a better knowledge of electives available close to London and that every fourth year student spend some time in a small hospital.

For further information on any of these electives, contact the editor of the Medical Journal , or contact D. Munro, Ill Meds, 672-7783.

C:lass l'Je~s MEDS '73

Now that the excitement of Tachy is over, class members have settled down to work and into the realization that they can 't possibly read all of both Harrison and Schwartz much less learn the material covered-but, then , that 's the joy of third year-what's life without a little panic?

Sunday nights across London have turned into " Therapeutics Night" for many '73'ers­long hours of combing through books filled with generalizations and short on answers. After Dr. Walker 's fecaloma it's a wonder anyone believes half the cases we're given.

By the way-how's your deportment these days? The Dean 's letter leads me to believe that some of the clinical groups fall short of Good Housekeeping 's Best-Dressed List. If any of you are interested, I'd be more than

come out to the Banqueteer, if only to reminisce over last year's extravaganza.

willing to give instructions on " How to be Happy with Short Hair". For the other half who don 't care to comply with regulations I suggest you get your girlfriends to tutor you in bobby-pin-using . Nothing stays under nurses ' O.R. caps without them.

Betty Marchuk MEDS '72

Short of getting pleasantly inebriated with one 's respective alphabetical compatriots , thanks to the warm hospitality of Dr. J. B. Walker, '72 'ers haven 't had too much opportunity to exchange news and views as a group, except a chance encounter in the corridors. Tachy brought a certain number of us together but was generally a collective endeavour by the core group of past Tachy partisans.

Mary Harper, under pressure, cancelled her plans for a world tour next June and relinquished the class treasury for the imbibement of the whole class following the M.C.C.'s. Do come and drown your sorrows at what promises to be a bash to beat all others.

Marilyn Hopp MEDS '72

The chaotic clerking continues to create havoc with communication among classmates and finds the usual author of this passage on a passage to India. Most of us found the few days off at Christmas or New Year's a welcome break. Some of us were enjoying

February wedding bells are in the offing

life with the Eskimos or working at Moose Factory around that time of year. Wedding bells will be ringing for more members of the class soon, -- - Bob Marsden , Rick for Bob Marsden and Paula, and about the

same time, Marg Bains will likely join the list of class mothers. No doubt there is lots of other news for the hot line, but at the moment it has failed to bridge the communication gap. Any juicy tidbits for our final class round-up will be appropriately devoured for the nourishment of the whole class.

Lacey and probably others whose news hasn't reached my informants' ears. And we have another little one to add to our family-Ted Clark's little boy. Looking ahead, we'll soon know whether and where we'll be migrating next year. The Meds Ball has not arrived prior to the writing of this ; as we are all going , hopefully we will catch up on more The third year-fourth year-party will have to

go some to compare with last year's, but do news there than here. Carol Brock

THE UNIVERSITY OF WESTERN ONTARIO FACULTY OF MEDICINE

Scholarships and Prizes Fourth Year

1970-1971

1. The Medical Alumni Gold Medal-Daniel Slipacoff 2. The Alpha Kappa Kappa Gold Medal-Flora Jamieson Rathbun 3. The Dr. F. R. Eccles Scholarship-Flora Jamieson Rathbun 4. The Dr. Glen S. Wither Memorial Award-Benjamin Arthur Sawer 5. The Poulenc Award-Daniel Slipacoff 6. The Class of '55 Prize-Flora Jamieson Rathbun 7. The Dr. R. A. H. Kinch Prize in Community Medicine-James Cecil Hicks 8. The Abbott Prize in Anaesthesia-Robert John Byrick 9. The Dr. Fred N. Hagerman Memorial Prize in Surgery-Richard John Finley

10. The Pearl Devenow Fox Memorial Prize in Obstetrics and Gynaecology­Jacob Veenstra

11. The J. B. Campbell Memorial Scholarship in Medicine-Margaret Susan Youngman Mitchell

12. The Kingswood Scholarship-Dennis Ross Chap~an . 13. The Dr. Lawrence A. Burk Memorial Prize 1n Paed1atncs-Norman Chalmers May 14. The Class of 1917 Prize-Robert Barry Bourne 15. The Roche Scholarship-Gregor lain McGregor 16. The Ivan Hamilton Smith Memorial Prize-Robert Michael Cecil Brock 17. Thew. H. McGuffin Scholarship in Radiology-Robert James Henderson 18. The Khaki University and Y.M.C.A. Scholarship-Wayne Alexander Everett 19. The Lange Awards-Flora Jamieson Rathbun

Jacob Veenstra 20. The Horner Gold Medal Awards in Opthalmology and Otolaryngology

Opthalmology-Roger Howard Haag Otolaryngology-David Timothy Fisher

55

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' THE UNIVERSITY OF WESTERN ONTARIO

London 72, Ontario

>loving toward Tomorrow. At PARKE- DAVIS a large part of our work is directed toward tomorrow-tomorrow's drugs. We call this work. research . .. to improve existing pharmaceuticals ... to develop new and better drugs for the advancement of patient care. In the field of anesthesia, for example, PARKE-DAVIS scientists spent seven years (and over $9,500.000) in the search for a better parenteral anesthetic agent. Seven years of tomorrows during which hundreds of com­pounds with potential anesthetic and analgesic properties were investigated. The culmination of this research is KETALAR® (ketamine HCI), an agent with such unique properties that we feel it is a truly important contribution to anesthesia.

PARKE-DAVIS

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