VISIT TO THE
ROYAL VICTORIA HOSPITAL, McGILL UNIVERSITY
MONTREAL, MONDAY 2ND NOVEMBER 1970
Present: Dr. P. Pare"
Dr. Peter Macklem
Sir Charles Ellis
Mr. L. C. Laporte
Dr. D. G. Felton
Introduction
The Canadian Tobacco Industry has contributed $300,0001to
be matched by a roughly equivalent sum from the Canadian
Government, to McGill University to finance the establishment of
an interdisciplinary Respiratory Studies Laboratory. The gentle-
men visited at the Royal Victoria Hospital, one of the teaching
hospitals of McGill University, are closely involved in the
project.
Outline of the Project
Dr. Macklem, who is a Canadian MRC Research Fellow and must
spend 75% of his time on research, produced outline plans for the
building which would be adjoining the Pathological Institute.
He explained that it was planned to provide facilities in which
people of various disciplines could work together, sharing equip-
ment and contact with the Research Staff. Plans had been made
to provide space for 12 people (Research Fellows) to work on one
year research projects, covering all aspects of Respiratory Studies.
The Staff would include. a Pathologist (Dr. Thurlbeck?), an
Epidemiologist, a Physiologist, and so on. Experts on Radiology,
Pediatrics etc. could be called on as required. There is,
apparently, an almost complete lack of experts covering the joint
fields of Pathology and Respiratory Mechanics (lung physiology)
Dr. J. C. (Jim) Hogg was the only one known to Macklem. Hogg's NJ
training and research work across the interface had been very
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tedious and had highlighted the need for the Laboratory. Hogg
would be one of the Research Directors and other names mentioned
were Dollfus, Donovan, McLeod and Dr. Pare. pare is a physician
and is in charge of the Queen Mary Veterans Hospital, in a ddi ti. on
to being a clinician at the RVH. The Clinical members of the
team would be responsible for patient care, but would have no
responsibility for the direction of research.
Further Discussion
The discussion then turned to the problem of Smoking and
Health (Macklem is a cigar-smoker, who inhales). CDE raised the
question of bridging the gap and this led to a more general dis-
cussion on lung clearance mechanisms. Macklem mentioned a Dr.
Newhouse (Hamilton) who exposed smokers and non-smokers to radio-
active aerosols and found that smokers cleared the radioactive
burden more rapidly than did non-smokers. Another method of
lung clearance was by alveolar macrophages and Dr. Gareth Green
of the University of Vermont was the expert here.
When discussing how smoke constituents might reach the basal
cells of lung epithelium, Macklem offered two hypotheses:
(a) Direct penetration between the columnar cells (Which
he did not consider were quite as regular as they were
often represented)
come". (b) Drainage from the alveoli into the lymphatic system
which could return them to beneath the basement membrane.
Macklem did not believe the materials could penetrate the
basement membrane and, when asked to explain how they could act
at a distance, suggested that polonium or other radio elements
could be causative factors in smoke. He kept returning to this
as a causative factor, although he was reminded of the views of
Mayneord.
He explained how alveolar drainage worked by describing CD
C=)
Plateau's paradox. This suggests that alveolar drainage is brought
about by surface tension forces on the-.alveolar wall which ensure
movement to the sharp angles between faces, where the small
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lymphatic ducts are situated.
In discussing lung clearance by ciliary movement, he suggested
that stagnant areas could arise at the carina of the bronchus,
provided ciliary motion was always linear. To move material
upwards from the carina would require a spiral ciliary motion.
He did not know how the cilia in the human bronchus moved.
'When the conversation moved to emphysema, Macklem discounted
the Levine theory that it was caused by blocking the bronchial
artery. Instead, referring to the various Proceedings of Aspen
Conferences (for the last of which he had acted as Rapporteur),
he said that the latest theory was that emphysema was due to a
lack of autocontrol of proteoly.tic enzymes. Emphysema can be
induced in dogs by instilling papain into the trachea. The proteo-
lytic ensymes could come from macrophages, which are rich in these
digestive catalysts. Any. lung infection leads to an accumulation
of macrophages which engulf and digest the bacteria. Normally
there is an anti-proteolytic enzyme in the body which neutralises
the:activity and prevents auto-digestion following breakdown of
the macrophages. In about 1% of the population, it is known that
there is an Anti-l-X-trypsin deficiency, which correlates with
emphysema incidence.
As a result of the interest evinced in the Aspef% Conferences
Macklem provided us with a set of the abstracts of the last
Conference which were relevant to smoking.
CDE raised two possible projects for discussion. These were:
A. Autopsy investigation of the lungs of accident victims
and an attempt to correlate the findings with-smoking
habits, discovered'subsequently.
Macklem and DGF believed that Auerbach had already
published something along these lines. There are,
apparently, difficulties in Canada, where the procedure
is that autopsies are carried out by the Coroner's
pathologist and it is not always feasible to obtain
carefully selected specimens. C=@
r%11%
B. A careful study of the smoking behaviour of people sus-
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pected of respiratory illness. This would require the
pr Rence of a skilled observer.
Pare saw no ethical objections to such a project.
Macklem was critical of the use of subjective techniques
to estimate inhalation and suggested telemetric obser-
vation by impedance pneumograph. He could see no
difficulties in telling the patient that these were for
a different purpose so that he would remain ignorant of
the fact -that bis smoking habits were being monitored.
Macklem was a very attractive personality, prepared to talk
on any aspect of the problem without reservation. Towards the
end of the meeting, the discussion turne to t e way n w c
research projects might be introduced into the Interdisciplinary
Laboratory. Macklem could not see any difficulty in tackling a
problem of interest to the industry provided the research director
in question found it of interest and worthwhile as an interdis-
t
ciplinary problem, of value as training to a research fellow.
DGF/SEW/5.4
13th November, 1970
BATCo document for Province of British Columbia 19 April 1999