History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: December, 1951 Vancouver Medical Association 1951

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 THE
ULLETI
OF Mr
The Vancouver Medical Association
EDITOR:
DR. J. H. MacDERMOT
EDITORIAL BOARD
DR. D. E. H. CLEVELAND DR. J. H. B. GRANT
DR. H. A. DesBRISAY dr- J- L- McMILLAN
Publisher and Advertising Manager
W. E. G. MACDONALD
volume xxvm
DECEMBER, 1951
NUMBER 3
OFFICERS 1951-52
De. J. C. Grimson Dr. E. C. McCoy Dr. Henby Scott
President Vice-President 'Past President
Dr. Gordon Burke Dr. D. S. Munroe
Hon. Treasurer Hon. Secretary
Additional Members of Executive:
Dr. J. H. Black Dr. George Lanoley
TRUSTEES
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommeb, Whiting & Co.
SECTIONS
Eye, Ear, Nose and Throat
Dr. B. W. Tanton Chairman Dr. John A. Irving Secretary
Paediatric
Db. Peter Spohn Chairman Dr. John W. WHiTELAW-Secretary
Orthopaedic and Traumatic Surgery
Dr. A. S. McConkey Chairman Dr. W. H. Fahrni. Secretary
Neurology and Psychiatry
Dr. R. Whitman Chairman Dr. B. Bryson_ Secretary
Radiology
Dr. Andrew TuRNBUix_.Chairman Dr. W. L. Sloan Secretary
STANDING COMMITTEES
Library :
Dr. A. F. Hardyment, Chairman; Dr. J. L. Pabnell, Secretary;
Db. F. S. Hobbs, De. J. E. Walker, Dr. E. France Word, Dr. D. W. Moffatt
Co-ordination of Medical Meetings Committee:
Dr. J. W. Frost Chairman Dr. W. M. G. Wilson Secretary
Summer School:
Dr. Peter Lehmann, Chairman; Dr. B. T. H. Marteinsson, Secretary;
Dr. A. C. Gardner Frost; Dr. J. H. Black; Dr. Peter Spohn:
Dr. J. A. Irving.
Medical Economics:
Dr. F. L. Skinner, Chairman; Dr. W. E. Sloan, Dr. G. H. Clement,
Db. E. A. Jones, Db. Robert Stanley, Dr. F. B. Thomson, Dr. R. Langston
Credentials:
Dr. Gordon C. Johnston, Dr. W. J. Dorrance, Dr. Henby Scott
V.O.N. Advisory Committee
Db. Isabel Day, Db. D. M. Whitelaw, Db. R. Whitman
Representative to the B.C. Medical Association: De. Henby Scott
Representative to the Vancouver Board of Trade: Db. E. C. McCoy
Representative to Greater Vancouver Health League: Db. J. A. Ganshobn
Published  monthly  at  Vancouver,  Canada.     Authorized  as  second  class  mail,  Post  Office  Department,
Ottawa, Ont. VANCOUVER MEDICAL ASSOCIATION
PROGRAMME FOR THE FIFTY-THIRD ANNUAL SESSION
Founded 1898; Incorporated 1906
REGULAR MONTHLY MEDICAL MEETINGS
First Tuesday—General Meeting—Vancouver Medical Association—T.B. Auditorium.
Conical Meetings, which members of the Vancouver Medical Association are invited
to attend, will be held each month as follows:
Second Tuesday—Shaughnessy Hospital Staff Meeting.
Third Tuesday—St. Paul's Hospital Staff Meeting.
Fourth Tuesday—Vancouver General Hospital Staff Meeting.
Fifth Tuesday—(when one occurs)—Children's Hospital Staff Meeting.
Programme of General meetings will be circularized monthly by the Executive
Office of the Vancouver Medical Association Programme of Clinical meetings will be
displayed weekly on bulletin boards prepared for that purpose and placed in the Vancouver General, St. Paul's and Shaughnessy Hospitals.
VANCOUVER GENERAL HOSPITAL
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.
Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
Thursday, 9:00 a.m.—Medical Clinic.
12:00 noon—Clinicopathological Conference on Newborns.
Friday, 9:00 a.m.—Paediatric Clinic.
Saturday, 9:00 a.m.—Neurosurgery Clinic,
edition, 1950. 'MM
ST. PAUL'S HOSPITAL
Regular Weekly Fixtures
Tuesday—9-10  a.m p| Paediatric  Conference
2nd Tuesday of each Month—11 a.m. Tumor Clinic
Wednesday—9-11 a.m Medical Clinic
2nd and 4th Wednesday—11-12 a.m. Obstetrics and Gynaecology
Thursday—11-12   a.m. . Pathological  Conference
(Specimens and Discussion)
Friday—8  a.m. : Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m Surgical Conference
Friday—9 a.m Dr. Appleby's Surgery Clinic
Friday—11 a.m Interesting Films Shown in X-ray Department
Page 48 SHAUGHNESSY HOSPITAL
Regular Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology. .
Wednesday, 10:45 a.m.—General Medicine.
Wednesday, 12:30 p.m.—Pathology.
Thursday, 10:30 a.m.—Psychiatry.
Friday, 8:30 a.m.—Chest Conference.
Friday, 1:15 p.m.—Surgery.
BRITISH COLUMBIA CANCER INSTITUTE
Tuesday, 9:00 a.m. to 10:00 a.m. (weekly) —Clinical Meeting.
B.C. SURGICAL SOCIETY
Spring meeting—April 25th, 26th, 1952.
THE   BULLETIN     §
Publishing and Business Office — 17 - 675 Davie Street, Vancouver, B.C.
Editorial Office — 203 Medical-Dental Building, Vancouver, B.C.
The Bulletin of the Vancouver Medical Association is published on the first of
each month.
Closing Date for articles is the 10th of the month preceding date of issue.
Manuscripts must be typewritten, double spaced and the original copy.
Reprints must be ordered within 15 days after the appearance of the article in question, direct from the Publisher. Quotations on request. ||||j
Advertisements
Closing Date for advertisements is the  10th of the month preceding date of issue.
Advertising Rates on Request.
Page 49 10
20     30
Conies Close
to Being
the "IDEAL"
ANTIBIOTIC1
HIGHLY EFFECTIVE
In general, "... penicillin continues to be the
antibiotic of choice for . . . all gram-positive
infections due to staphylococci, hemolytic streptococci, pneumococci... all cases of gonorrhea
and syphilis."2
MINIMAL TOXICITY
"Penicillin remains a pharmacologic curiosity
because of its almost completely innocuous char-'.
acter. No toxic effects of the dose-related type
have been reported; this is the more remarkable
in view of the enormous number of persons-
(literally millions) who have receivedthedrug."3
Merck Penicillin Products are manufactured in Canada.
Literature available upon request.
MERCK PENICILLIN PRODUCTS
1. Pratt, R. and Dufrenoy, 3.. Antibiotics,
3. B. Lippincott Company, Philadelphia,
1949  P  30.
2. Keef'er, C. *S., Postgraduate Medicine 9:
101, Feb. 1951.
3. Goldstein. A.: Antibacterial chemotherapy. .V. England J. Med. 240: 137-147.
Jan. 27. 1949.
MERCK & CO. LIMITED
Manufacturing demists
MONTREAL .  TORONTO ,   VALLEYFIEID. VANCOUVER HEALTH DEPARTMENT
STATISTICS — OCTOBER, 1951
Total population - estimated	
Chinese   population   -   estimated.
Other - estimated	
3 97,140
6,282
640
September, 1951
Rate per
Number
Total deaths   (by occurrence) 321
Chinese deaths jSjj ,     5
Deaths, residents only _-.   290
"Birth Registrations—Residents and Non-residents:
(includes late registrations)
Male	
September, 1951
- 371
Female 1 ! : ... !_..439
810
24.5
Infant Mortality—residents only
September, 1951
Deaths under  1  year of age ; .     7
Death rate per 1000 live births -—--^ ■ ^jg^';   11.6
Stillbirths (not included in above item) t 10
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
September, 1951
SS3&3     Cases Deaths
Scarlet Fever H .     24 —
Diphtheria    j -     — —
"Diphtheria Carriers ^^^p^p; __.. 1     — —
Chicken Pox     18 —
Measles [     17 —
Rubella   J&L       4 —
Mumps I     14 —
Whooping  Cough   I I ^jRPjfj6."       1 —
Typhoid Fever .     — —
Typhoid Fever  Carriers  2     — —
Undulant Fever I i     — —
Poliomyelitis I—-i.i£       7 1
Tuberculosis fef|gf*j|     37 5
. erysipelas    i - .JjP'S
Meningitis	
Infectious Jaundice . i.
Salmonellosis	
Salmonellosis Carriers   :	
Dysentery	
Dysentery Carriers	
Tetanus	
Syphilis :—:	
Gonorrhoea	
Cancer  (Reportable Resident)
25 —
58
September, 1950
Cases
Deaths
9
—
15
z
9
—
11
—
15
—
23
1
13
18
3 —
20
2
210
—
92
61
Page 50 -( CONNAUGHT >
Rapid and Prolonged . . . .
PENICILLIN G PROCAINE AND PENICILLIN G SODIUM
For Aqueous Injection
The need for a penicillin preparation which gives initially high blood
levels as well as a prolonged effect is fully met by Penicillin G Procaine and
Penicillin G Sodium for Aqueous Injection. This product, as supplied by
the Connaught Medical Research Laboratories, provides in each cc. of the
suspended preparation 300,000 I.U. of penicillin G procaine and 100,000 1
I.U. of penicillin G sodium. The soluble penicillin G sodium permits of the
rapid attainment (usually within 30 minutes) of a relatively high level of
penicillin in the blood, followed by the maintenance of lower blood levels
for about 24 hours, due to the effect of the relatively insoluble penicillin
G procaine.
This new product of the Laboratories is prepared as a stable dry
powder which requires no refrigeration. By the addition of an appropriate
volume of sterile water, a free-flowing aqueous suspension is readily and
quickly obtained. The aqueous suspension is ready for immediate intra-;
muscular injection using a 20-gauge needle.
HOW SUPPLIED
1-dose vial—  400,000 International Units
5-dose vial—2,000,000 International Units
10-dose vial—4,000,000 International Units
□
CONNAUGHT   MEDICAL   RESEARCH    LABORATORIES
University of Toronto Toronto, Canada
Established in  1914 for Public Service through Medical Research  and the development
of Products for Prevention or Treatment of Disease.
DEPOT FOR BRITISH COLUMBIA
MACDDNALD'S    PRESCRIPTIONS    LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. To all our readers, we extend compliments of the season, and our best wishes for
1952.
This new year bids fair to be one of destiny for the British Columbia Medical
profession. For there will be many adjustments and changes in our domestic affairs—
and out of these we shall all hope to see improvement in many particulars, and a
strengthening of our position, with the public and amongst ourselves.
It has long been felt by medical men in British Columbia that we should be more
closely linked with the whole Canadian profession, and that this would best be done
by closer affiliation with the Canadian Medical Association. This body has ably
represented the profession for many years and anything we can do to give it greater
strength, and to increase unity, will be for the benefit of all of us who practice
medicine in Canada.
Some years ago the British Columbia Medical Association became a Division of
the CMA—in name at least. But its constitution was a loosely-designed affair—and
many felt that it was insufficiently precise and flexible—that it did not give adequate
representation to all sections of the profession—the word used was that it was not
"democratic" enough. Everyone knows what he means by this word—but his meaning
is not always the same as that given by his neighbour. Personally, we think the word
is overworked, and often used incorrectly—but the general idea of it is good.
So a new constitution was drawn up and adopted, and now the machinery is there,
and it is up to all of us to set it to work, and to make it possible for it to work.
A recent vote taken by the College of Physicians and Surgeons through its Council,
has shown that the majority of those voting, and so a majority of the profession, wants
this new body to undertake the business of the profession, its economics, its contracts
and agreements with various bodies—to handle its public relations in fact.
This imposes, of course, a great responsibility on the B.C. Division. But it also
imposes a great responsibility on us, all the members of the profession. We are sure
Ithat all of us will accept loyally the decision of the majority, and abide by it with all
(sincerity and goodwill. We believe that the B.C. Division is competent and willing
to do the job—but our support, moral and financial, are essential to its success. And,
having called on the Division to do this work, we must back it up in every way.
And we would say one more thing—that we must be patient, and having given
pur confidence, must retain it, and give the Division adequate time to do its work. For
the problems that confront us as a profession are many and difficult. They cannot
be solved by any easy, ready made decision or by violent action—they can be solved
py patience and goodwill, and a determination to deal fairly with all concerned. No
matter who is responsible for the conduct of our economic affairs, that organization
Bias a stupendous task ahead of it. But if we all pull together, and work together,
khere is no doubt that we shall succeed, and be all the stronger for the effort. We shall
ihave added to our own stature and made our contribution to the economic status of
the whole Canadian medical profession.
Page 51 I
s
m
LIBRARY HOURS:
Monday, Wednesday and Friday § 9:00 a.m. — 9:30 p.mj
Tuesday and Thursday - 9:00 a.m. — 5:00 p.m.
Saturday  I 9:00 a.m. — 1:00 p.m.
The Library has been most fortunate in having been presented, by Dr. W. C.
Gibson, with a reproduction of the "Edwin Smith Surgical Papyrus" together with a
translation of it by Professor J. H. Breastead. We print below the letter that accompanied this very fine gift and the Library Committee's letter of thanks and appreciation.
1690 Westbrook Crescent,
Vancouver, B.C.
October 14, 1951
The Chairman,
Library Committee,
Vancouver Medical Association.
Dear Sir:
I am sending along a copy of Prof. Breasted's translation of the Edwin Smith)
Papyrus for the library, as a small memorial to my father-in-law, Dr. Walter S. Baird,
who spent his life here in General Practice and who would have been delighted withl
the new Academy both as a building and as an idea.
I hope that this earliest historical document relating to scientific medicine may
be of interest to the members and may stimulate others to bring to the Academy
Library what they undoubtedly have languishing on their shelves at home! Having
seen good collections turn to dust for lack of circulation I would stipulate that this
volume, together with any others I may send you in the future, should be available to
anyone anywhere.
May I take this opportunity of telling you how much my laboratory owes to your
library and its librarians during the past year in getting our research programme
under way.
Yours sincerely,
(sgd)   Wm. C. Gibson.
November 21st, 1951
Dr. W. C. Gibson,
1690 Westbrook Crescent,
Vancouver 8, B.C.
Dear Doctor Gibson:
Your recent generous gift to our library of the "Edwin Smith Surgical Papyrus"
translated by Professor J. H. Breasted has been most gratefully accepted and may I, oni
behalf of the Library Committee and members of the Association, thank you very]
sincerely for these valuable volumes.
Page 52 This translation is, indeed, one of the greatest, both in historical and medical
importance. The Committee realizes that this work is now out of print and extremely
difficult to obtain, and for this we feel all the more indebted to you for your kindness
and thoughtfulness in presenting it.
The volumes will be inscribed as a memorial to Dr. Walter S. Baird and will find
a place for all time in our library which now has its own home in an atmosphere we
can all enjoy. |p|
Yours sincerely,
(sgd) John L. Parnell, M.D., Secretary,
Library Committee.
EDWIN SMITH SURGICAL PAPYRUS
As a short historical note on the above work, we can do no better than quote from
lie Foreword and General Introduction:
"The science of surgery has made such revolutionary progress during the last two
generations that there might seem to be a greater gulf between the surgeons of the
American Civil War and those of the present than there ever was between the surgery
of the ancient world and that of the American Civil War. Nevertheless, the fundamental transformation in the field of surgery, as in medicine, resulting from the earliest
recognition of natural causes as distinguished from demoniacal possession, occurred in
ancient times. Superstitious views of the universe, involving belief in demoniacal
possession, especially among the* ignorant, have persisted into modern times, as illustrated
in the Salem witchcraft, or even in the case of an educated man like Increase Mather,
once president of Harvard University. It is strikingly illustrated in the conditions
among which Mormonism arose only a century ago in western Pennsylvania and New
York State. It is obvious, therefore, that the transition from superstition to a
^scientific point of view cannot be placed at a fixed date.
In this document, therefore, we have disclosed to us for the first time the human
mind peering into, the mysteries of the human body, and recognizing conditions and
processes there as due to intelligible physical causes. The facts in each given case of
injury are observed, listed, and marshaled before the mind of the observer known to
us, and in this papyrus we have the earliest known scientific document.
While the copy of the document which has come down  to us dates from the
Seventeenth Century B.C., the original author's first manuscript was produced at least
a thousand years earlier, and was written some time in the Pyramid Age  (about 3000
to 2500 B.C.).    As preserved to us in a copy made when the Surgical Treatise was a
thousand years old or more, a copy in which both beginning and end have been lost,
I the manuscript nowhere discloses  the name  of  the  unknown  author.     We  may be
j permitted to conjecture, and it is pure conjecture, that a surgical treatise of such importance,  appearing  in  the  Pyramid  Age,   may  possibly  have  been   written  by   the
earliest known physician, Imhotep, the great architect-physician who flourished in the
Thirtieth Century B.C.    In that case the original treatise would have been written over
thirteen hundred years before our copy of the Seventeenth Century B.C. was made . . .
"Mr. Edwin Smith, after whom the papyrus is named, went to Egypt about the year
1858.    He was at that time thirty-six years of age. and had studied Egyptian in both
London and Paris before proceeding to Egypt.    Although as far as it is known he
•never published anything, it is quite evident from his papers in New York that he had
become very fully grounded in the new science, which was then only a generation
I old.£?-His knowledge of hieratic is praised by the sagacious Goodwin, who says, with
reference to the date of the calendar on the verso of the Ebers Papyrus: "The numeral
attached to the name of the knid is neither 3 nor 30 — both of which numbers have
been suggested — but 9.    It is due to Mr. Smith, whose acquaintance with hieratic
texts is very extensive, to mention that he pointed this out to me as long ago as 1864,
when he communicated to me a copy of the endorsement upon his papyrus."    It is
Page 53 evident from these remarks of Goodwin that Edwin Smith was the first scholar to read
correctly the date in this famous calendar ... In January, 1862, during his stay at
Thebes, Mr. Smith purchased the document which is the subject of this book . . .
"As at present unrolled and mounted between glass, the Edwin Smith Papyrus has
a length of about 4.68 meters (about 15 feet 3/4 inches). At least a column of writing
has been lost at the beginning, so that it originally had a minimum length of five
meters (about 16 feet 4 inches). The roll has a height of 32% to 33 centimeters
{about 13 inches), corresponding to the usual full-height roll of the period from the
Middle Kingdom through the Hyksos Age to the early Empire. It is put together out
of twelve sheets of the usual size, about 40 cm. (about 15% inches) wide, the first now
surviving being unfortunately fragmentary. The eleven joints are admirably done,
and in its craftsmanship the roll is an excellent piece of work. It now bears seventeen
columns of writing on the recto and five on the verso, all in horizontal lines . . .
"The seventeen columns (377 lines), all that is preserved of this ancient treatise,
occupying the front of the Edwin Smith Papyrus, contain 48 cases, all injuries, or
induced by injuries (with two possible exceptions). The discussion begins with the
head and skull, proceeding thence downward by way of the nose, face and ears, to the
neck, clavicle, humerus, thorax, shoulders and spinal column, where the text is
discontinued, leaving the document incomplete ..."
REGISTERED NURSE WITH MEDICAL CLINIC EXPERIENCE
AVAILABLE AFTER JANUARY 1st FOR POSITION IN
DOCTOR'S OFFICE.
For information apply
MRS. MARION MORRIS
Suite  201,  990  Bute  Street, Phone  PAcific   8982
jf FOR SALE
Medical practice of the late Dr. T. W. Sutherland at Parksville on
Vancouver Island.
Specially suitable for man who wishes to combine pleasant living conditions
with general practice. Offices for rent in year-round resort hotel. Some
instruments and books also for sale.
For particulars write
MRS. T. W. SUTHERLAND,
PARKSVILLE, B.C.
Page 54 CANADIAN MEDICAL ASSOCIATION—B. C. DIVISION
October,  1951  — September,  1952
OFFICERS
President	
President-Elect-
Vice-President—
 : Dr. H. A. L. Mooney, Courtenay, B.C.
 Dr. J. A. Ganshorn, Vancouver, B.C.
 ! Dr. R. G. Large, Prince Rupert, B.C.
Honorary Secretary-Treasurer § Dr. W. R. Brewster, New Westminster, B.C.
Chairman, General Assembly  Dr. F. A. Turnbull, Vancouver, B.C.
STANDING COMMITTEES CHAIRMEN
Constitution and By-Laws Dr. R. A. Stanley, Vancouver, B.C.
Finance : Dr. W. R. Brewster, New Westminster, B.C.
Legislation 1 Dr.  J.  C.  Thomas, Vancouver, B.C.
Medical Economics Dr. R. A. Palmer, Vancouver, B.C.
Medical Education Dr.  G.  O.  Matthews, Vancouver, B.C.
Nominations Dr. H. A. L. Mooney, Courtenay, B.C.
Programme and Arrangements ! Dr. R. C. Newby, Victoria, B.C.
Public Health Dr.  G. F. Kincade, Vancouver, B.C.
SPECIAL COMMITTEES
Arthritis and Rheumatism.
Cancer_	
Civil Defence	
Emergent Epidemics-
Hospital Service	
Industrial Medicine	
Maternal Welfare	
Membership	
Pharmacy	
CHAIRMEN
-Dr. A. W. Bagnall, Vancouver, B.C.
..Dr. A. M. Evans, Vancouver, B.C.
-Dr. L. H. A. R. Huggard, Vancouver, B.C.
-Dr. G. F. Amyot, Victoria, B.C.
-Dr. J.  C.  Moscovich,  Vancouver, B.C.
.Dr. E. W. Boak, Victoria, B.C.
.Dr. A. M. Agnew, Vancouver, B.C.
-Dr. L. H. Leeson, Vancouver, B.C.
..Dr. D.  M. Whitelaw, Vancouver, B.C.
The profession in this province has voted to have the British Columbia Division
of the Canadian Medical Association conduct their economic affairs. It should be
stated once and for all (and the doctors will agree to a man) that this is no reflection
on the members of the Council of the College of Physicians and Surgeons. These men
are universally recognized as leaders in their profession and they are highly respected
for their ability and integrity. It is for this reason they have been chosen to take charge
iof the licensing and the moral and ethical standing of the profession. The change in
j control of medical economics is purely a matter of organization and terms of reference.
The electorate of the College considers the constitution of the B.C. Division more
suitable than that of the Council to conduct their business affairs.
The economic committee of the B.C. Division will immediately face many difficult
problems. There will be frequent negotiations for higher fees with prepaid health
insurance organizations. There is still the unsettled matter of fees paid by the Social
Assistance Medical Services to consider. There'is the constantly recurring problem of
obtaining a more reasonable remuneration for services rendered to the Workman's
Compensation Board. Probably the most difficult and most urgent problem is to adjust
the alleged discrepancies in fees received by various groups within the profession for
work they are doing.
In respect to. the last mentioned question it will be apparent that until we can
Page 55 solve our internal differences we will not be sufficiently strong and united to satisfactorily
attack our outside problems. It behooves us all therefore to take a broad, tolerant
and statesmanlike view of this matter for the benefit of the profession at large and
ourselves in particular.
Since the economic committee of the B.C. Division (under the able chairmanship
of Dr. Russell Palmer) has for its objective the improvement in status of the entire
medical population they can reasonably expect widespread moral and financial support.
This not only applies to individuals but to every medical organization within the
province including the Council of the College of Physicians and Surgeons.
The cost of drugs for social assistance cases in this province is rapidly reaching
astronomical figures and will probably call for some drastic action on the part of the
government in the near future. Although this problem is primarily one which concerns
the government and the Pharmaceutical Association, the medical profession cannot
escape its share of the responsibility. We naturally believe that these people should
receive the best possible treatment but there is a tendency to prescribe expensive medicines wholesale to cases in which the indications may be far from clear and without due
regard to their cost to the taxpayer. As responsible citizens it is our duty to curtail this
waste as much as possible. —G.J.
RELATIONS WITH THE C.M.A.
The recent vote about Medical Economics in B.C. not only decided whom we preferred to handle Economics, but also stimulated a lot of discussion and thought about
the framework and purpose of our various medical organizations. One matter that
came up for query was the relation of our B.C.M.A., now officially termed the C.M.A.—
B.C. Division, with the national C.M.A. In particular, men wanted to know what
the C.M.A. contributed to Medical Economics, and how independent we doctors of B.C.
were from the C.M.A. in matters economic, or contrariwise, how much the C.M.A. could
or would affect economic decisions on a Provincial level.
Broadly speaking, the activities and policy decisions of the C.M.A., respecting
Medical Economics, are restricted to the national scene. The C.M.A. represents the
doctors of Canada at Ottawa. Our representatives at Ottawa musta keep continuously
informed about the activities of Parliament in regard to Health matters. The Minister
of Health, Hon. Paul Martin, has stated that within a few months he will form a Special
Parliamentary Committee on Health Insurance. The fires are hotting up. If our
representatives at Ottawa were weak or indecisive, if they seemed to proffer only
destructive criticism, if they stooped to make 'secret deals' with the politicians — the
fault would lie at our door. The C.M.A. is our organization. It is a voluntary association. The strength and effectiveness of the C.M.A. depends upon the weight of a
large membership and also, in large part, upon the contributions of moral support and
constructive thinking from the Provincial Divisions.
How is C.M.A. policy determined? Have we, in B.C., done our share of thflj
thinking? Can we improve our liaison with the C.M.A. and make our voice more
effective?
Major business of the C.M.A.. is conducted, and policy determined, by the General
Council which meets for two days prior to the Annual Meetings. Interim business}
between Annual Meetings, is carried forward by Standing and Special Committees, and
directed by an Executive Committee .(with one representative from B.C.). Members
of the General Council of C.M.A. are elected by their Provincial Association or Division.
In B.C. these members are elected by the Board of Directors. This year the number
of members from B.C. is eleven. (Names are announced elsewhere in this issue). About
a month prior to the Annual Meeting of the C.M.A. the members of General Councilj
receive a detailed agenda with full reports of all Committees. Most of the business and
policy debates in General Council stem from the Committee Reports.
Page 56 In the past, B.C. has been represented on the national scene by very effective
individuals, but our composite voice has usually been weak. This weakness was partly a
reflection of our disinterest, but also partly due to the haphazard nature of our local
organization. This year the members of General Council from B.C. have been chosen
from the elected members of the General Assembly. They represent the whole of the
Province. Furthermore, it is planned to call a Special Meeting of the General Assembly
in May, and one of the principal functions of that meeting will be a consideration of
projected C.M.A. business. Our delegates will not be told how they must vote at the
Banff meeting, but the will have thought over the business at hand and will know the
majority of our General Assembly.
Broad policies and public statements about economic matters that stem from a
C.M.A. meeting, may have a direct influence on the activities and attitude of Parliament
at Ottawa. Anyone who doubts this statement is advised to study Hansard of June 21,
1951. On this day some publicity about Trans-Canada Medical Services from the
C.M.A. Meeting at Montreal, touched off a full scale debate about Health Insurance in
Parliament. It makes interesting reading. Politicians seem to agree that when doctors
are organized they should be suspect.
Publicity about economics that is derived from a C.M.A. meeting, or from the
statements of C.M.A. leaders at Ottawa, is bound to have some effect in the Provinces.
If this publicity is baneful we have democratic means of correcting the ills through
the General Council. If the publicity is helpful we may have cause to be grateful for
the backing of all the doctors of Canada in relation to some local problem. The C.M.A.
cannot interfere directly in our Provincial Economic decisions. We may ask and
obtain the assistance of the C.M.A., but the B.N.A. act ensures that Provinces have
control of medical treatment services other than Public Health. Hence our sad
experience with the Weir Health Insurance Act of yesterday, the workings of S.A.M.S.
today and the problems of further governmental actions tomorrow, were and are
matters for negotiation between the doctors and the legislators of this Province.
Economic activities of the Provincial Division and of the national association
should in no way conflict. Strengthen the one and we strengthen the other. We are
neither isolationists nor federalists. There is need of a powerful C.M.A. for the
national scene, and a well organized, strongly supported divisional organization for
provincial affairs.    One will complement the other.
—F.T.
PRESCRIBING FOR S.A.M.S. CASES
In the last two years the cost of providing drugs for persons covered by the Social
{Assistance Medical Services has risen to a very considerable figure. The reasons for
this are several and include the larger number of persons eligible for this care and a
larger number of visits to the doctor on the part of each patient. These variables do
jnot account entirely, however, for the greatly increased cost of drugs. There has been
increased use of drugs which are expensive to provide. In many cases, of course, these
expensive drugs are very effective, so that they return the patient to normal health
and eliminate expense entailed in continued medical care and the consumption of less
[effective remedies.
Nevertheless, one cannot fail to be aware that medication is being prescribed which
is unnecessary, ineffective and expensive. This particularly applies to practices such
as the very potent vitamin preparations two or three times daily over lengthy periods,
Ithe injection of liver extract in cases of anaemia other than pernicious anaemia, the
injection of penicillin for the treatment of cases of the common cold, the use of
glutamic acid where hydrochloric acid would do as well, the use of expensive hormone
preparations in the treatment of senile psychoses.
It is inevitable that the cost of providing medical care to old age pensioners and
others will increase.    It is most desirable, however, that doctors should use the same
Page 57 restraint in prescribing for their patients as they would in prescribing for their private
patients. It is important to remember that the increased cost of caring for this type
of patient is borne by the taxpayers of whom the doctor is a prominent representative.
—D.M.W,
MEDICAL MEN AND MONEY
At the present time, we hear on every side complaints about the cost of this, that,
and the other. Doctors' fees come in for their share of this disfavour, but when one
goes a little more deeply into these complaints about our charges, they appear to be
based far less on the actual cost, than that the doctors are making too much money.
In this modern socialized world, the greatest possible sin is to have an income above
the average person, so the medical men are looked upon as very undesirable citizens,
because, in general, they do average a higher income than any other groups.
In considering medical incomes, there are many points which must be taken into
consideration; I do not intend to comment on the frequently expressed statements that
doctors have a very long and most expensive training. We must employ a nurse-
stenographer, keep up an office in a manner to satisfy our patients and ourselves, buy
and maintain much expensive equipment, as well as innumerable other running expenses.
All these items cost a great deal under this present high cost of living, so that, as
we all realize, doctors who gross less than $12,000 per year are fortunate indeed to
keep their ratio of expenses to 50% of their gross income. For those grossing from
$12,000 to $25,000 per year, expenses usually run about 40%, while for the few who
may be over this figure, expenses rise sharply, because there are assistant doctors to
be paid.
Official figures released from time to time by the income tax department, give
earnings of various groups.    In these figures or calculations, doctors are usually near i
the  top.   (In   1949  we  followed  engineers,   architects  and  lawyers).     The  medical i
population of Canada has been over thirteen thousand for the past several years, yet the !
number of doctors used to compute these high averages was 7,442 in 1947; 6,000 in *
1948; and 8,010 in 1949.   In other words, if we average the earnings of the top 60%
of all the doctors in the country we find a very satisfactory figure.    But what of the >
other 40%?    Evidently they haven't an income  sufficiently high  to be eligible  for j
income tax.    And what would happen to this  very high average  for the medical i
profession, as quoted, if all the doctors in Canada were included in working it out?
Would our profession be near the bottom of the list?    Is someone trying to prove
that doctors are making too much money, and so only using the top earners, to prove
their point?    Probably these figures do more than anything else could to prove that
generalization in figures about group incomes are absurd.
According to these income tax figures, the 8,010 doctors averaged $9,009 for
the year. However, in discussing this, let us be even more generous, and we will I
assume for the purposes of argument that doctors averaged a gross income of $16,000.
I choose this income, because it is obviously higher than a true one. With this income,
the doctor's expenses in running his practice will be about forty percent, which is
$6,400, leaving a net income of $9,600. For ease of figuring, let us allow him two
weeks holiday per year without pay, which leaves 50 weeks at $192.00 per week.
This is undoubtedly a good income, and well above the average, but let us look for a
moment at how he earns this sum. Everyone knows that the doctor is on call twenty-
four hours every day, and that he works long hours, including Sundays. By actual
calculation, this average number of hours per week comes to approximately 70. That
is, on the usual union rates, 40 hours straight plus 30 hours at double time, or a total
of 100 hours per week. This obviously works out that doctors average $1.92 per hour.
When one considers that doctors, as very highly skilled labour are working for $1.92
per hour, one wonders how long before the labor unions will be berating them for
undercutting pay rates.    Certainly, if we were members of any of the recognized
Page 58 rtOH,Tf.>«    T«H   THE      "\
1     I'll   r»»* rue       )
m a i w.
W$k
STILL    IN    THE    HORSE    AND   &UGG7   DAYS
unions, there would be loud outcries about this poor wage. No doubt the unions will
also be upset at our amount of overtime, and in the future, if state medicine comes toi
Canada, doctors' hours will be staggered like others, and each doctor will only have a
forty hour shift, so that when patients call the central depot for a doctor, they will
be sent one who happens to be on duty at that particular hour.
One last point to consider in the doctor's income, is that he is so busy earning this
income, that he has not the time to do many little household repairs and gardening,
and so must hire someone else to do what is necessary, probably at a cost of $2.50 per
hour, while he is earning $1.92 per hour, less the share going to the income tax department. Of course, doctors are big losers in income tax, which, it seems, is specifically
aimed at doctors so that one must earn enough to pay this excessive tax, and still
have something left for the high cost of living; but that is another story. —L.S.
Page 59 AIR-BORNE ALLERGENS*
C. H. A. Walton, M.Sc, M.D., F.A.C.P. |||
*Third in a series of five addresses delivered at the Annual Summer School of the Vancouver Medical
Society,   May,   1951,   Vancouver,   B.C.
An allergen must enter the body before an allergic reaction can take place.   There
are several routes of entry.    The allergen may be swallowed or ingested, such as food
or drink or medicine; it may be injected as with medications such as insulin liver,
penicillin, etc., it may enter the body through the skin as in the case of contact
dermatitis.    Finally, the allergen may enter the body through the respiratory tract.
To be inhaled the substance must be suspended in the air in the form of dust
particles. A dust particle cannot enter the respiratory tract unless it is air-borne so
that it reaches the nose or the lung in a current of air. The dust particle comes to
rest in some part of the respiratory mucosa. There it undergoes an aqueous form of
extraction. The aqueous extract is absorbed through the mucosa and may affect the
cells directly if they are sensitized, or it may travel via the body fluids to other tissues.
If such other tissues are sensitized a reaction will occur there. The site of the
reaction depends on the location of the sensitized cells and it is not necessarily related to
the route of entry of the allergen. The allergen may enter the nose and cause a
reaction in the nasal mucosa. It may enter the lung and do likewise in the bronchial
mucosa, but it may also enter the lung and circulate and reach such an organ as the
skin leading to dermatitis.
I would like to emphasize the obvious point that the dust particles must be airborne before it is possible for them to enter the respiratory tract. As these dust
particles are inanimate bodies it is apparent that they will become air-borne only in
the presence of a current of air. In perfectly still air dust settles and is not air-borne.
In air which is greatly agitated the dust becomes air-borne readily.
Air-borne allergens are among the commonest of all and come from a great
variety of sources. As they are commonly invisible, except in a beam of strong light,
most of us are unaware that we are constantly breathing, in and out of our respiratory
tracts, a great variety of very numerous dust particles. These particles are ordinarily
innocuous, that is to say they are not toxic. However, many of them have the property
of becoming allergens to sensitive people. No doubt, there are many dust particles
which we have yet to recognize, but fortunately for practical purposes we know the
origin and properties of many and their effects on individuals who are sensitive to
them. If these properties are known much can be done to recognize the source of
the patient's trouble and, therefore, how to deal with it. It is, therefore, necessary
for the physician to have a knowledge of the origin of the more common offending
dusts and to know what to do about them.
Seventy-five years ago Blackley in London demonstrated that he and various other
people like himself, suffered from hay fever and asthma during the season of grass
pollination. He demonstrated conclusively that he had symptoms only when grass-
pollen was in the air. He demonstrated the grass pollen floating in the air and he
estimated its quantity. He showed that it was in the air only when grass was actually
pollinating in June and early July. He also demonstrated that if grass pollen saved from
a previous season was placed in his nose or inhaled into his lung in some other season
symptoms were produced. Finally, he demonstrated that if grass pollen was scratched
into his skin, that an urticarial wheal resulted. This is the classical demonstration of airborne allergy. Since his time we have learned that the pollen of many plants is
allergenic and that it does, indeed, cause symptoms of hay fever, asthma, and some cases
of dermatitis in many individuals. It is obvious that such pollen must be air-borne
before it can reach the patient. Thus only plants which can produce air-borne pollen
are of importance in allergy. Many plants, particularly those with bright flowers, are
insect pollinated. Their pollen is too large and sticky and too heavy to be readily
air-borne. Such plants are not important in allergy. The rose and the goldenrod
are myths in allergy.    Plants with small, inconspicuous, ugly and badly scented flowers
Page 60 do not attract the insects and therefore to achieve cross pollination they much produce
large quantities of small, dry, light pollen grains which float in clouds in the air and
thus reach other plants.    These are the plants which concern us at this time.
These plants may be divided into three groups; the trees, the grasses and the
weeds. Such trees as the poplar, willow, elm, maple, ash, alder and the oak in these
latitudes, commence pollination usually rather suddenly in late April and continue
to pollinate into May. These dates, of course, vary in different latitudes and in
different areas. In general, the dates which I refer to are those which apply to the
Winnipeg area and the prairies, which area I have studied carefully and know. Whether
the dates apply strictly in Vancouver, I am not sure, because as far as I am aware there
has been no pollen or suitable botanical study made in this region. It is obvious that
if a patient is sensitive to the pollen of any of these trees he will develop symptoms
only when that pollen is in the air and can reach him. Therefore, the tree pollen case
always has his symptoms at the time the trees pollinate in his region.
The next item in the pollination calendar is the flowering of the various grasses.
Generally this starts early in June and increases in intensity into the early part of
July, but many species continue to pollinate, though not heavily, throughout the
summer. The amount of pollination, of course, varies greatly with cljniatic conditions.
In particular grass pollen is thin-shelled and absorbs moisture very easily. If there
is much rain or humidity grass pollen grains absorb moisture, become heavy and fall
rapidly to the groundn where they are harmless. In a hot, dry summer, if growth
has previously been good, pollination is heavy and bothers the patient a great deal.
Obviously, grass pollen is important to the patient only on the dates mentioned.
In the great plains of North America and throughout the Eastern part of the
continent, the next pollen season is that of the weeds. Generally this season starts at
the end of July and spends through August into September. The dates obviously vary
with each region as do the quantity. Again, I have no data on Vancouver and I hope
that some day this will be available, but I am informed, and have good reason to believe,
that the weeds which produce allergenically important pollen, do not thrive and, in
fact, are literally absent from this region. Obviously, the weed pollen sensitive case
suffers his trouble in the weed pollinating season. If he has the good fortune to be in
an area where weed pollen does not exist, he will, of course, have no symptoms. The
farmer who suffers from ragweed asthma or ragweed dermatitis and who moves to
Vancouver or Victoria and thereby recovers from his affliction, may credit it to your
salubrious climate, when in fact, the climate is not the conditioning factor, but the
fact is that he has left his ragweed or other weeds behind him.
In large areas of this continent one hears a great deal of ragweed pollinosis and
in truth, some three-quarters of the populated area of the continent suffers to a
greater or lesser degree from ragweed. However, ragweed and its relatives do not
occur in England or in Europe and as a result many a ragweed sufferer has found
relief by crossing the Atlantic to these countries. Many Canadian soldiers discovered
this accidentally.
This in brief is the story of pollinosis. Do not worry about the brightly flowered
plants or the brilliantly flowered trees, because they cause you and your patient no trouble.
The beautifully flowered lilac attracts attention in June, but it is the inconspicuous
blossoming grass around about it which in reality causes such misery to the patient.
Obviously, a patient suffering from pollinosis has his symptoms only in the season
when pollen is in the air and at no other time. If the pollen characteristics of an area
are known diagnosis should be simple.
There is another group of air-borne allergens which has some seasonal characteristics and which is somewhat analogous to pollen. These are the spores and cells of
fungi or moulds. Any study of the atmosphere will demonstrate dozens of fungous
spores. These, of course, vary greatly in each area and depend on local characteristics.
In the Great Plains area some of these spores are very numerous and characteristic.
Winnipeg has the distinction of being the worse in this regard than even Chicago,
although Chicago takes the prize for ragweed.
y0k Page 61 There are some fungi which produce spores in varying quantities throughout the
year irrespective of the temperature or other atmospheric conditions. Such fungi are
found outside and also inside buildings. I refer to this group of fungi as the perennial
type and it includes such common moulds as yeast, penicillin, aspergillus, rhizopus,
mucor, monilia, etc. All of these can be identified and counted in air studies and
this is done quite simply by the exposure of suitable culture plates.
There are a number of other fungi which are characteristically seasonal. In
Manitoba these seasonal fungi are found thriving after the snow has gone in early Spring
and they persist in large quantity until they are heavily blanketed with snow in the
late Fall. During winters in which there is very little snow, small numbers of them
survive and throw off a few spores throughout even the coldest months, but in general,
they only appear in significant amounts in the air in early April, gradually increasing
throughout the summer and reaching their height in late September or October, long
after the last pollen grain has left the air. They continue to give trouble until
thoroughly covered with snow. The three common examples of this seasonal group are
alternaria, hormodendrum and helminthosporium. In addition, in agricultural areas
we find the spores of rust and smut. Such parasitic spores are very widespread and
dense, but their season is very short. In Manitoba the peak of their season may be in
July or August and the total season seldom exceeds four or five weeks. Rust and smut
can be allergenic and are demonstrated in a few cases, but the other seasonal spores,
namely alternaria, hormodendrum and helminthosporium cause the greatest number of
allergic reactions and are comparable in their effect to pollen, such as ragweed. The
perennial spores also seem to be important, though less strikingly so than the seasonal
ones and they occur under many circumstances. Of course, their symptoms tend to
be at any time of the year. Exacerbations occur under special circumstances such as the
cleaning out of a mouldy basement, the opening of a summer home, etc.
The third type of seasonal air-borne allergens is represented by the scales from
insects. While physical allergy to these substances is not common, it does occur in a
very severe form under some circumstances. In Manitoba, we have an insect known
as the May Fly which occurs along rivers which are rapidly flowing. This fly collects
in great quantities in such places as power houses, so that in a sense it represents an
occupational hazard and the employees of hydro-electric plants are apt to show
sensitivity to these insects and their scales. I mention this relatively uncommon form
of allergy to illustrate another aspect of seasonal allergy.
Most of the other dusts I will mention occur throughout the year and are not
seasonal in the ordinary sense of that term. However, it is true that there are certain
seasonal characteristics for these dusts in that during the colder months of the year
they are more troublesome because the habitations, barns and workshops of the patient
are closed up for warmth and the dust concentration becomes higher in the confined,
slightly ventilated space. Thus, a patient who is sensitive to the family cat may be
very much better in the summer when the animal is out more and when his house is
more open, that is, the dust density of cat dander in the air at home is less.
Animals, that is haired animals, are a great source of allergenic dust and obviously
those animals with which man is most intimately associated are the worst offenders.
Cats and dogs which are so common as household pets, produce great quantities of
dander. This dander becomes an integral part of the house dust. Whether the animal
is in evidence at any particular moment or not, his dust is in the air and the sensitive
person inhaling it will manifest symptoms. No animal should ever be permitted in
the home of an allergic, patient, whether or not sensitivity has been demonstrated. It
is well to remember that apart from these two ubiquitous pets, that families very often
have unexpected pets such as rabbits, pet rats, hamsters, and so on. Even the old
cow-hide rug or the bear-skin, so proudly won hunting, may be a source of trouble.
There is much joking about the human animal and his dandruff and whether one can
become sensitive to it. I think ordinarily this is a small problem, but it is perhaps of
some importance among hairdressers and barbers. Apart from pets, animals on the
farm, or in other establishments where they are apt to be kept, are of great importance.
Page 62 Cows, a horse, animals in a circus, a zoo or a riding academy are all important sources
of dander and all cause a great deal of trouble. Birds are another source of dust.
The scales from their feathers are highly allergenic. A pet bird or birds in a poultry
house, or finally of course the most important of all, the feathers in our pillows, in our
eiderdowns and even in our mattresses are a great source of trouble. The allergic
child or the child of an allergic parent should not be introduced to a pillow. If he
doesn't become accustomed to one he will never miss it and he may be protected
from a very troublesome allergy later in life. If he must have a pillow, make it
of sponge rubber.
There are certain domestic dusts which are of great importance. House dust
itself, is of course, a mixture of - many things. It is probably a break-down of textile
dust, etc. However, house dust is remarkably uniform allergenically from house to
house. It is a very potent allergen and is a great source of trouble to many patients.
There are other dusts in the home, textile dust such as cotton lint, the lint from wool,
the dust from special forms of mattresses and many other sources. The dust from
bathpowder in the bathroom, the dust from insecticides used to kill moths particularly
pyrethrum and finally the dust from tobacco.
There are many occupational dusts. In my section of the country grain dust
is of the greatest importance. Farmers, elevator operators and other employees of the
grain trade are very common sufferers from respiratory and skin allergy due to
sensitivity to this very potent allergen. Again, of course, it is a mixture but it is
remarkable how uniform allergenically it is from place to place. Of course, the dust
from seed, old granaries and from feed, particularly crushed feed, is related to and very
much like grain dust. Another occupational dust, perhaps somewhat related, is flour
dust. The dust which the miller and the baker inhale when carrying out their normal
duties may be the cause of much asthma, rhinitis or dermatitis. An occupational dust
of great importance is fur dust; the dust which occurs in the establishment of furriers.
Still another is that which arises from hair set or hair wave lotion. Hairdressers are
peculiarly prone to this form of sensitivity and it is also seen, of course, among women
who are not hairdressers but who work on their own hair and that of their friends.
The basis of this particular dust is vegetable gum such as tragacanth, karaya and gum
arabic. People who are highly sensitive to fish may develop symptoms if fish is in
the same room. Of course, workers in the fish industry are inclined to suffer this way.
Much glue as used commercially comes from fish. Dried glue forming a dust is a very-
potent allergen. Of course, today plastic and other substances are replacing fish glue
to some extent and perhaps this particular allergen will become less important.
This brief list is not exhaustive but emphasizes some of the more important
members of the group known as air-borne allergens.
SPECIFIC MANAGEMENT OF INHALANT SENSITIVITY
If one accepts as a clinical fact that various air-borne dusts such as have just been
described can cause many cases of respiratory allergy, some cases of skin allergy and
perhaps even a few cases of migraine, then knowing their properties aids one in making
a diagnosis. Diagnosis can be aided by carrying out skin tests. Fortunately, skin
tests are highly specific and quite valuable in the diagnosis of inhalant allergy. Generally
speaking, skin tests are very simple and as simple as those carried out more or less
accidentally by Blackley seventy-five years ago. If the suspected dust is rubbed into
a superficial scratch and perhaps moistened by some agent as tenth normal sodium
hydroxide, a reaction will occur if the skin cells of the patient are sensitive. The
reaction consists of an erythematous flare surrounding an irregular urticarial wheal.
The more sensitive the skin the more irregular and large the wheal and/or the erythema.
This reaction is accompanied by considerable itching. Such a test is described as
the Scratch test.
There are many ways of carrying out skin tests. The scratch technique is still
the best and certainly the safest. Given a reasonably pure sample of the dust there
is no problem in carrying out scratch tests.    For convenience sake, the commercial
Page 63 houses now prepare extracts of the dusts. These are a little simpler to handle, probably
less troublesome and expensive, and are equally good. The only difference in technique
is that the extract is rubbed into the scratch in the skin rather than the dry dust.
A positive reaction, of course, means only that the skin or dermal cells are sensitized.
Fortunately, in inhalant allergy this indicates, in the vast majority of cases, that
the nasal and bronchial mucosa are also sensitive. However, false reactions may occur.
That is, the patient may suffer from animal dander sensitivity and yet his skin may
not react to it. On the other hand positive skin tests may occur without clinical
manifestations. Of course, the only test which is really acceptible is a direct test. If
the patient has hay fever it should be possible to reproduce the hay fever by planting
the suspected pollen on the nasal mucosa. If no reaction occurs the suspicion is obviously
ill-founded. Similar tests are done on the conjunctiva or by inhaling the dust in the
form of an aerosol directly into the lung. Obviously such tests are usually impractical
because of their inconvenience and because most patients would refuse to submit to
them. Luckily, the skin test is more convenient but must not be accepted blindly
and only with a knowledge of its limitations.
In the light of my preceding remarks it would obviously be of no importance to
find that a patient in Vancouver reacted to ragweed if, as I suspect, there is no ragweed
in Vancouver. Of course, it might be important to warn him not to visit Winnipeg
in August. In fact, he should remain west of the Rockies in the ragweed season.
Negative skin tests do not mean that the patient is not allergic. They simply mean
that his skin cells are not sensitive to the agents tested. His respiratory mucosal cells
might still be sensitive. Nothing is more tragic than to tell a mother that her boy does
not react to dog dander by skin and therefore that he may keep the dog when the dog
might well be causing much of his trouble.
Another form of skin test often used is the intradermal or intracutaneous test.
This is carried out by injecting an extract of the suspected dust into the dermal layers
of the skin and the subsequent reaction is similar to that produced by a scratch test.
This test is more delicate but it is also more dangerous and false reactions are more apt
to occur. In the hands of the experienced man who is doing a great deal of this class
of work the intradermal test is valuable but there can be little or no excuse for it
when it is used occasioually and is apt to do more harm than good. Skin tests are
only useful as an aid to diagnosis and are not a diagnosis in themselves. A patient
should not be given a list of skin reactions to carry around with him any more than
a list of his blood sugars, blood urea nitrogens or other laboratory tests. He cannot
interpret them and he nearly always gets into trouble with them. A careful history
and a knowledge of the patient's environment are the most important factors in
diagnosis. Skin tests serve to supplement these diagnostic measures and are not,
diagnostic in themselves. The misuse of skin tests has probably done more to put
clinical allergy into disrepute than any other factor. |||e
I have discussed diagnosis and inhalant sensitivity at some length because the
management of inhalant sensitivity is predicated on an accurate diagnosis and a thorough
understanding of the problem. It is obvious that once a diagnosis has been accurately
made, the proper treatment is to attempt to separate the patient from the offending
agent if this is possible. For example, it is obvious that the ragweed patient cannot be
separated from his ragweed pollen during August and September unless he goes to
some such salubrious place as Vancouver where ragweed does not exist. This is
obviously impractical in most instances. However, if the patient is sensitive to cat
dander it is perfectly clear that it would be much better for him to part with his cat
and clean the house out thoroughly than to undergo desensitization for the rest of his
life or at least, for the rest of the life of the cat. In general, it is possible and practical
to separate the patient from his offending agent when that agent arises from animals,
birds, cosmetics, tobacco, insecticides, etc. Sometimes, of course, the patient's livelihood
depends on him remaining in his unfavourable environment. The average farmer is not
able to leave his farm, particularly in the harvest season. Such a patient must have
other protection. The engineer who has spent his whole professional life in a hydro-
Page 64 electric plant obviously is unable readily to move to another and strange job. The
operator of a grain elevator may have no other training and needs to stay with his
job at all costs. Similarly with the furrier, the hairdresser or the fish worker, or the
miller. All these are highly specialized trades and it is rare that one can separate the
victim from his trouble. In all instances where it is impossible to separate the patient
from his allergens, and I repeat, this is your primary duty when it is possible, the
method of treatment is to offer him desensitization, or more correctly, hyposensitization.
Briefly, this is carried out by making an extract of the offending material with
physiological saline, and injecting tiny amounts of this subcutaneously into the patient.
These amounts are gradually increased as the patient is able to tolerate them and in
many instances a remarkably effective immunity results. Generally speaking, desensitization to animal dander is sometimes effective. Often the treatment carries an
element of danger and it should only be used when no other method is available.
Feathers are seldom of use in desensitization and avoidance is the only solution.
Obviously house dust itself cannot be avoided, although it can be mitigated. Desensitization to house rust is highly effective. Substances such as pyrethrum are better
not used for desensitization. Desensitization to grain dust is very effective. Fish dust
and glue dust is much too dangerous to use. Flour and other cereal dust cannot
effectively be made into suitable solutions for desensitizing. The vegetable gums are
also unsuitable and the hairdresser had best find another occupation. As I have said
desensitization is an effective procedure in selected cases. Unfortunately it is not
permanent but has to be continued for many years. It must be done carefully because
if too large a dose is given a very grave general reaction, and even a fatality may occur.
If too small amounts are given protection is poor. A conscientious doctor who carried
out a desensitization program very carefully, will often be rewarded with good
protection for his patient. Ingenuity, of course, will suggest the use of a rubber pillow
and other protective devices to help the patient. Grain elevator operators, even with
desensitization, find they must wear a mask when the dust density is great. A pollen
sensitive patient should not go to the country at the height of his pollen season. The
housewife will learn new methods to keep dust down, perhaps she will use a vacuum
cleaner with a water bath dust collector. Suitable cosmetics are available for allergic
women. Bath powder left in the family bathroom cupboard should not be permitted.
The bird fancier must deny himself the luxury of pets in his home.
Inhalant allergy is common. Diagnosis must be specific. With an accurate
etiological diagnosis treatment will readily suggest itself and will be most satisfactory
to both the doctor and the patient.   Diagnosis is the essence of good management.
Division of Medicine,
Winnipeg Clinic,
St. Mary's & Vaughan,
Winnipeg, Manitoba.
PARKINSONS DISEASE PATIENT
Home for a healthy, well educated gentleman with Parkinson's
Disease, 45 years of age. Bed sitting room with space for book shelves,
requires some help, good board, preferably in Doctor's home or advertiser will purchase house sutable for this purpose.
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675 Davie St.,
MArine 7729
Page 65 Dr. J. C. Kovach, of Vancouver, has begun a year of surgical studies in New York.
Drv C. G. Campbell, of Vancouver, has begun a practice of internal medicine in
new offices.
Dr. J. A. CcCaffrey is now practising urology in a new location in Vancouver.
Dr. J. A. Ganshorn, of Vancouver, has been elected a director of M.S.A. The
other medical representative on the board is Dr. E. C. McCoy.
Dr. William G. Trapp, of Tranquille, has been awarded a bursary to continue
surgical studies at the Vancouver General Hospital.
Dr. Adam Woldie has taken over the offices of Dr. J. C. Shillabeer in Vancouver..
We wish Dr..Shillabeer a pleasant retirement.
The Bulletin is interested in publishing items of interest to all B.C. doctors. Please
send in regional notes. Iftil
Dr. Warren Bell, of Vancouver, is continuing his studies in internal medicine
this year in Philadelphia.
Dr. John Nelson will return from the Eastern U.S. this month to become director
of V.D. Control when Dr. Charles Hunt returns to private practice.
Dr. F. J. Buller has closed his city office in Vancouver and plans to carry on a
limited practice before full retirement.
Drs. J. D. Stenstrom, J. G. Patterson and /. E. Dalton, of Victoria, attended
the 5 th Congress of the Pan-American Surgical Association in Honolulu in November.
Dr. Stenstrom presented a paper on "Carcinoma of the Lung."
Dr. Neil Stewart, of Victoria, is taking a Residency in Internal Medicine at the
Research and Education Hospital of Chicago.
The Annual Dinner of the Victoria Medical Society was held on December 1, and
the Guest Speaker was Dr. John M. Ewing, of Victoria, Principal of Victoria College.
Dr. E. A. Boxall, of Vancouver, has received his certificate in internal medicine.
Dr. A. Crossland has begun practice in Vancouver.
Dr. J. M. Hershey, formerly of Victoria, is now with the office of medical defence
for New York State.
Dr. A. W. Brown, of Kelowna, has been granted a certification of ophthalmology,
by the Council of the Royal College of Physicians and Surgeons.
Dr. J. H. Kope is now practising at Enderby.
Dr. W. D. Panton is now practising in Powell River.
Dr. H. M. Shimokura is now practising in Vancouver.
Drs. Estelle and Arnot Stevens are now practising in Campbell River.
Dr. S. C. Peterson, of Vancouver, has retired.
Dr. W. A. Wickett is now practising in Penticton.
Births
To Dr. and Mrs. A. E. Gillespie, of Victoria, a daughter.
To Dr. and Mrs. Sid Segal, of Vancouver, a son.
To Dr. and Mrs. James Minnes, of Vancouver, a daughter.
To Dr. and Mrs. Bruce Cates, of Vancouver, a son.
Page 66

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