History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1951 Vancouver Medical Association Apr 30, 1951

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The Vancouver Medical Association
Publisher and Advertising Manager
APRIL, 1951
OFFICERS  1950-51
Db. Henry Scott     ||||, Dr. J. C. Grimson Dr. W. J. Dorrance
President Vice-President Past President
Dr. Gordon Burke fcV Dr. E. C. McCoy
Hon. Treasurer Hon. Secretary
Additional Members of Executive:
Dr. J. H. Black Dr. D. S. Munroe
Db. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommer, Whiting & Co.
Eye, Ear, Nose and Throat
Dr. N. J. Blair I Chairman Dr. B. W. Tanton Secretary
Dr. C. J. Trefry Chairman Dr. Peter Spohn Secretary
Orthopaedic and Traumatic Surgery
Dr. D. E. Starr. Chairman Dr. A. S. McConkey Secretary
Neurology and Psychiatry
Dr. F. E. McNaib Chairman Dr. R. Whitman Secretary
Dr. Andrew Turnbull Chairman Dr. W. L. Sloan Secretary
Db. E. France Word, Chairman; Dr. A. F. Hardyment, Secretary;
Dr. F. S. Hobbs, Db. J. L. Pabnell, Db. S. E. C. Tubvey, Dr. J. E. Walker
Co-ordination of Medical Meetings Committee:
Dr. R. A. Stanley. Chairman Dr. W. E. Austin 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. E. C. McCoy, Dr. T. R. Sarjeant,
Dr. W. Li. Sloan, Dr. J. A. Ganshorn, Dr. E. A. Jones, Dr. G. Clement.
Dr. G. A. Davidson, Dr. Gordon C. Johnston, Dr. W. J. Dorrance
Special Committee—Public Relations:
Dr. Gordon C. Johnston, Chairman; Dr. J. L: Parnell, Dr. F. L. Skinner
Representative to B. C. Medical Association : Dr. W. J. Dorrance
Representative to V.O.N. Advisory Board: Dr. Isabel Day
Representative to Greater Vancouver Health League: Dr. L. A. Patterson VANCOUVER MEDICAL ASSOCIATION
Founded 1898; Incorporated 190$.
(Spring Session)
FEBRUARY 6th—GENERAL MEETING—Devoted to Medical Economics.
MARCH 6th—OSLER DINNER—Dr. H. A. DesBrisay, Osier Lecturer.
APRIL 3rd—GENERAL MEETING   (Speaker to be announced).
MAY 28th to JUNE 1st (inclusive)—ANNUAL SUMMER SCHOOL.
FIRST TUESDAY—GENERAL MEETING—Vancouver Medical Association—T. B.
Clinical Meetings, which members of the Vancouver Medical Association are invited
to attend, will be held each month as follows:
Notice and programme of all meetings will be circularized by the Executive Office
of the Vancouver Medical Association.
Refresher Courses for the General Practitioner
SURGERY—February 12 th, 13 th, 14th, 1951.
EYE, EAR, NOSE and THROAT—March 5th, 6th, 7th, 1951.
OBSTETRICS and GYNAECOLOGY—April 9th, 10th, 11th, 1951.
Regular Weekly Fixtures in the Lecture Hall
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.
Regular Weekly Fixtures
2nd TUESDAY of each month—11 a.m.::- v--TUMOR CLINIC
(Specimens and Discussion)
(Alternating with Surgery)
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.
Tuesday, 9:00 a.m. to 10:00 a.m. (weekly)—Clinical Meeting.
B. C. Surgical Society Meeting Dates:
Spring Meeting,  March  30th-31st—Vancouver Hotel   (open  to  all members  of   the
profession). ||||
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.
Closing Date for advertisements is the  10th of the month preceding date of issue.
Advertising Rates on Request.
Page 158 Naturally . • i the Product of Choice
"Not primarily because of the content of thiamine,
niacin and riboflavin but rather as a source of other
B Complex nutrients not yet synthesised"—Jolliffe,
Norman, J.A.M.A. 129:9, 613.
Each daily dose of three teaspoonfuls of Vibelan B.D.H.
represents proportionate amounts of all the factors normally
found in the following natural sources:—
on J is standardised to contain:
Rice Bran.... 300 Gms. Thiamine Natural... 1.80 mgm.
Fresh Liver... 15 Gms. Riboflavin Natural... 2.25 mgm.
Brewers' Yeast     3 Gms.    Nicotinamide Natural   15.0 mgm.
DOSE: One teaspoonful three times a day.
Issued in bottles of 4 and 16 fluid ounces
5-50B If she reads a menu
the bottom up
Ohe may not always be scrupulous about following the
prenatal or postnatal diet — good reason to prescribe
Dicaldimin as a supplementary source of necessary minerals and vitamins.
Your patients will appreciate Dicaldimm's convenience
— average dose is one or two moderate-sized capsules
with each meal. You'll appreciate its sound, comprehensive formula. Three Dicaldimin Capsules daily supply:
• Generous amounts of calcium and phosphorus.
• Sufficient vitamin D to meet the entire daily requirement during pregnancy and lactation.
• Twice the amount of iron and nicotinamide recommended for pregnant women.
• More than 3 times the recommended amount of
• Six times the recommended amount of  thiamine.
In addition to the above, Dicaldimin with Vitamin C
provides 50 mg. ascorbic acid.
Just in case some patients may not adhere strictly to
diet, why not prescribe one of these supplements? Both
Dicaldimin and Dicaldimin with Vitamin C
!^^^^ are available in bottles of 100, 500 and
^^o^^*""^. 1000 capsules, at phar
macies everywhere.
(ABBOTT'S Dicalcium Phosphate with Vitamin
D,   Iron   and   Vitamin   B   Complex   Factors)
*Trade Mark Reg'd. -C CON NAUGHT >
Following   an   extended   period   of   clinical   trial   there   is   now
generally available a modified Insulin preparation known as NPH
Insulin. The product is distributed as a buffered aqueous suspension
of  a  crystalline preparation  of  Insulin,  protamine,   and  zinc.   It  is
supplied in 10-cc. vials containing
either 40 or 80 units per cc.
NPH Insulin exerts a blood-
sugar-lowering effect extending for
slightly more than a 24-hour period.
In most instances this new preparation has been found to act more
quickly than Protamine Zinc Insulin
but for a shorter period. Probably
because of the fact that NPH
Insulin is a suspension of crystals,
its use has been found advantageous
in cases where it is desired to administer Insulin and a modified form of Insulin in a single injection without
appreciable alteration of the effect of either of the two preparations.
Crystals   formed   of   Insulin,   protamine   and   zinc
in  NPH   Insulin
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.
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. In the last issue of the Bulletin, there is a very timely letter from Dr. Murray Baird,
President of the Council of the College of Physicians and Surgeons. He speaks or the
danger of sending special laboratory work to ill-equipped laboratories, under the control
of men who are not medically trained — sometimes not even properly trained
We must agree heartily with this, and we cannot understand why some medical
men will persist in doing this. Certainly, if they did not patronize these places, the
latter would soon go out of existence.
The objection to sending work to these laboratories is based upon a good many
considerations, the' least of which is perhaps that they are not run by medical men.
We think they should be under the supervision of a competent pathologist or bacteriologist, who can judge competently the laboratory findings and correlate them where
necessary with the clinical findings. But even in the best laboratories, the great bulk
of the work is done by technicians, and the really important consideration is that these
technicians should have received an adequate training under competent teachers, and
should come up to adequate standards, such as those set by the Canadian Association
of Laboratory Technologists. These are very rigorous standards—requiring at least a
year of training, a great number of hours of laboratory work, of lectures and didactic
training and so on. The laboratories in which they are trained must be of a certain
size and standard—under the control and supervision of a trained medical pathologist
and bacteriologist—there must be one technical teacher to each student—the preliminary-
education of that student must be at least Grade XII and so on. Even then, the
graduate has a great deal to learn, but at least he has a foundation on which to build.
When one considers the vital importance of thorough training of those who are going
to examine our material, make our tests and furnish our reports—and when one considers
how dangerous, even sometimes fatal, a mistake may be, one is all the more amazed
that a medical practitioner will choose anything less than the best: where the workers
are registered technologists, and adequately trained. Even in the best laboratories the
occasional mistake might possibly occur—but most of us will search our memory in
vain for any such, in our hospital and public health laboratories.
We do not believe that commercial laboratories should be patronized, unless and
until we have a complete knowledge of their personnel, their standards of training,
and their methods of work. Certainly this should be the case in the bigger centres,
such as Vancouver, Victoria, etc., where adequately equipped and staffed medical
laboratories are available.
It is not, of course, always possible to find, in the smaller centres, such fully-
equipped medical laboratories and there are several non-medically run laboratories in
the province which we understand are quite satisfactory.
For the guidance of medical men, in any part of the province, would it not be
possible for the B.C. Medical Association, or the Council of the C.P. & S. to prepare a
list of all laboratories in the province which solicit or accept work, and grade them
according to definite standards? so that anyone of us would know where he might
safely send his patients for laboratory work. We should then be sure of two things—
first, that we were getting reliable and accurate information—and secondly, which is
just as important, that our patients were receiving the best care and the fullest value
for their money.
Page 159 I
Monday, Wednesday and Friday 1 9:00 a.m. - 9:30 p.m.
Tuesday and Thursday - -—9:00 a.m. - 5:00 p.m.
Saturday  9:00 a.m. - 1:00 p.m.
American Proctologic Society, Transactions of 48 th Annual Session, 1949.
Association of American Physicians, Transactions of 63rd Session, Vol. 63, 1950.
Boyd, William—Pathology of Internal Diseases, 5th Edition, 1950.
Bradford, F. K. and Spurling, R. G.—The Intervertebral Disc, 2nd Edition,
(2nd printing), 1947.
Harris, H. J.—Brucellosis  (Undulant Fever), Clinical and Subclinical,  2nd Edition,
Pohl, J. F. M.—Cerebral Palsy, 1950.
Ricci, J. V.—The Genealogy of Gynaecology, 2000 B.C.—1800 A. D., 2nd Edition,
1950,  (Historical and Ultra-Scientific Fund).
Royal College of Physicians of London—Committee Reports, 1942-1947.
Surgical Clinics of North America—Symposium of Gastroesophageal Surgery, Chicago
Number, February, 1951.      -?^S
U.S. Naval Medical School of the National Naval Medical Center—Color Atlas of
Pathology, 1950.
Medical Research Council Special Report Series No. 276—Occupational Factors in the
Aetiology of Gastric and Duodenal Ulcers with an Estimate of their incidence in
the General Population, by Richard Doll and F. Avery Jones, with the assistance
of M. M. Buckatzsch, 1951.
The following is a letter of thanks and appreciation sent to Dr. D. E. H. Cleveland
recently by the Library Committee for his gifts of journals to the Library:
February 27th, 1951.
Dr. D. E. H. Cleveland,
925 West Georgia Street,
Vancouver, B.C.
Dear Doctor Cleveland:
For some years past, you have been exceedingly kind in donating to the Library
each month several journals which are used as valuable duplicate copies. May I, on behalf
of the Library Committee, thank you most sincerely for this generous gesture. Your
continued interest in the Library is much appreciated by the Committee.
'mm     Yours very truly,
(sgd.)  A. F. Hardyment, M.D.,
Secretary, Library Committee.
STURGIS.   NEW YORK: GRUNE & STRATTON, 1950 pp. 821 illus. fjl
Seldom has a work on Gynaecology of such quality been offered to the medical
prefession. Here, in 800 odd pages is all that is important in this subject. Each
chapter is written by an outstanding authority on the respective subjects and all that
is worthwhile is included; the obsolete has been discarded and only the good remains.
The authors are both outstanding men in the field of Gynaecology and have
assembled in the one volume all the latest work that has been done. Starting with a
chapter on the embryology of the reproductive tract, through all the common and
uncommon gynaecological diseases, the book steers a clear course. The present status
of surgery in cancer of the cervix is written in a concise form.
For anyone wishing a short postgraduate course in Gynaecology—this book is a must.
F. S. H.
Some four years ago a number of men in Vancouver conceived the idea of a
properly equipped Research Institute, where medical men who had problems requiring
adequate laboratory equipment, leisure and room to work, might undertake research into
these problems and their soution.
The particular piece of research that brought the matter to a head was some work
that Dr. Ross Robertson of Vancouver was doing on congenital heart disease—work that
since has been brought to practical fruition in the surgical relief of congenital conditions
in infants and children.
Dr. G. F. Strong, whose powers of organization have so often accomplished the
well-nigh impossible, became interested and set to work. Another leader in this work
was Mr. W. C. Mainwaring, so well known in all matters affecting public welfare.
We believe that he was at this time precident of the B.C. Division of the Canadian.
Cancer Society. In any case, this organization became actively interested in the project,
and contributed $50,000 to start the Institute off. Later, the same organization, in
two different years, contributed $25,000—making a total of a hundred thousand
Mr. W. L. (Biff) McTavish, who died recently, was also an active force in the
early growth of the Institute.
During the four years, there has been a great deal of work and devotion expended.
Delays have been constant—obstacles have been rife. Room had to be found, and it
was felt that the Institute should be, if not a part of the Vancouver General Hospital,
at least in constant and close touch with it. The reasons for this were many. It made
for economy of effort, and allowed close interchange with the laboratories of the
hospital problems and so serve the hospital—it could serve the needs of the new
Medical School which is in close contact with the Hospital, and so on.
But it was a heartbreaking job at times, we are told, and it needed much faith
and persistence, and the constant co-operation of the authorities of the Vancouver
General Hospital. Dr. Strong, that human gadfly, supplied the persistence, and never
lost faith—and the V.G.H. authorities co-operated nobly.
As a result of the contributions of the Canadian Cancer Society (B.C. Division)
a deal was made with the V.G.H.—which gave up its business offices for reconstruction
into the Institute, while new ones (no doubt even more efficiently arranged) were built
for the hospital's use. Those who know the layout of the hospital will have noticed
the changes this made.
Now the Institute is in full working order, and was formally declared open on
Thursday, April 5th, by Dr. W. J. Kerr, Professor of Medicine at the University of
Page 161 California, who has been Guest Chief of Medicine for the past week at the Vancouver
General Hospital. We were present at the simple ceremonies that marked the opening,
and heard Dr. Kerr's speech—emphasizing the constant and ever-growing necessity
for research.
Later, we had the pleasure of going through the building, which is thoroughly
equipped for research, and will accommodate many workers at a time. A Director of
the Institute is to be appointed soon. In the meantime, the affairs of the Institute are
controlled by a Board of Trustees of laymen, of whom Mr. W. C. Mainwaring is the
President. Other names well-known to Vancouver people are those of John Dunsmuir,
Fred Brown (Hon. Treasurer), A. J. Cowan, K.C., Norman G. Cull, and others. There
is a Medical Board, headed by Dr. G. F. Strong, and including representatives of the
Medical Board of the V.G.H., of the Medical Faculty of the U.B.C., and others.
This Medical Board will pass on projects submitted, and accept or refuse them.
The Institute merely provides room to work, the use of equipment material, animals
and so on. Any medical man in the Province who has a project of worth may submit
it to the Board. Once accepted he can go ahead. He must provide his own operating
expenses, technicians, etc.
There are several projects under consideration—in fact, some fifteen have been
submitted—and some are now being actively carried on. Dr. M. L. Menter for
example, is doing research on leukaemia, and we watched her working for a few
minutes, though she didn't know we were watching.
There are six sniall laboratories for individual workers—and two large ones for
general use—balance rooms, animal rooms with cages, beautifully kept, an animal
operating room, a dark room, and so on.
A project soon to be put in train is research on isotopes, and we understand that
an isotope laboratory is to be established very shortly.
This is no plaything, this Institute — it is an up-to-date concern, adequately
equipped, under the direction of men who mean business. It is a matter of pride to
all medical men and can become one of the outstanding institutions of its kind in
No one man is responsible, of course, for the success of the undertaking which
has just been completed—nor would any one man want us to emphasize his share,
when many others helped so greatly. So we shall refrain from personalities as far as
possible. The men we mentioned were the starters, and gave generously of their time
and devotion: but many others helped-—Mr. Geo. Ruddick, assistant director of the
V.G.H. being one—The B.C. Division of the Canadian Cancer Society made it financially
possible—the General Hospital did all it could to help—the Medical Faculty has lent
support and given help loyally, and their joint effort has now crystallized into a splendid
But one thing perhaps should be said at this point. All this costs money, and
will continue to cost money—and it will be one of the best ways of spending money
that anyone could devise. A campaign for funds is to start soon—and it is designed
to appeal to every section of the community: and of all the appeals for aid that we
meet in the course of the year, this is one of the most worthwhile. We think of
Banting, struggling under terrific difficulties and discouragement, himself practically
penniless, and with few to encourage him, much less help him—unable for a long time
even to find a laboratory to work in, and dependent ultimately on the half-hearted
charity of a man who didn't really think that much of the scheme at all. What would
not Banting have given for a place like this to work in? and how many others must
have been frustrated in similar work? There may be some such among us, who may
contribute as great or even greater things, if they are given the chance. We should
like to quote, as we have once before, the words of John Masefield:
Adventure on, for from the littlest clue
Has come the greatest worth men ever knew:
The next to lighten all men may be you.
-     (by H. A. DesBRISAY, M.D.)
The Osier lecture has been given before the Vancouver Medical Association foi
a period of thirty years. In this time, so many themes have been extracted by talented
speakers from the body rhetorical, that there would now seem to remain very little
but bones.
There is, however, a fascination in bones, and perhaps it is not out of place to
consider such a subject as the remains of ancient mortals, when we meet to do honour
to the memory of Sir William Osier, for was he not primarily, and always, a student
of history and pathology?
"Gladly did he learn and gladly teach."
Osier has written that time should be taken in divided doses. I propose to give
you glimpses of time, as applied to man, in small doses.
"What is man that thou art mindful of him?" When and where was he born?
What do his bones disclose?
When Darwin published his "Origin of Species," in 1860, the majority of scientific
men believed, on Scriptural authority, that man's existence covered a space of less
than 6,000 years. 4004 B.C. was the date solemnly assigned as man's birthday, by one
Archbishop Usher.
It is worthy of note that Sir Thomas Browne, one of Osier's favourite authors—
wrote in 1635—in "Religio Medici," 225 years before Darwin—"Thus we are men and
know not how." "For first we are a rude mass, and in the rank of creatures which
onely are, and have a dull kind of being, not yet privileged with life, or preferred to
sense or reason. Next we live the life of plants, the life of animals, the life of men,
and at last, the life of spirits, running on in one mysterious nature—those five kinds
of existences—which comprehend the creatures—not only of the world, but of the
Now, more than three hundred years after Sir Thomas Browne's day, could
anyone speak of man's origin more beautifully or add to the thoughts expressed?
"Who can give the answers?    Wise men never try."
When was man born?
Archaeologists and anthropologists tell us that man in some form has inhabited
the earth for perhaps one million years. Evolution was slow—"A thousand years are
as a watch in the night."
Some forty million years ago (in the Oligocene age) there lived in Egypt, the
earliest known anthropoid. Twenty million years later (in the Miocene period) the
human branch managed its separation from its common stalk with the anthropoids.
Recent finds haye indicated that the evolution of this primate branch called "man" had
begun much earlier, than was previously ever considered1. For monkeys and apes had
finished their specialization at the time that pre-man was slowly developing the
upright position, with subsequent increase in the size of skull and brain.
Implements, dating far back to a time prior to the first glacial age, are known,
but no bones have been found of the early beings who used these tools.
We are told that about a million years ago (in the Pliocene Age) a variety of
caricatures of men had roamed across the old world, in the form of the Java man,
the China man and the Piltdown man (of Sussex).
But a much earlier being has recently been pictured, for in Java again were
found in 1939 and 1941, the fossil remains of the earliest pre-man ever seen. He was
of enormous size—twice that of a male gorilla—(See Genesis 6:4). "There were
giants in the earth in those days."
Page 163 The Neanderthal man, of vast antiquity, who wandered over Europe in the third
"Interglacial Period," at a time when the Sahara was a well watered and fertile land—
was never completely annihilated, as was long supposed. The remains of intermediate
forms linking Neanderthal and modern man, have been brought to light in Palestine
in the last twenty-five years.
The Cromagnon man (whose remains were found in France and Spain) and the
Grimaldi man—of negroid type (in Africa), appeared about the same time, in the
late Paleolithic (Old Stone) Age. A continuous line of evolution.in Asia can now
be traced—f rom the ancient giant pre-man of Java to the modern Australian Bushman.
In Africa, in the same way, the Rhodesian cave man can be linked through intermediate forms, found in South American soil—with living racial groups of that
These epoch-making discoveries of recent years have thus shown that man had
his birthplace not merely in one Garden of Eden somewhere in Southwest Asia or
North Africa, as was long believed.
As the Fourth Glacial period softened toward more temperate conditions over
fifty thousand years ago, Homo sapiens is seen finally emerging in widely scattered
areas over the old world. The appearance of the first human post-glacial people was
an enormous leap forward in the history of mankind.
What minerals in the soil, what chemical compounds in plant life, what beneficent bacteria contributed, with the stresses of living, to the development of superior
enzyme and endocrine systems, to drive life on and up?
The first groupings of human beings may, however, have occurred in the
Mediterranean region. Look back at primitive man (as does H. G. Wells) far, far
away, long before the dawn of history, as the last glacial age ebbed, living a more
or less peaceful life of happy innocence, in the agreeable climate of the Mediterranean
Lake valley—before the breaking in of the Atlantic waters. For, with the melting
of the great ice fields far to the North, rather suddenly, ocean waters poured in from
the West, the level of the previous peaceful Mediterranean Lake rose, and the flood
.did not abate. Settlements were submerged, the waters spread up the valleys, over
the tree tops, over the hills, driving the survivors of mankind before them, until the
whole basin of the present Mediterranean was filled:—and a great silence was upon the
SPerhaps the Genesis story of the flood and also the Babylonian tradition of the
deluge, is derived from this great catastrophe (of the Paleolithic Age). Possibly
civilization was here held back for some thousands of years.
All through the ages man's increase has been checked by disaster, flood, pestilence
and war, as if nature must balance the scales, lest fiercely spawning man outdistance
his food supply. A single pair of human beings, increasing at the rate of one per cent
per annum, as at present, could have two billion living descendants in a little over two
hundred years. But, after eons of time the world population is still only some two
billion. An astounding fact is that all the peoples on earth today could be placed
in a mammoth box—one mile long by one-half mile wide and one-half mile deep. A
push by some mighty power*down into a yawning chasm, and mankind would be
completely obliterated.    Incredible, but mathematically true:
So small is man in the immensity of time.
Although civilization must have arisen as did man himself in widely scattered
regions—yet nowhere were circumstances so favourable for its development as in
the Nile valley (ten thousand years ago).
How do we know that civilization in Egypt began some ten thousand years ago?
Civilization was contemporary with the first arable soil. Ten thousand years were
required for the Nile mud to be deposited at the rate of five inches to the century.
Before this time, the volume of that river—filling most of the Nile valley at one time—
was so great as to bear its mud far out to sea. After the Nile had retreated to its
present level, man was still in the old Stone Age indicated by flaked unrolled flints,
found at the lowest surface level of the desert.
Page 164 Egypt—protected by desert to the East and desert to the West—was less open to
invasion than was Mesopotamia, and was indeed only held by foreign invaders for a
brief three hundred years in approximately three thousand. Oases, those vestiges of
a once fertile Sahara, did not breed great armies, nor was there often need of them.
It was not war that shaped the history of Egypt, and so civilization—it was the Nile.
Picture then this cradle of civilization.—The Nile, over four thousand miles long,
its fertile banks but ten miles wide at the most—whose source, for thousands of
years, man sought, but did not find, until ninety years ago.
Look at this mighty beneficent river with Emil Ludwig's eyes—"For over half
of its course the Nile receives neither tributaries nor rain, yet it does not dry up, but
close to its mouth it creates the most fertile of all lands. Its banks are peopled by the
richest of bird, life, by nearly every animal species known to Paradise—lined by
vegetation from alpine flora to tropical forest, through swamp, steppe and desert to
the richest arable land on earth. It feeds hundreds of different races—Arabs, Christians,
Cannibals, Pygmies and Giants. The struggle of these men for power, for wealth,
for faith and custom and supremacy of colour, can be traced back further than anywhere
else in the history of mankind."
Egypt, ninety three per cent desert, but nurtured for six hundred miles by the
Nile—Egypt,—the birthplace of occidental man.
Here a people flourished by the two Gods of its climate, the sun and the river.
Here lived men full of practical enterprise, men who invented the art of writing, with
an early alphabet, by 7000 B.C. For eons these sons of the desert must have observed
and mused upon the stars, that hung like glittering diamonds in the clear Egyptian
skies. Observations showed them that the rising of "Sirius" the dogstar coincided
with the beginning of the Nile flood each year, and thus the Sirius of Sothic calendar
was devised. When it was noted that the sun years were similar, the. sun calendar
came into being—this in 4241 B.C.,—the first recorded date in history.
By 3000 B.C. the Egyptians had mapped out the stars into constellations, had
drawn up the Zodiac with its twelve months, and by the time of the New Kingdom
(1600 B.C.) had discovered and named five planets. (Another three thousand years
were to pass before two more planets were discovered, and a further fifteen hundred
years before man conceived an expanding universe of perpetual creation, whose "margins
fade forever and forever").
Yet here, in Egypt, where early scientific men built huge mathematically calculated
monuments, there arose no enduring faith, no clear or simple religion, only a tangle of
many legends of at least four unrelated cults—but all with the single thought that
dominated these sons and daughters of the sun-god—the fight against death. They
could not organize the incomprehensible, and the world they pictured beyond death,
was, with all its grandeur, merely a copy of this life.
The great pyramids, stretching for some sixty miles up the Nile from Cairo, are
monuments to man's endeavour to obtain personal immortality through architectural
extravagance.    Immortality here triumphs only in stone.
Civilization had developed through curiosity, with slow increase in knowledge, by
trial and error discovery—all because man had as his constant preoccupation the saving
of his own life. Preoccupied with* himself as an entity—for death he observed always
happened to others—he could not conceive his life to be but "a nightmare between
two nothings," and he was full of panic and fear of the unknown. And thus with
civilization there evolved religion—the life quest—with its universal hope for personal
The appearance of temples is simultaneous with the beginnings of civilization—
when men became "members one of another." The city community grew around the
altar of the seedtime, the harvest and blood sacrifice. In the temple dwelt the god,
rarely seen, and so enhanced by imagination—the god—whose approval gave prosperity
and whose anger brought calamity. The Priests who served and protected the god,
were for long ages the only learned thinkers, the only writing class. Temples were
observatories, libraries, museums, treasure houses, and medical clinics.
Page 165 The first Deity identified with the Nile was Hathor, the moon-goddess, the mother
goddess, from whom are derived all other goddesses of history—as Aphrodite, Diana,
Venus, and the Fairy Queen.
Osiris was the first king of Egypt. Tradition has it that he found the Egyptians
leading a brutal existence, and that he taught them agriculture, laws and worship. Able
to predict the Nile flood, he came to be regarded as its controller—usurping the
functions of the great mother goddess. Thus he became a deity—God of the Nile,
Creator of the Flood, and source of all blessings. After his death he became ruler
of the other world—where spirits dwelt, underground. Later he was more or less
merged into the more ancient Re (or Ammon-Re) the Sun God and became head of
the spirit world in the sky. He was then called "King of Eternity," "Lord of Ever-
lastingness," "King of Kings," "Lord of Lords," "Governor of the World."
The legend of Osiris tells of his origin. The sky goddess Nuth, wife of the sun
god Re, had an affair with the earth god Seb. Re, upon discovering this, put a curse
upon her, condemning her to stay perpetually pregnant. However, another love, the
god Toth, won a wager for time with the Moon, (who controlled the monthly cycle
of women), thereby acquiring one-seventy second part of every day of the three
hundred and sixty day year. This equalled five days (making our present calendar).
These five days being outside of any month the curse was null and void, and the
goddess was able to give birth. She was delivered of a child for each of the five days—
Osiris being the first born, Isis the fourth. Osiris later married his sister Isis.
Consanguineous marriages were common throughout Egyptian history. Horus, their
son was the next King.
As Osiris was a god, so Horus and every king of Egypt was proclaimed or had
himself proclaimed a god—the son and heir of Osiris. All this, long before—some
two thousand years before 3400 B.C., when Menes, the first king to unite the two
kingdoms of North and South appeared as heir of Osiris, king of the fruitful earth.
From the time of Menes, the first king of the First Dynasty—three hundred and
fifty Pharaoh's of Egypt—some mere shadows, but some of them personnages of note—
were to pass in this tremendous parade of history, of well over three thousand years, to
end in the Thirty-Third Dynasty with Cleopatra the seventh. Cleopatra the Great,
that resourceful clever woman, who at the age of twenty-one held Caesar in her power
and who might have become Empress of the World, but for his murder. Cleopatra,
the last Sovereign of the last Dynasty—and the last offspring of many incestuous
marriages—who died by her own hand in the last Century B.C. (30 B.C.).
A glance back through history gives the explanation for many habits and customs.
From Horus, the second king of Egypt, has come a symbol we all use daily. For
Horus lost an eye in a fight with the god of evil, but had it miraculously restored, and
the eye of Horus became a good-luck talisman. By gradual change it came to resemble
the letter "R" and finally the "F£" of prescriptions.
Gold was a relatively useless metal prior to the time of Tutankeman (1350 B.C.).
Barley was used as currency. When gold was given an arbitrary value, it had the
most tremendous effect on the world's history, and became the chief factor in creating
strife and warfare.
The magic properties of blood, and red-coloured substitutes, have prevailed through
the ages, as seen in 'blood sacrifice, to rejuvenate kings of Egypt grown senile, and in
the animal sacrifices of the Old Testament. The placenta, full of magic blood, was
looked upon as man's other self, his twin brother, to be carefully preserved as a
protector. In early Egypt a representation of placenta and cord was carried on the
staff of the chief of the clan, and later a substitute of red, white and blue streamers.
(Hence the Union Jack and the Stars and Stripes.)
These few examples indicate the effect upon our daily lives of primitive times.
Primitive medicine arose with primitive religion, when man sensed something
greater than himself, and developed pity and compassion for others. Early man surely
did as much for himself as did the animals he observed—the wolf eating grass,  the
Page 166 monkey stopping haemmorhage by pressure—the Ibis, that sacred bird of ancient Egypt,
giving itself an enema. Basic truth in medicine has always been accompanied by bizarre
practices and half-truths. The leader of a tribe was medicine man, magician and
Medicine, under the aegis of the gods, was practised by two orders of Egyptian
priests. Those of the lower order were obliged to learn anatomy, pathology, pharmacology, gynaecology, surgery and ophthalmology. (Good old general practitioners!)
Those of higher order devoted themselves to charms, conjuring, prayers and incantations.    (Psychiatrists!)
The earliest medical records are pictures of surgical operations of 2500 B.C.,
representing circumcision and surgery of extremities. The Ebers Papyrus, the best
known of at least eight papyri—dates back to 1550 B.C. (but records practices of a
much earlier date). Although it contains a list of about seven hundred different
bizarre remedies and incantations, it does describe a system of ''vessels" leading from
the heart to various organs, conveying air, water, blood and other substances.
The Smith Papyrus, shown by Breasted to be slightly older than the Ebers Papyrus,
is a handbook on the treatment of injuries, beginning with those of the head and passing
downward in orderly fashion. Cases are arranged systematically under the heading of
complaint, examination, diagnosis and verdict. The Ascheim-Zondek test was anticipated by some thousands of years, for Egyptian priests knew that the urine of a
pregnant woman hastened the sprouting of barley.
Perhaps these ancients knew how to prolong the life and vigour of special persons,
for records show, that one Pharaoh Piop (or Pepy II) of the Sixth Dynasty (2500 B.C.)
reigned for ninety four years, the longest reign known to history.    He reigned so long
that when he died at one hundred, Egypt had been   torn by revolution, with the final
collapse of the Old Kingdom.
Rameses II (the Great) that vivid personality of the Nineteenth Dynasty (12th
Century B.C.) who as a youth was said to have fought his way—alone in a chariot—
through thousands of riittites (at the battle of Kadesh) lived to the age of eighty-six.
At his death, he possessed an intact set of teeth, and—one hundred and eleven officially
begotten sons and daughters. Considering the size of his harem, this number is believed
by historians to be an understatement.
Egyptian science, it is believed, attained its full growth in the period covering
3000 to 2000 B.C.
At the beginning of this period arose Imhotep, the first recorded physician in
history—the wise Imhotep, grand vizier, chief ritualist, sage and scribe of King Zoser
of the Third Dynasty. Also an architect, Imhotep directed, no doubt, the building of the
step pyramid at Sakkara, the oldest known structure in the world. So history remembers
Imhotep, (of 2900 B.C.) deified as the god of knowledge and of medicine. Three
temples were built to his honour—at Memphis, Thebes and Philae.
It is known that specialists existed in these days, for there was one for every
organ,—said Herodotus later. In the Old Egyptian cemetery there were discovered,
twenty-five years ago, a stella from the tomb of a court physician (of 2600 B.C.) —
named Pepi-ankh,—with a text describing him as "The physician of the belly of
Pharaoh—the guardian of the anus." *^
The foundations of anatomy and pathology, though most rudimentary, were laid
through the preparation of the dead, through the striving for some indication of
immortality—by the attempted preservation of the dead man's personality. Even in
the Neolithic age, the dead were returned to the dry Egyptian earth, wrapped in a
mat, and curled up like the unborn—with a suggestion of reverence. The dry deserts
fringing the Nile were natural burial grounds, and preserved the remains of hundreds
of thousands, together with evidence of their early culture.
The Egyptians lavished every care on their dead, preserved them by artificial
means, and housed them, with all the paraphernalia thought necessary for their material
Page 167 Because of this custom down through the ages has cdme the most complete records
of any people of antiquity. For in no other part of the world of six thousand years
ago, did the dry air so preserve, and did custom so adorn the abode of the dead. Some
two hundred plants have been found in the tombs—Laurel wreathed about the head,
jasmine or mint in garlands around the neck, myrtle in the hands, mignonette and
marjoram, roses and rosemary, on the couch of the dead. Delicate furniture, linens,
textiles, papyri and paintings have survived, with texture and colour undimmed by time.
What were the methods of embalming, what the secrets of this art, which sought
so zealously to hold back the decay of death, until the soul could re-enter?
Embalming had its beginning by at least the Second Dynasty, well over fifty
centuries ago, to be continued in Egypt for more than three thousand years. Numerous
improvements introduced by the time of the New Kingdom (Eighteenth Dynasty)
have preserved the mummies of many of the royal households of this period. Often
however, they have been mutilated by tomb robbers. One of the few tombs not
plundered until A.D. 1922, was that of Tutankeman (Eighteenth Dynasty)—whose
tomb compared to many others, is said to be a mere sepulchre.
The account of embalming as given by Herodotus (in the Fourth Century B.C.)
is believed to be reasonably accurate for that time. Herodotus wrote—''There are
certain individuals appointed for the purpose, and who profess the art. These persons,
after any body is brought to them, show the bearers some good models of corpses,
painted to represent the original. They then show a second which is inferior to the
first and cheaper; and a third which is cheapest of all. They then ask of them according to which of the models they will have the deceased prepared. Having settled
upon the price, the relations immediately depart, and the embalmers proceed to perform
the embalming in the most costly manner.
In the first place with a crooked piece of iron, they pull out the brain by the
nostrils; a part of it they extract in this manner, the rest by means of pouring in
certain drugs. In the next place after making an incision in the flank with a sharp
Egyptian stone, they empty the whole of the inside, and after cleansing the cavity and
rinsing it with palm wine, scour it out again with pounded aromatics; then having
filled the belly with fine myrrh pounded, and cinnamon, and all other perfumes—
frankincense excepted—they sew it up again. Having done so, they steep the body in
natron—keeping it covered for seventy days, in that it is not lawful to leave the body
any longer in the brine. When the seventy days are gone by they first wash the corpse,
and then wrap the whole body in bandages cut out of cotton cloth, which they smear
with gum.
The above is the most costly manner in which they prepare the dead. For such as
choose the middle mode, from a desire of avoiding expense, they prepare the body
thus: They first fill syringes with cedar oil, which they inject into the belly of the
deceased without making any incision, or emptying the inside, but sending it up by
the seat. They then close the aperture, to hinder the injection from flowing backwards,
and lay the body in brine for the specified number of days, on the last of which they
take out the cedar oil, which they have previously injected, and such is the strength
it possesses, that it brings away the bowels and inside in a state of dissolution: on the
other hand the natron dissolves the flesh, so that in fact there remains nothing but the
skin and bones.    When having so done, they give back the body.
The third mode of embalming, which is used for such as have but scanty means,
is as follows—after washing the inside with syrmae they salt the body for the seventy
days, and return it to be taken back."
Diodorus Sicculus (some four hundred years after Herodotus) wrote out a few
more details—"First he who has the name of 'scribe, laying (the body) upon the
ground, marks about the flank on the left side, how much is to be cut away. Then he
who is called the cutter, or the dissector, with an Ethiopic stone, cuts away as much
of the flesh as the law commands and presently runs away, as fast as he can; those who
are present pursuing him, cast stones at him, and curse him, hereby turning all the
execrations which they imagine due to his office, upon Mm.    For whosoever offers
Page 168 violence, wounds or does any kind of injury to a body of the same nature with himself,
they think him worthy of hatred; but those who are called the embalmers, they esteem
worthy of honour and respect; for they are familiar with the priests, and go into the
temples as holy men without any prohibition."
What medical histories are unfolded by the study of early man's remains and
We learn that longevity is essentially a modern achievement—for studies of
suture-line closure show that ninety five percent of Neanderthal man, eighty eight
percent of Cromagnon, and seventy four percent of civilized men of Roman Egypt,
were dead before the age of forty.
Arthritis, older than man, is found in the bones of prehistoric animals who lived
a million }rears ago.    Prehistoric man was a victim.
Autopsies on more than thirty thousand mummies (by Elliott Smith, Ruffer,
Wood Jones and others) have revealed many interesting conditions and causes of death.
Now let us look at a few of these musty mummies of once immortal kings of
We find from the Seventeenth Dynasty, the mummy of Pharaoh Sequenerra, who
died in battle thirty five hundred years ago, at about the age of thirty five. Weigall
describes his appearance—"His head is covered with wounds, a battle-axe has crashed
through the upper part of the forehead, leaving a hole two inches long, the hair matted
with blood; another blow from an axe has cut into the brain above the right eye; a
sword-thrust has pierced his left cheek; a spear has been driven in above the ear on
the left side; and a blunt instrument has smashed the right eye socket and broken the
nose. The face is agonized,• the clenched teeth have bitten through the tongue; and
the hands are convulsed and clawing."
He died in a war between rival kings of upper and lower Egypt—a war which
broke out, so it is said, after King Apopi of the South objected to the noise of the
hippopotami which disturbed his sleep.
Next we note the mummy of Amenhotep III (1370 B.C., age 50) who was
confined to his palace for the last six years of life, perhaps insane. His many carious
teeth are evidence that the ancient Egyptians knew little of dentistry—contrary to
many accounts.
Ikhnaton (1350 B.C.) the heretic king, who worshipped A ton, the spirit of the
Sun, next comes to view. Great folds of skin proclaim obesity. (One picture shows
his abdomen actually hanging over the edge of a balcony.) He was a "4F" (Far too
Fat For Fight).   He stayed at home and lost Egypt many possessions.
Sety I (1298 B.C.) the father of Rameses the Great, died at about the age of
fifty. He was a great fighter in war, and was in peace, an eager builder of temples
and tombs. We might guess that he died rather suddenly—possibly of coronary artery
occlusion—for his mummy is the most impressive and lifelike of all the Royal mummies
now at Cairo.
From the same period (1213 B.C.) is the mummy of a young man, Pharaoh Siptah,
with one leg shortened and foot deformed, who is believed to have had infantile
Mer-en-ptah (1220 B.C.)—The supposed Pharaoh of the time of the Exodus,
was not drowned in the Red Sea, for his mummy rests in Cairo. Autopsy has shown
that he died of coronary arteriosclerosis at about the age of fifty.
The tissues of these mortals, entombed for thousands of years, were found to be
hard and brittle and tended to crumble on handling. However, Sir Marc Armond
Ruffer, almost incredibly, was able to prepare and make microscopic sections of some
of these tissues (in 1908-1913).
His studies showed the general arrangement of anatomical elements to be well
preserved. The chief microscopic characteristics of the skin, breast, lung, heart, liver,
kidneys, testicles, intestines and stomach, blood vessels and muscles, could be easily
Page 169 Tme skim from, a mam, who had a vesicular or feoMous ermptiom strikingly like
smnott-fssx, showed vertical septa* and large numbers of gram positive bacteria.
Sections of ai lieait greatly slurmmken after eiglkt thousand years, revealed cross-
stnstion of tdae muscle-fibres, and nuclei plainly visible.
Ilkeuaimoiaasai was evident in some lung sections, witfe bacteria staH present, and in
one, short bacilli,, suggesting- plague.
Tfee Ever of Ramaffer* High Priest of the Sun, showed the typical arrangement of
cells five thousand years after Ins last rites.
Im one kidney witlk multiple abscesses, weJl stained feacilli resembling E. Coli were
seen.   Another kidney showed calcified eggs of feilharzia in the straight tubules.
Very few healthy arteries were found hx the Royal miurnmies. Arteriosclerosis
on microscopic sectiam* appears exactly the same as today.
Tie: Ancient Egyptian suffered from:
Arteriosclerosis* arthriitis and appendicitis*
Buboes and bunions,
CSkribosis and calemlG. (rariimary}*
Gouit and gall stones,
Leprosy, Bsudc not lues,
Malaria and mastoid disease,.
Pneunionia and pfeaorfey and nephritES^
I^iomyelitas, parasites and petgic abscess,
EOasgus and jpcoHlapsev
Tuaaaocs and tuberculosis.
*Ote statuette of am ackoudroplastie dwarf has beem preserved. He was Chnoum-
hotep ""dafef of the BefffEEmes5*—-"Head off the Wardrobe.** He lived forty five
fcondred years ago.
The remains ©ft am ancient priest of Amtmiom, dead three thousand years, show
ewisfemee of tuberculosis of the spine* with a psoas abscess.
Many skeletons show the ankylosis of the vertebrae and sacroiliac articulations
of Marie StrumpeE spondylitis.. Am example is that of a roan whose name we know—
INSriteranaafc. He lived five thousand years ago, in the Third Dynasty. Perhaps because
of his increasing disability, lee had to samp woriSoimg on the step pyramid. Imhotep,
the first Ibaown physician in Imstory, may have treated Nefernmaat. At his death the
spinal column, from tfee fomrth cervical vertebra to the coccyx* had been converted
into, one rigid block.
Tmese was no variation in the pathological anatomy of arthritis, nor of any other
disease,, in Egypt* over a period of eight thousand years at least.
LoQiking: back tmem* through tme pages of history, it is evident that for eons of
time, there leas been no percept-Safe change in the structure of man, and that diseases
that afStct modern man ws-e smfleiied fey his earJy ancestors,—while they too, pondered
on the inexhaustible mystery of life and death.
Tie s^ikfe* like tBae mind,
lifee tfee light of wonder in a yommg boy's eyes,
May fee experienced,, but not explained..
Osier wco&es—^Ieu the hopes and fears that make up mem we find only broken
portions of the absolute tonaddk. Each one of ms may pick mp a fragmemt, perhaps two;
and in moments wheat mortality weighs less feeavify upon the spirit, we can, as in a
vision,, see tlae form divine,:—just as a gceat naturalist can reconstruct an ideal creature
from* a fesaE feag^aent^
Here, mow, we rernem&er tlae immortal spirit ef Osier. He fired m magnificence^
the niagnifficence ©f service. Thomgh mow **hid in death's dateless night," he yet fives
on in the memory of generation alter generation of medical men.
"fflfe does mot die who cam bequeath
Some influence to the land he knows.""
R. B. KERR, M.D.
(Professor of Medicine, University of British Columbia)
We publish this paper of Dr. Kerr's with especial pleasure as it is our first professional contribution
from a member of the Medical Faculty of the U.B.C., and we hope to have many more. —Ed.
The disease diabetes mellitus offers many problems of importance to the practising
physician and of interest to the investigator. An increasing knowledge of the disease
has accumulated since its recognition but even now, with many features elucidated,
there are many aspects which require further investigation.
The actual cause of human diabetes mellitus cannot be definitely stated. We
known from animal observations that a condition analogous to, if not the same as
human diabetes, can be produced by various experimental procedures. Removal of the
pancreas from certain species of animals produces many features of the disease. Ad-
ministration of extracts of anterior pituitary can do likewise. Alloxan may produce a
diabetic state in some animals. The maintenance of a hyperglycaemia by continuous
infusion of glucose will result in a permanent diabetic state in cats. All of these
procedures are related eventually to the malfunction of the Beta cells of the Islets of
Langerhans and we of course know that insulin, which most likely is a secretion of
these cells, allows us to correct many, if not all of the abnormalities of the diabetic
state. We know that other endocrine glands such as the anterior pituitary, adrenal
cortex, adrenal medulla and thyroid, influence the metabolic disturbances seen in diabetes.
However, one cannot escape the fact that an absolute or relative deficiency of insulin is
of primary importance in the mechanism of production of the diabetic state.
The application of the known experimental observations to the human problem
leaves many gaps to be explained by further knowledge. At the present time we can
only outline various factors which may have a contributing role to the development of
diabetes in the human.
(a) Age—There is a marked peak of incidence in the age of development of the
disease in the fifth and sixth decades. This is unexplained, but presents a most interesting
problem for elucidation.
(b) Obesity—There appears to be a close correlation between the occurrence of
excess weight and the incidence of diabetes. Approximately 80% of diabetics, whose
disease begins in later life, are overweight and half are more than 20% above the ideal
weight. It has also been shown that diabetes is about seven times more common
among the obese older persons than among the thin. The explanation for this association of obesity and diabetes is not clear. However, it has been suggested that as a
person increases in weight by the deposition of fat the surface area is increased. This
allows a higher rate of radiation of heat from the body and increases the rate of
metabolism by the active tissues. This, in turn, necessitates a greater need for insulin.
Another fact which may be of importance in this connection is the recently demonstrated observation that insulin is closely linked with the deposition of body fat and
the conversion into fat as adipose tissue.
(c) Heredity—The increased incidence of diabetes in family groups is well
known. The overall incidence of diabetes among relatives of diabetics is about 6l/z%
compared' to 1 or 2% among the general population. The onset of diabetes in identical
twins has been observed to occur frequently. In 50% of similar twins both had
diabetes, whereas only in 3% of dissimilar twins did the disease occur in both, as
pointed out in a study made by Joslin. There are a few apparently predictable points
of information which provide an answer on the part of a physician to some of our
patient's questions. If two diabetics marry, all their children will become diabetic
if they live sufficiently long. If one parent is a diabetic and the other is non-diabetic
but comes from a family with a diabetic history, the children of this marriage have
Page 171 approximately 50% chance of being diabetic. If a diabetic marries a person who has
no diabetics in the family, none of the children are more likely to develop the disease
than the average population. It is thought that the diabetic tendency is transmitted as
a recessive characteristic and may be bred out as a consequence of the diabetic marrying
into a non-diabetic family background.
(d) Other Endocrine Factors—There are relatively few cases of diabetes in the
human where the etiological factor can be traced to the abnormal function of another
endocrine gland. Thus, in acromegaly we see some 17% of patients who show diabetes.
It is tempting to relate this diabetes to the effect of excessive growth hormone. Likewise in Cushing's Syndrome, there is an association of the diabetic state with hyper-
function of adrenal cortex. Pheochromocytoma has been associated with diabetes in a
very few reported cases.
One cannot assemble evidence to incriminate other endocrine glands as an etiological
factor in the usual case of human diabetes, however, at the present time.
(e) Infection—Infection plays a minor role in the causation of diabetes. We
do see some cases in which the diabetes becomes apparent during or shortly after an
infection, but one cannot be sure that a latent mild diabetes did not exist before, and
it is well known that infection frequently renders a known diabetes more severe.
(f) Miscellaneous Factors—Very occasionally, acute pancreatitis or the pancreatitis accompanying mumps is followed by a diabetic state. Haemochromatosis is
believed to produce diabetes by infiltration of the pancreas by fibrous tissue. Very
occasionally, diabetes is seen associated with pancreatic tumours of diffuse character.
It would appear that approximately 1% of the population is known to be diabetic.
From surveys which have been conducted it is probable that for every known diabetic
in a community there is one undiscovered person who is diabetic. This has been
demonstrated in a survey conducted in a town in Massachusetts and was found again
recently in a survey in a town in Ontario. As medical practitioners we should be
aware of the possibility that diabetes may exist undiscovered among our patients. The
type of individual in which the greatest likelihood of the disease exists is the obese,
the relatives of a diabetic and those over the age of forty. The American Diabetes
Association has sponsored publicity during the past two years aiming at the detection
of unknown diabetics.
It is most probable, as I have already stated, that diabetes mellitus is due to an
absolute or relative lack of insulin. It is well to study the sequence of events which
happen when an organism is deprived of insulin in order to understand the findings
in a patient with diabetes. When insulin is deficient the blood sugar rises, because of
the liberation of sugar from glycogen in the liver and from the increased conversion
of protein to sugar. The fat stores are depleted and the fat is broken down in the
liver to form ketone bodies along with a small amount of glucose, which comes from
the glycerol portion of the fat molecule. The rise in blood glucose produces glycosuria
when the blood sugar rises above the renal threshold. Polyuria results and dehydration
occurs. The ketone bodies consist of acetone and relatively strong organic acids.
These acids combine with available base and as the disease progresses, an acidosis may
develop. Thus we have a condition of glycosuria, acetonuria, dehydration and loss
of weight through breakdown of fat and protein of the body.
The young diabetic tends to show a more sudden onset, a more rapid and severe
course, greater tendency to acidosis and a more labile state generally. Whereas the
diabetic whose disease begins in older age tends to show an insidious onset, not infrequently without symptoms, slow and milder course, less tendency to acidosis and a
more stable state of the disease.
A discussion of the diagnosis of diabetes may be superfluous. However, there are
a few points which I would like to make in this connection.
The patient who comes to us with symptoms and glycosuria together with a high
fasting blood sugar represents no problem. A fasting blood sugar above 140 mgm. per
100 cc. in the absence of severe infection is diagnostic of the diabetic state.
If glycosuria is discovered with mild or no symptoms, further careful study is
necessary. Again the fasting blood sugar may be elevated sufficiently to warrant the
diagnosis of diabetes. A blood sugar taken two hours after a liberal meal in the
normal should not be above 120-150 mgm. per 100 cc. In a diabetic this post-prandial
blood sugar may be of help in the diagnosis. If the fasting blood sugar is normal, one
usually must employ a glucose tolerance test adequately to study the patient. There
are many types of this test; however, the most widely used is the oral administration
of 100 grams of glucose in the adult followed by blood' sugars at ^4, 1, 2, and 3 hours
after the glucose is given. The normal curve should begin within the normal range
and rise to levels below 150 mgm. per 100 cc adn fall to normal in 2 to 3 hours. If
glycosuria occurs during the normal curve, we are dealing with a state of renal glycosuria
in which the renal threshold for glucose is lower than normal. If the test results in a
>curve which rises to levels above 170 mgn. per 100 cc and persists at high levels for
three hours, a presumptive diagnosis of diabetes mellitus is considered. There are many
factors which influence the glucose tolerance test which must be taken into account
before a definite diagnosis of diabetes should be made in a questionable case.
(a) Infection — During any infection or inflammation, an abnormal glucose
tolerance test may be discovered in which the elevation of the blood sugar will be
excessive and possibly somewhat prolonged.
(b) Previous Diet—Many observations have been made upon the effect of the
previous diet with respect to the glucose tolerance test. Himsworth, among others,
has shown that the carbohydrate content will produce an abnormally influencing factor.
Low carbohydrate content will produce an abnormally high blood sugar, whereas a high
carbohydrate diet will produce a flatter curve. It is also to be remembered that the
capillary blood sugar is frequently 30-40 mgn. per 100 cc higher than the venous
blood sugar at the peak of the curve. It is well, in a doubtful case, to insure that
the patient has been on a diet adequate in carbohydrate before a glucose tolerance test
is done.
(c) Liver Disease—Impairment of liver function, such as occurs in acute hepatitis
or cirrhosis of the liver, may produce a tolerance curve which shows a diabetic tendency.
This is, in all probability, due to the failure of the storage function of the liver under
these circumstances.
(d) Hyperthyroidism—Increased activity of thyroid function may result in an
abnormal glucose tolerance curve and final assessment may have to be deferred until the
hyperthyroidism has been brought under control.
A further point in connection with the diagnosis should be mentioned. Very
occasionally one finds in older persons that the renal threshold for sugar is excessively
high and glycosuria is not present even though the blood sugar is in the abnormal
range. The most striking example of this in my experience was a patient who suffered
from an ulcer of the foot which resembled that seen in diabetics. Study of her case
revealed that the renal threshold was somewhere above 390 mgm. per 100 cc and that
she was a diabetic without glycosuria. This probably occurs very rarely, but should
be thought of under certain circumstances.
The question of the interpretation of a glucose tolerance curve in which the blood
sugar rises to levels higher than normal at the 1 hour interval but falls promptly
to normal in 2 or 3 hours arises not infrequently, This has been called the "lag"
curve. If the factors mentioned above had been ruled out, one must interpret this
(type of response as suspicious. Many individuals with this type of curve carry on for
years without developing a definite diabetic state.   However, some subsequently progress
Page 173 to a frank diabetes.    It is my practice to advise, in this situation, a diet restricted in
carbohydrates and carry out continued observation.
This section has been purposely referred to as "control of the patient" to emphasize
that we are concerned in this disease as much, if not more than in any other condition,
with the aiding of the patient to manage his whole life as well as his disease.
If the handling of the vast majority of uncomplicated diabetics does not result
in a healthy, well nourished person, there is something wrong with the supervision or
the obedience of the patient to his physician's advice.
Uniformity and control of the diet and the use of insulin, if necessary, are the
chief means of treatment of the disease.
The diet should have a total caloric content sufficient to maintain the weight at
or slightly below the ideal weight for the patient's height and build. The caloric requirement may be calculated from tables or may be estimated from a basal requirement
at rest of about 20 calories per kilogram of body weight in the adult, somewhat higher
with respect to children. The actual level of caloric intake will depend upon the
activity of the patient and whether one wishes to increase or decrease his weight. It
is most important to reduce the weight of an obese diabetic to the ideal weight. This
reduction in weight often makes the diabetes less severe and may in some cases produce
a return to apparently non-diabetic state. The final caloric content of the patient's
diet cannot be assessed until after about six months of observation of the weight because
of one's inability to assess the individual's activity and requirements. The under-weight
patient should have his weight increased to his ideal weight or slightly below that level.
The protein content of the diet is widely held to be 1 gram per kilogram of body
weight, higher for children. The fat and carbohydrate content of the diet is the subject
of considerable difference of opinion among clinicians. I prefer a carbohydrate content
of 150-160 grams or lower, with the caloric requirement made up with fat because I
believe that most patients are more likely to be well controlled on this programme.
One may begin observation of a patient who is not in acidosis by placing him for a
few days on a diet of basal caloric requirement, approximately 1500 calories in the
average adult, constituted as 50 grams of protein, 100 grams of fat and 100 grams of
carbohydrate. If this diet results in control of the diabetic by disappearance of glycosuria and a normal fasting blood sugar, it is possible that he will not require insulin.
The diet may be raised in protein fat and carbohydrate content until a maintenance
caloric level is attained—1800-2400 calories for the average adult. If the diabetes is
stil! under control, no insulin is required. It may be that we wish to continue a diet
low in calories for the purpose of weight reduction. If the glycosuria persists and the
blood sugar remains elevated on this restriction of diet, insulin will be necessary. Most
patients may be controlled on one dose of protamine zinc insulin given before breakfast.
The dosage of insulin is adjusted until the glycosuria and blood sugar is controlled.
The actual dosage required cannot be predicted in a given case, but in the average adult
requiring insulin, a dose of 15-20 units may be used at first and subsequent changes
made depending upon the response to this initial dosage. Intervals of 3-7 days should
be allowed before changes in dosage in protamine zinc insulin are made, as more frequent
changes do not allow time for adjustment of the blood sugar to occur. The dosage
of protamine zinc insulin is increased until the fasting blood sugar becomes normal.
If glycosuria persists throughout part of the day on one dose of protamine zinc insulin,
the addition of regular insulin with the morning dose and sometimes before the evening
meal aids in further control. This regular insulin may be given as a separate injection
or may be mixed with the protamine zinc insulin in the syringe. However, it must
be remembered that excess protamine zinc is present in protamine zinc insulin
and some of the regular insulin will be converted into protamine zinc insulin. A
common mixture used in two parts of regular to one part of protamine zinc insulin..
This is a crystalline protamine zinc insulin.||It is a cloudy suspension of crystals whichv
are produced under certain conditions of acidity in their manufacture.    The product
Page 174 contains no free protamine. It differs somewhat in its action from amorphous protamine
zinc insulin in two respects. It begins to act more quickly, having an appreciable
action in 2 hours and its action is not as prolonged as the amorphous protamine zinc
insulin. If used in mixtures of regular insulin, it must be remembered that there is no
free protamine present so that the action of regular insulin in such a mixture will be
much more apparent and less regular insulin will be required in the mixture. It would
appear that NPH insulin has some value in decreasing the rise of blood sugar after
the morning meal. It is not certain at present whether this new form of insulin will
prove to be widely yseful. NPH insulin probably takes a place intermediate between
Globin insulin and protamine zinc insulin as far as duration of action is concerned.
The ideal control of the diabetic consists of the maintenance of ideal weight, the
continuance of a sense of well being, strength and energy, the freedom from, or minimum
of glycosuria, the fasting blood sugar level within normal limits or post-prandial blood
sugar not exceeding 180 mgm. per 100 cc, and the absence of insulin hypoglycaemic
reactions. This represents the ideal, and the closer we can come to this ideal the more
satisfactory will be our handling of the patient. It is recognised that there are some,
especially the young diabetics, who present problems of control which cannot allow this
ideal to be reached.
No programme of handling of the diabetic is complete without a thorough
education of the patient. This is best done by means of repeated interviews, in which
various aspects of the disease can be discussed with the patient. The patient should be
encouraged to read a well written manual about the disease, and have contact, with a
dietician and a nurse who can teach him about the aspects of diet and handling of
insulin.    The-following points are of importance in the diabetic's education:
1. He should be told as much about the disease as his intelligence will allow.
2. He should be imbued with an enthusiasm for the control of his disease.
3. He should be made to feel that diabetes is not necessarily the handicap many
people are led to believe, but should learn that many useful, active citizens
have diabetes and live almost normal active lives.
4. He should be made thoroughly familiar with the dietary programme and be
taught as much about dietetics as he can absorb. A dietician is of great help
in this respect.
5. He should be made thoroughly familiar with the administration of insulin, the
sterility of his hypodermic equipment and all aspects of the handling of this
6. He should learn a simple method of urinalysis for sugar.
7. He should be warned about hypoglycaemia and the methods of combatting it.
8. The danger of infection and its effect upon diabetes should be pointed out.
9. In the older age group, instruction should be given as to the care of the feet.
Cleanliness, prevention of traumata, care of the nails, socks and shoes should
be emphasized.
10. The effect of exercise upon his diabetes should be described. In many patients
exercise will produce a lowering of blood sugar which may require special care
to prevent hypoglycaemic attacks.
Diabetics have sought ways of helping themselves by organizing into Diabetic
Associations under the general sponsorship of an organization such as the American
Diabetes Association. In such societies diabetics have attempted to learn more about
their disease and to sponsor moves to make the lot of the diabetic a happier one.
The diabetic should visit his physician sufficiently frequently to enable a close
supervision of his case to be attained. The frequency varies with the circumstances.
Well indoctrinated diabetics require a visit only every 3-6 months. Others, especially
more labile diabetics, require more frequent visits. The patient should report the
picture of his urinalysis, and frequently a blood sugar taken either in the fasting state
or, if this is not practicable, throughout the day gives further information about the
control of the disease. Some diabetics may be encouraged to make minor changes in
insulin dosage on their own, depending upon the urine picture but this is a question of
Page 175 individual judgment of the capabilities of the patient. The main purpose of the
patient's visit should always be to afford the opportunity of imparting a continued
feeling of interest and encouragement to the patient, to help him to continue with the
programme or handling.
The condition of acidosis develops usually under the following circumstances—at
the onset of the disease, during periods of infection or during periods of carelessness
with respect to insulin dosage or dietary control. ^
The clinical picture consists of a history of exacerbation of the symptoms of loss
strength and energy, polyuria, polydipsia, weight loss, with the onset of vomiting as
the condition progresses. The result is a condition of dehydration, acidosis and loss
of electrolytes. Abdominal pain, tenderness and rigidity may occur during diabetic
acidosis and may be a source of difficulty in differential diagnosis from an acute abdomen.
However, in the absence of intra-abdominal catastrophe, these symptoms rapidly subside
with treatment of the acidosis.
The two most important points with respect to the treatment of diabetic acidosis
are administration of insulin in adequate amounts and replacement of the fluid loss.
The earlier one can begin treatment in the development of an acidosis the more favorable
will be the outcome. The average case requires 200-300 units of regular insulin during
the first 24 hour period; the first dose should be administered 50 units subcutaneously
and 50 units intravenously. The subsequent doses at 4-6 hour intervals, subcutaneously,
depend upon the progress of the patient. The average case of acidosis requires about
5 litres of intravenous fluid during the first 24 hours unless evidence of cardiac failure
is present. The question of the use of glucose in intravenous fluids has been the subject
of controversy during recent years. Root believes that better results are obtained with
normal saline alone in the early hours of treatment. It is the case, however, that glucose
will be required sometime after the first 6 hours of treatment in most patients to
prevent hypoglycaemia, and if no glucose is used in the early period one is will advised
to have frequent estimations of the blood sugar so that hypoglycaemia does not develop.
The use of intravenous alkaline solutions such as sodium bicarbonate or sixth
Molar Sodium Lactate should be confined to those patients in whom the carbon dioxide
combining power does not rise materially after 8 or 12 hours of treatment.
The importance of the deficiency of potassium which takes place in the development of diabetic acidosis has been the subject of study during the past few years. A
few cases of muscular weakness and paralysis have been reported during the recovery
period associated with a low serum potassium. A marked fall in serum potassium
usually occurs following the initiation of treatment. This reaches its lowest level at
from 6-24 hours after the beginning of therapy. If muscular weakness develops during
this time, potassium may be administered as potassium chloride by mouth, if possible,
in doses of 1-2 grams, or very cautiously by intravenous indusion. It should be pointed
out, however, that a danger exists with intravenous infusion in patients who have poor
renal function. Whether patients would do better with potassium administration in
the absence of muscular weakness cannot be assessed at the present time. Early feeding
of such fluids as meat broth and orange juice is to be encouraged to replace the
potassium deficit.
During the treatment of diabetic acidosis the patient should be observed carefully
at frequent intervals for the development of cardio-vascular collapse, as shown by a
marked drop of blood pressure. The administration of stimulants such as pituitrin in
l/z cc dosage intramuscularly may help this condition. The use of intravenous plasma
or whole blood has also been of use under these circumstances.
It has been possible to review only some of the aspects concerning the disease
diabetes mellitus. f J The disease, of course, has many ramifications which one has not
considered.   .This disease presents a challenge to the profession from the standpoint ofv
further investigation and the complete application of our present knowledge to the
handling of our patients.
The Care of the Dying is a suitable subject for a paper because of its importance
and also because it receives so little notice in our professional training and in the
literature. Clinical practice of whatever kind brings to all of us responsibility for the
dying and not a little of the doctor's art can be shown by the resource displayed in
their care. When Swinburne wrote that "Peace, rest and sleep are all we know of
death" he defined also the needs of the dying and the measure of our success in caring
for them is the continuity with which those needs are fulfilled.
Although some patients become aware of the imminence of death, to a great
number this awareness seems to be denied. There are many reasons* why this should
be—an important one is lack of knowledge about the state of affairs. Then there is the
will to live; the human capacity for optimism and the deception practised upon the
mentality by illness itself help to mask truth. More often the dying are occupied with
symptoms rather than portents. The easy deaths are those where consciousness goes
early, the sudden death of the comatose. Next to these are the quiet deaths so common
among the elderly and the insane, who literally fade away. With toxic deaths the
patients almost always have suffered their worst sometime before the end, and -net
often do they call for much relief in the last stages. The dying patients who tax our
skill are those with surviving consciousness who are struggling with asphyxia or with
pain. Even so, there is evidence of considerable dimming of consciousness at the time
of real or apparent suffering.
When is it possible to say a patient is dying?
A man may be ill with cancer of his stomach, may give evidence of secondary
deposits scattered about his body, may "look the part" by way of cachexia and yet
the signs of impending death may not be written upon his face or upon any part of him.
Then there are illnesses such as pneumonia, acute congestive heart failure, coronary
thrombosis, poisoning and some other morbid states where a person is ill to a degree
that seems to render survival impossible. The one with incurable cancer is not dying
because we feel a moderately early end is inevitable, nor should the mere degree of illness, however extreme, in the other diseases mentioned be mistaken for the signs of
impending death. Roughly, a patient is dying when the well-tried remedies fail to act
and no substitutes can be found, and in some unknown way the patient enters the
act of dying.
Whatever our impression of the nearness of death may be, restricted forecasts are
usually wrong. Sometimes it is difficult to avoid prediction, but we are not entitled
to set bounds to a matter fraught with uncertainty. It is not the time so much as the
manner of death which matters, as Edmund Cooke said—
"Death comes with a crawl or comes with a pounce,
But whether he's slow or spry
It isn't the fact that you're dead that counts
But only, how did you die?"
Many wise physicians and surgeons are cautious about claiming finality for their
diagnoses and prognoses. It is a matter of common knowledge that the faith-healing
sects have made much of their capital out of hasty and erroneous diagnoses by doctors.
Futhermore no one knows when some new treatment and possible cure may come
suddenly around a corner. But when there is reasonable assurance as to diagnosis and
prognosis, what should we do about telling the patient the truth? Some doctors who
are gallantly and remorselessly sincere, urge truth-telling at all costs!
In the New England Joudnal of Medicine, December 23, 1948, Willard L. Sperry
(1) (a Doctor of Divinity) has this to say: "Much, perhaps all, depends on a patient's
temperament and mental state at the time. Resolute natures in full possession of their
wits usually want to know what we think and expect and are able to take it.    I see
Page 177 no reason or warrant for withholding what we believe to be the truth from such a
person."' Dr. Sperry mentions a Yale professor who had an obscure illness and died
untimely after going the rounds of specialists in both New York and Boston. He was
a man of quick intellect and good courage. "He once said to me in a mood of
discouragement and temporary bitterness, 'I no longer believe anything that any doctor
says to me. They have all lied to me so consistently that I have lost all faith in them'."
This was a bit of deliberate overstatement on his part, but I think he meant that he
was tired of being cheered up by a too facile optimism or dismissed with deliberate
On the other hand, many persons do not even ask themselves how ill they are,
let alone ask anyone else. They prefer to take what comes as it comes. The reticence
of such persons should be respected. There is no occasion and no moral obligation to
intrude the supposed truth upon such minds. To do so would be a bit of gratuitous
cruelty. And all of us know that there is a point in the course of an illness at which
nature herself mercifully dulls the mind and its power of grasping ideas begins to
relax. In his Ingersoll Lecture on the Immortality of Men given at Harvard some years
ago, William Osier said that most people die as they were born—unconscious of what is
In short, the whole question of truth telling seems to depend upon the temperament
and the mental state of a patient. No single categorical rule can be laid down. We
have to trust our instinctive knowledge of human beings and be guided accordingly.
Turning now to the actual care of the dying, many of their needs are common to
all sick and bedridden patients. First, as a matter of policy, we must avoid doing
harm. This includes belated attempts at remedial treatment and measures likely to
increase discomfort, such as useless moves or recourse to dangerous or toxic drugs when
their time has clearly passed. It includes also the subjection of dying people to dramatic
but useless surgery or to investigations of no practical value. We should try to avoid
vigorous fiddling. Not only is it often ill-judged, but it may invite criticism. Many
of the cynical remarks about doctors caricature this point. ''.Young doctors kill their
"patients, old doctors allow them to die." Joseph Zabara, author of the "Book of
Delights" written in the 13 th century, added a sting in his saying, "A Doctor and the
Angel of Death both Kill, but the former charges a fee."
The next important matter is the relief of distress—usually pain or suffocation.
Sometimes special measures are employed to avoid particular symptoms, as the tapping of
recurrent pleural effusions, or attention to the bladder. As for the bowel, one often
.finds scybalous masses lying just inside the rectum and requiring digital removal.
But in general the best relief comes from groups of drugs which depress cortical activity;
the opiates, hypnotics, alcohol and hyoscine.
Morphine still stands out head and shoulders above every other drug, as in the days
of Sydenham's dictum that few would have the temerity to practice* physics without its
aid. Codeine perhaps should be employed first up to its maximum effect. At a time
when morphine is the one means of giving relief, it is often withheld for fear of
hastening death. Actually morphine can prolong life in an amazing way, probably
by its effect on slowing metabolism and so reducing the demands of the organism for
oxygen. Morphine by itself, however, is rather capricious in its action. Hyoscine
greatly prolongs the sedative action of morphine but it can be unexpectedly fatal in
some cardiac cases in which it should only be used sparingly at first. It is worth using
to minimize the remembrance of severe symptoms which are bound to recur; for
example, paroxysms of extreme pain or dyspnoea.
"Although the depressant drugs are of great value they sometimes may make a
patient utterly miserable. Cocaine hydrochloride, by mouth, in doses of an eighth to a
half grain is of benefit in these cases. The chief use of cocaine, however, is in alleviating
nausea and vomiting with patients suffering from inoperable carcinoma of the stomach."
Alcohol finds its chief use among the dying when* physical discomfort is not great.
It helps to take the edge off symptoms, to bolster up morale however falsely, and to ease
Page 178 the mental depression which comes so often during a slow death.    The choice of form
should usually rest with patient and his means.
Now turning to other matters . . . The doctor's own visits may have little to
bring and although it is tempting to curtail their length and number, it may be unkind
to do so. Alfred Worcester once remarked, "In the practice of our art it often matters
little what medicine is given, but matters much that we give ourselves with pills."
Whispered conversation in the hearing of the patient is never wise, for the dying
hear when least expected, and a chance remark may do bitter harm. Before death
is near at hand there is often no point on insistence upon rest in bed exclusively, when
patients desire otherwise, and, however important a restriction of visitors may be
during serious illness, there is much less reason for this with the dying, and old friends
should never be forbidden during these last days. A subservient insistence upon bed
pans as a routine is out of place in the dying. The elderly, particularly, often long
for home as life draws to its end and this request should be granted whenever possible.
It is extraordinary how many people still do not make a will, and how even
intelligent people seem never to have given real thought as to what is to happen after
they have gone. It is best not to let the patient actually reach the stage of dying before
tackling this problem. Many will say that it is none of the doctor's business; yet
innumerable families and patients have been grateful to a physician who has not taken
such a narrow view of his professional responsibilities and opportunities.
Finally a few words about the younger patient. In younger people and in middle
life there is more of a struggle for recovery and hope persists until quite near the end.
We know that these patients show such powers of recovery that they should never be
considered dying until they are dead, even though suffering from some chronic
pulmonary, cardiac, renal, or malignant disease.
Much more might be said on most of these topics but time does not permit. In
conclusion may I say that, come what may, the patient's interest comes first, and that
the physician has a duty to his patient that is not discharged until the last breath has
been taken and the flickering pulse is still.
References: 2£®|
(1)  Sperry,   W". L.  "The Moral Problems in the Practice of Medicine"  New England Journal of
Medicine 239:985.    December 23, 1948.
Leak, W~. N.   "The Care of the Dying" The Practitioner 161:80-87.    August, 1948.
Horder, "Signs  and Symptoms of Impending Death"  The  Practitioner   161:73-75.    August,   1948.
Hoyle, C.    "The Care of the Dying" Post. Graduate Med. Journal 20:119-123. April, 1944.
Two International Congresses take place simultaneously in London from
July 21 to 26, 1952, which will be of interest to medical men and members of
the dental profession. These are the 10 th International Congress of Dermatology and the International Dental Federation.
Thos. Cook & Son has been appointed Official Travel Agents for the
Dermatological Congress and we insert this notice at this time to bring to the
attention of those practising Dermatology in British Columbia that it is not
too early to make at least tentative plans in connection with transportation and
accommodation, if they intend to go to London in July, 1952.
D. E. H. Cleveland, M.D.
The Canadian Arthritis and Rheumatism Society announces the appointment of
Dr. CeciLE. Robinson, M.D.C.M., F.R.C.P., as Medical Director.
Dr. Robinson graduated from Queens University in January, 1943. He interned
at the Vancouver General Hospital and served with the R.C.A.M.C. in Canada and
overseas from 1943 to 1946. He did post graduate work in the Department of
Medicine at Shaughnessy Hospital from 1946 to 1948, at Queens University in the
Department of Pathology from 1948 to 1949, in Internal Medicine at the Postgraduate
Medical School and its special institutes in London, England, in 1949 and 1950 and at
the University of Toronto in 1950.   He obtained his F.R.C.P. (C) in December, 1950.
Dr. Robinson's duties will be the direction and control of the medical problems
of the Canadian Arthritis and Rheumatism Society throughout B.C., being guided by
the decisions of the Special Committee on Arthritis and Rheumatism of the British
Columbia Medical Association.
Dr. J. H. MacDermot, April 17, 1951.
1701 West Broadway,
Vancouver, B.C.
Dear Dr. MacDermot:
In our conversation yesterday I mentioned that the Medical Ball Committee had
asked me to approach you in the hope of having a letter addressed to the medical
profession published in the bulletin of the Vancouver Medical Association. As you
mentioned that it might be possible to include they: letter in an early issue, I am
enclosing it herewith.
With kindest personal regards.        Irgl     Yours sincerely,
Assistant to the Dean.
To Members of the Medical Profession in British Columbia:
# The Medical Ball Committee of the Medical Undergraduate Society wish to thank
the doctors and their wives who gave such fine support to the inaugural Annual
Medical Ball, held on March 10th at the Hotel Vancouver. Nothing forecasts the
success of similar events in the future so much as the enthusiastic way that many of
our medical friends undertook to help us.
Though the social success of the Ball is known to all who attended, we felt that
everyone would be interested in its financial success.
Ticket Sales and Donations $1,615.50
Expenses of the Ball  1,382.59
Excess Income over Expenses $   203.20
The sum of $200.00 has been deposited with the University to provide two much-
needed bursaries for medical students during the forthcoming session: the balance will
be carried over in the Medical Ball Account. The recipients of these bursaries will be
selected in the usual manner by the Joint Faculty Committee on Prizes, Scholarships
and Bursaries.
Sincerely yours,
Page 180


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