History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1951 Vancouver Medical Association Sep 30, 1951

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 THE
UL.L.ETI
Itf: of
The Vancouver Medical Association
EDITOR:
dr. j. h. MacDermot
EDITORIAL BOARD
DR. D. E. H. CLEVELAND DR. | H. B. GRANT
DR. H. A. DesBRISAY DR. J. L. McMILLAN
Publisher and Advertising Manager
W. E. G. MACDONALD
VOL. XXVII
SEPTEMBER, 1951
NUMBER 12
OFFICERS 1951-52
Dr. J. C. Grimson Dr. E. C. McCoy Dr. Henry Scott
President Vice-President Past President
Dr. Gordon Burke Dr. D. S. Mtjnroe
Hon. Treasurer Hon. Secretary
Additional Members of Executive:
Dr. J. H. Black Dr. George Langley
TRUSTEES
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommer, 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. D. E. Starr Chairman Dr. A. S. McConkey Secretary
Neurology and Psychiatry
Dr. R. Whitman Chairman Dr. B. Bryson Secretary
Radiology
Dr. Andrew Turnbull Chairman Dr. W. L. Sloan Secretary
STANDING COMMITTEES
Library:
Dr. A. F. Hardyment, Chairman; Db. J. L. Pabnell, Secretary;
Db. F. S. Horbs, Db. J. E. Walker, Dr. E. France Word, Db. D. W. Moefatt
Co-ordination* of Medical Meetings Committee:
Db. J. W. Frost Chairman Db. W. M. G. WrLsoN„__Secretary
Summer School:
Db. Peter Lehmann, Chairman; Dr. B. T. H. Marteinsson, Secretary;
Db. A. C. Gabdner 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,
Dr. E. A. Jones, Dr. 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: Db. Henby Scott
Representative to the Vancouver Board of Trade: Db. E. C. McCoy
Representative to Greater Vancouver Health League: Db. J. A. Ganshobn 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.
Clinical 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 MEET-
M   ING-
Notice and programme of all meetings will be circularized by the Executive Office
of the Vancouver Medical Association.
VANCOUVER GENERAL HOSPITAL
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.
ST. PAUL'S HQSPITAL
Regular Weekly Fixtures
TUESDAY—9-10 a.m.._ . 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 286 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.
THE  BULLETIN
Publishing and Business Office — 1 7 - 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.
Advertisements
Closing Date for advertisements is the  10th of the month preceding date of issue.
Advertising Rates on Request.
B.C. DIVISION) CANADIAN MEDICAL ASSOCIATION
ANNUAL MEETING
OCT. 2-3-4-5th, 1951
VANCOUVER HOTEL
Scientific papers by:
Dr. H. C. Church—Pres. Canadian Medical Association.
Dr. H. S. Polley—Mayo Clinic.
Dr. Taylor Statten—Montreal.
Dr. G. R. Brow—Montreal.
Dr. E. C. Janes—Hamilton.
Dr. J. Baker—Seattle.
Entertainment
Annual Luncheon, Wednesday, Oct. 3.
Gala Buffet Dinner Dance, Thursday, Oct. 4.
H.M.C.S. Discovery Bar.    Dal Richards and Hotel Vancouver
Orchestra.
Annual Dinner, Friday, Oct. 5.
Hotel Vancouver.    Cocktails.    Music.
Speaker: Prof. Wm. Boyd.
Golf.    Sherry-Coffee Party for Ladies.
Harbor Cruises, North Star Flights over City.
All Details in Next Issue.
Page 287 Hgdrogel Bulk Therapy...
Low-Residue Constipation
HYDROGEL
1 THERAPY
llll        -    Of
CONSTIPATION
New York 13, N. Y.    Windsor, Ont.
The elderly, the postoperative, the
convalescent, the special diet patients
frequently are afflicted with constipation
as a result of a low-residue diet.
Mucilose—highly hydrophilic hemicellulose
—augments food that is deficient
in indigestible residue, provides bland
emollient bulk in the bowel,
and thereby encourages return of
normal peristalsis.
2 TEASPOONFULS...
2 TIMES DAILY...
WITH 2 GLASSES OF WATER
Available   as   flakes   (Concentrated
and Special Formula with
M dextrose)  4 oz. and 16 oz.
Trial supply will be sent to
Physicians upon request.
Mucilose, trademark reg. U. S. & Canada
443 SANDWICH STREET WEST, WINDSOR, ONTARIO VANCOUVER HEALTH DEPARTMENT
STATISTICS
JULY,   1951
Total   population   —
Chinese   population  —
Other — estimated __
estimated...
estimated.
397,140
6,282
640
Number
Total   deaths   (by   occurrence) 333
Chinese  deaths 20
Deaths, residents only j 297
June,  1951
Rate per
1000 pop.
10.1
38.2
8.9
Birth Registrations — Residents and Non-residents:
(includes late registrations)
Male   .
Female
June, 1951
876
26.5
Infant Mortality — resident only:
June, 1951
Deaths under 1 year of age 14
Death rate per  1000 live births . ■...    21.9
Stillbirths  (not included in above item} . 8
CASES OF COMMUNICABLE DISEASES  REPORTED IN THE CITY
Scarlet Fever__ :	
Diphtheria . .	
Diphtheria Carriers	
Chicken Pox	
Measles .: \ 169
Rubella \ 54
Mumps .. '. \ ? 38
June, 1951
Cases      Deaths
66 —
95
Whooping Cough	
Typhoid Fever	
Typhoid Fever Carriers.
Undulant Fever	
Poliomyelitis ;	
Tuberculosis i	
Erysipelas	
Meningitis	
Infectious  Jaundice—
Salmonellosis	
Salmonellosis   Carriers-
Dysentery	
Dysentery   Carriers	
Tetanus ~	
Syphilis	
Gonorrhoea	
Cencer   (Reportable)  Resident-
17
11
45
June, 1950
Cases      Deaths
2 —
71
Page 288 LIVER
 C CON NAUGHT J ■	
EXTRACT! INJECTABLE
15 UNITS PER CC.)
Liver Extract Injectable is prepared specifically for the treatment of
pernicious anaemia. The potency of this product is expressed in units determined by responses secured in the treatment of human cases of pernicious
anaemia. Liver Extract Injectable as prepared in the Connaught Medical
Research Laboratories
.—contains at least 15 micrograms of vitamin B12 per cc.
derived directly from liver and determined by the Lactobacillus leichmannii test.
—is carefully tested for potency.
—is low in total solids and light in colour.
—is very highly purified and therefore can usually be administered without occurrence of discomfort or local reactions.
Liver Extract Injectable (15 units per cc.) as prepared by the Connaught
Medical Research Laboratories is supplied in packages containing single 5-cc.
vials, in multiple packages containing five 5-cc. vials, and in 10-cc. vials.
Liver Extract for Oral Use in powdered form is supplied in packages
containing ten vials; each vial contains extract derived from approximately
one-half pound of liver.
1
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
MACDONALD'S    PRESCRIPTIONS    LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. 7<4e fMUotX Paqe.
An article recently- appearing in the Vancouver press "Can Voluntary Health
Insurance Do the Job?" seems to us to contain a good many points of great interest and
importance to ourselves. It is written by Evarts A. Graham Jr. — a well known
American writer, and deals mostly with the question as it effects the United States —
but much of what he says really applies to us.
His first paragraph, we think, contains the meat of the matter, and the last
sentence is particularly worthy of our close attention.
He says "Voluntary Health Insurance Plans, despite their tremendous growth in
the last decade, will have to grow a lot more, if they are to do much of a job of bringing
the cost of medical care within most Americans' means. At least some additional
expansion is probable but how much will depend in large measure on whether organised
medicine lets the plans do a better job." (italics ours).
With all the plans now in existence in the U.S. only 12% of the total money spent
for private medical care in 1949, was covered by insurance. That probably would be
close to the figures in Canada as a whole, perhaps somewhat higher if anything.
The article goes on to say that "the growth of comprehensive insurance has been
painfully slow, in large part because of the opposition or organised." This is not quite
applicable to Canada, where the medical profession, especially in certain provinces, is
definitely in favor of prepaid medical plans, and through its federal Association is
exploring the possibility of nation-wide voluntary insurance plans—but the attitude
of a large part of the profession is still somewhat undecided.
We must make up our minds to certain things.
First, the average citizen cannot afford the cost of full medical coverage. This
means either that we do not get paid for what we do, or he does not get adequate
medical care. Both of these are bad. We are constantly being told that under prepaid
plans, under hospital insurance, the costs of medical care are much higher, and are
mounting. ffThis does not necessarily mean that the doctor is giving too much medical
care, or "running wild" on expensive drugs, etc. It means, in the great majority of
cases, that the doctor is now able to give adequate medical care, which he could not
do before, because the patient simply could not pay for the X-rays, laboratory work,
drugs, etc., that were necessary.
Secondly, we must face the fact that by one method or another, the public is
going to demand, and get, prepaid medical care. Either by some voluntary method
which nobody can afford to turn down, or by some compulsory method of health
insurance, state medicine, etc.
As a profession, we should, of course, much prefer no schemes at all. If the old
doctor-patient relationship could be maintained, we should like it better.^But it
cannot. We must choose one of the above alternatives, and having made our choice,
we must honestly and without equivocation follow the path we choose where it takes us.
We have, ostensibly at least, agreed to the voluntary plan of prepaid medical care
as, on the whole, giving us greater freedom, and a better chance to maintain high
standards of medical care.
We are, rather, timidly, thinking of embarking, by means of the Trans-Canada
Medical Aid plans, on a wider ocean, in deeper water. But we are still testing the
temperature of the water with our toes, before summoning up the courage to take the
plunge.
We should make up our minds, and then act—and be willing to take the consequences of our act.   If we firmly believe, as most of us do, that the prepaid plans are
Page 289 the right way of approaching the problem, we should go all out in promoting them,
making them work, and above all, playing fair with them in every way. We must, as
organized medicine, "let the plans do a better job."
Otherwise, let us make no mistake about it, the matter will be taken out of our
hands, sooner or latter, and given to governmental or lay bodies for solution and
action.    This would, to us, mean disaster.
The article in question says "Comprehensive plans might be able to do the job,
if organised medicine and the law would get out of the way." While we do not agree
with the way this is put, we must recognise the genuine sense of grievance felt by
those who, working for extension of what they feel to be beneficial plans find, as
they have done in the U.S.A., that the strongest opposition comes from those who
should really be helping to solve the problem. In Canada, there is not this organised
opposition, but we have not yet clearly made up our minds, and adopted a clear-cut
policy, and it is high time we did.
Editor, The Bulletin,
Dear Doctor MacDermot:
I am delighted to know that the Academy of Medicine of British Columbia expects
to open its new building in Vancouver on October 1st.
Perhaps there is no more hackneyed but yet more universally accepted aphorism
than, "There is no place like home". No doubt, before many years go by, the medical
profession of British Columbia will begin to appreciate more fully than they are now
aware what it means to have a medical home. As I look back over the years and recall
my many visits to your province, I am reminded of the discussions and the men who
took part in them, urging that this forward step be taken. It would be invidious to
single out individuals but one can think of a number of stout hearted men who not only
had vision but the desire and ability to put their idea across.
Anything which contributes to the practice of medicine such as this new home
will do, contributes to the public weal. Therefore, congratulations to the citizens of
British Columbia are also in order.
I am sorry I shall not be present at the dedication but I shall be with you all in
spirit. If I were obliged to provide some dedicatory words I would express the wish
that your new home may always be a place of friendship, enlightenment and strength
to those members of the profession who are privileged to call it Home.
Yours sincerely,
T. C. ROUTLEY,
General Secretary.
Editor, The Bulletin,
My Dear, Dr. MacDermott:
I have just received from our secretary of the Canadian Medical Association a
request for a few lines re the opening of the Academy of Medicine of B. C. Building.
In any province the housing of all the medical bodies in one building, makes for
economy of time and effort, allowing for the quick and easy interchange of information
which is so often essential.
By bringing this Academy building into being, British Columbia is leading in the
example of unity and co-operation.
May I express to my British Columbia friends and confreres my very best wishes
for success in this new undertaking.
Very sincerely,
Harcourt B. Church,
President Canadian Medical Association.
Page 290 THE ACADEMY OF MEDICINE
It is a good number of years since the idea was first conceived of a building which
should be the home of medicine in British Columbia. For a long time it seemed only
a sort of wishful thinking: the medical profession of British Columbia, though Quite
ambitious, and very organisation-conscious, was small in numbers, and unable to
contemplate without a shudder the cost that such a building would entail. So the idea
of an Academy of Medicine remained on the list of future possibilities, and while
it was often brought out and looked at, nothing was done.
The need for an Academy of Medicine is based on a good many reasons. First,
the national desire that we should have our own building, and as a centre where our
activities could be brought to a focus. We have suffered, too, as a profession, from
cramped quarters, for library purposes, for office work, and so on. We have had to
depend on the generosity of other organisations for room where we could hold our
meeting, and we have had most generous treatment, which we must all most gratefully acknowledge.
But the situation is unsatisfactory in many ways. Human nature is so constituted
that it .likes to have a visible emblem of its ideals as a proof of the stability and
reality of those ideals. Human nature, too, likes a home of its own—and is unwilling
for long to occupy other people's property, even on a rental basis, much more on a
free basis. MM
And so our leading spirits continued to seek a way by which the difficulties could
be overcome and finally, the College of Physicians and Surgeons decided the time was
ripe to take a definite step in the matter. Through the Council, the plan was finally
made feasible by raising our annual dues, and by working out a schedule of financing;
and at last the Academy of Medicine became an accomplished fact, as the first unit
in a plan which will ultimately include other items, such as an auditorium, and we
know not what else.
This Academy of Medicine is different from some others in Canada, notably the
Academy of Medicine of Toronto. It is not a Vancouver institution, nor a Lower
Mainland Institution, it is the British Columbia Academy of Medicine, and is the
home of the British Columbia Medical Profession. It had to be somewhere and Vancouver  was  the  most  convenient  place;   but  it  is   the  property  of   the  College  of
Page 291 Physicians and Surgeons of B.C., and each medical man in B.C. has an equal right
in it with every other medical man in B.C. He has paid his share, and it is his
property too.
We can envisage the day when we shall have our own auditorium (the land
for this has been purchased adjoining the Academy) perhaps a museum, and other
adjucts to our new Academy. The Royal College of Physicians and Surgeons of
England, we may remember, started in a small way too and now it has its own headquarters, its own museum and so on. We shall no doubt, have these things too in
time.
And from the point of view of the public at large, we can see the value of such
an institution. More and more the medical profession is coming to see that we must
improve our public relations, and enter into "franker and fuller understanding with
the public as a whole. This cannot be accomplished by piously passing resolutions, and
by lamenting over the mistaken ideas which are held about us by a public which
we have never taken the trouble to inform. We know how virtuous we are, how devoid
of guile, but the public as a whole is apt to entertain suspicions, some of which
are certainly ill-founded, all of which should be met and dealt with. With the
advent of the new building, where our various official organisations will be readily
available, these -conditions should improve greatly.
And from the point of view of efficiency and greater ease of operation, as well
as economy, we believe this Academy of Medicine will prove to be of the greatest
value to us. The B.C. College of Physicians and Surgeons, the B.C. Division of the
Canadian Medical Association, the Vancouver Medical Association, will all be within-
room's length of each other. The library will be, in a sense, the centre of the building,
and it will be convenient, roomy, and a delightful place in which to work. The
Bulletin of the Vancouver Medical Association is to have its own office, and perhaps^
this will enable that periodical to. meet its deadlines more effectively; at least it will
have less excuse to fail to do so.
Altogether this is a big forward step towards increasing the unity and solidarity
of our profession. It should also, and this is just as important, help us in our constant
struggle to maintain and improve our standards of medical care, and should help us
to do better work for those for whom we work, on a friendlier and more mutually
amicable basis. T H M
The building honored by this issue of the Bulletin is worthy of every line of
print in its favor. In and out it shows the considered thought of a group of gifted
and conscientious men.:*\    jg|p
The very approach from Tenth Avenue gives the medical man an impression of
solid strength as the rough concrete walls meet his eye and the heavy steel doors swing
smoothly open at his touch. Inside, this impression is intensified by compact planning,
solid tile or cement floors, terrazzo stairs and deeply-carpeted rooms with long
horizontal, lines.
...-. The main floor is allotted mainly to the Vancouver Medical Association, with a
luxurious lounge to the right of the foyer and a long central hall leading to the
library at the back of the building. Off this hall are the offices of the executive
secretary of the Association, the editor of the Bulletin and the workroom, for mailing
and repairing library books.
The library, backbone of any medical group, occupies a bright room forty by
sixty-five feet, with five private study cubicles and a microfilm room along the rear
.wall. Leading off.^his main room ar^.two large reading rooms with excellent indirect
lighting and insulated walls. g£
At the head of the modernistic stairway leading to the second floor are the large
Page 292 sunlit offices of the College with the private offices of the secretary, the registrar, and
of the executive secretary of the B.C. Medical Association along the Burrard Street wall.
Almost half of this floor consists of a long board room which can be divided by
folding walls into  three smaller rooms  for  simultaneous meetings.
The decor of all these rooms is ultra-modern, with light woods, pastel shades
of plaster on most walls and ceilings and with broad sweeps of glass for adequate
lighting.
Prophesying that the Academy may become the center of social activities for
specialty divisions of the Association, the planners have provided a large rumpus room
on the basement level, with a dance floor, sectional furniture, a food bar and kitchen.
On this floor also are the apartment for the caretaker and his wife and storage
space for little-used library books and records. Freight between all floors is taken care
of by an easily operated dumb-waiter system.
Considerable discussion finally resulted in the heroic relief sculpture of Hippocrates
on the Burrard Street wall of the Academy. Created by Beatrice Lennie, Western
Canada's foremost sculptor, the figure is ten feet by four feet, composed of cement,
marble dust, sand and waterproofing and bolted through the wall on a reinforced
steel base.
Work on the project took months of research and the artist submitted over ten
sketches to the committee.
Hippocrates stands before a medical cross, holding a papyrus scroll in one hand
representing a fragment of the ancient Doric books on the practice of medicine and
in the other hand is the staff with one snake entwined. The snake has been
included in medical pictures because it was originally thought to have a mystical alliance
with the herbs used in the early days of medicine.
Expressing the purpose of the building for visitors at large is a brass plaque in
the entrance hallway with the following inscription:
Academy of Medicine
College of Physicians & Surgeons
Dedicated to the High Calling
of the Healing Art
This First Day of October, 1951
'Inspire in me a love, for my Art
and for Thy Creatures."
—Prayer of Maimonides,
(1135-1204)
J.L.M.
CANADIAN MEDICAL ASSOCIATION, B.C. DIVISION
REPORT OF THE HONORARY SECRETARY-TREASURER
The audited statement of our financial activities is appended. Our relations with
the Council of the College of Physicians and Surgeons this year in respect to finance
have been harmonious, and in accord with arrangements which were established just
before the last Annual Meeting of our Association.
At the time that this report is written negotiations with Council respecting the
method of our financing for the year 1951-1952 have not been concluded. I expect
to be able to report a satisfactory agreement at the Annual Meeting in October, 1951.
F. A. TURNBULL, M.D.,
Honorary Secretary-Treasurer,
Canadian Medical Association,
B.C. Division.
Page 293 CANADIAN MEDICAL ASSOCIATION, B.C. DIVISION
STATEMENT OF ACCOUNTS
For the year ended 31st August, 1951
Report by Buttar & Chiene, Chartered Accountants,
Vancouver, B.C., upon the accounts of the
Canadian Medical Association, B.C. Division,
for the year ended 31st August, 1951.
We have examined the books and accounts of the Canadian Medical Association,
B.C. Division, for the year ended 31st August, 1951, and have found them correctly
stated and sufficiently vouched and we have prepared therefrom the following statements
which we hereby certify, in our opinion, to be correct, namely:
1. Abstract of Receipts and Disbursements of the Association
for the year ended 31st August, 1951.
2. Abstract of Receipts and Disbursements of the Association's
Benevolent Fund for the same period including a Summary
of the Bonds held for that fund at 31st August, 1951.
Reported by
BUTTAR & CHIENE,
Chartered Accountants.
Vancouver, B.C.
8 th  September,   1951.
RECEIPTS
College of Physicians and Surgeons of B.C. -
Membership Grant 	
Canadian Medical Association - re 1950 C.M.A.
Convention   	
Annual Meeting Receipts:
Year 1950  $     3,340.25
Year 1951   (On account)          3,500.00
DISBURSEMENTS
Annual Meeting Expense, year 1950  |>L_$ 5,862.28
Travelling Expenses   1,862.94
Vancouver Medical Association Bulletin  700.00
Constitution and By-Laws Expense   433.06
Election Expenses   204.52
Bursary, U.B.C. Faculty of Medicine  100.00
Office Furniture - Table .  72.10
Administration and General Expenses   2,329.18
EXCESS OF RECEIPTS OVER DISBURSEMENTS	
CASH BALANCE
In Bank and on hand at 31st August, 1950 $ 4,772.93
Add - Increase in funds represented by Excess of Receipts
over Disbursements for the year ended  31st
August, 1951 gp  975.31
In Bank and on hand at 31st August, 1951  $ 5,748.24
$    5,378.00
321.14
6,840.25
$  12,539.39
11,564.08
$        975.31
Page 294 CANADIAN MEDICAL ASSOCIATION, B.C. DIVISION
BENEVOLENT FUND
ABSTRACT OF RECEIPTS AND DISBURSEMENTS
For the year ended 31st August, 1951.
RECEIPTS
College of Physicians and Surgeons of B.C.
Contributions    $    7,817.50
Interest:
On Investments $     1,590.65
On Savings Account   23.92
     $     1,614.57
$    9,432.07
DISBURSEMENTS
Bonds Purchased l $    9,450.00
Payments to Beneficiaries  .        1,979.54
Premium Surety Bonds  .  10.00
Audit Fees -  50.00
Bond Safekeeping Charges   55.55
     $  11,545.09
EXCESS OF DISBURSEMENTS OVER RECEIPTS SSI $    2,113.02
BANK ACCOUNT
Balance at 31st August,  1950  $     5,083.55
Less - Decrease in Bank Balance represented by Excess of
Disbursements over Receipts for the year ended
31st August, 1951        2,113.02
Balance at 31st August, 1951  . $    2,970.53
SUMMARY OF BONDS
As at 31st August,  1951
On hand at 31st August, 1950 - $57,000.00 Bonds at cost  $  55,056.25
Acquired during year -
$10,000.00 Dominion of Canada i3/4%  -  1968         9,450.00
On hand at 31st August, 1951 - $67,000.00 Bonds at cost  $  64,506.25
(Market Value - $61,735.00) 	
CANADIAN MEDICAL ASSOCIATION, B.C. DIVISION
Committee  on Constitution  and  By-Laws
Annual Report, 1950-1951
The past year has seen tremendous change in the pattern of our organization with
the introduction of our new Constitution. During its introduction there may be come
confusions and misunderstandings. As experience develops there will doubtless be
need for amendment. We appreciate the foresight and labour of those who assumed the
task of its preparation.
Page 295 Your Committee for this year has concerned itself in particular with the following
matters: &$$
1. Interpreting from the Constitution and By-Laws the rules and regulations
which should guide our first General Election, and outlining the mechanics
of this election.
2. Discovering and discussing problems of the Association, in the solving of which
amendment to the Constitution might be advisable. The following were considered of major importance at this time:
a. Redefining the boundaries of the Electoral Districts.
b. Amendment to the wording of By-Law No. IV, Section 2, to state more
clearly what representation of Delegates and Vice-Delegates is designated
from each District.
The possible need for changing the date of our Annual Meeting so that
it would precede the Annual Meeting of the Canadian Medical Association,
thereby providing our team with more current information,  advice and
organization.
The drawing up of terms of reference for a Committee on Public Relations.
In each of these matters the opinion of this Committee was passed on to your
Executive for the information.
Respectfully submitted,
ROBERT A. STANLEY, Chairman.
Members of the Committee:
Elmer A. Jones, Secretary
J. F. Sparling
H. Carson Graham,
Gordon Johnston |kl§|
A. W. Wallace
c.
d.
TAKE NOTICE
NOTICE OF AMENDMENT OF CONSTITUTION AND BY-LAWS
The following extraordinary resolutions amending the Constitution and By-Laws of
the  Canadian  Medical  Association,  B.C.   Division,   will  be  proposed   at   the  Annual
Meeting of the Association to be held at  8:00  p.m.,  Tuesday, October 2,   1951, in
Salon "A" Hotel Vancouver, Vancouver, B.C.
1.—RESOLVED: That By-Law No. IV, Section 1, shall be amended to read as follows:
By-Law No. IV, Sect. 1—Organization—For the purpose of developing the organization of the profession in this Province, the Branches shall be grouped.   These
groups shall be called Districts, to be known as Districts Nos. 1, 2, 3, 4, 5,
6 and 7,  which  shall respectively comprise  the  areas  contained in  certain
counties as defined in the "Counties Definition Act Amendment Act, 1936."
District No.  1 shall comprise the County of Victoria.
District No. 2 shall comprise the County of Nanaimo.
District No. 3 shall comprise the County of Vancouver.
District No. 4 shall comprise the County of Prince Rupert  and Cariboo.
District No. 5 shall comprise the County of New Westminster.
District No. 6 shall comprise the County of Yale.
District No. 7 shall comprise the County of Kootenay.
2.—RESOLVED: That By-Law No. IV, Sect. 2., Sub-sect,   (a)   be amended to read
as follows:
Page 296 By-Law No. IV, Sect 2 (a) Elect one of their number for the Office of Principal
Delegate, provided that in any District with a membership in excess of 100,
they may elect one additional Principal Delegate for each additional 100
members or fraction thereof. '
The Principal Delegates so elected shall be the Representatives of the District
on the Board of Directors.
3.—RESOLVED: That By-Law No. IV, Sect. 2, Sub-sect, (b) be amended to read as
follows:
By-Law No. IV, Sect. 2   (b)   Elect one other of their number to act as Vice-
Delegate, provided that in any District with a membership in excess of 100,
they may elect one additional Vice-Delegate for each additional 100 members
or fraction thereof.
4.—RESOLVED: That to By-Law No. IV, Sect. 2 there be added Sub-Section  (d)
as follows:
By-Law No. IV, Sect. 2 (d) The Electoral strength of each District shall be based
on the number of members in the District in good standing on the rolls of
the Association thirty days prior to the date for the mailing of the Nomination Papers.
ANNUAL MEETING
Hobby Show
The Hobby Show was such a success last year that it has been decided to hold
one again this year.
The Hudson Bay Co. have kindly offered their services in the arrangement of the
exhibits.
In order that the show be a success it is hoped that all those who have articles to
exhibit please do. It does not matter what the subject is—the more exhibits the better.
Examples of the exhibits last year are:
Paintings
Etching
Photographs
Woodwork
Model train
Yacht
Copperwork
Fretwork
Cabinet work
Tropical Fish
Prizes of the various classes will be a small engraved silver cup and the Grand
Prize—the perpetual trophy—a handsome cigarette box donated by Birks Ltd. Judges
will be from the Vancouver School of Art.
All exhibits are to be sent to the Hobby Show, care of the Bell Captain, Vancouver
Hotel, not later than Monday, October 1, and to be picked up again, Saturday, October
6. The exhibits sent from out of town will be packed by professional packers and
returned by post.
Do not be too shy to send in a sample of your work.
A. C. GARDNER FROST, M.D.,
Chairman Hobby Show Committee.
ANNUAL MEETING  SECTION OF DERMATOLOGY
The  inaugural  Section  Meeting  of  Dermatology  will  be  held  on  Wednesday,
October 3.    Time and place will be announced to members later.
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oo  BRIEF SERIES OF LECTURES ON PSYCHIATRY
IN GENERAL PRACTICE*
W. DONALD ROSS, M.D.   (Man.), F.R.C.P.  (C)
Assistant Professor of Psychiatry, University of Cincinnati
no. 5 — indications and contraindications for psychiatric
Breferral
"To refer or not to refer; that is the question." We might frame this problem
of psychiatric referral along the lines of Hamlet's soliloquy: "To be or not to be" . . .
and paraphrase portions of it thus: "Whether 'tis nobler in one's own office to suffer
the slings and arrows of outrageous fortune, or to take arms against a sea of troubles, and
by referral, end them .... but in that consultative step what dreams may come, must
give us pause." There is one thing wrong with this framework for our problem.
Hamlet was contemplating suicide, and psychiatric ,referral is hardly tantamount to
death, nor should it end the relationship between the general physician or surgeon and
the patient.
There is the problem, of course, as.to whether the patient would be insulted by a
psychiatrist referral, in view of the traditional association, in the past, of the psychiatrist with the mental hospital and with insane people, and, also in the past, with
custodial care rather than active treatment. However, this situation has changed.
Psychiatrists are no longer concerned solely with the care of complete misfits of society.
The general public knows this. The flood of cartoons and jokes about psychiatry
recently, with their embarrasing publicity for the psychiatrist, is testimony to the
widespread acceptance of psychiatry as a medical specialty, even if it should still be a
slightly hostile acceptance. Doctors at times may even be behind the laity in this
acceptance, certainly behind some of their patients who would like psychiatric help
but whose physicians are apprehensive that they might be hurt by the suggestion of a
psychiatric consultation. This is illustrated by an experience at a Canadian Army
hospital overseas around the end of World War II. A major who was a patient on the
medical side of the officer's ward came to my office to ask if he could see me. I told
him that I would see him on referral from the physician looking after him, so he
proceeded to ask his doctor for a consultation with me. The doctor, who was the
O.C. of medicine, told me afterwards that he had actually been wondering how to
break the news to this officer that he would like a psychiatric consultation!
Another problem lies in the fact that physicians often look on a psychiatric
referral as a last resort, or as a means of disposal for a troublesome patient. Such
referrals may be made with poorly veiled hostility on the part of the doctor, as if to
say: "I can't help you, you had better see a psychiatrist." Such a referral, of course,
does not help the patient to receive the psychiatrist in a favorable light. And it does
hurt the patient, because of the feeling of rejection engendered in the patient by what
has been an actual, even if disguised, rejection. The psychiatrist may not be able to
undo the effects of a rejecting referral, especially of the patient is resentful and
defensive, and the result may corroborate the physician's fear that psychiatric referral
is not worthwhile anyway.
The helpful method of referral to a psychiatrist is one which puts the consultation
in the same light as a referral to any other specialist. Patients have anxiety about
referral to any specialist. They wonder how seriously ill they may be, or why it is
that their doctor cannot handle the problem himself. Doctors are accustomed to
handling this anxiety with regard to referrals to other specialists. They can handle
the added anxiety of misconceptions about psychiatry by presenting the suggestion in
an unperturbed way, as a consultation with a colleague who specializes in emotional
disorders such as the patient has confided in the doctor. Such consultations go more
smoothly if the general practitioner has already taken the trouble to listen to the
patient and elicited enough of personal information for the patient to recognize the
* Presented to the Vancouver Medical Association, May 2 8-June 1, 1951.
Page 300 value of specialized help on emotional problems. With such information the doctor
can also be more confident that psychiatric referral is indicated rather than further
help by himself, or referral to a family agency or to some other counsellor such as a
minister or a lawyer or a vocational guidance expert or other psychologist.
The actual indications and contraindications will vary in accordance with the
amount and kind of psychiatric help available in the particular community, for
example, with how much psychotherapy is done by the psychiatrists who are available.
If there are not enough psychiatrists in a community they will be too busy with
diagnostic assessments or with physical treatments, and so that group of patients who
could benefit from intensive psychotherapy may have to return to the general physician
with a feeling that the consultation was not worthwhile. The general physician will,
of course, not be deciding what type of psychiatric treatment will be carried out by
his specialized colleague, nor giving the patient any promises on this score. However,
just where he will draw his line on referral versus non-referral in regard to patients
who might need psychotherapy rather than physical methods of treatment, will depend
on the methods being used by the psychiatrists who are available. This will be decided
most wisely after trial and error with different referrals. An excellent arrangement
is to have a contract with a psychiatrist whom you can consult about your patient
before broaching referral to the patient, so that the psychiatrist can advise you as to
whether he might be able to be of help or, alternatively, to give you advice about your
handling of the problem.
I shall give you a list of suggested indications and one of suggested contraindications, and then discuss the less obvious items in these lists and the borderline
problems.
SUGGESTED  INDICATIONS
Depression with sufficient retardation so that patient is not able to talk easily about
his troubles.
Depression with suicidal risk.
Other suicidal risks or, threats.
Active psychotic symptoms.
Somatic symptoms with moderately severe emotional factors of moderately long
duration.
Behaviour disorders of recent onset.
Psychoneuroses with predominantly psychic symptoms.
Physical illnesses with moderately severe emotional complications interfering with treatment or prolonging convalescence.
Patients who have had repeated operations with return of symptoms.
Patients with too strong an emotional attachment to the general physician  creating
difficulties for him.
SUGGESTED CONTRAINDICATIONS
Mild psychoneuroses of recent onset.
Somatic symptoms with mild emotional factors of recent onset.
Very chronic severe psychoneurotics, especially with hypochondriacal features possibly
bordering on psychotic.
Eccentric characters with inactive psychotic features and no changes in symptoms
taking place.
Patients  who  are  happily  dependent  on  the   general  physician   and  not   creating  a
problem for him.
Long standing severe behaviour disorders.
The principles in these lists include the idea that general physicians should be
able to treat the milder conditions of recent onset, and that some of the more chronic
conditions, if not involving any active risk, can be handled better in a palliative,
supportive way by a general physician rather than by a psychiatrist. The most common
error in psychiatric referral by general physicians is to refer the chronic hopeless cases
Page 301 who can only be supported in any case, and to hang on too long to moderately severe
psychoneurotic patients who might be cured by intensive psychiatric treatment. If
psychiatric treatment is not going to offer anything new, and if it is not necessary to
assess the problem, it may be upsetting and disappointing. If there is a good working
arrangement with a psychiatric, of course, the borderline patients can be seen by a
psychiatrist and returned for the general physician to continue supportive treatment
in accordance with specialized advice. Some of the best referrals in terms of the benefit
to the patient, have come from internists practicing good psychosomatic medicine, who
have sent mainly three types of patients: depressed patients in need of shock treatment,
moderately severe neurotic patients, or patients with physical illnesses and emotional
problems, in need of intensive psychotherapy, and borderline psychotic patients who
were stirred up by the internist's history taking but who settled down after a few
psychiatric sessions, and who were then best handled by occasional supportive visits
to the internist, having gained some reassurance from having run the gauntlet of
psychiatry and remained intact.
REPORT ON THE SURVEY OF
CRIPPLING DISEASES OF CHILDREN
Made in the Province of British Columbia
by the Sub-Committee on Crippling Dieseases
of Children (Federal Grant)
October,  1950
MEMBERS OF THE SUB-COMMITTEE ON CRIPPLING DISEASES OF CHILDREN
Chairman Dr. Donald Paterson
Vancouver Preventorium Mr. H. K. Hall
Queen Alexandra Solarium ||p* Dr. Glen Simpson
Mr. R. L. Mayhew
Junior Red Cross i Miss M. Palmer
Children's Hospital Mr. E. S. H. Winn
Mr. H. P. j Gunn
St. Paul's Hospital Dr. George Lamont
Western Society for Physical
Rehabilitation Dr. W. J. Thompson
Department of Health and
Welfare \ - Dr. George Elliot (co-opted)
Metropolitan Health Committee Dr. Stewart Murray (co-opted)
Division of Vital Statistics Mr. J. H. Doughty
l^^^y    Vancouver General Hospital^ Dr. Reginald Wilson
Health Centre for Children Dr. A. F. Hardyment
Although the preliminary discussions and detailed organization of the Survey
started in April, 1949, it was not until September, 1949, that a definite plan with a
satisfactory card of enquiry was produced. Later in the year final improvements were
made on this enquiry card.
Prior to the distribution of the enquiry card, the British Columbia Medical
Association Executive were approached and they passed the following resolution: "The
British  Columbia  Medical Association  approves of  the  carrying out of  a  survey of
Page 302 crippling diseases of children in this Province, and requests that all doctors in British
Columbia cooperate to the fullest extent to ensure a complete and accurate picture
being obtained."
The enquiry card or questionnaire was drawn up by a group composed of
Orthepaedic Surgeons, Paediatricians and Specialists in the Diseases of Eye, Ear, Nose
and Throat, Skin, Mental Diseases and with the advice of the Division of Vital Statistics
for the Province.
In order to ascertain the best method of carrying out this work, a small pilot survey
was undertaken of those doctors in the Cambie-Broadway district of Vancouver and
also in the Abbotsford district, the former being an urban and the latter being a rural
area. From the replies and records received, it was clear that in the city area response
from private doctors would be an extremely small one. In a rural area such as
Abbotsford, the response from the private doctors was very limited by a high degree
of cooperation manifest. It became evident immediately that the survey would
need to be conducted by Public Health Nurses and Doctors throughout the Schools
and Well Baby Clinics and by our own trained nurse who would examine hospital
records on a large scale.
Over the past year, therefore, the Public Health Nurses and Doctors in larger
cities and in the smaller towns and country districts throughout the Province have
filled in these cards and sent them to the Division of Vital Statistics for tabulation.
In addition our own Registered Nurse has examined the records of all hospitals and
institutions where children with any crippling disease are treated or lodged. In these
lattr institutions the records of infants and children from birth to the age of 21 have
been carefully examined and thus those admitted during the years 1948 and 1949 are
included in our records. Up to date over 20,000 cards have been tabulated by the
Division of Vital Statistics, and it is on the figures received from such cards that we
base our conclusions and recommendations for the future.
On May 29th, 1950, a preliminary survey of 7,000 cards was made by the Division
of Vital Statistics, but it was obvious that no conclusions at all could be drawn from
such figures as they contained glaring discrepancies due to the irregular collection
of data from the various institutions. Nevertheless, it became obvious that even in
the first 7,000 cards matters of interest appeared. It was clear that we would be
collecting a vast number of children with refractive errors, the number of spastics
(Cerebral Palsy, cases) was much greater than had been visualized, and that the
Province contained a number of unsuspected defects. It was also realized that the
data received about these children was arriving far too late to be of maximum importance. Instead of the disease and deformities being notified at birth or shortly
after, our records were obtained from hospitals where such children were receiving
attention at a much later date. This suggested that the optimum time for notification
of crippling diseases of children was at birth, and steps were then taken to contact
the Division of Vital Statistics for the improvement of the Physicians' Notification of
Birth Card so as to include as much pertinent information and as many conditions
causing crippling diseases later on, as possible.
At a meeting of the Sub-Committee on Crippling Diseases of Children on May
18th, 1950, the question of the institution of a register of Crippling Diseases of
Children in the Province was considered. The diseases which might be registered were
those which (a) might cause difficulty in a child's obtaining education and (b) those
which put him at a disadvantage in earning his living later on. When the first 7,000
cards were examined, it was clear from the material obtained that we should be warranted
in advocating the setting up of a registry of Crippling Diseases of Children for the
Province.
Up to date 20,000 cards have been tabulated, and going over the data obtained
it fell into several clear-cut groups:
1. Those diseases which start as an acute illness and those <that require surgery
and which are treated largely in our active treatment hospitals.-    Conditions such as
Page 303 Rheumatic Fever which may give rise to a heart ailment or Poliomyelitis which may
leave paralysis of various muscles could be cited as examples of the former, while
hernia, undescended testes, mastoiditis and abscesses as examples of the latter.
2. Those chronic conditions which may require a long continued stay in hospital,
such as Rheumatoid Arthritis, Congenital or Acquired Heart Disease, Tuberculosis
Disease of the bones, joints and spine, and Congenital Malformations make up this
group. In dealing with Congenital Malformations, reparative surgery and long continued rehabilitation will be necessary.
3. This group would require prolonged or indefinite institutionalization and are
made up of the grossly mentally defective, serious cases of deafness and blindness, and
children with incurable congenital malformations and chronic acquired disease.
In the period June, July and August, 1950, the interested groups of the Medical
Profession were consulted and we were able to obtain from them their suggestions
as to which of the conditions it would be most worthwhile to register.
Taking our Group 3 first, namely those with a gross mental defect and serious
cases of deafness and blindness, the Province has already made fairly adequate provision for institutionalizing these, but for children with incurable congenital malformations and chronic acquired disease, up to the moment there is no adequate institution
available.
Turning to our Group 1, namely those suffering from acute disease which may
leave damaging after effects, or those requiring surgery of a reparative type, the Province is moderately adequately provided and the standard of nursing and medical care
reasonable, although it is to be hoped this will be augmented and improved in the
near future.
It would appear that our chief problem and hope lies in the 2nd Group where long
term treatment both as in-patients and out-patients will need to be undertaken. In
order to deal with the large numbers of cases which the survey has revealed, there
would need to be a great increase in long term beds and greatly augmented out-patient
facilities over those at present available. What facilities have we for the treatment of
children suffering from Asthma, minor degrees of Deafness, Congenital Heart Disease,.
Squint and severe Refractive Errors? What provision have we made for prolonged
physiotherapeutic treatment for such conditions as after effects of Poliomyelitis and
Cerebral Palsy, and how are we dealing with cases of speech defects and Childhood
Tuberculosis? We must confess that they are woefully inadequate and what treatment is available is largely available only in one or two centres.
We do not know the exact proportion of those children in the Survey who are
already under treatment or who have now recovered, but there is strong evidence that
a sufficient number have not yet received any treatment or are inadequately treated to
warrant the Sub-Committee making the following recommendations:
1.    Policy
(a) Short Term. As an immediate or short term policy, we would recommend
the setting up of a voluntary registry. In order to do this we would need to approach
the British Columbia Medical Association for their cooperation and permission to
circularize the whole of the Medical Profession about the details of the registry. We
visualize that it would be necessary to engage a clerk or individual with executive
ability and possibly some experience in Social Service who would report to the Subcommittee on Crippling Diseases of Children. It would be understood that the Sub-
Committee on Crippling Diseases of Children would continue to advise and help direct
policy and be kept thoroughly informed of the results of this voluntary registry.
rExperience having been gained over a period of months or years, the long term policy
outlined below could then be further implemented. It is obvious that as the registry
accumulated material, the further need for expansion of our hospital and institutional
facilities would be increasingly obvious, and this would be a great help in exerting
pressure for such an expansion. It might be advisable to have a small sub-committee
of medical personnel from the institutions concerned, paid on a sessional basis, who
Page 304 would screen these cases and advise how they would best be dealt with. The groups
which would be collected in the first instance would be those for which we already
have some facilities, such as squint, hearing, speech therapy, spastics, heart disease, etc.
(b) Long Term. After a study of the short term policy, a Province-wide
notification of Crippling Diseases of Children should be set up with the object of
continuing to uncover those crippling diseases which place a child at a handicap in
receiving education or in earning his livelihood later. This would give us statistically
the number of children suffering from crippling diseases which had been reported each
year. Out of such notifications a Registry limited to the low income group or those
requiring institutionalizing, and possibly confined to only certain selected diseases,
should be undertaken. Such a Registry would be used to follow up these low income
group cases in an effort to assist the doctors and if necessary, parents, in securing
adequate treatment. This Registry would assist in coordinating facilities available
in the Province in such a way that the child would receive the maximum of care.
1. It is recommended that in the case of the first group, which deals with acute
acute infections which may lead to permanent damage, or where reparative surgery
is undertaken, the present faculties should he expanded and improved. Children with
disabilities requiring a longer stay should be transferred to those hospitals or institutions
which are equipped to keep them for a prolonged period, thus freeing more acute beds.
To be more explicit, in the acute group, expansion would be necessary in first the
number of beds available, and secondly in the providing of out-patient facilities for
after care and follow up of those cases discharged from the wards. The institution
of an out-patient implies more than just the seeing of patients at various clinics. It
also carries with it the possibility of out-patient Physiotherapy, Speech Therapy, and
educational facilities which are so necessary for rehabilitating a crippled child.
3. Dealing with the largest and most important group, Group 2, namely those
requiring long stay, both as in-patients and out-patients, and also possibly reparative
surgery, a much augmented number of beds should be made available Province-wide.
Such beds and out-patient facilities must carry with them ancillary services such as
physiotherapy and those skilled in the treatment of Cerebral Palsy, as well as occupational therapy and educational therapy, orthoptics and speech therapy, in order to be
of the maximum value. Experience has shown that a great number of beds can be
freed if an adequate out-patient service is available, particularly if the ancillary services
are of a high order.
4. In our 3rd Group which consists of the Mentally Defective and the Deaf and
Blind, although the Provincial services have been and are being augmented from time
to time, they are still inadequate and they do not provide anything like a sufficient
number of beds for those children between birth and six years. We are not aware
of any facilities in the Province for the care of those suffering from incurable congenital
malformations or chronic acquired disease. An examination of our figures will reveal
the fact that such beds are urgently needed.
We feel that the Government of the Province of British Columbia should interest
itself much more in this vital problem than it has heretofore, working through a
voluntary Committee of interested parties, both medical and lay, such as the Sub-
Committee on Crippling Diseases of Children. This Committee should work through
existing agencies and thus bring about a closer spirit of cooperation and efficiency.
We recommend that this Sub-Committee be permitted to make this report available
to all interested agencies who by its use could further the work.
This our Report is hereby approved and recommended for submission to the
Minister of Health and Welfare for the Province of British Columbia.
Donald H. Paterson, M.D.
Chairman for Sub-Committee on Crippling
Diseases of Children (Federal Grant)
Schedule A.    Listing of Disabilities by Type of Treatment Required.
ill Page 305 Table I. Showing the Figures by the Source of Reporting.
Table II. Showing the Figures by Diagnosis and Whether Under Treatment.
Table III.        Showing the Breakdown of Survey Figures into the Three Major Groups
Mentioned in this Report.
SCHEDULE A
Listing of Disabilities by Type of Treatment Required
Group 1—(Requiring Short Term Treatment)
1. Syphilis and Gonorrhoea.
2. Acute Poliomyelitis.
3. Other infections such as Acute Infectious Encephalitis, Meningococcal Meningitis, etc.
4. Neoplasms—Malignant and Benign.
5. Acute Rheumatic Fever.
6. Chorea.
7. Refractive Errors—not constituting any special disability.
8. Hernia.
9. Hydrocele.
10. Cleft Palate and Hare Lip—Initial Surgical phase.
11. Undescended Testes.
Group 2—(Requiring Long Term Treatment)
1. Tuberculosis—Pulmonary, Primary, Bone and Joint, and other.
2. Poliomyelitis—after effects.
3. Chronic Asthma.
4. Diabetes.
5. Other Metabolic  and Nutritional disturbances including Coeliac Disease.
6. Endocrine Disturbances—Pituitary, etc.
7. Blood Diseases Haemophilia, etc.
8. Borderline Mental Deficiency.
9. Speech Defects—Organic and Psychogenic.
10. Severe  Personality  Disorders—Requiring  help   from  a psychiatrist  and  Social
agency.
11. Mental Illness—such as Schizophrenia, Psychoneurosis, etc.
12. Cerebral Palsy with Normal Mentality.
13. Epilepsy with Normal Mentality.
14. Other  Nervous  Diseases—such  as  after  effects  of  Encephalitis  or  Meningitis,
Cerebral Hemorrhage, etc.
15. Severe  Refractive Errors  and other  Diseases  of  the Eye including  Cataract,
Glaucoma, etc.
16. Strabismus.
17. Impairment of Hearing
18. Chronic Rheumatic Heart Disease and other Chronic Heart Disease  (acquired).
19. Bronchiectasis and other Respiratory Diseases including Empyema.
20. Malocclusion and Gross Dental Abnormalities.
21. Diseases of Digestive System including Fibrocystic Disease of the Pancreas.
22. Chronic Nephritis or Nephrosis.
23. Rheumatoid Arthritis.
24. Osteomyelitis.
25. Osteochondritis.
26. Curvature of the Spine.
27. Club Foot.
28. Severe Flat Foot, Bow Legs, Knock Knee.
29. Rickets—after effects.
30. Other Diseases or Malformations of Bone and Joints such as Pseudo-Hypertrophic
Muscular Dystrophy  (Eventually in Group 3). ^p|
Page 306 31. Congenital Cataract.
32. Other Congenital Malformations of Nervous System not classified elsewhere,
such as Aplasia, Dysplasia, or Hypoplasia of Spinal Cord or Nervous System.
33. Congenital Heart Disease.
34. Cleft Palate and Hare Lip—Cases requiring repeated Surgery and Speech Therapy.
35. Congenital Malformations of Digestive System such as Hirchsprung's Disease.
36. Congenital Malformations of Genito-Urinary System, such as Extroversion of
Bladder, etc.
37. Congenital Dislocation of Hip.
38. Other Congenital Malformation of Bone and Joint such as Osteogenesis Imperfecta (also in Group 3).
39. Other Congenital Malformations causing disability and requiring long term
treatment—such as absence or replacement of any organ or site not classifiable
elsewhere.
40. Birth Injuries—Cranial, Spinal, or others—such as Brain Hemorrhage, Hematoma,
Erb's Paralysis, etc.
41. Fractures, Amputations, Burns and Nerve Injuries, with resulting disability.
Group 3—(Requiring Institutionalization)
1. Gross Mental Defects—including Cerebral Palsy, Epilepsy and Hydrocephalus
with Mental Deficiency.
1. Blindness.
3. Deafness or Deaf Mutism.
4. Monstrosity.
5. Severe Spina Bifida.
6. Severe Congenital Heart.
7. Pseudo-Hypertrophic Muscular Dystrophy.
TABLE I
Showing the Figures by the Source of Reporting
Reported by Male Female Total
Vancouver  General   Hospital  1262 812 2074
St. Paul's Hospital . j  271 185 476
St. Vincent's Hospital . -  92 40 132
Royal Columbian Hospital  152 93 245
Children's Hospital  683 499 1182
Royal Jubilee Hospital  135 90 225
St. Joseph's Hospital ~ i  47 .30 77
Grace Hospital  7 18
Queen Alexandra Solarium  351 278 629
Division of Tuberculosis Control  353 483 836
School for Mental Defectives  98 123 221
Metropolitan   Health  2631 2943 5574
Health Centre for Children  466 387 853
Provincial  Public  Health  1835 2083 3918
Private   Physicians  222 167 389
Indian Health Service  20 23 43
Victoria  Health  Unit  466 455 921
Child Guidance Clinic  195 112 307
Preventorium    \  46 45 91
School for Deaf and-Blind  66 56 126
Western Rehabilitation Centre  10 14 24
Speech Clinic  35 14 49
V.D. Clinic  777
School for Mental Defectives - additional cases  150
19,303
Page 307 TABLE II
Showing the Figures by Diagnosis and Whether Under Treatment
0020
0040
0010-
■0190
0200-
•0390
0800-
0803
0810
0400-
•1380
1400-
•2050
2100-
■2290
2300-
•2390
2410
2400-
2450
2500-
2540
2600
2700-
-2770
2830-
■2840
2870
2800-
•2892
2900-
2990
3253
*251-
■2-4-5
3261-
3262
3264
3000-
-3263
3510-
-3520
3530
3300-
■3690
3800
3801
3840
3890-
■1-2-3
3700-
-3880
3911-
-3912
3930
3970
3980-
-3982
3983
3900-
-3960
4000
4010
4020-
-4021
4100-
-4160
4343
4200-
■4470
4500
-4680
5260
4700-
-5272
5330
5600-
-5615
DISEASE OR DISORDER w *g
Total Cases Under Treatment £ 2
Pulmonary  T.B.     130
Primary T.B.  :  353
Other T.B.   I  68
Syphilis and Gonorrhoea   4
Poliomyelitis — Acute  22
Poliomyelitis—After effects .       18
Other Infections   4
Malignant Neoplasms  -  5
Benign Neoplasms   30
Unspecified Neoplasms   3
Asthma  223
Other Allergies  1
Thyroid  I  5
Diabetes  2
Other Endocrine Glands   12
Rickets  17
Obesity  196
Other Metabolic   11
Blood Diseases   '        3
Borderline Mental Defects  49
Gross Mental Defects   273
Speech Defects  119
Personality Disorders   62
Other Mental Illness  | 128
Cerebral Palsy   (Spastics)     63
Epilepsy  I J .  3 0
Other Nervous Diseases   26
Refractions—Corrected    -  445
Refractions—Uncorrected  2216
Squints  |  168
Blindness    3 2
Other Diseases of Eye  25
Chronic Otitis Media  3 6
Mastoiditis    10
Deaf Mutism   —
Deafness  3 9
Hard of Hearing   219
Other Diseases of Ear  1
Rheumatic Fever—Acute   94
Rheumatic Fever with Heart   11
Chorea  .  11
Chronic  R.H. Disease    32
Acquired H.D. other than R.   45
Other Heart Disease  18
Arteries and Veins |  1
Bronchiectases    |  8
Other Resp. Diseases  10
Malocclusion  6 5
Hernia   98
Page 308 -5872
-5930
-6030
-6371
-7160
-7270
-7303
-7442
-7452
1-7492
-7586
-7593
Other Dis. of Digestive System	
Nephritis  |	
Other Diseases of Kidney	
Hydrocele |	
Other Genito-Urinary Diseases	
Skin 	
Abscesses   	
Arthritis	
^Osteomyelitis	
Osteochondritis  	
Other Bone Diseases	
Curvature of Spine .	
Flat Feet « :	
Club Foot ..	
Other Deformities 	
Monstrosity   	
Spina Bifida	
Congenital Hydrocephalus 1	
Other Congenital Mai. of N.S. 	
Congenital Heart Disease       121
Cleft Palate 	
Congenital Mai. of Dig. System	
Undescended Testes _• ■....
Other Congenital Mai. G.-U. System __
Congenital Dis. of Hip	
Other Cong. Mai. of Bone and J.	
Other Congenital Malformation	
Cranial or Spinal Birth Injury 	
Other Birth Injury	
Erythroblastosis _•	
Other Diseases of Early Infancy 	
Speech—2nd to Organic	
Other and 111 Defined	
Fractures  g	
Dislocations  -—
Sprains s	
Head Injuries	
Internal Injuries 	
Open Wounds, Eyes, etc. 	
Amputations  —.	
Contusions 	
Foreign Bodies	
Burns  i	
Nerve Injuries	
Other  |	
2
48
—
50
5
24
—
29
8
38
1
47
8
18
1
27
2
10
—
12
6
48
—
54
—
16
—
16
6
51
—
57
8
99
—
107
9
115
1
125
20
84
1
105
58
66
3
127
82
255
I 2
339
15
293
1
309
28
132
1
27
1
161
1
39
9
3
6
21
— i
42
19
19
2
40
121
117
5
243
19
161
5
183
1
68
2
71
101
53
1
155
12
61
—
73
4
63
—
67
42
75
4
121
25
44
2
71
11
11
—
22
10
62
—
72
7
27
—
34
1
4
—
5
22
35
—
57
8
42
—
50
21
852
—
873
1
5
1
7
1
8
2
~—
8
3
7
40
1
48
4
53
—
57
2
16
—
18
—
16
—
16
1
161
—
162
—■
9
—
9
—
2
—
2
6164    12975    164    19303
Page 309 TABLE III
SHOWING THE BREAKDOWN OF  SURVEY FIGURES INTO THE
THREE MAJOR GROUPS MENTIONED IN THIS REPORT
This Is Not a Final Breakdown As Some Of The Figures Should Be
Divided Between Two Groups According To Severity of Disability.
Group 1—(Requiring Short Term Treatment)
No.
Refractive Errors—Corrected   3943
Uncorrected    2527
Syphilis and Gonorrhoea   786
Hernia    -i|j 478
Other Disabilities—Mastoiditis, Erythroblastosis, etc.   333
Neoplasms   i  311
Rheumatic Fever—Acute   219
Poliomyelitis—Acute  1  206
Undescended Testes   155
Chorea    . jg 3 5
Hydrocele  27
9020
243
1.26
183
0.95
121
0.62
73
0.38
71
0.36
67
0.35
42
0.22
40
0.21
99
0.51
Group 2—(Requiring Long Term Treatment)
Tuberculosis     1168
Congenital Malformations  939
Heart 	
Cleft Palate and Hair Lip       183
Bone and Joint 	
Genito-Urinary System 	
Digestive System 	
Dislocation of Hip	
Cataract 	
Nervous System	
Other 	
Fractures •  873
Squints  I -- 1  786
Asthma    -  —- 678
Glandular and Metabolic—Obesity and Thyroid  426
Impairment of Hearing   361
Cerebral Palsy I  3 5 8
Flat Feet  3 3 9
Club Foot  309
Other Mental Illness   291
Other Injuries—Burns, Nerves, etc.  . 287
Speech Defects    273
Heart Disease—Acquired or Rheumatic  267
Other Bone Deformities—Bow Legs, Knock Knee   266
Epilepsy    161
Personality Disorders  1  132
Curvature of Spine   127
Osteochondritis  ..  125
Other Nervous System Diseases  122
Osteomyelitis  ' 107
Diseases of the Ear  104
No.
Page 310
%
20.42
13.09
4.07
2.48
1.73
1.62
1.13
1.07
0.80
0.18
0.14
46.73
6.05
4.86
4.52
.4.07
3.51
2.21
1.87
1.85
1.76
1.60
1.51
1.49
1.42
1.38
1.38
0.83
0.68
0.66
0.65
0.63
0.55
0.54
% Birth  Injuries  	
Malocclusion	
Other Diseases of the Eyes	
Poliomyelitis—After Effects _ !	
Rickets—After Effects	
Diabe tes	
Mental  Deficiency—Borderline 	
Other Diseases—Skin, Allergies, etc.  .	
Rheumatoid Arthritis :	
Other Diseases of Digestive System—Intestinal and Pancreas
Other Diseases of Genito-Urinary System—Kidneys	
Bronchiectasis	
Chronic Nephritis and Nephrosis I	
94
0.49
87
0.45
82
0.42
82
0.42
81
0.42
74
0.38
65
0.34
62
0.32
57
0.30
50
0.26
47
0.24
40
0.22
29
0.15
9349
48.43
Group 3—(Requiring Institutionalization)
Gross Mental Defects 	
Deafness and Deaf Mutism	
Blindness   	
Spina Bifida and' Monstrosity 	
682
3.53
139
0.72
73
0.38
40
0.21
934
4.84
19303
100.00
Page 311 n
ew5 an
d floted
Dr. R. D. McKay, former pediatric resident at the Vancouver General Hospital,
is now in practice with Dr. A. S. Turner of Lulu Island.
Dr. K. K. Pump is now on the staff of the Department of Tuberculosis Control
in Vancouver.
Dr. M. W. Chepesiuk of Vancouver has retired.
Dr. C. H. Bastin of Vancouver has retired.
Dr. J. R. Parish is now practising surgery in Vancouver.
Dr. E. D. Herberts is now practising Urology in Vancouver.
Dr. W. Laishley of Nelson has retired.
Dr. P. M. McLean is now practising orthopaedics in New Westminster.
Dr. Aaron Malkin of Shaughnessy Hospital is now at the Pathological Institute
in Montreal.
Dr. D. K. Merkely of Saskatchewan is now practising in Vancouver.
Dr. W. G. Morris of New Westminster has retired.
Dr. R. E. Beck of Vancouver is now resident in medicine at the Royal Victoria
Hospital.
Dr. A. W. Brown of Kelowna has received Certification in Ophthalmology.
Dr. J. W. Anderson formerly associated with one of the groups of doctors of
Hong Kong has joined the staff of the Victoria Tuberculosis, Division.
Dr. Herbert Murphy, director of the Royal Jubilee Hospital radiology department
for 20 years, has retired from the staff.    Dr. H. M. Edmison succeeds Dr. Murphy.
Dr. C. Ibbotson who has spent five years with the Indian medical service has
joined the radiology staff of the Royal Inland in Victoria.
Dr. George McKenzie has begun to practice in Victoria.
Dr. Charlotte Dohan is in practice in association with Dr. Anne Steel of Victoria.
Dr. Ian Kenning is in practice with Drs. S. and G. Kenning of Victoria.
Dr. Lucille Wilson is a resident in pathology at the Royal Jubilee.
Dr. Enid Denton is a resident in Obstetrics and Gynecology at the Royal Jubilee.
Dr. A. E. Gillespie has begun a practice in pediatrics in Victoria.
Dr. L. H. Appleby of Vancouver addressed the International College of Surgeons
in Chicago this month.
Dr. C. M. Robertson of Creston is now living in Osoyoos.
Dr. E. S. Sarvis of Huntington has retired.
Page 312 Dr. J. H. MacDermot, September 22, 1951.
Editor,
Vancouver Medical Association Bulletin,
925 West Georgia Street,
VANCOUVER, B.C.
Dear Mr. MacDermot:
Re: Admission Chest X-Rays
I am writing this letter in the hope that its contents may be made available to
the members of the Medical Association throughout the Province. I feel that practising
physicians will welcome information with respect to the facilities in local hospitals
for X-ray examinations of the chest.
The Provincial Department of Health, with the assistance of the Federal Health
Grants, has installed four photo-roentgen X-rays, using miniature film, in the major
hospitals of the Province. There are now more than thirty such installations in
hospitals selected on the basis of annual admissions or strategic location. These are
listed at the end of this letter.
There were three reasons for installing this equipment:
1. To provide protection to other patients in the hospitals;
2. To provide protection to the staff of the hospitals;
3. To serve as a case-finding method.
The increased risk of tuberculosis among hospital personnel has long been recognized and, for a number of years, a satisfactory method of controlling exposure to
tuberculosis infection has been sought. A practical screening method became possible
with the development of photo-roentgen x-rays using miniature film. The tuberculosis
hazard can be recognized and, therefore, minimized through the routine use of this
equiprrunt for chest x-rays on admission to hospital. It has also been well established
that examination of hospital admissions is the most efficient case-finding method yet
discovered. A higher percentage of tuberculosis is fdund in this way than by surveys
of other groups.
In some hospitals in British Columbia, almost one hundred per cent of admissions
are being x-rayed. (It has been shown that, on the average, at least seventy-five per
cent of admissions could be x-rayed conveniently.) However, in other hospitals in
the Province, only a small percentage of admissions are being x-rayed. It is with
respect to these that we wish to stimulate interest. We would, therefore, welcome even
further assistance from the medical profession who, we hope, will arrange for the chest
x-rays of all of their patients admitted to hospitals in which the miniature equipment
has been installed.
It should also be known that, in most areas, out-patients may be referred from
the doctor's office to the hospital. Many doctors throughout the Province have established ,a policy under which all cases visiting their offices are referred to the local
hospital for chest x-rays. The Department of Health is impressed with this policy
developed by the practicing physicians and hopes that other physicians will see its
value and institute similar programmes.
Fpr the information of all concerned, the hospitals in which the equipment has
been installed are as follows:
St. Paul's Hospital  _  Vancouver
Metropolitan Health Unit   Vancouver
Royal Columbia Hospital  New Westminster
St. Vincent's Hospital   Vancouver
Vancouver General Hospital  I  Vancouver
Royal Jubilee Hospital   Victoria
St. Joseph's Hospital  |  Victoria
McDougall Hospital  Kimberley
St. Eugene Hospital  . Cranbrook
Page 313 Trail-Tadanac   Hospital       Trail
St. Joseph's Hospital Comox
Royal Inland Hospital  -  Kamloops
Mater Misericordiae Hospital   Rossland
Prince Rupert General Hospital Prince Rupert
Kelowna General Hospital __•_  Kelowna
Kootenay Lake Hospital   Nelson
Vernon Jubilee Hospital  |  Vernon
West Coast General Hospital   Port Alberni
Ocean Falls General Hospital   Ocean Falls
Mount St. Joseph's Hospital Vancouver
Lourdes General Hospital Campbell River
King's Daughters Hospital I* Duncan
St. Mary's Hospital  New Westminster
St. George's Hospital   Alert Bay
Fernie General Hospital   Fernie
Chilliwack General Hospital __.» Chilliwack
Grace Hospital Vancouver
Powel River General Hospital   Powell River
Penticton General Hospital   Penticton
Uorth Vancouver General Hospital  -.— North Vancouver
Creston Valley General Hospital Creston
Prince George and District Hospital   Prince George
Nanaimo General Hospital Nanaimo
In closing, I should like to thank you for this opportunity of communicating,
thrc   >h the Bulletin, with the members of the Medical Association.
Yours sincerely,
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health &
Provincial Health Officer.
Page 314
4  »>4% JL Im ^ *-.
SERIALS
2S'
- 1979 i' '
*        * Hops
UNIVERSITY OF B.C. LIBRARY
—..... i..i mi ,aa ,i
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