History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: May, 1946 Vancouver Medical Association May 31, 1946

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 THE    VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
Dr. J. H. MacDermot
Dr. G..A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XXII
MAY, 1946
No. 8
Dr. Gordon Burke
Son. Treasurer
OFFICERS, 1946 - 1947
Dr. H. A. Des Brisay Dr. G.' A. Davidson Dr. Frank Turnbull
President Vice-President Past President
Dr. Gordon C. Johnston
Hon. Secretary
Additional Members of Executive: Dr. W. J. Dorrance, Dr. J. W. Shier
TRUSTEES
Dr. A. W. Hunter        Dr. G. H. Clement      Dr. A. M. Agnew
Auditors: Messrs Plommer, Whiting & Co.
SECTIONS
Clinical Section
Dr. E. R. Hall Chairman Dr. Reg. Wilson Secretary
Eye, Ear, Nose and Throat
Dr. Roy Mustard Chairman Dr. Gordon Large Secretary
Paediatric Section
Dr. Howard Spohn Chairman Dr. R. P. Kinsman Secretary
Orthopaedic and Traumatic Surgery Section
Dr. K. J. Haig Chairman Dr. J. R. Naden Secretary
Section of Neurology and Psychiatry
Dr. A. M. Gee ..Chairman Dr. J. C. Thomas Secretary
STANDING COMMITTEES
Library:
Dr. W. J. Dorrance, Chairman; Dr. D. E. H. Cleveland, Dr. J. E. Walker,
Dr. R. P. Kinsman, Dr. J. R. Neilson, Dr. S. E. C. Turvey.
Publications:
Dr.  J. H.  MacDermot, Chairman;  Dr.  D.  E.  H.  Cleveland,  Dr.  G.  A.
Davidson, Dr. J. H. B. Gtant, Dr. E. R. Hall, Dr. Roy Mustard.
Summer School:
Dr. L. G. Wood, Chairman; Dr. J. C. Thomas, Dr. A. M. Agnew,
Dr. L. H. Leeson, Dr. A. B. Manson, Dr. D. A. Steele.
Credentials:
Dr. H. H. Pitts, Dr. A. E. Trites, Dr. Frank Turnbull.
V.O.N. Advisory Board:
Dr. Isabel Day, Dr. J. II. B. Grant, Dr. G. F. Strong.
Representative 1o B. V. Medical Association : Dr. Frank Turnbull.
Sickness and Benevolent Fund: The President—The Trustees. Truly well nourished? Then he'd be outstanding. The hurdles of mastication, digestion and absorption which the aged have to
meet frequently threaten nutritive intake.
Only by careful inquiry can the vitamin
status of elderly patients be determined.
"Severe atypical deficiency disease,"
states Spies1, "like other forms of nutritive
failure, can be successfully corrected by the
application of . . . four essentials." One of
these is administration of the four critical
water-soluble vitamins in high dosage.
Squibb Basic Formula is the identical formula
used by Spies1,2 and Jolliffe and Smith8—
based on years of clinical experience.
Each Squibb Basic Formula Vitamin tablet
contains: thiamine HC1 10 mg., niacinamide 50 mg., riboflavin 5 mg., ascorbic
acid 100 mg.
For our newest professional leaflet with
complete information, write on your prescription blank "Nutritive Failure," and mail
to £. R. Squibb & Sons of Canada Limited,
36-48 Caledonia Rd., Toronto, Ont.
(&vu^(yumibu Sqijibb
1. Spies, Tom D.; Cogswell, Robert C, and Vilter, Carl: J.A.M.A.
(Nov.   18)   1944. Spies, Tom  D.:  Med. Clin.  N. Am. 27:273,   1943.
2. Spies, Tom D.: J.A.M.A. 122:911 (July 31) 1943. 3. Jolliffe, Norman, and Smith, James J.: Med. Clin. N. Am. 27567 (March) 1943.
For literature write
E. R. SQUIBB & SONS OF CANADA LIMITED  •  36-48 Caledonia Road, Toronto, Ontario VANCOUVER HEALTH DEPARTMENT
STATISTICS—MARCH,  1946
Total population—estimated    ,2, R_0
Japanese Population—Estimated  ._.. __.!_ ~~Z!LZIZ.~IZZZ TEvacuated
Chinese population—estimated
Hindu  population—estimated
6,566
361
Number
Total  deaths i.' f  324
Chinese   deaths   j 1 _ 13
Deaths—residents .only        286
BIRTH REGISTRATIONS:
Male,  323;  Female,   323     646
INFANT MORTALITY: f|j| March, 1946
Deaths under 1  year of age . . >|j£ 22
Death   rate—per   1,000   live  births       34.O
Stillbirths   (not  included  above) ; . 5
CASES OF COMMUNICABLE DISEASE REPORTED IN THE CITY
Rate per 1,000
Population
11.8
23.3
10.4
February, 1946
Cases     Deaths
Scarlet  Fever • 29 0
Diphtheria _■_  2 0
Diphtheria   Carrier :  6 0
Chicken  Pox  124 0
Measles a  7 0
Rubella  3 0
Mumps    :  90 0
"Whooping   Cough    ;  3 0
Typhoid Fever   0 0
Typhoid Fever Carrier  :  0 0
Uudulant Fever ..  0 0
Poliomyelitis  .  0 0
Tuberculosis    91 0
Erysipelas  1 0
Meningococcus   Meningitis    1  1 0
Infectious Jaundice   1 0
Salmonellosis    •  3 0
Salmonellosis    (Carrier)     :  0 0
Dysentery  2 0
Syphilis    89 3
Gonorrhoea     221 0
Cancer  (Reportable):
Resident    I  99 0
Non-Resident    25 0
March, 1946
Cases     Deaths
April 1-15, 1946
Cases     Deaths
BIOG LAN
Hg+rr
•Prepared separately for male and female.
Composition: Anti-thyroid principles of the pancreas, duodenum, em-
bryonin, suprarenal cortex, tests (or ovary). Each 1 cc. ampoule
contains the equivalent of approximately 29 grams of fresh substance.
Indications: Graves's disease, hyperthyroidism, exophthalmic goitre,
thyrotoxicosis.   The most effective therapy available.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page One Hundred and Sixty-nine Spadina Crescent Building,, providing administration, research laboratories and the production of Penicillin.
School of Hygiene Building, a portion of which accommodates additional research laboratories and the preparation of Insulin and other glandular products.
Virus Research Laboratory, one of the research labor -
atoriesin the Duffer in Division, a 7 45 -acre farm Property
12 miles north of Toronto.
CONNAUGHT MEDICAL RESEARCH
LABORATORIES
In 1914 the preparation and distribution
of essential public health biological and
related products were undertaken in the
University of Toronto In the Antitoxin
Laboratory. In 1923 the greatly expanded undertakings were named
Connaught Laboratories.
The work of the Laboratories Is well
known because of the widespread distribution of products. Throughout the years,
however, research in preventive medicine
has been a primary function. The number
of research undertakings has kept pace
with the growth of the Laboratories and
to-day more than fifty studies are In
progress.
To express the fundamental interest of
the Connaught Laboratories in research,
the Board of Governors of the University:
of Toronto has approved of the inclusion
of the words "Medical Research" in the
name of the Laboratories, which will now
be known as "Connaught Medical
Research Laboratories."
The preparation and distribution of biological   and   related   products   will  be
continued.
CONNAUGHT MEDICAL RESEARCH   LABORATORIES
University of Toronto - Toronto 4, Canada
Depot for British Columbia
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. 1U ZdUori, Paae.
A situation has been brought to our notice about which we feel that something
should be said.
One has only to pick up a daily newspaper and scan the classified ads, to come
across something like this: "Skino," the Wonder .Remedy, guaranteed"  (here one must
imagine successive sentences, capitalized, asterisked and exclamation-pointed)   "to cure
. Asthma, Psoriasis, Rheumatism, Piles, Pediculosis Capitis, and all diseases of the Blood
and Ductless Glands."
Sold by (and here follows the name of a druggist, whom we had always thought to
be reputable and of a better class, one who constantly looks to the medical profession
to send its patients and prescriptions to his store).
Now, we have no objection to legitimate advertising on the part of any business man
or firm. A druggist is a man of business—his store is a business house—he has wares to
sell, often other than drugs and chemicals—and he has every right to urge their sale
through advertising. But a druggist is something more. He is a member of the profession of pharmacy—and it is an honourable profession—its members take pride in this
fact, and most rightly so. His profession touches human life and human well-being—
he contributes greatly to the measures taken for human healing, and the relief of human
ills. In his hands are drugs and medicaments, potent for good or evil, as they are rightly
or wrongly used.
Thus, our friend and helper, the pharmacist, has a great responsibility, as we see it
—even the same responsibility that we, the men of medicine, have—to see that this
power, this possession of the means of healing, which can so easily be perverted and
changed into weapons of hurt, be not abused and not prostituted for gain. And we
submit in all friendly sincerity, that when a man, with the training and knowledge that
a pharmacist possesses, advertises for sale a filthy, lying quack nostrum, which he knows
full well cannot possibly do the things, any of the things, still less all of the things, that
it purports to do, he is acting in a manner unworthy of his noble calling. For we respect
and honour the ethical and the honourable pharmacist—but we have no respect for the
man who, for a few dollars, will swindle a suffering man or woman, by selling them stuff
that is not honest or clean, or worth anything to them for relief of their ailments.
It is the tendency, and a good tendency, for human institutions, constantly to try to
raise their standards, to promote honesty and fair dealing and truthful practice amongst
their members. And it is because we know full well that the profession of Pharmacy
follows and abides by this rule, and believes in this concept, that we write this. We do
not need to say this to the great majority of men of this profession—it would be impertinence on our part to remind them of what they so well know—but the very few who
are guilty of such action, are casting an undeserved slur on the good name of their own
profession, and doing what they must know is unworthy and false: nay, more than this,
they may be doing actual harm, delaying cure of the illnesses which these "remedies"
cannot help in any way, so that those who are sick may be led to put off seeking competent care, and many suffer aggravation of a condition which, properly treated at its
onset, might have been promptly and safely cured, but which, if wrongly treated, may
develop into a serious illness, if no worse befall.
Page One Hundred and Seventy Vancouver  Medical  Association
President Dr. H. A. DesBrisay
Vice-President Dr. G. A. Davidson
Honorary Treasurer . Dr. Gordon Burke
Honorary Secretary Dr. Gordon C. Johnston
Editor Dr. J. H. MacDermot
SUMMER SCHOOL
VANCOUVER MEDICAL ASSOCIATION
HOTEL  VANCOUVER
September 9th to 13 th incl.
Plans are being made to hold the annual Summer School in September,
on the above dates, and this year the lectures will be arranged over a
five-day period, instead of the usual four, to allow for some leisure time in the
evenings. The slate of speakers is now complete and we take pleasure in
announcing that the following outstanding men will participate in our programme:
Dr. Elmer Belt, Urologist, Los Angeles.
Dr. Simeon T. Cantril, Director of the Tumor Institute of the Swedish
Hospital, Seattle.
Dr. Russell L. Cecil, Professor of Clinical  Medicine, Cornell University
Medical College, New York.
Dr. J. R. Lindsay, Professor of Surgery  (Otolaryngology)   University of
Chicago.
Dr. Roy D. McLure, Surgeon in Chief, Henry Ford Hospital, Detroit.
Dr. N. W. Philpott, Dept. of Obstetrics & Gynaecology, McGill University,
Montreal. W%M$
THE LIBRARY
HOURS:    (From June 15th to September 1st)
Monday through Friday, 9:00 a.m. to 5:00 p.m.
Saturday, 9:00 a.m. to 1:00 p.m.
NOTICE
Please note that the evening hours in the library will be discontinued
during the summer months but will be resumed in the fall.
RECENT ACCESSIONS TO LIBRARY:
Surgical Clinics of North America, Symposium on Surgical Diagnosis, New York
Number, April, 1946.
Transactions of the American Therapeutic Society, 1943-1944.
Psychiatric Dictionary with Encyclopaedic  Treatment  of Modern Terms,   1945,
by Leland E. Hinsie, and Jacob Shatzky.
Nelson Loose Leaf System
Revisions of the following articles have been received:
Page One Hundred and Seventy-one Vol. I      —Measles, by Ruth K. Russell.
Rubella, by William St. Lawrence.
Vol. II    —Anthrax, by Herman Gold.
Infectious Hepatitis, by John R. Paul.
The Mycoses, by David T. Smith.
Vol. Ill   —Hodgkin's Disease, by Henry Jackson, Jr., and Frederic Parker, Jr.
Vol. VIII—Filariasis, by Richard P. Strong.   .
ARTICLES OF SPECIAL INTEREST:
J.A.M.A.  131:  81-86, May 11,  1946—Radioactive iodine in the study of thyroid
physiology.    Saul Hertz, Boston, and Arthur Roberts, Cambridge, Mass.
J.A.M.A.  131:  86-91, May 11,  1946—The  Treatment  of  hyperthyroidism  with
radioactive iodine.   Earle M. Chapman and Robley D. Evans, Cambridge, Mass.
The above noted articles from the Massachusetts General Hospital give a very
lucid exposition of the principles upon which this recent advance in the therapy of
goitre depend, together with results of their clinical application.
BAL  (British Anti-Lewisite) :
Attention is drawn to a very complete article in Science vol. 102: 601, Dec. 14th,
1945, on the value of BAL in the treatment of arsenical poisoning and poisoning
by the heavy metals, such as lead, cadmium and zinc.
This review gives a brief summary of the information on BAL, particularly with
reference to its development in the United States.
DEPARTMENT OF VETERANS' AFFAIRS
Every member of the profession in British Columbia will by now have received a
letter from this Department dealing with the Medical Treatment of Veterans by the
Doctors of their Choice.
We urge all medical men to read with great care all the rules and conditions laic}
down for their guidance in this care of returned veterans. This undertaking by the
Department of Veterans' Affairs should mean great benefit, both to the veterans coming
within its purview, and to the medical profession. It is a sound piece of work—and if
we do our part, and cooperate adequately, this can be of great significance in later years,
when it comes to the widening of health benefits, to make them available to larger groups
in the community.
We are assured by Dr. D. W. Johnstone, Medical Advisor to the D.V.A., that the
Department is anxious to encourage veterans to seek medical aid from doctors of their
own choosing. But only under certain conditions can this be secured—we. must remember that the Department is responsible, in the last analysis, for the medical care of
veterans, and we must work with the Department.
We would draw attention to the following points:
1. The main object of this scheme is the rehabilitation of the returned man—and
his return to a life of usefulness in the community—and to the ability to earn his living.
Our approach must be positive and constructive in every possible way.
2. Medical men must make sure that the veteran is eligible for treatment under
this Act. Information as to eligibility can be obtained at once from the nearest D.V.A.
centre.
3. We would call especial attention to Paras. 2, 3, 7 ,12  (two parts).
4. Farnilies are not included in this scheme.
We note with satisfaction that home nursing care by the Victorian Order of Nurses
is available for patients eligible for treatment under the Regulations. This is an excellent thing: as it will help to prevent excessive hospitalisation, and yet provide adequate
nursing. care.
Page One Hundred and Seventy-two GOLF
— FIRST TOURNAMENT, MAY 9th, 1946
The first tournament was held at Burquitlam on May 9 th, 1946. A warm sunny
day attracted sixty-one golfers to this scenic course with its fairways bordered byi
dogwood trees in full bloom. Competition was keen and fifty-eight remained for thfij
dinner and presentation of prizes. Dr. George T. Wilson, of New Westminster, welJ
corned the golfers to Burquitlam as president of the club.
Low gross scores of eighty-one were turned in by Drs. Leith Webster and H. Morton,!
both playing to a ten handicap. In the toss for prizes Dr. Leith Webster won the stern
ling silver cigarette cup. Playing faultless golf, Dr. George Clement turned in a nee
sixty-six to win the low net prize, a sport shirt donated by Straith's Limited. Dr. Johni
Sturdy won the long drive and Dr. Tom McAlpine was nearest the pin. By scoring the
only three on the seventh hole, Dr. R. Campbell won the hidden hole prize, a white
sport shirt from Charlton & Morgan. Dr. George Upham turned in the high gross of
one hundred and twenty-three to win the silver pen knife as prize.
Final plans were made for the trip to Seattle on May 16th and a team of eighteen
players will participate. The next tournament will be held on June 27th, and it is hoped
an even larger number of men will be participating.
VANCOUVER MEDICAL ASSOCIATION
ANNUAL REPORTS—1945-46 j
REPORT OF THE HONORARY SECRETARY
Mr. President and-Members:
During the past year eight general meetings were held, the March meeting as usual
taking the form of a dinner at the Vancouver Hotel to observe the annual Osier Lecture,
which was given this year by Dr. A. L. Lynch. On the same evening P. G. F. Degrees
were conferred on Doctors W. T. Ewing and W. L. Pedlow.
There has been an encouraging increase in the attendance at meetings, the average
being 73 as compared to 57 in the previous year.
Membership
The total membership of the Association, including applicants awaiting election
stands at 366, made up as follows:
Life members  .-—1 13
Active  members    - j 295
Associate members  , 53
Privileged members 5
An outstanding feature of the past season has been the marked increase in membership, 46 applications having been received, of which 32 have been elected to date. We
are happy to report, too, that most of our members who were serving in the Armed
Forces have returned to active practice, and there are now very few to come back.
It  is  regretted  that  the Association  lost  eight members  by  death  during  the
year—
Doctors: J. R. Atkinson,   J. A. Gillespie,   Colin McDiarmid,   Murray Meekison,
H. H. Planche,  Bruce Smith,  James A. Sutherland and K. H. Wray-Johnston.
The Executive Committee held ten regular meetings during the year.
Respectfully submitted,
Page One Hundred and Seventy-three
GEO. A. DAVIDSON, Honorary Secretary. REPORT OF THE HONORARY TREASURER
Mr. President and Members:
I beg to submit herewith the following financial report of your Association for
the year 1945-46, which has been duly audited by Hommer, Whiting & Co., Chartered
Accountants, under date of March 31st, 1946:
Receipts and Expenditures
Receipts:
Income from members' annual dues $4,740.00
Interest on invested funds  380.68
Profit on sale of bonds  491.87
Relief Administration, Management Allowance  _ 600.00
Profit on Association Bulletin 4  129.56
$6,342.11
Expenditures:
Salaries    g£| $3,573.51
Rent     %  1,3 77.00
Total    1 |  4,950.51
Received from C. P. & S. and B.C.M.A.—
their  share —- 2,453.88     $2,496.63
Other  running   expenses    'H      774.51
Total expenditures, apart from library maintenance —
The Association has also expended on the library $1,224.75
3,271.14
Excess of Income over Expenditures   $3,070.97
Depreciation:
Library : ^$1,306.37
Furniture and Equipment       107.16
$1,41.3.53
Net transfer to General Surplus Account  1 $1,657.44
General Fund Bonds and Savings Accounts
Present value  (as at March 31st, 1946) j $14,342.91
(One  $1000 Dorninion of  Canada Bond was purchased during the year from the
General Account).
Trust Funds
Historical and  Ultra-Scientific  Fund,  Savings   $   361.67
Stephen  Memorial  Fund,   Savings    \        30.46
Sickness & Benevolent Fund, Savings (including proceeds from levy, $262.00)   1,113.55
Benevolent     Endowment     Fund    v — <      734.00
Pearson   Lecture   Fund,    Savings         819.69
Pearson  Lecture  Fund . j 2,981.25
The Summer School Fund, which is not invested separately, amounts to $4,079.66,
an increase of $78.09 over last year.
The receipts for the year show an increase of approximately $1,000 over last year.
This is accounted for by an increase in receipts from members' dues, and a profit of
$491.87 on the sale of some of our bonds, which has been distributed amongst the
various Funds.
Respectfully submitted,
GORDON BURKE, M.D., Honorary Treasurer.
Page One Hundred and Seventy-four REPORT OF TRUSTEES
The Board of Trustees begs leave herewith to submit the Annual Report.
It is with regret that we report the passing of Trustee Dr. J. A. Gillespie. He was
active on this committee. He served long and efficiently. During the year Dr. William
T. Lockhart resigned to retire to a more salubrious climate on a sunny Gulf Island.
Dr. George H. Clement was appointed to fill the vacancy created by Dr. Lockhart's
resignation.
The Treasurer's and Auditors' report, as of March 31st, 1946, have statements of
the amounts in the various funds over which the Trustees have control.
During the year a number of bonds were converted, resulting in a profit of $491.87.
This was distributed proportionately in the funds from which the bonds were sold.
A Dominion of Canada Bond ($1,000.00) was purchased from the General Fund.
All of which is respectfully submitted, A. W. HUNTER.
»*• *t *t *>L
•P *S" »T *T
REPORT OF THE LIBRARY COMMITTEE
Mr. President and Members:
I beg to submit herewith the annual report of the Library Committee for the year
ending March 31st, 1946:
BOOKS ADDED TO LIBRARY—
General   Collection—§51 new books added at a cost of i$   371.60
6 gifts
2 from Nicholson Fund, at a cost of  7.88
Total 1 59 books added at a cost of       379.48
2 books purchased at a cost of $    7.88
leaving a balance of  I 281.03
64 journals subscribed to at a cost of       581.40
57 journals received as gifts
NICHOLSON FUND:
MEDICAL JOURNALS:
Total 121 journals received in Library.
OTHER EXPENSES—     107 volumes bound at a cost of      235.25
Dues to Medical Library Ass'n.     16.76
Miscellaneous    I     11.86        28.62
TOTAL I $1,224.75
During the year seven meetings were held, and these were well attended.
Because of a marked increase in the volume of work in the Library, due in part
to members returning from the Active Services and to library privileges extended to
medical officers in the Forces, as well as an increased membership, it was decided to ask
for permission to keep the Library open several nights a week, and to obtain the
services of a part-time assistant in the Library who would be in attendance during
the evening hours. This new schedule was authorized an dhas been in effect since
the first of March. We are glad to report that there is evidence of increasing use of
the Library during the evenings, and it is felt that as more members become aware
of this extended service, it will prove to be of much value.
It was the opinion of your Library Committee, too, that it might be wise to commence planning for a new library, to be constructed when possible, and in this
connection they recommended that the Librarian should visit a number of medical
libraries in the United States and Canada, with a view to studying their methods
and plans. This was approved and the sum of $750.00 was voted to the Library
Committee at a General Meeting.    It has not been possible, to date, for the Librarian
Page One Hundred and Seventy-five to make the suggested tour, but arrangements are being made to enable her to get
iaway within the next few weeks.
It was felt that the most suitable way of recognizing the long years of service
[to the Library by the late Doctor A. W. Bagnell, would be to place a memorial
plaque in the Reading Room. This was authorized by the Executive Committee and
plans are under way to have it completed as soon as possible.
The Library is fortunate each. year in being the recipient of gifts of valuable
| books and specialized journals, which it would otherwise lack. To all those who
(have made these generous contributions throughout the year, your Committee wishes
to express herewith its thanks and appreciation.
All of which is respectfully submitted,
W. J. DORRANCE, M.D., Chairman.
*
SUMMER SCHOOL COMMITTEE
| INTERIM REPORT   fa
Your Summer School Committee is making plans for the Annual Session, which will
be held this year from September 9th to 13th, inch, the change in time being necessitated by the fact that the Canadian Medical and British Columbia Medical Associations are* having their Annual Meeting at Banff in June. It will be noted that the
Summer School will last for five days in order to allow a little leisure time during
some of the afternoons and evenings.
Drug exhibits will be arranged this year, to accommodate those who usually
exhibit  at the British Columbia Medical Association Meeting in the Fall.
A number of prominent speakers have been contacted and so far your Committee
has had definite acceptances from Doctors Elmer Belt, Urologist, Los Angeles, Calif.;
Simeon Cantril, Director of the Tumor Institute of the Swedish Hospital, Seattle,
and J. R. Lindsay, Assoc. Professor of Surgery (Otolaryngology), University of
Chicago, School of Medicine.
L. G. WOOD, M.D.,
Chairman, Summer School Committee
REPORT OF THE PUBLICATIONS COMMITTEE
During the past year, this Committee has attempted to hold regular meetings
monthly, and has succeeded on all but one. or two occasions. The work of the Bulletin
has gone on regularly, and thanks to the very great help given by our Librarian,
Mrs. Craig, has been by no means a heavy burden to those concerned.
Financially, we have had our most successful year so far. We have a credit balance
on the Calendar Year 1945 of some $500.00, owing largely to the fact that we have
had considerably more advertising than formerly. The Executive of the. Association
considered the question of raising our advertising rates, which at the present time,
are well below the regular rates that our circulation would allow us to charge, and
has decided to raise them, as the contracts fall due late in the year. We shall not
feel the effect immediately, but shall do so later, and we shall probably be able to
report an even larger balance next year. /
We hope, however, to turn- some of this balance back into the Bulletin, and
secure some improvements. Thus we might initiate the practice of illustrations and
cats, which add so much to the interest and value of articles.
Again, we desire to thank our publisher, Mr. W. E. G. MacDonald, most sincerely
for his invaluable help and loyalty to our interests. He has made the Bulletin one
of his chief personal concerns, and it is difficult to thank him adequately for his
co-operation; he is always most willing and eager to help us in any way possible.
His wide business contacts have enabled him to secure advertising, and he keeps our
interests always in mind.    His firm has been most generous in the matter of extra
Page One Hundred and Seventy-six copies, for which we  are  constantly  asking, e.g.  for the  Council of  the Canadian
Medical Association.
Lastly, I desire to thank personally, the other members of the Publications Board,
who have worked so loyally and willingly in regard to the Bulletin, and without
whose help and advice it would have been impossible to do as well as we have been
able to do. Present conditions have made any changes or modifications inadvisable
at present, but we hope to do all we can to improve the Bulletin constantly, and make
it an even better journal as time goes on.
Others who have helped us greatly, and whose help we gratefully acknowledge,
are Mrs. Bender of the B.C. College of Physicians and Surgeons, Miss Smith, her
assistant, and Dr. M. B. Caverhill, Executive Secretary of the B.C. Medical Association.
All of which is respectfully submitted.
J. H. MacDERMOT, Editor.
a *t *t **-
Sp 3j» Sjf *jp
REPORT OF HISTORICAL COMMITTEE
I regret that, owing to illness, I am unable to present this report personally.
Work on the History of the Vancouver Medical Association has progressed during
the year. Considerable statistical work has been done, which is essential but of no
great interest.
The  Editor  of   the  Bulletin  kindly   suggested   that   installments   of the  history
might be published, and a few have appeared.    This may have the effect of mistake!
being discovered before the material is finally deposited in the Archives. It is hoped
that anyone noting such mistakes, will call attention to the same.
G. E. KIDD,
Chairman of the Historical Committee.
*      *?      *      *
REPORT OF THE RELIEF ADMINISTRATION COMMITTEE
The Relief Administration Committee has suffered the loss of two of its members
during the year, Doctors C. A. McDiarmid and J. A. Sutherland. Doctor Sutherland
was one of the original members of the Conunittee which was formed in 1934 and
Doctor McDiarmid joined the Committee in 1935.
Doctor W. T. Lockhart retired from active practice at the beginning of the year
and handed in his resignation. He too was a member of the original Committee and
during his twelve years of service rarely was absent from a meeting. He is making
his home in Ganges, Salt Spring Island, and we wish him many happy years to enjoy
his favourite pastime, golf.
The amounts paid for relief work during the past year ranged from 100% paid
in September, October, November and December down to 70% paid for March
accounts. The gross amount of accounts for the year ending March 31st is $79,973.30
and the amount paid to the men doing the work, $46,840.28, no one receiving more
than $75.00 in any one month.
There has been a slight increase in the amount of accounts over the year 1944-45,
but there has been a marked increase in the number of doctors doing the work. In the
heaviest month in 1945, 149 men handed in accounts while in March of 1946 there
were 174.
The Relief Administration Committee now consists of Doctors D. F. Busteed,
Gordon Burke, A. O. Brown, F. Day-Smith, A. T. Johnston, Neil McNeill and J. C.
Grimson.
All of which is respectfully submitted.
J.   C.   GRIMSON,   Secretary.
Page One Hundred and Seventy-seven REPORT OF THE CLINICAL SECTION
Seven meetings of the Clinical Section were held during the year, three at the
[Vancouver General Hospital, two at St. Paul's, and two at Shaughnessy.
This was the first time that more than one meeting in the season was held at
^haughnessy, and their excellent programmes were much appreciated.
All meetings were well attended and the programmes presented were of a high
itandard.
Your Committee wishes to take this opportunity of expressing its appreciation to
he officers and staff of the three Hospitals for their kind co-operation and hospitality.
Respectfully submitted,
S. E. C. TURVEY, Chairman.
REPORT OF PAEDIATRIC SECTION
Executive: Chairman, Dr. H. Spohn; Secretary, Dr. R. P. Kinsman.
Five regular and special meetings were held during the year.
At the December meeting the following motion was adopted:
That the Paaediatric Section goes on record urging that a survey be made
regarding the building of a children's hospital centre, bearing in mind its value
as a teaching centre for the university, and, that the Professor of Paediatrics,
of McGill, and Toronto Universities, and Dr. Harvey Agnew, be asked to
select the person to make such a survey.
Acting on this resolution, conferences were held with orthopedic surgeons and
others, and with a social service group, and as a result of these conferences, Dr. Alan
Brown made the survey.    Work is proceeding on this project.
During the year was instituted the procedure of weekly Paediatric ward rounds.
These were held at the Vancouver General Hospital, St. Paul's Hospital, and the
Crippled Children's Hospital.
This report is respectfully submitted.
R. P. KINSMAN, Secretary, Peadiatric Section.
Whereas, the City Council has been granted the power by Provincial legislation,
this section recommends the said City Council enact bylaws which will enforce the
universal pasteurization of milk within the City of Vancouver.—Motion passed by
the Paediatric Section at meeting in May, 1946.
REPORT OF THE EYE, EAR, NOSE AND THROAT SECTION
During the past twelve months the section has held an increased number of
monthly evening meeting, six such meetings having been held. In addition two
luncheon meetings were held during the week of the Summer School.
The outstanding scholastic event was the visit of Dr. David Webster, Surgical
Director, Manhattan Eye, Ear and Throat Hospital, New York, N.Y. who was one
of the speakers at the last Summer School for 1945.
The two luncheons noted above and an eye clinic in addition to the regular lectures
gave all doing eye work an excellent opportunity of obtaining much knowledge
from this truly great man who possessed in addition to his special knowledge great
kindness and human understanding. The section feels the Summer School Committee
is to be commended on having selected Dr. Webster as a speaker.
The section during the past year welcomed the return of several of its colleagues
from the armed services.
Respectfully submitted,
H. R. MUSTARD, Chairman.
Page One Hundred and Seventy-Eight REPORT OF THE NEURO-PSYCHIATRIC SECTION
A Neuro-psychiatric section of the Vancouver Medical Association was formed oij
December 11th, 1945.    The section has a membership of twenty, and meetings hav^
been held each month following its inception.     Some time was devoted to the stud]!
of  Juvenile Delinquency,   and  two  speakers   from   the  Juvenile  Court  addressed  th
section.    One  meeting was devoted to a round-table  discussion on psychiatric prob
lems,  in preparation for  the  Annual  Meeting  of  the  Canadian  Medical  Association!
A final dinner and clinical session was held at the Provincial Mental Hospital at Essonl
dale, with a total attendance, including guests, of forty.
The section demonstrates much strength and enthusiasm and we look forward tc]
a full educational and social program for the ensuing year.
A. M. GEE, Chairman.
*£m »t «i <m
REPORT OF THE COMMITTEE ON SHORTAGE OF
HOSPITAL ACCOMMODATION
This Committee has held three meetings since it was formed early in March. At]
these meetings discussions have been held with representatives of the Registered Nursea
Association, the Nursing Directors of the main Vancouver Hospitals, and with Doctor*
Haywood and Seymour of the Vancouver General Hospital. The Committee has
also studied the very thorough Report of the Study Committee on Hospital Planning
submitted to the Provincial Secretary in February of 1945. In addition various sug-J
gestions and recommendations submitted to the committee by various individual
members of the Association have been sifted and studied.
Shortly after the formation of the Committee it was announced by the Provincial
Government that a survey of  the Hospital situation in the Province is to be madq
in  the  early summer  by Mr.   Graham  L.   Davis,  Hospital  Director  of   the  Kellogg
Foundation.    Mr. Davis desires to hear any recommendations or suggestions from any]
interested bodies.
As a result of the work of the past ten weeks your Committee would like to place]
before you the following suggestions and recommendations:
(A) The immediate problem—
1. The doctors in general should devote more attention to the possibility!
of saving hospital days by adoption of early ambulation in all suitable cases.]
2. Deterrnined efforts should be made to discharge all patients as soon]
as possible. It is realized that this is linked in many cases with the social and
welfare problems and the lack of convalescent and chronic hospitals.
(B) The long term policy—
1. There should be set up at the earliest opportunity a Provincial Hospital]
Commission or Council who could control and coordinate the location ancu
types of hospital centres throughout the Province, acting through district or
area hospital councils. The major initiative should be left to the voluntary]
hospitals, but the Provincial Government should encourage development and
necessary expansion in accordance with a definite long term plan, and by the
granting of necessary financial and other appropriate assistance.
2. The most urgent need would appear to be for suitable convalescent
and chronic hospitals and certain special hospitals such as one devoted to sick
children. If these facilities were provided, the acute general bed shortage
would -be relieved.
3. Your Committee also feels that competent authorities should enquire
into the whole question of hospital construction. It would seem that thej
time honoured form of hospital construction, following which hospitals are
built to endure for many generations and become obsolete in one or two, are
needlessly costly, especially in this Province. It is felt that commonly quoted
cost figures can be very materially reduced, especially in the case of convalescent and chronic hospitals.
Page  One Hundred and Seventy-nine 4. Although the number of nurses in B.C. has increased 55% since 1939,
and although B.C. is very favourably situated in this regard compared to other
provinces, the demand for nursing services has increased to the extent that
now the demand cannot be met. Hospitals cannot maintain their nursing
staffs at an adequate level. It is suggested that all possible efforts be made to
make institutional nursing more attractive. This means larger salaries and
better living and working conditions. Facilities for training larger classes
should be made available and consideration given to the possibility of shortening the training period for the general duty nurse.
5. It is felt that many more quickly trained lay help, both female and
male, could be made available for hospitals if working conditions and salaries
were made more attractive, and this lay help could take over much of the work
now done by graduate nurses.
Your Committee would emphasize that this is only a brief summary of findings
to date, and they feel that this study should continue. However, if the suggestions
as outlined are approved, your Committee requests authority to incorporate the general
suggestions into a brief to present to Mr. Graham L. Davis when he commences his
survey in June. Your Committee would also like authority to lay these views before
the Coordinating Council of Welfare Groups with the joint presentation to the Provincial Government.
All of which is respectfully submitted.
A. TAYLOR HENRY, M.D., Chairman.
|N OTIC Ei
Please note that the evening hours in the library will be discontinued
during the summer months but will be resumed in the fall.
Page  One  Hundred and  Eighty B. C. CANCER INSTITUTE
CLINICS
Monday and Wednesday 10.00  a.m. Gynaecology
Tuesday 9.00-10.00 a.m. Honorary Attending Stafl*
Thursday   10.00 a.m. Breast Clinic
Friday '  9.00 a.m. Skin Clinic
NEW PATIENTS EVERY DAY.
Monday and Thursday Mornings RADIUM APPLICATIONS—UTERUS
AND CERVIX—Main O. R., V.G.H.
Tuesday and Wednesday Mornings.-.RADIUM IMPLANTS—LIPS AND SKINS
—B. C. Cancer Institute.
Every Day—All Day X-RAY THERAPY—B. C. Cancer Institute.
Issued April, 1946
PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
SCHEDULE OF MORNING CLINICS—9.00-12 Noon
Monday—General Venereology; Eye,
Ear, Nose and Throat Conference
9.00-10.00 a.m.
Tuesday—General Venereology.
Wednesday—General Venereology,
Cardiology, Dermatology.
Thursday—General Venereology,
Neurology.
Friday—General Venereology,
Neurology.
Saturday—Pediatrics.
SCHEDULE OF EVENING CLINICS—5.30-7.00 p.m.
Monday—-General Venereology; Neurology (one per month).
Thursday—General Venereology.
The Vancouver Clinic welcomes physicians to observe diagnostic and therapeutic procedures. Instruction and consultive advice are available on all phases
of venereal disease. Approximately 700 patients are in attendance weekly and
provide a wide range of clinical material.
Issued April, 1946
Page One Hundred and Eighty-one Monday
Tuesday
PROVINCIAL BOARD OF HEALTH
DIVISION OF TUBERCULOSIS CONTROL
9-12
Outpatient
Diagnostic
Clinic
Outpatient
Diagnostic
Clinic
VANCOUVER UNIT
9-12
Outpatient
Survey
Outpatient
Survey
Clinic
9-12
1 -2.30
Inpatient Outpatient
Pneumothorax   Pneumothorax
Clinic (9.00)      Clinic
Inpatient Outpatient
Pneumothorax   Pneumothorax
Clinic (9.00)      Clinic
Bronchoscopic
Clinic
V.D. Heart Cl.
Wednesday
Outpatient
Outpatient
Inpatient
Outpatient
Diagnostic
Survey
Pneumothorax
Pneumothorax
Clinic
Clinic
Clinic (10.00)
Eye, Ear, Nose,
Throat Clinic
Clinic
Thursday
Outpatient
Outpatient
Inpatient
Outpatient
Diagnostic
Survey
Pneumothorax
Pneumothorax
Clinic
Clinic
Clinic (10.00)
Surgical T.B.
Clinic
Lipiodol
injections
Clinic
Friday
Outpatient
Outpatient
Inpatient
Outpatient
Diagnostic
Survey
Pneumothorax
Pneumothorax
Clinic
Clinic
Clinic (9.00)
Clinic
Saturday
Outpatient
Diagnostic
Clinic
Outpatient
Survey
Clinic
•
Note:   1. Ward rounds posted at information desk.
2. Chest Surgery I.D.H. 4 operations will be posted at information desk.
3. Chest films read daily, beginning at 9.00 a.m., in X-ray view rooms.
4. Dental Clinic, Monday, Wednesday, Friday, 9-12.
5. Special cases—slides in view room and photographs and histories in
library.
6. Rehabilitation project — Vancouver Occupational Industries — open
daily. ||J|
7. For further information apply at information desk,.
Issued April, 1946
Page   One   Hundred   and  Eighty-two VANCOUVER GENERAL HOSPITAL
OUTPATIENTS DEPARTMENT CLINICS
MEDICINE
General
Cardiovascular
Dermatology
Neurology
Gastro-intestinal
Psychiatry
Diabetic
Hematology
Arthritic
Daily
Monday
Tuesday
Every Second Tuesday
Wednesday
Wednesday and Friday
Thursday
Friday
Saturday
SURGERY
General
Proctology
Orthopedics
Urology
Varicose Veins
Mon., Wednesday, Friday
Every Second Wednesday
Thursday
Friday
Friday
OTO-RHINO-
LARYNGOLOGY
Thursday
OPHTHALMOLOGY
REFRACTIONS
Tuesday
Friday
PEDIATRICS
Saturday
OBSTETRICS AND
GYNAECOLOGY
Clinic
New Admissions
Monday
Wednesday
DENTAL
Daily
NUTRITION
Daily
Page One Hundred and Eighty-three  MODERN TRENDS IN MEDICINE
By D. M. Baellie, M.D., Victoria, B.C.
It is interesting and instructive to look back through the past twenty-five years
and trace the changes in-medical practice and organization in this country of ours.
We can see these changes occurring at an ever increasing tempo as the Science of
Medicine broadens in scope and increases its demands.
A generation ago the focal point in Therapeutic Medicine was the general practitioner.
Specialists were few in number and most of these were in the field of Ophthalmology
and Oto-Rhinology. Partnerships were, also, few in number in these days of robust
individualism, while the number of clinics in Canada and the U.S.A. could almost be
counted on the fingers of one hand.
Medicine has gone a long way in these intervening years. Knowledge has increased
immeasurably and dazzling discoveries in Medical Science have forced the coming of
some remarkable changes which, even today, are not by any means appreciated and
appraised by the rank and file of Medicine. These changes have come about relatively
slowly, and against a great weight of inertia and conservatism. There seems to have
been in the Medical profession and in its leadership a great reluctance to "think
ahead." The "daily round, the common task" have filled our consciousness to the
exclusion of many things, particularly those that have to do with a more rapid raising
of standards and an increasing efficiency. Why are unlicensed practitioners and quacks
so rampant in this country? Surely to a great extent because of our deficiencies—
largely due to faulty fand inadequate organization in our profession.
The Rise of the Specialist.
Perhaps the most striking change has been the rapid increase in the number of
specialists and practitioners who are specializing along certain lines. I have no figures
to quote but the number now in Canada must be very large. A rapid survey of the
situation in Victoria gives the following information:
General Practitioners  1 19    General Practitioners majoring along
Specialists 30    specialized lines     15
Some of these, I'll admit, are difficult to classify. For example there are a few men
who are specialists in anaesthesia who, also, do some general practice. There are some
medical specialists who may do a limited amount of Obstetrics but no Surgery. There
may be some obstetricians who are not above doing tonsillectomies. The figures are
startling, however, when compared with the conditions in this community twenty-five
years ago, when the only specialists were four men in the Eye, Ear, Nose and Throat
division. Incidentally I haven't included among the specialists three radiologists and
two pathologists at the local hospitals.
In recent years, too, I have noticed a tendency towards earlier and more exclusive
specialization. This trend towards specialization is not confined to this community
but operates throughout the North American Continent. The reference is, of course,
that the general practitioner—in the larger centres—is being remorselessly squeezed
cut. He is coming to the conclusion that he is nothing but a "feeder" of specialists.
The younger men and women show their awareness of this phenomenon by the number
of them who "work into" specialization, sometimes even before they leave Medical
school. And herein lies a great danger, because a specialist above all things must have
maturity, balance and wisdom, which can only be acquired in contact with the variegated ills and troubles of mankind.
There is another incentive: The young man knows that he can make more money
with shorter hours and much less effort as a specialist than as a general practitioner.
He, also realizes that he can make himself much more valuable and efficient in a restricted field. As a matter of fact it is impossible for the doctor of average intelligence to cover the whole field of General Medicine in these modern days. The best
he can do, if he attempts to do so, is to be what one might call a "casualty clearing
station."
Page One Hundred and Eighty-five I think, perhaps, we had better make up our minds that the days of the general
practitioner are nearly over. It is possible that in isolated country districts he may
continue to exist to some extent, although already we are witnessing the shuffling,
by air, of more serious cases to the urban centres.
Group Medicine
Another phenomenon has been noticed in this changing medical scene. A process
of "clumping" or "agglutination" is going on, especially among the specialists. This
"clumping" is sometimes of a loose kind and is manifested by the referring of cases
from one specialist to another so that the patient revolves in the orbit of a galaxy of
specialists without reference to the general practitioner at all. These specialists may
all have their separate offices and be financially independent of one another, but aware,
all the same, of the merits and virtues of co-operation and symbiosis. Of late years
'there has been a stronger tendency towards cohesion and a stronger agglutination manifested in the formation of medical co-operatives and clinics. Their number is increasing rapidly. I. am advised that there were 697 of them in 1940 in the U.S.A.
and Canada and the number has increased since then. They seem to become increasingly attractive to the younger men. The "set up" is, of course, familiar and some
of them have grown to amazing size, e.g. the Roos Loos Clinic in Los Angeles which
has a medical personnel of some three hundred. The number of specialists in a group
varies, but most of them have from 10 to 30 individuals. Some as in the instance
above quoted are composed of specialists and general practitioners who may or may not
aspire to specialization. There are other groups, primarily of general practitioners,
each anxious to develop along a specialized line. These are particularly applicable to
the smaller urban centres or even country districts. We have some of these in British
Columbia, e.g. in Trail, Nelson, and Kamloops, which have been eminently successful.
I am surprised that they have not been copied more widely. The benefits and advantages are very obvious. The tremendous benefit occurring from the close association
and interchange of information and knowledge between the older men's experience
and the younger men's recently acquired ideas of techniques, which redounds to the
increased betterment of the patient, should not be difficult to appreciate. The development of teamwork in Surgery and the ability to specialize in Regional Surgery and
Medicine are made considerably easier. The great increase in leisure and the consequent
raising of'one's cultural level, that would follow the establishment of. an eight hour
day, the enjoyment of week-ends, when one can "go off duty" without worrying about
one's patients, are all of great value. The possibility of increased holiday time, of the
opportunity and necessity of post-graduate study should appeal to most of us. There
are other advantages/ not the least being that of increased economic security.
There is another slant to this question. What do the public think of these groups
and clinics? To judge by the large numbers of people who flock to them the reaction
is extremely favorable. The public is quick to appreciate the efforts made to improve
the services rendered to them, and has become much more sensitive to the scientific
standard of the practitioner than to his personal qualities. The slave-like devotion
of patient to doctor, so common a generation ago, has very largely become a "thing of
the past. In the main, the patient goes where he feels he can get the 'most value for
his money.
What are the disadvantages of group practice? One of the most obvious is that
each member has got to conform to the wishes of the majority, in other words he
loses part of what he would call his "personal liberty." There is no doubt that the
"clash of personalities"—more often than not due to prejudice, gossip and misunderstanding is one of the unfortunate and grievious things in Medicine. We see it, more
particularly in the smaller towns, where some of the men will not even speak to others
if they can possibly avoid it. It would be so much better if they could get together
and help each other in giving a better service to their public. There is another difficulty.
These groups, especially in the larger centres, so often incur the enmity and hostility
of the other men in private practice.    This is, in the nature of things, almost inevit-
Page  One  Hundred and Eighty-six able, and can be chalked up as the price we have to pay for change and progress.   The
phenomenon I have been describing will go on despite it.
How will these groups fit into a National Insurance or State Medical Scheme?
The answer is that they will be ideally suited to that purpose. We find that in Aneurin
Bevan's projected scheme for National Health in Great Britain the focal point is going
to be the "Medical Centre." In the U.S.S.R. the "working unit" is not the individual
medical doctor but the "Clinic," "Polyclinic," "Ambulatorium," "Medical Centre,"
where doctors work in groups to fill the health needs of their communities. Time
cannot stand still. We in Canada are caught up in the current of world events and
we have, willy nilly, to adapt ourselves and our institutions to meet the rapidly oncoming changes that surge down upon us.
"What are We Going to Do About This Problem?
Well, we can carry on as we are and retain a trtaissez faire" attitude. "Let things
work themselves out." I cannot help feeling, however, that something should be done
by the leaders of the profession to actually encourage the formation of these groups.
There are great opportunities in the smaller communities for the medical men to thus
get together to help each other become more proficient in some specialty. This
policy should be particularly attractive to the younger men, whom I would advise in
any case to give this matter serious consideration whether they practice in city or
country.
Let us overtake the future and not allow the future to overtake us.
THE MOUKDEN MEDICAL COLLEGE IN RECENT YEARS
Reproduced from a letter to Mr.  F.  J.  Fish of the Vancouver  General Hospital,
from Dr.. H. S. D. Garvin, formerly Second Assistant Superintendent in that hospital. |
In the spring and summer of 1931—almost twenty years after the founding of the
college—the future looked bright indeed.    Here in summary was the position:
A complete new storey had just been added to the teaching block to provide new
class rooms and museum space. The Chinese staff had grown to 22 members and of
these seven had completed or were just completing Post-Graduate study in Britain and
Europe. The total number of graduates had risen to 192 and at that moment 40
were actually in mission employ while many others had given years of service to missions in Manchuria and China before beginning private or government work. The
first women graduates had already been qualified for a year or two and all doubts of
the wisdom of their choice of career and their future sphere of usefulness had disappeared. There were in residence 90 students of whom 23 were women. They were
undergoing a seven years course of training, two years of premedical study, four years
cf preclinical and clinical study, and one year of interneship in the Moukden Hospital.
In College and Hospital a larger and larger share of the burden was being shouldered
by the growing Chinese staff. Good progress had been made in our aim that the
coDege should be "controlled, staffed and financed by the Chinese themselves."
The measure of confidence which the College enjoyed in the Chinese community
was evidenced by the proposal which had been made by the government North Eastern University. This was nothing less than the suggestion that the Moukden Medical
College—a private missionary institution—should become the medical faculty of the
Government University. After long and careful consideration, a provisional agreement, in which the Christian basis and character of the College were adequately
safeguarded, had been drawn up.
Page One Hundred and Eighty-seven Such a plan was rudely shattered by the irruption of Japanese troops into Manchuria in September, 1931, and the subsequent establishment of the new state of
Manchoukuo under the aegis of the Japanese Army of Occupation. This resulted in
the closure of the Government University and the withdrawal of its staff to China
within the great wall.    The College stood alone as a private institution.
In the first years of the occupation no grave difficulties were encountered. This
was largely due to a Japanese professor of international repute on the staff of the
Japanese medical school, run under the auspices of the South Manchurian Railway.
He volunteered to guide the College in its relationships with the new government and
ensured its registration and continued existnce as a registered medical school.
The respite was short, for in 1935 members of the Chinese staff, students and
many others suffered persecution at the hands of the Japanese special police, the
"Gestapo" of Japan. . After their release from prison the continual spying and informing against them, their wives and their families, resulted in the loss of seven
of our nine members of staff who had now had Post-Graduate study in Europe, and
also of many of the junior staff.    Our loss was Free China's gain.
Increasing pressure from the totalitarian state was evident in the necessity for the
re-registration of the College with the government authorities. This involved a considerable loss of freedom of action, and a lowering of the teaching standards. It
necessitated a reduction of the course of study from seven years to four. It also made
necessary the reconstruction of the Board of Management in a Japanese registered
"Judicial Person" or Board of Trustees, of which a number of Japanese had to be members. Transfer of the property from the Home Board was made to this new controlling body.
Further pressure against the freedom of the individual conscience and the institution came in the various orders that the College be officially represented at ceremonies,
first in the Confucian Temple, later at the Japanese War Memorial, and last at the
Shinto Shrine. Such questions had resulted in the closure of the Church of Scotland
mission schools.
When, in 1941, Pearl Harbour was attacked, the foreign members of the staff
still remaining in Moukden were interned. Later the British members were taken to
Japan and after a period were returned to Brtiain in the "Gripsholm." Dr. Pedersen,
of the Danish Mission, who was then Principal, was kept more or less confined to his
house and until peace came in 1945 was not allowed to have any connection with the
College or Hospital.
Drs. W. H. Gow and T. L. Leo, the two most senior Chinese members of :the staff,
graduates of the first class in the College, and a young Chinese staff were left on December 8 th, 1941, to face the difficult situation. Dr. Chira, a Japanese Christian doctor, who had occupied official positions in the Manchoukuo government, became principal of the college, and other Japanese professors were appointed. The Chinese staff
remained at their posts. The Board of Trustees was reconstructed and the college
continued to function as a private institution with a Christian basis. The student
activities were strictly supervised by the Japanese, the Chinese staff being allowed to
do only the class room teaching.
Later Dr. Tamura, a Buddhist, who had previously held a post in a medical school
in Japan, was appointed principal and Dr. Chira went back into official government
work.    Still later, however, he returned to the college as its head.
In 1945 the government announced its intention of commandeering the college
and although there was considerable delay it had actually done so before the war ended. When this happened the Chinese staff resigned "en bloc" but were asked to continue their work.    A few weeks later peace came.
In the hospital, which lies immediately adjacent to the College, Dr. T. L. Leo
had been allowed a much wider measure of freedom. He had been able, in spite of
all the difficulties, to keep the staff, doctors, nurses, dispensers, and others, together
Page One Hundred and  Eighty-eight as a working unit, and able to continue the extensive work of the in-patient and outpatient  departments.     Christian work  in  the hospital  also went on  all  through  this i
period.    In addition to the Moukden Hospital, Dr. T. L. Leo and a church committee |
had been able to keep eight of the smaller outstation mission hospitals open.
When peace came in the Pacific, the Japanese staff in the College handed over the
keys to Drs. Gow and Leo, and were then interned in the foreign staff houses which they
had been occupying. Dr. Pedersen was soon able to establish contact with the Chinese
staff and visit the College and Hospital. In the first excitement of their new freedom,
the young members of the staff and the students were influenced by strong nationalistic feelings and expressed the desire to be free from all foreign connection. This
wave of not unnatural feeling, however, soon passed and will, I am convinced, disappear.
In his visit to the College, Dr. Pedersen found the building and its equipment intact.
There has been no destruction of property and only one microscope is reported missing.    The building, however, will need extensive cleaning and redecoration.
Peace brought its problem to the Chinese staff who had endured so much, waiting
for just this day. They had themselves now to cope with all the teaching. After
the Government commandeered the College, students with a very inadequate preliminary training in school were forced on the College, and they received Government
pay and allowances.   These, of course, stopped abruptly, and problems of maintenance
are acute.
<§
The general situation has been very unsettled owing to the presence in Manchuria
of the Soviet Occupation forces, the Eighth Route Army, and the Central Chinese
Government troops. For the last three months no news of the actual situation has
reached this country. In the last news received, the College had been able to keep
its doors open and the hospital was full to overflowing.
A group of church leaders in Moukden, although unable to get a representative
meeting from all the districts due to these disturbed conditions, has sent out a letter.
It would welcome the arrival of a Commission from Scotland to examine the situation
at first hand, confer with the church and with them plan the wisest way for our continued co-operation in the whole programme of Christian work in Manchuria. The
Church of Scotland had already decided that this should be its method of procedure
before actually beginning its post-war activities there. This commission is leaving now
for Manchuria.
There is at the moment no properly constituted governing body of the College in
the field and one of the first duties will be to reconstitute a Board of Directors in
Moukden. In the College there will be the need for a return to a high standard of
teaching. This will prove long and arduous, for the general standard of school work
has fallen greatly during the Japanese occupation. Fourteen years of steadily falling
standards will mean years of patient reconstructive work now.
Soon it should be possible to see the reunion of the scattered Chinese members of
the staff. To those who remained in Moukden and determined with dour courage and
resource to stand by the College and Hospital in the great hope that one day freedom
would return, will be added those who in varied capacity have served in Free China.
In Government medical schools and hospitals, Christian medical schools and elsewhere, they have given a great account of themselves and occupied positions of responsibility. Their wish is to return to Moukden. their "alma mater," to serve there again.
After these hard years of exile, which have brought them great breadth of experience
and depth of insight, they have much to give.
Page One Hundred and Eighty-nine And to these two groups there can be added those of the foreign staff who have
in varied ways and on different continents worked through the war years with hope
and longing and are now waiting to return xo the work they chose years ago.
Surely there is material here to begin again the task of giving to Manchuria a
Christian Medical profession; doctors versed not only in the Science of modern medicine but also in the spirit of that Art of medicine whose founder was and is the Good
Physician.
Glasgow, December, 1945. H. S. D. G.
GENERALIZED SCLERODERMA
By B. Kanee, M.D.
The occurrence of generalized scleroderma in a child is indeed a rarity. Since the
prognosis is today regarded by internists as serious, the following case is presented to
stimulate further interest in this problem.
Case Report
History: E. R., a white male aged ten years, was first seen on November 27th, 1945,
through the kindness of Dr. J. W. Millar, presenting a generalized skin involvement of
at least two months' duration.
Present Illness: According to the child's mother, she first became aware of an infiltration of the skin involving the cheeks about two months ago; when she noticed that
on pinching her son's cheeks she was unable to raise the skin up into folds as one normally is accustomed to. I was unable to elicit any history of subjective complaints, nor
that of fever, common cold or any illness preceding the above observation. In the intervening two months the patient has had no treatment and there has been no change
noticed by his mother.
Past Illnesses:
1. Appendectomy in 1941.
2. Mumps in 1943.
3. Swollen cervical glands in 1944 of six weeks' duration.
4. Rash on the trunk and extremities in the fall of 1945.
Family History: Father, mother and two sisters alive and well.
Skin Examination: The face appears puffy and although ruddy has a waxy appearance.
There is a loss of the normal lines or furrows on the forehead and face resulting in a
masked expression. Palpation readily reveals the fact that the entire skin of the face
and forehead except for the central portion, namely the nose and peribuccal area, is
infiltrated and one is unable to lift up the skin in folds in the usual manner seen- in
normal skin. He has no difficulty in opening or closing his mouth nor on swallowing.
There is an infiltration of the skin of the upper extremities, trunk and thigh, but to a
less degree than on the face and neck. Small, oval and circular depigmented spots are
present on the extensor surfaces on the upper extremities as well as on the back. The
genitals are apparently normal.
Physical Examination: A healthy, robust looking youngster in no apparent distress.
Weight—80 lbs.    Physical examination is essentially within normal limits.
Laboratory Data: A blood count on November 29th, 1945, showed: erythrocytes,
4,750,000; leukocytes, 3,500; haemoglobin content 81%; polymorphonuclear neutrophils, 4%; staff forms, 50%; lymphocytes, 37%; eosinophils, 3%; monocytes, 6%.
Chemical examination of the blood on November 30th showed a total calcium of
12 mg. per cent (normal 9-11).
Page One Hundred and Ninety A roentgenogram of the chest on December 1st was essentially normal, showing no <
evidence of any tuberculous process nor any evidence of pulmonary fibrosis.   The tuberculin test to old tuberculin, 1/20 mg., was negative.    The basal metabolic rate was !
per cent above the average normal.
On December 20 th the patient was presented at ward rounds at The Vancouver
General Hospital and in view of the elevated blood calcium and low white count which
could be the result of sclerosis of the bone marrow, it was recommended that further
investigations be carried out to rule out hyperparathyroidism.
Blood count repeated on December 20th showed erythrocytes, 4,460,000; leukocytes, 5,850; haemoglobin content, 80%; polymorphonuclear neutrophils 62%; staff
forms, 4%; lymphocytes, 32%; monocytes, 2%. Sedimentation rate was 1/4 mm.
Chemical examination of the blood on December 24th showed serum calcium 10.89
mg.. per cent; phosphorus, 4.8 mg. (normal 3.7-5); and phosphatase, normally 4-10
Green units—11.2 per cent.
In hyperparathyroidism one would expect an elevated serum calcium, a lowered serum
phosphorus and an increased phosphatase if there was any osteoporosis and bone atrpohy
present.
A roentgenogram of the long bones and abdomen on January 4th showed no evidence
of cystic bone lesions nor any calculi in the urinary tract.
Histologic Study: Biopsies of the skin of the left cheek, forehead and left arm showed
changes compatible with the diagnosis of scleroderma.
Treatment and Subsequent Course: The patient is under observation and at present
is receiving prc^tigrnine bromide internally as well as cod liver oil and the recommendation of a daily massage to the affected parts.
Comment
Scleroderma or Hidebound Disease is characterized by the affected skin and subcutaneous tissue becoming hard and thickened and usually resulting in atrophy. There
are two types:
1. Generalized or diffuse scleroderma.
2. The localized variety known as 'morphea." In children .when this occurs on
the forehead in band formation (called morphea encoup de sabre) it is often followed by
hemiatrophy of the face. As a rule the generalized form of scleroderma affects adults
and rarely children. |||f
Etiology: The disease is of unknown origin and may occur at any age. Females are
affected three times as frequently as men. There may be a predisposing history of acute
infectious disease, trauma or endocrine disorders including hyperparathyroidism.
The acute variety as exemplified by the above case report begins gradually with tlg|
appearance of symmetrical areas of non-pitting oedema and may terminate in spontaneous
cure after a few months or enter the chronic phase.
Histopathology of the Skin: In the acute infiltrative stage there is considerable
oedema of the collagen bundles in the cutis along with some interstitial oedema, perivascular round cell infiltration in the subpapillary cutis, along with mild epidermal
hyperplasia. Later on there is marked atrophy of the epidermis, disappearance of the
inflammatory infiltrate and fibrosis of the cutis and subcutis and loss of the appendages.
Morphea presents the same picture with the addition of telangiectasia.
The clinical picture in the chronic form is that of progressive scleroderma with
typical sclerodermatic facies (ironing out of the normal lines of the face, beaked nose
and drawn expression)*, pigmentation and telangiectases. These may be preceded by
or associated with vasomotor disturbances such as parasthesias, acrocyanosis and angiospasm or a Raynaud-like syndrome, usually of the upper extremities, resulting in sclerodactylia.     There  are  frequently  associated  calcareous  concretions   and  ulcers  in  the
Page One Hundred and Ninety-one affected areas. This syndrome occurs almost exclusively in women and usually makes
its appearance at the menopause2. Occasionally, there are prodromal symptoms such as
arthralgia, fibrositis and rheumatic pains resulting in limitation of movement of joints.
Generalized scleroderma is really a systemic disease as is often evidenced by the
narrowing of the oesophagus3, resulting in dysphagia, pulmonary fibrosis4, abnormal
electrocardiographic findings, as well as diffuse electrocortical activity revealed by
electro-encephalographic studies5.
Internists are evincing an increasing interest in scleroderma particularly in the
generalized variety. Banks7 has suggested that there is a common denominator of such
serious and, at times, rapidly fatal diseases as dermatomyositis, acute lupus erythematosus,
periarteritis nodosa and generalized scleroderma. Duryee6 feels that the prognosis in
generalized scleroderma is indeed a serious one.
REFERENCES
1. Kanee, B:: Scleropoikiloderma with Calcinosis Cutis, Raynaud-like Syndrome and Atrophoderma,
Arch. Dermat. & Syph.  50: 254, Oct.,  1944.
2. Thibierge, G., and Weissenbach, R. J.: Une forme de concretions calcaires sous-eutanees en relation avec la sclerodermic, Bull, et mem. Soc. med. d. hop. de Paris 30:  10-14,  1910.
3. Ehrmann, S.: Ueber die Beziehung der Sklerodermie zu den autotoxischen Erythemen, Wien. med.
Wchnschr.  53:   1156-1159,  1903.
4. Murphy, J. R.; Krainin, P., and Gerson, M. J.: Scleroderma with Pulmonary Fibrosis, J.A.M.S.
116: 499-501, Feb.  8, 1941.
5. Weiss, S.; Stead, E. A., Jr.; Warren, J. V., and Bailey, O. T.: Scleroderma Heart Disease, with a
Consideration of Certain Other Visceral Manifestations of Scleroderma, Arch. Int. Med. 71: 749-776,
June, 1943.
6. Duryee, C. A.: Personal communication to the author.
7. Banks, B. M.: Is There a Common Denominator in Scleroderma, Dermatomyositis, Disseminated
Lupus Erythematosus, the Libman-Sacks Syndrome and Polyarteritis Nodosa? New Eng. J. Med. 225:
'433-444, 1941.
;J.
NOTICE
Please note that the evening hours in the library will be discontinued
during the summer months but will be resumed in the fall.
Page One Httndred and Ninety-two New* and Mated,
It is with regret that we record the passing of John Ewart Campbell of Vancouver,
and more recently of Secret Cove, where he retired in 1944.
Sympathy is extended to Dr. Eric Elkington of Victoria, in the loss of his father,
Mr, W. H. Elkington of Duncan; and to Dr. E. E. Day of Vancouver, whose mother,
Mrs. Jane Day, died in that city recently.
Congratulations are being received by the following proud parents, on the birth of i
sons: Dr. and Mrs. J. H. Black, Dr. and Mrs. W. G. Trapp of Tranquille, and Dr. andi
Mrs. W. M. G. Wilson of Port Alberni.
Daughters were born to: Dr. and Mrs. H. G. Cooper, Dr. and Mrs. S. A. Creighton,
Dr. and Mrs. B. T. H. Marteinsson of Vancouver, and Dr. and Mrs. H. Emanuele of
Penticton.
*t *t it *t
•r *? nr *ir
Major G. H. Francis has been discharged from the R.C.A.M.C, and has returned to I
Vancouver, where he will resume practice.
•5* sj* *$• *S*
Squadron Leader L. S. Chipperfield has received his discharge from the Air Force,
and is now practising in New Westminster.
* *       *       *
Major W. R. Walker, R.C.A.M.C, has returned to civilian life, and to practice in
Penticton.
* *       *       *
Colonel J. L. M. Anderson, who returned from service overseas some months ago,
and received his discharge from the R.C.A.M.C, is carrying out the duties of Medical
Health Officer for the City of Victoria.
Lieut.-Colonel R. A. (Russ) Palmer has recently returned from overseas, and is
enjoying a well-earned holiday prior to discharge. Colonel Palmer will be resuming
practice in Vancouver shortly.
•t *t *% *z*
•IT »Sr **r *r
Dr. G. B. Helem of Port Alberni was a recent visitor to Vancouver. His brother,
Dr. E. V. Helem, formerly of the R.C.A.M.C, has joined Drs. G. B. Helem and W. L.
Chisholm in the practice at that centre.
*
«t
Capt. F. L. Wilson, R.C.A.M.C, has received his discharge, and has returned to
practise at Trail.
:;-
»»,
Dr. G. B. Bigelow of Victoria was a recent visitor to Vancouver.   While here he
took part in the British Columbia Amateur Golf Tournament.
Dr. R. Scott-Moncrieff of Victoria was a visitor to Vancouver recently.
I" iJ* -'f it
Dr. Arnold Francis of New Denver is in Vancouver, having a well-earned respite
from practice.
yr
At the annual meeting of the Vancouver Medical Association, the following were
elected to office: Dr. H. A. Des Brisay, President; Dr. G. A. Davidson, Vice-President;
Dr. Gordon Burke, Honorary Treasurer; Dr. Gordon C. Johnston, Honorary Secretary.
Page  One Hundred and Ninety-three

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