History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1951 Vancouver Medical Association Oct 31, 1951

Item Metadata

Download

Media
vma-1.0214330.pdf
Metadata
JSON: vma-1.0214330.json
JSON-LD: vma-1.0214330-ld.json
RDF/XML (Pretty): vma-1.0214330-rdf.xml
RDF/JSON: vma-1.0214330-rdf.json
Turtle: vma-1.0214330-turtle.txt
N-Triples: vma-1.0214330-rdf-ntriples.txt
Original Record: vma-1.0214330-source.json
Full Text
vma-1.0214330-fulltext.txt
Citation
vma-1.0214330.ris

Full Text

       THE
B. C. MEDICAL CENTRE UBRAR1
NOV 6      1951
BULLETIN
VOLUME XXVIII
OCTOBER, 1951
NUMBER 1
&&*£»
VANCOUVER
MEDICAL ASSOCIATION
In This Issue:
COMMON ALLERGIC DISORDERS,
By C. H. Walton, M.D	
Page
BRIEF — Re Hospital Insurance 15
THE AESCULAPIAN STAFF AS THE CORRECT
SYMBOL OF MEDICINE, By R. E. McKechnie, M.D 19 Coughing spasms can be controlled by
giving Scilexol E.B.S. with the following sedatives.*
1 Codeine   ......     1  gr. per ounce
2 Methadon .....    10 mg. per ounce
3 Tincture Opium Camphorated 80 min. per ounce
*Narcotics Order Required
THE ISpl^p^HUTTLEWORTH   CHEMICAL  CO.. LTD.  TORONToTcANAOA
Representatives: Mr. Vic. Garnham, 3228 West 34th Ave., Vancouver 13, B.C.
Mr. F. R. Clayden, 3937 West 34th Ave., Vancouver 13, B.C. 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.
Fall meeting—Friday, November 2nd, 1951.
Spring meeting—April 25th, 26th, 1952.
THE  BULLETIN
Publishing and Business Office — 17 - 675 Davie Street, Vancouver, B.C.
Editorial Office — 203 Medical-Dental Building, Vancouver, B.C.
The Bulletin of the Vancouver Medical Association is published on the first of
each month.
Closing Date for articles is the 10th of the month preceding date of issue.
Manuscripts must be typewritten, double spaced and the original copy.
Reprints must be ordered within 15 days after the appearance of the article in question, direct from the Publisher. Quotations on request.
Advertisements
Closing Date for advertisements is the  10th of the month preceding date of issue.
Advertising Rates on Request.
Page 2 Vasoconstriction
combined with
antibiotic therapy in
NEO-SYNEPHRINE
(brand of phenylephrine)
with
I CRYSTALLINE
PENICILLIN
In upper respiratory tract infections,
topical application of penicillin to the nasal cavity has a decided bacteriostatic action against
typical respiratory pathogenic microorganisms.
To provide clear passage for such therapy,
Neo-Synephrine is combined with penicillin-*
shrinking engorged mucous membranes and
allowing free access of the antibiotic.
Neo-Synephrine—a potent vasoconstrictor—
does not lose its effectiveness on repeated ap-
j plication... is notable for relative freedom from
sting and absence of compensatory congestion.
NEO-SYNEPHRINE
with
CRYSTALLINE PENICILLIN
Stable • Full Potency
Supplied in combination package for preparing 10 cc. of
a fresh buffered solution containing Neo-Synephrine hydrochloride 0.25% and Penicillin 5000 units per cc.
443 SANDWICH STREET WEST,
mm
New York 13, N. Y.    Windsor. Ont.
Neo-Synephrine, trademark reg. U. S. & Canada
WINDSOR. ONTARIO VANCOUVER HEALTH DEPARTMENT
STATISTICS — AUGUST, 1951
Total population — estimated *       397,140
Chinese population — estimated*         6,282
Other — estimated  640
June, 1951
Rate per
Number        1000 pop.
Total deaths   (by occurrence) i . __  294 8.8
Chinese   deaths      10 19.1
Deaths, residents only : | \  297 8.9
Birth Registrations — Residents and Non-residents:
(includes late registrations) t££i
June,  1951
Male . 451
Female 425
876 26.5
Infant Mortality — resident only:
June, 1951
Deaths under 1 year of age j {p    14
Death rate per  1000 live births { J     21.9
Stillbirths  (not included in above item) i j       8
CASES  OF  COMMUNICABLE DISEASES  REPORTED IN THE CITY
June,
Cases
Scarlet Fever  6 6
Diphtheria  —
Diphtheria Carriers  —
Chicken Pox  95
Measles :  169
Rubella -  54
Mumps , _  3 8
Whooping Cough   16
Typhoid Fever |j|  —
Typhoid Fever Carriers  —
Undulant Fever j— —
Poliomyelitis  j  —
Tuberculosis j  3 7
Erysipelas i i -        2
Meningitis i  —
Infectious  Jaundice 1 I  —
Salmonellosis .  17
Salmonellosis   Carriers "f^^^£j.  —
Dysentery | 1  —
Dysentery   Carriers ; ,  —
Tetanus & _ j  —
Syphilis .- —      8
1951
June,
1950
Deaths
Cases
2
Deaths
—
112
—
—
243
—
—
678
1    —
—
196
—
—
38
—
11
Gonorrhoea ! 161
Cencer   (Reportable)  Resident .     99
45 <CONNAUGHT>
HEPARIN
Clinical experience in the use of Heparin as a blood anticoagulant has extended over
many years.   The product has been administered intravenously in very dilute solution.
Recent experience has shown that intramuscular injection of concentrated solutions
is an effective means of prolonging clotting time.   This method of treatment provides
,an increased measure of freedom for the patient and can be extended over a period of
months on the basis of two or three daily injections.
HOW SUPPLIED
Solution  of  Heparin—Distributed  in  rubber-stoppered  vials  as sterile  neutral
solutions of heparin prepared from purified, dry sodium salt of heparin contain-    \
ing approximately 100 International Units per mg.   The product is supplied in
the following strengths:
1,000 International Units per cc.
5,000 International Units per cc.
10,000 International Units per cc.
Heparin (Amorphous Sodium Salt)—Dispensed in 100-mg. and 1-gm. phials
as a dry powder, containing 95 to 100 International Units per mg., for the
preparation of solutions for laboratory use.
Recent References:
Stats, D., and Neuhof, H.: Am. J. Med. Sci., 1947, 214:  159.
Walker, J.: Surgery, 1945, 17: 54.
Cosgriff, S. W., Cross, R. J., and Habif, D. V.: Surgical Clinics
of North America, 1948, 324.
De Takats, G.; J.A.M.A., 1950, 142: 527.
□
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 FDR BRITISH COLUMBIA
MACDDNALD'S    PRESCRIPTIONS    LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. We were greatly interested in the speech of Dr. H. B. Church, the President of the
Canadian Medical Association, made recently, in which he deplores the tendency on
the part of the medical student to think only in terms of specialism when he graduates,
or as soon as possible, rather than of taking up general practice. He laments, too, the
fact that the general practitioner, and particularly the country doctor, is so lightly
regarded, and is becoming the "forgotten man" of medicine.
Those of us now in the sere and yellow, or at least rapidly approaching that
unattractive stage of our careers, will sympathise a great deal with Dr. Church, and
there is much in what he says. It is true that the "family doctor", who, in his way
has played so important a part in medical practice, is becoming scarcer all the time.
But we cannot back the clock.   In the words of the poet,
"Oh world where all things change and naught abides
Where e'en though better follow, good must pass ..."
There are many reasons why the trend is becoming so definitely set towards specialism. With all due deference to Dr. Church, if he is reported correctly, we do not
believe it is mainly a mercenary instinct that makes the young medical student, about
to graduate, decide to specialise early. There may be some element of attraction in the
supposedly higher financial reward of specialism; but' things tend to level out, and in
any case, Mr. Abbott is always there to see that the specialist, no less than the general
practitioner, shall have "his bounds set, that he ma)'' not pass", in the matter of income.
We think, as we observe the young entry, that they are a very good lot—at least
as good as we were when we graduated, though perhaps not as resigned to hard work,
and not quite so ready to accept night calls, and unassisted maternity work. They are
less willing, too, to take up country work, and cling to city life. But the type that we
see passing through the hospitals looks to us like a very fine one; keen, intelligent and
full of ardour.  The future of medicine is, we think, quite safe in their hands.
Our theory of the "fons et origo mali" is a little different from that of Dr. Church.
We cannot help thinking that there are some serious dangers in the modern system
of medical training, which puts too much emphasis on specialism form the start, and
conditions its graduates in this direction, urging them into specialism. Perhaps this is
an overstatement, but it is the impression we have. General practice, which is undoubtedly the best training ground that a man can .have, is apparently rather sniffed at.
We regard, too, as wholly pernicious, the system that makes it necessary for a man
to secure certification before he starts practice, and makes it practically impossible for
a man who has been in practice for several years to come back and secure a specialist's
certificate. Yet the history of medicine in Canada until the past few years has shown
that nearly all our best specialists came to their full growth in specialism through and
after general practice—and we do not accept the theory that modern medicine is so
complicated that it cannot continue to be this way.
This system has many bad points. It puts a premium on the financial competence
of the student, and not necessarily on true ability. The cost of the extra training is so
high that many men who would amply justify having it simply cannot afford it. It
shuts out, as we have said, the man who, after several years of practice, has found the
department of work that he likes, and at which he is specially good. Again, it forces
young men into special fields that in later years, they may discover are not really the
fields in which they will be happiest, and most likely to succeed.
We see scores of men who have certificates, to acquire which they have spent many
years and much money, forced to take up general practice in order to earn a living.
This is very good for them, of course, and fills the ranks of general practitioners, but
surely it would have been better for them, if they had been trained on broader lines.
Page 4 to be excellent general practitioners, with the prospect always before them, as it was
before the Gallies and the Shepherds, and the Howards and Gordons and all the other
giants of our profession, who, like Jacob of old, were content to serve their seven or
fourteen years, so that they could in the end, get the Sarah for whom they had toiled,
in the form of the specialty they wanted and for which they had fitted themselves.
We can only hope that some day the pendulum will swing back (it generally
does) and a truer and better system will be found, where men will begin, as we think
they should, in general practice, and gradually climb up to the higher levels of
specialism. And then the country doctor will come into his own again, for there was
never any more fertile source of good specialists than these country practitioners, who
have learnt their art literally from the grass roots up, and who were given the opportunity of advancement rightfully theirs, in the days when things were allowed to
follow a natural, rather than an artificial, course of development.
THE VANCOUVER GENERAL HOSPITAL
Announces
REFRESHER COURSES
for the
GENERAL PRACTITIONER
for the year 1951-1952
October 29-30-31, 1951
November 28-29-30, 1951
February 18-19-20, 1952
PAEDIATRICS
MEDICINE
SURGERY
ANESTHESIOLOGY
February 25-26-27, 1952
OBSTETRICS and GYNAECOLOGY
April 7-8-9, 1952
A fee of $15.00 is set for registration in each course.
Notices  of  each  course  will  be  sent  out  six  weeks- prior  to  the
scheduled  date,  with  application  forms  attached.
ADDRESS ENQUIRIES TO:
Dr. Reginald A. Wilson,
Chairman, Refresher Course Committee,
Vancouver General Hospital,
Vancouver, B.C.
Page 5 I
mm
Library Hours:
Monday, Wednesday and Friday  -|| 9:00 a.m.-9:30 p.m,
Tuesday and Thursday .0m. L Jl^fe:. 9:00 a.m.-5:00 p.m.
Saturday  1 \ 9:00 a.m.-l:00 p.m.
Members are reminded that no keys are available to the V.M.A. Library in the
Academy of Medicine Building and access to the library is only allowed during the regular
hours. |g|g
Recent Accessions
Medical Clinics of North America—Symposium on Specific Methods of Treatment,
Boston Number, September, 1951.
New and Unofficial Remedies—The Council on Pharmacy and Chemistry of the American Medical Association, 1951.
Ophthalmological Society of the United Kingdom—Transactions of the  1950 Session,
Vol. LXX—1951. jj|
Schweitzer, Albert—On the Edge of the Primeval Forest and More from the Primeval
Forest, 1951 (Nicholson Collection).
Surgical Clinics of North America—Symposium on Surgical Aspects of the Cancer
Problem, Mayo Clinic Number, August, 1951.
The Canada Year Book—Dominion Bureau of. Statistics, 1951.
The Medical Annual, 1951.
Recent Supplements to the Acta Medica Scandinavica:
No. 256—Blood Volume Determination with the Evans Blue Dye Method by B. von
Porat!
No. 257—Heart Volume, Myocardial Volume and Total Capacity of the Heart Cavities
in Certain Chronic Heart Diseases by C. E. Friedman.
No. 258—The Destruction of Red Blood Corpuscles in Experimental Hemolytic Anemia
by C. Wasatjerna.
No. 259—First International Congress of Internal Medicine, Paris, September, 1950.
No. 260—Neurological Changes in Pernicious Tapeworm Anaemia by G. Bjorkenheim.
No. 260—Neurological Changes in Pernicious Tapeworn Anaemia by G. Bjorenheim.
Page 6 Recent Supplements to the Acta Paediatrica
No.    80—Studies on Bacterium Bifidum in Healthy Infants by E. Frisell.
No.    81—On the Weight and Structure of the Adrenal Glands and the Factors affecting
them, in Children of 0-2 years by H. Tahka.
BOOK REVIEW
THE MECHANISM OF ABDOMINAL PAIN by V. J. Kinsella.   London: H. K. Lewis
& Co. Ltd., 1948 pp. 230 illus.
This monograph contains a discursive and somewhat contentious review of the
literature pertaining to abdominal pain from the days of Willis in the 17th century to
modern times with a quite complete bibliography of two hundred and thirty-eight references. Inasmuch as the author has obviously taken a keen interest in the mechanism of
abdominal pain over a period of very many years of clinical practice it is not surprising
that he has presented his material in a somewhat chronological and more or less reminiscent fashion with frequent intimate references to his teachers and other authorities. He
states his reasons for his belief in direct visceral tenderness as well as direct visceral pain.
Not everyone would agree with all of his views, for instance he rejects the acid theory
of pain in peptic ulcer and propounds compression of nerve fibres by muscular compression as the essential factor. This is not a book for the general practitioner or general
clinician, but rather one for the physiologist or anatomist or one particularly interested
in the subject. —B.S.
THE EYE, EAR, NOSE & THROAT
AND CHIROPODY CLINICS
The Eye, Ear, Nose & Throat Clinic in the Out-Patient Department was officially
opened September 20th, 1951, week. This has been the great desire of the specialists
of this department. This clinic was furnished by the Medical men of this department
including generous donations.
Another long desired clinic, which has been in the minds of our staff for quite
some time has materialized, and we are now pleased to inform you that the Chiropodial
Clinic was also opened September 20th, 1951. This clinic will function under the
control of the Director .of the Out-Patient Department and the Orthopedic Department.
The Chiropodists at their own expense have furnished this clinic and supplied
all the equipment and instruments. It is their hope that they can be of service to many
patients attending the Out-Patient Department.
The following have been appoined by the Board of Management, Administration
and Medical Board; to serve in this Clinic:
J. I. Gorosh, D.S.C.,  (Senior Clinician)
J. B. Paris, D.S.C.
R. B. Paris, D.S.C.
S. J. Gillis, D.S.C.
D. Meakes, D.S.C.
An Introductory Reception was held September 20th. All members of the attending staff were invited to visit for the occasion.
Page 7 COMMON ALLERGIC DISORDERS
DIFFERENTIAL  DIAGNOSIS OF  ASTHMA
Presented at the Vancouver Medical Association's
Summer School, 1951.
C. H. WALTON
Allergy has been shown to account for many medical syndromes, previously misunderstood. It has been invoked often and still continues to be invoked to explain
many medical mysteries. It has done so in some cases but it must not be used as an
easy and uncritical way out of a difficulty. Clinical allergy is common and its
careful management produces worthwhile practical results. As in all diagnosis,
tninking of the possibility of allergy is the first step in. its diagnosis.
Diagnosis in allergy is the recognition of a syndrome in which allergy is likely
to play a major role or even an associated role. A serious attempt must then be made
to identify the agent or allergen to which the patient is reacting and appropriate action
taken.
ALLERGIC DISORDERS OF THE SKIN
The three commonest skin manifestations of allergy are urticaria (angio-oedema),
atopic dermatitis (eczema) and contact dermatitis. I believe that urticaria and angio-
oedema might be classed together for practical purposes. They vary clinically only
in degree.
Urticaria is usually considered to be primarily allergic. Often there is a marked
psychogenic factor particularly noticeable in the precipitation of an acute episode.
Pathologically and clinically there is no difference between demonstrable allergic urticaria
and so-called neurogenic or psychogenic urticaria.
In the latter type no allergic factor can be recognized and the psychogenic factor
appears to be primary. However, it should be pointed out that because an allergic
factor is not demonstrated it does not follow that such a factor does not exist and every
effort should be made to find it. It is too easy and too glib to label a case psychogenic
when in reality the physician has overlooked or failed to find the allergic cause. There
is probably an endocrine factor in some cases of urticaria as evidenced by the variations
in the disease during menstruation, pregnancy, the menopause and so on. Quite
probably foci of infection also play a part in some cases. (Such foci as dental
abscesses, etc., are often important. This might be taken as an example of intrinsic
allergy.)
Urticaria is most often due to ingestant allergens, chiefly food and drink but
often including such common drugs as aspirin and the barbiturates. Urticaria also
occurs in some instances with inhaled allergens such as pollen, dust, animal dander, etc.
In addition, it is caused not infrequently by injected allergens such as penicillin, the
other antibiotics, liver, insulin, etc.
The urticarial reaction takes place in the cutis and it is characterized by an
extravasation of fluid with eosinophil accumulation. The appearance of the lesions
varies considerably and is easily recognized. Dermographia is often found with it
and swelling of the joints is sometimes seen, and often painful. Any joint may be
involved and the small joints of the hands and feet are those most commonly affected.
If it is recognized that urticaria and angio-oedema are essentially allergic diseases
then the physician is more apt to make a diligent search for the offending agents. When
these agents are found treatment is simple because the patient and the agent can be
separated. If the offending agent or allergen is not found the only recourse left is to
treat the patient symptomatically.    Often this is a most discouraging affair.
In considering the differential diagnosis of urticaria is should not be forgotten
that insect bites such as those of the bedbug can reproduce lesions that are almost
indistinguishable from urticaria.
Page 8 Atopic dermatitis or eczema is primarily allergic, but secondary changes often
develop in the skin because of associated scratching and infection. Characteristically,
this disease is seen most commonly in infants but it may be seen at all ages, and the
term infantile eczema is apt to mislead one into believing that the disease occurs only in
infancy. It is true that in many cases the disease resolves spontaneously at about the
age of two, but in a fairly large number it may persist throughout childhood and even
into adult life. The allergic agents are most often ingestants and food is, of course,
the chief offender, but not infrequently inhalants also play a considerable part. This
is most typically seen in so-called ragweed dermatitis. The inhaled or ingested allergen
reaches the skin via the circulation. The lesion is not exudative unless secondary
infection occurs, but it may exfoliate and often shows lichenification. The lesions are
characteristically found on the flexor surfaces of the extremities, the face and the
breast. Clinical experience has shown that very often atopic dermatitis has an associated
contact factor, that is to say while the primary allergen reaches the skin via the
circulation, contact allergens such as wool and other irritants may add considerably to
the problem. Local treatment may be directed towards protecting the skin, combatting
infection and giving symptomatic relief to the itching. The primary duty of the
physician is to find, if possible, what allergen or allergens are causing the trouble and
to remove them from the patient. If this is done the skin heals extraordinarily rapidly.
When the allergen is again exhibited the skin breaks down most dramatically.
Contact Dermatitis. The third commonest allergic dermatitis may be called
contact. Dermatologists reserve the term allergic dermatitis for this particular type
to contrast it with atopic dermatitis or eczema. The name implies a local skin
reaction to the allergy. Perhaps the most commonly seen reaction is that from poison
ivy. However, there are many agents which will cause dermatitis, for example, cosmetics particularly nail polish, white metals as seen in costume jewellery, cigarette
lighters, metal on garters, etc. Obviously treatment of this condition resolves itself
into discovery of the offending agent and removing it.    Recovery is usually rapid.
GASTRO-INTESTINAL ALLERGY
Allergic reactions can occur in any part of the alimentary system from the mouth
to the anus. There is reason to believe that some forms of stomatitis are due to direct
allergic stimulation. If the stomach or the upper part of the small bowel are involved
severe dyspepsia, vomiting and other manifestations occur. Not infrequently such
"symptoms as abdominal pain, chiefly colic and diarrhoea, particularly when associated
with large amounts of mucus in the stool, are due to food or drug sensitivity. All
doctors are familiar with the patient who will develop sudden violent crampy abdominal
pain, sometimes with vomiting and often troublesome diarrhoea without apparent
reason. Obviously such a patient may be suffering from a variety of pathological
processes. Such diseases, because of their seriousness must be ruled out in the usual
way. However, when all examinations fail to reveal an inflammatory, mechanical, neoplastic or other organic cause and when there is no psychogenic disturbance apparent
it should be remembered that allergy can cause these symptoms too. Allergy is probably
a common cause of gastro-intestinal symptoms. If all other diseases are ruled out
and if allergy is thought possible, allergens must then be searched for and handled in
the usual way by eliminating them from the diet. Foods and drugs are the usual
offenders.
Finally, pruritus ani not infrequently is due to food sensitivity and it is very
gratifying when discovered because the patient may then be saved much discomfort.
it must not be forgotten, however, that pruritus ani may also be due to a variety of
other causes.
Before leaving the gastro-intestinal tract, it is probably proper to say that allergy
has been thought to play a part in the etiology of ulcerative colitis. The behavious of
this disease would lead one to suspect allergy and some observers have felt that they
could demonstrate food allergy.    I have never been able to do so and it is doubtful
Page 9 whether with our present methods we can hope to invoke allergy in helping us manage
this very distressing illness.
Another disease which should be mentioned, not because it is common, but because
of its importance is the Schonlein-Henoch syndrome. This syndrome involves the
skin with a purpuric rash, the intestinal tract with signs of severe regional ileitis, the
renal tract with signs of nephritis and the joints. It is often demonstrably allergic in
origin and, of course, if this can be demonstrated a great deal of help can be given to
the patient.
THE CENTRAL NERVOUS SYSTEM
Migraine is a very common disorder and it is frequently attributed to allergy. In
my experience and that of others, it seems that primary allergy can be demonstrated
in perhaps one-third of the cases. This disease is so difficult to treat symptomatically
and is so discouraging to manage, that it is highly desirable to remember that allergic
factors can be demonstrated in as large a percentage as one-third because if they are
demonstrated management becomes very simple. Perhaps the commonest offender in
migraine allergy is chocolate. It .has been suggested that Meniere's disease may be
allergic in some instances. This suggestion has not been widely accepted and has been
rarely demonstrated, i
THE GENITO-URINARY SYSTEM
Urinary frequency very occasionally is traceable to an allergic reaction and I have
seen one case with an urticarial reaction in the bladder mucosa which responded immediately to antihistamine drugs. It has been suggested that perhaps such entities
as enuresis may have an allergic background but one would hesitate to stress this point
other than to draw it to attention. Renal colic may in rare cases be allergic in origin.
In the Schonlein-Henoch syndrome albuminuria, haematuria and dysuria are features
and, as has been mentioned, are frequently allergic in origin.
THE HAEMOPOIETIC SYSTEM
It is now becoming rather widely accepted that agranulocytosis and acute haemolytic
anaemia are due to the development of allergy to drugs such as Amidopyrine.
THE RESPIRATORY SYSTEM
I have deliberately left consideration of this system to the last because of its very
great importance and its frequent allergic involvement. Wjk
Allergic rhinitis or hay fever is characterized by periodic, severe nasal obstruction,
marked sneezing, rhinorrhoea, itching of the nose, eyes, palate, etc., and in appearance
by a pale, wet, swollen nasal mucosa. This disease may be strictly seasonal as with
pollinosis, or it may occur throughout the year, that is perennially. While allergic
rhinitis is a very unpleasant disability, it does not assume serious proportions unless
one realizes that it very commonly precedes asthma. It is my experience, and that of
most observers, that as many as 50% of cases of allergic rhinitis will develop bronchial
asthma sooner or later. Allergic rhinitis is most commonly due to inhaled allergens but
it also occurs very commonly with food and drug sensitivity. It is to be distinguished
from vasomotor rhinitis in which the mucosa is reddened and not swollen or wet and
in which the secretion is not predominantly eosinophilic. The latter is a vasomotor
phenomenon and it is very doubtful if allergy is involved in its etiology. Allergic
rhinitis is most commonly confused with the common cold and sinus disease.
The lesion in allergic rhinitis is due to increased capillary permeability which causes
great oedema of the mucosa and usually leads to a very watery, sometimes mucoid, and
copious secretion. The secretion contains but few cells and most of these are eosino-
philes. There are very few pus cells. If the oedema persists for a long time polypoid
mucosa results. These polyps may become quite large and act as mechanical obstructing
agents. I believe that it is very important that polyps be recognized as being probably
allergic.    It is well known that their removal is but of temporary benfit and if the
Page 10 primary allergic process can be arrested, the management of polypi becomes rather
simple.
Bronchial Asthma is probably the most important of the common allergic disorders.
In my opinion it is always an allergic phenomenon although the allergic nature of a
particular case may not always be demonstrable. Some observers have used the term
"non-allergic asthma" to include this particular category, others "intrinsic asthma" or
"infective asthma." It is true that one-quarter to one-third of cases of asthma cannot
be given an undoubted allergic diagnosis with the means at our disposal, but if it is
borne in mind that all cases of asthma are probably allergic then the large group at
present undiagnosed may be made smaller as pur knowledge progresses. I think that it
is fair to say that because these is such a large group in which the allergic basis cannot
be demonstrated physicians are inclined to assume that few, if any, cases of asthma
are truly allergic and in this way they avoid making an etiological diagnosis which
may otherwise be possible. It seems to me particularly important to stress this point
because if an etiological diagnosis cannot be made the case becomes one for symptomatic
management only and this is notoriously disappointing and difficult. Those cases which
probably number two-thirds of the total in which a distinct etiological agent or agents
can be demonstrated are relatively simply managed by control of the allergic factor.
Pathologically there is no demonstrable difference between the case of known allergic
etiology and the case in which such an agent has not or could not be found.
Today we have a reasonably good idea of the pathology of bronchial asthma.
Essentially the disease is due to obstruction of the bronchi. This obstruction is due
to swelling of the mucosa, to oedema and to an outpouring of a thick, viscid mucus
containing many eosinophil cells. Mucosal oedema and mucus plugging cause the
widespread bronchial obstruction. The bronchial wall may be thickened by oedema
and in a few instances by smooth muscle hypertrophy. I doubt if bronchial spasm is
an important feature in producing obstruction. Ordinarily inflammatory processes are
not striking. Bronchial asthma is not an inflammatory disease. This is an important
consideration because it permits acceptance of the conception of complete reversibility.
When the allergic reaction has subsided the tissues return to normal.^; This fact
accounts for the very striking changes seen clinically. A very severe asthmatic case
may within a few hours present no physical signs of any kind, owing to the complete
resolution of the allergic process. This striking recovery is not limited to the mild
cases and is often seen today when using ACTH and Cortisone.
If the process is long continued the bronchial obstruction may permit secondary
infection or bronchial stenosis and more commonly emphysema. I believe it is fair to
say that the commonest cause of emphysema is bronchial asthma. This is not to say
that emphysema may not be caused by other pathological processes, particularly in
degenerative processes as seen with advancing years. When it is realized that emphysema
is the common and serious complication of asthma, that it may occur in childhood or
early adult life, it is realized that it is indeed an importaint complication of this disease.
Pathologically hypertrophy of the right ventricle of the heart is very common but
Cor pulmonale in asthma is less commonly recognized clinically. However, it does
occur and may be the final cause of death. The pathology of bronchial asthma has
been studied in life by means of the bronchoscope and various functional procedures.
A large number of cases dying in an attack of bronchial asthma have now been studied
at autopsy and the findings are uniform. The pathological picture seen in the so-called
intrinsic, infective or non-allergic asthma, is no different from that seen in the true
allergic or demonstrably allergic asthma. If the pathological and allergic concept is
correct the time-honoured diagnosis of chronic bronchitis with secondary asthma or
bronchial spasm is no longer tenable.
THE DIFFERENTIAL DIAGNOSIS OF BRONCHIAL ASTHMA
Bronchial Asthma is a form of dyspnoea which is usually paroxysmal in type
and is characterized by prolonged difficult expiration, wheezing, and by severe cough.
Page 11 Asthma is reversible. It is a manifestation of allergy or hypersensitivity in many and it
is often associated with other allergic manifestations such as hay fever, urticaria,
eczema or migraine, either in the patient or in close relatives. The disease occurs at all
ages from early infancy to old age and is about equally distributed between the sexes.
It is more frequent in the male in childhood, but in the reproductive ages the disease
is about twice as common in women. In the aged the sex incidence is about equal.
Characteristically the symptoms start abruptly, very often during the night, and they
end equally abruptly. Cough is often the first striking symptom, particularly in childhood but often too, in the adult. Wheezing and dyspnoea may not be noticed until
later. A persistent severe cough with little or no sputum (mucoid) in a child or in an
adult and for which no adequate cause can be found, must be considered as possibly
allergic. Sooner or later characteristic signs may be elicited. In this connection it is
important to emphasize that the characteristic expiratory rhonchi can often be demonstrated by causing the patient to inhale forcibly.
While asthma may be persistent for weeks or months in long standing and severe
cases, it is ordinarily a periodic disease with striking remissions and exacerbations of
abrupt nature. Often the symptoms are strikingly seasonal or episodic in character.
The acutely ill patient may appear surprisingly normal within a few hours of an attack.
Sputum is often scanty, it is never purulent, and blood tingeing is uncommon. It is
characteristically tough, tenacious and hard to raise. The patients are seldom febrile
except in early childhood and there are none of the common general signs of infection
such as malaise, etc. Pallor, sweating on exertion, local muscle pain in the chest are,
of course, common. Cyanosis may be striking. Of course, an asthmatic may develop
intercurrent respiratory infection with all the usual signs.
On examination the chest is hyperresonant and moves as a massive unit. Vesicular
breath sounds are poor or absent. Expiration is prolonged and expiratory rhonchi are
prominent throughout. Rhonchi may also be heard on inspiration but are not as
strinking or prolonged. Moist rales are seldom heard except in complications and in
localized disease of the lung. Blood eosinophilia is usually in excess of 4%. Frequently
the asthmatic»attack is preceded by a "cold" which turns out usually to be an allergic
rhinitis.
The allergic diathesis is markedly hereditary and asthma, therefore, is a markedly
hereditary disease. It occurs commonly in families having asthma and other allergic
manifestations. The presence of allergic disease in the family is a strong stimulus to
finding it in other members of the family. As asthma is a manifestation of a constitutional diathesis, namely allergy, it is important to emphasize that other diseases of the
respiratory tract may supervene. There is no reason why an asthmatic cannot have
pneumonia, bronchiectasis, tuberculosis, bronchogenic carcinoma, lymphomata or heart
disease.      These diseases are not infrequently seen in asthmatic patients.
In the diagnosis of asthma the history is perhaps of the greatest importance. Too
often the patient tells a garbled story of cough or dyspnoea, bronchitis or chest colds, but
in the absence of actual pulmonary signs the doctor is apt to pass it off lightly as a
neurosis or some vague entity such as trachetitis, too much smoking, etc. The diagnosis
of asthma and, of course, this term includes the diagnosis of the cause of the asthma,
demands an accurate record of dates, times, and the circumstances of each attack.
The presence of other allergic phenomena such as hay fever, urticaria, atopic dermatitis,
either in the patient or his family is of great significance. Most asthmatics learn
instinctively to exhale as gently as possible so as not to precipitate cough. If this is
remembered the patient who has no gross signs in his chest should be caused to exhale
forcibly and if he will not do this he should be exercised so that the increased respiration
will produce signs which otherwise might be missed. Another useful diagnostic point is to
give the patient a suitable sympathomimetic drug, such as Ephedrine, with instructions
to take it when he has symptoms. He will quickly note if benefit occurs. This is most
suggestive. However, it must be realized that heart failure may also be benefitted by
such a drug. ||||
Page 12 DIFFERENTIAL DIAGNOSIS
In infants up to two years the most difficult differentiation is between asthma and
bronchopneumonia. Asthma is characterized by being recurrent, with or without
moderate fever. The illness is brief. The response to medication is striking. There
is often a family history. The infant may have eczema. Thymus enlargement may
sometimes be wrongly credited with the symptoms. A foreign body, of course, must
be thought of and tracheobronchitis with all its risks is a serious problem.
In the pre-school child the greatest difficulty arises in differentiating pertussis,
pneumonia, bronchitis and foreign body. In the school age child there is usually little
difficulty.
In adults it is usually not difficult to distinguish true bronchial asthma. Of
course, it must be distinguished from bronchitis, tuberculosis, rheumatic heart disease,
hypertensive heart disease and mediastinal tumors. The differential problem in older
adults is somewhat similar.
SPECIAL TESTS IN DIFFERENTIAL DIAGNOSIS
In the blood there is rarely anaemia and eosinophilia is common. Sputum is usually
mucoid and eosinophiles predominate. Tubercle bacilli must be ruled out. X-ray of
the chest is characterized by increased broncho-vascular markings, often emphysema
and perhaps emphysematous bullae, and, in children particularly, transient infiltrations
may be seen and confused with broncho-pneumonia.
In the differentiation of congestive heart failure, measurement of the circulation
time and venous pressure and perhaps electrocardiography would be useful. Bronchoscopy is valuable to rule out endobronchial disease. Skin tests are not diagnostic in
asthma nor even of clinical allergy. They are valuable only as indicators that specific
antibodies exist in the dermal cells and only if the patient's symptoms fit the facts is the
skin test valuable.
Typical paroxysmal bronchial asthma is usually not difficult to recognize in the
absence of other disease. However, it often presents difficulty in the presence of other
disease of the lung or of the heart. Bronchogenic carcinoma developing in a known
asthmatic is not uncommon. The acute onset of very severe dyspnoea in an asthmatic
may herald an acute myocardial infarction. Asthma may co-exist with congestive
heart failure (mercuhydrin test). Such evidence as valvular murmurs, auricular
fibrillation and so on are important in differentiation. Sometimes confusion arises in
the case of a known allergic patient who has never had asthma. Such a patient may
become dyspnoeic, not because he has developed asthma, but because he has congestive
heart failure. |g>*.;
DISEASES WHICH MAY SIMULATE ASTHMA
AND MUST BE DIFFERENTIATED
(a)    Pulmonary Diseases Wm
1. Bronchitis, bronchiectasis, acute and chronic
Purulent sputum
Localized signs
Moist rales
Toxaemia
2. Primary atypical pneumonia
3. Tuberculosis
4. Bronchogenic carcinoma
5. Primary emphysema
Barrel chest
Poor breath sounds
Prolonged expiration but no rhonchi
If rhonchi heard it is most likely asthma with secondary emphysema
Page t3 (b)
6. Foreign body
History
Localized signs
X-ray
7. Pleural effusion
8. Pulmonary fibrosis
Pneumokonioses
Bronchopneumonia
Chronic venous congestion
Bronchiectasis
9. Mediastinal tumors
10. Laryngeal lesions
11. Thymus gland enlargement
12. Enlarged thyroid with tracheal pressure
13. Pertussis
Cardio-Vascular Disease
1. Congestive heart failure
Rheumatic heart disease
Arteriosclerotic heart disease
Hypertensive heart disease
Cor pulmonale
2. Myocardial infarction
3. Aneurism
General  Causes
1. Anaemia
2. Nasal obstruction
3. Uraemia
' 4. Neurosis and hysteria
It is important to recognize asthma and distinguish it from other diseases causing
dyspnbsea. If asthma is recognized there is a good chance that its cause may be
determined and useful theurapeutic results follow. Therapy other than the treatment
of symptoms demands the recognition of asthma and requires an etiological diagnosis.
(c)
SURGICAL SOCIETY DINNER MEETING
There will be a Dinner Meeting for the members of the British Columbia
Surgical Society, Friday, November 2nd, at 6:30 p.m., in the Hotel
Vancouver. Dr. Joel Baker, of Seattle, Wash., will be the guest speaker.
His subject will be "Changing Concepts in Gastroduodenal Ulceration."
Dr. John Balfour, M.D.,
Secretary-Treasurer.
Page 14 BRIEF
Submitted to the
BRITISH COLUMBIA ENQUIRY BOARD
CONCERNING BRITISH COLUMBIA
HOSPITAL INSURANCE SERVICE
Submitted by
THE COLLEGE OF
PHYSICIANS AND SURGEONS OF
BRITISH COLUMBIA flj
SEPT., 1951
Introduction
The membership of the College of Physicians and Surgeons of British Columbia,
comprising physicians licensed to practice in the Province, has a sincere interest on
behalf of individual patients and on behalf of the community in the successful
operation of the British Columbia Hospital Insurance Service.
Pursuant to this expressed interest, therefore, the Council of the College of
Physicians and Surgeons welcomes the opportunity which the government of British
Columbia has provided through the public hearings of the Hospital Inquiry Board to
present the viewpoint of the medical profession on this important public matter.
Presentation of this viewpoint is motivated by a strong desire to support constructively the project of the government, the purpose of which is to provide the best
hospital services for those who need them and to distribute the cost of these services
fairly among all citizens.
Summary of the Medical View Point:
The following opinions are recorded in summary and will be developed in detail
on the body of the Brief:
(1) The medical profession agrees that every citizen should be insured against
the cost of necessary hospital care.
(2) The development of facilities for the care of convalescent and chronic cases
outside the hospitals is most urgent.
. (3)   The rigid pre-fixed budget for hospitals may have a deleterious effect on the
standard of medical care.
(4) There should be. a doctor, with voting power, on the board of management
of every hospital, who has been elected to the board by the medical staff of the
hospital.
(5) Advice on the degree of illness of patients should be made by a doctor on a
local level or committee of doctors.
1.    GENERAL REMARKS
There is agreement among doctors that insurance of all citizens against the possibility of a large hospital bill is in the best interest of the community. Since the
inauguration of Hospital Insurance in B.C. we have witnessed numerous instances of the
gratitude of patients who have received expensive hospital care. The bills for this
hospital care would formerly have threatened their economic security.
With removal of the economic barrier there has been the expected increased
utilization of hospital services. Some of the additional hospital admissions are for
conditions that formerly might have been the occasion for procrastination about hospital
care. The reason for procrastination in these cases was economic. The patients had
as good a reason for entering hospital then as now, but because their disability did not
Page 15 require emergent ereatment and did not threaten their lives, they preferred to put off
expense. From our observation the use of hospital nowadays for conditions that could
be handled just as well outside represents a very small and insignificant proportion of
the total admissions. These unnecessary admissions are limited by: (1) shortage of
hospital beds, and (2) the general desire on the part of the medical staffs of hospitals
to eliminate any possible abuses of Hospital Insurance within their hospital.
The average stay in hospital has been lengthened by a day—more or less. It may
be easier for a doctor to condone his patient's reluctance to go home early but most
doctors are anxious to get their patients out as soon as safety warrants, to cooperate in
providing more available beds. The chief factor in delayed discharge is the lack of
available facilities for convalescent care outside of hospital.
The increased utilization of laboratory and X-ray services and increased consumption of drugs within hospital is a matter that is very difficult to interpret. To
an extent which is impossible to analyze but which we believe to be very small, it
represents wastage of services. To a greater extent it appears to us to represent more
safeguards and more effective treatmnt of patients in hospital. Arbitrary general
rulings that prevent or limit the utilization of laboratory services or drugs may create
intolerable situations for the doctor and his patient. Close cooperation between the
executive staff and medical staff of each hospital with periodic review of the relative
amount of these services expended is the only practical means of control.
2.    THE DIRECTION AND CONTROL OF HOSPITAL POLICY
(a) The "Fixed" Budget
The financing of hospital care is not our business. We wish to point out, however,
that in any hospital a rigid budget, pre-fixed at an arbitrary level by an agency outside
that hospital may have a deleterious effect on the standard of medical care. A hospital
is a community service institution and cannot be regarded as a boardinghouse for
the sick. If a hospital exercising careful controls over its budget is told to make an
arbitrary reduction in that budget, service must suffer. There is, and will continue
to be, an inevitable and necessary increase in the cost of medical care because the
economies that result from more efficient means of treatment do not offset the increased
costs of more complex methods. The setting up of arbitrary controls at Victoria to
decide what increase in service, if any, may be permitted, will have an ill effect, in
time, on the standards of hospital care in British Columbia.
(b) Medical Representation on Boards of Management
With the increased cost of hospital care that has resulted from rising wages,
higher costs of food, etc., hospital management has become Big Business. The past
decade in B.C. has witnessed the emergence of a new group of professional hospital
managers. They are experienced, well-trained and efficient. In two of the major
hospitals a non-medical administrator has replaced a doctor as General Superintendent.
In smaller hospitals the new administrators have assumed more direct and firmer control
of total hospital activities than their predecessors.
We assume that this has resulted in more efficient administration of the business
affairs of hospitals. We wish to point out, however, that coincident with the change
there has appeared to the doctors to be a Worsening of liaison between the policy-making
level and medical staffs. The subject is mentioned in this brief because the Hospital
Insurance Service has allied itself closely with the new trend in administration of
hospitals and if not actively opposing, at least has made no effort to re-open satisfactorily
the lines of communication for medical opinion.
To come to the point at once, we recommend that on the Board of Management
of every hospital which has an organized medical staff, there should be a doctor with
full voting powers who represents and has been elected by the medical staff of the
hospital. The majority direction of hospital policy will remain in control of non-medical
trustees  but  the provision  which  we  recommend  will  ensure   that  medical  opinion
Page 16 derived from the medical staff will be expressed at the policy-making level. We know
that there are situations in hospital affairs wherein shrewd business sense may conflict
with the standards of medical care, e.g. the purchase of special equipment. And in
other matters the viewpoint of the doctor and the layman differ. We believe that it
is in the patient's interest that here shall be a balanced viewpoint in hospital management.
To achieve this balance there is need for effective medical as well as non-medical thought
on occasion.
3.    THE DESIGNATION OF PATIENTS AS NON-ACUTE
It is recognized by the doctors that B.C.H.I.S. was not set up to provide chronic
hospital care and that controls in this respect are a "necessary evil." We object strongly
on behalf of our patients, to the method of control that has been set up in Victoria to
handle this problem.
Certain categories of patients, in particular, may be placed in distressing circumstances when present methods are followed. These categories include patients with advanced cancer, patients with severe acute forms of non-pulmonary tuberculosis, mental
patients above the age of seventy, and patients with certain conditions of long duration
that may require very special hospital care, notably poliomyelitis and paraplegia. It
is intolerable to us that an arbitrary ruling can be made by a single medical civil servant
in Victoria indicating that certain individuals in any of the above mentioned groups,
whom he has not seen and whose doctors assert are still requiring acute hospital care,
are now eligible for two more weeks or four more weeks or no more care at all under
B.C.H.I.S. It has been apparent to us that the doctor on the staff of B.C.H.I.S. in
Victoria is in no position to determine the eligibility of individual patients for insurance
coverage in these difficult and controversial problem cases.
Decision in these matters should be made at a local level by a competent medical
man or committee and should be based on the findings in each case. It will be
impossible to find doctors to act in these capacities until more adequate services are
made available for the care of convalescent and chronic disease outside of the acute
general hospitals. No doctor in practice will condone or be party to the discharge
of a patient from an acute general hospital if that discharge means* gross deterioration
in the standard of medical care. That, in fact, is what we are being asked to do now
by B.C.H.I.S. on not infrequent occasions.
We have been told by the Commissioner that the number of such patients whose
hospital insurance coverage has been terminated, because they were considered to be
non-acute, is less than 1/10 of 1% of the total number of of hospital admissions.
His figure does not include an unknown but significant number of patients who have
Jt>een refused admission to any acute general hospital because the hospitals, anticipating
the Commissioner's ruling, declare them to be not eligible, for admission. This second
group includes, for example, people who have suffered strokes. If their doctor does
not act as an advocate and put up a very strong case for the need of acute care, they
are "sidetracked" directly to a nursing home, where there do not exist sufficient
facilities to verify the diagnosis, and where facilities for care during the acute stages
are so meagre that the patient's life, let alone recovery, is in jeopardy.
Apart from consideration of patients who are sidetracked away from acute hospital,
we feel that the number of patients whose coverage is terminated before their doctor
considers that they are fit for discharge, though it is a small number, is significant.
It is just these cases of catastrophic hospital expense that led the majority of citizens
to accept hospital insurance as a good measure. We have been told, in respect to these
cases, that the Hospital Insurance Service does not state that a patient should be
turned out of hospital. That is true, but when a citizen of limited means is told
that if he or his dependent remains in hospital he must pay eight or ten or thirteen
dollars a day, the practical result is the same. Furthermore, there will be immediate
and very strong pressure from the hospital to move that patient out because the
hospital does not want to be stuck with the bill if that citizen defaults.
Page 17 We are told that at this unhappy stage "welfare steps into the picture." What
that means for a citizen who is not on Social Assistance is that he is given a list of
nursing homes, which in Vancouver may contain two dozen names. He may phone
them all and find no bed for his ailing relative in any of them. He is certain to be
turned down by every nursing home if his sick relative happens to be an elderly
individual with mental deterioration. He is almost as certain to find no bed if his
sick relative has far advanced cancer, because most nursing home proprietors state
frankly that they have not sufficient facilities for the care of these difficult cases.
We know of only one practical solution to this problem. That is the provision
of more facilities for the care of convalescent and chronic cases in hospital. In regard
to responsibility for establishing and maintaining this service we are daily witness to
what can be termed "passing the buck." In the case of certain tuberculous patients
and in the case of irlental cases over the age of seventy and under the age of six, we
see two branches of the same department of government acting as though they did
not know the existence or problems of each other. The subdepartment of Welfare is
frustrated and helpless to care adequately for a patient who has been refused admission
or invited out of hospital by the subdepartment of Health. Municipal governments
who have authority to initiate new construction for convalescent and chronic hospitals
are able to throw up a smoke screen and obscure their responsibility by pointing out
that the Provincial Government entered that business when it assumed operation of
the Marpole Infirmary.
The problem is obviously greater than that of Hospital Insurance alone. There
is no easy solution. Defense of the activities of the Hospital Insurance Service is not
enough. There must be concerted action by a strong committee that represents all
responsible groups. We suggest that initiation of such a concerted action should come
from the senior government.
St. Paul's Hospital Meeting Nov. 20, 1951
(1) X-Ray Therapy of Oral Carcinoma, Hodgkin's Disease and Haemangioma.
Drs. Gordon Campbell & J. S. Madill.
(2) Rare Ocular Complication of Diabetes Mellitus.
Dr. Howard Mallek.
(3)  Pathological presentation.
Drs. H. H. Pitts & J. Sturdy.
Drs. D. H. Williams, T. R. B. Nelles, H. A. MacKechnie, Ben Kanee and D. E. H.
Cleveland of Vancouver and R. E. Burns of Victoria attended the semi-annual meeting
of the Pacific Northwest Dermatological Association in Portland on October 18.
Page 18 THE AESCULAPIAN STAFF AS THE CORRECT
SYMBOL OF MEDICINE
R. E. McKECHNIE, M.D.
For many years there has been considerable confusion in the minds of the medical
man, to say nothing of the general public, as to what is the correct symbol or insignia
to symbolize those things pertaining to the practice of medicine. Seemingly nothing
has been^declared officially and today there are two symbols for the practice of medicine
in general use. The first is the caduceus represented by a staff with two serpents twined
around it and facing each other at the upper end and the other is the Aesculapian staff
with a single serpent twined around.
In reviewing those things medical, such as buildings, medical columns in lay
magazines, etc., where an insignia is used, sometimes one and sometimes the other
emblem is found in use, apparently without rhyme or reason. The most apparent
inconsistency is to see the Medical Officers of the R.C.A.F. sporting the two serpent
models on their badges whereas their counterparts in the R.C.A.M.C. display the single
serpent job. To add to the confusion of all concerned the caduceus is being used as a
symbol of various commercial organizations such as the Canadian Bank of Commerce.
What connection there is between the practice of medicine and the Bank of Commerce
is, perhaps, not too readily apparent.
Others have noted these inconsistencies and apparent contradictions and one doctor,
Edwin S. Potter, of Santa Barbara, California, went so far as to have a small book1
privately published—dedicated to "Fighting Aesculapians" reviewing the history and
origin of the two symbols in detail and finally pointing out where some of the confusion
first arose and why.
In giving consideration to the subject under discussion first of all it is to be
remembered that symbolism must not be confused with family arms or heraldry. In
ancient times heraldry was a very exacting science and the studbook containing the
records of the various family trees was kept in Stationers Hall and was exact and
authoritative. This was necessarily so as the possessions, wealth and power of great
families had to be handed down in proper lines of succession and all property, battle'
accoutrements and particularly shields had to be marked by the family crest to denote
association and ownership. Symbolism on the other hand is not an exact art, and
various symbols have been adopted on a purely elective basis by individual groups or
persons to denote ownership or membership. These symbols are frequently derived from
mythology, often including the symbol or name of an appropriate god or goddess (such
as Hygeia—the goddess of health.) Others are more individual and illustrate, not
necessarily accurately any particular fancies or vanities the owner wishes. The most
common illustration of this latter type is the book plate to be pasted in the fly of a
book. It is usually headed by "Ex Libris" (from the library of) followed by the
owner's name and symbols of his hobbies such as guns, fishing rods, etc.
Because the medical profession has no registered coat of arms the problem at hand
cannot be solved by turning to the stud book in Stationers Hall. To decide which is
most correct between the two symbols in common usage, a review of the origin of the
symbols might be in order.
The serpent has, since the beginning of history, been worshipped along with the
sun, as the god of life. The reason for this worship is presumed to be that the serpent
was considered a symbol of the phallus, that, like the sun, gives life on earth, warms
man's love for woman and influences the daily life of man in general.
Along with the sun-god the Babylonians worshipped Ningishzida, the god of spring
and fertility. This god was pictured as the tree of life (a staff) with two serpents
entwined in the act of creating life. This god was the original caduceus. Sometimes
the staff sprouted branches with fruit representing the procreation of life and some
say that it is that fruit that originated thexstory of the apple in the Garden of Eden.
Page 19 The cross of Christianity and the swastika are also said to have been derivations of this
original caduceus.
The staff of life with the two entwined serpents retained its importance down the
centuries until the Roman times. Then Hermes, son of Zeus and Maia became the
representative of the caduceus god. He was the herald and messenger of the gods and
also had many attributes which placed him as the social promoter of men and commerce
and that of maintaining peace. He was the god of roads and therefore was the protector of travellers.^-He was the patron of gymnastic games. He was the god of
commerce, (hence the adoption of the caduceus by the Bank of Commerce) and the
source of wealth, gain, riches, and good luck. As the giver of wealth this quality was
stretched to make him the "god of gambling." Being endowed with shrewdness and
sagacity he was regarded as the author of many inventions. He was a great charioteer
and a cupbearer. As a musician he was well known and was often pictured carrying
a lyre. Another important function was to conduct, for the gods, the shades of* the
dead from the upper into the lower world. He changed into gold everything he touched
and thus was the symbol of abundance and legerdermain.
Because Hermes was a messenger and herald of the gods his two serpents and
staff emblem (the caduceus) was carried by the Roman heralds and messengers, particularly when on peaceful missions during war. The heralds were known as caduceators
and the caduceus became known as the symbol of a non-combatant on a peaceful mission.
On the other hand the Aesculapian symbol (a staff with a single serpent entwined
around) originated from the legend that Aesculapius, the god of medicine, was visiting
the stricken Glaucus to attempt to heal him. While standing in thought a serpent came
and twined itself about his staff. He killed the serpent. ||fAnother serpent came
carrying in its mouth an herb and called to life the one that had been killed. Aesculapius
made use of the same herb thereafter with the same effect on man and his fame became
widespread as a physician. The staff and entwined serpent became his symbol, the
symbol of the god of medicine.
The present confusion of symbols originated many years ago. First of all at the
Geneva Convention, 1864, the Army Surgeons selected the caduceus as the emblem of
the non-fighting Army Medical Man. This was the first linkage of the caduceus and
medicine. Then the Royal Army Medical Corps, chose the staff of Aesculapius as their
regimental badge. The R.A.M.C. was able too choose its own regimental emblem
because, as Dr. D. E. H. Cleveland pointed out to me, the R.A.M.C. was unique in
that it is a regiment in its own right in contra-distinction to the medical personnel of
the Navy and Air Force who were not in such a unit. The Royal Canadian Army
Medical Corps, a unit patterned after the R.A.M.C. also adapted a modification of the
Aesculapian staff. To those not aware of the reasons behind all this the medical
personnel of the Army, Navy and Air Force did not seem to agree on their medical
emblems. To add to the confusion, a number of years ago a large American medical
association used, in error, the caduceus as the medical emblem and had it placed on
their journal, car emblems, etc. Naturally many copied the emblem, believing such
an organization was an authority and by the time the error was discovered and corrected
the mistake was widespread.
To sum this discussion up it would seem that the two-serpent caduceus can be
properly used as a crest of the non-fighting medical man, or caduceator, as a symbol
of his peaceful mission. Beyond indicating the peaceful mission of the Army Surgeon
the symbol actually does not appear to have much to associate it with the medical
profession and could as readily have been chosen by the Chaplain service. The
Aesculapian single serpent and staff on the other hand carries nothing but honor and
is exclusively the insignia of the god of medicine and thereby is seemingly most
suitable as a representative symbol of the medical art.
1 Potter, Edwin S. "Serpents in Symbolism, Art and Medicine"—
The Schauer Printing Studio, 1937.
Page 20 n
ew5 an
d iloted
Dr. W. L. Sharp is now practising in Vernon.
Dr. -E. M. Stevens is now practising in Vancouver.
Dr. R. E. Outerbridge is now practising orthopaedic surgery in New Westminster.
Dr. R. B. Hicks is now practising at Terrace.
.Dr. Ernst Frinton is now practising in Coquitlam.
Dr. R. A. Burns is now practising in Alberni.
Dr. Sam McClatchie of Vancouver is now a battalion surgeon in Korea.
Dr. G. F. Kincade has been named director of Tuberculosis Control  for B.C.,
succeeding Dr. W. H. Hatfield.
Dr. Charles Davies of Vancouver will serve as oculist for Indian and Eskimo
Arctic residents reached by H.B.C. supply ship during the next two months.
BIRTHS
To Dr. Anne Steel of Victoria, a son.
To Dr. and Mrs. W. B. Touhey (Dr. Jacqueline Vance), a son.
IMPORTANT  NOTICE
"Whenever a Doctor wishes to have Physiotherapy administered to
one of his Compensation Board cases it is requested please that you
telephone the Clinic direct for an appointment. (Cedar 9144). It
will no longer be necessary to refer your cases first to the Head Office."
POSITION  REQUIRED
RECEPTIONIST with general office experience.    Routine Lab work.
Available Immediately.
Box 10, Bulletin Office, 675 Davie Street
Page 21

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/cdm.vma.1-0214330/manifest

Comment

Related Items