History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: July, 1936 Vancouver Medical Association Jul 31, 1936

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 The BULLE«|gM
OF THE     X^Hf3^J
vancouverIm:
association
£?.
Vol. XII.
JULY, 1936
No. 10
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,1898,
In This Issue:
Convention Number
INTERNAL DERANGEMENT OF THE KNEE JOINT
NEWS and NOTES BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) THE    VANCOUVER    MEDICAL    ASSOCIATION
BULLETIN 1
'Published ^Monthly under the ^Auspices of the Vancouver iMedical ^Association in the
interests of..the tJ&edical "Profession.
Unices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird                                        Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XII.                                                   JULY, 1936                                                 No.  10
OFFICERS  193 6-1937
Dr. W. T. Ewing Dr. G. H. Clement Dr. C. H. Vrooman
President Vice-President Past President
Dr. Lavell H. Leeson Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Executive—Dr. A. M. Agnew, Dr. J. R. Neilson
TRUSTEES:
Dr. F. Brodie Dr. J. A. Gillespie Dr. F. P. Patterson
Auditors: Messrs. Shaw, Salter & Plommer.
SECTIONS
Clinical Section
___ Chairman      Dr. Russell Palmer  —Secretary
Eye, Ear, Nose and Throat
  Chairman     Dr. L. Leeson___ Secretary
Pediatric Section
Dr. G. A. Lamont    Chairman      Dr. J. R. Davies   Secretary
Cancer Section
Dr. B. J. Harrison  Chairman      Dr. Roy Huggard __  Secretary
Dr. Roy Huggard
Dr. H. R. Mustard
STANDING COMMITTEES
Library
Dr. A. W. Bagnall
Dr. H. A. Rawlings
Dr. W. D. Keith
Dr. S. Paulin
Dr. W. F. Emmons
Dr. Roy Huggard
Publications
Dr. J. H. MacDermot
Dr. Murray Baird
Dr. D. E. H. Cleveland
V. O. N. Advisory Board
Dr. I. T. Day
Dr. W. A. Dobson
Dr. G. A. Lamont
Dinner
Dr. A. Lowrie
Dr. A. E. Trites
Dr. J. G. McKay
Summer School
Dr. J. W. Arbuckle
Dr. J. E. Walker
Dr. H. A. DesBrisay
Dr. H. R. Mustard
Dr. A. C. Frost
Dr. J. R. Naden
Credentials
Dr. A. B. Schinbein
Dr. H. A. DesBrisay
Dr. J. R. Naden
Rep. to B. C. Medical Assn.
Dr. Wallace Wilson
Sickness and Benevolent Fund—The President—The Trustee:
'It Biological Products
Anti-Anthrax Serum
Anti-Meningococcus Serum
Anti-Pneumococcus Serum {Type I)
Anti-Pneumococcus Serum {Type II)
Diphtheria Antitoxin
Diphtheria Toxin for Schick Test
Diphtheria Toxoid
Perfringens Antitoxin
Scarlet Fever Antitoxin
Scarlet Fever Toxin for Dick Test
Scarlet Fever Toxin
Staphylococcus Antitoxin
Staphylococcus Toxoid
Tetanus Antitoxin
Tetanus Toxoid
Tuberculin
Pertussis Vaccine
Rabies Vaccine (Semple Method)
Smallpox Vaccine
Typhoid Vaccine
Typhoid-Paratyphoid Vaccine
Heparin
Insulin
Liver Extract for Oral Administration
Liver Extract for Intramuscular Use (2 cc.
containing extract from 10 gms. of liver)
< i
The following additional products have been made available recently
by the Connaught Laboratories
Adrenal Cortical Extract
Epinephrine Hydrochloride Solution 1:1000
Epinephrine Hydrochloride Inhalant Solution 1:100
Liver Extract for Intramuscular Use
(2 cc. Containing Extract from 20 gms. of Liver)
Outfit for Rapid Typing of Pneumococcus by Physicians
i.i
CONNAUGHT   LABORATORIES
UNIVERSITY  OF  TORONTO
TORONTO 5 • CANADA
Depot for British Columbia
MACDONALD'S   PRESCRIPTIONS   LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. VANCOUVER HEALTH DEPARTMENT
STATISTICS—MAY, 1936
Total Population   (estimated) _._ _    247,5 5 8
Japanese Population  (estimated)    __    8,05 5
Chinese  Population   (estimated)      7,895
Hindu  Population   (estimated)  ._ _   320
Rate per 1,000
Number Population
Total deaths    _     214 10.2
Japanese deaths       _          6 8.8
Chinese deaths     _ _       15 22.4
Deaths—residents   only   _     184 8.7
Birth Registrations: Male, 147; Female, 118 .--_______.      265 12.6
INFANTILE MORTALITY— May, 1936 May, 1935
Deaths under one year of age   __.   5 6
Death rate—per  1,000  births.          18.9 18.8
Stillbirths (not included in above)   5 3
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
June 1st
April, 1936 May, 1936 to 15th, 1936
Cases   Deaths Cases Deaths Cases   Deaths
Smallpox .  _.          0           0 0           0 0 0
Scarlet   Fever ._         31           0 33           0 11 0
Diphtheria              0           0 0           0 0 0
Chicken Pox __        64          0 57          0 28 0
Measles             31            0 17           0 1 0
Rubella _ _ _ 2422           0 15 80           0 202 0
Mumps      243           0 224           0 114 0
Whooping  Cough I        15           0 23           0 3 8 0
Typhoid Fever           10 0           0 0 0
Undulant  Fever            0           0 0           0 10
Poliomyelitis _              0           0 0           0 0 0
Tuberculosis  _.       28         10 40 20 26
Meningitis   (Epidemic)            0           0 0           0 0 0
Erysipelas     ____           7           0 4           0 2 0
Encephalitis Lethargica           0           0 0           0 0 0
Paratyphoid  Fever           0           0 0           0 0 0
Bioglan Hcrmone Treatment
A SCIENTIFIC BIOLOGICAL
PLURI-GLANDULAR  REMEDY
Its use is being attended with better than ordinary results.
Descriptive literature on request.
MADE IN ENGLAND BY
THE BOWSHER LABORATORIES LTD.
Biological and Research
PonsDonnxe Manor, Hertford, England.
Rep., S. XT. BAYNE
1432 Medical .Dental Building'       Phone Sey. 4239        Vancouver, B. C.
References: "Ask the Doctor who has used it."
Page 214 REYQU
//////////////jar//, //////////fcy/Zli
DIABEflCS
?
Then you know how the average diabetic dreads the
daily hypodermic injection. He will welcome oral medication with Pancrepatine and a moderate restriction of
carbohydrates.
Pancrepatine contains the hormones of pancreas and
liver, ACTIVE BY MOUTH. These hormones are
fully protected from ferment action in the duodenum
by the special capsule of the globule.
Many physicians attest the efficacy of Pancrepatine as
an effective oral treatment for diabetes mellitus. Especially useful in the mild or average uncomplicated case.
Reduces blood and urinary sugar and spares insulin.
Controls the annoying symptoms of polyuria and polydipsia. The general condition of the patient is improved.
When treating your next case of diabetes we invite you
to try Pancrepatine. You will be pleased with the results revealed by Benedict's test.
Prescribe 2 to 4 globules t.i.d. after meals in increasing
doses. Bear in mind the appropriate dietary restriction.
Supplied in bottles of 100 hormone-protected globules.
May we send you a liberal complimentary sample?
Write to Anglo-French Drug Co.
354 St. Catherine Street East, Montreal,    Quebec
^^^hi/e  OrcXTreaint%i{orDLabeies VANCOUVER MEDICAL ASSOCIATION
TENTATIVE  PROGRAMME
FOR
K SUMMER  SCHOOL iff
September 8, 9, 10 and 11, 193 6
1. Dr. Gordon B. New—Prof. Oto-Laryn. and Khin., Dept. Oral and
Plastic Surgery, Mayo Clinic, Rochester, Minn.
Malignant diseases of the mouth and accessory structures.
Tumours of the neck.
Reconstructive surgery of the face.
Tumours of the larynx.
2. Dr. Evarts A. Graham—Prof, of Surg., Washington University, St.
Louis, Mo.
Two lectures on Thoracic Surgery.
Certain phases of gallbladder disease.
Surgery of the pancreas.
3. Dr. J. McF. Bergland—Lecturer of Clin. Obstet., Johns Hopkins
Hospital, Baltimore, Md.
Accidental complications of pregnancy.
Direct complications of pregnancy.
Relief of pain.
Puerperal infection.
4. Dr. Rollin T. Woodyatt—Prof, of Clin. Med., Rush Medical Col
lege, University of Chicago, Chicago, III.
Diabetic coma.
Diabetes with intercurrent conditions.
Newer preparations of protamine insulin and their uses.
Treatment of nephritis.
5. Dr. Irvine McQuarrie—Prof, of Pediatrics, University of Minne
sota, Minneapolis, Minn.
The pathogenesis and treatment of cedema.
Clinical significance of the basic minerals of the body.
Special roles of fats and fat-like substances in health and disease.
The mechanisms and treatment of various convulsive disorders of childhood.
6. Dr.   C.   B.  Farrar—Prof,   of  Psychimry,   University  of  Toronto,
Toronto.
Evolution of delusion.
Psychoneuroses and psychotherapy.
Differentiation of benign and malignant symptoms in incipient mental disorders.
7. Dr. C. E. Dolman—Acting Prof, of Bacteriology and director of Con
naught Laboratories, University of British Columbia, *Yancouver,
B. C.
Undulant fever.
Page 215 i
.I»j
...i
II
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EDITOR'S PAGE
The recent Convention Week at Victoria has given us much to think
about. The raison d'etre of the meeting was, of course, the Canadian Medical
Association meeting in annual conclave. The choice of Victoria, and therefore British Columbia, as the place of meeting was a particularly wise one
at the present juncture.
Among the topics discussed was that of amalgamation of the provincial
with the Federal Association. One member of Council spoke very wisely
and well when he said that what we should think of is not amalgamation of
the provincial associations, but amalgamation of all the medical men in
Canada into a coherent whole.
This is the true note to strike: these are the terms in which we should
enunciate the problem which we have to solve. We hear too much and too
often about the British North America Act, the autonomy of the provinces,
the "impossibility" of a national conception of medical matters, till the
defeatist element amongst us begins slowly, and almost in spite of us, to gain
a hearing for its policy of laissez faire, of individualism, of provincial handling of problems, rather than a national policy to which we as medical men
could subscribe.
We confess that this to us is all unnecessary, and we cannot accept these
views. There is an old Zulu proverb, Rider Haggard tells us, "If we go forward we die; if we go backward we die; better to go forward and die", and
the words attributed to Marshal Joffre on the Marne follow the same idea.
We are too prone to fear the "big battalions." But history, if we read it
aright, will give us hope, and a test. Are we right? Are our motives sincere
and just? Are we truly anxious to serve, and to give to the sick the best
there is? Then we need have no fear. Reaction, timeserving, political expediency, may make us smart for a while, and possibly we deserve the smart,
because we failed somewhere in our duty, but they will not last.
Canada is suffering, very badly through the lack of vision of those who
made of her a collection of provinces, rather than a nation. But many
Canadians have seen this. There are still many thousands "who have not
bowed the knee to Baal." And after all, nothing is irrevocable in nation-
making. We may still retrace our steps; there may yet be a Moses to lead us
out of Egypt, and who knows but what the medical profession may be that
Moses?
We need not forever be bound by shackles imposed by our forefathers—
We can surely think as Canadians, and perhaps medical men can do so more
easily than any other group of men, since there are no provincial barriers
in our business. We have had men in our ranks who could see and think
nationally, and the Dominion Medical Act is one of their accomplishments.
But this must not be thought of as more than the first step.
One hears occasionally a sort of threat expressed that we in the province
may seek to go back to our former autonomy if things do not go our way.
What sort of solution would this be? and what sort of policy of despair
would this be? No, that would never solve our problems—it would simply
commit us to the harmless nullity of the isolated unit, useless alike to ourselves and to the community at large.
We have two main objects of which we must never lose sight. The ultimate goal pf our endeavour must be national solidarity—a welding of the
whole profession.
The immediate goal must be strong units. Ontario has shewn us the
Page 216 way. The address of Dr. Colbeck of that province on Tuesday night before
the B. C. Medical Association deserves to be writ in letters of gold. It was
not merely a fighting speech, though it was that too. It was a record of
achievements—honourable and constructive—helpful not only to the
profession to whose undying credit this achievement stands for a monument, but bringing, too, a real contribution to the solution of the difficult
problem that faces governments and medical profession and the people of
low income all equally—the problem, as Dr. Peebles put it in a speech, of
bridging over the gap between the people who need medical attention, but
cannot afford it, and the people who can give it.
This work in Ontario gives the greatest hope we have yet been able to see
of bringing about a rapprochement between these two elements. It was made
possible because the medical profession and the government got together in
good will and sincerity, and each side worked honestly and generously to
exhaust every possible means of solution. They not only succeeded, but they
have started together on a road that is becoming clearer and clearer, and is
leading them to a solution of other problems affecting the indigent and the
unfortunates on our doorstep.
We have a situation confronting us, too, and we may well take a lesson
from Ontario, and so strengthen and weld together our medical men in
British Columbia as the Ontario Medical Association has done theirs. Then,
as each province swings into line, active and virile and united, we can hope
for a greater measure of success than ever, in our efforts at creating a truly
Canadian medical body, composed of strong memberships.
Dr. Colbeck shewed us again what we must go on repeating till we all
master the lesson—that strong local units, handling their own situations,
disciplining their own men, solving their problems themselves, will alone
form the nucleus of strong provincial units, which again will form a national
unit. But we must derive our strength, and seek for the source of that
strength, not from the centre to the circumference, but in the other direction. The units must be strong if the whole is to have enduring stability.
NEWS AND NOTES
Dr. Arbuckle's son "Billy" accompanied Dr. and Mrs. Spohn and their
son to Europe. The two young men will visit in Leningrad as well as Vienna.
Dr. BagnalPs s6n, who is on his way home for the summer, won first
class honours in his fifth year Medicine at the University of Toronto.
A son was born to Dr. and Mrs. A. B. Manson on June 23rd.
We announce the marriage recently of Dr. Fraser Murray, at St. Paul's
Church. Dr. and Mrs. Murray left immediately after the ceremony for a
ten days' honeymoon.
Dr. S. G. Elliott has returned from a trip to the prairies.
Word has been received from Dr. Ethlyn Trapp that she is at present in
Austria.
Dr. C. E. Brown has returned from a five weeks' trip to the East, during
Page 217 which time he attended the annual meeting of the Ontario Medical Association.
The Summer School Programme is practically complete and sounds most
interesting and varied. Owing to a serious operation Dr. McKim. Marriott
has found it impossible to keep his engagement with the Summer School
Committee, but at bis suggestion Dr. Irvine McQuarrie, Professor of P_edi-
atrics of the University of Minnesota, Minneapolis, was invited, and has
accepted. Dr. Marriott has assured the Committee that Dr. McQuarrie is a
brilliant speaker, and has done some very outstanding work in recent years.
The list of topics on which he will speak sounds very stimulating.
The profession in British Columbia congratulates itself on the election
of Dr. H. H. Milburn to the Executive Committee of the Canadian Medical
Association. All who know Harry will agree that British Columbia will have
a voice in the proceedings of that central body.
LIBRARY HOURS DURING JULY AND AUGUST
During the months of July and August the Librarian will be
on duty until five o'clock p.m. Monday to Friday and until
one p.m. on Saturdays.
]L_
d  _
RECENT  ADDITIONS  TO  THE  LIBRARY
Medical Clinics of North America—Chaicago number, January, 1936.
Medical Clinics of North America—Boston number, March, 1936.
Medical Clinics of North America—Cleveland number, May, 193 6.
Surgical Clinics of North America—Chicago number, February, 1936.
Surgical Clinics of North America—Philadelphia number, April, 1936.
Trans. Amer. Ophthalmological Society, 1936.
Trans. Ophthalmological Society of United Kingdom, 1936.
Trans. A. M. A. Section on Ophthalmology, 1936.
Trans. 41st Meeting Amer. Laryn., Rhin. and Oto. Society, 193 5.
Trans. A. M. A. Section on Laryngology, Otology and Rhinology, 193 5.
Sutton, R. L.—Diseases of the Skin.  9th ed., 1936.
Thompson-Walker—Genito-Urinary Surgery.   2nd ed., 1936.
Wiener, A. S.— Blood Groups and Blood Transfusion.   193 5.
Landsteiner, K.—Specificity of Serological Reactions.   1936.
Medical Annual, 193 6.
Beaumont and Dodds—Recent Advances in Medicine.   1936.
Dorland, W. A. N.—Illustrated Medical Dictionary.   17th ed., 1936.
CONVENTION NEWS AND NOTES
The sixty-seventh annual meeting of the Canadian Medical Association,
held in Victoria during June, has now taken its place as one of the happiest
and most enjoyable in the history of our medical fraternity.
From the point of view of numbers, it was a success. To date we are not
sure of the exact number, but it was very large. All hotels were crammed to
bursting, and the Empress Hotel alone could easily have filled quite a large
annex, say, something the size of Gerry McGeer's new City Hall, or Bill
Hatfield's less pretentious pile, which, we understand, will make possible
new and rapid strides towards the goal of a T.B.-free province.
Page 218 Be this as it may, we merely record the fact that Victoria hotels were
very busy.
From the point of view of the weather, again we must give a hundred
per cent marks. Victoria is a delightful city at all times; occasionally, it is
true, the effeminate and crapulous Vancouverite wishes there was not quite
so much wind there between the months of January and December, but that
is not to say that the wind always blows. Last week was one of the weeks
when it did not blow, and the sun was gorgeous. The flowers in Victoria
must be seen to be believed, and were at their very best during the week—so
that sent and colour and beauty rioted before us.
Socially, it was a success. The people of Victoria do things as they should
be done, and when they play the host, they play it to perfection. Everything
was open to our members, and the friendly, kindly hospitality of many of
the lovely homes of the city will leave a lasting memory of pleasant enjoyment.
Those who played golf, too (and who does not?), found many opportunities to keep the head down, and follow through.
Nor must we forget the private view of the Schmeling-Louis fight, so
kindly shewn at a private view by the Dominion Theatre. The interest of
the many medical men who attended this at 8:15 on Tuesday morning was,
of course, purely scientific, and does credit to them all—though there were
occasionally regrettable expressions of an animation and enthusiasm to
which the cold-blooded man of science does not often give vent.
Nor must we forget the mise-en-scene of the convention. The Empress
Hotel is eminently suited for such a gathering, since it has large space and
comfortable chairs, and quiet places.
The exhibits were excellently arranged, and very well worth seeing.
But most important of all was the fact that a great deal of very good
work, from the point of view of our profession, was done at this meeting.
Real progress has been made towards greater unity—frank speech and frank
explanation have led to the removal of a good deal of misunderstanding and
will make for a better and clearer atmosphere.
The problems of each province vary to some extent, of course, with local
conditions; but on the whole, they are the same for all, and one of the greatest benefits to be derived (and it was derived) from such a gathering as this,
is the interchange of experience and ideas that takes place. We learnt much
from our brethren from other provinces. We saw where they had been given
problems to solve, and situations to meet, and we saw that they had gone a
long way to meeting and solving their difficulties, and we found that their
difficulties and ours were really the same. So we are very grateful for the
chance to learn—and we believe that this meeting will be of inestimable
help to us all.
One of the outstanding features of this convention has been the excellence of the newspaper reporting. All the papers of Vancouver and Victoria
have earned our gratitude and thanks by the manner in which they dealt
with meetings and by the almost uncanny accuracy of their reports. Usually
newspaper reports on medical topics suffer, as one must naturally expect,
from the highly technical nature of the subject matter, and while we may
find an element of the ludicrous in some of these accounts, we should probably make a worse hash of reporting, say, the annual transactions of the
Royal Society of Canada. But the reports were good, and one is more and
more impressed these days by the excellent technique of the newspaper men.
Their creations have a span of life comparable to that of the butterfly for
Page 219 w\*
shortness, and must scintillate and be as gaily attractive as is that flippant
insect; yet they must be accurate, to the point, readable, and capable of
assimilation by the most mediocre intellect.
The first day of the session was sacred to the Canadian Medical Association Council meetings, and a long list of reports of Committees was dealt
with, extending over to Tuesday morning and afternoon. Tuesday was the
birthday of His Majesty King Edward VIII, our gracious Patron and beloved
King, and a telegram of loyal congratulation was sent to him.
Some of the reports were of special interest, notably that of Dr. D. A.
Stewart on the work of the Committee on Ethics. For many years the report
of this Committee consisted of a paragraph the size of a want ad inserted
by a penurious and poverty-stricken Scotchman—this year's report was a
joy to read. It is interesting and one of the pleasures of life to see the wheels
go round, and to learn how things are made. Through a fortunate error (if
indeed it is an error, and not an assist) on the part of our General Secretary,
the working notes, the rough sketches, of the Committee were included with
the report—and one could hear the asides and the obiter dicta of the Chairman, whose mind is of the Osier type, always questing and gathering and
shedding as it goes, out of its brimming hands, precious bits of knowledge,
sheaves which one who follows him on his road of enquiry may glean. We
all mourn that Dr. Stewart was too ill to come himself, but the latest news
from his bedside is good.
Every session must have its key-subject—its most important question
for solution—and at this one, the really important issue was Medical Economics. The relations of the medical profession inter se, and above all, the
question of closer relations between the provincial associations, were given
a thorough discussion.
There is nothing gained by trying to deceive oneself—"kidding oneself"
in the slang and most expressive phrase. There is, in each province, in each
district, in each local medical society, an element which is the real obstacle
to unity and progress in our growth as an organised body. By direct attack,
by innuendo, by inertia, by sneers, and by logical appeal to the letter1 of the
law, these men present constantly the negative and reactionary side of the
picture. They have stock arguments: "it has never been done" :"medical
men can't stick together": "the provinces have complete autonomy": "ours
is too individual a profession" and so on, and so on, ad nauseam. Their appeal
is to the lazy good-for-nothing, selfish side of our nature—and so it is a very
successful appeal all too often. Theirs is the philosophy of Swinburne in
his poem:
I thank whatever gods there be
That no man lives for ever,
That dead men rise up never,
That even the weariest river
Winds somewhere safe to sea.
And of the Preacher, "Vanity of vanities, all is vanity."
These men make hard the way of Executive Secretaries, and of enthusiastic Presidents, and of the self-sacrificing workers in the hive. But, praise
be to Allah, the negative never wins. "The world do move" and carries
along with it these drones as well. And when it gets there, they are generally
in front, Cassandra-like, prophesying disaster and failure at the next move.
Well, we made progress. A unanimous recommendation went forward
Page 220 urging the Executive to appoint a full-time man to speed up the organisation of the profession from coast to coast, and the principle of closer union
was reaffirmed.
Tuesday afternoon and evening were given over to the B. C. Medical
Association and the Council of the B. C. College of Physicians and Surgeons.
In the afternoon, Dr. H. H. Milburn, who has been one of the keenest,
most hard-working and most efficient Presidents the B. C. Medical has
ever had, presided at a meeting which was a most significant one. The usual
rather placid, report-accepting, mutually congratulatory sort of meeting
was replaced by one where a lot of good work was done, and a number of
excellent steps taken towards increasing the quality of our work.
The Auditor's Report shewed a satisfactory balance. There was, however,
a curtailment of expenses for tours, and the President asked for expressions
of opinion as to the value and acceptability of these tours. The response
from various members left no doubt in our minds that these tours are quite
vitally important to the profession in areas outside the big cities. We take
liberty to think that they are just as valuable to the bigger cities too.
Dr. Strong read the report on Constitution and Bylaws. This brought
up the question of incorporation, under the Societies Act, of the B. C.
Medical Association.
Last year, the Executive was instructed to go ahead with steps towards
bringing about the amalgamation of the provincial association with the
Canadian Medical Association.
Dr. Strong explained that many things had come up which had led the
Executive to the decision that delay was advisable.
First, we had been informed by our legal advisor that the loose voluntary
organisation which is the B. C. Medical Association has no legal status, and
could not amalgamate as desired. Before this could be done, we must incorporate as a definite organisation under the Societies Act. This will give us
officials, a definite organisation, and will limit and define our liability in
financial matters.
He made it clear that such incorporation in no way commits us to an
amalgamation, but is in itself a necessary step.
Next, events of the past year have made it seem wiser that a clearer
understanding as to the rights and duties of both parties to the negotiations
should be reached. It was felt that a number of rather vague idealistic generalities should be brought down to a practical, clearly defined, categorical
basis.
Again, legislation as regards Health Insurance occupied the forefront
of our attention, and since any changes in status involved opening the
Medical Act, it was felt to be wiser not to do this at present.
The meeting authorised the Executive to take immediate steps towards
incorporation.
Dr. Colin Graham read the report of the Programme and Budget Committee. An innovation this year is the payment of the expenses of the delegates from other parts, when they attend executive meetings. Out-of-
pocket expenses alone are paid, but the meeting agreed with the Executive
Page 221 that this was a good step to take, and added greatly to the value of execu-
The Committee on Economics reported through Dr. A. W. Hunter.
In the discussion of the report of the Committee on Public Health, two
questions of major importance were brought up.
1. Codeine.—Letters were read from the Chief of Police of Vancouver,
the City Prosecutor, and Magistrate Wood, stressing emphatically the genuineness of the menace which codeine is to health and well being of the community. The facts adduced are shocking beyond words; the prevalence, and
steady growth, of the codeine habit, the degradation caused by it, the
crimes, especially theft, committed by those who feel the urge of this drug;
the threat to the younger people—all these points were brought out.
The following resolution was passed, and ordered sent to the proper
"That this Association go on record as of the opinion that Codeine is a
habit-forming drug, of the same nature as morphine, heroin and similar derivatives of opium, and that it should be placed on the list of
prohibited drugs as defined by the Narcotic Drugs Act of Canada,
and should be subject to the same restrictions as regards manufacture,
sale and dispensing."
2. Milk.—Here again a very important threat to our infant and child
welfare lies in the continual discharge by interested parties of most vicious
propaganda directed against the pasteurization of milk. Evidence was
adduced shewing that direct untruths are broadcast, that this is being done
by smaller, less reputable dairies, seeking to evade the "cost of proper pasteurising machinery and peddling improperly safeguarded raw milk to an
uninformed public.
N
I*..
INTERNAL DERANGEMENT OF THE
KNEE JOINT
By J. R. Naden, M.D.
Read before the Osier Club, May 27, 193 6.
The knee joint is the largest joint in the body, and it derives its great
strength from the powerful ligaments that units the two component bones
and especially to the muscles and fasciae that surround it. It derives no
strength from the shape of the articular surfaces; since they are merely
placed in contact with one another, for in no position of the joint is there
ever more than a small area of the femur in contact with the tibia, the semilunar cartilages intervening.
The lateral ligaments are comparatively feeble, are tense in extension
and slightly relaxed in flexion. The internal lateral ligament is a flat band
which is attached above to the inner side of the internal condyle of the
femur, just below the adductor tubercle, or about an inch above the articular
margin. Passing downwards and a little forwards, it is inserted into the
inner side of the head of the tibia and into the shaft immediately below.
As it crosses the joint, its deeper fibres gain a firm attachment to the upper
border of the internal semilunar cartilage. Elsewhere, the connection of the
internal lateral ligament to the deeper parts is by loose areolar tissue.
The external lateral ligament is a round cord-like structure attached
above to the outer side of the external condyle of the femur, and below to
Page 222 the head of the fiffula just in front of its apex. It stands well away fromflgi
joint, crossing the tendon of the popliteus on the side of the femoral condyle, and splitting the tendon of the biceps muscle at its insertion into the
head of the fibula. It has no direct attachment to the external cartilage.
The crucial ligaments are two in number and extend from the intercondylar notch of the femur to the upper surface of the tibia. They are
about the thickness of a pencil and are intracapsular but extrasynovial. The
anterior crucial is attached to the depression in front of the spine of the
tibia, being blended with the anterior extremity of the external semilunar
cartilage. It passes obliquely backwards, upwards and outwards to be
inserted into the inner and posterior part of the outer condyle of the femur.
The semilunar cartilages are two fibrocartilaginous discs which are
interposed between the. condyles of the femur and the head of the tibia.
They are deficient centrally, where each forms a thin free concave edge
directed towards the centre of the joint, and they are thick towards the
circumference of the joint, where they are attached for the most part loosely
to the capsule. The extremities or horns of the semilunar cartilages are
attached to the head of the tibia in the middle line between the articular
surfaces. The horns of the external cartilage are attached close together, the
anterior immediately in front of the tibial spine, the posterior to its summit,
and it should be noted that these attachments are close to the axis of rotation
of the tibia, so that the fixed portions of the external cartilage move very
little during rotary movements of the leg.
The horns of the internal semilunar cartilage are attached further apart,
the anterior horn being attached to the rough area at the head of the tibia in
front of the anterior crucial ligament, while the posterior horn is attached
behind the tibial spine immediately in front of the posterior crucial ligament.
It should be noted particularly that the attachment of the anterior horn is
at some distance from the axis of rotation of the tibia, so that its excursion
is appreciable during movements of the leg.
It is very important to discuss the normal physiology of the knee joint.
The knee is not well adapted to rotation strains. There is little mechanism
apart from the quadraceps which prevents rotation until the knee is locked
in full extension. The muscles are the first line of defence against strain,
and it is only when the first line breaks down that strain of the ligaments
comes into play.
Stability of the knee-joint in the lateral direction is secured by the
lateral and crucial ligaments which retain the broad condyles of the femur
in contact with the head of the tibia in all positions of the joint. In the
normal adult knee no appreciable lateral motion is possible without sprain
or rupture of one of the lateral ligaments.
Stability in the antero-posterior direction is secured by the crucial ligaments, which prevent forward or backward displacement of the head of the
tibia, and by postural muscles of the thigh, which regulate the normal
movements of flexion and extension. In all natural standing attitudes the
knee-joint is slightly bent, as anyone may observe for himself on his own
knee. From this attitude of ease the knee may be thrust into full extension
by an effort; but this is unnatural, and fatiguing. The quadraceps is the
great postural muscle of the thigh; by its reflex contraction it takes up the
strain of the body-weight and prevents the knee from bending, both in
standing and in all other active uses of the limb. Conversely, weakness or
"insufficiency" of the quadraceps is a frequent cause of "giving way" or
insecurity of the knee after injuries or diseases of the joint, which lead to a
loss of tone and wasting of the muscles. Hyperextension ordinarily is pre-
Page 223 vented by the hamstring muscles which, acting in conjunction or reciprocally with the quadraceps, maintain the desired position of the joint at
any moment. Only paralytics achieve stability by hyperextension of the
knee so that tension is thrown on the posterior ligaments of the joint.
Stability with respect to rotatory movements of the leg is just as important as that in other directions. Rotation of the tibia beneath the femoral
condyles is a normal movement of appreciable extent, and, while it is
limited anatomically by passive structures, it is controlled physiologically,
like other movements, by muscular action. External rotation of the tibia
(or internal rotation of the femur) is controlled, i.e., prevented by the
popliteus muscle and by the semitendinosus, gracilis and the sartorius. Internal rotation of the tibia is controlled, when the knee is flexed, by the biceps.
The movements which occur at the knee-joint are flexion, extension,
and rotation of the head of the tibia upon the condyles of the femur or of
the condyles of the femur upon the tibia, as the case may be.
Flexion and extension occur between the condyles of the femur and the
upper surfaces of the semilunar cartilages. During these movements the
semilunar cartilages (with, of course, the head of the tibia) glide round the
inferior surfaces of the condyles of the femur in an anteroposterior direction.
Flexion is limited by contact between the leg and the thigh. Extension is
limited automatically by tension of the posterior, lateral and the anterior
crucial ligaments, and in the absence of muscular control, violent hyperextension of the knee is likely to produce sprain or rupture of the last named
structure (Ant. crucial).
Rotation occurs between the head of, the tibia and the under surface of
the semilunar cartilages. But this movement is possible only when the knee
is bent, because in this position the ligaments are relaxed, whereas, when
the knee is straight, the ligaments are tense and rotation of the tibia is prevented. Rotation ist greatest when the joint is flexed to about a right angle,
being then possible through a range of about 3 6 degrees.
The anterior crucial ligament limits extension in part, prevents forward
displacement of the tibia and rotation inwards of the leg. The posterior
crucial ligament resists extreme flexion and displacement backwards of
the tibia.
There are three main types of injury to the knee, which are distinct as
regards mechanism and which are seldom combined:
1. Lateral strain, when force is applied to adduct the knee or abduct the
leg, resulting in a simple strain of the internal lateral ligaments or
rupture of the femoral attachments of the ligament; more rarely
there is an injury of the external lateral ligament due to an abduction
of the knee or a forced adduction of the leg.
2. Rotation strain, when the weight is: borne on the limb with a resulting injury to the cartilage, or when there is no direct transmission
of weight through the joint a resulting damage to the coronary or
other attachment of the cartilage.
3. Hyperextension strain, resulting in a tear of the anterior crucial
ligament or an evulsion fracture of the tibial spine.
The commonest cause of internal derangement of the knee joint is injury
to the internal semilunar cartilage.
The relative frequency of the injury to the internal semi-lunar cartilage
as opposed to the external is explained by the mechanism of the injury. The
external cartilage is more likely to escape the grinding force of the femur
for two reasons. In the first place, it is less fixed and the coronary ligament
allows freer excursion of the cartilage, both because of its great length and
P-"e224 because of the gap which occurs posteriorly in connection with the tendon
of the popliteus. The second factor which saves the external cartilage is its
shape. It is a circular ring, accommodating the external condyle of the femur
and it is better adapted for rotation than is the less circular internal cartilage.
There is less likelihood of damage to the external cartilage because it does
not have to accommodate itself to the so-called gliding movement which
the internal femoral condyle makes in full extension, for it is the pivot
around which this movement takes place.
When the knee is bent, and the femur is forcibly rotated inwards upon
the tibia—as when, the foot is fixed upon the ground, and the body swings
inwards towards the midline—the tibia (relatively) rotates outwards
beneath the semilunar cartilage as far as it will go. A state of tension then
arises, and, if the force continues, something has to give way. On the inner
side, where the movement is greatest, the anterior horn of the internal
cartilage is carried forwards and inwards, and the tibia then tries to drag it
forward from beneath the condyle of the femur. But the posterior end of
the cartilage is held back, partly by its attachment to the internal lateral
ligament and partly by the close contact between the femoral condyle and
the head of the tibia. So that a great longitudinal strain is thrown upon the
cartilage, the anterior end of which is carried forwards, while its posterior
end is held back.
Now, it is obvious that the effect of such a strain upon a curved structure, such as the semilunar cartilage, will be to straighten out the curve,
and, when the cartilage is suddenly straightened by a longitudinal stretching
force, it is often torn from its peripheral attachment to the capsule, and
pulled in towards the centre of the joint, where it is liable to become caught
between the condyle of the femur and the tibia. This is the familiar "bucket-
handle" detachment of the internal semilunar cartilage. Other types of cartilage injury may be produced by the same stretching force. Even more
common than the "bucket-handle" is detachment of the anterior horn of
the cartilage, which is pulled off froml the head of the tibia, with more or
less detachment of the cartilage behind it. Again the cartilage may be torn
transversely somewhere about its middle or at the junction of the more
moveable anterior two-thirds with the more fixed posterior third. Lastly but
much less often, the posterior horn may be pulled forwards between the
condyle and the head of the tibia.
All these different types of injury to the internal cartilage are produced
by forcible internal rotation of the femur upon the fixed tibia, when the
knee is more or less bent, and they give rise to a characteristic train of
symptoms.
The history of a patient with a torn internal semilunar cartilage is
usually characteristic. There is an injury to| the knee when there is weight
bearing with an inward twist accompanied by an acute pain on the inner
side of the knee with "locking," thatf is, the1 knee is fixed in a partly bent
position. There is usually persistent pain with inability to straighten the
knee; or often to move the knee at all on account of the severe pain. There
is an effusion into the joint almost immediately. Pain and tenderness are
usually referred to the inner side of the joint particularly in front, in the
angle formed by the inner condyle of the femur and the head of the tibia,
or further back along the joint line. If there is not immediate "unlocking"
of the joint, the injury is followed by atrophy of the quadraceps, especially
the vastus internus, with loss of muscle tone. The very typical unlocking is
even more characteristic than the locking.
Any of the types of injuries to the cartilage as previously described may
Page 225 •$'
have occurred. If the injury has been of the "bu^ethandle" variety, when
the joint is unlocked, or "reduced," the cartilage is always further displaced
towards the centre of the joint where it lies in the intercondylar notch. If
it has been the anterior portion of the cartilage involved it will be possible
to release the imprisoned end and it will nearly always remain free in the
anterior part of the joint.
It is almost an axiom, "once a torn cartilage, always a torn catrilage."
A semilunar cartilage once torn and displaced will nearly always give rise
to further trouble sooner or later, either in the form of recurrent displacement or locking, or in setting up of osteoarthritic changes.
There is usually little difficulty in arriving at a correct diagnosis of a
recurrent displacement when an accurate history is obtained of a previous
injury and of repeated times when the joint has given way or has locked.
Usually the patients have methods of their own for reducing the displaced
cartilage.
Dislocation of the external semilunar cartilage is much less common
than injury to the internal cartilage. The history is not usually clear cut
and it is often difficult for the patient to accurately interpret his symptoms,
as frequently there is a feeling of pain over the outer sidet of the knee when
there is an injury to the internal cartilage. The relative frequency of injury
to the internal semilunar cartilage compared with injury to the external is
roughly six to one.
Cysts of the semilunar cartilages may give symptoms very similar to
those of injury to the semilunar cartilages with laceration, but there is no
locking, and there is usually an area of elastic tenderness over the cartilage.
Cysts are much more common in the external cartilage than the internal,
the ratio being roughly four to one. In a large percentage of patients there
is a history of trauma which is more often that of a blow than a twist or
strain.
Rupture of the crucial ligaments and fracture of the tibial spine will be
discussed together on. account of their frequent association. The two conditions may be associated or either may exist alone. If after an injury of the
knee the tibia can be displaced backward or forward or rotated inward in
the extended position, an injury of one or both crucial ligaments may be
diagnosed. If in the extended position the tibia cannot be displaced forward
it may be assumed that the anterior crucial ligament is not torn across. If in
full flexion the tibia cannot be displaced backward, the posterior ligament
is presumably not ruptured. The history of injury is very important, as
similar findings may be demonstrated after long standing effusion into the
joint, Carcot's disease, and in locomotor ataxia.
Avulsion of the tibial spine or its internal tuberosity is produced by
violent tension on the anterior crucial ligament, a mechanism similar to
that which produces rupture of the crucial ligaments.
It is believed by some authorities that the anterior crucial ligament is
not a vitally necessary structure, and that its loss is thoroughly compatible
with relatively normal function of the knee; and that the disability is due
primarily to the loss of the integrity of the internal lateral ligament.
It is only with some difficulty at times that it is possible to differentiate
between a torn cartilage and a loose body in the joint. Very often the patient
has been able to localize the loose fragment. It is important to take an x-ray
in all patients with joint injuries.
With a loose body there is usually true locking but lasting only a moment
and releasing on any movement, and the pain on locking is referred to
different parts of the joint on different occasions.
Page 226 The condition of osteochondritis dissecans can usually be determined by
a careful examination of the x-ray plates, the loose body having a smooth
and a rough surface, and it is almost always possible to determine the bed
from which the fragment has come, the position being most often on the
outer (lateral) side of the internal condyle of the femur, near the attachment of the posterior crucial ligament. Two cases have been described
Hfely. one with bilateral osteochondritis dissecans of the patella, and the
other with involvement of one side only.
Hypertrophy of the infrapatellar fat pad will, often give rise to symptoms referable to the the front of the knee joint, especially beneath the
patella. These patients will most often complain of pain below the patella
when they are going up or down stairs, the pain being most severe when
the weight is taken on the affected leg with the knee slightly flexed, and on
examination there is usually some increased thickening about the fat pad
with some tenderness on pressure. In the later stages of fat pad congestion
it is often difficult to differentiate between a fat pad and a cartilage injury,
but there is no limitation of movement or locking.
Synovial chrondromatosis will often fill the joint space with multiple
loose bodies, and may be secondary to osteoarthritis.
Osteoarthritis involving a knee joint will often simulate a joint with
injury to the cartilages. In these cases the history is very important; there
is no history of sudden injury with locking and the characteristic unlocking;
there will often be limitation of full extension, with pain at the extremes,
but under appropriate treatment the knee will extend fully. Along with the
history, there is usually synovial thickening with some local heat and local
tenderness not confined to the line of the semilunar cartilages.
A discoid semilunar cartilage will give indefinite symptoms of internal
derangement, the onset often being in childhood. The differential diagnosis
has not included dislocation of the knee or recurring dislocation of the
patella, as these obviously do not complicate the picture.
The remaining condition which will be briefly mentioned is chronic
knee sprain. The common knee sprain of the upper attachment of the internal ligament is caused, not by internal rotation of the femur but by forced
abduction of the leg. The injury is caused by the same force acting but
without the same degree of severity that would if carried through cause a
tear of the cartilage from its attachment. The symptoms caused by this
condition are very like those of actual injury to the semilunar cartilage, but
usually milder in degree and always without the characteristic locking,
which is almost pathognomonic of a displaced cartilage.
A very few words- about treatment. Our opinion is that displaced and
torn semilunar cartilages should be completely removed. Loose bodies should
be removed. Rupture of the crucial ligaments should be repaired if giving
severe symptoms, and the lateral ligaments repaired at the same time.
Avulsed tibial spines should be replaced if possible or removed. Hypertrophy
of the infra-patellar fat pad should be treated conservatively by means of
a reverse figure of eight bandage with the knee slightly flexed, for a number
of weeks, and later surgical removal if not improved. With the cysts the
cartilage should be completely removed.
In conclusion, our diagnosis is based on an accurate history, with knowledge of the mechanism of the joint, a careful and complete examination
including x-rays, aided by our judgment founded on experience.
Our treatment is guided by our diagnosis.
Our results depend on an accurate diagnosis with appropriate treatment.
Page 227
W 'I
B. C. MEDICAL ASSOCIATION MEETING
The Annual Dinner of the B. C. Medical Association was held in the
Ballroom of the Empress Hotel, Victoria, on Tuesday evening, June 23 rd.
Dr. S. G. Kenning of Victoria presided, and had at the head table with
him various distinguished-looking individuals, of various ages, and from
various parts of Canada.
The guest speaker for the evening was Major Harold Brown, of Vancouver and British Columbia, managing director of the Union Steamship Co.
Some two hundred or two hundred and fifty medical men were there,
and had a very pleasant dinner. Cocktails were served in the downstairs
Lounge, evidently with a sort of idea of a process of exclusion, a la Gideon's
army. Those fitted by nature or by self-control to survive, found their way
upstairs. One cannot help but feel that there must be some sort of cumulative action about cocktails and their like, since certain large gentlemen,
one well-known in Victoria and its suburb of Vancouver as a specialist (we
forbear to mention the brand), and the other, we believe, a classmate of his
'way back in the gay nineties, shewed the effects for a long time. They
circumnavigated the room two or three times, visiting each table in turn,
and shewing the greatest affection for all their colleagues.
Major Brown's speech was the highlight of the evening. It was an
unusual speech for a medical dinner. The speaker is well known to all who
live in B. O, and to many elsewhere, as a delightful speaker, who is never
content with generalities or platitudes, but thinks for himself, has thought
long and deeply over many philosophical topics, and is always ready to give
utterance to the faith that is in him.
His use of English is a delight to hear. He knows words and knows them
as friends. He does not abuse his friends' confidence, nor/ tax their patience.
He uses each word rightly and well, and has a wide acquaintance amongst
them. So that, just as an effort of elocution, it was very well worth while
to hear.
But there was much more to it than this. He sounded a deep note: he
appealed to the thoughtful and responsible part of our makeup. He paid us,
as medical men, the fine compliment of assuming that we have enough
intelligence and honesty and good citizenship to lead us to respond to this
appeal, for a sincere attitude towards conditions as they are, for an honest
effort towards the solution of the huge problems that confront the world.
After all, while his training and experience of life lead the doctor to shun
the emotional and sentimental, and to suspect the wordy efflux from these
elements in the mind of man, still he can understand and respond to the
appeal to his idealism and the deep sense of the transcendental, almost the
mysticism, that perpetual contact with the great realities of birth, life and
death must engender in us. And Major Brown sounded this note of appeal.
He reminded us that while we sat in ease and with all our aesthetic appetites
catered to, the world was crashing about our ears. That our seeming security
and peace are on this side of a curtain, which may go up at any moment,
and reveal the stark horror of chaos behind. That this curtain, hitherto, has
remained unlif ted is due not to us, but to the efforts throughout the ages of
a select few whose minds and souls have been in tune with the great spiritual
realities of the universe.
We have the brains, and the courage, and the ability, said the speaker,
to discover and apply the solution, and check the disintegration that is
going on. What we lack is spiritual leadership, and a willingness to assume
that leadership when we realise that we should do so.
Page 228 We must, he weife on, in some way reach and maintain our conviction
with spiritual power. Too long we have left this to charlatans and quacks
and false prophets, and have followed those who have held up only material
things for us to grasp.
Major Brown's speech was relieved again and again by quips and
humourous sallies, which kept it from any appearance of mere evangelism,
or pietism: and we were very grateful to him for what was a very fine speech,
finely delivered in beautiful language.
The election of officers followed, and the names of those elected follow:
President: Dr. G. F. Strong of Vancouver.
Vice-President and President-Elect: Dr. Gordon C. Kenning of Victoria.
Immediate Past President: Dr. H. H. Milburn of Vancouver.
Second Vice-President: Dr. D. E. H. Cleveland of Vancouver.
Hon. Secretary-Treasurer: Dr. J. R. Naden of Vancouver.
After this, the meeting changed into the third Annual Meeting of the
B. C. College of Physicians and Surgeons.
The third Annual Meeting of the members of the College of Physicians
and Surgeons of B. C. was held in the Ballroom of the Empress Hotel at 10
p.m. on Tuesday, June 23rd, 1936, with the President, Dr. Thos. McPherson,
in the chair.
The meeting stood during the reading, by the Registrar, Dr. A. J. MacLachlan, of the list of those members of the College| of Physicians and Surgeons who had been removed by death since the last meeting of the College.
The minutes of the last meeting, held Sept. 19th, 193 5, were adopted
as read.
Dr. Thos. McPherson spoke briefly, referring to the matter of medical
care of indigents, and introduced Dr. Colbeck of Welland, Ontario, the
President of the Ontario Medical Association, who addressed the meeting,
dealing with the question of relief in the Province of Ontario.
Dr. Colbeck gave us the history of the negotiations, for long fruitless,
between the Government of Ontario and the Ontario Medical Association.
Both under the Henry Government and the Hepburn Government, the
task of administering relief and paying for medical attention on any sort of
basis proved to be beyond the capacity of the governmental departments,
and Mr. Henry and Mr. Croll, the present Minister of Health, alike threw
up their hands.
The difficulty seemed to arise mainly from the presence amongst the
members of the profession of what Dr. Colbeck called "till-tappers":
though any bad name would do equally well. These men, constituting some
3 to 5 per cent of the profession, never more, are quite impervious to any
appeal to their sense of honesty or generosity. These would seem to be
atrophic or congenitally absent.
The Medical Association, however, persisted, and eventually were given
one final chance. They must, within a week, present a scheme that would
work. With fear and trembling the Association assumed the responsibility,
and within a week evolved a scheme.
The money offered was 2 5 cents a month per indigent head: i.e., $3.00
a year.
The O. M. A. conceived the idea of centralising the administration of
the money and decentralizing the control of medical bills.
Ontario is divided into 11 districts and these into 5 0 counties. In nearly
all of these there are very active district or county societies. The county
society became the disciplinary and assembling unit.
P_-?_>229 .«
A central committee of three was appointed to deal with the Government, hear appeals, and be the final arbiter of accounts if disputed.
The idea was to pay bills out of the pool pro rata. Only office and house
calls and maternity cases were paid for.
A meeting was held in Toronto to settle details, at a cost of $2000.
The result of all these was a very large measure of peace and success.
Our of 3 5,000 accounts, only 50 were submitted to the central court of
appeal, the local committees adjusting all others.
Then the O. M. A. made a further discovery. These fifty accounts were
accompanied by tremendous noise and protest on the part of those whose
bills they were, who resented bitterly any sort of dictation. Apparently,
nobody was going to audit their bills except over their dead bodies. Again it
meant too much uproar and confusion. So the central committee ceased to
function as an appeal board, and these accounts were turned back to the
local county society and their decision made final.
The delinquent doctor, the dishonest doctor, or the careless doctor, is
henceforth judged by his peers, his immediate colleagues.
This has worked exceedingly well. Some 400,000 people have been cared
for, and only two complaints in eighteen months have been made direct to
the Minister of Health about doctors, as compared with a former steady
stream of complaints. The very small number of doctors whose errors and
wrongdoing were the direct cause of wrecking the whole scheme at first,
are now controlled and rendered harmless by this plan.
The cost of administration is an important feature of this scheme.
In Great Britain, after 25 years of operation, Health Insurance administration costs are 14.6% of the whole.
In Ontario, 5.2% pays for the costs of a very sirqijilar scheme, when the
doctors themselves administer the money.
The Government is exceedingly well pleased with the results, is co-operating willingly with the O. M. A., and it is unthinkable that any government would want to go back to government control, with its added cost
and worry to itself.
This was for the indigent alone; however, what about the low income
groups? In Windsor were men who had a real vision. They started in to
evolve a method of medical treatment for low income people, they started
research on costs of disease by age and groups. They put in a card index
scheme, changed it four times as experience demanded, and eventually produced an excellent plan, with, as a by-product, a great result of statistics
and figures which are of real value.
Mr. Wolfenden, a well-known actuary, was employed by the O. M. A.
to check this, and reported that it was a very good, up-to-date scheme, with
entirely new possibilities for actuarial study, which would provide figures
and statistics which were of immense importance, but hitherto have been
unobtainable.
These medical men spent $4000 of their own money in this study, and
then presented the scheme to the O. M. A.
A voluntary Health Insurance scheme is now under way in different
parts of the province.
Control is by the local societies, discipline is in their hands; they settle
disputes, assemble taxed bills, and send them in to the Central Committee,
which handles the money, sends out cheques, etc.
A great point in this is* that it has not been done merely for dollars and
cents. The money available was small: a mere pittance for the work don?
But the medical profession started out with the idea that, regardless of the
Page 2}0 money, they would give a first-class medical service anyway, well-run along
high ethical lines—and talk about money afterward.
What has been the result? A solidity and welding of the medical profession that has never before been attained, so that now the O. M. A. has
the backing of almost every man in the province. It has won the confidence
of these men, and now no mam can afford to stay out.
It has won the confidence of the Government. It co-operates with the
latter; they get together, and the Government accepts gladly the principle
that the medical profession should manage its own affairs and dispense the
money itself.
Excellent medical service has been provided. The financial returns are
inadequate—but there is room for improvement, and the Government is
coming to realise the need for this—and has sympathy with us in this.
Valuable information of all kinds is being obtained—information and
statistics that will be of great value in future investigations.
An example has been set to the medical profession all over Canada—
and the knowledge that the O. M. A. has painfully acquired is now available to all. This is one of the greatest contributions to national unity of
our profession.
Dr. Colbeck advised us, as he closed, to exhaust every avenue of conciliation and co-operation before we gave up hope of obtaining satisfactory
terms.
Dr. McPherson thanked Dr. Colbeck on behalf of the College of Physi-
cians and Surgeons of B. C. for his excellent address.
Dr. MacLachlan then read the minutes of the last meeting of the College,
held in Vancouver September 20th, 193 5, which were adopted as read.
Dr. McPherson, the President, addressed the meeting. He said much had
taken place in the past year, the most serious occurrence being that Dr.
Ainley had been forced to resign as Chairman of the Health Insurance Committee owing to ill-health. His resignation was accepted on the condition
that he remain on the Executive of the Council of the College. He (Dr.
McPherson) had been appointed in his stead as Victoria was considered the
pivotal point, and Dr. Wallace Wilson was appointed Vice-Chairman.
Dr. Wallace Wilson was called on to speak. He said he had very little
to say, as the profession had been advised by mail. One or two facts he
would like to emphasize; first, to play a waiting game. One or two meetings
have been held with the Commission and they wish to co-operate. They
realise that we hold the key. They do not know as yet} the solution of the
indigent problem, but the Premier has promised legislation, also Dr. Weir.
He reminded the profession that it need not worry if it is organized. The
Health Insurance Committee feels that all members should be considered
and that the consent and approval of the medical men is needed.
Dr. R. W. Irving moved a vote of thanks to Dr. J. J^.fllis and Dr. W.
H. Sutherland for the wonderful fight they had put up on behalf of the
medical men. Seconded.  Carried.
Dr. J. J. Gillis thanked the meeting on behalf of Dr. Sutherland and
himself. He stressed the point that cohesion was everything as far as the
medical profession was concerned. It must stand behind the Health Insurance Committee, as it is working for the best interests of the profession.
Dr. Kenning spoke of the proposed amendments to the Act. He explained that as the Government had made no move to revise the statutes
it was considered unwise to open the act while the Health Insurance Bill
Page 2 n ,11
!'
' •ji
iii'
1
Jl
j 1
F_^»
2.
3.
4.
5.
was under discussion. He stated that the following amendments were proposed :
1. The term of office to be for four years;
To change the boundaries of Electoral Districts;
To allow men who had been practising in the Province for forty years
to remain on the register without payment of dues;
Necessary amendment if B. C. Medical Association becomes a branch
of the Canadian Medical Association;
Sanctions authorized for the incorporation of the B. C. Medical Association.
Dr. Strong in presenting his report for the Constitution and By-laws
Committee spoke of the proposed amalgamation with the Canadian Medical
Association. He confirmed Dr. Kenning's report that it was considered
inadvisable to open the Medical Act or to make any changes at the last
meeting of the Legislature. He informed the meeting of the proposed incorporation of the B. C. Medical Association under the Societies Act.
Dr. S. C. MacEwen, speaking for the Economics Committee, reported
that it was just starting to collect data in regard to contracts throughout
the Province. He asked the men of the profession to co-operate and send in
their reports, as the committee was working for their protection.
SOME NOTES FROM THE OFFICE OF
OUR EXECUTIVE  SECRETARY
Your Executive Secretary, Dr. M. W. Thomas, has visited Prince Rupert,
Ocean Falls, and other points on the coast, as well as Lytton, Lillooet, Pioneer, Bralorne, Minto City, Williams Lake, Quesnel, Wells, Prince George,
Vanderhoof, Fraser Lake, Burns Lake, Smithers and Ashcroft, returning in
time for the Victoria meeting.
He returns from the tour and the meeting convinced that the profession in this Province is worthy of the best effort of those whose responsibility it is to render them service. On the Coast, the Bulkley Valley, the
Omineca, the Cariboo, Bridge River and these other points, the men are
giving to the people an efficient service, this being conducted against great
handicaps in winter. Dr. Thomas found the men cheery and always optimistic in their splendid professional attitude.
They are 100% behind their elected authority, the B. C. Medical Council, and its Health Insurance Committee. This confidence is an inspiration
and a challenge. The great problem at all points, outside of contract practice, was due to the scant remuneration for medical relief and the many difficulties surrounding this work and in obtaining recognition in sufficient
measure. If the regularly employed moderate income groups, who present
no urgent problem, are to be regimented under a Health Insurance scheme,
some very definite plan must be evolved by the Government to provide
medical care for those larger groups of unfortunates who create the real
problem for the profession in this Province. The profession owes it to these
pioneer practitioners in the outlying parts to see that their loyalty is reciprocated.
The Secretary found these men doing successfully all general work and
enjoying the deserved confidence of the people.
The profession in the larger centres is asked to co-operate fully with the
local doctor in all cases coming from the inland districts so that his status
may be preserved. In some (rather many) instances he found that patients
Page 232 returned with no reports and no communication of any kind bearing on the
nature of the case or its subsequent care, and this had placed the local practitioner in an unenviable position and was an embarrassment to both patient
and doctor, impairing efficiency and tending to destroy confidence, upsetting
the relationship that means so much in practice.
The bulwark of organization lies in service, and it is the sincere desire of
your Executive Secretary to see that this feature is progressively developed
and asks the co-operation of every practitioner in this matter. Service will
strengthen the organization and will cement the profession into one consolidated unit.
Where municipalities are neglecting to recognize, even in a partial way,
Medical Relief, the matter was discussed with the competent authority,
notably in Prince Rupert and Prince George, and assurance of immediate
action was obtained. If other organized communities are shifting their
responsibilities to the shoulders of the willing doctor and accepting his past
generosity as their right, Doctor Thomas is ready to assist anyl local group
in presenting the request for recognition.
One of the outstanding bright reflections of the Victoria meeting was
the exhibition of loyalty to and appreciation of our profession by the many
lay individuals and groups in Victoria and vicinity, as evidenced by the ready
assistance in entertainment and transportation. This dignified meeting with
its splendid programme impressed the whole community, as expressed in the
editorial columns of the Victoria Colonist.
Those members who have accounts for Provincial Relief cases are reminded that they should secure authority from the Government Agent
or Disbursing Officer in their district, and that accounts showing work done
should be rendered in triplicate and approved by the local authority before
being forwarded to Dr. J. G. McCammon, Standard Bank Building, Vancouver. It is important that accounts be forwarded regularly at the first of
each month. Much dissatisfaction and misunderstanding may be avoided.
Dr. McCammon would appreciate a personal visit from any member at
any time.
Accounts for those who should be classed as "Pestitute, Poor and Sick,"
and distinct from Provincial Relief cases, are paid out of a separate fund and
should be forwarded to Department of Welfare,  Parliament Buildings,
»h»
V
ictoria.
There is being sent to every member a questionnaire, the completion of
which will provide valuable information which will allow the Secretary to
classify contracts into types and aid members to evaluate these services.
Many contracts in this Province are neither satisfactory nor sufficiently
remunerative, and it is felt that this can be remedied.
Dr. F. D. Sinclair, who has practised in Cloverdale for twenty-five years,
called on Dr. Thomas this week and had a choice reminiscence which will
bear retailing.
While visiting a school on a tour of inspection, Dr. Sinclair found a class
in session and listened-in as the teacher asked the children to define "a gentleman." One little girl was particularly vehement in her hand-waving
Page 233 "' \m
attempting to attract attention. The teacher wondered and said, "Well,
Mary, what is a gentleman?" Mary, springing to her feet, shouted, "Doctor
Drew."
There are many of us who think that Mary's illustrative reply was very
aptly chosen. 	
DR. COLBECK ON HEALTH INSURANCE
The following is a brief report of Dr. Colbeck's speech at the meeting of the Council,
Tuesday, June 23rd, 1936, at the Empress Hotel, 10:30 a.m.
I have been a student of this since 1912. I happened to be in England
when Lloyd George brought in his scheme. I recently took out of old trunks
copies of the Times, etc., which brought back forcibly the struggle in
England with Lloyd George. Of course, we all know the outcome of that.
We also realize that their problem is different rom our problem. We do
know that their cost of administration, after all these years, is still 14.6%.
It is amazing to me that it should still go on where distances are short.
In Ontario the Government were not very interested but they have now
got to the point where they are really worried, because the taxpayer has
come to the point where he is about at the breaking point. We find that the
Government is becoming very anxious about overhead. We in the east have
two sources of information through organized medicine. We are in very
close touch with this Province. Even with these two sources and with Dr.
Routley out here, our information was fragmentary until I got here. It is
very easy for men to be misled by dispatches and press.
As I understand it, by devious routes, you have landed with a commission of four, whose business would be to gather fa this money of 1 % from
employers and 2% from employees, taking in all up to $1800. They are to
gather in the money and disburse it, and then propose to take in medical
attention with specialties. I take it they are to take in and pay part of the
drug supply and they are to pay the hospitals, and they are confronted now
with the business of getting the money in and setting up the system of
accounting. They have got to the point where they have to decide how
they are going td do the field work.
It was the impression among a great many in the East, from the information we got, that the Government did not know where the costs would
be; there was this minimum and maximum, there was this minimum of
$4.50 for the doctors, but the Government did not have the faintest idea
what it was going to cost.
In Toronto, where the Academy of Medicine will take over, they are
working it out with the hospitals and doctors arid will likely know very
shortly now. The Academy of Medicine anticipates it will work out to about
$13 for the doctors and $4.50 for the hospitals. Based on a $3.50 rate for
the hospital per year and hospitalization, is paying three days per patient
per year. They had brought it up to $4.5 5. The average across Ontario is
three days.
In Ontario the medical profession obtains the money from the Government. From 240 municipalities we centralize the money and decentralize
the administration. Both the Conservative and present Government tried it
and failed. We asked each of fifty county branches to appoint a local medical relief committee and then to the 3000 doctors we gave a contract, and
if they wished to do relief work they must sign this contract. The "teeth"
in it was they agreed to abide by the finding of the local medical relief
committee. Some 50 counties ran up to 96 committees, but in spite of everything—96 committees working, appointed by 50 counties—instead of
Page 234 working with a lot of friction, at the end of the year 3 5,000 accounts had
been passed through their hands and we only had 30 taxed by a com-
mittee of our own doctors. That convinced the Government there was only
one way to run this show, and we were amazed it worked so well. We had
hard feeling over the 25c per month allowed indigents, but we were dealing
with the layman. The fact remains that the people were well satisfied with
the service, the Government was not bothered by complaints, and we discovered local medical committees could get their own house in order better
than anybody else.
Our central committee is composed of three outstanding men. The
doctors resented that central appeal board; on the other hand, there was
not one man brave enough to go on the floor of the successive societies and
try to justify their charges. As a result, we have shoved it all back to the
counties. We have the administration shoved out in the field; everything is
beyond headquarters. We have set up a Finance Committee to keep the
books, run the show and all else.
We are pleased to be able to show that we can carry on business. We
administered $1,224,000 and the expense allowed to take over our local
medical relief committees was only 2.6%. So in a new game, which we only
had three weeks to set in action, we have a much lower overhead than anything that has ever been known before. The advantage of that is that we
know, with these 5 0 committees, if we were thrown into Health Insurance
tomorrow, not one of us has any doubt these committees would function
under a Health Insurance scheme easier than under this relief scheme. We
will have the key that will unlock the door so we can control the unethical
medical man or surgeon, the 21,\  or 3 % that give us a bad name.
HEALTH INSURANCE
A brief report by Dr. Wallace Wilson
While the Health Insurance Committee has nothing further of a tangible
nature to give to the profession at this time, it would like to briefly report
on its activities at the-annual meeting in Victoria.
During that week members of the Council and members of the Committee on several occasions met the members of the Health Insurance Commission. At these meetings the discussions were entirely of a general nature.
Nothing else was possible at the present time, because there is still another
member to be appointed by the Commission, the-Medical Director has not
yet been appointed and the Commission will not go forward until its personnel is complete.
In the meantime we were informed on each occasion that the Commission is most anxious to co-operate in every way with the medical profession.
This is good news, because your Committee, also anxious to co-operate,
realizes, as does the Commission, that unless this mutual co-operation takes
place nothing satisfactory or lasting will be evolved.
The Health Insurance Conarnittee has only two objectives—a "square
deal" for those who cannot purchase their medical care, and reasonable
remuneration with just working conditions for those rendering the service.
Of course we do not know what will be done with regard to the indigent
at the autumn meeting of the Legislature, nor do we know whether the
Commission will consult the profession in the drawing up of the particular
regulations affecting the medical care of the insured, but we are very willing
to co-operate in every way that will go towards ensuring an arrangement
that will be satisfactory and fair to all concerned.
Page 23 5 Members of the Committee were glad of the opportunity they had in
Victoria of talking with men from various parts of the Province. The Committee realizes that, due to local conditions, many men have problems of
practice that are peculiar to the place in which they live and it is understood
that their problems will require individual considerations before any final
decision is made.
The profession will shortly receive a questionnaire re contracts from
Dr. Thomas, the Secretary. We hope this will be fully and promptly
answered, also that men who are not working under contract but whose
work is done under some other arrangement will explain it fully on the
questionnaire.
The Committee wishes to thank all members who sent in their returns
on income. Over 5 0 per cent have now done so and we hope the remainder
do not think it is now too late. It is not. The returns from another 40 per
cent would immeasurably increase the value of the figures we are trying
to obtain.
At the annual meeting of the College in Victoria, Dr. Colbeck, President of the Ontario Medical Association, gave a stimulating and heartening
talk. The men in Ontario are now united as they never were before and
because of their unity they are "going places" with their Provincial Government in the handling of the problems of the medical care of the indigent.
From every province came news of the economic problems that the
medical men are faced with and in those provinces where the profession was
most strongly banded together they were making the most progress.
We in British Columbia are also united as we never were before and if
we only stay that way we will eventually see daylight ahead.
VANCOUVER  MEDICAL   ASSOCIATION
Summer School Clinics
September 8 to 11, 193 6, inclusive.
SPEAKERS:
DR. J. McF. BERGLAND, Lecturer or Clin. Obstet., Johns Hopkins University, Baltimore, Md.
DR. C. E. DOLMAN, Acting Prof, of Bacteriology and Director of Connaught Laboratories, University of British Columbia, Vancouver, B.C.
DR. C. B. FARRAR, Prof, of Psychiatry, University of Toronto, Toronto.
DR. EVARTS A. GRAHAM, Prof, of Surgery, Washington University,
St. Louis, Mo.
DR. IRVINE McQUARRIE, Prof, of Pediatrics, University of Minnesota,
Minneapolis, Minn.
DR. GORDON B. NEW, Prof, of Oto-Laryn. and Rhin., Department Oral
and Plastic Surgery, Mayo Clinic, Rochester, Minn.
DR. ROLLIN T. WOODYATT, Prof, of Clin. Medicine, Rush Medical
College, University of Chicago, Chicago, 111.
Fee, $7.50
Information: DR. H. A. DESBRISAY, Secretary,
203 Medical-Dental Bldg., Vancouver, B. C.
Hotel Vancouver,
Vancouver, B.C.
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CONSTIPATION
THE BASIC CAUSE OF ALL COMPLAINTS
Treatment Room, showing the Irrigation Table.
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•M
DIARRHEA
"the commonest ailment  of
infants in the summer months"
CHOLT AND McINTOSH: HOLT'S DISEASES OP INFANCY AND CHILDHOOD. 193S)
One of the outstanding features of DEXTRI-MALTOSE i
that it is almost unanimously preferred as the carbohydratJ
in the management of infantile diarrhea.
In cases o!.malnutrition
^r0VeSr^f.e'intelUgentl"-
the sugars ai
■^_^^JJg__5gES
,oseness,
in infancy     aopearance.
andmdigest^ome "'to prop
ndenc:
When tne^^tri-malS__-
301S buu..; --       -,      tms   i   iv,.--      , y   to
V P.^^en there is * ««&or
1916.
^.rhnhvdrates;
Arrlt
xcel-
nextn-maltose is a very excel
lent carbohydrate. It is made h_
of maltose, a disaccharide which
in  turn  is broken  up  into two
olecules of glucose—a sugar that
is not as readily fermentable as
levulose and galactose—and dextrin, a partially hydrolyzed starch.
Because of the dextrin, there is
less fermentation and we can therefore give larger amounts of this
carbohydrate without fear of any
tendency of fermentative diarrhea."—A. Capper: Facts and fads
f_j   j«fn„i  frrrfi"-    '"   "     "    '    '
Tn cases of diarrhea, "For the
first day or so no sugar should
be added to the milk. If the bowel
movements improve carbohydrates may be added. This should
be the one that is most easily
assimilated. -" ^ty-maltose ■-
the carbohydrate ot cnoice. ->
H- McCaslan: Summer diar
IV
n infants and young child
^*^^^™---------_______-J_/. }>1fl.   llSi (0~&0&
'U there is an
irnprovement
in
Pents carbohydrate may be'add
"hfearVo^dSfe^V^^^   1	
jnost easily™™ tfJ^ S£°UK bfc?
_L.«© diarrhea    •</-.    .   ■
dfitidanaffi' „i?iarb°,hydra
Zd.ll   I--   I.._.welJ Cookerl ^
A  di
infantile 'diarrhea
Sra>«"ouI
cooked cerfalsT ^ f
tie
I or rice.
«^-*a_asiB1SfB3r
th
and the
SERIOUSNESS
OF DIARRHEA
There is a widespread opinion that,
thanks to improved sanitation, infantile diarrhea is no longer of serious aspect. But Holt and Mcintosh declare that diarrhea "is still
a problem of the foremost importance, producing a number of
deaths each year. ..." Because dehydration is so often an insidious
development even in mild cases,
prompt and effective treatment is
vital. Little states (Canad. Med.
A. J. 13:803, 1923), "There are
cases on record where death has
taken place within 24 hours of the
time of onset of the first symptoms."
"-os. easily assimilated IW • PJT"- u"u Iria
fore the carbohydratef o'rS^^S2^0^--.ls the
rheas in the youne ?Lt °'.C-e- ~^^'»er di
9:liuiis>   a   ?ounS.   Internm, ,   ..   ■ "L a'
lily   ab-J
commofi
m°orr X«*
the carbpi
Maltose  is
,rbed than.cane
,ebmayap&*_ deficient sup
iy of sugar." diarrh°el
•-When sugar cau o£ ,U
Mead's^^fegiyabsortj
expensive!
-"•"-, v,ptter than cas
eems not to be bene ^^
' iMulrilto*
Ud..^s\\
d0S/S 1%u^erforqto castor |
J_iLS\acPtosVs °
\°<J*g%d7ng ' and
Infant   rir.inemann,
don, I-''80' '*
entatiot!
„ etJ a"d have a defiij
laxative   tendency,   which
when  carried   to   excess -
severe intestinal irritatSn'*
drate-le^0rt-C8mplex carboh
orates    of  which  dextrin is tl
Z rfA.fe/ment more gradually at
do not have this laxative effect!
Regarding   the    treatment'
diarrhea
most
fo
-E
In our experience, th.
most satisfactory carbohydrah
naltost  M US? .? Mead's S
WZB^Z- J:rrP-.lt.fay&l
"The condition in whirh dextri-maltose is pa
in acute attacks of vomiting, diarrhea and fever,
covery is more rapid and recurrence less likely to
tri-maltose is substituted for milk sugar or cane
e been used, and the subsequent gain in weight is more rapid
"In brief. I think it safe to say that pediatricians are relying les
implicitly on milk sugar, but are inclined to split the sugar element
giving cane sugar a place of value, and dextri-maltose a decidedl
prominent place, particularly in acute and difficult cases, —tr. U
Hoskins: Present tendencies in infant feeding, Indianapolis M.
July. 1914-
of lactose
centage of sugar be required it is better to replace
»t by dextri-maltose. such as Mead's Nos. 1 andM
where the maltose is only slightly in excess of the
dextrins, thus diminishing the possibility of excessive fermentation."—W. J. Pearson: CommtM
Practices in infant feeding, Post-Graduate Med. J.
6:38. 1930; abst. Brit. J. Child. Dis. 28:152-153,
April-June, 1931.
_«?
Just as dextri-maltose is a carbohydrate modifier of choice, so is CASEC (calcium caseinate) an accepted protein, modifier. Casec is of special value for (1) colic and loose green stools i_-
breast-fed infants, (2) fermentative diarrhea in bottle-fed infants, (3) prematures, (4) maras-
 mns, (5) celiac disease.  MEAD JOHNSON 8c CO., EVA_S_.VI__._CE, IOT).. U.S.A.
When requesting samples of Dextri-Maltose, please enclose professional card to cooperate in preventing their
reaching unauthorized persons. OPEN
ALL
NIGHT
GEORGIA PHARMACY
W.OEOROIA
dfcttfrr $c batata £til
Established 189}
VANCOUVER, B. C.
North Vancouver, B. C.    Powell River, B. C.
PUBLISHED MONTHLY AT VANCOUVER.  B. C   BY ROY WRIGLEY LTD.,  SOO WEST PENDER STREET
IMJ gt^glggSi-gK^^
I
m
Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288

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