History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: August, 1944 Vancouver Medical Association Aug 31, 1944

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 &
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The BUlLElftH
of the
'«_<£
■KJIS/ANCOUVER-
MEiDICAL ASSOGIATION
Vol. XX
AUGUST, 1944
No. 11
With Which Is Incorporated
Transactions of the
Victoria Medical Society
the
Vancouver General Hospital
and
St Paul's Hospital
In This Issue:
Page
B. C. MEDICAL ASSOCIATION ANNUAL MEETING _*RO^RA_v_ME_M287
B. C. MEDICAL ASSOCIATION ANNUAL _ REPORTSj|jl|fe: ./$$'-- ^290
THE MANAGEMENT OF AMPUTATIONS AND
THE USE OF SATISFACTORY PROSTHESIS ||- ^02
NEWS AND NOTES ^Ml^WPfirWWWi    ^^^^^^^^^^^^^»7
ANNUAL MEETING BRITISH COLUMBIA MEDICAL
^SSOCIATIO^
EMPRESS j^>TEI, — VICTORIA, B/c|g
SEPTEMBER 2 6, 2|| 2 |||9
Please make reservations directly/with the hotel—ana* early OESTltOf<)I M
Trade Mark
Standardised fnatural oestrogenic  hormone
Whenever indications for oestrogenic hormone therapy are present,
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natural oestrogen, it is readily tolerated in all cases, and its use is
free from the untoward toxic effects that sometimes occur when
the synthetic substances are administered.
Oestroform is indicated in the treatment of—r
Climacteric and menopausal disturbances, both natural
and artificial.
Oligomenorrhcea and amenorrhcea, primary and secondary
Delayed puberty and defective development of the
secondary sex characteristics in the female
Sterility and dysmenorrhcea due to uterine hypoplasia
Pruritus vulvae and senile vaginitis, also vulvo-vaginitis
In Infants
Oestroform is indicated also in certain conditions associated with
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Stocks of Oestroform are held by leading druggists throughout the
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THE    VANCOUVER    MEDICAL    ASSOC
BULLETIN
Pulished Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building,' Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
Dr. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XX
AUGUST, 1944
No. 11
OFFICERS, 1944 - 1945
Dr. H. H. Pitts •
President
Dr. Frank Turnbull
Vice-President
Dr. A. B. Trites
Past President
Dr. Gordon Burke
Hon. Treasurer
Dr. J. A. McLean
Hon. Secretary
Additional Members of Executive: Dr. G. A. Davidson, Dr. J. R. Davies
TRUSTEES
Dr. F. Bbodie Dr. J. A. Gillespie Dr. W. T. Lockhart
Auditors: Messrs. Plommer, Whiting & Co.
Dr. E. R. Hall	
SECTIONS
Clinical Section
 Chairman Dr. S. E. Turvey —Secretary
Eye, Ear, Nose and Throat
Dr. Letth Webster Chairman Dr. Grant Lawrence Secretary
Pediatric Section
Db. J. H. B. Grant Chairman Dr. John Piters Secretary
STANDING COMMITTEES
Library:
Dr. S. E. C. Turvey, Chairman: Dr. A. Bagnall, Dr. F. J. Buller,
Dr. W. J. Dorrance, Dr. J. R. Neilson, Dr. S. E. C. Turvey
Publications:
Dr. J. H. MaoDermot, Chairman; Dr. D. E. H. Cleveland,
Dr. G. A. Davidson
Summer School:
Dr. W. L. Graham, Chairman; Dr. J. C. Thomas, Dr. G. A. Davidson,
Dr. R. A. Gilchrist, Dr. A. M. Agnew, Dr. G. O. Matthews
Credentials:
Dr. D. E. H. Cleveland, Dr. W. J. Dorrance, Dr. J. R. Neilson
V. O. N. Advisory Board:
Dr. Isabel Day, Dr. J. H. B. Grant, Dr. G. F. Strong
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont
Representative to B. C. Medical Association: Dr. A. E. Trites
Sickness and Benevolent Fund: The President—The Trustees SULMEFRIN
/ Squibb Stabilized Aqueous Solution Sulfathiazole Sodium \
I (2.5%)  with df-desoxyephedrine hydrochloride (0.125%)/
H
Ctirfti*       -
w&
£
m^
w
• Sulmefrin contains desoxyephed-
ronium sulfathiazole — a combination having the antibacterial
properties of sulfathiazole with the
proved vasoconstrictive action of
ephedrine-like compounds.
Clinical studies have shown that
Sulmefrin facilitates drainage and
ventilation, generally producing
prompt and prolonged vasoconstriction without such side-effects
as sneezing, tachycardia or nervousness. It is mildly alkaline (pH
approx. 9.0) and this, according to
Turnbull, is preferable for nasal
medication  because   (1)   of  high
antibacterial activity in the pH
range 8 to 10, and (2) it allows
continuation of ciliary motion for a
long period of time.
Sulmefrin may be administered
by spray, drops or tamponage. It
is supplied in 1-oz. dropper packages and 16 oz. bottles. The
solution is pink-tinted.
Sulmefrin—for intranasal treatment of
SINUSITIS
RHINITIS
PHARYNGITIS
LARYNGITIS
♦"Sulmefrin' 'is a trade-mark of E. R. Squibb & Sons.
For //terotur. write 36-48 CALEDONIA ROAD, TORONTO, ONT. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JUNE, 1944
Total Population—Estimated
299,460
Japanese Population—Estimated Evacuated
Chinese Population—Estimated 5,728
Hindu Population—Estimated  227
Rate per 1,000
Number Population
 \  295                      12.0
— .   Population Evacuated
Chinese  deaths  21                      44.7
Deaths—residents  only  242                        9.9
Total deaths 	
Japanese deaths
BIRTH REGISTRATIONS:
Male, 342;  Female,  337      679
INFANT MORTALITY: June, 1944
Deaths under one year of age       13
Death   rate—per   1,000   births 19.1
Stillbriths   (not included above)         9
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
27.7
May, 1944
Cases      Deaths
June, 1944
Cases      Deaths
July 1-15,1944
Cases      Deaths
Scarlet Fever  160
Diphtheria  0
Diphtheria  Carrier  0
Chicken Pox  !  281
Measles   .  44
Rubella ,  116
Mumps  3 3
Whooping Cough  23
Typhoid Fever  0
Undulant Fever  0
Poliomyelitis  0
Tuberculosis  77
Erysipelas
Meningococcus Meningitis
Paratyphoid Fever 	
Infectious Jaundice 	
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
Vancouver
Syphilis  (May)  	
Gonorrhoea   (May)
West
Burnaby      Vancouver
0 0
0 0
BIOGLAN-A
The most effective therapy for -waning mental and physical energy,
deficient concentration and memory, reduced resistance to infection,
muscular -weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated during
1932-1943.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page Two Hundred and Eighty-three It's Aqtueotts
There is no oil in Aquaphedrin to
keep the active constituents away
from the inflamed tissues.
It's Isotonic • • •
There is no painful, sudden,
osmotic disturbance when Aquaphedrin is used.
The pH is carefully adjusted to 5.5. The pH of
nasal secretions during
an attack of acute rhinitis
or rhinosinusitis is more
alkaline than the normal
range of pH 5.5 to 6.5.
Aquaphedrin, adjusted to
the acid end of the normal
range, is designed to
counteract the alkalinity
of the inflamed membranes; thus aiding the
physiologic control of the
pathogenic organisms.
Indications for
Aquaphedrin E.B.S.
Asthma, hyperaemia, swollen and
congested turbinates, sinus blockage,
rhinitis, rhinosinusitis and nasopharyngeal inflammations.
Packages:
One-half ounce, one ounce
dropper bottles and in
bulk for atomizer use.
Prescribe thus:
1$ AQUAPHEDRIN
BBS
XT
COMPANION PRODUCT WITH OIL BASE
Phedronal Inhalent, E.B.S. A 1% solution of
ephedrine in a bland, neutral, protective oil.
m
THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING CHEMISTS VANCOUVER     MEDICAL     ASSOCIATION
FOUNDED 1898    ::    INCORPORATED 1906
*        *        *        *
PROGRAMME OF THE FORTY-SEVENTH
ANNUAL SESSION f
GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.
These meetings will continue to be amalgamated with the clinical staff meetings of
the various hospitals for the coming year. Place of meeting will appear on the agenda.
General meetings will conform to the following order:
8:00 p.m.      Business as per agenda.
9:00 p.m.   ' Paper of the evening.
October 3—GENERAL MEETING:
Symposium—Medical Education of the Future, from the standpoint of
(a) The Clinician—Dr. G. F. Strong.
(b) Preventive Medicine and Laboratory Research—Dr. C. E.
Dolman.
(c) The Medical Health Officer—Dr. S. S. Murray.
October 17—COMBINED CLINICAL MEETING and STAFF MEETING at
VANCOUVER GENERAL HOSPITAL.
November    7—GENERAL MEETING:
Symposium on Industrial Medicine, arranged by Dr. W. G. Saunders,
Director of Industrial Medicine, Wartime Merchant Shipping Ltd.
-November 21—COMBINED CLINICAL and STAFF MEETING at ST. PAUL'S
HOSPITAL.
December    5—GENERAL MEETING:
Report of Work at Crippled Children's Hospital.    New Methods of
Treatment of Club Feet—Dr. Gerald Burke.
December 19—COMBINED CLINICAL MEETING and STAFF MEETING at
SHAUGHNESSY HOSPITAL.
Ntmn $c QUfamiifltt
2559 Cambie Street
anc ouver
,B.C
Page Two Hundred and Eighty-four ANTI- MEASLES SERUM
FOR MODIFICATION OR PREVENTION OF MEASLES
Human serum prepared from the blood of healthy adults so as to
involve a pooling from a large number of persons may be used effectively
either for modification or prevention of measles.
Modification is often preferable since it reduces to a
minimum the illness and hazards associated with measles,
but does not interfere with the acquiring of the active and
lasting immunity which is conferred by an attack of the
disease. On the other hand, complete prevention of an attack
of measles is frequently desirable, and can be accomplished
provided that an ample quantity of serum is administered
within five days of exposure to the disease.
For use in modification or prevention of measles, pooled human serum
is available from the Connaught Laboratories in a concentrated form.
While the recommended dose of this pooled and concentrated human serum
for purposes of prevention is ordinarily 10 cc, the most usual dc$se for purposes of modification is 5 cc.   The serum is therefore supplied in 5-cc. vials.
CONNAUGHT LABORATORIES
University of Toronto    Toronto 5, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. At the forthcoming meeting of the British Columbia Medical Association, to which
this number of the Bulletin is especially devoted, considerable time has been allotted
for discussion on medical economics—and we hope that amongst the matters discussed
will be the question of our relations as a profession with the Dependents' Allowance
Board of Ottawa—a body especially set up to deal with the costs of medical care to
the dependents of soldiers. It is best, we think, to speak frankly about this matter, as
it is becoming steadily more of a sore point with the profession of medicine, at least
as regards this Province—we cannot speak for the others.
First, let us say that we think the institution of the Dependents' Allowance Board
to assist dependents in meeting medical and hospital bills was an admirable idea, and
there is no doubt that it has given very badly needed help to these dependents. Our
quarrel is not with the principle of this institution but rather with the methods and
practices of those who administer this Fund. During the past several months, representatives of the medical profession have been striving, and to a great extent in vain, to
remove the objectionable features of this administration, and to obtain courteous and
equitable recognition of our position.
We take issue with the Dependents' Allowance Board on two main points: Lack of
candour and lack of courtesy. First as regards lack of candour. The D.A.B. assures
us that they have no intention of dictating to us what our charges shall be. Yet, since
the outset, this is exactly what they have done. Their first system of letters when they
sent the cheque to the patient, was as near blackmail as one could very well get within
legal limits. The patient was instructed to offer the cheque in settlement, and if the
doctor refused, to send his name to the Board.
Later letters, to us, were an improvement: but here again we were offered a settlement on a basis of a greatly reduced fee: if we did not take it, we should get nothing.
Repeated efforts to ascertain on what basis, or according to what schedule, this fee was
arrived at, have been useless. We learn that there is a scale of fees at present forming
the basis at Ottawa: we happen to know what this scale is. But we do not know who
set this scale, and we cannot find out. It was not the result of "open agreements openly
arrived at" between the D.A.B. and the medical profession. Surely, if we are to work
on a scale of fees, we should know what that scale is, and have a say in the setting of it.
If this is going to be the method, when health insurance is instituted—if some bureau
at Ottawa is going to set our fees without consultation with our represtntatives, the
Canadian Medical Association, there is going to be a great deal of friction and trouble.
But we are told that this is merely by way of assistance to the dependent. The form
of the letter refutes this statement entirely. We are told that we must, if we wish to
get this amount, sign a release in full.    Disingenuousness could go no further.
Let is be understood clearly, we are not quarrelling with the fact that this is a
reduced fee. We are quite willing to deal with dependents of servicemen on a reduced
basis—but we have a right to demand that we be the ones who make the concessions—
not have them made for us by an autocratic board at Ottawa, which has not shown us
the courtesy of asking our leave in the matter. We are quite capable of being reasonable and generous. In the last war, we treated all these people without any charge, but
things are different now, and it has been rightly decided that we should charge a reasonable fee.
The situation, as it stands, is unfair to the dependents themselves. They have been
assured by the papers, and in various ways, that their bills will be paid by the D.A.B..
The investigators of the latter go and urge them to avail themselves of this privilege.
We are asked for our bills, as is the hospital too. Sometimes weeks, sometimes months,
after the bill has been incurred, this offer of a settlement is made—and, largely owing
Page Two Hundred and Eighty-five to the mystery which surrounds the communications from Ottawa, the complete lack
of explanation of the reduction of our fees, and the lack of candour and frankness
which has been shewn, the medical man concerned is annoyed and often rightfully indignant over the way his account has been treated. Yet the public thinks we are satisfied,
and that our bills are being paid in full.
We think that the medical profession should make a determined effort to have this
matter cleared up—and we think that it would be greatly to the advantage of the beneficiaries of the Fund that this should be done. We will never allow the dependents of
servicemen to go without the very best we can give them—but we resent, and many of
them too resent, the way in which this matter has been handled, and the autocratic interference with the relations between ourselves and our patients. We should demand that
we have a say, and an equal say, in the setting of a'scale of fees—that allowances be
made for special difficulties and complications in a case, as is done in every other agreement that we have made; that payment be prompt in consideration of the concessions
made—and that discourteous letter, be changed into an ordinary business formula. We
do not get letters from the M.S.A. or the Vancouver School Teachers, offering a sum
in full settlement, and asking us to cooperate with them in seeing that the patient be
not charged more than he or she can afford. Let us discuss this matter through our
Association, with Ottawa, and have a clear business understanding and agreement: and
let us have an end to the secrecy and utter refusal to explain or justify their actions
hitherto shewn by the authorities with whom we have to deal.
LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY:
Medical  Clinics of North America,  Symposium  on Chemotherapy, Mayo Clinic
Number, July, 1944.
Backache and Sciatic Neuritis, 1943, by Philip Lewin.
Medical Annual, 1944.
INSTRUCTIVE BOOKS FOR PATIENTS
The following books are in the Library, and are available for the instruction of
patients:
Diabetic Manual (For the mutual use of doctor and patient), by Elliott P. Joslin.
A Primer for Diabetic Patients, by Russell M. Wilder.
Primer of Allergy, by Warren T. Vaughan.
Expectant Motherhood, by Nicholson J. Eastman.
The Woman Asks the Doctor, by Emil Novak.
Growing Up   (The story of how we become alive,  are born and grow up), by
Karl de Schweinitz.
The Three Gifts of Life (A girl's responsibility for race progress), by Nellie M. Smith.
The Home Care of the Infant and Child, by Frederick F. Tisdall.
Cultivating the Child's Appetite, by Charles A. Aldrich.
The First Five Years of Life (A guide to the study of the pre-school child), by
Arnold Gesell, et al.
Sex in Childhood, by Ernest R. Groves and Gladys H. Groves.
Convulsive Seizures: How to deal with them.   (A manual for patients, their families
and friends.)   By Tracy J. Putnam.   (On order.)
Science and Seizures: New Light on Epilepsy and Migraine, by W. G. Lennox.
(On order.)
You Don't Have to Exercise! (Rest Begins at Forty), by Peter P. Steincrohn.
Plain Words About Venereal Disease, by Thomas Parran and R. A. Vonderlehr.
Handbook of First Aid and Bandaging, by Belilos, Mulvany and Armstrong.
Page Two Hundred and Eighty-six British  Columbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President Dr. P. A. C. Cousland, Victoria
First Vice-President Dr. A.  Y. McNair, Vancouver
Second Vice-President Dr. A. H. Meneely, Nanaimo
Honorary Secretary-Treasurer Dr. G. O. Matthews, Vancouver
Immediate Past President Dr. A. H. Spohn, Vancouver
Executive Secretary Dr. M. W. Thomas, Vancouver
1944 ANNUAL MEETING
SEPTEMBER 26, 27, 28, 29
EMPRESS HOTEL, VICTORIA, B. C. j
Plan to attend your Annual Meeting.
Please make your reservations early, and directly with the Hotel.
SPEAKERS:
MAJOR GENERAL G. B. CHISHOLM, R.CA.M.C, D.G.M.S., Ottawa.
COLONEL G. S. FAHRNI, R.CA.M.C, Consulting Surgeon, Canadian Army.
FLIGHT-LlfeuT. W. C GIBSON, R.C.A.F., Flying Personnel Medical Section.
SURGEON COMMANDER J. W. MacLEOD, Consultant in Medicine, Navy.
(Formerly Internal Medicine, Montreal.)
DR. HARRIS McPHEDRAN, Associate Professor of Medicine, Toronto.
DR. WILLIAM MAGNER, St. Michael's Hospital, Assistant Professor of Pathology,
Toronto.
SURGEON COMMANDER H. S. MORTON, Surgeon, Esquimalt. (Formerly
Montreal.)
DR. ALBERT ROSS, Assistant Professor of Surgery, McGill University.
DR. G. H. STEVENSON, London, Ont., Professor of Psychiatry, University of
Western Ontario.
REPRESENTING CANADIAN MEDICAL ASSOCIATION:
DR. HARRIS McPHEDRAN, Toronto, President.
DR. T. C ROUTLEY, Toronto, General Secretary.
The Committee on Programme has prepared excellent fare for this four-day meeting.
• Fifteen lectures on four mornings.
• Afternoon sessions:
Wednesday afternoon in charge of the Committee on Economics of the Coun
cil; Chairman, Dr. H. H. Milburn.
Page Two Hundred and Eighty-seven Thursday afternoon under the Committee on Industrial Medicine; Chairman,
Dr. D. J.. Millar—Session on Industrial Medicine.
Conference by (_ornmittee on Emergent Epidemics; Chairman, Dr. G. O.
Matthews.
• Annual Meetings:
Tuesday evening—College of Physicians & Surgeons.   All doctors should
attend.
Wednesday evening—British Columbia Medical Association (Canadian Medical Association, B. C. Division).
Note: Annual meetings are being held on separate evenings to avoid late
sessions.
• Official Luncheon, addresses by Doctors McPhedran and Routley of the C.M.A.
• Golf—Friday afternoon.
• Annual Dinner, Friday evening—Guest speaker, Dr. Norman MacKenzie, Presi
dent, University of British Columbia.
• Entertainment for Ladies.
• Public Meeting—Thursday evening,   addresses  by Doctors Harris  McPhedran,
William Magner and C E. Dolman.
PLEASE NOTE: Registration Desk Phone will be—BEACON 2241.
GOLF
Golf play on Friday afternoon, September 29 th,
at 1:30 p.m. at the Oak Bay Golf Links.
Dr. F. M. Bryant, 1209 Douglas St., Victoria,
and Dr. E. L. McNiven, 701 Yates St., Victoria, are
arranging the tournament.
The British Columbia Medical Association trophy
is up for competition. Dr. G. A. Davidson is the
present holder and will defend his title. Other prizes
have been arranged. Send your handicap to Doctor
Bryant.
LADIES' REGISTRATION AND ENTERTAINMENT
All ladies are asked to register, and attend the Ladies' Tea and the Ladies' Dinner.
Special Note: Reception at Government House.
COMMERCIAL EXHIBITS
A large number of commercial exhibits, which are always interesting, haVe been
arranged.
Page Two Hundred and Eighty-eight PROGRAMME FOR THE
VICTORIA MEETING
September 26, 27, 28, 29
'■ <:_TKi"«-. -
8:30 a.m.
9:30 a.m.
10:15 a.m.
11:00 a.m.
12:00 noon.
8:00 p.m.
TUESDAY, SEPTEMBER 26th
Registration.
Dr. Stevenson—"Psychiatry in General Practice."
Dr. Magner—"Infectious Mononucleosis."
Colonel Fahrni—"Surgery in the Army with special reference to care of
the wounded."
Official Luncheon—Grill Room.
Speakers: Dr. Harris McPhedran,
Dr. T. C. Routley.
Annual Meeting—College of Physicians & Surgeons of B.C.
All doctors should attend.
9:00 a.m.
9:45 a.m.
10:30 a.m.
11:15 a.m.
12:00 noon.
2:00 p.m.
8:00 p.m.
WEDNESDAY, SEPTEMBER 27th
Dr. McPhedran—"Management of Congestive Heart Failure."
Dr. Magner—"Carcinoma of Lung."
Colonel Fahrni—"Surgery in Army."
Surg. Commander Morton—"Loose Bodies in the Elbow Joint."
Lunch hour.
Session on Economics—Chairman, Dr. H. H. Milburn, Committee on
Economics of the Council of the College.
Annual Meetings—British Columbia Medical Association.
All doctors should attend.
SPECIAL
1944 ANNUAL MEETING
September 26, 27, 28, 29
VICT ORIA
LADIES' PROGRAMME
September 28th—Thursday, 4:30 p.m.: Reception at Government House.
September 29th—Friday, 7:00 p.m.: Ladies' Dinner.
„
Page Two Hundred and Eighty-nine 9:00 a.m.
9:45 a.m.
10:30 a.m.
11:15 a.m.
12:00 noon.
2:00 p.m.
4:00 p.m.
8:30 p.m.
9:00 a.m.
9:45 a.m.
10:30 a.m.
11:15 a.m.
12:15 noon.
1:30 p.m.
7:00 p.m.
7:00 p.m.
Mat-
THURSDAY, SEPTEMBER 28th
Dr. Stevenson—"The Prevention of Mental Diseases."
Surg. Commander MacLeod—Clinical Experience with Pemcillin."
Surg. Com. Morton—"External Skeletal Traction."
Dr. Ross—"Acute Diverticulitis of the _»igmoid."
Lunch hour.
Conference on Industrial Medicine—Chairman: Dr. D. J. Millar.
Conference on Emergent Epidemics—Chairman:  Dr. Gordon O.
thews.
Public Meeting—Metropolitan United Church.
FRIDAY, SEPTEMBER 25»th
Surg. Commander MacLeod—"Gastroenterological Problems in the Canadian Navy."
Major General Chisholm—"Mental Hygiene of Soldiers."
Dr. Ross—"Fractures of Surgical Neck of the Humerus;"
Flight-Lt. Gibson—"Medical Aspects of High Altitude Flying."
Luncheon—Board of Directors.
Golf—Oak Bay Golf Links.
Annual Dinner. Guest speaker, Dr. Norman MacKenzie, President, University of British Columbia.
Ladies' Dinner.
REPORTS  BY  CHAIRMEN  OF  STANDING COMMITTEES
The following reports of Committees of the British Columbia Medical Association
are published in advance in' the hope that time will be saved at the Annual Meeting of
the Association in Victoria on Wednesday evening, September 27th. Members are
requested to read these reports. They contain much valued information and will be
open for discussion at the Annual Business meeting.
REPORT OF THE COMMITTEE ON PROGRAMME AND FINANCE
Your Committee was responsible for arranging a speaker for the annual meeting
of the West Kootenay Medical Association at Nelson in September, 1943. Dr„ P. A. C.
Cousland, the President of the British Columbia Medical Association, presented a paper
on the lecture programme, and addressed the members following the annual dinner.
The annual meeting of No. 4 District Medical Association was held at Vernon, and
Dr. Cousland, our President, again addressed the members at the annual dinner, and Dr.
H. A. DesBrisay and Col. L. H. Leeson provided the lecture programme at the afternoon
session.
Dr. Cousland attended the annual meeting of the Upper Island Medical Association
at Nanaimo and addressed the members at the annual dinner.
A largely attended meeting was held when Col. L. C. Montgomery, Consultant in
Medicine Overseas, and Colonel W. P. Warner, Consultant in Medicine to the D.G.M.S.,
Ottawa, addressed the Association.
A special meeting of the Association was held on April 19th, 1944, for the purpose
of discussing Health Insurance, and the Principles approved by the Board of Directors
were adopted by the Association.
It is hoped that you will enjoy the 1944 Annual Meeting being held in Victoria.
The Committee wishes to acknowledge the provision by the Canadian Medical Association
of four speakers on the lecture programme. We wish to record our thanks to die
Director General of each of the Medical Services for speakers from the Navy, Army
and Air Force.
I wish to move the adoption of this report.
J. R. NEILSON, Chairman.
Page Two Hundred and Ninety REPORT OF THE COMMITTEE ON MEDICAL EDUCATION
In annual meeting last September, the British Columbia Medical Association approved
the recommendation of this Conunittee that the establishment of a Faculty of Medicine
was urgently needed at the University of British Columbia, and instructed the Committee to investigate ways and means to further its formation. To this end the Committee was enlarged to represent all organized medicine in the Province.
The enlarged Committee decided that the project should first be discussed with the
Board of Governors of the University, and to place the situation before them a brief
was prepared. The brief, even when condensed, covered ten typewritten pages, and
presented very strong arguments for the immediate establishment of this additional
Faculty at the University. The Board of Governors then nominated a strong committee
to act with our Committee. Several meetings have been held, sub-committees organized, much work has been done and decisions made.
Two buildings will be required to house the medical school. The pre-clinical classes
will be held in the medical building on the University Campus, to follow several years
of pre-medical studies. This building will adjoin the Institute of Preventive Medicine
presently to be constructed, where instruction will also be given. The location will also
permit medical students to engage in many university student activities to their advantage. The final clinical years of the medical course will be housed in a building to be
constructed close to the Vancouver General Hospital. Here the medical students will
be largely segregated from University activities, but that is unavoidable.
A sub-committee under Dr. C. E. Dolman was given the task of getting data from
the various medical schools of Canada concerning the size of buildings, the grouping of
courses, and the operating costs of the various departments. This information is now
almost complete.
It is found that student fees provide for about one-third of the operating costs of
medical schools, and the balance is provided by grants from the Provincial Governments,
or from endowments. A medical school graduating fifty students annually, which we
will need here, will require an annual operating budget of $150,000 to $200,000. Our
sister Provinces recognize the necessity of this annual outlay and provide for it. British
Columbia cannot continue, as at present, to allow other Provinces to pay two-thirds of
che cost of educating our medical students. Practically they are refusing to do it, and
sutdents from B.C. are having increasing difficulty in being accepted in Medicine by
Eastern Universities.
At the present time it costs from $1200.00 to $1500.00 per year to educate a B.C.
student at an Eastern medical school. There are approximately one hundred and fifty
students in this category today. Therefore, at least $180,000.00 from B.C. is being
spent annually on medical education outside the Province, and many students are prevented from entering Medicine because of the expense. This large sum should be spent
at home.
A delegation from the' combined committee hopes to interview our Provincial Government in the near future with a request for the necessary finances to establish our
medical school. We must envisage a school which will be attractive to our students, and
will give them a solid and comprehensive groundwork in the medical sciences. Naturally, we will estimate our costs at bare requirements, with the expectation that donations will be forthcoming from public minded and generous citizens for the many extras
needed.   We have reason to believe that we will be well received by the Government.
It is not the function of this Committee to organize a medical faculty. We hope to
turn the project over to our University authorities, but organized Medicine will be
vitally interested, and will work with the University.
We have carefully kept out activities from the press. The public will be informed
of the necessity for a Medical Faculty at the University of British Columbia after the
Provincial Government has been approached. This will strengthen the hand of the Government in making the necessary grants, and may also stimulate offers of endowments
which will certainly be needed.    There is no better monument than an educational
Page Two Hundred and Ninety-one endowment to perpetuate a worthy name, and the recent gift of $750,000 from Lord
Bennett to Dalhousie University might well be duplicated here from other donors.
All of which is respectfully submitted. K. D. PANTON, Chairman.
REPORT OF THE COMMITTEE ON ECONOMICS
Our chief activity in the past year has been the study of the Principles of Health
Insurance as adopted by the Canadian Medical Association. Early in this year the
Executive of the C.M.A. suggested that each Division study the Principles as adopted
at Jasper and revise or amend them to bring them into line with our present day ideas.
Your Committee spent a great deal of time at this study and early in February submitted
their recommendations to your Board of Directors, which body approved of the Principles on February 9th. This draft was submitted to the Committee on Economics of
the Canadian Medical Association, and was studied hy that group, by the Health Insurance Committee of the CM.A., and by the Executive Committee of the C.M.A. These
suggestions were then re-submitted to all Divisions. It was at this stage that a special
meeting was held in the Vancouver Hotel on April 19th for the final study and adoption
of the Principles as approved by the B.C. Division.
This draft was then re-considered by Council at the annual meeting of the Canadian
Medical Association at Toronto, where changes were made in wording, but not in meaning (see copy CM.A. Principles). In«regard to our Principle No. 3 in which we had
recommended the application of Health Insurance in successive stages, tr_vs Principle
was not approved by the Canadian Medical Association, but in the opinion of your
Committee, it should still have the support of «this Division, and should be recommended
if and when our Provincial Government considers the adoption of Health Insurance in
this Province.
Principles  of  Health  Insurance  approved by the B. C. Division in
meeting, April 19th, 1944.
1. We approve the adoption of the principle of
contributory Health Insurance, and favor a
plan which will secure the development and
provision of the highest standards of health
services, preventive and curative, if such plan
be fair both to the insured and to all those
rendering the services.
2. The health of the people depends to a great
extent upon environmental conditions under
which they live and work, upon security
against fear and want, upon nutritional
standards, upon educational facilities, and
upon the opportunities for exercise and leisure. The improvement and extension of
measures to satisfy these needs should precede
or accompany any future organization of
medical service. Failure to provide these
measures will seriously jeopardize the success
of any Health Insurance Scheme.
3. In our opinion it is impractical to introduce
at once a nation-wide scheme of complete
Health Insurance. Any such scheme should
be developed in successive stages in each Province that accepts the Federal Enabling Act.
Note: The term "successive stages" comprises:
1. Hospitalization;-
2. Diagnostic aids, including X-ray and Laboratory facilities for ambulatory patients and those not hospitalized;
3. Medical, surgical and obstetrical care.
Page Two Hundred and Ninety-two
Principles relating to Health Insurance, approved by General Council,
C.M.A., May, 1944.
1. The Canadian Medical Association approves
the adoption of the principle of contributory
Health Insurance, and favours a plan which
will secure the development and provision of
the highest standards of health services, preventive and curative, provided the plan be
fair both to the insured and to all those rendering the services.
2. Inasmuch as the health of the people depend-
to a great extent upon environmental conditions under which they live and work,
upon security against fear and want, upon
adequate nutrition, upon educational facilities and upon the opportunities for exercise
and leisure, the improvement and extension
of measures to satisfy these needs should precede or accompany any future organization
of medical service. Failure to provide these
measures will seriously jeopardize the success
of any Health Insurance plan.     v Principles  of  Health  Insurance  approved by the B. C. Division in
meeting, April 19th, 1944.
4. Each Province should be served by an adequate Department of Public Health, organized on the basis of the provision of individual health supervision by the medical
practitioner.
5. The Association believes that it is not in the
public interest in Canada that the state
should convert the whole medical profession
into a salaried branch of any government
service.
6. It is not in the public interest that the state
should invade the patient-doctor relationship.
This relationship includes free choice of doctor by patient, free choice of patient by
doctor, and maintenance of the confidential
nature of medical practice.
7.   In   any   form   of   Health   Insurance   there
should be no income limit.
8. Medical care for indigents and transient indigents should be provided under the plan, the
Government to pay the premiums of the
indigents, who then receive medical care under exactly the same conditions as other
insured persons.
9. The dependents of insured persons shall be
included in the medical benefits.
10. "We favour the principle of insured persons
being required to contribute to the insurance
fund.
•
11. Any Health Insurance plan should be studied
and approved actuarially before being
adopted, and actuarially approved at periodic
intervals.
12. In the Province where Health Insurance is
established it shall be administered by a
small, independent Health Insurance Commission, the Chairman of which shall be a
Doctor of Medicine, regularly qualified, duly
licensed, and in good standing in the Province, who has practised Medicine for at least
ten years.
13. There should be a Central Advisory Committee composed of representatives from various lay and professional groups to discuss
matters of policy and administration with
the Health Insurance Commission.
14. The Province should be divided for purposes
of administration of Health Insurance into
Regions, each Region with a Regional Medical Officer, Regional Public Health Officer,
and Regional Advisory Committee.
Principles relating to Health Insurance, approved by General Council,
C.M.A., May, 1944.
12. Each province should be served by an adequate Department of Public Health, organized on the basis of the practising physician
taking an active part in the prevention of
disease.
3. It is not in the national interest that the
State convert the whole medical profession
into a salaried service.
4. It is not in the patient's interest that the
State invade the professional aspects of the
patient-doctor relationship. Subject to geographical and ethical restrictions this relationship includes free choice of doctor by
patient and free choice of patient by doctor;
it implies also maintenance of the confidential
nature of medical practice.
5. While leaving to each province the decision
as to persons to be included, the plan must
be compulsory for persons having an annual
income insufficient to meet the costs of adequate medical care.
7. Medical care for resident and transient indigents should be provided under the plan, the
Government to pay the premiums.
6.   The dependents of insured persons should be
included in the health benefits.
16. The principle of insured persons being required to contribute to the insurance fund
is strongly endorsed.
17. Any Health Insurance plan should be studied
and approved actuarially before adoption and
thereafter at periodic intervals.
10. Health Insurance should be administered by
an independent non-political Commission representative of those giving and those receiving the services. Matters of professional detail should be administered by committees
representative of the professional groups concerned. <
Page Two Hundred and Ninety-three Principles  of  Health  Insurance  approved by the B. C. Division in
meeting, April 19th, 1944.
15. The professional side of Health Insurance
medical service should be the responsibility
of the medical practitioner providing the services under the Act through the appointment
of a Central Medical Services Committee and
Regional Medical Services Committees, to
consider and advise on all questions affecting
the administration of the medical benefit and
preventive and public health services.
16. Under Health Insurance the Chief Medical
Officer and the Regional Medical Officers
should be appointed by the Health Insurance
Commission from a list submitted by the
organized medical profession of the Province.
17. Cash benefits should not be included in any
Health Insurance Act. Should cash benefits
be considered desirable from the viewpoint of
social welfare, such should be provided from
funds other than the Health Insurance Fund.
18. Medical Benefits to be organized as follows:
(a) Every qualified licensed medical practitioner to be eligible to practise under the
plan.
(b) The medical service to be based upon
making available to all a general practitioner service supplying preventive medicine and public health measures as well
as the treatment of disease.
(c) Additional services to be secured ordinarily through the medical practitioner.
1. (a)  Specialist medical service,
(b)  Consultant medical service.
2. Special private duty nursing service.
3. Hospital care.
4. Auxiliary services, usually in hospital.
5. Pharmaceutical service.
(d) Dental service.
19. The medical practitioners of each Province
should be remunerated according to the
method or methods of payment agreed upon
by the medical profession and the Commis-
*    sion.
20. Under Health Insurance provision must be
made for:
(a) Adequate   clinical   teaching   in   medical
schools and hospitals.
(b) Facilities for research work.
(c) Periodic   post-graduate   training   of   all
medical practitioners.
Principles relating to Health Insurance, approved by General Council,
C.M.A., May, 1944.
11. Under Health Insurance the Chief Executive
Officer to the Commission and the Regional
Executive Officers should be physicians appointed by the Commission from a list submitted by organized medicine in the province.
9.   Cash   benefits,   if   provided,   should   not   be
taken from the Health Insurance fund.
8.   Health benefits should be organized as follows:
(a) Every regularly qualified, duly licensed
medical practitioner, in good standing in
the province, should be eligible to practise under the plan.
(b) The benefits conferred should be such as
to provide for the prevention of disease
and for the application of all necessary
and adequate diagnostic and curative
procedures and treatment. Specialists
and consultant medical services should
be available.
(c) The folowing additional services should
be available through the medical practitioner:
1. Nursing service;
2. Hospital care;
3. Auxiliary services, usually in hospital;
4. Pharmaceutical   service;   subject   to
regulation.
(d) Dental service.
14. The method, or methods, of remuneration of
the medical practitioners and the rate thereof,
should be as agreed upon by the medical profession and the Commission of the province.
15. Every effort should be made to maintain
health services at the highest possible level.
This requires:
(a) Adequate facilities for clinical teaching
in the medical colleges and hospitals;
(b) Post-graduate training of all medical
practitioners at frequent intervals.
(c) Necessary facilities for and support of
research.
Page Two Hundred and Ninety-four Principles  of  Health Insurance approved by the B. C. Division in
meeting, April 19th, 1944.
Comment i
3. The introduction of Health Insurance should
not be undertaken until the medical personnel that is now engaged with the Armed
Forces is again available for civilian duty.
Important Additional Comments:
1. It is sometimes suggested that the introduction of Health Insurance will practically
eliminate the need for curative medicine, but
it should be emphasized that in spite of the
great importance of Preventive Medicine, even
the full application of our presnt-day knowledge of preventive measures will not abolish
all disease or eliminate the need for curative
medicine.
2. We are opposed to the inclusion of any and
all irregular practitioners in any scheme of
Health Insurance.
3. The introduction of Health Insurance should
not be undertaken until the medical personnel
that is now engaged with the Armed Forces
is again available for civilian duty.
4. The introduction of any system of Health
Insurance into Canada should be preceded
by an increase in the facilities for undergraduate and post-graduate medical training.
5. Some plan should be devised for the provision
of pensions for medical practitioners.
6. A survey of existing hospital facilities and
future requirements is an urgent necessity.
7. Preceding any Health Insurance programme
there should be initiated avast plan of new
hospital construction.
8. In accordance with our recommendation that
Health Insurance be introduced in successive
stages we believe that a compulsory hospital
insurance scheme would be the logical first
Principles relating to Health Insurance, approved by General Council,
CM.A., May, 1944.
13. The granting of a licence to practise medicine was designed primarily to protect the
public Therefore it is in the interests of the
patient that all who desire licensure to practice a healing art should be required to conform to a uniformly high standard of preliminary education and of training in the
recognized basic sciences as well as to furnish
proof of adequate preparation in the clinical
and technical subjects.
18. In the provision of health services, cognizance should be taken of the fact that well
over a third of Canadian doctors are now
in the Armed Forces. If Health Insurance
should be implemented in any province before demobilization, the interests of the medical officers in the Services should be fully
protected.
stage.
Medical Association Committee on
study of fee schedules across Canada,
Acting as a sub-committee of the Canadian
Economics, some additional time was spent on the
and the following report made—
1.   Present Medical Fee Situation in Canada.
The schedules of regular medical fees and of Compensation Board fees in all the
Provinces of Canada, with the exception of Prince Edward Island, have been studied and
compared and certain conclusions have been reached. In general, medical charges are
highest in the West and lowest in the Maritime Provinces. Manitoba tops all Provinces
in fees, and is closely followed by British Columbia, which is very similar to Ontario.
It is probable that one reason for the difference between the West and the East is to be
Page Two Hundred and Ninety-five found in the relatively lower expenses of physicians in the Maritimes where offices are
usually in the homes and where distances to patients are not so great. There is also
an apparent difference in the actual cost of living. It would appear that there will continue to be higher charges as a rule in the Western Provinces.
If the various charges are examined separately it is found that in general routine
minor procedures, such as office consultations, home visits, mileage and so forth, British
Columbia allows the highest fees, while in major work, such as surgery, obstetrics and
gynaecology, orthopaedics, Manitoba leads in charges. In only one branch of major surgery is British Columbia highest, and that is in genito-urinary work. In orthopaedics
British Columbia is lower than both Ontario and Quebec. Incidentally, British Columbia is the only Province that allows a fee of $150.00 for all types of appendectomy. The
drop in fees in New Brunswick and Nova Scotia is very noticeable. Two dollars is still
the charge for office consultations and house visits and $25.00 for normal obstetrical
cases, which is the same as in Quebec, while Manitoba charges $50.00, with an additional
$10.00 or $15.00 for anything not absolutely normal.
A table of twenty-seven procedures has been prepared, showing charges for each in
the eight Provinces, from which we have information. These procedures were selected,
first, in order to cover certain common things about which information was desired;
second, to show that in some procedures there is some uniformity in fee, and third, to
illustrate the fact that in other procedures there is the greatest disparity. (See CM.A.
Journal, Sept., 1944, p. 37.)
The Workmen's Compensation fees have been compared and are found to vary from
East to West much as the ordinary fees. Generally, British Columbia is highest and the
Maritimes lowest. In home visits, subsequent visits, night visits and mileage British
Columbia is highest as it is in nearly all minor procedures, such as removal of foreign
body from the eye ($5.00 allowed in British Columbia compared to $2.00 in all other
Provinces) and aspiration of bursa ($5.00 allowed in British Columbia as compared to
$3.00 elsewhere). One Compensation Board fee in British Columbia is lowest in Canada
—$50.00 for exploratory laparotomy for which $75.00 or $100.00 is allowed in all of
the other Provinces. Fractures are about the same across Canada, except slightly higher
in Manitoba and definitely lower in New Brunswick and Nova Scotia. Dislocations are
poorly paid in these two Provinces, as are amputations.
Conclusions drawn from these comparisons of fees are that there will be many difficulties in arranging one schedule which would be satisfactory to all Provincse. It would
seem advisable that some of the charges for major operations in British Columbia and
Manitoba, particularly, should be reduced, and that the Eastern Provinces should raise
their entire schedule. In Nova Scotia the fee allowed for complete obstetrical case,
including pre- and post-natal care, is still $25.00; while $$100.00 is allowed for simple
herniotomy and appendectomy. This does not appear a proper relationship for the skill
and amount of medical care required. In general, it would seem that there is an overemphasis on surgery, and not enough consideration given to skilled medical work. The
value of the first examination should be recognized and the fee proportionately raised.
The value of medical care where special skill is involved should not be based on a charge
per visit.
In view of the facts set out above, this Conunittee feels that it is out of the question
to attempt to have one schedule of fees for the whole of the Dorninion. We are strongly
of the opinion, however, that there should be uniformity in the relative value of medical
services. To illustrate, we feel that the relation between the charge for a normal obstetrical case and the charge for a simple appendectomy should be altered to take into consideration the skill and medical care required, and the relative values should be the same
in every Province.    To this end the following resolution was passed:
"A schedule of fees that could be used as a basis for payment of doctors in
any part of Canada should be based on a unit system. This schedule should
relate only to the relative value of fees—expressed in terms of a unit—and not
expressed in dollars. Appendectomy, for example, would have a certain set relation to maternity case.   The practitioners of each Province could then decide the
Page Two Hundred and Ninety-six value in dollars of one unit.   This value would vary across Canada and be determined by such factors as the cost of medical practice and the general cost of
living in each Province."
Your <_ommittee would recommend that this subject be given further study.
2.   Method of Remuneration of Doctors under Health Insurance.
As can be imagined, this subject was given a very great deal of consideration.
Although opinion in this regard was available from only a few of our corresponding
members, there was unanimity only as to the fact that we are not in favour of a salaried system for all. In other words, we are opposed to State Medicine. It is recognized, of course, that the salaried services that now exist are satisfactory in principle,
but the salaries are usually much too low. It is also recognized that in sparsely settled
areas a salary,'or partial salary, may be required. Your Sub-Committee came to the
conclusion that the question of the method of remuneration of doctors under Health
Insurance must still be left to the decision of representatives of organized Medicine in
each individual Province, and we are not prepared.to make any further recommendation
at this time.
In conclusion, your Committee would recommend to this Annual Meeting:
(1) That we endorse the Principles relating to Health Insurance as approved by the
General Council of the Canadian Medical Association in May, 1944, to the end the
the medical profession all over Canada may present a united front.
(2) That we reiterate our belief that Health Insurance should be applied in successive
stages.
(3) That there be continued study of the medical fee situation.
All of which is respectfully submitted.
G. F. STRONG, Chairman.
*****
REPORT OF THE COMMITTEE ON HOSPITAL SERVICE
I have pleasure in submitting this Annual Report as Chairman of the Hospital Service Committee for 1943-44.   The members of the Conunittee are as follows:
Dr. R. A. Seymour (Chairman), Vancouver; Dr. R. P. Kinsman, Vancouver;
Dr. R. A. Gilchrist, Vancouver; Mr. E. J. Lyon, Prince George; Dr. A. G.
Naismith, Kamloops; Dr. H. Campbell-Brown, Vernon,; Dr. W. F. Anderson,
Kelowna; Dr. J. R. Parmley, Penticton; Dr. A. B. Hall, Nanaimo.
Because of the geographical distribution of the members of this Q>mmittee there
have been no special meetings called.    No business or problems have been referred to
this Committee by your Board or by individual members during the current year.
Respectfully submitted,
R. A. SEYMOUR, Chairman.
REPORT OF THE COMMITTEE ON THE STUDY OF CANCER
During the urgency of war unassociated cornrnittees and their reasons for existence
are apt to be forgotten; may I, therefore, be forgiven for reminding you once more that
this <_on_niittee is the B. C. representative of the Department of Cancer Control of the
Canadian Medical Association; that it has existed as such since 1937 when this Department of the Canadian, Medical Association was established by means of funds set aside
by the trustees of the King George V Silver Jubilee Cancer Fund, and that its object is
the furthering of the knowledge of Cancer among the profession. Its present Chairman
of the Department is Professor William Boyd of Toronto University and the local committee has held four meetings during the past year.
The last meeting was called to consider a recent letter from Dr. T. C. Routley
asking for suggestions for the extension of the Cancer programme, especially with respect
to the following:
1. Medical education in diagnosis and treatment of cancer.
2. Establishment of a clinical research fellowship at a University centre.
Page Two Hundred and Ninety-seven 3. Establishment of a programme for cancer education of nurses.
4. The use of films for cancer education.
These points were discussed and suggestions made as follows:
1. Medical Education—
(a) There should be lectures at Annual Meetings—at least one lecture.
(b) Special lecturers or lecturer sent to District Associations.
(c) Special meetings devoted to Cancer by District Associations.
(d) Lecture tours to larger centres.
(e) Educational films for the profession.
(f) Collection of an exhibit for education among undergraduates and graduates.
(g) The use of colour photography in preparing slides or pictures showing types,
stages, treatment and progress.
(h)   Organized instruction among under-graduates.
(i)    Cancer education could be stressed during post-war refresher courses.
(j)    (1) Bulletins and journals encouraged to publish articles on cancer.
(2) These periodicals could develop a cancer section to provide that short
articles should appear regularly.
(3) Reviews of and abstracts from longer articles.
(k)   Doctors taking course leading to D.P.H. provide opportunity for post-graduate
education.
(1)    The enlistment of interest of pathologists holding conferences on pathology,
(m) Tumour clinics.
(n)   Cancer Study Groups.
2. Question 2 dealt with the establishment of a clinical research fellowship at a university centre. The question of clinical research was discussed and it was considered to
fall into separate groups: :
(a) The epidemiological and statistical approach as a definite research for one fellowship with particular reference to the picture in Canada.
(b) Clinical studies.
(c) The pathology of the disease.
It was noted here that at present clinical observation of a group of presumably
normal young women with specific relation to breast changes was being carried out.
The interest of life insurance companies might be enlisted to support financially.
cancer prevention clinics. In the course of routine examinations at these centres
cancer is frequendy discovered, largely because people may come for this cause. Life
insurance companies should be interested in epidemiological and statistical research.
3. Programme for education of nurses.
A planned programme adequately arranged by doctors should be developed for
under-graduate nurses, graduate nurses, public health nurses, and may be extended to
include social workers.
4. Films—
It was decided that a film library should be built, which would be available to
serve the needs of the association, its divisions and district societies.
In reply to Doctor Routley's letter, it was decided that the suggestions outlined as
above should be forwarded.
Your Committee would be grateful for further suggestions or comments from district cancer committees or from any member of the profession interested in contributing
to this important problem of cancer control.
All of which is respectfully submitted.
ETHLYN TRAPP, Chairman.
REPORT OF THE COMMITTEE ON INDUSTRIAL MEDICINE
Looking back over the past two years in which this Committee has been actively
working and putting into operation Industrial Medicine, one can see that much has been
accomplished; but sober reflection prompts me to say that a great deal has yet to be done
Page Two Hundred and Ninety-tight before this branch of active medical practice is put on a sound and enduring basis.
Our present active participation in industry has and continues to be dependent upon
contributions from the Dominion Government through Wartime Srupbuildig Limited.
What will happen when the Dominion Government discontinues the war industry? Can
we simply retire from the field or should ge not now prepare for the change to Provincial
and private control? Your Committee feels much concerned over this and is attempting
to find a way to meet the situation when it arises.
It has been established that great saving has been effected by the work our Doctors
are doing in the various plants in which there has been established a department of
Industrial Medicine. It is probable that when these War Plants revert to private work,
that our showing will induce the management of such plants to take on the expense and
continue the work; but we are a little fearful of letting the employer control the service.
We think that without outside control and guidance the Industrial Surgeon may become
nothing more than a glorified First Aid service and a convenience for his employer.
We want the Provincial Government to set up a department of Industrial Medicine
with a full time Director and to put into effect regulations necessary to keep the service
what it should be.   To this end we are now working.
We regret the lack of enthusiastic support which we naturally expected would be
foi^coming from the Workmen's Compensation Board of the Province.' Perhaps we
have not approached them in the proper manner or perhaps they have not taken the
time to ascertain how very important this' work is or could be in assisting to solve some
of the problems which are met with in administrating the Workmen's Compensation Act.
During the year a special Sub-Committee was set up to make a complete survey of
First Aid Service as regulated and supervised by the Workmen's Compensation Board of
B.C. A very comprehensive report of findings was made to your Committee with recommendations for improvement of the Service. As you are aware, we presented these
recommendations to your Directorate, where they were duly approved, and we were
advised to approach the Workmen's Compensation Board with the suggested changes.
The President of the College (Dr. H. H. Milburn), the Executive Secretary (Dr. M. W.
Thomas) and your reporter met the Chairman and members of the Board and presented
the recommendations, together with a request for a reply as to whether they wished the
medical profession to work with them. We have not yet had any advice from the
Board, although some months have passed since the interview. We have still hope that
soniething may come of this very great amount of work put on the subject.
For whatever progress we have made in this Committee we want to thank all the
members who so readily gave of time and thought to the work during the past year.
Particularly do we want to mention Dr. W. G. Saunders, who in addition to guiding
the work as active Director of the Service, has acted on all important Sub-Committees.
We also thank Dr. Lyall Hodgins, who headed up the advisory sub-committee. This
sub-commitete is a most important one and will become even more important in any
set up contemplated for the future. Dr. M. W. Thomas, your Executive Secretary, has
been of inestimable assistance, freely giving time and advice as Secretary. We thank the
Provincial Health Officer, Doctor Amyot, for his presence at most of our meetings and
for his interest in the work of the Conunittee. We are assured that he will get behind
any scheme we are able to have set up under Provincial control.
Respectfully yours,
D. J. MILLAR, Chairman.
REPORT OF THE COMMITTEE ON EMERGENT EPIDEMICS
The Coirunittee on Emergent Epidemics is a national organization, sponsored and
organized by the Canadian Medical Association, but made up of representatives from the
Canadian Red Cross, the St. John Ambulance Association, the Canadian Nurses' Association, the Canadian Hospital Association, the Indian Affairs Department and the
Department of Pensions and National Health.
Page Two Hundred and Ninety-nine There is a central and national Committee to advise and stimulate, and Provincial
Committees to direct all attention within the said Province, sponsored and organized by
the Provincial Division of the Caandian Medical Association, in our case, the Brtish
Columba Medical Association.
Fortunately, your Committee has had no need to function, except in an organizing
sense. Last November, your Chairman attended a Central Conunittee meeting held in
Ottawa, and sponsored by the Department of Pensions and National Health. In attendance were duly authorized representatives from every Provincial Sub-Cornmittee, as well
as representatives from every national organization represented on our Conunittee, also
from National Women's organizations, both French and English, and strong representations from Universities and teaching hospitals.
A full discussion of all phases of epidemics took place, and finally a suggestive plan
of action for the Provincial Committees to follow was submitted.
Last January, your Provincial Conunittee met in Vancouver, and the above plan of
the Central Committee was adopted with a few minor changes.
It can now be reported that with the co-operation of the Provincial Health Officer,
all the Medical Health Officers of the Province Have been contacted and they have
formed, or have in the process of formation, local sub-committees, composed of the
leaders of the different organizations interested. Therefore, if we do have visited upon
us a catastrophe such as a virulent pandemic, we will have in every locality in our
Province a conunittee that is forearmed, organized and well prepared to quickly throw
the necessary material resources and personnel into combating it. Any epidemic, if
any, will be wide-spread, and so we are happy to report our present plan of decentralization.
My thanks to all members of the Committee and to their respective organizations,
and also to Doctor Amyot, without whose help what little organizing has been done
would have been quite impossible.
As the Committee on Public Health is part of the Committee on Emergent Epidemics, this could be considered a report of both Committees.
G. O. MATTHEWS, Chairman.
REPORT OF EDITORIAL BOARD
There is not a great deal to report on the work of this Conunittee for the past year.
Each month news or notes of any significant matters are sent to the Canadian Medical
Journal, which has been very generous in affording-space, and in publishing any special
note—as, for example, in the matter of the speech made by Major A. E. Jukes before
the Vancouver Medical Assocaition, which was widely circulated in the East, and gave
rise to some adverse comment, as it was misreported.
The News and Notes of the British Columbia Medical Association are published in
the Bulletin of the Vancouver Medical Association, and owing to the admirable system
of news gathering worked out by Dr. M. W. Thomas, they are remarkably full and
complete, covering all areas of the province.   We find that they are eagerly read.
The Editorial Board feels that grteful acknowledgment is due to the Vancouver
Medical Association for the generous manner in which the Bulletin has given full publicity in regard to this Annual meeting; we are glad, too, to have regular space in the
Bulletin for reports of matters of importance and interest to the profession of B.C.
All of which is respectfully submitted.
J. H. MacDERMOT, Chairman.
REPORT OF THE DIVISIONAL ADVISORY COMMITTEE
Your Divisional Advisory Committee has completed its fifth year in office. During
the past year we have met twelve times and have conducted the business of the committee, we hope, in a satisfactory manner. Our meetings have been well attended and
Page Three Hundred special credit should be given to the out-of-town members who have been unfailing
in their attendance and invaluable in their contributions. I believe that our president,
Dr. Cousland, has been in attendance at every meeting. The medical heads of the Armed
Forces are of the greatest assistance at our meetings.
Our relationship with the National Selective Service continues to be most satisfactory. Colonel Simpson, the personal representative of the G. O. C, Pacific Command,
sits Qn the N. S. S. board and also on our committee. All N. S. S. matters pertaining
to medical men are brought to our committee by this liaison officer. The decision of
the D. A. C. has been accepted by the N. S. S. in every case without exception.
The committee was represented at a meeting of the D. A. C. in Ottawa in February.
There legislation was enacted whereby medical men in uniform could be placed in areas
badly in need of civilian medical services. The scheme enacted did not meet with the
approval of this D. A. C, although the Province of British Columbia has approved of
the arrangement in principle. Up to date it has not been acted upon in this province.
We believe it fair to say that with very few exceptions the civilian population of this
province enjoys fairly complete coverage.
MURRAY BLAIR,
Chairman.
The Library is receiving considerable literature dealing with Post-War Planning:
e.g., the Report of a Conference held in Toronto at the 73rd Annual General Meeting
of the Canadian Manufacturers' Association.
The greatest attention is directed, of course, to trade, markets, production, etc., but
it is encouraging, too, to note that research is a prominent item in the recommendations
made.. Reserach, adequate laboratories, utilization of men specially fitted for research
work, are advocated. We feel that it is impossible to exaggerate the importance of
research, and are glad to note these items.
The American College of Surgeons has cancelled its Annual Clinical Congress, to help
the authorities in their efforts to keep down traffic, and relieve the strain on transportation systems. A very interesting releave on this subject, with comments by the
Surgeon-General of the U. S. Army, R. H. Clare, Asst. Director, Passenger Section, Div.
of Traffic Movt., O.P.A., and others, is in the Library.
A release from the National Foundation for Infantile Paralysis, Inc., states that in
the first 31 weeks of 1944, the U.S.A. has had more cases of infantile paralysis reported
than at any comparable time in 28 years. 3,992 cases are reported, with increases in
all the states referred to. The original is in the Library. Another report from the same
source shows that the American people have contributed $10,473,491 to the 1944 Fund-
Raising Appeal of the Foundation. The film industry, sports world, press, radio, war
workers, and labour are all- contributing and cooperating, and the March of Dimes, contributed to by school children, has raised enormous sums. In North Carolina alone
a million and a half dimes "are at work."
Page Three Hundred and One THE MANAGEMENT OF AMPUTATIONS AND
THE USE OF SATISFACTORY PROSTHESIS
By Colonel R. I. Harris
Given at Vancouver Medical Association Summer School, 1944.
This is a singularly appropriate time for us to be discussing the question of amputations and reviewing our knowledge of the subject and the various uses of prosthesis;
because we are faced again with the prospect of large numbers of casualties, and
amongst those casualties will be those who have lost their extremities, so that we must
again be prepared to deal with amputation problems and prosthetic problems as we were
in the last war. So what I have to say is of necessity intimately concerned with war
amputations. It nevertheless has a very important application in civil practice. Amputations are no different in civil practice from war amputations, except that they are
less complicated and much simpler to handle. So, if we can decide on good and sound
methods of handling war amputations, we have laid the foundation of good handling
of industrial and traumatic surgery in civil life.
The experience of the last war in Canada and in England and to some extent in the
United States has laid the foundation for our present knowledge of amputation surgery.
The necessity of handling large numbers of amputees resulted in the establishment of
methods in all three of these English-speaking countries which, in broad outline, were
similar, and perhaps the most essential and important part in the management was the
fact that all three nations learned very quickly the wisdom of segregating amputation
problems in special centres. In Canada that led to the development of an amputation
centre in what was then the Dominion Orthopaedic Hospital in Toronto, and it also led,
because of difficulties in the supply of artificial limbs, to the establishment of an artificial limb factory being set up, staffed and run by the government through what is
now the Department of Pensions and National Health. In England similar experience
led, through similar reasoning, to a similar though not exactly the same result. They
have gathered their amputation problems together in one place, Roehampton, and they
also manufacture their artificial limbs under government supervision, though they do it
now by contract with a single firm. At one time they had several firms; now they
have one firm which manufactures artificial limbs according to specifications laid down
by the Ministry of Pensions and conforming to inspection standards, which are governed. So, in effect, they have the same system as we have; viz., the segregation of
amputation problems in one place and the supply of artificial limbs made, here, by a
government factory; there, by contract under government supervision. In the United
States the same procedure was set up to a certain point. Amputation surgical problems
were gathered together in special centres, and dealt with by a special staff, and they
were supplied with a temporary artificial limb and then discharged from hospital. From
there on the handling of the problem of these veterans has been different. Their veterans' bureau has developed the policy of using the established manufacturers of artificial limbs for the provision of aids for these men, and the soldier goes with an order
from the veterans' bureau to certain numbers of approved firms who manufacture the
limb, which is accepted after inspection by the veterans' bureau. You will realize that
this procedure has resulted in the accumulation of a large amount of information, under
the direct supervision of surgeons who were interested in the problem, or who became
quickly interested in the problem. As a matter of fact, this mass of experience—and
particularly the necessity of the surgeon's controlling the type of artificial limb which
was supplied—is the experience upon which American amputation surgery is founded.
Prior to that experience, the surgeon amputated his patient's limb with too little consideration as to how that stump would function after he had amputated the limb. The
limb manufacturer took the stump which the surgeon gave him and as best he could
he fashioned the artificial limb for it. The result was far from ideal. There are certain
stumps which function better than others and it has been this association of surgeon and
limb manufacturer that has been the mark of the progress which has arisen out of the
Page Three Hundred and Two experience of the last war. Anything that we do in this war, and anything that we do
in civil practice, will be good if it is based on that similar association of surgeon with
limb manufacturer. The limb manufacturer has skill and experience to bring to the
aid of the surgeon and the amputee. The surgeon, on the other hand, has knowledge
partictdarly of the anatomy and physiology of the extremity, and surgical skill without
which a good functioning stump cannot be obtained. Both have contributed to what
we now have in amputation surgery..
If we start off with war problems we must say that in war amputation surgery,
the ever-present menace of infection governs the surgeon's activity. You cannot, in
the field, amputate an extremity with the expectation that the amputation performed
will be the last amputation that the man will need to have, and that ultimately the
amputation stump will be fitted with a limb and will function well. In order to have
a good stump which functions well, and a good artificial limb, it is necessary that the
wound of the amputation heal by primary union. If it does not, the stump all too
frequently is a poor stump, and has to have something done as a secondary operation.
Since primary healing of wounds in the field is as yet almost too much to expect, we
must, therefore, divide our amputation surgery of war into two stages:
(1) The procedure which has to do with the fashioning of the stump, and that is
again divided into two stages—1. The amputation which is undertaken in the field, the
object of which is to save the man's life; and 2. A second stage in which we remodel
the emergency amputation done in the field into a stump which will have the best
possible prospect of good functioning.
I have tried to indicate on a diagram the problems of amputation surgery, and these
are problems in war amputation. Up to this stage the problems are the same for civil
practice.
There are two phases of amputation surgery: (1) the surgeon's phase, which is concerned chiefly with producing the stump, and (2) the limb maker's phase, which is concerned with the prosthesis.
In war surgery, in view of what is going to happen to this stump later, it is necessary
that we amputate the limb as soon as possible so that the later operation may be done.
In order to combat infection, the wound'must be left open; we must perform an operation which is guillotine in type. In favorable cases, when the infection has been controlled in 10 days' or 3 weeks' time, we can close the wound by primary closure. In our
army that operation will be performed in field surgical units, the operating unit which
is immediately behind the line and to which all major surgical cases are sent for operation.
This problem of fashioning the stump is continued at a later date when the primary
wound has healed, and then the surgeon's problem is to fashion a stump which will fit
an artificial limb, and which will function well in an artificial limb. In order to do
that to his satisfaction, he must have as much stump left as possible and not be
restricted by undue shortening of the stump or undue scarring at the end of the stump.
That is the importance of leaving, in the field, as much as possible. A good example
of this is shown by the value that we place upon a Syme's amputation. When a man
in the field has been wounded so that his foot is shattered and amputation is necessary,
a simple and easy solution in the field would be to amputate the leg in the middle of the
tibia. It would be much better for his future function if the foot were amputated and
the heel flap saved in order that he might later have a Syme's amputation. This pre-
liminary operation, which should be done in amputation centres set up for that purpose,
in order to be as good as possible must heal by primary union. It is best undertaken only
when the operation done in the field is completely healed. It is necessary to ensure that
the stump will be put into the best possible position for wearing the artificial limb. This
eliminates flexor deformities, increasing the strength of the muscles which may have
become flabby, teaching the amputee to use his extremity and to use the muscles of it
in a new way, because many amputations interfere with the exertion of muscles and the
patient has to re-learn the use of what muscles are left, and also shrinking the stump
so that it will not be flabby and will fit the artificial limb as satisfactorily as may be.
Page Three Hundred and Three It also involves fitting the prosthesis to the stump. I have indicated in my diagram how
these things can most satisfactorily be done at an amputation centre.
In our country and in the United States these amputation centres have been set up.
We have faced the problem as to whether or not we should provide our amputees with
artificial limbs through the Ministry of Pensions and have decided against such a policy
as being wasteful of time, wasteful of effort, involving the necessity of setting up amputation centres in England and dividing our effort into two phases.
Finally, we have to deal with problems relating to the prosthesis—its design, its
manufacture and its fitting. That is the concern of the limb factory, except that this
problem is a problem which is a joint responsibility of the surgeon and of the limb
maker and fitter. That problem is shared jointly with the amputation centre and by
the limb factory.
One cannot emphasize the value of bone amputations when they are necessary for
trauma or Infection. This is the best way of managing wounds in which we know
infection is a problem. The bone amputation may be by fashioning of flaps and not
suturing them, but, better still, it is by a modified guillotine amputation. • This is a
circular amputation in which the limb is removed by dividing the soft tissues and the
bone at successively high levels so that when the amputation has been performed, we
have a stump that looks something like this (slide shown), in which the bone is higher
than the skin margin. If that is undertaken for gross infection already established, the
wound must be left without anything further until the infection is under control. When
the infection is under control, or in cases in which the infection is less serious or less
evident, skin traction should be applied. If not, the skin will shrink far off the limb
and necessitate a re-amputation. Skin traction can be applied by a sleeve of stockinette
fastened to the skin by adhesive and held in place by a crepe bandage, and a rope on
the end of the stockinette gives traction to the skin. This slide shows the appearance
of the skin two weeks after and five weeks after the operation. If you commit yourself
to guillotine operations like this, it is important that you handle the stump in the manner that I have illustrated by skin traction and healing by granulation. If you don't do
so, if you attempt to close the wound at the end of a week or ten days by secondary
suture, the resulting stump will not be as good as in this other way. This ensures that
the end of the stump will be conical, there will be a firm but not excessive scar and.
there will not be any gross bulky mass of tissue over the stump.
If you decide, therefore, to manage your case by circular amputation, make up your
mind that this involves healing by granulation with skin traction.
When we come to consider amputations of the lower extremities—and I am thinking now of the last operation, the one that is going to give the man the functioning
stump—there are two kinds of stump which experience has proved to be valuable to the
patient. Under certain circumstances we can fashion a stump either for the above-knee
amputation or the below-knee amputation which will bear the weight on the end of the
stump. In both cases this type of stump necessitates that the bone be tansected through
the expanded cancellous lower end and if the amputation cannot be done there then
that patient cannot have a good stump. So that we may transect the tibia just above
the ankle joint or the femur just above the knee joint and cover the end of the stump
with skin accustomed to bear weight and, with a little skill, secure a stump on the end
of which the patient can bear all of his weight. The advantages of such stumps are
very great. The patient easily bears all his weight on the end of such stumps, they are
fitted with a simpler prosthesis, they enable the patient to walk and stand much better
than with other types and, therefore, they are very desirable. So they are to be used
wherever it is possible to use them. And that is one reason why the primary amputation in the field should be undertaken in such a manner as to save the largest possible
amount of the limb.
If the patient cannot have an end-bearing amputation then he will have a stump on
which the weight of his body will be borne, not on the distal end of the stump but on
the top end of the stump.    Since he is going to bear his weight on the top of the arti-
Page Three Hundred and Four ficial limb applied against the top of the stump, the length of the stump in these cases
is of value only for motivating the artificial limb, and it is not true that the longer
the stump the better the limb. Indeed, in the below-knee stump there are many arguments for having as short a stump as possible and, generally speaking, the length of the
stump, if the limb is not going to be an end-bearing one, is fixed within narrow limits
and it is determined by the length of stump which will make the artificial limb move
satisfactorily.
You may ask why a longer stump would not help the man to walk better. Well,
as far as motivating his artificial limb is concerned, it might help him to walk better,
but it brings with it certain problems. The fact that he bears his weight means that
it is wedged in there with some force and every time he walks he thrusts it down and as
he takes his weight off it, it comes up a little bit from the artificial limb. It tends to
jam his stump into the artificial limb. The patient tends to lace the corset of the artificial limb tightly and that interferes with the circulation in the stump and a swollen
stump jams itself still more tightly into the artificial limb. This may become the cause
of serious troubles in the limb. The longer the stump the more likely those troubles are
to occur. There are other troubles associated with below-knee amputations which I
will mention in a moment.
Let us discuss for a moment the Syme's amputation. The Canadian surgeons have
been strong advocates ox the Syme's amputation as a good stump. It was designed by
the great master surgeon, Syme, chiefly for tuberculosis of the ankle joint or tarsal bone
at a time when artificial limbs as we know them today did not exist, and he was trying
to get an amputation stump which a man could put into his own boot and get around.
It is today the best amputation for limbs below the knee. This slide shows the technique
of this type of operation. Here we see the appearance of a good Syme's stump. Here
is another good Syme's stump. This is a picture of the artificial limb which that
patient wears and here is another example of it. It consists of the standard foot and
then, above that, a rather heavy metal skeleton with a leather corset which laces around
the stump.
In this picture you can see the only shortcoming of the Syme's operation; viz., that
you can't get, in the prosthesis of a Syme's amputation, a good likeness of the normal
leg. Here w^ have a double Syme's amputation with artificial limbs which this man has
worn for 27 years.   These are the prostheses that he wears.
I am very much indebted to the Department of Pensions and National Health, who,
through the good offices of Major Bell, has sent from Ottawa these cases of artificial
limbs.
This shows a girl who suffered from a congenital non-union of the tibia. Here is
the non-union of the tibia as seen in the X-ray. She was 21 years of age, weighed over
200 lbs., wore an enormous thing on her leg which weighed 25 lbs., and was very much
depressed about her condition. A Symes amputation was done, but because of the
enormous shortening, one leg was very much shorter than the other one. However, a
limb manufacturer made this artificial limb for her so that it looke quite a bit like her
normal leg.
This is a good example of how valuable a Syme's amputation can be. Canadian surgeons are very much in favour of Syme's amputations, but there has not been universal
acceptance. I cannot explain the objections raised. I think that condemnation of it
it not justifiable. If there are vascular changes they may be related to such things as
chilblains, which are very common in England but not common here in Canada. Now
the American Army has adopted the Syme's type of amputation.
If the limb below the knee cannot be amputated so as to produce an end-bearing
stump, then it must be amputated in such a manner that the weight will be borne in
another way. The amputation should be done by choice so as to produce a stump about
6" long. The flaps are best equal. This slide shows the technique of this other type of
amputation.   The stump when finished should be cone-shaped and tapered uniformly at
Page Three Hundred and Five the top and bottom. This slide shows a good below-knee stump. This shows an artificial limb of the English type. The skin which bears the weight is not adapted to
bearing weight. The constant trauma of bearing weight often leads to trouble, such as
infection in a series of furuncles. Some of that problem can be diminished by the manner in which the corset above the knee is handled. If it is stiffened and carried up
higher, then a greater amount of the man's weight can be carried on his thigh. If the
corset is made stiffer and carried up higher, he can take all the weight of his below-knee
stump.
This slide shows the three types of artificial limbs for this type of amputation. It
does not, as a general rule, however, permit the man to work on his feet all day long.
The surgeon to the Goodyear Tire and Rubber Co. recently has surveyed all the amputees
in his firm to see how the below-knee amputations stood up and he found that they
cannot stand up at their work all day long.
If one cannot fashion a below-knee stump then the next best stump is one through
the condyles of the femur, the so-called Gritti-Stokes amputation. This slide shows
the technique of this type of amputation. There are other types of weight-bearing
stumps which are good but the Canadian surgeons have had no experience with them.
This shows a good Gritti-Stokes amputation. Here is an X-ray picture of the patella in
this case. The patient lacks voluntary movement of his knee joint, and if one has to
choose between the two, one should choose the below-knee stump and let the man
demonstrate what he can do. If it gives him trouble, it can always be amputated into
a Gritti-Stokes.
This is a good mid-thigh stump and this is a type of artificial limb supplied for it.
It is a metal limb with a pelvic belt. This is a limb for a patient whose stump is so
short that he cannot wear a mid-thigh limb or who has lost his femur by disarticulation.
I won't say much about arm amputations -except this—that the function that we
can obtain from this is incomparably less than we can obtain from the prosthesis of
lower extremity amputations. The complex mechanism of the hand cannot ever be
produced by any kind of prosthesis because we cannot ever reproduce the fine movements of the fingers nor can ~ve give a man the fine sensations that are in the normal
hand. We can give him an appliance which is useful to him if we abandon the thought
of giving him a normal-looking hand.   He gets on best with an ingenious hook.
As to the psychological aspect of amputations, a man who has lost an extremity—
especially a young man—faces a profound psychological revision of his attitude towards
the world. He wonders whether he can get along and perhaps he wonders whether his
family and his girl are going to like him as well as they used to. The most important
thing we must do for these men is to assure them that they can lead normal lives in
spite of their mutilation.
We had an amputation conference here in February. It was very interesting and I
think it was productive of some important measures, but to me one of the most impressive events of that conference was something that was entirely unpremeditated. When
the conference was under way we received a letter from the War Amputations Association of Canada, which said: "We owe a lot to doctors and we would like to invite you
to a dinner in Toronto." After some hesitation we accepted the invitation and we had
one of the most unique experiences of our lives.
That psychological aspect is important, and to all of you who have anything to do
with amputees I would stress that you keep in mind the psychological aspects. One of
the most valuable things is to prepare a little film which I am going to show you now.
Page Three Hundred and Six NEWS    AND    NOTES
The profession was shocked to learn of the sudden passing of Dr. Peter Sinclair
McCaffrey of Agassiz. Dr. "Pete" McCaffrey held a warm place in the hearts of his
colleagues.
The sympathy of the profession is extended to Doctors T. R. B. Nelles, W. L.
Pedlow, G. H. Worthington and Major R. P. Borden in the loss of their sons while on
Service with the Infantry.
3p 8f- Sp 3p
Dr. Thomas McPherson of Victoria and Miss Dorothy Grubb were married recently.
Dr. McPherson of Victoria, Dr. H. H. Milburn and Dr. P. A. McLennan of Vancouver are in Ottawa attending the meeting of the Medical Council of Canada.
3fr 3fr 3p 3p
Lieut. Robert Knox, R.C.N.V.R., is visiting with his parents, Dr. and Mrs. W. J.
Knox in Kelowna, after service overseas.
\ __ __ __ _L
J8* ^* ^* *r
Lieut. Steve Covernton, son of Dr. C. F. Covernton of Vancouver, is visiting on
the coast after service overseas.
•r 3fr *r *r
Major C. H. Ployart, R.C.A.M.C, formerly in practice at Lillooet, has returned from
overseas to be stationed on this coast.
*_ *_ *_ __
*r ^ *C ^
Dr. S. W. Baker has returned to his practice at Ladysmith after some weeks' vacation.
Dr. S. P. Findlay of Fraser Lake was at the coast for a short visit in August.
Dr. C. C. Browne of Nanaimo had a pleasant ten-day cruise in his sloop Ann.
t s_* Jfr <v
Dr. P. L. Straith of Courtenay has just returned from Rochester and Eastern cities,
where he has been doing post-graduate work.
3fr Jp Sp 3fr
Dr. F. M. Bryant of Victoria has been visiting in Vancouver, and enjoying some
very good golf.
*_ _L __ *_
*F V V ^
Dr. R. Geddes Large of Prince Rupert has been down to military camp as medical
officer with a Reserve Unit.
* *      *      *
Dr. C. H. Hankinson of Prince Rupert had a vacation on Vancouver Island.
3fr Sfr Sfr Sp
Dr. W. T. Kergin, who formerly practised in Prince Rupert, has been visiting there
and renewing old acquaintances.
* *      *      *
Dr. J. P. Cade of Prince Rupert has had a month's vacation.
3fr 3fr 5p 3fr
Dr. L. W. Kergin had a trip along the new highway from Prince Rupert, which has.
opened up some virgin fishing.
* *      *      *
Dr. E. S. Hoare had a holiday at Trail.
* *      *      *
Dr. D. J. M. Crawford of Trail visited in Medicine Hat.
Page Three Hundred and Seven TT
Capt. W. J. Endicott, formerly of Trail, is now overseas.
Dr. R. W. Garner of Port Alberni is in the East..
Dr. George Young and family, formerly of Salmo, now with the Department of
Pensions and National Health, Calgary, spent his vacation in Nelson.
Major S. L. Williams, stationed in Eastern Canada, visited Nanaimo. Part of his
time, accompanied by the family, he was holidaying in the Forbidden Plateau.    Dr. E.
D. Emery and wife accompanied Major Williams to the Forbidden Plateau.
* *       *       *
Dr. C. C. Browne of Nanaimo is going to Mayo Clinic and will spend several weeks
there. He will be accompanied by his wife. Doctor Browne is entering his sloop Ann
in competition against the R.V.Y.C. yachts at Yellow Point on September 3rd.
Dr. A. H. Meneely of Nanaimo and family will have a short Labour Day week-end
at Qualicum.
* *       *       *
Dr. L. Giovando of Nanaimo is planning to do some bird hunting at Campbell River.
•s* 5r f 5fr
Dr. Allan Hall is spending Labour Day week-end at his cottage at Rothtreeves
Beach.
ANNUAL MEETING—September 26th-29th
Special Announcement
LADIES' PROGRAMME AT VICTORIA
Thursday, 28th, 4:30 p.m.—Reception at Government House.
Friday 29th 7:00 p.m.—Ladies' Dinner.
Colonel D. H. Williams was visiting on the coast and he and his family stopped at
Vaucrof t.
Major E. J. Curtis called at the office while visiting his family in Vancouver last
month.
Dr. R. W. Irving was in town and very inetrested in the feats of the ponies at
Hastings Park. >
* *      *      *
Dr. H. F. Tyerman of Ashcroft made a flying visit to Vancouver recently.
5S» 3j" 5fr Sfc •
We are glad to report that Dr. E. J. Lyon of Prince George and wife are none the
worse for their experience on Stuart Lake.
* *      *      *
Capt. F. L. Wilson had an unusual fishing trip at the top of Stuart Lake.    They
threw back everything under 7 pounds.   Some trout!
* *      *      *
Dr. R. G. Turner, formerly at Pinchi Lake, also fished in Stuart Lake and vouches
for the size of the trout, which run up to 18 lbs. and are bonny fighters.
Page Three Hundred and Eight Major R. R. Laird and wife have returned from Great Britain. Major Laird formerly
lived in Oliver, was an interne at the Vancouver General Hospital, and just prior to
entering the R.C.A.M.C. was ship surgeon on the Empress of Russia. Major and Mrs.
Laird have the best wishes of the profession.
*       *
Dr. A. R. Wilson of Chilliwack is spending a vacation at Qualicum Beach, Vancouver Island.
* *      *      *
Dr. G. A. C. Roberts of Chilliwack has returned from two weeks' respite from
work at Savary Island.
* *      *      *
Dr. G. F. Enns is planning to spend two months on post-graduate courses in Chicago.
Captain Harold Stockton, R.C.A.M.C, formerly of the No. 3 Canadain General
Hospital, is expected to be repatriated soon as a result of injuries received on active
service last March.
Obiit
PETER SINCLAIR McCAFFREY
Sept. 5, 1944
In the death of Dr. P. S. McCaffrey of Agassiz, the medical profession
of B. C. has lost one of its finest characters, and one of its best-loved members—the Fraser Valley, and especially Agassiz, has lost one of its bset and
most valuable citizens, and a most devoted practitioner of medicine.
"Pete," as everyone who knew him well called him naturally (who is it that
said that the man who has no nickname has very few friends?) has served his
community for a long time, over thirty years: and during that time he has built
himself an enduring place in the confidence and affection of those he served.
He did good work, and he had lots of it to do. Withal, he developed, as the
years went by, into a wise counsellor, and a man of weight in the community.
Amongst other medical men he was always eagerly welcomed and at home.
He had a delightful wit, and it was always a pleasure to hear him speak at a
meeting: he hated shams and pretentiousness, and was himself most straightforward and sincere, even to bluntness. But his sympathy was always for the
younger men, and those in the less favoured places, and his voice was always
raised on their behalf.   We shall miss his wisdom and experience.
To his wife and family we extend sincerest sympathy.
Page Three Hundred and Nine IN ANY PLACE... AT ANY TIME
You or Your Patient Can Test for Urine-Sugar
with SIMPLE—CONVENIENT—DEPENDABLE
CLINITEST
(Copper Reduction Tablet Reagent)
SPEED • • • Just add a Clinitest Tablet to proper amount
of diluted urine. Allow a few
seconds for reaction.
DEPENDABILITY • • • Compare with color scale for urine-
sugar percentage reading.
FOR IABORATORY
The Clinitest Laboratory
Unit contains 10 vials of
25 tablets each...250 tests
...together with Clinitest
dropper and instruction
book with color scale.
Reasonably priced.
CLINITEST   SET   FOR   PATIENT
.Complete set... as shown on the right... is self-
contained. It is equipped with test tube, dropper,
instruction book, color chart and enough Clinitest
Tablets for 50 tests. Costs the patient $1.75.
Tablet refills (for 75 tests) $1.75.
Clinitest Sets and Supplies are procurable from
your surgical supply house or prescription
pharmacy. Will promptly send descriptive
literature on request.
CONVENIENCE.
No Powder to Spill.
Eliminates flame, external heating,
water-bath,complicated apparatus.
The use of tablet and test tube
confines the test to the known
agents and reagents. It guards the
test from possible oxidization by
atmospheric oxygen.
EFFERVESCENT   PRODUCTS   INC.
Sole Canadian Distributors
FRED.    J.    WHITLOW     &    CO.,    LTD.,    187    DUFFERIN    STREET,    TORONTO MUCARA
for
Intestinal Stasis
MUCARA
INCREASES BULK «f Bewol
Content without dlaestiv*
disturbance
INCREASES    MOISTURE
Content of Steels which
Will well formed —
•oily passed
INCREASES UR6E to Bowel
Movement ■Ithoojt bowel
irritatiea
TENDS TO BREAK "Laxative Habit" but It not
hablt-formine   of   Itself
Mucara is purely physical in action. It is
neither digested nor
absorbed during its
passage through the
intestinal tract
Mucara will not produce abnormal motility.
of the bowel, and patients should be advised of this fad
Two Types
MUCABA PLAIN
and
MUCARA WITH
CASCAHA
KARAYA GUM—SOLID GRANULAR FORM
(Magnified)
Note hard, flint-like surface and also limited
amount at surface area exposed to intestinal
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SPECIALLY PROCESSED MUCARA GRANULES
(Magniiied)
Note porous sponge-like surface area presenting hundreds of almost microscopic granules
loosely bound together; each exposed to the
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upon.
Available  in two sizes:
6V_ ozs. and 32 ozs.
John Wyeth & Brother (Canada) Limited
WALKERVILLE   —   ONTARIO *pax *7*ectt«ite*tt
THE RELIABLE RABBIT
DELIVERS THE GOODS
• . . three clinically-proven
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by pertussis.
Pertussis Antitoxin and Antibacterial Serum (Rabbit) Combined
No. 489—vials of 10 cc
'pwt 1Pneue*ttioH
Pertussis Vaccine with Pertussis Toxoid
No. 486—vials of 6 and 24 cc
Pertussis Toxin for the Strean Test
No. 497—packages of 10 and 100 tests
«&                            Detailed literature will he sent on request.
| _ 
WAYERST, McKENNA & HARRISON LIMITED
Biological and Pharmaceutical Chemists •  Montreal,   Canada
218 HIGHLY
EFFICIENT
ANTISEPTIC
at ntmanfaMcf
foot cadt
Bottle of 4 FLUIDOUNCES
*ca4et 4 GALLONS
Less than
24 cents per gallon i
Cost of customarily used Aqueous Dilutions of Zephiran Chloride:
1:1000—per gallon,
less than 24 cents.
1:5000—per gallon,
less than 5 cents.
1:20,000—per gallon,
about 1 cent.
Zephiran Chloride Stainless Timcture
1:1000 can be prepared from the Concentrate 12.8 per cent Aqueous Solution
at Correspondingly low cost. Detailed
formula on request.
________
ZEPHIRAN
Trademark Reg. U. S. Pat. OS. _ Canada
CHLORIDE
Brand of
BEN7ALKONIUM CHLORIDE REFINED
CONCENTRATE 12.8%
AQUEOUS SOLUTION
ft! ntiseptic costs can be radically reduced
by the use of Zephiran Chloride Concentrate 12.8 per cent Aqueous Solution . . .
The various dilutions customarily employed
are made with ease by the hospital pharmacist . . . Zephiran Chloride dilutions
possess not only a potent antiseptic action
but also a desirable detergent property.
Zephiran Chloride Concentrate 12.8 per cent
(Aqueous Solution) is supplied in bottles of
4 ounces and 1 gallon.
WINTHROP CHEMICAL COMPANY, INC.
Pharmaceuticals of merit for the physician
GENERAL   OFFICES:   WINDSOR,   ONTARIO
Quebec   Professional  Service  Office:
Dominion Square Bldg.
Montreal, Quebec
Bottle of
1 GALLON
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128
GALLONS eel
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CAMPBELL & SMITH LIMITED
820 Richards Street   •   Vancouver, B.C.   •    PAcific 3053
13th Ave. and Heather St.
Exclusive  Ambulance  Service
FAirmont 0080
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE  IN  AMBULANCE SERVICE  ONLY
J. H. CREL.LIN
W.  I*  BERTRAND aigif->f-:S
i
low simplified I
INTRACtlfANEOU5 TESTING FOR PROTEIN SENSITIVITIES
WITH
ALLERGENIC TESTING SET
(BARTOS SYSTEM)
ONLY ONE SYRINGE—the new "Breech-loading"
'Tubex" syringe—for administering all allergens. No
battery of syringes neededl
NO DILUTING ALLERGENS—"Tubex" hold specific
allergens in suitable dilution—all ready for immediate
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TESTS READ WITHIN 10 MINUTES—saving your
time!
TESTS   ECONOMICAL —each    "Tubex"    contains
enough allergen for 20 to 30 tests!
John  Wyeth  &   Brother   (Canada)   Limited
REICHEL
Walkerville
DIVISION
Ontario
To prepare syringe: Simply insert Tubex of possible exciting allergen
Mo breech-loading syringe—then dose breech which locks Tubex
into place.
Complete! Wyeth Allergenic Testing Set (Bartos System) in handsome cabinet, includes breech-loading Tubex syringe, over 200
Tubex of essential allergens, one dozen needles, plus other helpful
accessories.
Par descriptive Booklet fully describing
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system, write JOHN WYETH & BROTHER
(CANADA) LIMITED, Relchel Division,
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Name.	 CASE HISTORY
Vehicle and Digestant
Fermentol contains pepsin,
renin and papain. It contains
NO sugar.
FERMENTOL has a dual role in medicine.    It
has been  used  for twenty years
as the ideal vehicle for:
bromides, iodides and salicylates.
FERMENTOL   is  also  used  as a digestant.    A.
wineglassful after meals will help
greatly in digestive upsets.
FERMENTOL  is packaged in 16 oz. bottles.
AGE: _4 PAPPY
OCCUPATION:  Underminer
Patient is engaged in the German
diplomatic services. While in
Washington he became consultant
in subversion and this intriguing
occupation resulted in considerable
nervous tension. Pains in the abdomen became a frequent occurrence-.
History of Present Illness:
Patient    is    in    a    highly    nervous
state,   his   moustache   is   chewed   to
shreds   and   is   no   longer   useful   as
a    decoration.      His    disorder    was
apparent   during   the   last   war   while   in   the
.,    and    there    were    numerous   .upsets    which
lly   caused  the   patient  to  leave   the   country.
After a period  as vice-chancellor he  rose to vice-
chief   and   entered   the   undermining   business   in
Turkey.    British    interests    caused    a   collapse    in
his Turkish workings  and  worry over this  failure
resulted in the present condition.
Diagnosis:
Peptic   ulcer   associated with   trichophagia   barbae.
RECOMMENDED   TREATMENT:
Complete gastrectomy,  jejunectomy  and  colectomy
followed by nutrient enemas.
FRANK W. HORNER LIMITED
Montreal, Canada
Breaks the vicious circle of perverted
I   menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
I    musculature. Controls the utero-ovarian
Ilk    circulation and thereby encourages a    1
Hk   normal menstrual cycle. ^P
1%. • MARTIN H. SMITH COMPANY
§W^ ISO IAFATITTl  STRUT.   NIW  TOM. N. V. y_H
(g|p
Full formula and descriptive
literature on request
Dosage:   l to 2 capsules
3 or 4 times daily.  Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule is cut in half at seam. TA8LSTS ton Otal use-
AMPULS FOR  ^CVfCCtCOH
There has long been a real need
for a potent, mercurial diuretic compound
which would be effective by mouth.
Such a preparation serves
not only as an adjunct to parenteral
therapy but is very useful when
injections can not be given.
After the oral administration of
Salyrgan-Theophylline tablets a
satisfactory diuretic response is obtained
in a high percentage of cases. /
However, the results after intravenous
or intramuscular injection of Salyrgan-
Theophylline solution are more consistent.
Salyrgan-Theophylline is supplied in two forms:
TABLETS (enteric coated) in bottles of 25, 100 and 500.
Each tablet contains 0.08 Gm. Salyrgan and
0.04 Gm. theophylline.
SOLUTION in ampuls of 1 6c, boxes of 5, 25 and 100;
ampuls of 2 cc, boxes of 10, 25 and 100.
Write for literature
SALYRGAN-THEOPHYLLINE
"Salyrgan," Trademark Reg. U. S. Pat. Off. & Canada
Brand o/MERSALYL and THEOPHYLLINE
WINTHROP CHEMICAL COMPANY
Phamaceuticals of merit for the physician
GENERAL OFFICES: WINDSOR, ONTARIO
Quebec Professional Service Office:
Dominion Square Building, Montreal, Quebec
INTHROP
i •
■ --/*m mm+m mtmim _^     ^_f _«^_wsv Jhm **m   #___•_-_-
{*P.
The assault and trauma of disturbing psychic influences
may reflect themselves in a hyperexcitability of the autonomic nervous system.    The resulting spastic disorders of
the gastro-intestinal tract are now being effectively managed   with   the   well-known   antispasmodic   and   sedative
NEURO-TRASENTIN*   .  .  .  supplemented by additional
dosage of Trasentin*  when increased spasmolytic effect
is desired.
*Trade Mark Reg'd.
Literature and samples      NEURO-TRASENTIN
on request.
TDACFKITIKI
%
'                  ^         MONTREAL, CANADA
__>ount BMeasant TUnbertakfng (To. %tb.
KINGSWAY at 11th AVE. Telephone FAirmont 005 8 VANCOUVER, B. C.
R. P. HARRISON W. E. REYNOLDS 1930     t^8"' p- P- Drake. T. G. „.. and
Brown. A.: A new cereal mixture containing   vitamins  and  mineral   elements.  Am.
J. Dis. ChiM. 40:79r-799. Oct. 1930.
10^1 Tisdall. F. P.: Dietary factors and
M-^-JM- health. Soc Tr.. Am. J. Dis. Child.
42:1490. Dec 1931.
1932 Summerfeldt, P.: The value of an in*
creased supply of vitamin Bt and iron
in the diet of children. Am. J. Dis. Child. 43:284-
290. Feb. 1932. Morse. J. L.: Pads and fancies
in present day pediatrics. Pennsylvania M. J.
35:280-285. Feb. 1932. Henricke. S. G.: The
vitamin B complex: Its rote in infant feeding in
the light of our present knowledge. Northwest
Med. 31.165-169. April 1932. Langhorst. H.
P.: Vitamins: Their role in the prevention and
treatment of disease. M. J. & Rec 135:326-329.
April 6. 1932. Crimm. P. D.: Dietary of Childhood Tuberculosis: Cereal as a'source of added
mineral and vitamin elements; preliminary report. J. Indiana M. A. 25:205-206. May 1932.
Troutt; L.: Quality studies of therapeutic diets':
I. The ulcer diet; a conunittee report, J. Am.
Dietet. A. 8:25-32. May 1932. Summerfeldt. P.,
Tisdall, F. P., and Brown, A.: The curative
effects of cereals and biscuits on experimental
anaemias, Canad. M.A.J. 26:666-669, June 1932.
Sneed, W.: Ununited and delayed union of fractures. Kentucky M. J. 30:363-370. July 1932.
Silverman. A. C: Celiac disease. New York State
J. Med. 32:1055-1061. Sept. 15. 1932. von Mey-
senbug. L.: Infant feeding with especial reference
to some of its problems during the first year,
Texas State J. Med. 28:543-547. Dec 1932.
1933 Sampler. P. J.'.and Forbes. J. C.: C_-
cium and phosphorus metabolism in a
case of celiac disease. South. M. J 26:555-558.
June 1933. Brown, A., and Tisdall. P. P.: The
role of minerals and vitamins in growth and resistance to infection, Brit. M. J. 1:55-57. Jan. 14,
1933; Effect of vitamins and the inorganic elements on growth and resistance to disease in
children. Ann. Int. Med. 7:342-352. Sept. 1933.
Crimm. P. D.. Raphael, I. J., and Schnute, L. P.:
tare on infant development. Am. J. Dis. Child.
50:324-336, Aug. 1935. Coward, N. B.: Infant
feeding. Nova Scotia M. Bull. 14:525-532, Oct.
1935. Tisdall, P. F.: Inadequacy of present
dietary standards, Tr. Sect. Pediat.. A.M.A..
1935: Canad. M. A. J. 33:624-628. Dec. 1935.
Marriott. W. McK.: Infant Nutrition, second
edition. C. V. Mosby Co.. St. Louis. 1935. p. 202.
Summerfeldt. P.: Iron and its availability in
foods. Tr. Sect. Pediat., A. M. A. 1935, pp. 214*
220.
J_93_ Dafoe, A. R.: Further history of the
care and feeding of the Dionne quintuplets. Canad. M. A. J. 34:26-32. Jan. 1936.
Conn. L. C. Vant. J. R.. and Malone. M. M.:
Some aspects of maternal nutrition, Surg.,
Gynec. _ Obst. 62:377-383, Feb. 15. 1936.
Ross, J. R., and Summerfeldt. P.: Haemoglobin
of normal children and certain factors influencing
its formation, Canad. M. A. J. 34:155-158. Feb.
1936. Smyth, F. S.: Allergic diseases, J. Pediat.
8:500-515. April .1936. Lemmon. J. R.: Problems of the crying infant. Southwestern Med.
20-48-250. July 1936. Rice, C. V.: The success of treating celiac disease from a standpoint
of vitamin deficiency. Arch. Pediat. 53:626-629.
Sept. 1936. Smith. C H.: Management of nutritional anemia in infancy. M. Clin. North
America 20:933-950. Nov. 1936. Strong, R. A.,
editor: Nutritional anemia of infants, Orleans
Parish M. Soc Bull., pp. 6-9. Nov. 9, 1936.
Jeans, P. C: Specific factors in nutrition. Round
Table discussion. J. Pediat. 9.-693-698. Nov. 1936.
Young, J. G.: Meeting the requirements for
proper nutrition in infancy. Texas State J. Med.
32:531-533. Dec. 1936.
1937 Stearns, G., and Stinger, D.: Iron retention in infancy, J. Nutrition 13:127-
141. Feb. 1937. Strong. R. A.: Nutritional
anemia, Mississippi Doctor 15:13-16, Aug. 1937.
Smith, C. H.: Prevention and treatment of nutritional anemia in infancy. Preventive Med.
7:115-124, Aug. 1937. Saxl, N. T.: Pediatrics,
in Dietetics for the Clinician, edited by Id. A.
Bridges, third edition. Lea & Febiger, Philadelphia. 1937. pp. 637-639.      Boyd. J. D.: Nutrition
1940 McOougal, L. L., Jr.: Feeding a normal infant. Mississippi Doctor 17:437-
442, Jan. 1940. Monypenny. D.: The early
introduction of solid foods in the infant diet
Canad. M. A. J. 42:137-140. Feb. 1940. Robinson, E. C: A study of two hundred and forty
breast-fed and artificially fed infants in the St.
Louis area. Am. J. Dis. Child. 58:816-827. April
1940. Ratner, B.: Round Table discussion on
food allergy. J. Pediat. 16:653-672. May 1940.
Rosenbaum. I.. Jr.; The management of the allergic child, Kentucky M. J. 38:199-203. May
1940. Barondes. R. de R.: Report of a case of
pellagroid. M. Rec. 151:376-380. June 5. 1940.
Brown. A.: The fourth Blackader lecture on a
decade of paediatric progress, Canad. M. A. J.
43:305-313. Oct. 1940. Drueck. C. J., Vitamin
therapy in colon and rectal disease, Illinois M. J.
78:337-341, Oct. 1940. Swift, F. L.: Infant
feeding. Lackawanna Co. M. * Soc Reporter.
33:16-18, Nov. 1940. Bogert. L. J., and Porter.
M. T.: Dietetics Simplified, ed. 2, Macmillan Co-
New York. 1940, p. 181. Davison. W. C: The
Compleat Pediatrician, third edition, Duke University Press, Durham, N. C, 1940. No. 216.
Hawley, E. E.. and Maurer-Mast. E. E.: The
Fundamentals of Nutrition. C. C. Thomas,
Springfield. 111.. 1940. pp. 296. 456. Kugelmass.
I. N.: The Newer Nutrition in Pediatric Practice;
J. B. Lippinoott Co.. Philadelphia. 1940. p. 372.
Leaman. W. G-. Jr.: Management of the Cardiac
Patient, J. B. Lippinoott Co.. Phila., 1940. p. 549.
Paterson. D., in Index of Treatment, edited by
R. Hutchison, ed. 12, revised, Williams & Wilkins
Co.. Baltimore. 1940. p. 491. Thomas. G. I.:
Dietary of Health and Disease, ed. 3, revised.
Lea & Febiger. Phila.. 1940. p. 171.
IQ41 Gipson, A. C: The role of allergy in
pediatric practice, J. M. A. Alabama
10:272-274. Feb. 1941. Ross. J. R.. Monypenny, D.. and Jackson, S. H.: II. The effect
of cooking on the digestibility of cereals, J.
Pediat. 18:395-398. March 1941. Kennedy,
A. S., Snider. O., Hazen. J. S.. and McLean, C:
The dietary management of intestinal tuberculosis, Canad. M. A. J. 44:380-385. April 1941.
McAlpine, K. L.: Management of the nutritional
BACKGROUND
in 1930, and  Pablum  in 1932, by
SCIENTIFIC
Mead's  Cereal was  introduced
Mead Johnson & Company. Since then, the growing literature indi
bates early, recognition and continued acceptance of these products
jand the important pioneer principles they represent.^
Diet of tuberculous and non-tuberculous children:
Effect of increased supply of vitamin B concentrate and minerals. Am. J. Dis. Child. 46:751-
756. Oct. 1933. Smith. A. D.: Consideration
of various infants* foods. Pacific Coast J. Homeop.
44:463-465. Sept.-Dec. 1933,
1934 Somers, R_ Rotton. G. C, and Rown-
"^ tree, J. E: Possibilities of improving
dental structures, Soc Tr., Bull. King Co. M.
Soc 13:6. Jan. 15. 1934. Blatt. M. L.: Development of infants on a diet of a special cereal
mixture. Soc Tr.. Am. J. Dis. Child. 47:918.
April 1934. Rice, C. V.: Anemia of infancy
and early childhood. J. Oklahoma M. A. 27:125-
129. April 1934. Hawk. W. A.: A few of the
commoner fmlmg problems in infancy, Univ.
Toronto M. J. 11:218-229. May 1934. Ross.
J. R.. and Burrill. L. M.: The effect of cooking
OB the digestibility of cereals, J. Pediat. 4:654-
659. May 1934. - Rice. C V.: Sauerkraut juke
for the acidification of evaporated milk in infant
feeding. Arch. Pediat. 51:390-395. June 1934.
Eder, H. L.: Iron therapy: A routine procedure
during infancy. Arch. Pediat. 51:701-713, Nov.
1934. Lynch, H. D.: Fundamentals of infant
feeding. J. Indiana M. A. 27:571-574, Dec. 1934.
Chaney. M. S-. and Ahlborn, M.: Nutrition,
Houghton Mifflin Co.. Boston. 1934, p. 323.
1035 Bailey, C W.: Anemia in infants and
young ctiilrn—n. J. South Carolina M.
A. 31:54-58. March 1935. Kugelmass. I. N.:
The recent advances in treatment of nutritional
disturbances in infancy and childhood, M. Comment 17:5-13. March 1.1935. Ross. J. R.. and
Summerfeldt, P.: Value of'increased supply of
vitamin Bt and iron in the diet of children; Paper
II. Am. J. Dis. Child. 49:1185-1188. May 1935.
von Meysenbug, L.: Breast feeding with especial
reference to some of its problems. New Orleans
M. _ S.J. 87:738-743. May 1935. Tarr, E. M..
and McNeile, 0.: Relation of vitamin B deficiency to metabolic disturbances during pregnancy and lactation. Am. J. Obst. & Gynec.
29:811-818, June 1935. Blatt, M. L.. and
Schapiro, I. E.: Influence of a special cereal m_>
of the Infant and Child, National Medical Book
Co.. Inc. New York. 1937, p. 110. Brenne-
mann, J.: Practice of Pediatrics. W. F. Prior Co.«
Inc. Hagerstown. M&, 1937. Vol. 1. Ch. 25. p.
19. Griffith. J. P. C. and Mitchell. A. G.: The
Diseases of Infants and Children, second edition,
W. B. Saunders Co.. Philadelphia. 1937. pp. 106.
111. Saxl. N. T.: Pediatric Dietetics, Lea &.
Febiger. Philadelphia. 1937, pp. 131-133.
1938 Hoffuuw." S." J..' Greenhfil, J. P., and
Lundeen. E. O; A premature infant
weighing 735 grams and surviving, J.A.M.A. -
110:283-285. Jan. 22. 1938. . Krasnow, P.;
Nutritional influence on teeth. Am. J. Pub.
Health 28:325-333, March 1938. Ratner, B.:
Round Table discussion on asthma and hay
fever in children, J. Pediat. 12:399-413, March.
1938. Ratner, B.: Panel discussion on the role
of allergy in, pediatric practice, J. Pediat. 13:582-
604, Oct. 1938. Snelling. C E.: Nutritional
anaemia. Bull. Acad. Med. Toronto 12:710, Oct.
1938. Dauphinee, J. A.: The iron requirement
in normal nutrition. Canad. M.A.J. 39:483-486,
Nov. 1938. ; Summerfeldt, P., and Ross, J. R.:
Value of an increased supply of vitamin Bi and
iron in the diet of children. Paper III, Am. J.
Dis. Child. 56:985-988, Nov. 1938. Tisdall.
P. F., and Drake, T. G. H.: The utilization of
calcium. J. Nutrition 16:613-620. Dec 1938.
Drake, T. G. H.: Introduction of solid foods into
the diets of children. Canad. M. A. J. 39:578-580.
Dec 1938.
1939 Strong,  R.' A.:   The  most  frequent
causes of vomiting in infancy, Texas
State J. Med. 34:665-676, Feb. 1939.     Ratner. ■
B-. and Gruehl, H. L.: Anaphylactogenic proper,
ties  of  certain  cereal   foods  and  breadstuff's;
Am. J. Dis. Child. 57:739-758, April 1939.
Monypenny,   D.:   Early  introduction  of  solid
foods ui the infant diet. Soc Tr., Am. J. Dis.
Child. 58:1144-1145, Nov. 1939. Brown, A., and
Tisdall, P. P. Common Procedures in the prac- -
tice of paediatrics, third edition. McClelland &
Stewart, Ltd., Toronto, 1939. pp. 77-79.
anaemia of infancy. Canad. M. A. J. 44:386-390.
April 1941. Patek. A. J- Jr.. and Post. J.:
Treatment of cirrhosis of the liver by a nutritious diet and supplements rich in vitamin B
complex. J. Clin. Investigation 20:481-505, Sept.
1941. Bercovitz. Z., and Johnson. H. ].:
Ulcerative Colitis, in Dietetics for the Clinician,
by M. A. Bridges, fourth edition, revised. Lea _
Febiger, Phila.. 1941. p. 295. Bridges,.M. A.:
Dietetics for the Clinician, fourth edition, revised. Lea & Febiger, Phila.. 1941, pp. 727, 751.
809. Griffith, J. P. C. and Mitchell. A. G.:
Textbook of Pediatrics, ed. 3, revised, W. B.
Saunders Co.. Phila.. 1941. pp. 87. 91. Rowe.
A. H.: Elimination Diets and the Patient's
Allergies, Lea & Febiger. Phila.. 1941, p. 23a
Twiss. J. R: Gall-bladder Disease, in Dietetics
for the Clinician, by M. A. Bridges, fourth edition, revised. Lea & Febiger, Phila.. 1941, p. 401.
"IQ4, _ Gleich, M.t The premature infant,
■"■-^        Part II, Arch. Pediat. 59.99-135. Feb.
1942. Part IV, Arch. Pediat.59_41-263, April
1942. Brown, A., and' Robertson. E. C: Factors to be considered in the construction of the
diet of the older child, J. Kansas M. Soc. 43:237-
244, June 1942. Porter. L.. and Carter. W. E.:
Management of the Sick Infant and Child, ed.
6. C. V. Mosby Co., St. Louis. 1942. p. 125.
Proud fit, P. T.: Nutrition and Diet Therapy,
ed. 8, Macmillan Co., New York, 1942. p. 515.
Willard, J. H.: Digestive Diseases in General
Practice, P. A. Davis Co., Phila.. 1942. p. 147.
|Q_.1 Adair. P. L.. Dieckmann, W. J_
*-*^J Michel. H., Dunklc F.. Kramer. S..
and Lorang. E.: The effect of complementing the
diet in pregnancy with calcium, phosphorus, iron,
and vitamins A and B, Am. J. Obst. & Gynec
46:116-121, July 1943. Byrum, J. M.: The
premature infant,' with a case report, -Bull. Pottawatomie Co. M. Soc. 6:9-12, March 1943.
Davison, W. C: The Compleat Pediatrician, ed.
4. Duke University Press, Durham, N.C., 1943.
No. 216. 222. Zahorsky. J., and Zahorsky.
T. S.: Synopsis of Pediatrics, ed. 4, C. V. Mosby
Co., St. Louis. 1943, p. 60.
Ill In response to requests from paediatricians, we are |Slso marketing^PABEN^Ob^
precooked oatmeal, enriched with vitamin and mineral supplements/ PAB|N«
ilosely resembles Pablum in nutritional qualities, and offers the|same features
of thorough cooking*§conve|tience and economy!? Supplied in ^P^^^ISlJ0^!
Mead Johnson & ^mpany of Canada, Ltd., BellevilleJ Ont. ; I I
^£*
4t W*Ult'
WANTS
<fc ^^
Human sperm, in contact with hostile genital secretions, apparently
suffer carry immobilization—particularly if the seminal picture is characterized
by a low sperm count and feeble motility.*
In clinical tests, a pre-coital douche of Nutra-Ortho (a physiologic glucose douche powder)
S as been found to promote fertility in many stubborn cases free from detectable
deficiencies or pathogenies.   In temporarily relieving local incompatability, it also
supplies the nutrient glucose, metabolized by the sperm for motile energy.
The results obtained with Nutra-Ortho may obviate the necessity for more elaborate
diagnostic procedures.
Ortho Products of Canada, Limited, Toronto.
'tcfa-Utfw?
*MacLeod and Hotchkiss, Amer. J. Obst. & Gynec,
Sept. 1943
FOR USE In selected cases of infertility IF ARTHRITIS and ECZEMA
ARE ALLERGIC
ETIOLOGICALLY
effective treatment suggests the use of
agents to correct mineral deficiency,
increase cellular activity, and secure
adequate  elimination  ef  tonic  waste.
r orally given, supplies calcium, sulphur,
iodine, and rrstdln bl tartrate — an
effective solvent. Amelioration of
symptoms and general functional improvement  may be  expected.
LYXANTHINE ASTIER -<
Write for Information.
Canadian Distributors
ROUGIER FRERES
3S0  Le Moyne   Street,   Montreal
Colonic and
Physiotherapy Centre
Up-to-date Scientific Treatments
COLONIC IRRIGATIONS, SHORTWAVE
DIATHERMY, ' SINNEWAVE GALVIN-
1SM, IONIZATION, ULTRA VIOLET
RAY,  STEAM  BATHS AND SHOWERS
Medical and Swedish Massage
Physical Culture Exercises
STAFF OF GRADUATE NURSES
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
1119 Vancouver Block
MArine 3723      Vancouver, B.C.
Doubr|^Mft|ift
»ITS GENTLE
LAXATIVE ACTION IS
DIFFEREI^R- :fj|
^ j|r IS HIGH IN
PROTECTIVE FOOD
THE "bulk" laxative action of xbixogo _
all-bran is different from that of some
other "bulk" laxatives. And while all-bran is
indicated where constipation is due to insufficient dietary "bulk"—it dobs not greatlt
DISTEND    ITSELF   IN   THB    COLON.   All-Bran   pTO-
vides cellulosic elements which help the friendly
flora to fluff up and soften colonic wastes for
easy, natural c1itr"n«*if>fi, Reasonable excess
over an ordinary serving does not matter—the
extra cellulosic bulk remains inert*
The above is one good reason why doctors
recommend eating all-bran regularly, as
cereal and in muffins, and drinking plenty of
water—to correct diets lacking sufficient''bulk".
The second good reason is—kellogg's all-
bran is good food, often recommended in
"protective" diets. In fact, in "protective"
nutritive qualities, all-bran goes substantially
beyond whole wheat.
Made by Kellogg Co. of Canada Limited, London, Onl. IIIIIIIIIllllIIIIIIIlIIlMIIIIIIIttlllllllflllllllllllllltltllllllllllilllllllllllllllllllllllllllllllllllllllltlllllllllltllllllllllllllllllllllillllfllllllllllllll IlllMIIlIIItlllllllllllllllllllllllllllflllll
When the patient is allergic
 to milk	
aRRADI ATED Carnation Milk is usually well tolerated by
individuals who are sensitive to the proteins of raw,
pasteurized, or even boiled milk.
The heat treatment given Carnation Milk largely coagulates
the soluble proteins, throwing them into suspension along
with the casein and causing them to be retained in the
digestive tract sufficiently long to permit digestion by
proteolytic enzymes. This appreciably diminishes their
antigenic properties.
Also, the fine, flocculent curd of Irradiated Carnation Milk
aids digestion and helps the patient to derive full benefit
from all the nutritive factors of the milk.
The nation-wide distribution enjoyed by Irradiated Carnation Milk makes these desirable properties accessible
everywhere, in milk whose composition is uniform and
whose quality is high, regardless of where it is purchased.
CAKNATION  COMPANY, LIMITED, TORONTO, ONT.
IRRADIATED
Carnation
"FROM CONTENTED COWS*
la\natioA>
Milk
A Canadian Product We Carry Orim
For 36 years Georgia Pharmacy has built up
a   reputation  for  top co-operation  with  the
Medical profession. Even war restrictions hrt
materials and manpower have not greatly interfered with our ability to serve you well.
Phone
MArine 4161
jLdLL&Jhd**^
GEORGIA PHARMACY
Ol^nfei^anttallth
ESTABLISHED 189S
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C. *
4
New Westminster, B. C.
For the treatment of
NEUROPSYCHIATRIC
DISORDERS
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 721 Medical-Dental Building, Vancouver, B. C.
PAcific 7823
Westminster 288
27

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