History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1941 Vancouver Medical Association Sep 30, 1941

Item Metadata

Download

Media
vma-1.0214429.pdf
Metadata
JSON: vma-1.0214429.json
JSON-LD: vma-1.0214429-ld.json
RDF/XML (Pretty): vma-1.0214429-rdf.xml
RDF/JSON: vma-1.0214429-rdf.json
Turtle: vma-1.0214429-turtle.txt
N-Triples: vma-1.0214429-rdf-ntriples.txt
Original Record: vma-1.0214429-source.json
Full Text
vma-1.0214429-fulltext.txt
Citation
vma-1.0214429.ris

Full Text

 Ihe p U L L EJfTiV
of the
ll fVANCOUVER
MEDICAL ASSOCIATION
Vol. XVII
SEPTEMBER, 1941
No. 12—
htow
\
Si
With Which Is Incorporated
Transactions of the
Victoria Medical Society
the
Vancouver General Hospital
and
St. Paul's Hospital
mi
li-i
si!
In This Issue:
Page
NEWS AND NOTES JlL, H ^^^^^^^^^^^HI
B. C. MEDICAL ASSOCIATION ANNUAL MEETING:
PROGRAMME AND REPORTS- ^^^^tff^Bg^^^^^^^^%357
THE CLOSED TREATMENT OF COMPOUND FRACTURES Ji. WMM
THE STORY OF DOCTORS IN BRITAIN HARD HIT BY THE WAR-A 72
A REVIEW OF 145 CASES OF PSYCHONEUROSIS, •^j^^^^K-Jf 374
A CASE OF RAMSAY-HUNT S#lm£OME   S^Jigi^^MS^ --8 377
ANNUAL MEETING BRITISH COLUMBIA MEDICAL
ASSOCIATION
1941
SEPTEMBER 16, 17, 18.
n
wt
!«'*» 11 if
if
my.
fiii
#■
<"':■ ,;-v-
<i;
ii!:
cL;!
Urr
Mi
m
i|pn
ft.
14
: •■•;
i«
IK
«*
|"*=n
«<!
VITAMIN KfeXS
ii
i*i
m
The Anti-Haemorrhagic Vitamin
Vitamin K has been found* to be an essential link in the process of blood clotting
and, when the clotting time is abnormally long, the administration of Vitamin
K may prevent fatal haemorrhage.
Vitamin K E.B.S. is supplied for oral or parenteral (intramuscular) administration in the high potency forms described below.
Nee-natal haemorrhage:
Newborn infants pass
through a period of dangerously low prothrombin concentration shortly after
birth. Many fatal haemorrhages occur for this reason.
Administration of Vitamin
K, both to the mother for
a period before delivery, and
to the infant after birth, is
of the greatest value.
INDICATIONS:
Jaundice i
The danger because of
lengthened clotting time can
be much reduced by administering Vitamin K and Bile
Salts for several days before
operation. Bile Salts are necessary for the absorption of
Vitamin K and should be
simultaneously administered,
where biliary insufficiency
may exist.
* Descriptive literature on request.
Supportive treatment t
The very numerous applications include biliary f istulae,
catarrhal jaundice, moderate
liver injury, obstruction due
to carcinoma of the bile
duct, of the head of the
pancreas or of the liver.
2 Methyl 1:4 Naphthoquinone)
2 Methyl 1:4 Naphthoquinone)
S.C.T. No. 746 Vitamin K—25,000 Dam Units (1 mg.
C.C.T. No. 749 Vitamin K—25.000 Dam Units (1 mg,
and Bile Salts 5 grains
No. A-130 STERILE SOLUTION—30 cc Vitamin K in Sesame Oil (25,000 Dam Units)
(1 mg. 2 Methyl 1*4 Naphthoquinone) per ml.
Intramuscular
THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING   CHEMISTS
CANADA
SPECIFY        f. B. S.       ON       YOUR
PRESCRIPTIONS
Nii THE    VANCOUVER    MEDICAL    ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical- Dental Building, Georgia Street, Vancouver, B. C.
EDITORIAL BOARD:
Dr. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XVII.
SEPTEMBER, 1941
No. 12
OFFICERS, 1940-1941
Dr. W. M. Paton Dr. C. McDiarmid Dr. D. F. Busteed
President Vice-President Past President
Dr. W. T. Lockhart Dr. R. A. Palmer
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Dr. Gordon Burke, Dr. Frank Turnbull
TRUSTEES
Dr. F. Brodie Dr. J. A. Gillespie Dr. G. H. Clement
Auditors: Messrs. Plommer, Whiting & Co.
SECTIONS
Clinical Section
Dr. Karl Haig Chairman Dr. Ross Davidson Secretary
Eye, Ear, Nose and Throat
Dr. J. A. McLean Chairman Dr. A. R. Anthony Secretary
Pediatric Section
Dr. R. P. Kinsman Chairman Dr. G. O. Matthews Secretary
STANDING COMMITTEES
Library:
Dr. F. J. Buller, Dr. D. E. H. Cleveland. Dr. J. R. Davies,
Dr. A. Bagnall, Dr. A. B. Manson, Dr. B. J. Harrison
Publications:
Dr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. G. A. Davidson.
Summer School:
Dr. H. H. Caple, Dr. W. W. Simpson, Dr. Karl Haig, Dr. J. E. Harrison,
Dr. H. H. Hatfield, Dr. Howard Spohn.
Credentials:
Dr. A. W. Hunter, Dr. W. L. Pedlow, Dr. A. T. Henry   .
V. O. N. Advisory Board:
Dr. W. C. Walsh, Dr. R. E. McKechnie II., Dr. L. W. McNutt.
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont.
Greater Vancouver Health League Representatives:
Dr. R. A. Wilson, Dr. Wallace Coburn.
Representative to B. C. Medical Association: Dr. D. F. Busteed.
Sickness and Benevolent Fund: The President—The Trustees. «s
lis-- 4* i
"■.#!
: ■" ■',
fS
f?
:M
;1 H;
ft
III
* »
piJ
•'I
i:
.!»-
I:
ID
A
IN PREGNANCY
ifef
SUGGESTED
FOR TREATMENT OF THREATENED
OR HABITUAL ABORTION DUE TO
VITAMIN E DEFICIENCY
j^H
FOR INCREASED
CALCIUM REQUIREMENTS
0 Each capsule contains 50 milligrams of mixed tocopherols,
equivalent in vitamin E activity
to 30 milligrams of a-tocopherol.
Tocopherex contains vitamin E
derived from vegetable oils by
molecular distillation, in a form
more concentrated, more stable
and more economical than wheat
germ oil.
For experimental use in prevention of habitual abortion (when
due to Vitamin E Deficiency): 1 to
3 capsules daily for 8% months.
In threatened abortion: 5 capsules
within 24 hours, possibly continued
for 1 or 2 weeks and 1 to 3 capsules
daily thereafter.
Tocopherex capsules are supplied
in bottles of 25 and 100.
0 Each capsule of Viophate—D
contains 4.5 grains Dicalcium
Phosphate, 3 grains Calcium Gluconate and 330 units of Vitamin
D. The capsules are tasteless, and
contain no sugar or flavouring.
Where wafers are preferred, Vio-
phate—D  Tablets  are  available,
pleasantly flavoured with winter-
green.
One tablet is equivalent to two
capsules.
How supplied:
Capsules—Bottles of 100 and
1,000.
Tablets —Boxes of 51 and 250.
For literature, write 36 Caledonia Road, Toronto
I 1 .
E-R:Sqsjibb&.Sons of Canada. Ltd.
MANUFACTURING   CHEMISTS  TO   THE   MEDICAL   PROFESSION   SINCE   1858
I I
>.&'
i, ** VANCOUVER  HEALTH  DEPARTMENT
STATISTICS—JULY, 1941
Total population—estimated _	
Japanese population—estimated _
Chinese population—estimated _
Hindu population—estimated  	
Total deaths	
Japanese deaths h	
Chinese deaths	
Deaths—residents only
Number
.    277
6
15
.    241
BIRTH REGISTRATIONS:
Male, 253; Female, 269.
INFANTILE MORTALITY:
Deaths under one year of age	
Death rate—per 1,000 births	
Stillbirths  (not included in above).
July, 1941
._     10
L     19.2
_     11
  272,352
 :  8,769
  8,558
  360
Rate per 1,000
Poptdation
12.0
8.1
20.6
10.4
22.6
July, 1940
12
25.6
5
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
June, 1941
Cases   Deaths
July, 1941
Cases   Deaths
Aug. 1-15,1941
Cases   Deaths
Scarlet Fever
Diphtheria 	
Chicken Pox -
  i
  0
  78
Measles  24
Rubella  41
Mumps  2
Whooping Cough  5
Typhoid Fever  0
Typhoid Fever Carrier  0
Undulant Fever  0
Poliomyelitis  0
Tuberculosis !— 32
Erysipelas  1
Meningococcus Meningitis   3
Paratyphoid Fever  0
♦(Outside)
0
0
0
0
0
0
0
0
0
0
0
9
0
1
0
6
0
15
3
4
0
1
1
1
0
0
37
3
7
0
0
0
0
0
0
0
0
0
0
0
0
11
0
0
0
6
0
1
4
1
0
0
1*
0
0
0
16
0
0
0
Syphilis	
Gonorrhoea
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,
DIVISION OF VENEREAL DISEASE CONTROL
Hospitals &
Private Drs.
2f
West
North
Vane.
mab;
Y  Vancr.
Richmond
Vancr.
Clinic
0
o
1
0
21
0
0
0
1
48
so
22
A DYNAMIC MENTAL AND PHYSICAL TONIC
INDICATED IN THESE DAYS OF STRESS
BIOGLAN "A
99
Another Product of the Bioglan Laboratories, Hertford, England
Phone MA. 4027
Stanley N. Bayne, Representative
1432 MEDICAL-DENTAL BUILDING
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Vancouver, B. C
Page 351 1
1
w
*•**
Mi *'•!
;»!
.-<
; ■''■ ■ '
u»- ;
4
%
a
It doesn't hurt now!
In abrasions and other soft tissue
injuries, Antiphlogistine may be
applied warm or at room temperature. There is no sting or pain on
application. It may be used on the
most sensitive parts.
//
ANALGESIC   (   BACTERIOSTATIC   •   DECONGESTIVE   •   DETERGENT
is kind to injured tissue
THE DENVER CHEMICAL MFG. CO., 153 Lagauchetiere St. W., Montreal
HI' VANCOUVER MEDICAL ASSOCIATION
Founded 1898 . . . Incorporated 1906
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
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.
PROGRAMME OF THE FORTY-FOURTH ANNUAL SESSION
1941
October   7    GENERAL MEETING—
Dr. W. D. Keith: "Safety in the Operation for Toxic Thyroid."
October 21    CLINICAL MEETING.
and, as adjuvant to treatment:
"A GUINNESS A DAY"
(famous British health rule)
Physicians recently reported seventeen conditions
for which they use GUINNESS STOUT. They
emphasized, of coarse, its famous tonic properties
and its usefulness in inducing sound, natural
sleep without the depressing after effects of most
hypnotics.
AN ANALYSIS OF GUINNESS STOUT 100 cc.
Total solids \ 5.87 gm.
Etbyl alcohol   (7.9%  by volume) 6.25  gm.
Total carbohydrates 3.86 gm.
Reducing  sugars  as   glucose 0.66 gm.
Protein Noise
Total  nitrogen 0.10  gm.
Ash 0.28  gm.
Phosphorus 38.50 mg.
■Calcium    i 7.00 mg.
Iron .. 0.072 mg.
Copper - 0.049 mg.
fuel value 61  cal.
Vitamin Bi 6 Int. Units
Vitamin  G 33   Sherman Bourquin Units
A. GUINNESS, SON & CO., LIMITED
DUBLIN and LONDON
For older people, Guinness is a stimulating and
appetizing food. The energy expense of digesting
Guinness is low.
Guinness is brewed from only four ingredients:
barley malt, hops, yeast and 'water. It is matured
over a year in oak vats and bottle. Unlike other
stouts    and    porters,    Guinness    is    unftltered    and
unpasteurized, and thus
contains all its natural
goodness, including active yeast, a source of
vitamins B and G and
valuable minerals.
Guinness has been
brewed in Dublin since
1759 and is the largest
selling malt beverage
in the world. Foreign
Extra Guinness is obtainable through all
legal outlets. Write for
convenient 3" x 5" file
card giving complete
analysis and indications
to Representative, A.
Guinness, Son & Co.,
Limited, 501 Fifth Avenue,  N.Y.C. 13
Vh
<1
w
Bfj
fW
*.*
tf
III
fc
%
III
Silit
*
Iffil
Hit
iffci
$i;
1
«K
3ft
I-
.:•
11
;.■
ih
ana.ata.12efA.~y
DIGITALIS FOLIUM
not catena/ management of;
'liea&e
/
/
/
/
/
m
m.
Ym
m
/
/
/
/
Supplied in five strengths:
No. 311—equivalent  to    5   minims  Tincture  Digitalis
Folium C.F.
No. 312—equivalent  to   10   minims  Tincture  Digitalis
Folium C.F.
No. 313—equivalent  to  15   minims   Tincture  Digitalis
Folium C.F.
No. 314—equivalent  to  20  minims  Tincture  Digitalis
Folium C.F.
No. 315—equivalent  to 30  minims Tincture  Digitalis
Folium C.F.
Xiccutate
Stalrle
Readily -@(r5ot(ted
Economical
Convenient
Ia5tele56
The contents of capsule No. 311 show the physiological potency of J^ grain (0.032
Gm.) of Powdered Digitalis, B.P. 1932, equivalent to 0.32 International Units of
activity when tested on frogs by the method employed by the Laboratory of
Hygiene of the Department of Pensions and National Health, Ottawa. Proportionate relationship exists with other strengths. Supplied in bottles of 100, 500
and 1000 dry powder capsules.
AYERST, McKENNA & HARRISON LIMITED, Biological and Pharmaceutical Chemists, MONTREAL, CANADA
936
HELP WIN THE WAR —BUY WAR SAVINGS CERTIFICATES — PRESCRIBE CANADIAN-MADE PRODUCTS THE   EDITOR'S   PAGE
In this issue of the Bulletin we are publishing a letter received from Dr. G. C.
Anderson of the British Medical Association, with notes of cases of doctors and their
families who have been victims of air raids in Great Britain.
Some time ago, the Bulletin set up a Fund for the relief of such cases. The Fund
has been registered at Ottawa, and we are authorized to receive subscriptions. The
response has been fair in Vancouver, and we have received subscriptions from other parts
of British Columbia, but we feel that the profession at large has not realised the terrible
need for help, and so has not grasped the opportunity as a whole. Every man who has
been talked to individually has gladly and willingly contributed: we are sure that if we
could speak to everybody personally the response would be equally prompt. Steps are
being taken to cover the whole province with this appeal. No set amount is asked for:
there is no upper or lower limit—anything you may feel able to give will be most gladly
received and acknowledged, and will meet a need that is immediate and most urgent.
This is a registered benevolent fund, and it would seem that all moneys contributed could
be treated, for income-tax purposes, as are other contributions to charitable purposes.
In any case, we ask you to do your utmost.
'«
•'-I »
The Annual Meeting of the B. C. Medical Association is all in order now—and we
may look forward to a very profitable three days. The programme of lectures is good—
luncheons, dinners, golf games are arranged for. We hope we shall have a flock of
visitors, and that they will all enjoy every minute of their stay. The Exhibition is over
now—and so we should be able to provide good weather: and that means a lot.
We print an extract from a letter by Dr. McRitchie, who left Fernie, where he was
practising at the beginning of the war, to join one branch, the naval branch of His
Majesty's Armed Forces. This letter tells of high adventure and very "perilous 'scapes":
and it takes very little imagination to see between the casual, almost nonchalant, statements of fact, a very grim and terrible reality. Being an M.O. in this war is no joke.
Our enemy, one cannot help but feel, gets more real pleasure out of bombing ambulances and wounded men than out of any other military activity. Like women and
children, ambulance drivers and doctors cannot hit back, and for the Nazis, as for Vit-
torio Mussolini, bombing helpless Ethiopians, this constitutes a perfectly lovely war.
We rejoice that Dr. McRitchie came through so well, and offer him laurels for his gallant, selfless conduct, worthy of the highest traditions of his profession and of his race.
:B3
I*
l»
SPLINTERS FROM A MEDICAL OFFICER'S LOG
[The extract below is taken from a letter written by Dr. Murdo McRitchie, formerly
of Fernie, B.C. No further comment is necessary: the letter is one that everyone will
read with pleasure and pride.—Ed.]
Dr. McRitchie was at Crete during the recent action there and his letter describes
his experiences during that battle. The letter was written on Jun 15 th, sent by Clipper
plane, and reached Fernie on July 21st.
Describing the Crete action Dr. McRitchie wrote:
"And now for Crete that you have been reading about, and the evacuation. But let
me assure you that I am very well. I got to Crete on May 9 and we were attacked
by bombers and aerial torpedoes on the way but we landed at Suda intact.
Page 353
iti'i
trfi
■\&
ii * ■ m
\    :
t«i*'
'k:
1'ii
< ••>
sfrsii
,h[
H
m
n
s" I*
"Up to the time of the invasion, bombing was rather heavy, but we had a good antiaircraft barrage. The invasion began with plane, gliders and parachutists filling the
sky, and many landed within a quarter of a mile of us, where heavy fighting continued
for the next week on both sides of us.
"Wounded men began coming in at once and we were operating continually till we
had to leave. I got practically no sleep those ten days and rations were scarce as we had
450 patients even though we had only a staff to handle 50. It was a great strain operating in a tent with so much bombing and machine-gunning by the planes overhead.
Sometimes we had to take the patient off the table on to the floor in the midst of an
operation when the bomb blasts nearly shook the tent down.
"Our patients were a mixture of all nationalities. The Greeks and Maoris were wonderful fighters, the Greek civilians as well as Aussies, N. Z.'s and British. We had quite
a number of naval casualties previous to the invasion.
"I can't praise the men too highly as it must have been awful lying there helpless in
a tent with so much enemy action going on. But I never heard them grumble in spite
of all their hardships. Those less seriously wounded were under the olive trees and others
in a monastery close by.
"We were located between Suda and Canea and when our troops withdrew it seemed
impossible that we could move all the patients in one night. I was quite resigned to
being a prisoner and that wasn't a very pleasant feeling, but all the doctors volunteered
to stay.
"The men drew lots as to who would remain and I gave your address to some who
left with the first batch of patients so that you'd know what happened. By 4:30 a.m.
there was no sign of a returning ambulance so we decided to carry the eight remaining
stretcher cases. Our Greek interpreter and myself carried a heavy Maori for 2l/z miles
before we met the ambulance.
"Since we arrived here we were told that the Germans were surrounding us that
night and that we had come through their lines.   However, they did not molest us.
"We remained at an army hospital the next day. In the evening we started with
our patients, making for the south coast of the island. By morning we still had some
distance to go and at noon our ambulances were spotted by bombers. But we had seen
them first and had time to get the patients under some large rocks. They bombed and
machine gunned us, putting the ambulances on fire.  They kept this up till dark.
"That night we got to the coast and were taken off by destroyers, and was I ever
proud of the navy. Ours had an Australian crew and they gave us hot soup, cocoa,
sandwiches and cigarettes.   Did it ever taste good after bully beef, beans and dry biscuits.
"It was miraculous that we didn't lose a single individual and we can only thank
God for that.   There was more than chance or luck to it."
m
'm
NEWS    AND    NOTES
Dr. and Mrs. J. H. Black of Wells are receiving congratulations on the birth of
a son, on August 25th.
r *
;
I
Dr. and Mrs. C. E. Cook of Michel have been visiting in Vancouver.
Lieut. W. H. Fahrni, R.C.A.M.C, was married on August 3rd to Miss Isobel MacKay
of Steveston.
The best wishes of the profession are passed to Dr. and Mrs. Bede J. Harrison, who
were married in Washington, Penn., in July.
Page 354 I;
Dr. and Mrs. A. P. Miller of Port Alberni are at present on vacation in the Interior.
Dr. and Mrs. C. C. Browne of Nanaimo have been on the Alaska trip.
Dr. A. C. Nash of West Vancouver has been vacationing at Sechelt.
* *       *       *
Dr. Gerald Baker of Quesnel made the headlines when he shot a black bear which
had been molesting the sheep in that neighbourhood.
Dr. H. B. McGregor of Penticton has joined the R.C.A.F. Medical Services.
•r »P *i* *•
Dr. R. B. White of Penticton frequently wanders back to his old haunts and has been
spending a few days at Camp McKinney.
Dr. A. J. Wright of Vernon visits both Penticton and Kelowna at regular intervals
for X-ray and urological consultations.
* *       *       *
Squadron Leader W. N. Kemp is now located in Edmonotn.
Dr. A. G. Macdonald, recently at Cumberland with Drs. MacNaughton and Hicks,
is now at Copper Mountain with Drs. Paul Phillips and J. W. Vosburgh.
CANADIAN RED CROSS SOCIETY
Young women who offer themselves for voluntary service with the C.R.C.C.
—CANADIAN RED CROSS CORPS—are being referred to their own doctor
for physical examination and completion of the Medical Certificate. The form
adopted is similar to that used for War Services and provides for categorization.
Dr. H. V. Gale, formerly of Copper Mountain, is now associated with Dr. W. G.
Gunn in Vancouver. *       *       *       *
Dr. B. T. H. Marteinsson of Port Alberni is spending a vacation at Salt Spring Island.
Dr. W. McK. McCallum of Salmo has joined the Army Medical Corps.
Dr. Kingsley Terry, formerly of the Provincial Board of Health, Tuberculosis
Devision, is serving with the R.C.A.M.C.
Dr. C. M. Robertson is now associated with Dr. F. M. Auld of Nelson. Dr. Robertson was until recently at Mayo, Y.T.
Dr. R. Geddes Large of Prince Rupert has been on a trip in his new yacht, Soowillis.
Dr. M. E. Krause of Trail is in Montreal doing post-graduate work in surgery.
*e -<* •£■ »r
Dr. F. L. Wilson of Trail has been fishing at the coast.
Dr. H. R. Christie, formerly of Rossland, now with the R.C.A.F., is in Toronto.
Drs. G. F. Amyot and F. M. Bryant of Victoria came to Vancouver for the August
meeting of the Board of Directors of the British Columbia Medical Association.
Drs. H. L. Burris of Kamloops, H. McGregor of Penticton, E. D. Emery of Nanaimo,
C. T. Hilton of Port Alberni, W. A. Clarke and G. T. Wilson of New Westminster,
attended the meeting of the Board of Directors.
Page 355
•   j     h
•ii\.
'im
iM
"•li!
m
1 I' 1% ,'.■
rtPr
MSiv
TM i?
Mi
;|
n< r
1
I
u
m
1
»4:
It:
M"V
H
1'ti i'i*
i
LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY
Medical Clinics of North America—Symposium on X-ray and Radium in Diagnosis and
Treatment, Mayo Clinic, July 1941 Number.
New and Non-official Remedies, 1941.
Renewal pages for The Oxford Loose Leaf Medicine and Nelson's Loose Leaf Medicine.
The former include such interesting articles as—
"Viruses as Agents of Human Disease," by F. M. Burnet, M.D., Ph.D., Asst. Director, Walter and Elizabeth Hall Institute of Research in Pathology and Medicine,
Royal Melbourne Hospital, Melbourne, Australia.
"Diseases of the Biliary System," by Dr. T. Grier Miller and Dr. Thomas E. Machella.
fessor of  Clinical Medicine  and  Dean of  the  Faculty of  Medicine,  Harvard
University.
"Acute Lobar Pneumonia" (Revised article), by Ernest E. Irons, M.D., Ph.D., Clinical Professor of Medicine and Dean, Rush Medical College.
Included in Nelson's Medicine are the following:
"Infection and Immunity" and "Vaccine and Serum Therapy," revised chapters by
Dr. Augustus B. Wadsworth, head of the Division of Laboratories of the New
York Department of Health.
"Polycythemia," by Dr. Paul Reznikoff.
"Diseases of the Biliary System," by Dr. T. Grier Miller a»d Dr. Thmas E. Machella.
"The Sex Hormones," by Dr. P. E. Smith and Dr. E. T. Engle.
■Mm
! I
y<
Mi i
' N-
i 1
tifl.
:»'
BOOK REVIEW
OUTLINE OF SYPHILOLOGY, by Frank E. Cormia, M.D.
Dr. Cormia, of the Department of Dermatology and Syphilology of McGill University and the Royal Victoria Hospital, Montreal, designed his book as a synopsis of the
subject for undergraduate students. In preparing it, the author, who is well known for
his researches in syphilology, especially in connection with the toxic reactions arising
from the employment of some of the arsphenamin group of drugs, wrought better than
he knew. He is to be mildly censored for the excessively modest view he took of his
work. As it was intended only for limited distribution to students at a low cost, it has
so far appeared only in multigraph form, bound in light cardboard.
It is, however, a book of great merit and value to all who wish to be informed on
the subject for practical purposes. It is to be hoped that the book will later appear in
regular format, but in the meantime the library is fortunate in having secured a copy.
In the compass of 149 pages the author has succeeded in compressing an enormous
amount of valuable and up-to-date information. He has done this by thorough sys-
tematization under 22 subject headings which are named at the beginning of the book,
and which make it possible to look up any detail quickly, although an index which will
appear in later editions will make this still easier. While rigid compression has been
observed, it has not been carried to the point where logical sequence has been lost sight
of, as is the common fault of most synopses. The book, in other words, is convenient
to use as a reference book, but is also easy to read through and the time spent is well
worth while. From the biased viewpoint of a syphilologist aware of the chaotic state of
mind of the average practitioner, and the frequent occurrence of a state of abysmal
ignorance of bare essentials where syphilis is concerned, it might be considered that no
one is fit to deal with syphilis at all who has not a grasp of the contents of this volume.
Be that as it may, it can be stated unequivocally that anyone who is familiar with the
principles and information set forth in it may claim to be well equipped, even well
versed, to deal with syphilis. It is commended to the thorough and repeated perusal of
our members.
D. E. H. C
Page 356
ft. 1
British   Columbia  Medical   Association
(CANADIAN MEDICAL ASSOCIATION, BRITISH COLUMBIA DIVISION)
President Dr.  Murray  Blair,  Vancouver
First Vice-President Dr. C. H. Hankinson, Prince Rupert
Second Vice-President Dr. A. H. Spohn, Vancouver
Honorary Secretary-Treasurer Dr. Walter M. Paton, Vancouver
Immediate Past President^ Dr. F. M. Auld, Nelson
Executive Secretary Dr. M. W. Thomas, Vancouver
1941 ANNUAL MEETING    -:-    VANCOUVER
HOTEL VANCOUVER
September 16,17,18
THREE DAYS—FULL OF FINE FEATURES
SCIENTIFIC SPEAKERS
DR. THOMAS ADDIS,  San Francisco,  Professor of Medicine,  Stanford University
School of Medicine.
DR. LENNOX G. BELL, Winnipeg, Associate Professor of Medicine, University of
Manitoba.
DR. GORDON S. FAHRNI, Winnipeg, Assistant Professor of Surgery, University of
Manitoba.
DR. LOUIS P. GAMBEE, Portland, Associate Clinical Professor of Surgery, University
of Oregon Medical School.
DR. C. K. P.- HENRY, Montreal, Associate Professor of Surgery, McGill University.
DR. F. G. McGULNNESS, "Winnipeg, Professor of Obstetrics, University of Manitoba.
"I!
\A     J"-:'
m
REPRESENTING CANADIAN MEDICAL ASSOCIATION
DR. GORDON S. FAHRNI, Winnipeg, President.
DR. T. C. ROUTLEY, Toronto, General Secretary.
1941   ANNUAL  MEETING
TUESDAY, SEPTEMBER 16th
8:00 a.m.      Registration.
9:00 a.m.      \.   Dr. Louis P. Gambee—The Management of the Distended Abdomen.
2. Dr. Thomas Addis—Nephritis—Practical Methods for Diagnosis and
Treatment.
3. Dr.  F.  G. McGuinness—Maternal Deaths  occurring  in  the  2-year
Pregnancy Survey in Manitoba.
4. Dr. Lennox G. Bell—Some Common Drug Intoxication.
Page 357
Jk
»-?'tJ *;
wm
\U
12:30 p.m.      Official Luncheon—His Worship the Mayor, the President of the Vancouver Medical Association, Dr. Gordon S. Fahrni,
and Dr. T. C. Routley.
2:30 p.m.      Clinic—St. Paul's Hospital.
8:00 p.m.      Session on Medical Economics.
Speakers: Dr. T. C. Routley; Dr. S. C. MacEwen, Medical Director
of the Medical Services Association; Dr. Wallace Wilson,
Chairman of the Committee on Medical Economics, Canadian Medical Association.
(As this subject is always of considerable interest, any members having
questions are requested to submit them to the Secretary prior to September 6th.)
:HF
v
*?
WEDNESDAY, SEPTEMBER 17th
8:30 a.m.      1.   Dr. F. G. McGuinness—Obstetrical Causes of Prematurity.
2. Dr. G. S. Fahrni—Parathyroid Tumours and Hyperparathyroidism.
3. Dr.  Thomas  Addis—Nephritis—The  Theory  of  the  Treatment of
Bright's Disease.
4. Dr. Lennox G. Bell—The Diagnosis and Treatment of Purpura.
5. Dr.  Louis  P.   Gambee—The  Diagnosis  and  Management of  Acute
Intestinal Obstruction.
12:30 p.m.      Social Luncheon.
2:30 p.m.      Clinic and Demonstration—Vancouver General Hospital.
8:00 p.m.      Annual Meeting—College of Physicians & Surgeons of B .C.
8:30 p.m.      Annual Meeting—British Columbia Medical Association.
Report of Divisional Advisory Committee.
Present: Surgeon-Commander A. G. LaRoche, Naval
Services.
Lieutenant-Colonel   G.   C.   Kenning,   Army
-:.*':.  ■ ^ Services.
Wing-Commander E. E. Day, Air Force Services.
,*.
, ii:*;
8:30 a.m.
THURSDAY, SEPTEMBER 18 th
1. Dr. Lennox G. Bell—Some Problems in the Diagnosis of Anaemias.
2. Dr. F. G. McGuinness—Toxaemias of Pregnancy.
3. Dr. Louis P. Gambee—Common Hand Infections.
4. Dr. Thomas Addis—Nephritis—The Results of Treatment.
5. Dr. C. K. P. Henry—Cancer of the Gastro-intestinal Tract.
Luncheon—Board of Directors, British Columbia Medical Association.
Golf—Jericho Golf and Country Club.
Annual Dinner—Speaker.
Distribution of prizes.
MEDICAL ECONOMICS
A session on Medical Economics will be held on Tuesday evening. The Committee in
charge have at this date to report that the discussion will be led by Drs. T. C. Routley,
S. Cameron MacEwen and Wallace Wilson. Owing to the growing interest on the part
of the profession it has been arranged that questions be invited from the Members. These
should be sent in to Dr. M. W. Thomas, 203 Medical-Dental Building, prior to the
meeting (before September 6th).
Page 358
12:00 noon.
1:30 p.m.
7:00 p.m. WAR MEDICAL SERVICES
Surgeon-Commander A. G. LaRoche, Senior Medical Officer, Naval Service, at
Esquimalt; Lieutenant-Colonel G. C. Kenning, District Medical Officer, M. D. No. 11,
and Wing-Commander E. E. Day, Chief Medical Officer, Western Air Command, have
been invited to attend the Annual Meeting of the British Columbia Association on
Wednesday evening.
Because of the great interest in the War Medical Services it has been arranged that
questions will be submitted prior to the meeting. Please send your questions to Dr. M.
W. Thomas, 203 Medical-Dental Building, before September 6th.
ANNUAL DINNER
The Annual Dinner will be held in the Banquet Room in the Hotel Vancouver on
Thursday evening, September 18 th.  This promises to be an outstandingly fine Dinner.
A good speaker and music will be arranged for, and golf prizes will be distributed.
GOLF
The British Columbia Medical Association Trophy
(presented by the Mead-Johnson Company) will be
up for competition. The past holders are: 1937, Dr.
D. Fraser Murray; 1938, Dr. G. R. F. Elliot; 1939,
Dr. Neil M. McNeU; 1940, Dr. H. H. MacKenzie,
Nelson.
Dr. D. Fraser Murray is Chairman of the Subcommittee on Golf and has already made provision
for play at the Jericho Golf and Country Club
Course. Dr. Murray anticipates a very heavy registration and has provided prizes for everyone (almost). Please return the golf card indicating your
desire to play.
LADLES' PROGRAMME
TUESDAY, SEPTEMBER 16th
All Ladies are requested to register, signifying intention of participating in the various features of entertainment.
4:00 p.m.—Wives of members of the Board of Directors, wives of out-of-town members and members of committee to be guests at Tea at the home of Mrs.
Murray Blair, 1215 West 32nd Ave. Transportation for out-of-town
guests will be provided.
WEDNESDAY, SEPTEMBER 17th
2:00 p.m.—Drive to West Shore and British Properties for visiting ladies.
4:00 p.m.—Tea—Shaughnessy Golf Club. All ladies are asked to register and receive
invitations to attend this Tea as guests of the British Columbia Medical
Association.  Ladies who take in the Drive will arrive in time for the Tea.
THURSDAY, SEPTEMBER 18th
7:30 p.m.—Ladies' Dinner to be held in the Social Suite.  Tickets: $1.50.
The Ladies' Dinner has grown in popularity and is largely attended. The
above programme will give the wives an opportunity to meet and know one
another.
Page 359 it
«*
■ *   ■-
».jj
i
14
.,
II
l«.
tt
j."
it
First Day
TUESDAY
SPECIAL FEATURES
CLINICAL
Vancouver General Hospital Auditorium—Chemistry Building
September 16th, 2:30 p.m.
Short (10-minute) Demonstrations of Practical Clinical Procedures.
2:30 to 4:00 p.m.
1. Intra-Peritoneal use of Sulphonamides.
Dr. J. Ross Davidson—Dept. of Surgery, Vancouver General Hospital.
2. X-ray Treatment of Carcinoma of Skin and Lip.
Dr. Bede J. Harrison—Dept. of Radiology, Vancouver General Hospital.
3. The Use of the New Miniature X-ray Film.
Dr. W. H. Hatfield—Provincial Board of Health, Division of Tuberculosis
Control.
4. Demonstration of New Orthopaedic Procedures.
Dr. J. R. Naden, Dept. of Orthopaedic Surgery, Vancouver General Hospital.
5. Demonstration of Newer Laboratory Tests.
Dr. H. H. Pitts and Staff—Dept. of Pathology, Vancouver General Hospital.
6. Clinical Demonstrations.
D r. Ethlyn Trapp— British Columbia Cancer Institute.
7. Practical Neurological Procedures.
(a) Use of Tidal Drainage in Cord Bladder.
(b) Treatment of Bed Sores in Spinal Cord Lesions.
Dr. F. A. Turnbull, Dept. of Neurology, Vancouver General Hospital.
8. The Diagnosis of Primary Syphilis in the Male—a Demonstration.
(a) Clinical Features.
(b) Methods of Collection of Material for Dark-field Examination.
(c) Management of case until diagnosis confirmed.
Dr. D. H. Williams, Provincial Board of Health, Division of Venereal
Disease Control.
4:00 to 5:00 p.m.—DEMONSTRATIONS AND EXHIBITS.
1. Department of Radiology, Main Building, Vancouver General Hospital.
2. Department of Pathology, Cor. 12th and Willow St.
3. Division of Tuberculosis, Willow St.
4. Division of Venereal Disease Control, Laurel St.
5. British Columbia Cancer Institute, 11th Ave. W.
Transportation will be arranged.
WEDNESDAY        Nurses' Auditorium, St. Paul's Hospital.
Second Day 2:30 p.m.
2:30 to 4:00 p.m.—"ROUND TABLE" INFORMAL DISCUSSION.
Topic: "PEPTIC ULCER."
Dr. Thomas Addis
Dr. Lennox G. Bell
Dr. Gordon S. Fahrni
Dr. Louis P. Gambee
Dr. C. K. P. Henry
Please note: You will receive a questionnaire card.  Please send in your questions. All
questions will be submitted to this unusual conference.
4:00 to 5:00 p.m.—DEMONSTRATIONS AND EXHIBITS:
Department of Pathology,
Department of Radiology,
Department of Surgery.
All will be held at St. Paul's Hospital.
Transportation will be arranged.
Page 360 REPORTS OF STANDING COMMITTEES
REPORT OF THE COMMITTEE ON CONSTITUTION AND BY-LAWS
During the past year there has been no need for much activity on the part of your
Committee. As stated last year our Constitution and By-laws is sufficiently comprehensive and elastic to enable all the business of the Association without difficulty. Under
these circumstances, it would be unwise, we feel, to offer and changes at present.
H. H. Milburn, Chairman,
Committee on Constitution and By-laws.
REPORT OF THE COMMITTEE ON  PROGRAMME  AND  FINANCE
Programme.
Your Committee has continued the policy adopted in recent years of keeping the
tours restricted to a minimum. In the past year only two such tours were arranged, the
first on November 28th, 1940, the meeting of the Upper Island Medical Association at
Qualicum.. The speakers at this meeting were Drs. M. Blair, L. H. Appleby and M. W.
Thomas. The second tour was on April 23 rd, 1941, on the ccasion of the second
meeting of the Upper Island Medical Association, the speakers being Drs. E. J. Curtis,
J. R. Naden and M. W. Thomas.
The programme for the annual meeting has been under consideration for the past
several months and I am sure will meet with the approval of our members.
Finance'.
We continue to draw from the Council the funds required for necessary expenses.
This is under an arrangement by which it is agreed that we will not use more than the
sum of $2500.   It.is with pleasure that we are able to report that we have succeeded in
getting through this past year with an expenditure of only $1900.
All of which is respectfully submitted,
G. F. Strong, Chairman,
Committee on Programme and Finance.
*E* *r •** *r
REPORT OF COMMITTEE ON MEDICAL EDUCATION
Your Committee during the past year has assembled end kept on file full information
concerning all aspects of Medical Education in Canada and has stood prepared to supply
such information to all interested individuals or organizations.
The Committee has no further activities to report.
Respectfully submitted,
D. F. Busteed, Chairman,
Committee on Medical Erucation.
*
REPORT OF COMMITTEE ON ARCHIVES
The Report of the Committee on Archives can be covered briefly as follows: Representative members of the senior men in the profession in all districts of the province have
been written asking them to be members of the Committee and for their co-operation
as members of the Committee on furnishing historical, anecdotal material, personal
memoirs, etc., in order that a collection of records of the medical history of the
Province might be made. Nearly all responded to the request and promised to furnish
material. None has as yet been furnished.
D. E. H. Cleveland, Chairman,
Committee on Archives.
REPORT OF THE COMMITTEE ON MATERNAL WELFARE
The chief matters occupying this committee during the past year have been:
1. Revising and condensing the maternal record card.
2. Drafting questionnaires on maternal and neo-natal deaths.
Page 361
■a.*
i«M
. •+
J'n $#>.:
!■ i f
;V: !!«
IS
lb
!*<
3
II'
1*3*
«■
iiK
N
«*
3.   Provision and publication in the Bulletin of short articles on maternal wal-
fare subjects.
The questionnaires on maternal and neo-natal deaths were drawn up at the request
of Dr. Amyot, and it is hoped that by condensing the maternal record they can all be
included on one card.
To insure that the most useful information on neo-natal deaths would be obtained,
a joint meeting was held with a committee from the Paediatric Branch to draft the
questions.
The Provincial Board of Health is working on the new card and hopes to get out
proof in a short time for final revision.
Maternal deaths for 1935-36-37-38 averaged 44.5 with a rate of 4.4 for 1000 living
births. In 1939-40 this has dropped to an average of 28.5 deaths and a rate of 2.25—
just about half, and the figures for the first half of 1941 seem to be about as good. This
is a great improvement, but the causes of maternal deaths are to be studied and it is
hoped that with the information to be got from the new cards it may be possible to
suggest a new technique which will still further reduce this mortality.
C. T. Hilton, Chairman,
Committee on Maternal Welfare.
Ill
if I
COMMITTEE ON PUBLIC HEALTH AND NUTRITION
Your Committee on Public Health and Nutrition has again been particularly concerned with the milk situation as it exists throughout the Province. Working in
co-operation with the Greater Vancouver Health League, a good deal of public educational work has been attempted and it is thought that the general public have shown
a growing interest in the dangers of unpasteurized milk. Several approaches have been
made to the Metropolitan Board of Health and a promise was given recently by the
Medical Health Officer that immediate consideration would be given to the introduction
of a new Milk By-law to the Vancouver City Council.
During the year several requests have been made for co-operation in connection with
various undertakings. One of these was in connection with the great confusion between
Federal and Provincial rights in connection with sewage disposal at tide water. A
recommendation in this regard was made to the Health Committee of the Canadian
Medical Association.
Your Committee also co-operated with various service organizations in regard to the
general care and diet of some of the refugee children under their guide.
A study of the present status of vitamins was suggested as an undertaking for this
Committee and this is still under consideration. In this regard a request was made for
support in an apple week campaign and your Committee was asked to endorse certain
claims which have not as yet received scientific endorsation. This point is mentioned
because of the increasing tendency of various lay bodies to give the public information
which has not been scientifically proved. Some of the pseudo-scientific statements made
over the radio are detrimental to public health. The influence of the radio is increasing
and it is clear that in some manner medical associations should exert more influence
concerning the information given the public on matters relating to Public Health and
Disease.
All of which is respectfully submitted.
A. H. Spohn, Chairman,
Committee on Public Health and Nutrition.
COMMITTEE ON CREDENTIALS AND ETHICS
During the past year no questions have come before the Committee on Credentials
and Ethics.
No meetings have been held.
Respectfully submitted,
A. H. Meneely, Chairman,
Committee on Credentials and Ethics.
Page 362 COMMITTEE ON THE STUDY OF ECONOMICS
This Committee has functioned in this province for the B. C. Division of the
Canadian Medical Association. It has helped toward the studies of the Cenrtal Committee of the C.M.A.
In British Columbia its strongest local interest has been in the development of the
Medical Services Association. You will have read in the Bulletin on the present status
of this plan. It is shewing steady growth and operating smoothly. Under this plan,
members of employee groups may provide medical, surgical and obstetrical care for the
employee and dependents on a prepayment basis by deductions from pay-roll. The
patient has the doctor of his choice, who is remunerated on the basis of the Schedule of
Fees of the College of Physicians and Surgeons of B. C.
During the 1941 Annual Meeting a special session on Economics will be held on
Tuesday, September 16th, Drs. T. C. Routley, S. Cameron MacEwen and Wallace Wilson
will lead the discussion.
The study of Medical Economics is becoming increasingly important to the doctor.
Governments are already making plans for the post-war years. The Committee urges
the members to attend all sessions devoted to this subject.
W. A. Clarke, Chairman;
Committee on the Study of Economics.
REPORT OF COMMITTEE ON PHARMACY
The principal work of the Committee during the past year has been the preparation
of the provincial formulary. This is being prepared in co-operation with a committee of
the B. C. Pharmaceutical Association. A number of meetings have been held and a great
deal of work has been done. The pharmacopoeia has been prepared and is now in the
form of proof sheets, and is being corrected and revised, and it is hoped that by early
fall it will be ready for distribution throughout the province.
Each doctor in the province will receive a free copy through the courtesy of the
Pharmaceutical Association, who are paying for the printing and distribution.
It has been the endeavour of the Committee to make this as useful as possible in
the hope that it may be generally used by both the hospitals and the medical practitioners throughout the province. It is urged that the medical men on receiving this
book will not only use it themiselves but urge the various hospitals with which they are
connected to make as extensive use of it as possible.
The Committee, composed of both medical men and pharmacists, has spent many
hours in the preparation of this pharmacopoeia, and special mention should be made of
the work and co-operation of Mr. R. Stewart, secretary of the Pharmaceutical Association, on whom the major part of the compilation and proof-reading has fallen. Mr.
J. E. Smith, pharmacist of the Royal Jubilee Hospital, has also spent a good deal of time
in revising prescriptions so that they will be pharmaceutical^/ acceptable.
C. H. Vrooman, Chairman,
Committee on Pharmacy.
COMMITTEE ON HOSPITAL SERVICE
In my previous report of January, 1941, I informed you of the organization and
personnel of the Hospital Service Committee, showing the set-up of the local members
and others from the Island and Interior. A full meeting of this Provincial-wide Committee is to be planned at the time of the Annual Meeting in September.
To date there have been no problems or matters referred to this Committee by corresponding members from the Island or the Interior. Such problems as have been
brought to this Committee are still problems.
In the matter of intravenous therapy by specially trained graduate nurses or technicians, instead of doctors or internes, this fortunately has not become a necessity in
*he larger hospitals of the Province.   For the smaller hospitals, the members from the
Page 363
*>
ji'
f>,"
V$\    .   '4
-.1
if AW
UK
:1
n
n
gill
t
^
4  t
I
?S
if fc
Iff
ItlS
«*!
Island or Interior have not reported difficulties. The decision of authorities not to enlist
Medical Officers until they have had one year's interneship has left largely undisturbed
the supply of Junior internes for hospitals. Thus, the intravenous problem has not
become particularly acute.   Nevertheless the hospitals should be preparing for it.
In the matter of internes enlisting, as stated above the supply of junior internes is
being maintained. A change by the Universities that will affect the* interne situation is
the shortening of the course and the estabUshing of eight months interneship instead of
twelve in the University hospitals. This programme change is not uniform and all
Universities are not subscribing to it wholly. Hospitals will have to adjust themselves
to this new situation. The Canadian Interne Board have not yet met to discuss and plan
for this change.
In the matter of installation of Standard Nomenclature in hospitals, this has been a
subject of conference by record officials of Canadian hospitals. It is progressing slowly,
but, as expected, the progress of the War has inhibited all but urgent changes in hospital organization.
Your Chairman of this Committee has no further matters on which to report.
Respectfully submitted,
R. A. Seymour, Chairman,
Committee on Hospital Service.
EDITORIAL BOARD
The work of this Committee for the past year has been very light. In the previous
' year, the papers read at the Annual Meeting were collected and published, but financial
considerations prevented us from doing anything of the kind with the papers read at
Nelson last September. This was more to be regretted, as many of these papers were of
a very high order, and some of them represented the first report of very important
original work. To take one instance, there was the account by Dr. Harold Wookey of
Toronto of his work on carcinoma of the larynx and oesophagus. Other papers, too, were
very well worth keeping for future reference, but it was, as I have said, out of the question to publish a Supplement. However, some of the papers were published, or rather
extracts of them, in the Bulletin of the Vancouver Medical Association, and so
made the most of.
We owe to the courtesy of the Vancouver Medical Association the constant use of
the columns of their Bulletin. This is a service to the rest of the Province which has
been of very great value, and we feel it is greatly appreciated. The contribution made
by this Association is also, we believe, of great importance to Vancouver. It has made
the circulation of the Bulletin a real thing, and the interest which men outside the
City of Vancouver take in it is reflected in the attitude of our advertisers, who regard
it as a mpst valuable medium, and say so freely. So there is a mutual advantage in this
interrelation between the two bodies.
In this connection, I should like to acknowledge the untiring interest shewn by our
Executive Secretary, Dr. Thomas, who has done by far the most of this work. He collects the News and Notes, prepares matter of provincial interest for publication, and
if we did not have his constant help, it would be very difficult indeed to keep the
section devoted to Association affairs up to date, and adequately covered.
All of which is respectfully submitted.
J. H. MacDermot, Chairman,
Editorial Board.
COMMITTEE ON THE STUDY OF CANCER
The Committee on the Study of Cancer has a large membership, representative of
all districts in the Province. Regular meetings, held throughout the year, have been well
attended, and minutes have been sent to out-of-town members.
At the initial meeting held last Fall, the following Sub-committees were set up:
Page 364 The Sub-committee on Records and Cancer Record Forms, under the Chairmanship
of Dr. H. H. Caple, has been active in stimulating interest in the matter of records.
Seventeen reporting centres have received Cancer Record Forms. The Committee has
prepared a special form to be used for Progress Report, and an Identification Card, to be
carried by die patient, has also been prepared to avoid duplication in reporting.
Dr. G. F. Amyot, Provincial Health Officer, is arranging to have Cancer cases
reported on the same form as is now used for Infectious Diseases.
The Sub-committee on Biopsy Service is still active. Drs. H. H. Pitts and A. Y.
McNair still hold tenaciously to the plan whereby in co-operation with Governmental
Laboratories a Province-wide service will be available in all areas.
The Sub-Committee on Educational Programme is attempting to bring the question
of Cancer before the profession at meetings. Dr. G. F. Strong, Chairman of the Committee on Programme of the British Columbia Division, has taken on this extra work
and with success. All District Associations have been urged to introduce this subject on
their programme.
On April 1st, at the request of the Vancouver Medical Association, the Clinical
portion of the General Meeting of the Vancouver Medical Association asked this Committee to provide the programme—a Symposium, for which thirteen speakers dealt with
all phases of Cancer Control efforts in this Province. There was a large attendance and
the importance of Cancer was impressed on the members. This meeting has been
reported in full in the Bulletin.
Arrangements have been made with the Provincial Board of Health for the publication of articles on Cancer in the Bulletin. Brief articles have been prepared and will
appear in the Bulletin of the Vancouver Medical Association.
Study groups have been developed in various hospitals throughout the Province, and
we are pleased to report that a Tumour Clinic has been established at the Jubilee Hospital
in Victoria. It is our hope that the growing chain of Tumour Clinics will increase
during the coming year.
Dr. Kitching has been very active in promoting Cancer education among nurses of
the Metropolitan Health Board and others.
We are gratified again to have in person Dr. C K. P. Henry of Montreal, a speaker
on Cancer, at this Annual Meeting. m
Respectfully submitted,
Ethlyn Trapp, Chairman,
Committee on the Study of Cancer.
COMMITTEE ON THE STUDY OF CANCER
DO WE KNOW THE CAUSE OF CANCER?
Since the beginning of the Twentieth Century there has been a gradually increasing
volume of experimental work carried out in an attempt to discover the cause of cancer.
Many intriguing facts and theories have been brought forth and most of them have
some clinical support. Heredity, trauma, chronic irritation, virus disease, chemical
toxins, radiation waves and avitaminosis, are a few of the causes of cancer that have been
suggested with certain clinical facts associate to bear them out.
However, on sitting back and coldly analyzing the present day knowledge of cancer
and its cause, we readily recognize that although many interesting isolated facts are
known about cancer, we do not as yet know the actual cause of cancer. But because
we do not know know the cause, let the physician not lie back and wishfully dream of
the time when the actual cause of,cancer is discovered with resulting specific diagnostic
tests and treatments. Rather, let the physician abandon those dreams of the rosy future
of coming generations and pick up the tools that are available today, namely, early
diagnosis, biopsy, surgery, and irradiation, and wield them diligently and well and save
the lives of your brother and my sister, your friend and my friend today, not waiting for
the never present tomorrow.
R. E. McKechnie, II, M.D., CM., M.S.
Page 365 *4
I- ti.
•;   ",-
3
Efi
ntik
•?
fMd
SM:
'*
COMMITTEE ON MATERNAL WELFARE
INDUCTION OF LABOUR
Part II.
Methods of induction of labour:
The method selected for induction should depend on the condition of the mother and
child, local pathology, the state of the cervix, and the relation of the foetus to the birth
canal. As an induced labour takes longer or as long as a normal one, Cesarean section
must be done when haste is required.
For medical induction, three drugs are in common use. Castor oil in doses of one to
two ounces. Quinine in late years is being used less because of suspicion in the causation
of foetal deaths and auditory impairment. Quinine sulphate is* safest, in three to five
grain doses (preferably three), and repeated no more than once. Pituitrin and pitocin
are used more extensively now, but not in the earlier large doses.
Hypodermically, the primary injection should be two niinims to rule out idiosyncrasy. Subsequent dosage may be repeated injections of three or four minims, or, rarely,
5 minims, at 15 to 30-minute intervals. Intranasally, pituitrin may be used x/z to
1 cc. soaked into a pledget of cotton and laid against the inferior turbinate, removing
or changing at the end of an hour as. indicated. Patient must be watched closely for
tonic contractions and the cotton withdrawn immediately.
Artificial rupture of the membranes is most valuable when the cervix is soft, the
uterus irritable and the presenting part well down in the brim. It should not be
employed when the head is floating, for fear of cord prolapse. It is more effective in the
morning after a dose of castor oil the night before.
The intrauterine bougie or rectal tube with or without gauze packing of cervix and
vagina need only be mentioned as an older form of induction, not now widely used.
Asepsis is obviously difficult.
The hydrostatic bag has also been left behind, although it is an effective and good
form of induction, particularly in cases of placenta praevia, where it aids in controlling,
haemorrhage.   Careful introduction technique largely eliminates the chance of infection.
The main disadvantage of surgical induction is that if unsuccessful, the hazard of
infection increases in proportion to the delay, and if other complications arise, making
Cesarean section advisable, the risk of infection is too great.
Estrin sensitization of the uterus is being used more widely with our advance in
knowledge of the hormones.   With the stronger, yet less expensive, synthetic products,
which are effective by mouth, we may expect to find its application coming into stulj
greater prominence.    Doses of 5.0 to 15.0 mg. daily are given for 3 or 4 days, and if
labour has not commenced spontaneously by then, medical induction may be used.
I '.;■
Ii 4
R
MM'
11
Page 366 c
ol ege o
f Ph
ysicians an
dS
urgeons
President Dr. Wallace Wilson, Vancouver
Vice-President Dr. W. A. Clarke, New Westminster
Treasurer Dr. F. M. Bryant, Victoria
Members of Council—Dr. F. M. Auld, Nelson; Dr. F. M. Bryant, Victoria; Dr. W. A.
Clarke, New Westminster; Dr. Thomas McPherson, Victoria; Dr. H. H. Milburn,
Vancouver; Dr. Osborne Morris, Vernon; Dr. Wallace Wilson, Vancouver.
Registrar Dr. A. J. McLachlan, Vancouver
Executive Secretary Dr. M. W. Thomas, Vancouver
\
DR. M. W. THOMAS ADDRESSES M-S-A MEMBERS
Dr. Thomas addressed the members of the Medical Services Association at the close
of the Annual Meeting, stressing the comprehensiveness of this plan.
Monthly Prepayment Basis
He stated that the plan had been developed to meet a need. It permitted the
employee to budget for Medical, Surgical and Obstetrical care on a monthly prepayment basis.
Free Choice of Doctor
The plan provides the services of a doctor of the member's own choice, and covers
all the ills and accidents of life.
Prepayment Plans Are Not New
Many plans limit the choice of doctor. It was pointed out that the M-S-A allowed
the member to have his own doctor.   There is no restriction of liberty.
Normal Patient-Physician Relationships
Medical practice under the- M-S-A plan assures all the privileges of private practice
for both patient and doctor.
f
Patient Tells Doctor He Is M-S-A Member
The doctor approves of the plan and commends the patient for being a member.
The doctor has an opportunity to proceed with the indicated investigation,—may use
the necessary diagnostic aids. Patient's duty is to recover; his bills are paid by the
M-S-A.
Many Procedures Are Costly
Even when no surgical operation is needed there is always expense. The M-S-A
covers every procedure, whether surgical or not.
Mf
Doctors Approve Plan
The doctor wishes his patient to have the best in modern medicine. Under the
M-S-A plan he can practise Medicine untrammelled by the need to consider the patient's
financial position where certain expensive diagnostic and therapeutic procedures would
be extremely helpful.
Professional Members
Practically every doctor in the Province has applied for Professional Membership.
This means that the patient may have the services of his own doctor.
Page 367
* h w
K
* 4 «**   *.■'
\\\
a;
MB U ?r
i <4
■;!
j»is-
i- «■
*»
••!■■   '.
<i ' .'
n
31
Rig
I
*,
>;■
i •**:*;
tti
s
THE CLOSED TREATMENT OF COMPOUND FRACTURES
Surgeon-Lieutenant W. C. MacKenzie, M.D.C.M., M.S.(Surg.), F.A.C.S.
Surgeon-Lieutenant T. B. McLean, M.D.CM.
Surgeon-Lieutenant McLean and I were first interested in this subject because it
seemed to us that it presented the ideal method of treating compound fractures and
gunshot wounds at sea. This method, which we will later describe in detail, entails fewer
dressings and a great deal less general care than any other; and Surgeon-Lieutenant
McLean, after his experience aboard ship, is convinced that these features alone would
tend to make it the procedure of choice even if the results were equal to the other
methods that we have available. Whereas, in the opinion of many recent observers, the
end results with closed treatment, properly instituted, are generally better than those
with other forms of treatment which have been used to date. It would be easier,
obviously, to transfer men to small boats in a solid plaster spica than it would be to do
so with a Thomas' splint and the usual paraphernalia associated with it (although as
Blair says, the spica would be no set of water wings if he hit the briny).
Petit, in the early part of the eighteenth century, was the first man to advocate the
principle of surgical excision of devitalized and contaminated tissue from traumatic
wounds. Larry, approximately a century later, once again called attention to this very
sound principle, but, even after careful debridement in compound fractures, hospital
gangrene occurred so frequently that amputation remained the prevailing practice.
Lister, in 1867, published his immortal contribution on the principles of antiseptic surgery, reporting in a very detailed manner eleven cases of compound fracture which he
had treated with carbolic acid packs.
Thus there developed two vital principles in the treatment of contaminated wounds:
antiseptic agents were used to reduce the number of bacteria in the wound and the
contaminated and devitalized tissues were excised, removing the best culture media of
bacteria.
Down through the years these antiseptic agents were produced by the score, but
basically they all suffered-from the same defect as Lister's Auginal Carbolic Acid—they
were even more capable of injuring normal tissue than they were of injuring the pathogenic organisms present in the wound. Their use, therefore, was limited, for it soon
became evident that even the strongest were incapable of complete sterilization of a
wound, with the result that the wound yet contaminated was further devitalized.
Dakin's introduction of neutral hypochlorite of soda and its extensive use by Carrel
in the war wounds of 1914-18 is perhaps an exception, but even this solution must be
very carefully used if its irritative properties are not to outweigh its bactericidal effects.
During the war days of twenty-five years ago, debridement was usually followed by
active chemical antisepsis which, while very often beneficial, in itself was much too often
injurious because it greatly disturbed the dressings and splints. Sir Robert Jones has
said that it was the practice too often at that time to treat fractures as wounds until
healed and thereafter as fractures.
It was approximately four to five years after the last war that a new approach to
this problem was presented by Winnett Orr, an orthopaedic surgeon of Lincoln, Nebraska
—the so-called "closed treatment" of compound fractures. In it he embodied one of
the prevailing principles in the treatment—the excision of dead or devitalized tissue—
but omitted the active chemical antisepsis. There has been much controversy as to the
originator of this method, but it is now generally credited to Dr. Orr.
Page 368
.'* Mr. S. L. Higgs, President of the section of Orthopaedics of the Royal Society, made
an interesting statement on December 7, 1940, in discussing the treatment of war
wounds in the light of recent experiences: "It was with incredulity, mingled with horror,
that some of our members listened to Winnett Orr, ten years ago, describe his treatment
for osteomyelitis by opening the infected area before drainage, by plugging with vaseline
gauze, and then locking the whole limb in plaster of paris and leaving it for a matter
of weeks. His results, however, were impressive, and orthopaedic surgeons very soon tried
out his method and found it a good one, and they later extended it to compound fractures and found it equally good."
Dr. Joseph Trueta has also generously recorded his indebtedness to Winnett Orr in
the concluding paragraph of his excellent book recording his experiences in the Spanish
Civil War.
The Orr method, devised in 1921-22 and first published in 1923, consisted not only
of infrequent dressing with aseptic (not antiseptic) vaseline gauze packs, but of an
adequate drainage when required, immobilization to prevent trauma during and following
operation, and prolonged protection of the patient against irritative motion, muscle
spasm, secondary wound infection and deformity. It is a combination of these factors
and not the use of any one or two that constitute the method.
The operative programme does not vary whether the case is a recent one or one
brought in following prolonged infection, drainage, deformity or disability. If the
patient is in shock, the usual methods are employed to counteract this condition; i.e.,
intravenous saline and glucose, whole blood or plasma transfusion. Do not, however,
leave him too long with a mangled limb unreduced, and tortured by painful movements
and muscle spasm.
Under general or spinal anaesthesia, the patient is immobilized on a traction table
with all the injured parts in correct anatomical position. The fracture is reduced at
once, and of course the most important factor in reduction is efficient traction. The
original traction may be made upon a pin through the lower end of the femur, through
the heel or one of the metatarsal or metacarpal bones, depending of course on the site of
the fracture. When necessary, pins are passed through the limb proximal to the fracture
as well as distal to it. Once reduction is accomplished you have circulation and nerve
supply restored as nearly as possible to normal. The next step is opening the entire
infected area and draining by a suitable operation (debridement) so that foreign material
and dead or dying tissues are removed. A good many workers accomplish this by saucer-
izing the whole infected area. Winnett personally, at this point, wipes out the infected
site with pure tincture of iodine and alcohol in an attempt to reduce the amount and
virulence of the incidental infection. This single maneuvre is the only approach to
chemical antisepsis in the entire procedure.
The wound is then filled with non-absorbent, non-irritating petroleum pack to provide permanent drainage and to protect the skin. This wide open treatment of the
wound is also credited with the prevention of gas bacillus and tetanus infection in a
great many cases. Drainage tubes are not used, and the covering up of any part of
the wound by flaps, suture or overhanging portions of tissue must be particularly
avoided. The pack is -carried to the depths of the wound and it must flow over the
edges at the top to a distance of one or two inches on the surrounding skin. This
insures the drainage of discharges away from the area just around the wound. The
dressing is completed with a sterile dry absorbent pad bandaged firmly over the drainage
pack and its edges.
The whole limb is then enclosed in a plaster of paris case. The corrective apparatus,
whether it be adhesive plaster, ice tongs, traction pins, or pins directly into the fracture
fragments, is incorporated into the plaster. This makes permanent the traction and
fixation obtained on the table during operation. The cast must be extensive enough to
overcome muscle spasm and counteract irritative motion of all kinds, and a good many
men, including Winnett Orr, use a double leg plaster with a pelvic spica for every
compound fracture of the lower limb.
Ill
ill
11
ml
it
m
iii
Page 369 DO NO POST-OPERATIVE DRESSINGS. If immobilizing devices become
inefficient, if discharge is profuse, or if the odour (because of mixed infection) becomes
unendurable, the dressings are changed in the operating room without disturbing the
parts and with a minimum of damage to the surface of the wound. Usually the
original dressings may remain in place from four to eight weeks or even longer until
the wound has made good progress toward healing.
As a preliminary to all this, we must bear in mind that for first aid on the battlefield
or at the scene of the accident, the use of the tourniquet and traction immobilization
in a Thomas' splint (as first recommended by Sir Robert Jones in 1914) have demonstrated their value as life saving and limb saving expedients. Prepared in this way, a
patient may be transported safely to a hospital where the aforementioned procedure may
be carried out.
It is very easy to visualize how a restless patient with an unreduced fracture, the
accompanying muscle spasm and pain and aseptic wound, can do himself more harm
every hour than the surgeon will do with a thirty-minute procedure which results in
the compound fractured limb being permanently immobilized in correct position, the
wound adequately drained and the surface of the wound and the limb protected against
further trauma and infection.
To consider this, or any other surgical procedure, "foolproof" or free from danger
is not good surgery or good reasoning. It is generally agreed that the results are excellent if the patient is kept under observation for some days where the operation has been
performed. But the risk of oedema and infection under the case, causing gangrene of
the limb, must always be borne in mind. In other words, it is just another case where
the finest and most carefully instituted surgical procedure may be ruined by lack of
careful observation and proper care immediately after the operation. An ill-fitting
plaster cast may be removed in the operating room with little or no disturbance of fragments or dressings, and if this is done early no permanent damage will result.
Minor complications, such as dermatitis, are occasionally seen but are rarely of any
consequence. Another disadvantage is the bad odour, but Surgeon-Lieutenant McLean
will have more to say about that.
Spooner, in studying the bacteriology of these cases among the casualties evacuated
from Dunkirk, found the haemolytic streptococcus to be the chief offender, and Cole-
brook has advocated the use of intensive sulphanilamide therapy for two days. This, he
thinks, will eliminate the organism in the great majority of cases.
The first real test of this type of treatment was in the military hospitals in Catalonia*
during the war in Spain.    Although a few surgeons on both continents had used this
method to the exclusion of all others ever since Winnett Orr had demonstrated its
usefulness, the real proving ground was the battlefield of the Spanish Civil War.
The patients were all strapping young men, battered, crushed or crippled from the
effects of rifle, machine gun, shrapnel, shell and aerial bomb explosions in this area.
There were two different schools of thought in the methods of reducing and setting the
fractures, but the fundamental principles of the fracture treatment were the same in
all Catalonian hospitals. Dr. F. Jimeno, the chief at Banolas, a most devoted pupil of
Bohler of Vienna, resorted to skeletal tractions with Kirschner's wire, stirrup tractors,
or Steinman's pins, and, as a rule, resorted to gradual reduction before packing and
encasing the limb in plaster. Dr. Joseph Trueta, chief of the State Military Hospital in
Barcelona, was the first man to formulate the Catalonian method on the basis of
Winnett Orr's teaching, and he depended for reduction on mechanical extension, availing
himself of the open wound and debridement to secure the best apposition of the fragments. After packing, the immobilization of the limb followed, with plaster encasement applied during extension. At first the wounds were packed with vaseline gauze,
but eventually the vaseline gauze ran out and plain sterile gauze aloue was substituted.
All wounds with few exceptions that were brought in ten or more hours after the injury
were enclosed in plaster without suture; secondary suture in rare cases being applied
after the wound became healthy and filled with granulations.
Page 370 Frequently these plasters were removed in from fifteen to twenty-one days and the
stench of the soiled encasements was indeed nausating. A mould of decomposing
purulent material, wound secretions including sweat and other matter covered the surface of the wound under the plaster. But, after wiping this off with warm water and
soap and removing the pack, it was a pleasant surprise to expose excellent healthy
well-granulated wounds. Another surprising and pleasant feature was the healthy condition of the patients. They were without pain and had enormous appetites. Suffice
it to say that when fresh wounds are relieved of all dead or devitalized tissues and
put at absolute rest, they are quite able to take car of themselves without the aid
of antiseptics which (when truly bactericidal) hinder the normal reproduction of the
tissue cells and weaken their defences. When one peruses the reports of Trueta and
Jimeno, it seems that they would have us believe that if there is-one essential for the
successful treatment of compound fractures it is plaster of Paris. It is interesting to
observe that, while we are all at our wits' end to keep germs out of wounds, they in the
Spanish War area seem to discount the importance of germs, provided the tissues are
allowed to put up their own fight, not encumbered by the culture medium present by
devitalized tissue and kept immobilized and protected by complete fixation in plaster.
If we compare the Surgeon-General's figures issued five years after the last war,
indicating that the mortality in compound fractures of the femur was approximately
12%, with the comparatively recent figures of Jimeno, referring to the same fracture,
of 3.2%, the latter cases treated by the closed method, we probably should feel as Matas
of New Orleans does—that not all cheese that smells bad is bad.
In the last two years we have seen the growth of chemotherapy in the treatment of
infections of all kinds. Jensen and his co-workers in the Minneapolis General Hospital
have some excellent results using sulphanilamide locally in compound fractures, followed
by primary suture and a plaster cast. Perhaps their lead will be followed in this present
conflict and the sulphonamide derivatives may as completely revolutionise the treatment
and end results in compound fractures as they have in so many other surgical and
medical conditions up to this time.
»4i
•'!?
V0
n
v*
J 4
iss!)
BIBLIOGRAPHY:
ORR, H. Winnett—"Treatment of Osteomyelitis  by  Drainage  and Rest":  West Virginia M.  J.,  24:
313-318, July, 1928.
"Treatment  of   fractures   by   means   of  Skeletal   devices,   with   fixation  in   plaster-of-paris   cases.":
J.AM.A., 98:947-951, March 19,  1932.
"Immediate Treatment of Compound Fractures": J.AM.A., 101:1378-1380, October 28, 1933.
"Principles   Involved   in   Treatment   of   Osteomyelitis   and   Compound   Fractures"-.Journal-Lancet,
54:622-624, October 1,  1934.
"First Aid and After Care for Compound Fractures of the Extremities": Kansas City Medical Journal,
April, 1940.
"Methods of Treatment and Results in Compound Fractures of the Femur": Am. J. Surg., 49:189-194,
July, 1940.
COLLER, Frederick A., and VALK, William L.—"Delayed Closure of Contaminated Wounds": Ann.
Surg.,  112:256-270, August,   1940.
MATAS, Rudolph—Discussion of above article by Coller and Valk: Ann. Surg., 112:256-270, August,
1940.
JENSEN, N. K., JOHNSRUD, L. W-, and NELSON, M. C—"Local Implantation of Sulfanilamide in
Compound Fractures": Surgery, 6:1-12, July, 1939.
MTTCFTINER, Phdiip H—"General Principles of Treatment of Air-Raid Casualties": B. M. J., 1:309-311,
March 1, 1941.
I in
:♦►!
■M
Page 371
•8
■*
^s
j* v.
1"
Ih
Mm
m
' i"-v
IP
'i
11
lif
»;
gi»'
1814
IK
DOCTORS HARD HIT BY THE WAR
HELP FROM MEDICAL RELIEF FUND OF
BRITISH MEDICAL ASSOCIATION
He was decorated for gallantry in the last war; and when an incendiary bomb set
fire to his house some months ago, destroying his furniture, clothes, books, instruments,
spare cash, and other possessions, Dr. A could "take it," though the financial consequences were very serious. He is a general practitioner who has been carrying on under
difficulties in a much-raided district from which many of his patients have departed.
He bought the practice only a few years ago. His bank, which provided the necessary
capital, holds his investments as security for the loan. He has found that rent, rates,
taxes, bank interest, insurance premiums, and other expenses, professional and domestic,
absorb almost the whole of his diminished wartime income. But Dr. A has been carrying on, paying his way.
When the bomb fell Dr. A was determined to continue carrying on. But how to
continue paying his way? There were vague reports in the Press about a proposed Government Bill to provide compensation for air-raid damage. At some remote date Dr. A
might perhaps be able to recover at least part of his loss. Meantime he had to pay for
board and lodging for himself and his wife. And he urgently needed new clothes, new
instruments, and a second-hand car.
Fortunately for Dr. A, the Medical War Relief Fund had recently been established.
He seemed just the sort of man, involved in wartime misfortune through no fault of his
own, that the Fund was designed to help. He was granted a substantial gift of money
to provide for immediate needs, and in addition a loan which he is expected to repay,
without interest, when he is in a position to do so. The Fund has received from him
the following letter: "I am overwhelmed with gratitude and cannot express to your
Committee the heartfelt thanks I wish to offer them. My case is probably typical of
many others, but I have never been dealt with so kindly in all my life. I will now be
able to buy some clothes, and I shall use the money to the very best advantage. I am
enclosing a separate letter accepting your loan, free of interest, and I undertake to pay
it back when I receive my next panel cheque. I may at some time probably be able to
let you have the whole of this amount back, when more peaceful times arrive. For the
moment I cannot say more than 'Thank you'. Your gift has cheered me up tremendously."
Dr. B is a comparatively young man who practises as a specialist. It was a high-
explosive bomb that came his way, seriously damaging his house and wrecking his garage.
His private practice has largely vanished. His children are at boarding schools and his
educational expenses are heavy. He has a few National Savings Certificates, but most
of his savings have been invested in life insurance policies. In acknowledging a loan
from the Medical War Relief Fund Dr. B wrote: "I feel that my colleagues have come
to my rescue in a noble manner, and the keen edge of anxiety is removed. I shall of
course repay the loan when I am in a position to do so."
Dr. C is a fnan of advanced age with a small practice and correspondingly modest
expenses. His income has been reduced owing to loss of patients through evacuation,
while his expenses have temporarily increased as a result of his house having been seriously damaged by enemy action. This exceptional expenditure presented a difficult
problem to a man of slender means who was just making ends meet. The Medical War
Relief Fund has solved the problem with a gift which will tide Dr. Cover the emergency.
Dr. D is a general practitioner in middle age. He has been handicapped by health
troubles, but in the years immediately preceding the war his professional income increased
steadily, and although his house was heavily mortgaged his financial affairs were not
such as to cause alarm. He is a veteran of the last war, and in his circumstances many
a man would have been content in September, 1939, to consolidate further his position
in civilian practice, leaving the uniform of the R.A.M.C. to the younger generation.
Not so Dr. D.   He served in France, but after Dunkirk he was obliged to relinquish his
Page 372 commission on the ground of ill-health. Meantime the income from his practice had
diminished, and there was an awkward interval between the date when his Army pay
ceased and the date when professional accounts would become payable. He was in need
of a considerable sum of money for current expenses and for the payment of pressing
debts. The Medical War Relief Fund gave him the necessary amount, partly as a loan
and partly as a gift, as it was thought that an obligation to repay the full sum would
prove an unduly burdensome addition to his other commitments. Dr. D has written:
"I wish to express my sincerest appreciation and thanks for your very generous gift and
loan to enable-me to re-establish myself in my practice after my discharge from the
Army. I shall be refunding the loan at the very earliest opportunity to enable you to
help others who may find themselves in my late predicament."
Dr. E., an elderly general practitioner, has given his life on the Home Front. The
bomb which killed him destroyed his home and all his possessions. His reduced practice,
situated in a relatively vulnerable area, is unsaleable. The Medical War Relief Fund
could not undertake to contribute towards the maintenance of his widow for the
remainder of her life, but it gave her a substantial sum to meet immediate necessities,
and also assisted her to obtain a very satisfactory pension from another organization.
She has left the committee of the Fund in no doubt as to her gratitude.
Dr. F was killed by a bomb when on duty at a first-aid post. Other bombs damaged
his residence and his surgery. The widow will receive a pension of £1 17s. 3d. a week
from the Government, and there will be little addition to this even if it is possible to
sell the practice when the surgery has been repaired. Mrs. F has no relatives who can
assist her financially, and she cannot at present undertake remunerative work as there are
children to be cared for. The Medical War Relief Fund has granted her a gift which
will be paid in annual instalments over a period of five years. The money has been
handed to the Royal Medical Benevolent Fund for administration, and this body will
therefore be able to maintain contact with the family and advise Mrs. F if at a later
date additional help is required for the completion of the children's education.
Hi
,v
4;:;
Aims and Constitution of the Fund
It might happen to any one of us, though we are not all exposed to equal risks. It
would be good to know that there would be help for our wives and children if they
should be numbered among the unfortunate; to know that our colleagues had created a
fund to which they could appeal without humiliation, a fund which we ourselves had
helped to establish, a fund that could come to the rescue in a manner worthy of a
generous profession. It is to achieve this object that the Medical War Relief Fund has
been instituted, and the above cases illustrate the work that is being done.
The purpose of the Fund is defined as the temporary assistance of registered medical
practitioners and their dependents who find themselves in financial straits .as a direct
result of war conditions. Applicants must be "registered members of the medical profession, British subjects domiciled in England, Scotland, Wales, the Isle of Man, the
Channel Islands, and Northern Ireland, and such of their dependants as the Committee
may determine." Assistance takes the form of a gift or a loan free of interest, or may
be given partly as a gift and partly as a loan. The fund is administered by a Committee
representative of the British Medical Association, the Royal Colleges, and the Royal
Medical Benevolent Fund. The cost of aclministration is very small and it has not been
necessary to acquire special office accommodation or to appoint a special staff. The
Honorary Treasurer and Honorary Secretary of the Fund are officials of the British
Medical Association and the cost of their work, which includes much correspondence
connected with the collection of subscriptions, is defrayed by the Association. A Distribution Subcommittee has been appointed to consider applications and vote awards.
The Royal Medical Benevolent Fund was invited to nominate a number of the members
of the Subcommittee, and the Secretary of that body acts as Secretary of the Subcommittee.
Page 373
if;
'■■k'i
1
''» I?
fit'
h'1      li*'
fill
"M*+
if ^
fr?
ft
». «••
nm
..'»?
It
••
»i
ii
5 It
"»«
*■
•fit
I.
*!n
i*
i
1 s '1.:':
J
Ml
•
M
1
*■<
„   1
More Support Needed
The subscription Usts already published show that many individual practitioners,
B.M.A. Branches and Divisions, Local Medical War Committees, Local Medical and
Panel Committees, and other professional organizations have responded to the appeal in
a magnificent way. At the end of March, 1941, the contributions exceeded £20,000,
and more than £4,000 had already been expended since the date of the first awards—
that is, during a period of four and a half months. Further subscriptions will certainly
be needed, for the number of applicants is increasing and will doubtless continue to
increase as the war goes on. Every member of the profession is asked to send a contribution, however modest. Collections are being made in many areas, but any practitioner who has not received a local appeal may send his subscription to the Honorary
Treasurer of the Medical War Relief Fund at B.M.A. House, Tavistock Square, W.C. 1.
Cheques should be made payable to the Medical War Relief Fund. The latest list of contributions is published in the Supplement this week.
Doctors will not fail to discharge their responsibilities, whatever the risk, and it
seems inevitable that many of them will suffer. Is it not both a duty and a privilege
to ensure that in their hour of need they will be able to echo the words of one who
has been helped by the Fund and say that they too are "proud of their profession"?
(Reprinted from the British Medical Journal, April 12th, 1941, Vol. i, p. 566.)
ancouver
enera
Hospital
A REVIEW OF 145 CASES OF PSYCHONEUROSIS IN THE
OUTPATIENTS' DEPARTMENT, VANCOUVER
GENERAL HOSPITAL
By T. F. H. Armitage, M.D.
This paper deals with one hundred and forty-five cases of psychoneurosis diagnosed
in the Neurology and Psychiatry Clinics of the Outpatients' Department from 1936
to 1940.
The definition of psychoneurosis given by Ross in his book "The Common Neuroses
is: "A functional nervous disorder in which no physical lesion has been found."  He
states also: "Patients with a psychoneurosis are ill and yet there is no lesion in any of
their organs."
The diagnosis of psychoneurosis is made when no organic basis for symptoms is
revealed by a thorough history and physical examination, and when laboratory tests are
negative, and a definite cause for the psychoneurotic state is found.
Frequently the personal history reveals previous so-called "nervous breakdowns,
"nervous spells" and poor adjustment to common situations in life, and thus aids in
diagnosis.
Symptoms suggestive of psychoneurosis are "pressure type" of headaches, band-like
constrictions around the head, continuous agonizing headaches, tenderness of the head,
general weakness, giddiness, insomnia, inability to concentrate, failure of memory, intolerance to light, blurring of vision after reading a short while, buzzing in the ears, fear
of insanity, phobias, anxieties and hysterical reactions.
The Differential Diagnosis of psychoneurosis includes such conditions as myasthenia
gravis, myotonia, neurocirculatory asthenia, shell shock, and hypoglycaemia. These diseases were at one time included under the heading of psychoneurosis, but are now recog-
Page 374 nized as definite entities. Diseases to be excluded are early tuberculosis, carcinoma, hyperthyroidism, psychosis and many others.
A case which represents the diagnostic problem is one which most of you know,
Mr. Wm. Lewis, aged fifty. He was admitted to hospital in 1939 with vague complaints
of abdominal and chest pain. He presented a good basis for a psychoneurosis, having
lost his farm and gone badly into debt two years previously.
On examination he shower hysterical anaesthesia over his nose and left shin, and
spurious Rombergism. He was diagnosed as psychoneurosis, with a reservation because of
a persistently high sedimentation rate.
Finally he coughed up his own evidence in the form of pus, which was full of
echinococcus hooklets. An echinococcus cyst in his liver had ruptured through into his
right lung. He made a good recovery after operation, and his psychoneurotic, hysterical
symptoms quickly disappeared.
Classification.
The classification used in this summary is under five headings:
(1) Anxiety reaction.
(2) Workmen's Compensation cases.
(3) Pension cases.
(4) Constitutional inferiors.
(5) Depressive states and possibly psychopaths.
Under the heading of anxiety, the chief precipitating factor in these cases seemed
to be an economic one. Other factors such as sexual difficulties, family trouble, marital
difficulties, and crowded homes, were often attributing causes.
Group 2, the Workmen's Compensation cases, are those patients seeking settlements
from the Board when their claims have been turned down.
Group 3, the Pension cases, resulting from the first war, are patients seeking settlements from the Pensions Board. Most of them have symptoms which began twenty
years ago.
Group 4, the constitutional inferiors, are those patients who have a long history of
very poor adjustment to environment, who are trouble-makers, and most of whom are
unable to hold any one job more than a few months.
The summary of the one hundred and forty-five cases of psychoneurosis was made
on the following groups:
Age:
7-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61 and over
3
32
32
37
32
8
2.0%
22.3%
22.3%
26.0%
22.3%
5.5%
Two cases under seventeen years of age were not included.
Sex:
Male
93
64.1%)
Female 52
Excluding thirty pension cases which are all male, this leaves sixty-three males or
43.5% compared with fifty-two females, almost an equal number of m'ales and females.
Marital Status:
Male
Wm          Single
Married
Others
Single
42
48
3
13
28.9%
33.1%
1.8%
8.9%
Female
Married
38
26.2%
The total group is too small to draw any conclusions. The female group shows,
however, three times as many psychoneurotics among married as compared to unmarried
women.
Page 375
Others
1
0.6% No.
English  75
Scotch  24
Irish  10
Middle European  12
Scandinavian     11
French  5
Percentage
51.7 1
Russian
16.5 j-
75
Italian
6.8 J
Dutch
8.2
Hebrew
7.5
Oriental
3.4
Hindu
No
y.
2
Percentage
1.2
2
1.2
1
0.6
1
0.6
1?
0.6
1
0.6
The proportion of British people attending all clinics at the Outpatient Department
has not been determined, but it is believed to be about this same average. It might
ordinarily be expected that a larger percentage of middle Europeans would be included
in this group.
Treatment:
I would like to mention at this point an article written by Dr. Luff, who is now
practising in Vancouver. This article deals with "The After Results of Psychotherapy
in Five Hundred Adult Cases" at the Tavistock Clinic.
The treatment consists of interviews of one hour, once, twice or three times a week
in the earlier stages, and less frequently in the later stages. Fifty per cent of the five
hundred patients were seen for less than twenty interviews, 39% of the five hundred
were seen for twenty to sixty interviews, and 11 % for over sixty interviews.
Results on discharge of the five hundred cases were grouped as follows:
(1) Much improved  22.8%
(2) Improved j  42.8%
(3) Slightly  improved   , ,  17.4%
(4) Not improved  17.0%
These patients were treated well and adequately.
Obviously no such extensive treatment has or can be carried on at the Outpatient
Department with the present facilities. A clinic for psychoneurotic cases only, with
several psychiatrists, would be necessary.
Treatment of psychoneurotic cases in the Neurology Clinic is as follows:
(1) A detailed history, physical and neurological examination, and laboratory are
done as a preliminary measure.
(2) Reassurance to the patient that no organic disease is present.
(3) The use of phenobarbital.
(4) Leaving the problem with the patient. This is approximately the routine followed at the Mayo Clinic.  The chief problem is that of disposal of the cases.
In the series of one hundred and forty-five cases, an average of 4.6 visits per patient
to the Neurological Clinic was made, the lowest number being 2 visits, the highest
number 15 visits.
In fifty-seven of the one hundred and forty-five cases, or 39% of the cases, no
attempt at treatment was made and they were discharged as soon as the diagnosis was
made. They were discharged because of poor co-operation or because of the hopelessness
of the situation. This 39% includes all of the pension and workmen's compensation
cases.
Results of Treatment:
The groups suggested by Dr. Luff's work have been used to estimate the results of
treatment, not with any thought of comparison of the results in the two series, as that
would be absurd.
In Group IV, in a separate sub-group, were included those patients who were not
treated.
Page 376 Average Duration
No. Percentage of Symptoms
Group   I      Much improved     18 12.5 1.2 years
II      Improved 23 15.8 2.2 years
III Slightly improved • 34 23.4 9.0 years
IV A.    Not improved 13 8.9 9.0 years
B.    Not  treated 57 39.3 15.0 years
The results of treatment, as far as can be judged from this series, are definitely related
to the duration of symptoms.
To date, one hundred and ten of the one hundred and forty-five cases, or 76%,
have been discharged or become inactive.
In conclusion, it would appear that treatment of psychoneurosis in the Outpatient
Department of the Vancouver General Hospital was chiefly a matter of diagnosis and
disposal. 	
A CASE OF RAMSAY-HUNT SYNDROME
C. E. Gould, M.D.
S. E. C. Turvey, M.D.
A sixty-three-year-old white male was admitted to the Vancouver General Hospital
in 1940, with a history of having been well until five days prior to admission, when there
began a "neuralgia" over the left side of his head and around the left ear, extending
forward over the left side of the jaw, and backward over the left occiput. In twenty-
four hours there occurred a soreness of the left side of the mouth and tongue, aggravated
by eating, and accompanied by swelling of the left ear and tingling pain in the external
auditory canal. Twenty-four hours later he developed tinnitus of a buzzing character
in the left ear that lasted about one day, and mild dizziness that persisted until admission.
Examination revealed a rather lean, elderly man, with signs of a moderate degree of
generalized arteriosclerosis, but an otherwise negative examination with the exception of
the positive findings in the head, which were as follows:
1. A left-sided facial paralysis, of peripheral nerve type.
2. Diminished hearing in the left ear, with bone-conduction greater than air-
conduction.
3. The left ear swollen and oedematous, with the external canal crusted, and filled
with purulent exudate.
4. A dry mouth, with an edentulous upper jaw and a few remaining carious teeth
in the lower jaw, and with a slightly raised, oedematous swelling of the left side
of the hard and soft palates and oropharynx, this swelling involving the entire
left side, and ending abruptly at the midline. There was some crusting of the
left side of the oropharynx.
5. Several small vesicles along the lateral border of the tongue, on the left side.
The temperature, pulse and respiration were normal.   Urinalysis was negative.  The
blood Kahn was negative.
A diagnosis of herpes zoster of the geniculate ganglion (Ramsay-Hunt Syndrome)
was made, and he was given sodium iodide intravenously, with symptomatic treatment
to the infected cutaneous lesions in the external ear canal and mouth. Codeine was
necessary during the first week to allay pain.
During the ensuing three weeks, his herpetic lesions in the ear and mouth cleared up,
his pain left him and his left seventh nerve function returned to the point where there
was only a slight residual degree of facial paresis. He was discharged to the Outpatient
Department for follow-up, and there has been no recurrence of symptoms up to the
time of writing.
Thirty years ago Ramsay-Hunt described the syndrome that bears bis name, and his
clinical and anatomical description was so complete that little of importance has been
added since:
Page 377
M
\ I
<*
M He drew attention to the wide field which may be the seat of vesicular eruption,
and showed that this depends upon the frequent association of the seventh nerve sensory
fibres with the sensory branches of neighbouring nerves. The importance of the great
superficial petrosal nerve as a sensory vehicle must be borne in mind. More recently
Wakely and Mulvany have pointed out that in this respect it probably has four distinct
properties:
(a) By means of its tympanic branch it is responsible for all pain referred to the
tympanic plexus from areas situated within the sphenopalatine nerve distribution, with the exception of the soft palate, which it serves jointly with the
glossopharyngeal nerve.
(b) It may provide, via the otic ganglion, a major pathway for the passage of gustatory fibres to the anterior two-thirds of the tongue.
(c) It may be responsible for the passage of sensory fibres to the auriculotemporal
area via the otic ganglion and its communicating branch to the auriculotemporal nerve.
(d) Its distribution comprises the whole of the sphenopalatine territory, in which
the whole area of the hard palate should be included.
The distribution of the herpetic rash in this syndrome becomes clear, then, if one
bears in mind the sensory connections of the geniculate ganglion; of the seventh nerve.
Herpes zoster constitutes the primary lesion of this syndrome. The ear may be involved
via Arnold's nerve branching from the seventh; the area around the ear by the posterior
auricular branch of the seventh; the tongue via the chorda tympani from the seventh;
and also, as pointed out above, by the branch from the otic ganglion to the chorda
tympani; the hard and soft palates and turbinates via the descending palatine and
branches from the sphenopalatine ganglion, which in turn is connected to the geniculate
ganglion by the great superficial petrosal. The latter nerve also sends a branch to the
tympanic plexus that accounts for the involvement of that area.
MEMBERS OF
THE GUILD
OF PRESCRIPTION OPTICIANS
OF AMERICA
Always maintain the
ethical principles of
the medical profession.
Guildcraf t Opticians
430  Birks Building Phone  SEymour  9000
Vancouver, Canada
ARTHRITIS and ECZEMA
of endogenous origin
claimed to be allergic, may be
favored or induced by calcium
and sulphur deficiency, impaired
cell action, and imperfect elimination of toxic waste.
LYXANTHINE ASTIER
dministered per os, brings about
cell nutrition and ae-
'••Msed elimination, re-
improved
ng symptor
functional
improvement.
Canadian Distributors
ROUGIER FRERES
350  Le Moyne   Street,  Montreal OESTROFORM
In Nervous States
The principal use of Oestroform, the natural cestrogenic hormone, is in the relief of menopausal symptoms; it acts in a
specific manner, swiftly relieving both the nervous and the
vaso-motor symptoms. This relief is of vital importance at the
present time when the woman at the climacteric stands in need
of help to enable her to withstand the stress and strain of
present day conditions.
Less commonly realised is the fact that some degree of ovarian
hypofunction may be present throughout adult life, and is not
necessarily confined to the usual menopausal age. Such hypo-
function may be insufficient to produce signs of gross ovarian
dysfunction; nevertheless, it does give rise to a wide range of
symptoms that are a source of distress to the patient. The
symptoms usually comprise exhaustion, emotional instability,
backache, migrainoid headaches, insomnia, pain in the breasts,
nausea and vomiting, cramps, vaginal irritation, hot flushes and
loss of sexual desire. Oestroform will be found of great value in
the treatment of these cases.
Stocks of Oestroform are held by leading druggists throughout
the Dominion, 'and full particulars are obtainable from:
THE BRITISH DRUG HOUSES (CANADA) LTD.
Terminal Warehouse Toronto 2 Ont.
Oes/Can/419 fl
W!f:
«■ t*
;*;
u.
>i
ifc  *••:
*i
sea
'"ttHypi
p¥i
flDount pleasant Tttnbertafcino Co. %tb.
KINGSWAY at 11th AVE. Telephone FAirmont 0058 VANCOUVER, B. C.
R. F. HARRISON W. E. REYNOLDS
•»'
mm
mm
Sw^SSfes*-i
Se&Si&Z
13 th Ave. and Heather St.
Exclusive Ambulance Service
FAirmont 0080
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE  IN AMBULANCE SERVICE  ONLY
J. H. CRELLIN
W.  L.  BERTRAND wm murvv
In the chemical research laboratory, a quick eye and expert
fingers measure the quantities of
solutions in fractions of drops.
Within Four Walls
The four walls of the laboratory do not a prison make for the vision of
the inspired worker in search for new frontiers in medical progress.
From his retorts and crucibles issue new ways and hitherto unknown
measures for the alleviation of disease and for its prevention. To
the earnest search for new and improved medicinal substances
the Warner Institute for Therapeutic Research is dedicated. The
results of its exploration in the field of purely scientific research
are presented in the reports published from time to time. To make
available its discoveries in therapeutic products to the physician and
pharmacist, is the privilege of William R Warner & Co., Inc., a worldwide organization, with laboratories and agencies in 75 countries.
'<'.
-i
WARMER
ISTMUSMiO 1136
The Warner Institute for Therapeutic Research of New
York is an affiliate of the Warner organization, which maintains laboratories and agencies in seventy-five countries.
WILLIAM     R.    WARNER    &    COMPANY
TORONTO    •    CANADA
in
I";
;'•
,<i
r,.! ! FV2
ft if IJ
;ft
Wt J
sk$£
r
TS  fc*
'Ii-
SI?
: ,*;:
■id
. «>i *..
:;f
I KB
SS
ill
<
r-";f;-»,
HOW SUPPLIED
MYOCHRYSINE is supplied in
aqueous solution or in oily suspension as follows:
Ampoules of 0.01, 0.05, 0.10,
0.20, 0.30 gram, singly or in
boxes of  10 ampoules.
gs§iil%g^gg?sgSg
In the Treatment of
RHEUMATOID
| ARTHRITIS   1
There are many recent reports by leading Investigators which would indicate that, when used with
due caution, Myochrysine is a valuable agent in
the treatment of this hitherto intractable and
crippling condition.
As a result of these studies, series of courses with
relatively small doses have now been established
as a satisfactory basis for effective treatment.
Frequent determinations of the Blood Sedimentation Rate provide a reliable index of the response
to treatment with Myochrysine.
Interested physicians are invited to request our revised booklet (2nd edition), "Myochrisine in the Treatment of Rheumatoid Arthritis," which gives complete information about
methods of use, dosage, conduct of case, toxic effects, references, etc.
RECENT REFERENCES on MYOCHRISINE:
Key, J. A., Rosenfeld, H., and Tjoflat, O. E., Gold Therapy in Proliferative (especially atrophic) Arthritis. J. Bone & Joint Surg.
21:339-345, April,  1939.
Goldie, W., Effect of Chrysotherapy on Sedimentation Rate in
Rheumatoid Arthritis. Ann. Rheumatic Dis. 1:319-322, Oct., 1939.
Sabin, A. B., and Warren, J., The Curative Effect of certain Gold
Compounds on Experimental Proliferative, Chronic Arthritis in Mice.
J. of Bacteriology 6:823-856, Dec,   1940.
Tarsy, J. M., Clinical Experience with Gold Salts in the Treatment
of Rheumatoid Arthritis. N.Y. State J. Med., 40:1185-1191, Aug.
1,   1940.
Cecil, R. L., Present Trends in the Study of Arthritis and Rheumatism.   Minnesota  Med., 23:553-542, Aug.,   1940.
juzJrvxeitoztf I (mJuuu: jt£AjeA
O F      € A Hi A  D A      II   11  I T  E U-MONTREAL
il: f JM
A  NUTRIM  BABY
SHEILA   ELLEN   at  16  months
For all-round development, and as a foundation for later life,
VITAMINS and MINERALS in abundance are a dietary essential
from the time the first solid feedings are commenced. NUTRIM
provides such an easy way to make sure the child gets VITAMINS
A, Bi, C, D and G, as well as the MINERALS, Calcium, Phosphorus,
Iron, Copper  and   Iodine.    Highly   palatable.    Requires  no  cooking.
KuPum
... The Product of an ALL-CANADIAN
Company whose profits remain in Canada.
Baby
Cereal
»Ro ARit euts«e ux&i* *&>**',
MM
■HKfl
MSSAl
H« VITAMIN*
r*£&&fc5^fCftOn
SAMPLES
Clinical    Samples    of    Nutrim
will be gladly sent on request.
VITAGRANE FOODS LTD.
18 Eaton Ave., Toronto.
.H: OLEUM PERCOMORPHUM (Liquid)
10 and 50 cc. brown bottles in light-proof cartons. Not less than
60,000 vitamin A units, 8,500 vitamin D units (International) per
gram.
OLEUM PERCOMORPHUM (Capsules)
Especially convenient when prescribing vitamins A and D for
older children and adults. As pregnancy and lactation increase
the need for vitamin D but may be accompanied by aversion to
large amounts of fats, Mead's Capsules of Oleum Percomorphum
offer maximum vitamin content without overtaxing the digestive
system, 25 and 100 10-drop soluble gelatin capsules in cardboard
box. Not less than 13,300 vitamin A units, 1,850 vitamin D units
(International) per capsule. Capsules have a
vitamin content greater than minimum requirements for prophylactic use, in order to
allow a margin of safety for exceptional cases.
FOR GREATEh
ECONOMY,!
the 50 cc. si2e of
Oleum Percomorphum is now supplied with Mead's
patented Vacap-
Dropper. It keeps
out dust and light,
is spill-proof, unbreakable, and delivers a uniform
drop. The 10 cc.
size of Oleum Per-
comorphum is
still offered with
the regulation
type dropper.
LJSGS ' For the prevention and treatment of rickets, tetany, and selected cases
of osteomalacia; to prevent poor dentition
due to vitamin D deficiency; for pregnant
and lactating women; to aid in the control
of calcium-phosphorus metabolism; to promote growth in infants and children; to aid
in building general resistance lowered by
vitamin A deficiency; for invalids, convalescents, and persons on restricted diets; for
the prevention and treatment of vitamin A
deficiency states including xerophthalmia;
and wherever cod liver oil is indicated.
MEAD JOHNSON & CO. OF CANADA, LTD.
Belleville, Ont.
ETHICALLY MARKETED
"We purposefully selected for
these products classic names
which are unfamiliar to the laity,
or at least not easy to popularize.
No effort is made by us to "merchandise" them by means of pub-
He displays, or over the counter.
They are advertised only to the
medical profession and are supplied without dosage directions
on labels or package inserts.
Samples are furnished only upon
request of physicians.
If You Approve This Policy
Specify MEAD'S
Etk^ttly^^^^^^^^^^^^^^^^P^^^1^
Wpann enclose professional card when requesting samples of Head Johnson products to cooperate in preventing their reaching unauthorized pert" w
ZL*u!
Capdulei !
IN PROVIDING
raffil^Smnv vamw- B
Planning of diets which,
provide sufficient amounts
of the factors comprising
vitamin B complex presents
certain difficulties. The quantitative distribution in foods has been rather accurately determined for some of the factors,
but regarding others much must still be
learned. Moreover, there is an appreciable
loss of water soluble factors during cooking.
In view of these and other perplexities, the
synthesis and concentration of the various
factors of the vitamin B complex group
assume particular importance.
Betaplexin—vitamin B complex—is available in several forms. Variations in dosage
are made readily and individual tastes are
easily satisfied.
BETAPLEXIN
Trademark Reg. U. S. Pat. Off. & Canada
Brand of VITAMIN   B COMPLEX
WINTHROP  CHEMICAL   COMPANY, INC.
Pharmaceuticals of merit for the physician
General Offices:
WINDSOR,  ONTARIO
Professional Service Office:
Dominion Square Build ing, Montreal, Quebec
JIM
\m
'■>.
(*
821-MC Anti-Anthrax Serum
Anti-Meningococcus Serum
Anti-Pneumococcus Serums
Diphtheria Antitoxin
Diphtheria Toxin for Schick Test
Diphtheria Toxoid
Old Tuberculin
Perfringens Antitoxin
Pertussis Vaccine
Vaccine Virus
eranis, Vaccines. Hormones
AND
Related Biological Products
Pneumococcus Typing-Sera
Rabies Vaccine
Scarlet Fever Antitoxin
Scarlet Fever Toxin
Staphylococcus Antitoxin
Staphylococcus Toxoid
Tetanus Antitoxin
Tetanus Toxoid
Typhoid Vaccines
(Smallpox Vaccine)
Adrenal Cortical Extract
Epinephrine Hydrochloride Solution (1:1000)
Epinephrine Hydrochloride Inhalant (1:100)
Epinephrine in Oil (1:500)
Heparin
Solution of Heparin
Insulin
Protamine Zinc Insulin
Liver Extract (Oral)
Liver Extract (Intramuscular)
Pituitary Extract (posterior lobe)
Prices and information relating to these preparations will be
supplied gladly upon request.
CONNAUGHT LABORATORIES
UNIVERSITY   OF   TORONTO
nto 5
Canad
Depot for British Columbia
Macdonald's Prescriptions Limited
MEDICAL-DENTAL  BUILDING, VANCOUVER, B. C if!
Nuntt Sc
t
2559 Cambie Street
ancouver
, B. C
Colonic §
Irrigation
Centre
Up-to-date scientific treatments
COLONIC   IRRIGATIONS,   SHORT
WAVE DIATHERMY, COLD QUARTZ
ULTRA VIOLET RAY, STEAM
SWEATS, SHOWER AND
MASSAGE.
Graduate Nurses Only in Attendance
Superintendent
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
1119 Vancouver Block
VANCOUVER, B. C.
MArine 3723
314 Scollard Building
Victoria, B. C.
The Purified
ACTIVE PRINCIPLE
OF
SANDALWOOD OIL
9« a mm ECOHOMICM.
Dosage Form
Doctor, why use ordinary sandalwood
oil when you can just as easily administer the active principle of the oil
with the irritating and therapeutically
inert matter removed—and at a cost
to your patients of only a very few
pennies more?
You can do this by prescribing the
new, economical 50-centigram capsules of
ARHEOL
(ASTIER)
now obtainable in bottles of 12, 24 and
100 capsules at $1.00, $1.75 and
$6.00 a bottle respectively.
ARHEOL is the purified active principle of sandalwood oil. It is a uniform, standardized product with which
prompt and dependable results may be
expected. Undesirable sequelae often
associated with sandalwood therapy
are either absent or reduced to a
negligible degree.
ROUGIER  FRERES, Agents
350 Le Moyne Street, Montreal
Please send me a sample of ARHEOL
(Astier) in the new economical dosage form.
 M.D.
Street	
City Prov	
A3-BVMA
Canadian Distributors
ROUGIER FRERES
350  Le Moyne   Street,  Montreal
K<f
i
93
<mi&'.
Ii FOR  THE  TREATMENT OF PEPTIC  ULCER,   HYPERACIDITY  AND  FUNCTIONAl  DYSPEPSIA
THANKS TO MY DOCTOR THE OLD
INSIDE   NO LONGER * ACTS UP *
NEUSORB
//
For the treatment of
COLITIS  and
ACUTE ENTERITIS
"NEUSORB"
with Mineral Oil
mlneral °'*B$ounce.
By-dsorbinsch^jcaland^
terial toxins ,l Yf"'    titufion to
mucous membranes.
DOSE
five times daily, m ^ ,nister
,UVOLU,neempt &-ach, before
^eatfasr^d-afternoon    and
before retiring.
Available in 6 oz. and 16 o*
bottles.
i^**'-
(A Colloidal Suspension of Masnesium Trisilicate "sIwajT )
SUPERIOR IN NEUTRALIZING
AND   ADSORPTIVE  CAPACITY
TO   POWDERED,   GRANULAR   OR
TABLETTED PREPARATIONS
The ideal preparation for the treatment of peptic
ulcer is one that will protect and remove irritation
from the ulcer with the least disturbance of metabolic processes. Magnesium Trisilicate in colloidal
suspension approaches that ideal more closely
than any other preparation now available.
NEUSORB offers the following important advantages over other Magnesium Trisilicate preparations.
1. The Magnesium Trisilicate used conforms strictly
to the specifications defined by Mutch.
2. In colloidal suspension Magnesium Trisilicate
(Neusorb) presents maximum neutralizing and
adsorptive capacity, in these respects exceeding considerably powdered, granular or
tabletted preparations.
3. "Neusorb" contains no carminatives and no
sugar and may be administered to diabetic
patients.
4. Immediate and extended neutralizing and
adsorptive activity keep the gastric contents
neutral in reaction.
DOSE
One to four teaspoonfuls diluted with two or three times Its
volume of milk or water. Administer 10 to 15 minutes after food.
The schedule of administration may be adjusted to the dietary
technique employed in the treatment of Peptic Ulcer.
Available in original 6 oz. and 16 oz. bottles.
efuuikd &S*oa«t&®>.
MONTREAL CANADA
WHERE PRICE AND  QUALITY ARE EQUAL OR BETTER, PRESCRIBE CANADIAN PRODUCTS ;?
Breaks the vicious circle of perverted
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
musculature. Controls the utero-ovarian
circulation and thereby encourages a    J
normal menstrual cycle. A
hk  • MARTIN H. SMITH COMPANY      jt
k^ ISO l*f ATIITI SIKft   NEW TOJW. N. t. jm
Full formula and descriptive
literature on request
Dosage: 1 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.
1
A new "Ciba" product, which exhibits, according to the dose, a sedative-
antispasmodic effect of a central and peripheral nature,
or acts as a mild soporific—
NEURO-TRASENTIN
(Trasentin-\-phenyletbylbarbituric acid)
FOR THE TREATMENT OF NEURO-VEGETATIVE DISTURBANCES
Neuro-Trasentin should undoubtedly be of
great value in the following conditions:—
Excitability, states of agitation, cardiac neurosis, angina pectoris,
vascular spasms, hypertonia, nervous dyspepsia, ulcer pains,
climacteric disturbances, dysmenorrhcea, pruritus, hyperthyreosis,
etc.
Issued:
Tablets, in bottles of 30 and 100; also 500 for hospital use.
9
m
»i •
HP*
Ml
CIBA    COMPANY    LIMITED
MONTREAL
!i!
ii. ®
>J
%
"Quality*Starts on the Farm
I ft:
i?pfc
' 1* \s-
■«.,
W
:   .«
> 41,  '     H
HfJ*'
>'//!,
*
¥
§&
*»:■*«•»*
iw1
Healthy, regularly inspected cows provide
rich pure milk.—At Jersey Farms this wholesome richness and flavour is retained in all
Jersey products with scientific, sanitary, and
exacting care.
if
IMITED
'£?or J€RS€Y QUALITY.
MILK   CREAM   BUTTERMILK INDEX TO VOLUME XVII, V.M.A. BULLETIN, 1940-1941
ALCORN, D. E., and NEWTON, B. L.—Psychiatric considerations in surgial diagnosis.... 245
ANDERSON, GEORGE H.—Hyperventilation syndrome     75
ARMITAGE, T. F. H.—Review of 145 cases of psychoneurosis in the Outpatients' Department, Vancouver General Hospital  374
BARRETT, G. R.—The hospital point of view in parenteral therapy	
BENZOL   (BENZENE)   POISONING—Division  of   Industrial  Hygiene,   Dept.   of  Pensions and Nat. Health	
BRAIN TUMOUR—MORTALITY RATE IN OPERATION—Frank Turnbull '.	
BRITAIN KEEPS  FIT—THE NATION'S HEALTH AFTER THE  "BLITZ"—
Robert   Williamson	
BRITISH COLUMBIA MEDICAL ASSOCIATION—
Annual   Meeting   (Nelson)	
Annual Meeting,   1941—Programme  31S,
Annual Meeting,  1941—Reports of Standing Committees	
Committee   on   Cancer   56,  63,  295,  326,
Committee on Maternal Welfare -  9,  40, 151,  191, 223, 325,
The War   152,
BRITTON, ELSPETH H.—Pre-natal and post-natal muscle work	
BROWN, CLARENCE E.—Sulphathiazole and undulant fever	
BULLETIN WAR RELIEF FUND   257,  294,   316,
BURKE FREDERICK  S.—Awarded  Professional   Institute   Medal	
BURKE, GERALD  L.—Gravity  curves and the  anti-gravity  jacket	
BUTT, HUGH R., WEIR, JAMES F., and SNELL, A. M.—Further observations on the
clinical use  of vitamin K -	
241
201
348
9
357
361
365
366
259
53
110
372
308
84
188
V
fl.S
CANADIAN MEDICAL ASSOCIATION—
Report of the Executive Committee: T. C. Routley 1  103
Annual  Meeting  293
By-laws governing membership in and attendance at annual meetings of the Canadian Medical  Association .  189
CANCER—British Columbia Medical Association Committee  56,  326,  365
CANCER—FURTHER WORK ON TEST FOR—F. N. Robertson  155
CANCER MEETING—VANCOUVER  MEDICAL ASSOCIATION   225
CHEMOTHERAPY—PANEL  DISCUSSION,   SUMMER  SCHOOL,   1941   327
CHOLECYSTITIS WITH ASSOCIATED PANCREATITIS—R. E. McKechnie II  194
CLEVELAND, D. E. H.—Treatment of pyogenic skin infections  122
COLLEGE OF PHYSICIANS AND SURGEONS—
Medical   Economics     15,  42,  64, 106,  224, 261
Medical Services Association—Annual   Meeting,   1941  263
Annual   Report,   1941  296,  322
CORONARY ARTERY HEART DISEASE—SOME OBSERVATIONS ON—G. F. Strong.... 267
CURTIS,  E.  J.—Fluid administration  in  childhood  221
CYSTOMETRY—L. G. Wood  299
!i*
DAM, HENRIK—Vitamin K -	
DAVIDSON, J. R,, and JONES, P.—Report of gas gangrene infections at the Vancouver
General Hospital in past 15 years	
DAVIES, C. E.—The role of vitamin A in ophthalmology	
DEFICIENCY STATES AND THEIR TREATMENT—A.  M.  Snell	
DEPARTMENT OF NATIONAL WAR  SERVICES:  MEDICAL EXAMINATION
OF  TRAINEES    -	
DEPARTMENT OF PENSIONS AND NATIONAL HEALTH—DIVISION OF
INDUSTRIAL HYGIENE—
Benzol (benzene)  poisoning	
Nitrous fume   poisoning	
DIPHTHERIA TOXOID—THE REINFORCING DOSE—Metropolitan Health Committee..
DOCTOR AND HIS PATIENTS—Arthur E. Hertzler  114,
DOCTOR LOOKS AT WAR (Excerpts from a letter from Dr. R, Watson-Jones)	
DRUG MANUFACTURING—ETHICS AND ECONOMICS—T. M. Matheson	
DWARFISM—SUMMARY  OF THE  PROBLEM WITH  PRESENTATION  OF TWO
CASES—C.  E: Gould	
DYSMENORRHOEA FROM AN ENDOCRINE  STANDPOINT—J. H.  Willard	
184
43
47
49
209
73
12S
101
138
25
174
337
17
EPILEPSY—AN UNUSUAL CASE—C. E. Gould and S. E. C. Turvey  110
EWING,  W. T.—A case of pellagra    108
EYE, EAR,  NOSE AND  THROAT  MANIFESTATIONS OF  ENDOCRINE DISTURBANCE—E. "F.   Raynor  197
t",-
14
it
V
m
FLUID ADMINISTRATION IN CHILDHOOD—E.   J.  Curtis  221
FRACTURES,   COMPOUND—CLOSED   TREATMENT—Surg.   Lieut.   W.   C.   MacKenzie
and Surg. Lieut.  T. B.  McLean ,  368
G-
GAS  GANGRENE  INFECTIONS  AT   THE VANCOUVER   GENERAL   HOSPITAL   IN
PAST 15 YEARS—REPORT—J. R. Davidson and P.  Jones - - 43
GOULD, C. E.—A summary of the problem of dwarfism with presentation of two cases 337
and TURVEY, S. E. C.—Case   of  Ramsay-Hunt   Syndrome -•-  377
An unusual  case  of  epilepsy  110
aa-
■«N ■ «■ ».
% ?
..• 41;'
ii
SI
if- ll li
3* fc. £*
n#
I
•■3  & •
is
INDEX TO VOL. XVII—Continued
H
HALL, EARLE R.—The obstructing prostate—recognition and  treatment     67
Nephrectomy  with  bilateral   renal  tuberculosis         126
HERTZLER, ARTHUR E.—The doctor and his patients   114, 138
HOLLYWOOD   SANITARIUM  . 33
HYPERVENTILATION SYNDROME]—George  H.  Anderson	
I
INCOME   TAX   INFORMATION   (DOMINION)     65
J
JEANS, P. C.—Congenital   syphilis     343
Nutritional  requirements of the  growing child  304
JONES, P., and DAVIDSON, J. R.—Report of gas gangrene infections at the Vancouver
General Hospital in past 15 years     43
M
MATHESON, T. M.—Ethics and economics of drug manufacturing....:  174
MENINGITIS,   FULMINATING   PNEUMOCOCCAL,   FOLLOWING   REMOVAL  OF
NASAL  POLYPI—Vincent  W.   Smith  m
METROPOLITAN HEALTH COMMITTEE—The reinforcing dose of diphtheria toxoid.... 101
MURRAY, STEWART—A review of public health activities after four years under a
metropolitan plan       83
Mac
McCAFFREY,  J. A.—Clinical importance of venous pressure  159
McCURDY, G.  A.—Shock | _  131
Mo.KECHNIE,  R.  E.,  II—Cholecystitis with associated pancreatitis  194
MacKENZIE, W. C, and McLEAN, T. B.—The closed treatment of compound fractures.. 368
McLEAN, T. B., and MacKENZIE, W. C.—The closed treatment of compound fractures.. 368
McRITCHIE, MURDO—Extracts from a letter—Splinters from a medical officer's log.... 38§
XT
NATIONAL   DEFENCE   TAX—INFORMATION §
NEILSON, J. R.—Clinical aspect of parenteral fluid therapy	
NEPHRECTOMY WITH BILATERAL RENAL TUBERCULOSIS—Earle R. Hall	
NEWTON, B. L., and ALCORN, D. E.—'Psychiatric considerations in surgical diagnosis.
NITROUS FUME POISONING—Dept. of Pensions and National Health, Division of
Industrial Hygiene	
NOMENCLATURE OF DISEASE—Vancouver General Hospital	
NUTRITIONAL REQUIREMENTS OF THE  GROWING CHILD—P. C.  Jeans	
OBITUARIES—
Dr.  P.  W.  Barker	
Dr.   William  Y.   Corry	
Dr.   Ezra  N.   Drier .'.	
Dr. E.  L.  Garner	
Dr.   W.   F.  Mackay	
Dr.  Walter   S.   Turnbull	
Dr.   H.   A.   Whillans...	
OSLER LECTURE, 1941—Dr. G. F. Strong.
16
242
126
245
128
29
304
317-
149
317
90
61
59
256
267
PAEDIATRICS—DEVELOPMENTS IN THE PAST QUARTER CENTURY—
Grover F.  Powers  162
PAEDIATRIC PRACTICE, PITFALLS—Reginald Wilson _  205
PARENTERAL FLUID THERAPY—CLINICAL ASPECT—J.   R.  Neilson  242
PARENTERAL THERAPY—HOSPITAL POINT OF VIEW—G. R. Barrett  241
PELLAGRA—CASE—S. E. C. Turvey  105
PELLAGRA—CASE—W.   T.   Ewing  10S
POWERS, GROVER F.—Developments in paediatrics in the past quarter century  162
PRE-NATAL AND POST-NATAL MUSCLE WORK—Elspeth H. Britton  53
PROFESSIONAL INSTITUTE MEDAL—Adwarded to Dr. Frederick S. Burke  308
PROSTATE,  OBSTRUCTING—RECOGNITION AND  TREATMENT—Earle  R.  Hall  67
PSYCHIATRIC CONSIDERATIONS IN SURGICAL DIAGNOSIS—D. E. Alcorn and
B.  L.  Newton  245
PSYCHONEUROSIS—REVIEW OF  145  CASES   IN THE  OUTPATIENTS'  DEPARTMENT, VANCOUVER GENERAL HOSPITAL—T. F.  H. Armitage....  374
PUBLIC HEALTH  ACTIVITIES—REVIEW AFTER FOUR YEARS  UNDER A
METROPOLITAN   PLAN—Stewart   Murray  93
PYOGENIC  SKIN INFECTIONS,  TREATMENT—D.  E.  H.  Cleveland  122
M
RAMSAY-HUNT SYNDROME—CASE—C. E. Gould and S. E. C. Turvey  377
RAYNOR, E. F.—Eye, ear, nose and throat manifestations of endocrine disturbance  197
REID, J. G.—Clinical aspects of vitamin B complex     78
ROBERTSON,  F. N.—Further work on test for cancer  155
RUNYON, DAMON—My old man on doctors     83-
S
ST.   PAUL'S  HOSPITAL  SECTION  126, 194, 311
SHOCK—G.   A.   McCurdy  131
SMITH, VINCENT W.—Case of fulminating pneumococcal meningitis, following removal
of  nasal  polypi  -  11J
SNELL, A. M.—Deficiency states and their  treatment -     49
and WEIR, JAMES F., and BUTT, HUGH R.—Further observations on
the clinical use of vitamin K  188 ;.i <
INDEX TO VOL. XVII—Continued
s
SPINAL ANALGESIA IN THE VANCOUVER .GENERAL HOSPITAL IN 1940—
g G. Stonehouse   280
SPLINTERS FROM A MEDICAL OFFICER'S LOG—Extracts of a letter from
Dr.   Murdo   McRitchie  353
STONEHOUSE, G.—Review of spinal analgesia in the Vancouver General Hospital
in   1940     280
STRONG, G. F.—Some observations on coronary artery heart disease  267
SULPHATHIAZOLE AND UNDULANT FEVER—Clarence E. Brown :...;.   110
SUMMER  SCHOOL—PANEL DISCUSSION  ON CHEMOTHERAPY _  327
SYPHILIS,  CONGENITAL—P.   C.  Jeans  343
SYPHILIS, DIAGNOSIS BY GENERAL PRACTITIONER—U. S. Public Health Service..    27
T
TURNBULL, FRANK—Mortality rate in operation for brain tumour  201
TURVEY, S. E. C.—A case  of  pellagra .'.  105
and GOULD, C. E.—An unusual case of epilepsy   110
A case of Ramsay-Hunt syndrome ..„  377
•'*
•
UNITED STATES PUBLIC HEALTH SERVICE)—The diagnosis of syphilis by the
general practitioner     27
VANCOUVER GENERAL HOSPITAL—
Case Reports   108, 110,  337, 377
Nomenclature   of   diseases  29
VANCOUVER MEDICAL ASSOCIATION—
Annual   reports,   1940-41...." .,  216
Special   cancer   meeting  225
VENOUS PRESSURE,  CLINICAL IMPORTANCE—J. A. McCaffrey  159
VICTORIA  MEDICAL   SOCIETY   SECTION   Ill,  204, 245
Annual   General   Meeting  52
.   Annual Dinner  53
VITAMIN A—ROLE IN  OPHTHALMOLOGY—C.  E. Davies  47
VITAMIN B COMPLEX, CLINICAL APPLICATIONS—J.  G.  Reid  78
VITAMIN" K—HENRIK   DAM    .'. ,  184
VITAMIN K—FURTHER OBSERVATIONS ON CLINICAL USE—James F.  Weir,
Hugh R. Butt, and A. M.  Snell  188
W
WATSON-JONES, R.—A doctor looks at war (Excerpts from a letter)  25
WEIR, JAMES F., BUTT, HUGH R., and SNELL, A. M.—Further observations on the
clinical use of vitamin K ^  188
WILLARD, J. H.—Dysmenorrhoea from an endocrine standpoint .  17
WILLIAMSON,  ROBERT—Britain  keeps  fit—The   nation's  health  after  the  "blitz"  348
WILSON,  REGINALD—Some pitfalls in  paediatric practice  205
WOOD,   L.   G.—Cystometry  299
!-i'
%
•! i fl"
For Sale
CORONA  PORTABLE  TYPEWRITER
Practically New
Phone Librarian
MArine 4622 Evenings: MArine 7789
Hi
if*
Ui.Hj-';-,^ WfQ
1 |4i 1*
ft
ill
(ft
1
M
n
l
a
Ii
>i
le
ii
\i
SULFAGUANIDINE
SQUIBB
(Sulfanilyl Guanidine Monohydrate)
For Bacillary
Dysentery
GRANAYA
(Granular Karaya Squibb)
For Chronic
Constipation
.•»•   ,_»       -  •  '  V-V »>!».     J<    -     " •
While fairly soluble, Sulfa-
guanidine is poorly absorbed
from the gastro-intestinal
tract and therefore tends to
build up relatively high concentrations of the drug in the
intestinal contents. It is
useful in the treatment of
acute bacillary dysentery and
pre- and post-operatively, in
surgery of the colon.
Detailed information on
Sulfaguanidine; indications,
dosage precautions and contraindications is available to
physicians on request. The
product is supplied in 7.7
grain (0.5 gram) tablets and
in powder form.
Because of its superior bulk-
producing effect and because
it is bland and pleasant to
take, Granaya is useful in
chronic constipation where
habit forming laxatives are
to be avoided. Prepared from
especially cleaned karaya gum
and remarkably free from undesirable foreign matter. Has
no effect on digestion or
absorption of fat-soluble
vitamins. Wm
Granaya is available in two
forms; Granaya Plain for
patients requiring only a bulk
laxative, Granaya with Cas-
cara for patients requiring in
addition a mild laxative drug.
Both forms supplied in 4, 10
and 24 oz. bottles.
For literature write 36 Caledonia Road, Toronto
E-R:Sqjjibb&Sons of Canada, Ltd.
MANUFACTURING   CHEMISTS   TO   THE   MEDICAL   PROFESSION   SINCE   1858 ncreasing
Confid
—this must be so, for our phones are
busy on Doctors' orders. Our 30 years
as prescription specialists is bearing
bigger and better fruit!
DAY or NIGHT
MArine 4161
Free City Delivery
until 10 p.m.
'jhdu, &jU*d**»\
GEORGIA PHARMACY
l_ "l,M  I TE  O
OIORMA
((tatter $c ifmutttlltt.
ESTABLISHED 1893
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/cdm.vma.1-0214429/manifest

Comment

Related Items