History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1939 Vancouver Medical Association Apr 30, 1939

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 The bulleHimPI
of the
VANCOUVER
S&wB
"T-V
*«fcE
MEDICAL ASSOCIATION
Vol. xv.
APRIL, 1939
No. 7
With Which Is Incorporated
Transactions of the
Victoria Medical Society
the
Vancouver General Hospital
end
St Paul's Hospital
In This Issue:
OSLER LECTURE
SENSE OF TASTE
NEWS AND NOTES BULKETTS
(With Cascara and Bile Salts)
. i FOR i .
Chronic  Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited
45 6 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) 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:
De. J. H. MacDermot
De. M. McC. Baibd De. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XV.
APRIL, 1939
No. 7
OFFICERS  1938-1939
Db. Lavell H. Leeson        Db. A. M. Agnew
President Vice-President
Db. W. T. Lockhabt
Hon. Treasurer
Dr. G. H. Clement
Past President
Db. D. F. Busteed
Hon. Secretary
Additional Members of Executive: Db. J. P. Bilodeau, Db. J. W. Abbuckle.
Dr. F. Brodie
TRUSTEES^
Db. J. A. Gillespie
Historian: Db. W. D. Keith
Auditors: Messes. Shaw, Salteb & Plommee
Db. Neil McDougall
SECTIONS
Clinical Section
De. W. W. Simpson Chairman     Db. F. Tubnbull Secretary
Eye, Ear, Nose and Throat
Db. S. G. Elliott Chairman     Db. W. M. Paton   Secretary
Pediatric Section
Db. G. A. Lamont Chairman     Db. J. R. Davies Secretary
Cancer Section
Db. B. J. Harrison  Chairman     Db. Roy Huggabd  Secretary
I STANDING COMMITTEES
Library:
Db. A. W. Bagnall, Db. H. A. Rawlings, Db. D. E. H. Cleveland,
Db. R. Palmeb, Db. F. J. Bullee, Db. J. R Davies.
Publications:
Db. J. H. MacDebmot, Db. D. E. H. Cleveland, Db. Mubbay Baibd.
Summer School:
Db. A. B. Schinbein, Db. H. Caple, Db. T. H. Lennie,
Db. Fbank Tubnbull, De. W. W. Simpson, Db. Kabl Haig.
Credentials:
Db. A. B. Schinbein, Db. D. M. Meekison, Db. F. J. Bulleb.
V. O. N. Advisory Board:
Dr. I. Day, Db. G. A. Lamont, Db. Keith Bub well.
Metropolitan Health Board Advisory Committee:
Dr. W. T. Ewing, Dr. H. A. Spohn, Dr. F. J. Buller.
Greater Vancouver Health League Representatives:
Db. W. W. Simpson, Db. W. N. Paton.
Representative to B. C. Medical Association: Db. G. H. Clement.
Sickness and Benevolent Fund: The Pbesident—The Tbustees. 1tfi»
oW»
SQUIBB VITAMIN B -~
COMPLEX SYRUP
For the growing group of physicians who believe that better therapeutics in
B-deficiency conditions require the use of a preparation rich in all the recognized
factors which are generally included under the term "Vitamin B-Complex."
Each teaspoonful contains 250 units of Thiamin Chloride. The other factors
of the B-Complex occur in the ratio in which they are naturally contained in
wheat germ, milk whey and rice polishings.
AVERAGE DOSE: 1-4 teaspoonfuls daily, plain or mixed with milk, tomato juice or similar
vehicle.
Supplied in 3, 6 and 12-oz. bottles and 10-lb. containers.
For literature and samples write:
Professional Service Department, 36 Caledonia Road, Toronto.
ERiSqjjibb&Sons of Canada. Ltd.
MANUFACTURING   CHEMISTS   TO   THE    MEDICAL    PROFESSION    SINCE    1858 VANCOUVER HEALTH DEPARTMENT
STATISTICS, FEBRUARY, 1939
Total population—estimated	
Japanese population—estimated |	
Chinese population—estimated	
Hindu population—estimated .	
Number
Total deaths.:    218
Japanese deaths        3
Chinese deaths      17
Deaths—residents only    191
BIRTH REGISTRATIONS:
Male, 189; Female, 151.
340
INFANTILE MORTALITY Feb., 1939
Deaths under one year of age I        9
Death rate—per 1,000 births      26.0
Stillbirths (not included in above)        5
    263,974
        8,891
7,728
  389
Rate per 1,000
Population
10.8
4.4
28.5
9.4
16.8
Feb. 1938
10
29.3
7
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
March 1st
January, 1939
Cases  Deaths
February, 1939
Cases  Deaths
to 15th, 1939
Cases   Deaths
Scarlet Fever..-    27           0 24 0 11
Diphtheria-       0           0 0 0 0
Chicken  Pox  145           0 127 0 48
Measles         3           0 2 0 2
Rubella         6           0 2 0 0
Mumps       7           0 11 0 0
Whooping Cough    96           0 74 0 46
Typhoid Fever      10 2 0 1
Undulant  Fever      0           0 0 0 0
Tuberculosis      44          13 26 12 10
Poliomyelitis      0           0 0 0 0
Erysipelas       2           0 3 0 3
Ep. Cerebrospinal Meningitis      0           0 0 0 0
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,
DIVISION OF VENEREAL DISEASE CONTROL.
Burnaby
Syphilis       0
Gonorrhoea         0
West
Vancr.
0
0
Richmond
1
0
North
Vancr.
0
0
Vancr.    Hospitals,
Clinic   Private Drs.    Totals
BIOGLAN
THE SCIENTIFIC HORMONE TREATMENT
Descriptive Literature on Request.
A Product of the Bioglan Laboratories, Hertford, England.
Represented by
STANLEY    N.   BAYNE
1432 MEDICAL-DENTAL BUILDING
trAsk the Doctor Who Is Using It"
Phone: SEYMOUR 4239 VANCOUVER, B. C.
Page 190 |    A NEW TREATMENT FOR
HYPERTENSION   HEADACHE
HYPOTENSYL is a synergistic combination of Viscum album extract (European
mistletoe) with hepatic and insuline-free pancreatic extracts.
Especially indicated for headache and dizziness associated with essential hypertension, fibrotic kidney and elevated blood pressure accompanying pregnancy.
The dose is 3 to 6 tablets daily, one-half hour before meals.
For literature and samples write to:
ANGLO-FRENCH DRUG CO., 3 54 Ste. Catherine E., MONTREAL
HYPOTENlSYL
FOR RELIEF OF HIGH BLOOD PRESSURE. VANCOUVER MEDICAL ASSOCIATION
Founded 189 8
Incorporated 1906.
GENERAL MEETINGS will be held on the first Tuesday of the month at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month at 8 p.m.
Place of meeting will appear on the Agenda.
General meetings will conform to the following order:
8 p.m.—Business as per Agenda.
9 p.m.—Papers of the evening.
Programme of the 41st Annual Session (Winter Session)
1939
March 7th—OSLER LECTURE:
Dr. J. H. MacDermot: "The Layman and the Doctors."
March 21st—CLINICAL MEETING.
f.
April 4th—GENERAL MEETING.
Canadian Society for the Control of Cancer.
April 18th—CLINICAL MEETING.
April 25th—ANNUAL MEETING.
STILBOESTROL B.D.H. I
(4:4' dihydroxy-<r:B-diethylstilbene)
The Oestrogenic Substance for Oral administration
Prolonged clinical trials have now established the fact that Stilboestrol B.D.H.
is an effective substitute for the natural ovarian follicular hormone for use in
the treatment of
Menopausal and climacteric disturbances
Amenorrhoea
Dysmenorrhoea
Pruritus vulvae
and all associated conditions of follicular hypofunction.
Stilboestrol B.D.H. is issued in tablets for oral administration; it is available
also in solution in ampoules for use by injection in those cases in which is oral
administration may be contra-indicated.
Stocks of Stilboestrol B.D.H. 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.
Stil/Can/394
Page 191 A contribution by Dr. D. M. Baillie of Victoria, published in this issue, is of considerable interest and brings out certain points often overlooked. He has taken the trouble to
analyse the medical profession of Victoria from the point of view of their relation to
public or community health work, this involving their sources of income. He elicits
rather remarkable facts, for which we refer our readers to his article. We are much more
tied to some form of State Medicine than we tend to think.
A recent questionnaire on matters of medical economics sent out by the Committee
on Economics of the Canadian Medical Association to the various provincial associations,
brought from Saskatchewan a very similar analysis. It was rather a surprise to the Committee to learn that of the something over 500 men practising in that province, less than
half were completely independent of provincial, federal or municipal sources of income.
It would be of great interest, and probably most illuminating, to follow this line of investigation through all the provinces.
There is no doubt that there is a steadily growing number of medical men who do
whole-time or part-time work for some public health organisation. This is quite as it
should be—and we feel that every practising physician should in some way or another
be linked up with the preventive and public health forces of the state or city in which he
practises. But this condition of affairs has certain other implications, and Dr. Baillie
emphasizes one of these, perhaps the main one, very clearly, when he says that we must
have a closer union of therapeutic and preventive medicine. We would go further, and
say that we must work for the day when there will be only one medical organisation, with
its members engaged in their own work, but acknowledging a common and undivided
loyalty to one Canadian Medical Association. We do not wish for an autocracy—but we
do feel that as a profession we should unitedly control and determine our\ own destiny—
and that it should not be possible for any governing body to ignore us in their calculations and policies: or to feel that if the worst comes to the worst they can always take
advantage of our disunity. We have no serious divisions—there is no barrier that cannot
be removed between the two branches of medicine—we have both the greatest need of
unity—and there is no reason in the world why we should not have it. But it will not be
attained by pious resolutions and earnest wishing—only by honest effort, constructive
thinking, goodwill and sincerity. These are all available and must be the basis of
negotiations.
Whom would you like to have for your next President, your next Secretary, your next
Chairman of the Summer School Committee, or of the Clinical Section? Well, why not
put his name down? Why compel a small group of men to run all the elections, especially
when they don't want to? Someone has to do it, though, and if the members of the
Association do not take sufficient interest, they cannot cavil at the choices made. If you
have not submitted a name, there will still be an opportunity before the Annual Meeting:
and everyone should attend this, one of the most important of the year.
IMPORTANT.
LODGE PRACTICE.
Will the doctors who submitted information regarding their Lodge Practices please
let us know the number of people participating in such contracts.
A. J. MacLachlan,
For the Committee on Economics of the Council of the
College of Physicians and Surgeons of British Columbia.
Page 192     - NEWS    AND    NOTES
The sympathy of the Association is extended to Dr. M. W. Thomas, the Executive
Secretary of the College of Physicians and Surgeons of British Columbia, on the death of
his mother, Mrs. J. E. Thomas, on March 20th. Born in Bideford, Devon, Mrs. Thomas had
lived in Victoria for the past fifty-three years. Besides her husband, Mrs. Thomas leaves to
mourn her loss two daughters and one son, Dr. M. W. Thomas.
Dr. Gordon Kenning, President of the College of Physicians and Surgeons of British
Columbia, was asked to represent the British Columbia Medical Association at the funeral
services.
Dr. A. W. Hunter will attend the meeting of the Western Branch of the American
Urological Association at San Francisco at the end of March and will deliver a paper at
the meeting.
Dr. Gordon Kenning and Dr. Wallace Wilson have returned from a meeting of the
Executive Committee of the Canadian Medical Association at Toronto.
The journal Your Health, official organ of the British Columbia Tuberculosis Society,
has appeared in a beautiful new spring (?) dress. We were interested in finding, among
other very readable articles therein, a contribution from Dr. P. W. Barker, issued in three
parts, on "Shakespeare in Relation to Medicine."
Assistant Chief Health Officer Dr. Kenneth Brandon will leave shortly for Hartford,
Connecticut, where he will join the staff of the Aetna Insurance Company.
Dr. R. H. Bruce Reed, of Kincardine,'Ontario, was married in Vancouver on Saturday,
March 18th, to Miss Mary Stevenson. Dr. Reed has registered with the College of Physicians and Surgeons of British Columbia and will enter practice in British Columbia. We
offer our congratulations to Dr. and Mrs. Reed.
Dr. W. M. G. Wilson of the Burris Clinic, Kamloops, has recently returned from postgraduate studies in New York,. Chicago and Toronto.
Dr. R. W. Irving and Miss Evelyn Irving of Kamloops recently left for a few months'
visit in England.
Dr. F. H. Bonnell of Vancouver, Dr. J. B. Roberts of Victoria and Dr. J. A. Ireland
of Kamloops attended the meeting in Calgary on March 3rd and 4th of the Western Section of the Canadian Radiological Society. At this1 meeting Dr. Bonnell presented a paper
entitled "Lesions of the Intervertebral Discs."
Dr. D. J. M. Crawford of Trail left on March 12th for Montreal, where he will spend
approximately two months taking a post-graduate course at the General Hospital there.
Dr. M. E. Krause of Trail had his appendix removed on February 15th and Dr. W.
Leonard of Trail followed his example on March 9th.
Dr. and Mrs. N. E. Morrison were the recipients of a beautiful silver tea service at the
Salmo Ice Carnival in February. Dr. Morrison, who recently joined the partnership of
Borden and Morrison of Nelson, was president of the Salmo Skating Rink.
Dr. G. F. Young is taking over Dr. Morrison's practice at Salmo.
Page 193 Dr. A. Francis of New Denver was an enthusiastic curler at the bonspiel held in Nelson.
The North Shore Medical Society, at its meeting on March 14th, was addressed by
Dr. J. R. Naden of Vancouver, whose remarks were timely and much appreciated.
The North Vancouver Unit of the Canadian Society for the Control of Cancer held
an open meeting on March 3rd. Dr. Roy Huggard of Vancouver was the principal speaker.
Dr. G. A. B. Hall of Nanaimo and Dr. Kerr (retired dentist from Duncan) left by
motor on an extended tour via San Francisco, where they are to take in the Fair, and on
to Phoenix, Arizona, where Dr. Hall will visit his son, Dr. Norman Hall.
Dr. H. F. P. Grafton, who recently returned from England with the degrees of L.M.
& D.G.O. of Dublin, F.R.C.S. of Edinburgh and M.R.C.O.G., London, is now relieving
in Kamloops during Dr. Irving's absence.
The Victoria Medical Society, at a recent meeting, had as guest speaker Dr. A. M.
Agnew of Vancouver, who gave a very interesting and informative lecture on "The Cervix,
va Focus of Infection."
Dr. W. A. Jones, Professor of Radiology at Queen's University, Kingston, visited
Victoria to inspect x-ray plants and to visit a former pupil, Dr. J. B. Roberts, Assistant
Radiologist at the Royal Jubilee Hospital.
Dr. C. W. Duck of Victoria, who has been ill, has finished his convalescence and is
back in practice. He reports an enjoyable and enlightening holiday in San Francisco and
environs during his convalescence.
The profession extends congratulations to Dr. Lawrence Mitchell Greene of McBride
on his approaching marriage to Miss Adelaide Grace Scott on April 13 th.
COMMITTEE ON ECONOMICS OF THE COUNCIL OF THE COLLEGE
OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA
IMPORTANT    NOTICE
APPOINTMENTS AND CONTRACTS
Members of the College of Physicians and Surgeons of British Columbia are
reminded by the Committee on Economics of the Council that they SHOULD
NOT APPLY for any APPOINTMENTS or enter into negotiation with reference to any CONTRACT without having first communicated with either or both:
Dr. A. J. MacLachlan, Registrar,
College of Physicians and Surgeons of B. C.
or/and Dr. M. W. Thomas, Executive Secretary,
College of Physicians and Surgeons of B. C.
Page 194 OSLER LECTURE, 1939
This year we have had the rare pleasure of listening to an address which, to our mind,
comes as near as possible to what the requirements of the Osier Lecture should be. It was
entirely in the tradition of William Osier; for it was in good vigorous straightforward
style, and made a distinct contribution to medical knowledge. We say this advisedly,
because medical knowledge should legitimately include a knowledge of what the public
thinks of us collectively, and why.
Burns' oft-quoted prayer that we might be given to see ourselves as others see us Dr.
MacDermot's address went some ways towards answering. We all know, when we pause
to think of it seriously, that we must clean our own house first before we start in upon
the homes of our slovenly neighbours. In pointing out the inadequacies of our own housekeeping, the lecturer did not spare us from the truth, but his criticism was carefully
reasoned and accurate. He fully realizes that our actions have been misconstrued at times
also, and not always without hostile intent. Finally, as critics should, and many do not,
he closed on a constructive theme which will appeal to us all.
The address was a good one to listen to, and still' better to read. Although frequently
repeated stimuli produced no fatigue phenomenon in the listener's mind, one was constantly making a mental note that one must come back and dwell upon this idea or that,
and for the present must rush along with the speaker. On reading the Lecture, as now set
in print, one finds from time to time something which one does not recall having heard.
In this instance at least we have had our cake and it is still to be eaten—and digested. In
the expressive words of the Book of Common Prayer, it is for us "to read, mark, learn and
inwardly digest."
On reading Dr. MacDermot's work at leisure one cannot but be impressed that it comes
from a man at once scholarly and practical, savoured with the salt of wisdom. As a disciple
of Osier and an exponent of the Oslerian vision, it was a happy choice that made him the
Lecturer this year. —D. E. H. Cleveland.
LIBRARY NOTES
PUBLICATIONS OF MEMBERS.
The intravenous glucose tolerance curve as an index of liver function and liver replacement therapy in cases of hepatic insufficiency. Dr. R. A. Wilson: Canadian Medical
Assn. Journal, March, 1939, p. 268.
Cerebral angiography by direct injection of the common carotid artery. Dr. Frank Turn-
bull: Amer. Jl. Roentgenol., February, 1939, p. 166.
RECENT ADDITIONS TO THE LIBRARY.
(Purchased from the Dr. F. J. Nicholson Fund)
We Europeans, by Julian S. Huxley and A. C. Haddon.
While the main purpose of this book is to disprove the! "Myth of the Aryan Race," in
doing so the authors first cover in a concise and comprehensive way the whole field of
genetics, as well as the evolution and prehistory of man. They then proceed with a detailed
account of the origins and physical characteristics of the various peoples of Europe, of
whom they speak as "ethnic groups," disclaiming the existence today of any such thing
as purity of race.
For one who wishes to make himself familiar with these features of the science of man,
without too much detail, he will find no better text anywhere. The analysis of the pedigree of the peoples of the Jewish faith, to which considerable space is given, is particularly
enlightening.  It is shown that the Jews have no claim to be characterized as a race.
In demonstrating the fallacy of the doctrine of superiority of certain select peoples,
one may get the impression that the authors are inclined to lean over backward in claiming
for all races an innate capacity to rise to equal intellectual levels. Note the suggested
desirability of mass crossing of the British with the Bantu to get new genetic combinations.
(Continued at foot of next page)  G. L. K.
Page 195 V
ancouver
Medical   Association
GENERAL MEETING, APRIL 4th, 1939
Programme.
Dr. Ethlyn Trapp—"Department of Cancer Control of the Canadian Medical Association and the British Columbia Medical Association."
Dr. Bede J. Harrison—"Aims and Objects of the Cancer Institute and its position in
the Cancer Programme of British Columbia."
Dr. A. Y. McNair—"Aims and Objects of the Canadian Society for the Control of
CM
ancer. 	
SUMMER SCHOOL CLINICS, JUNE 6th TO 9th, 193 9
Lecturers:
Dr. L. C. Conn, Professor of Obstetrics and Gynaecology, University of Alberta, Edmonton, Alberta.
Dr. Emil Holman, Professor of Surgery, Stanford University, San Francisco, California.
Dr. Charles P. L. Mathe, Urologist, San Francisco, California.
Dr. Frank R. Menne, Professor of Pathology, University of Oregon, Portland, Oregon.
Dr. Dwight L. Wilbur, Associate Clinical Professor of Medicine, Stanford University,
San Francisco, California.
ROYAL PROCESSION
The Royal Reception Committee in charge of the Royal Procession when the King and
Queen will tour the city, has asked the Vancouver Medical Association to secure the names
of 3 0 doctors who will volunteer for First Aid duty along the route of march. Volunteers
are asked to leave their names with the Librarian at the office of the Vancouver Medical
Association.
LIBRARY NOTES—Continued from page 194
The Life of Chevalier Jackson : An Autobiography. Chevalier Jackson.
In the building up of the medical fabric of the United States, many races have contributed their peoples and their people's talents. The French grandfather of Chevalier
Jackson was, we are told, a man of very outstanding mechanical gifts, and in the grandson
this talent manifested itself in the genius he has displayed in devising instruments to meet
almost every bronchoscopic contingency.
His brilliant leadership has placed bronchoscopy, and lately gastroscopy, as therapeutic
measures of very wide usefulness in medicine. The difficulties of his early life, the
restricted family finances, the rough, merciless treatment of his schoolmates through the
younger years, platyed their part in developing the character of young Jackson. Though
eliminating social life almost completely, yet Chevalier Jackson has had a most happy
family life—a remarkable gift for drawing, painting and woodwork filled up all his spare
time and made his working hours far too short.
Probably no book of modern times tells more vividly of the contribution that medicine
makes and has made for generations to those unable to pay for treatment. The question of
fees never entered Chevalier Jackson's mind, arid until later years in Philadelphia, when his
secretary took the business side of his practice in hand, he had great difficulty in making
both ends meet. Even in later years only 5 per cent of his clients have been able to pay
anything.
This simple story of a life of one of our great leaders in a special field of medicine
tells something of the romance of modern medicine and the f ruitf ulness of high endeavour.
—W. D. K.
Page 196 rrnr
VANCOUVER MEDICAL ASSOCIATION
ANNUAL MEETING
The Annual Meeting of the Vancouver Medical Association, to be held on April 25th,
will take the form of a dinner meeting this year. A prominent local citizen has been
invited to give an address on some topic of interest to the medical men. The usual reports
will be presented briefly and elections take place as usual. This is. an innovation which, it
is hoped, will ensure a good attendance at this important meeting. Attendance at this
meeting is, of course, limited to members of the Association and especially invited guests.
Members are urged to keep this date in mind—April 25th, at 7 p.m.
NEIL E. McDOUGALL, M.D., CM.
It is very difficult to write an adequate appreciation of our departed friend,
or to express in any restrained way our thoughts about him and his most untimely
ending. But we know certain things about him, and can testify to them. He was
a man of undoubted courage and most sterling character. His whole life and history, his war record, his family background, all bore witness to these things: his
hosts of friends, who welcomed the sight of him, and found in him unfailing
cheerfulness, wisdom, and the quiet strength of character that was his, all know
that there was no soft spot in Neil McDougalPs courage, and we must tread softly
and hold our peace as to what has happened, for we can never understand.
We can only think with sympathy and awe of the torment and suffering that
must have been his, and that accumulated till they overwhelmed him. We can,
too, let the affection we all bore him, and the trust we had in him, take the place
of any attempt to understand.
To say that we miss him, and mourn his> loss, is mere words, and most inadequate. Neil had the gift of friendship, and a personal charm of manner which
never wavered or failed, since it was rooted deep in his being. To all who knew
him, he soon became a delightful and lovable friend and companion, though
naturally he had his own intimates of the soul, to whom he meant even more than
this. He always seemed to be a man without moods, without pettiness or rancour
—with a glorious sense of humour which tinged and mellowed all his contacts
with the frets and fevers of life. But deep under it all there was granite, and an
unwavering steadiness of personality which made him the man we all knew and
trusted: to whom we looked, and never in vain, for wisdom and counsel. His
common sense, his sense of humour and proportion, more than once were of
inestimable value as a guide to those who needed advice—and though he seldom
appeared in any sort of limelight, which he shunned, his word always carried
weight.
To those he leaves behind, we can only humbly tender our sympathy. Theirs
is the greatest loss, and we can but wish them strength to bear their grief. For
Neil himself, and we can now only wish bon voyage-, he is outward bound: may he
reach safe port and a happy haven of rest and peace: a "happy issue out of all
his afflictions."
Page 197 «
OSLER LECTURE, 193 9
The  Layman  and  the  Doctors
»
Dr. J. H. MacDermot
We commemorate in these lectures held yearly, and now an integral part of our corporate activity, the life of a great man. Osier was a great physician but he was far more;
he was a great man. He was one of those of whom Carlyle speaks when he says, "The
history of the world is the history of great men." "One comfort is," says the Sage elsewhere,
"that the great man, no matter how you take him up, is profitable company. We cannot
look upon him, however imperfectly we may do so, without gaining something thereby."
Osier would, doubtless, have been great in any field that he might have chosen to enter—
but I like to think that medicine, pre-eminently amongst the professions, indeed more
perhaps than any other calling, offered him the widest scope. For his mind was so predominantly that of the ideal physician, "Don't think, try, be patient, be accurate," the
immortal words of the immortal Hunter, might have been Osier's motto. He had, too,
the illimitable human sympathy and understanding: the warm love of men, the broad tolerance for their weaknesses, the glint of humour, the kindliness and friendliness that gush
from every written word of his, every spoken utterance, in such abundance; all these made
him especially fitted to be our model of what a physician should be.
Wherein lay his greatness? Who can itemize the features of greatness? Not I. Many
others have analysed Osier better than I ever could—have done him greater justice. But
tonight I would pick on one characteristic of him—because it links him with my subject.
The greatness of a great man, to some extent surely, lies in the universality of his nature:
the fact, perhaps, that every1 trait which may be called great is to a more or less degree
represented in him. One element of greatness, I think, one most essential ingredient, is
flexibility. It is the spirit that "sees life steadily, and sees it whole": that refuses to be a slave
to custom and tradition: and changes with the changing years. It is a quality that is rather
lacking in, the professions. Individuals may and do possess it—and it is an index of one's
mental and spiritual youth and vigour.  Osier possessed it in a marked degree.
By flexibility I do not mean pliability or a tendency to weakness: far from it. There is
the plasticity of clay, of rubber, of the jelly-fish; distinct from these is the flexibility of
the spinal column, which has within it the potentialities not merely of flexibility but of
rigidity and strength—or of the Toledo blade, which is supple but keen and razor sharp.
Such was the flexibility of Osier's mind. He never stopped learning—his mind never
became static: and there was no finality in his opinions, in fact, he had in him the secret of
perpetual youth of mind.
As an instance, one has only to consider his Textbook of Medicine, which has gone
through so many editions. In each edition, he gave, in his own inimitable style, the latest
and the best opinion on each subject—but he was never wedded to any opinion and always,
as new light came, he turned it relentlessly on each passage, and, with complete and transparent honesty, ruthlessly cut away dead wood, even replacing whole paragraphs by new
ones, so the truth would be there.
Take appendicitis for instance. In the second edition we read, "Through the pernicious
influence of the daily press appendicitis has been a fad, and it has become an important
duty of the physician to stand between the patient and the knife."
Osier was an internist, but this does not mean that he was opposed to the surgeon: for
we see in a later edition, "The general practitioner does well to remember, whether his leanings be toward the conservative or the radical methods of theatment, that the surgeon is
often called too late, never too early."
As this is an Osier lecture, I should perhaps be well within the scope of my commission
if I were to bring to your attention certain facts not widely known about him, and the
impact of his personality upon his time. For the facts to which I refer I am indebted to
my brother in Montreal, H. E. MacDermot, who is an Osier addict, and wrote to congratulate me when he heard I was to give this Osier lecture. I should like to quote from
his letter, and it will contain two or three points which, I am sure, will be of interest
to you all.
Page 198 He says, to begin with: "Osier is deceptive. There is so much to say about him, but so
much has been said. One thing I certainly would take particular pains to say would be
that the only life of Osier to read is Harvey Cushing's. People say it is so long, and there
are the other pre-digested pruned-down lives of him—all very good, but Cushing's is a
real meal and nothing else is so satisfying. It is like Lockhart's Life of Scott. No other is
nearly as good. One might as well have a shortened edition of Boswell's Johnson. These
big men were big and they take up plenty of room.
"Penfield said something the other day in a Canadian Club address which I thought
was interesting. He was talking about universities, and spoke of Nuffield being influenced
in his gift to Oxford by the fact that once Osier had chatted with him while he was just
a young motor mechanic doing something to Osier's car. That story is well known, of
course, but Penfield went on to say that it was curious that Osier unwittingly had also
been the influence which had produced another, and much greater, benefaction to medicine
—the Rockefeller Foundation. I had never thought of linking him with both, though I
knew of them separately."
I should like to read an extract from an article contributed by my brother to the
McGill News, entitled "Osier's Textbook of Medicine." This will describe the inception
of the Rockefeller Foundation, and I think you will find it of interest.
"No single book in modern medicine has had a wider influence on medical thought and
endeavour. There was; one specially noteworthy influence with which it is credited, and
that was its helping to bring into existence the Rockefeller Institute of Medical Research.
In the summer of 1897, a copy of the book came into the hands of Mr. F. T. Gates, a member of Mr. J. D. Rockefeller's philanthropic staff, and he was so attracted by it that, with
the aid of a medical dictionary, he read it from cover to cofver. 'Having once started, I
found a hook in my nose that pulled me from page to page.'
'I made a list,' he says, 'and it was a very long one at that time—much longer than
it is now—of the germs which we might reasonably hope to discover but which as yet had
never been, with certainty, identified: and I made a longer list of the infectious or' contagious diseases for which there had been as yet no cure at all discovered.
'When I laid down this book I had begun to realize how woefully neglected in all
civilized countries, and perhaps most of all in this country, had been the scientific study
of medicine. ... It became clear to me that medicine could hardly hope to become a
science until it should be endowed, and qualified men could give themselves to uninterrupted study and investigation, on ample salary, entirely independent of practice.
" 'Here was an opportunity for Mr. Rockefeller to become a pioneer. ... I knew
nothing of the cost of research: I did not realize its enormous difficulty; the only thing I
saw was the overwhelming and universal need and the universal promise, world-wide,
universal, eternal.'
"And then he tells how he took his copy of Osier's book to his office and dictated a
memorandum for Mr. Rockefeller in which he tried to show the actual condition of medicine in the United States and the world as disclosed in the book:
" 'I enumerated the infectious diseases and pointed out how few germs had yet been
discovered and how great the field of discovery: how few specifics had yet been found and
how appalling was the unremedied suffering. ... I pointed out the fact, first stated by
Huxley, I think, that the results in dollars or francs of Pasteur's discoveries about anthrax
and on the diseases of fermentation and of the silkworm had saved for the French nation
a sum far in excess of the entire cost of the Franco-German war . . . even if the proposed
institute should fail to discover anything, the mere fact that he, Mr. Rockefeller, had
established such an institute of research, would result in other institutes of a similar kind
. . . and that out of the multitudes of workers we might be sure in the end of abundant
rewards. . . .'
"These considerations took root in the mind of Mr. Rockefeller and, later, of his son.
Eminent physicians were consulted as to the feasibility of the project, and out of the wide
consultation the Rockefeller Institute of Medical Research came into being."
So, as the Sage of Chelsea says, "Books do still work miracles."
Page 199 In choosing my title, you will notice that I have put layman in the singular, and doctors
in the plural—and I do this deliberately, for as you will, I hope, gather as I go along, I am
not referring to the layman's ideas of any particular doctor—but of doctors as a whole.
It is a remarkable and significant fact, and isf indeed the raison d'etre of this paper, that
while the respect and esteem of the average man for his own medical attendant was probably never higher, or the position of the individual doctor more secure, a feeling of distrust
and suspicion has grown up, and is still growing, on the part of the average man, against
the medical profession as a profession. There are many factors in this, of which I hope to
cover some: there is, perhaps, the fact that in dealing with his own doctor he can talk
things out, receive explanations that suit him, and so on, while the medical profession is
co the layman something of an abstraction.
You know the old Latin phrase, etOmne ignotum pro terribile"—we look upon everything unknown as terrible: we cannot get face to face with it. There is, too, the underlying
natural suspicion of organizations which we all share, and perhaps not without reason, even
if nearly every one of us belongs to some one or more organisations. There is the steady
stream of adverse criticism and unfavourable publicity brought to bear against us by
those who wish us harm, and which we do little or nothing to offset or to dispel. But
whatever these causes may amount to, and though we may lay flattering unction to our
souls that they are false and will pass, there are certain other factors in| the situation.
I have for many years been interested, and actively interested, in medical organisation:
I have believed in it, preached it, worked for it. And yet I am conscious that a vast deal
of it is, if not wasted effort, at least effort far too costly and exhausting for the effect it
produces. I see splendid work being done: unselfish and unsparing self-sacrifice and devotion lavished ungrudgingly on the cause: and yet we find ourselves divided, our efforts
rendered largely nugatory as a result of this division: public opinion unfriendly and becoming more and more antagonistic, and I have been asking myself—Why is this? and what
can we do about it?
It seems to me that there are two attitudes of mind almost equally fatal to advancement and mental and material progress. The first, and most obvious, is the reactionary
attitude of mind that says, "What was good enough for my father is good enough for me."
This is the frozen, static, attitude of the cadaver. Death is there, corruption has begun its
fatal and consuming work, and the end is dust. I do not think this attitude can be found
in many medical men's minds today. But there is a certain amount of it visible in a suspicion of anything new that may be suggested—a fear of any change in the existing order:
a resentment against those who come to us with new proposals, which we will not examine
objectively and without bias.
The other, almost equally dangerous, attitude, is that of the man who is always after
something new, who unhesitatingly and sweepingly condemns the old, and is ready to try
any new political, social or other nostrum or panacea offered to his gullible vision by
fanatics, visionaries, or others of less excusable motive.
This is the attitude of the jelly-fish, or the tumble-weed—with no abiding place, no
roots, no stability—and it leads to all sorts of trouble. Whilst either attitude is bad, I must
admit a certain sympathy for the second, an unwavering opposition to the first. The man
who is always opposed to change because it is change will never get anywhere: the other
will at least act as a gadfly, and may irritate us to thet point of action, if it is only to get
rid of him, and find peace once more. 'To abstain from action is good," says the Oriental
wisdom, and the sage Laotzu advocated "wu-wei," which means abstinence from doing.
This, however, does not preclude a receptiveness to new ideas, in fact, it rather predicates it.
We need not feverishly try every new thing that is suggested to us: but we should at least
listen to it. We should follow St. Paul's advice, "Prove all things, hold fast to that which
is good."
I hope I shall never fall into either of these categories—I do not believe that the old is
necessarily the best, nor do I think, that all change means progress—but I realize that all
progress means change. New birth has its pangs to be undergone, and these changes will
not be made without some discomfort—feNon sine pulvere," said the old sage,—not without dust in your lungs and eyes will you win the race.
Flexibility should be our ideal—but with a solid spine behind it.
Page 200 What I want to do tonight is to suggest that we pause for a few moments and try to
look at ourselves objectively, through a layman's eyes. It may give us a surprise, even an
unpleasant surprise: we may get one or two shocks as we realise that we are not altogether,
as an organized profession, an object of entire admiration or affection. On the other hand,
it may, nay I think it will, do us a lot of good to "see ourselves as others see us."
Personally, if I believe in anything, I believe in the sincerity and true altruism of our
profession, I honour and revere its noble traditions, its lofty ideals of practice, its honesty
of purpose. I am proud to my bones of its achievements and accomplishments for mankind—of its universality: its freedom from chains of race or creed or calling—its boundless
generosity. Not in one single item could I ever wish to see a change in these regards. But
I am jealous for the honour and credit of our profession: and I hear it abused and vilified,
and I want to know why—and if anything I can do will help to restore its standing, I want
to do it. I do not want us to be on a pedestal—but we are on an eminence, and may be the
target for mud and other missiles: perhaps we have provoked some of them.
There is something wrong in the relationship of the layman and the medical profession
to one another. Is it all his fault: or is it partly or mainly ours? Perhaps a little analysis
will be of help.
There is a difference, I would first of all point out, in the layman's mind, between his
doctor and doctors as a whole: and it is about the second relationship that I wish to speak.
There was a time when each doctor was a self-contained unit, and mentally we have not
quite got past that time. We are still very individualistic in our outlook, a mental attitude
that served us well when we were units, each as complete in itself as could be made: when,
as Shakespeare's character says, "as who should say,
'I am Sir Oracle,
And when I ope my mouth, let no dog bark.' "
But that day is gone for ever: and medicine is becoming a most complex, complicated,
interwoven fabric. No man now, not even the general practitioner, is self-contained.
Whether we admit it or know it or not, we are entirely interdependent—we work in
groups: and the patient is up against, not a single doctor, but a complex structure containing a doctor, a consultant, a laboratory, an x-ray, a hospital, a) nurse, and many other
component parts.  It bothers him rather.
Further, medicine as a profession is really becoming self conscious. It is becoming
organised, learning to work together: and it is this new, rather unfamiliar relationship,
that I think has brought about the difficulties and problems of misunderstandings. Nobody
could believe more firmly in organisation than I do: I believe it contains within it the
seeds of utter good for the public we serve, equally with ourselves: perhaps even more
than for ourselves. But we are still rather green and unlearned at this game: the new
machine does not yet work smoothly and function efficiently: there is still stiffness and
noise and clashing of gears.
Read Kipling's story, "The Ship That Found Herself," if you want to see what I mean.
There were many stresses and strains in the new ship: storms beset it early in its career: till
each part had learned, finally, the lesson that it could not expect other parts to do their
work, till it was willing itself to do its share, not as a unit, but as a part of a greater whole,
there was no ship, only a collection of parts—and so it is with us. It is about this question
of organisation—some of its duties, some of its powers, some of its responsibilities—that
I should like to speak for a while.
Medicine has gone far on the road of unity and organisation. A great deal has been
done—^excellent work, productive already of much good, rich with promise of future good.
Of course, our first steps have often been faltering, marred by stumbles and falls'—there
have been tears and pain—but we are gradually becoming more sure-footed, more steady
on our pins. We are moving faster and with greater certainty of direction—we turn down
occasional side-paths and explore them. We begin to see our goal—in medical economics,
in various departments, we are beginning to record achievement and success. But what
I want to emphasize this evening is that we are not all moving on the same road or in the
same direction. A large part of our force has become split off from the main army, is
assuming new direction, following new leaders, moving further and further from the
main force. This makes a situation full of danger.  It is dividing our forces—and so ren-
Pase 201 dering us weak and liable to successful attack. We must reunite these forces—and return
to a single leadership.  I shall return to this later.
What the layman wants of his doctor is quite different from what he wants of medicine as a whole. His relations to his doctor are those of a rather helpless easily frightened
child to a strong, dependable parent. He wants a doctor to make and keep him well, to
bear patiently with his1 fears and foibles, to listen to his tales of woe, to reassure him, and
not to tell him too much of the truth. He likes to be told definitely, and in the voice of
authority, what to do and how to do it—and he is willing to pay, not too much, for this.
In the words of a modern poet:
Doctor, here's a tip
From a quivering lip:
Come back to feverish me
And leave psychology!
The complex may be fresher
Than germs and old blood pressure;
The libido may now cause
Flat feet and broken jaws;
But still I have to tell
I really am not well.
Be old-fashioned, do!
Give me a pill or two.
Forget, just once, the trauma,
Only ask me how'm'a
Feeling. That's my need,
Doctor, it is indeed.
But when it comes to organised medicine, to the medical profession as a whole, the
layman's attitude is quite different. He regards us as a cross between the Ku Klux Klan
and Al. Capone's organized gang of racketeers. He considers that, sheltering ourselves
behind a highly protective Medical Act, we fleece the public, meaning him, and make
enormous sums of money out of his sufferings. Where or how we do this he does not know
—nor, for that matter, do we—but he has plenty of Lady Macbeths whispering over his
shoulder, pouring the poison of insinuation into his ear, and confirming him in his sus-
pisions. Of course, he exaggerates—but while there is no justification, there is some
excuse, I think, for the layman's rather unfriendly, somewhat suspicious attitude towards
medicine. He does not see or have explained to him the truth about organised medicine:
he does not appreciate our difficulties; he has only garbled and distorted accounts fed to
him by people who, though he does not realise it, are interested parties, and are playing
him for a sucker, to use a slang phrase. It is our fault, as much as his, that his ignorance
of the facts is not dispelled, and a knowledge of the truth substituted therefor.
The Layman's Side.
It might be well to try to analyse the situation in this way: first to set down what seem
to be the factors from the layman's point of view that make up one side of the equation we
are trying to find. These may be regarded as the known factors. Then we have to find an
equation for these on the medical side before we can settle the problem finally.
(a)  Factors in the layman's attitude:
1. The layman realises that he is confronting an organisation which is daily growing
stronger and more vocal and efficient. He rather suspects* this and perhaps resents it. He
is told by people whom he more or less trusts that this organisation is selfish, reactionary,
and is preventing him from obtaining his just dues: e.g., Health Insurance, etc. We, I may
remark, have done nothing to prove the contrary to him, or to remove his suspicions and
fears.
2. He has a deep distrust of medical ethics. He thinks that we are a closed union,
hypocritically hiding ourselves behind a code which is calculated to protect us from the
consequences of our mistakes and to deprive him of his rights. He thinks that one doctor
will always back up another, regardless of the truth. Again, we have done little or nothing
to explain to him our code of ethics, our rules of conduct, which really are designed to
protect him far more than to protect ourselves.
He considers that the Medical Act is purely class legislation, and is designed to give us
exclusive privileges to make money out of the ills of others, and to exclude legitimate
competition by others who do not happen to practise our way. In case you might feel that
Page 202 this is merely the attitude of ignorant people, let me say that there are no more bitter or
outspoken opponents of our stand on such things as chiropractics, medical economics, and
so on, than a number of university professors, clergymen, and others who should know
better. But is it altogether their fault that they do not?
Again, take medical evidence in court. The layman beholds daily here a sorry spectacle: I need not enlarge on it. I can hardly think of anything more calculated to bring
us into contempt, and to justify that contempt.
3. The layman feels that we are gravely at fault in our attitude towards the prevention of disease. He feels that we know a great deal about this but that we will not divulge
it. He fails to take account of the constant efforts towards publicity made by the forces
of preventive health: he does not regard these as part of the medical profession; and there
is, as I hope to show, considerable justification for this misapprehension. He sees us failing
to use all the modern methods of publicity, sheltering, as he thinks, behind hoary and outworn traditions of secrecy and silence. He thinks we know more than we do, I have no
doubt—but again we have not really faced this problem, and solved it to our mutual
advantage.
One great danger, if I may digress for a minute to emphasize it, is that while we do not
give him the right publicity he yet gets plenty of it: half-baked, mistaken, actually incorrect, often dangerous information. The daily papers, the radio, the platform, pour out a
constant stream of so-called "health information." The McCoys, the Bernarr McFaddens,
the Lady Paishes, are all with us. One can only hope that they do not do the harm they
might do.
4. Arising out of this, the layman feels that we are merely jealous of all these "health
specialists." He thinks our opposition to them is based on two things. First, they injure our
practice, and threaten our incomes; secondly, they know things we don't, and we decry
their efforts and work merely through jealousy and ignorance on/ our own part.
The first of these is quite absurd, of course; the effect of these things on us economically
is, I think, slight. As regards the second, while it is not true, there is some excuse for it,
in the fact that we do not know what good there is in some of these things, and we cannot
exactly define where or why they are* evil.
This is not a fair, sensible or sane attitude for an enlightened profession to take. "If it
be of God, try it." Are we afraid, one whispers, of the good in these things? Do we utilise
the good in them? or do we just condemn them?  I want to refer to this again.
5. He feels that we are specialised to death: that there are too many specialists. His
objection to this is not a specific objection to specialists qua specialists: in fact, he eagerly
seeks them, even when general practitioners like myself think he should come to us first.
But his objection is an economic one and this brings us down to the core of the subject.
Many, if not most, of the layman's grievances and troubles are based on an economic
foundation. He sees medicine growing more and more complicated, more and more expensive. He sees it growing beyond his means to pay. That we suffer as much or more than
he does is of course not apparent to him—he can only feel his own economic pains.
So he feels that we do not realise his dire economic straits: that we have no sympathy
with him, and that we do not take any steps to help him to solve this fundamental and
vital problem.
There are, no doubt, some other factors, but these will more than do for this evening.
The Challenge.
Ladies and gentlemen, my whole purpose tonight is to suggest to you that as a profession we have reached a crossroads in our existence. We cannot smugly answer all the criticisms I have suggested, and the so many others that have been put forward, by a negative
attitude of self-righteousness: we cannot and must not ignore them. It is our bounden
duty to answer and satisfy these critics: to turn them into supporters and friends: not only
for their sakes, though that should be reason enough, but for our own. Medicine has, for
good or evil, set her foot on the path of organisation and collective action. She cannot now
retreat and resume the supposedly idyllic paths of individualism: nor should she. Nor,
again, is there any profit in continually looking over our shoulder at the happy land of ease
and selfishness from which we came. Remember Lot's wife.
Page 203 These opinions held about us and against us by laymen are to be regarded, I think, as
a challenge. "Beware," said the Master, "when all men speak well of you." It is
sound. There is a saying, (tDe mortuis nil nisi bonum": Of the dead speak only good. We
might transpose this: Speak good only of the dead. There is a natural tendency to resent
and dislike criticism. But criticism always has a basis in fact—and we must not merely
seek to disarm criticism—we must examine it, find the cause, and cure this. This is sound
medical practice, and we must follow it.
To what extent are we responsible for this criticism and suspicion? Are they founded
if not on acts of commission on our part, at least on acts of omission? on attitudes which
we should discard, on subservience to outworn and harmful tradition? on our selfishness
and disregard of other people's difficulties? on division amongst ourselves, mutual misunderstandings ?
If we are to survive and be a strong force in the life of our social organism, we had
better pause and consider. Let us look at Great Britain, at Germany, where the medical
profession has been caught in the grip of bureaucracy to a greater or less extent. Look at
the troubles of the profession in New Zealand, in South Africa, in the/ United States.
We must work out our own salvation. Too long have we hunched our shoulders
apathetically under the showers of public criticism and antagonism: hoping that the storm
would pass, and that we should not get too wet. But the storm is deepening and getting
stronger and the showers are turning to a downpour.
Why should we not analyse this situation, find out how much truth there is in these
charges, how much cause there is for this criticism, and honestly and sincerely go about
to remove these causes?
My own suggestions are yours for what they are worth.
I should like to put forward the following as what I believe are the factors on our side
of the equation that must be taken into account, and corrected where necessary. They
come under the following two main heads:
1. Lack of true unity as a profession. We do not, and at present cannot, face thes€
problems as a united body.
2. Adherence to tradition, regardless of its worth, regardless of the danger of such
adherence in many instances.
I believe that this is the correct order, but I am going to deal with the second first,
because it stands in the way of solving the first.
I want to amplify these two statements a good deal—and to present to you certain
arguments and suggestions which I think demand the earnest study and concerted action
of a profession which fills an honourable place, and should occupy an honoured place ir
the community.
I would put, then, as the first cause of our troubles, our adherence to traditions and
rules of conduct, many of which are outworn, have long outlived their usefulness, and,
like all vestigial organs, are now a menace to the body that harbours them. These traditions
and rules, many of which were excellent at the time they were first conceived, now shackle
and cramp our movements, and cannot be adjusted to modern conditions. The world has
changed in the last fifty years—economic standards, social standards, community standards, are all completely different. Have we changed with them? I think not. "Tempora
mutantur et nos mutamur in Mis." Times change, and we change with them, is not, but
should be, a motto of the medical profession.
Take our noble tradition that no sick person, of any age, sex, race, or religion whatsoever, shall ever suffer for need of medical care on account of poverty or any other cause.
God forbid that I should suggest that we ever change from the principle and attitude of
mind underlying this tradition. But this tradition should be based on our willingness to
give, and should be construed as an act of our charity. It should not be exploited: nor
should it be assumed as a God-given right by its beneficiaries. Least of all should it be a
right-of-way for needy and penurious governmental and administrative bodies. Belgium's
famous cry, "We are a nation, not a right-of-way," should be ours.
If we choose to give our services to the poor and needy that is our business. Nobody
has any right to give away our money, our time, our brains, our charity. Yet we allow this
tradition, so-called, to go on its way, to a great extent unmodified and uncontrolled: and
Page 204 r
we have allowed it to degenerate from a tradition into a chain that binds us. It was
originally based on the needs of the indigent sick, for whom no municipal or other relief
was provided, and who were therefore legitimate objects of our charity. Times have
changed, ladies and gentlemen, in this regard: but we have not changed with thefn.
And the layman does not either demand or expect from us this continued senseless
submission to exploitation. He knows full well he ought to pay. Many think we are paid
for our work in the hospitals done for staff cases. We are constantly finding that the man
on the street takes it for granted that we are paid. And in certain countries, notably Denmark and the Scandinavian countries, doctors are paid.
This brings me to a subsection of this tradition—our almost traditional horror of salaries for medical work, of payment by any other than our long-established custom of
charging fees. Why, one asks oneself, is it so disgraceful, so unworthy, for a medical man
to be paid for his services? At bottom, medicine is primarily a vocation, a means of
earning a livelihood. We offer our services for pay. There is nothing shameful about that.
Even the missionary band of apostles sent out by their Master were told to accept what
was offered them, and his justification for this was, "The labourer is worthy of his hire."
Honest pay for honest work is a fair exchange, and is an honourable thing. Yet medical
men have always been somewhat apologetic about charging for their services, from the
days when a doctor's pay was an "honorarium" not enforceable by law, to now, when in
many places the patient, as he leaves, lays a guinea coyly on the table, like a tip that the
diner leaves for the waiter. This is not a very worthy attitude.
I would suggest that we reconsider, as a profession, our whole attitude towards this
matter of traditions. If we are in the business of traditions, why not make a few new ones?
Stick, by all means, to the elements in the old traditions that are good andi worthy. To
refer again to St. Paul, "Hold fast to that which is good." We usually forget that he preceded this advice by "Put all things to the test." We should take stock occasionally, and
throw out the junk that accumulates with the passing of the years.
Why not refurbish the old traditions, and say that while we are still willing to give, of
our own free will, help those who stand in need, and have no helper, we are no longer
going to allow ourselves to be exploited, our pockets to be' picked, our services to be given
away? If the community has, as it has done, embarked on a system of collectivist organised charity, for which we as others pay our full share: if the community buys and pays
for all other services given out in charity or relief, then for these people they must buy
medical services as they do other things, and pay for them as they do for other things.
This would mean a great many changes. It might involve payment of those on medical
staffs and I for one can see no objection to this at all. It might involve the appointment
of salaried physicians. I can see no great harm in this. The public health services, the
Workmen's Compensation Board, other bodies, employ salaried medical men, and these
men's work is at least as efficient as that performed under a fee system. I should like best
of all to see a plan whereby every medical man could get his share of this work, and be paid
for it. The principle has been admitted under our relief plan; notably in Ontario, it is
working well—and it should be extended to include all those who are in need.
Here I should like to put forward, rather timidly, a suggestion for your consideration.
We have coming up every year a fresh crop of highly-trained, thoroughly educated new
doctors. These men sit in offices doing nothing for many months. They cannot go out and
get work, and it takes years to build up a practice. They are the mark for lodges, benefit
associations, and all those who want much for little, including many industrial organizations, who offer contracts at disgracefully low prices, trusting, and all too frequently with
reason, that the need of these men will bring them to terms that injure not only themselves but all other medical men. Some of them go to other places to practice, others
specialise all too early, in the hope that they will get on faster.
We have, on the other hand, free clinics packed to bursting. Nothing is paid for the
work done here. In Denmark and elsewhere this work is paid for, and the medical profession, which at first looked on this fact with misgivings, has come not only to accept it but
to welcome it. Why should we not demand that this work be paid for—and why should
it not give to many young beginners a perhaps small but welcome income? It would be
better all round—the indigent would, I believe, receive better care, medical men would
Page 205 be paid for it. It would have other advantages. The new doctor would keep busy, in constant practice—he would be doing a general practice, which I think is essential to every
man's full growth, even if he specialises later—and we should be able to establish our just
claim to be paid for the work we do. I do not think we could expect full fees or very large
salaries—but it would be a beginning. It would take the indigent out of the picture, in
which they are at present nothing but an incongruous and unassimilable discord. As a
matter of expediency, we do have certain men who are paid salaries for the medical care
of the indigent—but it is mainly for administrative work in connection with relief and
outpatient clinics.
Another method by which the young man could be utilised would be through a wider
adoption of the principle of group practice. This does not necessarily mean formal clinics.
But a group of men practising together might well employ one or two recent graduates as
spares, as men who could do night work, take emergency calls, act as substitutes for members of the group doing post-graduate work or taking holidays. A salary would be paid
them at first, and there would be the incentive that would be contained in the prospect of
full membership later on, if their work was satisfactory.
Take again the tradition that every patient is entitled to choice of a doctor. In one
sense this is quite true—and it is a valuable privilege for the layman. But certain lateral
implications have made this a burden rather than a privilege, as far as the doctor is concerned. It means slavery for him very often: he is to be available day and night—and
nobody else will do. And is it so absolutely necessary? Where group medicine is practised,
the patients no doubt have their first and second choice—but the medical man has his
regular periods of work—and nobody is the worse for the fact that he also has his regular
periods of leisure: time off for postgraduate work, etc.
A revamping of this tradition to suit modern conditions, a willingness to have it modified, would help in a great many ways—it would probably make our lives longer and
happier, and far more efficient; we are much too often exhausted by over-long hours and
the strain of overwork; and we cannot do our best under these circumstances. It would
also open the way for reasonable changes in medical practice: suggested changes are often
opposed by us, not because they are necessarily evil—but because they run counter to some
supposedly cherished tradition.
We are all practising group medicine in any case today. No day passes but we call in
to our aid the x-ray, the laboratory, the eye, ear, nose and throat specialist, and many other
men in special lines. But we do it in a cumbersome way—our patient must tack about,
hither and yon, in the rain and in the sunshine, to have his or her composite picture taken.
My second suggestion has to do with something quite different. One of our most
sacred traditions, comparable only to the veneration of the pious Hindu for the sacred
cow, is our holy horror of publicity in any form. I would suggest to you that we should
examine carefully this whole question of publicity, and see whether or not we are right
in remaining "mute and inglorious."
I think our attitude towards publicity is that of the man with an inferiority complex.
The most rabid antis are those who have the least chance of being pros. The "sour grapes"
attitude is a very human, but a very dangerous one. We do not know how to use publicity: we have never used it: therefore it is no good. This is a very mistaken way, I think,
to look at it.
The whole trend of modern life is towards publicity. Radio, the films, uncounted
magazines and digests, Sunday supplements, true confession magazines, all keep the world
told about all sorts of things: it is true that a great deal of it is wrong and tawdry and sensational—but it has, too, its good side. Knowledge of the truth hurts nobody at any age:
and it cannot be too complete and too frankly given. When we withhold facts from those
who should and want to know them, we have only ourselves to blame if they are given
other information which is wrong, misleading, and prejudicial to us. Remember the man
with the devils, who swept and garnished his soul: and found that because he left it empty
it became refilled with many other worse devils.
We have been doing our best to remove ignorance, superstition, fear and misunderstanding from men's minds. We must fill them with the healing knowledge of truth.
Why are we afraid of publicity?  So much has been accomplished by it.
Page 206 Partly, no doubt, because quite properly we oppose individual advertisement. But
that is not the sort of publicity to which I refer.
The principal reason is, I think, that as a practising profession, publicity, public education, are not really in our line. We feel that these things are good and necessary—we make
sporadic efforts in their direction—but we are not equipped really to provide them.
Now the other half of the profession that deals with public health and preventive medicine is so equipped, and this should be their province. If we are to be an adequately organized profession, we must include all the branches of medicine. To be an efficient organisation we must make use of the tools of organisation, of which publicity is one of the chief.
We should link up with such bodies as Health Leagues, Parent-Teacher Associations,
and others where laymen are associated in health work. The therapeutic branch cannot do
this very well: the preventive branch can. One has only to look) at the success obtained
where laymen's aid and interest have been enlisted in the form of auxiliaries, etc.
We have failed markedly, I believe, in our duty to the public, to give them accurate
information and facts. Take the question of Health Insurance. There is no doubt at all
that the man in the street blames the doctors for the failure of the Health Insurance Act.
We know that we did a public service in opposing that Act in its present form; the layman
does not. He should know. Quite apart from the risk to ourselves and our prosperity that
our silence creates, we have done nothing to educate the layman in the facts regarding this
legislation, which is as vital to him as to us; and of which we could and should, in my
opinion, have told him the truth. But we have no machinery for telling him, and we salve
our consciences by various forms of rationalisation. The mens conscia recti will not do here,
ladies and gentlemen, not only for our own sakes, but for the better understanding and
satisfaction of the public, this knowledge should be given. We have allowed misleading and
untrue statements and impressions to reach, the public mind. Now my point is that only
through a complete organisation can we devise adequate machinery for public information.
Education of the public hi health matters.
As a profession, I feel that we rather fight shy of this. Those on the preventive side
of medicine have done much in this direction: but they are to some extent working against
the stream. There is, if not hostility, a feeling of suspicion and apathy on the part of their
therapeutic brethren; and this handicaps them—and gives a bad impression to the public.
To devise a really good scheme of public education is not an easy task—but many of
us think it should be undertaken. In the first place, the public really wants it, listens
eagerly to it, and while a great deal of it is apparently wasted, a great deal is assimilated and
used.  Undoubtedly a certain amount of real good is done.
In the second place, as nature abhors a vacuum, so a real need or want is always met
in some way, right or wrong. If we do not supply the correct information, there are many
who will be glad to give the other kind.
To their honour be it said, the preventive and public health forces have done and are
doing very fine work in this direction. We tend, on our side of the fence which should be
pulled down, rather to sneer at their efforts. This is all wrong. We should support them
with all the means in our power.
How are we to tackle this question of publicity?  What should publicity cover?
First, we should rid our minds of many preconceived ideas about publicity. We should
ask ourselves, "Why do we oppose publicity?" The answer may be given, that we are
opposed to self-advertisement. If this element were removed* is there any way in which
publicity could be made a useful adjunct to our work?
The public wants to know. If any of my hearers doubt this, I would refer him to the
meeting in the Hotel Vancouver some weeks ago when some 2500 people packed the hall
room, its galleries and approaches, to hear about venereal disease. To watch that audience,
when Dr. Williams was speaking and giving in clear terms the facts about V.D., was a
revelation. They sat gripped by his voice, and were obviously eager to learn. I believe that
the Crystal Ballroom and larger auditoriums could be packed similarly to hear about milk,
and cancer, and maternal mortality, and many another subject of public health.
How is this to be done, and who is to do it? It must be impersonal—it must, too,
be done well, or it were better not done at all.
Page 207 And look at our attitude to the Press. It is quite true that most medical information
appearing in the Press is inaccurate, sensational, often misleading: but I do not think we
are blameless in this matter. My own limited experience with newspaper men convinces
me that they are only too ready and anxious to be given an accurate account—and if we
will work with them, they will work with us.  But they cannot get our help, ana mean-
* J J O IT 3
while the public clamours for some information. I quote from the speech of an authority:
'The real difficulty of the Press is that, needing assistance from the medical profession, it is
met by an attitude of jealous secrecy, supported by a jargon intelligible only to medical
men, and by a barely concealed contempt for the journalist who tries to translate their
technicalities into plain English."
The remedy is in our hands, in the shape of rigidly controlled accurate publicity, with
the aid of competent press men.
It has been suggested, and I think well suggested, that every public health organisation
should have a press service.
The Main Factor.—I think, however, that the most serious disability from which we
suffer is the unhappy divisions amongst ourselves. Many years ago a small, almost unnoticed bud grew out of the stem of the parent tree of Medicine. It has grown and grown
since then, putting forth leaves and branches and bearing much fruit, till it is a limb well
nigh as big as the original stem from which it grew.
This branch is Preventive Medicine, Public Health Medicine, what you will. The
dichotomy is becoming more marked, the divergence ever wider: and herein lies tragedy.
We tend to think of the therapeutic part of the profession as greatly the larger. But
the numbers of the other branch are growing steadily and the ratio of one to the other is
often a surprise. More and more men are becoming workers in public health, free government clinics, quarantine stations, mental hospitals, and so on. These men are all salaried—
all more or less separated from the practice of medicine as we usually use the term—all
attached more or less firmly to governmental bodies and all more or less under control of
some municipal, provincial or federal government department.
Figures obtained from a statistical study of the Saskatchewan profession in answer to
the Questionnaire on Health Insurance show that less than half the medical men in that
province are entirely independent of some sort of salaried work, and Dr. D. M. Baillie of
Victoria, in a communication soon to appear in the Bulletin, gives similarly surprising
figures.
We are accused, very often, of not paying sufficient attention to prevention of disease.
Those who say this seem to forget that one whole division of medicine is given up entirely
to the prevention of disease; viz., preventive medicine, public health, etc. The men doing
this work are doctors. Preventive medicine is not another profession: it is part of medicine.
The great names in Public Health, in leprosy, malaria, smallpox, typhoid, cholera, yellow
fever, are all names of medical men.
The achievements of these men are the achievements of medicine as a whole. We talk
a great deal of the necessity for preventive medicine. In discussing Health Insurance we
urged that Preventive Medicine must be a cardinal feature of any scheme introduced. Yet
we have not a member of the preventive medicine side, not a public health man, on the
Health Insurance Committee. How can we speak for the Public Health men? And how,
without them, can we make adequate provision for a preventive side? Here, again, we
must include both branches of the profession.
Preventive medicine is not our province. We tend to feel guilty—to feel that there
is truth in the charge laid against us, that we neglect prevention. But our job is treatment
mainly.
On the other hand, treatment is not the province of preventive medicine, of public
health. Yet there is a tendency on their part to encroach on tins—as there is also a tendency
on our part to encroach on prevention of disease.
There is only one remedy: for these two complementary parts to come together again
and form one organic whole—and let the public know that they must look to organised
medicine for all medical matters: not only therapeusis but prophylaxis.
If preventive medicine has tended to drift away from us, to become a function of
Page 208 government, to undertake duties not theirs, to become a threat to us, the fault is ours to a
great extent. I do not believe it is too late to remedy this.
We should, as an organization, call together representatives of both sides, and confer
freely, frankly, and fully. We must recognise the points of difference, the danger points
of further division, the dangers of the present situation.
Perhaps I have seemed over-critical. I do not mean to do this. We have accomplished
so much—our organised profession has done and is doing a tremendous amount. Take
Canada, for instance. Our Canadian Medical Association, severely handicapped as it is,
is still doing much good work. It is studying all sorts of economic matters: it is studying
hospital matters: its constant aim is towards improving our relations to one another and
to the public at large.
But we are, at present, only half a profession. If we are to have a real, effective, hundred per cent organisation, we must all be in it. We must have the preventive side with us:
and we must not merely be allied to them. Treaties are useless things; only organic union
can do what we want. What, then, is to be the remedy for all these ills? It is, I think, a
simple one, not beyond our grasp—but requiring the utmost honesty and sincerity to
apply. It is a fuller attainment of unity amongst ourselves. We have already made a
start. Medical organisation, has made great strides in the past two or three decades—
medicine is becoming conscious of its strength, and the potentialities for leadership that
are its own. But we have not by any means yet reached our goal: nor will it be an easy
and unobstructed path that leads to that goal.  t(Non sine pulvere"
Medical organisation has done much: British Columbia's experience has shown what
power there is in adequate organisation—and we do not yet know what the end will be;
Canadian Medical organisation is slowly but surely beginning to take shape—and there is
every room for hope and confidence. But unity as a profession is not yet ours. St. James
the Apostle, in a shrewd and biting phrase, exposes our weakness, "Whence come wars and
fightings among you: is it not the lusts that war amongst your members?" and we have a
higher authority for our argument in the words of St. James' Master, "A house divided
against itself cannot stand."
Medicine is one: not two. There is no room, no need, for divided loyalties. Medicine
is not alone an art. If it were, therapeutic medicine would be supreme. Nor is it alone a
science: else preventive medicine, public health, would rule unchallenged. But medicine
is both an art and a science: the two interwoven and inseparable—complementary and
indispensable to each other. Our art, of treatment, of healing, is merely wasted effort
without the science, the steady progress of research and inquiry of testing and experimenting, on which we draw constantly for our daily bread. Their efforts to eradicate disease,
to find and keep health for their public, are constantly hampered and thwarted by the
mass of illness and disease which we alone can treat.
Our enemies are theirs: our fate is inextricably bound up with that of our sister, preventive medicine.  We must unite and be at one.
Union will not be very easy to achieve, perhaps, but there should be no insuperable
difficulties. We have a strong central organisation, representative, impersonal, possessing
the necessary machinery. We have a General Secretary whose tireless efficiency has done
much, perhaps most, to bring about the present degree of organisation. We need more
full-time men, perhaps, to do the organisation work: we can afford them, let us have them.
At all costs we must strengthen, widen, deepen our organisation and our unity. Then, for
every problem that arises, we shall have expert knowledge to bring to bear on it: there
will be no conflict of interest or division of opinion.
Take our Canadian Medical Jottrnal. Number after number, volume after volume, it
is given up almost entirely to therapeutic medicine. There is no intent to ignore public
health, preventive medicine: but the journal is conducted chiefly, if not entirely, by men
from the therapeutic side. Publicity, public education, Health Leagues, preventive work,
public health, are all conspicuous by their absence. Look at ourselves. The address by Dr.
Stewart Murray, our Medical Health Officer, on the Health of the City, was a gallant
and a most praiseworthy gesture of friendship and co-operation. It was also the first
attempt of its sort ever made before the Vancouver Medical Association as far as I can
remember.  Yet I wonder if we gave it the attention we should: or if some of us do not
Page 209 think that Dr. Murray is just another good man gone wrong, since he gave up therapeutic
medicine and went preventive.
We have talked for years of things we should do. We have said, and had it said to us,
for instance, that our system of medical evidence is all wrong: that it is out of date, subversive, very clumsy, often calculated to impede rather than aid the work of justice, that
it puts us in a bad light. Yet what have we done about it? Nothing. Nor can we as individuals do anything about it: nor can any provincial association change it. If there is to
be change, it must come about through consultation between the officers of the legal
department of Canada and the representatives of our whole profession.
We must take cognisance, too, of another factor in the layman's attitude towards us.
He considers that we do not sufficiently recognise the good that is done and can be done
by our imitators and would-be substitutes: the chiropractor, the physiotherapist, the diet
specialist and the like.
There is no doubt that we are to some extent to blame in our wholesale condemnation
of these things. They are not wholly bad. To quote Carlyle once more: "Some speculators
have a short way of accounting for the Pagan religion . . . and all other isms by which
man has ever for a length of time striven to walk in this world. Mere quackery, priestcraft
and dupery, they say: no sane man would ever believe it—merely contrive to persuade
other men, not worthy of the name of sane, to believe it. They have all had a truth in them,
or men would not have taken them up."
And we must remember that we owe many of our greatest discoveries to men who
were not medically-trained. Take x-rays, antiseptics, the microscope: we did not discover
these: yet we could not do without them.
With regard to chiropractic. When, some years ago, Dr. Whitnall of McGill was out
here as witness before a Royal Commission on Chiropractic, he told me in conversation
that there was no doubt there was certain truth in the philosophy of chiropractic. He
said "They had something." He did not at the time tell me what it was. He had other
plans then for working it out fully and publishing later—but so far I do not think he has.
This is a pity, I think. Bacon, in one of his essays, says "Surely there is no better way to
stop the rising of new sects and schisms than to reform abuses: to compound the smaller
differences, to proceed mildly and not with sanguinary persecutions: and rather to take
off the principal authors by winning and advancing them, than to enrage them by violence
and bitterness."
Many of you must have read The Citadel, that book written by a doctor, rather savage
in parts in its attack on our weaknesses, but a wholesome medicine nevertheless, if we
make a right use of it. In this book, the hero, Dr. Andrew Manson, is charged with
infamous conduct because he has sent a patient suffering from T.B. to the only man
who possessed the knowledge and skilli necessary to heal her. But this man was a layman,
not an ordained minister of the mysteries of the Aesculapian deity. He was, worse, an
American.  So Manson was guilty of infamous conduct.  Read the book—read his defense.
And you remember Barker, the bonesetter in England, the the long history of his fight
for recognition.  Not very creditable to us.
My suggestion for this is that our national association should institute a Research Bureau
which would dispassionately examine all these things and try them out. Then we could
speak with knowledge and authority and not merely from resentment and distrust. Then
we could extract the good from these, and reject the residue of ignorance and charlatanism.
What are our faults in this matter? Are we to blame for the lack of unity in our profession?  And what can we do about it?
I am speaking to men, the vast majority of whom, like myself, are engaged in therapeutic medicine. Our work takes up most of our time and energy: naturally one is apt to
concentrate on the therapeutic side.
I have tried to show some of the problems that confront us: I have stated that, in my
opinion, the first thing we have to do is to secure organic, union of our whole profession.
We must cease to talk of therapeutic medicine and preventive medicine and talk of
Medicine, with a capital M.
What are the dangers of our failing to secure unity? I see several, and these serious
ones.  There is a constant pressure on governments, public health departments, hospitals,
Page 210 by a large section of the public, to secure free medical treatment. That the reason for this
is chiefly economic does not alter the fact. Hospitals in many places are selling hospital
insurance on a group plan. They are being besieged to provide medical aid too. Some
centres are at least toying with this idea.
Where can they get doctors to do this work?  Can they get them?
We talk unity—but so far, we have only envisaged unity in the therapeutic end—we
do not seem to have even contemplated complete unity.
The men engaged in public health and preventive work are doctors like ourselves. They
have, we all know, every bit as much loyalty to our ideals as we have: they want to work
with us, they have offered to do so, they are ready to do so. If we keep on; ignoring this
readiness, if we persist in our isolationist policy, I foresee certain dangers—dangers in our
attitude, and which may arise if we do not really unify ourselves.
1. Public Health men will cease to try to work with us.
2. They will be forced by official and public pressure more and more to encroach on
treatment.
3. Our efforts to secure adequate payment, proper recognition, will be only half-
efficient, since we shall not have the support and adherence of many of our men.
4. They will constitute a threat, since they can be forced to do work. So our ground
will be perpetually knocked from under our feet.
5. Free clinics, free treatment will increase. If we won't do it, they will have to. The
public will not pay for it unless they are compelled to do so.
6. They can be used to force us to accept unfair schemes of health insurance, etc.
They can be used to man hospital staffs.
7. They need our support and help as much as we need theirs, to enable them to be
protected: to secure for them better treatment than they now have: to raise their standards
of salary, etc.
8. Only by a complete unification of our profession can we avoid these dangers.
We must, as a preliminary to union, honestly examine the points on which we are perhaps at variance with the attitude of the man engaged in preventive and public health
work. As a result of our indifferencd in this regard, there can be no disguising the fact
that the relations of these two sections have developed points of strain. If we do not recognise these and deal with them, a serious divergence of policy and of interest may result.
This would be a real tragedy—and must be averted.
I should like briefly to run through some few of these points, as one sees them arising.
Public Health activities—Toxoid, vaccination, and so on. Well-baby clinics. How
far should these go? Should they be merely diagnostic? Who should receive free treatment?  How far should treatment go?
We hope some day to have recognition of our claims to remuneration for care of the
indigent. Meantime a well-rooted, well-organised system of clinics is growing up and
becoming extremely efficient.
We must distinguish here between the various types of free clinic. First, the one
where the medical staff is paid, e.g., T.B., V.D., etc. With the latter I personally have little
or no quarrel—provided adequate safeguards are placed around the selection of cases
accepted. Under our'present system, private treatment of the very great majority of these
patients is out of the question.
With regard to the other free clinics, however, I thoroughly disagree. Either a staff
of salaried medical men should do the work, under rigid selection of beneficiaries according
to income, or the work should be thrown open to all medical men and paid for, at least on
a relief basis. This, however, is not the place nor the time to discuss this. What I am concerned with is the fact that the foundations are being laid for a vast system of free medical
care. At present we provide this. If we object or refuse, does this mean that this is going
to stop? I think not. Those responsible will look about for other doctors, and there is only
one place to find them: the ranks of the salaried men.
The modern clinic, too, for the indigent is becoming a most complex affair. It is not
merely a diagnostic centre, in the sense of diagnosing physical disease. The workers in it
have found that to get any results they must include a great deal of other work—social
investigation, inquiry into family conditions and family problems, financial and other
Page 211 aid, vocational guidance, psychiatric investigations: these must all be taken into consideration. All this can not be provided, they say, on the basis of a private physician,
except at a staggering cost. They can, they tell us, provide medical service at a quarter
the cost of private medical care.
Is this true? and how is this cheapness secured? Is it merely by mass production? or is
it done by exploitation or underpayment of medical men? or by pressing into service the
hard-worked and underpaid member of the public health staffs, municipal or provincial?
Again, how far can doctors in practice be made use of in public health work? It is
done in some places—it was suggested by Dr. G. F. Amyot some years ago, and I think it
should be done; but the medical profession will need education on this subject—and their
co-operation is not altogether easy to secure—but it should be and can be obtained.
Only by joint action through a single organisation can all these questions and many
others be satisfactorily answered. Meantime, public needs and public demands make a
solution imperative.
Our Faults in This Matter.
First, we on the therapeutic side display a lamentable ignorance of public health objectives. Many of our members are health-minded—we find this especially in certain branches,
for example, the paediatricians—but as a whole we neither know nor care much about
modern public health methods, the social needs that make these necessary, and we, somewhat naturally in view of our ignorance, tend to regard all these things either with the
eye of Gallio, who cared for none of them, or with the more positive eye of suspicion.
We tend to suspect that these men are infringing on our rights taking away our work,
and so on. Nothing could be farther from the truth. Careful observations in Great
Britain, made by the British Medical Association, showed beyond doubt that the private
practitioner profits immeasurably by the efforts of the social worker, the public health
nurse, the school nurse, etc., who ferret out early conditions requiring medical care, which
otherwise would not be discovered till they had reached pathological proportions.
Even from our perhaps interested point of view this is an excellent thing. But from
the much more important view of public welfare, it is even more vital and necessary.
We should give our utmost support to such work. We need not fear that the public
health worker wants to encroach on our rights of treatment; far from it—he is always
trying to turn this over to us. We see that again and again: only if they are forced by our
apathy and unwillingness to undertake it will they do therapeutic work. For the work
must be done.
Modern social awareness: modern knowledge of public health needs and the potentialities of preventive medicine: all these things demand a change and new methods.
Can we supply these needs? By working together with our sister, Preventive Medicine
and Public Health, we most assuredly can.
We need closer contact with this branch: by conferences, by lectures, by constant
intercourse, we can help each other incalculably.
We must once and for all abandon our attitude of aloofness and unwillingness to work
with these colleagues of ours Over and over again they have shown their willingness and
anxiety to co-operate. If we do not find a modus vivendi, it will not be long before they
are in the saddle and then we shall be in the ditch.
No single man, nor small local group of men, can accomplish these things. It must
be the function of organised medicine. It is for the leaders of the profession to consider
dispassionately and in full detail the ways in which our house should be put in order. It is
for organised medicine as a whole to undertake any educational programme, to conduct
researches, etc.
It is for organised medicine to close the gap between the forces of prevention and the
forces of therapeusis: and to weld us together.
We go on saying, over and over, that it is for us to take these steps, not to wait till
they are forced on us. The history of the experience of the profession in other parts of
the world should surely be a lesson to us in this. Nor is it any good our blaming governments and those charged with the conduct of the public affairs. Pressure of public opinion,
of definite public needs, forces them to act, and if we cannot anticipate them, and guide
Page 212 action in the way we feel it should go, so much the worse for us, and the fault is ours, not
theirs. In undertaking the solution of these problems, we are going to need all our best
minds. The leadership must not be left entirely to the older and perhaps more conservative
members of the profession: nor is it entirely a matter for the energy and enthusiasm of
youth. "Si la vieillesse pouvait, si li jeunesse savait" is the negative side of the attitude
we should adopt. It should be "La vieillesse sait, la jeunesse peut." We need the experience
and judgment and patience of the older man, we need the keenness and determination of
the younger man.  And. we can get them, and combine them.
What do I urge? What would be my suggestions as to what we should do?
First, I think the Canadian Medical Association should take control and do) what has
to be done. It represents us all: it has no personal or provincial axes to grind: it has the
money and the machinery—and the time for study, research, and organisation.
We might, as a division of the C.M.A., take the initiative in suggesting to our parent
organisation the necessity for improvement and change.
A conference of both branches of medicine, the therapeutic and preventive, should be
held, and a basis for more complete union laid. Provision should be made for suitable space
in the Journal: the questions of publicity and education of the public! should be discussed,
and these duties allocated to those best qualified to undertake them. The whole question
of co-operation between the two branches in clinics, schoolwork, public health work, preventive medicine, periodic health examinations, should be canvassed thoroughly.
A special Committee of Economic Research should be set up. This committee should
be under the leadership of a paid secretary. Its duties would be very extensive. They
should include study of some of the problems I have touched on: e.g.:
Topics affecting the practice of medicine;
Group practice;
Payment of staffs in hospitals;
Relation of hospital practice to externe practice as regards the indigent, wards of the
government, etc.;
The employment of the new graduate;
The payment of the practitioner of medicine for public health work, for any preventive work he may do;
The question of cults and irregular practitioners: physiotherapy, dietetics, and so on,
The profession should be kept fully informed of these studies by bulletins, etc.
These and many other cognate subjects would fall within the purview of this Committee.
If it is true, as I think most of us will admit, that one of the greatest causes of trouble
is the economic factor, then medical economics should be by far the most important subject we have to deal with. Yet this whole subject is relegated to a committee which is hamstrung by geography, by inaccessibility of membership, by the time drag, and so on:
though undoubtedly this year, under Dr. Wilson's leadership, the work of the committee
has been done better than ever before. Looking at this from the inside, one can see how
hopeless purely voluntary work like this must be. We need professional assistance: actuarial experts, economists, and so on. We need machinery to educate our own men: to
ensure immediate access and quick registration of opinion: intensive study of economic
problems.   Solution of these would go far to solve all our problems.
But the first and most important immediate thing is the achievement of unity amongst
ourselves. This is not to say that the therapeutic and preventive branches are to interfere
with each other's work: far from it; they are to supplerrient each other's activities, keep
informed about each other, maintain a constant interaction of activities.
For instance, I should like to see in Vancouver, in Victoria, and elsewhere, a definite
recognition by the numerically larger group of therapeutic physicians of their partners,
the public health and preventive group. The V.M.A. might have on its executive a representative of the Metropolitan Health Bureau. At least one evening a year should be given
up to public health—our relation to it, and so on. Why should not a member of this
group be President of the Association some day?
The B. C. Medical Association similarly might have full representation. In recent
annual meetings of the B.C.M.A., our Executive Secretary, Dr. Thomas, has inaugurated
Page 213 meetings of the preventive and public health members of the profession, to discuss matters
pertaining to public health.   This is altogether admirable.
And in this, and many other ways, we can work towards a real unity, with suitable
autonomy of the component parts. We must inaugurate the change from the individualistic attitude, which has so long been ours, which has served an honourable turn, which
was inevitable in its time, but which is now threatening our prosperity, our efficiency, our
very existence. For make no mistake, ladies and gentlemen, a change is coming. We should
be the ones to make the change, to realise the need for it, to determine its nature, to act
honestly and above all to act quickly. As I see it, we can only do this through a really
united organisation. In the words of a statesman whose name I have forgotten, "We must
hang together, or we shall hang separately." We hear the expression, "The handwriting
is on the wall." We must not wait for that. When the handwriting appeared it was
already too late. The phrase used was "Thou art weighed in the balance, and found
wanting." That was the verdict; the only thing left was the sentence.
So we have three objectives which will make atonement for the past, and by a thorough
examination of the present do much to secure the future.
First, we must attain unity. But not alone for our own protection. We are not a labour
union: nor a medical Trust. It must be for the sake of a constructive policy toward the
community: in order that we ourselves may know where we are. We have no unity, though
gallant attempts have been made in this direction: but if you want to realise the facts,
fallow the course of a questionnaire sent to the various provincial executives, let us say
by the Committee on Economics, touching the matter of Health Insurance. Some are
keen, and au fait with reality. Some are quite uninterested: and cannot see what Health
Insurance could have to do with them. Others are very much interested—but do not talk
the same language as we do—they do not mean what we mean by Health Insurance. What
is needed is a liaison officer, who can go around the country and obtain and impart information. I cannot see any hope in the old, time-wasting, years-consuming method. Our
general secretary, energetic and capable as he is, cannot dcJ it all, and this Sisyphean task
of ever rolling the stone up a hill, down which it ever slides back, must be abandoned.
Our next task must be to make a complete, searching, honest survey of the whole
medical set-up in Canada. Whether this has been done elsewhere I do not know, but we in
Canada are used to pioneering. It will take time, it will take money, it will take personnel,
energy and brains. But as far as I can see it is the shortest way in the end. It means establishing a sort of Research Bureau, centralised in Ottawa or Montreal1 or Toronto, with a
personnel containing a paid secretary or secretaries, actuaries, economists. The secretaries
should be medical men with some knowledge of the practice of medicine. They should
include questions such as group practice, clinics, hospital and otherwise, the establishment
of the young graduate, payment of staffs, hospital insurance, contract practice.
They should investigate the question of medical evidence, of insurance certificates,
death certificates.
This bureau should be prepared to investigate and report on such things as chiropractic,
physiotherapists, dieticians, cancer cures, and so on.
The question of public education should be linked up with their work. In some such
way as this we shall achieve not only unity, but, more important, leadership. We shall
thus win our way back to the confidence of the layman. He will know that he is dealing
with a united profession, that knows his problems, has studied them and is prepared to help
him solve them. He will know- where to go for accurate information on vital subjects.
He will realise that we are not entirely selfish or self-seeking, but really desirous of mitigating suffering and economic loss, and preventing disease: and in turn he will be willing
to meet us half way and appreciate our difficulties. He will see that we are not tied by
tradition and ritual, as he now thinks that we are, but that we are open to conviction and
amenable to persuasion. He will then, and only then, be willing to concede to us the right
to lead and advise in the matters in which we are expert, and of which we know more than
anyone else.
No, it is not too late. We are charged, ladies and gentlemen, with great responsibility,
for great privileges are ours. We are the custodians of the public health.  Whether we like
Page 214 it or not, whether the layman likes it or not, his health, his future, his present, are in our
hands for weal or woe. If he is frightened and resentful he is not to blame: it is our duty
to find out the cause for these things and remove it. We are the shepherds, and a good
shepherd safeguards his flock—he leads and guides them: he does not expect them to direct
him. We cannot be static: we cannot rest on our laurels. It is for us to review the past,
to survey the present, and to determine the future—honestly, unselfishly, and untiringly:
till we regain the confidence and trust of those whose welfare is in our hands. In the lovely
words of Matthew Arnold:
Go, for they call you, shepherd, from the hill,
Go, shepherd, and untie the wattled cotes.
No longer leave thy wistful flock unfed
Nor let thy bawling fellows rack their throats,
But when the fields are still,
And the tired men and dogs are gone to rest,
And only the white sheep are sometimes seen
Cross and recross the strips of moon-blanched green—
Come, shepherd, and again begin thy quest.
British  Columbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President Dr. D. E. H. Cleveland, Vancouver.
First Vice-President Dr. F. M. Auld, Nelson.
Second Vice-President Dr. E. Murray Blair, Vancouver.
Honorary Secretary-Treasurer Dr. A. H. Spohn, Vancouver.
Immediate Past President Dr. Gordon C. Kenning, Victoria.
Executive Secretary Dr. M. W". Thomas, Vancouver.
The Committee on Maternal Welfare, under the Chairmanship of Dr. C. T. Hilton of
Port Alberni, is province-wide in its composition.
The Nucleus Committee was met by Dr. Hilton on March 8 th, and it was decided to
discuss with the remainder of the Committee the development of a plan whereby the
Public Health Nurse would be used to a greater extent in the pre-natal work.
*J* $r *}? *£•
The Committee on Hospital Service, under the chairmanship of Dr. Walter S. Turn-
bull, is a new activity in our provincial association. The nucleus of this Committee had
an informal meeting with Dr. Harvey Agnew of the Department of Hospital Service of
the Canadian Medical Association, during his recent visit.
This Committee is being developed with a province-wide membership and it is hoped
that many problems which are bound to arise in connection with our hospital work will
be attacked in co-operation with those men in practice who are intimately associated with
these institutions. Hospital service vitally1 affects the profession.
The Committee on Pharmacy, of which Dr. C. H. Vrooman is Chairman, met on
March 14th with the President, Secretary and two Councillors of the Pharmaceutical
Association of British Columbia and discussed the necessity and advisability of developing
a Formulary for use in British Columbia. This matter is to be considered further by the
Committee and recommendations will be made to the Board of Directors bearing on this
question.
Page 215 The regular meeting of the Board of Directors of the British Columbia Medical Association (Canadian Medical Association, British Columbia Division) was held on Wednesday, March 8 th, following dinner at the Hotel Georgia.
The following were present: Dr. D. E. H. Cleveland, President and Chairman of the
Board of Directors; Doctors: F. M. Auld, Nelson; W. E. Ainley, L. H. Appleby, M. McC.
Baird, E. Murray Blair; W. A. Clarke, New Westminster; G. H. Clement, P. A. C. Cousland, Victoria; W. A. Fraser, Victoria; A. C. Frost; C. T. Hilton, Port Alberni; Roy
Huggard; G. C. Kenning, Victoria; A. C. Nash, West Vancouver; F. R. G. Langston,
New Westminster; D. M. Meekison, H. H. Milburn, A. H. Spohn, M .W. Thomas and
Wallace Wilson.
The Board of Directors endorsed the action of the Greater Vancouver Health League
in laying the question of broadcasting all matters of strong provincial interest before the
proper authorities with a view to securing autonomy in such matters. A letter was directed
to the Executive Cornmittee of the Canadian Medical Association presenting the views of
the Board of Directors. The restriction exerted in a certain case has been discussed fully
by the Broadcasting Corporation and some assurance has been given that such interference
is not liable to occur again.
The members of the Provincial Association who confine their practice to the specialty
of Eye, and that of Ear, Nose and Throat, and also those who specialize in Paediatrics, presented applications for the formation of Scientific sections under By-law No. 12, in the
provincial organization. These applications were presented over the signatures of twenty
members of the Association and the Board of Directors approved the formation of an Eye,
Ear, Nose and Throat Section and also a section of Paediatrics.
A letter from Dr. Stewart Murray, Chief Medical Officer of the Metropolitan Health
Committee, asked that representation be appointed to the Medical Advisory Committee.
The names of Dr. D. E. H. Cleveland and Dr. Walter S. Baird were sent forward as the
choice of the Board of Directors. Dr. Stewart Murray has signified his intention of using
the Medical Advisory Committee more actively and has stated that he will summon its
members to a meeting in the near future.
"THIS CLINIC BUSINESS"
Whither B. C. Medicine?
D. M. Baillie, M.D.
This brief memorandum is an attempt to take stock of a situation which has interesting and far-reaching possibilities.
Of late years the Provincial Board of Health has encouraged and developed clinics for
the diagnosis and treatment of tuberculosis and venereal disease, especially in our larger
cities. It has in this way markedly encroached upon the "medical preserves" of the private
practitioner of medicine. At the same time we have to admit that it has tremendously
increased efficiency in the treatment, management and control of these conditions. The
Government, also, runs pre-natal, post-natal and psychiatric clinics and, of course, Essondale and Tranquille.
The next step is a drive against cancer, as evidenced by the establishment of the Cancer
Foundation in Vancouver and the projected organization of one, or possibly two, new
growth clinics at Victoria. These latter are not, as yet, under the asgis of the Government,
but very likely, as they develop, the Government will have to exercise some control in one
way or another.
Is it too much to suggest that before very long we shall be talking about cardiological
clinics, fracture clinics, rheumatism clinics, and so on?
Page 216 rr
It is important to realize that these developments do not arise of their own volition, but
as an answer to a fundamental need on the part of our people. It is well to realize, also,
that they are due to a fundamental lack or fault in our medical organization. In other
words "we aren't delivering the goods."
These clinics, we must remember, were established without the blessing of the bulk
of our profession. In some cases they were met with active hostility to begin with. Progress in Medicine has invariably met with this response.
They are at best compromises and the profession rather grudgingly acknowledges their
existence and place in the community. We look upon them as a menace to our economic
security and so, in some respects, at the present time they are. The doctors who work in
them are mostly on a part-time basis and all of them, whether wholly or part-time employed, are most inadequately paid. This condition is primarily, in my opinion, the fault
of the B. C. Medical Association, which, when boiled down, means you and me. We should
have insisted, from the beginning, that these Government. jobs (and this includes our
medical officers of health) should be adequately compensated to measure up to the responsibilities involved. It would have been much better if, from the beginning, we had insisted
on whole-time service with salaries equivalent to those of the judiciary. Why should a
well trained and efficient physician or public health man be rated at a lower level, (from
a salary point of view), than a judge?
When shall we realize that the profession of medicine is undergoing an economic revolution and that these things are the "clinical" signs thereof? State Medicine, which we
have been actively repelling in the front garden, has climbed over the back fence and taken
possession of the basement and part of the first floor. It is there "for keeps" and we have
been compromising with it without realizing what it really was. Not only that—it looks
like taking over the house room by room.
One half of the profession does not know how the other half lives. A rapid survey of
Victoria, for instance, reveals:
1. In active practice (including public health, clinics and private practitioners) are
sixty-three individuals—of these—
2. Thirty-six receive remuneration (in whole or part) from Federal, Provincial or
Municipal sources, directly or indirectly (as in the hospitals).   This works out to 57%.
3. Twelve work on a full-time basis—in public health, T.B. clinic and in the hospitals—19%.
I suppose these figures could be duplicated in other parts of the province, and indicate
that the old idea of robust individualism in Medicine is not what it's cracked up to be.
Look at it in another way.
Preventive medicine is pushing into territory which it claims as its own and bids fair
to be the dominant factor in the medical situation. It does its best work through clinics
and organizations of that kind. It finds itself in antagonism with orthodox, out-moded
Therapeutic Medicine, which has to readjust itself or die.
This is what is taking place, part readjusting, part dying and, finally, and I think
before very long, we shall witness the coalescence of Preventive and Therapeutic Medicine.
About this time we shall begin to realize that a revolution has taken place and the Art and
Science of Medicine will be on a very much higher plane than it is at present. We shall
begin to get results hitherto undreamt of.
What can we do about it at present?
1. Forget all about Health Insurance.
2. Accept the present Public Health and Clinic setup as a basis for the establishment
of a Provincial Medical Service.
3. Insist on full-time service in the Public Health and Clinic Services, with adequate
salaries.
4. Study more earnestly the possibilities of a complete Provincial Medical Service.
Page 217 Victoria
President   .
Medical  Society
Officers, 1938-39.
_.       .Dr. P. A. C. Cousland
Vice-President
  Dr. W. Allan Fraser
Hon. Secretary   .
    ..     Dr. W. H. Moore
Hon. Treasurer
_  Dr. C. A. Watson
THE SENSE OF TASTE
R. Scott-Moncrieff, M.D.
I fear that in dealing with the senses of taste and smell I am going to be somewhat
inconsistent in that I propose to take up the sense of taste in a rather general way, stressing the comparative anatomy and philogenesis, and then discuss from quite another point
of view the sense of smell and the work which has been done in this field in the past as well
as in the last few years.
Receptors such as the eye and the ear, the organs of smell and taste, and the more
diffuse sensory equipment of the skin are found in all the more complex animals. They
abound in the vertebrates, the molluscs, the arthropods and to a less extent in the worms.
They may be said to occur even among the jelly fishes, though in the majority of these
animals the receptors present a diffuse condition more like that seen in the vertebrate skin
than in the vertebrate eye or ear. This diffuse state seems to be characteristic of the simpler
sessile invertebrates. The more complex animals such as are capable of locomotion exhibit
almost invariably specialized types of organs.
Fig. 1.—Catfish. See text
In such animals as the jelly fishes there appear to be responses to two types of stimulus
in particular—to touch and to stimulation, such as is provided by the presence of food substances. The latter, which is generally referred to as the common chemical sense, represents
the beginnings from which the sense of taste in the higher types of animals have developed.
In jelly fish, coral animals and such this common chemical sense is distributed over the
greater part of their exposed surfaces. When we come to such species as the catfish, we
find that taste has developed as a separate entity, besides which there is found the common
chemical sense. In these types, taste is not limited, as it is in the higher vertebrates, to the
mucous membrane of the mouth, but has quite a wide distribution over the flanks. (Fig. 1.)
The common chemical sense, however, has retained its very extensive distribution over
Page 218 practically the whole of their exteriors, as in the invertebrates already referred to. It has
been shown that for most fishes and amphibians the whole outer surface is sensitive to
chemical substances of a mildly irritating nature. For instance, in the dog-fish the skin
is everywhere very sensitive to acids and alkalis, less so to salts and bitter substances, and
not at all to sugar solutions.
The form of nerve terminals that is concerned with the reception of chemical irritants
in the skin of vertebrates is well indicated in the catfish. If bait in the form of a piece of
meat is held close to its flank, such a fish will probably turn suddenly and snap it up. This
is not a surprising response, for the sides of these animals are well provided with taste buds.
They are also supplied with lateral line organs. Both of these sets of receptors may be
eliminated by cutting on the one hand the branch of the facial nerve that goes to the taste
buds of the side of the body, and on the other, the lateral line nerve that is distributed to
the lateral line organs of the same region. After recovery from such an operation, the fish
will no longer respond to the bait held near its flank, but the skinj of the region is still perfectly open to stimulation by sour, salt and alkaline solutions. As the only1 receptors' left
after the above operation are the free-nerve terminals of the spinal nerves, these terrninals
must be the receptors for the chemical irritants. This conclusion is perfectly in accord
with the fact that this type of nerve ending is the only one that occurs in many parts of
the skin of the dogfish, the foot of the frog, and the partly exposed mucous surfaces of the
higher vertebrates such as those of the mouth and nose, all of which are sensitive to
chemical stimulation. Moreover, when these endings are rendered inoperative by cutting
their nerve trunks, irritating substances are no longer effective.
As opposed to this type of receptor ending, organs of taste always involve specialized
end-organs, the taste buds.
The relation of the receptors for irritants to those for pain and for touch seems to be
clearly indicated by experiments in which exhaustion and narcotics have been used. If the
tail of an amphioxus is subjected to about twenty applications of weak nitric acid in fairly
rapid succession, the fish will cease to respond to this type of stimulus. It will, however,
continue to respond to the touch of a fine brush. The reverse procedure is also true. Similarly, the hind foot of a spinal frog, if treated with a 1 % solution of cocaine, will cease to
respond to pricking, scratching or pinching^ but will react vigorously to a salt solution.
The further application of the cocaine solution will eventually eliminate the response to
chemical stimulation also.
i
SW££T
Taste distribution on the tongue.
It is perhaps not often realized that this common chemical sense, which gives rise to the
curious feeling associated with the presence of vapours that irritate the eyes, nose, or even
the mouth, is definitely not related to touch, smell or taste and is certainly quite distinct
from pain. Pain can be easily separated from the common chemical sense by the use of
cocaine, and we are therefore justified in concluding that this chemical sense is a true sense
with an independent set of receptors and a sensation quality entirely its own.
Page 219 In man the organs of taste, the so-called taste buds, have been identified on the dorsum
of the tongue, excepting the mid-dorsal region, on both the anterior and posterior surfaces
of the epiglottis, on the inner surfaces of the arytenoid processes of the larynx, on the soft
palate above the uvula, on the anterior pillars of the fauces and on the posterior pharyngeal
wall. This is the usual adult distribution. In human embryos the distribution is much
wider still.
Except on the tongue, where they are almost invariably associated with certain kinds
of papillae, taste buds are found simply embedded in the mucosa. The human tongue possesses several classes of papillas, which from their form have been called conical, filiform,
fungiform, foliate and vallate. It is only the fungiform, foliate and vallate that carry
taste buds, and as is common to taste buds right up from the fishes to man, they penetrate
the whole thickness of the epithelium.
There are no separate gustatory nerves in the vertebrates as there are olfactory nerves
or optic nerves. Gustatory fibres from the taste bud terminals occur in three of the cranial
nerves, the lingual branch of the trigeminal, the glossopharyngeal, and the vagus, in that
order from before backwards.
The stimulus for taste is an aqueous solution of a great variety of substances. But
tastes, unlike odours, fall into four well defined classes: salt, sour, bitter and sweet. The
multitude of flavours and other sensations associated with our food are undoubtely mixed
in character, and involve touch, heat, cold, chemical stimulation and especially odour.
As regards the quality of tastes, some fairly definite conclusions have been reached.
The sour taste has been shown to be the response hydrogen ions. The sourness of all acids
is alike. The ultimate mode of action of these ions has not been solved.
Similarly it has been found that the recognition of a salt is dependent on the anions
present in the solution.
The bitter taste is characteristic of almost all alkaloids, and of certain unrelated substances such as the glucosides, ether, and some inorganic salts such as magnesium sulphate.
Several chemical radicals have been specified as the ultimate bitter stimulus, but the matter
is by no means settled. It is, however, primarily associated with organic compounds. The
sweet taste is likewise excited mostly by organic compounds. It centres round the alcohols
and especially the sugars, in much the same way that the bitter taste does about the alkaloids. What determines the sweet taste in the carbohydrates is much disputed. It apparently turns upon very slight differences—for instance dextro-aspargine is sweet and its
stereoisomer is quite tasteless.
When the reaction times of the four tastes are tested, it is found that their refractory
periods always bear the same relation to each other. Salt taste has the most rapid response,
then sweet, then sour and slowest bitter.
Part II—Olfaction—will be published in a later issue.
A PRESCRIPTION SERVICE . . •
Conducted in accord with the ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
McGi  &OiTmo
LIMITED V—f
FORT STREET (opp. Times)
Phone Garden 1196
VICTORIA, B. C.
Page 220 V
ancouver
enera
Hospita
Two Cases of Hysteria (Conversion Type)
Case I.—W. A. Dobson, M.D.
J. O.: This girl of 16 years was admitted to hospital under service of Dr. H. H.
Boucher, Orthopaedic surgeon, on August 20, 1938.
She complained of exquisite pain in left knee and was unable to extend the limb beyond
135 degrees at that joint. The condition came on during the previous night and rendered
the patient quite helpless.
Dr. Boucher, after careful examination, was under the impression that the more or less
disabling condition was of a functional rather than an organic nature and asked for a
psychiatric investigation and advice as to suitable treatment.
The girl was of average intelligence and obvoiusly very emotional. She gave a history
of several hospitalizations dating back to 1931, and it was noted that the admissions were,
from the first, mostly under orthopaedic services.
For some weeks prior to the most recent admission this girl was living happily with a
relative who, because of illness, has since given up her quarters, and consequently the girl
must now return to her own home. Investigation has disclosed crowded conditions there;
absence of essential plumbing; a stepmother of immature development, with whom the
patient clashes, and of whose discipline she has an obvious dread; and also a nervous,
erratic, although kindly disposed father.
When the patient retired on the night prior to the onset of her recent illness she was
much disturbed and rebellious over her future prospects; in the morning she had the painful contracture which, at least temporarily, solved her problem.
When she was seen by this department she was smiling and appeared to be .contented
in spite of the pain of which she frequently complained. Such a contented attitude often
suggests that the patient actually "enjoys her illness." The more correct interpretation
would be that, in contrast to the painful mental forebodings felt prior to the disability,
the unconscious conversion presented features less disturbing.
After the history and picture of the unfavourable home conditions had been obtained,
the process through which the illness had developed was explained to the patient. She was
able to appreciate the part her attitude had played in producing the morbid picture and
co-operated in a simple routine which cleared up the disability in a few days. When a
patient is in an open ward and subject to keen observation of the other children, a dramatic
sudden cure, while possible, does not give the chance to "save face" that is provided by
a "course of treatment" extending over a few days or longer.
The outlook in this case is uncertain. She is not naturally equipped to contend satisfactorily with adversity, and it is not unlikely that in the future, when again she becomes
involved in a severe depression, her emotional assets will be strained beyond her credits
and nature will likely have to provide her with a moratorium in the form of another
hysterical episode which will necessitate a fresh inquiry with the needed explanations and
suggestions.
It would be asking for trouble to insist on her return to an environment that is not
a healthy one and which she finds so undesirable. Something, is being done to eliminate
that unwholesome possibility.
Case II.—G. A. Davidson, M.D.
A. B.: A single, fairly well educated girl of 18 years, was admitted to the Vancouver
General Hospital for a period of ten days.
Her complaints were: Headaches and fainting spells. These had troubled her for a
period of several months. She was admitted in a wheelchair and at the time was weak,
faint and dizzy and complained of pressure over her eyes.
Temperature, pulse and respiration were normal and she weighed 112 pounds.
Page 221 Laboratory procedures showed: Urine, negative; Kahn, negative; blood count, normal;
B.M.R. —4%; stool, negative for amoeba and occult blood.
Some thirteen diagnoses were considered, but all were gradually eliminated except
epilepsy and psychoneurosis of hysterical type. The "collapsing" spells when seen were
not suggestive of epilepsy, so she was discharged with a diagnosis of psychoneurosis,
hysterical type, and asked to report to the Psychiatry Outpatient Department.
In a psychoneurosis, it can be assumed that one is dealing with a discouraged individual
who chooses this type of reaction as a way out of a difficult situation. One looks for
upsetting emotional factors and tries to get the patient to respond in a more adult manner
to the difficulties.
The family history showed that the father was psychotic and had been removed to a
mental hospital when the patient was nine years of age.
The mother was an irritable woman who, in the presence of the police matron, flew
into a rage, swore at the girl and tried to strike her. As she did so she told the girl that
she would soon be where her father was.
The description of the home life suggested that it probably upset the patient and that
it did not provide the sympathy and affection that the girl asked.
She was taken to the Y.W.C.A. and had only one spell there during a three weeks'
stay. When this occurred her room-mate drenched her and the spell quickly terminated.
As the girl had been having several spells daily while in the hospital, it was felt that the
decrease in number was satisfactory.
She was sent out to work, but the position was evidently not satisfactory and her spells
again became numerous. She was again removed to a more satisfactory environment with
a fairly good response.
Discussion: The removal of the breadwinner from the family when this girl was
young probably caused the mother a good deal of anxiety and economic insecurity. It is
probably not to be wondered at that she was irritable and difficult to live with at times.
The patient appears to have borne the brunt of this irritability and to have been
taunted on occasions with the possibility of "going crazy like her father."
The disagreeable home situation appears to have become intolerable to the patient and
it was probably (at least subconsciously) realized that illness would be a means of removing her from this situation.
Probably being the centre of the stage and the amount of attention received in the
hospital pleased the patient and showed her the value of her illness. One can easily understand that where there may normally be little attention and affection shown, that this
would be a pleasant experience to the individual (in spite of protests to the contrary).
For successful treatment one must educate the patient to understand herself. One
must suggest healthy emotional outlets and above all let her see the necessity of facing and
dealing satisfactorily with the situation at hand.
THE PROBLEM OF RHEUMATISM AND ARTHRITIS
A Review of American and English Literature, the Fifth Rheumatism Review, Parts
1 and 2, will be found in the Annals of Internal Medicine for January and February, 1939.
Page 222 Case   of   Hydronephrosis   and   Hydroureter;   Chronic   Pyelonephritis;  Chronic  Cystitis  with Diverticula of  Bladder;
Chronic Prostatitis (Non-Specific) ; Posterior
Urethral Strictures.
H. H. Milburn, M.D., and Earle R. Hall, M.D.
We wish to present the following case, not because it is uncommon, but to illustrate
the results of a common condition if left to pass unrecognized over a long period of time.
The symptoms in this instance have existed for twelve years, commencing when the
patient was twenty-six years of age, and illustrate the chain of events following bladder
obstruction plus infection of the urinary tract.
The patient, R. G., white, male, age 3 8, was admitted to St. Paul's Hospital with the
following history:
Previous illnesses, family history, were negative. Denies venereal disease. Has had
negative Kahn tests.
Complaints presented: (1) Pain in back; (2) pain in abdomen; (3) dysuria; (4)
nocturia.
Onset and Course: For the past twelve years he had had pain involving the right side
and radiating to the lower right quadrant of the abdomen. The pain was described as a
dull aching type and, at times, when it would become very severe it was also felt posteriorly
in the region of the right shoulder. At first the pain was present in attacks, and often
commencing in the right lumbar region, and, if severe, would usually radiate downward
to the lower abdominal quadrant on the right, and at times to the right inguinal region
and was also felt occasionally in the region of the right testis. For the first few years the pain
came on in spells, persisting only for a few days, and then he would have intervals of freedom extending over several months. The attacks of pain, however, have been progressively
worse and gradually becoming closer together. During the past six months he states that
pain has been of a steady nature. The onset of pain, at times, has been associated with
nausea and vomiting.
For the past ten or twelve years he has had burning with urination, this being felt along
the urethra and also at the bladder neck region during the passing of urine. This at times
would become very severe and was described as a stinging pain. For the first few years,
this burning was" present for a few days and then he would have freedom for several
months. This has been gradually becoming more consistent and present at some time
during the day for the past few months.
For the past twelve years he has had to pass urine at night—at least once, and occasionally twice. He states that there has never been any day frequency, except occasionally
he would pass urine about every two hours for a few times, but that he apparently has
had no difficulty in holding urine during the day.
One year ago he had swelling and pain involving both testes; this gradually subsided
with rest and heat, but ever since he has had, at times, pain in the region of the testes.
There has been no swelling of late.
Three years ago, during presence of pain in the abdominal region, he had appendectomy,
but states that following this he still had attacks of similar pain.
Upon admission to hospital, urine examination showed: S.G. 1010, neutral reaction,
albumin plus one, sugar none. Microscopic: Pus cells plus 1, bacteria plus 4. W.B.C.
16,200. N.P.N. 41 mg.
Abdominal examination disclosed some tenderness in the right portion, and with
bimanual palpation this was found to involve the right kidney region and this organ was
palpable, appearing to be enlarged.
Page 223 Twenty-four-hour urine specimens were examined for presence of TB, but these were
all reported negative.
Cystoscopy and Pyelography: St. Paul's Hospital: The cystoscope found a very tight
obstruction in the posterior urethra and sounds had to be passed before it would enter
the bladder cavity. These sounds disclosed some very tight strictures, which appeared
to be in the prostatic urethra. The bladder showed a large number of thick interlacing trabeculations involving all the walls with cellules intermingling, and numerous
openings of small diverticula involving the lateral and posterior walls. The trigone was
cedematous and congested and there was definite hypertrophy of the interureteric ligament. Both ureteral orifices were observed, and just above the left there appeared to be a
large diverticulum. At the bladder orifice there was no involvement of prostate. Catheters
passed up both ureteral orifices without obstruction. Urine was obtained from each kidney
and sent to the laboratory for culture and guinea pig inoculation. Three cc. of indigo-
carmine were injected intravenously. The dye appeared from the left kidney in 11 minutes
and from the right kidney in 15 minutes.
Report of Pyelography: Tremendous hydronephrosis of the right kidney with marked
hydroureter. The left pyelogram showed some degree of enlargement with dilatation of
pelvis and calices, also dilatation of the left ureter.
Urine report: Culture showed: Ureteral specimens, staphylococcus aureus haemolyticus.
Bladder specimen: Non-hasmolytic staphylococcus.
Rectal: Prostate was slightly enlarged, broadened in the upper region somewhat, vesicles appeared distended and thickened, prostate was firm with areas of varying density.
Prostatic fluid showed pus three plus and many large pus clumps. Stained showed:
Staphylococci and a large number of gram negative bacilli.
Progress while in hospital: Following cystoscopy he had a severe chill and his temperature rose to 104 degrees, dropping to normal the next day. A few days later, his temperature having been normal, he stated that he was passing urine much easier and there
was larger amount than before his admission to hospital, and apparently he has not had as
much pain. N.P.N. 23 mg. He received the following treatment: (1) Prostatic massage; (2) urethral dilatation; (3) hot sitz baths; (4) injections of mixed vaccine.
On subsequent urethral dilatations he would have slight chills and elevation of temperature, but this would always return to normal the following day.
Prostatic examinations showed presence of large amount of pus and pus clumps in the
strippings. Culture and staining of fluid showing colon bacilli and staphylococci. He was
also given preparation of ammonium mandelate directed against the presence of bacilli in
the urine. He was discharged for hospital approximately two months after his admission.
Previous to his discharge x-ray of teeth showed infection present and these were extracted.
Report of guinea-pig inoculation was negative for any evidence of TB.
At time of his hospital discharge he had had no elevation of temperature for several
weeks. He had gained weight and felt very much improved. He had no pain and was
passing urine without difficulty. He was advised to continue treatment following his
discharge from hospital.
Comment: This case exhibits every finding that can result from obstruction to the
outflow of urine from the bladder, and these are similar findings to those found in men
with bladder obstruction resulting from prostatic enlargement. In this instance the man
was young, being 3 8 years of age, but with a bladder showing damage to the same extent
as could be found in a 75-year-old man with prostatic obstruction. In this case the obstruction is not due to hyperplasia of the prostate as usually found in elderly men, but caused by
obstruction in the form of strictures within the posterior urethra. These strictures, no
doubt, resulted from non-specific infection of the prostate gland.
We feel that the presentation of this case is of value to illustrate the great extent of
complications and permanent damage to the urinary tract resulting from a relatively
simple-appearing condition—one that may produce any part of the results found here,
depending, of course, upon the degree of obstruction and time which it is allowed to exist.
Page 224 Pelvis Disease Following Subtotal Hysterectomy
Case Report.—Robert E. McKechnie II, M.D.
The case being presented is one in which a tubo-ovarian abscess, chronic cervicitis and
carcinoma of the stump of the cervix arose in a comparatively young woman subsequent
to a subtotal hysterectomy.
The patient was a healthy-looking white female, aged 36 years, and the mother of a
normal child. She had had one stillbirth and five induced abortions. In 1929 an appendectomy, csecopexy and subtotal hysterectomy were performed. The patient was well
after this, except for some vaginal discharge, until the onset of the present illness three
years ago. At that time she developed pain in the right sacro-iliac region radiating through
to th6 right lower quadrant of the abdomen. This pain was present for a week or so at a
time and recurred at two- or three-week intervals. During the previous eight weeks, however, the pain had been constantly present and situated in the right lower quadrant of
the abdomen. The pain was aggravated by lifting, stooping and sexual intercourse. About
four weeks ago the pain became intense and was then partially relieved by the sudden discharge per vaginam of some foul, blood-stained pus. Other than this blood there had been
no vaginal bleeding.
General physical examination, including fluoroscopy of* the heart and lungs, was
negative except for a tender mass in the right adenexal region and a chronic cystic endo-
cervicitis in the uterine stump. Urinalysis was negative. Haemoglobin 78%; red blood
cell count was 3,850,000; leukocytes 6,400 and the Kahn test was negative.
A diagnosis of a chronic tubo-ovarian abscess and cystic endocervicitis was made and
operation advised. This was done and an inflammatory mass involving the right tube and
ovary was removed along with the left tube and the cervical stump.
Pathological examination of the specimens revealed a chronic inflammatory condition
of the right tube and ovary, a chronic cystic cervicitis and an early carcinoma in the
cervical canal.
This case is of interest because it demonstrates three of the complications that may
arise subsequent to a subtotal abdominal hysterectomy. R. L. Pearse, of the Free Hospital
for Women in Brookline, Massachusetts, made a survey of 1040 cases of subtotal hysterectomies in reference to carcinoma of the cervical stump, five years after their operation.
He found that two cases had died of carcinoma of the cervix known to be present at
the time of operation; two had died of carcinoma of the cervix that had apparently been
present at the time of operation but unrecognized; eight (1%) of the 802 patients living
at the time of the study had developed carcinoma of the cervical stump;1 542 patients had
received no further treatment but 98 (18%) of these complained of a vaginal discharge.
Of the 260 (32.4%) remaining women, 37 had had the cervix cauterized; 85 had had a
trachelorrhapy; 121 had had an amputation of the cervix; 10 had polypi excised; 7 cervices
were cored out from above and 33 (12%) complained of discharge even after these secondary operations. In this paper no mention was made of complications arising in the
tubes and ovaries.
This study of disease of the cervix subsequent to subtotal hysterectomy made by
Pearse is only one of several made by responsible authors. Their figures all closely approximate each other, and serve to remind the surgeon that although the fudus of the uterus
has been removed, the tubes, ovaries and cervix are all still present and all potentially1 the
site of malignancy and disease. Judicious selection of the operative procedure employed
and careful follow-up to eliminate all disease in the remaining pelvic viscera are of prime
importance in preventing further trouble in a large number of cases subsequent to subtotal hysterectomy.
Reference: Pearse, R. L.: Supravaginal hysterectomy; statistical survey of 1900 cases with especial reference
to later development of carcinoma in the retained stump. Surg., Gyncec. & Obst., 58:845-851 (May),
1934.
Page 225 The British Columbia Branch of the Canadian Society for the Control of Cancer has
the following to report:
Fifty-seven units, with officers and executive committees, are actively functioning
at this date.
Units are established in forty-eight cities and towns, Vancouver accounting for nine
units.
A glance at the map will show the distribution in every corner of the Province.
In the order of their formation the following places have their units developed:
Salmon Arm
Nanaimo
Lillooet
Mayne Island
Invermere
Courtenay-Co mox
Salmo
North Vancouver
Sooke
Smithers
Kelowna
Michel
Shawnigan Lake
Ucluelet
Nelson
Port Alberni
Ganges
Sloe an
Grandview, Vancouver
Port Alice
Fairview, Vancouver
Pender Island
Hammond
loco
Revelstoke
Kitsilano, Vancouver
West Summerland
Chemainus
Chase
Trail
Penticton
Lytton
Dunbar, Vancouver
Alert Bay
Enderby
Haney
Stewart
Sidney
New Westminster
Nakusp
W. Point Grey, Vancouver
Vancouver Heights
Shaughnessy, Vancouver
Cumberland
West Vancouver
Marpole
Agassiz
Coquitlam
Britannia Mines
Britannia Beach
Queen Charlotte City
South Vancouver
Oliver
Cranbrook
Kamloops
Pender Harbour
Hazelton
A doctor in each community was asked to give leadership to initiate the local effort.
District Councils
Now that a fair number of units is established, it is proposed, by a convention of unit
representatives, to construct the District Executive Committees. Eventually, from the
District organizations, the Provincial Council will be set up at a convention of District
delegates.
Annual Meeting
It is hoped to hold the first Annual Meeting of the British Columbia Branch of the
Canadian Society for the Control of Cancer in September of this year.
Speakers
The Speakers' Bureau is meeting increasing demands daily for informative addresses at
luncheons, dinners, evening meetings, church groups, fraternal societies, men's and
women's organizations, service and veterans' clubs. The Women's Institutes and other
groups of women have been most helpful in the development of units and meetings. Well-
attended meetings have been held.
Page 226 HEALTH PLAN GROWTH SEEN
An American Hospital Association accountant at Cleveland recently predicted that
40,000,000 Americans will have guaranteed hospital and medical care by 1944 if doctors
agree to supplement the group hospital insurance plans now in effect in fifty-two cities.
The accountant was Dr. C. Rufus Rorem of Chicago, Director of the Committee on
Hospital Service of the American Hospital Association.
Approximately 3,000,000 persons were participating in the group hospital insurance
plans last January 1, Dr. Rorem said. This figure, he predicts, will increase to 12,000,000
by 1942 under the force of guaranteed hospital service alone, and would swell to 40,000,000
by 1944 if doctors agree to supply medical service under similar arrangements.
Plan Explained.—Under the hospital service plan, subscribers pay certain amounts of
money every month; some of these subscribers go to their local participating hospitals for
care; the plan then pays the hospitals for the care given, retaining a reserve for epidemics
and administration costs.
Heads of the various community plans were in Cleveland for a midwinter conference.
Their offiicals expressed hope physicians and surgeons soon will embrace the hospital plan
and provide medical care under a similar arrangement.
Frank Van Dyk, Director of the Associated Hospitals of New York, said Government
medical regulation is inevitable unless some such plan of group medical care is made nationwide by the medical profession itself.
"This programme is growing so fast doctors will be forced into it whether they like it
or not," he said. "If they 'strike,' the only alternative is Government control."
He said studies have shown such combined medical-hospital care could be provided in
New York for not more than $ 3 a month a family or $ 15 a year for an individual.
—Los Angeles Times.
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it has extended far beyond the original conception, but its primary importance for the sick
and the convalescent remains.
Ovaltine is a carefully balanced concentration
of fresh milk and eggs and a special barley malt
extract, lightly flavoured with cocoa. Stirred
into fresh milk, hot or cold, patients enjoy it. It
has a pleasant, appetizing flavour. It is quickly
and easily digested. It nourishes body, nerves
and brain. It stimulates natural appetite. It
helps restful sleep.
Clinical sample on request.
OV4LTINE
TONIC  FOOD  BEVERAGE
Manufactured by A. WANDER LIMITED,
Peterborough, Canada.
Also factories in Switzerland, England, France and
the United States.
Ovaltine Contains These Dietary Factors:
Proteins
and
Carbohydrates
Vitamin
A
Calcium
Vitamin
B
Phosphorus
Vitamin
D
Iron
Vitamin
G
flftount pleasant IHnbertakincj Co. %ti>.
KINGSWAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C.
R. F. HARRISON W. R. REYNOLDS OR young children and
infants who are often such
difficult patients, the use of
->= ~
is most serviceable.
Especially in such cases as Pneumonia, Bronchitis, and
Broncho-Pneumonia, where the least possible disturbance
of the little patient is desirable, only one application of
Antiphlogistine in 24-36 hours is often all that is necessary.
Sample and literature
on request
ID'S
Gross and microscopic
sections through trachea
and bronchi in acute
bronchitis, showing
early ulceration and exudation.
THE DENVER CHEMICAL MFG. COMPANY
163 VARICK STREET • NEW YORK CITY 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. 100 times cod liver oil* in vitamins A and D.
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 GREATER
ECONOMY,
the 50 cc. size 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.
* U.S.P. Minimum Standard
MEAD JOHNSON & CO. OF CANADA, LTD.
Belleville, Ont.
r
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.
// You Approve This Policy
Specify MEAD'S
iljlj^^
Reane enclose professional card when requesting samples of Mead Johnson products to cooperate in preventing their reaching unauthorized pere°ofl* Whenever  You   fhone
You'll Find Us  Ready!
Open day and night, Sundays and holidays—
ready to give you absolute accuracy, unvarying quality and prompt service.
Free City Delivery Until 12 P.M.
OMMAU
MIOMT
GEORGIA PHARMACY
LIMITED
SEymour
2263
W.OtOROlA
STRBIT
(&mt?t $c ijmma IGtiL
BttahlisM 1993
VANCOUVER, B. C.
North Vancouver, B. C.   Powell River, B. C. Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. 0. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
ROY WRIGLEY PRINTING ct$£^r>* PUBLISHING CO.  LTD.

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