History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: December, 1953 Vancouver Medical Association 1953

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 THE
ULLETI
OF |
The Vancouver Medical Association
EDITOR
DR. J. H. MacDERMOT
EDITORIAL BOARD
DR. D. E. H. CLEVELAND DR. J. H. B. GRANT
DR. H. A. DesBRISAY DR. J. L. McMILLAN
Publisher and Advertising Manager
W. E, G. MACDONALD
VOLUME XXX.
DECEMBER, 1953
NUMBER 3
OFFICERS 1953-54
Dr. D. S. Munroe
President
Dr. George Langley
Hon. Treasurer
Dr. J. H. Black
Vice-President
Dr. E. C. McCoy
Past President
Dr. F. S. Hobrs
Hon. Secretary
Additional Members of Executive:
Dr. R. A. Gilchrist Dr. A. F. Hardyment
TRUSTEES
Dr. G. H. Clement Dr. Murray Blair Dr. W. J. Dorrance
Auditors: R. H. N. Whiting, Chartered Accountant
SECTIONS
Eye, Ear, Nose and Throat
Dr. W. M. G. Wilson Chairman Dr. W. Ronald Taylor Secretary
Dr. J. H. B. Grant.
Paediatric
.Chairman Dr. A. F. Hardyment Secretary
Orthopaedic and Traumatic Surgery
Dr. W. H. Fahrni Chairman Dr. J. W. Sparkes Secretary
Neurology and Psychiatry
Dr. A. J. Warren Chairman Dr. T. G. B. Caunt Secretary
Radiology
Dr. W. L. Sloan Chairman Dr. L. W. B. Card  Secretary
STANDING COMMITTEES
Library
Dr. D. W. Moffat, Chairman; Dr. R. 3. Cowan, Secretary; Dr. W. F. Bie;
Dr. C. E. G. Gould ; Dr. W. C. Gibson ; Dr. M. D. Young.
Summer School
Dr. S. L. Williams, Chairman; Dr. J. A. Elliot, Secretary;
Dr. J. A. Irvine; Dr. E. A. Jones; Dr. Max Frost; Dr. E. F. Word
Medical Economics
Dr. E. A. Jones, Chairman; Dr. W. Fowler, Dr. F. W. Hurlburt, Dr. R. Langston,
Dr. Robert Stanley, Dr. F. B. Thomson, Dr. W. J. Dorrance
Credentials
Dr. Henry Scott, Dr. J. C. Grimson, Dr. E. C. McCoy.
V.O.N. Advisory Committee
Dr. Isabel Day, Dr. D. M. Whitelaw, Dr, R. Whitman
Representative to the Vancouver Board of Trade: Dr. J. Howard Black
Representative to the Greater Vancouver Health League: Dr. W. H. Cockcroft
-— ■ —
Published   monthly   at   Vancouver,  Canada.     Authorized   as   second   class   mail,   Post   Office   Department,
Ottawa, Ont.
Page 101 CANADA'S FIRST AND FOREMOST
PROFESSIONAL PHARMACY
Medical-Dental Bufldin^
*~Tree C^//u oDeliveru and. *jfree f-^rovinciatJ-^osta
r
Page 102 HOSPITAL CLINICS
VANCOUVER  GENERAL  HOSPITAL
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic
Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
Thursday, 9:00 a.m.—Medical Clinic.
12:00 noon—Clinicopathological Conference on Newborns.
Friday, 9:00 a.m.—Paediatric Clinic.
Saturday, 9:00 a.m.—Neurosurgery Clinic.
ST. PAUL'S   HOSPITAL
Regular Weekly Fixtures
2nd Monday of each month—2 p.m. Tumour Clinic
Tuesday—9-10 a.m. . Paediatric Conference
Wednesday—9-10 a.m. Medical Clinic
Wednesday—11-12 a.m : Obstetrics and Gynaecology Clinic
Alternate Wednesdays—12 noon—, Orthopaedic Clinic
Alernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion)
Friday—8  a.m. Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m. Surgical Conference
Friday—9 a.m Dr. Appleby's Surgery Clinic
Friday—11  a.m Interesting Films Shown in X-ray Department
SHAUGHNESSY  HOSPITAL
Regular Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology. Monday, 11:00 a.m.—Psychiatry.
Wednesday, 10:45 a.m.—General Medicine. Friday, 8:30 a.m.—Chest Conference.
Wednesday, 12:30 p.m.—Pathology. Friday, 1:15 p.m.—Surgery.
BRITISH  COLUMBIA  CANCER  INSTITUTE
2656 Heather Street
Vancouver 9, B.C.
SCHEDULE OF CLINICS—1953
MONDAY—9:00 a.m.-10:00 a.m.—Nose and Throat Clinic.
TUESDAY—9:00 a.m.-10:00 a.m.—Clinical Meeting.
10:30-12:00 noon—Lymphoma Clinic.
THURSDAY—11:00 a.m.-12:00 noon—Gynaecological Clinic.
DAILY—11:45 a.m.-12:45 p.m.—Therapy Conference.
Page 105 smaller size
eadi&ttbMvatffoat
small dosage
ottfy3ca/tkut£e*dcufy
Obelins
the new generously formulated
prenatal capsules
Containing 13 vitamins and minerals,
Obelins provide exceptionally complete
protection against vitamin and mineral deficiencies
during the stress period of pregnancy.
Added to the advantages of generous
formulation, Obelins' small, easy-to-swallow size
and small dosage of only 3 capsules daily
assure instant patient acceptance and continued
use throughout pregnancy.
Vitamin and Mineral Potencies
Nutrient
3 capsules
supply
Vitamin A
6000 I.U.
Vitamin D
600 I.U.
Ascorbic acid
100 mg.
Obelins
MEAD JOHNSON & CO. OF CANADA, LTD
Belleville, Ontario
Thiamine hydrochloride 3 mg.
Riboflavin „ 4.5 mg.
Niacinamide 30 mg.
Pyridoxine hydrochloride 1.2 mg.
Calcium pantothenate 6 mg.
Folic acid 2 mg.
Vitamin B„ (crystalline) 1 meg.
Iron (from ferrous sulfate) 22 mg.
Calcium 375 mg.
Phosphorus 188 mg.
Supplied: Bottles of 100.
Local Representative: RONALD TURNER, The Branches, Caledonia Avenue; Deep Cove 2261
Page 106 GREATER VANCOUVER PUBLIC HEALTH
Metropolitan Health Committee
Dr. Stewart Murray, Sr. Medical Health Officer, City Hall, Vancouver, B.C.
Population
(Estimated)
Vancouver   390,325
Burnaby Municipality  f  61,000
North Vancouver City  16,000
North Vancouver District Municipality  16,000
West Vancouver Municipality  14,250
Richmond     19,186
University Area  .  3,800
District Lot 172  1,469
TOTAL      522,030
SCHOOL HEALTH SERVICE
Public Health workers in school health services are carefully reviewing their
programmes in order to be sure that professional time is being utilized to the greatest
advantage in attaining the objective of the service.
A school health service was started in Vancouver schools in 1907, the third city
on the continent to institute such a programme. At the beginning the doctors' time
was occupied mainly with vaccination against smallpox. This primary function was
gradually replaced by examinations for defects to be corrected. Over the years the
concept of school health work has again changed from the mass screening of large
numbers of pupils to one of health education. This emphasis o*\ health education in no
way minimizes the importance of a medical examination to assess the total health of
the child, but rather utilizes it as a tool to educate the student and parent in ways of
more healthful living. The assessment of the total health of the child of necessity includes
an examination for physical defects and emotional difficulties which may affect his
ability to lead a full life in keeping with his capability.
In the Greater Vancouver area there are approximately 70,000 children in public
schools, and 3,200 in parochial schools. To accomplish the above type of programme for
73,200 children requires a large staff. The full time public health physicians and nurses
of the Metropolitan Health Committee carry on a generalized health programme with
assistance from part time medical staff in conducting the work in schools.
Besides these workers the staff of the Mental Health Division—two psychiatrists,
two social workers and two psychologists—work with the school doctors and nurses
in helping to correct the emotional problems of children.
Approximately 40% of the student body is examined by the school doctors each
year. The remainder of the students are inspected by the public health nurse who
refers to the doctor any child which she believes needs further examination.
People today are much more health minded than ever before and the schools are
playing an important part in creating and maintaining a positive attitude toward better
physical and mental health.
Page 107 { CONNAUGHT>
—FOR PROLONGED ACTION—
CORTICOTROPHIN <acth)
with
PROTAMINE  and  ZINC
Corticotrophin with Protamine and Zinc, for prolonged action and in a
form convenient for use, is now available from the Laboratories. The
product is prepared as a milky suspension in aqueous medium and is ready
for use after shaking. In clinical investigations, two injections per day
have been found to replace adequately four daily injections of regular
Corticotrophin (ACTH). In some cases even greater prolongation of effect
may be experienced.
Corticotrophin with Protamine and Zinc is prepared with ingredients
whose properties are of established value in parenteral administration.
The Connaught Medical Research Laboratories now provide Corticotrophin (ACTH) in three forms—a dried powder, a sterile solution, and
a suspension with prolonged-action properties.
HOW SUPPLIED
Dry Powder
—10 International Units per Vial
—25 International Units per Vial
Sterile Solution   —10-cc. vial (20 I.U. per cc.)
Prolonged-acting:
Suspension       —10-cc. vial (40 I.U. per cc.)
CONNAUGHT   MEDICAL   RESEARCH   LABORATORIES
University of Toronto Toronto, Canada
Established   in  1914  for Public Service  through  Medical  Research   end  the  derelopment
of Product* for Prevention or Treatment of Disease.
DEPOT FOR BRITISH COLUMBIA
MACDQNALD'S    PRESCRIPTIONS    LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C.
Page 108 To all its readers, the Bulletin extends its hearty good wishes for A Merry Christmas
iind Happy New Year. It does not seem a very long time since we first wrote 1953
pn prescriptions—or since we made out our Income Tax returns, which are again looming
over the horizon.
The coming year will be a most important one to the profession in British
Columbia—the wheel has come full circle and it is once more our turn to be hosts to
the Canadian Medical Association in June, under the leadership of its President, Dr.
G. F. Strong. A great deal of work is being done in preparation for the Convention,
and we need have no fear but what the 1954 Annual Meeting will be at least the equal
of any that have gone before. A hard working Committee of the B.C. Division,
headed by Dr. Frank Turnbull, is preparing an Entertainment Programme which will
take care of the social side of the affair—and will ensure to our lady visitors a happy
land memorable visit.
The last time B.C. was host to the C.M.A. was during the war, and it was impossible at that time to hold the meeting in Vancouver, so it was held at Banff. Thanks
to the courtesy and help of our Alberta colleagues, everything went off most successfully,
and certainly there could be no finer place for any convention. It is our memory that
we followed a convention of lumber, and logging magnates, and the sober and orderly
[medical profession afforded, we were given to understand, quite a contrast.
Nineteen hundred and fifty-four will bring other developments of interest to us.
The voters of Vancouver have endorsed a good many bylaws, all of them necessary—
none of them more so than the one which makes possible the building of an extension
to the Vancouver General Hospital, of 500 beds. While our personal opinion is that
other beds should be built elsewhere in the city, and built soon, we can only be glad
that at least this addition will be made to our sadly deficient hospital bed total.
Another of the new year's highlights, perhaps the brightest, will be the graduation
of the first group of medical men and women to bear the title M.D. (U.B.C.). The
work of the Faculty in the past four years, not to speak of the preparatory work of at
least two years more, has made it sure that this degree will be the equal of any in
Canada, and we shall all welcome with all our hearts, these newcomers into our profession. The rapid growth of British Columbia leaves us quite sure that they will all
be absorbed quite readily.
As will be seen from their announcement in this issue of the Bulletin, the B.C.
Division of the Canadian Academy of General Practitioners will start operations in
1954. Good luck to this Division, and all honour to the able leaders who have done so
much in this regard, and have, indeed, been the spark that activated the movement
throughout Canada.
So here's to 1954—and may its coming activities add to the health and prosperity
of all the people of British Columbia first, and Canada as a whole.
A telegram recently received by Dr. Gordon Ferguson, Executive Secretary of the
CM.A., B.C. Division, announced the fact that the Supreme Court of Saskatchewan had
annulled, or reversed (whatever the technical term is), the verdict of the lower Court,
of $7,000 against the College of Physicians and Surgeons of Saskatchewan, in the
suit brought by the heads of the Koch Treatment against the College. Every one
of us will rejoice at this, and we congratulate the Saskatchewan C.P. & S. and more
particularly Dr. Gordon Ferguson who, as their Registrar at the time cause for the
•nit was laid, was very deeply concerned. This decision of the Supreme Court of
Canada vindicates him, and will be to him a cause of deep satisfaction.
Page 109 Library Hours
Monday to Friday 9:00 a.m. to 9:00 p.m.
Saturday 9:00 a.m. to 1:00 p.m.
Recent Accessions
Year Book of General Surgery, edited by Evarts Graham, 1953-54.
A Symposium on Essential Hypertension by the Recess Commission on Hypertension!
of the Commonwealth of Massachusetts, 1951.
Infant Development by Arnold Gesell, 1952.
The Medical Clinics of North America—Three Year Cumulative Index, 1953.
William Cheselden by Zachary Cope, 1953.
The British Health Service by Derek H. Hene, 1953.
Pathology of Tumors by Willis, 2nd Edition, 1953.
Holt's Pediatrics, 12 th edition, 1953.
Textbook of Pathology by William Boyd, 6th edition, 1953.
Visual Anatomy—Thorax and Abdomen by Sidney M. Friedman, 1952.
The following journals will be added to the library's list of subscriptions in 1954:
Anaesthesia—Journal of the Association of Anaesthetists of Great Britain and Ireland.
The Southern Medical Journal—Alabama.
A Sure Test by Johannes de Mirfield (1362-1407)
"If there is any doubt as to whether a person is or is not dead, apply a lightly
roasted onion to his nostrils and if he be alive he will immediately scratch his
nose."
CANADIAN ARTHRITIS & RHEUMATISM SOCIETY
B. C. DIVISION
MEDICAL DIRECTOR WANTED
Applications are invited for the post of full-time Medical Director of
the B.C. Division of the Canadian Arthritis and Rheumatism Society,
effective July 1, 1954. Full information may be obtained in writing
from the undersigned. Applications are to be received before January
21, 1954.
(Miss) Mary Pack,
Executive Secretary, B.C. Division,
Canadian Arthritis & Rheumatism Society,
1093 West Broadway,
Vancouver 9, B.C. THE COLLEGE OF GENERAL PRACTICE OF CANADA
It is hoped that you will have read the article in the December issue of the Canadian Medical Association Journal announcing the preparations for the launching of the
College of General Practice of Canada.
To re-emphasize the main points:
a. After five years of earnest preparation, The College of General Practice of Canada
is soon to be brought into being.
b. This College is to be independent of the Canadian Medical Association and of the
Royal College of Physicians and Surgeons of Canada.
c. The aims and objects of this new College are primarily educational, designed to attain
high standards of practice. Matters economic and political will remain in the hands
of the medical associations.
d. It is recognized that the new graduate is not properly equipped to meet the multiplicity of problems presenting themselves in a general practice. It is also recognized
that it is necessary for the General Practitioner to continue a post-graduate educational program throughout his years of practice.
e. Realizing that early support of the College may rest in the hands of relatively few,
and that finances may present a problem, it is proposed to establish, early in 1954, a
Foundation fund, whereby those who may be interested, may support this forward
step in medical education.
f. The January issue of the C.M.A.J. should contain details, including the opening date
for the acceptance of membership applications.
Most of us will recognize this as a conscientious attempt by the general practitioners of Canada to take their place formally with other medical groups in helping
to mould the new pattern of practice—the pattern evolving a sufficient number of
specialists arrive in each field to do the less common and more difficult procedures
required of physicians.
This situation presents a new and often perplexing problem, and a vital challenge
to tht General Practitioner. A very few years ago he was THE DOCTOR. He took
each case as he found it and treated it to the best of his ability. He could feel for
the most part that he was as well equipped as any one else in the community. His
task was clear. Rather suddenly he has been confronted with a new responsibility, a
completely new type of responsibility, the responsibility for assessing his capabilities in
comparison with those of these somewhat mystic shrouded new comers, the responsibility for distinguishing those cases for which the available specialist has more to offer
than he has. This has been a tremendous problem for the individual and so far it has
been handled by the individual. Frequently he has been perplexed, and frequently he
has been resentful—this latter in particular when he has received direction from sources
whose judgment he did not respect. It is essential that he have an organization of his
own from which he can receive direction and support, and which will provide the
facilities to prepare him, and to permit him to continue his preparedness, to treat with
confidence those ailments of which he is capable. The challenge is that he treat them
well.
One might counter, "Certainly, we have these problems, but they are problems
for our organized medical societies and our medical schools. We do not need a new
organization." The answer to this is that the Canadian Medical Association has been
working on the problem for the past five years, and has decided that it should turn
the task over to this new College. The Royal College of Physicians and Surgeons was
formally approached, and though they were sympathetic and realized the importance
of this task to the whole of medicine, quite understandably they were not prepared to
take it on.
Opinions expressed by senior medical students and recent graduates bear out the
impression that medical schools are no longer completing the training of men who might
take on the task  nf treating the multitude of common and uncomplicated ills that
Page 111 plague mankind. Instead they have become matriculation schools, providing the
undifferentiated general training necessary for further progression in any field. Training
to the ultimate in these limited fields has been well organized by the various specialty
groups. So far the special training necessary to prepare for General Practice has been
lacking. It is just now that we are coming to realize that if such training is to be
adequately organized, we ourselves are the only ones with the experience, the inclination,
the time and the energy to do it.
The matter becomes urgent, in that if it is not done soon the supply of adequate
general practitioners will rapidly diminish to the point where even the common and
uncomplicated procedures will of necessity be done by men whose training might make
them feel that they were intended for more difficult tasks. The general practitioner
with a wide range of capabilities will disappear, and a completely new pattern of practice
of medicine will evolve. We believe that this is not in the best interest of either the
public or the profession.
I recently had the opportunity of discussing these matters with groups of rural
physicians. The reluctance of the new graduate to start practice in a rural community
became readily understandable. There are so many things especially in the surgical field
that he has not learned to do. He has several possible courses of action: As an assistant,
partner or friend, he may apprentice with one of the older doctors; or he may refer a
great deal of his practice to men with whom he is in direct competition, an untenable
situation; or he may go bull-headedly ahead and attempt things for which he has
had insufficient training, trusting to his ability, his judgment and his good luck, until
he has mastered sufficient skill to revive his confidence. Few are capable of the latter.
The alternatives are to set up practice in the protected environment of the city, where
his limitations are not so apparent; or to continue in a teaching centre progressing
towards a specialty. To the correction of this situation will our new college be dedicated.
The crux of these several problems is fairly obvious. There has in very recent years
been a tremendous increase in the sum total of medical knowledge and techniques. It
has become impossible for any one individual to master more than a fraction. In
teaching centres, teachers and students have divided themselves into groups, each
pursuing a limited field to the ultimate. Each group has found its vocational time
and energy completely occupied with its task. The graduate from medical school
has continued to be thought of as a trained general practitioner, but gradually mdre
and more of the practical training has given way to the increasing mass of theory.
The practical aspects have been left for a hypothetical post-graduate training which
no one has provided. No one has taken on the task of assimilating from each of the
specialties those things which the General Practitioner might well be expected to do,
and of providing the facilities whereby he might learn how to do them.
These tilings have long been recognized. It was in 1844 that the first attempt was
made to form a College of General Practice in Britain. As you are aware, our cousins
to the south have their Academy of General Practice. Here in British Columbia we
have been actively engaged in discussing these problems for the past five or six years
and have arrived at the point where we are prepared to form our Academy of General
Practice at the meeting of the Section of General Practice of the B.C.M.A. at Harrison
Hot Springs next March 18-20. It is anticipated that this Academy will in effect
become a chapter of the College of General Practice of Canada. Certainly all of you
who might be interested should be at Harrison on those dates, prepared to give freely
of your ideas, your time and your energy; and when the application forms are available
for membership in the College of General Practice of Canada, fill one out.
FOR SALE
Nucleus of a general practice in New Westminster
Phone N.W. 960
Page 112 CANADIAN   MEDICAL   ASSOCIATION
BRITISH   COLUMBIA   DIVISION
1807 West 10th Ave., Vancouver, B.C.      Dr. G. Gordon Ferguson, Exec. Secy
OFFICERS 1953-1954
President—Dr. R. G. Large Prince Rupert
President-Elect—Dr. F. A. Turnbull Vancouver
Immediate Past President—Or. J. A. Ganshorn ! Vancouver
Chairman of General Assembly—Dr. G. C. Johnston Vancouver
Hon. Secretary-Treasurer—Dr. J. A. Sinclair New Westminster
PRINCIPAL DELEGATES TO  THE  BOARD OF  DIRECTORS
Victoria
Dr. J.
Dr. E.
F. Tysoe
W. Boak
Nanaimo
Dr. C. C. Browne
Prince Rupert and Cariboo
Dr. J. G.  MacArthur
New Westminster
Dr. J. F. Sparling
Dr.  D. G.  B. Mathias
Kootenay
Dr. S. C. Robinson
Yale
Dr. A. S. Underhill
Vancouver
Dr. Ross Robertson
Dr. R. A. Gilchrist
Dr. J. Ross Davidson
Dr. R. A. Palmer
Dr. A. W. Bagnall
Dr. P. O. Lehmann
Dr. Roger Wilson
Chairmen of Standing Committees
Constitution and By-laws Dr. Carson Graham, North Vancouver
Finance Dr. J.  A.  Sinclair,   New Westminster
Legislation Dr. J. C. Thomas, Vancouver
Medical Economics Dr. P. O. Lehmann, Vancouver
Medical Education : Dr. Charles G. Campbell, Vancouver
Nominations Dr.  R. G.  Large,  Prince Rupert
Programme & Arrangements Dr.  Myles  Plecash,  Penticton
Public Health Dr. J. Mather, Vancouver
Chairmen of Special Committees
Archives Dr. J.  H. MacDermot, Vancouver
Arthritis and Rheumatism- Dr. F. W.  B. Hurlburt, Vancouver
Cancer Dr.  Roger Wilson, Vancouver
Civil Defence Dr. John Sturdy, Vancouver
Ethics Dr.  Murray  Baird,  Vancouver
Hospitals Dr. F. A. Turnbull, Vancouver
Industrial  Medicine  Dr. W. S.  Huckvale, Trail
Maternal Welfare • Dr. A. M. Agnew, Vancouver
Membership Dr. L. Fratkin, Vancouver
Nutrition Dr. J. F. McCreary, Vancouver
Phannacy Dr. B. T. Shallard, Vancouver
Public Relations  Dr. A. VV. Bagnall, Vancouver
A. W. D. (BILL) KNOX MEMORIAL FUND
In November, 1950, Bill Knox died after a short tragic illness. He was standing
on the threshold of a career in Surgery after long years of preparation. He was to
return to his native province, British Columbia, and his alma mater, University of British
Columbia. The shock of his death has passed but we who knew liim would like to
fittingly preserve his memory.
Also in 1950, the new Medical School at U.B.C. opened to fill a long-standing need.
In 1954 the first class will graduate. The undergraduate years have been a financial
struggle for many. On graduation some will enter general practice after a year of
hospital training, others will desire more post-graduate work. Without financial assistance some outstanding and deserving students will be unable to pursue further studies.
A committee has been established to form a memorial fund to Bill Knox. Moneys
raised will be used by U.B.C. to further the post-graduate education of worthy and
needy medical graduates, particularly the pursuit of graduate training in Surgery.
Bill himself received the finest post-graduate training. We believe nothing would
please or honour him more than that others should receive assistance towards the same,
in his name.
We hope you feel, as do we, that this is a fitting and worthy cause. Donations can
be made by cheque to the U.B.C. Alumni Development Fund earmarked "A. W. D.
Page 113 (Bill)   Knox  Memorial  Fund".   They  will  issue  a  receipt  suitable for income  tax
deduction.
The names of donors will appear in a list of "Gifts, Grants and Requests" included
in the Fall Convocation Programme at U.B.C. under the heading "A. W. D. (Bill)
Knox Memorial Fund", unless otherwise requested. A copy of this list will be sent
to the Knox Family by the committee.
-&
•At
THE DEFENSE ASSOCIATIONS
It seems important to review one aspect of our national life and to see how we as
physicians fit into it. This short paragraph will refer to the Defense Medical Association.
Canada has developed a national life during the period following the intensive
struggle for territorial gain and empire building that occupied the older countries of
Europe in the preceding centuries. Since we have escaped that form of national
development we have never had the need for large bodies of trained soldiers to maintain
peace or our position in the world. However, when the occasion did arise for armed
intervention on the part of Canada, that intervention was always superb and to the
full extent of the nation. Citizens became soldiers for the time being and after the
struggle was over, returned to their peacetime occupations. Probably that is why
up until not so long ago our army was composed mostly of militia men.
The interest and help in the national effort is also maintained in the various
branches and corps of the armed forces through what are known as Defense Associations.
This is the means of obtaining the considered opinion of many men who have had
actual experience in serving and who can maintain an interest in the future development
of their corps. This applies to the Defense Medical Association and the following remarks
will give you a more definite idea of its more exact function.
The Canadian Defense Medical Association is an Association of all service or
ex-service medical men of the Dominion who are interested in the maintenance of
efficient A.F.M.S.'s (Armed Forces Medical Services) in our country. It offers you a
medium for the expression of your views.
What does it do? It is responsible for liaison between the civilian medical practitioner and the A.F.M.S.'s. It gives an opportunity for the expression of opinion by
the civilian doctor on the training, methods of recruiting, terms of service of the
personnel in the armed forces. It permits the civilian medical officer to have a voice
in the keeping up to date in the light of modern practice, the equipment of the
A.F.M.S.'s. It obtains the general opinion of the medical men throughout Canada
regarding changes necessary in the general organization of the A.F.M.S.'s and in the
establishments of individual units within such services.
How does it do it? By the maintenance of a branch in every military district
in Canada. These branches are, if possible, composed of all actively serving and
ex-service medical men residing in the district.
Each branch holds an annual meeting and the Executive committee of the branch
holds as many meetings as appear necessary. At the annual meeting, a delegate is
elected to present to the annual meeting of the Canadian Defense Medical Association
any resolutions which may have been adopted at the branch annual meeting.
How is this Association financed? Each member pays a small membership fee and
$2.00 of this fee is forwarded to the central office in Ottawa. This sum of money is
pooled, with a grant from the Department of National Defense, which enables the
delegates to be sent to Ottawa at the expense of the Defense Medical Association.
Dr. C. E. G. Robinson was the delegate to Ottawa this year and from time to
time comments from the meeting will be published in the Bulletin. It is felt that
every medical officer who has served in the Medical Services of any of the Armed Forces
will wish to continue his service to his country in peace as he did in war.
Page 114 HYPOPARATHYROIDISM  IN  CHILDREN
DR. J. W. WHITELAW
Hypoparathyroidism is a rare disorder in children. A review of the literature
reveals only sporadic case reports with even such authorities as Albright limited in
experience. Clinically, in children, 3 types of parathyroid insufficiency are recognized
—post-operative, infantile and idiopathic, all characterized by tetany. The postoperative cases follow removal or injury of the parathyroid glands and present no problem in diagnosis.
The infantile cases are confined to the first few days of life, when the signs of
tetany appear in association with disturbed calcium and phosphorus levels in the blood
quite probably due to immature function of the parathyroids.
The idiopathic cases include those where there may be atrophy or aplasia or degenera-
tion from infection or other trauma, a congenital or hereditary basis, or simply a failure
of the physiologic function without a demonstrable lesion. Sutphen, Albright and
McCure (1943) reported 5 cases associated with moniliasis but were unable to determine
whether this was cause or effect; Leonard in 1946 associated one case definitely with
Addison's Disease. Another case showing marked fat replacement of cells was associated
with pituitary insufficiency, but the disease does not occur in panhypopituitarism. A
diencephalo-pituitary regulation of calcium metabolism has been postulated.
The signs and symptoms of hypoparathyroidism may begin in childhood long before
their cause is recognized. They are dependent upon a heightened irritability of the
C.N.S., due to a decrease in the amount of available calcium and, in later stages, to
trophic changes in the ectodermal tissues. The most constant early feature is a subjective
tingling and numbness of the fingers and toes, usually associated with cramps—the
typical carpo-pedal tonic contractions of tetany. There may be associated jerking of
facial muscles with grimacing and dysarthria and occasionally a generalized choreiform
twisting of the child.
At this stage the classical signs of tetany, Chvostek's, Trousseau's and Erb's, may
be ellicited. Laryngeal stridor may now become apparent. Finally generalized convulsive seizures dominate the picture, occurring at daily, weekly or monthly intervals, and
characterized by abdominal pain, tonic rigidity of the body, head retraction, cyanosis
and loss of consciousness. These convulsions frequently lead to the mistaken diagnosis
of epilepsy. Associated with headache, vomiting, increased intracranial pressure and
papilledema, these convulsions may also be attributed to a brain tumour.
Numerous convulsions may lead to mental deterioration and retardation. There
[are multiple ectodermal trophic changes. Supersaturation of body fluids by calcium
phosphate leads to symmetrical bilateral punctate calcifications of the basal ganglia
detectable by X-ray. Keratoconjunctivitis, lacrimation, photophobia, corneal ulceration
with scarring and cataracts may occur. The hair may be thin and patchy and the eyelashes and brows scanty. The skin may be dry, coarse and scaly. Fingernails may be
short, thick, atrophic and overgrown by skin. If the disease develops during the formation of teeth these may be aplastic or hypoplastic. The bones have no characteristic
appearance, but may show either slightly increased density or osteomalacia. The disease
has characteristic blood chemistries with a low serum calcium, reduced or absent urinary
calcium, increased serum phosphorus and reduced urinary phosphorus. The serum
phosphatase is normal or slightly low.
Treatment of hypoparathyroidism involves the use of Parathormone, Calcium,
Vitamin D, diet and Dihydrotachysterol. Parathormone acts rapidly in increasing
phosphate excretion in the urine and raising serum calcium levels to normal within a
few hours after injection. The dose is 10-15 units per day. It has a place in the
treatment of convulsions but has a serious disadvantage in the long-term control of the
disease, because many subjects become quickly immune to parathyroid extracts.
The low serum calcium demands the administration of calcium salts to restore the
depleted supply. Calcium Gluconate in 10% solution may be given intravenously to
control convulsions.    Long term control relies on the oral administration of Calcium
Page 115 SUMMARY
Hypoparathyroidism and its treatment are reviewed. An illustrative case in a boy
of 12 years is presented. Unusual features of the case and a differential diagnosis are
discussed.
Cal
cium
and Phosphorus Estimations During
Treatment
Blood
Serum
Urine
Excretion
TREATMENT
mgm.
Ca
Ph
grams
Ca
day
Ph
10<7o
Cal.
Glue.
Para
Thyr.
Ext.
s/c
Ca
C12
Ca
Lact.
Vit.
D
A. T.
10
10-
11.5
4-
5.5
0/1-
0/3
1.1
Low
Ph
Diet
March
0
4.2
7.8
6.4
6.6
8.0
7.2
6.4
7.4
6.0
7.6
8.0
8.6
8.6
9.8
8.4
7.8
8.6
8.6
8.5
9.2
7.0
9.1
9.0
9.8
8.8
9.0
9.3
8.6
9.2
7.5
12.5
8.0
9.7
8.1
8.6
8.4
8.0
8.9
8.9
7.0
5.9
6.8
6.4
6.1
8.0
7.8
6.7
6.6
6.2
6.4
6.1
Tr.
0/23
0/21
0/23
0/42
0/47
0/52
0/56
0/47
0/47
0/44
1.27
1.59
1.33
0/21
0/44
0/40
0/19
0/6 5
0/59
0/34
0/28J
0/23
0/28
0/21
0/22
0/35
0/39
0/39
0/19
0/35
0/30
0/82
0/18
0/33
0/43
0/37
0/29
lOcc
lOcc
12
0/4cc
daily
75 gr
daily
13
100,000
Unit-
daily
14
16
150gr
daily
17
18
19
2cc
daily
20
21
24
25
27
30
April
4cc
daily
1
2
3
4
2cc
daily
7
11
6Gm.
daily
3cc
daily
14
17
3Gm.
daily
20
2cc daily
24
25
1 CC
daily
Page 118 PUBLIC HEALTH AND MENTAL HEALTH NEWS
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health, Province of British Columbia
A. M. GEE, M.D.,
Director, Mental Health Services, Province of British Columbia
^alPg;
3E
a»
S*v
'*«
?C?^»f~.
:*;». »'i *".;. i,it.   -_&<"« * I in    •    »■.»** ? s,Sy<>: j:;::b¥.*«,X « * »t «
PROVINCIAL HEALTH BUILDING, VANCOUVER
Construction of a Provincial Health Building in Vancouver is now under way on
I Tenth Avenue adjacent to the present Division of Tuberculosis Control. This building
will provide satisfactory facilities for all provincial health services in Vancouver. Their
location in this area will assist the Provincial Health Branch to maintain a close relationship not only with the clinical facilities of the Vancouver General Hospital, but also
with the Faculty of Medicine, University of British Columbia.
In particular, there will be located in the new building the offices of the Assistant
Provincial Health  Officer and   the Division  of  Vital Statistics   (births,  deaths   and
I marriages), offices and laboratories of the Division of Laboratories, and offices and clinic
space for the Divisions of Tuberculosis and Venereal Disease Control.   In addition, one
floor wiH be occupied by the Red Cross Blood Transfusion Services.
This building will eventually cost close to two million dollars; a grant of $145,000
from the National Hospital Construction Grant has been made towards the provision
of clinic and laboratory facilities. It is expected construction will be completed early
in 1955.
VSr rir fc
CRIPPLED CHILDREN'S REGISTRY
Preliminary statistics from the Crippled Children's Registry were published in the
October, 1952, issue of the "Bulletin".   At that time the Registry had only been
Page 119 culosis, then, is to find infectious cases as soon as possible after they have become
infectious.
The value of finding cases is directly related to personnel and facilities available
for adequate supervision and proper hospital treatment. Ideally, therefore, before conducting a case-finding program, one should estimate the number of cases which exist in
the community and arrange for adequate facilities for their care and supervision. However, human nature being what it is, and with the demands for public funds often
exceeding available amounts, it is frequently necessary to reverse this process and find
the cases first. When this is done, a community's authorities may be approached with a
specific, concrete problem needing immediate solution, rather than an estimate of a
problem for which facilities should be provided. We can get higher percentage yields
of active cases of tuberculosis by seeking these cases in certain, special segments of the
population, such as the household contacts of known cases and patients admitted to
general hospitals. Such segmental case-finding programs are essential but the difficulty
is that if case-finding activities were confined solely to such groups, we should still miss
the majority of active cases in a community. This is especially true in the large cities,
where infections are likely to occur from sources which cannot be traced by the usual
epidemiological investigations.
About five years ago, it became clear that the community-wide approach to
tuberculosis case finding was the indicated method. The difficulties and expense of
community-wide surveys were not underestimated, but these were not regarded as
insurmountable obstacles. Moreover, the promise which the community-wide chest
X-ray survey held for effective tuberculosis control would more than justify the efforts
needed to launch the program.
It was obvious that community-wide chest X-ray surveys could be conducted most
effectively and efficiently in the large cities, the very places which were most in need
of such case-finding programs, and where local case-finding facilities were often not
adequate for completing such programs in a reasonable period of time. Since the large
cities have the highest tuberculosis death rates and well organized medical and public
health facilities, including hospitals, clinics, and official and voluntary health organizations, they were the most logical places to initiate these mass screening programs.
The time element is very important in community-wide chest X-ray surveys. If
the survey is conducted at such a slow tempo that only a fraction of infectious cases
are discovered in a given year, little or no dent is made in the amount of infection in
the community. Finding 10 per cent of the cases per year over a nine year period, for
example, is not nearly as effective as finding 90 per cent of the cases in one year.
It would be ideal to have every person receive an annual chest X-ray through local
facilities as part of a general physical examination, preferably with the physical examination performed by the family physician. However, this is only an ideal at the present
time, and the community-wide chest X-ray survey offers a practical way of bridging
the gap until we can reach this goal. An undertaking like the community-wide chest
X-ray survey is bound to result in temporary adjustments and changes in normal
community health services, and these, in turn, can make for problems and difficulties.
Experience, however, has shown how to minimize these problems and difficulties and
also that such temporary dislocations of a community's health services are not without
benefit. First, before a chest X-ray survey is begun, the official and voluntary health
agencies of a community must go through some new thinking in the evaluation of their
tuberculosis control program. Second, other community groups and civic leaders are
brought actively into the program of tuberculosis control, often for the first time.
Third, the survey helps to make almost every citizen of a community aware of the
tuberculosis problem, and to realize that he can help solve it. And finally, the mass
case-finding program stimulates a community's civic leadership toward providing facilities for the diagnosis and treatment of tuberculosis more rapidly than they otherwise
would.
There are still many questions to be answered with regard to community-wide
chest X-ray surveys.    Some of these are:  (1) How often should surveys be repeated?
Page 122 (2) At what low point of tuberculosis prevalence in a community will the yield of
new cases be so low as to make the expense of community-wide chest X-ray surveys
exorbitant? (3) To what extent can and should community-wide chest X-ray surveys
be combined with screening programs for other conditions? The existence of these
questions does not justify altering the program for the present. Surveys conducted thus
far have indicated that they are practical procedures, that they yield worthwhile results,
and that they must be continued for some time to come.
Since tuberculosis is a communicable and therefore unnecessary disease, the community-wide chest X-ray survey deserves the full support of the medical profession,
the official health agency, and the voluntary health association. The action of the
Public Health Service in making personnel and facilities available to large cities through
their state health departments for these surveys was a bold and courageous step which
is paying large dividends for tuberculosis control.
—Reprinted  from No.  7, Vol.  XXVI  of  the N.T.A.   and Circulated  by  the C.T.A.
Dr. Philip Maisonville has opened a practice in ophthalmology in Vancouver.
Dr. J. A. Hopkins has begun to practise urology in Victoria and Dr. A. Cawker
has returned to Vancouver.   Dr. L. Herberts is in Urology in New Westminster.
Dr. Don Cleveland and Dr. Ben Kanee attended the American Academy of Dermatology in Chicago in December.
Dr. Lionel Reese of Vancouver has accepted a teaching position in urology in
London, Ontario.
Dr. and Mrs. W. B. Brummitt of Vancouver have a little daughter.
Dr. L. Mirabel has begun to practise in the Vancouver Broadway district.
Dr. Milton Share is taking post graduate work in Hartford, Connecticutt.
Dr. William Tait of Vancouver is continuing his radiology training in Massachusetts.
NEW REGISTRANTS
October 20, 1953 ELPHICK, George Denis,
The C. S. Williams Clinic, Trail, B.C.
November 18, 1953 ARNEIL, Allan Stewart, Telkwa, B.C.
November 18, 1953 MONTGOMERY, Cecil Benjamin,
Cumberland, B.C.
November 18,  1953 .WOOD, Harold George, Kitimat, B.C.
November 18, 1953 McLEAN, Clifford Carey,
Division of T.B. Control,
2647 Willow St., Vancouver, B.C.
November 18, 1953 _FONG, Amy,
O. 425 Tegler Bldg.,
Edmonton, Alberta.
November 26, 1953 MILLER, Ronald Joseph,
O. 713 Columbia St.,
New Westminster, B.C.
(Assoc, with Dr. L. S. Chipperfield).
November 30,  1953 RIDEOUT, Chester Franklin,
O. 4493 Kingsway, Vancouver, B.C.
Page 123 INVESTORS
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This smart new building situated across from the Post Office at a
prominent  corner,   and   in   Greater   Vancouver's  finest   residential
municipality, offers an excellent opportunity for a medical practitioner
to develop his profession and live in lovely surroundings.
Ready for occupancy about February 1st, 1954
don   McMillan   ltd.
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Phone West 2203
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FUNERAL   SERVICE
Kings way at Nth Ave. — Telephone EMerald 2161
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Page 124

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