History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: February, 1953 Vancouver Medical Association Mar 2, 1953

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OF ■      ' r|;
The Vancouver Medical Association
Publisher and Advertising Manager
Db. E. C. McCoy
Dr. George Langley
Hon. Treasurer
OFFICERS 1952-53
De. D. S. Munroe
V ice-President
Dr. J. C. Grimson
Past President
Dr. J. H. Black
Hon. Secretary
Additional Members of Executive:
Dr. G. Br. F. Elliot Dr. F. S. Hobbs
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommer, Whiting & Co.
Eye, Ear, Nose and Throat
Dr. J. A. Irving Chairman Dr. W. M. G. Wilson Secretary
Dr. J. H. B. Grant Chairman Dr. A. F. Hardyment Secretary
Orthopaedic and Traumatic Surgery
Dr. A. S. McConkey Chairman Dr. W. H. Fahrni Secretary
Neurology and Psychiatry
Dr. B. Bryson Chairman Dr. A. J. Warren Mil-Secretary
Dr. J. S. Madill Chairman      Dr. H. Brooke Secretary
Dr. J. L. Parnell, Chairman; Dr. D. W. Moffat, Secretary;
Dr. A. F. Hardyment ; Dr. W. F. Bie ; Dr. R. J. Cowan ; Dr. C. E. G. Gould
Co-ordination of Medical Meetings  Committee
Dr. W. M. G. Wilson | Chairman Dr. B. T. Shallard Secretary
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. G. H. Clement, Dr. W. Fowler,
Dr. F. W. Hurlburt, Dr. B. LangSton, Dr. Robert Stanley, Dr. F. B. Thomson
Dr. W. J. Dorrance, Dr. Henry Scott, Dr. J. C. Grimson
V.OJN. Advisory Committee
Dr. Isabel Day, Dr. D. M. Whitelaw, Dr. R. AVhitman
Representative to the Vancouver Board of Trade: Dr. D. S. Munroe
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. NEW 5-mg. Tablets of
For accurate adjustment of
Maintenance Dosage and
for therapy in conditions
responding to Low Dosage
Advantages of 5-mg. Tablets
Used alone or in conjunction with the
25-mg. tablets, the new 5-mg. tablets afford
greater flexibility in adjusting dosage, to
the individual patient's requirements.
Fluctuations in the natural course of rheumatoid arthritis may be better controlled.
Permit more accurate establishment of
minimum maintenance doses, thus controlling symptoms more closely and further
minimizing the incidence of undesirable
physiologic effects.
Prevent waste of Cortone by more exact
correlation between requirement and dosage.
Literature on Request
•Cortone is the registered trade-mark
of Merck & Co. Limited for its brand
of cortisone. This substance was first
made available to the world by Merck
research and production.
MERCK &  CO. Limited
Manufacturing Chemists
Founded 1898; Incorporated 1906
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.
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
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.
2656 Heather Street
Vancouver, British Columbia
Every Monday—9:00 a.m.-10:00 a.m Ear, Nose and Throat Clinic
11:45-12:45 p.m.  —.: Therapy Conference
Every Tuesday—11:00 a.m.-12:00 p.m Clinical Meeting
12:00 noon-1:00 p.m : %$. Therapy Conference
Every Wednesday—11:45   a.m.-12:45  p.m ggftll- Therapy Conference
Every Thursday—11:45 a.m.-12:45 p.m Therapy Conference
Every Friday—9:00 a.m.-10:00 a.m jfe . -.Lymphoma Clinic
(during February)
10:15 a.m.-ll:15 a.m.  (as of March 6)— J*x_ Lymphoma Clinic
11:45 a.m.-12:45 p.m i^^tZ^l. Therapy Conference
Page 197
V \\ C-r . //
Brand of vitamin supplement for children
Tablet No. 446 ~§umA"
Each sugar-coated tablet contains:
Vitamin A '$$$...   2000
Vitamin D     1000
Thiamine HCI  1
Riboflavin  1
Niacinamide  6
Pyridoxine HCI  1
Ascorbic acid  30 mg.
Vitamin B12  2.5 meg.
(crystalline cyanocobalamin)
Sodium iodide  0.04 mg.
One to three tablets daily.
Bottles of 30 and 100.
Each five drop dose (0.25cc.) contains:
Vitamin A  2000 I.U.
Vitamin D  1 000 I.U.
Thiamine HCI  1 mg.
^Niacinamide  2.5 mg.
Ascorbic acid  30 mg.
Sodium iodide  0.04 mg.
*Not declared on label
Five drops daily.
Bottles of 8, 15 and 30 cc, with calibrated dropper.
etuuk* &.®kot>tyt8c6o.
[Total  population   (census)  344,833
■Chinese population 1       7,117
§§$$* December, 1952
Rate per
Number 1000 pop.
Total deaths   (by occurrence)—- ___' .... 370 12.9
Chinese   deaths    . *     20 33.7
Deaths,   residents  only    . 339 11.8
Birth Registrations—residents and non-residents  (includes late registrations)
Male _
December, 1952
_ 371
L 347
Infant Mortality—residents only
December,  1952
Deaths under 1 year of age     15
Death rate per  1000  live births 1     27.6
Stillbirths .(not included in above item) .       9
December, 1952
Cases      Deaths
Scarlet Fever . :  34
Diphtheria —
Diphtheria  Carriers i . —
Chicken Pox 115
Measles I 1 39
Rubella . I 1     4
Mumps 2 0 4
Whooping Cough 16
Typhoid   Fever £ .     1
Typhoid Fever Carriers j —
Undulant Fever____ j . —
Poliomyelitis 5 I .     2
Tuberculosis — 3 5
Erysipelas .     1
Meningitis   (meningococci     2
Infectious  Jaundice - 22
Salmonellosis t     3
Salmonellosis   Carriers - —
I Dysentery j 13
Dysentery Carriers i  —
Tetanus —
 I j 6
Cancer  (reportable resident) 100
December, 1951
Cases    Deaths
135 —
28                 8
3                —
2                —
6               —
19               —
159               —
97               52
Page 201
Clinical experience in the use of Heparin as a blood anticoagulant has
extended over many years. The product has been administered intravenously
in very dilute solution.
Recent experience has shown that intramuscular injection of concentrated j
solutions is an effective means of prolonging clotting time.   This method of
treatment provides an increased measure of freedom for the patient and can
be extended over a period of months on the basis of two or three daily injections.
Solution of Heparin—Distributed in rubber-stoppered vials as sterile
neutral solutions of heparin prepared from purified, dry sodium salt of
heparin containing approximately 100 International Units per mg. The
product is supplied in the following strengths:
1,000 International Units per cc.
10,000 International Units per cc.
Heparin (Amorphous Sodium Salt)—Dispensed in 100-mg. and 1-gm.
phials as a dry powder, containing 100 International Units per mg., for
the preparation of solutions for laboratory use.
Recent References:
Stats, D., and Neuhof, H.: Am. J. Med. Sci., 1947, 214:
159- H
Walker, J.: Surgery, 1945, 17: 54.
Cosgriff, S. W., Cross, R. J., and Habif, D. V.: Surgical
Clinics of North America, 1948, 324.
De Takats, G.: J.A.M.A., 1950, 142: 527.
University of Toronto Toronto, Canada
Ettablithcd ia 1914 for Public Service through Medical Research tad the devclopauat
of Product* for Prevention or Treatment of Diieaie.
Page 202 We should like to take this opportunity of congratulating the B.C. Division of the
C.M.A. on the attainment of its first anniversary since its recognition. Nor are our
congratulations based merely on the fact that it has survived the first year of life,
always a very dangerous year—nor that it has gained an adequate amount of weight,
as represented by a surprisingly large membership (though there is room for improvement here). We feel, rather, that our chief reason for congratulation, and may we
say admiration, is the amazing vitality of the young Division. For it started its life in
circumstances which were not altogether favourable, and in an amosphere of tension
and urgency which is not the happiest environment for a growing infant. A year ago,
there were not a few who shook their heads rather gravely over the newcomer's crib,
and the prognosis was not unanimously hopeful.
But happily, all this is past—and there must be few of us now who would fail to
predict a long and lusty life for the B.C. Division. For it had good parents. The men
who , in the face of discouragement, and mountains of work, and grave problems, gave
I of their time and energy and devotion, so unselfishly and so unstintedly, have been
abundantly justified of their effort by the results which they have achieved. They faced
a very difficult task. First of all they had to secure a membership whose size and enthusiasm would make the B.C. Division a practical success. Then they had to meet and
so^ve a great many difficult economic problems. How well they have succeeded in this
part of their work, we can all see today. A new, and on the whole, an excellent schedule
of fees has been promulgated—relations with the government over S.A.M.S. cases have
been improved—as also with the Workmen's Compensation Board; and this has bene-
Ifited the whole profession. All these things have meant an appalling amount of work—
[how much work, most of us will never know. But they did the work, and we owe them
a very great debt of gratitude. These architects of the B.C. Division have done a job
of which they may well be proud.
Their next job, and one of the biggest they had to tackle, was the improvement of
public relations, and relations with the press: an undertaking long overdue, and one
calculated to daunt any people less determined to succeed. And they have done, and
are doing, a very good job in this respect. Our relations with the press have, we believe,
been very greatly improved, and through radio broadcasts and by other means, our
relations with the public are gradually becoming much franker and more cordial.
Because of its obvious sincerity and honesty of purpose, the Division is coming
to be regarded as a genuine, and approachable, spokesman for the medical profession as
a whole. And we believe it is fully, to be trusted in this capacity. Our new Executive
Secretary is a tower of strength in this regard, and he has back of him an Executive on
which he can thoroughly rely. As a result of their joint efforts, this new Division, the
youngest in Canada, is also one of the strongest and most efficient—and in many ways,
we feel, is an example of what the Divisions of the Canadian Medical Association should
be, and its work is an example of what they should all be doing.
And in congratulating the officers of: the Division and their Secretary, we congratulate ourselves—we feel pride in their work and their accomplishments—and if we
have any sense at all, we shall all join the Division as members (preferably paying
Founders' fees, too) and give them our enthusiastic support in their endeavours.
Page 203
I- Vancouver Medical  Association
President —Dr. E. C. McCoy
Vice-President Dr. D. S. Munroe
Honorary Treasurer Dr. G. E. Langley
Honorary Secretary j Dr. J. H. Black
Editor I u j Dr. J. H MacDermot-
June 1st to 5 th, 1953
The 31st Annual Summer School of the Vancouver Medical Association will bei
held in Salon A of the Hotel Vancouver this year on the above dates.
The Summer School was first instituted in 1921, and has been held yearly since
then, except for one year during the Second World War. It has become an important)
fixture in the annual programme of medical meetings in British Columbia, and a con-|
stant succession of notable speakers has been secured from year to year, thanks to thej
hard work and devotion of the various Summer School Committees.
The programme arranged for this year is in every way up to the high standards of j
past years, and medical men throughout the province will do well to arrange their
timetables so as to take in this year's School. As will be seen from the list of speakers!
published below, this programme will have a great deal to offer to every medical m^n,
especially to the general practitioner, for whom these Schools are, of course, specially!
The speakers are as follows:
Orthopaedic Surgery      Dr. Joel Baker, Mason Clinic, Seattle, Wash., U.S.A.
Surgery Dr. Howard Stearns, Clin. Professor of Obstetrics and Gynae-s
cology, University of Oregon, Portland, U.S.A.
Obstetrics and
Dr. Martin M.  Hoffman, Professor of Medicine, Dalhousie
University Dept. of Metabolism, Halifax, N.S.
Dr. R. Graham Huckell—Professor of Orthopaedic Sugery,!
University of Alberta, Edmonton, Alta.
Dr. Carl Aberhart of Toronto has also been invited to give a paper or papers on
Urology, but his acceptance has not yet been definitely received.
Summer School Chairmen for 1953
Dr. S. L. Williams, Chairman Dr. Max Frost
Dr. John A. Elliot, Secretary Dr. France E. Word
Dr. J. A. Irving Dr. Elmer Jones
More details will be given in subsequent announcements in the Bulletin.
On busy main highway on Lower Mainland.   Splendid location.
Available March 1st
Apply Publisher, MArine 7729
Page 204 library Hours:
Monday to Friday 1 9:00 a.m. - 9:30 p.m.
Saturday   9:00 a.m. - 1:00 p.m.
Recent Accessions:
Surgical Clinics of North America, Symposium on Safeguards in Surgical Diagnosis.
December, 1952. The Queen Charlotte Textbook of Obstetrics edited by S. G.
Clayton, 1952.
Cowdrey's Problems of Ageing edited by A. Lansing. 1952 Year Book of Drug
Therapy, 1952, edited by H. Backman. Transactions of the Association of American Physicians, 1952.
Medical Clinics of North America, Symposium on Gastro-intestinal Diseases.
January, 1953.
The following volume has been presented to the Library by Dr. D. B. Collison:
The Principles and Practice of Medicine by Sir William Osier.  Sixth Edition, 1906.
The journals listed below are those received in the Library in the surgical field:
American Journal of Surgery.
Annals of the Royal College of Surgeons of England.
Archives of Surgery.
Australian and New Zealand Journal of Surgery.
British Journal of Surgery.
Bulletin of the American College of Surgeons.
Journal of Bone and Joint Surgery.
Journal of the International College of Surgeons.
Journal of Neurosurgery.
Journal of Thoracic Surgery.
Surgery, Gynecology and Obstetrics: International Abstracts of Surgery.
Western Journal of Surgery, Obstetrics and Gynecology.
'Paradise Enotv"
"When I die," said dear and whimsical old Doctor Pycroft, "I shall have a bell
hung on my head-stone, with an inscription asking the compassionate passer-by to ring
it long and loud.  And I shan't get up.
Confessions of an Uncommon Attorney."
Doctors Office equipment.    Apply Doctors Millar and Millar,
2232 West 41st Avenue.    KErr. 0409. THIRD ANNUAL MEDICAL BALL
Date: Thursday, March 26, 1953.
Time: 9:30 p.m.
Supper at 11:00 p.m.
To be held in the Banquet and Ballroom of the Hotel Vancouver.
For reservations: Write to Medical Ball Committee,
c/o Medical School Office,
University of British Columbia.
Phone KErr. 1357 between 6 p.m. and 7:30 p.m.
Tickets: Send requests to:
Chairman, Medical Ball Committee,
Medical School Office,
enclosing $9.50 for each couple ticket required.
Tickets on Sale in some of the larger hospitals
the week previous.
Report on Past and Present Medical Balls and Future Prospects -
A. First Two Medical Balls     l||l
1. Attendance (a)   1st Ball—300
(b)   2nd Ball—500
2. Results (a)   1st Ball—Two $100 bursaries
(b)   2nd Ball—Two $100 bursaries
The money from the Balls goes into a Medical Bursary Fund administered
by the Adrninistration.   These bursaries are, of course, for medical students only.
B. Third Medical Ball
1. Place—Hotel Vancouver
2. Price—$9.50 per couple
3. Date—March 26, 1953
4. Expected attendance—600
5. Plans
This year the Medical Ball Committee has decided to pay more attention to
the Interior and Northern British Columbia medical men. They realise, of course,
that they must of necessity concentrate on the doctors living on the Island and
Lower Mainland. Those in the Interior who are not able to attend are being
encouraged to support the bursaries directly be contributing to the fund. Direct
contributions may be made through the Alumnae Development Fund.
C. Future Prospects
1. Attendance—As many doctors in the province who can possibly attend
2. Prospects
(a) We hope to make this Ball "the" annual event for the Medical profession
in the province.
(b) We hope to have enough money for bursaries so that aid can be extended
to all who require it.
Page 206 per cent
per cent
• 2  per cent
William F. Finn, M.D. and R. Gordon Douglas, M.D.
(From the Department of Obstetrics and Gynecology of the New York Hospital
and Cornell University Medical College.)
Two-thirds of all cancers of the female genital tract are detected in advanced
stages. This results in the existent poor outcomes because a direct correlation exists
between the stage of the cancer when treatment is begun and the survival rate. Cancer
y{ the breast, which accounts for twenty-five per cent of all cancers in women, is the
commonest cancer of the female body. Female genital tract cancer comprises another
25 per cent of these cancers.   The breakdown by organ is as follows:
Cervix 13  per cent
Endometrium 5
Ovary 5
The remaining 50 per cent are composed chiefly of intestinal and skin cancers.
The survival rate will not increase until we find, more cancers in earlier stages. To
accomplish this we must educate both the patient and the doctor. Instruction of the
patient should be directed toword two aims, 1) the prophylactic physical examination,
and 2) appreciation of early symptoms. Routine physical examination performed on
apparently well persons in the course of insurance applications, industrial examinations,
induction into the armed forces, and at cancer detection centres reveal a high incidence
of unsuspected disease other than cancer, averaging about 50 per cent, and reveals about
J^per cent unsuspected cancer. Fortunately many of the cancers in which we are
interested are readily accessible and can be detected by inspection of the cervix and
palpation of the uterus and adnexa. Besides stressing the value of physical examination
on the well patient, the patient should learn the importance of early symptoms of
cancer and should be impressed with the need of prompt medical consultation supple-
I men ted by cytological smear, diagnostic biopsy and curettage as indicated.
Education of the physician is also necessary. The Philadelphia Committee for the
Study of Pelvic Cancer1 found that the physician was responsible for one-third to
one-half of all delay in the diagnosis and treatment of cancer. The physician is more
concerned in the diagnosis and treatment of existing diseases than in the detection of
asymptomatic diseases in incipient stages. He has not as yet fully accepted the need
for prophylactic physical examinations. However, success in cancer treatment can
result only from diagnosis in increasingly earlier stages so that the existing modes of
therapy will be effective. Another professional failing is the tendency to minimize early
symptoms and the failure to recommend and to perform indicated diagnostic tests.
Smear, cervical punch biopsy and curettage are the indispensible cornerstones of diagnosis.
They must be applied to more patients, especially to patients with slight symptoms
which at first questioning may appear to be of slight consequence. Another professional
error is the habit of treatment before all diagnostic tests have been used. A busy
practitioner is tempted to treat the symptom without thorough diagnosis. But
progress in cancer can result only when the emphasis is on detection in early stages,
for then every cancer patient can begin treatment while the cancer is still confined to a
curable stage.
These general principles will be applied in turn to the various genital organs. We
shall start with the commonest cancer—cancer of the cervix.
*Read before the Summer School of the Vancouver Medical Association, May 26-30, 1952.
Page 207
h Two out of every three patients who develop cancer of the cervix die within five j
years. These high mortality figures are disturbing since cervical cancer constitutes
about 15 per cent of all cancers in women and about half of the cancers of the female
genital tract. Foote and Li2 state, "Dr. Morton L. Levin, of the New York State
Division of Cancer Control, and Mrs. Ruth Salt of the Department of Statistics,
Memorial Hospital, independently estimated that in the female population at large one
would expect approximately one case of carcinoma of the cervix per firteen hundred
women over the age of 35." The New York State Department of Health3 estimates
that the probability of a woman developing cancer of the cervix from birth to death
is 2.2 per cent. This high incidence of cancer in an accessible part of the body
emphasises the need for prompt diagnosis. The analysis of survival according to the
stage in which treatment was instituted show that the current high mortality rate
could be reduced immeasurably, if cancer of the cervix was detected in earlier stages.
(Table l)4 Several startling facts emerge from these data. First, only 15 per cent
of the cervical cancers were detected while still confined to the cervix, i.e. Stage 1.
Second, the overall cure rate of cervical cancer is only half of the cure rate of stage 1
and only one-third of the cure rate of stage 0 which approximates 100 per cent.
Further review of previous annual reports show that the overall cure rate has risen
only slightly in the past decade—from 26.3 per cent in 1938 to the present rate of
32.6. These data show the imperative need for the recognition of cervical cancer in
early treatable stages. What is "early cervical cancer?" Opinions vary. Some believe
that a stage 1 cervical cancer is early, but when we reflect that 20 per cent of the
so-called "stage 1" lesions already have positive pelvic lymph nodes as shown by
Meigs5, and when we reflect further that the five-year survival rate of patients with
stage 1 cervical cancer is only 5 8 per cent, we realize that the detection of stage t cancer
is already too late and that we must discover cervical cancer in still earlier stages, to
wit, stage 0. Douglas and Studdiford6 aptly summarize the situation: "In short, should
we continue to regard stage 1 cancers as the earliest manifestation of the disease, there
seems to be little chance of improving our therapeutic results—whether by radiation or
by radical or ultraradical surgery."
Investigations suggest that the last and obvious stages of cervical cancer constitute
but a short period in the total life history of the disease. This concept of a long latent
period during which progression to clinically obvious cancer may, but does not necessarily, occur was first proposed by Schiller7. Schauenstein8 in 1907, and Pronai9 in
1908 described anaplastic changes in cervical epithelium. Schottlander and Kermauner10
in 1912 described such anaplastic changes in the surface epithelium near invasive cancer.
It remained for Schiller7 in 1928 to state that these changes were early cervical cancers.
This concept met with determined opposition from those to whom cancer connotes
invasion. Now, however, the work of Smith and Pemberton11, Younge and Hertig12,
TeLinde, Garvin and Jones13-14-13, to name only a few of the many writers on this
subject, make it evident that the cytological changes in surface cancer and invasive
cancer are identical and that surface cancer has been observed to progress to invasive
cancer.    Many fascinating speculations arise in this connection.
1. Does intraepithelial cancer inevitably progress to invasive cancer?
No! Many cancers have been observed to remain in an intraepithelial location for
many years. Wespi16 has reported follow-up for as long as eight years without evidence
of invasion. Kottmeier17 has observed 42 patients with intraepithelial cancer; only
three of these have developed evidence of invasion during one to nine years of
2. What is the longest time interval so far recorded in ^the progression to invasion?
Jones, Galvin and TeLinde14 have observed this progression to occur over a period
of 17 years.
Page 208 3. How many intraepithelial cancers have become invasive?
The latest tabulation by Galvin et al15 lists 30 such cases.
4. How many cervical cancers are preceded by intraepithelial lesions?
Galvin et al15 report that in a group of patients with cervical cancer 11 of the
13 patients who had had previous cervical biopsies, and 2 of 8 patients who had had
previous curettages have shown evidences of intraepithelial lesions prior to development
of invasive cancer.
This entire subject is best summarized by a direct quotation from Galvin, Jones
and TeLinde10: "1. Carcinoma in situ is potentially invasive, and, if untreated, may
progress to clinically evident cervical cancer. 2. As this study is retrospective, it does
not indicate that carcinoma in situ always becomes invasive. It does, however, indicate
that clinical cervical cancer is preceded by carcinoma in situ in too large a proportion
of cases to be coincidental. 3. The clinical course of cervical cancer represents only a
small segment of its life history ami the greater part of its existence is spent in the
preinvasive stage."
Routine mass screening is not feasible except under special circumstances such as
a study in industry or the Armed Forces. Selective screening is more practicable and
should be directed toward the patient with a high probability of developing cervical
cancer. Such cancer-potential patients, as shown by Lombard18 are those who have
married young, have given birth while still young, have had cervical lacerations or
have had syphilis. The incidence of cervical cancer, conversely, is low in Catholic
nuns as shown by Gagnon19, and about one-ninth as common in the Jewish woman as in
the Gentile, as shown by Rothman, Rapaport and Davidson20, and Kaplan and Rosh21,
Selective screening directed toward cancer-prone groups would result in significantly
higher percentages of cancer detection than mdiscriminate sampling of the entire
population. This is suggested by Day's22 recent study at the Kips Bay Health Centre
in which three intraepithelial cervical cancers, 0.23 per cent, were detected in 1300
apparently healthy women, while routine smear examinations of patients applying at a
gynecological clinic or admitted on a gynecological service show a higher incidence
of latent cervical cancer, 1 to 2 per cent.
This examination should consist of history, pelvic examination, speculum visualization of the cervix, cystological smear, and biopsy of the cervix.
1. History. History can help only when symptoms have occurred. We should
question regarding contact bleeding, e.g. after a pelvic examination, after a douche or
after coitus. We should further query regarding leukorrhea. But since our goal is
the detection of asymptomatic cancer, history is of little avail.
2. Pelvic examination. The detection of cervical cancer by the palpation of a
crater or of parametrial thickening is now outdated. To attain the best results cancer
must be detected in a stage when little or no physical evidence exists but when the
diagnosis is exclusively based on miscroscopic findings.
3. Speculum visualization. This aids us in distinguishing the various non-malignant
lesions, i.e. unrepaired laceration, erosion, eversion, cervicitis, polyps, hyperkeratosis,
which might cause confusion. It permits selection of a biopsy site and aids in obtaining
endocervical smears. Since inspection alone is unreliable, confirmation must be obtained
by biopsy and smear. Colposcopy, so ardently advocated by Hinselman23 never became
popular in this country because it was inconclusive and furthermore needless, since
biopsy confirmation was still necessary.
4. Cytological Smear. The introduction of a cellular diagnostic method by
Papanicolaou and Traut24 in 1943 constituted a major advance in the earlier diagnosis
Page 209 of cervical cancer. It permits the diagnosis of asymptomatic latent Cancer which in
many cases is still confined to the surface epithelium. Direction in this intraepithelial
stage, where cure rate approaches 100 per cent, is our goal.
Patients should be cautioned not to douche for 48 hours prior to the taking of
smears. No lubricant should be employed in the vagina immediately prior to the
obtaining of smears. Smears may be taken directly from the vagina by inserting an
applicator or a cannula into the vagina. Smears which are especially abundant in cells
may be obtained from the material on a dependent blade of the speculum. Smears may
be taken from the endocervical canal by aspiration, by a cotton applicator, or by scraping
with a tongue blade or a spatula as recommended by Ayre25. Contact smears may be
obtained directly from the surface of the lesion or by a Gelfoam sponge, as advocated
by Gladstone26. All smears must be properly spread and fixed immediately in a solution
of equal parts of ether and 50 per cent alcohol.
Smears are of especial value in the detection of the early lesion. This is amply
attested by many writers, including L'Esperance27 who writes that observations at the
Strang Clinics showed that 62 per cent of the cancers of the cervix, both the preinvasive
type and the early infiltrating carcinomas, were first recognized by the smear before there
was any evidence of a gross lesion of the cervix or before the onset of the earliest
symptoms. The smear has the further advantage that it is easily done, does not hurt
the patient and may be repeated frequently.
Its disadvantages are false negative reports which occur in 2 to 5 per cent of all,:
examinations. These may be due to improper collection or fixation of the specimen, or
to errors in interpretations. Such negative reports lull the clinician into a false sense
of security. False positive interpretations-may also occur. Pund28 states that these are
chiefly due to healing ulcerations and to imperfect metaplasia. While smears are invaluable as a screening technique and in detecting asymptomatic cancer, the above
mentioned errors make the performance of a biopsy mandatory before the institution of
5. Biopsy. The cervical biopsy is the decisive diagnostic test in the detection of
cervical cancer. The punch biopsy is the commonest type. The obtaining of a cervical
biopsy should mean not a single sample of tissue, but the obtaining of many particles
from the lesion and the surrounding borders, or if no lesion is obvious, from the vicinity
of the external os. Pain, which is slight, can be reduced, if the biopsy forceps is not
pulled but twisted gently in a clockwise fashion until the tissue is removed. Bleeding
is rarely of consequence and can be readily checked by the application of a cauterizing
agent. Biopsies may also be obtained by scraping with a Novak29 spoon, by a ring
incision with an Ayre30 knife, by cutting wedges from the cervix and by a Gusberg31
coning curette. Routine punch biopsies with the occasional use of curettage of the
endocervix or wedge or ring excision of the endocervix have served our needs.
We have not applied Lugol's solution to the cervix prior to biopsy, but have relied
on extensive biopsies about the external os rather than on staining reactions. We always
take multiple biopsies, agreeing with Foote and Stewart32 that most cervical cancers
arise in a critical zone about the external os. Previously biopsy was employed only
when there was an obvious cervical lesion, but if we are to detect the early intraepithelial
cancer which has not produced a change on the surface of the cervix, we must condition
ourselves to taking biopsies from the normal appearing cervix. Routine cervical biopsies
in this fashion by Cox, Buhler and Mixson33 detected two invasive cervical cancers and
three intraepithelial cancers in 110 patients. Lock34 has advocated obtaining a cervical
biopsy at every curettage. Biopsies thus obtained will detect treatable, confined intraepithelial lesions before progression to an unconfined extraepithelial state occurs.
6. Curettage. Curettage of the endocervix is essential in the detection and/or
confirmation of high endocervical lesions which are beyond the reach of biopsy clamp.
A by-product of curettage for another indication may be hitherto unsuspected cervical
Page 210 cancer.   This method is particularly valuable in the detection of adenocarcinoma of the
7. Amputation of Cervix or Hysterectomy. One per cent of the total hysterectomies performed at The New York Hospital between 1947 and 1951 resulted in the
detection of previously undetected cervical cancers as shown by Finn35. These were
very early cancers, were usually in the endocervical canal, and most cases were overshadowed by myomas or prolapse which appeared to provide adequate explanation for
the symptoms.
The application of the above methods will result in increased detection of extremely
early cervical cancer and thereby increase the survival rate of patients with cervical
Cancer of the endometrium is becoming more important because it is on the increase.
This increase is not merely due to better reporting of cancer, but is due to the increasing
age of our population. More women are living to attain the age of 55 to 60 when
cancer of the endometrium is most common. It has been estimated that 3 5 out of every
1,000 women who attain the age of 40 will develop cancer of the endometrium.
Certain women are more prone to develop endometrial cancer. A composite picture
of such a woman would be—middle-aged, single or, if married, with either none or
only a few children, a story of late menopause, obese, more likely well-to-do and a
private patient, who may have diabetes, who might have had radium insertion or excessive
estrogens in the past, and who may have had hyperplasia of the endometrium previously.
These are some of the antecedents and concomitants of the endometrium. Routine
screening techniques to obtain maximum yield should be directed toward such groups
of women.
The peak incidence occurs in a middle-aged woman of about 55, but the disease
occurs in younger women as shown by Hertig36, Speert37 and others. Dockerty, M.B.38
et al record that two per cent of the endometrial cancers observed at the Mayo Clinic
occur in women under 40. Hirst39 has recorded the youngest patient, a girl of 16.
Hence youth is no guarantee that endometrial cancer is not present. The patient, with
endometrial cancer, is frequently a spinster. If married, she may have reduced fertility.
Corscaden and Gusberg40 report a sterility incidence of 38.6 per cent, Randall41
reported 28.2 per cent, while Taylor and Becker43 recorded 31.5 per cent. It is interesting to speculate whether the factors which resulted in infertility ultimately caused
cancer. A corollary is that subsequent follow-up of patients in an infertility clinic may
yield a higher incidence of endometrial cancer than in the general population. A number
of patients with endometrial cancer have excessive bleeding at the time of menopause
and continue to bleed longer than those women who do not develop endometrial cancer.
Corscaden and Gusberg40 estimate that the average age at menopause of patients with
endometrial cancer is 52-54, several years later than the average. Crossen and Hobbs43
have stated that late menopause, i.e. after 50 years, is four times as common when endometrial cancer is present. Randall41 has estimated that 35 per cent of the women with
endometrial cancer have continued to menstruate after 50 years of age as opposed to
eight per cent of those who have not developed cancer during a 15-year period after
menopause. Obesity accompanies endometrial cancer. Palmer et al44 observed that
75 per cent of their patients with endometrial cancer were overweight. This is approximately twice the incidence in a control group of the same age. Diabetes has been
reported by Palmer and his co-workers to be anywhere from 3 to 16 times as prevalent.
Radiun appears to have a carcinogenic effect as observed by Smith 45 and others. Speert46
and Peightal reported that eight per cent of the patients with endometrial cancer at
Roosevelt Hospital had been irradiated prior to the development of endometrial cancer as
opposed to a 0.3 per cent incidence in the group of patients with carcinoma of the
cervix. Hyperplasia is a common precursor of endometrial cancer. Hertig36:47-48
in his development of the concept of in situ endometrial cancer states that hyperplasia
Page 211 and polyps commonly occur 6 to 13 years prior to the appearance of endometrial cancer
and that adenomatous hyperplasia and anaplasia are commonly observed during the
3-to-5-year period prior to the discovery of fully developed endometrial cancer. This
naturally leads to the consideration of the role of estrogens in the development of
endometrial cancer. Fremont-Smith49 and his co-workers, Vass50 and others, have
described the appearance of endometrial cancer after the administration of large doses
of estrogen. It has been estimated by Ingram and Novak51 that 15-27 per cent of the
patients with feminizing tumors develop endometrial cancer. Endometrial cancer is
100 times as common as the expected incidence when a feminizing tumor, particularly a
thecoma, exists. The co-existence of mammary and endometrial cancers is 24 times as
great in the presence of a feminizing tumor as would be expected from chance alone.
Such evidences, while not conclusive, suggest that estrogens may cause endometrial
cancer. The concept of the woman who is prone to endometrial cancer has been
developed at length, because earlier detection of endometrial cancer will be achieved if
we direct our energies toward such cancer-prone individuals.
Approximately two-thirds of all patients who develop endometrial cancer have
passed the menopause. Their presenting symptom is post-menopausal bleeding. This is
frequently neglected by the patient who feels that she is rejuvenated or by the doctor
who may attribute it to some superficial cause such as atrophic vaginitis. Post-menopausal bleeding cannot be overlooked. Fifty per cent is due to cancer. It must be
promptly investigated. The patient who has the dramatic reappearance of bleeding after
the menopause is fortunate compared with the younger woman who has irregular bleeding while still menstruating. Such bleeding may be ascribed to "change of life" without
further investigation. The most grievous delays are incurred in this younger group.
A current problem is withdrawal bleeding a few days after the cessation of estrogens. If
it occurs in orderly fashion at the customary time, it may be attributed to withdrawal
but any variations from an orderly pattern warrant investigation.
Diagnosis is all important. It seems platitudinous to insist that diagnosis be made
prior to the institution of treatment but the press of events in modern life frequently
encourage the easier approach of treatment first to see what will happen. Our diagnostic
armamentarium consists of smear, endometrial biopsy and curettage. Smears are
desirable in screening procedures, but their accuracy is only 70 to 85 per cent in the
detection of endometrial cancer. Scheffey52 and Fremont-Smith53 have reported 30
per cent failures with smears, while Cuyler54 et al have observed a 16 per cent incidence
of false negative reports. The location from which smears are obtained is most important.
Smears obtained by aspiration from the endometrial cavity are more accurate than
samples of the entire vaginal detritus. A positive smear needs confirmation while a
negative smear has a 16 to 30 per cent chance of error. Hence smears which are most
desirable in the detection of cancer of the cervix do not achieve that degree of accuracy
in the detection of endometrial carcinoma.
Endometrial biopsy may be used. Its simplicity, the fact that it may be done in
an office without anesthesia, and its cheapness recommend it. But when we consider
how much of the endometrium still remains in the uterus even after the most thorough
of curettages performed under anesthesia, the inadequacies of the biopsy which at best
can onlp sample the endometrium, are evident.
The indispensable means of diagnosis is curettage. Curettage is mandatory in alra
cases of irregular excessive menstruation. Thoroughly performed curettage will yield
the diagnosis in almost all cases, but errors in diagnosis may occur as outlined elsewhere
by Finn55 (1) The uterus may be perforated, (2) The internal os may not be dilated,
hence only endocervix is curetted, (3) the cancer may be in an inaccessible part of the
uterus such as a cornu, (4) a polyp or submucous myoma may protect the cancer from
the curette, (5) hematometra may simply be drained without curettage, and (6) discovery of an obvious cause of bleeding may lead to the deferment of thorough investigation.
Page 212 Hysterography has been advocated, chiefly by European authors. We have had
little experience with this technique and doubt that it will replace a thorough curettage.
Similarly hysteroscopy has been suggested by Norment56. This is still an experimental
stage and will not supplant the curettage. Curettage will remain the indispensable
means of diagnosis for cancer of the endometrium.
Sarcoma of the endometrium is the only sarcoma of the female genital tract which
is common enough to warrant mention. When located in the endometrium, its chief
symptom is excessive menstruation or post-menopausal bleeding. When located in a
myoma or in the myometrium, the myoma is observed to grow or a mass develops or
pain appears. These symptoms indicate the need for curettage and hysterectomy. Since
radiation is of little value, our sole hope of improving the survival of patients with
sarcoma is to detect them so early that the sarcoma is still confined to the uterus and
hence can be eradicated by hysterectomy. Surgical tours de force for more extensive
sarcomas do not improve the results.
Ovarian cancer .is hardly ever detected in an early stage. It is usually in a metastatic phase before symptoms ocur. Frequently delays in diagnosis occur even after
symptoms appear. Diddle57 in collating the statistics of Dallas, Texas, observed eight
months between the onset of symptoms and the establishment of the true diagnosis.
Frequent routine pelvic examinations with careful palpation of the adnexal masses
will help to detect incipient asymptomatic ovarian cancers. It would be well to perform
a pelvic examination as part of the general physical examination in every woman, particularly after an arbitrary age, perhaps of 30. The discovery of any adnexal mass
should then lead to thorough examination under anesthesia. The adnexal organs should
be investigated at every laparotomy, even though no symptoms have been present in the
pelvic area. For practical purposes, the only ovarian cancers which are detected early
are ovarian cancers which are unexpectedly found during the course of a laparotomy
for another indication. Developing this vein further, routine prophylactic oophorectomy
has been recommended when hysterectomy is performed at or after the age of 45. The
sudden appearance of ascites in a woman renders paracentesis mandatory. Bloody
ascitic fluid or fluid of high specific gravity is suggestive of ovarian cancer. A careful
pelvic examination immediately after paracentesis may lead to the discovery of ovarian
tumors which had been hitherto obscured by the presence of fluid. Cytological smears
of the fluid clinch the diagnosis. Peritoneoscopy and culdoscopy have not been helpful
in our hands. We prefer an adequate abdominal incision which permits inspection, palpation and the obtaining of copious biopsies from the original tumor as well as from
metastatic locations such as the omentum.
The prospects of early diagnosis of cancer of the fallopian tube are equally dismal.
Only two tube cancers in the group of about 500 have been diagnosed preoperatively.
Tubal cancer is rarely recognized in the operating room or at gross pathological examination and is usually first diagnosed on microscopic examination. The adnexal organs should
be carefully palpated during every routine physical examination, at each annual check,
and at the time of pelvic examination under anesthesia. They should be inspected
or palpated during the course of every laparotomy. Vaginal and cervical smears have
contained anaplastic cells from the tube as reported by Finn and Javert58 and others.
Hysterosalpingography has been suggested as a means of diagnosis, but seems to us a
fallible and potentially dangerous procedure. One problem encountered in our review
of the tube58 cancer was the occurrence of repeatedly negative curettages in the presence
of post-menopausal bleeding. Two of our patients with cancer of the tube exhibited
this.   Subsequent laparotomy revealed a tubal cancer as the source of the bleeding.   The
Page 213 problem of early diagnosis of cancer of the ovary and tube is one of the most discouraging in the entire field of gynecology.
A more encouraging outlook is present in cancer of the vulva, where we are dealing:
with an exposed surface of the body. Here prophylactic gynecology can be influential
in the prevention of cancer since about one third of all vulvar cancers have an antecedent leukoplakia. The treatment of leukoplakia is unsatisfactory, but simple excision
deserves consideration since it achieves the additional result of removing a potential site
of cancer development.
Early cancer of the vulva can be detected by inspection, palpation and biopsies.
All but the most rapidly developing vulvar cancers should be detectable in a premeta-
static stage. Cancer may develop in Bartholin's gland, but the biopsy of the ulcer or the
mass permits rapid diagnosis. Cancer may also develop in the urethra. Hematuria and
dysuria occur early, so that smear and biopsy facilitate ready recognition.
Cancer of the vagina may be asymptomatic, but more commonly manifests itself]
by vaginal discharge which may be blood stained or by bleeding*    This discharge or
bleeding may be intermittent.   Inspection, palpation, vaginal smear and biopsy are the
steps in diagnosis.   It is perhaps well to regard every vaginal cancer as metastatic uncil
primary lesions have been excluded elsewhere.
An unique cancer arises in the female genital tract—chorionepithelioma. This
cancer represents malignant change in the cells of the chorion of the placenta. It
usually follows a hydatidiform mole, but may occur after an abortion or after a term
delivery? Three indicators alert us to the possibility of a chorionepithelioma: (1) the
persistence or re-occurrence of bleeding after a mole, an abortion or a delivery, (2)
subinvolution of the puerperal uterus, and (3) persistently positive gonadotrophic titres
or the reappearance or an increase in gonadotrophs titres. Chroionepithelioma is rarely
detected in a premetastatic stage. Its rarity and the reluctance of the doctor to perform
hysterectomy in the young woman usually delay the diagnosis until after metastates to
liver, lungs and brain preclude any hope of cure. Curettage is of dubious value in
diagnosis since chorionepithelioma is a myometrial lesion which frequently cannot be
detected by curettage. The history of bleeding, the feeling of subinvolution and the
reappearance or increase in gonadotrophs titres are more important than a negative^
curettage. More recently hysterotomy and biopsy as tried by Javert59 shows promise
and deserves further trial.
Metastatic Lesions of the Genital Tract
Such lesions can be diagnosed by the appropriate means of diagnosis for the organ
in which the metastasis lodges. Investigation of the bladder or rectum may be necessary j
to detect a primary site in these locations. A gastro-intestinal series will be helpful
in the diagnosis of a primary stomach cancer which spreads to both ovaries. Hypernephroma has a predilection for the vagina as shown by Martzloff60. Hence, our exam-!
inations should be thorough and the commonness of primary lesions of the genital tract
should not blind us to the possibility of metastases.
Our desideratum is to detect cancer in so early a stage that the survival rate will
approximate 100 per cent. There is little hope of this at the present time with respect
to cancers of the ovary and of the tube, chorionepitheliomas or metastatic lesions from
other organ systems. But cancer of the cervix, of the endometrium, of the vulva and
of the vagina can be detected in earlier stages. This involves the acceptance of the in
situ concept of cancer with a dormant asymptomatic period during which it can be
Page 214 diagnosed while still confined to the surface epithelium. It requires frequent prophylactic physical examinations. It demands the use of the smear and biopsy in a routine
screening fashion. To be practical it forces us to concentrate our efforts on groups of
women who are more prone to cancer than are the general population. Our hope of
detecting genital cancer in treatable premetastatic stages lies in both the prompt use of
the existing diagnostic tests when symptoms are present and in their routine use as
screening techniques when symptoms are not present.
TABLE I (Hayman4)
Annual Report—Cancer of Uterine Cervix
Number of
Stages Patients
Apparent Treated
1    ...10,5 82
2    23,190
3    22,911
4 .  7,529
Unclassified           24
Total    - 64,236
Per cent
Vol. VII, 1952
with no
of Disease
1. Howson, J.  Y.,  Observations on the Delay Period in the Diagnosis of Pelvic Cancer.    Med. Clin.
North America, Vol. 32, No. 6.
2. Foote, F.  W". and Li, K.: Smear Diagnosis of in situ Carcinoma of the Cervix.    Am. J. Obst. and
Gynec. 56: 335, 1958.
3. New York State Department  of Health.    Program  Plan  for  Cancer  Control,  Bureau of Cancer
Control, New York State, Department of Health.    May,  1948.
4. Heyman,  J.:   Annual   report   of  the  results   of  radiotherapy  in   carcinoma  of  the   uterine   cervix.
Vol. VII.    Stockholm, 1952.
5. Meigs, J.  V.:  Radical  Hysterectomy with  Bilateral  Pelvic lymph  Node  Dissections.     A  report  of
100 Patients Operated on Five or More Years Ago.    Am. J. Obst. and Gynec.    62:  854, 1951.
6. Douglas, G. W. and Studdiford, W. E.: The Diagnosis of Early Carcinoma of the Cervix.    Surg.,
Gynec. and Obst.    91: 728, 1950.
7. Schiller,  W.:   Uber   Fruhstudien   des  Portio   carcinoms   und  ihre  Diagnose.  Arch.   f.   Gynak.   133:
211, 1928.
8. Schaunstein, "W.: Histologische Untersuchungen uber atypisches Plattenepithel an der Portio un an
der innerflache der Cervix uteri.    Arch. f. Gynak.    85: 576, 1908.
9. Psonai, K.:  Zur Lehre von der Histogenese und  dem "Wachstum des  Uteruscarcinoms.    Arch.   f.
Gynak.    89: 596, 1909.
10. Schotdander, J. and Kermauner, F.: Zur Kenntnis des Uteruskarzinoms. Berlin, Verlag von S.
Kr auger, 1912.
11. Smith, G. V. and Pemberton, F. A.: The Picture of Very Early Carcinoma of the Uterine Cervix.
Surg., Gynec. and Obst. 59: 1, 1934.
12. Younge, P. A., Hertig, A. T. and Armstrong, I.: A study of 135 cases of Carcinoma in situ of the
cervix at the Free Hospital for "Women.    Am. J. Obst. and Gynec. 58: 867, 1949.
13. Galvin, G. A. and TeLinde, R. w\: The Present-Day Status of Non-Invasive Cervical Carcinoma.
Am. J. Obst. and Gynec. 57: 15, 1949.
14. Jones, H. W". Jr., Galvin, G. A. and TeLinde, R. W.: Intraepithelial Carcinoma of the Cervix and
its Clinical Implications.    Int. Abst. Surg. 92: 521, 1951.
15. Galvin, G. A., Jones, H. "W. Jr. and TeLinde, R. w".: Clinical Relationship of Carcinoma in situ and
Invasive Carcinoma of the Cervix.   J.A.M.A. 149: 744, 1952.
16. "Wespi, H.: Early Carcinoma of the Uterine Cervix. New York, Grune and Stratton, 1949.
17. Kottmeier, H. L.: Personal Communication.   Quoted in reference 13.
18. Lombard, H. L. and Potter, E. A. Unpublished Data quoted by Morris, J. Mc.I and Meigs, J. V.
Carcinoma of the Cervix. Statistical Evaluation of 1,938 cases and Results of Treatment. Surg.,
Gynec. and Obst. 90: 135, 1950.
19. Gagnon, F.: Contribution to the Study of the Etiology and Prevention. of Cancer of the Cervix'
of the Uterus.    Am. J. Obst. and Gynec. 60: 516, 1950. ||1| -    g|||
Page 215 20. Rothman, A., Rapaport, L. P. and Davidsohn, I: .Carcinoma of the Cervix in Jewish women. Am.
J. Obst. and Gynec. 62: 160, 1951.
21. Kaplan, I. I. and Rosh, R.: Cancer of the Cervix, Bellevue Hospital Method of Treatment over a
Period of Twenty-One Years.    Am. J. Roent. 57: 639, 1947.
22. Day, E., Rigney, T. G. and Beck, B. F.: Cancer Detection. Analysis and Evaluation of 2,011
Examinations, In Press.
23. Hinslman, FL: Die Diagnose der Uteruskarcinoms.    Klin. Wehmscher. 9:  1507,  1930.
24. Papanicolaou, G. N. and Tract, H. F.: Diagnosis of Uterine Cancer by the Vaginal Smear, Ne^a
York, 1943.    Commonwealth Fund.
25. Ayre, J. E.: Selective Cytology Smear for Diagnosis of Cancer. Am. J. Obst. and Gynes. 53: 609,
26. Gladstone, S. A.    Sponge Biopsy.    A New Method in the Diagnosis of Cancer.    Cancer, 2: 604, 1949.
27. L'Esperance, E. S.: The Early Diagnosis of Cancer in "Women. Bull. N.Y. Acmd. Med. 26: 703,
28. Pund, E. R., Nieburgs, H. E., Nettles, J. B. and Caldwell, J. O.: Pre-Invasive Carcinoma of the
Cervix Uteri. Seven Cases in "Which it was Detected by Examination of Routine Endocervical
Smears.    Arch. Path. 44: 571, 1947.
29. Novak, E.: What Constitutes an Adequate Cancer Detection Examination of the Cervix. Am. J.
Obst. and Gynec. 58: 831, 1949.
30. Ayre, J. E.: Diagnosis of Preclinical Cancer of the Cervix: Cervical Cone Knife: Its Use in Patients
with a Positive Vaginal Smear.    138: 11, 1948.
31. Gusberg, S. B.: Detection of Early Carcinoma of the Cervix. The Coning Biopsy. Am. J. Obst.
and Gynec. 57: 752, 1949.
32. Foote, F. W. Jr., and Stewart, F. W.: The Anatomical Distribution of Intraepithelial Epidermoid
Carcinomas of the Cervix.   Cancer 1: 431, 1948.
33. Cox, K. E., Buhler, V. B. and Mixon, W. C: Changing Concepts in Cervical Biopsy. Am. J. Obst.
and Gynec. 56: 112, 1948.
34. Lock, F. R. and Caldwell, J. B.: The Early Diagnosis of Carcinoma of the Cervix. Tr. Amer.
Assoc. Obst., Gynec. and Abd. Surg. LIX:  127, 1948.
35. Finn, W. F.: The Postoperative Recognition and Further Management of Unsuspected Cervical
Carcinoma.   Am. J. Obst. & Gynec. 63: 717, 1952.
36. Sommers, S. C, Hertig, A. T. and Bengloff, H.: Genesis of Endometrial Carcinoma. 11 Cases 19
to 35 Years Old.    Cancer, 2: 957, 1949.
37. Speert, H.: Carcinoma of the Endometrium in Young Women.    Surg., Gynec. & Obst. 88: 332, 1949.
38. Dockerty, M. B., Lovelady, S. B. and Foust, G. T.: Carcinoma of the Corpus Uteri in Young
Women.   Amer. J. Obst. & Gynec. 61: 966, 1951.
39. Hirst, B. C: Malignant Growths of the Uterus in Young Girls. Am. J. Obst. & Gynec. 18: 104,
40. Corscaden, J. A. and Gusberg, S. B.: The Background of Cancer of the Corpus. Am. J. Obst. &
Gynec. 53: 419, 1947.
41. Randall, C: Disc, of 40.
42. Taylor, H. C. Jr. and Becker, W. F.: Carcinoma of the Corpus Uteri. End Results of Treatment
in 531 Cases from 1926-1940.    Surg. Gynec. & Obst.  84:  129, 1947.
43. Crossen, R. J. and Hobbs, G. E.: Relation of Late Menstruation to Carcinoma of the Corpus Uteri.
J. Mo. St. Med. Assoc. 32: 361, 1935'.
44. Palmer, J. P., Reinhard, M. C, Sadugor, M. G. and Goltz, H. L.: A Statistical Study of Cancer of
the Corpus Uteri.    Am. J. Obst. & Gynec. 58: 457, 1949.
45. Smith, F. R.: Disc, of 40.
46. Speert, H. and Peightal, T. C: Malignant Tumors of the Uterine Fundus Subsequent to Irradiation
for Benign Pelvic Conditions.    Am. J. Obst. & Gynec. 57: 261, 1949.
47. Hertig, A. T. and Sommers, S. C: Genesis of Endometrial Carcinoma. I Study of Prior Biopsies.
Cancer 2: 946, 1949.
48. Hertig, A. T., Sommers, S. C. and Bengloff, H.: Genesis of Endometrial Carcinoma HI Carcinoma
in situ.   Cancer 2: 964, 1949.
49. Fremont-Smith, M., Meigs, J. V., Graham, R. M. and Gilbert, H. H.: Cancer of the Endometrium
and Prolonged Estrogen Therapy.    J.A.M.A. 131: 805, 1946.
50. Vass, A.': Occurrence of Uterine Fundus Carcinoma after Prolonged Estrogen Therapy. Am. J.
Obst. & Gynec. 58: 748, 1949.
51. Ingram, J. M. and Novak, E.: Endometrial Carcinoma Associated with Feminizing Ovarian Tumors.
Am. J. Obst. & Gynec. 61: 774, 1951.
52. Scheffey, L. C, Rakoff, A. E. and Hoffman, J.: An Evaluation of the Vaginal Smear Method for
the Diagnosis of Uterine Cancer.    Am. J. Obst. & Gynec. 55: 453, 1948.
53. Fremont-Smith, M., Graham, R. M. and Meigs, J. V.: Early Diagnosis of Cancer by Study of
Exfoliated Cells.   J.A.M.A. 138: 469, 1948.
54. Cuyler, W. K., Kaufmann, L. A. and Caster, B.: Genital Smears in the Diagnosis of Adenacarcinoma
of the Uterus.   No. Car. Med. J. 11: 494, 1950.
Page 216 55. Finn, W. F.: Delays and Errors in the Diagnosis and Treatment of Endometrial Carcinoma.   N.Y.
St. J. of Med. 52: 235, 1952.
56. Norment, W. F.: Hysteroscope in Diagnosis of Pathological Conditions of Uterine Canal. J.A.M.A.
148: 917, 1952.
57. Diddle,   A.   W.:   Genital   Cancer   Among   Women.     Factors   Affecting   Its   Control   in   an  Urban
Population.    Am. J. Obst. & Gynec. 59: 1373, 1950.
58. Finn, W. F. and Javert, C. T.    Primary and Metastatic Cancer of the Fallopian Tube.    Cancer 2:
803, 1949.
59. Javert, C. T.  (Abstract of Park, W. W. and Lees, J. C: Choriocarcinoma: A general Review with
an analysis of 516 Cases.   Arch. Path. 49: 73-104, 205-241, 1950)    Cancer 4: 433, 1951.
60. Martzloff,  K.   H.   and  Manlove,   C.   H.:   Vaginal   and   Ovarian   Metastases   from   Hypernephroma.
Surg., Gynec. and Obst. 88: 145, 1949.
The supply of free cancer dressings for those for whom the cost of dressings may
be a difficult burden has been a major humanitarian project of the Order of the
Eastern Star for several years.
At present there are 36 stations throughout the Province working to make and
supply these dressings. In some cases, although sufferers could pay for dressings without
being unduly burdened, special dressings are required, such as could not be purchased!
in the ordinary way. In these cases special dressings will be made and supplied to meet
special requirements, as advised by the medical and nursing attendance.
For these special dressings, and also for ordinary dressings, it must be clearly
understood that no payment will be accepted. On occasion patients may wish to show
their gratitude in some tangible form, and a donation to further this work of the
Order of the Eastern Star will not be refused. It hardly needs repeating that this
service is rendered to all cancer patients without regard to Colour, Race or Creed.
This notice is being published because although the medical profession has in the
past been circularized with full information, it has been observed that many cancer
patients and their doctors are as yet unaware of this valuable and humanitarian service,
which is at the disposal of them all.
Dressings may be applied for by doctors, V.O.N, or Public Health Nurses or other
authorized medical attendants at the local Dressings Station or the Headquarters at
2586 Heather Street, Vancouver.
We would call special attention to this notice, which will be a help to many
medical men, and above all will mean a great saving in expense to cancer patients who
require dressings. The work of these ladies is most worthy of our appreciation and
the best way we can show this is by using the service they so generously supply.       Ed.
A panel discussion of the subject "Is Home Care a Solution to
the Hospital Bed Shortage?" is to be held on February 26, at 8:00
p.m., at the T.B. Seal Auditorium. Dr. Stewart Murray, City Health
Officer; Dr. Myron Weaver, Dean of the Faculty of Medicine; Mrs.
Rex Eaton, O.B.E., President of the Provincial Council of Women;
A. H. J. Swencisky, President of the B.C. Hospital Association, and
Tom Alsbury, President of the Vancouver Trades and Labour Council,
will take part in the discussion.
The annual meeting of the Victoria Order of Nurses will take
place following the panel discussion.
Page 217 British Columbia Hfutston
Canadian iHfediral Association
1807 West 10th Ave., Vancouver, B.C.      Dr. G. Gordon Ferguson, Exec. Secy
President—Dr. J. A. Ganshorn—
President-elect—Dr. R. G. Large-
Vice-President and Chairman of General Assembly—Dr. F. A. Turnbull	
Hon.  Secretary-Treasurer—Dr. W. ~R. Brewster	
.Prince Rupert
.New 'Westminster
Members of the Board of Directors
Dr. G. Chishotm
Dr. E. W. Boak
Dr. C. C. Browne
Prince Rupert and Cariboo
Dr. R. G. Large
New Westminster
Dr. J. A. Sinclair
Dr. W. R. Brewster
Dr. A. S. Underhill
Dr. C. J. M. Willoughby
Dr. F. A. Turnbull
Dr. A. W. Bagnall
Dr. F. P. Patterson
Dr. P. O. Lehmann
Dr. G. C. Johnston
Dr. Ross Robertson
Dr. R. A. Gilchrist
Dr. J. Ross Davidson
Dr. R. A. Palmer
Dr. J. McMurchy
Standing Committees
Constitution and By-Laws.
-Dr. R. A. Stanley, Vancouver
Medical Economics.
Medical Education-
Programme and Arrangements	
Public Health \	
Special Committees
Arthritis and Rheumatism	
Civil Defence	
Hospital Service	
Industrial Medicine	
Maternal Welfare	
Membership !	
.Dr. W.  R. Brewster, New Westminster
 -Dr. J. C.  Thomas, Vancouver
 Dr. P. O. Lehman, Vancouver
 Dr. T. R. Sarjeant, Vancouver
 Dr. J. A. Ganshorn, Vancouver
 Dr. Harold Taylor, Vancouver
 Dr. G. F. Kincade, Vancouver
 Dr. F. W. Hurlburt, Vancouver
-Dr. Roger Wilson, Vancouver
 Dr. John Sturdy, Vancouver
 Dr. J. C. Moscovich, Vancouver
 Dr. J. S. Daly, Trail
 Dr. A. M. Agnew, Vancouver
.Dr. E. C. McCoy, Vancouver
Public Relations.
_Dr.  D.  M.  Whitelaw, Vancouver
—Dr. G. C. Johnston, Vancouver
In considering post graduate courses, I have recently been impressed by the excellent
opportunities in this regard, offered by our city. Let us consider them a moment, I am
sure they will give you a sense of achievement.
Any week at all, there are many activities going on. Look at the third page of
this journal and you will see regular weekly fixtures at different hospitals. In addition
to these, there are the Out Patient Clinics at the Vancouver General, St. Paul's, and
Children's Hospitals, five days a week, at which any visiting doctor is welcome to go
and observe or even take part. In this way it means that any week one could visit
Vancouver and arrange a very full and satisfying period of instruction. It is these
basic week by week activities that make a centre really important.
Page 218 Of course all medical centres have "specials", and Vancouver is no exception in
this regard. Let us look at a few: The Vancouver General Hospital puts on frequent
refresher courses of different categories—if you are not now receiving their notices
I suggest you might contact them, for you will find these excellent concentrated features
along some important points of the various subjects undertaken. The V.M.A. has an
interesting medical conference every Tuesday evening at the various hospitals. Then
of course there is their highlight, the annual summer school, which is certainly one of
the best short courses available anywhere. You will be finding further information
on this subject in the Bulletin each month. Your provincial association also has an
annual meeting every fall, with excellent clinical material. Again note the dates on the
cover of this Bulletin. All these are most excellent opportunities for study or refresher
However, in addition to this, there are the activities of each section—for example,
the B.C. Surgical Society is having a two day meeting on the 25 th and 26th of April.
The B.C. Society of Internal Medicine is having an all day meeting on the 28 th of March,
while each other section has meetings and the clinical portions of all of these are open
to you.
While most of these Specialist Societies, whether provincial or extending beyond,
are open only to those qualified in the particular field, there has recently been formed
an international group to which any doctor may belong. This was formed in 1950,
with members from Northern California, Oregon, Washington, Idaho, and British
Columbia.^-It is essentially for the dissemination and integration of medical knowledge
in the north west. The medical schools in Seattle, Portland, and Vancouver supply the
impetus and papers, but the greatest number of members are those who come to listen
and learn. There has been one meeting in each of the university centres, with a second
this year in Seattle. Next year the meeting will be in Vancouver. The subjects considered at these meetings cover all of medicine and the speakers have included professors
of medicine at each of the universities, professors of pathology, radiology, surgery,
obstetrics and gynecology, plus departmental heads in almost all branches. Dr. E.
Christopherson is the president this year and is in charge of arranging the meeting in
Vancouver next spring. Here is your chance to join an international organization—the
North West Society for Clinical Research.
F. L. SKINNER, Editor.
RADIO BROADCASTS—Your Public Relations committee feels that you may
not all be able to hear all the programmes so we are reproducing a sample. You will
see here that our object is to try to make it interesting to the public by giving them
authentic -information on purely medical subjects, and intersperse these programmes
with others which we feel are more important to us as a profession. Our announcer in
all these is Mr. Dorwin Baird of CJOR.
Tuesday, January 20, 1953—"HEALTH INSURANCE"
BAIRD—This is, the Doctors' Viewpoint. Each week at this time your doctor,
through the British Columbia Division of the Canadian Medical Association, presents a
program giving the doctors' viewpoint on various medical matters. Tonight the subject
of our discussion will be Health Insurance, and our speaker will be Dr. John A.
Ganshorn, president of the B.C. Division. Many Canadians have recently been asked
to sign a petition being circulated throughout the nation, which calls for state health
insurance. Tonight, and in other broadcasts in future weeks, your doctor will discuss
health insurance. Perhaps Dr. Ganshorn, you could give us the doctors' viewpoint on
this question from a policy point of view—and then we can go into details.
DOCTOR—The Canadian Medical Association, as long ago as 1942 approved
the adoption of the principle of health insurance.   We are not in favor of state health
Page 219 insurance however, because politics and health don't mix, and because government with
its bureaucracy would cause deterioration in the standard of medical care. Health insurance, to our way of thinking, is a cooperative effort to pool resources and utilize all our
medical faciHties to the utmost, and to assure that the relationship between patient and
doctor is one that will foster even greater development of the service and make certain
that medical advance will not be stifled.
BAIRD—Since you do not favor a government plan, have you an alternative?
DOCTOR—We have done, and are doing, a great deal about health insurance
plans. We have inaugurated local or provincial plans along the lines which we believe
can be the answer to the very reasonable demand for coverage for all people. A plan
of this sort would be sponsored by the doctors, just as M.S.A. in B.C. was first sponsored by the doctors, but in the same way, the plan would not necessarily be run by
the doctors.
BAIRD—What are the more important points of your plan?
DOCTOR—There are four of them I should mention here. One—the patient
must have a free choice of doctor. Second, there must be no interference in the patient-
doctor relationship. Third, it should be a contributory type of insurance, and fourth,
the fee for service basis of payment to the physician should be used.
BAIRD—Your points, I gather, leave an important element of private enterprise
and personal initiative in the picture.
DOCTOR—Definitely, and they leave the individual with responsibilities with
regard to his own health.
The free choice of doctor, and the payment of a fee for each service, continues to
encourage better doctors. It also encourages the steady development in medicine that
we have had in the past half century. Physicians naturally vary in their capacity to
work, as well as in their professional abilities. Fee for service in the only way to allow
different compensation for these personal characteristics. Each doctor is paid in proportion to his effort.    We believe this to be the only reasonable method.
BAIRD—I can see where the free choice of a doctor benefits the patient too.
DOCTOR—It certainly does. A patient must have faith in his doctor, and the
foundation of that faith is the fact that he selected the doctor in the first place. Your
faith might well be shattered now and then if you had to apply to a board or a government department for a family doctor selected by them. Certainly, the mutual confidence that is so necessary between doctor and patient might not always be there. Both
the patient and doctor would be free under this system. The patient would be free to
choose, and change doctors, and the doctor would be free to develop. He would not
be a salaried civil servant.
BAIRD—You are, I understand, in favor of the regional plan idea rather than any
national super-plan.
DOCTOR—We do feel that each province should have a plan, developed to suit
its particular needs. Basic standards could be nation-wide. It's just that in the actual
running of the plan we feel the government should keep hands off. A health scheme
should never become a political football. It should be above politics. We believe that
administration should be a joint effort by those rendering and those receving the services
—and as far as policy is concerned in actual medical care, this should be the responsibility
of the doctors.
BAIRD—There are those who say that a government health plan will almost automatically lead to a healthier nation.
DOCTOR—This just isn't true. We are becoming a healthier nation by leaps-
and bounds—and this is because of all the developments of the past few decades which
have come about because of the system we now have. The medical profession has
encouraged research, and health education—and both have been responsible for our
progress to date. The road to a completely healthy nation is a long one. We are
moving faster along that road today than at any other time in the history of mankind.
We feel that the institution of any government health plan would slow down our
Page 220 progress, not speed it up. As long as we have doctors with initiative, push and ambition,
the standard of care and the health of the nation will continue to rise. Of those
qualifications, initiative is the most important, for it has been the doctors of initiative
who have given us our greatest medical advances. We feel that under a bureauocracy,
initiative would be stifled, and the standards would deterioriate.
BAIRD—In this discussion, is there anything to be learned from the experience
of medical men in the armed forces?
DOCTOR—Yes. In the armed forces treatment of the individual was not always
personal because administrative demands sometimes dictated the treatment. In such a
highly organized effort, the supply and inegration of an army, together with evacuation
demands interfered with the individual. In civilian life this is not necessary and our
plan can avoid these administrative and bureaucratic requirements.
BALRD—What do you feel are the points in the health insurance petition mentioned earlier, with which you disagree?
DOCTOR—Two of the points in the petition, we feel, are far wide of the mark.
In the first place, by advocating financing by general taxation, the proposal ignores the
very important factor of personal responsibility. And second, I believe that we have
discussed the disadvantages of state plans sufficiently tonight to answer that part of the
BAIRD—I know that this field of health insurance is too broad for one broadcast,
but could you give us a summary of the position that you have outlined tonight?
DOCTOR—Once again, the main point is that there are so many advances in
medicine today that only by planning can the new things be made universally available
at reasonable cost to the individual. We are therefore in favor of spreading this cost
through health insurance. We are not in favor of state health insurance because we
fear for the standards of medical care under such a political system of control. We do
have a plan of our own, and the plan receives its strength by maintaining the present
relationship between patient and doctor. We also keep the free choice of a doctor, and
free choice of patient, and we advocate the payment of doctors on a fee for service
basis. The fourth important point is that the individual can do so much to keep his
mind and body in a healthy state that he must be left with considerable responsibility
himself. Our interest today, as always, lies in seeing the standard of care continue to
improve—and in this way our interests are the interests of every Canadian. An insurance plan is an ideal thing for Canada, but your doctor feels very strongly that a state
plan, without responsibility by the individual, would fall far short of doing the job.
In future broadcasts, other doctors will elaborate on this viewpoint, in order that it
may be fully understood.
BAIRD—Tonight, the Doctors' Viewpoint has brought you a discussion on health
insurance, with Dr. John A. Ganshorn, president of the B.C. Division of the Canadian
Medical Association—sponsor of these weekly talks. Your doctor invites you to send
in your comments on these broadcasts, and to be with us again next Tuesday evening,
when the Doctors' Viewpoint will discuss various aspects of cancer, and its control in
Canada.   Listen again next week then, for another broadcast of The Doctors' Viewpoint.
Tuesday, January 27, 1953—"CANCER"
BAIRD—This is, the Doctors' Viewpoint. Each week at this time, your doctor,
through the British Columbia Division of the Canadian Medical Association, presents
a broadcast of discussion of medical matters in the news. From time to time on this
series, we have discussed various diseases which themselves frequently become headline
news. Tonight Dr. A. Maxwell Evans speaks for the doctors, on the subject of cancer.
Perhaps the best way to start, Doctor, would be to get some definition of cancer.
DOCTOR—I suppose the best definition would be to say that cancer was a new
growth or mass of tissue growing from normal cells which are altered by some unknown
Page 221 process.    The growth has no useful function.    It continues to grow, and if it is not
treated, it is fatal.
BAIRD—Is this one of the diseases recently discovered since the advances of medical
science in this century ... or is it older?
DOCTOR—We have evidence that cancer was known to the ancients. Our modern
methods of diagnosis mean that we have more cases today than ever before, but that is
largely because we have better ways of spotting cases. One other matter of interest
right here, and that is that cancer is not selective. It affects every race . . . class . . .
colour and age group.   Indeed, we find it in plants and animals, too.
BAIRD—In plants?    That seems strange.
DOCTOR—I'm sure you've seen trees with strange growths on them that seem
tx> have no relationship to the tree itself. But don't get the idea that you can get the
disease from plants or animals.   Cancer most definitely is not infectious.
BAIRD—Does that mean you cannot induce cancer experimentally?
. DOCTOR—No. Tumors have been produced experimentally. Two Japanese
doctors did it back in 1914, dealing with rabbits. It has been produced in other instances
too, but so far that has not led us very close to the knowledge of what cancer is. I
think our present situation can be summed up by saying that we are learning more and
more ways to discover cancer, and to either cure or treat it—but that our knowledge of
the cause is still pretty sketchy. Doctors all over the world are trying very hard to
get at the causes of the disease, but it is entirely possible that some day we will find
a complete cure, without ever knowing everything there is to know about cancer itself.
BAIRD—In that case, I guess our best bet is to discuss some of those treatments
now in general use.
DOCTOR—Yes—but first I should say that the secret of successful treatment is
early discovery of the disease. If every person •would realize the importance of going
to their medical practitioner when they felt that something was wrong, we'd be able
to start treatment earlier, and have just that much more chance of success.
BAIRD—You say . . . "when something is wrong." Do you mean, when pain
is experienced?
DOCTOR—Not necessarily. Pain usually encourages an early visit to the family
doctor, but pain does not always turn up as a symptom of cancer. In some cases, a
tumour may reach a large size without any discomfort to the patient. What I mean is
that a great many people notice lumps that have no explanation, or cracks or sores that
do not heal, or other unusual things happening to their bodies that are not always painful.
Sometimes people with these conditions may suspect cancer, but for some reason a certain
kind of person will hesitate to go to his doctor. I think perhaps these people have a
fear of cancer. By this fear they put off diagnosis and treatment until the condition
is advanced. We doctors suggest that since the odds are against it being cancer, that
the best thing to do is allow your doctor to examine you and either set your mind at
rest, or if cancer is present, start a treatment that will arrest the tumour in its early
stages. Your doctor has a wide range of tests available to him now. He has the means,
in other words, to spot the early development of most types of cancer. That is why I
believe that a person with any reason to believe that something is wrong with him
should see his doctor. It might not be cancer. Chances are it isn't . . . but it still
might be another condition that should be checked and treated.
BAIRD—Is this possibility of early diagnosis a pretty general rule?
DOCTOR—Yes, although there are exceptions. There are also exceptions to the
rule that we can arrest cancer when we find it soon enough. It's that kind of a disease.
Our fight against it has made tremendous strides, but there is a great deal yet to be
learned. We can say though, that the majority of cases respond to early treatment . . .
the earlier the better.
BAIRD—Which brings us to the subject of treatment itself.
DOCTOR—This falls into two fields, surgery and radiation. Surgery can be very
effective in many cases.    Removal of the tumour is naturally a very efficient way of
Page 222 getting rid of it, provided of course that vital parts of the body do not have to be
removed too. In the past twenty-five years surgery has advanced a long way, due to
better methods of anaesthesia, the discovery of antibiotics, the availability of blood, and
so on. Along with this general advance in surgery has gone an advance in surgery
for cancer conditions . . . but as I said, there are some limitations.
BAIRD—In mentioning radiation, I presume you mean X-rays, radium treatment,
and radioactive isotopes such as the Cobalt Bomb?
DOCTOR—The X-rays, discovered by Roentgen in 1895, were in use a few
years later. About that time, the Curies discovered Radium, and we stayed at that
stage until the discovery of the Radioactive Isotopes, which now could be said to be a
by-product of the atom bomb. Personally I feel the curative uses of these "by-products
are far more vital to the future of Man than any other aspect of atom-smashing.
BAIRD—What is the basis of radiation treatment, Dr. Evans?
DOCTOR—It is based on one very important fact—the ability of these radiations
to destroy cancer cells without destroying normal tissue. This is important, because
you can very easily appreciate what would happen if both cancer and everything else
in the path of the ray were to be destroyed. It is also important to point out that some
tumours are only partially sensitive to radiaion, while some others do not react at all.
The Cobalt Bomb has given us what might be called a powerful source of radiation but
it is still new enough that we do not know all of its capabilities, nor have we yet discovered all of its limitations. We do know enough about it to say that Canada deserves
to be proud that this instrument was devised in this country.
BAIRD—Considering all the various treatments now in use, and the research work
now being done in the cancer field, have you any special remarks regarding the future
of Cancer control?
DOCTOR—A complete solution to the problem of cancer seems at the moment to
be an extremely complex one. As we have pointed out, a great deal of research is now
going on. Perhaps the eventual solution may be found to be quite simple—as has been
the case in other diseases we have brought under control. However, the present day
picture is considerably brighter than that of a quarter century ago. The disease can
be cured and controlled in a large measure, with the fullest use of present day methods.
We are looking forward to the day when it can be completely controlled, and we have
every reason to believe that day is coming. In the meantime, may I urge once again
that all persons give themselves a break by reporting to their doctors when any suspicious developments occur that could possibly be cancer, or any other disease.
BAIRD—Thank you, Dr. Evans. Tonight the Doctors' Viewpoint has presented
a discussion of some aspects of Cancer, with Dr. A. Maxwell Evans as our guest. These
broadcasts are presented by your doctor, through the B.C. Division of the Canadian
Medical Association. Your doctor invites you to be with us again next Tuesday evening
for another broadcast of The Doctors' Viewpoint.
Proposed Section of Physicians in Public Service of the Canadian
Medical Association, B.C. Division.
On April 9th at 8:15 P.M. in the Christmas Seal Auditorium at
Tenth and Willow, a meeting will be held to discuss the formation
of such a Section. The Canadian Medical Association, B.C. Division,
has signified its approval of such a step.
All Physicians and Surgeons employed full or part time in an
institution or with a government department are urged t6 attend.
135 St. Clair Avenue West
Toronto 5.
January 30, 1953.
Re: New Immigrants
Our attention has been drawn to the fact that a number of immigrants coming
to Canada have been found shortly after their arrival to be physically and mentally
The question has been asked of this office, "Do the medical examiners abroad carry
out their task as thoroughly as they should?"
It will be appreciated if you will let me know of any instances which came to
your attention in your own province which would suggest a tightening-up policy
healthwise in respect to Canadian immigration, especially from European countries.
Yours sincerely,
General Secretary.
Since no comments in this regard have been heard by the secretary, the letter is
published in the hope that any practising physician in British Columbia who has encountered any evidence of sick immigrants being admitted to Canada, will advise the
office of C.M.A., B.C. Division, of their experience.
The special committee on Arthritis and Rheumatism wishes to
announce that two pamphlets will be distributed shortly to the doctors
of British Columbia. These have been published by the Canadian
Arthritis and Rheumatism Society as a service to you and your
patients, this initial free distribution being made possible by a grant
from the B.C. Department of Health under the Federal Health Grant
The pamphlet, "What You Should Know About Arthritis/7 contains general information about rteumatic diseases for laymen.
The pamphlet, "Rheumatoid Arthritis — A Handbook for
Patients", is designed to assist patients suffering from Rheumatoid
Arthritis and Spondylitis to gain a better understanding of their
disease and thus be better equipped to follow the general principles
of treatment.
A small charge of ten and twenty cents respectively will be
necessary for further pamphlets and, if more are desired, they may
be obtained by your patients by writing to the Canadian Arthritis and
Rheumatism Society, B.C. Division, 1093 West Broadway, Vancouver
9, B.C.
Chairman, Special Committee on
Arthritis and Rheumatism.
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
A free cancer diagnostic and screening service is available at the Cytological
Diagnostic Laboratory located at the B.C. Cancer Institute, Vancouver. This laboratory
was originally set up in August, 1949, under a research grant from the Canadian Cancer
Society, B.C. Division. Experience indicated that cytology service should be regularly
available, and from November, 1950, therefore, this laboratory has been financed by
the National Health Grant for Cancer Control and matching Provincial funds. The
laboratory is under the direction of the Director of Pathology, Vancouver General
At the time of its inception, this plan of having free cytological examinations
available at only one centre in the province was the logical step in the early planning
of this program. During the past year detailed consideration was again given to the
question of whether or not this service should be absorbed into the biopsy service, that
is, available at any general hospital where there is a certified pathologist, and it was
decided that there should be no change. The British Columbia Association of Pathologists supported this decision by resolution at their annual meeting in September, 1952.
However, it was also decided that this resolution would not prevent those pathologists
interested in cytology from giving similar services in their hospital, if so desired.
The steady growth of the services given by the Cytological Diagnostic Laboratory
is indicated by the following table:
Number and Result of Examinations
Three Years ended September, 1952
Total Positive
Year ended September,  1950 1,644 141
Year ended September,  1951 2,737 236
Year ended September,  1952 5,765 301
Of the 5,765 examinations done during the 12 months ended September, 1952, the
anatomical source was cervical in 76 per cent of the examinations, pulmonary in 15 per
cent, exudates 5 per cent and miscellaneous 4 per cent.
A follow-up program has been developed. During the past year 2,026 patients with
negative cytological reports have been followed for one year and 1740 have been followed
for two years. Owing to pressure of work only first year follow-up of patients with
negative reports has been done since August, 1952. In addition, 387 patients with
suspicious or positive reports have been followed at two monthly intervals until confirmatory information or otherwise is located, and then copies of all pertinent pathological, autopsy or x-ray reports are acquired together with tissue slides. As the follow-
up records of the 1951 cases were not closed until January, 1953, information on the
results of the follow-up is not yet available.
STAFF NOTES '  (1§^-   /v|§
Dr. Stephen Carr has been appointed Director of the Skeena Health Unit with
headquarters at Prince Rupert.
Dr. Duncan McC. Black has been appointed Director of the North Okanagan
Health Unit with headquarters at Vernon effective February 1. Dr. Black was formerly
Director of the Skeena Health Unit.
Page 225
Attending the Second Western Regional Conference of Civil Defence Health
Services at Edmonton, January 26, 27 and 28, 1953, were the following physicians
from this Province:
Dr. A. D. McKenzie, Asst. Professor, Surgery, University of British .Columbia, who
participated in a Panel Discussion on First Aid.
Dr. John Sturdy, representing the B.C. Division, Canadian Medical Association.
Dr. T. H. Patterson, Chairman, Civil Defence Health Services Advisory Committee,
British Columbia.
Dr. J. L. Gayton, Medical Health Officer, Victoria-Esquimalt Board of Health.
Dr. S. S. Murray, Senior Medical Health Officer, Metropolitan Health Committee
of Greater Vancouver.
Dr. G. R. F. Elliot, Assistant Provincial Health Officer.
The General Practitioners Section of the C.M.A., B.C. Division will hold a scientific session at Harrison, March 20th and 21st. Speakers will be Doctors J. F. McCreery,
R. B. Kerr, Dean Myron Weaver, in addition to a guest speaker from Seattle. Details
may be had from Dr. Howard Black, 925 West Georgia Street in Vancouver.
Dr. Samuel Bogoch is now doing post-graduate work at Harvard Medical School.
Dr. D. H. T. Lee is now studying radiology at Sunnybrook Hospital in Toronto.
Dr. J. C. Kovach of Vancouver is now in surgery at Bellevue Hospital in New
York.  Dr. Murray Enkin is also in Obstetrics there.
Dr. Elizabeth Mahaffy is now working on her M.P.H. degree at the University of
California in Berkely.
Dr. A. J. Venables is now in residence in pathology at the Tacoma General Hospital.
Dr. A. J. Kergin is now in general surgery in New Westminster.
Dr. A. McMurchy is now in the department of Anesthesiology at the Vancouver
General Hospital.
Dr. J. G. McPhee is now radiologist at the Royal Columbian Hospital in New
Dr. W. L. Sharp is now practising internal medicine in West Vancouver.
Dr. J. L. Danto is now practising in South Granville, Vancouver, B.C.
Dr. A. C. McKenna from Ireland has joined the staff of the Victoria Tuberculosis
Dr. and Mrs. S. Janowsky of Victoria have returned from a trip through California
and Mexico.
Dr. and Mrs. S. Avren of Victoria have returned from a motor trip through the
West Coast and Mexico.
Dr. R. E. Burns of Victoria attended the annual meeting of the American Academy
of Dermatology in Chicago last month.
Page 226 Dr. J. K. Clokie, formerly of the Vancouver General Hospital, is now practising
in Vancouver Cambie district.
Dr. B. R. Mooney is now practising on West Broadway in Vancouver.
Dr. M. Murray is now pathologist at St. Joseph's Hospital in Victoria.
Dr. H. A. Ort is now practising in North Vancouver.
Dr. R. C. Pronger is now in association, in otolaryngology, with Dr. R. S. Grimmett
of Vancouver.
Dr. T. K. Stevenson, former surgical resident at the Vancouver General Hispital,
is now practising in New Westminster.
Dr. J. W. Hunt is now associated with Dr. J. G. Patterson of Victoria.
Dr. R. D. R. Sargent is now practising at Port Renfrew.
To Dr. and Mrs. John Roe of Victoria, a daughter.
To Dr. and Mrs. D. A. Hewitt of Victoria, a daughter.
To Dr. and Mrs. T. K. Stevenson of Vancouver, a daughter.
To Dr. and Mrs. G. R. Barrett of Nelson, a daughter.
To Dr. and Mrs. S. Kaplin, of Vancouver, a son.
To Dr. and Mrs. L. E. Ranta, of Vancouver, a daughter.
To Dr. and Mrs. Ken Boyce, of Vancouver, a daughter.
To Dr. and Mrs. M. K. Allen, of Vancouver, a son.
Dr. W. D. Panton of Vancouver to Miss Mabel Robinson of Alert Bay.
Four room outside office suite in the Medical Dental Building. Built
in fixtures. Modern furniture. Dictating unit, adding machine,
Allison table, filing cabinets, typewriter, sterilizers, surgical instruments, scales, large centrifuge. Terms if desired. Selling with view
to retirement. Apply 1022-925 Georgia Street West, Vancouver, or
Telephone MArine 7848.
fl&ount pleasant Tftnbertafcing Co* Xtb*
Telephone: EMerald 2161
Page 227 Habit Time of Bowel Movement—
not merely relief of constipation—is
secured by proper use of Petrolagar.
Petrolagar promotes development
of normally hydrated, comfortable
and easily passed stools.
Once achieved, the normal bowel
habit may often maintain itself even
though the dosage of this adjuvant
is slowly tapered off.
Supplied in bottles of 16 fl. oz*.
Page 228


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