History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1943 Vancouver Medical Association Sep 30, 1943

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 Tjhe r|Ul|l|Ei|
of the
»««■***
1       WANCOBVER -   •
ME D IC A Lm S Si) <3»Tfe N
Vol* XIX.
SEPTEMBER, 1943
No. 12
With Which Is Incorporated
Transactions of the
Victoria Medical Socieiy
the
Vancouver General Hospital
and
St. Paul's Hospital
In This Issue:
LIBRARY NOTES
HEALTH INSURANCE
PROVINCIAL BOARD OF HEALTH
THE OBESE CHILD.
329
341
342
UNUSUAL CARDIAC DEATH DUE TO TRAUMA -fg^^^^^^^^s "~T
THE COMPLETE ANDf BALANCED
iVITArVIIN|BlCOIVIPLE)S
Most investigators agree that many
vitamin B deficiencies do not occur because of the lack of but a single factor
of the B complex. They have found that
a deficiency of any one component is
likely to be associated with a lack of
other components of the complex.
Therapy with one factor, usually brings
to light accompanying deficiencies of
other factors. In recent clinical investigations of Vitamin B deficiencies, great
success resulted from Vitamin B complex therapy.
ViplexE.B.S*^ answers the
need for ijvitamin B complex
preparation containing all
the known ^members of the
complex. jThese^ factors are
present in balanced amounts
in the proportions in which
they are needed for normal
^hutrition.3
[The clinical applications
for certain components of
the^itamin B complex
are definite, but in practically all deficiency conditions it has been found
that the addition of the
otherfxfactors of the
complex produces better
results^
VIPLEX E.B.S.—Liquid
Each teaspoonful
contains:
Vitamin Bi (Thiamin Chloride) 75 mgm. 260 int. units.
Vitamin B*      £§*2
{Riboflavin) £5 mgm.
Nicotinic Acid . .3.0 mgm.
Vitamin B* (Pyridoxine)
63 micrograms
Pantothenic Acid (Filtrate
Factor) 63 micrograms
Suggested Dosage: One
to two teaspoonfuls, four
times a day. after food.
Larger doses may be prescribed, where indicated.
VIPLEX E.B.S.—Tablet
(S.C.T.i746)
Each tablet contains: 11
Vitamin Bi (Thiamin fchlor-.
ide).. 75 mgm. 250 int. units;
Vitamin Bt 1|§§§1|
(Riboflavin) .5 mgm..
Nicotinic Acid . I 10.0 mgm.
Vitamin Bt (Pyridoxine)
250 micrograms
Pantothenic Acid (FiltraijfZj
Factor) 250 micrograms
Suggested Dosage: Two to
four tablets each day.' after
food.
VIPLEX E.B.S. Liquid is available in bottles of JJb.,
also in Winchesters and Gallons.
VIPLEX E.B.S. Tablets S.C.t. #746 bj» put 0|> in"
bottles of 100,500,1,000.
Wh*n Prescribing
Specify E.B.S.
Preparation ijil;m?
Jusi lo to Sun I
THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED
! Ju«ii<
' **»*a#^s«»
TORONTO
MANUFACTURING   CHEMISTS
CANADA [NIYSRSr
IRITISH CGLUMBi .
T i
1 r>
THE    VANCOUVER   MEDICAL   ASSOCIA
B UjL LETIN
Published Monthly under the Auspices of the Vancouver Medical Asociation
in- the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
Dr. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
-Vol. XIX
SEPTEMBER, 1943
No. 12
OFFICERS, 1943-1944
Dr. A. E. Trites *|#* Dr. H. H. Pitts Dr. J. R. Neilson
President Vice-President %{si*9     Past President
Dr. Gordon Burke Dr. J. A. McLean
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Dr. J. R. Davies, Dr. Frank Turnbull
TRUSTEES
Dr. F. Brodie Dr. J. A. Gillespie Dr. W. T. Lockhart
Auditors: Messrs. Plommer, Whiting & Co.
-J|    ' SECTIONS -.
Clinical Section
Dr. J. W. Miller Chairman Dr. Keith Burwell Secretary
Eye, Ear, Nose und Throat QJM
Dr. C. E. Davies Chairman Dr. Leith Webster ^...-Secretary
Pwdiatric Section
Dr. J. H. B. Grant Chairman Dr. John Piters , Secretary
STANDING COMMITTEES
Library:
Dr. A. Bagnall, Chairman; Dr. F. J. Buller, Dr. D. E. H. Cleveland,
Dr. J. R. Davies, Dr. J. R. Neilson, Dr. S. E. C. Turvey
Publications:
Dr. J. H. MacDermot, Chairman; Dr. D. E. H. Cleveland,
Dr. G. A. Davidson
Summer School:
Dr. J. C. Thomas, Chairman; Dr. J. E. Harrison, Dr. G. A. Davidson,
Dr. R. A. Gilchrist, Dr. Howard Spohn, Dr. W. L. Graham
Credentials:
Dr. D. E. H. Cleveland, Chairman; Dr. E. A. Campbell, Dr. D. D. Freeze
V. O. N. Advisory Board:
Dr. L. W. MacNutt, Dr. G. E. Seldon, Dr. Isabel Day
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont
Representative to B. C. Medical Association: Dr. J. R. Neilson
Sickness and Benevolent Fund: The President—The Trustees (Squibb Stabilized Aqueous Solution Sulfathiazole
Sodium with Desoxyephedrine Hydrochloride)
. .Relieves Nasal Congestion
.. Helps check the growth
of many invading microorganisms	
•fc Search for a safe and effective preparation for use in relief of nasal congestion
and the intranasal treatment of sinusitis
has at last resulted in SULMEFRIN—a
combination of a soluble sulfonamide
and a vasoconstrictor drug in a form
agreeable to use.
provides these advantages
ir   QUICK RELIEF OF NASAL CONGESTION
*   PRACTICALLY NON-IRRITATING
*   REMARKABLE STABILITY
Sulmefrin may be administered by spray
or drops, 5 to 10 minims into each nostril,
2 to 4 times daily; or by tamponage, 20
minims on each pack, applied for 15 to
30 minutes once a day.
For full particulars write
36 Caledonia Road, Toronto, Ont.
E-R: Sqjjibb &Sons
of Canada,Ltd.-
Manufacturing Chemists to the Medical
Profession since 1858.
Sulmefrin is available in 1-ounce
and 1-pint bottles.
Sulmefrin is a trademark of E. R.
Squibb  & Sons. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JULY, 1943
Total   Population—Estimated 'fi 288,541
Japanese  Population Evacuated
Chinese   Population—Estimated  5,541
Hindu  Population  301
Rate per 1,000
Number Population
Total   deaths : s  249                     10.2
Japanese   deaths     1 Population Evacuated
Chinese   deaths  12                      25.5
Deaths—residents   only .  208                       8.5
BIRTH REGISTRATIONS:
Male  331,  Female   317     648 26.4
INFANTILE MORTALITY: July, 1943 July, 1942
Deaths under one year of age [ 17 10
Death   rate—per   1,000   births       26.2 17.6
Stillbirths   (not included above)         9 10
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
June, 1943 July, 1943 Aug. 1-15,1943
Cases Deaths      Cases Deaths      Cases      Deaths
Scarlet  Fever ; «__ 31 0 16 0 15 0
Diphtheria  0 0 0 0 0 0
Diphtheria  Carrier  0 0 0 0 0 0
Chicken   Pox  _i i  211 0 28 0 21 0
Measles i  167 0 25 0 7 0
Rubella S __ 11 0 2 0 1 0
Mumps I  64 0 0 0 0 6
Whooping  Cough  36 2 13 0 7 0
Typhoid  Fever  0 0 0 0 0 0
Undulant   Fever • \  0 0 0 0 0 0
Poliomyelitis <_  0 0 0 0 0 0
Tuberculosis  65 13 42 17 9 0
Erysipelas jj  5 0 10 0 0
Meningococcus  Meningitis  3 0 1 0 1 0
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
West North       Vane.   Hospitals &
Burnaby    Vane.  Richmond   Vane.      Clinic   Private Drs.   Totals
Sy philis	
Gonorrhoea  Figures not yet available
1   BIOGLAN-A
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance tb infection,
muscular 'weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated since 1943.
Phone MA. 4027
Stanley N. Bayney Representative
1432 MEDICAL-DENTAL BUILDING
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Vancouver, B. C.
Page 324 PITUITARY EXTRACT (posterior lobe)
FOR USE IN OBSTETRICS, IN SURGERY AND
IN THE TREATMENT OF DIABETES INSIPIDUS
A sterile aqueous extract is prepared from the posterior lobe of the pituitary gland, and is supplied
as a solution containing ten (10) International
Units per cc.
ASSURED     Each   lot  is biologically assayed  in
terms of the International standard.
UNIFORM     Samples of each   lot are tested at
definite intervals to ensure that all
U I  b N C Y     extract distributed  is fully potent.
PITUITARY EXTRACT (POSTERIOR LOBE) is
supplied by the Connaught Laboratories in packages of five 1 -cc. rubber-stoppered vials.
CONNAUGHT LABORATORIES
University of Toronto    Toronto, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. VANCOUVER     MEDICAL     ASSOCIATION
FOUNDED  1898     ::    INCORPORATED 1906
PROGRAMME OF THE FORTY-SIXTH ANNUAL SESSION
(WINTER SESSION)
GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.
These meetings are to be amalgamated with the clinical staff meetings of the various
hospitals for the coming year.   Place of meeting will appear on the agenda.
General meetings will conform to the following order:
8:00 p.m.    Business as per Agenda.
9:00 p.m.    Paper of the evening.
1943
October       5—GENERAL MEETING:
Dr. S. E. C Turvey—"Epilepsy as a Problem in the Community"
(Illustrated by Slides)
October     19—COMBINED CLINICAL MEETING and CLINICAL STAFF MEETING at VANCOUVER GENERAL HOSPITAL.
November    2—GENERAL MEETING:
Dr. J. C. Thomas—"Civilian Medical Care in Chemical Warfare"
(Illustrated by Slides)
November 16—COMBINED CLINICAL MEETING and CLINICAL STAFF MEETING at ST. PAUL'S HOSPITAL.
COLONIC AND PHYSIOTHERAPY CENTRE
Up-to-date Scientific Treatments
COLONIC  IRRIGATIONS, SHORTWAVE  DIATHERMY,  SINNEWAVE GALVINISM,
IONIZATION, ULTRA VIOLET RAY, STEAM  BATHS AND SHOWERS
Medical and Swedish Massage
Physical Culture Exercises
STAFF OF GRADUATE NURSES
1119 Vancouver Block
MArine 3723
Superintendent
"5 E. M. LEONARD, R.N.
'. Post Graduate Mayo Bros.
Vancouver, B.C.
Page 325 CK UnS0^6'
My boss used to be as grumpy as a bear. He'd
growl and bang around and his wife said: "Poor
George, he's working too hard. It's wearing him
down to a frazzle!"
So, I told her a few plain facts:
... how I'd discovered the most amazing thing
. . . that physicians who prescribe S.M.A.
actually have more time for other things'. . .
because it isn't necessary to change the formula
throughout the entire feeding period. (She sat
up at that.)
. . . how S.M.A. eliminates many unnecessary
questions that mothers usually ask about other
modified milk formulae.
When I had finished, she said she would certainly speak to George about using S.M.A. as a
routine formula.
Just because my boss turned over a new leaf . . .
he wants everybody to pat him on the back for it.
But he's not fooling us . . . we know how he got
to be such a nice man.
BUSY DOCTORS TO-DAY PRESCRIBE S.M.A.
PREPARE.
S.M.A. IS EASIER TO
S.M. A. Biochemical Division
John Wyeth & Brother
(Canada) Ltd.
Walkerville, Ontario With this issue we close the 18th volume of the Bulletin: and the next will therefore open the 19 th volume. The Bulletin is rapidly approaching its maturity.
Whether it grows in stature as it grows in years, is for its readers to say.
The Publications Board of the Vancouver Medical Association feels that the time is
ripe, perhaps, to make some changes in the Bulletin, which, it is hoped, will make it
more useful to our readers. We cannot, in this year of our Lord, do anything very
revolutionary or spectacular: we are lucky, we consider, to be in existence at all, to be
solvent, to have material to publish. We do not feel that we should do anything very
drastic. But perhaps we have not done all we could with what we have, or made the
best use of our opportunities. So we are going to try, gradually at first, to explore
possibilities.
There is good and interesting material going to waste, right here amongst us. We
have, in the Association, a Clinical Section, a Pediatric Section, an Eye, Ear, Nose and
Throat Section (why can't these fellows find a single word for their specialty?): and
we shall one day have other Sections. These Sections, at their meetings, have excellent
material presented. Much of it could be of value to every man in the profession,
whether he specialises or not.
So we have added to our Board, the Chairmen of these Sections, and we hope to get
a great deal from them.
Then there is another field we can cultivate. Many men, not only in Vancouver,
but throughout the Province, have special knowledge and training which they would
gladly use to enlighten and help their colleagues in the profession. We shall try to get,
from some of these men, special articles of general interest.
Then there arise, from time to time, discussions on various topics of current interest.
We hope to obtain short articles, perhaps from several men at a time, in the form of a
symposium, which would help us all.
There are other possibilities which may, and we hope will, prove to be profitable to
our publication. What we are aiming at is a monthly publication which will contain
something for everyone in every issue.
One more word. We are the Bulletin of the Vancouver Medical Association,
in name at any rate. But we are really much more. We are a provincial journal at
least. Our circulation covers the whole province, and it is right that it should be so.
The wider our scope, the higher our aims, the more universal our appeal and usefulness,
the better it will be for every one of us in Vancouver, the home and source of die
Bulletin. We owe a duty to those in other parts of the Province, especially in those
parts which are not as fortunate or as well supplied with resources, clinical and educational, as we are. It is our high privilege, as well as our duty, to give all we have, freely
and gladly. It is only the common, daily tradition of our profession, which has no
trademarks, no patents, no secrets, no monopolies, but shares everything in common.
The B. C. Medical Association's Annual Meeting, recently held, was a very notable
success. Its attendance, just over 500, broke all records. A hundred and seventy-five
of these were in the uniforms of the three services: even so, the balance of three hundred and twenty-five constituted the largest attendance in the Association's history.
The Board of Directors, under the presidency of Dr. Howard Spohn, worked hard
and long to achieve this result.   The Programme Committee, under Dr. A. Y. McNair's
Page 326 chairmanship, deserves our gratitude and admiration for their admirable work: the list
of Speakers was a sure guarantee of an excellent meeting.
But all this work depends for ultimate fruition upon smoothly running, smoothly
funstioning, machinery. The arrangement of meetings, the ensuring of adequate space,
the luncheons and dinners, and golf tournament: the entertainment of guests, especially
of ladies who visit us, all this means a vast deal of hard, often unrecognised work: and
it turns mainly on the effort of one man. You will easily guess to whom we are referring, our indefatigable Executive Secretary, Dr. M. W. Thomas. He was always on
deck, always available, always genial and good-natured and helpful: and we feel that he
must have derived an immense satisfaction from the success of this meeting, which he
worked so hard over. We should like to pay tribute, too, to his assistants, Mrs. Bender
and Miss Smith, who worked with him, and who worked to such excellent purpose.
The Ladies' Auxiliary Committees, the Entertainment Committees, and many others,
too, contributed very greatly to the enjoyment of the meeting, and a general feeling
of happiness and satisfaction.
There were so many highlights that it seems invidious to single out any special ones.
But the Round Table Discussion on Medical Economics was especially worthy of mention: and we hope to present some of it in the Bulletin at some future occasion.
Another feature worthy of especial mention we felt, was the Annual Reports, which
reflected a good deal of hard work and thought on behalf of the profession. The one
that we felt most worthy of praise, was the report of the Conunittee on Medical Education, presented by Dr. K. D. Panton of Vancouver. This Committee came boldly out
with a plea for a Medical Faculty in the University of British Columbia, to be instituted
as speedily as possible. We hope sincerely that this suggestion will be adopted, just as
soon as can be-arranged.
To many, if not most, of us, the most delightful event of the whole meeting was
the address given by Dr. W. Boyd of Toronto University, at the Annual Dinner; on the
subject of Lawrence of Arabia. We could not say whether the address was long or
short (certainly it was much too short in one sense), but it was pure delight. Scholarly,
sincere, absorbingly interesting from beginning to end, it was a tribute from the heart,
to one of the greatest men of the hundreds of great men that the Mother of the Ejnglish
race has produced, with such abounding prodigality, from the beginning of her history.
It was given on a note of deepest admiration, rising to this side idolatry: the language
of the address was itself a model of English speech, and the voice of the speaker carried
in its tones and inflections the love and honour which he has for his "hero," as He called
Lawrence. As we listened, bound to silence by his words, we saw, as many of us had
never before seen, what a great soul was that of this man Lawrence. Pre-eminent as a
soldier, perhaps one of the greatest in English history—certainly the greatest since
Marlborough, he was no less great as an English scholar: as a writer of the English
language—but he not only had the words, he had the force and the fire and the inspiration of a great thinker and philosopher. And lastly, and mainly, he excelled as a man:
and won love and respect, not for bravery alone, not for ability alone, but for a
"saintliness," a nobility and grandeur of character, which mark him for ever as one of
the greatest: since his claim to greatness was the greatness of the service he gave.
All these things Boyd shewed us, and we owe him our thanks and gratitude for a
notable evening.
The following officers were elected: Dr. P. A. C. Cousland, President; Dr. A. Y. Mc-
Nair, First Vice-President; Dr. A. H. Meneely, Second Vice-President; Dr. G. O. Matthews, Honorary Secretary, and Five Directors-at-large: Doctors G. F. Amyot, J. S.
Daly, C. H. Hankinson, H. H, Milburn and G. A. C. Roberts, and these members will
comprise part of the new Board of Directors.
Page 327 LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY—
Medical Annual, 1943.
Transactions of the Ophthalmological Society of the United Kingdom, 1942.
Transactions, Section on Ophthalmology, A.M.A., 1942.
Medical Clinics of North America, Symposium on Physical Therapy, July, 1943.
The Pharmacology of the Opium Alkaloids—U. S. Public Health Service, 1941.
GIFTS TO LIBRARY—
The following books have been donated to the Library and have been catalogued
recently:
Treatment of Tuberculous Diseases in their Surgical Aspects, 1900, by W. Watson
Cheyne (donated by Miss Pearson).
Memories of the Crimean War, 1911, by Douglas Arthur Reid  (donated by Miss
Grace Fairley).
The following books, among others, in the library of the late Dr. G. S. Gordon, have
been catalogued:
Dropsy, 1866, by W. R. Basham.
Treatment of Pulmonary Consumption, 1871, by James H. Bennet.
Treatise on the Venereal Disease, 1791, by John Hunter.
Burton's Anatomy of Melancholy, 1837, A New Edition by Democritus Minor.
Treatise on Diseases of the Urethra, Vesica Urinaria, Prostate and Rectum, 1922, by
Charles Bell.
MISSING FROM LIBRARY
The following books and journals are missing from the Library, no record
having been made by the borrowers:
American Journal of Obstetrics and Gynaecology, vol. 43, 1942.
Bulletin of the New York Academy of Medicine, April, 1943.
It is urgenly requested that they be returned to the Library at once.
MICROFILM SERVICE—FREE OF CHARGE
The Library Committee is happy to announce that microfilms of short articles may
now be obtained without charge. The Army Medical Library has altered its policy in
this regard and now considers this a substitute for inter-library loans.
Their weekly publication, "Current List of Medical Literature," whicfy is received
in the Library, contains a classified list of articles which have been filmed during the
week. It is possible, however, to procure a microfilm of any article listed in the Index
Medicus, though there might be come delay in obtaining material which has not already
been filmed.
The Librarian will be glad to give detailed information to any members interested in
this Service.
Page 328 British  Columbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President Dr. P. A. C. Cousland, Victoria
First Vice-President ' ! Dr. A. Y. McNair, Vancouver
Second Vice-President Dr. A. H. Meneely, Nanaimo
Honorary Secretary-Treasurer Dr.  G. O. Matthews, Vancouver
Immediate Past President Dr. A. H. Spohn, Vancouver
Executive Secretary ■_, Dr. M. W. Thomas, Vancouver
HEALTH    INSURANCE   No.1
ABSTRACTS OF
DOMINION AND PROVINCIAL ACTS
INTRODUCTION
This subject has been introduced into the Dominion Parliament and is at
present under consideration by a special committee on Social Security. The
legislation takes the form of a Dominion Enabling Act providing Grants-in-
Aid and a Model Provincial Act. It is important that we keep in mind the
fact that many changes may be effected before this suggested legislation
becomes law. While the Canadian Medical Association through the Committee of Seven has made two submissions to the Committee on Social Security regarding tins proposed legislation, the Association has never been asked
to make an official pronouncement either accepting or rejecting the proposals.
Since the reading of the proposed legislation is a laborious task and much
of the intent is hidden under necessary legal phraseology the Committee on
Economics of the British Columbia Medical Association has prepared the
following abstract of that portion of the legislation that is of vital concern
to the medical profession. This abstract is not offered as a complete summary but only as a resume of those parts of the draft acts that are of interest
to the members of our profession. In some details the acts themselves are
very sketchy. An addendum gives briefly certain observations regarding
the financial aspects of Health Insurance. Further important information is
provided in the excellent abstract of the minutes of the proceedings and
evidence submitted to the Committee on Social Security, prepared by Dr.
Frank Turnbull, vice-chairman of our committee.
G. F. Strong, Chairman,
Committee on Medical Economics,
B. C. Medical Association.
Page 329 I.—DOMINION ACT—CALLED "HEALTH ACT
>>
1. Provision for grants to any Province that shall make statutory provision for the
economic and efficient use of such grants.
(a) The statutory provisions as respects Health Insurance shall be in such terms
as to provide benefits, (a) OF THE STANDARDS,^ (b) UNDER THE
CONDITIONS, and (c) FOR THE CLASSES OF PERSONS as set forth
in the model provincial act.
(b) Grants may be paid by the Dominion to the Province (a) FOR THE
OBJECT, (b) SUBJECT TO SPECIAL CONDITION, and, (c) IN THE
AMOUNTS specified by the Health Act.
2. Health Insurance Grant
The suggested amount is $3.60 per capita per annum.
3. Public Health Grants for
(a )  Tuberculosis
(b) Mental Diseases
(c) General Public Health
(d) Special Public Health
I. Venereal disease
II. Professional training
HE. Investigational
IV. Youth fitness
4. The provisions for Public Health in the Province shall include:
1 Preventive services
2 Consultative services
3 Educational facilities
4 Mental Hygiene
5 Communicable Disease Control
6 Food and Drug Control
7 Nutrition
8 Laboratory
9 Sanitation
10 Vital Statistics
11 Hospitals and Sanatoria
12 Dental Hygiene
13 Child and Maternal Hygiene '
Page 139 14 Industrial Hygiene
15 Quarantine including Air Navigation
16 Public Health Nursing
17 Housing
18 Venereal Disease Control
19 Tuberculosis
20 Cancer
21 Heart
22 School Health Services
2 3 Epidemiology
24 Research
5. These are additional provisions respecting the agreements between Dominion and
Provincial governments' reports thereon, and necessary inspection of records. •
6. Administration of Health Act to be under a division of the Department of Pensions
and National Health to be known as PUBLIC HEALTH and HEALTH INSURANCE DIVISION.
7. National Council of Health Insurance, consisting of the Director of Health
Insurance of the Department of Pensions and National Health as chairman, the
Deputy Minister of Health in each Province, the chief administrative officer of
Health Insurance of each province which has established Health Insurance and such
other persons comprising a representative of the Canadian Medical Association, the
Canadian Hospital Council, the pharmaceutical, nursing and dental professions,
labour, industry, agriculture, urban women and rural women respectively as may
be appointed by the Governor in Council.
II.    PROVINCIAL ACT—CALLED "HEALTH
INSURANCE ACT"
Persons Qualified
All persons who have their normal place of residence in the Province and in whose
cases the requirements of this Act are complied with by them or on their behalf.
Sources of Moneys
The moneys required shall be derived partly from contributions from employees and
employers and partly from grants (Dominion and Provincial)
Contributors
All employed persons shall contribute, others will be assessed—not only for themselves but for dependents other than children under sixteen. (The care of children under
16 is included in the contributions.)
Page 331 Registration
There shall be annual registration of all qualified persons and their dependents.
(There are then set forth the numerous provisions respecting the contributions of
employed and assessed contributors.)
Health Insurance Fund
There shall be a special account in the Consolidated Revenue Fund of the Province
called the Health Insurance Fund, which shall include all moneys received from the sale
of HEALTH INSURANCE STAMPS and contributions made otherwise, penalties,
grants by Dominion, sums payable by the Province under the Act, and interest.
Benefits
Shall be such as to provide for the prevention of disease and for the application of
all necessary diagnostic and curative procedures and treatment.
Shall include:
Medical, surgical, obstetrical;
Dental;
Pharmaceutical
Hospital
Nursing.
Medical, Surgical and Obstetrical
Commission shall make arrangements therefore with the organization representative
of the practitioners of medicine, surgery and obstetrics, including therein specialists and
consultants in medical, surgical and obstetrical diagnosis and treatment who are regularly qualified, duly licensed, and in good standing in the Province.
The regulations and arrangements aforesaid shall be such as to secure for each qualified person such adequate measures for the prevention of disease and all necessary and
adequate medical, surgical, and obstetrical treatment, attendance, and advice.
The regulations shall secure:—
1. Preparation and publication of lists of medical practitioners who have agreed to
attend qualified persons and the class or classes of service each such practitioner is
qualified and prepared to provide;
2. Right of any medical practitioner to be included;
3. Right of any qualified person of selecting the medical practitioner by whom he
wishes himself to be attended;
4. Right of any qualified person to services of specialists and consultants;
5. Services of medical practitioners in prevention of disease and conservation of health;
6. That no medical practitioner be entitled to remuneration for any service in the performance of which-he exceeds his professional competence;
7. That the method of methods of remuneration of medical practitioners and the rate
thereof whether by capitation, fee for service, or by salary, or any combination of
these, shall be such as are determined by the arrangements made with the organization representative of medical practitioners;
8. The keeping of adequate records.
Arrangements may be made with approved clinics.
Regulations shall prescribe:
Page 332 1. The rules to be followed in detennining the class or classes of professional service
which' are within the competence of each practitioner.
2. The classes of service which shall be deemed to be general practitioners services.
Dental Benefit
Pharmaceutical Benefit
Commission shall make arrangements for the supplying of proper and sufficient
drugs, medicines, materials, and appliances to qualified persons.
Hospital Benefit
Commission shall make arrangements for ALL necessary hospital service for qualified
persons in hospitals (including convalescent homes), other than treatment of tuberculosis and mental illness.
Regulations shall be such as to secure:—
1. Lists of hospitals showing service each hospital is capable of providing;
2. That arrangements shall be made only with non-profit voluntary, municipal, Provincial Government, and Dominion Government hospitals;
3. That qualified persons be entitled to hospital service only when ordered by medical
practitioner;
4. That any person for whom hospitalization is ordered shall have right of selecting
hospital;;
5. That governing body of each hospital shall have the right to determine the medical
practitioners who shall have the right of treating patients therein;
6. That in any case arrangements shall provide for general ward service only except in
emergency;
7. That any qualified person shall have the right to semi-private or private accommodation if available on payment of the difference;
8. That any qualified person shall be available for clinical observation for the instruction of students of MEDICINE AND NURSING.
Nursing Benefit
When ordered by medical practitioner.
Administration
1. This Act snail be administered by a Commission, "THE HEALTH INSURANCE
COMMISSION," consisting of the chairman and of such number of other Commissioners as may from time to time be determined by Order-in-Council.
2. The chairman shall be a doctor of medicine regularly qualified, duly licensed and
in good standing in the Province, and having practised medicine for at least ten years.
3. The Provincial Health Officer shall, ex-officio, be a member of the Commission.
4. The other Commissioners shall be appointed by the Lieutenant-Governor in Council
after consultation with organizations representative of medical practice, dental practice, pharmacists, hospitals, nursing, insured persons, industrial workers, employers,
agriculturists, and of such other groups or classes as may from time to time be
determined.
Administrative Regions
For the economic and effective administration of Public Health services and of
Health Insurance the Province shall be divided into areas known as Public Health or
Health Insurance Regions. Within each such region there shall be established a unified
administration of all Public Health services and of Health Insurance.
REGIONAL MEDICAL OFFICERS and assistants shall be provided on a full or
part-time basis.
Page 333 Duties of Regional Medical Officers:
1. To advise practitioner on discharge of their duties;
2. To keep in touch with practitioner with object of raising standards of service;
3. To examine and satisfy himself of the accuracy and sufficiency of the clinical and
other records of practitioner;
4. To investigate excessive prescribing.
Representative Committees
Commission to deal with committee representing Hospitals and Professions re supplying benefits.
OTHER PROVISIONS RE: Determination of Questions, Investigation of Complaints and Disputes, Inspection, Offences, Legal Proceedings.
Regulations
Many subjects are left to settlement by regulations of the Commission.
FINANCIAL ASPECTS
It is of course of the greatest importance to the medical profession that we satisfy
ourselves that this whole scheme is adequately financed. To that end we should secure
immdiately the advice of the best actuarial and statistical experts available to us.
The method used by the government to determine the costs of the suggested plan is
open to some doubt. The costs of medical care in Canada were ascertained and this
figure was divided by the number of adults 16 years of age and over. By this method
the figure of twenty-six dollars was reached. This then becomes the basic cost per
capita per annum and is estimated to cover all adults and their children under 16 years
of age. Parenthetically it must be noted that in this method of arriving at medical
costs NO ACCOUNT IS TAKEN of the VERY LARGE AMOUNT OF FREE MEDICAL SERVICE RENDERED EVERY YEAR. It is estimated that of the twenty-six
dollars, $18.00 is the actual cost of medical care per individual and $8.00 covers the
children. The breakdown of the eighteen dollars as between the various benefits has
not as yet been clearly set forth. The contribution from the Dominion Government is
as noted above to be three dollars and sixty cents for every man, woman and child under
the scheme.
HEALTH    INSURANCE    No.   2
RESUME OF THE MINUTES OF THE PROCEEDINGS OF
THE COMMITTEE ON SOCIAL SECURITY
(Abstract made by Dr. Frank A. Turnbull)
A REPORT FOR THE DOCTOR IN PRACTICE
INTRODUCTION
In March, 1943, at Ottawa, a large parliamentary committee on Social Security
was apointed. The purpose of this committee was "to examine and report on a National
plan of social insurance which will constitute a Charter of Social Security for the whole
of Canada." At their first meeting on March 16th, 1943, Hon. Ian MacKenzie presented a draft copy of a bill respecting Health Insurance. These meetings have gone
on during the summer, receiving submissions from all interested bodies. With a few
exceptions the discussions so far have been limited to matters relative to Health Insurance
rather to the broader aspects of General Security measures.  The minutes of proceedings
Page 334 and evidences have been published in a series of bulletins that now number 28. The
purpose of this paper is to summarize the highlights of these reports in so far as they
have a bearing on the present and future practice of medicine.
ORIGIN OF THE GOVERNMENT'S PLAN FOR HEALTH INSURANCE
The first attempts by a legislature in Canada to formulate a plan of Health Insurance was in the Province of British Columbia, in 1919. A commission was appointed
and brought in a report that outlined a plan for a state system. The subject was again
discussed at some length in our Provincial legislature in 1928, and in 1929 a Royal
Commission published reports dealing with Health Insurance and Maternity Benifits.
The Provincial legislature commenced a more determined effort to introduce an effective
Health Insurance Act in 1934. This culminated in the abortive statute of 1936, which
was passed by the house but never enforced.
Meanwhile at Ottawa in 1928 the Department of Pensions and National Health
received instructions to undertake a comprehensive survey of public health with special
reference to a National Health programme. These studies were guided by Dr. J. J.
Heagerty, the Director of Public Health Service. Information was accumulated about
foreign Health Insurance plans and about the cost of medical care in Canada. This
investigation was continued during the 1930s.
In 1942 the Dominion Government directed the formation of an Advisory Committee
on Health Insurance. The members of this committee were Civil service experts and
were almost all statisticians in various specialized fields. Dr. Heagerty was organizer of
the committee and the only medical member. It was by this committee that the Canadian Medical Association was first consulted, along with representatives of other groups,
including dentistry, pharmacy, nursing, hospitals, labour, and life insurance. Rapid
developments created the need for the unprecedented special meeting of the General
council of the Canadian Medical Association in January, 1943. Events were moving
swiftly. The parliamentary Committee on Social Security was appointed by the National government in March, 1943, and commenced activities without delay.
THE COMMITTEE
The special committee on Social Security is composed of 41 members. Their party
affiliations are: Liberal 29, Conservative 7, C.C.F. 2, New Democracy 2. The chairman
is Hon. Cyrus MacMillan, Dean of the Faculty of Arts and Science, McGill University. The average age of the committee is 55. There are nine doctors on the committee, with an average age of 63. Attendance at the meetings is good, and that of the
doctors much above average. Debate on medical issues has been very ably handled by
our representatives, notably by Dr. James McCann of Renfrew, Ontario, Dr. John
Howden of Norwood Grove, Manitoba, and Hon. Dr. Herbert Bruce of Toronto.
HON. MR. IAN MACKENZIE
Before introducing the draft for a Health Insurance Bill, Mr. MacKenzie stated
that Health Insurance is the greatest present lack in Canada's system of social security.
An all-inclusive national plan would be the ideal arrangement, but in Canada this
development would involve constitutional problems of the greatest complexity. Mr.
MacKenzie wants to do something "practical and useful for the people of Canada
quickly and effectively." For this reason the Advisory has drawn up a National Health
Insurance bill which avoids the constitutional pitfalls by retaining a high degree of
Provincial autonomy.
The Dominion Health Insurance Act that Mr. MacKenzie proposes is an enabling act
which incorporates a model provincial bill. In order to qualify for grants-in-aid for
certain major preventive health measures, each province must maintain wide health
services which are all stated in the model bill. The major health measures which will
receive Dominion support include such important projects as free treatment for mental
Page 33 3 disease, tuberculosis, and venereal disease, research problems and training facilities in
public health work, and a program of physical fitness for youth. No province will be
able to finance these major aspects of Health Insurance by itself, and thus it is ensured
that every province that does adopt the national plan will give a service that will be
uniform across Canada.
DIRECTOR OF PUBLIC HEALTH SERVICES AND THE CHIEF ACTUARY
Dr. J. J. Heagerty has been Mr. MacKenzie's right hand man in the years of planning and he played a major role as witness in the earlier meetings of the Social Security
Committee. His personal ideal of Health Insurance, as indicated at various points in
his testimony, is that it should cover all the population, that it should be administered
by the Department of Health, that the general practitioner should be brought into the
preventive field but remain the medical advisor and counselor of the family as a unit,
that specialist services should be organized into clinics at least in the urban areas.
Dr. Heagerty told the Social Security Committee how he had formed the Advisory
Committee on Health Insurance in 1942, and related some of the difficulties that were
encountered in planning a model Health Insurance Act. His Advisory Committee
initially favored administration of the Provincial Act by the Provincial Health Department but this attitude caused a great deal of dissension. Labour and agriculture insisted
that they should be represented on the governing body, chiefly because they were apprehensive of undue medical control. Our medical association argued that direction and
administration must be in the hands of those having professional knowledge and understanding of health problems. These conflicting viewpoints were reconciled by the proposal that the provincial administration shall be in the hands of a commission with a
salaried chairman, who shall be a qualified medical man. The chairman will be chief
executive officer of the Commission. (Note: Dr. Routley's letter of August 5th to
members of the C.M.A. has pointed out that at a recent meeting of the Committee on
Social Security the words "The Chairman" were deleted from the model Provincial Act
and the words "one member" were substituted therefor. No report of the discussion
that preceded this motion is included in the proceedings of the committee.)
On a number of occasions, Dr. Heagerty was asked by various members of the
Social Security Committee to explain how his Advisory Committee arrived at the figure
of $26.00 per year as the cost of complete medical care in Canada. His answers were
not always consistent. In a general way the figure was calculated by estimating the
total cost of medical care in Canada in 1935, adjusting this figure to the increased population of 193 8 and dividing the total into the population above the age of 16. In one
speech Dr. Heagerty claimed that it was a very precise and accurate figure, decided upon
by professional statisticians who are acknowledged experts—vol. 4, p. 127. On the
other hand, he made such statements as the following: "Broadly speaking, there is perhaps nearly enough money being spent by rich and poor to provide fairly satisfactory
service for all"—vol. 3, p. 101; "Insofar as cost is concerned we certainly are not high.
There is always some danger one may be low but we just do not think so"—vol. 3, p.
103; "We have not attempted to estimate to the last dollar or to the last cent what
Health Insurance is going to cost from the standpoint of treatment"—vol. 2, p. 57.
Mr. A. D. Watson, Chief Actuary, Department of Insurance, gave the most scholarly address of the whole session. It was a discussion of the history and philosophy of
social security, and the practical measures involved in the application of social security
in a constantly changing world. He pointed out the difference between public assistance
and social insurance, and stressed that social security measures must be framed to
strengthen, not weaken, the responsibility and purpose of the individual. In respect to
Health Insurance he stated that the working out of arrangements with the profession
and drafting of the necessary regulations by the Provincial Health Insurance Commissions will dwarf into complete insignificance the work involved in the preparation and
drafting of the proposed National bill. The whole scheme of operation must be worked
out and understood by all concerned before operations can begin at all.    He cautions
Page 336 against undue haste, and warns that "the risk of error is great in any legislation, but
nowhere as great as in social legislation."
It was surprising to learn from Mr. Watson's subsequent discussions with the committee that he had played no part in estimating the cost of Health Insurance in Canada.
He stated that this was a purely statistical rather than actuarial problem. He did discuss the likelihood of difference of cost in various provinces and gave his opinion that
this might be as wide as 35%.
(Note: This doubt about probable costs does not distress the theorists and planners.
If they are later proven to have been profoundly mistaken it may or may not affect their
professional reputations, but almost certainly will not affect their livelihood. On the
other hand it is a very vital problem for the doctors in practice. We recall the plight of
certain State-hired doctors in Saskatchewan during recent years who went for months
working without salary and in some instances were never paid, because municipal coffers
were low. The local authorities were able to offer cordwood in lieu of cash, but the
doctors just could not live on cordwood Common, sense dictates that we must hire
experts to advise us about these figures, particularly for the important negotiations that
will precede any Provincial Health Insurance Act.)
CANADIAN MEDICAL ASSOCIATION
Our initial submission to the Committee was very ably presented by Dr. A. E.
Archer and Dr. T. C. Routley. All of this material, dealing chiefly with the principles
of Health Insurance, has been published in the Canadian Medical Association Journal.
The French-speaking doctors, who are only represented in the C.M.A. by a small minority, authorized the leaders of their associations to express complete accord with the
opinions of the C.M.A. Mr. Mclnnis, M.P. for Vancouver East, could not see why
cash benefits should be separated from Health Insurance, and expressed the opinion that
medical certification would be necessary whether benefits were paid under Unemployment Insurance or not. Dr. Routley answered that if cash benefits were to be included
in the scheme we would of necessity have to issue certificates, but reiterated our^stand
that the cash benefits should come from a separate fund.
At the time of our first presentation there had been no opportunity to study the
draft of the proposed Health Insurance Act. At a later date Dr. Archer appeared before
the Committee again with more specific suggestions. The need for the support of
deserving medical students by government bursaries was indicated. The importance of
ensuring that no indigent group could be left out in a Provincial scheme was stressed.
Some guarantee was sought that patients insured under the plan would be available for
teaching purposes. It was also pointed out that grave difficulties and injustices might
result if a Health Insurance measure was introduced while 30% of our men are on
Active Service and those remaining in civilian life are carrying an increasingly heavy
burden.
CANADIAN PUBLIC HEALTH ASSOCIATION
The professional leaders of the public health services are naturally more concerned
about preventive aspects of Health Insurance than about curative medicine. They
emphasize in their brief that the family physician should assume, as a responsibility for
those under his care, certain preventive services, some of which are now being furnished
through the departments of health. They state that: "The general practitioner is hesitant, under present conditions of private practice, to advocate preventive measures from
which he will benefit financially. . . . The patients of the general practitioner are often
not sufficiently aware of the value of such supervision to request the physician to render
preventive services for which payment would willingly be offered. . . . Payment on a per
capita basis would greatly facilitate the rendering of such services by the physician. . . .
Payment on a fee basis for each service rendered would be impractical and tend to
defeat the fundamental conception of the prevention of sickness and disability."
They propose that the local Health Department through its health education programme would inform the public of the essential preventive services which the family
Page 337 physician is prepared to render.    These preventive activities of the general practitioner
will be supervised by the medical officer of health.
HOSPITALS
Dr. Harvey Agnew, representing the Canadian Hospital Council, outlined the essential principles in any Health Insurance plan that would be necessary to preserve the
best in our present system of hospital care. None of these proposals conflict with the
attitude of the Canadian Medical Association. It is of interest to us that hospitals insist
that they must retain the right to determine their own staffing privileges. They deplore
any development that would permit other interests to force them to extend highly
technical privileges to doctors whom the trustees, on the advice of their medical staffs,
do not feel should be admitted to the staff nor given such privileges.
The voluntary hospitals, largely controlled in Canada by Catholic interests, are much
concerned about impending developments. Their representatives pointed out that there
is a divided opinion regarding the advisability of "regimentation of every department of
our life under the auspices of government and the state or the preservation of that
freedom which is exemplified by the practice of private charity." Dr. Agnew related
that in many European countries where Health Insurance has been adopted the state had
gradually taken over voluntary hospitals.
TRADES AND LABOUR CONGRESS OF CANADA
On the whole, organized Labour favours the government bill, but they are critical of
the proposed method of administration because it seems to them to give too much control to the doctors. Mr. P. Bengough, who presented their brief, stated: "We are naturally prepared to concede to the medical profession the right to representation, but we
could not possibly agree to their having entire control. In our opinion, those who provide the funds, namely, the government, employees and employers, should control the
National Council in the matter of representation."
The Labourites stated that they could not possibly agree to the proposed Hospital
Benefit, section 31, which reads as follows: "That any qualified person in receipt of
treatment as aforesaid . . . shall be available for clinical observation by the teaching staff
of medical schools, etc." They argue that there should be no chscrimination between
the patient in the public ward and in the private room, and express vague fears about
experimentation by medical men on public ward patients.
CANADIAN FEDERATION OF AGRICULTURE
The Canadian Federation of Agriculture is a national federation of organizations that
represent all branches of agriculture across Canada and claims to have an affiliated
membership of 350,000. The major point of their brief before the Committee consists of a bulletin entitled "Health on the March," which has been widely circulated in
Canada. Mr. H. H. Hannam, president of the Federation, describes their plan as "a
modification of state medicine." They are chiefly concerned about medical care of the
rural population. It is submitted that Health Insurance must be developed as a national
plan, financed from the federal consolidated revenue fund, and that the majority of
the Commission at Ottawa should be lay people. They advocate community health
centers which shall include all necessary services such as X-ray, laboratory, dental,
nursing, and specialists. It is recommended that osteopaths and chiropractors be recognized under a national plan, or that their work should be incorporated into the course
of medical training. They are scathing in their criticism of the C.M.A. proposal that
the existing schedule of fees in the various provinces should form the basis of discussion
with the commission respecting fees under Health Insurance.
In criticism of these plans of the Agriculture group Dr. Heagerty stated: "You
cannot put into Canada one plan from one end of this country to the other that will be
satisfactory . . . the cost of administration of a plan from Ottawa would be financially
destructive ... in order to avoid a financial catastrophe, each province should introduce
Page 338 this scheme very slowly in certain areas ... we cannot go out and build great health
centres, great hospitals, or send masses of doctors into the country areas."
OSTEOPATHS
One volume of the proceedings is devoted entirely to the presentation of the Canadian Osteopathic Association. It is a puzzling document. The principles and practice
of Osteopathy are explained at great length. This reviewer has read the report through
several times and must confess to being entirely baffled regarding the fundamental difference between osteopathy and conventional medicine. Judging from their submission,
students of osteopathy take practically the same courses as medical students. Osteopaths
are trained in drug therapy, including the use of vaccines, insulin, etc., are qualified in
midwifery and general surgery, and they claim to train specialists in most of the
standard subdivisions that are recognized by regular medicine. They stress manipulative therapy but do not explain their statement that "manipulation without the osteopathic concept becomes sterile". They plead to be included under the Act on an equal
basis with Medicine rather than as an ancillary service.
CHIROPODISTS
There are only 150 accredited members of the Chiropody Association in Canada.
Chiropody is defined by their leaders as the medical, mechanical, surgical, and electrical
treatment of the ailments of the human foot, and massage in connection therewith.
They support the proposed Act but object to the provision which requires the patient
to go to a medical practitioner first. They state that all recognized schools of chiropody
give a four year course with junior matriculation as the entrance standard, and submit
that such intensive specialization in one small section of the medical field equips them
to perform their services better than anyone else.
OPTOMETRISTS
The Canadian Association of Optometrists, with a membership of 1500, requests
that Optometry benefits be added as a subsection of the proposed Act along with medical, dental, pharmaceutical, hospital, and nursing benefits. They claim that about 70
per cent of those who require optical attention patronize optometrists. The objection
that they take to the proposed Act is the proviso that patients will first have to go to
a physician and be referred by the physician to the optometrist. They state that under
this plan the doctors will refer all their patients to a medical specialist, but point out
that there are not enough medical men trained in refraction to cover the general need.
CULTISTS
The Christian Scientists requested that on the grounds of religious freedom they be
exempted from contributing to the maintenance and sharing in the benefits of the proposed Dominion-wide Health Insurance Act. They foresee that under the proposed Act
the integrity of the family as a basic unit of civilized society will be threatened, for by
the plan "the individuals of the family are to become members of a semi-military health
company, of which the doctor is to be sergeant-major." Various members of the committee pointed out that one of the major features of the proposed Act is in the field of
preventive medicine, which will benefit all members of the community. If any group,
such as the Christian Scientists, are exempted from payments, then those who are contributing to the public health scheme will be paying part of that cost for others who
do not contribute.
Page 339 The Chiropractors request that they be put on the same footing as medical practitioners in respect to the proposed Act. They warn that "if the government hands
over to the medical practitioners control over the life and health of individuals, such
steps will react against the government itself." Mr. Mclnnis, M.P. for Vancouver East,
stated during discussion that "as far as British Columbia is concerned, a Health Insurance Act which does not include chiropractors on a basis of equality with the medical
profession will not be satisfactory." The stone wall that confronts any medical man
who argues in public with one of these irregular practitioners was well illustrated in
these proceedings:
Hon. Mr. Bruce: "I should like to ask you this: Are you aware of the fact that
through a treatment developed over the last couple of years, one of the sulpha drugs will
cure cerebral spinal meningitis in at least 90% of the cases?    Are you aware of that?"
Dr. Sturdy: "I have heard that stated, but I would not accept that."
Hon. Mr. Bruce: "In the face of that would you still submit these cases to chiropractic treatment?"
Dr. Sturdy: "Absolutely, yes."
The Committee gave sympathetic attention to every brief that was presented. Their
tolerance was sorely tried when the officers of the Anti-Vaccination and Medical Liberty
League appeared before them. Reading this presentation is a complete waste of time.
One statement, however, is worth quoting: "If any Insurance scheme should be brought
into force under the control of the authoritarian medical group, and permitting them to
include this concept in 'Preventive Medicine' (prevention of disease by the introduction
into the body of products of disease—e.g., vaccines), we fear there will again be riots,
fines, sales of chattels, imprisonment, bloodshed."
CONCLUSIONS
The doctors of Canada have publicly declared themselves in favour of Health
Insurance. The Proceedings of the Committee on Social Security indicate what a
responsibility was entailed in that declaration. It will soon be necessary to submit more
specific and more detailed proposals and to be prepared to have these suggestions exposed
to the searching light of public criticism. We have plenty of friends who listen to our
plans with sympathy and attention.   We also have foes who are bitter and implacable.
Some of those who oppose our proposals respecting Health Insurance are jealous of
our present status and demand the right to treat the public regardless of what they have
to offer. Others are advocates for a cause or for a group, and may plead the tenets of
their followers in public, irrespective of their private views. A great number are
honest men who just don't know enough about the subject they debate.
On our side it is apparent that there must be a common front. "Divide and Conquer" is a principle that is just as effective in political manoeuvering as on the world's
battlefronts. Minor disagreements among ourselves need to be ironed out before the
important Provincial conferences, or our opponents will use them to our general disadvantage.
Page 340 ege ol
ysicians a
nd Su
rgeons
President : Dr. F. M. Bryant, Victoria
Vice-President . Dr. H. H. Milburn, Vancouver
Treasurer— Dr. G. S. Purvis, New Westminster
Members of Council Dr. F. M. Bryant, Dr. Thomas McPherson, Victoria (District No. 1);
Dr.  G.  S.  Purvis,  New  Westminster   (District  No.  2);   Dr.  H.  H.
Milburn,   Col.   Wallace   Wilson,   Vancouver   (District   No.   3«);   Dr.
Osborne Morris, Vernon  (District No. 4); Dr. F. M. Auld, Nelson,
(District No. 5).
Registrar j Dr. A. J. MacLachlan, Vancouver
Executive Secretary Dr. M. W. Thomas, Vancouver
In view of the fact that the supply of narcotics in Canada is limited it is
sincerely hoped that the medical men of the Province will protect the supply
by carrying their narcotics on their persons and not tempt the people of the
underworld by leaving narcotics in their bags to be stolen from their cars.
No PN licenses will be issued in 1944 as it is felt they constitute an invitation to thieves.
A. J. MacLachlan, Registrar.
(The following letter has been forwarded to all doctors in the Province.   Its importance is evident.—Editor.)
PROVINCIAL BOARD OF HEALTH
Division of Venereal Disease Control
Dear Doctor:
The importance of prompt diagnosis in primary syphilis, to be followed by early and
intensive treatment, cannot be overemphasized. Treatment should not be started until
laboratory confirmation, either in the form of a positive report on the darkfield examination of serum obtained from the lesion or a positive blood test has been received.
Treatment should not be started when diagnosis rests upon clinical grounds only.
Darkfield kits furnishing all that is required for collection and transmission of suspected serum is available and may be obtained by application to the Division of Labora-'
tories, Provincial Board of Health, 763 Hornby Street, Vancouver. Every practising
physician should keep several of these kits on hand. Those who do not have these should
apply for them at once. Unfortunately darkfield examinations can be made only at the
laboratories in Vancouver, and in order to remedy the unavoidable delay as far as possible
doctors are advised that specimens should be sent by airmail special delivery. The Division
of Laboratories will send the report back by telegraph as soon as the examination of the
serum has been made.
Yours truly,
D. E. H Cleveland, M.D.,
Acting Director,
Venereal Disease Control.
P.S.—Darkfield examinations are also done in the Royal Jubilee Hospital in Victoria.
If it has been your custom in the past to send these to Victoria, it will be quite in order
to continue to do so.
Page 341 THE OBESE CHILD:
A DISCUSSION OF TREATMENT
Dr. R. R. Struthers
Montreal
(Read before the B. C. Medical Association, September, 1943.)
In presenting this subject before you, I must plead guilty to having no very scientific viewpoint to present to you, but rather a discussion of the nutritional status of the
family of the child who is obese.
If one accepts the statement that the ordinary scales of average weight for height
and age in children, permits a leeway of 10% plus or minus the average and still remain
within the limits of normal nutrition, one may define the obese child as being one who
is 20% or more above the average in weight for age and height. This will permit ot
the common variations due to family inheritance and physique and is a fairly satisfactory working definition of obesity in children. The subject is of considerable importance, as your Committee has already intimated to me, in that while these obese children
may not be great in numbers, they are great in the potentiality of future discomfort and
disease, and are, when presented to us, a rather immediate and pressing problem calling
for our interest and very specific advice. As with a discussion of adult obesity, these
children may be of the group who suffer from endogenous obesity, in whom one
may find abnormalities of thyroid or pituitary function, and occasionally mental deficiency. With this group of children I do not intend to dwell, in that ordinary routine
physical examination, including X-rays for bone age, estimation of the blood cholesterol
level, sugar tolerance and the basal metabolic rate, will usually make the diagnosis
apparent, and suitable specific treatment may possibly be advised. In this group may
also come occasionally the child who, following an acute infectious illness or after surgical operation, shows sudden accumulation of fat. Similarly infections in these children may be followed by a sudden onset of endogenous obesity which is frequently
amenable to the temporary administration of suitable small doses of thyroid extract.
My presentation is particularly concerned with the child who presents evidences of
exogenous obesity, in which the bald statement is true that the expenditure of energy
does not equal the ingestion of calories, that is, that the exercise or activity is not
equivalent to the over-eating in which the child indulges, with the resultant production
of obesity.
From the etiological point of view, cases of this unfortunate condition may be
divided into those which are due to individual causes and those due to familial. Of the
individual causative factors, I would place fatigue first. Fatigue is a vicious circle in
obesity. Actvity because of obesity produces ready fatigue and with it indolence, but
the circle can be broken by adequate rest. As with adults, so the obese child suffers
from lack of rest in bed, the object of treatment being, of course, to relieve his fatigue,
give him a sense of well being and a desire for physical activity, because he has rested,
and so increase the expenditure of energy. As an example, a 10-year-old boy, who is in
the obese group, should have, if possible, 12 hours rest in bed at night, and 2 hours rest
in bed in the afternoon, simply with the idea of improving his sense of physical well-
being, so that he is more anxious to partake of athletic activities. Secondly, emotional
disturbances in children are unfortunately all too common and are likely, as a source of
solace, to result in excessive eating. The insecure, thwarted, frustrated child living in a
squabbling household or in an unhappy school situation, is very likely to seek relief and
happiness in something which he enjoys, that is, to partake of food and sweets, which
he does in excessive amounts. This phase of the subject of obesity in children has been
stressed by Dr. Hilde Bruch, working at Johns Hopkins, and while it may be associated
with other circumstances, from her point of view, it is unquestionably a common cause
of obesity.   Finally, the individual etiological factor "gluttony," by which is meant the
Page 342 uncontrolled and insatiable desire for food, similar to the alcoholic's desire for liquor,
has been suggested. This occasionally is apparently uncontrollable and may be due to
some heretofore unrecognized chemical imbalance or deficiency, the etiology of which
is obscure.    I mention this here only to plead ignorance of its cause.
There are, however, more important etiological factors in the family surroundings
than in the individual. We speak of children or individuals as being of the linear or
lateral type and appreciate that the individual with the short square trunk and wide
costal angle is more prone to become obese, if less likely to develop gastric ulcer, than
is the narrow linear type of individual. This may be true as a family characteristic
with certain families who tend to run to obesity. As I will point out in a further discussion, I fear that this is used as an excuse for obesity, rather than being truly a causative factor.    Whether heredity, as such, plays any important role, I sincerely doubt.
Most important of the family etiological factors, in my opinion, is the conditioning
of the child to certain types and quantities of food by his environment: and this is the
main point of my presentation, that obesity in children is in the main not due to faulty
social surroundings or inherent or familial characteristics, but is the result of the education of the child in certain dietary habits as a result of his childhood experience; and
that the family dietary habits are usually determined by the wife and mother who does
the buying and the cooking and the treating. In my experience the majority of obese
children in private practice come from family situations where the economic supplies
are adequate, where the mother is a good cook and delights in cooking or enjoys seeing
her family take pleasure in their food; not to suggest that the joys of the table should
be abolished, but rather that there should be temperance in all things, including eating.
A statement of the problem may be made that it is not so much a question of specific
instructions to the obese child, but re-education of the family habits as regards diet and
appetite.
Types of therapy may be divided into four groups, firstly drugs, such as codeine
which destroys the appetite, and benzadrine which is said to increase activity; but these,
in my experience in the average child, have no indication. Secondly, glandular products,
such as the use of thyroid or pituitary extracts; these I believe should be used only when
there is specific evidence of such glandular deficiency. Truly utilization of food may
be increased by the administration of thyroid even in the presence of a normal basal rate,
but it is, in my judgment, a dangerous reed on which to teach a child to lean, and
until dietary habits are also corrected, the obesity will recur with the cessation of administration of thyroid. Thirdly, dietary restrictions are essential, even though painful, and
most children co-operate well, particularly if one sits down and explains the problem to
the child, promising him, as one may, relief from his obesity, and sets a time limit on the
need for reduction. The aim of dietary restrictions for the obese child is not particularly to lose weight, but to stop the gain in weight until the height becomes more proportional to the weight. Restrictions of pie, pastry, cake, candy and added sugar to
food as served, and in tea or coffee if used, and sweetened soft drinks, for a definite
period, say of three months, usually produce in the child so satisfactory a response that
the patient is of himself quite willing to co-operate from that point on, particularly if,
in addition to those, any unsatisfactory emotional or social factors in the background
can be adequately rearranged. However, the principal object to be aimed at is not the
"selling" of dietary restrictions to the patient, but the re-education of the mother in
buying and cooking. She must be taught to provide fewer pastries, pies and cakes, to
cook with less butter, fats and shortening, to use less butter on the vegetables for the
family and serve fewer rich gravies and steamed puddings, to make desserts of fruit and
salads, rather than apple pie, not only for the child who is obese, but for the whole
family, for this is so frequently a family situation. For instance, Mrs. W. recently
brought her children to me for their annual examination. Mrs. W. is a charming, bright
faced, though obese individual of 35, who is a good cook. She stands 5 ft. 4 in. and
weighs 160 lbs.    Her daughter of 14 is a large child with square shoulders and is 50?
Page 343 lbs. overweight. Her son of .12 is 35 lbs. overweight, and her husband, at the age of
38, standing 5 ft. 8 in., weighs 180 lbs. The family is obviously overfed and the correction of the obesity in the family depends upon the re-education of the mother as a
housewife. She must learn to be more sparing in the use of fats and carbohydrates in
the feeding of her family. I appreciate that it is difficult at the present time to prescribe an appetizing high protein diet because of the moderate form of rationing under
which we are living, but I do feel that this is the answer to obesity in many children,
and they must be taught to live on a diet moderately restricted in fats and carbohydrates
and higher in proteins, particularly those of so-called higher biological Value. Similarly
in a family where the father, at the age of 48, standing 5 ft. 9 in. and weighing 225 lbs.,
died suddenly of coronary thrombosis. His wife, the mother of three children, an excellent cook, obese, the three children all overweight, one being 75% overweight for age
and height, all were corrected by the re-education of the mother as regards the dietary
requirements of her family. This included the forbidding of cream in the household,
removal of butter from the table and restrictions of the other factors which I have
mentioned, and the providing of skimmed milk in place of whole milk to drink.
As regards the personality difficulty: Jean C, a bright faced, seemingly happy child
of 14 weighing some 35 lbs. over average for her age and height, was brought because
of her excess weight. A complete metabolic study showed no abnormal findings, but
Jean admitted privately to me that she ate because she liked her food, that she got on
very badly with her two school teachers, and rather than play with other children of
her age a school, she went home and stuffed on bread, butter and jam, so that she would
not miss her former playmates. This is not common, but it does occur. The situation
was readily corrected by an altered school environment away from home.
On the symptoms produced by excess weight I need not dwell, other than to remind
you that they are principally subjective. Pains and aches in the feet, which, of course,
suffer from the excess load; pains in the legs, occasionally palpitation on exertion and,
of course, ready dyspnoea. Occasionally a child is brought for help because of these
symptoms, which are usually corrected spontaneously with the cessation of the gain in
weight and the return to a normal figure. I would point out that there is a well recognized spurt of growth in both height and weight for a few months or a year preceding
maturity, which is commonly spoken of a prematuration spurt in growth. This sudden
increase in height and weight, particularly the latter, causes parents considerable needless
alarm, as moderate obesity in this particular age group usually requires no therapy. We
recognize it as being due to the sudden increase in the growth stimulus associated with
maturation and will spontaneously correct itself after a year or two—unless excessive.
We must remember, too, that in any diet which is offered to such children, it must be
adequate in proteins, calcium, and vitamin "D."   On the details of this I need not dwell.
Fourthly, we appreciate these obese children suffer very markedly from what may, I
think, correctly be called an "inferiority complex," in that they are, because of their
ungainly bodies, less able to compete successfully in various sports or aptitudes with
their more streamlined playmates. I think the stimulation of the child's desire to excel
in some one thing, though minute, should be encouraged. I have on occasion, perhaps
foolhardily, advised parents that their medical fees for the treatment of their obese child
would be better spent in securing lessons from a professional teacher of some activity, or
grace, in which their overweight child may be taught to excel. By this, I mean lessons
in swimming, boxing, tennis, athletic dancing and so on. If the child can be taught to
become in any sense expert at any game, and his natural desire to excel above his fellows
be stimulated, the natural indolence which is associated with excess weight will no
longer be a problem. It is very gratifying to one's ego, irrespective of age or social sit -
uation, to be aware of one particular faculty in which one does excel.
In summary, my suggestions regarding the treatment of the obese child would be to
condemn the use of drugs and glandular extracts, unless such deficiency could be satis-
Page 344 factorily demonstrated; to warn against the attempt to correct the usual spurt of growth
which occurs immediately before adolescence; to draw attention to the fact that obesity
in children, while occasionally an individual matter and associated with some unhappy
social situation, is much more commonly a "conditioned" situation produced by the
parents who are in the habit of satisfying their own unfortunate food habits. To me
the most rational approach to the problem of the obese child is in the correction of
buying and cooking habits of the mother; and finally, that the added stimulus of adequate teaching, so that the individual may learn to excel in some particular activity,
particularly athletic, will help to solve the problem of the imbalance between the intake
of food and expenditure of energy, which is, after all, the crux of the situation.
V
ancouver
G
eneral
Hospital
UNUSUAL CARDIAC DEATH DUE TO TRAUMA
Pathological Conference—Vancouver General Hospital
H. H Pitts, M.D., Pathologist
F. P. Sparks, M.D., Assistant Director of Laboratory.
This patient was a man aged thirty-six years who, after an injury three years before
being admitted to the hospital, died after four months of hospitalization of acute cardiac
dilatation due to a rare complication. On his admission on June 29, 1942, he was complaining of pain in the right shoulder, periodic swelling of the right arm, and periodic
attacks of dyspnoea for three years, as well as attacks of weakness for two years. He
attributed all his complaints to an injury received while at work in a logging camp in
1939, when he fell on his right shoulder while carrying a heavy chain and heard- "something snap," but X-ray examination at the time failed to reveal any fracture. However,
he ran an irregular temperature which was attributed to a phlebitis of the veins in the
upper arm and shoulder, as there was a definite swelling and tenderness of the shoulder
area and upper arm. He was discharged from hospital some forty-five days after his
accident, but was unable to carry on his usual work because of these complaints. He
was examined on various occasions by several physicians but at no time did he mention
injury to the chest or shortness of breath.
On February 9, 1940, an examination revealed an engorgement of the superficial
veins of the right shoulder and upper thorax. He was given a pension to run for three
and one-half years, and he attempted to work at various times, but his right shoulder
felt heavy and when he used his right arm he "got weak all over"; he claimed that his
arm swelled and became blue and cold when he exercised it. In June, 1942, while splitting wood, his arm became very sore, blue, and swollen, and he became very weak and
"passed out." At that time the superficial veins on his shoulder and upper chest "stood
out." On June 29, 1942, he was admitted to the Vancouver General Hospital, where
he remained for sixteen days. He was tentatively diagnosed subacute bacterial endocarditis though blood cultures were negative. X-ray examination on June 30, 1942,
showed "In the left costophrenic sinus is an area of infiltration apparently occupying the
extremity of the tenth set of bronchi. The diaphragm moves freely at this site, suggesting there is no pleural involvement. It possibly represents a localized bronchiectasis
of a somewhat unusual type. The hilar markings on both sides are grossly increased,
due to enlargement of the pulmonary conus and the pulmonary artery on each side."
Page 343 He left the hospital entirely unimproved. He was re-admitted September 9, 1942, and
stayed in hospital until his death, January 30, 1943. His chief complaints on this last
admission were shortness of breath and weak spells.
Physical examination revealed a well-nourished and developed restless white male
lying in bed. He was dyspnoeic. His right eye was deviated tq the right and the
cornea completely opaque. The left eye was normal. Examination of the lungs was
negative. His heart was enlarged, the apex beat being eleven centimetres to the left
side of the midline, in the fifth interspace. There was a soft blowing systolic murmur
present at the apex at the time of his previous admission but this murmur was not
present this time. His pulse was 88, soft and regular. His blood pressure was 120/100
and respirations 20. His abdomen revealed no abnormality. Neurological examination
was negative.
His progress from the time of his first admission on June 29, 1942, was steadily
downward, although his heart apparently recovered to some extent after a month of
complete bed rest. His temperature varied between 96.1 in th morning to 102.2 in the
evenings. He left the hospital against advice in July, only to return on September 9,
1942. At the time of his discharge his temperature was slightly elevated and he complained of some pains in his shoulder. When the patient returned to hospital, on September 9, he was complaining of pain in the upper chest, weakness, difficulty in breathing and a non-productive cough. His temperature was 100, pulse 120, blood pressure
120/100, and respirations 55. An electrocardiogram on September 12, 1942, showed
"flattened T waves and some myocardial involvement." Report of X-ray examination
on September 14, 1942, was: "Right lateral, 6.0 cm.; left lateral, 12.0 cm.; long axis,
19.5 cm.; transthoracic measurement, 28.0 cm. The heart shows very marked general
enlargement, especially in relation to the left ventricle. There is also considerable
thickening shown at both the right and left hilus, circumscribed in character."
As the patient was thought to be suffering from a chest infection, he was put on
sulphadiazine. The temperature and dyspnoea improved but "splinter" haemorrhages
were noted under his thumb nail on September 11, 1942. This finding supported the
original diagnosis of subacute bacterial endocarditis though blood cultures were still
negative.    He was not improved by digitalis.
In November, 1942, his general condition was improved, probably owing to bed rest.
Physical examination revealed, in addition to the previously noted enlarged heart, a soft
systolic murmur at the apex. Moreover, there was an anterior to and fro friction rub
in the right anterior base of the lung and bronchial breath sounds were present over the
lower half of the left chest, posteriorly. The venous pressure of his left arm was 88
mm. water. The circulation times of his right arm were: arm to lung, 8 seconds; arm
to tongue, 30 seconds. The patient was allowed up for short periods. However, his
pulse remained fast, so he was kept on digitalis, grains 1 l/z daily. An electrocardiogram
on November 6, 1942, was reported "similar to September 12, 1942—Tachycardia,
some myocardial involvement." X-ray examination on November 7, 1942, revealed
"There is no essential change in heart measurements as compared to previous examination. There appears to be a slight amount of enlargement of the ascending aorta but
no marked pulsation. There is a slight interlobar thickening of the right side in relation
to the third and lower lobe." His condition remained the same until about the middle
of December, when his temperature began to rise. His condition became gradually
worse. On January 28, 1943, he became greatly nauseated and began to vomit. His
cough became very productive, of thin watery sputum; he became very much cyanosed
and expired January 30, 1943.
Laboratory Findings
Blood examinations showed a red blood count as follows: R.B.C. 4,900,000; Hb.
103%; Colour Index 1.06
White blood count varied from W.B.C. 5,000, P. 39, L. 37, M. 5, B. 3, Deg. 4,
Page 346 Staph.  12 on June 30,  1942, to W.B.C.  10,050, P. 46, L.  22, M.   1, E. 4, Deg. 6,
Staph 21 on Janu6ar 7, 1943.
His sedimentation rate increased from 2/7, September 9, 1942, to 2/29, November
10, 1942, and 18/686, January 7, 1943.
Kahn—negative.
Agglutination tests—negative on two occasions.
Numerous examinations of the urine were normal.
Sputum examinations on five occasions were negative for Bacillus Tuberculosis.
A post-mortem was done on this man on January 31, 1943.    The body was that of
a poorly nourished white male, which presented nothing of note on external examination.
Lungs: The right pleural cavity was entirely obliterated by old pleuritic adhesions;
the left cavity contained about 200 c.c. of straw-coloured fluid. The right lung weighed
1650 gm., the left 720 gm. Both lungs were cedematous but on cross-section there
were small areas of consolidation scattered from apex to base, in both lungs. They were
white, and in many areas showed small abscesses. They did not present a typical caseous
appearance but suggested rather a miliary tuberculosis. The lesions were more numerous
at the apices and bases of both lungs.
Smears from the lesions were positive for Bacillus Tuberculosis.
Heart: The pericardial sac was found to contain about 150 c.c. of clear straw-
coloured fluid. The heart was definitely enlarged and weighed 500 gm. Both right
and left ventricles were dilated, but the right side was larger than the left. The myocardium was fairly firm; that of the right ventricle measuring 0.8 cm. in thickness;
that of the left, 1.3 cm. There was no evidence of thrombus formation in any chamber
of the heart. The valve circumferences were as follows: P.V. 9.5 cm.; T.V. 14.5 'cm.;
M.V. 10.5 cm.; A.V. 9 cm. All the circumferences were larger than normal but the
tricuspid valve was definitely dilated and incompetent. There was a slight thickening
of the mitral leaflets and aortic cusps.
The coronary arteries and the aorta were free from sclerotic thickening.
Pulmonary Arteries: A large old, well-organized thrombus was found almost entirely
occluding the lumen of both right and left pulmonary arteries. The proximal ends of
the thrombi were smooth, whitish-yellow and well-rounded off, indicating that they had
been present for a relatively long period of time. These thrombi could be traced distally
into all the large branches of the pulmonary arteries of both lungs. It should be noted
that neither the main arteries or their branches were completely occluded at any one
point.
The liver weighed 1770 grams. It was a dark purplish-red colour and on cross-
section showed the typical nutmeg appearance of chronic passive congestion.
The spleen weighed 160 gm. The capsule was slate-grey. Running across the spleen
was a very fibrous area which was yellow in colour and nearly cut the spleen in two.
On cross-section it had the typical appearance of an old infarct. The splenic pulp was
greatly congested.
The gastro-intestinal tract, pancreas and adrenals were normal.
The right kidney weighed 130 gm.; the left, 110 gm. The cortex of both was distorted by old scarring. The capsules stripped with difficulty, showing an irregular cortical surface. Both cortex and medulla were markedly congested and showed evidence
of old infarcts.
Examination of the ureters, bladder and prostate was negative.
Page 347 Thus the findings were as follows:
1. Almost complete bilateral pulmonary thrombosis.
2. Acute dilatation of right and left heart.
3. Pleurisy (old), right side.
4. Consolidation and abscess formations, both lungs, due to tuberculosis.
5. Pulmonary oedema, right side.
6. Chronic passive congestion of liver, spleen, kidney6s.
7. Old infarcts of spleen and kidneys.
Summary and Discussion
Ante-mortem pulmonary thrombosis is a rare condition. According to Scovacole
and Charr1 who have reviewed the literature, one hundred cases of pulmonary thrombosis have been reported, and in forty-nine it was on the right side, in six on the left,
and in forty-five cases both arteries were thrombosed. In this case, both pulmonary
vessels were thrombosed. Brenner2 states that symptoms may be present from one
month to several years. He gives dyspnoea, exertion, cyanosis, chest pain, an enlarged
heart and a dense shadow over the pulmonary artery, as the findings in his cases. Pou
and Charr3 report rapid increase in dyspnoea, cyanosis, engorgement of cervical veins,
pain in the chest or epigastrium, restlessness, mental confusion, exophthalmos, blurred
vision, low pulse pressure with thin thready pulse and oedema of the ankles in the terminal stages, as outstanding clinical features of their six cases.
This patient had some of these symptoms. He had attacks of dyspnoea and weakness, and an engorgement of the veins of the upper chest. The cervical veins were not
engorged but cyanosis was present before his death. Pain in the chest was a feature
from his last admission till his death. His pulse pressure was low (120/100 and 100/
95). Bogaert and Scherer4, McGinn and White5, and Brenner2 found prominent Q
waves in the first lead and late invasion of T wave with a high origin in lead 3. In
some there was a tendency to right axis deviation. The electrocardiographic findings
in this case showed a pronounced- S wave in the first lead and a slight depression of S
and T in lead 2. There is a tendency to right axis deviation. These changes are suggestive of Cor pulmonale.
X-ray and physical examination are of questionable aid in the diagnosis of pulmonary
thrombosis. Pou and Charr3 conclude that a differential diagnosis of thrombosis of the
pulmonary artery from myocardial insufficiency, coronary artery occlusion, spontaneous
pneumothorax, intrathoracic new growths and pulmonary embolism may be possible by a
close observation of the clinical course of this condition.
As to the cause of pulmonary thrombosis, many different views are held by different
investigators. Brenner2 considers that most thrombi are embolic in origin. He states
that there is nearly always some pre-existing disease such as syphilis, rheumatism, tuberculosis; or there may be a patent ductus arteriosus in cases of true pulmonary thrombosis. Scovacole and Charr1 in their analysis of the hundred cases reported in the literature, conclude that pulmonary disease is not the only determining factory in the production of pulmonary thrombosis. In forty-six of them there was definite evidence of
parenchymal pulmonary diseases, not including those with arterial pulmonary changes
associated with cardiovascular disease. In this series of forty-six cases, twenty-two had
thrombus on the right side, ten bilaterally and five on the left side. In the remainder
of the hundred there was no pulmonary disease, but twenty-seven had thrombus on the
right side, twenty-six bilaterally and one on the left side. This suggests that the right
side predominance of thrombosis does not depend entirely upon the pulmonary disease
being more marked on that side, but rather upon some other factor.   These workers, in
Page 348 attempting to explain the predominance of right-sided thrombosis, refer to Seinor6, who
draws attention to the anatomical surroundings and greater length of the right pulmonary artery, which *lies horizontally under the arch of the aorta. In its course to the
hilum, the right pulmonary artery has certain structures close to it which the right artery
does not possess. In front there is the ascending aorta and the superior vena cava
as well as the phrenic nerve, the anterior pulmonary plexus and the reflection of pleura.
Lying close to the artery posteriorly is the right bronchus and azygos vein. Above the
artery is the arch of the aorta; below the artery is the right atrium and the right pulmonary vein (upper). At the root of the lung the right bronchus is above and beyond
it, and the pulmonary veins are below and in front of it. These surrounding pulsating
vessels would undoubtedly compress the right pulmonary artery and tend to cause a
slowing-down of the blood stream.
In the case under discussion, the thrombosis was bilateral and so the above anatomical
factor can be eliminated as a cause. Thus we are left with the other two causes: embolus
and pulmonary disease. An embolus could have broken free from the site of the old
phlebitis in the right arm and lodged in the pulmonary arteries with a subsequent building-up of thrombus to present the picture seen at post-mortem. On the other hand
there was widespread pulmonary disease present in both lungs, although the immediate
vicinity of the thrombi was free from disease. It is very difficult to assess the value of
each of these factors in assigning the cause of the thrombosis.
Summary
1. The clinico-pathological findings of a case of a bilateral pulmonary thrombosis
following trauma are described.
2. The outstanding clinical features of this case are described and compared with
the findings described in the. literature.
3. The conclusions of other writers are given as to the factors causing pulmonary
thrombosis, i.e.: Embolus, pulmonary disease, systemic diseases, inflammations, congenital
defects and anatomical factors causing a slowing-down of the blood in the right pulmonary artery.
(Our sincere thanks are due to Dr. George F. Strong for permission to publish this
case from his medical service.)
REFERENCES ,
1. Scovacole, J. W., and Charr, R.: American Review of Tuberculosis, 27, 1941.
2. Brenner, O.: Archives of Internal Medicine, 1935, 56, 1189.
3. Pou, J. F., and Charr, R.: American Review of Tuberculosis,  193 8, 37, 394.
4. Bogaert, A., and Scherer, H. J.: quoted by Pou and Charr  (3).
5. McGinn, S., and White, P.: quoted by Pou and Charr  (3).
6. Seinor: quoted by Scovacole and Charr   (1).
Page 349 vr J«w
1943
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filter presses which remove proteins, fat, and indigestible residue.
3. Blood agar tests are made to insure absence of hemolytic cocci.
4. Dextri-Maltose containers are paper-wrapped to prevent the cans from accumulating dust.
5. Bacteriological tests are made in a steam-washed plating room, the air of which is filtered.
6. Dextri-Maltose containers are automatically filled and
closed without human handling of the product.
7. The direct microscopic test which Dextri-Maltose receives is but one kind of 6 microbiological tests which
it must routinely meet.
8. The interiors of the large converters in which Dextri-
Maltose is processed are thoroughly scrubbed prior to
steam sterilization.
9. Steaming under 20 pounds pressure sterilizes the converters  for  processing   Dextri-Maltose.
10. After being packaged, Dextri-Maltose is held in storage
and released only after final approval from the bacteriological checking laboratory.
11. Portable equipment used in manufacturing Dextri-Maltose is sterilized in autoclaves at 20 pounds live steam
pressure for 20 minutes.
12. Dextri-Maltose is tested routinely to check the keeping
quality of prepared feedings held in refrigeration for
24 hours.
It is, therefore# no mere coincidence that Dextri-
Maltose enjoys greater paediatric acceptance today
than ever before. By constant research and ever*
lasting watchfulness, we try to keep pace with
paediatric progress, and we put forth every human
effort to merit the continued respect and confidence
of the medical profession.
The True Measure of Economy Is Value
MEAD JOHNSON & CO. OF CANADA, Ltd., DELLEVILLE, ONT. For maximum response in
sex hormone therapy
OESTROFORH
Trade Mark
am
PROGESTIN B.D.H.
The extensive use of Oestroform and Progestin B.D.H., both in private practice
and in research units, has clearly established the fact that the administration of
these sex hormone preparations produces a specific effect in every case associated
with hypofunction of the ovarian follicle and of the corpus luteum respectively.
By reason of the established clinical efficacy of both Oestroform and Progestin
B.D.H., as well as their chemical purity and accurate standardisation, the practitioner can rely upon obtaining a maximum therapeutic response whenever they
are administered for the treatment of any of the many conditions in which they
are specifically indicated.
OESTROFORM, the natural oestrogenic hormone standardised in international
and international benzoate units, is indicated for the relief of menopausal symptoms, delayed puberty, amenorrhcea, oligomenorrhoea, sterility and dysmenorrhea
dute to uterine hypoplasia, pruritus and kraurosis vulvae.
PROGESTIN B.D.H., the hormone of the corpus luteum standardised in international units, is indicated in habitual and threatened abortion, menorrhagia and
metrorrhagia.
Stocks of Oestroform and of Progestin B.D.H. are held by leading
druggists   throughout   the   Dominion,   and   full   particulars   are
obtainable from
THE    BRITISH    DRUG    HOUSES    (CANADA)    LTD.
Toronto Canada
-SHor/Can/439  C III N Mffifelr
URINE-SUGAR
ANALYSIS
TABLETS
CLINITEST
TABLETS
GENERATE
THEIR OWN
HEAT
THE NEW ONE-MINUTE
URINE SUGAR-TEST
The new Clinitest Tablet Method for Urine-
Sugar Analysis has been developed to meet
the needs of the physician, the laboratory
technician, the nurse and the diabetic patient.
Time-Saving — Simple — Dependable
It is so simple and easy that persons who
are not familiar with it can perform tests
very satisfactorily in less than a minute—
just drop a Clinitest Tablet into a small
amount of previously diluted urine, allow
a few seconds for reaction and examine
for color.
No equipment for boiling over a flame or in
a water Bath is needed. Each tablet contains
an accurately measured amount of the reagent, eliminating guess-work and unreliable
measuring methods.
The Clinitest Color Scale retains the familiar
progression of colors used in the Benedict's
test, to indicate the following amounts
of sugar:  0%, H%9 %%,   %%,  1% and
2% plus.
Clinitest is
Convenient, Portable,
Economical
The complete set (with
tablets for 50 tests)
costs your patient only
$2.00. Tablet Refill
(for 75 tests) — §2.00.
Write for full descriptive literature.
Available through
your surgical supply
house or prescription
pharmacy.
5 drops urine plus
.10 drops water.
m
Drop in tablet.
©
Allow for reaction
and compare with
color scale.
EFFERVESCENT   PRODUCTS   INC.
FRED.
WHITLOW
Sole Canadian Distributors
CO.,    LTD.,    187    DUFFERIN     STREET,     TORONTO s
y~
■klk.
HImH
■^Wm
for active and passive immunization
against
PERTUSSIS
Results of numerous clinical trials furnish
evidence of the ability of these products to
control Pertussis.
(SLf£Mt
To Determine Susceptibility—
Pertussis Toxin for the Strean Skin Test (No. 497)
For Prevention —
Pertussis Vaccine with Pertussis Toxoid (No. 486)
For Treatment—
Pertussis Antitoxin and Antibacterial Serum
(Rabbit) Combined (No. 489)
Prepared and standardized under the supervision of
Professor E. G. D. Murray, Department of Bacteriology
and Immunity, McGill University. Literature on request.
AYERST, McKENNA & HARRISON LIMITED • Biological and Pharmaceutical Chemists • MONTREAL
J 58 Breaks the vicious circle of perverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
musculature. Controls the utero-ovarian
k    circulation and thereby encourages a    M
Hk    normal menstrual cycle. Jf
• MARTIN H. SMITH COMPANY      J$-
IK,        im umtoii sram. nw towc m. t.       ^^f
Full formula and descriptive
literature on request
Dosage:   l to 2 capsules
3 or 4 times daily.   Supplied
in packages of 20*
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule is cut in half at seam.
cMead GoUi Checked
WITH 3 DROPS IN EACH NOSTRIL . . .
PRIVINE"Ciba"
(1:1000 solution of 2-(naphthyU-1—methyl)-imidazoline hydrochloride)
NASAL   DROPS
Clinical investigations on Privine Nasal Drops have proved that'
they are excellently suited for the treatment of all forms of nasopharyngeal affections. In head colds, a few moments after the
instillation of 3 drops of Privine in each nostril, the headache and
sensation of heaviness in the head disappear, while the nasal respiration becomes easier, the watering of the eyes stops, the voice regains
its normal tone and the sense of smell is restored.
ISSUED:
In bottles of Vt. ounce with dropper, and bottles of 4 ounces.
CIBA COMPANY LTD.
Montreal •II/.
X
\
^,
pp
co
Postprandial     distress
Having to listen to a prosy after-dinner oration
may be a painful experience, but more real, in
the physical sense, is the distress that awaits him
who has dined well but none too wisely.
Gourmandism is difficult to cure, as is the habit of
hurried dining, and so it becomes a matter of alleviating the gastric distress caused by hyperacidity.
Physicians for many years have found in
Cal-Bis-Ma the kind of preparation that will help
provide this relief. A palatable powder composed
of substances recognized as effective for gastric
neutralization, Cal-Bis-Ma may be prescribed
with assurance that it will act promptly and safely.
A trial supply will be gladly sent to physicians.
Please write to the Dept. of Professional Service.
j CAL-BIS-MA
WILLIAM R. WARNER & CO., LTD., 727 King St, West, Toronto, Ontario n
b
n
u
^w
The United States Bureau of Dairy Industry in its research
has discovered a new growth-stimulating factor in milk.
This factor—now called "X" until further identification is
possible—is different from all of the now-known nutrients of
milk. Dr. C. A. Cary and his associates at the Bureau of Dairy
Industry, United States Department of Agriculture, have been
conducting research on milk over a period of yea rs.^| These
studies have led them to the conclusion that milk definitely has
more value than has yet been discovered.
These research workers fed experimental animals a synthetic mixture of all of the known nutrients of milk. They fed
other experimental animals the complete food—milk. The ani-
male which were fed milk—as such—grew better and were in
better general physical condition than the animals which received
all of the various known components of milk.
Although many nutritionists have indicated that there might
be further nutritive substances in milk than have been discovered, this is the most recent proof of that fact. Good nutrition
is a basis to stamina and endurance—each a "must" in the
war effort. INDEX TO VOLUME XIX, V.M.A. BULLETIN, 1942-43
A
ACTINOMYCOSIS, PROBABLE CASE—W. Keith Burwell  77
ARGBNTAFFTNOMATA,  REVIEW OF CASES,  V.G.H.—L.  B.  Harville  17
ARTHRITIS,  CHRONIC—John W.  Scott  57
B
BOOK REVIEWS—
Advances in Internal Medicine, v. 1—J. Murray Steele, Ed     34
Advances in Paediatrics, v.  1—A. G. DeSanctis, Ed     99
Blood Grouping- Technic—Fritz Schifi! and Wm. C. Boyd       6
Manual of Industrial Hygiene and Medical Services in War Industries  219
War Gases—Morris B. Jacobs       6
War Medicine—Winfield Scott Pugh, Ed —      7
BRITISH COLUMBIA CANCER INSTITUTE—
Annual Meeting of Honorary Attending Staff  192
Review of Cases of Carcinoma of the Body of the Uterus—Margaret Hardie  192
BRITISH   COLUMBIA   MEDICAL  ASSOCIATION   13,  40,     75
Annual   Meeting   _ _  273, 299
Canadian Medical Association—Special Meeting of General Council   104
—Meeting,   Montreal    =-  275
Committee on Economics—"Health  Insurance—How Soon?"—T.  C.  Routley  228
Committee on Industrial Medicine     68
Committee on Study of Cancer—^Cancer of the Stomach     38,    75
Communication—Dept.  of Munitions and  Supply,  Controller  of  Chemicals—Quinine 250
Health Insurance—No. 1—Abstracts of Dominion and Provincial Acts  329
—No. 2—Resume of the Minutes  of the Proceedings of the Committee   on   Social   Security—A  Report  for  the  Doctor  in
Practice      _  334
Upper Island Medical Association Meeting _     39
BRITISH COLUMBIA PHARMACEUTICAL ASSOCIATION—Health Insurance
Committee      118, 233
BROMIDE POISONING, REVIEW OF 12 CASES—Phillip E. Pemberton  106
BURWELL, W. KEITH—Probable case of actinomycosis     77
C
CAESAREAN SECTIONS IN V.G.H., 1941—George H. McKee  206
CAMPBELL, C. G., and PROWD, C. W.—Gastric mucosal patterns....  226
CAMPBELL,  E. A.—Classification  of  the neuroses  134
CANTOR, MAX M.—Evaluation of hepatic function  316
Evaluation of  renal  function  309
CARCINOMA OF BODY OF UTERUS—Margaret Hardie  192
CARDIAC DEATH DUE TO TRAUMA—H. H.  Pitts and F. P. Sparks  345
CATARRHAL   JAUNDICE,   EPIDEMIC—J.   S.   Kitching  114
CECOSTOMY—INDICATIONS  AND   TECHNIQUE—Roscoe   R.   Graham  22
CHRISTIE, JOHN—Congenital pachyonychia and keratoderma, Case  113
CLEVELAND, D. E. H.—Osier Lecture—The fear of the skin  196
COLLEGE  OF PHYSICIANS  AND  SURGEONS  11, 12,  157,  191, 249
Election of Members  of Council  70
Medical  Services   Association  306
Annual  Report    70
Information   for   Doctors  101
B
DAVIDSON,  GEORGE  A.—The  treatment of  neuroses  144
DESBRISAY,   H.   A.—Medicine  and   war  276
DIVISION   OF  VENEREAL  DISEASE   CONTROL |   116,  341
Reporting   cases*—Notification   form   N.l _  232
D\)BSON, W. A.—Early psychotic manifestations resembling neuroses  140
DOLMAN, C. E.—Laboratory diagnosis of venereal disease  131
Sero-diagnostic   tests   for   syphilis 131
DUNN, EILEEN M.—Diet in disease of the gall-bladder     14
E
ERYTHROBLASTOSIS FOETALIS AND ITS RELATIONSHIP TO THE Rh FACTOR—
A. H. Spohn and Peter H.  Spohn.  211
P
FROST,  A.  C.—General  principles  of gynaecological   surgery  181
FRACTURES,   TREATMENT—MODERN   TREND—H.   S.   Morton     79
G
GALL  BLADDER  DISEASE,   DIET—Eileen  M.   Dunn     14
GASTRIC MUCOSAL PATTERNS—C. W. Prowd and C. G. Campbell  226
GRAHAM,  ROSCOE  R.—Indications  and technique for cecostomy     22
GYNAECOLOGICAL   SURGERY—GENERAL  PRINCIPLES—A.   C.   Frost  181
HAEMATOMA,   SUBDURAL,  IN INFANCY—J.  W.  Cluff  289
HAEMORRHAGIC BLOOD DISEASES—John W.  Scott k     86
HARDIE, MARGARET—Carcinoma of the body of the uterus  192
HARRISON, BEDE  J.—Whither?   163
HARVILLE, L. B.—Argentaffinomata, review of cases     17
HASKINS,  JOHN L.—Psychological warfare !     48
HEART ATTACK IN YOUTH—H. G. "Weaver  307
HENRY, C. M.—Review of roentgen therapy in acute infections     43
HEPATIC FUNCTION, EVALUATION—Max M.  Cantor  316
HYPERINSULINISM—J. C. Thomas  -   177
HODGINS, G. L.—Staff medical work in the Vancouver General Hospital  288 X
INCOME  TAX  RETURNS—INFORMATION    - -  160
IRON DEFICIENCY ANAEMIAS—John W.  Scott     »2
J
JOHNSON, A. M.—Plasma proteins in modern medicine     20
JOHNSTONE, ALAN—The law and social hygiene  304
K
KITCHING,  J.  S.—Epidemic  catarrhal   jaundice  H4
B
LABORATORY DIAGNOSIS OF VENEREAL DISEASE—C. E. Dolman  131
LAW AND SOCIAL HYGIENE—Alan Johnstone.  304
LEE, G. H., and PITTS, H. H.—Retroperitoneal lymphangioma, case  41
M
MEDICINE AND WAR—H. A. DesBrisay _  276
MEMORIES—P. A.  McLennan    251
MORTON, H. S.^-Modern trend in the treatment of fractures i     79
Mc
McCULLOUGH,   MARJORIE—The   soya  bean  172
McKEE, GEORGE H.—Caesarean sections in V.G.H.  in 1941  206
McLENNAN,   P.   A.—Memories  251
N
NEUROSES, CLASSIFICATION—E.   A.   Campbell ,  134
NEUROSES, EARLY  PSYCHOTIC  MANIFESTATIONS  RESEMBLING—W.  A.   Dobson 140
NEUROSES,  SIGNIFICANCE OF SYMPTOMS—S. E.  C.  Turvey  142
NEUROSES IN WAR TIME—J. C.  Thomas  136
NEUROSIS,  COMPENSATION—Frank   Turnbull    -  139
NEUROSIS, TREATMENT—George A.  Davidson -^  144
NEUROTIC—BACKGROUND AND PERSONALITY—Gordon H. Hutton  133
O
OBESE CHILD—DISCUSSION OF TREATMENT—R.  R.  Struthers  342
OBITUARIES—
Anderson, Lt.-Col. W. H. K  244
Lamb,   A.   S j -  100
Lees,   Lt.-Col.   Frederick  W.  245
McDiarmid,   Capt.   J.   M  127
McGregor,   Herbert  127
Oliver,   Capt.  G.  D , .1. 244
Perry,  H.  H : .  100
OSLER LECTURE—THE FEAR OF THE SKIN—D. E. H. Cleveland  196
F
PACHYONYCHIA AND KERATODERMA,  CONGENITAL,  CASE—John Christie  113
PEMBERTON, PHILLIP E.—Review of  12  cases of bromide poisoning  105
PHARMACISTS—RELATION  TO  PUBLIC HEALTH AND  HEALTH  INSURANCE—
Hugh  Wolfenden     119, 147
PITTS,, H. H., and LEE, G. H.—Retroperitoneal lymphangioma,  case  41
and SPARKS, F. P.—Cardiac death due to trauma .  345
PLASMA PROTEINS IN MODERN MEDICINE—A. M.  Johnson  20
PROWD, C. W.,  and CAMPBELL,  C.  G.—Gastric mucosal patterns  B26
PSYCHOLOGICAL WARFARE]—John  L.  Haskins  48
r
RENAL FUNCTION,  EVALUATION—Max M.  Cantor   309
RETROPERITONEAL LYMPHANGIOMA, CASE—G. H. Lee and H. H.  Pitts     41
ROENTGEN THERAPY IN ACUTE INFECTIONS, A REVIEW—C. M. Henry     43
S
ST. PAUL'S HOSPITAL—
Case   reports        77, 113
General principles of gynaecological surgery—A. C. Frost  181
Erythroblastosis  foetalis and  is  relationship  to  the  Rh  factor—A.  H.   Spohn  and
Peter H.   Spohn  211
SCOTT, JOHN W.—Chronic   arthritis     57
Haemorrhagic   blood   diseases  86
Iron   deficiency   anaemias  52
SKIN, THE FEAR OF—D. E. H. Cleveland _  196
SOYA   BEAN—Marjorie   McCullough  172
SPARKS, F. P., and PITTS, H. H.—Unusual cardiac death due to trauma  345"
SPOHN, A. H., and SPOHN, PETER H.—Erythroblastosis foetalis and its relationship
to the Rh factor  211
STRUTHERS, R. R.—The obese child: a discussion of treatment  342
SYPHILIS—Serological  test  for :  116
Sero-diagnostic tests  131
T
THOMAS, J. C.—Hyperinsulinism      177
Neuroses  in  war-time   :  136
TURNBULL,  FRANK—Compensation  neurosis    139
TURVEY, S. E. C.—The significance of symptoms in the neuroses ,..„..,„ 142 VANCOUVER GENERAL HOSPITAL—
Case reports    17, 41, 106, 307, 345
Chinese diets—H. S. D. Garven  210
Department of Dietetics—Diet  in  disease  of   the  gall-bladder     14
The   soya   bean .".  172
Facts  and  figures *  179
Report by Dr. F. N. Robertson to Medical Board  286
Review of Caesarean Sections,  1941—Geo. H. McKee  206
Staff medical work in V.G.H.—G.  L. Hodgkins  288
Subdural haematoma in infancy—J. W. Cluff .'.  289
VANCOUVER MEDICAL ASSOCIATION—
Annual  reports,   1942-43  220
Library   notes     6, 34, 69,  98, 127, 156, 219, 272, 298,  328
. Microfilm  service    128, 138
Notes on B. C. Formulary—No.  1 Analgesics „  133
Summer   School,   1942 ■       8
Summer   School,   1943  216,  246, 270
VICTORIA  MEDICAL SOCIETY  43,    79
W
WEAVER ,H. G.—A heart attack in youth  307
WHITHER?—Bede  J.  Harrison   163
WOLFENDEN, HUGH—Relation of pharmacists of Canada to public health and
health   Insurance     119, 147
Breaks the vicious circle of perverted   1
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and  stabilizing the tone of its
musculature. Controls the utero-ovarian
k    circulation and thereby encourages a    j
Ik   normal menstrual cycle.
* MARTIN H. SMITH COMPANY
^ ~     iso iAF»Yim suiti. Ntw vonc n. v.        *m
Full formula and descriptive
literature on request
Dosage:   l to 2 capsules
3 or 4 times daily.   Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule is cut in half at seam.
Telephone MArine 2015
Residence: B Ay view 8116-M
Moth} C. Jlaboey
A.P.A., A.R.P.T.T.
CANADIAN PHYSIOTHERAPY ASSOCIATION
MASSAGE   —   REMEDIAL EXERCISES
ELECTRICITY, Including Short Wave
House Visits
704 Birks Building, 718 Granville Street
Vancouver, B. C. IN PREGNANCY
suggested
|or;trea^eht of threatened
|r habitual abortion que to
f    vitamin e deficiency
FOR INCREASED
Ialcium REQUIREMENTS
% Each capsule contains 50 milligrams of mixed tocopherols,
equivalent in vitamin E activity
to 30 milligrams of a-tocopherol.
Tocopherex contains vitamin E
derived from vegetable oils by
molecular distillation, in a form
more concentrated, more stable
and more economical than wheat
germ oil.
For experimental use in prevention of habitual abortion (when
due to Vitamin E Deficiency): 1 to
3 capsules daily for 8% months.
In threatened abortion: 5 capsules
within 24 hours, possibly continued
for 1 or 2 weeks and 1 to 3 capsules
daily thereafter.
Tocopherex capsules are supplied
in bottles of 25 and 100.
0 Each capsule of Viophate—D
contains 4.5 grains Dicalcium
Phosphate, 3 grains Calcium Gluconate and 330 units of Vitamin
D. The capsules are tasteless, and
contain no sugar or flavouring.
Where wafers are preferred, Viophate—D  Tablets  are  available,
pleasantly flavoured with winter-
green.
One tablet is equivalent to two
capsules.
How supplied:
Capsules-—Bottles of 100 and
1,000.
Tablets —Boxes of 51 and 250.
For literature, write 36 Caledonia Road, Toronto
E-R:Squibb&.Sons of Canada. Ltd.
MANUFACTURING   CHEMISTS  TO  THE   MEDICAL   PROFESSION   SINCE   1858
 I SO  LC^|i!^»!;'§IE
WASSr-^»L/lT
cJuce Jhe poss|bif^^^p|Bies^^feifjng
Phone
MArine 416
,jbdU*^.J&*d**0*\
GEORGIA PHARMACY
LIM1TCO
MWUMA
(Sntpr &; l| t^i|I&.
ESTABLISHED 1893
VANCOUVER, Wm
North Vancouver, B.Cl
Powell River, B. (B^
DHHH| wm
mm
#*& %##
ft
New Westminster, B. C.
For the treatment of
NEUROPSYCHIATRIC
DISORDERS
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C
or 721 Medical-Dental Building, Vancouver, B. C
PAcific 7823
Westminster 288
87    University of British Columbia Library
DUE DATE S
SERIALS
JAN ° 0 n/ \
VHIV a. b  CV «g
FEB 10 1966
J A jy 9 7 f?P7]
FORM 310S &70%/2^
m
m
WOODWARD
LIBRARY 

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