History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: August, 1946 Vancouver Medical Association Aug 31, 1946

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Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
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. XXII. AUGUST, 1946 No. 11
m\       I     I     OFFICERS, 1946 - 1947
Dr. H. A. Des Brisay Dr. G. A. Davidson Dr. Frank Turnbull
President Vice-President Past President
Dr. Gordon Burke Dr. Gordon C. Johnston
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Dr. W. J. Dorrance, Dr. J. W. Shier
Dr. A. W. Hunter        Dr. G. H. Clement      Dr. A. M. Agnew
Auditors: Messrs Plommer, Whiting & Co.
Clinical Section
Dr. E. R. Hall Chairman Dr. Reg. Wilson Secretary
Eye, Ear, Nose and Throat
Dr. Roy Mustard Chairman Dr. Gordon Large.. Secretary
Paediatric Section
Dr. R. P. Kinsman Chairman Dr. H. S. Stockton Secretary
Orthopaedic and Traumatic Surgery Section
Dr. K. J. Haig Chairman Dr. J. R. Naden Secretary
Ism Section of Neurology and Psychiatry
Dr. A. M. Gee Chairman Dr. J. C. Thomas Secretary
Dr. W. J. Dorrance, Chairman; Dr. D. E. H. Cleveland, Dr. J. E. Walker,
Dr. R. P. Kinsman, Dr. J. R. Neilson, Dr. S. E. C. Turvey.
Dr. J. H. MacDermot, Chairman;  Dr. D. E. H. Cleveland, Dr. G. A.
Davidson, Dr. J. H. B. Grant, Dr. E. R. Hall, Dr. Roy Mustard.
Summer School:
Dr. L. G. Wood, Chairman; Dr. J. C. Thomas, Dr. A. M. Agnew,
Dr. L. H. Leeson, Dr. A. B. Manson, Dr. D. A. Steele.
Dr. H. H. Pitts, Dr. A. E. Trites, Dr. Frank Turnbull.
V. O. N. Advisory Board:
Dr. Isabel Day, Dr. J. H. B. Grant, Dr. G. F. Strong.
Representative to B. C. Medical Association: Dr. Frank Turnbull.
Sickness and Benevolent Fund: The President—The Trustees. Eadiuitmsnt
to Livin
f     f
-Jkz hiucfzia hxoljLEm±
of menopause begin before and may increase after the vasomotor
disturbance associated with precipitate estrogen deficiency. In the
presence of disturbing organic symptoms even the woman who
has enjoyed an emotionally generous life may find the change
at menopuase difficult. Personality problems which may have been
latent for years can at this time leap into prominence and cripple
the years of full maturity. By relieving vasomotor disturbance, a
potent estrogenic substance such as Estrogens, Lakeside, prepares
the patient for adequate treatment of such personality difficulties.
Estrogens, Lakeside, assist in making a change of life a readjustment   to   living.     Lakeside   Laboratories,   Milwaukee,   Wis.
£±blOq£H±    LAKESIDE
For literature write
Vancouver, B. C.
Founded 1898       : :      Incorporated 1906
GENERAL MEETINGS will be held on the first Tuesday of each month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of each month at 8:00 p.m.
October    1      GENERAL MEETING—Symposium—"Recent Advances in Paediatrics."
Doctors E. J. Curtis, E. S. James, W. H. S. Stockton and Reg. Wilson.
October 15      CLINICAL MEETING—Vancouver General Hospital.
November    5 GENERAL MEETING.
Doctors A. R. Anthony, L. H. Leeson and J. A. McLean.
November 19 CLINICAL MEETING—St. Paul's Hospital.
December    3   GENERAL MEETING.    Symposium on Gynecology.
Doctors Leigh Hunt and Gardiner Frost.
December 10   CLINICAL MEETING—Shaughnessy Hospital.
f   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
§k    normal menstrual cycle.
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.
Page  Two  Hundred and  Forty-one INSULIN        |
The twenty-fifth anniversary of the discovery of Insulin will be marked
by the American Diabetes Association at its meeting in Toronto on 16th,
17th and 18th September, 1946.
The discovery of Insulin by Banting and Best, working at the University
cf Toronto, introduced a new era in the treatment of diabetes mellitus and
a new chapter in physiological research.
From the commencement of the
supply of Insulin, the Connaught Medical Research Laboratories have been
responsible for its preparation in Canada and have carried on related research problems. Of special interest
was the work of Dr. D. A. Scott who
discovered the necessary conditions for
the preparation of crystalline forms of
Insulin. All unmodified Insulin regularly distributed by the Laboratories is
highly purified material of crystalline
Origin. Photomicrograph   of   Zinc-Insulin   Crystals
Through research conducted at the Laboratories by Scott and Fisher,
discoveries of Hagedorn and his colleagues in Denmark were extended,
resulting in the preparation of Protamine Zinc Insulin. This product provides
an effective means of treatment for patients, requiring a more prolonged
blood-sugar-lowering effect than that resulting from, the administration of
unmodified Insulin.
University of Toronto *   Toronto 4, Canada
Total   population—estimated
Chinese    population—estimated  6 566
Hindu population—estimated
Total  deaths  I  318
Chinese   deaths  16
Deaths, residents only  .  272
Male  360
Female :  337
Rate per 1,000
Deaths under 1 year of age       27
-per 1000 live births .       3 8.7
June, 194 5
Stillbirths  (not included above)         4 11
Death rate
Scarlet Fever i	
Diphtheria i	
Diphtheria   Carrier   	
Chicken Pox  233
Measles  9
Rubella  6
Mumps     3 51
Whooping Cough  .  0
Typhoid Fever   1
Typhoid Fever Carrier  j  0
Undulent Fever  0
Poliomyelitis :  0
Tuberculosis  93
Erysipelas   .^_  1
Meninboccus  Meningitis .  3
Infectious Jaundice  .  0
Salmonellosis  2
Salmonellosis    (Carrier)      22
Dysentery : ■  .0
Syphillis    I j  176
Gonorrhoea  301
Cancer  (Reportable)
Resident  62
|§U'   Non-Resident - _ :      41
May, 1946
JuneJ 1946
3 .
0  .
July 1-
15, 1946
B I O G L A N "C"
Prepared separately for male and female.
Composition: Anti-thyroid principles of the pancreas, duodenum, em-
bryonin, suprarenal cortex, tests (or ovary). Each 1 cc. ampoule
contains the equivalent of approximately 29 grams of fresh substance.
Indications: Graves's disease, hyperthyroidism, exophthalmic goitre,
thyrotoxicosis.   The most effective therapy available.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
Page Two Hundred and Forty-tv/o Administered intravenously, Intocostrin
promotes safety by producing abdominal
relaxation without deep anesthesia. The intestine is contracted and a quiet abdomen
produced. Action is rapid, profound, and
brief. In therapeutic doses there are no
effects on involuntary or cardiac muscle,1
no untoward postoperative complications.
Intocostrin has been used to advantage with
cyclopropane; ether, nitrous oxide, ethylen
and sodium pentothal. It is a purified
standardized extract of curare (chondodendro
tomentosum) which produces muscle relaxatio
through a readily reversible myoneural blocl
(1) Cullen,  S.Gj  Anesthesiology   5:166   (March)   194'
(2) Griffith, ftlli  UOkK 127to42 (March   17) 194.
(3) Griffith, HJLt Canad. M. A. J. 50x144  (Jan.) 194*
For literature write E* R. Squibb & Sons
of Canada, Limited, 36-48 Caledonia
Road, Toronto,
^ybw IjQxkj IxS^tx^
E.   R.   SQUIBB   &   SONS   OF   CANADA,   LTE
36-48   CALEDONIA   ROAD.TORONT' *lke ZdiioriL Paqe.
An event which occurred in the Magistrate's Court at Surrey recently, brings up
several points worthy of the earnest consideration of the whole medical profession of
this Province.
This event was the imposition of a fine by the Magistrate on Dr. Rose of Langley
—who had been seeing patients in the adjacent municipality of Surrey—and the reason
given for the fine was that he had done so without paying the professional license fee
for this municipality. In other words, he had no right to practice medicine in any
municipality which charges doctors a yearly fee, unless he first paid that fee.
We understand that the case is being appealed, and that the B. C. College of Physicians and Surgeons through the Council, is supporting Dr. Rose in his appeal.
This judicial action gives one a great deal to think about. In the first place, we have
always understood that our license to practice medicine in B. C. was obtainable only
by the action of the C.P.S. of the Province, and that it entitled us to practice medicine
anywhere in British Columbia. No other authority in the Province, we believe, can
grant or deny this right, or limit it in any particular. Now we are told, in effect,
that our right to practice medicine is susceptible to limitation by cities and municipalities, through what amounts to a license fee similar to that imposed on businesses and
trades of various sorts, who do not have a provincial licensing body to pass on their
right to carry on business.
Some years ago, various cities and municipalities in B.C. initiated this yearly tax
on doctors. It is not called a license fee, or trade license tax, but is bowdlerized into
Professional Tax, apparently it is recognized that it is not a license to practice that
is conferred. It is simply that we are.here and a tax is being imposed upon us. We
have always felt that this is a most iniquitous and unjust tax. The principle of taxation, as we conceive it, is that the tax is levied as payment for services rendered by the
taxing body. Surely, there is no other basis or justification by taxation: Anything else
is sheer pocket-picking—and we regard this tax as simply a gouge. We receive no services for it, no extra consideration of any kind—since we already have the right to
practice, and this right, we believe, cannot be taken away from us, even if we do not
pay the tax, though a judgment can be obtained for it.
We are not the only profession that suffers in this way—the legal and engineering
professions have also to pay this impost. Probably there is nothing we can do at this
late date to alter things, though we feel that some attempt should be made to do so.
But at any rate, we should only have to pay the one tax, in the municipality in which
we live. If we are right in believing that this tax does not and cannot influence our
right to practice medicine, then it can only be a residential tax—though why a doctor
should pay more residential taxes than anyone else, we cannot see. He uses his residence
less than most people, in any case.
If this tax is allowed to stick, and if Dr. Rose has to pay fees in two or more
municipalities, it is worth while considering to what this may lead. A surgical specialist
or a consultant in medicine, or an anaesthetist who happens to live and pay taxes in
Vancouver or Victoria, cannot go and see patients or do operations or give anaesthetics
in Chilliwack or Langley or Duncan or Courtenay, and similarly in other parts of
the Province. The same principle will apply to lawyers, consulting engineers and so on.
For a Vancouver barrister to plead in a Victoria court, will mean that he has laid
himself open to a fine for practicing law without due payment of what the Surrey
Magistrate described, we are told, as a trade license fee. This is a perfectly logical
deduction from the facts of this case.
Page Two Hundred and Forty-three We sincerely hope that this matter will not be allowed to drop, no matter what
it may cost us, till these points are cleared up. We believe that this tax should never
have been imposed—that it should be abolished, and that it is an unjust and tyrannical
exercise of arbitrary power on the part of the governing bodies of the various municipalities of the Province.
We have heard it urged that we as medical men should be immune because we do
a good deal of charity work for the cities and municipalities in which we live. We
mention this only to say that we think his argument is not in any way valid, and
should never be used. Two wrongs do not make a right. Both this tax, and the doing
of charity work, are wrong, and bad economics. If we are immune on this score,
we must admit the justice of the tax and this we cannot do. The work that we do
gratis is our own business, and cannot and should not be used as a basis for bargaining.
We believe this tax to be just as iniquitous when imposed on lawyers, as when imposed
upon us.   It is merely a steal—we get nothing for it, and should not have to pay it.
HOURS:  (Summer months)
Monday through Friday—9:00 a.m. to 5:00p.m.
Saturday, 9:00 a.m. to  1:00 p.m.
Commencing Wednesday, October 2nd, 1946, evening hours will be resumed, with
the Library remaining  open until  9:30  p.m.  on Mondays,  Wednesdays   and
Surgical Clinics of North America, Symposium on Colon Surgery, Lahey Clinic
Number, June, 1946.
The Management of Obstetric Difficulties, 1945, 3rd ed. by Paul Titus.
Physical Examinations of Selective Service Registrants During Wartime, Nov.  1,
Published by National Headquarters, Selective Service System.
We are pleased to announce that we are now receiving on an exchange basis,
Medical Annals of the District of Columbia. This very fine publication is a distinct
asset to our ever growing list of subscriptions.
Among the Vancouver men who have recently returned to practice in that City,
is Dr. E. S. James, who specialized in paediatrics here before the war, and has resumed
that specialty. Dr. James was one of the very first Vancouver doctors to apply for
enlistment, and was with the R.C.A.M.C. throughout the war. He was overseas about
the entire time, saw service in Germany—was, we believe, one of the first Canadian
medical men to cross the Rhine—and did outstanding work in the field. He received
serious burns to his hands while operating which are, happily, now practically healed.
Dr. James is one of a group of returned medicos who, finding office space unobtainable in the usual localities, have courageously decided to build their own medical
centre, by taking offices at the corner of 41st Ave. and Granville St. He is one of a very
goodly company—and we hope to see this become one of the leading centres of medical
practice.    We believe, with the men who are joining it, that it cannot fail to do so.
Page Two Hundred and Forty-four ancouver
Honorary Treasurer-
Honorary Secretary-
 Dr. H. A. DesBrisay
 Dr. G. A. Davidson
 !—;—Dr. Gordon Burke
 Dr. Gordon C. -Johnston
 Dr. J. H. MacDermot
•!'        I SUMMER SCHOOL, 1946 f
Hotel Vancouver, September 9th to 13 th, Inclusive
Dr. Elmer Belt, Urologist, Los Angeles, Calif.
Dr. Simeon T. Cantril, Director of the Tumor Institute of the Swedish Hospital,
Seattle, Wn.
Dr. Russell L. Cecil, Professor of Clinical Medicine, Cornell University, Medical
College, New York, N.Y.
Dr. J. R. Lindsay, Professor of Surgery (Otolaryngology), University of Chicago, 111.
Dr. Roy D. McClure, Surgeon-in-Chief, Henry Ford Hospital, Detroit, Mich.
Dr. N. W. Philpott, Dept. of Obstetrics and Gynaecology, McGill University, Montreal, Que.
9:00 a.m.—Dr. Belt: "Urinary Obstruction from Infancy to Great Age.'*
10:00 a.m.—Dr. Cecil: "Acute Upper Respiratory Infections and Virus Pneumonia."
11:00 a.m.—Dr. Philpott: "Modern Trends in the Care of the Maternity Patient."
12:30 p.m.—Luncheon, Banquet Room. Guest Speaker, Dr. Elmore Belt: "Experiences
and Observation at Bikini."
2:30 p.m.—Gynaecological Clinic. Vancouver General Hospital, Dr. Philpott.
8:00 p.m.—Dr. Cecil: "Osteoarthritis."
8:45 p.m.—Dr. McClure: "Chemotherapy in Surgery."
9:35 p.m.—Dr. Lindsay: "The Use of Chemotherapy in the Treatment of Ear and
Sinus Infections.
9:00 a.m.-
10:00 a.m.-
11:00 a.m.-
2:00 p.m.-
8:00 p.m.-
8:45 p.m.-
-Dr. McClure: "Pancreatitis."
-Dr. Lindsay: "Normal Function and Pathologic Conditions of the Eustachian Tube.    Their Importance in the Prevention of Deafness."
-Dr. Philpott: "Breech Delivery—Methods of Delivery."
-Surgical Clinic.   Shaughnessy Hospital. Dr. McClure.
-Dr. Cecil: "Rheumatoid Arthritis."
-Dr. Belt: "Surgical and Electrosurgical Treatment of Prostatic Obstruction."
9:35 p.m.—Dr. Philpott:  "Pelvic Peritonitis—Diagnosis and Treatment.
9:00 a.m.
10:00 a.m.
Dr. McClure: "Bleeding Peptic Ulcers and Cancer of the Stomach."
Dr. Cantril: "The Use of Artificially Radioactive Substances in Biology
and Medicine."
11:00 a.m.—Dr.   Lindsay:   "Meniere's  Syndrome.     Differential  Diagnosis   and  Treatment."
Page Two Hundred and Forty-five 2:00 p.m.—Cancer Clinic.  Chemistry Building, Vancouver  General Hospital.
8:00 p.m.—Round   Table  Discussion:   "Thrombophlebitis."     Chairman,  Dr.   L.   H.
9:00 a.m.—Dr. Belt:  "Obstructive Uropathy in Childhood."
10:00 a.m.—Dr. McClure: "Treatment of Burns."
11:00 a.m.—Dr. Cecil: "Rheumatic Fever."
2:00 p.m.—Golf Tournament. Capilano Golf and Country Club.
9:00 a.m.—Dr. Lindsay: "Dysphagia. Observation on Some of the Less Common
Causes for Difficulty in Swallowing."
Dr. Philpott: "Abnormal Uterine Bleeding—Use and Abuse of Endocrines."
Dr. Belt: "The Use of Antibiotics in the Control of Urinary Infections
and Infestations."
•Medical Clinic, St. Paul's Hospital.    Dr. Cecil.
Dinner. Banquet Room. Guest Speaker: Dr. E. L. Turner, Dean, University of Washington Medical School.
10:00 a.m.
11:00 a.m.
'2:00 p.m.
6:30 p.m.
The Summer School Committee feels proud of the roster of outstanding medical men
who comprise this year's lectures. In medicine, Dr. Russell L. Cecil, Professor of
Clinical Medicine at Cornell, needs no introduction to the profession, many of whom
used his monumental text book on medicine as students. In surgery we are fortunate
to have secured Dr. Roy D. McClure, surgeon-in-chief of the Henry Ford Hospital in
Detroit. He is an outstanding speaker and clinician. The lectures in obstetrics and
gynaecology are to be delivered by Dr. W. W. Philpott of McGill University. His
former pupils here can attest to his great capabilities in this field.
The widespread interest in the ophthalmological lectures given last year prompted
the committee to devote a portion of the Summer School to the same specialty again
this year. We feel in Dr. J. R. Lindsay of the University of Chicago we have chosen
an outstanding lecturer whose talks will be of interest to both general practitioners and
Coming to lecture in urology will be Dr. Elmer Belt whose dynamic personality
is already widely known." He is just back from Bikini where he was an observer at
"Operation Crossroads." i
For the first time at a summer school session we are to have a lecture and clinic on
cancer. They will be presented by Dr. Simeon T. Cantril, Director of the Tumor
Institute of the Swedish Hospital of Seattle. Dr. Cantril is one of the foremost authorities on this subject in North America and we are sure that this innovation will be both
interesting and instructive.
HE' f 2.     FEES
The fee will be the same—$7.50, despite the fact that the school will run for a day
more than any previous session.
All medical officers are cordially invited to attend the Summer School and complimentary tickets will be issued when they enroll.
Internes also may enroll free of charge and may obtain tickets from the Committee
or at the registration desk on the opening day.
Page Two Hundred and Forty-six 5. GUEST SPEAKER — BANQUET
At the final banquet, Dr. E. L. Turner, Dean of Medicine at the University of Washington, will be the speaker. In view of the present status of the projected medical
school at U.B.C, what Dr. Turner has to tell us will be most interesting and informative. We would like to see every one enrolled at the summer school present at this
final dinner.
A private phone will be installed at the registration desk, and a bulletin board in
the lecture hall will make transmission of calls a simple procedure.
7.     GOLF
On Thursday afternoon, September 5, Capilano Golf and Country Club will be
the scene of the annual Golf Tournament. As usual, attractive and worthwhile prizes
will be distributed to the lucky (?)  ones.
Tickets are on sale at the Hospitals and at the Medical Library, and may also be
obtained from members of the S. S. Committee.    Out of town colleagues may obtain
tickets from the Secretary, or at the registration desk which will open at 8:30 a.m.,
September 9th.    Ticket holders may be requested to show them at each session.
[We are printing below, two extracts taken from the Journal of the American
Medical Association, of the date August 17, 1946. They seem to us to be especially
appropriate at the present time. (Ed.).
The first is taken from a Survey of Medical Education in the United States and
Canada—being the 46th annual report by the Council on Medical Education and
Hospitals of the American Medical Education and Hospitals of the American Medical
Association. It is a very full report and covers a great many subjects—including premedical and post-graduate education. It reports on all the medical schools of both
countries, and is a monumental piece of work. But the paragraph which we reproduce
is found on pp. 1281-3 and is headed: "The Location of a Medical School" and reads
as follows: ]
In recent years, with proposals for new medical schools or expansion of basic
science schools to the four year status, the question of location of the jproposed school
has been debated at length. In its simplest form, the question may be formulated thus:
When a university wishes to establish a medical school, should that school be located
on the university campus or should it be located where clinical facilities are already
available? The question has been and is being debated in Alabama, North Carolina,
Missouri, California and (in Canada) British Columbia. The question arises because
often universities are not located in large population centers, or adjacent to established
clinical faculties. The answer to the question is simple, provided an "if" is permitted.
A medical school should unquestionably be located on a university campus IF sufficient
funds are provided. This is a very large "if." The funds must be adequate to construct a hospital if a satisfactory hospital is lacking on the campus. This means the
expenditure of at least $10,000 per bed to cover construction and equipment. At
least a 400 bed hospital is required. The cost of operating such a hospital on a charity
basis, including transportation of patients and the employment of full time clinical
faculty members in a relatively small community, is staggering and dwarfs other
university expenditures into insignificance. No proposal made recently to establish a
medical school and teaching hospital on a university campus at a distance from popula-
Page Two Hundred and Forty-seven tion centers or established clinical facilities has included adequate financing for construction and equipment and for maintenance throughout the years. The well known
and entirely valid arguments for a university location of a medical school and its
hospital are sheer rhetoric and wishful thinking unless there is also a realistic appreciation of the costs involved and a willingness and ability to assume the financial responsibility entailed. *
The second extract is from the Editorial Comment in the same issue (p. 1357) and
we read:
The question "Should we establish a new medical school?" immediately raises the
corollary question "If so, where should the school be located?" In some instances the
answer to the second question is easy because location on a university campus does not
raise serious problems of available hospital facilities and clinical material. The problem
becomes more difficult when universities that seek to establish medical schools are not
located in large population centers or adjacent to established clinical facilities. The
problem of location has been and is being debated at length at least in Alabama, North
Carolina, Missouri, California and (in Canada) British Columbia. The desirability of
locating a medical school on a university campus when all the conditions are propitious
is self evident. Medical education and research may be conducted at the university's
level of quality on a par with other graduate scientific education and research, with a
close integration of the medical with the other natural science of the university. However, location of a medical school on a university campus may in some instances involve
evils far greater than separation of the school from the university. Unless patients,
teachers (including clinicians in the specialties) and teaching hospitals are available
at the campus, the medical school will be far inferior to a school located adjacent to
such necessary facilities. Hospitals and clinics may be provided on a university campus
unless the university is too far removed from population centers. Their construction
demands much greater sums of money initially and through the years than are required
in any other field of education. Apparently the states and universities now contemplating the establishment of new medical schools and university hospitals on a university
campus seem to be unwilling to pay the price. If such programs are attempted with
inadequate funds, the results will inevitably be an inferior grade of medical education.
[We will not comment further on these extracts, except to say that we believe they
should receive careful reading and attention.   Ed.]
Committee on Medica
of British Columbia
Committee on Economics of the Council of the College of Physicians and Surgeons of
British Columbia and the British Columbia Medical Association                                   .
Canadian Medical Association {British Columbia Division)
Word has now been received from the Canadian Medical Association that the
D.V.A. Schedule of Fees as approved by General Council of the Canadian Medical
Association at the recent Annual Meeting, has now been approved by the Treasury
Board of Canada.
The new schedule will become operative as soon as official notification can be sent
by the Department of Veterans Affairs to all practising physicians.
Page Two Hundred and Forty-eight Vano046ue/i Qene/uU ^oA^UtaJL Section
Senior Interne, Neurology, The Vancouver General Hospital.
Case History:
Miss M. M., a girl of ten years of age, was admitted to The Vancouver General
Hospital on February 1, 1946.
Chief Complaints:
1. Visual difficulty—since May, 1945.
2. Vomiting,  malaise  and  severe  frontal  headache—onset,  December,   1945.
3. "Cross eyes"—noted by parents and playmates in December and January.
4. Convulsions—several since January 14,  1946.
History of Present Illness:
Patient was well until May, 1945. She was in Grade 5 and did well in her school
During the month of May, patient began having visual difficulties. She found it
hard to read the. blackboard and often turned her head sideways to look at objects.
She found that when counting pennies from her bank she frequently missed one, apparently not having seen them. This trouble occurred intermittently during the
summer holiday months.    She had glasses prescribed but they were of no use.
In the fall, on returning to school, the patient was moved to the second row because
of difficulty in seeing the blackboard and was able to carry on until December 20. At
this time she came home from school, complaining of "feeling dopey". She had a headache and vomited soon after returning home.
Vomiting occurred again six days later. The retching was severe but there was
little or no associated nausea. Her appetite was good but she was unable to hold food,
and especially liquids, down. There was a severe frontal headache just before and after
vomiting.   The headache was not steady and was usually associated with the vomiting..
She returnd to school in January but on January 10 vomiting began again and
continued during the next day. Headache was intense and strabismus was noted by
On January 11, she suffered her first convulsion. She called out and would have
fallen if her mother had not caught her. Her hands were clenched, her feet turned in,
and her body rigid in tonic spasm.    The whole convulsion lasted about two minutes.
She was sent to hospital in Cranbrook where she had several more convulsions. Then
she improved and was discharged in about a week.
At home her mother noted that her left eye was "crossed" and that the patient
squinted.    This persisted for four or five days and disappeared.
On January 25, the patient suffered another, more prolonged convulsion lasting some
twenty minutes. She was again sent to hospital where further convulsions occurred.
Severe headaches and some vomiting were associated with these attacks. The patient
was sent directly from the Cranbrook hospital here for further investigation.
Past History:
Essentially negative.
No serious illnesses.
No injuries.
Page Two Hundred and Forty-nine Family History:
Mother and father—alive and well.
Two sisters, one brother—alive and well.
Physical Examination
The patient is bright and co-operative. The most striking feature is her size. She
is very small, weighing only thirty-eight pounds. Her muscular tone and development are very poor. She looks like a little old woman, her appearance suggesting
pituitary deficiency.
Eye Examination:
The pupils were equal and active. Movements were normal. No nystagmus or
field defects were found. Disc margins were slightly swollen but venous congestion
was not marked.
Heart, Lungs and Abdomen:
Neurological Examination:
Revealed no further abnormalities.
Spinal Fluid:
Findings were within normal limits.
X-ray Examination:
Revealed a number of irregular lime deposits in the region of the sella turcica. The
sella itself was not increased in size or distorted in any way. Air ventriculogram
showed grossly dilated lateral ventricles. The anterior two-thirds of the third ventricle was obliterated by a rounded mass, suggesting a supra-sellar cyst.
Diagnosis was made on the basis of three main points;
1. The history suggestive of increased intracranial pressure and the slight papillce-
dema on admission.
2. The growth deformity of the child, suggesting hypopituitarism.
3. The x-ray findings suggestive of supra-sellar cyst.
A supra-sellar cyst in this situation showing calcareous deposits is almost sure to
be a craniopharyngioma, so a tentative diagnosis of this tumor was made.
By means of the right frontal route, the right lateral ventricle was opened. Through
a dilated foramen of Munroe the characteristic bluish-green wall of a craniopharyngioma!
cyst was seen. The contents of the cyst, which consisted of an oily yellowish fluid,
were evacuated. Biopsy was taken and the aperture in the cyst wall was enlarged so
that the cyst could drain into the ventricles.    Radical removal was not attempted.
Post-operative course was smooth and the patient was discharged in good health on
February 20.
A Brief Discussion of Craniopharyngiomae in General
1.   Embryology:
The pituitary develops as a result of the fusion of an out-pocketing of the ectoderm
of the stomodaeum with a process which extends downwards from the floor of the
fore-brain. The stomodeal pouch becomes a closed-off sac from which are derived
the pars anterior and pars intermedia of the pituitary. The process from the fore-
brain forms the pars posterior and the infundibulum. The remnants of the cranio-
pharyngeal pouch remain, and come to lie anterior to the infundibulum and at the
upper angle of the pars anterior.   They may also be found within the sella turcica itself.
Page Two Hundred and Fifty 2. Pathology:
Tumours arising from these embryonic relics show characteristics resulting from their
origin in the stomodaeum. They contain cells resembling those of the buccal epithelium of the embyro, including ameloblasts of the embyronic enamel organ. These tumors are very liable to undergo cystic degeneration and calcification, and may even
develop bone. They usually arise above the sellar diaphragm but occasionally within
the sella itself, causing erosion and distortion of its shape.
3. Symptomatology:
Since craniopharyngiomas depend upon abnormalities of development, symptoms
usually appear at an early age, and in more than one-third of cases, the patient comes
for treatment before the age of fifteen. Less frequently, however, they cause no symptoms until middle life.
These tumours produce:
(a) endocrine disturbances.
(b) pressure symptoms.
(c) characteristic radiological findings.
A. Endocrine disturbances:
Since these tumours are situated between the floor of the third ventricle and pituitary
and develop early in life, they may produce a large variety of disturbances of growth
and metabolism, due to pressure on the pituitary, tuber cinereum or both. In childhood there is usually stunting of growth with obesity later imposed in some cases, but
in Cushing's words, "the patient may show extreme degrees of adiposity or emaciation,
of dwarfism, of sexual infantilism or of premature physical senility".
B. Pressure Symptoms:
Headache and associated vomiting are early symptoms. The headache is diffuse
and generalized, and nearly always precedes visual difficulties. The tumour may compress
the optic nerve, chiasma or tracts leading to corresponding field defects. Visual findings, however, are very inconstant.
To add to diagnostic difficulties, cerebellar signs may be present from involvement
of the red nuclei and their connections.
C. Radiological findings:
These consist of (1) general signs of increased intracranial pressure, such as the
"beaten silver effect" in the bones of the skull; (2) erosion of the clinoid processes and
flattening of the sella turcica; (3) radiographic evidence of calcification within the
tumour, present in about 85% of cases, and varying from faint opaque plaques to an
egg-sized mass lying above the sella turcica.
4. Differential Diagnosis:
During childhood and infancy, differential diagnosis is aided by the practical absence of the pituitary adenoma, which must be considered during adult life. The
principal tumour to be differentiated in childhood is the glioma of the optic chiasm,
but it causes trouble only in the rare cases when suprasellar calcification is absent or in
the still rarer cases when the suprasellar glioma is calcified.
In adult life, besides pituitary adenoma, rare tumours, such as suprasellar meningioma,
chordoma, etc., must be considered.
5. Treatment:
This"is a tumour which can be accurately localized; its pathological structure, relationships and life history have been well studied and clearly understood. It appears
benign and well encapsulated and would seem to fulfill all the idea conditions for surgical removal.
The tumour, however, because of its central position in the floor of the third ventricle, presents insuperable obstacles to the surgeon. Cushing indicates that attempts at
radical removal result in approximately 100% mortality.
Page Two Hundred and Fifty-one For these reasons the surgeon resorts to the palliative procedure of evacuation of
the cyst. The mortality of this operation is low and on tapping the cyst, immediate
improvement takes place. Intervals as long as twenty years have been reported before
recurrence of symptoms but in the vast majority of cases, improvement lasts only a
few months.
6.   Summary:
Craniopharyngioma is a suprasellar tumour arising from the embyronic vestiges of
Rathke's pouch. It is a benign cystic structure, easily localized, but because of its
position in the floor of the third ventricle, impossible to remove completely. Treatment can only be palliative and an eventual fatal outcome is certain.
DISCUSSION by Dr. Frank Turnbull:
This is a very good instance presented by Dr. Simpson of a rare condition. I think
the craniopharyngioma is of general interest because it illustrates some of the general
problems of neurosurgical diagnosis. It is of special interest in this particular case
because of the surgical treatment employed.
The child had metabolic disturbances. She had not grown properly and represented
the "little old woman" type of pituitary dysfunction. That aspect was very apparent.
She was brought in as an acute problem. The general appearance and history suggested
increased intracranial pressure which was verified by the appearance of the cranial
discs. We did not find on neurological examination any localizing signs. Radiographs showed very characteristic calcified spots above the sella which, in conjunction
with other aspects of the history, indicated very definitely that the child had a craniopharyngioma. We considered every aspect of treatment. We had to make a decision
as to whether it was a predominately solid tumour or cystic tumour. The majority are
solid just above the pituitary gland and become cystic. The cyst may attain a very
considerable size. Sometimes a cyst develops and then the solid tumour very quickly
follows and grows into the cyst. These cases inevitably end fatally. They are not
radio-sensitive. Hitherto the usual approach seemed to be that for the pituitary
gland. If one found a solid tumour, there was nothing to be done except take tissue
for biopsy. The patient's chance of surviving operation was very good. The operation
did not provide any hazard. On the other hand if one found by that approach a
large cyst, and if one punctured the cyst, it would collapse and give post-operatively
very immediate relief and the cyst would seal off. Invariably, or in the great majority
of cases, it would start to fill out sometimes within two weeks; usually in a matter
of six months, the situation is the same as before operation.
In 1933, I wa,s horrified to see the treatment used in Berlin. When a diagnosis of
craniopharyngioma was made, instead of operating in the orthodox manner, they
made a little burr hole in the forehead and aspirated frequently, each time with
apparent recovery.    It was necessary to change the site of the burr hole occasionally.
In this case, ventriculograms showed a large mass about the sella of which we did
not know whether it was cystic or solid. Going into the lateral ventricle and approaching
the cyst in this manner, if a large cyst presented, it is just impinging on the infero-
medial aspect of the frontal pole of the lateral ventricle. The cyst may actually
present right in the ventricle. The rationale is to make a permanent drain in the cyst
so as to wash away the fluid in the spinal fluid. This operation was carried out here.
If we had encountered a solid tumour in approaching through the ventricle, the child
would have died in twenty-four hours. We hope that the opening in the ventricle is
large enough that it will not seal off.' That, of course, only time will tell. The case
demonstrates a new advance in neurosurgery.
Page Two Hundred and Fifty-two USES AND ABUSES OF PENICILLIN
There is a habit of using new remedies simply because they are new which unfortunately is not confined to the laity but is found too prevalently amongst members of
our own profession. These remedies are used empirically and not rationally. They
are used without due consideration of the nature and capabilities and limitation of
the remedy and without a definite diagnosis having been made of the condition which
is being treated. A recent and very widespread example of this is the use of sulfonamides which were used in all sorts of conditions in which they could not possibly be of
any value.    An old saying in this connection comes to mind—
"Be not the first by whom the new is  tried,
Be not the last to lay the old aside."
Penicillin is commonly encountered now used for such conditions as eczema, contact or industrial dermatitis, acne, "athlete's foot" and other forms of ringworm.
Penicillin is quite useless in such conditions, unless there should be some pyogenic secondary infection present. In such a case any improvement observed is simply due to
the bactericidal action on the secondary infections and it stops there.
Fortunately unfavourable reactions to penicillin are mild and infrequent compared
to those from sulfonamides, nevertheless they do occur. Reactions which were first
reported were observed in physicians and nurses administering the drug, which were
from accidental and repeated contacts, also in pharmacists, laboratory workers and
others. These are believed to be true allergic reactions. They do not appear upon the
first contact which is only a sensitizing contact, but are observed on repeated or prolonged contact. In the presence of fungus infection there is definitely known to be
an increased susceptibility, which suggests allergenic fractions which are common to
penidllmm notatum and other fungi which may be present on the skin which latter
fungi may or may not be pathogenic. The reaction most commonly reported is an
urticarial one, but eczematoid, morbilliform, vesicular eruptions of the hands and feet,
and of course always pruritus, have all been observed.
Pemcillin as a topical application is most efficient in the most superficial types of
infection due to the common pyogens, such as impetigo, ecthyma, secondarily infected
dermatitis of various origins, pyodermia, infective or infected ulcers. In very superficial folliculitis (Bockhart's impetigo, or on the face secondary to impetigo, penicillin
is very useful. In the deeper and more chronic types of folliculitis of the beard
("barber's itch") enthusiastic reports from England have stated that it is very efficacious. These experiences have not been repeated on this side of the Atlantic, most
American and Canadian observers agreeing that in true folliculitis barbae penicillin is
of very little value. The apparent contradiction may be a matter of terminology, the
name "barber's itch" or sycosis barbae being applied indiscriminately to all folliculitis
of the beard in the British Isles whereas the term is usually reserved in America for
the deep-seated chronic type of infection, which is very resistant to all forms of therapy.
In the case of erysipelas, the writer has had no experience, and it would not appear
that as a topical application it would be of any value, since erysipelas is not a superficial
infection of the skin but rather a lymphangitis of the deeper portions of the skin. If
there are, however, associated fissures and other superficial lesions, such as are sometimes observed about the nares, ears, lips, etc., that would appear to be sound reason
for using a penicillin cream here. No doubt, too, penicillin intramuscularly would be
of value in this disease, but since the disease regularly responds promptly and with very
rare exhibitions of untoward results, sulfanilamide given by mouth means less trouble
to administer and gives equally good results. In furunculosis penicillin is of no value
as a topical remedy. In multiple furunculosis, however, it is of definite value when
used intramuscularly.   The recommended initial dose is from five to twenty thousand
Page Two Hundred and. Fifty-three units, followed by five to ten thousand units every three hours, with a total dosage of
two hundred and eighty to four hundred thousand units.
With regard to furunculosis, it is to be remembered that furunculosis is riot a systematic disease but a disease with a local cause. It starts with a single infectious lesion
which ruptures; the contained infectious material is spread superficially over the skin,
and later lesions appear successively and not simultaneously as they would in the case
of a haematogenous infection. It is an infection of the pilo-sebaceous structure. The
additional lesions should be treated locally, x-ray furnishing an excellent method of
treatment, accompanied by rigorous surface disinfection, using 70% ethyl alcohol or
isopropyl alcohol, permanganate baths, scrupulous cleanliness of person, hands, nails,
clothing, linen; avoidance of friction, chafing, scratching, rubbing, etc., and local
rest of affected parts. Penicillin should only be necessary when the infection has
already got out of hand when it comes to the doctor. ,
In a recent paper in the New England Journal of Medicine (February 28, 1946)
the direct injection of penicillin in cases of carbuncles, felons, cellulitis, perianal abscess,
and furuncles has been recommended. The injection is not made directly into the
inflamed area but juts outside of the painful border which surrounds it. The injection
is made all about the border and when possible beneath the lesion. The injection is
painful but efficient. The amount of pain produced depends upon the amount of loose
cellular tissue into which the material is injected, thus into a lesion on. the abdominal
wall the pain would be relatively small and on the other hand the injection into a
finger would be quite painful.
Various ointment bases have been suggested for the topical employment of penicillin, some of them containing proprietary preparations which are not very commonly
known, such as Lanette-Wax, Span, etc. . . Impregnated gauze, sprays, also have been
recommended. The latter forms of application while they may be practical in hospitalized patients are certainly not to be depended upon in the patient's own hands at home.
The ointment bases most commonly used are oil and water emulsions, such as the well-
known cholesterinized hydrocarbons, in the United States called Aquaphor, and in
Canada Eucerin. A pH concentration of about 6.5 is considered most desirable and
this may be obtained in a mixture of Eucerin and water, a 30% Eucerin cream. This
makes an easily applied soft ointment which does not dam back secretions. The addition of 6% white wax gives a little more body if desired. This preparation remains
stable for about a week if kept under 50° F. A concentration usually recommended is
250 units per Gm.—about 7500 units in the 1-ounce jar.
The instructions to the patient are very important: the jar must be kept in an icebox or refrigerator or in outdoor shade. In the summer, if refrigeration is not available,
the jar may be immersed in water in a larger vessel with a small stream of cold water
running in from a tap sufficient to produce an overflow.
Nothing unsterile must be introduced into the jar of ointment. A teaspoon or a
knife-blade boiled ten minutes, and cooled without contamination, may be used to dip
out the requisite amount from the jar and this is placed on a paper, the jar closed and
immediately put away. The fingers then may be used to apply the ointment to the
skin. Elaborate precautions have been sometimes recommended, such as application
to the skin on sterile gauze, but are quite unnecessary. The skin is not sterile, and it is
better left uncovered. The reason for these precautions is that not all organisms, pathogenic or non-pathogenic, are killed by penicillin and by the casual introduction of a
non-sterile finger, as is usual, into the jar of ointment there may be thereby introduced
bacteria and fungi, ferments from which are capable of attacking the penicillin and
rendering it impotent, and it is also possible that pathogenic organisms may be introduced into the jar where they may flourish.
In severe and extensive infections, for instance pyodermia of the extremities with
lymphangitis and lymphadenitis, the ointment should be applied every three hours, but
Page Two Hundred and Fifty-four in milder and more limited cases, three times daily and at bedtime is adequate. It is
recommended that continuous application be maintained for three or four days at least
after the last clinical evidence has disappeared. Fewer relapses take place when this
lule is observed.
When penicillin is used parenterally the recent studies which were carried out at
the Peter Bent Brigham Hospital in Boston concerning maintenance of high blood
levels are to be noted. It is possible that this may prove to be an easy way to maintain
the level.
1. It was found that restriction of the fluid intake to 1500 cc. and of salt intake
to 15 grams daily doubles the penicillin-blood-level on interrupted intramuscular
2. The administration of benzoic acid on unrestricted diet may double the penicillin-
3. Combinations of (1) and (2) increase the penicillin-blood-level four- to eightfold with prolonged effective blood concentrations.
Benzoic acid is detoxicated in the normal liver, conjugating with glycin to form
hippuric acid. This is called its "penicillin-blocking power". To accomplish this
four capsules of 0.6 Gm. benzoic acid were given every four hours by mouth.
It is a recognized policy of Governments to establish Departments of Health providing service to the people through establishment of various special divisions and generalized local health services. The practical direction of the services as provided for under
Government policy has been placed in the hands of persons qualified by training, study
and experience on both local and provincial levels of service and with proven ability
in dealing with the public.
As a result of the cumulative experience in all the various aspects of public health,
a policy has been established from an administrative point of view providing for integration and co-ordination of the various special Divisions with the local services so as to
provide for the people of this Province a more balanced and practical service than formerly.
At the present time, the three Divisions of the Public Health Service particularly
concerned are established in separate buildings, relatively isolated from and independent
of each other, each with its own administrative set up, and directed and staffed almost
entirely by persons who are essentially specialists in their own particular section of
the broad field of public health.
The Provincial Health Officer, as the official responsible for the direction and carrying out of the public health services, after prolonged study, has presented recommendations providing for the housing of all Provincial Divisions located in Vancouver in one
building along with branches of all other public health services, with pooling of facilities
wherever possible and with provision for exchange of ideas and information concerning
public health problems in general as well as specifically. The advantages of such a
plan it is thought are obvious from both an economic and public health point of view
and if carried through as planned it will constitute a real contribution to progress in
public health in this province.
The need for such a plan to be translated into action is considered to be urgent by
those interested in the efficiency and progress of the Department of Health. At the
present time, the Division of Laboratories is housed in dilapidated and inadequate quarters which limit the activities and types of service made available to the public.    The
Page Two Hundred and Fifty-five Division of Venereal Disease Control also is housed in quarters the inadequacy of which
are less well publicized, but which are in every way as inadequate and confining as those
housing the Provincial Laboratory. With the single exception of the Division of T.B.
Control, other services of the Provincial Department of Health serving the mainland
are without housing of any kind. Because v6f the size of the population, the mainland
receives a large part of the public health services provision of which requires much
travel back and forth between Victoria and Vancouver. When in Vancouver the public
health personnel representing the many provincial health services have no office space,
are out of touch with the Central office, and lack facilities of any kind for carrying
out their work in anything like a satisfactory manner.
In view of the situation as it exists in regard to the Divisions of V.D. Control and
Laboratory Service alone, it is apparent that immediate consideration must be given
to the provision of adequate and up-to-date housing for these Divisions and a building
programme to this end is indicated in any case at an early date. From an econorhic point
of view it would appear that it will be cheaper to house the Provincial Public Health
Services located or required in Vancouver in one building planned for the purpose,
than to erect several buildings to meet the obvious requirements of the various Divisions.
From the viewpoint of service to the public through improved efficiency in administration, in integration of services and in improved inter-departmental co-ordination, the
advantages of housing the Provincial Public Health Services in this manner are apparent.
It is true that some years ago a different plan was mooted, approved and then
shelved by those responsible for policy at the time. That plan provided for the setting
up of one branch of the Provincial Public Health Service, the Division of Laboratories,
in a building on the campus of the University of British Columbia to be known as the
Institute of Preventive Medicine which would provide in addition to the Division of
Laboratories, space for the University Departments of Bacteriology and Preventive Medi-
cme and the Department of Nursing. During the years that have intervened since
that plan was first considered, such progress has been made in the field of public health
in this province, that it is not surprising that the Provincial Health authorities instead
of endorsing the original plan, have reviewed the whole situation in the light of experience and have submitted the new plan referred to above. This new plan has received
the almost unanimous approval of the senior public health personnel and officials concerned in recognition of the needs of the times.
It is apparent now that the original plan of several years ago obviously must have
been a plan intended to benefit primarily the University rather than the Department of
Health. That plan took into consideration only one of the Provincial Services, the
Division of Laboratories, and provided for the complete and permanent isolation of
that service from the rest of the Provincial Public Health Services and from the
Department of Health itself. The new plan on the other hand makes provision for
all, not just one, of the Public Health Services, and provides for their co-ordination and
integration from a general public health, administrative and economic point of view.
The Division of Laboratories is one of a group of Public Health Services provided in
this Provivnce and any plans concerning a Public Health Laboratory should be viewed
not merely from the laboratory point of view but as it affects the total public health
picture. It would appear that consideration of the needs of the University dominated
the planning some years ago. In this respect the "REPORT ON THE SURVEY OF
dealing with the placing of the Public Health Laboratory on the University campus
may be quoted (P. 38) as follows:—
"The University could have had more room in the Science Building for the
past six crowded years; a fine new building on its campus, at one-half its probable
cost today; and also the nucleus for its medical school,"
Page Two Hundred and Fifty-six and again—
'This summary of a sequence of misfortunes and mistakes is set down in no
bitterness at failure to have a vision consummated, but solely in the belief that a
reversion to the former policy is most desirable for the future welfare of the
University, and more especially of its medical school; and in the hope that publication of an objective outline of the facts may lead to a thorough investigation of
the sources and motivations of the new scheme before it is irrevocably adopted."
The public health authorities in this province are just as anxious as anyone that
the University of British Columbia be adequately equipped and staffed to meet the needs
of the people of the province and make its rightful contribution to the advancement
of the people of the country as a whole.    The public health service, however, also has
a contribution to make to the welfare of the people, and to achieve their ends both
of  these public  services  must  have  administrative  set-ups  which  within  their  own
sphere of responsibility provide for proper control of their own various services and
departments.   For the Division of Laboratories of the Provincial Department of Health
to be located on the University Campus and be directed by a University Professor
devoting the great part of his time to University duties would mean that sooner or
later the University would be responsible for and be operating, through one of its own
Departments or Heads, an essential service of the Department of Health.    From an
administrative point of view such a situation could hardly prove satisfactory to anyone.
The service would of necessity be isolated from other public health services instead of
being made a part of them as should be the case; there would be danger of the service
being curtailed or being made subservient to the needs of and the chiefresponsibility
of the University—the teaching of students;  and the Public Health Service of the
province would be handicapped by loss of control of the direction of one of its important services.
It is interesting to note that in the "Report on the Survey of Medical Education"
referred to above, somewhat similar situations are discussed with regard to both the
necessity for complete control of an essential service and the importance of centralization as a factor making possible essential inter-relation of various Departments of the
University.   To quote (P. 3):—
"That the University, through the Faculty of Medicine, be granted complete
control of a sufficient number of hospital beds, of the right categories, to ensure
proper teaching facilities; and exercise the right to nominate the teaching staff
for its affiliated hospitals, and to close its wards to all others."
and (P. 4):—
"That the whole medical school be located on the campus as the only satisfactory means of assuring the desired physical contiguity and spiritual affinity
between the medical science and clinical departments within the Faculty of Medicine, and also between the Faculty of Medicine and other Faculties at the Univer-
"Another fundamental feature of any hospital affiliated with a medical school
is that the wards containing teaching beds be placed entirely under University
control, and closed to all doctors not on the University staff."
and   (P.   25):—
"The other feature common to these trends is that for effective promotion,
they require all departments of the Faculty of Medicine to be closely inter-related
in every respect."
and (P. 27):—
"It isn't debatable that the essence of success for a medical school is complete
university  control  of   the  hospital,   and  the  closest   possible  proximity  of   the
medical science and other University science departments,"
and further (P. 30):—
"But even superficial analysis of these statements, if they be fair samples of
Page Two Hundred and Fifty-seven ■ the beliefs and outlooks behind them, yields only further evidence of the urgent
need for the medical school to be completely under University control."
For the author of this report to demand for the University the very things that
he denies to another public service is to say the least, inconsistent, and suggests that
the plea made in the same report for the isolation from other public health services of
the Division of Laboratories by locating it on the University campus is based on special
interests rather than on sound administrative principles otherwise endorsed by him.
Obviously the arguments supporting control of services and centralization of services
or departments applies with even greater force with respect to the public health services
since the needs of the public for health services are considerably greater, more varied and
at least as real as the academic needs of he medical student. It would be just as unreasonable for the Department of Health to advocate that it should control the Department of Bacteriology of the University because the Department of Health operates
a Division of Laboratories as it is for the University to support any move to include or
incorporate the Division of Laboratories in its Department of Bacteriology. Certainly
the University could be expected to oppose with all its power the first part of such
a possibility. Similarly the Department of Health on equally sound grounds is opposed
to the second part of any such suggestion. For the University to adopt or pursue a
policy in opposition to that of the Department of Health in affairs directly concerned
with it and a function of it, can not be considered in the best interest of the general
The public health authorities agree with the author of the report referred to above
regarding the "possibilities for usefulness (to the University) afforded by conjunction
(of the public health Laboratory) with the Faculty of Medicine of the type envisaged."
(P. 38). The fact remains, however, that a public health Laboratory is a service, not
a teaching laboratory and on reports from this Laboratory depends the diagnosis and
the subsequent treatment of a number of important diseases, and on the basis of laboratory
reports Health Officers throughout the province restrict in the public interest the activities and liberty of citizens within their jurisdiction. This can be a serious matter, not
only from the point of view of he individual whose liberty is affected, but in actual
dollars and cents. A public health Laboratory, therefore, is different from a teaching
Laboratory and should be literally a'"closed shop" rather than a stamping ground for
"students in dentistry, veterinary medicine and sanitary engineering" as well as "medical students," public health nurses in training, "pharmacy students" and graduate
students (P. 39). In the Province of Ontario, the public health Laboratories in Queen's
Park are located in the centre of the city along with the offices of the Department of
Health in the Parliament Buildings adjacent to the campus of the University of Toronto.
However in spite of their proximity to 'or conjunction with a Faculty of Medicine"
they are not used for the teaching of the many students attending the University of
Toronto who require courses in bacteriology and preventive medicine.
The Division of Laboratories is a branch and an essential part of the public health
service in Communicable Disease Control. Apart entirely from the questions of the
importance of integration of various public health services as a whole and their interrelationships it will be readily apparent to most that to divide an individual service of
this type and importance by placing part of it, with control of that part, in the
University, leaving the rest of the service in Communicable Disease Control in the
Department of Health, would seriously handicap the effectiveness of such a service.
Communicable Disease Control in this province is still a major public health problem,
and to be effective requires complete integration of its various parts and must be dealt
with in an efficient and practical manner. In Communicable Disease Contol the Division
of Laboratories is used by and is dependent on a variety of other public health services,
including the Division of T.B. Control, the Division of V.D. Control, the Division of
Public Health Engineering and Sanitation and the Divisions of Local Health Services,
and Vital Statistics.    All these services are of importance in Communicable Disease
Page Two Hundred and Fifty-eight Control and to remove one or other of them from effective participation by segregation can mean only one thing—an inadequate service to the people. If this thought
"derives from the petty-mindedness of health officials jealous of their prerogatives,"
then officials of this Department plead guilty to the charge.
Reference has been made in the report referred to above regarding "the many research opportunities afforded other departments of the Faculty of Medicine by the
large numbers and variety of specimens reaching the Provincial Laboratories." (P. 37).
The Department of Health in the future as in the past will be very glad to co-operate
with the University in making available for further study all specimens sent to the
Provincial Laboratories suitable for such a purpose. To do so, however, it should not
be necessary to disrupt the Provincial Public Health Services and move the Laboratory
to the University campus. The specimens reaching the Laboratory are sent to it by
publci health personnel and medical practitioners from all over the province and the
chief problem in transportation and preservation of specimens has already been met
before they reach the Laboratory. The problem of making available to the University
specimens which are suitable for research purposes therefore should not be insurmountable. The importance to the Provincial Laboratories of the value of research work
carried out in Universities is not to be denied, and the public health authorities as pointed
out above are anxious to co-operate with the University in this respect in every way
possible, and expect employees- in the Laboratories to take full advantage of the worthwhile results of research in the Laboratories of the University and in the Connaught
Medical Research Laboratories at the University, as well as elsewhere. It would appear
from "The Report" that considerable has been done in this respect under existing conditions but to infer that this no longer will be the case (P. 39—last sentence) unless the
Laboratories are housed on the University campus is to place the University and the
Connaught Medical Research Laboratories at the University, as well as elsewhere. It
would appear from "The Report" that considerable has been done in this respect under
existing conditions but to infer that this no longer will be the case (P. 39—last sentence)
unless the Laboratories are housed on the University campus is to place the University
and the Connaught Laboratories in a very poor light.    To quote:—
"It would indeed be unfortunate if this fruitful partnership should not be
consolidated, but instead have to dissolve, through denial of the opportunity to
pursue such closely correlated activities under one roof."
It has been said ("The Report" etc.—P. 37)  regarding public health Laboratories
"Moreover they can be more economically operated in conjunction with University Departments, for they require the same kinds of expensive equipment and
staffs of similar qualifications."
In this regard it is suggested (1) that the Public Health Laboratories can be operated as economically in a building housing other public health services, as it can at the
University in a building housing other Departments of the University; (2) that personnel in public health Laboratories with very few exceptions are, and should be, full-
time employees of and responsible to the Provincial or State Departments of Health
operating the Laboratory Services. Interesting and valuable as it might be, public
health Laboratory personnel are essentially technicians and for the most part have not
time for teaching. The work of the Laboratory is of paramount importance and
neither the physician nor the patient, apart from the Public Health authorities, would
appreciate the possibility of delay in reporting due to employment in the Laboratory
of part-time personnel with divided interests.
What has been said above in regard to the general Laboratory service applies as well
to a biopsy or pathology service when and as this service is made available for the
provinc at large through the Division of Laboratories. Again in this respect, the
function of the Laboratory is primarily to provide service to the public and it is felt
Page Two Hundred and Fifty-nine <
VW**\ >vt^wv^
that this can be done best in conjunction with and a? a part of the general and specific
public health services of the province and not as a University service. Furthermore, for
a University Laboratory to dominate a Public Health Service Laboratory carrying out one
quarter of a million tests a year and with every prospect of this number being increased
considerably in the near future, obviously is unsound from both an administrative and
practical point of view.
The purpose and immediate aims of the public services provided through the Department of Health and the University are by their very nature different from one another.
Co-operation between the two public services should be the key-note of all relationships
but there can be no justification for the handicapping of one service in order to build
up the other as suggested, to quote from the report (P. 40 - 1)—
"From the University standpoint, not only would the Departments of Bacteriology and Preventive Medicine, and of Nursing and Health, be able to cope with
impending demands for training of yet more students^—demands impossible to satisfy
in the present quarters—but they could develop as yet undemonstrated potentialities.
Moreover, the space vacated in the Science Building would be extremely helpful to the
Department of Chemistry."
Furthermore, it seems probable with respect to the argument (P. 40)—
"From the standpoint of the Government as a whole" that provision of adequate
laboratory facuities in a Provincial Public Health Service building in Vancouver
more than likely would permit new services for which there is a popular and
soundly-based demand  (e.g. tumour biopsies and pre-marital blood tests)  to bel
promptly undertaken."
At the present time neither the Provincial Health Department nor the University
can offer the Laboratory adequate space and facilities.   In any case, however, it seems
likely that the Department of Health will be able to do so at least as soon as the
University can provide such space.
In recent years the Provincial Department of Health has encountered serious diffi- !
culty in obtaining qualified public health physicians to fill existing vacancies and ii|
meeting the demand for additional public health personnel for Health Units throughout]
the Province.   In "The Report" it is stated that—
"In our own Province, the obvious need for more rural Health Units goes
unfulfilled mainly because of lack of trained men to staff them. This training
could be furnished as soon as the building and the staff described above became
available. It would indeed be a strange and reprehensible situation if any state
Health Department deprived itself of necessary trained personnel and technical
assistance, by intransigently adopting a policy which hindered or even prevented
its own state University from furnishing such help."
It should be pointed out that the inability of the Department of Health to secure]
trained men is for reasons other than those given in "The Report." This matter has
been discussed elsewhere with the proper Departments of Government concerned and
it is hoped that the situation in this respect will improve in the immediate future.
In any case it is rather ingenuous to suggest that the supply of trained public health]
physicians in this province is dependent in any way on the location of the Provincial
Laboratories on the University campus.    The School of Hygiene at the University oi
Toronto provides a diploma course in Public Health and Preventive Medicine and thi
School has served the whole Dominion for years and has met the training requirement
of public health departments in this province and elsewhere without there being a
any time any question of admission of suitably qualified candidates.    Incidentally .
might be pointed out again that although the Division of Laboratories of the Ontarii
Department of Health is located in Queen's Park adjacent to the Campus of the Univeil
sity of Toronto, it is not used other than for special visits arranged through the CO
operation of the officials concerned, in the training even of public health physician
Page Two Hundred and Sixty
" Apparently, it is recognized that the Laboratory of the Department of Health in Ontario also is primarily a service laboratory and not a teaching laboratory and the University of Toronto has recognized this situation and has provided its own laboratories
for the teaching of bacteriology and public health laboratory procedures.
In any case however, plans have been made by the Department of Health to provide
Health Unit coverage with full-time personnel for practically the entire province within
a period of two to three years. It is apparent that the University of British Columbia
through its proposed Department of Preventive Medicine can play little or no part
within that time in training the public health physicians required for these Health
Units. Once these Units are established the requirements of this Province for trained
public health physicians will have been met to a very considerable extent for some
years to come.
The Provincial Department of Health is planning for a building to be erected in
Vancouver which will house all Divisions and branches of services located in or required
in Vancouver, supplying the Mainland. The need for' such a building is urgent because
of the fact that two important Divisions—V.D. Control and Laboratories are very
inadequately housed and there is an urgent need for additional office space for central
office personnel working in and out of Vancouver, and for quarters for additional
services needed in the near future.
By housing all such Provincial Public Health Services in Vancouver in one building,
the services can be operated more economically and more efficiently. Furthermore, if the
services are brought together as recommended, it will be possible to bring about a much
better integration and co-ordination of the various services, factors of great importance
from an administrative point of view.
The plan recommended at the present time replaces one advocated some years ago.
That plan gave consideration only to the housing of the Public Health Laboratory services and provided for the location of the Laboratory on the University campus in a
University Department. This plan no doubt might be of some advantage to the University but it fails to take into consideration the urgent and growing needs of the
Department of Health of which the Division of Laboratories is an important and
essential part. The older plan therefore must be considered as out-dated and should be
replaced by that planned by the Department of Health itself.
The following letter from the Commissioner of the Canadian Red Cross Society has
recently been received and is published for general information.
British Columbia Medical Association, June 11, 1946.
925 W. Georgia Street,
Vancouver, B. C.
At the Annual Meeting of the Central Council of the Canadian Red Cross Society,
the following resolution was unanimously adopted:
"This Central Council hereby expresses its thanks to the medical profession
for their assistance and advice in the work of the Society.**
The President and members of the British Columbia Provincial Executive desire
to join in this National recommendation in expressing profound gratitude to the medical
profession for the ever-ready assistance rendered to the Society during the past *J4
years.      l
It will be appreciated if the respective members of your profession could be made
aware herein.
Yours sincerely,
(signed) C. A. Scott, Commissioner.
By Dr. G. A. Kidd j|K
Continued from the March Issue
In the autumn of 1908, Dr. Carder, who was librarian at the time, reported that
there were on hand 899 books, and that journals to the value of $102 had been subscribed to during the year. So rapid was the expansion of the library, and so great a
use was being made of the reading room, it was recommended that larger quarters be
secured and that a full time librarian be engaged. Books might then be properly
catalogued and could be loaned to members for use in their homes. 'Once more subscriptions were asked for and a sum of $285 was collected. More extensive quarters
were found and Miss Morrell was suggested as the first full-time librarian, being on
duty one-half of each day. She was replaced by Miss Keenleyside in 1910 who in
turn was followed by Miss McLagan in 1915. Miss Haskin held die position from
1916 until 1922 when Miss Firmin became librarian. When die latter retired in 1935
Miss Choate took her place, retaining it until 1940 when she was replaced by Mrs.
Craig, the present occupant of die position.
In 1908 Dr. Stephen died. Since its inception he had been a moving spirit in all
library activities. A William Stephen memorial fund was inaugurated, whereby a
sum of money was set aside for the purchase of books relating to Tuberculosis. This
fund is still being made use of.
At the annual meeting of 1909 the treasurer reported a deficit in the funds of the
Association. The library suffered correspondingly, and it was decided to increase the
annual membership fee of the Society to $15.00. This would replace the former fee
of $2.00 to the Association and the annual subscription of $10.00 which all library
users were asked to contribute. As a result of this financial infusion the young institution expanded rapidly. In 1910 the Library Committee reported that the room
space had been doubled, and that large gifts of books had been received during the
year, notably from Dr. deWolf Smith, and from the Royal Society of Medicine. Several fine engravings had been presented to the library. These still hang on die walls
of the reading room.
New. ventures were simmering in die minds of the committee members. In 1911
Dr. Pearson, who was then their chairman, recommended the establishment of a museum
in connection with the library. He later implemented the suggestion with a definite
plan whereby $100 would be set aside during die first year for At purchase of suitable jars, etc These would be handed over to die pathologists of the two hospitals
who might select such specimens as might be of interest for preservation. These
specimens were to be the property of the Association and would be on display in its
rooms. He suggested that a curator be appointed and the museum material placed
in his care. All these recommendations were duly authorized by the Association,
and the machinery for the bringing into being of a pathological museum was set up.
At this time the Association was prosperous. New members were coming in rapidly. During the three sessions from 1909 to 1912, some seventy-five new names
were added to the list of members of the society. Vancouver was booming and its
population was growing rapidly. This prosperity led the Association into a financial
venture which was to end not at all happily.
The Library and Heading Room
At the March meeting of 1910, Dr. Pearson suggested that the Society acquire land
on which to build: "For Association Purposes." The following autumn, Dr. Monro,
the incoming President, followed up the suggestion by recommending that steps should
Page Two Hundred and Sixty-two be taken to procure a permanent home for the Medical Society. This recommendation
was strongly supported by other members. The outcome was that a committee was at
once appointed to "acquire a permanent home for the library." Dr. Seldon was named
The committee lost no time in getting down to business. At the next meeting of
the Association, Dr. Seldon reported that the scheme had been adopted by his committee
and that subscriptions in support of it had been asked for from members of the Society.
The general meeting supported this.
A month later the con.mittee further reported that 85 subscriptions, totalling
$8500.00, had been promised. It was at once authorized by the Association to procure
a suitable site or building, "on the south side of False Creek." In February, 1911, Dr.
Seldon reported that two lots on the southeast corner of the junction of Eleventh Avenue
and Heather Street had been secured at a cost of $7800.00. Immediate payment of
$2500.00 had been agreed upon, the balance to be paid at the end of six, twelve and
eighteen months. Trouble with financing the project was anticipated by Dr. Seldon,
as the banks refused assistance.   The committee was again told to go ahead.
In March Dr. Seldon told the Association that the committee had a note for $1000.00
to meet at the bank within eight days, and that it owed the Society $450.00. To meet
these obligations it had on hand only $400.00. A special meeting was called to discuss
the situation. Subscribers had not come through with the promised funds, and notes
were falling due with no available cash" to meet them. Considerable opposition to the
whole scheme developed, some members holding that the site purchased should have
been down town, while others favoured selling die lots outright, holding that the Society
had taken on more than it could handle. It was finally agreed to authorize the committee to sell one of the lots for the highest price obtainable.
At the annual meeting in October, 1911, an exhaustive report on the whole question
was given by Dr. Monro. He recommended that the Association give a mortgage on
the property to four of its members, who would then endorse a note for $2500.00 with
which the second payment might be met. This was done. More members were urged
to subscribe, and it was arranged to initiate a life membership in the Association, to be
given in return for a donation of $300.00 towards the library site.
From this point things tended to drift along. The committee reported at regular
intervals and was given authority to continue to act as it saw fit. It was not until
April of 1915 that Drs. Monro and Pearson insisted that some reorganization of the
entire scheme should be undertaken, since the financial position of the project was most
Still no action was taken, and the occasional reports of the committee were for the
most part favourable. The balance owed to the bank was being reduced, although some
arrears in taxes were accumulating. In December of 1913 a letter was received from
Dr. Osier expressing regret that die Association was not yet housed in its own building.
He offered $100.00 towards the erection of such a building. He was notified of the
arrangements which were under way and his gift was accepted.
By the autumn of 1915 the war was threatening to inflict drastic changes oi a far-
reaching nature, and these were to affect the well laid plans of the Vancouver Medical
Association. Dr. Gordon, who was at the time President of the Society, regretfully
appointed three members to act as a committee to lay the whole project of the library
building before the Governing Board of the General Hospital, with a view to having
the latter body purchase the Society's lots. Since these were immediatley adjacent to
hospital property, they might conveniently become an integral part of area of land
belonging to that institution. Failing an outright purchase, the Board would be asked
to assist the Association in financing its undertaking through those strenuous times.
As it turned out, the Hospital Board was favourable to the purchase, and at a special
meeting of the Association held in July of 191$, it was agreed to turn the lots over to
that body in consideration of the Board relieving the Society of any other payments on
the said property.
Page Two Hundred and Sixty-three. In July, one year later, a special meeting was called to consider an item of unpaid
taxes to the amount of $658.00. It was agreed that this should be borrowed from
funds of the Credit Bureau, and the taxes paid. Finally in October of 1917, Dr. Seldon
was able to announce a final settlement of the whole affair.
Those who were directly interested maintain that the plan was a good one. It was
caught in the depression and real estate slump which began in 1913. The next year saw
the onset of World War I, and by the end of 1915 out of 117 Association members, 52
were on active service. The wonder is that the Society came through the venture as
well as it did.
The attempt to form a pathological museum also had to be abandoned. There was
a difficulty of finding a proper place in which to display the specimens. Dr. McEachern,
Superintendent of the General Hospital at the time, offered the use of that institution,
but this was thought to be unsuitable.
In 191$ three rooms were made available in Birks building which might house the
Library and the Credit Bureau. The cost was $10.00 a month. Here the Library remained until the opening of the Medical-Dental building in 1929, when it was transferred to its present site. It continues to expand, and its value to the members of the
Association can scarcely be estimated. Much of the recent and authoritative medical
literature is at their disposal for consultation. This is also true for those Associate
members of the Society who reside outside Vancouver.
The Library Committee now has an annual budget of about $1200.00. One hundred and twenty of the better medical journals are on its subscription list. Certain of
these are selected for binding, and these bound volumes constitute an uninterrupted
source of reference literature, covering in some cases a period of over one hundred years.
The following periodicals are included in this group:-—
The Lancet. The library has an unbroken file since the first number published
in 1823.   This is one of its most valuable possessions.
The British Medical Journal. The file is complete since 1866, with broken numbers as far back as 1862.
The American Journal of Medical Science, This is complete since 1827. It was
first published in 1820.
The Canadian Medical Journal. The file is complete since the first number pub-
fished in 1911.
Valuable gifts of books have been received by the Library from time to time. The
more notable contributors have been the late Doctors G. S. Gordon, A. S. Munro, Cunningham and Newcomb; also Doctors C S. McKee and Wallace Wilson.
Certain funds have been set aside for the purchase of specialized literature relating
to various subjects.   Among these are:
The W. T. Stephen fund, for the purchase of books on Tuberculosis.
The Historical and Ultra Scientific fund; to purchase such books as its name
implies. It was established in 1920 from surplus funds accruing from the C.M.A.
meeting, which was held in Vancouver that year.
The F. J. Nicholson fund. For some years previous to his recent death, the late
Dr. Nicholson from time to lame donated considerable sums of money to the Association, which he specified should be used for the purchase of books for the Library.
These books should be "written about Doctors, or by Doctors,** but of a purely cultural or historical nature. Through tins fund the library has been supplied with a
large number of excellent books, relating indirectly to die Profession of Medicine,
but which are in no way text books.
An efficient supervision of all matters pertaining to die health of Greater Vancouver is today taken for granted. The Metropolitan Board of Health spreads its protecting wings over the area and guards the well-being of every citizen in matters pertaining
Pagf^fwo Hundred and Sixty-four to general sanitation, food inspection, communicable disease control, school services,
and many others. The foundations of this service were laid sixty years ago when Vancouver first became an organized Municipality, and it has gradually evolved into what
it is today, but not without watchful effort on the part of a few, notably members
of the Vancouver Medical Association.
Long before Vancouver existed, the first Health Act was passed by the Provincial
Government—in 1869. In 1895 a second act came into force which created a General
Board, made up of five well known Physicians chosen from throughout the Province.
This body laid the foundation for the present health laws governing British Columbia.
It prepared regulations for the control of smallpox, diphtheria and typhoid fever, and
for the enforcement of quarantine and disinfection. It established isolation hospitals
and appointed Municipal Health Officers throughout the Province. Later on this Board
was dissolved and authority became centered in a new organization headed by a Secretary of the Provincial Board of Health.   Dr. Fagan was the first to occupy this position.
(To Be Continued)
Afewd attd Motel
The members of the profession in British Columbia were shocked to learn of the
sudden passing of three of their colleagues—Dr. R. A. Walton of Vancouver, who died
on July 14th; Dr. W. C Mooney of Vancouver, on July 16th, and Dr. R. B. Boucher
of Vancouver on July 22 nd.
♦ »      »      »
Deepest sympathy is extended to Dr. and Mrs. D. E. Starr of Vancouver in the
loss of their young daughter.
♦ ♦      »      »
Dr. L. F. Brogden of Penticton has the sympathy of the profession in the loss of his
wife, who died on August 27th, following a lengthy illness.
* *      *      »
Dr. T. F. H. Armitage and Dr. Olive Sadler of Vancouver have our sympathy in
the loss by death of their mothers.
• •      »      •
Dr. and Mrs. D. W. Motfatt and Dr. and Mrs. D. A. Steele of Vancouver are receiving congratulations on the birth of daughters.
♦ •      *    , •
/ Congratulations are being received by the following parents on the birth of sons:
Dr. and Mrs. J. D. Galbraith of Prince Rupert, Dr. and Mrs. J. J. Gibson of Penticton, Dr. Albert and Dr. Agnes 0*Neil, Dr. and Mrs. F. E. McNair, Dr. and Mrs. F. H.
Bonnell, Dr. and Mrs. W. H. Perry, and Dr and Mrs J. A. McLean of Vancouver.
»      •      »      »
Lieut. Winnifred Van Kleek and Lieut. G. B. Wilson exchanged marriage vows in
a ceremony held in Vancouver rccendy.
Dr. C. E. Batde of Vancouver was married a short time ago.
* »      »      »
The following Medical Officers have received their discharge from the services:
Surgeon Lieut.-Commander R. D. Millar of Vancouver, Major D. E. Alcorn of Victoria,
Capt. J. R. Farish, Capt, So Won Leung and Capt. R. H. B. Reed of Vancouver.
r »      #      •      »
Dr. Gordon Brown has received his discharge from the U.S. Army Medical Corps,
and is now in practice at Kelowna with Doctors Urquhart, Wilson and Black. Previous
to joining the Army Dr. Brown practiced in Cranbrook.
■ Page Two Hundred and Sixty-five Dr. Donald Black is taking up his practice again in Kelowna after several months
absence due to illness.
* *>      *      »
Dr. H. S. Hamilton has joined Dr. L. A. C. Panton in his practice at Kelowna as
Eye, Ear, Nose and Throat specialist.
a>      •      »       *
Dr. W. H. White of Penticton attended the Washington State Medical meeting at
Spokane.   He was accompanied by Dr. J. R. Parmley, who went on to Vancouver.
♦ *      *      *
Penticton reports that preparations are being made for the District No. 4 Annual
Meeting to be held there on October 4th.
effective treatment suggests the u*e of
agents to correct mineral deficiency,
increase cellular activity, end secure
adequate elimination of toxic wests.
orally given, supplies calcium, sulphur,
iodine, and Irsidln bitartrate — eat
effective solvent. Amelioration of
symptoms and general functional improvement  may be expected.
Write for Information.
Colonic and
Physiotherapy Centre
Up-to-date Scientific Treatments
Medical and Swedish Massage
Physical Cullure Exercises
Post Graduate Mayo Bros.
1119 Vancouver Block
MArine 3723      Vancouver, B.C.
Nttntt $c QHjimtBfltt
t     *
2559 Cambie Street                    N   * | Vancouver B.C.
Page Two Hundred and Sixty-six


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