History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: May, 1945 Vancouver Medical Association May 31, 1945

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Witb Which Is Incorporated
Transactions of the
In This Issue:
TREATMENT OF TTTT.au af.mta ||g|       " 'IJMfe   191
—By S. C. Turvey, M.D         jp    J%;  .^^Mfi^^^^q^
LOW BACK PAIN—By Wing Comdr. R. C. Lsard-^^^^196
—E. A. Boxall, M.D., CM., and G. W. Prueter, M.D.||_ 203
MILITARY MEDICINE __H 8§1.^^SH—-—_^105
Innnnl   lf-.n-.n-r   B. C. MEDICAL ASSOCIATION
ADDBal JNeeting       September 12-13.14
It is important that out-of-town members attending this
meeting make their hotel reservations NOW!
VOL XXI.     NO. 8
Rapid, safe response to oral administration
Digitoxin is the only digitalis material known to be
completely absorbed when given by mouth. "A dose
of digitoxin is equally as effective by oral as by intravenous administration in man."*
PURODIGIN, digitoxin Wyeth, is of such constant
potency that dosage is expressed in terms of weight
rather than in "units."
With PURODIGIN the "doses necessary for full therapeutic effects are too small to produce gastro-intestinal
irritation, with the result that nausea and vomiting
from local action seldom occur."*
Dependable Effects
By Mouth
Vials of 30 scored tablets, 0.2 mg. each
and ZAHM, W.; Clinical Studies on Digitoxin; Witt Further Observations on its
Use in the Single Average Full Dose Method of Digitalization, J. Pharmacol.!
Exper. Ther ap. 52:1 S7-1SS (Oct) 1944.
JUL9   1945
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 Or. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XXI.
MAY, 1945
No. 8
OFFICERS,   1945 - 1946
Dr. Frank Turnrull
Dr. H. A. Des Brisay
Dr. H. H. Pitts
Past President
Dr. Gordon Burke
Hon. Treasurer
Dr. G. A. Davidson
Hon. Secretary
Additional Members of Executive: Dr. R. A. Gilchrist, Dr. D. M. Meekison
Dr. J. A. Gillespie Dr. A. W. Hunter Dr. W. T. Lockhart
Auditors: Messrs. Plommer, "Whiting & Co.
Clinical Section
Dr. S. E. C. Turvet Chairman Dr. E. R. Hall : Secretary
Eye, Ear, Nose and Throat
Dr. Grant Lawrence President Dr. Rot Mustard Secretary
Paediatric Section
Dr. John Piters Chairman Dr. Harry Baker Secretary
Orthopaedic and Traumatic Surgery Section
Dr. D. M. Meekison Chairman Dr. J. R. Naden Secretary
Dr. W. J.. Dorrance, Chairman; Dr. F. J. Buller, Dr. R. P. Kinsman,
Dr. J. R. Neilson, Dr. D. E. H. Cleveland, 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. S. E. C. Turvey, Dr. Grant Lawrence
Summer School:
Dr. G. A. Davidson, Chairman; Dr. J. C. Thomas, Dr. R. A. Gilchrist,
Dr. A. M: Agnew, Dr. L. H. LEeson, Dr. L. G. Wood.
Dr. J. R. Netlson, Dr. H. H. Pitts, Dr. A. E. Trites
V. 0. N. Advisory Board:
Dr. Isarel Day, Dr. J. H. B. Grant, Dr. G. F. Strong
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont
Representative to B. C. Medical Association : Dr. H. H. Pitts
Sickness and Benevolent Fund: The President—The Trustees • wmm
HIGH and PROLONGED salivary concentration
of sulfathiazole is brought directly to the site of
oral and pharyngeal infections following the use of—
Even a single tablet of White's Sulfathiazole Gum
chewed for one-half to one hour provides a high concentration of locally active sulfathiazole. The medication
is brought into immediate and prolonged contact with
oropharyngeal areas which are not similarly reached by
ordinary measures of topical chemotherapy. Moreover,
resulting blood levels of the drug, even with maximal
dosage, are so low that systemic toxic reactions are virtually obviated.
INDICATIONS: Local treatment of sulfonamide-suscep-
tible infections of oropharyngeal areas:
a. acute tonsillitis and pharyngitis;
b. septic sore throat;
c. infectious gingivitis and stomatitis;
d. Vincent's disease
DOSAGE: One tablet chewed for one-half to one hour at
intervals of one to four hours depending upon the
severity of the condition.
Available in packages of 24 tablets, sanitaped, in slip-
sleeve prescription boxes.
A product of
High Local Concentration: One
pleasantly flavored Sulfathiazole
Gum tablet chewed for one-half to
one hour promptly provides a high
concentration of locally active
sulfathiazole (average 70 mg. per
cent) that is maintained throughout the chewing period.
Low (negligible) Systemic Absorption: Blood levels of the drag,
even when maximal dosage is employed, are almost negligible—
rarely reaching 0.5 to 1 mg. per
IMPORTANT: Please note that your patient requires your
prescription to obtain this product from the pharmacist. VANCOUVER HEALTH DEPARTMENT
Total population—estimated '. , i 311,799
Japanese Population—Estimated  . ! Evacuated
Chinese population—estimated -,395
Hindu population—estimated 335
Total  deaths	
Chinese deaths	
Deaths—residents only 278
Male, 3 32; Female, 298
March, 1945
Rate per 1,000
March, 1944
Deaths under one year of age >       16
Death rate—per  1,000 births 25.8
Stillbirths (not included above) 12
February, 1945
Cases      Deaths
March, 1945
Cases      Deaths
April 1-15, 1945
Cases      Deaths
Scarlet Fever	
Diphtheria '.	
Diphtheria Carrier	
Chicken Pox	
, Whooping Cough 	
Typhoid Fever  (Carrier)	
Undulant Fever	
Tuberculosis I	
| Erysipelas '' !
Meningococcus Meningitis 	
Paratyphoid Fever   (Carrier)
Infectious Jaundice	
Dysentery _'	
Vancouver       Richmond      Vancouver
 72 1 0
  175 0 0
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance to 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 during
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
Page One Hundred and Eigbty-nine PENICILLIN
The original plate method of N. G. Heatley, colleague of Sir Howard Florey, is
used in the Connaught Laboratories for the final measurements of potency.
The illustration shows the striking action of penicillin in inhibiting bacterial
growth, and indicates the method by which the strength of the penicillin
solution to be tested is determined irt terms of a standard solution.
In the assay of penicillin, an agar plate is seeded with a
culture of Staphylococcus aureus, and cylinders set in the
plate are filled with various dilutions of penicillin. The
clear zones surrounding the cylinders are the areas where
penicillin has inhibited bacterial growth, and potency is
determined by measuring these areas.
Penicillin of high quality is NOW AVAILABLE in rials of
^f^ 100,000 Oxford units. f
Sterile saline solution for preparing penicillin
is supplied in 20-cc. vials.
University of Toronto     Toronto 5, Canada
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Rickets during infancy and through
the entire growing period can be prevented by only three drops daily of
Navitol with Viosterol. Three drops
supply 5,000 U.S.P. units of vitamin
A, 1,000 US.P. units of vitamin D
For Literature—Write
36 Caledonia Rd„ Toronto, Out.
—the maximum potencies of Concentrated Oleovitamin A and D spedfied
by U.S.P. XII. Such high potency
makes the small dose of three drops
easy to administer, palatable, and economical—about one-half cent a day.
PROFESSION      SINCE      1858 7<4e &dU&& Patje 1
The present epidemic of measles in Vancouver has been very widespread, and certain
questions arise in one's mind as to whether we are dealing altogether wisely or satisfactorily with this situation.
Measles is often regarded as a sort of joke—at least as a mild and more or less harmless childish disease, which every child may as well have and get it over. We confess
that we cannot take such a light view of this affliction. We note with regret and a
certain degree of discomfiture that officially children who have had this disease are
allowed to go back to school in eight days. This is approximately, of course, the period
during which they are infectious to others.
But it is surely wrong to take it for granted that it is safe for the average child who
has had measles to go back to school in such a short time. Those of us wh6 are in
general practise, and more particularly those who specialise in paediatrics, cannot but
agree that children, after this short period, even after two weeks, are still suffering from
the secondary effects of the disease. Many of them are still coughing—many are underweight—have not yet got back their appetite or energy—have enlarged glands, and are
a perfect set-up for intercurrent infections of various sorts.
We remember some years ago talking about this matter to the Head of the Public
Schools Medical Department of San Francisco. She told us their experience with regard
to measles.   Briefly it was this:
They followed, for many years, the rule we have here now, of letting children go
back to school as soon as they appeared free of infection—say within two weeks.
Keeping careful track they found that these children were, in many cases, coughing,
without energy or appetite, slow to pick up their work, and backward in their studies.
They found a high incidence of other infections—and even a definite proportion of
cases contracting tuberculosis. They lengthened the period away from school to three
weeks, then to four—then to six weeks. They found that when children were kept at
home for six weeks, fed up, given tonics and extra rest, and cared for, they went back,
to school in excellent condition—and within a very short time had caught up, and more
than caught up, with their work—in other words, they lost less time than those who
went back sooner. Now, we were told, the rule was definitely adopted that all cases
of measles were to stay at home for six weeks from date of recovery.
We do not know if this is still a hard and fast rule in San Francisco but it would
be easy to find out. We suggest to our School Medical Authorities, or to our Public
Health Authorities, that they give serious consideration to this subject, and, if in their
wisdom, they see fit, that they should institute a more effective set of regulations, which
would avoid the dangers we refer to. As it is, people who wish to keep their children at
home on their doctor's advice, are rung up by the school nurse or teacher, who wishes
to know why the child cannot come back to school. The nurse or teacher is simply
doing her duty, and carrying out regulations as they stand—but we suggest that it
might be well to revise these regulations after consultation with leading paediatricians
and health experts, here and elsewhere. We have plenty of skilled advice available right
here—and we should use it.
Our sincere congratulations and thanks are hereby tendered to the Summer School
Committee of the Vancouver Medical Association, who gave us one of the best Summer
Schools we have had yet. The attendance (313) was very good indeed—and the programme was excellent. The speakers all gave notable papers—and we have been fortunate enough to secure promises of copies of most of them. Some we have already in
hand—and they will be published as fast as possible.
The Annual Meeting of the British Columbia Medical Association, to be held in
Vancouver in September, is the next item on the menu for 1945.   We urge our out-of-
Page One Hundred and Ninety town members who plan to attend—and we hope they will be many—to secure Hotel
and travelling reservations now.
Our congratulations to the following, who have been chosen as leaders of various
departments of our Canadian medical life:
Dr. Ethlyn Trapp, of Vancouver, who has been elected President of the Canadian
Medical Women's Association for the following year. Nobody better could have been
selected for this post.
Surgeon-Lieut. La Roche, R.C.N., of Victoria, B.C., who has been elected as President of the new Urological Society of Canada. We understand that the first meeting of
this Society will be held in Vancouver shortly.
Dr. A. B. Nash, of Victoria, who has been elected as Councillor of the Canadian
Society of Obstetrics and Gynaecology, whose President is John Fraser of Montreal.
S_» 3_» *'- *^
Toronto takes its time, but it gets there. In recent issues of the press, our readers
may have noticed the recent conferring of the degree of M.D. (Tor.) on a good many
men who started practice in Canada 50 years ago when they obtained their M.B. degree.
Among these, British Columbians will be greatly interested to note Dr. W. B. McKechnie,
formerly a leading Vancouver surgeon, and now living in Armstrong, B.C. Our friend
and colleague, Dr. W. D. Keith, of Vancouver, is another of the number, though he was
unable at the time to go to Toronto to receive the degree, and be photographed along
with the others.
Dear Doctor: Pa8e Mr- llsley!
In regard to that sum of $2.50 I owed you. I soon will be making out my income
tax papers and will take it off the income tax and they will pay you then and you will
get it soon.
Here hoping this matter is now settled to all concerns.
Thanking you for waiting for this sum so long but I couldn't afford to pay it then.
Yours truly,
The Bulletin is glad to publish the following statement, sent to us by Dr. C. E. Dolman, Head of
the Department of Bacteriology at the University of British Columbia. Our readers will remember a
report that we recently published of a case of Tularemia, and B. C. is very fortunate to have available
a supply of streptomycin for trial in cases of this disease.—Ed.
The January issue of the Bulletin published a report and a commentary on a fatal
case of tularaemia. In view of the therapeutic difficulties which that case exemplified,
and of the likelihood that further human infections with P. tidarense will occur in
British Columbia, it should be of interest to physicians, particularly those in the interior
of the Province, to know that one of the newer antibiotics, Streptomycin, has been used
with apparent success in the treatment of tularaemia.
A small supply of Streptomycin for trial in the treatment of authenticated cases of
this infection has been made available by the pioneer commercial manufacturer of this
material. As the supply is limited, the Streptomycin will only be released when the
epidemiological, clinical and laboratory evidence supports the diagnosis of tularaemia, and
on condition that a full report on the case is furnishing.
Any physician desiring to try out the materials under these circumstances should
telegraph or telephone the relevant details to me at the Department of Bacteriology and
Preventive Medicine, University of British Columbia.
June _th, 1945. C. E. Dolman.
Page One Hundred and Ninety-one SUMMER SCHOOL
The twenty-third annual Summer School was -held somewhat earlier than usual this
year in order that it should not conflict with the Canadian Medical Association Convention in the middle part of June.
The sessions were well attended, and the total registration was over the 300 mark.
Although this showed a decrease from the previous year, it is still well above the pre-war
average of 200-250. It is interesting to note than an exceptionally large number of
Americans from the States of Washington and Oregon registered this year.
The customary luncheon was held on the opening day of the School, in the Mayfair
Room of the Hotel, and those attending heard an inspiring address by Major Harold
Brown, who is well known in Vancouver.
Many favourable comments were heard on the speakers, all of whom presented their
papers in a convincing and interesting manner.
Capilano Golf andv Country Club was once more the setting for the Golf Tournament, in which many of the Summer School registrants participated. The prizes were
won by:
First Low Gross (84)—Leith Webster.
Second Lo wGross (94)—Boyd Story.
First Low Net (74)—E. E. Day.
Second Low Net (77)—W. E. Milbrandt.
Long Drive—S. G. Baldwin.
Closest to the Pin—R. M. Campbell.
Highest Score—J. A. Porter.
The Summer School Committee wishes to take this opportunity of expressing its
gratitude to the Naval, Army and Air Force Commands for sending us three specialized
speakers—Surg. Commander Graham, Lieut. Colonel Gordon and Wing Commander
Laird, and also to John Wyeth & Brother for their generous contribution toward the
speakers' travelling expenses.
A complete list of those registered is given on Page 193.
Recent Advances in Encrocrinology, 1945, Edited by A. T. Cameron.
Fundamentals of Internal Medicine, 2nd edition, 1944, by Wallace M. Yater.
Pathology of Internal Diseases, 4th edition, 1944, by William Boyd.
Surgical Clinical of North America, Symposium on Common Problems in General
Surgery, and Symposium on Rehabilitation, April, 1945, New York Number.
New Journal Subscription—
Journal of Clincal Encocrinology (Commencing with January, 1945, issue).
Have you any of the following journals, missing from the library shelves?
American Journal of Surgery:  December,   1944;  January,   1945;  March,
Surgery, Gynecology and Obstetrics: February, 1945; April, 1945.
Archives of Otolaryngology, December, 1944.
The books listed below have been missing for some time:
The Story of San Michele, by Axel Munthe.
The Doctors Mayo, by Helen Clapesattle.
Please check your office and home libraries for these publications, and return
to the Library without delay.
Page One Hundred and Ninety-two SUMMER SCHOOL REGISTRATION, 15>45
Agnew,  A.  M.,  Vancouver
Aikenhead,   Capt.   J.   F.,   Vancouver
Alcorn,  Major  D.  E.,  Vancouver
Alexander,  E.   H.,   Vancouver
Alexander,  J.  D.  F.,  Vancouver
Alton,   J.   A.,   Lamont,   Alta.
Anthony,   A.   R.,   Vancouver
Arber, Surg. Lt. S. R., Comox
Atkinson,  J.   R.,   Vancouver
Badre,  Capt.  E.  J.,  Vancouver
Baker,  H.,  Vancouver
Baldwin,   S.   G.,  Vancouver
Balmer,  F/L   I.   A.,   Sea   Island
Basted,  M.   R.,   Trail
Battle,  C.   E.,   Vancouver
Beach, D.  W.,  McBride
Becher, J.  C.,  Vancouver
Begg,   Major  H.   N.   G.,  Vancouver
Benaron,   Major   T.,   Vancouver
Benwell,   C   E.,   Essondale
Bissett, Major G.  W.  C, Victoria
Blair,  J.   H.,   Vancouver
Boucher,  R.   B.,  Vancouver
Bowles,  A.  W.,  New  Westminster
de  Boyrie,  R.,  Vancouver
Brason, Lt.  F.  W., Vancouver
Brewster,   W/C   W.   R.,   Vancouver
Brogden,   L.   F.,   Penticton
Brown, Burton A., Tacoma, Wash.
Brown,   C.   E.,   Vancouver
Brown,   Harold,   Vancouver.
Fruce, F/L J. D., Tofino
Brydone-Jack,   F.   W.,   Vancouver
Bryson,   F/L   B.   F.,   Vancouver
Buller,  F. J.,  Vancouver
Burke,  Gerald,  Vancouver
Burke,   Gordon,   Vancouver
Burnett,   J.   W.,   Greenwood
Byrne,  Major  V.   P.,  Vancouver
Callaghan,   Mary,   V.G.H.
Campbell, E.  A.,  Vancouver
Campbell,   R.   M.,  Vancouver
Canfield, H. H., Seattle, Wash.
Carruthers,   R.   S.   P.,   Vancouver
Cates,   Capt.   C.   A.,   Vancouver
Caunt,   T.   G.   B.,   Essondale
Chase, E. F., Seattle, Wash.
Chipperfield,  F/L  L.   S.,   Boundary  Bay
Christopher, H. C, Seattle, Wash.
Clement,  G.  H., Vancouver
Cleveland,  D.   E.   H.,  Vancouver
Cope,  G.  W.,  Oliver
Cornish,  Lt.  Col.  A.  L.,  Gordon  Head
Covernton,  C.   F.,  Vancouver
Cowan,  F/L   R.   G.,  Vancouver
Craig,  Lt.   Col.   K.   L.,   Nanaimo
Danby, Surg. Lieut. C. W. E., Vancouver
Davidson,  G.   A.,  Vancouver
Davies,   C.   E.,   Vancouver
Davis,  H.  R.  L., Vancouver
Page One Hundred and Ninety-tbree
Day,  E.  E.,  Vancouver
Des   Brisay,   H.   A.,   Vancouver
Dooley,   S/L   R.   J.,   Vancouver
Dorrance,   W.   J.,   Vancouver
Dowling,  S/L  H.  E.,  Vancouver
Dowsley,   G.   A.,   Vancouver
Drach,  V.,  Vancouver
Dudey, H. D., Seattle, Wash.
Durkin,   D.   J.,   Victoria
Dwyer, Capt. C. H., Gordon Head
East,   E.   N.,   Qualicum
Edwardh, D E., V.G.H.
Ein,  Capt.  H.   N.,  Gordon  Head
Elliott,  B.   S.,  Vancouver
Emmons,  W.   F.,   Vancouver
Endicott,   Capt.   W.   J.,   Vancouver
Fiszhaut,   S.   H.,   Vancouver
Fortin, Capt.  Guy, Vancouver
Francis,   Major   G.   H.,  Vancouver
Freeman,   V.   J.,   V.G.H.  '.
Frost, A.  C,  Vancouver
Frost, Surg. Lt. Cmdr. J. W., Vancouver
Floren,  Capt.   S.   A.,  Nanaimo
Gale,   H.   V.,   Vancouver
Gee, A.  M.,  Essondale
Gee,   E.   A.,   Tranquille
Gilchrist,   R.   A.,   Vancouver
Girling,   W.   N.   M.,   Seattle,   Wash.
Glasgow,   Major   R.,   Vancouver
Gourlay,  S/L  W.  N.,  Vancouver
Graham,   Colin,  Victoria
Graham,   H.   C,   North   Vancouver
Graham,   W.   L.,   Vancouver
Greaves,   G.   A.,   Vancouver.
Green,   W.   G.,   Vancouver
Grimshaw,   F/L   W.   L.,   Edmonton
Greene,  I.  B., Everson
Grimson,   J.   C,   Vancouver
Gundry,   Major   C.   H.,   Vancouver
Gunn,   W.   G.,   Vancouver
Haig,   Major   K.   J.,   Vancouver
Hakstian,  A.,  Vancouver
Hall,  Capt.   N.   B.,  Victoria
Hallowes,   B.   J.,  Vancouver
Hanson, Geo., Seattle, Wash.
Hardie,   M.,   Vancouver
Harrison,  S.  R.,  Vancouver
Harrison, W.  E., Vancouver
Harry,  B.   H.,  Vancouver
Haugen,   R.,   Armstrong
Hay, M.  C, Vancouver
Hazlewood,  F/L  B.   F.,  Sea  Island
Hebb,   F.   J.,   Vancouver
Helem, G. B., Port Alberni
Henderson,   W.   A.,   Chilliwack
Henry,   A.   T.,  Vancouver
Herstein,  Capt.   A.,  Vancouver
Hicks,   Capt.   A.   R.,   Petawawa
Hicks,   E.   R.,   Cumberland
Hoehn,   G.   H.,  Vancouver Hodgins,   G.  L.,   Vancouver
Horsley, J. S., Vancouver.
Hunt, Major A. L., Vancouver
Hutchins, L. R., Seattle, Wash.
Hutton, G. H., Vancouver
Hutton, Lillian, Vancouver
Irving, J. A., Vancouver
Janowsky, Capt. S., York Island
Jaron, Capt. T. W., Victoria
Johnston, D. B., Earl Grey, Sask.
Jones, C. W., Vancouver
Jones, F/L E. A., Prince Rupert
Kaplan, Capt. S., Vancouver
Karsgaard, A. T., Tofino
Keith, W. D., Vancouver
Kelly, Major D., Nanaimo
Kemp, W. N., Vancouver
Kidd, G. E., Vancouver
Kincade, G. E., Vancouver
King, B.  T., Seattle, Wash.
Kirby, O. E., Vancouver
Kirk, Capt. D., Chilliwack
Knox, Capt. A. W., Nanaimo
Knox, R. E., Vancouver
Kovach, J. C, Vancouver
Laishley, W., Nelson
Laird,-Major R. R., Vancouver
Lang, J. W., Vancouver
Langston, G. R., Vancouver
Lapin, S/L A. W., Vancouver
Large, S/L A. W., Sea Island
Laroche, Surg. Capt. A. G., Vancouver
Lawrence, Grant, Vancouver
Learoyd, Major D. R., Vancouver
Lee, B. H., Vancouver
teeson, L. H., Vancouver
Lehmann, Major P., Vancouver
Leitch,  Gordon  B.,  Portland,  Oregon
Lennie, T. H., Vancouver
Likely, Capt. J. C, Vancouver
Lindsay, Capt. J. H., Vancouver
Little, G. E., Vancouver
Losier, F/L P. J., Sea Island
Lovegrove, F/L W. M., Victoria
Magid, F/L L.  G., Vancouver
Mallek, H., Vancouver
Mallek, J., Vancouver
Manson, Major A. B., Vancouver
Mateko, Rueben, Vancouver
Matthews, G. O., Vancouver
Mattson, J. F., Tacoma, Wash.
Melgard, J. F., Seattle, Wash.
Merheley, D. K., Vancouver
Milbrandt, W. E., Vancouver
Milburn, H. H., Vancouver
Millar, F/L D. B., Vancouver
More, G., Duncan
Morris, Wm., Vancouver
Morrison, F/L C G., Patricia Bay
Morrison, M., Vancouver
Morrow, J.  R., Seattle, Wash.
Morse, G., Haney
Moscovich, Major B. B., Vancouver
Mugan, F/L J. F. M., Alliford Bay
Murray, D. F., Vancouver
Murray, J. Scovil, West Vancouver
Mustard, Roy, Vancouver
Myers, H. A., Vancouver
Myers, Violet, Vancouver
McAmmond, E. N., Vancouver
McCaffrey, R. T., Vancouver
McCallum, D., Vancouver
MacCrostie, M. W., Vancouver
McDonald, J. A., Vancouver
McEwan, R. W., Vancouver
McGregor, R., Vancouver
McKay, Surg. Lt. Cmdr. A. L., Vancouver
McKay, S/Ldr. G., Patricia Bay
MacKechnie, H. A., Vancouver
McKinnon, Surg. Lt. Cmdr. A. G., Comox
McKinnon, C. R., Vancouver
McLachlin, Lt.  J. A., Prince Rupert
McLean, J. A., Vancouver
MacLean, Major Keith, Vancouver
McLeod, E. C, Vancouver
McLeod, J. L., Vancouver
Macmillan, L., Vancouver
McNair, A. Y., Vancouver
McNair, F. E., Essondale
McNeill, Neil, Vancouver
MacNutt, L. W., Vancouver
Nash, W/C E. T. W., Vancouver
Neilson, J. R., Vancouver
Nelson, Margaret, Vancouver
Neufeld, W. P., Vancouver
Panton, K. D., Vancouver
Panton, L. A. C, Kelowna
Parlee, Capt. H. B., Vancouver
Parrott, Capt. Ross, Prince Rupert
Patten, C. G., Vancouver
Patterson, Capt. L. A., Chilliwack
Paulin, S., Vancouver
Peacock, E., West Vancouver
Peacock, K., West Vancouver
Pelletier, G. L.  J., Vancouver
Phillips, Lt. D. L., Vancouver
Pipe, Lt. B. J. (U.S. Army), Seattle, Wash.
Ployart, C. H., Vancouver
Porter, J. A., Vancouver
Powles, F/L G. P. S., Comox
Rich, Major C. B., Vancouver    v
Roberts, G. A. C, Chilliwack
Robertson, J. G., New Westminster
Ross, S/Ldr. H. M., Vancouver
Ross, Surg. Lt. J. D., Victoria
Rotenberg, Capt. C, Victoria
Rothwell, F/L G. S., Vancouver
Roy, D. G., Vancouver
Ruskin, Capt. J. D., Vancouver
Sadler, Olive, Vancouver
Sarvis,  E.   S.,  Huntington,  Wash.
Saunders, W. G., Vancouver
Sauriol, L. E., Essondale
Saxton, G. D., Vancouver
Schilder, G., Vancouver
Schori, J. W., Bellevue, Wash.
Seale, C. E., Vancouver
Seldon, G. E., Vancouver
Shandro, S/Ldr. W. A., Vancouver
Shaw, W., Vancouver
Sherban, D. A., Vancouver
Shuler, I. J. D., Seattle, Wash.
Siddall, F/O J. R., Vancouver
Sievenpiper, S. H., Vancouver
Silver,  L.  H.,  Seattle, Wash.
Simpson, R. E., Vancouver
Page One Hundred and Ninety-four
V Skinner, J.  E.,  Tacoma, Wash.
Skinner, L.  E., Tacoma, Wash.
Slade, Major H. C, Prince Rupert
Smith, J. A., Vancouver
Sparks, F/L H. D., Boundary Bay
Spiro, Capt. H., Vancouver
Stark, Capt. W. J., Vancouver
Steck, L. G., Chehalis, Wash.
Steele, D. A., Vancouver
Stephens, Lt. J. W., Vancouver
Story, Boyd, Vancouver
Strong, G. F., Vancouver
Stubbing, Sylva, Vancouver
Sullivan, T. J., Cranbrook
Swarok, E. W., Vancouver
Sylling, M. F., Vancouver
Tait, Surg. Lt. Cmdr. W. M., Vancouver
Taylor, W. H, Port Angeles, Wash.
Terry, Maj. K., Victoria
Thomas, J. C., Vancouver
Thompson, Surg. Ltd. W. J., Vancouver
Thomson, J. W., Vancouver
Thorlakson, H. F., Seattle, Wash.
Trapp, Ethlyn, Vancouver
Trites, A.  E., Vancouver
Trowbridge, F/L E. B., Port Hardy
Turnbull, Frank, Vancouver
Turnbull, H. L., Vancouver
Turvey, S. E. C, Vancouver
Underhill, F. J., Seattle, Wash.
Upham, G. A., Vancouver
Van Kleeck, W., Vancouver
Virtue, Surg. Lt. J., Vancouver
Vrooman, C. H, Vancouver
Vye, J. P., Victoria
Wallace, S/Ldr. J. D., Vancouver
Walsh, W. C, Vancouver
Wannop, Lt.  Col., Victoria
Warcup, L. W., Vancouver
Ward, Capt. J. G., Victoria
Waselek, Angela, Vancouver
Watson, H. N., Duncan
Webb, F/L E., Patricia Bay
Webster, L. H, Vancouver
Wilks, W. E., Vancouver
Williams, D. H., Vancouver
Wilson, G. B., Vancouver
Wilson, G. T., New Westminster
Wilson, Col. Wallace, Vancouver
Wiltsie, S. F., Seattle, Wash.
Winsor, Helen, Vancouver
Wishart, Capt. J. M., Vernon
Wishlow, M. F., Ladner
Wood, L. G., Vancouver
Wride, G. E., Vancouver
Yak, J., Vancouver
Yoerger, R. G., Vancouver
(Contributed by Dr. S. C. Turvey)
Since the beginning of this year, there has been an innovation in the treatmnet of
paralytics in Vancouver which has been quite revolutionary. All of us have had paralyzed people under our care at one time or another, particularly the paraplegics, who
have always been a hopeless problem. Usually they died of some intercurrent infection
after being confined indefinitely and helplessly to their beds. A school has now been
started in Vancouver in which these handicapped people are taught to walk and to
attain a great degree of independence.
Milton H. Berry, Sr., was born in California and developed the idea about 1900.
Through his friendship with a paralyzed person, he gradually evolved the Berry Method
and had outstanding success. He later went to Chicago where he worked for fifteen
years under the late Dr. John B. Murphy, rehabilitating handicapped individuals. Later
he returned to California and started "The Milton H. Berry Institute" with a Board of
Direcotrs of many prominent civic leaders of Los Angeles. The purpose of this Institute was not only to re-educate the paralytic but also to train other teachers in his
method. He died in 1939 and since then his two sons and one son-in-law have carried
on the work. They now have eleven schools in nine states. It was our good fortune in
Vancouver to interest the younger son, Martin A. Berry, in starting such a school in
British Columbia.
Mr. Berry has already a large class and is spending part of his time on military cases
at Shaughnessy Hospital, part of his time on private cases and part of his time on patients
for the Workmen's Compensation Board. A Committee of Physicians has been formed
to work with Mr. Berry and to give any advice necessary concerning the medical aspect
of this problem and this committee includes: Dr. H. A. desBrisay, Dr. G. A. Greaves,
Dr. J. R. Naden, Dr. A. B. Schinbein, Dr. Howard Spohn, Dr. F. A. Turnbull, Dr. S.
E. C. Turvey, Dr. L. G. Wood. lit is Mr. Berry's special request that it be emphasized
that he is working entirely under medical guidance, with the doctors and for the
doctors. He makes no claims whatsoever to treat these patients and confines himself
entirely to teaching them how to walk.
Page One Hundred and Ninety-five Not all cases are suitable candidates for the course. Thus, a person with advanced
Disseminated Sclerosis would be unsuitable by reason of the extreme ataxia. The ideal
case is the flaccid paraplegic, most of which are due to injuries of the spinal cord, but
spastic conditions, involving the legs and the arms, are also quite amenable to treatment.
These include the spastic paraplegics, the diplegics, and those instances where there is
only partial injury of the spinal cord. Patients are fitted with braces when necessary,
and the further treatment consists in educating muscle groups which are not paralyzed
to perform functions for those which are paralyzed. People who have been confined to
bed for months, or even years, have been taught to walk freely around their homes, to
attend social gatherings and shows, and even to drive automobiles. Application forms
have been prepared and they may be obtained from B. Strong, 1529 West 37th Ave.,
Vancouver, B.C. Any further information required by any physician about the Berry
Method can also be obtained from this same source.
Mr. Berry is also interested in training young men in this method of paralysis correction, and any physician who knows of likely candidates should let Mr. Berry know.
The training period of apprenticeship lasts from six to nine months and certainly would
equip a young man with an excellent occupation for life. The physicians who have
worked with Mr. Berry and seen some of bis results have no hesitation in recommending
him most highly to the profession and, in fact, they feel that British Columbia is particularly fortunate in having this venture in British Columbia.
Wing Commander R. C. Laird
Read at Vancouver Medical Association Summer School, 1945.
The subject of this paper is one that is a daily problem in the professional life of most
physicians, and my purpose in discussing it is to clarify the main features of the problem, and if possible to simplify our approach to it, and subsequent treatment of it.   The
, actual site of low back pain should be limited to lower lumbar, lumbo-sacral and sacroiliac regions.
In reviewing the anatomy of this region it is evident that there are many possible
sources of pain. The vertebrae are made up of cancellous bodies, and very hard processes posteriorly. Articulations vary from the intervertebral disc which acts both as
a cushion and as a ball-bearing, to the fairly freely movable joints between the facets
posteriorly, and- to the almost completely immovable sacro-iliac joint. All these articulations have supporting ligaments of varying strength and position. Surrounding these
bones and joints are the muscles which control their movements. These muscles extend
from one unit to the next, or from one group to another, and there is practically no
movement elsewhere in the body which is not accompanied by some tension or activity
of the spinal muscles. The movements of the spine in this region are chiefly flexion
and extension, with a small amount of rotation. Generally speaking the articulations are
so placed and of such shape as to facilitate these movements, but there may be many
slight congenital abnormalities which may interfere with perfect function. When man
assumed the erect position and acquired the secondary lumbar curve above and opposite
to the primary sacral curve, then he initiated the problem of low back pain. The movements and static tension of the upper nine-tenths of the spine are based on an oblique
foundation, and the muscles have origin from a short handle, the sacrum, and insert
diffusely along the whole upper length of the spine. These two factors may easily lead to
muscle decompensation.
Etiology and Pathology
In assessing the various possible causes of low back pain, a definite systematic approach is essential, and I have chosen the usual pathological classification of congenital
anomalies, trauma, infection, and new growth.    These refer to intrinsic conditions in
Page One Hundred and Ninety-six the spine or its associated structures.   There are in addition many possible causes in the
specialties of gynaecoloy and urology which will be referred to.
Congenital anomalies are fairly frequent in the lower lumbar and lumbo-sacral
region, and their significance is always a problem in assessing low back pain. Such
anomalies include spina bifida occulta, sacralization of the transverse processes of the
fifth lumbar vertebra, transitional fifth lumbar vertebra, defective neural arch of the
fifth lumber characteristic of prespondylolisthesis, irregular facets between lumbar five
and sacral one, obliquity of the upper surface of sacrum, and an abnormal angle between
sacrum and lumbar spine.    These are all identified in a good X-ray of the area.
Trauma may be either acute or chronic. Acute trauma includes fractures, sprains,,
ruptured intervertebral discs, and possibly fibrositis with a fairly frequent history of
recent sub-acute infection. There seems little doubt that minor trauma and the presence of infection are important factors in fibrositis. Fractures may be present either in
the cancellous body or in one of the hard posterior processes, and the degree of fracture
and displacement is no definite measure of the amount or duration of pain. The rupture of an intervertebral disc may interfere with the mechanics of movement at that
level, but its chief disability is due to pressure on one or more of the spinal nerve roots
and interference with its function.
The commonest form of chronic injury is seen in the chronic ligamentous or muscle
strain. For some reason, either fatigue or inefficiency of function of the spinal muscles,
recurrent strain is placed on the lower lumbar and lumbo-sacral articulations. Contributory factors are certainly overweight, long hours of standing, or one of the congenital structural abnormalities which may hinder efficient function. For a long time
there are no definite pathological changes in the joints, but eventually there will appear
evidences of traumatic arthritis.
The other result of chronic injury may have an early acute incident to initiate the
trouble. In spondylolisthesis there is a congenital lack of fusion of the neural arch
between the upper and lower articular facets. This abnormality may never give trouble,
but occasionally a sudden strain will start the separation and repeated ones will continue the forward slip. This occurs chiefly with fifth lumbar on first sacral, but may
occasionally be seen at one level higher up.
Acute infections are chiefly osteomyelitis and septic arthritis. These may be typical
blood-borne infections, or may be the result of local infection following such things as
gunshot wounds. The acute inflammatory reaction is the same as anywhere else, but
being more deeply placed is more likely to give rise to difficulties in localization and
Of the chronic infections, tuberculosis is occassionally seen in this region, and the
lesion is typical, whether it originates in bone or joint. The other important chronic
lesion is arthritis, and the varied manifestations of this disease are becoming more
familiar to all.
Tumours of bone which may cause low back pain are more likely to be metastatic
new growths, although primary tumours are ocacsionally seen. Such a one as a
hemangioma is fairly rare, but a very interesting lesion. There is also a group of tumours
of spinal cord which may be responsible for local pain in this area.
It is difficult to reach any definite conclusion as to the number and importance of
gynaecological and urological lesions which cause low back pain. Let it suffice to say
that definitely established lesions of those groups may cause this pain, and must always
be searched for and eliminated in the solution of the problem of diagnosis. -
The taking of a careful history and the execution of a meticulous physical examination are naturally prime essentials in any individual complaining of low back pain.
Enquiry must be made into the regular work and other physical activities, with the
effect of these on the pain. If there is a history of injury, it must be carefully examined
and the actual relationship of injury and pain assessed.    The character of the pain is
Page One Hundred and Ninety-seven important, whether it is the dull aching pain which is present most of the time the individual is up and around, or the sharp stabbing pain which markedly increases on the
slightest movement. Duration of the pain, and the factors which increase or relieve it
may also be significant. Such activities as standing, bending and lifting tend to increase
most pains in the back, and coughing and sneezing often give sharp exacerbations,
especially in nerve root pain. Some types are relieved by lying down, while others are
relieved by activity. The radiation of the pain may be indicative of such things as nerve
root pressure seen typically in the sciatica of ruptured intervertebral disc.
The examination of the patient begins with observation of the gait as the individual
enters the room. Limp associated with a complaint of low back pain may be due either
to the pain or to weakness in the extremity. A marked deformity like a scoliosis will be
noticed at once, and must be checked for location and degree. It is interesting that
most scoliotic deformities in the erect position due to spasm in ruptured disc lesions will
disappear when the patient lies down. Less obvious deformities are those of spondylolisthesis, and of ankylosing spondylitis. Spasm of the sacro-spinalis muscles is seen
generally when the pain is acute, and is largely a protective reaction to limit the painful
movements. Local tenderness should always be checked, as well as the presence of
firm nodules in soft tissue areas. The movements of the spine are normally free and
painless, although the degree varies in each individual. Any limitation of these movements should be observed, as well as any limitation of straight leg raising. This latter
can be compared, one side with the other, both actively and passively, and likewise the
effect on the pain. A careful neurological examination will check sensory, motor, and
reflex changes in the extremities. There are unlikely to be neurological findings in low
back pain alone, but with an associated sciatica they are recognized quite frequently.
Finally good X-rays must be taken, antero-posterior, lateral, and occasionally oblique in
order to outline the prespondylolisthesis. Special radiological investigation such as a
myelogram may be indicated by history or examination.
Following such an investigation one can readily determine whether the condition is
acute, chronic, or acute followed by chronic. There is little problem in the individual
who, following an attempt at lifting a very heavy object, gets a sharp stabbing pain
in the. soft tissues between the spine and iliac crest, has muscle spasm and localized
tenderness, and recovers completely with one to two weeks rest in bed with heat. Similarly the individual with dull aching pain in the lower lumbar region, slight kyphosis of
one spine and limited spinal movements, and an X-ray positive for tuberculous disease
of a lower lumbar body, offers no particular problem either in diagnosis or disposal.
Many of the complaints of low back pain can be diagnosed as readily as this. There is,
however, a large group of cases with a rather indefinite history, a completely negative
physical examination, and a negative X-ray, or an X-ray showing one of the many congenital structural abnormaHties. Many of these, and in fact, I believe the majority of
these must be classed as chronic lumbar or lumbo-sacral strain. They are the result of
muscle decompensation, and if allowed to progress, will eventually show positive findings of arthritis in both examination and X-rays.
The problem of treatment of the individual complaining of low back pain resolves
itself into two parts. Depending on the diagnosis, there is specific treatment directed
toward the individual lesion, and non-specific treatment, in the way of general principles
applicable to many lesions. A fracture should be immobilized until Union occurs, a ruptured intervertebral disc may be removed; a definite spondylolisthesis may require fusion;
and an acute infection may be benefitted by penicillin. Of the general principles underlying treatment, rest is probably the most important. This may vary from relative rest
to complete rest, and there are many stages in each. Along with or immediately succeeding rest comes the important principle of exercise. Graduated back exrcises will
build up the spinal musculature which has been inactivated by acute injury, or which
Page One Hundred and Ninety-eigbt has never been strong enough to carry the load of body or of work. These principles
have been demonstrated for some years in fractures of spine immobilized in plaster, with
constant exercises to keep up the muscle tone. They can also be demonstrated in the
cases of chronic lumbo-sacral strain, and 1 believe many of our mos tdifficult problems
can be solved in this way. There will remain a small number of individuals who have
persistent low back pain unrelieved by any conservative measures. If no lesion is
demonstrable for which specific treatment is indicated, and presumably with a diagnosis
of chronic strain unrelieved, it is possible that local spinal fusion will come to the assistance of the spinal musculature, and eliminate the decompensation and the pain.
By Illarion Kononenko
People's Commissar of Health of the Ukrainian S.S.R.
Built up during the years of socialist construction, the public health network of the
Ukrainian. S.SjR. had by the beginning of the present war developed into a powerful
state organization. Its work was based on the principles of concentration on prophylactic measures to prevent disease, free medical treatment for all, and the enlisting of
wide cooperation of the general public.
An idea of the scope of these services may be seen in the fact that in 1941 the medical institutions of the Ukraine were staffed by 93,900 people, including 29,700 doctors.
Corresponding figures shortly before the great October Socialist Revolution were about
5,000 doctors and 10,000 other medical personnel.
The Ukrainian Republic had a chain of medical schools and universities for training
medical workers. In 1941 there were nine medical institutes, two pharmaceutical and
two stomotological colleges with 25,700 students. The annual contingent of graduates
exceeded 3,500. In 1941 more than 45,600 students were attending 199 medical schools,
which graduated 21,000 specialists annually. The vast number of medical workers
trained in these schools made it possible to satify fully the demands of the health service
in the Ukraine, and also to send a considerable number of trained nurses and other personnel to other Republics.
The Ukraine's 49 scientific research institutes successfully solved problems of urgent
importance for medical theory, clinical practice and war surgery.
Functioning in Ukrainian towns and villages in 1941 were 1,932 hospitals with
129,000 beds, some 6,000 dispensaries and polyclinics and more than 10,000 minor dispensaries and health centers. There were 2,445 rural medical centers in the Republic
and the majority could serve as models in the organization of medical and sanitary service
in the countryside under collective farm conditions.
A tremendous decrease in tuberculosis, skin and venereal diseases was achieved.
Chancroid completely disappeared, cases of syphilis declined by 90 per cent as compared
with 1913. Fresh cases of syphilis were very few and were rapidly disappearing. Important successes were achieved in the struggle against the spread of gonorrhoea.
The Ukraine and the entire Soviet Union were justly proud of the network of
organizations built up in the Republic during the years of socialist construction for the
protection of mother and child. In 1941 the Ukraine had 1,647 mother and child health
centers; 632 milk kitchens, maternity homes with a total of 31,000 beds, 2,700 permanent nurseries with accommodations for 130,100 youngsters, 25,200 seasonal nurseries,
etc. This development was fully in line with' the exceptional attention paid in the
U.S.S.R. to mothers and to the bringing up of the young generation.
A large number of sanatoriums and rest homes were built; by 1941 the Republic
had more than 400 sanatoriums and 173 rest homes maintained by health authorities,
trade unions and other organizations. Every year mare than 100,000 working people
availed themselves of the facilities for treatment offered by the Ukrainian health resorts,
Page One Hundred and Ninety-nine and more than 300,000 spent their vacation in Ukrainian rest homes.   Some 900,000
children were accommodated annually in Ukrainian sanatoriums and rest homes.
Statistical data showed a continuous improvement in public health protection. The
rate of disease was declining steadily and the demographic indices of physical development pointed to great improvement. Illustrative in this respect are the figures on the
growth of population in the Ukraine. The increase from 1919 to 1941 was 21.6 per
cent (and 22 per cent for the whole of the U.S.S.R.
Effects of German Occupation
The German invaders caused great damage to public health in the Ukraine. Hundreds of thousands of civilians were murdered or deported for slave labor. The spread
of tuberculosis, skin and venereal and highly infectious diseases attained exceptional
The network of medical and prophylactic institutions almost completely ceased to
exist during the occupation period, and a considerable section of it was destroyed. The
remaining medical institutions introduced payment for treatment. Prophylactic vaccinations against smallpox and diphtheria were not practiced. According to preliminary
estimates, the material damage caused to the public health services in the Ukraine exceed
two billion rubles.
The invaders also caused heavy damage to the municipal and public utility services.
All this brought about a drastic deterioration in sanitation on occupied territory. In
all liberated cities and districts of the Ukraine, highly infectious diseases were rampant.
Restoration of Health Services
That is why rehabilitation in every liberated city and village began with the restoration of health services. So far, 766 sanitation and epidemiological centers, 4,500 dispensaries and polyclinics and 6,000 gynaecological and first-aid stations have been
restored. The public health network is being steadily expanded and now has more than
86,400 hospital beds.
One hundred and ninety-six dispensaries and wards with 3,790 beds, and sanatoriums
with about 4,000 beds have been set up for the treatment of tuberculosis. Special
country schools for children suffering from this disease and homes for tubercular invalids have been opened. Institutes engaged in the study of tuberculosis have been
restored in Kiev, Kharkov and Odessa. Together with scientific research and clinical
treatment, these institutions are helping to improve and expand the network of institutions combatting tuberculosis.
The Republic now has 701 child helath centers and 344 milk kitchens; nurseries with
57,300 beds and many other health institutions for children in both town and country.
Last year, 721,400 children were accommodated in 20,700 seasonal nurseries. The number of beds in maternity homes has been brought up to 8,800. All organizational and
material requisites have been created for the complete restoration and further improvement of the network of services for mother and child.
Much effort has been put into the restoration of the educational and scientific-
medical institutions in the Ukraine. As a result, eight medical, one stomatological and
three pharmacy institutes, three post-graduate institutes for doctors and one for pharmacists have already been restored. The medical colleges in the Republic now have a student
body of more than 16,00p, and a further 16,000 enrolled in 75 reopened medical schools.
Forty-six restored scientific research institutes are working on urgent problems of wartime sanitation, theoretical and clinical medicine, and aiding the public health authorities
with advice in this restoration period.
The greatest attenton is being paid to sick and wounded soldiers and commanders of
the Red Army. Hospitals are provided with the best equipment, housed in the best
buildings and staffed with the most efficient personnel.
The Ukraine is well on the way to complete restoration of its public health services,
but the damage caused to the health of the Ukrainian people and the medical network
is enormous and will require considerable effort on the part of the Republic, and 'further
fraternial aid from the peoples of the U.S.S.R.   The Ukrainian people appreciate mightily
Page Two Hundred the aid rendered by our great Allies which is striking an expression of solidarity in the
struggle for complete victory over the enemy of mankind. Contact between the scientists and medical institutes of the Ukraine and the Allied countries will doubtlessly help
in a further and even more successful solution of the urgent problems of medicine for
the benefit of mankind.
I am convinced that in this field, too, the peoples of the Soviet Union, the United
Kingdom and the United States of America will display unity in the pursuit of their
progressive aim.
This information supplements package instructions provided with each vial of penicillin.   It is a tentative guide in a rapidly changing field of new therapy.
Gonorrhoea—Office Treatment of Proven and Suspected Infections.
1. Shortage of hospital beds merits trial of ambulant therapy.
2. Institute therapy IMMEDIATELY in all instances where clinical and/or epidemiological (named as contact) evidence exists.
3*.   Take specimens for smear examination but do not hold up treatment pending
return of laboratory report.
4.   Ambulant treatment for males and females is suggested as follows:
(a) Two injections of 100,000 units each (total 200,000 units) dissolved in 4
c.c. of diluent, administered four hours apart, injected in the upper outer
quadrant of the gluteal muscle.
(b) If clinical and/or bacteriological response unsatisfactory after 5 to 7 days,
repeat course as above—4. (a).
(c) If failure after second course, admit to hospital for continuous, intramuscular (pectoral) drip of 200,000 to 400,000 units.
(d) Observe all patients carefully for recurrence and instruct re "masked
syphilis."    (See Appendix "A" attached.)
1. Penicillin therapy for syphilis is still EXPERIMENTAL.
2. It is always a HOSPITAL PROCEDURE.
3. Use should be limited to EARLY SYPHILIS (less than four years in duration—
primary, secondary, early latent, and congenital infection in infants.)
4. Use should be limited to the following EXIGENCIES:
(a) Serious reactions to routine arsenic-bismuth therapy.
(b) Relapsing, resistant or fulminating forms of early infection.
(c) Early~syphilis in asocial promiscuous persons.
(d) Early syphilis in persons unable to obtain regular weekly treatment (remote
rural areas, certain seamen, fishermen, loggers, miners, etc.).
(e) Elderly persons with early infection.
(f) Persons with "difficult" veins—addicts, obesity.
5. Flans of Treatment.
Always a continuous hospital procedure lasting 7 to 10 days.
I.    Continuous Intramuscular Drip Flan
(a)   Daily administration of  300,000 units dissolved in 600 c.c. normal
saline—adjusted for continuous absorption over 40-hour period.
Page Two Hundred and One (b) Site of injection—pectoralis major.
(c) Continue 8 days for a total of 2,400,000 units.
(d) Bismuth salicylate intramuscular (gluteal) in doses of 1.0, 1.5 and 2.0
c.c. on 1st, 4th and 8 th days respectively and 2 c.c. weekly for seven
weeks after completion of penicillin therapy.
II.    Multiple Intramuscular Injection Plan
(a) Daily administration of 300,000 units in 8 equal divided doses administered every 3 hours day and NIGHT.
(b) Injection site—upper outer quadrant gluteal muscle.
(c) Continue 8 days for a total of 2,400,000 units.
(d) Bismuth salicylate intramuscular (gluteal) in doses of 1.0, 1.5 and 2.0
c.c. on 1st, 4th and 8th days respectively and 2 c.c. weekly for seven
weeks after completion of pemcillin therapy.
6.   All patients treated with penicillin should be followed closely for evidence of
relapse   (clinical, serological,  neurological).    Observation  should extend  for  a
five-year period!   Penicillin treatment for syphilis is EXPERIMENTAL!!
For further advice please write Provincial Board of Health, Division of V. D. Control, 2700 Laurel Street, Vancouver, B.C.
Sample of Instructions Given to Provincial Board of Health Clinic Patients
treatment you must have a second injection in four hours. You will wait in the clinic
until the time comes for your second injection and then you will be told when to return
for tests to determine if you are cured. While waiting you will be given some pamphlets
to read so that you may know more about venereal disease and may be able to avoid
catching it.   Read them carefully.
2. If you take all your treatment in four hours you may not need any further care
but it will pay you to report back as required for your tests of cure.
AT THE SAME TIME. Penicillin may hide or delay the appearance of syphilis in your
body, therefore, it is absolutely essential that you have a blood test either here or from
your private doctor in three months. This is the only way you can know for sure that
you haven't got syphilis. Don't forget. A blood test in three months is your only way
to be sure.
4. Watch your body carefully during the next three months and if you notice any
sore on your genitals, or should a skin rash appear, see your doctor, or go to your clinic
have completed your tests of cure.
Syphilis extends to the fcetus about the fifth month of pregnancy. Prior to that-
spirochaetal invasion of the fcetus has not occurred in most cases. If maternal syphilis
is discovered before the fifth month—invasion of the foetus can be checked. If treatment
is continued till term, the baby has a 95 per cent chance of being normal and non-
"Blood Tests for Every Expectant Mother Before the Fifth Month."
*       *       *       *
"Find V.D. Contacts — Report V.D. Cases."
Page Two Hundred and Two V
Ernest A. Boxall, M.D., CM., and Gordon W. Prueter, MJD.
A white male, age 58, was admitted to the Hospital on August 10, 1944, because
of painful spasms of has muscles. He was well until fourteen days before admission when
he was building a house on a cattle ranch where there was "cow-dung everywhere."
While working on a roof he slipped and saved himself by grabbing the jagged end of
a broken two-by-four, contaminated with cow-dung. This gashed the distal two-thirds
of the palmar surface of his right little finger. He immediately washed the wound with
tap water and applied a bandage. Within two hours from the time of injury a doctor
cleaned the wound with Metaphen and inserted three sutures. No anti-tetanic serum
(A.T.S.) was given. He was advised to stop work temporarily and every second day
reported to the doctor's office to have the wound inspected and painted with Metaphen.
At no time did the wound bother him except for slight itching. On the fourth day the
sutures were removed, leaving a wound which, although the edges were not well approximated, was well scabbed over and symptomless. On August 6, thirteen days after the
injury, he noticed a feeling of tiredness, a stiff neck on waking in the mornings, and
spells of stiffness and tremor in the limbs. When he turned over in bed at night his
heels would "beat a tattoo" on the mattress for a brief moment. He also noticed difficulty on boarding a streetcar, due to stiffness and inability to control the direction of
movements of his limbs. By August 9, sixteen days after the injury, his throat was sore
and he could not swallow well, his limbs would "tremble and jerk" and he had trouble
keeping his balance. There was anorexia, sweating and slight fever. That night true,
tonic painful spasms began so he was sent to the hospital.
He described the spasms: "They feel like you were on a rack and your muscles were
being stretched. They were exceedingly painful and my toes would point and my back
stiffen off the bed. They seemed to build up in the stomach and spread from there. I
could feel them coming and had to turn violently to get relief. If I lifted my body off
the bed so that I rested on my heels for a few minutes I could get some relief." There
was no history of previous tetanus or toxoid immunization.
On physical examination he was lying flat in bed with a drawn anxious look. Eyes,
ears, and nose were negative. The masseters were tense and the mouth could be opened
only half an inch. Heart and lungs were negative. Pulse was 95, blood pressure 135/85.
The abdomen was tense and board-like and palpation caused a generalized contraction of
the whole abdominal musculature. There was an increase of tonus and of the deep reflexes
of the limbs. The right thigh muscles were contracted with frequent twitchings. There
was stiffness of the neck and a bilateral Kernig _ sign. There were no sensory signs.
Laboratory Work:
August 11—Lumbar puncture: Initial pressure 195 mm.
Cerebro-spinal fluid.
Protein 24 mg.%.
Chlorides 772 mg.%.
Kahn and Wasserman Rate negative.
Colloidal gold curve 111000.
Culture showed no growth in five days.
August 16 and 23—Urinalysis negative.
Progress in Hospital:
The spasms increased in intensity and frequency, being most painful in the legs and
back. Marked sweating was a prominent feature. Retention of urine required catheterization. At no time did trismus progress to such an extent that he could not open his
Page Two Hundred and Three mouth, but moderate opisthotonus appeared with the spasms. Intellect remained unimpaired. Pulse remained good throughout but rectal temperature would rise to 102° after
the administration of intravenous and intramuscular antitoxin. From August 12 to
August 17, the spasms were severe and frequent, each lasting about two minutes, being
entirely tonic with no clonic element and exceedingly painful, causing him to scream
with pain and swear violently. A spasm could be initiated by any slight stimulus such
as opening the door quickly or speaking to him in a low voice, when he was unaware of
anyone being in the room. Intravenous and intramuscular injections always caused a
spasm. Gradually they became less frequent and of shorter duration. Towards the end
of his illness he developed a few moist rales at the right lung base for which he was
given sulfadiazine, and also a stomatitis caused by mouth breathing while under heavy
sedation and atropine, which aided in drying out the mouth; otherwise recovery was
uneventful and he was discharged well on the twenty-third hospital day.
A total of 853,000 units antitetanic serum given as follows:
20,000 intravenously
20,000 intravenously
40,000 intramuscularly
20,000 intravenously
40,000 intramuscularly
20,000 intravenously
40,000 intramuscularly
20,000 intravenously
40,000 intramuscularly
20,000 intravenously
20,000 intramuscularly
Aug. 10—100,000 intravenously
Aug. 11—100,000 intravenously
15,000 intrathecally
Aug. 12—100,000 intravenously
Aug. 13— 60,000 intravenously
Aug.  14— 20,000 intravenously
50,000 intramuscularly
20,000 intravenously
40,000 intramuscularly
20,000 intravenously
40,000 intramuscularly
8,000 locally
A preliminary serum sensitivity test was done intracutaneously which was negative.
All intravenous antitoxin was given diluted in 500 cc. of 5% glucose in isotonic saline
•followed by 500 cc. of 10% glucose in isotonic saline for its caloric content. Parenteral
vitamin B complex was added to the latter solution. During convalescence the patient
received a multivitamin preparation by mouth.
On August 12, the wound on the finger was opened, some dead tissue excised, and
5% magnesium sulphate compresses applied until August 14 when the wound was again
opened a.nd syringed with hydrogen peroxide followed by compresses of Dakin's solution.
This was repeated on August 16 when about 8,000 units of antitoxin was injected
around the wound edges and a loose dressing applied, allowing free access of air.
Heavy sedation was maintained with sodium amytal intravenously and intramuscularly in doses of 3% grains and 7l/z grains. In addition avertin by rectum in doses of
75 mgm./kg. body weight was given on August 12, 14, 15, 16, 17, and lateral phenobarbital, Yz grain three times a day, with nembutal, 1 J_ grains at bedtime.
Atropine sulphate 1/lOO.grain every six hours was given from August 11 to August
18, inclusive. Sulphadiazine, 2 grams stat and 1 gram every four hours in tragacanth
for slight bronchopneumonia from August 18 to August 23. Sodium perborate mouth
washes every hour and mouth and tongue painted with 2 % aqueous gentian violet twice
a day for stomatitis.
The incubation period of this case was fairly long (thirteen days), which is said to
carry a favourable prognosis. Most authorities agree that the mainstays of treatment
are heavy sedation to control the spasms and intravenous and intramuscular antitoxin,
although the value of the latter is doubted by some. Otherwise, therapy consists in
maintaining an adequate fluid and caloric intake, with care of the bladder and bowels.
The value of local treatment of the infected wound is still debatable. Most authorities
are against such radical measures as amputation of a digit, if such be the offending focus,
but re-opening the wound and the use of oxidizing agents and antitoxin locally would
Page Two Hundred and Tour seem rational. The intrathecal administration of antitoxin would seem of little value in
this disease according to work by Sohier and Jude1, who found an antitoxin titre of 0.1
unit/cc. in the spinal fluid of a patient at a time that the blood concentration was 50 to
100 units, in spite of the fact that 50,000 units had been injected intrathecally sixteen
hours previously. The modern view is that the tetanus toxin is blood borne and this,
plus the fact that there are no changes in the spinal fluid in tetanus other than increased
pressure, would leave little argument for the use of antitetanic serum (A.T.S.) intrathecally. Recent work by Cooke and Jones2 has demonstrated that a clinical case of
tetanus confers little or no immunity to subsequent infection because the amount of
toxin absorbed during an attack is too small to produce a primary antigenic stimulus
in the body. The above case shows the ineffectiveness of ordinary antiseptics in killing
tetanus spores in a wound and that there is still a place for the prophylactic administration of 1500 units, or, better still, 3000 units of antitetanic serum (A.T.S.) in the
treatment of wounds sustained in places where there are likely to be tetanus spores.
We would like to thank Dr. W. G. Morris for permission to publish this case report
from his service.
1. Bull, et mem. Soc. med. d'hop. de Paris, 1 : 80 (Jan. 14), 1938.
2. J.A.M.A., April 10, 1943.
By Leeut.-Colonel Rocke Robertson, R.C.A.M.C.
During the four years of the last war great strides were made in the treatment of
wounds—methods of first aid were revised; a satisfactory technique of wound excision
was evolved; abdominal injuries, treated expectantly at first following the practice of
the Boer War surgeons were, in the last three years, operated upon, with a considerable
reduction in mortality. Anti-tetanic serum was introduced and the incidence of tetanus
decreased rapidly. In this war, too, advances have been made—penicillin, blood and
plasma transfusions, the recognition of immobilization as one of the essentials in the
management of a wound, refinements in plastic surgery and in the other specialized
branches—and so on. Besides these, changes have been made in the Medical Service
itself. They have been made necessary by the transformation that has come about in
the style of warfare. Just as Reconnaissance and Armoured units have been added to
the strength of an Army so have Mobile Unit sbeen included in the Medical Corps. It is
with these Mobile Units that we are particularly concerned tonight.
You must all be familiar with the system prevailing in the first World War. It was
designed to care for the wounded evacuated from a static or slow moving front and for
this it was quite adequate. The C.O.S. could be moved up to within a few miles of the
trenches without risk of being overrun, and the Field Ambulances could deliver the
patients along well established lines of communication with the least possible delay. But,
sufficient as it was to satisfy these conditions, this system would obviosuly have broken
down in a war of movement. The C.C.S., the focal point of surgery in the last war,
could not have kept up with a rapid advance, for it is a large unit and cannot be packed
and moved with rapidity.
To meet the demands of mobile warfare Field Surgical Units were developed. It
must be pointed out that they were first used in the Spanish Civil War in which, on the
Republican side at least, they were found to be of great value.    There is an excellent
Page Two Hundred and Five description of the field surgery in that war written by a British surgeon, D. W. Jolly.
In his book he gives a complete picture of this type of surgery together with a detailed
outline of the equipment and personnel required. His work must have been most useful
to those responsible for the planning of our own Field Units.
So far as I know the first Mobile Units in the British Army were organized early in
the North African Campaign. Here, where the armies moved at a tremendous pace, the
need for highly mobile units was great. At the outset the surgery was performed by
units composed of personnel borrowed from hospitals and C.C.S.'s, using borrowed and
ill-assorted equipment and vehicles. Later, when these teams had proven their usefulness
they were organized as distinct independent entities and were called Field Surgical Units.
The first Canadian Surgical Units were formed in the latter part of 1942 and two of
them were sent out "with the First Canadian Division to Sicily in July, 1943. In the
Canadian plan a Field Surgical Unit consisted of 11 men—a Surgeon, an Anaesthetist, 5
orderlies, 3 drivers and a batman.
Its transport comprised 3 vehicles. A surgical van designed to carry the surgical
equipment (operating tables, instruments, etc.), and an electric generator; a 3-ton
truck to carry the large volume of other materials such as tents, personal kit, etc., and
8 cwt. vehicle to carry the personnel.
Thus equipped, the team can move itself and set up in almost any situation that may
arise and function as an operating team. It is responsible for the actual operations—the
preoperative and post-operative care are the duties of the Field Transfusion Unit and the
Field Dressing Station respectively. The former consists of the Officer and 3 other
ranks who travel and carry their wares in a truck fitted with a refrigerator for preserving whole blood. The Field Dressing Station is a larger unit organized to provide
postoperative care for anything up to about 60 patients. They provide the Medical Officer and orderly personnel for this purpose in addition to the cooking and Quartermaster
facilities for the smaller Surgical and Transfusion Units. These three units (F.D.S.,
F.T.U., F.S.U.), which are usually grouped together and called an Advanced Surgical
Centre," have been inserted into the old lines of evacuation composed of R.A.P. Field
Ambulance, CCS., and Hospital, and they have been introduced in order to supply early
surgery for those cases whose chances of recovery would be jeopardized by delay.
Let us now examine the position in line which these new units take by tracing the
course of a casualty at the front. He is picked up by his regimental Stretcher Bearers
and passed through the R.A.P. and thence to a Car Post of a Field Ambulance which is,
as a rule, situated at about Brigade Headquarters level. Up to now his course is similar
tc that of a casualty in the last war and the first aid treatment that he receives follows
closely that laid down in 1916—the same dressings and splints are used. The only new
practices are the introduction of Sulphonamide into the wound, the giving of Plasma to
the severely shocked in the R.A.P. and the transportation of the patient on a stretcher-
bearing jeep. From the Car Post he will be taken back to the Main Dressing Station of
a Field Ambulance and here his condition will be reviewed. If it is judged that he is
seriously ill he will be directed to the A.C.S., where he will receive treatment. If, on the
other hand, it is considered that he is fit to travel on, he will be put back into an ambulance and sent to a CCS. and thence to a hospital.
The siting of the A.S.C's is important. It must be close enough to the front so that
cases can reach it without too much delay—say not more than an hour's trip in an
ambulance. At the same time it should be far enough back so that it is out of range of
field artillery. These conditions are not always easy to satisfy, particularly when the
roads are bad and the ambulances are forced to travel slowly. This A.S.C. must also
be placed close to the MJD.S. where the triage is carried out in order that the patients
may be transferred from the main line of evacuation with the least possible loss of time.
As a rule it was usually possible in the Sicilian and early part of the Italian Campaigns
to house the M.D.S. and the A.S.C in the same building or in adjacent houses in a village or, failing buildings, in adjoining tents in a field.
Page Two Hundred and Six Admitted to the A.S.C, he will be treated there and retained until he is fit to travel
on back. He may remain at this level for a period varying from 12 hours to 3 weeks,
depending upon his condition and the general situation at the time. A man with a compound femur, for example, injured during a large scale attack when there are many other
casualties, may be operated upon in the A.S.C. and evacuated in a matter of hours if he
is in reasonably good shape. If, on the other hand, he is ill, he will be retained. He'may
develop a wound infection and not be fit to be moved for days. Abdominal cases are
routinely kept for a minimum of a week no matter how well they seem—chest cases
are not moved until they are free from dyspnoea at rest regardless of how long this may
take—and so on. It is, thus, quite impossible to predict how long a man may stay once
the treatment is commenced—hence the system must be an elastic one to handle the
numerous difficulties that arise. Picture an A.S.C. in action with, say, 30 bed patients.
The army advances—the F.S.U. and F.T.U. are moved ahead to set up with another
F.D.S. and the patients remain behind with the original F.D.S. One by one as they
become fit they are evacuated to the base, but it may be a long time before all 30 have
moved on. Meanwhile the F.D.S. may be needed forward. In such a case the main body
will move ahead, leaving behind a medical officer and orderly personnel and cooking
staff sufficient to care for the remaining patients. Such a group is called a "Nest" and
it is not uncommon, in a rapid advance, to find several "Nests" scattered along the lines
of communication, providing a problem of supply and administration to tax the best
20 hrs.
30 hrs.
35 hrs.
This table is produced to show how the time intervals between wounding and admission to an A.S.C and between wounding and operation. It will be noted that the
average interval between wounding and admission was in the neighbourhood of 5 hours.
This seems long but it must be realized that the greatest and most variable factor is the
time elapsing between the wounding and the arrival at he R.A.P. Frequently conditions
are such that it takes many hour, to carry a man from the point at which he was hit to
this Medical Officer—it may not be possible to reach a man during daylight-—or it may
take time to find him in the dark—the carry may be long and difficult. Once in an
ambulance his progress is steady and relatively rapid.
So much for the administrative side. Let us now turn to a consideration of the
manner in which these units function and of the types of patients which they are called
upon to treat. I can speak only of the situations in Sicily and Italy up to Rome—having
no first hand knowledge of the experiences of the teams in Northern Italy or in France,
though I imagine that the picture is essentially the same in every theatre.
We considered ourselves fortunate that in 8 months of this type of work we saw a fair
variation—variation in the type of warfare and in weather—the two factors which 'mainly
govern the numbers and condition of casualties, and variations in working conditions.
Of the actual warfare we saw but little in spite of the fact that we were never very far
behind. We were, however, in a position to be interested spectators and were able to
learn something of the art both from what we saw and from what we were told by those
actively engaged. This was not the least attractive feature of the job. We took part—
a very inactive part I should say—in two assault landings, and we followed behind the
troops in their rapid advances and camped behind them when they were temporarily
halted by the enemy. During the advances we would travel sometimes for days without
having to stop to work—the casualties would be light and the morale high. A most
pleasant existence.   How different it was when the going became hard, the movement
Page Two Hundred and Seven would slow down and finally stop and the number of wounded would mount as the artillery and mortars came iitto action. As a rule these rude interruptions would be shortlived and the chase would be on again, but on those occasions when the enemy made a
real stand we had a taste of the work of the last war—casualties coming in in large
numbers during attacks, with a steady flow in between from patrols. This life was very
trying for all concerned and one often marvelled at the patience that those who experienced years of it in the last war must have shown. Just as moving ahead was exhilarating—new scenery—new markets, and above all a feeling of accomplishment—so was
standing still dull and depressing.
The weather had a great influence upon our activities. At the moment we need not
consider its effect upon the movement of troops—which has been as evident in the
Italian as in any other campaign—but mention should be made of both the seasonal
diseases and the difference noted in the condition of the wounded with changes in the
So common were malaria and dysentery in.the summer months and infectious hepatitis in the autumn and winter that all the medical officers were affected to some extent
by having to lend a hand in treating the cases and by falling victims to one or another
of the diseases themselves. Then again these illnesses were complicating factors in many
of the wounded. A man with a subclinical malaria would as likely as not upon being
wounded develop the full blown disease; and occasionally (particularly early in the
game) his fever would be ascribed to some complication of the wound rather than to
its proper cause. Similarly an individual might develop jaundice after being wounded
and in such cases the jaundice was often a more serious affair than it otherwise would
have been. Indeed there were several deaths from hepatitis recorded amongst our
The effects of dysentery were probably less important. Certainly it was a great inconvenience to a man to be encased in plaster and to have diarrhoea.at the same time but
it is unlikely that his chances of recovery were seriously affected. It is not, however,
t unreasonable to assume that one so unfortunate as to sustain an abdominal wound whilst
he was suffering from a bout of diarrhoea would be more liable to a widespread peritonitis
—although I cannot recall any cases to support this assumption.
Another byproduct of the weather was the fly problem. The flies during the hot
weather would appear in such numbers as to form a real nuisance. They would swarm
about a wound in clouds and drive a patient to distraction. In an operating theatre that
was not adequately screened and sprayed they would collect in such quantities as to
render useless any effort at asepsis. In the early part of the campaign when we lacked
a lot of essential equipment we used to have to employ one of our men full time to
combat the flies. He would spent most of his time waving a magazine over the field of
operation to prevent the flies from landing on the wound. If one could compute the
number of organisms introduced into wounds and carried from one wound to another
by these creatures the result would doubtless be most impressive.
As regards the effects of heat and cold upon the condition of the casualties one has
little to add to the observations of the workers in the last war. We had ample opportunity to confirm the fact that shock is more prevalent and more severe during cold
weather. In this connection one new feature has crept in during recent years. It concerns the treatment of the cold shocked patient. Heretofore it was customary to apply
external heat in the form of hot water bottles and heat cradles. Not long ago it was
pointed out that such efforts would, by producing a peripheral vasodilatation, tend to
nullify the other measures such as blood and plasma transfusions designed to restore the
volume of circulating blood. Thus the present attitude is to take steps to prevent the
patient's losing heat by placing him in a comfortably warm room, removing his wet
clothing and wrapping him in warm dry blankets—but not to overheat him. It is difficult to escape the feeling that this treatment, while theoretically sound, is not always
for the best. Time and again one sees men with a variety of wounds complaining of only
one thing—cold.  They are not impressed by passive measures and they cannot be per-
Page Two Hundred and Eight suaded that the ice-cold blood pouring into their spastic veins is really doing them any
good. They invariably ask for heat and will not settle dowrf until they get it. It was
amusing to see, once the first burst of enthusiasm for the new theory had passed, hot
water bottles being brought back into use and the oil stoves being moved closer and
closer to the stretchers.
We came to the conclusion that gross overheating was a bad thing but that rigid
restriction of heat was equally bad and that one should be guided by the patient's comfort more than anything else.
Perhaps one of the most interesting features of this field surgery is the constant
changing of location. In peacetime or in a base hospital in wartime, one is brought up
to operate in a proper operating theatre and one becomes accustomed to and somewhat
dependent upon its fixtures and conveniences. In the field it is different. There are no
fixtures and the conveniences are sometimes very scarce. This is not to deny that field
surgery is pleasant—for it is undoubtedly enjoyed by all those who take part—nor is it
to say that it is not efficient—for it often is. But it does mean that a certain amount
of ingenuity is required to produce satisfactory surgical conditions on all occasions.
During the Sicilian campaign, which lasted only 31 days, we set up our equipment
in seven different places along the line of advance. We worked- first in a barn near the
landing beaches, next in a wine cellar, then in a farm house, then in tents in an orchard,
moved on to a school, back to tents in a field and finally in a school. One would not
dare claim that we did create proper conditions at each side—in fact, in the early days
particularly, our arrangements were at times very poor. This was due to two factors-—
first and foremost our own inexperience and second our lack of equipment at the outset.
We had had adequate time for training in England but, as is the case in most branches of
the army, it was difficult, almost impossible, to reproduce in training the proper set of
circumstances. Time and again we had set up and taken down our equipment, but we
hadn't foreseen many of the difficulties that arose when we were faced with the actuality.
Furthermore we had never had the opportunity to treat injured people under the conditions in which we later found ourselves. It is understandable that the hospitals would
not hand over their patients to us to operate on because we could not hope to attain the
standard of a hospital operating room and it did not seem fair to the patient. It is
amusing to recall that the only actual operations we performed as a team using our own
tables, instruments and sterilizers, etc., before being launched into the full stream of
battle casualties, were circumcisions.
We tried to make the exercises as realistic as possible. We would clear out one of
the regular theatres in the hospital, drive up in our fully loaded vehicles, install ourselves
and when all was ready send a stretcher for the patient who was, as a rule, somewhat
surprised by the handling he received and the things he saw. The anaesthetic and operation were carried out with as much ceremony as possible—we even used to administer
plasma—but we achieved little in the way of training. Not until we had been doing the
real thing for some time did we learn how to pack our equipment efficiently, nor did we
find out how best to employ our men and ourselves. Thus we made many mistakes at
the beginning, some of which we were able to rectify as time went on. Having gained
experience we found that we could convert almost any decent sized room into a satisfactory operating theatre in a remarkably short space of time, we knew which articles we
needed in the room at all times and which were better left in the truck until required
and we had learned to combat the flies and the elements. After a short period of excitement we became accustomed to the fact that every case we dealt with was more or less
of an emergency. While we had adequate tentage to enable us to be independent of
buildings we soon came to the conclusion that almost any building is preferable to a tent
—a conclusion which is not, I understand, generally shared. I am told that the teams in
Normandy preferred their tents, their reason being that if they stuck to tents all the
time they always knew what o expect. Perhaps Italy was different. Generally we could
find buildings to work in and often we were grateful to Mussolini's Educational Programme which had provided large spacious schools in every town, which structures
Page Two Hundred and Nine suited our purposes admirably. We would use a schoolroom for an operating room and
open as many others as we needed for resuscitation rooms, wards and quarters. Sometimes there was water laid on in the building, but as a rule the water had to be carried
in by hand from the water trucks. Generally speaking and with few exceptions the
operating theatres and wards were good-. Our instruments and utensils were of the first
order, the lighting was satisfactory and the wards were well equipped with beds and
other paraphernalia.
The two Surgical Units performed during an eight-month period some 700 operations—not including the numerous incisions of abscesses, changes of dressings and other
minor procedures. These 700 cases represented the bulk of the seriously wounded men
evacuated from the divisional front during that time except for those with head wounds
or facio-maxillary wounds, who were sent on to the specialist teams in the rear if their
condition permitted. Occasionally the A.S.C would become overrun with cases and it
would be necessary to send on patients who ordinarily would have been retained for
treatment—but this was not the rule. The two teams would work in shifts—we finally
settled on 24-hour shifts—and only.during the busiest periods would both teams be
working at the same time.
Analysis of Cases
Type Percentage
Minor Wounds      5%
Multiple Small wounds     3%
Abdominal Wall  22%
Abdominal Visceral Injury 17%
Chest Cases     8%
Lower Extremity  i  28%
Upper Extremity  ".  11%
Spinal Cord 2%
Neck 2%
Head—Cerebral injury
Arterial Lesions	
Gas Gangrene	
_    0.3%
_    3.0%
_    3.0%
- 2%
L 6%
_ 3%
_     6%
- 5%
_ 10%
Table 2 shows the types of cases that were treated. It will be understood that the
majority of patients had multiple wounds and that thee diagnosis here records only the
•most important wound.
The operative mortality in this group was about 15 %—but in view of the fact many
cases were operated on more than once the case mortality was higher—in the neighbourhood of 20%. This does not include a considerable group of patients who were admitted
to the A.S.C. and died without being operated on. I have no record of these patients but
I think it would be fairly near the truth to say that about 25% of all cases admitted to
an A.S.C die of their wounds.
These figures are given to provide a picture of the work that is being done by Field
Surgical Units. Obviously the standard of surgery which these small units provide is
not always, for one reason or another, of the best, but, taking all in all they do offer a
fair chance of survival to the man who is so seriously injured that he may not stand the
trip back to the realms of the fully equipped hospital.
It is with deep regret that we record the passing of Dr. M. J. Keys of Victoria, who
had practised there since 1915, specializing in eye, ear, nose and throat. Doctor Keys
has left many friends throughout the Province, Canada and the United States.
Congratulations are extended to Capt. and Mrs. D. W. Moffatt on the birth of a
daughter on June 12th, and to Flight-Lieut, and Mrs. G. S. Rothwell on the birth of a
son on May 28th.
Dr. J. S. Daly of Trail has just returned from a week's holiday in Vancouver.
Page Two Hundred and Ten A son was born to Dr. and Mrs. C E. Davies of Vancouver on May 26th, and
daughters were born to Dr. and Mrs. G. D. Saxton and Dr. and Mrs. K. H. Wray-
Johnston. *       *       *       *
Dr. Francis E. McNair of Vancouver was married to Miss Margaret G. McKenzie^
daughter of Dr. and Mrs. G. E. McKenzie of Vancouver, on June 9th.
* «•       «•       si-
Major K. J. Haig and Major J. W. Shier, both formerly in practice in Vancouver,
have returned from service overseas, and are posted for duty in the Pacific Command.
The following Medical Officers have returned from service overseas, and are at
present on leave: Major L. W. Bassett of Victoria; Major J. Ross Davidson, Vancouver;
Major J. A. Ireland; Major Henry Scott, Vancouver; Major J. A. Wright, Vancouver,
and Capt. C C. Covernton, Vancouver.
Capt. G. E. Langley, R.CA.M.C, has returned to civilian life and will practise in
* *      *      *
Dr. T. J. Sullivan of Cranbrook attended the Summer School Sessions in Vancouver,
and then went o nto spend a holiday on Kootenay Lake where he hoped to catch some
of those large Rainbow trout.
* *      s-      *
Dr. M. R. Basted of Trail spent a week in Vancouver during the time of the Summer
School Sessions of the Vancouver Medical Association.
* *      *      *
Dr. F. M. Auld of Nelson has gone East to attend the meetings of General Council
of the Canadian Medical Association in Montreal.
* *      *      *
We are informed that Dr. L. E. Borden of Nelson has retired from active practice.
^r *F *r ^
We are pleased to hear that Dr. E. W.-Boak of Victoria has returned to practice after
an illness of many months.
*__ __■ *_
*C *C *e
Doctors P. A. C Cousland, F. M. Bryant and A. B. Nash of Victoria attended the
meeting of the Canadian Medical Association in Montreal.
Dr. G. A. Wright, formerly in practice in California, has opened an office in Victoria.
* *      *      *
Dr. W. H. Moore of Victoria, who has had a protracted convalescence from an
operation and an illness, is at present on a short fishing trip to Great Central Lake, and
will be back at work very soon.
3f> 3(> _$• 9£
Dr. R. B. Robertson has returned to his practice in Victoria after a well-earned but
brief rest in Portland.
* sc-       *      #
The staff of the Victoria unit of the Department of Tuberculosis Control made a
presentation to their retiring chief, Dr. Frederick Kincaid, recently, and expressed the
wish that the gift would be enjoyed by him for many years to come.
* *      *      *
Colonel C. A. Watson has arrived back in Victoria after four years' service in Europe.
The following doctors from British Columbia travelled to Montreal to serve as
members on General Council of the Canadian Medical Association at the meetings held
in June: Doctors F. M. Bryant and P. A. C. Cousland of Victoria, F. M. Auld of Nelson,
A. H. Meneely of Nanaimo, G. O. Matthews, H. H. Milburn, A. H. Spohn and Ethlyn
Trapp of Vancouver.
Page Two Hundred and Eleven ANACARDONE
Trade Mark
(Nikethamide B.D.H.)
Nikethamide, over a period of years, has won an established
position for the treatment of collapse from shock and poisoning,
also for the control of the depth, or duration, of basal anaesthesia,
particularly that induced by intravenous barbiturates.
Nikethamide has been recommended also for the treatment of
syncope in blood donors (Journ. Amer. Med. Assoc, May 27th,
1944, p. 314 (abs.)), the incidence of which, it was stated, is
about 7 per cent. In this report nikethamide was described as
being 'the most effective single pharmacodynamic agent for the treatment
of donor syncope..'
For parenteral administration nikethamide is available as Anacardone, in 2 c.c. and 5 c.c. ampoules (Injection of Nikethamide
B.P.) and for oral administration as Anacardone (oral), a flavoured
25 per cent solution of nikethamide.
Stocks of Anacardone are held by leading druggists throughout
the Dominion, and full particulars are obtainable from
Toronto Canada
_Ancd/Can/455 Xvecalling the period shortly after Roentgen's
famous discovery, is this depiction of how the
progressive contemporary physician, inspired by
the possibilities with x-rays in medicine, proceeded to. obtain a radiograph of his patient's
A crude set-up, as you see, yet it served his purpose—even though this two-plate static machine
had to be manually cranked for a half-hour to
produce a "skiagraph" of the hand!
To fully appreciate how far x-ray science has since
advanced, consider today's facilities for producing
chest radiographs in 1/60-second or less, and of
8-inch steel castings in 3 1/2 minutes!
Looking back upon this half-century of progress,
of the G-E organization enjoy a profoui
satisfaction in having been privileged to collab
rate with the radiological profession and indm
trial engineers toward continual advancements in
this science; while pledging anew our facilities
for research and development as they may in the
future serve the mutual interests.
TORONTO: 30 Bloor St.. W. - VANCOUVrR: MotorTrans Bldg. 570 Dunsmutr St
MONTREAL: 600 Medical Arts Building • WINNIPEG: Medical Ms Building CO/j^LETEL^ MISCIB1E    IN    MILK
JL/esynon is synthetic vitamin D (the equivalent of vitamin D of animal origin) in pure
crystalline form. Desynon with vitamin A is a preparation which disperses uniformly in
milk. It is not oily and imparts no odor or taste to milk.
High Antirachitic Potency
Desynon with vitamin A contains 30,000
international vitamin A units and 3000 international vitamin D units per Gram . . .
The special dropper supplied with each
package delivers 500 vitamin A units and
50 vitamin D units per drop.
For prevention and cure of rickets, 10 drops
daily incorporated in milk. In pregnancy
and lactation and for conditions of disordered calcium and phosphorus metabolism,
from 40 to 60 drops.
Supplied in vials of 73 cc.
Brand of pure synthetic Vitamin D.t (Activated 7-Debydrocbolesterol)
Pharmaceuticals of merit for the physician WINDSOR, ONT.
Quebec Professional Service: Office; Dominion Square Bldg., MonfrecKQue. __■
A -    A C O o
^"MENT    CO"
fllfllCO Presents
the Stethetron
For the first time, there is now available
to the medical profession, a small, highly
efficient electronic instrument for quicker,
easier, more accurate auscultatory diagnosis.
The Stethetron not only intensifies body
sounds, but enables the physician to emphasize particular sounds while subduing
others. Rales and heart murmurs, extremely important in diagnosis but often scarcely
distinguishable with an acoustic stethoscope, may be intensified many fold, and
given greater relative prominence by subduing the normal heart-beat sounds. Both
volume and tonal emphasis may be regulated  at will.
Being self-powered with tiny hearing-aid
batteries, the Stethetron may be used anywhere. Its trim, compact case may be suspended from a strap worn around the neck
or may be laid on a desk or table while in
The Stethetron is the fruit of years of
research and patient collaboration of physicians and engineers. It is the latest
achievement of an organization that has
long pioneered in medical electronics—an
organization that has attained notable recognition in the medical profession by supplying 90 per cent of America's precision
Distributors for British Columbia
413-415 Lyric Theatre Building
751 Granville Street
Phone: MArine 2752       VANCOUVER, B.C.
A complete blood and urine
laboratory service that is fast
and reliable.
blood containers supplied free
of charge on request.
3 so
loo-la 4
Dept. 9
Colonic and
Physiotherapy Centre
Up-to-date Scientific Treatments
Medical and Swedish Massage
Physical Culture Exercises
Post Graduate Mayo Bros.
1119 Vancouver Block
MArine 3723      Vancouver, B.C. In Hay Fever
Prolonged symptomatic relief of nasal congestion. Effective for 2 to 6 hours without
reapplication. Samples and descriptive
literature upon request.
Trade Mark Reg'd.
',; ■•--;:--*--;---r-rrr-:'''.v:-r»---.--1—-—-----.■-*.---—.—-— **—  ..-•
c o M.p-Ajp^-|r d .
ItfflKI'l       MIBlCIKf       ftOM       IfUI'l       "1IKKI FOR   THE   TREATMENT   OF
Theolamine -----    5 grs.
(Theophylline ethylencdiamine Siaxi )
Potassium citrate - - - 40 grs.
Tincture of Ipecac - 40 minims
Chloroform - - - 8/10 minim
Simple syrup, flavoured     -       q.s.
Available in 4 oz., one pound, and
Winchester bottles.
The Canadian Mark of Quality
Pharmaceuticals Since 1899
Clinical observation has provided evidence that
during the exudative stage of a respiratory infection NUSDLYN tends to liquefy secretions and
dilate the bronchi, and in this way facilitates the
expectoration of respiratory tract exudates. Coughing is avoided, healing is promoted and patients
are permitted rest and comfort.
ADULTS: 1 to 2 teaspoonfuls diluted with |_» wine
glass of water, and taken every four hours.
CHILDREN: 1-2 years: ^ teaspoonful (30 drops);
2-4years: */£ teaspoonful(40drops) to J_j teaspoonful (60 drops) diluted to one teaspoonful of water,
and taken every four hours.
ehankd &_fo6St&_b.
Oestrogenic Treatment
by the
Oral Route...
Ores&l £^5*.
In the Female . . .
Orestol E.B.S., may be used in women
for treating all conditions for which
the natural oestrogens are used.
Menopausal symptoms, senile vaginitis, kraurosis vulvae, infantilism and .
gonorrhoea} vaginitis in chfldren—for (DIEIrlYL-STILBOESTROUDIPROPRIONATE)
all these ailments, Orestol is widely
used. It affords definite relief in breast engorgement, and if administered immediately
after delivery will completely inhibit lactation.
Many physicians report successful use of
Orestol in the treatment of dysmenorrhoea,
amenorrhoea and habitual abortion.
In the Male • • •
Orestol E.B.S. ... a female sex hormone ...
has a pronounced anti-androgenic effect in the
male. It is rapidly displacing surgical castration in cases of prostatic neoplasms, in
which it not only inhibits further growth but
usually causes the enlargements to soften, and
often to diminish in size.
Dosage • • .
Orestol is given in the smallest doses which
will control the symptoms for which it is used.
Nausea and other side-reactions usually indicate the need for lighter dosage. Pregnant
and puerperal women-seldom show any toxic
reactions. Mild cases of nausea can be
readily controlled by administering Orestol
with milk.
In the male, the dosage is increased until
gynecomastia occurs.
The dose is then reduced low enough that
the nipples return to normal.
Orestol E.B.S., is available in tablets of
three sizes, put up in bottles of 100 and 500 as
C.CT. #530 ...!/_ mg. CCT. #531.,
C.C.T. f 532... 5 mg.
.1 mg.
When prescribing:
specify   E.B.S. .
525 Logan Avenue, Toronto 6
A wholly Canadian Company
ESTABLISHED 1879 reater love hath no man than this,
That a man lay down his life for his frieni
John XV 13
CANADA 0~«s?s%
TABLETS Containers of 20, 100 and
J 00 tablets. Also in suppository form
for rectal use.
Physicians are cordially invited
to request clinical samples.
followed by
Soneryl is a medium acting barbiturate,
which is relatively free from undesirable
after-effects. Sleep is induced within thirty
minutes and continues restfully for six to
eight hours.
JUivv^aixriij I cmlettc ji£/i£A
OF      CAM/IDA       LIMITED  —  MONTREAL  **?'
She, and millions like her, are today spared
the physical and emotional disturbances
usually suffered by women during the
menopause. Through the use of Progy-
non her physician is making it possible
for her to negotiate the middle years of
life gradually ,~>-. and gracefully.
Progynon therapy in the menopausal
*Trade-M»rks Reg. U S. Pat. Off.
\ tt
syndrome consists of intramuscular injections of Progynon-B* until symptoms are
controlled. Therapy may often be maintained with Progynon-DH* Tablets.
137 St. Peter Montreal P|EN|CILLIN
Yes ?'+ . and* in tM 4M«9F Cottadlcm ||fUnidp||tities. too . . .
for this new antibiotic is now being dhstributed through the same
channels which moke other Parke4)avis|prescript«Ma£ products
available to the physicians and pharmacists of the countiy. fn
the short space <^f Dye years PenicHllo has developed from a
moid on a petri dish in a London laboratory to a package on
the shelves of ttw prescription rooms ;^||||pMtisands of retail
pharmacies tls^aghoil^MA United States and Canada.
To the triumphs of Fleming and Florey Wist he added the
genius of pharmaceutical productions the United States and
Canada, which rapidly developed tb# means and methods of
mass manufacture*in sufficient quantity to meet first, the needs
of the armed forces; n#x4 the demands of critical civilian cases;
then, to supply limited quantities to selected hospitals, and
finaity, to release Penicillin for general distribution.
Physicians may  HOW prescribe
dispense . . t§|
and  pharmacists
&>mde, _2W#&  & We^t/ia*^ SBte.
Montreal Toronto Winnipeg UPP
■ §
DEXTRI-MALTOSE is no ordinary carbohydrate.
Step by step, its manufacture is surrounded
with every care and precaution, evolved through
long years of experience and research. Unseen by
physician and patient are numerous safety factors,
the practical effect of which nevertheless is present
in every package of Dextri-Maltose. To name a
few of these:
1. Dextri-Maltose is sampled for bacteriological testing
before drying.
2. Steam under pressure sterilizes Dextri-Maltose filter
presses which remove proteins, fat, and indigestible
3. Blood agar tests are made to insure absence of hemolytic cocci.
4. Bacteriological tests are made in a steam-washed plating room, the air of which is filtered.
5. Dextri-Maltose containers are automatically filled and
closed without human handling of the  product.
6. The direct microscopic test which Dextri-Maltose receives is but one microbiological test which it must
routinely meet.
7. The interiors of the large converters in which Dextri-
Maltose is processed are thoroughly scrubbed prior to
steam sterilization.
8. Steaming under pressure sterilizes the converters for
processing Dextri-Maltose.
9. After being packaged, Dextri-Maltose is held in storage
and released only after final approval from the bacteriological checking laboratory.
10. Portable equipment used in manufacturing Dextri-Maltose is sterilized in autoclaves under steam pressure.
11. 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_ everlasting 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., BELLEVILLE, ONT. flfe ount pleasant IHnbertafcing do. Xtb.
KINGSWAY at 11th AVE. Telephone FAirmont 0058 VANCOUVER, B. C
Breaks the vicious circle of perverted
W   menstrual function in cases of amenorrhea,
[   tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
I    uterus and  stabilizing the tone of its
||    musculature. Controls the utero-ovarian
Ik    circulation and thereby encourages a
k   normal menstrual cycle.
ik • A
Full formula and descriptive
literature on request
Dosage: 1 to 2 capsules
3 or 4 times daily. Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, risible only when capsule  is  cut in half  at seam. MILK -
Canada'*, Vital
Milk is accepted as the most valuable protective
food because it surpasses all others in supplying
vitamins, minerals, and high quality proteins that
build and maintain sound physical fitness. No
wonder our fighting forces are among the best fed
in the world—their milk consumption is exceptionally high—and no wonder Canada's home front,
too, is by far the best fed!
A quart of milk (4 glasses) gives the following
percentages of your DAILY FOOD NEEDS.
Iron 16%
Vitamin C*%-_-16%
Energy 22%
Vitamin B __28%
* Values Variable.
Vitamin A. _. 37%
Protein __49%
Vitamin G 79%
Phosphorus    —.69%
for J€RS€Y QUALITY (&tttet &%wmititiL
North Vancouver, B. C.
Powell River, B. C.
' Nutus $c
2559 Cambie Street
Vancouver, B.C.
of endogenous origin
claimed to be allergic, may be
favored or induced by calcium
and sulphur deficiency, impaired
cell action, and imperfect elimination of toxic waste.
administered per os, brings about
improved coll nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement.
Write for Information
Canadian Distributors
350  Le Moyne   Street,  Montreal THE RESPONSIBILITY
to the medical profession has been uppermost
in our operations for over 37 years—and will
continue to govern every prescription entrusted
to us.
MArine 4161
13 th Ave. and Heather St.
Exclusive  Ambulance  Service
FAirmont 0080
W. L. BERTRAND ^00 £>*ttfs
(Sin. HxmxUb **J+
New Westminster, B. C.
For the treatment of
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
New Westminster 288
or 721 Medical-Dental Building, Vancouver, B. C.
PAcific 7823 PAcific 803-


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