History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: August, 1952 Vancouver Medical Association Aug 31, 1952

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 THE
ULLETI
H °f i .ft ?§
The Vancouver Medical Association
EDITOR
DR. J. H. MacDERMOT
EDITORIAL BOARD
DR. D. E. H.  CLEVELAND DR.  | H. B. GRANT
DR. H. A. DesBRISAY DR. J. L.  McMILLAN
Publisher and Advertising Manager
W. E. G. MACDONALD
VOLUME XXVIII.
AUGUST, 1952
NUMBER 11
OFFICERS 1952-53
Dr. E. C. McCoy Dr. D. S. Munroe
President Vice-President
Dr. George Langley
Hon. Treasurer
Dr. J. C. Grimson
■ Past President
Dr. J. H. Black
Hon. Secretary
Additional Members of Executive:
Dr. G. R. F. Elliot Dr. F. S. Hobbs
TRUSTEES
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommer, Whiting & Co.
SECTIONS
Eye, Ear, Nose and Throat
Dr. B. W. Tanton Chairman Dr. John A. Irving  Secretary
Paediatric
Dr. Peter Spohn Chairman Dr. John W. WmTELAW-Secretary
Orthopaedic and Traumatic Surgery
Dr. A. S. McConkey Chairman Dr. W. H. Fahrni Secretary
Neurology and Psychiatry
Dr. R. Whitman Chairman Dr. B. Bryson Secretary
Radiology
Dr. R. G. Moffat Chairman Dr. H. Brooke Secretary
STANDING COMMITTEES
Library
L>r. J. L. Parnell, Chairman; Dr. D. W. Moffat, Secretary;
Dr. A. F. Hardyment ; Dr. W. F. Bie ; Dr. R. J. Cowan ; Dr. C. E. G. Gould
Co-ordination of Medical Meetings  Committee
Dr. J. W. Frost Chairman Dr. W. M. G. Wilson -.Secretary
Summer School
Dr. J. H. Black, Chairman;  Dr. J. A. Irving,  Secretary;  Dr.  B. T. H.
Marteinsson ; Dr. Peter Spohn ; Dr. S. L. Williams ; Dr. J. A. Elliott
Medical Economics
Dr. E. A. Jones, Chairman; Dr. G. H. Clement, Dr. W. Fowler,
Dr. F. W. Hurlburt, Dr. R. Langston, Dr. Robert Stanley, Dr. F. B. Thomson
Credentials
Dr. W. J. Dorrance, Dr. Henry Scott, -Dr. J. C. Grimson
V.O.N. Advisory Committee
Dr. Isabel Day, Dr. D. M. Whitelaw, Dr. R. Whitman
Representative to the Vancouver Board of Trade: Dr. D. S. Munroe
Representative to the Greater Vancouver Health League: Dr. W. H. Cockcroft
Published  monthly  at  Vancouver,  Canada.     Authorized  as  second  class  mail,  Post  Office Department,
Ottawa, Ont.
.,    Nfel Page 369 n
1888    Theophylline was discovered by
Kossel. This now well known and
useful medication has the disadvantage of
insolubility and gastric intolerance.
1933    Aminophylline discovered by Gruter.
This association of theophylline with ethylene
diamine achieved solubility—a marked advance.
Its alkaline (thus caustic) reaction
and instability led to undesirable side reactions.
1950    Neutraphylline became available in
Canada after extensive laboratory
and clinical trial since its first preparation by
Maney, Jones, Gross and Korns in 1946.    |f| _
n e
■ raphy Hi n e       j|' '
neutral S| stable — soluble
1952
provides a decided advance in therapy.
It possesses ail the properties of solubilized
theophylline without the disadvantages.
Effective orally and rectally as well as by
injection (painless).
Neutraphylline is available in tablets,
suppositories and ampoules. Also supplied with
phenobarbital and with papaverine phenobarbital.
Write for complete information.
1952 marks for Rougier Freres
the beginning of their second fifty years
of devotion to medical advance
through ethical specialties of therapeutic
excellence.
Page 370 VANCOUVER MEDICAL ASSOCIATION
PROGRAMME FOR THE FIFTY-THIRD ANNUAL SESSION
Founded 1898; Incorporated 1906
The Regular Monthly Meetings of the Vancouver Medical Association are
discontinued for the summer months, but will be resumed in October.
VANCOUVER GENERAL HOSPITAL
Regular "Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.
Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
Thursday, 9:00 a.m.—Medical Clinic.
12:00 noon—Clinicopathological Conference on Newborns.
Friday, 9:00 a.m.—Paediatric Clinic.
Saturday, 9:00 a.m.—Neurosurgery Clinic.
ST. PAUL'S HOSPITAL
Regular "Weekly Fixtures
2nd Monday of each month—2 p.m Tumour Clinic
Tuesday—9 -10 a.m Paediatric Conference
Wednesday—9-10 a.m Medical Clinic
Wednesday—11-12 a.m Obstetrics and Gynaecology Clinic
Alternate Wednesdays—12 noon 1 Orthopaedic Clinic
Alernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion)
Friday—8  a.m Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m _ Surgical Conference
Friday—9 a.m Dr. Appleby's Surgery Clinic
Friday—11  a.m Interesting Films Shown in X-ray Department
Page 373 More POWERFUL
Bactericidal Action
Over a BROADER Spectrum
en
pEs"4:l" and "4:y2"
(Penicillin and Dihydrostreptomycin Merck)
FOR AQUEOUS INJECTION
PenStrep* "4:1" and "4:%" contain both rapid- and prolonged-action penicillins,
together with two different concentrations of dihydrostreptomycin, to provide:
1. powerful bactericidal action through' the mutual synergism of
these two drugs;
2. a wide range of application since the bacterial spectra
of the two drugs supplement each other;
3. a remarkably high degree of safety.
PenStrep is especially useful in treating mixed infections of susceptible gram-
positive and gram-negative organisms and may be of value in conditions of unknown
etiology pending bacterial identification.
Both forms supplied in one-dose and five-dose vials.
*PenStrep is a trade-mark of Merck & Co. Limited
MERCK & CO. Limited
Manufacturing Chntislt
MONTREAL • TORONTO • VANCOUVER • VAllEYEIEIO
Page 374 SHAUGHNESSY HOSPITAL
Regular "Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology.
Wednesday, 10:45 a.m.—General Medicine.
Wednesday, 12:30 p.m.—Pathology.
Monday, 11:00 a.m.—Psychiatry.
Friday, 8:30 a.m.—Chest Conference.
Friday, 1:15 p.m.—Surgery.
BRITISH COLUMBIA CANCER INSTITUTE
685 West Eleventh" Avenue,
Vancouver 9, B.C.
|§ SCHEDULE OF WEEKLY CLINICAL MEETINGS
Monday—9 a.m. - 10 a.m _„ Ear, Nose and Throat Clinic
Tuesday—9 a.m. - 10 a.m Weekly Clinical Meeting of Attending Medical Staff
Tuesday—10:30 a.m. - 11:30 a.m Lymphoma Clinic
Daily—11:45 a.m. - 12:15 p.m. Therapy Conference
B.C. SURGICAL SOCIETY
Spring meeting—April 25th, 26th, 1952.
EXCLUSIVE AMBULANCE
LIMITED
EM. 2266
NW. 60
OXYGEN THERAPY SUPPLIED ON YOUR ORDER
■      H   124 HR. SERVICE   ft   :|W:    M
J. H. CRELLIN W. L BERTRAND
Page 375 CANADA'S FIRST AND FOREMOST
PROFESSIONAL PHARMACY
i
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Ll<fc§£k
I*
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toacdo
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•sa».
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Medical-Dental Bufldin^
BiMrm*
criptions
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4141
^jrree C^itu oDeti
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d *JTree f-^rovincial f-^odti
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Page 376 VANCOUVER HEALTH DEPARTMENT
STATISTICS—JUNE, 1952
Total population—census figure   (final)
Chinese population	
I
Total deaths   (by occurrence)
Chinese  deaths   	
Deaths, residents only 	
June, 1952
Birth Registrations—residents and non-residents (includes late registrations)
Male   I
Female
Infant Mortality—residents only
Deaths under 1 year of age 	
Death rate per  100 live births  	
Stillbirths  (not included in above item)
June, 1952
427
401
828
28.8
CASES OF COMMUNICABLE DISEASES REPORTED IN CITY
June, 1952
Cases Deaths
Scarlet Fever  J       101
Diphtheria   	
Diphtheria   Carriers   	
Chicken  Pox        145
Measles *-	
Rubella          17
,,          98
Mumps 	
Whooping  Cough  	
Typhoid Fever 	
Typhoid   Fever   Carriers   	
Undulant Fever 	
Poliomyelitis	
Tuberculosis 	
Erysipelas i	
Meningitis 1
Infectious Jaundice	
Salmonellosis	
Salmonellosis   Carriers   	
Dysentery     —-	
Dysentery Carriers	
Tetanus   j .-- ~~
Syphilis _ — ~ i '■
12'
Gonorrhoea —	
Cancer (Reportable Resident)       12!
June, 1952
Cases Deaths
66 —
17
11
65 <CONNAUGHT>
CORTICOTROPHIN
(ACTH)
In December  1949, at  the invitation and with  the financial support of the ,
Federal and Provincial Governments,  the Laboratories undertook to produce ACTH
in Canada.
Specially collected pituitary glands were obtained across Canada through the
helpful co-operation of i the Canadian meat-packing industry. The facilities and staff
of the Laboratories were applied to the development of methods of production and
testing of ACTH, with the result that a product was prepared which met with
favourable acceptance. Under the arrangements in effect during the initial period,
supplies of ACTH were delivered to the National Research Council of Canada for
distribution for research purposes by its Advisory Committee on ACTH and Cortisone.
In January of this year the Laboratories commenced distribution of ACTH
direct to Canadian hospitals, physicians and research workers. The product was supplied
as a stable, sterile powder, protein in nature and readily soluble in water or saline.
More recently, the Laboratories developed a stable aqueous solution of ACTH
(Corticotrophin). This readily injectable form of the product, which is now available
in addition to the freeze-dried material, has a potency of 20 International Units per
cc. Both forms of the product are free from other pituitary hormones or harmful
impurities in clinically significant amounts.
Dry Powder
Sterile Solution
(in 10-cc. vials)
HOW SUPPLIED
— 10 International Units per vial
— 25 International Units per vial
— 20 International Units per cc.
Amounts of ACTH have been expressed in terms
of International Units, Provisional U.S.P. Units,
and milligrams (of an' original house-standard).
These various units represent equal amounts of
activity as assayed in rats by the ascorbic acid
depletion method.
CONNAUGHT   MEDICAL   RESEARCH    LABORATORIES
University of Toronto Toronto, Canada
Eftablithcd in 4914 for Public Service through Medical  Research  and  the development   \
of Products for Prevention or Treatment of Due ate.
DEPOT FOR BRITISH COLUMBIA
MACDQNALD'S    PRESCRIPTIONS    LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C
Page 378 It is with great pleasure that The Bulletin has devoted this issue to Cancer. In
the following pages our readers will see for themselves the great advances that have
been made in this Province in dealing with this age-old problem.
The. past twenty or thirty years have seen a great revolution in the attitude of
medicine towards problems that for ages have been regarded as insoluble, and so have
come to be accepted as necessary evils. Cancer is only one of these. Those of us who
began the practice of medicine thirty or forty years ago can remember quite well
when we accepted as inevitable such things as mental disease, heart disease, arthritis,
diabetes, pernicious anaemia, even tuberculosis, though with the developing knowledge
given us by bacteriological and epidemiological research, we were beginning to face this
particular enemy with some degree of hope. But there was nothing we could do about
the others, and the majority of the medical profession merely threw in their hands
when the deal turned up that way.
Nowadays, the whole attitude of medicine has been radically altered. We are
beginning to see that there is no such thing as an impossibility in medicine. Men of
courage and foresight have accepted the challenge of "incurable" disease. We have
only to look at the work being done in mental disease, at the results being achieved
by research and study, to receive inspiration and stimulation. Heart disease, especially
congenital heart disease and the degenerative diseases of the arterial system, are further
examples of this. No longer do we sentence the sufferer from coronary disease, for
example, to total incapacity and an early death, or what is worse, a long-drawn-out
uselessness: we give him hope and help, so that often he may live a long and useful
life. Countless babies with congenital heart disease are being cured and given a normal
life.
And the same is true of cancer. The men and women who are leading us in the
battle against this greatest of all captains of death, simply refuse to yield or accept
defeat. Year by year, through research and study, through professional and public
education, through the enlistment of the lay public, they are gaining in the fight—
often overcome for a time, but never licked. And some day, nobody knows when, we
shall find the chink in the enemy's armour, the loophole in his defences, when we
find the cause of cancer. Meantime, countless lives are being saved, relief given to
many more.
British Columbia has great reason to be proud of its Cancer Foundation. It has
had and still has, magnificent leadership. It owes much to many men of vision and
generous hearts. H. S. Foley, W. C. Ditmars, W. J. Twiss, E. W. Hamber, R. R.
Arkell, N. Levin, W. H. Malkin, E. H. Brown, A, C. Turner and many others have
given ungrudgingly of their time and money and executive ability—while among medical
men G. F. Strong (now President of the Foundation), H. H. Milburn, R. J. Harrison,
A. M. Evans, Ethlyn Trapp, H. H. Murphy and a score of others, have guided the
project wisely and well, so that today British Columbia has an equipment second to
none, to aid it in its fight against this mortal enemy. More, thanks to the long vision
of all these men, we can look forward to steady development, and the keeping pace
with modern discoveries in the line of therapy and research.
Page 379 Vancouver Medical  Association
President Dr. E. C. McCoy
Vice-President ! 7 Dr. D. S. Munroe
Honorary Treasurer Dr. G. E. Langley
Honorary Secretary ! I . Dr. J. H Black
Editor 1  Dr. J. H. MacDermot
CORRESPONDENCE
June 26th, 1952.
Dr. J. H. MacDermot,
Editor,
The Bulletin,
Vancouver Medical Association,
Vancouver, B.C.
Dear Dr. MacDermot: • ;
I have been very much interested and impressed by the series of articles and
editorials appearing in your Bulletin over the past while on Medical Economics. I felt
that I should write to you to express my appreciation and to make a few comments of
my own.
In your editorial in the May issue which reached my desk this morning, I note your
argument that prepaid medical plans are the only answer we have to prevent, in part
at least, a completely socialized form of medical care. Of course I am entirely in
agreement with this thought and very vigorously made a statement to this effect at
the main luncheon meeting of the Ontario Medical Association at which I was the
guest speaker.
The longer I am connected with prepaid medical care, however, the more I am
convinced that the statement you made that prepaid plans do not go far enough, is
true. At the present time, although rapidly expanding, our Corporation is now offering
care to only 265,000 people in this vast province—a mere drop in the bucket. I
cannot visualize, even with maximum expansion, our reaching hundreds of thousands
of people who need to be reached. It is here of course, that state subsidy must be
brought in.
You raise a second point that medical men must play fair with prepaid plans.
The conviction is growing stronger in my mind day by day that there are three types
of medical people who are going to pull down the whole medical profession unless we
can check their stupidity. In the first place there is the doctor who charges excessive
fees; this applies of course, particularly to specialists, but the general practitioners are
involved as well. We have had brought to our attention innumerable instances of
gross over-charging by specialists—fees that were just out of all reason. We know
that many of the exorbitant fees are levelled at people without any regard to their
economic status. For example, we saw that other day accounts run up by two workmen
in the U.S. for hospital and surgical fees and the total in one case was $15,000.00 and
the other was $12,000.00. These bills were incurred in a period of less than a year.
We were shown these accounts by the General Manager of one of the largest Corporations
in Canada and he assuredly is no socialist, but his comment was, "How far does the
Profession think it can get with this sort of thing?" Our own participating specialists
in P.S.I. in general bill fairly, but there is a small percentage of them who persistently
overbill everybody regardless of economic status. This of course, does only one thing—
it just creates the most frightful type of public relations in this province.
The second type of doctor who worries me is the fellow who is against the entire
principle of prepaid care and who refuses to look in the eye of reality. We have our
share of them in this province.    This fellow and people like him fortunately constitute
Page 380 a minority, but unhappily a vociferous one. In many instances I suspect that this
fellow is not so much opposed to the principle as he is to the fact that there is some
control over his fee by somebody else.
The third type is the fellow who pays lip-service to the principle of prepaid care
and who participates in the plan and then tries to steal the plan blind. Here again
men of this ilk form a minority but a tremendously important one because we realize
as we go along that unless we bring these fellows into line they will wreck any plan
that .ever operated.
I made mention of these matters in public in May in Hamilton and the repercussions have not been serious although we have had one specialist resign from P.S.I,
because of my statements. It is time that the profession gets rid of those who are
fouling our own nest.
I hope I have not burdened you with these matters but it is apparent to me that
you are seeing along the lines that we are here and I thought that the least I could
do was to acknowledge you for your recent letters and articles.
Yours sincerely,
R. M. ANDERSON, M.D.,
President,
Physicians'  Services  Incorporated.
J~
X
y
FOREWORD
BRITISH COLUMBIA CANCER FOUNDATION
G. F. STRONG, M.D., President
It is appropriate here to extend our sincere thanks to the Editor of the Vancouver
Medical Association Bulletin for making possible this special Cancer Number to mark
the opening of the new British Columbia Cancer Institute. The British Columbia
Cancer Foundation is a lay-medical community enterprise organized to bring improved
facilities for the diagnosis and treatment of cancer to this Province. The Foundation
operates the British Columbia Cancer Institute and Boarding Home in Vancouver, the
Victoria Cancer Clinic in Victoria, and Diagnostic Clinics throughout the Province.
In the early days of this organization the question was frequently raised as to why
the Government should not carry out this programme. Under our present system of
free enterprise the Government has assumed responsibility for certain aspects of public
health. For example, the care of Tuberculosis and Venereal Disease and of Mental
Disease is now an accepted Governmental responsibility. On the other hand if the
diagnosis and treatment of cancer became the responsibility of Government there would
be no reason for not extending that same service to diabetes, heart disease, and all the
other common health problems.
The policy followed by the Directors of the Foundation from the start was that
this effort should be a community one with Government aid. It is a great pleasure to
acknowledge the assistance that has always been given to our activities by our Provincial
Government. The Health Department of that Government has shown interest in
these activities from the first. In addition to grants in aid for operating expenses, our
first deep x-ray therapy machine was supplied by the Provincial Government. Since
the establishment of the National Health Grants in 1948 the portion of our operating
expenses not derived from patients' fees has been met from the Cancer Grant which is a
matching grant made up in equal parts of contributions from the Dominion and
Provincial Governments.
When the present Institute was originally planned bed accommodation was included. It may be a source of regret to many that beds are not provided in the new
building.    However, in view of the fact that the Institute is located across the street
Page 381 from the General Hospital, and in view of the fact that satisfactory arrangements have
been made with the Hospital for the accommodation of our bed patients, it was decided
by our Directors to use the funds available to provide the best possible facilities for
radiation therapy.
When the Cobalt 60 Beam Therapy Unit is installed our new Institute will have
equipment second to none for the radiation therapy of malignancy. The tunnel under
Heather Street with improved elevator service in both buildings will make the facilities
of our Institute available to all patients in the General Hospital.
S
J~
J~
THE BRITISH COLUMBIA CANCER FOUNDATION
The following brief history of the British Columbia Cancer Foundation will be of
great interest to our readers. It has been supplied by the Public Relations Department
of the B.C.C.F. through Mrs. M. Good, the head of this Department.
—Ed.
Readers of the Bulletin who were living in Vancouver in 1935 will recall a certain
luncheon, held in the Italian Room of the old Vancouver Hotel. The date was June
12th, and invitations had gone out to more than sixty of the city's most representative
citizens. The purpose of the meeting was to interest these people in the newly formed
organisation—THE BRITISH COLUMBIA CANCER FOUNDATION.
For some time before this period the British Columbia Medical Association had
expressed concern at the incidence of cancer in British Columbia, and was particularly
perturbed by the fact that nobody appeared to be doing anything about it. A special
cancer committee of the Association was set up to investigate the situation, and cooperation was sought from the Board of Trade Health Bureau and the Greater Vancouver
Health League. Each of these groups appointed two representatives and the resulting
committee of six—they were Dr. G. F. Strong, Dr. H. H. Milburn, Mr. Wm. C.
Ditmars, Dr. B. J. Harrison, Mr. W. J. Twiss and Mr. Norman Levin—recommended
that a province-wide organisation be formed to institute an intensive drive against
cancer.
Thus the British Columbia Cancer Foundation was incorporated, on May 7th, 1935,
and its objects were:
1. Collection and distribution of funds for the control of cancer in the Province
of British Columbia; 6cSj|
2. To improve facilities for the diagnosis and treatment of cancer in the Province
of British Columbia;
3. Education of the medical profession and laity in respect of cancer;
4. To  give  the necessary publicity to  the cancer problem  in  the Province of
British Columbia;
5. To engage in any research work that may seem desirable in dealing with the
cancer problem in general.
These aims were comprehensive enough in their scope, and were an assertion of
the Foundation's determination to tackle the problem systematically, and from all
angles. The difficulties would no doubt begin with the transition from the theoretical
stage to the practical.
The British Columbia Cancer Foundation was—and still is—composed of members
of our lay citizens. Between them they have, through the years, decided policy, raised
funds, formed the necessary standing committees to administer the Foundation's services,
and generally accepted the responsibilities of providing for the people of this province
the best means whereby cancer can be most vigorously combatted.
In 1935 the task ahead of them was not easy.
Page 382 lafe?
SOME OF THE STAFF
Dr. A. M. Evans, Dr. JR.. D. Nash, Dr. Margaret Hardie, Dr. R. G. Moffat.
The first step toward their goal was taken in the early part of 1936 when 3 l/z
grammes of unprocessed radium were bought. This was made possible by a loan from
the Provincial Government, and for a period of two years, in order to help the Foundation, the Honourable E. W. Hamber paid the interest on this loan. Eventually all
but one gramme of radium was sold.
The First Clinic
As yet there was no building in which to begin the diagnosis and treatment of
cancer patients. But in 1938 an anonymous benefactress left the Foundation $50,000.
This was the first sizeable sum the Foundation had received and with it the Vancouver
General Hospital Internes' Residence was converted into the first cancer clinic. At the
same time the remaining gramme of radium was processed and a qualified radiotherapist
and radiotherapy technician were engaged.
Many of us will remember the formal opening of the converted building, on
November 5 th, 1938, by the Lieutenant Governor of the Province, the Honourable
E. W. Hamber.   The first patient was admitted on Monday, November 7th, 1938.
During the war years progress was retarded. Dr. A. M. Evans, who was then
Medical Director, and Miss Dorothy Findley, the radiotherapy technician, both went
overseas with the Canadian forces, and Dr. Ethlyn Trapp took oyer the direction for
the period of the war. When Dr. Evans returned she handed back to him an Institute
which by that time was growing so rapidly that the need for X-ray facilities as well
as radium was apparent.
Page 383 The Provincial Government provided the first X-ray therapy machine, a 400 K.V.,
which went into operation in November, 1945, and its installation necessitated an
increase in staff.
Departments of X-ray therapy and Social Service were set up, Medical Records
were enlarged, and a part-time physicist came on to the staff.
In the meantime the British Columbia Division of the Canadian Cancer Society
was growing active in the field of lay education, the promotion of research and the
provision of welfare assistance.
In 1946 and 1947 the two organisations, the Foundation and the Society, arranged
joint campaigns for funds. These drives, together with bequests and legacies from
people who were sympathetic to the Foundation's ideals, made available a considerable
sum of money which was set aside for capital expansion.
At this time the President of the Foundation was Mr. Harold S. Foley, of the Powell
River Company. He was alert to the difficulties confronting .the Foundation, and
anxious that funds should be spent wisely, and it was at his insistence that Dr. Simeon
T. Cantril, Director of the Tumour Institute at Seattle's Swedish Hospital, was invited
to make a survey of the situation in British Columbia.
Dr. Cantril's recommendations bore out the original concept—the co-ordination
of all radiation therapy in one main centre, and the advisability of having beds under
the same direction if practicable. About the same time advice was sought from Dr.
Ralston Paterson, of the Holt Radium Institute in Manchester and his reactions were
a complete endorsement of Dr. Cantril's ideas.
Now that the Foundation had a blueprint from which to work it was able, in 1947,
to ga ahead with plans for a temporary building with more therapy machines and a
diagnostic X-ray Unit. This new building, at the corner of Heather Street and 11th
Avenue, was opened in 1948, and at that time facilities included a 120 KV, a 220 KV
and the original 400 KV therapy machines, a diagnostic X-ray Machine and a physics
department with Dr. Harold Batho in charge as a full-time physicist.
In 1949 a 260 KV X-ray therapy machine was added with money donated by the,
B.C. Division of the Canadian Cancer Society. The same year a photographic department was developed and a Cytology laboratory, financed by the Society, was given
space within the Institute building. A boarding home, furnished by the Society, was
opened in 1949. This home is for patients, chiefly from out of town, who are undergoing diagnostic and/or treatment procedures.
Despite this constant expansion the Foundation could not keep pace with the
demands made upon it and once again, in 1949, it had to face the fact that the building,
which had been opened only the previous year, was no longer adequate.
A long-term expansion seemed the only solution.
Property adjoining the Institute at Tenth Avenue and Heather Street was bought*
and the old house next door demolished. The Foundation entered into an agreement
with the Vancouver General Hospital to secure title to the property on which the
original building stood, and the Hospital agreed also to make available to the Institute
patients thirty beds withinj the hospital buildings. A tunnel running under Heather
Street and connecting the two institutions was decided upon.
Construction of the new building started in May, 1951, and by June of this year
most of it was ready for occupancy. The old building is in process of re-construction
and will provide for expansion of the Physics, Medical Records and Diagnostic Department, a Nurses' Lounge, a Library, a Cystoscopic Room, an enlarged Radium Department, and a Mould Room.
The new building will also house a Cobalt 60 Beam Therapy Unit, the third in
Canada.
Provincial Responsibilities
During these years of development the Foundation had not overlooked its responsibilities to the rest of the Province, and in January, 1948, the first Unit outside Vancouver was opened in Victoria at the Royal Jubilee Hospital—the Victoria Diagnostic
Page 384 Clinc with Dr. H. H. Murphy as the Director.    In 1951 this was expanded to include
treatment facilities and the Unit is now known as the Victoria Cancer Clinic.
The Foundation's original plan foresaw the need for consultative services in other
parts of the province and by the end of 1949 consultative clinics had been .established
at Penticton, Vernon, Kelowna and Kamloops. By July Nelson, Trail and Cranbrook
were included.    Prince George was added in 1951 and Prince Rupert in 1952.
Attending Medical Staff
The Attending Medical Staff of the Institute is appointed annually by the Executive
Committee on the advice of the B.C. Medical Association and a weekly clinical conference is held where new cases are discussed and former ones re-assessed.
The British Columbia Cancer Institute is one of the most modern clinics in
Canada. However, past experience has taught the Foundation to adopt a long-term
view and the present building is so constructed that several floors can be added as and
when required. One thing is certain however; just so long as we have the British
Columbia Cancer Foundation, the people of this province will be assured of the best
available treatment faciHties for cancer patients. And the public is indebted to these
visionary and far-sighted members of the laity and the profession whose industry has
made this possible.
J~
S
X
THE NEW BUILDING
By The Editor
A short while ago, in our editorial capacity, we visited the new buildings of the
Foundation: Mrs. Robertson, the Secretary, received us very kindly, and interrupted a
busy period of work to show us around, and explain everything to us.
It was a memorable voyage of discovery. We had watched the building going
up, and in a general way knew what it was for—but had no idea at all of what really
had been accomplished. The Foundation will, we understand, be holding Open House
in October, when it is formally opened, and the citizens of Vancouver will be able
to see for themselves what a magnificent piece of work this institute is. Everyone
should make an effort to go and see what has been done here.
The first thing that strikes one is the atmosphere of calm—nobody is in a hurry,
yet at every corner one sees someone working—a nurse giving a deep-therapy treatment,
a crowd of outpatients sitting reading magazines or chatting, as they wait for their
hour: administrative offices in full swing. There is a feeling of spaciousness here, as if
each department had plenty of room.   There is, too, lots of light and fresh air.
The Outpatients' Clinic is, of course, the biggest single department: as most
people who come here come on an outpatient basis: what beds are occupied for treatment are in the main building of the V.G.H. and are reached by a tunnel, one of the
many that connect the various buildings. On the main floor there are eight examining
rooms, fully equipped—where patients are examined or checked. These occupy one
corridor. Another at right angles to this houses the therapy rooms: all the machines
are on this floor—and I saw the room which is being prepared for the new cobalt 60
bomb: a massive floor of concrete with a great gutter in it, ready for the installation
of this, the third in Canada.
Then we went upstairs where on the first floor is the Conference Room, a long,
well-equipped room with comfortable chairs, where medical clinics and conferences
will be held. Some 250 or 300 can be seated here. Arrangements are made too, for
bringing in patients—with rest rooms for them and suitable nursing care.
The Medical Records room is on this floor too, and is a hive of busyness. It is in
a sense the brain of the establishment, or at least its memory centre.
The floor above has a beautiful lounge or solarium, some thirty or forty feet long
and wide in proportion.    This is a place where patients may rest and read and bring
Page 385 their friends. It has been equipped by the I.O.D.E., and is a thing of beauty. On the
other side of the hall are rooms where dressings are made to be sent out, according to
the Foundation's plan for home nursing of cancer cases.
And so it went—one finely organised and equipped department after another. We
visited the old building, which now looks so small and out-of-date, but where so much
splendid work has been done. We saw the "boarding home" with its fourteen beds,
where out of town patients can be housed, who need examination and treatment in the
Clinic, but do not need hospital beds.
As we went through all this, we thonght of the old days, when to merely mention
the word "cancer" to a patient was the equivalent of a sentence of death. To-day we
use the word, in talking to patients, almost as freely as we say "tuberculosis" to
another group of sufferers. And it is institutions like the B.C. Cancer Foundation,
who had the courage and wisdom to use the word frankly themselves, that have brought
about this change in the public attitude, Slowly, the panic that used to be the inevitable
result of diagnosis is being dispelled. People are getting less afraid—more hopeful, more
confident that much can be done for them. And this means earlier diagnosis and
earlier treatment—and this means more lives saved, less suffering and agony and some
day, please God, the end of Cancer.
V
s
X
SOME OF THE PROBLEMS OF LARYNGEAL CANCER
By DR. L. E. WOOD, Vancouver, B. C.
Malignant tumours of the upper respiratory tract are common, and whilst most
of them occur in sites other than the larynx, growths in the latter situation are all too
frequently seen. Indeed, something like 5 per cent of all malignancies of the body occur
in the larynx.1
The larynx is an ideal situation for the growth to cause maximum discomfort
and distress and often to necessitate radical forms of treatment, each of which adds
its own contribution to the misery which all too often precedes death.
On the other hand providing diagnosis and treatment are early, the larynx can
be a very favourable site in which to have a malignant growth, since treatment is very
successful and there are great possibilities from the point of view of a cure.
The first real problem of laryngeal cancer then is one of early diagnosis.
Chiefly for the purpose of description laryngeal growths are thought of as being
either intrinsic or extrinsic. Intrinsic growths are those situated within the area outlined
by the thyroid cartilage, i.e., within the voice box. If it extends outside this area it
is said to have become extrinsic. Growths also occur primarily in an extrinsic position,
but these are not regarded as true laryngeal growths.
This arbitrary placement of the growth is not entirely without clinical significance,
since intrinsic and extrinsic growth differ in their natural history, treatment and
prognosis.
Intrinsic lesionss occur anywhere in the larynx, but the common sites are:
1. Anterior part of one vocal cord.
2. Middle part of one vocal cord.
3. Anterior commissure—where the cords meet.
Intrinsic lesions derange the function of the larynx and so produce voice changes
and respiratory obstruction. Hoarseness in well over 95 per cent of cases is the earliest
and often for a long time the only symptom. Dyspnoea, on the other hand, is a late
symptom usually and is encountered far less often.
Now hoarseness is not much of a symptom. Patients too often ignore it and
indeed there are far commoner causes of hoarseness than cancer. Not infrequently
the hoarseness of cancer becomes manifest at the time of a head cold, which itself is
Page 386 a prime producer of hoarseness and voice change. The lesson here is to examine every
larynx in every patient who is hoarse, no matter whether or not the symptom would
obviously seem due to a cold or sore throat. If on examination there is nothing seen
to arouse suspicion such treatments as are necessary may be instituted and the patient
watched. If the hoarseness does not clear up rapidly further examination should be
made, and if it has lasted for more than two weeks one should be most suspicious.
This is true no matter what the age of the patient may be. Laryngeal cancer has its
greatest incidence after 40 years of age; Figi and New in a report on 380 cases found
that 84 per cent occurred in 40-70 a*ge group and 9 per cent in those under 40.
They report a case of 15 and another of 28 years of age.2
It is also accepted that men are more prone to the disease than women, about
10 to 1.
No matter what the sex or age of the patient may be, cancer should be kept in
mind as a possible diagnosis until this is proved wrong.
Laryngeal examination is of cardinal importance in making a diagnosis of any
laryngeal condition, for how else can you be sure what is wrong unless you look and
see. Indirect examination by means of a mirror is not difficult. To accomplish it a
little skill is needed and a lot of patience. True, there are several snags, but most of
these can be overcome if the examination is carried out in an orderly fashion. The
first step is to get the patient seated properly. Most people for some unknown reason
adopt the wrong position and the examiner fails to correct it. The patient should sit
well back on the-chair and sit straight up with a little forward lean. The examiner
should be seated and should be lower than the patient. The standing examiner trying to
visualise the larynx in a patient slouched backward in a disorderly manner is doomed
to disappointment. The light should be well focussed and the examiner confident that
his headmirror can throw this light into the oral cavity and move it from place to place
A
;S:v • ..o ::i-;:i:'. ft: ;-£: -* i ~:-: ::.S:V.:. :'ft A'S-;":::
Faulty Position.
Good Position.
Page 387 until all the structures to be examined have been illuminated and well visualised. The
patient is then instructed to put out the tongue as far as possible and at the same
time to breathe slowly and deeply through the mouth. ■:. It is useful to get the patient
to breathe noisily, for then you know that he is not breath holding. The tongue is
grasped with a dry cloth and should not be pulled, but rather rolled over a finger
placed undeneath it. This rolling movement causes a greater excursion of the upper
surface of the tongue than the lower, which is shorter and fixed, with the result that
the epiglottis which is attached to the back part of the dorsum is raised up. The tongue
should not be squeezed so as to cause discomfort nor should it be pushed down on the
incisor teeth. The light should be focussed on the base of the uvula and upon this
point the mirror should be placed. The mirror should be warmed to prevent steaming,
but not hot enough to burn the patient. The patient is told to breathe deeply with
the result that the soft palate moves upwards and backwards and the mirror follows
this movement and is then held firmly but gently in this new position. The larynx
should now be exposed.
Gagging is one of the common pitfalls. Too often this'is due to attempted
examination in a bad position. Often it is due to pulling on the tongue, touching the
dorsum of the tongue or the posterior pharyngeal wall with the mirror or moving the
latter in its position on the uvula. If the tongue is forcibly pulled the patient gets
a desire to swallow. The majority of patients can be examined by this means but there
remain a few who defy even the gentlest handling. Here it is necessary to render the
throat insensitive by spraying the soft palate and dorsum of tongue with an anaesthetic
(10 per cent cocaine).
§*<
The Stoma
Completely Covered When Dressed
Another snag is often presented by the epiglottis. Sometimes the epiglottis overlies
and obscures the anterior part of the larynx and manipulation may not be sufficient
to obtain a satisfactory exposure. Some of this can be eliminated by correct rolling
of the tongue instead of pulling, and some of it be getting the patient to say "eh".
Page 388 In obstinate cases it may be necessary to raise the epiglottis with a probe whilst the
patient rolls out his own tongue. Sometimes this fails either because of the intolerance
of the patient or from lack of gentleness on the part of the examiner. In this event
examination by other means (direct) is imperative since failure to visualise the anterior
part of the larynx because of an overlying epiglottis means failure to see that part of the
larynx where cancer is commonest.
Another snag is that no matter how well the larynx may be visualised a growth
may be missed because it is out of sight—this applies particularly to those lesions
under the cords or in the ventricles. In this case where you are suspicious or where
you cannot properly see because of the epiglottis overhand direct examination by a
laryngoscope should be done.
There is nothing terrible about direct laryngoscopy; it is an easy procedure, given
good preparation, and very informative. If no preparation were needed we might find
it to be a standard office procedure such as proctoscopy or vaginoscopy and in that
event probably far less cancers would be missed.
Appearances:
There are three classes of things to look for:
1. The tumour itself which may be:
a. A slight thickening or roughening of one card.
b. A  fungating  cauliflower growth.
c. Whitish red ulceration.
2. Impairment in mobility of or fixation of the vocal cord.
3. Oedema.
Spread:
Direct surface or tissue extension is the early method of spread. The lymphatic
system in the larynx is peculiar and is called a closed system and a growth may remain
for a considerable period of time without dissemination. Glands are usually involved
late and not until the growth has become extrinsic. This factor greatly influences the
prospects of treatment and the prognosis, and it is a generally accepted fact that
patients with an intrinsic lesion have great possibilities with regard to a cure and the
longer the condition goes undiagnosed the more these possibilities decrease.
Extrinsic Growths:
Spread of the growth beyond the confines of the larynx may be in any direction
and depending on this are the symptoms produced:
1. Posteriorly—over the arytenoid area into the hypopharynx and upper oesophagus.
2. Laterally—along the ary-epiglottic folds to the pyriform fossae or base of the
tongue.
3. Anteriorly—into the base of the epiglottis or tissues of the neck.
4. Superiorly—into the epiglottis or tongue.
5. Inferiorly—into the subglottic region or upper trachea.
6. Into the lymph glands.
The early symptoms of extrinsic spread are mild and misleading. Patients complain
of sensations of tickling and pricking or discomfort in the throat, of a feeling of a
lump in the throat and pain in talking or pain in swallowing. All these symptoms
have much commoner causes than malignant disease. The later symptoms are dysphagia,
local pain in the throat, earache (referred pain), dyspnoea, cough and haemoptysis
and neck swellings   (glands).
The early symptoms should never be overlooked for they do have a definite cause.
If this cause be not obvious, if there is no improvement on treatment, or if one's
suspicions are aroused, further investigation is imperative (direct laryngoscopy and
cesophagoscopy). Early diagnosis in the stage wherein these mild symptoms are manifest
will very often ensure amenability to treatment, but beyond this stage, the possibility
of successful treatment declines rapidly.
Page 389 Outside the larynx the lymphatics are abundant and extrinsic growths disseminate
quickly—therefore the prospect of treatment is not good and the prognosis bad.
Everything then depends on getting at the growth before it spreads outside of the
larynx, i.e., before the above symptoms have made their appearance.
Treatment:
The problem of therapy is essentially one for the specialist, but it is important for
patient and doctor alike to know something of the possibility of treatment. Early
treatment of intrinsic growth is highly successful. When a lesion is confined to one
vocal cord, the cure rate is around 90 per cent. The voice remains, but may vary from
being harsh and husky (if surgery is performed) to more or less normal (with certain
types of irradiation).
In certain intrinsic growths and some of the extrinsic ones radical surgery may
be the treatment of choice. This consists of total excision of the larynx. The trachea
is brought to the skin surface low down in the neck and the continuity of the pharynx
and esophagus preserved. This procedure in select cases gives excellent results although
it has received much criticism from certain quarters. The main points of criticism seem
?||f to be 1, That it is unnecessarily mutilating, and 2, the patient is robbed of his voice.
It would seem timely to answer these criticisms.
No procedure designed to preserve life would seem unnecessary. The absence of
the larynx causes the outline of the neck to be depressed and the operation scars are
conspicuous only for a few months. Apart from this the only other evidence of
mutilation is the stoma. This tracheostoma is small and lies low in the neck, being out
of sight when the shirt collar is fastened. Breathing is not objectionable and indeed
hardly noticeable to the patient or his friends. Swallowing is natural and the patient
can smoke as much as he likes and enjoy it.
Speech does not depend upon the larynx but upon the supralaryngeal structures—
pharynx, palate, tongue and lips. Nor is the larynx necessary for the whispered voice
for normal people. Laryngectomy then only robs the patient of his power to make a
noise which noise is used by the other structures to develop speech. Therefore if the
patient can learn to make* a substitute noise he will be able to speak loudly and clearly.
Experience bears this out.
The older method of voice training depends on the regurgitation of air, but
oesophageal speech of this type has several disadvantages although it is fairly easy to
learn. Harder to acquire but of much better quality is pharyngeal speech. The basis
of this is the taking in of air at the mouth and nose (by suction) holding it in the
pharynx by a trigger-like action of the tongue and releasing it slowly, allowing it to
vibrate against the palate and pharynx. Our patients start smoking on the first postoperative day; there is a little hesitancy at first but progress is quick, and we show
them that if they can suck smoke in at the mouth and hold it and then blow it out
of the nose and mouth they can do the same with air, and if they can do that they
will learn to talk again.
The fact that laryngectomy does not materially affect the whispered voice gives
a good background for rehabilitation. Given a whisper, a well functioning pharyngeal
suction pump and a psychologically attuned patient, in time that patient will develop
an excellent voice.
The psychological attitude both toward the cancer and the proposed method of
treatment is terribly important and presents quite a problem.
There are those who are spiritually defeated on learning the diagnosis, and again
there are those who accept it and enquire into what is to be done. There are those
who in spite of explaining to the contrary are sure they will be left speechless, some,
the very old, are not temperamentally suited to the procedure. Many snatch at the
prospects of a cure without fully realizing all that is involved. I believe that all
candidates should observe the results for themselves and it is my practice to get them
to meet a patient recently laryngectomized.   They see and hear.   They look at the
Page 390 neck and the stoma, they see the patient smoke, eat and drink and they hear his voice,
however poor. If they can accept this and make up their minds to be every bit as good
only then do I consider laryngectomy. For laryngectomy is only the method of choice
for a few select sufferers. Imagine for a moment the hypothetical case of a foreigner
with poor command of English, an older person perhaps, and one who cannot write:
probably he is bewildered and does not fully appreciate what it is all about. This man
I suggest is the worst possible candidate for operation, for no matter how successful
the operation may be from a surgical point of view, he will be left excommunicated,
unable to express himself, useless and pitiable. •
But if the patient fully realizes that he can and will talk again, eat, drink and
smoke normally and with enjoyment, be able to work and live a fairly normal life, if
he makes up his mind to do just this, then and only then does laryngectomy become
not only necessary and justifiable but also imperative and is by way of being one of
the most satisfying things that one man can do for another.
REFERENCES
1., 2.—Histopathology of Ear, Nose and Throat, EGGSTON & WOLFF, page 1015.
PUBLIC HEALTH AND MENTAL HEALTH NEWS
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health, Province of British Columbia
H A. M. GEE, M.D.,
Director, Mental Health Services, Province of British Columbia
THE RELATIONSHIP BETWEEN TIJE PROVINCIAL
HEALTH BRANCH AND THE B.C. CANCER FOUNDATION
The B.C. Cancer Foundation has for many years been the organization taking
the major interest in the control of cancer in B. C. Through the B. C. Cancer Institute
in Vancouver, the Foundation has conducted a programme of diagnosis and treatment
of those suffering from this disease.
Prior to the inception of the National Health Grants in 1948, considerable
discussion had taken place regarding ways and means of expanding the programme and
stabilizing its financial status. However, no final decision had been made at the time
the National Health Grants were announced. In view of the large amounts of funds
which would become available through the National Health Grant for cancer, Dr.
O. H. Warwick, executive director, National Cancer Institute of Canada and Canadian
Cancer Society, agreed to in the fall of 1948, to carry out a survey on all phases of
the cancer problem in this province.
A logical outcome of the recommendations made by Dr. Warwick in his report,
"The Care of the Cancer Patient—With Special Reference to the Province of British
Columbia," was the decision to name the B. C. Cancer Foundation agent of the
Province of British Columbia in the-provision of diagnostic and treatment services for
cancer. In effect, therefore, the programme of the B.C. Cancer Foundation is the cancer
control programme in this province.
After the B. C. Cancer Foundation had been named as the agent of the province,
it was agreed that the Provincial Health Branch would assume responsibility for the
operating expenses of the B. C. Cancer Institute, although one-half of these expenses
are reclaimed from the National Cancer Control Grant. Prior to this time the Provincial Health Branch had made annual grants to the B. C. Cancer Institute, but there
had been no fixed policy. The new arrangement also applies to the operating expenses
of the services which have since been added, namely, the nursing home, consultative
Page 391 cancer clinics and the Victoria cancer clinic. Assistance from the Cancer Control
Grant and the matching provincial funds has also been given to the B. C. Cancer
Foundation for the purchase of equipment.
The importance of cancer control is readily acknowledged. Progress undoubtedly
is being made through a sound programme in British Columbia which is a co-operative
effort between the Provincial Health Branch, the Canadian Medical Association, B. C.
Division, and our voluntary agencies, the B. C. Cancer Foundation and the Canadian
Cancer Society, B. C. Division.
The programme must be geared to the problem, and the problem is known only
as the result of adequate reporting of cases. The accompanying tables and comments,
prepared by the Division of Vital Statistics, Provincial Health Branch, reveal the
importance of the problem which would undoubtedly be much greater if all cases were
reported. Ill
The most frequently used measure of the extent of the problem of malignant
tumours is the count of deaths ascribed to this cause. However, for obvious reasons,
mortality statistics give an incomplete picture of the incidence and prevalence of the
disease. Yet in planning treatment facilities, it is most important to have this later
information. In an attempt to obtain more useful information, the Provincial Health
Branch has maintained a reporting system and his obtained certain data from the
malignancy reports received. The following tables present a brief summary of the
number of new cases reported during 1951 and also the number of deaths registered
from this cause. It will be seen that the number of new cases reported is only slightly
in excess of the total number of deaths. The number of new cases would undoubtedly
be considerably greater if complete reporting were achieved. More extensive analyses
and cross-classifications of the reported morbidity and the mortality, including age-
specific rates, have been made, and are available upon request.
Although cancer was made a notifiable disease in this province at the request of
the B. C. Medical Association, less than twenty per cent of the new cases have been
reported directly by the physicians. The other eighty per cent have been located by
checking biopsy reports, reports from the B. C. Cancer Institute, and reports from
general hospitals. The attention of all physicians is directed to the importance of
reporting all new diagnoses of malignancies, in order that a true assessment of the
problem may be made.
MALIGNANT NEOPLASMS
New Cases Reported* and Deaths Registered.
By site and sex—1951
SITE
Male
New-
Cases
Skin   241
Digestive System  190
Genital  System    121
Breast     6
Respiratory System   ->— 93
Buccal Cavity   122
Blood and Lymphatic System  3 8
Urinary System  71
Brain 1 II ~ 4
Endocrine Glands   5
Other      37
Total 	
*Reported prior to death.
Page 392
Deaths
13
442
102
2
166
30
82
67
30
4
31
928       969
Female
New-
Cases     Deaths
176
161
234
278
19
31
19
31
4
14
23
5
266
132
159
34
9
56
25
20
12
20
990  738
Total
New
Cases Deaths
417
351
355
284
112
153
57
102
8
19
60
18
708
234
161
200
39
138
92
50
16
51
1,918 1,707 MALIGNANT NEOPLASMS
New Cases reported* and Deaths registered
By Age-group and sex,  1951
AGE-GROUP Male Female Total
New New New
Cases       Deaths Cases    Deaths Cases  Deaths
0-9         111 8 10 9 21
10-19        5 5 5 4 10 9
20-29  . \       7 10 23 7 30 17
30-39  j T__    27 19 85 24 112 43
40 - 49  I     69 48 141 73 210 121
50 -59  _!_„ B   171 130 243 148 414 278
60 169  ... 276 296 223 204 499 500
70 - 79  |  254 339 171 204 425 543
80 and over  p     89 111 57 64 146 175
Not stated  .     29 — 34 — 63 —
Total   928      969 990      73 8 1,918   1,707
""Reported prior to death.
BIOPSY SERVICE
The Provincial Biopsy Service, which was inaugurated in February, 1950, provides
for free biopsy services relating to cancer to be carried out by those hospitals employing
certified pathologists. The service is available to anyone in the province either as an
in-patient or out-patient at a hospital or phyisician's office. The physician may refer
the tissue specimen to any one of the following approved hospitals for examination
without charge to the patient providing the specimen is accompanied by the Biopsy
Request Form:
i$l*ff; Royal Jubilee Hospital, Victoria.
St. Joseph's Hospital,  Victoria.
Vancouver General Hospital, Vancouver.
St. Paul's Hospital, Vancouver,
North Vancouver General Hospital.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
During the nine months ending December, 1950, 6,965 examinations were
carried out under this service. For the corresponding period in 1951, 8,983 examinations were done, or an increase of 20 per cent. The percentage of specimens examined,
which were found to be malignant, increased from 12 per cent in 1950 to 14 per cent
in 1951. Although the increase in the number of specimens examined is no doubt due
in part to the fact that this is a new service, the large volume of examinations done,
as well as the increase in the percentage of specimens found to be malignant, indicates
that the need for this type of service is being met.
In addition, these hospitals continued the examination of specimens originating
in their own hospitals. The total number of examinations done on specimens originating
in the hospitals was 14,986 for the nine months ended December, 1950, and 16,440
for the same period in 1951, or an increase of 9.7 per cent. The percentage of these
specimens found to be malignant was 6.8 per cent in 1950 and 9.1 per cent in 1951.
The main factor contributing to the lower ratio of malignancy found in this group
as compared to the specimens referred under the Biopsy Request Form is the policy
of the routine examination of large numbers of specimens from hospital in-patients
regardless of whether or not malignancy is suspected.
In the two-year period ending March, 1952, the total number of specimens examined, including those originating in the hospital as well as those referred under the
Biopsy Request Form, was 61,021, of which 6,033, or practically 10 per cent were
found to be malignant.
Page 393 1
2.
3.
4.
5.
6.
COLLEGE   OF a
^5js&
« BRITISH COLUMBIA
REQUIREMENTS FOR MEDICAL REGISTRATION
IN BRITISH COLUMBIA  ft
The following information is submitted by the Council of the C.P.S., in full, for
the guidance of:
'A*    Doctors who intend making application for registration in this province.
B. Internes who intend applying for hospital positions.
C. Hospitals in British Columbia who employ internes.
D. Applicants for Enabling Certificates  to  write  the  examination  of  the  Medical
Council of Canada   (L.M.C.C.).
A. REGISTRATION.
A doctor who is applying for registration shall complete the prescribed form and
fulfil the following requirements;
1.     An applicant must be a graduate of a medical school approved by the Council of
the College of Physicians and Surgeons of British Columbia.
An applicant must be a Licentiate of the Medical Council of Canada (L.M.C.C.).
An   applicant   shall  present   a   certificate   of  having   completed   twelve   months
interneship in a hospital approved by Council.
An applicant, not being a Canadian or a British subject, shall have filed intention
of becoming a Canadian citizen, and produce documentary evidence of having
done so.
An applicant must be able to read, write and speak the English language.
An applicant shall be required to make a personal appearance Before the Committee
on Registration and produce original documents regarding his qualifications (including passport and visa).
General Information—The fee for registration is $200.00.    Temporary permits to
practice  are not  granted.     Under no  circumstances  can  interim  certificates  be
added for purposes of locum tenens.
7.     Applicants are advised that it may require sixty days for completion of registration
procedure outlined herewith.
B. INTERNES.
Medical graduates who are accepted by a hospital in British Columbia should complete their registration in this province or be covered by an Interim Certificate.
Interim Certificates cannot be granted to undergraduate internes or for purposes
of locum tenens.
Applications for "Interim Certificates" are submitted to the Registrar of the
College of Physicians and Surgeons of B.C., by the hospital concerned. An applicant is required to complete the prescribed form, and appear in person before the
Committee on Registration. He must be a graduate of a medical school approved
by the Council of the College of Physicians and Surgeons of B.C. Interim Certificates are issued without charge.
Page 394 C. HOSPITALS.
Hospitals approved for interne training are requested to apply to the College of
Physicians and Surgeons of B.C. for the necessary application forms for graduate
internes not registered in this Province. This Certificate may only be granted to
graduates of Universities approved by the Council, as provided under Section 38 of
the Medical Act. They shall forward a list of graduate internes employed, showing
medical degrees and where obtained. The necessary application forms will then
be forwarded to the hospital together with the advice that these applicants must
appear in person before the Committee on Registration.% On receipt of these completed forms the Registrar will advise the hospital the date of meeting of Committee on Registration at which applicants are to appear.
The following general hospitals in British Columbia are approved for Interne
training:
Vancouver General Hospital, Vancouver
St. Paul's Hospital, Vancouver
Shaughnessy Hospital, Vancouver
Royal Columbian Hospital, New Westminster
Royal Jubilee Hospital, Victoria
St. Joseph's Hospital, Victoria
Veterans Hospital, Victoria
In the case of foreign graduates it is recommended that their qualifications be
submitted to the Registrar for inspection prior to their appointment as an Interne.
The Registrar may only issue an Interim Certificate to a graduate of a medical
school approved by the Council of the College of Physicians and Surgeons of B.C.
D. ENABLING CERTIFICATES.
The Medical Council of Canada requires an Enabling Certificate from all applicants
who wish to take their examinations. This certificate may be obtained from the
licensing body of any Canadian province, provided that the applicant fulfils the
requirements of the province concerned.
In order to be granted an Enabling Certificate from the College of Physicians and
Surgeons of B.C., the applicant must complete the prescribed form and fulfil the
following requirements;
1. An applicant must be a graduate of a medical school approved by the Council of
the College of Physicians and Surgeons of British Columbia.
2. An applicant must be able to read, write and speak the English language.
3. An applicant shall be required to make a personal appearance before the Committee on Registration and produce original documents regarding his qualifications.
4. The applicant shall present a certificate of having completed twelve months
interneship in a hospital, approved by Council.
5. Applications must be submitted to the Registrar of the College of Physicians and
Surgeons of B.C. not later than ninety days prior to the date of examination of
the Medical Council of Canada.
General Information—If there is any doubt as to the experience and qualifications
of the applicant, he may be required to take an examination in basic sciences.
Particulars regarding the examination of the Medical Council of Canada may be
obtained from—
The Registrar,
Medical Council of Canada,
150 Metcalfe Street,
Ottawa, Ontario.
Fee applicable for an Enabling Certificate.
Any person who,
1.     In the opinion of the Council has been for a period of not less than five years a
bona fide resident of British Columbia; or
Page 395 Has taken his pre-medical course in the University of British Columbia;
shall be granted an Enabling Certificate for Five Dollars ($5.00).
For all other applicants the fee shall be Twenty-five Dollars ($25.00).
Inquiries and requests for application forms should be addressed to:
The Registrar,
College of Physicians and Surgeons of B.C.,
1807 West Tenth Avenue,
Vancouver 9, B.C.
CANADIAN MEDICAL ASSOCIATION - B. C. DIVISION
October,   1951   —  September,   1952
OFFICERS
President . Dr. H. A. L. Mooney, Courtenay, B.C
President-Elect _Dr. J. A. Ganshorn, Vancouver, B.C
Vice-President Dr. R. G. Large, Prince Rupert, B.C.
Honorary Secretary-Treasurer Dr. W. R. Brewster, New Westminster, B.C.
Chairman, General Assembly . Dr.  F. A.  Turnbull, Vancouver, B.C.
STANDING COMMITTEES CHAIRMEN
Constitution and By-Laws . Dr. R. A. Stanley, Vancouver, B.C.
Finance Dr. W. R. Brewster, New Westminster, B.C.
Legislation Dr. J. C  Thomas, Vancouver, B.C.
Medical Economics Dr. R. A. Palmer, Vancouver, B.C.
Medical Education . Dr.   G.  O.  Matthews, Vancouver, B.C.
Nominations Dr. H. A. L. Mooney, Courtenay, B.C.
Programme and Arrangements Dr. R. C Newby, Victoria, B.C.
Public Health Dr.  G.  F.  Kincade,  Vancouver,  B.C.
SPECIAL COMMITTEES CHAIRMEN
Arthritis and Rheumatism ..—Dr. A. W. Bagnall, Vancouver, B.C.
Cancer Dr. A. M. Evans, Vancouver, B.C.
Civil Defence Dr. L. H. A. R. Huggard, Vancouver, B.C.
Emergent Epidemics Dr. G. F. Amyot, Victoria, B.C.
Hospital Service Dr.  J.  C  Moscovich, Vancouver, B.C.
Industrial Medicine Dr. E. W. Boak, Victoria, B.C.
Maternal Welfare s. Dr. A. M. Agnew, Vancouver, B.C
Membership i Dr. L. H. Leeson, Vancouver, B.C
Pharmacy Dr. D. M.  Whitelaw, Vancouver, B.C.
Those who read the following articles may be struck by the fact that the subject
matter is mostly devoted to the activities of a local medical association. A word of
explanation may therefore be in order. It will be apparent that the affairs of regional
societies are not the concern of the B.C. Division as a rule. The Vancouver Medical
Association is, however, to a certain degree an exception, in that some of its most
important activities very definitely affect the profession in this Province as a whole..
When we recall that this Association has served the Profession in British Columbia for
about half a century, through its Library, its Summer School and its Bulletin, and that
''The Bulletin" has become the official organ of the B.C. Division, it will be obvious
that its future is the concern of every doctor in British Columbia. For this reason we
have had the temerity to discuss its affairs in the following paragraphs.
Page 396 When the B.C. Division began to conduct the business of the Profession, space was
allotted in "The Bulletin" for the presentation of its activities. In effect, this publication became the official organ of the B.C. Division and it is hoped that this portion of
the journal may be greatly improved and expanded. In the mean time, the editor of
this section would welcome questions, comments, suggestions and criticisms from
members of the C.M.A.—B.C. Division. In this way the "Cloakroom" discussions may
be the means of bringing enlightment and enjoyment to the entire Profession.
■'%$ —G.C.J.
X J~ X
THE DOCTOR AND THE MEDICAL SOCIETIES
Don't worry, this is not going to be a learned treatise, but just a few thoughts
that come to mind in considering this subject.
Medical men have always felt the need of an association where they could get
together, and discuss their mutual problems. For example, in 1898, the doctors of
Vancouver appreciated this, and so was formed the Vancouver Medical Association.
This society has had quite a saga, and as the wants of the doctors expanded, it responded with the formation of a library, which is one of the best medical libraries
to be found; a publication for the dissemination of medical and other news to all the
doctors in the province; a forum for discussion of medical, economic and any other
problems that might arise; a benevolent fund, now merged with the provincial fund
under the council of the college; a most effective public relations committee, who get
results, though perhaps not always in the way some of the doctors might have thought
best; the annual Summer School, a very excellent refresher course open to everyone in
B.C.; regular monthly business and clinical meetings. These are but a few of the
achievements of the Vancouver Medical Association.
Gradually, there arose a need for a province wide organization, so the British
Columbia Medical Association came into being. This has recently been revitalized and
reorganized as the B.C. Division of the C.M.A. As you know, the Council of the
College of Physicians and Surgeons has handed over to this body all functions, except
those specifically the property of the council. So, the economic affairs of the profession
in B.C. are under the guidance of this group. With the modern trends in affairs,
including the growing tendency for governments to intervene in our lives, this has
become a most important organization to which we must all give our support, for the
effectiveness of the society in dealing with any other group is in direct proportion to
the number of doctors belonging.
To return tothe V.M.A., though some of its functions may have been taken over
by other groups, it is now becoming even more important than ever. It retains its
value in the clinical field, but even more necessary are the business meetings. For while
it is important that we all belong to the provincial association, yet, owing to size and
geography, it is obviously impossible to have too frequent meetings of the entire
organization, or even the smaller Assembly, and we must leave the management of our
affairs to the elected representatives in the executive. However, the monthly business
meetings of the V.M.A. give us all an opportunity to bring up any subject on which
we feel some discussion will be of benefit. And one can be certain that any important
points raised there will rapidly find the ear of the provincial executive. This is the best
method of communication to that executive, and is of great help to them, in that they
are most anxious to have our views on various problems which arise, so by belonging
to and attending regularly at the meetings of the V.M.A., one is in a position to have
some say on what goes on. Don't do your crabbing in the doctor's room at the hospital,
but bring it out into the open at these meetings, and let some action be considered to
improve those things to which you object.
So, the reluctant conclusion to which I am forced is, that in one's own selfish
interests it is wise to belong to both the V.M.A. and the B.C. Division of the C.M.A..
—F. L. SKINNER.
Page 397 The Library
The Vancouver Medical Association Library had its beginning at a meeting held
in October, 1902. At that time Dr. Brydone-Jack gave a notice of motion as follows:
"That this Association form a medical club, for the purpose of renting a suitable room,
furnishing the same, and providing medical periodicals for the use of its members; also
starting a Medical Library and Reading Room."
The library had a small beginning and the first amount of money collected for
the start of the library was two hundred and fifty dollars. It was not, however, until
March of 1906 that the Library actually had a home of its own, and this was in a
house at the corner of Hastings and Granville streets, where a suitable room was found
to house the library at a rental of twelve dollars a month. From this very modest
beginning, the Library gradually grew and extended its activities until at the present
time we have the library housed in the Academy of Medicine Building on the corner of
Burrard and Tenth avenue.
Between 1906 and 1952 the library has had many financial struggles but it has
gradually grown until at the present time we have about eleven thousand volumes. In
addition to this, the medical and surgical journals received are one hundred and sixty-
seven. The more important ones of these are well bound. There is a good section on
the history of medicine together with the section on medical biographies, etc. The
librarian and her assistant perform many functions and bibliographies are prepared
upon request. Any* references that the Doctors may desire or any other information are
looked up and given as soon as possible to the inquirer.
The library maintains a messenger service for members living in the city and books
are mailed to members in and out of the city, postage being paid both ways by the
library. There is a microfilm service and photostats are requested for those articles not
in the library and there is an inter-library loan service for books not in the library.
During the winter months the library is open until 9:30 p.m. from Monday to
Friday for the benefit of those people who are not able to go to the library during the
day time.
In our present library there are two good reading rooms and five study rooms
together with a dark room for reading microfilms available for all members.
The librarian and her assistant are always on hand to give personal service to any
members who visit the library.
During the past several years medical libraries have been started in the various
hospitals in the city; namely at St. Paul's Hospital, The Vancouver General Hospital
and at the Shaughnessy Military Hospital. Libraries within the hospital are maintained
by the hospitals themselves and they are to serve the members of the hospital staff.
The predominant library in B.C. is that of the Vancouver Medical Association which is
available to all members and associate members. The Committee in charge of the
library are very active and they endeavour with the money allotted to them to give
the most valuable service possible.
On going over the history of our library, I find that from a small beginning in
1902, until its present status, that the finances required to bring it to this size have
always been provided by the members of this association. The library is supported
entirely by the funds collected as dues from the Vancouver Medical Association and this
library has always been in the past a major educational influence with the Association.
To allow anything to interfere with the development and progress of the library would
directly detract from the value of the Vancouver Medical Association.    |
The library is an essential part of any strong medical association, and the members
of the profession in Vancouver will wish to maintain the present standards and high
degree of usefulness, for with the increasing perplexities of medicine, it is more necessary than ever to have a proper place for reference. The library has in the past served
Vancouver medical men well, and it will continue to do so in the future.
—W.J.D.
Page 398 A SPECIAL LETTER—REPRINTED
July 15th, 1952.
Nineteen hundred and nineteen people who journeyed to the Banff Springs Hotel
and the Chateau Lake Louise during the week of June 9th, 1952, made the Eighty-third
Annual Meeting of the Canadian Medical Association one of the most notable in its
history.
With superb setting, a well-balanced programme and a kindly disposed weatherman,
the Convention just had to be a success.
But there were other happenings, too, which, in retrospect, make this meeting
not only memorable but something which should give every member a sense of pride
and satisfaction.
Your General Council, with one hundred and ten delegates present from the ten
Divisions, came to grips with the medical problems of Canada in a statesmanlike manner.
We all know—perhaps some of us vaguely—that such things as medical economics,
public relations, hospital accreditation, voluntary plans for medical care, undergraduate
and postgraduate medical education, national and international obligations—are of much
concern to Canadian doctors.
We also know that Canadian citizens, including politicians, are, in increasing
numbers, taking more than a casual interest in what we have been pleased to call "our
business". We cannot, and should not, ignore these facts. And your General Council,
with full appreciation of its obligations to every one of our nine thousand members,
determined that all of the problems which face us must be met intelligently and
effectively.
We have an excellent Journal which reflects the best efforts of Canadian doctors,
but with constantly rising costs we find that the Journal will cost $125,000 to
produce in the coming year.
The hospitals of Canada require inspection and accreditation. A Joint Commission
of the Canadian Medical Association, the Canadian Hospital Council and the Royal
College of Physicians and Surgeons of Canada is being set up to help every hospital in
Canada to improve its standards and usefulness. There is every likelihood that
this will cost the C.M.A. between $15,000 and $20,000 next year.
One year ago your Association founded the Trans-Canada Medical Services—a
Federation of the Voluntary Prepaid Medical Care plans sponsored by our Divisions.
The movement was commended in the House of Commons by the Prime Minister of
Canada. Our hope is that this may prove to be the answer to National Health Insurance.
Our contribution to the effort is $8,000 for this coming year—a small price to pay
for a very worthy purpose.
Medical economics, the study of our economic and social welfare, will cost us
$10,000 next year. And there is every possibility of this sum being considerably
increased.
The truth of the matter is that new projects demanding more staff, and increased
costs of our many activities call for a budget in the coming year of $75,000 more
than our present revenue from members' fees and advertising would produce.
What is the answer? Your General Council, without a dissenting vote (there
were a few abstentions), decided that our annual fee would have to be increased to
$20.00, effective January 1st, 1953.
Our present fee of $10.00 a year is exactly what it was in 1922—thirty-two years
ago. A look at National Medical Association fees around the world discloses that they
have in most instances increased 100 per cent or more in the last few years.
But your General Council didn't increase the fee because we were out of date
or out of line—not at all. Your General Council, after long and careful debate,
decided that the fee simply had to be increased if the Association is to do the job
which every member expects it to do.   And we must not fail.
Page 399 Your General Council is confident that you and all other members will recognize
that the Canadian Medical Association is the voice of Canadian Medicine. The Association belongs to you and you to it. We send you this letter now in order that you
may be fully informed of the vital necessity of increasing the Association's revenue.
We hope that, when your Provincial Division a few months hence, approaches you
for annual dues for 1953, we will have your containued support.
Yours sincerely,
Harold Orr, President Edward S. Mills, Honorary Treasurer
Norman H. Gosse, Chairman of General Council
T. C. Routley, General Secretary
X
S
X
CANADIAN MEDICAL ASSOCIATION—3. C. DIVISION
1952—CONVENTION        |   f
EMPRESS HOTEL, VICTORIA, SEPTEMBER 15-18 Inclusive
SUNDAY 10:00 a.m.    Board of Director.
September 14
Nominating Committee.
Louise Private Dining Room.
REGISTRATION—Hotel Lobby.
General Assembly—BALLROOM.
Official Opening of Medical Exhibits.
General Assembly reconvenes till noon.
General Assembly reconvenes for the whole afternoon.
Meetings of Sections.
'REGISTRATION.
College of Physicians and Surgeons—Annual Meeting.
Annual Luncheon—Crystal Gardens.
Guest Speaker: Dr. Harold Orr, President, C.M.A.
Surgical Round Table Conference.
"Emergency Surgery of the Newborn."
Chairman: Dr. J. Stenstrom.
Moderator: Dr. Rocke Robertson.
Members: Dr.  H.  Richard,
Dr. A, H. Bill Jr.,
Dr. J. R. Neilson.
ANNUAL GENERAL MEETING—
C.M.A.—B.C. Division.
MONDAY
8:00 a.m.
September 15
8:30
9:00
10:30
11:00
2:00 p.m.
8:00
TUESDAY
September 16
8:30 a.m.
9:30
12:00 noon
2:30 p.m.
8:00
WEDNESDAY
September 17
8:45 a.m.
9:00  a.m.
9:00
REGISTRATION.
Clinical Session.
Chairman—Dr. R. Burns.
"Carbon Tetrachloride poisoning.
of fire extinguishers."
Dr. K. Hamilton—Edmonton.
A health hazard
Page 400 9:30
10:00
10:30
10:50
11:30
1:00
8:00
p.m.
"Irreducible Intussusception in infants."
Dr. H. Richard—Edmonton.
"Treatment   of   inguinal   and   umbilical   herniae   in
infants and children."
Dr. A. H. Bill, Jr.—Seattle.
INTERMISSION.
"Systematic Lupus Erythematosus."
Dr. H. Orr—Edmonton.
"Medical Economics."
Dr. R. W. Richardson—Winnipeg.
Chairman—C.M.A. Economics Committee.
Golf—Victoria Golf Club.
Supper Dance—Crystal Gardens.
THURSDAY
September 18
8:45
9:00
a.m.
10:30
11:00
noon
p.m.
6:30
7:30
REGISTRATION.
Clinical Session.
Chairman—Dr. M. Mitchell.
"The Traumatised Hand."
Dr. H. Richard—Edmonton.
"Depressive Reactions in W.C.B. Settings."
Dr. K. Hamilton—Edmonton.
"Management of Obstruction of the Intestinal Tract
in Infants and Children."
Dr. A. H. Bill, Jr.—Seattle.
INTERMISSION.
"Congenital Abnormalities of the Rectum and Anus."
Dr. A. H. Bill, Jr.—Seattle.
New Board of Directors—Luncheon.
Private Dining Room—Empress Hotel.
Medical Round Table Conference.
"Care of the Aging."
Chairman: Dr. S. G. Kenning.
Moderator: Dr. R. B. Kerr.
Members: Dr. R. A. Hunter,
Dr. K. A. Hamilton,
Dr. M. M. Baird,
Dr. B. M. Fahrni.
Cocktails—Lower Lounge.
ANNUAL DINNER—Ballroom.
Guest Speaker—Mr. S. Keate.
X
X
x
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