History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: July, 1931 Vancouver Medical Association Jul 31, 1931

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Published  Monthly  under  the  Auspices  of  the  Vancouver  Medical  Association  in  the
Interests of the Medical Profession.
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the abovs address.
Vol. VII.
JULY, 1931
No. 10
OFFICERS 1929-30
Dr. C. W. Prowd Dr. E. Murray Blair Dr. G. F. Strong
President Vice-President Past  President
Dr. L. H. Appleby Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Executive:—Dr. A. C. Frost; Dr. W. L. Pedlow
Dr. W. D. Brydone-Jack Dr. J. A. Gillespie Dr. J. M. Pearson
Auditors:   Messrs. Shaw, Salter & Plommer
Clinical Section
Dr. J. E. Harrison^ Chairman
Dr. A. M. Agnew ; ; Secretary
Eye, Ear, Nose and Throat
Dr. N. E.  MacDoOGALL Chairman
Dr. J. A. Smith Secretary
Pediatric Section
Dr. C. A. Eggert  Chairman
Dr. S. S. Murray ■ Secretary
Library Orchestra Summer School
•~~,,,„ t-.tt>t-> Dr. R. P. Kinsman
Dr. D. M Meek,son Dr. J. R. Davies Dr   w   l   g
Dr. W. H. Hatfield Dr. F. N. Robertson Dr   q £   Brqwn
Dr. C. H. Bastin Dr. J. A. Smith Dr   T  L   Butters
Dr. C. H. Vrooman Dr. J. E. Harrison Dr; £ ^  Vrooman
Dr. C. E. Brown Dr j  w Arbuckle
Dr. H. A. Spohn               '                    Publications
Dr. J. M. Pearson Dr. W. C. Walsh
Dinner Dr. J. H. MacDermot Dr. F.  W. Lees
Dr. J. E. Harrison Dr- d- e- h- Cleveland Dr. A. W. Bagnall
Dr. H. H. Pitt Dr. F. J. Buller
Dr. N. McNeill                                      Credentials y Q ^ Advkory Board
r, *        t,  ^   'M j   a Dr. A. J. MacLachlan Dr. Isabel Day
Rep. to B. C. Med. Assn.   _      .  *'..  ,. ,.T t^«   u   tr  o
* Dr. A. Y. McNair Dr. H. H. Caple
Dr. H. H. Milburn Dr. T. L. Butters Dr. G. O. Matthews
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT
Total  Population   (Estimated)
Asiatic Population  (Estimated)
Total Deaths _.	
Asiatic Deaths	
Deaths—Residents  only	
Birth Registrations	
Male      193
Female 169
Deaths under one years of age	
Death Rate—Per 1000 births	
Stillbirths (not included in above) —
per 1,000
Smallpox '.         0
Scarlet  Fever         13
Diphtheria     .        14
Chicken-pox       54
Measles            1
Mumps        108
Typhoid Fever	
Meningitis   (Epidemic)	
Encephalitis Lethareica	
         . 14
 3 8.7
June 1st
to 15th, 1931
May, 1931
Cases    Deaths
in cystitis and pyelitis
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Private Exchange, Sey. 1484 connects all Departments.
L"l t I t 1 I 1 t t 1 1 I I I 1 I 1 I I 1 I I 1 1 I 1 1 1 1 I 1 1 1 I t t I t I T I f T t t t | OBITUARY
It is with the greatest regret that we record the death
of Dr. Thomas Bennett Green, who has been practising in
New Westminster for the last twenty-five years. His death
occurred on June 5 th, after a long illness during which he
had gallantly continued to do his work almost to the very
Dr. Green was a native of Ontario, where he was born,
in 1874, at Listowel. His original occupation was that of a
school teacher, and he practised this profession for some years,
obtaining his B.A. at Manitoba University in 1899. The
following year he came to British Columbia where he
taught for two years when he decided to take up medicine.
He graduated from McGill in 1906, and returned to B.C.,
where he married Mary Lloyd, daughter of Mrs. J. B. Kennedy,
of New Westminster. After a short period of practice at
Lilloet, he became the partner of Dr. R. E. Walker, of New
Westminster, and was associated with him until the latter's
death. Dr. Green saw active service overseas during the
Great War, first in No. 5 Canadian General Hospital, which
he joined in 1915, and later with the Canadian Red Cross
Hospital at Taplow, England. On his return from overseas,
he continued work with the S.C.R. and later he was positioned
to the Provincial Penitentiary and the C.P.R. He was a
Mason and a member of the Kiwanis Club and I.O.O.F.
He left beside his wife, a daughter and son to mourn
his loss.
Dr. Green was more than merely a practising physician
of medicine. He had a keen sense of his responsibility as a
citizen and as a member of the medical profession. Whilst
never specially active in political life he commanded the
respect of his fellow citizens and of the Government, which
appointed him a member of the first Commission on Health
He maintained membership in good standing of the
Fraser Valley Medical Association, the B. C. Medical Association and the Canadian Medical Association and was an
Associate Member of the Vancouver Medical Association. He
served as an Examiner for the Medical Council of Canada and
was a valued member of various committees of the B. C.
Medical Association. Dr. Green was one of the men whom
it is an honour and a delight to know and to work with.
He was a man of outstanding sincerity and honesty of mind,
frank to give his opinion without fear or favour, but equally
amenable to reason and to argument. His death leaves a
distinct gap in the ranks of medicine in British Columbia
and those who he dealt with in his capacity of a physician,
will miss him sorely and long, for he was above all things, an
example of the good physician.
The Sixty Second Session of the Canadian Medical Association is now
a matter of history.    The meeting was, as all must feel who took any
part in it, an unqualified success.    Misgivings we had felt, fears  that
had beset us, engendered by the prevailing economic depression, were all
shown to be unnecessary and groundless.    Here we would pay especial
tribute to the courage and vision of those who were in charge of the
arrangements  for this Session.    In normal  times,  it  would  be a hard
enough task, to prepare for such a Convention, but in this year of our
Lord, it required considerable faith, and more than ordinary devotion, to
undertake its organization, and carry it through.
They have their reward, however, in one of the most successful
meetings the Canadian Medical Association has had. Everything has proceeded on schedule and with the smoothness and exactness of a well-oiled
machine. A large and complicated programme has been carried through
without a hitch, with no disappointments, no delays and no friction.
Vancouver may well be proud of the men whom it chose as directors and
organizers. From the President, Dr. A. S. Monro, through the Local
Secretary, Dr. G. F. Strong, and the Local Central Committee, down to
the humblest worker, there has been the most complete efficiency and
harmony. As we heard one of the Committee remark a few days before
the Convention opened, it was a delight to see how Committee after
Committee turned in its completed work, finished and polished to the
last detail.
And of equal, perhaps greater, importance, was the work of the
Ladies' Auxiliary Committees. This has been beyond praise; and the
result of their work wil last in the memories of us all and especially in
the memories of those who brought their wives and families with them.
On every side one heard comments on the quality as well as the quantity
of the entertainment provided for our visitors—and everyone seemed
to feel at home, and to be having a good time.
It was a great pleasure to review acquaintance with so many old
friends. Genial Dr. Bazin, Chairman of Council, looking very much
as he did when the present deponent first knew him, some quarter-
century ago—friendly, wise, genuine—no mere politician, but statesman is he. One's only difficulty with him is that when one has at length
cornered him for a talk on some vital subject, every minute or half-
minute he is claimed by some "old student," who, whatever else he does
or does not do during the Convention, must see Dr. Bazin for a minute.
Everyone was glad to see Dr. Fred. Bell looking better and brighter
than he has done for years.
The years do not take any energy or vitality away from our old
friend Dr. Primrose, of Toronto, that pillar of the Canadian Medical
Association. His accumulated wisdom, and quiet sagacity, are of inestimable value in Council discussions. He speaks seldom, but always to
the point.
Congratulations are in order to Dr. L. J. Austin, the new president
of the Ontario Medical Association—also we congratulate the Ontario
Page 225 Medical Association. To see him roaming blithely around, in a characteristic hand-in-pockets, pipe-in-mouth attitude, was to be transported
back some years.
We were glad too, to see Dr. F. N. G. Starr, stalwart and active
as ever, surrounded by old Toronto graduates, and welcomed by all.
Of course, we missed some faces. Perhaps, most of all, that of Dr.
A. D. Blackader, that grand old man of the Canadian Medical Journal,
to whom we owe so much in Canadian Medicine. He sent his love and
best wishes for the success of the meeting. It is pleasant to think that
he was honoured in the Blackader Oration, given by Dr. Park, on the
subject of "Rickets."
One missed, too, Dr. A. H. Gordon, whom all of us from McGill
would like to have met.
But there is a great generation in medicine coming up: headed in
this Convention by Dr. Rabinowitch, of Montreal, who is a dynamo of
energy and keenness. He was the "willing horse" of the Convention,
but never seemed to tire. Many are the words of praise one heard, of
the addresses he gave: all seemed to feel that they came away from them
with a wealth of information, with stuff that they could use, that was
not merely stimulating (though it was that, too) and theoretical, but
practical and usable.   We shall hope to see him here again.
And if we say this of Dr. Rabinowitch, it is in no disparagement of
the other speakers—far from it: for they were all good. Their stuff
was good, and given well. Truly, there was no scamping of work here.
As one heard the carefully prepared papers, illustrated with slides and
tables, and thought of the amount of effort that had gone to the making
of these addresses, one felt that the personnel of the programme had been
well chosen. We shall look forward to seeing these addresses in the
Journal, where we can take our time over the assimilation and digestion.
One of the delightful things about this week has been the catholicity
of its programme. It entered into every department of our lives, did
this Convention, and the city shared in it. Thus our City Council
showed hospitality to our guests in the boat trip up Howe Sound, that
they so graciously tendered; and our thanks are due to them. Luckily,
the day was fine (comparatively) and everyone enjoyed the trip. Then
the Vancouver Harbour Commissioners extended hospitality to some of
the visitors and showed them over the Harbour.
The invitation to the Horse Races, on Thursday, must also be
acknowledged here with gratitude. All those who went, had a good time,
some had an especially good time owing to the soundness of their judgment, and the excellence of their choice. Windfalls are always far
pleasanter than fruit one must climb for.
Private hospitality, of course, abounded, and none of those who
visited us, we feel sure, were overlooked. To the many gracious hostesses,
who did so much to make our visitors' stay pleasant and memorable, we
render our hearty thanks.
Page 226 Service Clubs, Women's Associations, the Nursing Association of
the City, took advantage of the presence of eminent medical men to the
full. Dr. Grant Fleming's address to the Kiwanis Club is a notable
example. We are sure that our Medical Health Officer, Dr. J. W. Mcintosh, will not readily forget this address, which was a notable and
eloquent appeal to the public to support, both financially and morally,
the Public Health Department. When Dr. Fleming stated in the presence of most of the aldermen (one wonders who engineered their invitations) that if a City wanted an adequate health service, it must be prepared to spend two dollars and a half per capita yearly, one could feel
the Mcintosh smile. No doubt he woke too soon from the beautiful
dream, but it was delightful while it lasted. It was at this meeting that
Dr. Monro appeared, wearing his badge of office for the first time in
public.    It created great interest and commanded awe and respect.
In one particular only were we badly let down—and that was in
the matter of weather. For the first three days the rain held off fairly
well, though there were mutterings and occasional light showers; then
on Thursday, the day sacred to the deity Golf the heavens opened, and
Vancouver weather proceeded to show what it could do. It was one of
our wettest rains, and Golf had to forego his sacrifices. Very fortunately,
our wise men had arranged to circumvent the weather and to counteract
its treachery by arranging for our visitors to go to the races at Lans-
downe, so that the Goddess Chance had her innings instead of the Great
God Golf—again the woman's last word.
Attendance at the meeting was good beyond our most optimistic
expectations. We had hoped for 400, and would have felt resigned to
350, but when the attendance mark passed 400, on Tuesday night before
the real programme had actually begun, we discovered that Dr. "Fritz"
Strong is only human after all. He was, indeed, almost delirious, as he
circulated at a rapid rate through the corridors and lobby of the Hotel
Vancouver, announcing the fact that 400 had registered. But this was
not the end ,and by Thursday, 478 men, with 240 ladies, had registered,
the final figures being over 500 men and 260 ladies. We venture to say
that this is an extremely good record, when one takes everything into
account, the distance, the present financial stress, and so on.
Victoria, as always, played up splendidly. They are sportsmen, those
Victoria men, and as one saw them, one after the other, one was conscious again of that feeling of warmth and friendliness towards these good
fellows. They have, apparently, no Laodiceans over there, it must be
something in the climate. Victoria must have been almost without
medical men for some days.
Lastly, we must acknowledge a debt of gratitude to the Canadian
Pacific Railway, who were "mine host" to the Convention. The Hotel
Vancouver provided an excellent setting to the affair, roomy, dignified,
with its finished and complete service, it gave a feeling of comfort and
ease to the proceedings, and one felt as if in a well-appointed club, or,
which is very much the same in essentials, in a good home. As Dr.
Woolner of Ayr, Ontario, said, all or almost all, the comforts of home
were provided.
Page 227 The proceedings began with the meeting of the Council of the
Association on Monday and Tuesday. Under the Chairmanship of Dr.
A. T. Bazin and guided by the expert hand of Dr. T. C. Routley, our
General Secretary, these meetings accomplished a tremendous amount of
real work in very short order. The work, of course, had largely been
done through the year by various committees, whose reports were presented, but it was a pleasure to one privileged to attend these meetings
to see the absence of irrelevant and wasteful talk. The speeches made
were short and to the point, and the work goes on to next year's Committees to carry on.
The keynote of the meeting was perhaps medical economics. At
the luncheon given the Council by Dr. A. S. Monro at the Vancouver
Club, on Monday, Dr. Harvey Smith of Winnipeg, retiring President of
the Canadian Medical Association, sounded this note clearly in his valedictory address. Dr. Smith is excellently qualified to speak on this subject.
He has given long and earnest study to the question of medical economics and has been mainly instrumental in arousing in Manitoba a
widespread interest in the subject. Keen discussion followed the report
to the Council on Medical Economics—and the Canadian Medical Association will, as a result of a resolution passed at this meeting, undertake
a serious study of this subject, as it concerns the entire profession of
Canada, in an attempt to evolve a unified policy for the whole Dominion.
It is a very great privilege to attend the meetings of Council, with
its members gathered from all parts of Canada, even from far Prince
Edward Island, which sent one delegate, Dr. McNeil. One gets a glimpse
of the wide diversity of viewpoint, caused by widely diverse conditions
throughout Canada. Quebec has its point of view, Ontario has one
somewhat different, the prairie provinces and B. C. have their own problems, and it is vitally necessary that we should learn to know the various
viewpoints—or we shall get nowhere, except it may be into trouble. But
the free and frank discussions in the Council meetings remove many misunderstandings, and dispel many clouds and fancied grievances.
It is very interesting to see how the Postgraduate work of the Sun
Life Assurance Company has grown, and how much good it is doing.
Delegate after delegate testified to the value of this work, to its effect in
raising the standard of medical work everywhere. The Sun Life deserves our highest gratitude for this work.
Tuesday was the B. C. Medical day as well, and the afternoon and
evening were devoted to its Annual Meeting and Dinner. These were well
attended and very successful; perhaps the most important matter discussed was closer affiliation with the Vancouver Medical Association.
The B. C. Medical Association made it quite plain that it is willing to
go a very long way to bring about this most desirable consummation.
The three remaining days were devoted to the scientific programme.
The papers delivered in this will be published later in the Journal, and
we will not refer to them further now, except to say that they were
excellent; but it is to be regretted that the acoustics in the ballroom are
very bad, and made it difficult for speakers and audience alike.
One feature that was extremely successful was the public meeting
on Tuesday, when hundreds of people failed to obtain admittance, and
Page 22% a packed ballroom listened to the men who gave addresses on tuberculosis
and cancer and public health generally.
The Convention closed on Friday evening with a Dinner Dance,
which was one of the pleasantest items of the whole meeting.
It would be impossible to name and thank adequately all those who
did so much and gave so much time and hard work to make this Convention a success. Our Library Staff, the Registration workers, our
Ladies5 Auxiliary, the members of the various Committees made up a
great team and spared nothing to bring the work of many months to the
triumphant conclusion which it reached.
Chest in Children, Roentgenological^ considered.    Stoloff.
Pathology of Internal Diseases.    William Boyd.
Neoplastic Diseases.   Ewing, 3rd Edition.
Medical Clinics of North America, January, March and May, 1931.
Clinical Allergy.    Rackemann.
Antiquity of Man.    2 Vols.    Sir Arthur Keith.
Applied Physiology.   Wright.
Surgical Clinics of North America.   February and April, 1931.
System of Bacteriology.    Medical Research Council, Vol. 8.    Immunity.
Transactions American Association Genito Urinary Surgeons, 1930.
Transactions Ophthalmogical Society of United Kingdom, 1931.
Medical Annual, 1931.
Surgeon General's Library, Vol. IV.   Index Catalogue, 1931.
Proceedings  of  Interstate  Postgraduate  Medical  Association  of  North
America.   Minneapolis Session, 1930.
Heart Disease.   Paul White.
Report of the Henry Phipps Institute for 1930.
Studies from Dept. of Surgery.   Cornell University Bulletin.   April, 1931.
Factors of Infection in the Rheumatic State.    Coburn.
Mayo Clinic Volume, 1931.
New and Non Official Remedies.    American Medical Assn., 1931.
System of Bacteriology.   Vol. VIII.   Fungi Pathogenic to Man, etc.
Radium Therapy.    G. E. Birkett.
Recent Advances in Forensic Medicine. Smith and Glaister.
Noguchi.    Gustav Eckstein, 1930.
I. M. Rabinowitch, M.D., CM., F.R.C.P., (Can.)
Assistant Professor of Medicine, McGill University; Director, the Department of Metabolism, The Montreal General Hospital, Montreal, Canada.
Mr.   Chairman,   Members   of   the   Vancouver   Medical   Association   and
Guests,—The Council of the Canadian Medical Association:
Delivered  at the  Dinner  of  the  Vancouver  Medical  Association,   Vancouver,   B.   C,
June 22nd,  1931. Though there is some vanity in all of us, may I say that I am not
vain enough to fail to recognize that the courtesy of this invitation to
address you was not meant for me, but for McGill University and the
Montreal General Hospital, with which I have the honour of being associated.
Your cordial reference to my work, Mr. Chairman, I also appreciate
was due largely to the generosity which your office, on an occasion such
as the present, permits. May I, however, state that if the efforts of the
Metabolism Laboratories of the Montreal General Hospital have not been
without some success, it was not due to the activities of any one individual, but to the hearty and never-failing co-operation of the entire
staff of the hospital and not in a small measure to the interest and active
support of our past Superintendent, whom I see here this evening and
who is now Superintendent of your Vancouver General Hospital. Comparisons, at any time, are invidious, and I believe it was in Osier's Aequani-
mitas I found Montaigne's warning that "one never speaks of oneself
without some detriment to the person spoken of," but, speaking of our
hospital, I do not hesitate to state that I know of no institution where a
happier, a more ideal relationship exists between the laboratories and the
I should here like to take the opportunity of expressing my appreciation of another group of men—our Governors. We may not be in the
same material position as hospitals of similar size with respect to endowments for purposes of research, but we are fortunate in our Governors.
The Montreal General Hospital has now served the public of Montreal
for over one hundred years. By far the great majority of its patients
are public and it is not a civic hospital. Its financial state is, therefore,
readily appreciated. It has, however, never, as yet, had to close its doors
nor discontinue research because of lack of funds. Speaking from
personal experience. I have yet to hear the word "No" to any request
I have made during the last ten years, and I may tell you I have made
many. The silent method of the philanthropy of these men has become
a tradition, handed down from father to son, and perhaps no better
example of this tradition can be found than in the present occupant of
the President's chair—Colonel Herbert Molson.
In accepting your invitation, Mr. Chairman, I was influenced by
two considerations. Firstly, the compliment which it conveyed called
for the courtesy of acceptance. Secondly, the subject about which I
have been asked to speak affords me an opportunity of presenting before
a representative body conclusions at which I have arrived after some
reflection, and of submitting them for consideration to the best of my
ability.   I am to speak about the present status of laboratory medicine.
My difficulties are immediately obvious: I am to speak to a body of
men, the great majority of whom are my seniors and, as a matter of fact,
amongst whom I recognize some of my teachers. There is, however, one
redeeming feature: being my seniors you, as I, have missed in your college
training some of this newer knowledge known as laboratory medicine.
We all, therefore, have two alternatives: we may either confine our work
to phases which do not require the newer training we missed, or we may
Page 23 0 return to studies and make good our deficiencies. Most of us, particularly those who teach, have been forced to such studies, but there is, as
yet, much confusion of thought as to the practical value of these efforts.
When we compare the present rate of accumulation of knowledge
with that of the past, we find this is an age of rapid advancement—a
period of fruitful toil—and medicine is attempting to keep pace with
other sciences. The assertion is not infrequently made by those outside
of our profession that medicine is backward in this respect, because it
has, as yet, failed to conquer certain diseases and, in a scornful manner,
cancer and the ordinary cold are commonly cited as examples. The
question may well be asked—is medicine alone in this respect? What
about the economists in the present epidemic of world depression? These
critics fail to appreciate our efforts and handicaps in our duties to alleviate suffering and to lessen the chances of death. In order to perfect its
technique, present-day medicine draws from every possible fountain of
knowledge: newer ideas of radio-activity find their application in our use
of X-rays and radium; the science of thermo-dynamics is used in calori-
metry; newer chemical technique is applied to investigations of the composition of blood, urine and other body fluids; physical chemistry is made
use of in the study of such conditions as oedema and the regulation of
the reaction of body fluids. Even the value of mathematics is not lost
sight of; mathematics is employed constantly in the co-ordination of the
experimental results; the efficiency equation finds its applications in the
study of haemolysis, precipitation phenomena and the dissociation of
haemoglobin; the differential and integral calculus and trigonemetrical
ratios are used in animal mechanics (muscular action); there are the
numerous physiological applications of thermodynamic equations and the
pathological chemist makes use of the Law of Organic Growth; medical
statisticians apply the Laws of Probability and nomographic charts are
used daily in the calculation of basal metabolic rates.
- What is disturbing is the fact that there is still some uncertainty
as to the value of these laboratory methods in the minds of some members of our own profession. Differences of opinion are met with, not only
in general practice, but in medical schools. Universities disclose their
widely divergent views by their appointments of those who are to direct
the teaching of their students and to formulate their curricula. Teachers
of medicine may be divided into three groups: Firstly, there are those
who are clinicians anly and frankly say so. Expert as they may be in
clinical methods, they possess little knowledge of the experimental sciences
and frankly admit it. Next, there are those who may be familiar with
the experimental sciences but their knowledge of clinical medicine is
limited. This group, also, recognizes, and frankly admits, its limitations.
All humanity has its proverbial types and medicine is no exception. There
is, therefore, unfortunately, also a third type which may perhaps briefly,
but tellingly, be described as "he who knows not and knows not he
knows not." Each group has its own views as to what the student of
medicine should be taught and when curricula are based upon differences,
instead of unanimity, of opinion, one can sympathize with the student.
His position is somewhat analogous to that of a mariner who is attempting
to guide his ship through a reef-strewn sea by means of charts which
Page 231 contradict each other, a compass with no indicator and lighthouses whose
gleams are as confusing as they are faint. In less hyperbolic phrase, such
curricula are full of courses, but lack guiding principles. In practice,
the differences of opinion as to the value of laboratory methods are still
more marked because of the conditions under which this type of medicine
must be practised.
We may immediately dispense with those few who still cling dogmatically to the idea that laboratory medicine is a fad, and, like all fads,
may be disregarded, as it will have its day and disappear. On careful
analysis, what at first appears to be a well-considered and unbiassed opinion,
is usually found to be the result of a limited liability clause with respect
to breadth of vision. These men usually tell of successes of the good old
days of clinical medicine. This recalls to mind those who still harp back
to the "good old days" before the modern speed of transportation. Such
individuals ought to live in that part of China where more than fifty
million people still depend upon crude wheel-barrows for transportation
by land. It is admitted that one can travel from Montreal to Vancouver
in a wheel barrow. A journey of a few days only under the conditions
which modern transportation companies offer does, however, appear to
be more comfortable. This, however, is not a perfect analogy; laboratory medicine does not merely accomplish a similar object in a better way,
it often succeeds where clinical medicine alone fails. We, as a rule, tend
to be conservative and resist change; but though in some instances we
may submit to the inevitable reluctantly, in others we should welcome
the change. Modern life and laboratory medicine afford appropriate
examples. In this mechanized age, we are travelling with a furious and
relentless velocity and the past is being obliterated. It is admittedly sad
to see the romance of native populations disappear as economic forces
sweep across them and huge steel and uncomely structures replace the
feudal facade; and what is more pitiful than the electrically-lighted
coloured glass of the crowded apartment in the attempt to replace the
fire place of the spacious home. Some of us may agree that these changes
are not necessarily conducive either to happiness or the prolongation of life and health; but can one argue logically that our advances in
medicine do not tend in that direction?
The inconsistencies of those who fail to recognize the unavoidable
and necessary changes in the practice of medicine at times afford amusement. He who would make use of clinical methods only should, to be
consistent, dispense with his thermometer, the blood pressure apparatus
and blood cells counts. It would be interesting to note the amount of
information the present day student would obtain with respect to temperature by means of the palpation method alone. Again, to be consistent, he should dispense with the X-ray. But would he condemn his
daughter to vegetate in a sanatorium without X-ray evidence of the
presence of tuberculosis and the extent of the lesion? Or, would he
expose his wife to a major operation for chronic cholecystitis without
preliminary visualization of the gall bladder, or to a gastro-enterostomy
for ulcer without a preliminary investigation with the aid of the bismuth
meal? To be consistent, he should confine his practice to that possible
with the limited armamentarium of the days of Laennec, or, to be more
exact, to the days of Sydenham.
Page 232 It is perhaps best to define our terms. What are the aims of laboratory medicine? Laboratory medicine merely attempts to make the doctor
introduce the same spirit at the bedside which the experimental scientist
finds indispensable in the laboratory. The doctor of the past, in his
diagnosis, considered that he performed his duty when he succeeded in
giving his patient's disease a name. The physician of the future will, as
Noel Paton put it, "care less and less for such names. He will be concerned only with the solution of the questions—What is abnormal. Why
is it abnormal?" What is the mechanism of the production of a given
sign? How may it be modified? Medicine will then be a science as well
as an art. Laboratory medicine aims at assisting him in these quests. It
is the scientific method of approach to the problem. It involves, firstly,
a clear recognition of the nature of the problem; secondly, honest observation of what happens; thirdly, the correct recording of phenomena, and,
lastly, the drawing of conclusions based upon logic and not influenced
by preconceived ideas. It aims at discouraging the habit of accepting
statements unquestionably and on mere authority. It helps to inculate
the principles of intellectual curiosity and intellectual honesty—that desire
to know and that refusal to allow impulses other than tha intellectual to
operate in ascertaining facts and drawing conclusions. It, therefore, tends
towards more logical treatment. The change in our technique that
laboratory medicine demands is not destructive; it is rational; it attempts
to put medicine in the position it must occupy if our profession is to
be taken seriously in the future. We may, if we wish, continue our
practice as in the past, but, if the results happen to be satisfactory, let
us admit the frequent and kind assistance of the vis medicatrix naturae
and in our success repeat with Ambrose Pare "I dressed him—God
healed him."
I am obviously not suggesting that the spirit which laboratory
medicine tends to inculcate was not seen in the past and may not be
observed at present. The master clinician possessed, and still possesses,
all of the necessary qualities. What is more inspiring than these men
while at their work at the bedside? They possess all of the attributes of
the scientist. In their silent efforts we see the embodiment of the truism,
with respect to knowledge, that the highest state of advancement is the
lowest descent in humility. I see a number of them daily in my duties
about the wards. But what is that number? It can be counted on
the fingers of one's hand. Significant enough is the fact that these men,
at least in my experience, are the first to encourage the attempt of
methods which might enhance knowledge. Sad it is, but these master
clinicians are disappearing and who is to blame? Count the number of
Grade A medical colleges on this continent. Count the number of
prizes and scholarships offered by these institutions for research. How
many for the experimental sciences—chemistry, physics, physiology,
etc? How many are for purely clinical medicine? The ratio on this
continent at least is about 150 to 1.
Since these are the aims and attributes of laboratory medicine and
since there are few master clinicians and still fewer being developed, the
question may well be asked—Why is there such disagreement on the part
of those whose opinions are very highly respected? Why has laboratory
medicine not been accepted unanimously?    I may say that I have de-
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Phone: Seymour 1493 voted some time to this question and humbly submit my conclusions
for your consideration.
One reason is that laboratory medicine is in its infancy and its
progress is largely the result of the activities of comparatively young
men and, therefore, relatively inexperienced in the art of clinical medicine.
If it is human to err, it is a prerogative which belongs chiefly to youth
and the inexperienced. In general, limited experience and dogmatism
may be said to exist in symbiosis; and medicine is no exception. Lack
of appreciation of clinical phenomena has frequently resulted in a
diagnosis by the laboratory worker which was clearly incompatible with
clinical experience. This has done much to discredit laboratory medicine.
On the other hand, if dogmatism of the young laboratory worker has,
at times, led to error, we have the not infrequent bedside diagnosis incompatible with a laboratory finding, the reliability of which is no longer
questioned. If such errors do not discredit clinical methods, they should
not, logically, discredit laboratory methods.
Lack of co-operation between the clinician and the laboratory is
another common cause of error. It is not uncommon to find that the
one responsible for the performance of laboratory tests has no knowledge
whatever of the clinical aspects of the case. As a matter of fact, he may
not even be a physician. His duties are merely to test materials which
were obtained from patients and submitted to him at the request of their
physicians. Under these conditions, the clinician must rely upon his own
interpretation and unless he is thoroughly familiar with all of the possible
sources of error of the tests requested; unless he is thoroughly familiar
with the underlying principles of their use and all of the possible
physiological variables, he cannot possibly interpret such tests correctly.
One may hope for the Utopia where there will be the happy combination
of clinician, chemist, physicist, biologist and mathematician. Such a
superman has not, however, as yet, appeared on the horizon, nor is he
very likely to do so.
Another practice, and one which I may say is commonly found in
large hospitals and is, unfortunately, finding its way into Canadian
institutions, is to differentiate between routine laboratory work and that
done for research purposes. Such differentiation cannot but lead to the
discredit of laboratory medicine. In this practice, though most careful
attention may be paid to details, technical and otherwise, when a test is
performed for purposes of research, relatively little attention is paid to
exactness when the test is used for routine clinical purposes; for example,
Internes are permitted to perform chemical and other analyses. With all
due respect to these men, it may here be observed that they have been
trained to be physicians and not chemists or physicists. With extremely
few exceptions, they possess neither the skill nor the necessary training
for this work. The results of such practices cannot help but be disastrous
and strengthen the views of the unsympathetic.
Parenthetically, a word may here be said about some present-day
practices, even in research. These also tend to discredit laboratory
medicine. I refer particularly to the large amount and type of work
which is now being done by those not properly trained. The results of
this practice are reflected in the literature. What is rather amazing is
the freedom with which such work is permitted by those apparently in
Page 234 controlling positions and qualified to judge. This is truly the "Golden
Age of Mediocrity." I have no hesitation in venturing the opinion that
a large number of investigations which were made in hospitals of high
reputation and reported in the best of journals of clinical medicine on
this continent, would not have been accepted for publication in journals
whose editors are specially trained for the critical analysis of chemical and
physical data. Examples of such publications are found monthly. Their
one contribution to the literature is confusion.
Lastly ,and again the result of improper training, there are the
exaggerated deductions which have not infrequently led to unwarranted
recommendations of treatment. The use, or I should say the abuse, of
vitamines may be cited as an example. Although the nature and chemical
composition of vitamines are still unknown, no one with a knowledge of
this subject doubts either their existence or importance. There are still
those who insist upon a demonstration of their chemical composition
before they will accept their existence or importance. Such people, as
Hopkins put it, to be logical, should avert their eyes from such agents as
toxins and anti-toxins; these powerful remedies also still elude both objective and quantitative study. Important, however, as these vitamines
may be, their improper evaluation has led to practices which tend to discredit them. I refer to the exaggerated claims with regard to the different
window glass preparations, because of their properties with respect to
penetration of ultra-violet light, the ridiculous applications of quartz light
therapy and the use of yeast and irradiated foods. If, on a journey
through the Congo, we encountered the practices of the "medicine-man,"
we would regard them as impregnated with belief in fetish and tabu, and
our reactions would probably be justified. Let us humbly admit we
have our own "glass houses" and one of them is constructed of vitamines.
The apotheosis of the application of our knowledge of vitamines is found
in the irradiation of laundry and cigarettes. For this, however, the
medical profession is not to blame. In its fundamental instincts, the
human race is well found. The average normal individuals, when he
sits down to breakfast, knows and cares very little, and needs to know
and care very little, about the vitamine content of his food. Normal
man heeds the dictates of his instinct and experiences and his experience has been a long one and not without some success. This is one of
the many examples which might be cited; practices in endocrine therapy
afford a number of others, and the nth degree has been reached in the
recommendation by "73 leading dermatologists" with respect to the use
of soap.
These, then, are the matters which I submit for your consideration..
If I have dealt with them at some length, I may say, in extenuation, that
the opportunity afforded me was not to be wasted, and it would have
been wasted if I failed to give you something to carry away. In a recent
address, Sir Arthur Keith spoke of the inexorability of the Laws of Evolution in the practice of our profession. In this evolution, we have reached
the stage of laboratory medicine. This does not, by any means, dispense with clinical methods. One cannot stress too greatly the importance of not only retaining, but emphasizing, certain aspects of these
methods. Our attitude towards clinical medicine should be respect
tempered  with   criticism;   respect,   because   the   great  majority   of   the practices which have helped those of the past are most likely to be of
use to us also; and criticism, because, however valuable past practices
may have been, they should not deprive the younger generation, with its
newer equipment, of its right to enquire into and sift the evidence of
their value, provided it is properly trained to do so.
I have outlined a number of causes of differences of opinion and misunderstandings which, at least in my opinion, may be considered seriously
in the development of medicine in Canada. Canada may be comparatively
young, but its institutions of medicine are not mean. In the advancement of knowledge, these institutions have done, and are doing, their
share. We have much to be proud of and our training should greatly
assist us in this transition stage of medicine. As I stated before, one may
hope for the Utopia where there will be the happy combination of clinician, chemist, physicist, biologist and mathematician. Since such a
superman has, however, as yet, not appeared on the horizon, and is not
very likely to appear, let us follow the next best course—avoid the
errors which have been made and let the watchwords of both clinician
and laboratory worker be co-operation and correlation. Medicine cannot
posibly advance without the laboratory, nor can the laboratory accomplish much without the patient; as our Dean put it, "the patient remains
and ever should remain the central feature of the problem."
I thank you, gentlemen, for your indulgence and again assure you,
Mr. Chairman and Members of the Vancouver Medical Association, of my
appreciation of your kind invitation.
By Dr. John Eden Walker
My interest in this subject was aroused when looking through an
old scrap book of my father's in which were numerous newspaper clippings relative to events pertaining to medical affairs in this Province,
when some of the various acts governing the practice of medicine and
the foundation of our present medical societies and governing bodies,
were being initiated. It is of some interest, perhaps, to learn how these
institutions came into being.
In the last few years, the subject of pioneer days seems to have taken
quite a hold on the public imagination, if one may judge from the numerous articles that have been appearing almost weekly in some of our daily
In this paper I hope briefly to bring out some points of interest in
the history of our profession up to the year 1898 by which time most of
what we may style the essential pioneer work had been completed.
Up until 1850 the practice of medicine in what is now British
Columbia was non-existent, although if we search the records of history,
we will note the names of various medical men that visited our Coast.
In 1774, the Spaniards, under Juan Perez and Quadra, explored the West
Delivered before the  Osier  Society of Vancouver,  March  1931.
Page 23 6 Coast of British Columbia and Queen Charlotte Islands and probably
carried ship's surgeons with them, but if so we have no record of their
impressions. Four years later Captain James Cook, on his third and
last voyage, explored these regions on the "Resolution" and the "Discovery" and with him were two medical men, Wm. Anderson and John
Law. It is interesting to read in Capt. Cook's Journal the following
passage concerning Dr. Anderson:
"Monday, August 3, 1778—Along the Alaskan Coast.
Mr. Anderson, my surgeon, who has been lingering under consumption for more than twelve months, expired between 3 and 4 this
afternoon. He was a sensible young man, an agreeable companion, well
skilled in his profession and had acquired considerable knowledge in
other branches of science. Soon after he had breathed his last, land was
sighted to the westward, twelve leagues distant. It was supposed to be
an island and to perpetuate the name of the deceased, for whom I had a
very great regard, I named it Anderson Island."
Further along in the Journal, we come upon another incident.
"During a trip in a launch by some members of the expedition, a
small inlet in northern B. C. was explored. Some of the sailors, seeing
the rocks covered with mussels, ate heartily of them as they would have
done in England. But all who partook of them became violently ill,
with vomiting and purging; the party became so ill they regained the
ship with difficulty. One poor fellow died in spite of treatment;" this
constitutes the first recorded death of a white man in B. C.
In 1790, Capt. George Vancouver made his first appearance, having
been sent out by the British Government to take over this region from the
Spaniards, who, up to this time had lain claim to the whole western
coast of North America. He had with them two ships, the "Discovery,"
Capt. Cook's old command, and the "Chatham," both of which had ship's
surgeons, Cranston and Walker. Cranston was later replaced by Archibald Menzies, who in addition to being a medical man was also a naturalist
of great ability. He made great collections of plants and other natural
objects and at the present time there is a set of his collections in the
British Museum.
For the next sixty years there were no, what we might describe as,
practising physicians, though doubtless there were other ship's surgeons
visiting these shores from time to time. In passing, I might mention that
the Chief Factor sent out by the Northwest Company, which eventually
amalgamated with the Hudson's Bay Company, was a medical man, by
name McLaughlin, who played a very leading part on the Pacific Coast,
but whose duties were administrative rather than professional in character.
We now leave the period of what we may call exploration and fur
trading for that of colonization and settlement. In 1850, John Sebastian
Helmcken, a surgeon trained at Guy's Hospital, was brought out by
the Hudson's Bay Company to Victoria, where for several years he was
able to claim the title of leading practitioner from San Francisco to the
North Pole and from Asia to the Red River of the North; for in truth
he was the only doctor in all that vast territory.    We may gain some idea of the tough constitutions of the early pioneers from the following
extracts:—"One of Dr. Helmcken's duties was to put up the medicines
for the various Hudson Bay Company's trading posts up the Coast and
in the interior, for Victoria was the distributing point. The factors at
these posts had to do their best to treat what came their way, and as
their medical skill was nearly a negative quantity, the medicines sent
had to be divided into their proper doses, and properly labelled. Accordingly, as the doctor relates, he had to make up so many dozen purges,
so many dozen pukes, for medicine was a vigorous science in those days,
so many doses of quinine or calomel, and off these deadly missiles were
sent, to wreak their dire effects. However no casualties were reported,
which we must attribute either to the rugged constitution of the early
pioneers or to the skill of the doctor."
We now pass to the year 1867. Up to this time there were no laws
.governing the practice of medicine in B. C. Between 1867 and 1898
there were passed eleven acts in all by the local Legislature, but of these
three stand out prominently: these are the ordinance of 1867, the Act
of 1886 and the Act of 1898. The first Act to be passed in B. C. is
entitled "An Ordinance Respecting Practitioners in Medicine and
Surgery." It is dated as having passed the Legislative Council on April
1st, 1867, and assented to in her Majesty's name by Frederick Seymour,
Governor, at New Westminster, on April 2nd. The clauses of this Act
were few in number. First it provided for a Registrar, the deputy
provincial secretary to act in that capacity. The. qualifications set forth
as necessary to enable a medical practitioner to register were on the
broadest lines. The Act provided for the registration, upon application,
of any person possessing a diploma or license from any school, college,
society or faculty of medicine or surgery in the United Kingdom or a
foreign country provided such school required a compulsory course of
study extending over not less than 3 years. The fee for registration was
$10.00. Under this ordinance it was unlawful for anyone to assume
the title of physician or surgeon or doctor of medicine unless he was
.registered. Those doing so without registration were liable to a fine not
exceeding $100.00.
A copy of the register was to be published yearly in the B. C.
Gazette. In 1871, four years later, the Gazette contained only two
names, those of J. S. Helmcken, registered December 24th, 1869; and
John C. Davie, registered March 8th, 1870—both of Victoria.
From 1867 to 1886 there were several medical acts passed, but
these were not of major significance. During this period of time it was
•only natural that abuses should creep into the practice of medicine,
considering the very elastic and insufficient legislations governing this
practice. One of the most glaring examples of this abuse was the circumstance that on account of the ease of registration, many itinerant medical
Jtnen came to B. C, as a mere matter of speculation, stayed a short time,
and did a cash business only. These men advertised in the most objectionable manner, and then, having done what damage they could, would
leave for other fields. Often these individuals would fraudulently make
~use of the card and name of some well known San Francisco specialist,
representing that they were the man himself or his partner.    The first
Page 23 i medical society in our Province was formed in Victoria in 1885, primarily to deal with this evil, one must suppose, for when the new legislation
had been evolved, this society, which was called the British Columbia
Medical Society, ceased to exist; its whole lifetime extended over a period
of less than one month.
The chief features of the new Act which passed the Legislature on
April 6th, 18 86 were:
"1st, the election of a medical council by the practitioners of the
"2nd, registration of all persons already registered under the old
act and further the registration of all persons upon application and after
passing an examination set by the medical council of B. C, provided the
applicant held a diploma from any school or college, giving a three year's
course in medicine.
"3rd, the infliction of a penalty upon all persons practising without
first securing registration.    The officials of the first medical council of
B. C. were:  President, Dr. I. W. Powell, Victoria; Vice-President, Dr.
C. N. Trew, New Westminster; Treasurer, Dr. J. C. Davie, Victoria;
Secretary and Registrar, Dr. G. L. Milne of Victoria."
The first examination by the Council was held on November 3rd,
1886, when Dr. W. A. Dewolf Smith, of New Westminster, presented
himself and having passed a satisfactory examination was registered.
One notices that at this time Vancouver had no representatives on the
Council. Vancouver at this time was but newly born, its incorporation
as a city only taking place on April 6th, 18 86, and its population at this-
time being somewhat under two thousand inhabitants.
Between 1886 and 1898, there were several amendments to the Act
—some of which arose from causes not unlike some of the difficulties
under which we labour at the present time—namely the control of cults;
outside the medical profession. In 18 89, two amendments were introduced, much against the wish of the Council and the profession, relative
to homeopathic practitioners, thereby enabling them to register on application and upon producing a diploma from a college or school requiring a three year's course, but without examination from the Medical
Council. This aroused considerable opposition and through the influence of the Medical Council this was repealed the following year and
a clause substituted, whereby in addition these homeopathic practitioners
had to pass an examination by the Medical Council.
As time went on, it became apparent that more comprehensive
legislation was required. The Act of 1898 was prepared. This Act
provided for the incorporation of the members of the profession into a
body corporate styled "the College of Physicians and Surgeons of British
Columbia." The registration of members was as in the preceding Act
and its amendments with the addition, however, that the minimum,
period of study was raised to four years. It also gave the Council of
the College wider powers to make laws governing its procedure. It
provided for the enforced payment of annual dues, and for the removal
from the register of names of persons who were adjudged guilty of infamous or unprofessional conduct. The British Columbia Medical Association was formed in 1900.
It is interesting to note, in the presidential address of the year 1902,
that the question of the formation of a Dominion Medical Council was
first brought to the attention of the members. It was not, however,
until several years later that this body came into being. The bill pro-
Tiding for this body was ratified by B. C. in 1913.
The first Health Act passed by the Provincial Legislature of which I
find any record, was passed in 1895. The first Board of Health consisted of five members, Dr. J. C. Davie, of Victoria, being chairman, Dr.
A. T. Watt, Secretary; and Dr. J. M. Lefevre, of Vancouver; Dr. R.
E. Walker, of New Westminster; and Dr. L. F. Davis, of Nanaimo.
Public health matters in the Province at this time appear to have been
handled under very primitive conditions, and apparently great agitation
was necessary to educate not only the population, but strange to say,
even the legislature, as to the importance of what to us seem very elementary principles. One reads in one of the newspapers published in 1897,
a very spirited editorial aimed principally at the slackness and the
•dilatory manner in which the recommendations of the Board of Health
were being carried out by the Government. v
I have not attempted to bring this history up to our present time
or even to sketch in full the events that took place in the period I have
covered. Since the year 1898, there have been several acts and amendments passed which, however, we can hardly refer to as belonging to
pioneer days.
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(3) It is practically sterile, but may be boiled without curdling. (4) It is economical because there is no waste. (5) It is convenient for the traveling mother, as no refrigeration is required.
For physicians who appreciate the advantages of the powdered
form over the fluid form of lactic acid milk, but who prefer to
make their own carbohydrate additions, there is also available
NO. 2 (without Dextri-Maltose)
These three Mead infant diet materials are for sale at drug stores
—without dosage directions and are advertised only to physicians.
Mead Johnson & Co. of Canada, Ltd., Belleville, Ont. infaSPSfSffiaS^
£83 100% Whole Wheat Cereal STOVARSOL
(Preparation  "190")
The Acetyl derivative of Oxyaminophenylarsenic Acid
For the preventive and curative treatment of syphilis in
For the treatment of heredo-syphilis in infants.
Also   indicated   in   intestinal   affections,   pyorrhea   and
Available in compressed tablets of 0.2S gm. and 1 cgm.
An   outstanding  remedy  that   has   produced   remarkable
results in the treatment of general paralysis.
Administered  subcutaneously,  intramuscularly,  or  better
still, intravenously.
Supplies in ampoules of 0.50 gm., 1 gm. and 1.50 gm.
Canadian Distributors:
All dogs have worms (at some time) and many
doctors are dog lovers. We would like them to know
that the B. C. Pharmacal Co. Ltd. makes an effective
vermifuge capsule—hand-filled and soluble elastic.
For Humans we manufacture, of course, a full line
for all sorts of conditions, particularly of iron preparations.
B* C* Pharmacal Co* Ltd*
Since 1913 in Vancouver at 329 Railway Street. 2/uone
Therapeutic Corsetry
Nu-Bone Corsets and Surgical Belts,
boned with the soft, pliable Nu-Bone
Patented woven wire stay, gently yet
firmly support the frailest body with
Nu-Bone Corsetieres are specially trained in Therapeutic Corsetry, and will
study the individual requirements of the
patient under direction of the physician.
Nu-Bone — Nu-Trend — Nu-Zip
Office—455 Granville St., Vancouver, B.C. Sey. 7258
(latter & If artrm, ^(£t&
Established 1893
North Vancouver, B. C.
Powell River, B. C. Rest Haven Sanitarium and Hospital
MARINE DRIVE,  SIDNEY,  B.  C,  (Near Victoria)
Particularly convenient and  desirable for  Rest—Recuperation and  Convalescence.
Rates  are  reasonable,   with  meals  and  treatments  included.
Direct patients to Rest Haven from Victoria by the Vancouver Island Coach Lines, Ltd.,
at the Broughton  Street  Station.    Private car will meet boats if  desired.
Back in 1864, there appeared the rather inauspicious beginning
of what is today a great industry. It was in that year that
A. Clavel founded the laboratories which now are known as
"CIBA." From a vision to a successful realization is the
record of "CIBA'S" progress during these decades. An organization of international scope irrevocably dedicated to
precision in the scientific preparation of pharmaceutical products.
Of infinitely greater value than mere material success, is the
splendid reputation which "CIBA" has established by rendering a sincere service in the field of therapeutics. The seal
"CIBA" is a symbol of purity, effectiveness, reliability and
ethical merchandising.
Messrs.   Macdonalds  Prescriptions,   Ltd.       -      Vancouver,   B.   (
Messrs. McGill & Orme, Ltd.      -      Victoria,  B.  C.
keep a full range of "CIBA" specialties.  


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