History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1953 Vancouver Medical Association Apr 30, 1953

Item Metadata


JSON: vma-1.0214488.json
JSON-LD: vma-1.0214488-ld.json
RDF/XML (Pretty): vma-1.0214488-rdf.xml
RDF/JSON: vma-1.0214488-rdf.json
Turtle: vma-1.0214488-turtle.txt
N-Triples: vma-1.0214488-rdf-ntriples.txt
Original Record: vma-1.0214488-source.json
Full Text

Full Text

The Vancouver Medical Association
dr. j. h. MacDermot
Publisher and Advertising Manager
APRIL, 1953
OFFICERS 1952-53
Db. E. C. McCoy Dr. D. S. Munroe
President Vice-President
Dr. George Langley
Hon. Treasurer
Additional Members of Executive:
Dr. G. R. F. Elliot Dr. F. S. Hobbs
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors'. Messrs. Plommer, Whiting & Co.
Dr. J. C. Grimson
Past President
Dr. J. H. Black
Hon. Secretary
Dr. J. A. Irving
Eye, Ear, Nose and Throat
 LChairman Dr. W. M. G. Wilson Secretary
Dr. J. H. B. Grant Chairman Dr. A. F. Hardyment Secretary
Orthopaedic and Traumatic Surgery
Dr. A. S. McConkey Chairman Dr. W. H. Fahrni Secretary
Neurology and Psychiatry
Dr. B. Bryson Chairman Dr. A. J. Warren Secretary
J. S. Madill Chairman Dr. H. Brooke Secretary
Dr. 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. W. M. G. Wilson Chairman Dr. B. T. Shallard Secretary
Summer School
Dr. S. I/. Williams, Chairman;  Dr. J. A." Elliot, Secretary;
Dr. J. A. Irvine ; Dr. E. A. Jones ; Dr. Max Frost ; Dr. E. F. Word
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
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.
Page 287 WM
NEW 5-mg. Tablets of
For accurate adjustment of
Maintenance Dosage and
for therapy in conditions
responding to Low Dosage
Advantages of 5-mg. Tablets
Used alone or in conjunction with the
25-mg. tablets, the new 5-mg. tablets afford
greater flexibility in adjusting dosage to
the individual patient's requirements.
Fluctuations in the natural course of rheumatoid arthritis may be better controlled.
Permit more accurate establishment of
minimum maintenance doses, thus controlling symptoms more closely and further
minimizing the incidence of undesirable
physiologic effects.
Prevent waste of Cortone by more exact
correlation between requirement and dosage.
Literature on Request
*Cortone is the registered trade-mark
of Merck & Co. Limited for its brand
of cortisone. This substance was first
made available to the world by Merck
research and production.
MERCK &  CO. Limited
Manufacturing Chemists
^vancouver medical association
Programme for the fifty-third annual session
Founded 1898; Incorporated 1906
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
vlonday, 12:15 p.m.—Surgical Clinic.
uesday—9:00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
rhursday, 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.
Regular "Weekly Fixtures
tnd Monday of each month—2 p.m Tumour Clinic
uesday—9-10 a.m _ . Paediatric Conference
Wednesday—9-10 a.m... J Medical Clinic
Wednesday—11-12 a.m Obstetrics and Gynaecology Clinic
Uternate Wednesdays—12 noon Orthopaedic Clinic
\lernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion)
riday—8  a.m. Clinico-Pathological Conference
(Alternating with Surgery)
\lternate 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
Regular Weekly Fixtures
[Tuesday, 8:30 a.m.—Dermatology. Monday, 11:00 a.m.—Psychiatry.
Wednesday, 10:45 a.m.—General Medicine. '      Friday, 8:30 a.m.—Chest Conference.
Wednesday, 12:30 p.m.—Pathology. Friday, 1:15 p.m.—Surgery.
2656 Heather Street
Vancouver, British Columbia
Every Monday—9:00 a.m.-10:00 a.m f Ear, Nose and Throat Clinic
11:45-12:45 p.m. _. - 1L Therapy Conference
Every Tuesday—11:00 a.m.-12:00 p.m Clinical Meeting
12:00 noon-1:00 p.m.-.-: Therapy Conference
Every Wednesday—11:45  a.m.-12:45  p.m Therapy Conference
Every Thursday—11:45 a.m.-12:45 p.m -'ftjifl. Therapy Conference
Every Friday—9:00 a.m.-10:00 a.m.___ _^J£__._. —' Lymphoma Clinic
(during February)
10:15 a.m.-ll:15 a.m.  (as of March 6)—-fjL Lymphoma Clinic
11:45 a.m.-l 2:45 p.m |  Therapy Conference
Medical-Dental Bidding
*J~ree L^itu <=&eliveru and *srree J-^rovincial J-^o&la
Statistics - February,  1953
Total population  (estimated)     _ 390 326
February, 1953
Rate per
Number 1000 pop.
Total deaths   (by occurrence)          368 11.3
Deaths, residents only  f       335 10.6
pirtb Registrations - residents and non-residents
(Includes late registrations)
February, 1953
Female   '.  __	
fnfant Mortality - residents only
Deaths under 1  year of age 	
Death rate per 1000 live births 1	
Stillbirths (not included in above item)
i_hicken Pox	
Diphtheria   Carriers
Dysentery  Carriers
Erysipelas —
Infectious   Jaundice
Meningitis   (meningococcic)
Salmonellosis Carriers _______ ^
Scarlet Fever M£	
Syphilis \	
Typhoid Fever	
Typhoid Fever Carriers
Undulant   Fever	
Whooping  Cough	
February, 1953
Cases Deaths
101 —
7 —
1 —
93 —
16 —
48 —
2 1
313 —
8 —
3 —
41 —
13 4
42 15
February, 1952
Cases Deaths
104 —
flfoount pleasant THnbertaMng Co. Xtb.
Telephone: EMerald 2161
Page 293
a specific treatment f«
pyogenic dermatoses, infected,   degenerated  <
damaged     tissues     and
other    skin    condition
embodies  the medicinal
marriage of..*
whose bacteriocidal and bacteriostatic action
is significantly increased by their marked
synergistic action in combination (as shown
by Lubowe) but which possess a low
sensitizing power and toxicity permitting
prolonged usage without untoward effects
when applied topically
a long established, scientifically provi
dication supplying Natural Vitamins _j
the essential nutrients for tissue repa
accelerated healing; in the optimal ti
8:1 contained in a precisely bat
readily absorbed base which ensures
imum effect of the active ingredienj
Therefore, the NEW Herisan Antibiotic Ointment (1) provides a high level
antibiotic action with low dosages of Bacitracin and Tyrothricin due to theii
marked synergistic action in combination, (2) has a low toxicity rating, (3) ha:
a low sensitizing power, (4) is effective in the presence of blood, pus, plasma
necrotic tissue and penicillinase, (5) stimulates the formation of granulation tissue
(6) ensures rapid healing and thus treatment is of shorter duration.
Page 294 clinical tests prove
\f**  V** I 'nfoilt farm,,/,, 4£
for the baby
is the only
infant feeding formula that
establishes a predominantly gram-positive
flora—similar to the flora of the lower intestine of the breast-fed baby.1
produces a stool with a pH "practically
identical" with that of the infant fed human
milk. Stools of babies fed other formulas are
distinctly more alkaline (6.2 to 6.7).L
1 Better absorption of minerals, especially calcium,
2 Lower incidence of constipation. Formation
of calcium soaps is inhibited; acid produced
by fermentation stimulates peristalsis.
Lessened susceptibility to diarrhea. Lactobacilli
inhibit overgrowth of 'colon' group bacilli.
A stool typical of the breast-fed infant—having a
"buttermilk-like", rather than putrefactive odour.
Vitamins more readily available, especially
vitamin Bu. Growth of putrefactive organisms
which reduce amounts of vitamins available2
is inhibited.
Minimal danger of perianal dermatitis and
diaper rash in the new-born.3
I. Barbero, G. J., Runge, C, Fischer, D.,
Crawford, M. N., Torres, F. E., and
Gyorgy,P.:J. Pediat.40:152 (Feb.) 1952.
Watson, J.: Gordon ResearchConf. Vitamins and Metabolism, 1950.
Torres, F. E., Romans, I. B., and Wheller,
J. B.: A study of Infantile Diaper Rash.
To be published.
Registered Trade Mark
Page 295
Corticotrophin with Protamine and Zinc, for prolonged action and in a
form convenient for use, is now available from the Laboratories. The
product is prepared as a milky suspension in aqueous medium and is ready
for use after shaking. In clinical investigations, two injections per day
have been found to replace adequately four daily injections of regular
Corticotrophin (ACTH). In some cases even greater prolongation of effect
may be experienced.
Corticotrophin with Protamine and Zinc is prepared with ingredients i
whose properties are of established value in parenteral administration.
The Connaught Medical Research Laboratories now provide Corticotrophin (ACTH) in three forms—a dried powder, a sterile solution, and
a suspension with prolonged-action properties.
Dry Powder
—10 International Units per Vial
—25 International Units per Vial
Sterile Solution   —10-cc. vial (20 I.U. per ce.)
Suspension       —10-cc. vial (40 I.U. per cc.)
University of Toronto
Toronto, Canada
letiMitWW i_ 1914 for Public Service through UeJictl Ketcarch tni the develop*-*!
of Prodocu for Prevention or Treatment of Diieue.
Page 296 "At their Annual Meeting held at Harrison Hot Springs in March, the General
Practitioner's Section of the B.C. Division of the C.M.A. decided to inaugurate an
Academy of General Practice for B.C."
This bald announcement in the Press does not at all do justice to the vision and
nterprise of the men who sponsored this project. We congratulate them heartily
»n their courage and long-sighted view of the possibilities of general practice, and wish
hem godspeed in their undertaking.
If this was merely another Association, or Section, we should hot^f eel so enthusiastic
tbout it. If it were merely designed to increase the power and prestige of the General
Practitioner, we should not feel so keen about it either, but. these are nofethe.objectives
pf the Academy, if we understand it aright. The purpose of this step is to improve the
Standards of work done by the general practitioner—to keep him from deteriorating and
becoming, as the years go by, more and more just a clearing house for the specialties,
Which will inevitably be the case if general practitioners do not, by the quality and high
itandard of their work, show the public that they are an essential, perhaps the most
essential, part of the profession of medicine.
Moreover, the general practitioner is the first line of the medical army. He takes
the brunt of practice—he sees the patient first, or should do so. And it is at this point
that accurate diagnosis, thorough examination, and good judgment, are so vital. The
general man cannot be too well trained, or too careful and thorough in his work. For
St is here that error can be avoided—the error of dareless or mistaken diagnosis, of
slipshod and incomplete examination, that miss an accurate estimation of the disease
Ipresent, and waste that most vital of all things in the treatment of the sick—time. The
well-trained general practitioner may not be able to treat every sort of disease fully,
but he can treat most of it quite adequately, and if he uses the methods and aids to
diagnosis which are at his command, he can quite competently detect conditions which
undetected may later become serious and even go beyond hope of treatment, and
[direct them to those who are competent to handle them best.
But to do this, he must first be well-trained—and next, he must keep up with the
developments in medicine. And this means study and reading and post-graduate
| work—and all these things the Academy will demand of him.
Another point brought out in the discussion of the Academy and its aims, was
[that it was hoped that by making general practice better, more men would be inclined
to enter into it. This is a shrewd and correct view to take. In these days when so
many medical students wish to enter into specialties at the beginning of their career,
there is a tendency to regard general practice as something inferior to specialisation—
a refuge for those who are unfit, or financially unable, to specialise. Nothing, we feel
emphatically, can be further from the truth. General practice, "family" practice, has
its own dignity, and its own rewards, and many of us have chosen it as our career
deliberately, and with no regrets. And we ourselves are quite unrepentantly of the
opinion that the present system of "once a G.P.—always a G.P." is entirely wrong.
We feel that every medical man, whether he intends to specialise or not, should begin
bis career in general practice—and earn his right to specialise: prove that he is fitted to
do so. Perhaps that day will come again—we hope so. And things like this Academy
of General Practice will hasten its coming.
It is a statesmanlike and fore-sighted move—and we applaud it, and wish it all
Page 29? Library Hours:
Monday to Friday j 9:00 a.m. to 9:30 p.m.
Saturday   9:00 a.m. to 1:00 p.m.
Recent Accessions:
Transactions of the American Proctologic Society.    Fifty-first Annual Session,  1952.
Leonardo da Vinci on  the Human Body:  Five Hundredth Anniversary Volume by
Charles D. O'MaHey and J. B. de C. M. Saunders, 1952.
Lancisi's Aneurysms by Wilmer Cave Wright (Translator), 1952.
The Advance to Social Medicine by Rene Sand, 1952.
Albert Einstein: Philosopher Scientist by Paul Arthur Schilpp, 1951.
Toxemias of Pregnancy by William J. Dieckmann, 1952.
Gynecologic and Obstetric Pathology by Emil Novak.   Third edition, 1952.
Rheumatic  Diseases published  by  the  Committee on  Publications  of  the  American
Rheumatism Association, 1952.
The Treatment of Diabetes Mellitus by Elliott P. Joslin et al 9th edition, 1952.
The Autonomic Nervous System by James C. White et al. Third edition, 1952.
A Textbook of Orthopedics by Howarth M. Beckett, 1952.
The Versatile Victorian: The Life of Sir Henry Thompson Bt. by Zachary Cope, 1951.
Diseases of the Nervous System in Infancy, Childhood and Adolescence by Frank R.
Ford. Third edition, 1952.
The second edition of the British Encyclopaedia of Medical Practice 1950-52, edited j
by Lord Horder, has recently been acquired by the Library.
Professor William Boyd has kindly presented the Library with a copy of the ktest!
edition of his book: "An Introduction to Medical Science."
"With half an hour's reading in bed every night as a steady practice, the busiest
man can get a fair education before the plasma sets in the periganglionic spaces of his
gray ~ortex . . . ." Osier.
For an area in Northern British Columbia on main line of
Canadian National Railways. Doctor's practice would include two
farming communities as well as two Indian reserves and an Indian
residential school. Full particulars as to grants available from
government departments and available living quarters on request.,
Enquiries should be directed to the Secretary, Fraser Lake Women's
Institute, Fraser Lake, B.C.
Page 298 Vancouver
Dr. E. C. McCoy
Honorary TlTO-TOrer
 _Dr. D. S. Munroe
Dr, G. E. T.angley
Honorary Secretary     	
TV,   J    F,   piflrlr;
Editor __    . .
Dr.   T.   M.   MarTVrmnt
June 1st to June 5th (inclusive)
DR. CARL ABERHART, Toronto, Ontario.
DR. JOEL BAKER, Mason Clinic, Seattle, Washington.
DR. MARTIN M. HOFFMAN, Professor of Medicine, McGill University.
Orthopaedic Surgery—
DR. GRAHAM HUCKELL, Professor of Orthopedic Surgery, University of
Alberta, Edmonton, Alberta.
Obstetrics and Gynaecology—
DR. HOWARD STEARNS, Clinical Professor of Obstetrics & Gynecology,
University of Oregon, Portland, Oregon.
Monday, june ist
9:30 a.m.—Dr. Joel Baker: "Intestinal obstruction, certain rules in management."
10:15 a.m.—Dr. Carl Aberhart: "Differential diagnosis and treatment of scrotal
11:00 a.m.—Dr. Joel Baker: "Practical problems in surgery for gallstones."
12:30 p.m.—LUNCHEON—HOTEL GEORGIA.   Speaker: Dr. N. A. M. Mackenzie,
President of the University of British Columbia.
Dr. Joel Baker and Dr. Graham Huckell.
Dr. Martin M. Hoffman: "Current status of cortisone and ACTH."
9:00 p.m.—Dr. Howard Stearns: "Induction of labor and indications."
9:00 a.m.—Dr. Graham Huckell: "Congenital club foot."
9:45 a.m.—Dr. Martin M. Hoffman: "Problems in water and electrolyte balance
10:30 a.m.—Dr. Joel Baker: "Pancreatitis—The question of etiology and the problem
of treatment."
11:15 a.m.—Dr. Howard Stearns: "Functional uterine bleeding."
Page 299 2:00 p.m.—UROLOGIC CLINIC—SHAUGHNESSY HOSPITAL—conducted by
Dr. Carl Aberhart.
8:00 p.m.—Dr. Joel Baker: "The surgical abdomen—Diagnosis and choice of procedure after the abdomen is opened."
8:45 p.m.—ROUND TABLE CONFERENCE (Surgical) : "The Acute Abdomen"—
Dr. Joel Baker, Dr. Carl Aberhart, Dr. W. L. Sloan and Moderator: Dr.
H. Rocke Robertson.
9:00 a.m.—Dr. Carl Aberhart: "Diagnosis and treatment of urinary infections
excluding tuberculosis."
9:45 a.m.—Dr. Graham Huckell: "Foot disabilities."
10:30 a.m.—Dr. Martin M. Hoffman: "Problems in water and electrolyte balance
11; 15 a.m.—Dr. Howard Stearns: "Prolonged labour."
conducted by Dr. M. Hoffman.
8:00 p.m.—Dr. Carl Aberhart: "The prostate and some of its problems."
8:45 p.m.—Dr. Howard Stearns: "Treatment of vaginal infections."
9:00 a.m.—Dr. Howard Stearns: "Bleeding in the third trimester."
9:45 a.m.—Dr. Graham Huckell: "Fractures about the elbow."
10:30 a.m.—Dr. Martin M. Hoffman: "Management of chronic renal failure."
11:15 a.m.—Dr. Carl Aberhart: "Differential diagnosis and management of nontraumatic haematuria."
7, Dinner at 8 and Dancing from 9 till 1.
9:00 a.m.—Dr. Graham Huckell: "Acute and chronic osteomyelitis."
9:45 a.m.—Dr. Carl Aberhart: "The theory behind, and the treatment of paraplegic
10:30 a.m.—Dr. Martin M. Hoffman: "Endocrine management of functional uterine
11:15 a.m.—Dr. Graham Huckell: "Benign bone tumours."
by Dr. Howard Stearns.
8:00 p.m.—ROUND TABLE CONFERENCE (Medical): "Hypertensive Cardiovascular Disease"—Dr. Martin Hoffman, Dr. Sydney Sturdy, Dr. Peter
Lehmann and Moderator: Dr. R. B. Kerr.
Summer School Sessions  (5 day course)—$10.00.
Luncheon—Monday, June 1st, Hotel Georgia—$2.00.
Golf—Thursday, June 4th, Quilchena Golf Courses—$2.00.
Dinner and Dance, Thursday,, June 4th—Stanley Park Pavilion—$6.00 per coupltA
Page 300      §|l The Summer School Committee would appreciate if those wishing to register for
this course would make their cheque payable to the Vancouver Medical Association and
mail it to—Dr. John A. Elliot, Secretary,
Summer School Committee,
1807 West Tenth Avenue,
Vancouver 9, B.C.
The cheque (which is deductible from income tax) may be made out in an amount
to cover any or all of the above mentioned functions and tickets will be mailed accordingly.
**Advance registration would help to speed up opening morning activities. For
further information phone BA. 4158.
All Canadian physicians and medical under graduates with art or photography as
a hobby are invited to exhibit some of their work at the 9 th annual Physicians' Art
Salon, to be held at the Royal Alexandra Hotel, Winnipeg, from June 15 to 19, in
conjunction with the Convention. All entries in the division of fine arts, monochrome
photography, and colour transparencies will be displayed on the convention floor and
judged for awards by a panel of outstanding Canadian artists. Members of this panel
are: Mrs. J. M. Duncan, Mr. Alvin C. Eastman and Mr. Bert Hunter.
By popular request there will be a slight modification in judging of fine art. Entries
will be divided into traditional and modern works, and prizes awarded in each category.
Again sponsored by Frank W. Horner Limited, the salon is expected to attract a
large number of enthusiasts in the various media. Organized originally to foster restful
pursuits in the profession, the Physicians' Art Salon has aroused widespread interest
across the Doniinion and has become a forum at which artistically gifted physicians can
exhibit the produce of their leisure hours before an interested medical audience. I
In addition to awarding prizes the Horner Company will reproduce winners in the
1954 Physicians' Art Salon calendar. A copy of this attractive full colour desk model
can be obtained by writing Frank W. Horner Limited.
Anyone interested in entering work is urged to notify the sponsor, P.O. Box 6139,
Montreal, who will furnish full details and the necessary entry form. A short note or
postcard will do. All expenses, including the transportation of exhibits to and from
Winnipeg, will be borne by the sponsor.
Entry forms must be completed and in hand before May 25 th. Exhibitors are
also asked to ship entries far enough in advance to allow for the inevitable delays in
express and parcel post.   Full shipping instructions appear on the entry form.
JUNE 4th—Quilchena Golf Club.
JUNE 25 th—Vancouver Golf Club—Burquitlam.
*Dinner for golfers will be provided following the tournaments.
(Information)  H. B. Graves, M.D.,
Secretary, Vancouver Medical Golf Association.
Phone KE. 7232.
By Frank Turnbull, M.D.*
Paper given at B.C. Cancer Institute
Special Lecture Course
October   6th,  1952
At a meeting of the British Medical Association this year in Dublin, the programme
included a Symposium on Pain.  The leading speaker was an Irishman.   He divided painl
into three types: upper abdominal, lower abdominal and extra-abdominal.   For these
three varieties of pain his treatments were, respectively: bicarbonate of soda, salts and.
aspirin with or without a rub.    That is a sage and succinct statement about ordinary
pains that may afflict us all at various times.    But it is obvious that no such simplified
system can be applied to the pains that are associated with cancer.
Meaning of Cancer
Implications of the word "Cancer" have a bearing on my subject. To a medical
group 'cancer' has a wide variety of associations. Depending on our own particular
branch of medicine we may think in terms of growths in certain regions of the body,
or of special types of treatment such as radiotherapy or plastic surgery. Even if we
ponder over the possibility of being attacked by cancer in our own person the chains
of thought are various. We may speculate about how we would feel with obstruction,
or hemorrhage, or deformity, or cachexia, and we know that the solution of any one
of these problems may be very complex. About pain that is associated with cancerj
however, I think that our attitude would be quite forthright. Like the old man's report
of what the parson said about sin, we are "agin it." We would not tolerate it well, and
we would expect our colleagues to use every medical and surgical measure that they;
could command, to stop it at once and to hold it at bay.
Contrast this professional attitude toward cancer with the attitude of the average
layman. The word "Cancer", for the average non-medical citizen, is associated almost
invariably with Pain. And furthermore, he really does not think that we can relieve the.
pain. This attitude leads some of our cancer patients to the depths of depression though
their pains may be mild and infrequent. It may cause others who do suffer from severe
intractable pain to accept heroically months of unnecessary martyrdom.
General Management
To manage pain in the early stages of cancer, the Irish doctor's dictum about soda,
salts, and aspirin may be all that is required.   Anyone who has thought through his:;
therapy to principles that are so simple, will be experienced and wise enough to add tbe\
necessary psychological support.
In the later stages of cancer, pain may likewise continue to be a relatively minor-
problem. Patients sometimes go on to die from malignant disease, their bodies fiddled
with cancerous growth, and yet never suffer any pain at all. On the other hand, there
are certain patients for whom life is made intolerable by pains that call for every therapeutic resort that we can muster.
Each year brings forth new drugs for the relief of pain. Some day we hope that a
powerful pain-relieving drug will be discovered which is non-toxic in completely effective doses, and for which increasing tolerance cannot be developed. There is no such
drug available yet. The purposeful development of narcotic addiction is justified if one
can be certain that the patient is nearing his end. But how easy to be wrong about this
♦Clinical Associate Professor of Surgery  (Neurosurgery)   University of British Columbia Medical School
, Vancouver, B.C.
Page 302 Recognition of Intractable Vain
In the early stages of cancer we are usually overly optimistic about the probable
life span. In the late stages we tend to lean the other way. We are prone to say, "why
operate, he will likely be dead in a couple of months", and then, four months later,
find that we are still facing the same problem in the same patient. Four months or even
six months of intractable pain is a short time, when we relate it to the total life span.
Furthermore, it does not appear to be a matter of great importance, when we relate the
number of sufferers from intractable pain to the total group of patients who have cancer.
The patient whose consciousness is dominated by intractable pain, lives in the hope that
it will disappear. Before the doctor elects to prescribe narcotics unlimited, he should
make certain that there is no means of escape from the pains by other means.
We all have difficulty in recognizing when intractable pain has become established.
I can recall very few patients whose pain I was able to relieve satisfactorily by surgical
means, for whom it was not felt that total relief had been withheld too long. There
appear to be two principal reasons for the usual delay of surgical relief for pain. In the
first place, there is a natural reluctance to employ major surgery for purely symptomatic
treatment. One simple answer to this objection is that an operation to relieve pain may
be more gratifying and more important in retrospect than any operaion that the patient
has undergone. Secondly, it is not generally recognized that when deep, boring agonizing
pains, which do not respond to simple sedation, become established as a daily occurrence,
in a patient who has finished definitive treatment for cancer, the stage is set, and there
is no spontaneous relief in sight.
Pain as Unmanageable Disease
It has been our experience, at this Institute, that when intractable pain starts, the
patient has usually finished all of the curative surgical or radiation treatment that he can
take, or these measures have been abandoned in the face of a losing battle. This is a
period in the total course of illness that may be rather loosely directed. The patient is
passing out of the hands of his surgeon or radiotherapist, and back into the hands of his
family doctor. It is time for a new Plan. At this stage, if intractable pain has been
established, it is in the best interest of the patient to regard the pain as a disease in
itself—a disease that has become temporarily unmanageable.
How should one assess this unmanageable disease? Unless it is considered broadly
at the beginning the results of treatment are likely to be unhappy. One needs to consider
four general aspects—the Cancer, the Pain, the Mind, and the Home. They interlock
and they are all important. To consider one without the others is to invite frustration
and disappointment.
The Cancer
Cancer seems to be complicated most frequently by intractable pains when it has
originated adjacent to or in one of the natural orifices—the mouth and nasopharynx,
the rectum and cervix. The orifices have a greater concentration of sensory nerve fibres
in their supporting structures than other parts of the body that are commonly affected
by cancer. For obvious reasons the involvement by secondary growths of the sensory
nerve roots at any level of the spine and within the cranium, or of the bracial and
lumbar plexus, may also give rise to distressing pain.
The presence of obvious secondary growths, e.g. massive glands in the neck, or a
"frozen pelvis", makes it easy to decide that there is no hope for cure of the disease,
but does not tell us anything about the severity of the pain, or the likelihood that pain
will continue. Not infrequently intractable pains are established months before there
is any evidence by examination of secondary extension, or even of any recurrence of the
primary growth. The degree of cachexia and the relation of this state to the intractable
pains are difficult to assess. One has to rely on clinical judgment as much as on
laboratory tests to decide whether the patient is fit for operation, and if so, how much of
an operation.
Page 303 To sum up our viewpoint about the Cancer.   Intractable pain is more frequent
with cancer of the orifices.   It commonly starts at about the stage when definitive
treatment stops.   It may commence before there is evidence of local or generalizes!
recurrence. The development of cachexia does not have any clear relation to the severity
of pain, but may be a factor that influences one's symptomatic treatment.
The Pain Itself
There are three general types of pain that may be associated with cancer. Firsa|
there is the intense, constant, local pain of an expanding primary or secondary growth.
The second type of pain results from stretching or pinching of posterior nerve roots
which cause periodic, sharp, stabbing "root" pains. The third type is the hardest to
understand, and it is the most characteristic pain of advanced cancer. This is the deep,
boring, agonizing ache that is often associated with a feeling of "numbness" or fullness.
It usually spreads in an asymmetrical and patchy manner. As it increases in area and
intensity it begins to be associated with periodic stabbing pains of the "root" quality.
When pains of the deep, boring, agonizing type develop in a patient who has a
gross inoperable cancer, or has recently had a malignant tumour removed, those pains
will usually persist. If they do persist for several weeks or a month, one can be certain
that they represent secondary invasion by the tumour and are not the result of "scar
tissue" or "inflammation".   It is very unlikely that they will ever relent.
The precise location of the pain is of great importance from the standpoint of
possible neurosurgical relief. If cancer is arising in the pelvis and cordotomy is being
considered, one is anxious to learn if the patient describes any pains that seem to arise
in the upper abdomen. If such were the case, insensitivity to at least as high as the
nipples on both sides would be necessary for satisfactory relief. If pain is arising from
cancer adjacent to the mouth, one is interested particularly in pains that seem to spread
across the borderline zones from the domain of the trigeminal of the face, to the glossopharyngeal of the throat or to the nerves of the neck.
To sum up about our assessment of the Pain: The type that is most relentless and
of most serious significance is the deep, boring, agonizing ache that is associated with a
vague feeling of numbness. If sharp root pains are superimposed on this deep ache, the
situation for the patient is desperate, because the agony is so severe and because there is
almost no hope that it will relent spontanously. The site of pain needs to be carefully
considered in relation to pain fibres or nerves that one proposes to section.
The Mind
Consideration of the Disease and the Pain establish the physical status, both subjective and objective, but before one decides on a course of action it is prudent to assess
what all this has done to the patient's mind. Certain questions require an answer. Is the
patient a sturdy character who will carry on with the normal jobs of living in spite of
weakness and minor discomfort, if only rid of the intolerable, severe pains? Is the complaint of pain in reality an elaboration of minor discomforts to explain indirectly the
patient's mental distress about his fatigue or disgust about his physical appearance? To
what extent does fear condition the response? Will an operation that is calculated to
relieve tension and abolish fear, i.e. pre-frontal leucotomy—be of more benefit than the
peripheral section of pain fibres?
The pains that some of these patients endure would break down the hardiest among
us. One needs to make plenty of allowances before deciding that an obsessional neurosis
plays any part in their distress. A decision on this point is important because at this
stage one is considering not only the feasibility of symptomatic neurosurgical treatment,
but also an alternative—the introduction of narcotics for sedation. Purposeful narcotic
addiction in the face of gross terminal cancer may be a blessing. But if there is any
doubt about whether the disease is recurring and whether the pains might represent an
obsession, the introduction of narcotics can be bad for all concerned.
Page 304 To sum up about the relation of Mind: What one can do for symptomatic relief
by surgery is partly conditioned by the patient's will to get back to some normal
responsibilities. It takes a good- deal of determination and spirit for these patients to
recover effectively from pain tract section of the cord or section of cranial nerves. It
is important to decide whether the reactions such as fear and anxiety are overweighing
all other disabilities, and whether life could be tolerable if these reactions were abolished.
Pre-frontal leucotomy might be worthwhile in such a case. Finally, it is important to
recognize the patient whom disease has made hypochondriac or an obsessional neurotic.
They may be badly disabled, so. badly that leucotomy might reasonably be considered,
but pain tract section would substitute complaints, and narcotics merely change the
character of the disease.
The Home
Before any major neurosurgery is undertaken in these cases, one needs to consider
the home. An adequate environment includes the presence of a doctor who knows the
whole situation, has the confidence of the patient, and is prepared to stand by him to
the end. If contact with the family or personal doctor has been lost, he should be
re-introduced and asked to help in the decision about palliative operation. One needs to
consider also whether social service or nursing care will be required in the near future.
A patient may get along by himself in a roominghouse or hotel after section or nerve
roots around the head or neck. After cordotomy that has been followed by a sufficient
convalescent interlude, he might get by alone, but we could not be certain. , After
leucotomy, the patient requires a sheltered environment and the guidance of an understanding friend or relative for at least six months.
To sum up about tlae Home: Before undertaking any neurosurgical treatment for
intractable pain, it is abvisable to re-introduce the personal doctor into the picture, if he
has lost contact, and to assess the facilities at home in the light of the probable environmental support that may be required by the patient.
There are a great number of aphorisms about pain. One that is germane to my
subject today is a wise observation by Prof. Leriche: "There is only one pain that is
easy to bear.   That is the pain of others".
Result of Election for Members
of Council
of the College of Physicians and Surgeons of B.C.
District No. 1  (Victoria)
Dr. R. Scott Moncrieff
District No. 2  (Upper Vancouver Island)
Dr. A. H. Meneely —elected.
District No. 3  (County of Vancouver)
Dr. W. Elliott Harrison —elected.
Dr.  Robert G. Langston        —elected.
District No. 5 (Yale and Cariboo)
Dr. Wm. Roy Walker —elected.
District No. 6 (Kootenay)
Dr. D. J. McGregor Crawford—elected.
;^^^^^^^H WITH BENEMIDR* §"" .|B   " ^m
Department of Internal Medicine,
Fellow in Internal Medicine, The Leahey Clinic, Boston, Massachusetts.
Gout is a disorder of intermediary purine metabolism. In brief nucleoproteins
(from exogenous and endogenous sources) are hydrolyzed to purines which, in turn, ard
changed to uric acid by deaminization and oxidation. Uric acid is a threshold substance
which is excreted almost entirely by the kidneys. In normal urate clearance 90 to 95
per cent is reabsorbed by the tubules as a result of active enzymatic processes. The
high normal serum uric acid level is 6 mg. per 100 cc. in males and 5 mg. per 100 cc.J
in females.   The normal uric acid pool in the tissues is about 1200 mg.6
Purine Metabolism in the Gouty Patient
In the gouty patient the precise mechanism by which hyperuricemia occurs w|
obscure.    It is due to an absolute or relative; renal insufficiency (that is, the kidney
cannot reduce the tubular reabsorption of urate).    The hyperuricemia results in a
supersaturation of urate in the interstitial fluids and precipitation of sodium urate in-
the tissues.    The resultant uric acid pool may exceed the normal by three to fifteenj
times.   In most patients the evolution of gout goes through four phases:
(1) Hyperuricemia.   Hyperuricemia is transmitted by a single dominant gene, and?
a familial incidence has been demonstrated in over 75 per cent of cases.6    It occurs
predominantly in males (over 95 per cent), usually after puberty.
(2) Acute attack.   There is most always a history of preceding (trivial) trauma.
This unique, exaggerated, inflammatory reaction is promptly reversible with colchicine'!
or corticotrophin, but is not affected by benemid.
(3) Chronic gouty arthritis.    Intercritical symptoms supervene; later tophi and
disabling chronic arthritis develop.
(4) Complications.    Eventually,  complications  primarily of  a  vascular nature
develop (notably arteriosclerosis, nephosclerosis and hypertension).
The Action of Benemid
Benemid is a potent uricosuric agent which reduces tubular reabsorption of urate
by interference with the tubular conjugating enzymes. It does not increase glomerular?
filtration, and it does not effect the specific inflammatory reaction. Gutman7 has
reported an extra excretion of 75 gm. of urate in a patient receiving benemid over a five
month period. The action is very rapid, with the maximum effect being reached within
seventy-two hours. There have been no instances of refractoriness reported in the
literature. Toxic reactions are rare, with a total of twenty-two occurring in the
literature reviewed. They usually consist of rash, headache or mild upper gastrointestinal distress. No instances of hepatic, renal, electrolyte or hematologic abnormalities have been reported. The only consistent finding is a lpw normal phosphate.
Numerous investigators have reported acute attacks precipitated shortly after starting
treatment. There is a certain danger of precipitating uric acid crystals in an acid urine
when the initial serum acid level is high. The effect of benemid may be negated by the
presence of chronic renal disease, but this was not observed in our series. The actioa|
of benemid is completely blocked by aspirin or salicylates, but the precise mechanism
by which this occurs is obscure.
Recently there has been a number of encouraging reports in the literature regarding
the use of benemid in patients with gout.    We1 have reported the results of such
treatment in 30 patients with group of two weeks' to twenty-five years' duration
*BenemidR-p- (Di-n-propylsulfamyl) -benzoic acid (Sharpe and Dohme).
Page 306 (average eleven years). They were treated continuously for six to sixteen months
(average nine months). All showed a marked decrease in the frequency and severity
of acute attacks, and diminution of intercritical symptoms. All but 2 showed a fall of
serum uric acid levels. The average level before therapy was 9 mg. per 100 cc. and
during therapy 5.3 mg. per 100 cc. Twenty-two patients had acute attacks while on
treatment, with 2 having attacks shortly after starting the medication. Although 5
patients showed evidence of previous renal damage, the clinical effect of benemid was
not significantly impaired. Only one patient had a severe reaction (high fever and
generalized rash) which required the discontinuance of benemid. ButazolidinR was
substituted, with marked benefit.
Proposed Program of Treatment
From the above series (and 30 additional patients treated for a shorter period) we
have evolved the following plan for treating the average gouty patient.
1. Low purine, low fat diet is given for the first six months. Then the diet is
liberalized only if the daily maintenance dose of benemid is less than 1 gm. Alcohol
is interdicted.
2. Benemid is given in divided doses twice daily. The patient is started on 2 gm.
per day. After twenty-five days (that is, the first 100 tablets) the dose is gradually
decreased, depending on the level of the serum acid level. This level is maintained at
below 5mg. per 100 cc.
3. The patient is instructed to drink at least 3000 cc. of fluid per day. This helps
to eliminate uric acid, prevents precipitation of uric acid crystals and retards progressive
renal involvement.
4. Sodium bicarbonate (2 teaspoons three times daily) is given until the serum
uric acid level falls below 5 mg. per 100 cc. An alkaline urine also helps to prevent
precipitation of uric acid crystals.
5. If acute attacks develop during benemid therapy the patient is given: (a)
colchicine, 1/120 grain hourly for a total of 6 to 8 tablets; or (b) ACTH, 50 mg.
intravenously over a four to six hour period, or (c) acthar-gel, 40-60 mg. intramuscularly or (d) hydrocortisone, 25 mg. injected locally into the affected joint.
6. If a relatively severe reaction develops (rash or fever) benemid is stopped and
the patient is given butazoHdinR (600 mg. daily in divided doses).
7. The patient is told that he will probably have to remain on benemid therapy
for life. He is instructed to avoid aspirin and salicylates. The serum uric acid level
is checked routinely at three weeks; and at two, four and seven months from the onset
of treatment.
A plan of management is proposed for the average patient with gout. The action
of benemid in the treatment of gout may be considered analogous to the action of insulin
in diabetes mellitus. It is thought that benemid is a valuable adjunct to previous
standard methods of treatment (diet, colchicine, ACTH and physiotherapy), and that,
to date, the results of "long term" management have been most encouraging.
1. Bartels, E. C. and Kepkay, P.H.: Unpublished data.
2. Hollander, J. L., Brown, E. M., Jr., Jessar, R. A. and Brown, C. Y.: Hydrocortisone and cortisone
injected into arthritic joints; comparative effects of and use of hydrocortisone as a local anti-
arthritic agent.   J.A.M.A., 147:1629-1635   (Dec. 22), 1951.
3. Kuzell, W. C, Schaffarzick, R. W\, Brown, B. and Mankle, E. A.: Phenylbutazone (butazolidin(R)
in rheumatoid arthritis and gout. J.A.M.A., 149:729-734 (June 21), 1952.
4. Pascale, L. R., Dubin, A. and Hoffman, W\ S.: Therapeutic value of probenecid (Benemid(R) in
gout. J.A.M.A., 149:1188-1194  (July 26),  1952.
5. Talbott, J. H., Bishop, C, Norcross, B. M. and Lockie, L. M.: The clinical and metabolic effects of
benemid in patients with gout. Tr. Assn. Am. Physicians, 64:372-377, 1951.
6. Thorn, G. W. and Emerson, K.; Principles of Internal Medicine (Harrison, T. R.). Philadelphia,
Blakiston, 1951, p. 697.
7. Yu, T. F. and Gutman, A. B.: Mobilization of gouty tophi by protracted use of uricosuric agents.
Am. J. Med., 11:765-769  (Dec), 1951.
By Dr. H. H. Pitts
Another year has slipped into the past and once again we are gathered here to do
honour to that illustrious Canadian physician, Sir Willian Osier. I stand here deeply
bonscious of, and grateful for, the honour bestowed upon me by your executive in
offering me the opportunity of delivering the Osier Lecture here tonight.
The Osier Lecture was originated, as you probably know, in 1921, when Dr. Fred
Brodie was President of the Association, and the first lecture was delivered by Dr. W. D.
Keith. The roster of lecturers since that time bears the names of some of the outstanding figures in medicine in our city, and I feed that one may say, with very little
fear of contradiction, that Sir William himself would have placed the seal of approval
on each and every lecture delivered.
In recalling those lectures I believe it has been more or less traditional that the
speaker has built his theme about his specialty and so, not wishing to be an iconaclast,
I will endeavour to show how Osier's deep interest in pathology was probably one, if
not the greatest, factor of his future diagnostic acumen.
Osier's parents came to Bond Head, Tecumseh County, Ontario, from Cornwall,
England, in 1837, to establish an Anglican Church. For the first few years they
endured many hardships and as the district was very sparsely settled and travel was only
possible on foot, by canoe or with horses, Mr. Osier was away much of the time on his
ministerial duties. He held services in all manner of buildings, but chiefly in unchinked
log-barns, the congregation numbering members of all faiths. Realizing the great need
for a building specifically for worship in each community he set out unselfishly and
with his boundless energy to erect two churches, even before beginning work on his
own home. In the meantime they lived in log-barns which through the energies of the
parishioners were scrubbed and scoured to remove all traces of the recent bovine and
equine occupants. Their wood was to be supplied by these same parishioners but on
occasion they forgot their commitments and the entries in Rev. Osier's diary tell of
the whole family not infrequently going to bed during the day in order to keep warm.
However, the following spring an acre of ground and money were subscribed for the
parsonage into which, by comparison, palatial edifice they finally moved. Not long
afterwards Trinity Church was erected on the lower slope of the low hill on which
the parsonage stood. Mrs. Osier ably assisted her husband in his ministerial duties and
conducted a Sunday School and sewing class which were famous throughout a wide
district. It was only natural that the parsonage should become the social and religious
centre of the district with a family such as this resident in it. Sir William's faculty
for attracting people to him seems to have been honestly inherited, as following a trip
to England in 1841, because of a bad cough and general ill-health, the Rev. Osier and
his wife were met on their return, at Holland Landing by 60 wagon-loads of people
who escorted them back the 12 miles to the parsonage.'
William Osier, the youngest of six brothers, was born at the parsonage in Bond
Head on July 12, 1948. He was the second youngest of the nine children, there being
three sisters, although Emma, born two years later, died at the age of three. Harvey
Cushing in his 'Life of Sir William Osier' relates a somewhat amusing anecdote
relative to Osier's name and natal day. As you no doubt are aware July 12 is celebrated
by Orangemen throughout the world as the anniversary of the Battle of the Boyne,
usually with a prominent member representing William of Orange mounted on a white
charger, although this fiery steed, during the rest of the year, was probably the sole
means of locomotion of a milk-wagon. At Bond Head the parade formed at the
'Corners' and marched approximately a mile to the Parsonage where speeches ensued.
The parade finally reached the Parsonage on this particular July 12 and were soon aware
Page 308 MM of the happy event and the new arrival must needs be exhibited in the proud father's
arms. It was promptly and most vociferously decided by one and all that he should
be christened William and he was forthwith most ceremoniously dubbed the 'Young
Prince of Orange'. The fact that the names Walter Farquhar had been previously
chosen was of no consequence and William he was christened. Each year for several
subsequent July 12's young Osier stood on the parsonage verandah in broad orange and
blue sash to greet the parade which the children of the district regarded as being solely
in his honour, which supposition young Osier probably did little to dispel.
In the fall of 1854 the Rev. Osier wrote Bishop Strachan of Toronto requesting a
transfer, partly because of ill-health but probably more particularly because of the
rather indifferent education facilities for the six younger children in Bond Head. It
was not, however, until January 1st, 1857, this his transfer to the rectorship of
Ancaster and Dundas was approved, and with many tugs at their heart strings after
19J4 years of full measures of hardship and happiness, the Osier family set forth for
Dundas. An incident at this time is, I believe, worthy of mention. Two of the older
boys were already in boarding school at Dundas and the remainder of the family had
travelled from Bradford to Toronto by the recently constructed Northern Railway
and were to proceed from there to Dundas the next day by the Great Western Railway.
However, young Willie suffered an acute attack of croup and the journey was postponed. Who knows but that some beneficient guardian angel was watching over the
ailing Willie and thus saved for Canadian medicine this illustrious son, for as it was
approaching Hamilton this train they would havs taken was derailed and plunged
through a viaduct with great loss of life—the Desjardins catastrophe of March 12, 1857.
It was in Dundas that Osier's formal schooling began and it would appear that he
was in the van in the many pranks and practical jokes played on Mr. Flynn, the rather
despotic principal. These ranged from removing all furniture from the class-room
including the unscrewing of the desks from the floor and hoisting them through a
trapdoor into the garret, to the incarceration of a large flock of geese overnight in the
class-room of the common school which occupied the ground-floor. At any rate young
Osier and four accomplices were expelled and the next fall he was sent off to boarding
school in^Barrie. This transfer did not dampen his enthusiasm for pranks, for he, with
two other boys, earned the rather dubious distinction of being known as 'Barrie's Bad
Boys': albeit the pranks were always of a harmless nature.
Apparently neither young Osier nor his parents were particularly satisfied with
Barrie schools, and since a new school, Trinity College School, h^d opened at Weston
which was nearer to Dundas, they decided to send him there. This proved to be a most
important step in Osier's life, for one of the masters was the founder, Rev. William
Arthur Johnson, who as we shall see, played a most important role in Osier's early
training, stimulated his interest in the microscope, biology and zoology, and probably
more than anyone else sowed the seed leading to Osier's decision to make medicine his
life's work. However, he was equally impressed with Johnson's religious learning and
earnestness, so much so in fact, that he was for no inconsiderable time, very seriously
considering the ministry. Osier at this time was 17 years of age with a rather well-
knit, rather small body, and he was an excellent all-round athlete. He was an
enthusiastic, eager student who fell completely under the spell of Dr. Johnson's biology
and zoology field trips and microscope. The Medical Director of the institution was
Dr. James A. Bovell, an old friend of Dr. Johnson's, through whose request he had been
appointed to the position. He, too, was an ardent biologist, zoologist and microscopist,
and although he taught at the Toronto Medical School and practised in Toronto, he
spent a part of each week-end at Weston with Johnson, apparently oblivious of his
patients in Toronto, and with their eager and willing disciple, Osier, combed field and
stream for new specimens. Osier's retentive memory with its thirst for knowledge,
listening to these brilliant teachers, must have been fully sated after each of these
Page 309 In the fall of 1867 at the age of 18 Osier entered Trinity College in the Faculty;
of Arts at Toronto. Here he spent many Saturdays at Dr. Bovell's home keeping the
aquaria will filled with various pond waters that various algae, etc., might be studied.
In addition he spent many week-ends and vacations at Weston continuing the collection
and cataloguing of Dr. Johnson's material. It would appear that during this, his
freshman year, his learnings were definitely toward the ministry, and one wonders
whether the harvesting of inmumerable specimens during the summer of 1868 and the
interest they aroused in him, may have fanned to life some latent fire of medical zeal,
for, on his return to Toronto that fall for his second year in Arts, he attended only
a few lectures when he advised his parents of his desire to enter the study of medicine.
This news was probably no small disappointment to them but was enthusiastically
received by Dr. Bovell, and during the next two years, as Cushing states, they lived
more like father and son than pupil and teacher, and one would infer that it was Dr.
Bovell that actually launched Osier on his medical career. Young Osier threw himself
into his medical studies with whole-hearted enthusiasm and interest, and was a great
favorite with both teachers and fellow-students, with the former because of his interest
and knowledge, and with the latter because his knowledge was carried with no air of
superiority and because of his athletic ability and his readiness to engage in any prank
or practical joke.
In the fall of 1870, that is at the beginning of his second year in medicine Osier
transferred to the Faculty of Medicine at McGill. It is probably that this was largely
on the advice of Dr. Bovell, as the clinical opportunities in the Montreal hospitals were
much greater than in Toronto where bedside teaching was rather discouraged. In an
address given many years later Osier recalls the Montreal General Hospital in 1870 as 'an
old coccus-ridden and rat-ridden building but with two valuable assets for the student—
much acute disease and a group of keen teachers.' The four he most admired were
R. Palmer Howard, Professor of Medicine, William Wright, Professor of Materia Medica,
Duncan MacCallum in Midwifery and J. Morley Drake, Professor of >the Institutes of
Medicine. It was Palmer Howard, a stimulating teacher with an avid thirst for
knowledge which brought him, almost daily, to the postmortem room, who first kindled
in Osier this same deep interest. There was an established rule in the hospital, that
whenever a pulmonary lesion or other interesting lesion was found at autopsy, Howard
be called, and with Osier at his heels one can well imagine the many impromptu
clinico-pathological conferences held over the post-mortem table.
Osier graduated from McGill in 1872, not with the Holmes Medal for the highest'
standing for the full, course but with a special prize which was announced in the
Convocation programme as follows 'The Faculty has in addition this session awarded a
special prize to the Thesis of William Osier, Dundas, Ontario, which was greatly
distinguished for originality and research, and was accompanied by 33 microscopic and
other preparations of morbid structure, kindly presented by the author to the museum
of the Faculty. The gentlemen in order of merit who deserve mention—Messrs. Osier,
Browne, Waugh, etc.'
1^1In July of 1872 Osier and an older brother Edmund who gave him $1000 to see
him through a fairly prolonged tour of Europe, set sail and landed in Ireland, and after
visiting various scenic and historic places there, moved on to Glasgow and Edinburgh
following which Osier moved on to London, where he began a 17 months period of study
under John Burdon Sanderson in physiology at the University College Hospital. It
would appear that the general tenor of the work conducted in the department was
experimental pathology, for at that time pathology and physiology were not so clearly
separated as they have since become. Pathology had begun to assume a more important
role in the medical sciences especially since, as you will no doubt recall, in the earlier
1860's Virchow's new concepts of cellular pathology had thrown open a practically
unexplored vista for investigation. Osier's familiarity with the microscope acquired
under Johnson stood him in good stead during this period, and as Cushing states it was
his great interest and fund of knowledge gained in this stimulating environment which
Page 310 probably gained for him the appointment, two years later, of Professor of the Institutes
of Medicine at McGill, despite the fact he was only 25 years of age. As this department
embraced physiology, pathology and histology this training had admirably equipped him
for the position. It was during this time that he became interested in what he entered
in his note-book as 'Colourless elements in my blood,' and he continued to study a great
many speciments of both human and animal blood and tabulated his observations, the
results being reported to the Royal Society by Professor Sanderson the following spring.
Although these bodies, which we now know as platelets, had been observed and
mentioned by other investigators, none had noted them in the circulating blood or so
thoroughly investigated them.
In the fall of 1873 he arrived in Berlin, where he spent 3 months chiefly interested
in Virchow's course in pathology at the Pathological Institute. At this time Virchow
was 52 years of age and as Osier describes him, small, wiry and active. Despite his
arduous teaching commitments, he was most active politically and was leader of the
Prussian Opposition. His ability as a teacher, his thorough, painstaking presentation of
pathological material and his boundless energy made a deep impression on Osier. This
course attracted large numbers of foreign students to Berlin, partly because of the
newer concepts of disease it presented, but probably more particularly by reason of
Virchow's dynamic personality. In a letter written to the Canada Medical and Surgical
Journal at that time Osier briefly described the course which would appear to have
been a most intensive one. Three mornings a week from 8:30 to 11 Virchow conducted
a demonstrative course in pathology and on the other three pathologic histology. On
one of these mornings he personally performed a postmortem examination, lecturing
and demonstrating as he proceeded, and usually requiring from 3 to 4 hours to complete. During two of the mornings the demonstrations were held in a large lecture
room accommodating 140 students when the material from 10 or 12 postmortems
would be demonstrated and the microscopic sections examined as they passed along a
small moving tramway into which the microscopes were set. Finally on one of the
afternoons he lectured on general pathology. This course apparently thoroughly ingrained in Osier the value of pathology as the stepping-stone to clinical diagnosis, and
taught him to visualize what underlying pathological processes were responsible for
the signs and symptoms presented.
From Berlin Osier journeyed to Vienna, arriving there on New Year's Eve, 1874,
and his letters written to the Canada Medical and Surgical Journal were full of famous
names—Bamberger, Skoda, Rokitansky, Braun, Bandl, Billroth, Pollitzer, Neuman and
Hebra and many others whose ward-rounds, clinics and lectures he attended. Pathology
was still his chief interest, and here in Vienna there was a greater wealth of pathological
material but in his opinion it was not utilized or presented as in Berlin. Rokitansky
now in his 70th year was past his peak and apparently had left no successor to fill his
shoes adequately, at least at that time. Osier remained in Vienna for approximately 5
months, when he returned to London remaining there another month and then set forth
for Canada, arriving in Montreal in early July. He was appointed lecturer in the
Institutes of Medicine, and beginning that fall he had to prepare and deliver four
lectures a week. Although he had opened an office at the foot of Beaver Hall he was
far from being'a busy practitioner, probably the main reason being that he was seldom
in his office, as he spent most of his time at the Medical School. He had no hospital
appointment at this time and being eager to continue his pathological investigations
he volunteered to do the postmortem examinations at the Montreal General Hospital, a
task which the attending physicians and surgeons performed on their own cases. Money
was conspicuous by its absence, and it would appear that Osier, on many, if not most
occasions, led an almost hand-to-mouth existence. In the early 1870's the Montreal
General Hospital was a poorly lighted and poorly ventilated 150-bed institution with a
small much less sanitary isolation ward near by used chiefly for small-pox cases. The
staff physicians served a 3 months rotation in charge of this ward, which tour of duty
they did not particularly relish.    In   1875   a  very virulent  small-pox epidemic V>f
Page 311 haemorrhagic type broke out in Montreal and Osier volunteered to take full charge of
this ward where he had an abundance of material both clinical and pathological, as
there was approximately a 10% mortality and Osier completed his records in the postmortem room. He published several excellent papers on his findings not only on smallpox but on scarlet fever and anthracosis. There had been for some years widespread
agitation by the press and public-spirited citizens for a distinctly separate isolation
hospital, and finally in 1876 it was established and Osier apparently played no small
part in its development. Incidentally Osier himself contracted the disease toward the
end of the epidemic but it was fortunately of a mild degree. He was paid $600 by a
grateful conununity for his services and he promptly used the money to pay off his
indebtedness to Hartnack of Paris for 15 microscopes which he had purchased for his
course in the Institutes of Medicine.
At the end of the spring semester in 1875 Osier was appointed full professor of the
Institutes of Medicine succeeding his former teacher, Dr. Drake, and relative to this Dr.
Maude Abbott, long the curator of the Pathology Museum at McGill and an ardent
worshipper of Osier, recalls that in 1908 when Osier paid a visit to McGill she showed j
him a heart in an unlabelled jar and asked if he could identify it. He replied, *If
that heart had not petered out when it did, in all probability I would not be where I
am now'.   It was Drake's heart.
Osier was officially appointed pathologist to the Montreal General Hospital- on
May 1st, 1876, and during the first year a 3-months course was offered which consisted
of 25 lessons in practical histology and demonstrations in the postmortem room. He
entered into this phase of his work with his usual zeal and enthusiasm, and during the
first year he performed 100 postmortem examinations, writing them up in detail in
longhand. Many of the interesting specimens he mounted as pathological speciments and
many of these are still in the Osier collection in the Pathological Museum at McGill.
Because of his high regard for Virchow he patterned the course after his. To quote
from Cushing, 'It was during this summer, therefore, that he began his more serious
studies as a morbid anatomist, which were to continue almost without interruption
for the next thirteen years—until he went to Johns Hopkins. He had, of course, been
greatly influenced by Howard, who fully realized the importance for the successful
clinician making his own postmortem examinations; he had been still more influenced
during his brief sojourn in Berlin by Virchow; and his familiarity with the microscope,
unusual for the time, made his easily excel his fellows in modern methods, permitting
the minute study of the processes of disease. But aside from all this in unravelling
the mysteries of a fatal malady he felt the same profound fascination that hed kept
Bichat, Laennec, and many other brilliant and industrious young men for years at the
autopsy table.'
I believe it might be of interest, as an example of the time, thought and effort
which Osier expended on this demonstration course to quote verbatim from the
recollections of one of his students at this time as it appears in Cushing's book—'His
demonstration course in pathology was modelled on that of Virchow in Berlin with
whom he had recently worked. The course being optional and not yet on the curriculum
it was nominally for his class in physiology, but many of the seniors took advantage of
an opportunity that had been lacking in former years. This class met for an hour on
Saturday mornings in his lecture-room in the college. His method was to select three
or four of his class to perform the autopsies during the week in the Montreal General
Hospital; from these autopsies a certain number of specimens were selected for the
Saturday clinic. Before the class met, the specimens were arranged on separate trays
and carefully labelled. Each specimen in turn was carefully discussed and all the
important points clearly indicated. At the close of each case questions were asked
for and answered, the whole being most informal and conversational. The facts elicited
in the autopsies were carefully correlated with the clinical histories and notes of the
cases as taken in the wards.   In order that his teaching should be of the greatest value
Page 312 to those in attendance he furnished each one with a written description of each specimen,
and with an epitome of the remarks which he had prepared. These were always four
pages and at times eight pages of large letter size, written by himself and copied by
means of a copying machine; there were from 30 to 40 copies required each Saturday
so that the demand such a task made on his time must have been heavy.'
In December, 1877, Osier completed the volume of pathological reports representing
the work done by him during his first year as pathologist to the Montreal General
Hospital and in it appeared reports of many interesting and unusual cases with the
detailed and careful observations so characteristic of him.
Although identified more particularly with pathology and physiology and having
had little to do with the Outpatient department at the Montreal General Hospital, at
least from a clinical standpoint, he was, nevertheless, in 1878 appointed a "full
physician" as it was termed, at the Montreal General over the heads of many assistant
physicians, and probably one of the deciding factors for the Board of Governors was
the petition from the students with whom he enjoyed a well deserved popularity.
Apparently these older, and no doubt no little disgruntled physicians looked on in
gleeful anticipation for the rapid descent from the heights for this young upstart, but
instead Osier made numerous alterations in the set-up of his ward, transforming it into
a 'bright, cheerful room of repose' rather than a gloomy sickroom. Very little medicine
was prescribed, indeed Osier has been often referred to as a therapeutic nihilist, and
chronic cases that had been there for months were soon discharged well or improved, and
he had evidently established himself. In addition to his physiology and pathology
classes he now began bed-side instruction to the students, this routine continuing for
the next five years.
In March of 1882 Koch delivered his address to the Physiological Society of Berlin
in which he presented for the first time the proof that tuberculosis in man and animal
was due to a bacillus which he was able to demonstrate under the microscope in specimens
stained with the aniline dyes recently perfected by Ehrlich and Weigert in Germany.
In July of that same year at McGill Osier demonstrated the bacilli in the lungs of a
man dying of a generalized tuberculosis. Even before Koch's discovery and report,
Osier, at a meeting of the Medico-Chi in Montreal, in discussing a paper on the
contagious nature of bovine tuberculosis, stated that in his opinion the same held true
for human tuberculosis and suggested a campaign to popularize this contention and thus
help to diminish the incidence. However, the majority felt that it would only cause
alarm to no good purpose, and that the evidently hereditary character of the disease
adequately explained the occurrence in several members of one family. As a matter
of fact it was 20 years later before the knowledge of the infectivity and contagion
of the disease reached the public, i.e. after the Tuberculosis Congress in London in
1901, at which Osier was the representative from the United States.
Although somewhat out of chronological order I would like to mention here the
formation of the Journal Club at McGill in 1875. Osier's great interest in medical
literature was probably the stimulus which prompted him to organize it and with himself
as secretary-treasurer its roster included such names as Buller, Shepherd, Ross, Howard,
Drake, Fenwick and others, all enthusiastic men who had brought or were to bring
lustre and fame to McGill.
Osier was deeply interested in comparative pathology, especially in respect to
animal parasites, and devoted a great deal of time in visiting abattoirs, attending meetings of the Veterinary Society to which he presented numerous papers and in these
researches in animal diseases his keen powers of observation and elucidation were evident.
He frequently used the title Professor of Physiology in the Veterinary College, Montreal,
and Vice President of the Montreal Veterinary Medical Association in publishing these
papers and reports and indeed, it was at his suggestion that the privately owned
Veterinary College became the Faculty of Comparative Medicine at McGill.
Page 313 But McGill was soon to suffer a great loss, for in the summer of 1884 while he
was abroad, Osier received an invitation to accept the Chair of Clinical Medicine at
the University of Pennsylvania at Philadelphia and so a ten-year association at McGill
was obout to end and what Palmer Howard called "the potent ferment' was about to
seek further laurels in another setting. As Cushing remarks, 'What particularly
lured him is difficult now to tell. It may have been even difficult for him to tell. Fo||
a person capable of such strong local attachments there is something contradictory
about it. A great career was assured in Montreal, whereas Philadelphia was an uncertainty in a land more foreign to him than England. The singularity of the call may
have influenced him; and an ancestral impulse which bade him accept. He probably
realized that his bent lay in the study of disease as it was seen at the bed-side rather
than in the laboratory.' As W. T. Councilman has said, 'He could easily have become
a great scientist, but he chose the path which led to the formation of the great
clinician which he became; a worthy associate of the great men who have made English
medicine famous.'
So in the fall of 1884 Osier began his duties at Philadelphia, the incumbent of a
very important Chair for a man of only 35. William Pepper who had succeeded Alfred
Stille to the Senior Chair of Medicine enjoyed a very large private practice and in
addition was Provost of the University and because of these duties rarely appeared on
the wards except to give his prescribed lectures. Consequently, while he and Osier
shared the two large medical wards in the University Hospital Osier had the wards
practically to himself and immediately instituted his bed-side teaching which was
practically an unknown procedure there at that time, and proved increasingly popular.
Here, too, he equipped a small clinical laboratory under a part of the hospital amphitheatre, where the senior students were, for the first time, introduced to this more
detailed demonstration of disease processes. While for most a university appointment
was the stepping-stone for a good private practice, Osier had determined to use his time
other than for teaching, in consultation, and so he would be found almost every afternoon at Blockley with a group of students doing postmortems rather than sitting in
his office awaiting the arrival of patients. Apparently consultations were few and far
between during this first year in Philadelphia, and his following at Blockley increased
with students of all years and even graduates who could spare the time, composing the
group, for word had spread that here indeed was a fount of knowledge to be found
nowhere else in the University. However, as the saying goes 'All things come to him
who waits.' His consultations increased materially as his worth was recognized, but
even so his teaching activities at the bed-side and autopsy room were not curtailed, nor
were they throughout the five year period of his Philadelphia sojourn, and to ensure this
he drew on the rather meagre leisure time he had at his disposal. One marvels as one
reads through the pages of Cushing's biography of this Philadelphian phase of Osier's
life at what he accomplished in each passing day. He disdained the use of a carriage, and
this could well be in part due to a very lean wallet; visiting his friends was almost an
obsession with him, and probably no day passed that he did not drop in at two or three
homes unannounced; his consultations, teaching .duties and the almost continuous flow
oi papers from his pen.
On Christmas Eve, 1873, Johns Hopkins^ who had amassed a considerable fortune
as a merchant during and after the American Civil War, passed away in Baltimore.
Having no heirs he left $7 million in the hands of his executors to be equally divided
between a hospital and medical school, both to bear his name. In 1883 a provisional
medical faculty was established with Ira Remsen in Chemistry; Newell Martin, pupil
of Huxley's in Biology and William H. Welch as Professor of Pathology, the first such
position in any American university. On his return from abroad in 1886 Welch
instituted courses in Pathology for graduates and during this period a group of young
and enthusiastic men who were to bring fame and glory to Johns Hopkins, were
attracted to him. Among them were Flexner, Sternberg, Halstead, Walter Reed,
Councilman and others—names which still have a familiar ring even now.
Page 314 In the fall of 1888 John S. Billings, who had been appointed medical advisor to the
hospital, visited Osier in Philadelphia and offered him the position of Physician-in-Chief/
in the new Johns Hopkins Hospital. He accepted and so in the spring of 1889, after
5 very productive years in Philadelphia, productive and beneficial both for himself
and the University he served, he again tore up his not lightly-planted roots to assume
his new duties and responsibilities in an atmosphere in which youth and enthusiasm
reigned supreme, Welch being only 39, Halstead 37, Osier himself not quite 40, while
Howard Kelly (who had joined the group later in the summer of 1889 as gynaecologist)
was only 31. As his chief resident he selected Dr. H. A. Lafleur ("Hank" of cherished
memory) a recent McGill graduate. Here, one can well imagine, Osier spent some of
his happiest, most contented years, where he had ample opportunity for investigation,
advice and discussion, in a most modernly equipped (at least for that period) laboratory
and post-mortem room, presided over by a brilliant scientist and investigator, Wm. H.
Welch or 'Popsy' as he was affectionately called.
Here in Baltimore as in Montreal and Philadelphia he founded a Journal Club, was
one of the prime movers in the establishment of the Historical Club, one of the most
active contributors to the Johns Hopkins Hospital Bulletin, and was a leading light in
the weekly meeting of the Medical Society. Papers, teaching, consultations and visits
to his always increasing circle of new friends, filled his days and evenings, yet, despite
the multitudinous demands on his time he completed in 1891 the first edition of 'The
Principles and Practice of Medicine', which almost immediately became the accepted
text-book in medicine and grew in amazing popularity through succeeding years. In
writing of this work Cushing raises the question as to whether or not Osier would have
undertaken it had he realized—'what burdens, in the way of successive editions, its
extraordinary success would impose on him for the remainder of his life'.
In May of 1892 Osier and Grace Revere Gross, the widow of his close friend, Dr.
Samuel D. Gross of Philadelphia, were married in Philadelphia, Osier at this time being in
his 43rd year.
In December, 1892, following the death of Dr. George Ross who had succeeded
Dr. Palmer Howard on his death, the Chair of Medicine at McGill was vacant, and
Osier was offered the Chair with a very flattering financial inducement. There had
been considerable delay in the opening of the medical school at Johns Hopkins due to
lack of funds chiefly owing to depreciation in the value of Baltimore and Ohio Railway
stocks left by Johns Hopkins and Welch and others, and now Osier had been approached
by other schools. Consequently the canvass for funds was considerably accelerated and
finally just before Christmas, 1892, a Miss Mary E. Garrett of Baltimore agreed to
subscribe the balance necessary to complete the $500,000 which was the goal, but with
the stipulation that women students be admitted to the medical faculty. This request
was granted. So, with the promise of funds about to be an accomplished fact, Osier
probably regretfully declined the McGill offer.
The first class of medical students began their studies in the fall of 1893, a group
of 18 including 3 women and there followed a period during which the name of Johns
Hopkins and its professional staff was in the forefront of advances in all branches of
medicine with Osier one of the shining lights. So for the next 15 years during which
he served the hospital and medical school in Baltimore he added greatly to his medical
stature, not only at home but throughout the medical world and was a much sought-
after speaker at medical meetings in the U.S., Canada and abroad.
It was not my purpose to present a chronological story of Osier's life but, as I
read over what I had compiled, I fear that I have well-nigh bored you to utter disinterest with a lengthy recital in that vein and so, to add as little more insult to injury
as possible, I will curtail the more salient features of Osier's remaining years more or
less to dates.
In 1900 he was invited to and did make application for the chair of Medicine at
Edinburgh but withdrew it because of pressure brought to bear by the Faculty and
friends at Johns Hopkins.
Page 315 In August, 1904, he received from the then Prime Minister of Great Britain,;
Arthur Balfour, an invitation to become Regius Professor of Medicine at Oxford which
he accepted. He had just reached his 55th year at this time and it was after all final
arrangements had been made for his departure from Baltimore and he was being feted at
innumerable functions, that during the birthday celebrations of the Johns Hopkins,
when he received his LLD degree, he gave his now famous valedictory address. In it he
made reference to his being in favour of the retirement from active practice, business,
etc., of all men on reaching their 60th year and referred to Anthony Trollope's novel 'The
Fixed Point' in which he suggests a college into which, at 60, men might retire for a
year of contemplation and then be gently wafted into the hereafter through the agency
of chloroform. The deep sense of his address, its attempted humour to mask a deep
and sincere sorrow at the imminent breaking of strong ties of affection and high regard
were missed and the newspapers and magazines were covered with bold-face headlines
for days and weeks, innumerable cartoons and editorials appeared and controversy raged
for months. Many hundreds of abusive and threatening letters calling him a cold
blooded, heartless scientist were received at his home from all over the United States and
Canada but were skillfully kept from him by a very efficient secretary.
1905—Began his duties as Regius Professor of Medicine at Oxford.
1906—The Pathological Society of Great Britain and Ireland was formed with
Osier the prime factor in its inception.
1911—In the Honours list relative to George Fifth's coronation he was created a
1914-18—During the period of World War I Osier gave of his services unsparingly
as a consultant not only to the Canadian Hospitals but to all and sundry,
who had but to call him. %gm
1917—On August 30 of this year his only child, his son Revere, was killed in
action at Ypres which left a deep sorrow which never really was assuaged.
1918—Late in September Osier developed what appeared to be only an ordinary
'cold' but it persisted despite all therapy, progressed to a severe paroxysmal
bronchitis, pleurisy, empyema of influenzal type, which was drained surgically; the development of a pulmonary abscess which was also drained and
then with tragic suddenness a fatal secondary haemorrhage from which he
succumbed on the afternoon of December 29, 1919, at the age of 70 years.
So the portals close on a very full life. Probably not again for many decades, if
ever, will a Canadian physician of such humble beginnings rise to such heights of international acclaim as did Sir William Osier. His contributions to medicine, probably
more particularly in the field of diagnosis, played a very major role in the advancement
of medicine in North America in the latter part of the 19th and early years of the 20th
centuries. His firm belief in the bed-side method of teaching and his deep-rooted belief
that the post-mortem room was the stepping-stone to better diagnosis, where the silent
corpse speaks out for him who will but hear, in the correlation of lesions to signs and
symptoms and this throughout his Montreal, Philadelphia and Baltimore days he so
exemplified in the innumerable unscheduled meetings at any hour with students or
graduates in the postmortem room.
Osier might be likened to a gem of many facets, each one no less brilliant than its
fellow. He was a brilliant classical scholar; a lover of good music and art; a prodigious
writer and reader of medical literature; a much sought-after speaker both in North
America and abroad; an outstanding teacher and physician, and a man who must
somehow have had Tune by the forelock and by some means slowed his progress to
enable him (Osier) to crowd into a day the innumerable tasks, duties, visits, etc.,
which he did. This, to me at least, was one of his outstanding qualities. Yet with all
the praise, fame and honours from high places that came unto him he was, withal, a
broadmindedly religious, humble man who was beloved by all who came within his
Page 316 sphere—his greeting to char-women or Principal being no whit different in its warmth
of feeling. His capacity for making and keeping friends was remarkable, and with
his students he talked to and with them rather than down to them. Throughout his
life his very keen sense of humour was always in evidence.
Whether or not I have succeeded in establishing the fact that pathology did play
a very major part in Osier's medical career and in his teaching methods, I do not know.
However, I do know this, that I have long outstayed my welcome on this rostrum and
so I will close with two lines from the Ancient Mariner, which his nephew, Dr. W. W.
Francis read to him the night before his death and which he felt so appropriate a
valedictory for a man who so loved his fellow-men:
'He prayeth best who loveth best,
All things, both great and small.'
The Osier Dinner for 1953 was held at the Hotel Vancouver on March 4th. The
attendance was the largest on record for the Osier Dinner. The Osier Lecturer for
1953 was Dr. Harry H. Pitts, Director of St. Paul's Hospital Laboratories—and his
subject was "The Influence of Pathology on the Career of Sir William Osier."
This lecture is being printed in full in this issue of the Bulletin—and it is quite
safe to say that it maintained the high standards set by previous Osier Lecturers. It
was excellently given—and all present enjoyed it greatly.
The presentation of the Prince of Good Fellows (P.G.F.) degree was a feature of
the evening. After some difficulty in locating them in the large audience, two gentlemen, Drs. D. E. H. Cleveland and F. J. Buller were brought forward, and announced
as the choice of the Association for the year. The prolonged applause given to each
of these well-known members of the Vancouver Medical Association was adequate
witness to the popularity of the choice made. Both of them, it was fully agreed,
lived up to the requirements of the Degree "in that in all things he has proved his
loyalty to his profession and to his Association" or words to that effect. Their personal
popularity, and the esteem and affection in which they are held by all who know them,
was also clearly evident.   We feel that no better choice could have been made.
For Pender Harbour and district, with full facilities of 15 bed acute
general hospital. Rapidly growing and progressive community. Excellent residence available. Good central school of 120 pupils, and
several smaller schools. Splendid opportunity of establishing remunerative practice, easy access by car and boat to Vancouver. Apply
by telephone or letter to
Pender Harbour, B.C.
Page 317 iBrttuih Columbia Itf iriaton
Canadian mrfiiral Asportation
1807 West 10th Ave., Vancouver, B.C.      Dr. G. Gordon Ferguson, Exec. Secy
President—Dr. J. A. Ganshorn	
President-elect—Dr. R. G. Large Prince Rupert
Vice-President and Chairman of General Assembly—Dr. F. A. Turnbull Vancouver
Hon. Secretary-Treasurer—Dr. W. R. Brewster New Westminster
Members of the Board of Directors
Dr. G. Chisholm
Dr. E. W. Boak
Dr. C. C. Browne
Prince Rupert and Cariboo
Dr. R. G. Large
New Westminster
Dr. J. A. Sinclair
Dr. W. R. Brewster
Dr. A. S. Underhill
Dr. C. J. M. Willoughby
Dr. F. A. Turnbull
Dr. A. W. Bagnall
Dr. F. P. Patterson
Dr. P. O. Lehmann
Dr. G. C. Johnston
Dr. Ross Robertson
Dr. R. A. Gilchrist
Dr. J. Ross Davidson
Dr. R. A. Palmer
Dr. J. McMurchy
Standing Committees Chairmen
Constitution and By-Laws Dr. R. A. Stanley, Vancouver
Finance Dr.  W. R. Brewster, New Westminster
Legislation _Dr. J.  C.  Thomas, Vancouver
Medical Economics Dr. P. O. Lehman, Vancouver
Medical Education j Dr. T. R. Sarjeant, Vancouver
Nominations Dr. J. A. Ganshorn, Vancouver
Programme and Arrangements Dr. Harold Taylor, Vancouver
Public Health Dr. G. F. Kincade, Vancouver
Special Committees
Arthritis and Rheumatism Dr. F. W. Hurlburt, Vancouver
Cancer  . j Dr. Roger Wilson, Vancouver
Civil Defence 1 Dr. John Sturdy, Vancouver
Hospital Service Dr. J. C Moscovich, Vancouver
Industrial Medicine ; 1 Dr. J. S. Daly, Trail
Maternal Welfare Dr. A. M. Agnew, Vancouver
Membership Dr. E. C. McCoy, Vancouver
Pharmacy : Dr. D. M. Whitelaw, Vancouver
Public Relations ! : Dr.  G. C. Johnston, Vancouver
It seems important to review the subject of a national health insurance plan and
what has been occurring in Canada in health affairs. Today the subject of National
Health is foremost in many minds but the subject of la government national jhealjth
insurance plan seems to be popular only with some sections of the community. It seems,
at least to this writer, that the proposal for a government insurance plan is mostly a
form of indoor sport for some people who ire particularly pleased when they can bait
the medical profession on the question of socialized medicine.
Things have been happening, however, hut not along the lines of a national health
insurance plan.   Last Fall the C.C.F. leader, Mr. Coldwell, announced that a monster
Page 318 petition would be circulated to present to Parliament requesting that a national health
insurance plan be inaugurated without delay. There were descriptive words on this
petition that said very clearly that the health insurance plan should be administered
by the government of each province and that the payment for the plan should be
compulsory, non-contributory, and by income tax. Efforts were made through some
labour unions to circulate this petition and win great enthusiasm for many signatures.
One organizer appealed to the workers by saying that the inauguration of this plan
would mean ten or fifteen cents an hour increase in their wages, much more than they
could possibly get after weeks on strike. Very little was heard editorially about this
petition, but in this province at least, your Association answered some of these points
through "The Doctors' Viewpoint", your radio programme. The significant thing about
all this is that Mr. Coldwell, not many weeks ago, filed his petition in the House of
Commons and rather perfunctorily requested, on the strength of the petition, that a plan
be established now. The petition contained 100,000 names which was really a very poor
showing considering that it was conducted on the national level. What, then, has
been going on in Canada in respect to a health plan?
In 1948 the Government of Canada established a system of health grants to the
provinces in order to help them develop their health resources. These were to run for
five years and you are all familiar with them. Probably the most spectacular one was
the Hospital Construction Grant which has permitted the construction of many new
hospital beds across the country. There were also grants to stimulate programmes
against cancer, tuberculosis, venereal disease, to support public health, and to conduct
a health survey in each province. Some of these grants were direct grants to pay for
things done, others were matching grants in which each province was required to
contribute an equal amount of money to that put up by the Federal Government.
Some of the grants were not fidly utilized and others could have been utilized even more
widely.   This has been referred to as "Phase One" of Canada's Health Plan.
When Parliament opened in the Fall of 1952, the Speech from the Throne mentioned
that consideration would be given to Canada's health needs, but the Government
successfully overcame two votes of non-confidence asking for the inauguration of a
national health insurance plan. One came from the Conservatives and the other came
from the C.C.F. The Government said little about the matter all during the session,
except to say that they had a plan and that "Phase One" had been operating for five
In a radio commentary the Minister of National Health and Welfare, the Honourable Paul Martin, spoke about "Phase Two" being almost ready for unveiling. Every
effort was made by your Division and the Canadian Medical Association tto find out
what "Phase Two" meant. All that can be said now is that recently the Advisory
Council of the Association has met in Ottawa with the Minister to discuss the subject.
It is not known what was discussed and the meeting was held confidential by the
However, the budget has been brought down again and it is reported that in the
estimates for the Department of Health there is an item as yet unexplained for
$5,300,000. One can conjecture, fortified by what we read in the newspapers, that
this is "Phase Two" of Canada's Health Plan and will take the form of an extension
of the Dominion Government grants to the provinces. I think we can take it that
the other grants will remain, although possibly modified as the years go by, and that
"Phase Two" will be grants for new projects, probably to stimulate a programme for
rehabilitation, a programme to consolidate and extend prenatal and postnatal care, and
a programme of developing laboratories and diagnostic aids.
These new grants will likely again be matching grants which will require the
voting of money by the provincial legislatures. They match the whole grant or they
may only match a part of it according to their interpretation of the need within the
province. As soon as the second phase is announced, the B.C. Division on its part,
will approach the Government of British Columbia and offer its services toward the wise
Page 319 expenditure of the money and sound development of the health services in this
province. It is expected that from the time of announcement at Ottawa until the
next sitting of the B.C. Legislature, a period of planning will be available.
Since the clamour for a Government Insurance Plan has so greatly subsided, we may
be assured that the sound development of the Voluntary Prepaid Medical Care Plan
and Trans Canada Medical Plans, and their support by the profession, has borne fruit.
May we now mention particularly one grant which was made in 1948. This was
the Health Survey Grant, a sum of money based on population and made to each
province in order that they may conduct a survey of their health faculties and anticipated needs and make recommendations. This was done in each province according to
a method established by themselves but followed a pattern suggested by Ottawa. These
reports have been tabled in Ottawa from each province. In most cases written by
those charged with the task and presented to the Minister of Health in their province,
accepted by him as a report and forwarded to Ottawa as their Health Survey but not
necessarily being government policy or endorsed by the government.
In British Columbia the report was written by Dr. G. R. F. Elliot, the Assistant
Provincial Health Officer, from reports and informations made available to him. Dr.
Elliot might well be commended on the thoroughness of his report, although it must
be realized that there are some parts of it that will require thorough debate with the
Medical Association. Dr. Elliot must have foreseen this since many of his recommendations call for a further study and consideration on the subject, rather than a
direct recommendation for action. In most instances he has pointed the direction
rather than detailing the method of travel. The report was not submitted to the
Health Survey Committee for ratification.
The British Columbia Health Survey Report was tabled in Ottawa in the Spring
of 1952. It was printed later in 1952, but was not released by the Government of
British Columbia for some months. Indeed, it did not become available until early in
1953 when three copies came to the Association. The Minister of Public Health,
however, has now been pleased to accede to a request to forward seventy-five copies for
our General Assembly and these will be thoroughly studied by them now. There may
be a few extra working copies which can be loaned to any member if he or she will
write to the Association office. It must be clearly understood by all who read the
Health Survey Report that this is not a statement of Government policy. It represents
the written report of Dr. Elliot acting on a request from his Minister. There is no
doubt it will be seriously studied by the Government.
As Canada's Health Plan unfolds and the debate on health matters becomes closer
to us on the provincial level, the Board of Directors or General Assembly will publish
excerpts from this or other reports for your general information.
These notes are written in the hope that all members of the profession will give
some thought to this developing health plan in Canada and be prepared to contribute
by being informed and then offer constructive criticism.
The C.M.A.—B.C. Division is an organization through which every physician in
the\ province has the privilege of representation through membership and voting. This
is done by electing each year a Principal Delegate who is your representative to the
Board of Directors and other representatives to the General Assembly in the persons of
Vice Delegates and members of the Nominating Committee.
If the Association ever loses its influence, that loss will be the direct responsibility
of every physician who did not exercise his responsibility by giving serious thought to
his nomination and voting privilege.
Page 320 This advance notice is to let you know that, by the Constitution, the election will
be held in the middle of July and that the ballots will be in your hands one or two
weeks before.   Nomination papers will be sent to every member on June 15.
Your elected Board of Directors and General Assembly are going to be speaking
for you and in your name and it is important that they have your full confidence and
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health, Province of British Columbia
A. M. GEE, M.D.,
Director, Mental Health Services, Province of British Columbia
"The pandemic of 1918-19 was one of the great pestilences of mankind, destroying
more lives in a few months, than did the Great War irn four years" (Topley and
Wilson). This quotation, even in these days of wide-spread immunization, chemotherapy
and antibiotics, gives cause for sober reflection that pandemic influenza must rank with
the Black Death and Bubonic Plague among the great pestilences of all time, and is the
one common infection capable of producing another global catastrophe in our time,
notwithstanding all the advances of medical science.
Fortunately, the striking achievements which have been made in the prevention,
treatment and control of other communicable diseases have stimulated investigation into
the bacteriologic, immunologic and epidemiologic aspects of this disease. Thus the
studies of Andrews et al., in the United Kingdom, and of Horsfall and his co-workers
at the Rockefeller Institute in New York, into the different types of influenza virus
and the numerous component strains within each type, have contributed much to present
knowledge. With the recognition of these immunologically separate types, and of the
antigenic powers of the individual strains of virus, efforts have been made to develop a
vaccine which could be used for active immunization, although it is recognized that the
above-mentioned serological differences in the virus are likely to cause difficulties in
producing a suitable antigen capable of stimulating immunity to all strains. This is
the probable explanation of the conflicting reports following field trials with influenza
virus vaccine, which have appeared in the literature.
The first field trials in Canada were begun in 1951, when the Department of
National Health and Welfare set up a pilot study to evaluate the protective effect of a
polyvalent influenza vaccine amongst approximately seven hundred individuals in Old
Folks' Homes and other institutions in Ottawa. Although considerable serological
data of value was obtained from this project, the incidence of influenza in that year
was too low to permit of any conclusions regarding the protective value of the vaccine.
This-preliniinary pilot study, however, stimulated the development of a larger plan of
study, designed to afford a much wider trial throughout the country, so that Public
Health authorities might be able to draw some definite conclusions regarding the usefulness of influenza vaccine as a control measure in this disease. An evaluation of this
kind was considered essential before the vaccine could be recommended to the general
Since December, 1952, the British Columbia Departmentof Health has been collaborating with the Department of National Health and Welfare and other Provincial
Departments of Health in an evaluation study designed to include approximately 10,000
Page 321 individuals, across Canada. In the field studies under way in British Columbia, the allocation of vaccine for trial comprised two hundred doses each of influenza virus vaccine
and a harmless control solution. When it became apparent from epidemic intelligence
sources that there was, this winter, a very real possibility of A-prime influenza in epidemic form in Canada, an additional two hundred doses of each were made available.
Within the Province, the Provincial Department of Health, Metropolitan Health
Committee of the City of Vancouver, and Victoria City Health Department have carried out a programme of vaccination amongst various population groups of different ages
in the Vancouver, Victoria, and New Westminster areas, using a formalin-inactivated
virus vaccine prepared by ultra-centrifugation of chick embryoallantoic fluids and containing A, A-prime, and B strains of epidemic influenza virus. For adults, a single dose
of lc.c. of vaccine was administered subcutaneously over the deltoid muscle. In current
field trials, the vaccine did not give rise to any serious or constitutional reactions in those
who received it.
In order to evaluate the usefulness of the vaccine as a means of preventing or
attenuating an attack of influenza, the plan of study is as follows:
(1) To vaccinate a group of persons with the influenza virus vaccine and to give
a control group an innocuous control preparation,
(2) To keep a careful record of all respiratory illnesses which occur during a six-
months' follow-up period in both groups, and
(3) To compare the disease experience of both groups in the follow-up period
with their sickness records for upper respiratory infections in the two-year
period prior to vaccination.
Inasmuch as concurrent evaluation studies are being carried on in other provinces
to meet the chance distribution of localized influenza outbreaks, we have therefore a
real opportunity to evaluate influenza vaccine on a sizeable scale, the results of which
should be of considerable importance to Public Health in Canada.
Dr. Evelyn Gee and Dr. R. H. Irish on the staff of Tranquille Sanatorium and
Pearson Tuberculosis Hospital, respectively, Provincial Division of Tuberculosis Control,
attended two courses put on by the Extension Department of the University of
California School of Medicine in San Francisco from February 2 to 8. The first course
was on Cardiovascular Diseases and Electrocardiography and the second on Pulmonary
Dr. W. K. Massey, Physician-in-Charge of the Kootenay Travelling Clinic, Provincial Division of Tuberculosis Control, is attending the Sixth Annual Postgraduate
Course on Diseases of the Chest sponsored by the Council on Postgraduate Medical
Education of the American College of Chest Physicians and the Laennec Society of
Philadelphia.    The course is being given in Philadelphia, March 23 to 27.
Dr. W. E. Harrison, Senior Surgeon, Provincial Division of Tuberculosis Control,
is attending the annual meeting of the American Association of Thoracic Surgeons in
San Francisco, March 27 to 30. U:0':
Doctor's office, sharing reception room with
Drive,  North  Vancouver, at entrance  of  N<
immediately. Also 3 room suite in
Dentist —
»rgate  Park,
same block.
on Marine
744 West Hastings Street
TAtlow 2531
The College does not approve of any arrangement between two or more medical
practitioners whereby one receives part of the fee paid to the other practitioner, or any
arrangement and distribution of a composite fee. Each doctor concerned in the care
of a patient should give or send directly to the patient a statement showing charges for
professional services rendered. In cases where one or more consultants or specialists are
called in by the family doctor, each such consultant or specialists shall render his account
separately to the patient. A receipt should be sent directly to the patient by each doctor
upon receipt of payment of his fee.
The practice of having the referring doctor act as an assistant or anaesthetist at an
operation should be discouraged unless he is competent for either or both of these duties
by virtue of his training and continuous experience. If so a statement of the fee should
be sent by each doctor to the patient provided, however, that a surgeon who has a regular
assistant at operations may pay him directly. When the assistant has referred the
patient to the operating surgeon, the assistant should send a statement of his fee directly
to the patient.
If fees are collected by an organized clinic or medical partnership, such clinic or
partnership is in effect regarded as an individual which acts in that capacity. The same
principle applies when the clinic and hospital are combined and operate under the same
ownership. When a third person or organization enters into a financial relationship
between doctor and patient each doctor should render an individual account to the
third person or organization concerned; if more than one doctor is carrying out professional services a statement to the patient should show what proportion of the aggregate
amount was paid to each physician.
The receiving of commissions connected with the sale of a commodity or with the
referring of patients is entirely unethical conduct.
"It is undesirable that medical practitioners should have a proprietary interest in
preparations or appliances which it may be their duty to recommend to patients."
(British Medical Association's Decisions.)
The word "advertising" in relation to the medical profession must be taken in its
broadest sense. It includes all those methods by which a practising physician is made
known to the public, either by him or by others without his objection, in a manner
which can be fairly regarded as having for its purpose the obtaining of patients or the
promotion in other ways of the physician's individual professional advantage.
Excepting a plain card which conforms to local usages, any form of advertising is
unprofessional for the practising physician. Practice should not be gathered by any
kind of solicitation, direct or indirect. The best advertisement of a physician is a well-
merited reputation for ability and probity in his profession.
Advertising may be very insidious. A physician should not procure, sanction, be
associated with or acquiesce in, notices which commend his own or any physician's skill,
knowledge, services and qualifications, or which depreciate those of others.
An honourable physician will never be guilty either of boasting of cures, or of
promising radical cures, or of self-praise in order to gather practice.
Physicians should be extremely cautious in dealing with the Press. A physician
should insist, wherever possible, on seeing a proof of what is to be printed under his
name or on his authority.
Page 323 Drs. J. G. Patterson, J. W. Hunt and A. F. McGill, of Victoria, have transferred
their offices to a new location at 1053 Fort street.
Dr. E. A. Boxall and Dr. G. L. Manson have been appointed to the medical staff
of the M.S.A.
Dr. Neil Stewart has returned to Victoria after an absence of two years taking postgraduate studies abroad.    He has resumed practise in internal medicine.
Dr. A. Hancock is now associated with Drs. S. and G. Kenning of Victoria. •
Dr. R. S. Purkis has left Victoria to practise in Toronto.
Dr. M. Murray is now radiologist at St. Joseph's Hospital in Victoria and not
pathologist as previously reported.
Dr. O. E. Kirby has recently returned from Los Angeles County Hospital, where
he was associated with Dr. Howard House, Professor of Otolaryngology at the University of Southern California, for a five weeks post-graduate course in Aural and
Fenestration surgery.
Dr. Ben Kanee, associate in the Section of Dermatology, Vancouver General Hospital and former Consultant Syphilologist to the Provincial Board of Health V.D.
Control, has been invited to give a paper at the next meeting of the American Academy
of Dermatology and Syphilology.
He and Dr. John Nelson, Director of the V.D. Control and Consultant Epidemi-I
ologist to the Department of Health and  assistant in Medicine Vancouver General
Hospital, will discuss their work dealing with newer advances in venereal disease control.
Dr. J. G. Colbert has returned to B.C. after doing Post-graduate work in London,
England, since 1951.
Dr. Paul Kepkay has returned to Vancouver from Boston where he did Postgraduate work in Internal Medicine at the Lahey Clinic since 1951.
Dr. E. C. Hoodless has returned to Victoria after spending three years doing
Post-graduate work in England and then one year at Newton, Massachusets.
Dr. Morris Faigen has opened his office on Lulu Island.
Dr. Frank Paulson has left Vancouver to begin practising at San Jose, California.
Dr. H. G. Wadman is in Obstetrics for the next two years at the University
Hospital of Cleveland.
Dr. N. L. Goodwin is now practising in Victoria and is associated with the Medical
Clinic of Drs. Patterson, Hunt and McGill.
Dr. E. A. D. Boyd is now practising in West Vancouver.
Dr. R. Jameson has opened a practise in orthopedics in Victoria.
Dr. Arthur E. Riddell is now working at Tulsequah, B.C.
To Dr. and Mrs. V. O. Hertzman of Vancouver, a second son.
To Dr. and Mrs. James Minnes of Vancouver, a daughter.
To Dr. and Mrs. F. Tysoe of Vancouver, a son.
Born to Dr. and Mrs. A. E. Gillespie of Victoria, a daughter.
Born to Dr. and Mrs. B. E. Cragg of Victoria, a daughter.
Born to Dr. and Mrs. Vere Stuart of Victoria, a son.
Obiit April 2nd, 1953
Te recent death of Dr. G. C. Lyall Hodgins has removed from our midst
an outstanding man of medicine. He has been a conspicuous figure in the
British Columbia profession for many years—and has been honoured by the
profession of Canada through his selection as a member of the Council of the
Royal College of Physicians & Surgeons of Canada, on which body he served
for many years.
Dr. Hodgins began his practice in Vancouver many years ago. He was
associated in his early days with Dr. Alison Cumming, and when insulin was
first introduced, these two were entrusted with its experimental use in British
Columbia, in order that it might be properly and thoroughly tested before
being made available to the profession at large—this being in line with the
procedure in other provinces of the Dominion. This was a tribute to the
ability of these men, and was well deserved. Following Dr. Cumming's death,
Dr. Hodgins carried on his work, and rapidly became one of the leading internists in Vancouver. He became associated with Dr. W. H. Hatfield, and this
association was a very close one. It led to the formation some years ago of
the Medical Clinic which bears their names, and those of a large group of
medical men.
Dr. Hodgins was a prominent figure in the Clinics
General Hospital, and was on the Attending Staff of that
years. He had considerable organising ability, and much
the Staff work of the institution may be placed to his credit,
a friendly, kindly man, decided in his views, but willing
those of others.   He had many friends in all walks of life.
of the Vancouver
Hospital for many
of the progress of
Personally, he was
always to listen to
(^anada A   III/lost   Ulniaue rsedort
A glorious vacation adventure awaits you . . . An entire privately-owned
island exclusively your holiday domain. Miles of enchanting trails, colorful
shoreline, hidden coves and lovely beaches . . .all inviting exploration.
Deluxe cottage accommodations. Perfect for families. Informality. Excelr
lent salmon fishing.   Guides and boats.   Yacht basin.   Recreational activities.
Write today for color folder.   Early reservations advisable.
c/o GANGES, B.C.
David B. Conover, Mgr.
\x/z hr. scenic drive from Victoria — Princess Elaine from; Vancouver
or direct plane service. fg|||
Brand of basic aluminum glycinate
Tablet No. 382 "Sottf
Coloured Pink, Scored.
Each tablet contains:
"Alamino"  7.7 gr. (0.5 G.)
Atropine sulphate....   1 /500 gr. (0.1 3 mg.)
'Noctinai" (Butabar-
bital N.N.R.)  Va gr. (16 mg.)
Cfuvde^ &S*oodt&<Sb.
Tablet No. 813 "_~4»T
Coloured Yellow, Scored.
The same formula as Tablet 382 but with
Atropine sulphate....   1 /250 gr. (0.25 mg.)
DOSE: One tablet 10 to 15 minutes after
meals and at bedtime.
MODES OF ISSUE: Bottles of 100 tablets.
Tablet No. 381 "<3»Mf
Each tablet contains:
"Alamino"   7.7 gr. (0.5 G.)
DOSE: One to two tablets 10 to 15 minutes
after each meal and at bedtime.
MODES OF ISSUE: Bottles of 100 tablets.
Each 4 cc. teaspoonful contains:
"Alamino" J|| 7.7 gr. (0.5 G.)
DOSE: One to two teaspoonfuls after each
meal and at bedtime.
MODES OF ISSUE: Bottles of 16 fluid ounces*
Page 326


Citation Scheme:


Citations by CSL (citeproc-js)

Usage Statistics



Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            async >
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:


Related Items