History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: July, 1952 Vancouver Medical Association Jul 31, 1952

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OF jf;.
The Vancouver Medical Association
Publisher and Advertising Manager
JULY, 1952
OFFICERS 1952-53
Dr. E. 0. McCoy Dr. D. S. Munroe
President Vice-President
Dr. George Langley
Hon. Treasurer
Dr. J. C. Grimson
Past President
Dr. J. H. Black
Hon. Secretary
Additional Members of Executive:
Dr. G. R. F. Elliot Dr. F. S. Hobbs
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommer, Whiting & Co.
Eye, Ear, Nose and Throat
Dr. B. W. Tanton Chairman Dr. John A. Irving  Secretary
Dr. Peter Spohn Chairman Dr. John W. Whitelaw Secretary
Orthopaedic and Traumatic Surgery
Dr. A. S. McConkey Chairman Dr. W. H. Fahrni I Secretary
Neurology and Psychiatry
Dr. R. Whitman Chairman Dr. B. Bryson..: | Secretary
Dr. R. G. Moffat 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. J. W. Frost Chairman Dr. W. M. G. Wilson Secretary
Summer School
Dr. J. H. Black, Chairman;  Dr. J. A.  Irving,  Secretary;  Dr.  B. T. H.
Marteinsson ; Dr. Peter Spohn ; Dr. S. L. Williams ; Dr. J. A. Elliott
Medical Econoinics
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   327 *
tradition in infant feeding for 20 years
/fo quality and
dependability of
A multi-grain cereal and
three single-grain cereals share the Pablum* heritage of quality.
Uniform texture and maximum digestibility as well as
high nutritional values are
assured by careful Pablum
Vitamins and minerals from
natural sources are incorporated in Pablum Mixed Cereal, Pablum Oatmeal and
Pablum Barley Cereal. Pablum Rice Cereal, with crys
talline vitamins, has special
advantages of hypoallerge-
Recent improvements in
Mead's exclusive manufacturing process bring out
more than ever the rich, full
grain flavors of all the Pablum cereals.
Older children as well as infants will like these 4 cereals
and welcome the variety
they provide.
You may prescribe Pablum
cereals with confidence.
The Pablum packages,
designed for superior
protection and convenience,
have the exclusive
"Handy-Pour" spout.
Mead Johnson & co.
"Registered Trademark
Page   328
Founded 1898; Incorporated 1906
The Regular Monthly Meetings of the Vancouver Medical Association are
discontinued for the summer months, but will be resumed in October.
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.
Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
Thursday, 9:00 a.m.—Medical Clinic.
12:00 noon—Clinicopathological Conference on Newborns.
Friday, 9:00 a.m.—Paediatric Clinic.
Saturday, 9:00  a.m.—Neurosurgery Clinic.
Regular Weekly Fixtures
2nd Monday of each month—2 p.m Tumour Clinic
Tuesday—9-10 a.m. Paediatric Conference
Wednesday—9-10 a.m I 1 Medical Clinic
Wednesday—11-12 a.m if-—- Obstetrics and Gynaecology Clinic
Alternate Wednesdays—12 noon  Orthopaedic Clinic
Alernate Thursdays—11 a.m . Pathological Conference (Specimens and Discussion)
Friday—8  a.m Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m l Surgical Conference
Friday—9 a.m - Dr. Appleby's Surgery Clinic
Friday—11  a.m Interesting Films Shown in X-ray Department
Page   331 NEW 5-mg. Tablets of
S3   Hi
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 I
niinimizing 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
Afanufiuturiny Chemists
Regular Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology.
Wednesday, 10:45 a.m.—General Medicine.
Wednesday, 12:30 p.m.—Pathology.
Thursday, 10:30 a.m.—Psychiatry.
Friday, 8:30 a.m.—Chest Conference.
Friday, 1:15 p.m.—Surgery.
685 West Eleventh Avenue,
Vancouver 9,.B.C.
Monday—9 a.m. - 10 a.m Ear, Nose and Throat Clinic
Tuesday—9 a.m. - 10 a.m .Weekly Clinical Meeting of Attending Medical Staff
Tuesday—10:30 a.m. - 11:30 a.m Lymphoma Clinic
Daily—11:45 a.m. - 12:15 p.m .Therapy Conference
Spring meeting—April 25th, 26th, 1952.
EM. 2266
NW. 60
t t was*
■'*«     :5§&fc-
Page   333! Official recognition
Of the large number of antihistamine compounds introduced
during recent years, only two, mepyramine maleate and
promethazine hydrochloride have been incorporated in the
British Pharmacopoeia.
Official recognition now confirms the general experience of
the profession that these highly effective and safe antihista-
minics can be used with complete confidence for routine use
in the symptomatic relief of allergic and other conditions.
trade mark
trade mark.
mepyramine maleate
promethazine hydrochloride
^Canadian Patents
NEO-ANTERGAN is sold as ANTHISAN in England but under the same name
in the United States and France.
PHENERGAN is sold under the same name in England, France and the United
Total population—-census figure  (final) 344,833
Chinese population \     7,117
May, 1952
Rate per
Number 1000 pop.
Total deaths   (by occurrence)         357 12.4
Chinese  deaths c 15 25.3
Deaths, residents only . _^ 319 11.1
Birth Registrations—residents and non-residents—(includes late registrations)
Male ! ;	
Female ;	
May, 1952
Infant Mortality—residents only
Deaths under 1 year of age	
Deathe rate per 1000 live births	
Stillbirths (not included in above item)
Scarlet Fever	
Diphtheria Carriers
Chicken Pox	
"Whooping Cough
Typhoid Fever —
Typhoid Fever Carriers
Undulant Fever	
Erysipelas  _:	
Infectious Jaundice —
Salmonellosis Carriers
Dysentery Carriers
Cancer (Reportable Resident)
— |
VPage  335 -C CONNAUGHT >
Liver Extract Injectable is prepared specifically for the treatment of pernicious anaemia. The potency of this product is expressed in micrograms of
vitamin B12 as determined by the Lactobacillus leichmanii test. Liver Extract
Injectable as prepared in the Connaught Medical Research  Laboratories
—contains 20 micrograms of vitamin 2?12
per cc. derived directly from liver.
—is carefully tested for potency.
Ilpp      . —is law in total solids and light in colour.
||j| —is very highly purified and therefore can
usually  be  administered without  occurrence  of  discomfort  or  local  reactions.
.Liver Extract Injectable (20 micrograms of vitamin B12 per cc.) is
supplied in packages containing single 5-cc. vials, in multiple packages containing five 5-cc. vials, and in 10-cc. vials.
Dry Liver Extra for Oral Use is supplied in packages containing ten
vials; each vial contains extract derived from approximately one-half pound
of liver.
University of Toronto Toronto, Canada
Established in 1914 for Public Service through Medical Research and the development
of Products for Prevention or Treatment of Disease.
Page   336 We read with interest the recent announcements in the Press of a report by Premier
Johnson, in which he announced that the B.C. Hospital Insurance Scheme, during the
past year had accumulated a surplus of three million dollars. This is a very satisfactory
state of affairs, and reflects a great deal of credit on those who have had the very
difficult, and often unpleasant, task of administering the Scheme. It will make the
case for hospital insurance in the Province a great deal stronger, and will justify
to a great extent the measures taken to make it function efficiently.
It gave Premier Johnson too a chance to pat co-insurance on the back, as a very
good thing. He is reported to have said that it saved money by cutting down days'
stay. We doubt this very much, as far as the saving of money goes—since the moment
a patient goes out, in most of our hospitals, another immediately goes in. Perhaps it
helps that way—by giving more people a chance to get hospital beds.
But we should like to see the actual figures about days' stay. We seem to have
seen cases where it worked the other way—since once the ten days' co-insurance was'
paid, the patient was in no hurry to leave. He felt he had some time coming to him.
We have often wondered whether it would not be a more effective deterrent to apply
co-insurance only after, say a week or ten days of hospital stay. Then it would be
easier to persuade people that they were well enough to go home. It would not, of
course, be as easy to apply it that way.
Our new rulers have stated that they intend to abolish the compulsory clause,
and make hospital insurance voluntary. One speaker said more people would join if it
was voluntary. Unless the vote in June, 1952, means a very fundamental change in
human nature in British Columbia, we do not think this will turn out to be the case.
If hospital insurance is put on a voluntary basis, we feel that two things will happen,
at least. One is that it will have to go up very greatly in price. The only reason
hospital insurance could be offered at the ridiculously low rate charged (low as compared
with any type of voluntary insurance) was that it took in everybody—good risks, bad
risks and all. If it is left on a voluntary basis, with no compulsion, many people will
simply wait till they see trouble ahead, and then take it out. This would overload and
swamp any scheme at all.
Another thing we see in the crystal ball is utter chaos for the unfortunate
hospitals—which, under the B.C.H.I.S., have been just beginning to get into clearer
water.  Now they won't know where they are and will have more bad debts than ever.
We think, for .what our opinion is worth, that B.C.H.I.S. is and has been a magnificent piece of work in many ways: the principles on which it was founded are the
right principles. There have been many mistakes in its application; the price was set
too low at first; not enough advice was sought from those who knew—and there was
often a lack of frankness, and a disregard of the public feeling. But these things can
all be remedied, and the scheme has been of enormous value to the people of British
Columbia, and must be perpetuated, with what improvements and modifications are
necessary. We do not, frankly, believe it can be done on a voluntary basis—but time
will show, and we must give our new government all the help and support we can, as
long as they deserve it.
Meantime, we feel that B.C.H.I.S. will be a monument to the late Coalition Government of B.C., which, with all its faults and mistakes, yet has given British Columbia
some magnificent social legislation. The new government has some very fine foundations to build oh: let us hope they will build worthily and well. j
Page   337 Library Hours During the Summer Months:
Monday to Friday :.„9:00 a.m. - 5:00 p.m.
Saturday  I j 9:00 a.m. - 1:00 p.m.
Recent Accessions
Brock, R. C, The Life and Work of Astley Cooper, 1952 (Nicholson Collection).
Eastman, N. J., Williams' Obstetrics, 10th edition, 1950.
Maxcy, K. F. (editor)—Rosenau's Preventive Medicine and Hygiene, 7th edition, 1951.
Medical Clinics of North America—Symposium on Endocrine and Metabolic Disorders,
New York Number, May, 1952.
Ophthalmological Society of the United Kingdom, Transactions, 1951.
Peham, H. V. and Amreich, J., Operative Gynecology translated by L. Kraeer Ferguson,
2 vols., 1934 (gift).
Pugh, D. G., Roentgenologic Diagnosis of Diseases of Bones, 1950.
Wolff, H. G., and Wolf, S. G. jr., Pain, 1951.
World Health Organization, Pharmacopoea Internationalis, Vol. 1, 1951.
An interesting new precedent has been set by a local doctor donating to the Library
a gift in appreciation of medical treatment given to his family by a confrere.
Those of our readers who prepare bibliographies for their papers may be interested
in the following which appeared in "The Lancet" for June 21, 1952, in the column
"In England Now".
It is a big step forward for the young medical author (and a welcome one for his
editors) when he appreciates the niceties of bibliographical abbreviation as laid down
in the World List of Scientific Periodicals. This will show him how to avoid such betises
as 5. M. /. and /. A. M. A. and works of supererogation such as /. Pharmacol. & exp,
Ther. or Proc. Staff Meet. Mayo Clinic. After a couple of days with the World List
at his elbow he will be clearing such hurdles as /. Lab. clin. Med. and Proc. Soc. exp.
Biol., N.Y., with never a stop or capital misplaced or a superfluous syllable. He will
enjoy the very special thrill of pruning oversize titles like Bollettino delta Malattie dell'
Orecchhy delta Golay Delia Naso, di Tracheo-Bronco-Esofagoscopia e di Fonetica to the
laconic Bol. Mal. Orecch.
Foreign publishers are apt to follow a code of abbreviations of their own, and this
morning, when running through a Belgian abstract journal, we were shaken to find a
paper on the aetiology of peptic ulcer credited to Wikliwo 62, 674, 1950. This raffish-,
looking title suggested one of those Continental weeklies, filled with risque cartoons,
which one finds in the better Harley Street waiting-rooms. With bitter memories of
instigating library searches for the current volumes of Ibid., we appealed to a learned
colleague, schooled in military terminology, who identified it in a few seconds 3ls the
journal known in our chaster code as Wien. klin. Wschr. NATO, SHAEF, NATSOPA,
ROSPA, and now WIKLIWO; only a little farther down the slippery slope and we
shall find ourself figuring as a case-history in the /. ment. Sci (or will it be JOMESCI?).
By G. W. Thorn, 2nd edition, 1951, pp. 182 illus.
It is now about 100 years since Thomas Addison laid the foundation to the understanding of adrenal physiology correlating the clinical picture of the disease bearing his
name and destruction of the adrenal cortex. His study was shortly followed up by the
intrepid Brown-Sequard who observed that the demise of a variety of animals subjected
to bilateral adrenalectomy, was similar in many respects to that of patients suffering
from Addison's disease. In the subsequent 100 years, there has been a tremendous volume
of work published on the subject of adrenal function, and in the past fifteen years the
work of Selye on the Adaption Syndrome and the more recent discovery of the therapeutic potentialities of ACTH and Cortisone, have acted as potent stimuli in directing
attention to the adrenal cortex.
The name of George Thorn has, for some time, been closely associated with studies
on this gland. It is not surprising that his book "Diagnosis and Treatment of Adrenal
Insufficiency" has, in the space of two short years, run to a second edition. The book
itself gives a fairly complete account of the physiology, the symptoms, signs and
treatment of adrenal insufficiency. There is a useful chapter in which the activity and
potency of different adrenal cortical preparations is discussed. This is the only place
that I know where this information is collated. However, considering Professor Thorn's
extensive experience, there are some disappointments. There is no consideration given to
the intravenous use of ACTH in testing for adrenal insufficiency. This is of importance
because it has become recognized in the past few years that there is considerable inactiva-
tion of the hormone when given by the intramuscular route. There is little said
regarding the use of Cortisone and it would appear that the oral use of this material
is perhaps one of the most satisfactory ways of controlling Addison's disease. There is
little information with regard to the twilight state of adrenal insufficiency without
the full-blown picture of Addison's disease.
There is, though, much useful information in the book and it is to be hoped that
subsequent editions will remedy these failings.
H. W.  M.
• •       #    |        •     $ •        •
Following the Sixth General Assembly of The World Medical Association in
Athens, Greece, October 12-16, 1952, there will be a meeting of the Medical Editors
of the World, Friday, October 17, 1952.
The meeting held in Stockholm in connection with the Fifth General Assembly
was so successful that it was decided to hold a similar meeting this year.
The tentative program for the Conference is attached hereto.
of the
Athens Greece
October 17th, 1952
1. Medical-Political Editorials.
2. Control of Advertising in Medical Publications.
3. The Extension of Medical Information through Abstract Services.
4. Medical Publications in Latin America.
Subject: Practical Matters of Medical Publications. &(To include
Authors reprints, exchanges, etc.).
Page   339 Vancouver Medical  Association
Honorary Treasurer-
Honorary Secretary-
Editor :	
_Dr. E. C. McCoy
.Dr. D. S. Munroe
.Dr. G. E. Langley
__Dr. J. H. Black
 Dr. J. H. MacDermot
Editor, Vancouver Medical Association Bulletin.
Dear Doctor MacDermot:
I am enclosing a copy of the programme for the Refresher Course on Malignant
Disease which will take place during the week of October 6-10. The chief speakers are:
Sir Stanford Cade, and Professor B. W. Windeyer of London, England. Other visiting
guest speakers are: Dr. S. T. Cantril and Dr. Franz Buschke of the Tumour Institute
of^the Swedish Hospital, Seattle, Wash.; Dr. O. H. Warwick of the National Cancer
Institute of Canada; Dr. H. M. Parker of Richland, Wash, and Dr. B. V. Low-Beer
of the University of California Hospital, San Francisco.
Yours sincerely,
A. M. EVANS, M.D.,
Medical Director
Course is open to everyone.  There will be no charge—but anyone wishing to attend
is asked to write to above when a ticket of admission will be issued.  This is necessary to
find out the size of accommodation needed.   Apply now. -pj  xr r
OCTOBER 6-10, 1952
Morning Session:
8:30 A.M.    Registration.
9:00 A.M.
9:15 A.M.
10:00 A.M.
10:45 A.M.
11:15 A.M.
12:15 P.M.
Introduction by Dean M. M. Weaver.
Chairman: Dr. A. M. Evans—Cancer of the Breast.
1. Surgical Management—Sir Stanford Cade.
2. The Role of Radiotherapy—Professor B. W. Windeyer.
3. The Role of Hormones—Dr. L. G. Ellison.
4. Discussion Period.
Surgical Ward Rounds, Vancouver General Hospital.
Afternoon Session:
Chairman: Dr. F. P. Patterson.
The Treatment of Bone Tumours.
Sir Stanford Cade.
Professor B. W. Windeyer.
Dr. Franz Buschke.
The Treatment of Cancer of the Lip—Dr. A. M. Evans.
The Treatment of Cancer of the Skin—Dr. S. T. Cantril.
2:00 P.M.
2:30 P.M.
3:00 P.M.
3:30 P.M.
4:00 P.M.
Evening Session:
Chairman: Dr. G. F. Strong.
8:15 P.M.     Official Opening Ceremonies in the Ballroom, Hotel Vancouver.
The Rt. Hon. Paul Martin, Minister of National Health & Welfare.
Morning Session:
Chairman: Dr. A. Taylor Henry.
Clinical Meeting.   Presentation of new cases of malignant diseases.
The Treatment of Cancer of the Tongue by Radiotherapy and by Surgery.
Sir Stanford Cade.
The Treatment of Cancer of the Maxillary Antrum.
Professor B. W. Windeyer.
Demonstration of Treated Cases—Lip, Tongue, Tonsil, Skin and Breast.
9:00 A.M.
10:15 A.M.
11:00 A.M.
11:30 A.M.
Afternoon Session:
Chairman: Dr. A. B. Nash.
2:00 P.M.     The Treatment of Cancer of the Cerxix Uteri—Dr. S. T. Cantril.
2:45 P.M.     British Columbia Cancer Institute results—Dr. Margaret Hardie.
3:00 P.M.     The Treatment of Cancer of the Ovary.
1. Surgery—Dr. J. E. Harrison.
2. Radiotherapy—Dr. Margaret Hardie.
3:40 P.M.     The Treatment of Cancer of the Corpus Uteri—Dr. Ethlyn Trapp.
Evening Session:
Vancouver Medical Association.
9:00 P.M.     "The Changes in the Treatment of Cancer"—Sir Stanford Cade.
Morning Session:
9:00 A.M.    Clinico-Pathological Conference at Vancouver General Hospital.
Chairman: Dr. J. Balfour.
The Treatment of Cancer of the Bladder—Professor B. W. Windeyer.
The Treatment of Cancer of the Kidney—Dr. R. D. Nash.
Recent Advances in Surgery—Sir Stanford Cade.
10:15 A.M.
11:00 A.M.
11:30 A.M.
Afternoon Session:
Chairman: Dr. R. B. Kerr.
The Management of the Lymphomas.
2:00 P.M.     Professor B. W. Windeyer.
2:45 P.M.     "Experience in the Treatment by Chemotherapy of One Hundred Cases
of Leukaemia and Allied Diseases"—Dr. O. H. Warwick.
3:15 P.M.     The Practice at the Britsih Columbia Cancer Institute.
Dr. D. M. Whitelaw, Dr. R. G. Moffat.
4:00 P.M.     Discussion Period—Dr. Franz Buschke, Dr. H. H. Perry, Dr. H. K. Fidler.
Morning Session:
9:00 A.M.    Medical Ward Rounds, Vancouver General Hospital.
Chairman: Dr. H. Rocke Robertson.
The Role of Radiotherapy in the Treatment of Tumours of the Brain
and Spinal Cord—Professor B. W. Windeyer.
The Treatment of Pain in Malignant Disease—Dr. Frank Turnbull.
Surgery and Radiotherapy in the Treatment of Cancer of the Oesophagus.
Dr. Franz Buschke.
10:15 A.M.
11:00 A.M.
11:30 A.M.
Afternoon Session:
2:00 P.M.     Conferring of Honorary Degrees at the University of British Columbia.
Sir Stanford Cade—Professor B. W. Windeyer.
4:00 P.M.     Open House at the British Columbia Cancer Institute.
Tea by the Women's Auxiliary.
Page  341 FRIDAY, OCTOBER 10
Morning Session:
Chairman: Dr. L. H. Leeson.
"Diagnosis, Choice of Method of Treatment and Surgery in Cancer of
the Larynx"—Sir Stanford Cade.
"The Radiotherapeutic Treatment of Cancer of the Larynx".
Professor B. W. Windeyer.
The Treatment of Cancer of the Nasopharynx—Dr. S. T. Cantril.
The Spread of Tumours—Dr. William Boyd.
9:00 A.M.
9:45 A.M.
10:30 A.M.
11:15 A.M.
Afternoon Session:
Chairman: Dr. William Boyd.
2:00 P.M.     "The Role of the Physicist in the Treatment of Cancer".
Dr. H. M. Parker.
2:30 P.M.     The Use of Radioactive Isotopes—Dr. E. T. Feldsted.
3:00 P.M.     Cobalt 60 Beam Therapy—Dr. H. F. Batho.
3:30 P.M.     Clinical Experience in the Use of Radioactive Isotopes.
|§P Dr. B. V. Low-Beer.
4:00 P.M.     Diagnostic Uses of Radioactive Iodine—Dr. H. W. Mcintosh.
The human foot is to a great extent an unexplored area in medicine. The medical
student receives full training in the; anatomy of the foot, and its relation to the function
of the body, generally, but the dynamics of the foot, its relation to general diseases of
the body, its capacity for developing diseases and disorders of its own, are not adequately
taught. There are several excellent monographs on the foot available to the medical
practitioner; e.g., Lewin's "The Foot and Ankle", and Lake's "The Foot", but these are
not in general use for the medical student.
One can search through the leading systems of orthopaedics, surgery, paediatrics,
obstetrics and gynaecology, and find no reference to the foot as an entity. There is no
reference to diseases of the foot in the aged, nor to the prevention of the ills which
emanate from foot disorders. Morton, the well-known medical authority on diseases of
the foot, after whom "Morton's Disease" is named, says "The foot is the only part of
the body for which prevailing ideas of care and treatment have remained practically
unchanged for forty years."
However, we are beginning to realize more and more the importance of the foot as
a cause of human disability and suffering, and as a cause of very great economic loss.
Industry finds that foot ailments are the cause of much loss of time, poor work, and
accidents. Workmen's Compensation Boards are interesting themselves in the prevention
of crippling through injuries of the foot. The armed forces, in the last War, found a
tremendous amount of incapacity developing during service as a result of unstable and
weak feet, and conducted surveys which have been of great value.
Orthopaedists, paediatricians, and internists are becoming increasingly conscious
of the need for foot care. However, the great majority of people go first to their
family doctor and the training of these men, which is so complete in other lines, is not
such as to give them the necessary knowledge and skill either to prevent or to treat
foot disorders adequately.
Surveys indicate that modern life bears hardly on the foot. Women have gone
into many activities, in factories, in hospitals, in stores and restaurants, where the
increased strain on their feet is apt to be productive of much trouble. Pregnancy and
childbirth, with the shifting of the centre of gravity and increase in weight, are a serious
Page   342 threat to the foot. Girls' feet appear, from surveys made, to be more liable to disorders
than boys'. Lake, of Charing Cross Hospital, says in his book, "The Foot", that "not
more than 10 % of adult women have normal feet."
Men, too, in industry especially, have trouble referable to their feet. Sore feet in
industry, we are told, are a cause of absenteeism to the degree that one man in ten is
absent from two to seven days a month. In the auto industry, says one authority, foot
ailments are present in 50% of the men employed. Sore feet, says another authority,
are a frequent cause of accidents.
Such opinions have aroused the concern of employers of large groups of men and
women. Henry Kaiser, the automobile manufacturer, the Endicott-Johnson Shoe
Company, Sears and Roebuck, and other similar companies in the United States, provide
chiropody clinics and foot care for their employees.
The Metropolitan Life Insurance Co., Aetna Life Insurance, Zurich Insurance Co.,
U.S. Fidelity and Guaranty Co., are conducting studies on the relation of foot health
to accident prevention.
The records of the disabilities found in men in the United States who were being
examined with a view to military service, show that 14.5% of the men examined,
supposedly young, healthy men, showed foot defects. A great many of these conditions
could have been detected, and probably remedied, in childhood but had, with the passing
years, become irreversible, and made the man unfit for enlistment.
In the aged, too, a vast amount of suffering and disability is caused by bad feet
as a result of disabilities which could presumably have been corrected in earlier life.
In the later years, peripheral vascular disease, arterior-sclerosis, diabetes, produce consequences in the feet which can be very serious. Dr. J. H. Sheldon, in "The Social
Medicine of Old Age"—a report made to the Nuffield Foundation in England—says
"Pain in the feet is a most important cause of disability in old people, affecting nearly
40% . . . There is little doubt that the two measures which would give the greatest
relief to old people are adequate provision for chiropody and the supply of suitable
A report made in Great Britain by representatives of the Society of Medical Officers
of Health says that some 80% of old people need chiropody. Many of these, the report
adds, could probably be restored to earning capacity by suitable care.
All these statements, however, deal with actually existing foot disabilities. As in
other departments of medicine, the most important and most productive kind of medical
care is prevention. And this brings us to consider foot diseases in children, where most
of adult foot disability originates, and where alone it can be prevented by suitable
early care.
A survey made in New York by the National Association of Chiropodists, and under
the supervision of the educational and school medical authorities, showed that of 15,000
boys and girls in school, 63% showed foot disorders, some of which needed only advice
and general care. A larger number needed actual professional care—this proportion
being higher with the older students. Girls showed a 10% higher incidence than boys.
A good many of the conditions present could have been prevented by proper shoe
fitting. This question of shoes in childhood is perhaps the most important single factor
in the prevention of foot disorders. It is of interest that at the present time a study is
being instituted in Vancouver under the joint control of Professor J. F. McCreary,
Head of the Paediatric Department of the University of British Columbia, and Doctor
Frank Patterson, Head of the Department of Orthopaedic Surgery at the Vancouver
General Hospital, into the development of children's feet. In this study, the active
advice and participation of chiropodists has been solicited. It is intended to follow a
Series of infants and children with routine radiological and photographic examinations
to determine when arches develop.
Very briefly we have indicated the increasing realization of the-need for research
into the prevention and treatment of foot disease in three main groups—children, adults,
Page  343 especially women, and the aged. A great deal more could be said to expand this theme,
but one or two things stand out in summary. gf||
We have in the modern community a great deal of foot disability at all ages—
disability which causes a large economic loss and human suffering. A great deal of
this probably originates in childhood—most of it is recognizable in childhood, and may
be preventable or remediable in childhood. Little or no provision exists at present for
systematic surveys of children's feet at home, in schools or elsewhere. Such surveys
would uncover actual or potential trouble, and so allow preventive and curative
measures to be taken. These surveys could be undertaken in school medical systems,
in children's hospitals and clinics, in post-natal and infant welfare work. Negotiations
are now on foot between the School Medical authorities of Greater Vancouver and the
B.C. Chiropodists' Association, with a view to finding if some way cannot be worked
out of holding foot clinics in the schools, as dental clinics are held. The chiropodists
assure us that this could be the means of detecting much trouble in the early and curable
stages, instead of allowing minor disabilities to become fixed and develop into more
serious conditions later. It seems a logical way of attacking the preventive side of the
problem, and should be a constructive contribution to public health.
It is very doubtful if this work can be done by the medical profession itself. It
must be done with their help and support. The actual detailed care of foot disabilities,
either in children or adults, calls for an intensive application of specially acquired skills
and a knowledge of shoes that few, if any, medical men possess. Moreover, the man in
medical practice has not the time, if he had the skill, to do this type of work. Success
in the care of foot disabilities requires detailed, meticulous, often daily care, which can
be best given by one who devotes himself entirely to this work. It requires training
in shoe-fitting, in supportive measures, that can only be given in special curricula.
For example, in regard to flat-foot in children Lewin says—"Diagnosis is important
—treatment requires one year (Whitman) for a cure, but shoes need attention indefinitely. The indications for treatment are to teach proper walking, to increase the
power of the supporting structures, to support the weakened structure, to increase the
local circulation and to correct associated pathological conditions. Methods are . . .
prescribing proper shoes, exercising, massage, contact foot baths, felt pads, plaster casts
and operations." Except for operations, most of this is beyond the scope of the average
medical man to carry out alone. It needs, in addition, the services ^>f men who have
been trained in this sort of detailed work—in short, chiropodists.
The present state of affairs is somewhat analogous to that which existed in the old
days when there were few dentists, and those not very highly skilled. Every doctor
had a more or less complete set of dental forceps. If a patient had a toothache, he did
his best to pull the tooth for him, or as much as he could before the patient felt he had
had enough. Otherwise, since he knew nothing about teeth, he could do nothing for
such things as dental caries, dental obliquities, buried molars and so on. But the
dentists faced the problem, improved their methods and standards of education and
practice, ^developed methods of research and study, and went deeply into the preventive
aspects of dentistry. So they became the fine, scientific profession that they are today.
The result, in improved health, especially for children, in the prevention of adult dental
disorders, in the generally improved well-being of the community, is great.
My thesis is that we have to do the same thing about feet as we did about teeth;
recognize the foot, its disorders and diseases, its need for maintenance as a strong and
healthy supporting organ. The prevention of foot ill-health must be the subject of special
study and training, by men who will 'specialize in this limited field, as the dentists have
done in theirs, and devote themselves entirely to it. These men must, of course, be trained
along general medical lines, as are the dentists. They must be sufficiently trained in
general medicine and its cognate subjects; and in the basic sciences—anatomy,, chemistry,,
physiology, pathology and the rest—so that they have a comprehensive knowledge of
the body as a whole; and they must further have devoted sufficient time to the detailed
study of the foot, its care and treatment, and the prevention of disease.
The medical profession has come to recognize dentistry as an integral part of the
Page  344 medical structure, and accepts the claim of the dentist to complete professional standing.
His training is along medical lines, and his training in the basic sciences is adequate.
Medicine, in this country at least, has been slower to recognize chiropody in the same
way. This is due to several things. First, there is the natural reluctance of the profession to endorse any new thing till it has justified its claims thoroughly, and this is
a good habit of mind.
The second reason, I think, is that modern chiropody is a very recent thing. To
many of us, in the older age levels of medical practice, the word chiropodist brings to us
a memory of the "corn doctor" of thirty or so years or so ago—whose training was of
the sketchiest, and who could lay no claim to an adequate professional standing.
In the last twenty or twenty-five years, however, the picture has changed very
radicallv. Chiropody has gone a long Way in that time. It has steadily raised its
standards of education, both academic and pre-academic, till now the Canadian and
American chiropodist undergoes a four-year course of training, preceded by a general
education. To obtain a license, for example in British Columbia, the candidate must
show a standard of preliminary education which must be at least equal to the end of the
first year in Arts in the U.B.C., or other recognized Canadian universities. His training
at College is along medical lines—in that he has to pass examinations in the basic
sciences, anatomy, physiology, histology, chemistry, pathology, and so on. The teaching
in these subjects is given along general lines, and not limited to the foot. In most of
the colleges, these subjects are taught by medical men. He has some 4200 hours of
lectures, clinics, demonstrations and the rest, and as one who has spent some time
inspecting one of their colleges, I can testify to the fact that their course is a pretty
stiff one.
The chiropodist of today is a trained professional man, with professional and
ethical standards like our own, and based upon rigid training. Like the dentist, he
specializes in a limited field of the body, outside of which he never ventures. Apart
from his basic training, he is given courses in general medicine, surgery, dermatology,
pathology and so on, which make him a safe and reliable practitioner.
In the forty-eight States of the Union, chiropodists are recognized as an integral
part of the medical structure of the country. They are recognized by the American
Medical Association as a medical auxiliary profession. As a general rule, in each State,
they are subordinate to the State Medical Board, with whom they work in harmony.
In a considerable number of the States, their final examinations are set by the State
Medical Board, as in California—in others there is a Joint Examining Board of doctors
and chiropodists, in others the Chiropodists conduct their own examinations.
There are six main schools of Chiropody in the U.S.A.
Two of these are associated directly with universities.
Within the past year, all these schools have been recognized as institutions of
higher learning by the Department of Education, Federal Security Agency, Washington,
In Great Britain, the chiropodist is similarly recognized as a medical auxiliary,
and the Offices of the British Chiropody Society are housed in the British Medical Association Building in London.
Some time ago the B.C. Chiropodists Society, through their President, Dr. J. I.
Gorosh, of Vancouver, approached the Vancouver General Hospital, and offered to
install and equip at their own expense a Chiropody Clinic in connection with the
Outpatient Department of the Hospital, under the control of the Department. They
presented a Brief to the Medical Board of the Hospital, based on an enquiry made of
some 250 American hospitals in which these questions were asked:
Is there a Chiropody Clinic in connection with your hospital?
What is your opinion of its value?
Are the relations between the medical men and the chiropodists harmonious or
The answers were classified, and these facts emerged. A great many of the largest
hospitals in the States have chiropody clinics, and make extensive use of them.   Joslin,
Page   345 the noted authority on diabetes, in his big clinic in Boston, employs ten or more of
them continuously, and says that nobody can treat diabetes adequately without access to
and employment of the chiropodist's services. The Mayo Clinic, the Philadelphia
General Hospital, Massachusetts General Hospital, Mount Sinai Hospital in New York,
and many other large hospitals have clinics. These were all enthusiastic about their
clinics, and there were numbers of comments about their absolute necessity, especially
as regards diabetes and peripheral vascular disease. One hospital stated that before they
had the clinic, the incidence of amputations in diabetics had been about 19%, whereas,
with proper chiropodial care, this had been reduced to about 4%.
Almost without exception, the answer came that the relations between doctors and
chiropodists were most harmonious and friendly, and that there was no encroachment
whatever on the part of the latter upon fields that were not legitimately their own.
As a result of all this, the V.G.H. agreed to the establishment of a Chiropody
Clinic. In some three years this clinic has given some 8000 treatments (two days a
week), and is constantly some seven or eight weeks behind with its bookings. The
Clinicians of the O.P.D. value and respect this clinic—in fact most of the cases
treated are referred by other clinics in the Department. In the words of several of the
heads of departments, it is "indispensable", and it is one of the busiest and most
popular of all the clinics.
St. Paul's Hospital has recently installed a similar clinic, again equipped and paid
for by the chiropodists themselves, and it is rapidly repeating the history of the V.G.H.
clinic. In view of the fact that there are only some 38 chiropodists in B.C., that the
men in Vancouver give their time in rotation at the Clinic without charge, one cannot
but applaud the sincerity and public spirit of these men.
An interesting series of findings and recommendations is to be found in the Report
of "The Committees on Medical Auxiliaries" made to His Majesty by the Minister of
Health for Great Britain. This is known as the Cope Report and is issued under the
Chairmanship of V. Zachary Cope, M.D., M.&, F.R.C.S.
It deals with a great many subjects—diet, physiotherapy, radiotherapy, etc., and
has a section of some length on chiropody.  Some extracts are given here:
"More could be done by Local Education Authorities in giving attention to children's feet".
"Representatives of the British Orthopaedic Association told us that chiropody
should be available for the treatment of both in-patients and out-patients referred by
the hospital medical authorities".
"Representatives of the London County Council and the Society of Medical
Officers of Health told us that the chiropody service given by local Authorities was
extremely popular, and agreed that it was capable of great extension".
"In hospitals of the National Health Service in England and Wales there were 313
chiropodists, in Scotland 75, some full-time, but most part-time".
The conclusions at the end of the Report were:
"(a) There is evidence to support the view that there should be a chiropodist
available in every general hospital. Where departments exist for the treatment of
Diabetic, Orthopaedic, Dermatological and Rheumatic patients, the services of chiropodists are particularly required.
(b) There appears to be considerable demand for chiropody through the Local
Authority Clinics.
(c) If there is an extension in geriatric work, as seems likely, there will undoubtedly be an increase in the demand for the services of chiropodists in connection with
these units".
The medical profession, I feel, has much to gain, and nothing to lose by making
recognition of this group of men as part of the medical structure, limiting their work
to a certain field, the foot. They are rigidly controlled by their Chiropody Acts in each
Province, and could not infringe in any way on medical practice, if they wanted to.
They have high standards of practice and ethics, and are constantly striving to make
Page   346 these even higher. By recognizing them, by consulting with them, by utilizing their
special skill and knowledge, we shall be increasing our capacity for useful service to our
patients, and helping to improve public health conditions. As it is, there is a growing
tendency, among orthopaedists, paediatricians, internists and others to refer their patients
with foot conditions requiring expert care, to chiropodists who can help them greatly
in their work. They are taught in their schools to keep in close touch with the attending
medical man, and at all times to regard him as the responsible authority in charge of
the case.
At the Annual National Convention of Chiropodists in Great Britain this year,
Sir John Stop ford, M.D., F.R.S., Vice-Chancellor of the Victoria University of Manchester, was their guest speaker. In part, he said "During the first World War, I did
come much closer to your work because for a number of years I was in charge of nerve
injuries, and . . . associated with orthopaedic hospitals. I learned that no orthopaedic
service can be complete without having some connection with your profession.
"We must have the right relation with the medical profession ... we must both
still realize that each of us has a very distinctive part to play. Each of us must realize
that there is room and need for both of us and that we are interdependent and often
"Another important point is that chiropody and medicine cannot remain static . . .
The direction taken will depend upon the individual members of the profession, what
they are contributing. May I ask you to be research-minded. The preventive aspects
are very apt to be neglected in medicine and the fields of mdical auxiliaries, and yet
I am sure you will agree with me that (by preventive medicine) it is attaching the
subject at the right end.
"Just to summarize. First, let us insist on a high educational standard . . . Secondly,
let us do everything in our power to secure full and happy co-operation between the two
professions. Let us demand the highest ethical standards. Thirdly, let us try to advance
our subject and perfect our methods of treatment, and see that preventive measures
receive a full measure of consideration."
Dr. Charles A. Mayo gave an address in Des Moines, before a State Convention of
Chiropodists.  He said, inter alia-.
"Chiropody, unfortunately, does not receive the attention it merits in our medical
schools ... I am convinced that doctors of medicine, myself included, have paid too
little attention to the feet in their relationship to the condition of a patient. The doctor
of medicine should be capable of recognizing foot ailments, and when treatment and
care of such conditions are necessary should refer the patient to those accredited and
skilled.in that specialty."
Lastly, I should like to quote from an article in the "Practitioner" written by a
leading English chiropodist. This number of the "Practitioner"—February, 1946—
contained a symposium on "Disorders of the Feet". It is a most interesting number and
contains the following articles:
The Problem of Footwear—by Lake of Charing Cross Hospital, London.
Congenital Abnormalities of the Foot—by Mercer.
Minor Surgery of the Foot—by Moore of London.
Skin Diseases of the Foot—by Dowling of St. Thomas' Hospital.
Lastly, comes "Indications for Chiropody", by John H. Hanby, F.Ch.S., Consulting
Chiropodist at Guy's Hospital and the London Foot Hospital. He is also President of
the Society of Chiropodists which, I understand, has its head office in the British Medical
Association building in London. He deals with the modern outlook of chiropody, the
technique of treatment, foot ailments and their treatment, and closes with these words:
"The chiropodist's work, if intelligently applied, is closely connected with that of
the orthopaedic surgeon and the dermatologist.   Yet, the link is an harmonious one.
The chiropodist recognizes his limitations, but he feels that he has a noteworthy contribution to make towards the relief of suffering, and he is ready to take his rightful place
in the health services of the country.   There is a close co-operation between many con-
Page  347 sultants and chiropodists. Among the major body of medical practitioners, however,
there is a lack of appreciation of the basic and scientific training which is now undertaken at responsible schools of chiropody. It is in the interest of the general public, and
particularly children, that there should be a closer co-operation between the general
practitioner and the chiropodist, which must be to the mutual benefit of all concerned
in main taming a healthy and fit nation."
Associate Clinical Professor of Surgery (Oto Rhino-Laryngology)
University of Southern California
Los Angeles, California
Office practice in oto-rhinolaryngology varies as to the method of handling of the
patient as much as in any other specialty. The method of handling reflects the training
you received in medical school as well as reflecting the make up of the physician.
There is no such thing as the correct way because several different methods arrive at
the s\me end result which is the curing of the patient as well as having a satisfied
patient. My method is to see as many different patients as possible and to avoid useless
visits to the office.
I would like to discuss my treatment for different kinds of cases that come into
the office. It will help clarify our thinking as a new patient presents himself. I have
found it is efficient to be well organized ahead of time as to treatment for each
separate condition.
An adult comes into the office with a fresh runny nose cold and the nose is very
stuffy. I' know right away there is nothing I can do to cure the cold but there are
definite things to do for symptomatic treatment and to prevent complications. He has
no general toxic symptoms and no fever, and all of the symptoms are confined to the
nose. I ask the nurse to give him the following medicine to drink. Twenty drops in a
little water of equal parts of Tr. aconite, Tr. Belladonna and Tr. Opium. Before he
leaves the office the nose is quite dry and there is a sense of well being. To open the nose
temporarily, a flexible wire applicator with a little cotton on it and a drop of saturated
cocaine is passed along the floor of the nose from front to back. This is done quickly
and causes the minimum of discomfort. The patient is left for about five minutes
and upon my return, as a rule the nose is open. If not then a similar applicator is
passed along the middle meatus from front to back and in another two or three minutes
the patient can breathe well and, symptomatically, is free from complaints. I explain
that this is only temporary, then write down several things for him to do at home.
Every six hours, if the nose continues to run he takes twenty drops of the three tinctures.
He is told not to blow the nose under any circumstances and to take one or two aspirin
tablets every three to four hours. If he is fortunate, the cold will not go into the
suppurative stage and will remain open most of the time. As a final bit of advice, I
explain that most so called colds come on following an accumulative fatigue, so in the
future he is to try to avoid such a state. I do not give penicillin or any other antibiotic
for this condition.
A patient comes in with a cold that has been present for several days and there
are symptoms of the sinuses being blocked. The runny nose stage is past and there is
some purulent material that is being blown out and dripping into the throat. Depending
on the severity of the symptoms and the financial status of the patient, x-rays of the
sinuses may be ordered. The nose is sprayed with a vasoconstrictor and it makes little
difference which one is used. The flexible wire applicator with a small amount of
saturated cocaine solution is passed along the middle meatus on each side and around
the opening of the sphenoid sinuses. The patient is left for a few minutes, then is
given advice as to home treatment. This includes steaming compresses to the face,
* Read before the Vancouver Medical Association Summer School, 1952.
Page   348 warning the patient not to let the steamingI towel contact the tip of the nose as it
blisters quite easily. He is told to avoid blowing the nose. Hot throat irrigations, using
water without salt or soda may be ordered to be used two or three times a day for the
purpose of heating up the circulation in the throat and nasopharynx. Either neosy-
nephrin or propadrine capsules are prescribed about every three to six hours to help in
the vasconstriction. The dosage varies from the small 1 mg. neosynephrin to the 25 mg.
size and the propadrine varies from % to % grain, depending on the type and size of
the patient. If there is a very marked blocking of the sinuses, the patient is told to
fill one side of the nostriMn the head low position (Parkinson), using %% ephedrine
in normal salt solution once a day for three days. If there is no relief by the third day
or if it becomes worse with this treatment an x-ray, P.A. position is taken and the
treatment is then directed toward the involved sinuses. Again I put off the use of
penicillin or similar drugs until the results of the treatment are noted. Depending on
the financial status of the patient a culture may be taken at the time of the first visit,
then the proper antibiotic prescribed later if necessary. However, after three days, if
the sinus involvement is not relieved and the patient gives no history of sensitivity to
antibiotics then shots of penicillin are started. At times a smear is taken first to see if
the bacteria are gram positive or gram negative. This, of course, helps determine which
of the antibiotics may be of value.
A patient comes in with blocked Eustachian tubes which may be from a cold* or
fi-om a change in altitude while flying. The treatment is the same. At the first visit the
tube may be inflated, but the character of the infection, if present, may make it seem
unsafe to open the tube. If there is little or no infection then inflation of the Eustachian
tubes followed by massage of the drum is done. Then the patient is instructed to avoid
blowing the nose, take the neosynephrine or propadrine capsules as already described, take
a mild saline cathartic every morning before breakfast for dehydration purposes and
to get extra rest. He will report by phone in three or four days and if there is no
improvement he returns to the office for another inflation and a further check on the
adjacent sinuses which may be keeping up the congestion.
Another patient comes in with a marked vasomotor rhinitis with a chronically
congested nose. I am giving a complete lecture on that subject so will no more than
mention that it represents one of our most common complaints in Southern California
and certainly one of the most challenging conditions to treat. I would like to make one
statement, that the patient as a rule is one who does lots of nose blowing and uses a lot
of vasoconstrictors.
We are troubled with dry mucous membrane in our locality and the patient coming
in with a dry crusty nose is a difficult one to handle. In looking in the nose we see
dry exudate with minute bleeding points, each of which represents a break in the
continuity of the epithelium with granulations trying to heal the injury. The nose
may be open, with good breathing space at the moment, but later with nature's effort
to shut off the dry air, one side will swell shut for one-half hour or longer and no air
can pass through. There is then the tendency to blow hard with the resulting further
injury to the membrane as the scab is torn loose. The treatment is done entirely at
home and an outline is presented to the patient. Three times a day for a fifteen to
thirty rninute period he is instructed to put a light plug of cotton in one nostril and
at the end of such time, the cotton is removed. During this period the mucous membrane is recoated with mucus and dry spots are given a chance to heal. At no time
is the patient permitted to blow the nose. Twice a day, usually morning and evening,
he uses steam compresses over the face for two purposes, to add a little moisture and
to stimulate circulation. There may be a low grade infection on the septum which
keeps up the crusting and bleeding, so it may be necessary to use a mild antiseptic. I
very often prescribe some 2% aqueous mercurochrome on a light plug of cotton, and,
in order to make good contact with the septum the patient presses on the side of the
nostril. The cotton is removed at once and the mercurochrome has had a chance to
have its effects, one, a mild antiseptic and two, it has a mild protein precipitation
Page   349 effect and tends to 'toughen' the tissues. If there appears to be considerable scar tissue
from recurrent small ulcerated points, then iodine by mouth, usually in the form of
Lugol's solution, is used for a number of weeks. It improves circulation and stimulates
thin lubricating secretions.
A patient comes in with a so called scratchy throat. Examination shows the lateral
walls of the pharynx to have streaks of red and there is a lot of postnasal discharge.
The usual history is that the patient was fatigued when this condition came on. To
give immediate relief from symptoms I paint a streak on either side of the pharynx,
using carbofung, which is a combination of fuchsin, acqueous phenol, boric acid, acetone
and resorcinol. It is sometimes known as Castellani's solution. It anesthetizes almost
instantly and the patient tells me I have 'hit the spot' and the throat feels better almost
at once. I explain that this is not a cure but merely a booster. He is instructed how to
irrigate the throat and advised to get extra rest. For discomfort he can take one or two
aspirin tablets. Again I give no antibiotic. Very often in the office I will spray some
Besredka bacterial filtrate in the throat to stimulate local antibody reaction. This seems
to work very well in a number of cases. We used to be able to buy the Besredka filtrate
before the war but it has not been made since then, so we have it made at the hospital,
obtaining cultures from a number of patients, growing the culture for several weeks
until the bacteria tend to die out. The broth is then run through a Berkefeld filter and
the filtrate used on the patient.
Acute tonsillitis as a rule does not come into the office but is seen as a sick patient
in the home, usually by the general practitioner or pediatrician. Besides the use of
antibiotics, local treatment can give much comfort. If the patient is an adult, a dehydrating hot gargle of almost saturated magnesium sulphate will give much comfort.
A tablespoonful of the magnesium sulphate to one-half glass hot water is used as a
gargle aid. At first the patient will not like it but after one or two times will notice
that the throat has a clean astringent feeling. Hot throat irrigations are also used, using
hot water without salt or soda and followed by about one-half can of cold water this is
of much value in improving the circulation and washing away the exudate. Either hot or
cold compresses to the throat may help. The patient is instructed to try first one and
then the other and use the one which gives the greater relief. A small turkish towel
is wrung out of hot water and placed on the neck. This is covered with a piece of
plastic cloth, (which most people have in their home in the form of a kitchen apron
or something similar) then a dry cloth placed over this and the compress left on for ten
minutes. The cold compress can be used in the same way and the plastic cloth will
protect the clothing from moisture as well as hold in the heat or cold. mm
Stomatitis, whether it be from a drug reaction or non-specific, may last long
enough so that the patient's general health is impaired. Improper nutrition along with
the misery of a very sore mouth contribute to the general poor condition of the patient.
In some of the most severe cases the use of insulin, {7l/z units Lilleton) before meals
will improve the general metabolism and resistance to the point where the stomatitis
will rapidly recede.  The patient is, of course, instructed as to the proper intake of food.
For recurrent stomatitis, especially with ulcers, Dr. Jud Scholtz, one of our excellent dermatologists, has instructed me to give the following treatment. First, a regular
multiple-pressure vaccination. Second, one week later, or depending on the intensity
and duration of initial reaction, give increasing doses of vaccine solution, at 7 tol0-day
intervals. Draw the contents of a single capillary tube of vaccinia virus into 0.5 cc
of normal saline in a tuberculin syringe, and give in the following manner:
0.5 cc.
This is entirely an arbitrary schedule.
Injections are given intradermaily and subcutaneously for the larger
Page   350 I stay away from strong antiseptics, cauterizing agents and mouth washes. To
promote eating, the patient uses a %% Pontocaine spray on the sensitive areas.
Postnasal drip and clearing of the throat is another of the most common complaints
and one of the most difficult to treat. Allergy must always be suspect.ed and a smear
to check for eosinophiles is usually done. We use French Hansel's stain and if it is
proven to be allergy, then antihistamines are tried first. Later, if necessary, the usual
skin tests and desensitization are done. If the smear shows mostly polys, then the postnasal drip is treated as an infection. If the patient has bad nose habits such as blowing
and the use of vasoconstrictors, these are stopped. Usually I prescribe bacterial filtrate
twice a week for two weeks to help stimulate resistance to the low grade infection.
Throat irrigations are of much value as described before. To stimulate thin lubricating
secretions I prescribe iodine or ammonium chloride depending on the appearance of the
mucous membrane. It is important to avoid fatigue and over smoking and drinking. As
a final bit of advice I encourage the patient to stop clearing the throat, literally to talk
through the 'frog' in the throat and avoid the excessive clearing of the throat. He will
report by telephone about once a week.
The pediatrician calls up about a problem child he is sending in. A little girl of
six arrives in the office presenting herself as 2. rather thin, slightly under nourished and
unhappy appearing youngster. The mother gives the appearance of being at the end
of her rope and she tells the following story. Most of the winter has been spent at home
rather than in school because of recurrent colds and persistent low grade fever. There
is little or no appetite yet she has been filled up on vitamins and iron tonics. There is
rarely a happy moment in her life. The tonsils and adenoids are still present and an
x-ray of the sinuses shows a little congestion in the maxillary. X-ray treatments have
been given with no benefit. Examination shows a moderately congested nose, slightly
enlarged tonsils, moderately granular red pharynx and slightly enlarged cervical lymph
nodes throughout. The pediatrician and the mother wanted to know if the child should
have a tonsillectomy and if it is going to cure the child. I explain that in my opinion
the removal of tonsils and adenoids is not going to cure her of all the complaints but
it may be necessary to have it done later. In the meantime I want her to follow the
so-called 'rest regime' at home. I then dictate an outline of this to my nurse and
present the mother with a typewritten card telling of the home routine. Every evening
for one week or longer the child is to go to bed one hour before supper. If the feet are
cold, a heating pad or hot water bottle is placed at the feet. She may sit up in bed
and do interesting things but be sure and have a good light for the activities. Supper
is served in bed. Radio is permissible but I have found that television is not good
during this rest period. Lights are turned out at the regular bed time. It requires one
week of this regime to be rehabilitated and back to a normal feeling of being rested.
In the future whenever the first signs of fatigue are noted, the week of extra rest is to
be repeated. The signs of fatigue are irritability, loss of appetite, loss of sparkle in the
eyes and often a slightly congested running nose. If this regime is followed out the
inevitable so-called cold that will come on after a period of fatigue usually can be
These examples are given to let you know of one method of carrying on an office
practice. The general philosophy is to try on the first visit to establish a diagnosis and
outline treatment that will work toward a cure without repeated visits to the office. The
patient reports by phone instead of coming to the office to report. By doing this the
office is not cluttered up with a lot of useless visits and there is more time for new
patients with perhaps more interesting problems. I find, in the long run, the patients like
it much better and it is certainly a much more interesting way to practice oto-rhino-
The chronically congested nose is one of the most common complaints in ear, nose
and throat office practice and it is one of the most unsatisfactory conditions to treat.
This type of patient can either be a permanent visitor in the office or can be directed
as to home treatment and only occasionally have to come to the office. When relief is
given, seldom is there a more grateful patient.
There are many things that can be done for relief of the chronically congested
nose and it is some of these that are to be presented. One of the most important services
that can be rendered to a patient is to teach him how to take care of his nose so that
normal or nearly normal physiology is present. It is often the ill-advised patient who
develops a chronically congested nose. The normal nose should be one that serves its
purpose without producing symptoms.
First, let us discuss what a normal nose is like. Rarely does the normal nose require
blowing. At certain times of the day there is an excess of lubricating secretion and it
normally is directed posteriorly where it may cause postnasal drip. If one side of the
nose becomes a little too dry the inferior turbinate will enlarge in an effort to narrow
the space and prevent further drying as well as to increase the secretion and lubrication
of the cilia. These two normal conditions should be explained to the patient so that he
will not treat them as symptoms of disease.
The causes of a congested nose are many. In the adult one of the most common
is from excessive nose blowing and excessive use of vasoconstrictors. The patient comes
in with the statement that for the past three months his nose has been congested. He
had had to blow the nose a great deal and the only way he can get relief is to use
vasoconstrictors. There is also a great deal of postnasal discharge. It originally followed
a cold which seemed to hang on. The doctor gave him a vasoconstrictor and told him
to return if the cold did not improve. Instead of returning he had the prescription
refilled several times. He was never really sick and finally his wife could stand it no
longer so made him come in to the office. He reports that the discharge is almost always
clear, although at times there is some purulent or bloody material in the rather tenacious
mucus. After shrinking the nose, the findings are quite negative. Transillumination of
the sinuses is clear. The conclusion is that the correcting of the physiology will probably
cure the patient. He is then taught what I like to call 'nasal hygiene' and told to
report by phone at the end of four to five days. The advice given is no blowing of the
nose, no nasal medication, propadrine or neo-synephrin capsules if the nose is too congested and if the nose is too uncomfortable at bed time, he is to take two aspirin tablets.
If one side persists in being congested a light plug of cotton is put in the nostril and is
left in for 15-20 minutes, two or three times a day, to prevent drying from the inspired
air. Some patients receive considerable relief from hot compresses over the entire face,
and the technique is described. Care is taken not to contact the tip of the nose with the
hot compress or blistering will occur.
At this point it is well to discuss a similar condition in children. The treatment
varies somewhat in that fatigue often is the basis for continuation of the congested nose,
following a cold weeks or months before. I explain to the mother that if fatigue is
allowed to continue, a cold will usually develop. To get rid of fatigue a typewritten
paper with instructions is given the mother. If the child is old enough, I like to describe
to the child exactly what he is to do, and let the child know that mother is often so
busy with the household affairs that she is apt to forget. The first signs of fatigue are
loss of appetite, poor disposition, loss of sparkle in the eyes along with the nose symptoms. The rest regime is outlined as follows: At the first signs of fatigue the child is
to go to bed one hour before supper and have supper served in bed. If the feet are
cold, heat is placed at them. If there is restlessness, an aspirin tablet will relax. Amusement is furnished the younger children and older children are encouraged to do their
studying in bed. Experience has proven that television does not relax, while radio seems
Page   352 to do no harm. This regime has been worked out by the chest clinics over the United
States and has been used for the past twenty-five years. They have found nothing that
is its equal in building up resistance and getting rid of fatigue.
Inherited vasomotor rhinitis is treated as described above, but good results are not
as easily obtained. Often there are emotional factors which keep up the congested nose.
It is then necessary to go into the background of the individual and it often requires
careful detective work to determine what the basic condition is. It may be an inadequate
personality, unpleasant home surroundings, inability to keep up in school work and
many other conditions that tend to upset the emotional balance. Glandular conditions
may enter into the picture. Nasal allergy presents so many facets that a simple discussion is impossible. Our method of handling is first to eliminate local conditions such as
sinus infection, mechanical obstruction, or infected adenoid. Again the emotional
life may be of utmost importance. Fatigue is often related to the start of a severe
attack. The allergy life of the individual is studied. If it seems to be beyond our ability
to solve the allergy investigation or if the parent wishes to have an allergy specialist, we
encourage this inestigation and treatment by such a specialist. Antihistamines are of
great value in some and of no value in others. The tendency to out-grow the nasal
allergy is what both the doctor and the parents hope for.
Systemic conditions such as hypothyroidism and blood dyscrasias may be overlooked by the internist where the first manifestation may be noted in the ear, nose and
throat examination.   These should be cared for by the proper physician.
Air borne irritants are important in our area. We refer to them as smog and in
some it causes marked nasal congestion which clears when the patient goes to the mountains, desert or seashore.
The mechanical obstruction is cared for surgically. This includes deviated septum,
chronic turbinitis in which the turbinate is incapable of shrinking, or an enlarged
turbinate, especially the middle, in which there is a turbinate cell.
I would like to discuss local treatment for the chronically congested nose and I
believe these treatments can best be brought out by describing several different kinds
of patients that come into the office. A man of forty years complained of a congested
nose of about twenty years standing. He had used vasoconstrictors about six times a
day for twenty years. He had been told twenty years before that he should use a
vasoconstrictor about every four hours. He played golf every afternoon when the
weather permitted and he stated that at the end of the ninth hole he would use the
drops, then use them again at the end of the eighteenth hole. He awakened once in the
night to use the drops, then slept until morning, and used them again on arising. When
I saw him the inferior turbinates were completely blocking the airway and he had not
used the drops for three or four hours. I used a small amount of saturated cocaine on
a flexible wire applicator passing it along the floor from front to back. In a few minutes
the inferior turbinate had receded to the point that there was a good airway and no
disease could be found. X-rays were taken and found to be essentially negative. I
placed him on the nasal hygiene regime. I saw him again in four days and his nose was
clear. He then confessed to me that he had an appointment the next day with a doctor
in another city for a trans-antralethmosphenoidectomy. This, of course, was cancelled.
My final advice was that he follow the nasal hygiene regime and to stay away from ear,
nose and throat doctors unless it was a dire emergency. This case represents the typical
over-medication type of congested nose and is easily cured by stopping all medication.
A man of about forty comes into the office occasionally because of chronically
congested nose, apparently based purely on vasomotor rhinitis. There is a very marked
emotional factor which he feels is the cause in that the nose congests only when his
business causes him to be under considerable strain and stress. After trying a number
of things unsuccessfully we finally decided to use the electric needle. I have found the
Hyfrecator with an insulated needle to work very well. I have used it on him occasionally for the past two years and do not find any ill effect.   Prior to the electric needle
Page   353 I tried painting a strip of pure phenol from front to back and even a weak zinc ionization of the inferior- turbinates.
Stasis of the secretions is illustrated in the case of a college girl who, for about a
year, had had a very congested nose. There was thick mucopus lying in the floor of the
nose and the inferior turbinates were swollen. Aspiration brought out congealed pus,
apparently having been there for a long period of time. After several such aspirations
the cilia began functioning again and normal secretions formed resulting in a normal
In summary, the chronically congested nose can result from bad nose habits, the
over use of vasoconstrictors, emotional states, mechanical conditions in the nose, airborne
irritants and systemic conditions. Usually the nasal symptoms can be eliminated by
instructing the patient as to proper nasal hygiene.
Dr. Dick Beck has returned to become a teaching fellow at the Vancouver General
Hospital after a year at the Royal Victoria Hospital.
Dr. E. A. Boxall has opened a practice in internal medicine in Vancouver.
Dr. Gerry Smith of Vancouver has begun a year in surgery at Shaughnessy Hospital.
Drs. V. O. Hertzman and A. K. Maihisen of Vancouver have returned from the
American Internists Conference in Cleveland.
Dr. C. A. Cawker has opened a practise in New Westminster in referred urology.
Dr. Vaughan Ewart of Vancouver is now studying in New Rochelle, N.Y.
Dr. T. C. Johnston has opened a practice in Hastings East, Vancouver.
Dr. R. R. Laird of Tranquille has retired.
Dr. B. D. Prosterman of Vancouver is continuing her surgical studies in New Yorl$.
Dr. W. L. Valens has opened a practice in Victoria, B.C.
Dr. K. D. Varnum has opened an office in Vancouver.
Dr. M. Turko is now practising in obstetrics in Vancouver.
Dr. f. M. Coles is now practising general practice on Lulu Island.
Dr. A. D. McDougall is now practising at Williams Lake.
Dr. Carl Simpson has entered general practice in Vancouver-Cambie District.
Dr. P. Yates is now practising on Vancouver Island.
Dr. Mel Shaw of Vancouver is now resident in cardiology at the Vancouver General
Dr.   Frank  Hebb  is  now   full   time   physician   for   University   Health   Services,
University of British Columbia.
October,   1951   —  September,   1952
President [	
Honorary Secretary-Treasurer.
 Dr. H. A. L. Mooney, Courtenay, B.C.
 Dr. J. A. Ganshorn, Vancouver, B.C.
 Dr. R. G. Large, Prince Rupert, B.C.
 I Dr. W. R. Brewster, New Westminster, B.C.
Chairman, General Assembly Dr. F. A. Turnbull, Vancouver, B.C.
Constitution and By-Laws	
Medical Economics.
Medical Education-
.Dr. R. A. Stanley, Vancouver, B.C.
Dr. W. R. Brewster, New Westminster, B.C.
.Dr. J. C. Thomas, Vancouver, B.C.
.Dr. R. A. Palmer, Vancouver, B.C.
.Dr. G. O. Matthews, Vancouver, B.C.
.Dr. H. A. L. Mooney, Courtenay, B.C.
Programme and Arrangements l_Dr. R. C. Newby, Victoria, B.C.
Public Health Dr. G. F. Kincade, Vancouver, B.C.
Arthritis and Rheumatism ! Dr. A. W. Bagnall, Vancouver, B.C.
Cancer Dr. A. M. Evans, Vancouver, B.C.
Civil Defence: Dr. L. H. A. R. Huggard, Vancouver, B.C;
Emergent Epidemics Dr. G. F. Amyot, Victoria, B.C.
Hospital Service ^ Dr. J.  C. Moscovich, Vancouver, B.C.
Industrial Medicine Dr. E. W. Boak, Victoria, B.C.
Maternal Welfare ! Dr. A. M. Agnew, Vancouver, B.C.
Membership j Dr. L. H. Leeson, Vancouver, B.C.
Pharmacy Dr. D. M. Whitelaw, Vancouver, B.C.
Many will have read the issue of MacLean's dated June 15th, 1952, concerning
the high cost of medical care. If any have not seen this issue, they should get it and
study it, for it clearly portrays 'The Doctors Dilemma' of the present era.
Whether we agree with it or not, or whether we think it presents us in a fair light
or not, are questions of minor importance at the moment, and nothing is to be gained by
brushing it aside as a matter of little consequence.  On the contrary, we must recognize:
1. That the problems raised are of such magnitude that our leading national magazine saw fit to delegate one of its top men to make a five month unbiased study of the
situation and to devote most of one issue to report the results.
2. That this is what a large section of the Canadian people rightly or wrongly,
think of us.
3. That this summary of our profession went completely unanswered. Since it was
a national publication it should have been answered at a national level. Possibly there
is no answer, but it would seem that a prompt, thoughtful and unpredjudiced reply
could at least have improved the impression left by the aforementioned study. Our
silence can only be interpreted as acquiescence or indifference or both.
Page   355 4. That we must recognize the obvious fact that a large section of our citizens
want sickness and old age security and they want hospitalization and medical care,
etc., etct, but they would like someone else to pay for it, and they are willing to
sacrifice a large portion of their freedom and independence to have it so.
Pensions For M.P.'s
It is interesting to note that our federal members of parliament who now receive
a yearly indemnity of $6,000 of which $2,000 is free of income tax, have arranged a
pension for themselves. Anyone who is elected three time may apply. By the simple
process of paying 6% of the above remuneration (income tax free) which the govern-
,'jment will match from the copious purse of a grateful public, they can have $58 a week
for life, at an age as young as 35. This bill was so popular in the House of Commons,
^jjthat it passed almost unanimously, which shows that the economic theories of the
various parties are very similar after all. What seems so paradoxical is that the same
philanthropic government flatly refused to allow the medical profession in Canada to
lay aside any portion of its revenue (although unmatched from public coffers) for
the purpose of retirement, unless it first paid every cent of its income tax on such
monies.  Maybe we are public enemy No. 1?
Are You Doing Your Share?
I    COULD   (rO    A
UJirHOUT      TN IS /
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
In order to assist in the diagnosis of cancer and to make recommendations regarding
the treatment of patients referred by the physicians in the area, the British Columbia
Cancer Foundation has established Consultative Cancer Clinics throughout the province.
The clinics are conducted by radiotherapists from the staff of the British Columbia
Cancer Institute, Vancouver, who visit the various areas at intervals, the frequency of
visits depending upon the volume of work and demand of the local physicians. The
private physician is asked to attend the clinic, and detailed reports are, of: course,
returned to him. Clinics are held in the following cities: Penticton, Kelowna, Vernon,
Kamloops, Nelson, Trail, Cranbrook, Prince George and Prince Rupert.
Close co-operation is maintained with the director of the local health unit, from
further information may be obtained. Expenses of these clinics are met through funds
provided by Federal and Provincial grants.
On May 14, 1952, the Pearson Tuberculosis Hospital containing 264 beds was
opened in Vancouver. This new hospital provides complete treatment facilities for
tuberculosis. Future plans call for a duplication of the present beds making an overall
total of 528 beds.
Two health unit directors who have completed the course for their D.P.H. are
returning to their former positions in June. Dr. A. A. Larsen returns to Mission as
Director of the North Fraser Valley Health Unit, and Dr. H. M. Brown is returning
to Prince George as Director of the Cariboo Health Unit.
Dr. H. T. Lowe, who has filled Dr. Brown's position during his absence, is joining
the staff of the Tranquille Sanatorium for three months before proceeding to Toronto
in September to take his Diploma in Public Health.
The Provincial Mental Health Services recently brought Dr. MacDonald Critchley,
Dean of the Institute of Neurology, National Hospital for Nervous Diseases, Queen
Square, London, to Vancouver for a series of lectures and conferences with the medical
staff of the Mental Health Services. While in B.C., Dr. Critchley also addressed the
summer school of the Vancouver Medical Association.
Dr. A. M. Gee attended the annual meeting of the American Psychiatric Association in Atlantic City in May and while there, participated in a round table discussion
on the Psychiatrist as a Mental Hospital Administrator.
Dr. F. E. McNair attended the annual meeting of the Canadian Medical Association
at Banff and read a paper on "Psychosis Occurring Post Partum".
Although large scale studies have been set up to investigate the place of isonicotinic
acid hydrazide in the treatment of tuberculosis, discussions of this problem at the
annual meeting of the National Tuberculosis Association and the Canadian Tuberculosis i
Association indicated that it will be some time yet before it can be determined how it
should be used and how it compares in effectiveness with other antibacterial agents now
in use.
However, preliminary investigations have shown that the early reports from the
lay press were unduly optimistic. Although it appears that isonicotinic acid hydrazide
will prove very useful in the treatment of tuberculosis, there is, as yet, no indication
that it is superior to the established treatment by combined streptomycin and para-
amino salicylic acid therapy and therefore should not be used unless treatment by this i
method has failed. Isonicotinic acid hydrazide has not been proven to be bacteriocidal,
but it has been shown that as a result of its use resistant strains of the tubercle bacillus
develop in a relatively short time and in a higher proportion of patients than in the
case of streptomycin when it was used alone before the advent of the combined I
It was urged by the Council on Chemotherapy of the National Tuberculosis Association that the use of isonicotinic acid hydrazide by continued on an investigational basis
until its true value is determined and until some method is developed to control the
emergence of resistant strains. It is anticipated that this can be controlled as in the case
of streptomycin by using isonicotinic acid hydrazide in combination with other substances.
The continuous course of streptomycin in combination with PAS for six to twelve
months or longer is still the treatment of choice in active tuberculosis. The streptomycin
is given in doses of one gram intramuscularly twice a week and the PAS twelve grams
daily. To prevent the emergence of resistant strains PAS should always be used in
combination with streptomycin and if PAS is not tolerated, serious consideration should
be given to the discontinuance of the streptomycin therapy.
It is interesting to note that since 1948, under the Professional Training Grant
of the Federal Health Grant, some 60 physicians have completed post graduate
training; 21 of these physicians have had at least a full academic year of training and
29 have partaken in short term post graduate education. The fields covered in these
courses have been Psychiatry, Tuberculosis, Public Health, Venereal Diseases, Cancer,
Industrial Hygiene, Rehabilitation Services and Hospital Administration. In each
instance the physician to whom assistance has been granted has agreed to remain in the
employ of the sponsoring agency for a certain period of time dependent on the length
of post graduate training.
Dr. A. J. Nelson, Director, Division of V.D. Control, read a paper entitled "Some
Important Considerations in the Public Health Control of Gonorrhoea" at the recent
annual meeting of the Canadian Public Health Association held in Winnipeg.
Attending the annual meeting of the Canadian Tuberculosis Association in Regina
were Dr. Elliott Harrison, Consultant in Chest Surgery, Division of T.B. Control, and
Dr. K. Severin Alstad, Medical Director, Victoria Unit, Division of T.B. Control, who
presented papers entitled "Experience in Pulmonary Resection for Tuberculosis" and
**A Follow-up Study of Preventorium Care". Dr. Gordon Kincade, Dr. F. O. R.
Garner, and Dr. W. H. Hatfield also attended the proceedings of this annual meeting.
Page  358


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