History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: May, 1947 Vancouver Medical Association May 31, 1947

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 B If L A| Wl-p
of the $;.» H'
MEI^CAlJ
ASSOCIATION
With Which l§ Incorporated
Transactions of the
^ICTORIA MEDICAL SOCIETY^
WANCOUVER GENERAL HOSPITAL
and
ST. PAUL'S HOSPITAL
In JThis Issue:
ANNUAL REPORT OF V.M.A .. §BB||M
OSLER LECTURE-^—Medicine and Some Orthodoxies
By Bede J. Harrison, M;-9^^L BbHHB
By Roy ftuggartl, M.D.-^_     j| 1
NEWS AND NOTES™---iS_ :fe     Sllll
197
211
214
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VOL. XXIII. NO. 8
MAY. 1947 ;
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Supplied in 4 oz. arid 1 lb. jars.
Also available:
Scabiol liquid in pounds,
Winchesters and gallons.
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TH#|5p[j^^H0TfiEW0RTH|CHEMICAL  PsTOjTORONTO. THE    VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
De. J. H. MacDebmot
De. G. A. Davidson De. D. B. H. Cleveland
All communications to be addressed to the Editor at the above address.
VOL. XXJTT
MAY, 1947
No. 8
Dr. G. A. Davidson
President
OFFICERS, 1947-48
Dr. Gobdon C. Johnston
Vice-President
De. H. A. DesBrisay
Past President
Dr. Gordon Burke
Hon. Treasurer
Dr. W. J. Dorrance
Hon. Secretary
Additional Members of Executive'. Dr. Roy Htjggard, Dr. Henry Scott
TRUSTEES
Db. A. M. Agnew Dr. G. H. Clement Dr. A. C. Frost
Auditors: Messrs. Plommee, Whiting & Co.
SECTIONS
Clinical Section
Dr. Reg. Wilson Chairman Dr. E. B. Towbridge Secretary
Eye, Ear, Nose and Throat Section
Dr. Gordon Large Chairman Dr. G. H. Francis.- Secretary
Paediatric Section
Dr. J. H. B. Grant Chairman Dr. E. S. James Secretary
Orthopaedic and Traumatic Surgery Section
Dr. J. R. Naden Chairman Dr. Clarence Ryan Secretary
Neurology and Psychiatry
Dr. J. C. Thomas Chairman Db. A. E. Davidson Secretary
STANDING COMMITTEES
Library:
Db. J. E. Walkeb, Chairman; Db. W. J. Doebance, Db. D. E. H. Cleveland,
Db. F. S Hobbs, Db. R .P. Kinman, Db. S. E. C. Tubvey.
Publications:
Db. J. H. MacDebmot—Chairman; Db. D. E. H. Cleveland, Db. H. A.
DesBbisay, Db. J. H. B. Gbant, Db. D. A. Steele.
V. O. N. Advisory Board:
Db. Isabel Day, Dr. H. H. Caple, Dr. E. J. Ctjbtis.
Sumtner School:
Db. L. H. Leeson, Chairman; Db. E. A. Campbell, Db. J. A. Ganshobn,
Db. D. S. Munbo, Db. D. A. Steele, Db. L. G. Wood.
Credentials:
De. H. A. DesBbisay, Db. H. H. Pitts, Db. Fbank Tubnbull.
Representative to B. C. Medical Association : Db. H. A. DesBbisay.
Sickness and Benevolent Fund: The Pbesidfnt—The Tbustees.
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For Literature write
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Biological and Pharmaceutical Chemists
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Toronto                                                                                                     Orangeville
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Canada VANCOUVER HEALTH DEPARTMENT
STATISTICS—MARCH, 1947
m
Total populatoin estimated _ 339,350
Chinese population estimated       5,980
Hindu population—estimated   .  118
Rate per 1,000
Number Population
Total deaths     331 11.5
Chinese deaths ^       16 31.5
Deaths, residents only 305 10.6
BIRTH REGISTRATIONS:
Male 428
Female  ■ 398
826 28.7
INFANT MORTALITY: March, 1947 March, 1946
Deaths under  1  year of age 34 22
Death rate per 1,000 live births 41.2 34.0
Stillbirths (not included above) —      11 5
CASES OF COMMUNICABLE DISEASE REPORTED IN THE CITY
Scarlet Fever '	
Diphtheria  2
Diphtheria Carrier  0
Chicken Pox  119
Measles     710
Rubella  12
Mumps  401
Whooping Cough  8
Typhoid Fever  ,  0
Typhoid Fever Carrier  0
Undulant Fever  0
Poliomyelitis      0
Tuberculosis  42
Erysipelas     4
Meningococcus   (Meningitis)  2
Infectious Jaundice  1
Salmonellosis  0
Salmonellosis   (Carrier)  0
Dysentery  0
Dysnetery   (Carriers)  0
Tetanus  0
February, 1947
Cases      Deaths
15 1
Syphillis   	
Gonorrhoea 	
Cancer (Reportable)—Resident
Non-resident   	
March, 1947
Cases      Deaths
April,1947
Cases        Deaths
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Page One Hundred and Eigbty-two I
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Disposable Plastic Syringe
CRYSTALLINE PENICILLIN IN OIL AND WAX
(ROMANSKY FORMULA)
A FURTHER ADVANCE
The use of crystalline penicillin in
the Romansky formula of penicillin in
peanut oil and beeswax permits the
Laboratories to make available to the
medical profession an improved
product with distinct advantages.
Ease of Administration— The improved product flows more freely
through a hypodermic needle.
Minimum   of   Local   Reaction—
Because of the high purity of the
crystalline penicillin in the mixture, local reactions are reduced
to a minimum.
HOW SUPPLIED
DISPOSABLE PLASTIC SYRINGE PACKAGE
Included in this package is a sterile B-D*
Disposable Cartridge Syringe* ready for immediate use with a special cartridge containing
300,000 International Units of crystalline penicillin in 1 cc. of peanut oil and beeswax. The
plastic syringe is discarded after use.
METAL CARTRIDGE SYRINGE PACKAGE
This package includes a B-D* Metal Cartridge Syringe, two sterile 20-gauge needles,
and a cartridge containing 300,000 International Units of crystalline penicillin in 1 cc
of peanut oil and beeswax. The metal syringe
is designed for repeated use with readily
changeable needles and cartridges.
REPLACEMENT CARTRIDGE PACKAGE
Replacement cartridges containing 300,000
International Units of crystalline penicillin in
1 cc. of peanut oil and beeswax are obtainable
separately from the Laboratories. These cartridges are supplied for use with the metal
cartridge syringe.
Metal Cartridge Syringe *T. M. Reg. Becton, Dickinson & Co.
CONNAUGHT MEDICAL RESEARCH LABORATORIES
University of Toronto Toronto 4, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C.	
m *7^e &a\Uv& Paae
The Annual Reports contained in this issue show the Vancouver Medical Association
to be in a very healthy condition, materially at least, and we think in other ways as
well.   There has been one important readjustment during the past year, from a financial
point of view the transfer of the funds of the Society, which had been earmarked
for Benevolent Fund purposes, to the B. C. Medical Association, which has inaugurated
a similar benevolent fund, which will be used on a provincial scale, as set forth in the
last issue of the Bulletin.   This is, of course, a step forward in the right direction.
The address given at the Annual Meeting, by Mr. A. E. (Dal) Grauer, President
of the B. C. Electric Railway Co., has been secured, and will be published in a future
issue. We feel that the habit of inviting guest speakers, from other professions and walks
of life, to address us at our Annual Meetings, is an excellent one, and we hope it will
continue. It is very good for us, and gives us an opportunity to hear points of view
somewhat different from our own. The way things look to us, depends a great deal,
as Einstein and other great thinkers have told us, on the frame of reference which
we occupy, and other observers in other frames see things sometimes quite differently
from ourselves. That is why it is rather a good thing for a medcial man to occupy
a hospital bed himself occasionally; it gives him the chance of seeing things from another frame of reference.   It has very little else to recommend it, we must admit.
The Summer School has come and gone again, and we have no hesitation in saying
that it has been one of the best that has been held. We hope to be able to publish
many of the papers that were read. A considrable advance was made, we think, in
the use of the new method of recording on steel tape. It has always been a problem
to get the addresses in detail, except when the speaker was kind enough to give us his
paper—but many of the addresses are given from notes, and we lose these, unless we are
fortunate enough to have a very expert medical stenographer, and these are very rare.
In the old days, when we were able to secure the services of Mrs. Ellis, who was an
exceptionally able executant, we managed very well—but of late it has been impossible
for her to give the time.
We owe a great debt of gratitude to the Committee in charge of the Summer
School. They had a rather difficult job this year to secure speakers, and they did an
outstanding piece of work.
There was one item in the Annual Reports that would probably pass unnoticed by
a great many of our members, who "knew not Joseph", and yet ,as we think, should
receive very serious attention in the near future. That is the John M. Pearson Fund.
There are not many men now practising in Vancouver, who knew John Pearson, and
so, when the question arose, of allocating part of the Benevolent Fund monies, to make
this fund more adequate for its purpose, it is very natural that only a few men were
willing to support the suggestion. Personally, we think that no better use could have
been made of the money, and since we were winding up a Fund, and receiving back
our own money, we cannot see why this could not have been done. However, this is a
contentious point, and has nothing to do with the main argument.
Pearson was one of the outstanding personalities that have appeared in our Vancouver medical profession. He practically made the Vancouver Medical Association out
of thin air. In and out of season he laboured with his fellows, a mere handful of men,
like Father CFlynn of the song—"coaxing onaisy ones, helping the lazy ones on wid
a stick", till he got his way. He started our Library, one of the best medical libraries
in Canada—he worked and worked and worked at it, till he made it what it is today,
and nobody who knows the facts, fails to realize that our Library is a monument to
Pearson, more than to any other man.    He was the first Editor of the Bulletin, and
Page One Hundred and Eighty-three
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again, he impressed his personahty on it so strongly, that it has altered merely in size,
since he left it.
Pearson had a rare integrity and singleness of purpose. He was a man of vision, at a
time when there was very little vision. He was one of the few men who could foresee,
and who, when there was nothing apparently to work with, when he had little or no
support from others, could still hold the vision before him, and work selflessly and
unswervingly towards its realization. We owe a great debt to John M. Pearson. The
Fund which bears his name is a small tribute to his memory, and at present it is a sterile
one, and missing its purpose altogether. The only terms on which he himself would
have been willing to accept such a tribute, would have been that it should be operating to
fulfil its purpose. We hope that at a very early date, our Executive will see their way
to working out a plan whereby this Fund may be made operative along the lines on
which it was laid down.
Finally, a word of congratulation to our new Executive members as they assume
their offices. Especially to our new President, Dr. George M. Davidson. No better man
could have been chosen. He has served his apprenticeship long and faithfully, and we
are fortunate to have him to lead us. We on the Publications Committee mourn that
his new office removes him from our counsels, except ex officio—but we have an excellent new member, Dr. H. A. DesBrisay, whom we welcome heartily.
LIBRARY NOTES
ji ANNOUNCEMENT OF SUMMER HOURS
Evening hours have been discontinued from June 15 th to September 15th, inclusive.
During this period the daily hours will be:
Monday to Friday 9:00 a.m. to 5:00 p.m.
Saturday—9:00 a.m. to 1:00 p.m.
RECENT ACCESSIONS TO LIBRARY:
Medical Clinics of North America, Symposium on Diabetes, March 1947 Number.
The Pathogenesis of Tuberculosis, 1946, by Arnold R. Rich.
Surgical Clinics of North America, Symposium on Gastro-Intestinal Surgery and
Pediatric Surgery, April, 1947.
Banting's Miracle, 1947, by Harris Seale (Gift of Dr. J. C. Thomas).
Clinical Biochemstiry, 1946, by Abraham Cartarow and Mas Trumper.
Parenteral Alimentation in Surgery, 1947, by Robert Elman.
The Physiology of the Newborn, 1946, by Clement A. Smith.
(Gift of Dr. Smith).
Medical Clinics of North America, Symposium on Pediatrics, May, 1947.
Harvey Cushing, A Biography, 1946, by John F. Fulton.
SPECIAL BOOKS ACQUIRED:
Report of the Royal Commission under Order in Council P. C. 411, of February 5,
1946.  (Espionage Trials).
The Anatomy of Peace, 1946, by Emery Reves.
Hiroshima, 1946, by John Hersey.
FREE MESSENGER SERVICE
The new messenger service to members of the Vancouver Medical Association whose
offices are outside the Medical Dental Building, is now in operation.
Requests for loans received up to 10:30 a.m. will be delivered the same day, providing
the books required are in the Library at that time.
Requests for loans received after 10:30 a.m. will be delivered the following day.
Page One Hundred and Eighty-four Arrangements may be made also for books on loan to be returned to the Library
by messenger, preferably on the same call on which deliveries are made.
All books sent out will be wrapped or enclosed in envelope containers. It is requested
that the same or similar coverings be used in returning books to the Library.
THE PHYSICIAN'S BUSINESS—George D. Wolf, M.D. Second Edition. Published
by J. B. Lippincott & Co.
Among the recent accessions to the Library is this rather small volume which should
be of inestimable value to the young doctor embarking for the first time upon the
practice of Medicine. It could indeed be very profitably studied even by many more
experienced colleagues.
The author presents and discusses in a clear and candid manner the non-professional
problems that beset every professional novice in Medicine—problems which most practitioners solve only after long and wasteful years, if at all. Subjects such as fees, office
space, records, equipment, overhead, income tax, insurance, industrial and forensic
medicine, group practice, workmen's compensation, prepaid medical care plans, and
socialized medicine, are covered concisely, and in an eminently "readable" manner.
This book should prove very valuable in enabling the physician, particularly at the
beginning of medical practice, to attain the basic knowledge and intelligent approach
to these often neglected subjects which their importance deserves, particularly in this
day of changing trends in medical practice and medical economics generally.
DR. THOMAS FISON SAUNDERS
Obiit
When Dr. T. F. Saunders died recently, the medical profession of Vancouver,
and especially the Vancouver Medical Association, of which he was a life
member, lost one of their best members.
Tom Saunders was a good man, a good citizen, and a good doctor. He fulfilled all his duties, as he saw them, to the maximum of his ability. He served
in both the First and Second Great Wars, with distinction. He was a loyal
friend and colleague—was an active member of the V.M.A.—and his name
appears on the list of donors to the funds of that institution, to which he gave
the sum of $500.00.
His personality was a charming one—gentle and courteous, and possessed of
a great capacity for friendship, he was beloved by all who knew him. He will
be greatly missed by all his many friends.
Page One Hundred and Eighty-five CORRESPONDENCE
WjP
MOUKDEN MEDICAL COLLEGE
Small Biver Bank,
East Suburb,
Moukden, China,
May 17th, 1947.
Dear Mr. Fish,
Another set of papers for a pathological conference came in this last week. My thanks
again to you and Dr. Pitts.
I have been pretty busy these last weeks for there is no lack of things that need attention.
I am trying to get our Library back into shape. Do you think any of the doctors who
are interested in this type of work might care to send on their Canadian Medical Journals
and/or any others. They would be very welcome here. If instead they wish to give a
donation to our Library funds, that too would be very welcome for purchases of books
and journals in America, as gold dollars are not so easy to get either here or in Europe.
I don't want to trouble you, but when the Bulletin thought that the story of the College
was of sufficient interest to print, perhaps there are some who would like to help in this
way. If any should—the money could be sent to the Rev. E. H. Johnson, Room 801/100
Adelaide St. West, Toronto 7, Canada, who would send it to the agency that is going to
send the journals.
If you feel this is too much to ask, please don't hesitate to let it drop. The idea came
into my head and I thought you might be interested. But don't burden yourself with it
for you have plenty to do.
Some of your colleagues may like to know that I gave a talk here for the local medical association, and I took for my subject the work of the V.G.H. as a fine example of a
modern hospital on the North American continent, and went into details of the administration, nursing arrangements, records, pathological conferences, ward rounds, etc.
It seemed to be appreciated by the quite large audience.
With every good wish and my kind regards to those who remember me in V.G.H.,
Yours very sincerely,
H. S. D. GARVEN.
rt
Assistant required for West Coast hospital. Excellent opportunities
under experienced surgeon. Salary $400 per month. Write c/o "The
Bulletin," Vancouver Medical Association, 203 Medical-Dental Building,
Vancouver, B. C.
Page One Hundred and Eighty-six V
ancouver
ca
President	
Vice-President	
Honorary Treasurer-
Honorary Secretary-
Editor .	
ssociation
 Dr. H. A. DesBrisay
 Dr. G. A. Davidson
 Dr. Gordon Burke
-Dr. Gordon C. Johnston
 Dr. J. H. MacDermot
REPORT OF THE HONORARY SECRETARY
1946—1947
Mr. President and Members:
During the past year ten general meetings and twelve executive meetings were held.
Of the former, two were special meetings to consider, firstly, the construction of an
Academy of Medicine Building, and the second special meeting was held to hear an
address by Dr. Wilder Penfield.
As usual the Osier dinner was held on the first Tuesday in March. An outstanding
lecture was delivered by Dr. Bede J. Harrison, and the P. G. F. Degree was conferred
upon Dr. Anson C. Frost.
The average attendance at meetings continues to rise. In 1945 the average was 57,
in 1946—73, and during the current year the average attendance was 88.
MEMBERSHIP
Membership in the Association is also increasing rapidly.   The total membership this
year.is 426, which is over 100 more than the previous figure of 303 in 1939.
It is regretted that the following members died during the year:
Dr. R. B. Boucher
Dr. Colin Graham
Dr. Wilfred Graham
Dr. R. A. Walton
Subjects of special interest dealt with during the year are:
1. The transfer of the Sickness and Benevolent Fund of the Vancouver Medical Association to the British Columbia Medical Association Benevolent Fund.
2. Negotiations for an Academy of Medicine Building.
3. Expansion of office space which has been accomplished in conjunction with the
College of Physicians and Surgeons.
4. A great increase in membership.
Respectfully submitted,
GORDON C. JOHNSTON, M.D.,
Honorary Secretary.
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REPORT OF THE HONORARY TREASURER
VANCOUVER MEDICAL ASSOCIATION
Mr. President and Members:
I beg to submit herewith the following financial report of your Association for the
year 1946-47, which has been duly audited by Plommer, Whiting & Co., Chartered Accountants, under date of March 31st, 1947: »
Page One Hundred and Eighty-Seven i • i
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RECEIPTS AND EXPENDITURES
Receipts:
Income from members' annual dues  $4,766.25
Interest on invested funds  455.72
Relief administration, management allowance   700.00
Profit on Association Bulletin  1,090.90    $7,012.87
Expenditures:
Salaries     $ 3,645.3 7
Rent          1,633.04
Total ._       5,278.41
Credit by payment from C.P. & S. and
B.C.M.A.       1,810.60
Other  expenses,   including   charges
for office alterations     $390.30
Travelling expenses        711.19
$3,467.81
2,083.45
Total expenditures apart from library maintenance       5,551.26
The Association also expended on
the library     $1,141.07
Excess of-Income over Expenditures      $1,461.61
Depreciation:
Library       $1,295.79
Furniture and Equipment .  100.81 1,396.60
._    $     65.01
Net transfer to Surplus Account ,	
GENERAL FUND BONDS AND SAVINGS ACCOUNTS
As at March 31st, 1947
Present value (Bonds at cost)      $14,342.91
Cash on hand and in bank          3,874.68
TRUST FUNDS
Historical and Ultra-Scientific—Savings  -     $      393.45
Stephen Memorial Fund—Savings  -  25.34
Sickness and Benevolent Fund—Savings  1,585.66
Benevolent Endowment Fund  700.00
Pearson Lecture Fund  . ;     $2,981.25
Pearson Lecture Fund—Savings          935.17 3,916.42
An analysis of the foregoing figures reveals that the income from members' dues
($4,766.25) was approximately the same as last year's. The income on invested funds
was $455.72, as compared with $380.68 last year—an increase in earnings of $65.00.
There was, however, no profit derived from conversion of bonds as in 1946, when about
$450.00 was realized.
On the other hand, profits on the "Bulletin" show a sharp rise, due to the increase
in advertising rates, effective as from October 1st, 1946. The profit shown at March
31st, 1947, was $1,090.90, as against $129.56 at March 31st, 1946, the total increase
being approximately $860.00.
The Summer School showed a profit of $196.50.
Expenditure on office alterations and repair of equipment, (together) with the rental
of additional office space and an over-all advance of ten per cent in rents, as well as some
Page One Hundred and Eighty-eight $700.00 in travelling expenses, used up most of the surplus for the year.    $65.00 was
transferred to the Surplus Account.
Expectations are for an increase in income during the next fiscal year, both from
membership dues, and from "Bulletin" earnings.
All of which is respectfully submitted.
GORDON BURKE, M.D.,
Honorary Secretary.
ANNUAL REPORT—BOARD OF TRUSTEES
May 6, 1947.
The President,
Vancouver Medical Association:
The Board of Trustees of the Association beg leave herewith to submit the Annual
Report.
The Treasurer's and Auditor's reports, as of March 31, 1947, have statements of the
amounts in the various funds over which the Trustees have control.
Your Trustees wish to bring to your attention the advisability of considering the
consolidation of some of the different funds, namely, The Historic and Ultra-Scientific
Fund of $2,868.61, the Stephen Memorial Fund of $125.34, the Benevolent Endowment
Fund of $700.00, and the John Mawer Pearson Lecture Fund of $3,916.42.
We respectfully draw the attention of the Association to the Sickness & Benevolent
Fund of $6,886.29. This fund has been voted to be given to the B.C. Medical Association
Benevolent Fund, but, as yet, has not been transferred to them.
The General Surplus & Sundry Funds amount to $36,009.06. The excess of income
over expenditure for the year ending March 31, 1947, was $65.01.
There are certain bonds that are above par. The Association should consider consulting their investment counsel as to the advisability of selling these bonds and reinvesting at par in other guaranteed securities.
We respectfully submit these suggestions and this report for your consideration.
A. W. HUNTER, Chairman.
LIBRARY COMMITTEE
yt|    1946—1947
BOOKS ADDED TO LIBRARY—
General Collection—   38 new books added at a cost of	
9 gifts
2 from Nicholson Fund at cost of	
Total 	
59 books added at a cost of	
NICHOLSON FUND: 3 books purchased at a cost of $12.65, leaving
a balance of $268.38.
MEDICAL JOURNALS:    74   journals subscribed to at a cost of	
43 journals received as gifts
32 journals received in exchange
266.65
620.40
OTHER EXPENSES
TOTAL—  149 journals received in Library.
81 volumes bound at a cost of .	
Dues to Med. Library Ass'n.     $16.03
Miscellaneous       44.68
TOTAL
 $1,141.07
Page One Hundred and Eighty-nine
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Although only six meetings were held during the past season, your Library Committee
was very active, and efforts to provide greater service to the members were continued.
A number of new journals have been subscribed to, as reported from time to time
in the "Bulletin." Your Committee feels that an adequate coverage of current medical
literature is one of the most important functions of the Library.
Plans are under way also to build up the various subject sections by adding new texts
and monographs where indicated. Each Clinical Section of the Association has been
approached by letter, with the suggestion that consideration of books and journals relating to its specialty be included as a regular feature of the agenda, and that any recommendations endorsed by the meeting be submitted to the Library Committee. To date
there has been little response, except from the Section of Neurology and Psychiatry. It is
hoped that the Library Committee may look forward in the future to the full cooperation
of the Sections, as it is our opinion that in this way the library resources could be developed to the satisfaction of all. It is of course understood that suggestions from individuals are always welcome, and will receive earnest consideration at the Committee
meetings.
In anticipation of new Library quarters in the proposed Academy of Medicine Building, provision was made for a survey of medical libraries in eastern Canada and the
United States by the Librarian. This was carried out during the month of September
and her report was brought in at the first of the year. It included descriptive details of
each library visited, as well as a summary of a questionnaire which had been presented
in each instance, for the purpose of obtaining opinions on certain aspects of library activities and policies, and advice on features to be considered in the planning of a new library.
Some relief from the ever-increasing shortage of shelf space was obtained when an
extra office was secured for the Committee Room, and approximately half of the former
Committee Room was converted for the use of the Library. This has been equipped as
a Reference Room, and has made possible the transfer of a fairly large number of books
from the stacks.
The practice of keeping the Library open three nights a week has been continued, except during the summer months. Use of the Library during the evening hours has shown
a gradual but steady increase, and it is felt that the Committee is justified in continuing
this plan.
An additional service for which your Committee has obtained permission recently is
for the intrduction of a free messenger service for book loans for members in Vancouver
whose offices are outside of the Medical Dental Building. It is intended that this will be
put into effect on June 1st.
We are happy to report that the memorial plaque to the late Dr. A .W. Bagnall has
been completed and is now ready to be placed in the Reading Room.
The Library Committee wishes to take this opportunity of expressing its sincere appreciation to those who have so generously donated books and journal subscriptions
throughout the past year.   Individual acknowledgements have been duly made.
The increase in the Association's membership is reflected in a substantial growth and
development of the Library, and it is the intention of your Library Committee to keep
pace with, and if possible lead the way in a corresponding expansion of the Library.
All of which is respectfully submitted.
W. J. DORRANCE, M.D.,
Chairman, Library Committee.
PUBLICATIONS COMMITTEE
The report that I have to make this year on the progress of the Bulletin of the Vancouver Medical Association is in some ways the most important one yet, as it will ask
your consideration of several questions that are now arising out of the rapid growth of
Page One Hundred and Ninety
HbcmWi the Journal, and that will require settlement at an early date.
The Bulletin has made quite considerable progress in the past year in three main
directions.
The first is as regards circulation. An idea of our growth in circulation may be had
from the fact that a year ago we were printing and circulating 1150 copies a month.
Our publisher, Mr. Macdonald, tells us that our next printing (April copy) will be
1600 copies.
This rapid growth in circulation is chiefly due, of course, to the rapid increase in
the number of medical men practising in B.C.
In addition, we send 80 copies a month to the members of Council of the Canadian
Medical Association, and have exchanges.
This growth in circulation reacts in two or three ways that are important. First,
it increases pro rata the advertising rates that we are entitled to charge. In connection
wiht this remark, I should like to call your attention that except for the Canadian Medical Association Journal, ours is the only medical journal in Canada that receives a yearly
audit from the C.C.A.B. (Canadian Circulation Audit Bureau). This assures our standing with advertisers, and we owe the fact that this is available to Mr. Macdonald—who
publishes several Journals, and makes use of this Audit Bureau's Service—giving it to the
Bulletin free of charge.
Another way in which this increased circulation helps is that it attracts the better
advertisers, and more and more the advertising columns of the Bulletin are corning to be
of a very high order.
The second direction in which the Bulletin shows marked growth is in the amount
and quality of the material we are receiving for publication.
I am sure you will agree that the level of excellence attained by the papers published
during the past year has been very high, and we are now getting to the point where we
can afford to insist that this level be maintained. Throughout the year we have had
more material than we have been able to use, and we can only crave the indulgence of
those contributors who find the publication of their papers rather slower than they had
had the right to look for. In the coming year, the Publications Board hopes to meet this
situation by means to be mentioned later.
The third direction of progress has been the financial one. Our balance sheet shows
a profit of $745.00 in the year's expenses, and there is every reason to believe that next
year will show a considerably larger profit than this.
You may remember that in a previous report I stated that we proposed to increase
our charges for advertising in accordance with our C.C.A.B. rating. This was done, and
not only did our advertisers meet the increased charge, but we acquired new ones. Our
publisher tells us there are many more whose advertising we can secure. The only question is one of room.
It is evident, therefore, Mr. President and Gentlemen, that the Bulletin is rapidly
becoming one of the major assets from a financial point of view, of the Vancouver Medical Association. But you will agree that it would be quite wrong to lay undue emphasis
on this aspect of the Bulletin. If we can make a profit, while at the same time maintaining and continually improving our editorial and literary standards, such profit will be no
doubt welcome, and can be put to very good purpose. The Publication Board feels, however, that this Association will entirely endorse its view that our really important duty
is to develop the Bulletin, as far and as fast as we may, into a first-class medical journal
which will not only reflect and record medical growth and happenings, but will be of
educational value, and provide inspiration and incentive for the doing of better and better
medical work in this Province. We must consider that the B.C. medical profession is
increasing rapidly, that the establishment of a Medical School here is only a matter of
time, and that we should be ready to make space available as and when it will be required
by such an institution; more and more highly specialized work is being done here, and a
means of recording this must be available.
Page One Hundred and Ninety-one
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We feel, too, that we have now reached the time when more opportunity must be
given to contributors to illustrate their papers by cuts, sketches, etc.
More space should be devoted to meetings, especially the regular and clinical meetings of the Association.
Lastly, the Board feels that it is a matter of immediate urgency to provide more space
for reading matter. There can be no changes in the general set-up of the Journal till the
end of the Journal's year in September. Till then, we are merely adding more pages. But
we are now, in consultation with Mr. W. E. G. Macdonald, working out plans for a
larger and better Journal.
I think that at some time in the near future, a meeting might well be arranged between the Executive of the Association and the Publications Board, that we may together lay down a policy of development and growth. The Bulletin has gone beyond the
stage of being a small medical journal, to be edited and handled in anyone's spare time.
We are definitely at a critical point in its growth and development, and I feel that we
should consider together a number of matters—management, advertising, the possibility
of subscription charges, etc.
To me, personally, the past year has been one of intense interest and satisfaction.
Nobody could possibly have keener or wiser colleagues with whom to work on the Board
—we have at last attained a definite regularity in meetings. Our relations with our publisher, Mr. W. E. G. Macdonald, have been far more than just cordial and friendly business relations. What I have said about his making available to us such a valuable service
as that of the C.C.A.B., is merely one instance of the sincere interest and devotion he has
shown to the cause of the Bulletin. He has been of untold assistance, and I take this opportunity of thanking him.
Mrs. Craig, too, our librarian, as usual does most of the actual hard work of the Editorial office, and we cannot thank her too much.
All of which is respectfully submitted.
J. H. MacDermot, M.D., Chairman.
SUMMER SCHOOL COMMITTEE
INTERIM REPORT ||p|
Mr. President and Members:
The 1947 Summer School is to be held at the Hotel Vancouver from June 2nd to 6th,
inclusive.
Satisfactory progress is reported and final plans are nearing completion. Your Committee is confident that an outstanding slate of speakers and an interesting programme will
be presented.
A complete report will be given, as usual, at the first General Meeting of the Associa-.
tion in October. ,
L. H. LEESON, M.D., Chairman.
ANNUAL REPORT OF THE HISTORICAL COMMITTEE OF
THE VANCOUVER MEDICAL ASSOCIATION
Work is continuing on the preparation of a history of the Vancouver Medical Association. We naturally feel complimented that the Editor of the Bulletin finds room
in its pages to publish this history. Criticism of any kind will be welcome, and constructive suggestions will be greatly appreciated.
G. E. KIDD, Historian.
Page One Hundred and Ninety-two REPORT OF THE RELIEF ADMINISTRATION COMMITTEE
FOR THE YEAR ENDING MARCH 31 ST
During the past twelve months there has been a marked increase in medical care
rendered by the doctors of the City of Vancouver for social assistance cases and, consequently, a decrease in the percentage paid.
In 1946 the gross amount of accounts was     $79,973.30
In 1947 the gross amount of accounts was ..       90,297.00
The amount paid to medical men in the past year —       46,093.10
In 1946 we had approximately 170 men doing this work while we had 227 in the
month of February and 221 in March of this year.
Your Committee met with representatives of the City Council recently for the purpose of obtaining an increase in the amount allowed by the City of Vancouver and the
Province of British Columbia for the payment of medical care for Social Assistance cases
and we have reason to hope that an increase will be granted.
Doctor A. O. Brown who served on the Relief Administration Committee during the
war years retired from practice in June and resigned from the Committee. Doctor Roy
Mustard, who had been a member from 1935 until he entered Active Service in the
R.C.A.M.C. in 1939, rejoined the Committee. Those serving at the present time on the
Relief Administration Committee are as follows:
Dr. D. F. Busteed, Chairman, and Drs. Roy Mustard, Gordon Burke, F. Day-Smith,
T. A. Johnston,'Neil McNeill and J. C. Grimson.
All of which is respectfully submitted.
J. C. GRIMSON, Secretary.
CLINICAL SECTION
Ine President, Officers, and Fellow Members
of the Vancouver Medical Association:
I herewith submit a report on the activities of the Clinical Section during the past
year. Seven monthly meetings were held, commencing in October, 1946, and terminating
in April, 1947. Three of these were held at the Vancouver General Hospital, three at
St. Paul's and one at Shaughnessy.
The programmes all were, I consider, of high calibre, this being exemplified by a
good attendance, and the interest shown during discussion following the presentations.
I have noticed during the past few years, that these programmes are usually presented
by staff members of the particular hospital at which the meeting takes place. I would
like to suggest that encouragement be given to members of the Vancouver Medical Association, who are not necessarily members.of a hospital staff, to take part in these clinical
meetings. Not only would this be of interest to the membership at large, but would, I
think, tend to preserve the status of being primarily a Vancouver Medical Association
meeting.
I would also suggest that attention be exercised in the formation of programmes, so
that they are truly clinical in character. There is a tendency at times, for a presentation
to be more of a paper covering the subject in general, rather than directed toward a
clinical case.
All this respectfully submitted.
E. R. HALL,
Chairman of Clinical Section.
Page One Hundred and Ninety-three
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|g PAEDIATRIC SECTION REPORT
The Paediatric Section is pleased to report a very active and successful term.
We were hosts to the North Pacific Paediatric Society last October, when they had
one of their regular meetings. Some of our own members contributed to the programme
and it proved to be a very interesting meeting.
On the regular evening meetings of our section, the third Monday of every month,
we departed from our usual custom in having a member of our group deliver a paper,
and had an outside man talk to us on topics of paediatric interest. Doctors from the
Metropolitan Health Committee, the senior dentist of the School of Dental Services and
a representative from Ottawa on Child Welfare in this way contributed to our meetings.
As usual we have been holding our clinical rounds on Friday mornings at the Paediatric
Departments of the various hospitals in the city. This has become an established practice now and the members of the staffs of the respective hospitals present the cases and
lead in the discussions.
Respectfully submitted,
W. H. S. STOCKTON, M.D.
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REPORT OF THE EYE, EAR, NOSE & THROAT SECTION
m     | VANCOUVER MEDICAL ASSOCIATION
Mr. President and Members:
During the past twelve months the Eye, Ear, Nose and Throat Section have met, with
two exceptions, each month from October, 1946, to April, 1947.
Two luncheons with round-table discussions were held also in September to meet Dr.
J. R. Lindsay, the ear, nose and throat specialist from Chicago, who was speaking at the
Summer School. The lectures and discussions of Dr. Lindsay were much appreciated by
those of the Section who heard him.
The annual meeting was held on April 30th. At this time various resolutions were
passed, and it was felt that their adoption would make the meetings of still greater interest to the members.
H. R. MUSTARD, M.D., Chairman.
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SECTION OF NEUROLOGY & PSYCHIATRY
1946—1947
This section held six meetings during the year. Three were clinical meetings with
presentation of cases.
Mr. J. G. A. Hutcheson, president of the Vancouver Bar Association, spoke to the
group on some legal aspects of neuropsychiatry. This proved a most interesting and
profitable innovation.
The group presented an annual subscription to the Journal of Nervous and Mental
Diseases to the Library.
The final meeting was held at the Provincial Mental Hospital, when the members were
guests of the Superintendent at dinner.
All of which is respectfully submitted.
Page One Hundred and Ninety-four
J. C. THOMAS, M.D., Chairman. HISTORY OF V.M.A. (Continued)
THE SUMMER SCHOOL
The Summer School of the Vancouver Medical Association has for some years been
one of its most important educative Institutions. It consists of an intensive course of
lectures and clinics covering every branch of Medicine and Surgery, given by men who
are outstanding in the Profession, and who are gathered from every part of Canada
and the United States.   The course covers a period of four days.
The Summer School was first mooted by Dr. Riggs in October of 1919. His
original proposal was: "That a summer school be held in August of each year, to consist of clinical demonstrations and lectures by prominent men. That the University
consider it as part of an extension course, and appoint a member to the committee."
Dr. Riggs further suggested that winter clinics might be instituted as part of this
extension course.
The first Summer School was held in 1921. In so far as the lectures and clinical
demonstrations were concerned, it followed along the lines originally proposed by the
Association. However, it never took the form of a University extension course, nor
did it have any connection with the University.
Programmes for the School are arranged and are under the direction of a committee
of six members, two of whom retire annually. For the first few years of its existence,
attendance was rather poor, and there was at one time the danger that the recurring
annual deficits might lead to its being discontinued. This procedure was suggested
in 1926 but the Society decided not to be discouraged. Since that time the success
of the School has been continuously more marked. The attendance has now reached
400 and Doctors from all parts of the four Western Provinces, as well a!s many from
the Northern Pacific States.
T   THE MEDICAL TELEPHONE SERVICE
The Medical Telephone Service came into existence as the result of a controversy
which began in 1922 as a dispute over,—(1) The allocation of certain Workmen's
Compensation Board cases which were admitted to the General Hospital, but which
had been assigned to no particular doctors. (2) The encroachment on private practice by free Government clinics. The more important of these were,—the Government V.D. clinic; the maternity child welfare centres, and the free school medical work.
It was held by the Association that the activities of the latter should be confined to
educational, preventive and directional work. It may be noted that the attitude towards the first two of these organizations has materially changed during the past
twenty years.
In the autumn of 1922 the formation of an organization to be known as the Medical Services Bureau, was advocated. This was to operate under the direction of the
library committee, and its chief function was to help allocate cases which applied for
treatment at any hospital, clinic, or institution, and where no doctor had been specified.
It was planned that this bureau should, (1) Include a telephone service by which
doctors might be reached day or night, (2) Dispose of cases, pay or non-pay, in rotation among doctors, (3) Act as an investigation and information bureau, (4) Act as a
business department to co-operate with the Credit Bureau to handle accounts, etc.
It was, however, found impossible to organize a bureau on such a comprehensive
basis, and finally in 1924 there was instituted a Medical Telephone Service, the use of
which by any doctor was purely voluntary. This is as it exists today. The function
of the service is to keep in touch with, or to locate any doctors who may be temporarily
out of reach of their home or office telephones, and further, to supply medical attendance on emergency cases, which do not have or do not sgecify any particular doctor.
At present the service is being patronized by some 120 members of the medical profession practicing in Vancouver.
Page One Hundred and Ninety-five
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THE BULLETIN
Of all its ventures, the undertaking of the publication of a monthly journal by
the Association, is one of the most important. As early as 1912 a committee on publications was in existence, and during that year Dr. Keith suggested the issuing of a
monthly periodical which might report the activities of the Society. In the autumn
of 1913 a committee was named to arrange for the publication of such a journal, but
the war intervened and the plan was never carried out. In 1924, during which year
he was President of the Association, Dr. H. H. Milburn conceived the idea, and the
issuing of the first number of the Bulletin of the Vancouver Medical Association, in
October of 1924, was the result.
Quotation from the first number will best state the aims and hopes of the journal.
"The first issue is an important event because it represents the first attempt at systematic medical publication in the Canadian West. We hope by means of the Bulletin
the beneficent work of the Association will be strengthened and enlarged. We shall
strive for accuracy in our news, for good will and consistency in our comment, and
we hope from time to time to publish certain papers or abstracts, and report certain
discussions as they take place in our Association meetings."
In October of 1944 the Bulletin entered on its 21st year of publication, and a
special anniversary number was issued for the occasion. In it the Editor cited two
aims which the journal has always kept in mind,— (1) "To preserve and distribute
for the readers' use and benefit all that is of value in our daily work and intercourse.
(2) To act as a promoter of unity and solidarity—to keep us aware of each other
and of the bonds between us." Quoting the editorial further: "The Bulletin has
steadfastly striven to be not merely a Vancouver publication, but a British Columbia
publication. It works in close association with Victoria through its Medical Society,
and records the doings of areas throughout the entire Province. It also acts as the
unofficial organ of the B.C. Medical Association. Every medical man in the province
receives the Bulletin, as do all hospitals and many other institutions. It thus acts as
a medium through which contact may be maintained by the College of Physicians
and Surgeons and the B. C. Medical Association, with all members on questions of
importance." The Bulletin has also a close contact with the staffs of the Vancouver
General and St. Paul's Hospitals, members of which furnish valuable contributions for
publication.
The Association has been fortunate in its selection of men to edit its journal.
The late Dr. Pearson was the first Editor, a position which he held for ten years, resigning a year prior to his death in 1935. To quote the anniversary number again:
"Dr. Pearson was an excellent organizer and leader, and was intensely loyal to any
cause which he made his own. He organized the Bulletin so well that little or no
change has ever been found necessary, beyond that necessitated by the natural growth
of the journal." Dr. Pearson was succeeded by Dr. J. H. MacDermot, who is still
Editor of the Bulletin and Chairman of the Committee on Publications. In addition
to a marked ability as a Managing Editor, Dr. MacDermot has a literary style
equalled by few other medical men throughout the Dominion.
The number of copies of the Bulletin which are printed monthly continues to grow.
From the original two or three hundred, its circulation has now reached some 1500.
Page One Hundred and Ninety-six OSLER   LECTURE
MEDICINE AND SOME ORTHODOXIES
BEDE J. HARRISON, M.D.
trI shall  not  wholly  die.    What's  best  of  me
Shall 'scape the tomb."—Horace
(Triumphal Ode to Augustus.)
When Goethe wrote that "Freedom can come only from law" he might have been
speaking on behalf of orthodoxy in general, for it is only by acting within the boundaries prescribed by law that man can have the freedom to roam at will, without
coming to disaster.
The first law of which we have any knowledge runs as follows: "Of the tree of
knowledge of good and evil, thou shalt not eat." The negation should be carefully
noted, since it appears that orthodoxies confer freedom in proportion to the negativity
of their laws. The things that may not be done having been defined, liberty to do all
others is at once granted.    "Of every tree of paradise thou shalt eat."
The Ten Commandments contain mainly negative injunctions: "Thou shalt not
kill." The old Hebrew code, as well as its more modern recension, the British Common
Law, contains numerous negative injunctions. Thus, referring to the judiciary the
Hebrew code exhorts the judges as follows: "Thou shalt not wrest judgment, thou
shalt not respect persons, neither take a gift."
All law is of vital importance to the practising physician. Common Law and
Statute Law—moral law and social law—Each influences our patients, some physically,
some mentally, and since all disease is both physical and mental we must understand
the laws which guide and govern our patients' lives if we would understand them
and their diseases.
The Cartesian philosophy of the 17th century which, while teaching the existence
of both mind and matter, insisted on completely dissociating them one from the other
has been replaced by the earlier Christian idea that mind and matter are inseparable
and that it may be impossible to distinguish between the mental and the physical factors
producing or produced by disease.
Sometimes, especially when the patient has been under considerable stress, the
mental factor is dominant. In modern life stress is becoming increasingly greater and
more widespread and it will continue to play an increasingly dominant part in the
story of man's health. We have only to consider the sounds of nature—the wind
in the trees, the ripple of the waves on the sand, the song of the birds—and compare them with the noise of the city streets—the rattle of the factory, the rumble of
the train, the chattering of the pneumatic drill—appreciate some of the reasons for
the increased strain in the bodies and the minds of our patients that must result from
merely living the daily round.
It is our duty to know whether any of our laws operate harshly against our
patients and we must be prepared to take them into consideration each time a patient
hands his health over to us for care and protection.
The present principle that man must conform to law, must.be discarded, and be
replaced by another, namely, that the law must be made comformable to man.
The Tightness or the wrongness of law cannot be determined until we have decided
what man is, whither he is going, and what is the object of his existence, for law has
no reality except in its relation to man. Unfortunately ideas regarding the nature
of man and the essential objects of his existence are not as yet uniform.
Which of the various ideas regarding the nature of man has the physician adopted?
In recent years the most popular controversy regarding man has been that between the Communistic idea of which the only definite exemplar is Russia and the
democratic idea, exemplified in a somewhat indefinite manner by the English-speaking
world.
Page One Hundred and Ninety-seven 1
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To compare these two ideas in their relation to medicine, we must compare their
effects upon the two major subdivisions of medicine—the technological and the social.
Technological medicine, it will be remembered, deals with the methods necessary to
cure a diseased organ and to make it function satisfactorily in the patient. Social medicine treats of the art of curing a diseased person and restoring him to his full function
as a member of society.
Let us compare the beehive. The ordinary beehive does not consist merely of a
group of individuals. The whole group of the individual bees taken together makes
a unit.- The worker bee cannot perform the functions of the drone, nor the drone the
functions of the worker. The technological cure of the patient is equivalent to returning the particular diseased worker-bee back to her job but the social cure of the
patient is comparable to that in which the whole bee unit—the hive—consisting of
workers, queens, drones, et cetera, that is to say, the biological unit, having been damaged, is as a result of treatment restored to its normal functional social activity.
MARXISM
This year, 1947, it should be recalled, marks the centenary of the publication by
Marx and Engels of The Communist Manifesto.
Marx was born in 1818, thirteen years before the death of Hegel, and absorbed
most of the latter's philosophy completely; so much so, in fact, that Lenin in his
"Philosophical Notes" says, "Without Hegel, Marx' book T)as Capital' is unintelligible."
telligible."
Hegel's philosophy, insofar as it is cogent to the present discussion, may be summarized as follows: The only reality in the universe is spirit which, starting off knowing nothing, progresses throughout the life history of the universe to an ultimate
knowledge of everything. The active force which produces this progression is contradiction, which Hegel describes as "the very moving principle of the world." The
method through which this principle, known as the dialectic, operates is by a conflict
of opposite ideas, the struggle between which eventually leads to progress.
The dialectic may be exemplified as follows: The drinking of alcohol produces pleasurable sensations. This leads to excessive drinking in an attempt to produce further
pleasurable sensations. The excessive drinking produces drunkenness and thereby, displeasure, the exact opposite of the original sensation. The conflict between drinking
alcohol for pleasure and the drunkenness produced by excess leads to moderation in
drinking and this is a step in progress. Each thesis or idea, in this case, that of pleasure,
tends to produce its antithesis or opposite, in this case that of drunkenness, and the
result is a definite step in progress as a result of the synthesis of the ideas. This synthesis in its turn becomes a thesis of the ideas. This synthesis in its turn becomes a
thesis in a new set of opposites or a new conflict. For instance, moderate drinking,
once established, becomes a synthesis; it then leads to a multiplication of the facilities
for moderate drinking and this multiplication becomes the new thesis. Then as a
result of the action of the dialectic or principle of contradiction, a new antithesis
springs up, this time, such a thing as prohibition. As a result of the conflict between
the two ideals, a new synthesis develops. The number of Uqupr-vending establishments
becomes reduced to reasonable limits and thus a new synthesis and a further step in
progress appear.    And so on, indefinitely.
Marx took over the idea of the dialectic from Hegel, but differed from him in concluding that the only reality in the universe is matter and his system is thus known as
Dialectic Materialism. It is true that nowhere in his writings did he define what he
meant by matter, and that the sense in which he did use the word can be gleaned
only from his writings, but from them, we gather the idea that anything which makes
itself known to human experience in any way what ever, is a part of reality, and can
be called matter. He further concludes that outside of matter we have no need
to look.
Progress, for Marx, equally as for Hegel, is brought about by the dialectic or the
Page One Hundred and Ninety-eight conflict of opposites. In human society, these opposites are the ruling classes and the
ruled, and the conflict between them has gone on throughout history, with thesis producing antithesis and their conflict ending in a synthesis which, in turn, becomes a new
thesis, until in recent times the situation has been reached in which the conflict between capitalism, as thesis, and the proletariat, as antithesis, has become the modern
dialectic. According to Marx the motivating force in these struggles is increased production and any conflict between thesis and antithesis always ends in a synthesis
capable of greater production than previously existed.
The bourgeoisie rebelled against the landlords. The landlords were defeated and
production increased as a result. Then, following the struggle between the bourgeoisie and the proletariat, capitalism developed as a synthesis and again production was
increased. Today the capitalist, by his very increase in strength, has caused the proletariat to form into stronger and stronger organizations until now these two forces
arc ready for the final struggle.
According to Marx, the struggle between capitalism and the proletariat will be the
final struggle. The proletariat will win, and since there will be no other class in society
left to struggle against it, we shall have a classless society in which production will
reach its maximum.
It will be readily understood that in an orthodoxy such as this, man becomes
merely a unit for increasing production. He has no rights except such as production
gives him.   He is, in fact, an economic man and ceases to be a human one.
If we make this philosophy our orthodoxy, we shall inevitably develop a professional
perspective aimed at curing our patients in order to return them to the economic field
and the practice of medicine will aim and will be made to aim only at that end. The
laws regarding the practice of medicine will remain bound to that orthodoxy and any
physician breaking these laws will be guilty of treason. To indicate some of the possibilities let me here tell you the story of one of the world's well known scientists, Vavilov,
a Russian geneticist.
One of the newspapers in Moscow arranged a public debate between Vavilov and
another scientist named Lyshenko. Lyshenko maintained that Mendelism was a major
heresy against the dialectic materialism of the Marxist faith. He argued that all individuals are alike with equal potentialities and that changes in the environment alone
are necessary to bring out these latencies. These ideas are, of course, quite in keeping
with Marxist philosophy. Vavilov argued on the lines laid down by Mendel, and
amplified later by T. H. Morgan and his co-workers at Columbia, that many traits in
man can be directly traced to heredity, even though many others can be attributed
to the effect of environment. This argument was philosophically in favour of the
mdividuality of man and therefore was opposed to the Marxist philosophy. Consequently Vavilov's part in the debate was very poorly received. Now Vavilov had
been elected as President of the International Geneticists' Congress in Edinburgh^ for
1939. He did not attend the Congress. Instead, he disappeared and was not heard
from subsequently. Late in 1946 his death but not its date was announced. Professor Carl Sax of Harvard sums up the situation when he asks this question, "How
did Vavilov die and when?"
Do we, as physicians, consider our patients as nothing else but Marxist economic
men? Unfortunately I cannot swear that we do not. How often are patients treated
mainly with the idea of getting them well enough to go back to work? Does not the
very modus operandi of such organizations as Workman's Compensation Boards foster
that idea? One obtains the impression, on occasions, that a man away from work is
considered chiefly as a drain on the Compensation purse and an economic loss to the
community, and that he must therefore be got back to work as soon as possible. In
short, he is considered merely as an economic man and our function of restoring him
to full health is suspended.
If our philosophy is orthodox Marxism, we must support the present operation of
Page  One  Hundred and Ninety-nine
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such Boards, but should our orthodoxy differ from it, we must, if we think of our
patients as complete human beings instead of mere economic units, do our utmost to
see that the Workmen's Compensation and similar boards treat them accordingly.
For the uneconomic man, the question of euthanasia is immediately decided. It becomes a necessity to do away with him as soon as he ceases to be of economic value.
Childbirth, too, becomes a matter for state control, the number of children permitted or demanded by the state, varying according to the number of economic units
which will be required at some future time.
Wilful abortions become crimes or virtues, depending upon the number of economic units needed, while other great sources of mental stress, such as divorce, are
encouraged or condemned according as the economic state demands a greater or lesser
number of individuals to do its work.
The logical results of its philosophy have already caused some wear in the Marxist
machine. A particular example occurred with regard to divorce when that disease-
symptom was at its height of its incidence. It was found that many of the husbands
refused to acquiesce in the state's opinion. They murdered their wandering wives with
considerably greater regularity than is the fashion on this continent.
The dictum that the middle of the road is the safest is usually a trustworthy guide
in the practice of medicine, but this dictum applies only when there is reasonable doubt
in the physician's mind as to how he must act in the best interests of his patient, after
he has examined closely and exhaustively all aspects of the medical question involved.
He cannot in conscience refuse to examine all matters that involve his patient's good
or harm. Consequently, he must investigate this philosophy carefully, and determine
whether he is in favour of it or not. He cannot base half of his medical decisions on
it, and have the other half of his actions opposed to it, if he expects to do the best for
his patients, to understand them and to have them understand him.
DEMOCRACY
Should the physician decide against being a Marxist, conscious or unconscious, he
must consider his attitude in respect to that other group of laws which we know as
democracy. Here, he will be in a quandary because, taking our English-speaking
countries as examples, he will have some difficulty in determining how much of our
present political and social organization is basically Marxist and how much is basically
democratic.
The British democratic system, luckily for us, has no strictly defined constitution
to correspond with the dialectic materialism of Marx. It has a remarkable capacity
for change and adaptation and this keeps one hoping that if the proper light be seen
in time, the system will be able to lop off its recently sprouted totalitarian 'attributes
and will be able to develop into a true democracy.
British law is divided into common law and statute law. Common Law, according
to Blackstone, the famous authority on jurisprudence, is thus described: "This law
of nature is superior in obligation to any other. It is binding all over the globe, in all
countries and at all times. No human laws are of any validity if contrary to this and
such of them as are valid derive all their force, all their authority, mediately and immediately from   this  original."
This Clommon Law has been taken with them by Englishmen to all parts of the
world which they have colonized, and there it has become part of the law of the
land. On this side of the Atlantic, "behind the framework of the formal constitution
of the United States there stands the material constitution of the British Common Law,
without which the American Constitution is but a skeleton."
The Common Law, sometimes incorrectly spoken of as the unwritten law, is designed to protect the heritage, the freedom and the justice of the people and to establish a national purpose and a mode of conduct suitable to that national purpose. Its
origin is lost in history, but it resembles and appears to be based upon the Hebrew law
which developed supplementary to the Law of Moses.    It was observed by the Druids.
Page Two Hundred It was delivered to the people of England by their Kings before the birth of Christ.
It was codified by the Anglo-Saxon kings and then by William the Conqueror. It
was put into writing in the reign of Edward I. It was incorporated largely into the
Magna Carta. "It shall be lawful for everyone in our realm to rise against us and
use all the ways and means they can to hinder us. They shall in no way give attention
to us." These clauses of the Magna Carta were signed by King John who thus instructed his people that should he break the laws, they were to rebel in order to bring
him to lawful ways again. It was later confirmed by Henry III. Rebellion against the
King was thus definitely legalized, for the specific purpose of making the King return
to lawful ways.
At his trial, Charles I upheld the Common Law when he said: "It is not my case
alone. It is the freedom and liberty of the people of England, and do you pretend,
whatever you will, I stand more for their liberty; for if power without law can make
laws, may alter the fundamental laws of the kingdom, I know not what subject he
is in England that can be sure of his life or anything he calls his own." From King
Charles I to our Chief Justice Wendell B. Farris is a matter of three hundred years,
but a few weeks ago, the Chief Justice spoke of bureaucratic authority in Canada as
follows: "It tends to take away the individual's right to place his case before the
Courts."
The Common Law may be simply described as the skeleton which supports all
our law.
Such it was from time immemorial until recent years when Statute Law and usage
began to whittle away the privileges granted by it. Statute law handed down to us
by Parliament cannot create new rights for us. Such rights are part of our heritage
under Common Law. Statute law deals with particular circumstances, Common Law
with the basic principles.
The most serious attack on our Common Law rights was the passing of the Parliamentary Act of 1911 under which the Speaker of the House of Commons was placed
in such a position as to be able to override even the courts of law. Since 1911 numerous
other Acts have been passed which transgress the Common Law so that the time has
now arrived when the citizens' basic freedoms are in the jeopardous state promised us
by Charles I and indicated by our own Chief Justice. Parliament has begun to rule
by proxy, appointing non-elective people to sit on boards which affect every department of life. These appointees even act as judges in their own cases; they impose penalties on the citizens for breaches of regulations which they lay down themselves. There
is no need in this connection to do any more than draw your attention to the functioning of the Liquor Control Boards, the Workmen's Compensation Boards and the
Income Tax authorities.
How does this affect our patients? Mainly, by removing further and further from
them all sense of security. Our security was established under the Common Law but it
is being insidiously withdrawn piece by piece. That the present demand for security is
so loud is not because we are different from our forbears. All the evidence indicates that
our forefathers saw our problems, but, unlike us, they saw through them. We talk of
social services, of compensation boards, free medical attention, holidays with pay, old age
pensions, unemployment insurance, and so on, and forget that such services have been
our basic rights since the dawn of history, and that only in recent times has the stigma
of poverty, dole or charity become attached to them. The way these rights are treated
makes them smack of philanthropy rather than of natural justice, and philanthropy, you
will remember, has been called the insurance which capitalism pays to perpetuate its
existence.'
How many vagotomies and gastric resections can be traced back to the loss of our
Common Law rights? How many are due to stress, lack of security and loss and deprivation of our fundamental privileges before the onslaught of Statute Law? Many of
the basic principles included in the Common Law are not found in Stateute Law, but I
have no doubt as to what would happen to the barrister who argued in court that the
Page Tw9 Hundred and One
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Statute law was invalid because it was immoral or' because it violated the Christian
conscience or the will of the electorate.
It seems such a wrong application of so much talent to see our physicians working so
wholeheartedly, so conscientiously and so carefully to try to cure by technological
methods so many diseases that are due to evil laws. We raise our voice loudly over such
a question as the chlorination of our water supply, but we remain strangely dumb on the
question of whether we shall have social freedom or not. The lack of chlorination has
not as yet caused disease here, but the lack of social freedom is ceaselessly producing
physical and mental ill-health.
Does it seem to you that a gradual destruction of the basic rights of your patients
can possibly be beneficial to their health? Will a man feel more secure under any of
our proposed social security schemes such as the Beveridge Scheme, than he felt in those
days when his Common Law rights were fully recognized? Does it not seem likely that
these schemes instead of making a man a more perfect unit of biological society will
tend to do rather the reverse?
Is there any hope of improvement? It is not yet in sight. Let us see where we stand.
First and foremost, we must remember that there is no British Constitution in the same
sense that there is a Constitution of the United States. To repeal the Magna Carta and
to quarantine a dog require the same preliminary forms. All our basic rights can be removed just as easily. There is no Bill of Rights under the British system of law as there
is in the United States. The Rights are guaranteed to us under the Common Law, it is
true, but Parliament is gradually eliminating them.
Are we in danger, and if so, wherein does the danger lie? It lies mainly in the gradual assumption by Parliament of control over the basic inherent rights of the citizens,
which are essentially inalienable.
It is impossible to find the slightest allusion to the Cabinet, as we know it, in any
Act of Parliament ever passed and the title of Prime Minister is unknown to law even
today. Yet, there is nowhere to be found an individual with power so great as our Prime
Minister, or a group of men so capable of putting his ideas into law as the Cabinet. The
inner activities of the Cabinet are as much a mystery as the power of the secret cabinet
of the Bank of England. The principles and constitutions governing the Cabinet are
not fixed by any rules of practice. No official records of its proceedings are kept. The
relations of an individual minister to the Cabinet and of the Cabinet to the Premier are
not published.
Can such a system of government be called a democracy? Is it in keeping with British Common Law? Is it either responsible government or representative government?
Is it not rather a constitutional despotism? Is it not a type of government which can
be easily swayed by interests other than those of the electorate?
Maybe the following words from Deuteronomy are appropriate: "The foreigner who
is among you shall climb up over you from station to station but you shall sink lower
and lower. He shall lend to you. He shall be the head and you shall be the tail if you
do not care to practise the whole of the law."
It is not to be wondered at that under such a scheme of government children could
not get the milk necessary for their health, because the price to them was fifty-six cents
a gallon, whereas manufacturers were able to buy sufficient milk to make buttons and
umbrella handles because the price to them was only six cents a gallon. Shall we as a
profession give praise to such a so-called democratic government, while it allows the
children of our patient to remain undernourished? Are we fulfilling our professional
duties, if both individually and in association we are satisfied with our propaganda that
a child ought to have so much milk a day, instead of insisting that a child must not be
deprived of the necessary milk while sufficient is being produced? Are we prepared to
fight manufacturers of buttons for the milk necessary for the health of the children of
our patients? Have we any real sense of values? Which do we prefer—healthy children
or nice buttons?   Must our demands, made as experts, acting on behalf of the health of
Page Two Hundred and Two
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Squibb
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SODIUM
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VIALS (for aqueous solution)
The presence of a buffer (4 to 596 sodium citrate) makes
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Unremitting search for improved techniques has
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Clinical evidence demonstrates the therapeutic superiority of
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*Healy, J. C.: Hypochromic Anemia, Treatment with Molybdenum-Iron Complex, Journal-Lancet
65:218 (July) 1946.
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New York 13, N. Y. Windsor, Ont. the people, be submitted to the dictates of such a constitutional despotism as I have outlined?
We certainly must appear to be very inconsistent. We say we are experts and that
our patients require and must have certain facilities. We say that we are citizens and we
boast that we live in a democracy, and all the time we do not even try to get behind
the reasons given us by the politician in his endeavour to explain why our patients must
remain undernourished and in unease for the sake of the good of the umbrellas.
Do we want our patients to enjoy the best of health? Can we expect them to have
it under our present social system? Can anything be done about it? As medical men,
we must insist that our politicians be amenable to the wishes of the people. They will
not be amenable until the electorate has the power of recalling from Parliament any
member who acts in the House in a manner different from the principles laid down for
him at the time of his election. The institution of what is known as the power of recall
would appear to be to represent the first necessary step.
What about the government of our own profession? To which school does it belong
—Marxist, representative or democratic? A story may throw some light on the matter.
Some ten years ago I listened to a number of physicians, all of them members of this
Association, discussing a matter which was to come up for consideration during the business session of the next monthly meeting. One of the physicians voiced his opinion very
clearly and very forcibly, and it was suggested that he explain his ideas at the meeting.
His reply was illuminating—"I can't do that. I am just making my way here in this
town and I cannot jeopardize my future." The main point of the story is that not one
one of the other physicians present told him that he was mistaken.
Such undemocratic systems as those exemplified by our fraternities, with their conclaves secret and their proceedings as closely guarded as those of the political Cabinet,
should not be permitted to have the influence thy do. Ask yourself whether they are
Marxist, representative or democratic.
It looks as though the members of our profession, despite the particular advantages
of education and experience which they enjoy, feel that nothing can be done except
what our constitutional despotism ordains. An air of apathy, sometimes even of antipathy, develops among one's hearers when one suggests that we not only have the right
to alter things but that we actually have the power. It is difficult to obtain acceptance
of the idea that unless we commence now to demand back the rights which have been
gradually taken away from us, the constitutional despotism which is our recognized form
of government will become more and more despotic and less and less constitutional. For
the failure we, as medical men, must bear our share of the blame and it is a very heavy one.
Let us not imagine that these matters are none of our business. So long as we demand the right to guide the health affairs of the state and its citizens, we shall have to
take the blame for any failure, and the evidence is very clear that if we do not set
matters aright, someone else will attempt to do so. I feel that no other body of men
in the state has the same capacity for the task as we. Let us take it up. Let us dispose
of the idea that man is either a Marxist economic unit or a Parliamentary legal unit and
let us proclaim him as a full human being, entitled to medical care on a scale equal to
his dignity.
MAN, THE INDIVIDUAL
In 1906, during my early life at medical school, I sought the opinion of my professor
of anatomy on the question of Darwinian evolution. He was a man of great ability but
his reply struck me as being an act of faith rather than a statement of fact. I wonder
now what his reply would have been had he had a mathematical as well as a biological
training.
In 1900 Planck had inroduced the quantum theory, a theory which is one of the
underlying principles upon which the discoveries made in recent years regarding nuclear
energies and atomic fission were based. It states that energy does not develop in a continuous stream but in a series of small jumps or quanta. 1900 was the very year in which
the work of Mendel was rediscovered and 1902 the one in which De Vries described
mutations.   These biological discoveries, you will notice, suggest that it is not by smoothly
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and continuously changing phenomena, but by definite discontinuous jumps or quanta
that the development of the living organism proceeds.
Being a man of vast attainments, my professor, by 1906, may possibly have sensed
some interrelationship between these findings even although such had not yet been
formally described. If he had done so, his faith in the Darwinian principle would have
been greatly disturbed. It isworth noting here how extremely cautious the scientist
should be about his philosophical utterances, because at a later period further scientific
discoveries may play havoc with his former so-claled scientific knowledge, and may leave
his philosophy floundering so badly that he may be compelled to invent a new one in
keeping with his scientific tendencies.
Darwin's theory proved to be far from satisfactory. The key units necessary for its
complete vindication were never discovered, and though evolution within certain limits
still seems true, some explanation other than Darwin's must be sought. The philosophies
which grew out of Darwinism were formulated on what we now consider old-fashioned
or out-of-date physics. The law of conservation of matter has proven to be only another
statement of the law for the conservation of energy. Furthermore, whereas in Darwin's
tim the physico-chemical distinction between living and non-living things appeared clear,
nowadays we are not quite so certain. For example, the nature of the virus has not yet
been determined. In size the virus seems to be somewhat smaller than the smallest bacterium and somewhat larger than the largest known molecule. Biologists regard the
virus as a cell and chemists treat it as a molecule. Its size appears to be very similar to
that of the gene. The genes, it will be remembered, are the minute discrete bodies, which
aggregated together to form chromosomes of the living cells, correspond, each one, to a
definite physical characteristic observable in the mature animal. The genes participate
in the processes of fertilization and subdivision. They hand on to the offspring those
physical characteristics in which it resembles its parents. They are the minute bodies
which with a kind of immortality have transmitted through millions of years the chief
hereditary characteristics of man.
Should we wish to change one of the physical characteristics of a living organism we
need only to change the gene responsible for the transmission or the presence of that
c haracteristic. For example, in order to procure albinos it is neccs-ary only to destroy
the gene responsible for the formation of the pigment of the eye.
X-Rays are the most potent weapon we have for producing such changes in the genes.
Millions of ova from the Drosophila or fruit fly have been irradiated. Numerous mutations of characteristics have appeared, but, so far only mutations. We have not yet
produced a new type of fly, even though the new characteristics are transmissible and the
gene structure has been definitely altered. It must not be forgotten that if the mutations
are too great the organism dies, so that the process of mutation cannot be continued indefinitely. In short, there appears to be a limit to the degree by which the particular
change in the environment produced by the application of the x-ray can change the
descendants of a single fly.
Let us look a little deeper. Since the gens, so say ,the physicists, are merely huge
molecules consisting of aggregations of atoms, they can be subjected to the same physical
laws as the atoms. Such physical laws, however, are not absolute. They are only statistical laws. Their information cannot be applied to individual atoms, but only to mass
collections of atoms. In the same way, our health statistics can tell us that, say, 110
people out of 1000 die of a certain disease, without being able to tell us about the likelihood that any single individual will die of the disease. These physical statistics and laws
have been founded, insofar as living organisms are concerned, on the findings of experiments dealing with many trillions of atoms. They are able to tell us that, under certain
fixed conditions, out of a trillion atoms a certain percentage will be found to behave
in a particular way but they cannot tell us how one single individual atom will behave.
Each molecule of a salt, during the process of its solution in a fluid, moves differently
and we are unable to foretell the action of any individual molecule. The human body
likewise can be affected by accumulations of matter which are large enough to obey the
Page Two Hundred and Four statistical laws of physics, but at the same time it may be quite immune from any effect
due to the behaviour of an individual molecule in its environment.
The gene, it has been calculated, contains only about a million atoms—too small a
number for it to obey the ordinary statistical laws of physics, and yet it has remained
free from the influence of the countless millions of atoms comprising the human body
over a period of hundreds of thousands of years and has gone steadily on producing its
like for countless generations, practically unchanged.
According to Erwin Schrodinger, the explanation of this astounding phenomenon lies
in the fact that the gene is a molecule whose atoms are arranged in the non-repetitive
structure of an aperiodic crystal. In these crystals only a few different configurations of
the atomic pattern are possible. Intermediate states between these configurations cannot
exist and to change from one configuration to another, a definite quantum jump is
necessary. Such a jump demands a quantum of appropriate energy such as is derivable
from a beam of x-rays.
The foregoing philosophy, which has obviously passed far beyond Darwin, has dealt
with the purely physical part of the framework on which man and his own peculiar
something which we term personality is primarily built. The frame is static. We are
gradually beginning to understand it. We know almost nothing of the forces which
convert this pattern into a living form. Life is both changeable and changeless by its
nature and the frame is valuable for both purposes. Throughout development change
is continuous but when maturity has been attained, the body tends to remain unchanged
and to resist any attempt to alter it, either in form or structure. The laws governing
these tendencies still reside outside the range of our knowledge. They may well prove
to be even more far-reaching than the statistical laws of physics.
The Marxist lays stress on the changeableness of life and announces that environment
controls everything. The democrat, on the other hand, lays stress on the genetic
characteristics of the individual. There is this great difference between the two that,
whereas the democrat admits that the environment has a very important influence,
and can produce definite changes within a crtain limited degree, his point of view taking
in both the changing and the changeless aspects of the human being, the Marxist so far
has shown no sign of attributing any importance to the genes at all. When he does so,
the possibility of a fusion of ideals between the democrats and the Marxists will seem
near at hand.
The common attitude of the medical profession towards evolution is still, I am afraid,
in the state of the development of the primary amoeba, wallowing in the sea of Darwinian mud—somewhat immature. Many physicians of the same calibre and the same
intellectual attainment at those who a few centuries ago spoke of the average individual
as man, the son of God, now think of him as man, the son of monkey.
How otherwise can we explain the following? The ape, out of work, his natural
environment, and kept in the zoological gardens, is allowed considerably more money
by the Government for tis upkeep than is a human being who is out of work. Furthermore, the wife of the ape, on becoming pregnant, is granted an increased allowance to
ensure that she will be properly nourished during her pregnancy, to be able to produce
offspring of optimum potentiality. The wife of man has still to get along as best she
can. Again, the babe of the wife of the ape receives more than the babe of the wife of
man.   We have out-Darwinned Darwin.
What are our orthodox ideas here? Is it not time that the medical profession, sincerely interested in it is in the welfare of the people, should refuse to act any longer, on
the idea that man is simply an animal and must be treated as such? Let us avoid such
platitudes as the dignity of man and recognize the dignity of each individual man. Let
us not talk of love of humanity, but let us exercise and show our love for each individual man. If we do so it will not be long before we begin to take the necessary actions
to re-establish human dignity and love of humanity in their proper meanings.
But, first of all, the orthodox attitude towards Darwinism must disappear.
Page Two Hundred and five
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Since man is more than just a chemical man, we must see that his health is tended
with even more care than is the chemical emulsion which we use on our x-ray films.
Since man is more than physical man, the billions of dollars spent on nuclear physics
research must be looked upon as a small sum, compared with that which we are prepared
to spend on caring for man.
Since man is more than an animal, should we not have more numerous societies for
the protection of man and his health than we have for the protection of animals?
These problems are surely ours.
SOCIAL MAN—THE FAMILY AND SOCIETY
We now arrive at the consideration of man in the family and society. We may call
him the free-will man.
So far we have spoken of the relationship of the profession to man in the state, and
to man the individual. We must now consider man as a being with free will, living in
those two spheres which lie between the state on the one hand and the individual on the
other.   We must consider man in the family and man in the society of his fellowmen.
What do we understand by man in the family? Realising that man is not complete
in himself, that alone he is unable tocontinue the existence of the race, and that woman
is not just a frailer type of man but a completely separate and distinct being physically,
mentally and emotionally, we come to realize that men and women cannot work, side
by side, at the same task in life, but that they must perform the specifically different
types of duty allotted physiologically to their sex. These tasks must not be such as bear
no relationship one to the other. While one minds the warp, the other must tend the
woof.   It is only in this way that they can produce the proper pattern of life.
Even as an animal, man is not complete without woman. The two are bound together by the past and by the future history of the human race. And just as either is
incomplete without the other, so both together are incomplete biologically and factually
without the biological product of their oneness—the child.
Let us take a parallel from the beehive once more. The worker bees can get along
satisfactorily and live by thmselves for a little time but without the members of the hive
they will soon die. So, too, the queen bee. So, too, the drones. In the same way, the
mother, the father, the child. The absence of any of these means the death of the race.
Together they form a unit—the basic unit of the race—not the man, nor the woman,
nor the child, but all three. Anything which destroys the life of the family will ultimately destroy the race, just as anything which destroys the harmony of the hive will
ultimately destroy the bees.
Beyond his family, man is related to the remainder of his environment, his physical
surroundings, his neighbours, his friends, his work and his leisure, and these must all
operate in strict mutuality with him if he is to be a whole man. Such mutuality can be
found in nature, for instead of the picture of complete hostility between living units
which was drawn by Darwin, we realize that nature could not exist without a mutual
synthesis, participated in by all living organisms and all their environment.
We raise here the question of our orthodox attitude once more. The medical pathologist investigates the causes of death, rather than the causes of disorder. The medical
biochemist deals with the technology of conditions leading to disease rather than that
of conditions leading to increased health. The practising physician seeks for evidence
>>f dysfunction or perverted function. All are engaged in analyzing departures downwards below average normal health. Physicians are not consulted by persons of superabundant health and so they lack the opportunity to carry on researches into the nature
of the physical departures upwards above average normal health.
Real activity in aid of health must seek to do more than rid the body of disease. It
must seek to elevate the individual's health to the highest level that his body is capable
of attaining.
Under our present medical system the physician in his every day work must seek
primarily to bring about the patient's recovery from disease.    Now, absence of disease
Page Two Hundred and Six in itself only indicates a minimum standard of health and this is not enough. We must
be interested in the attainment of increased health for everyone, not merely in the
diminution of the amount of disease in the afflicted.
Remembering that our physiological and psychiatric standards bear a direct relationship to the health of the average individual, we may well ask at this point what is the
health of the average individual. The vital capacity of the lungs, the gastric acidity,
the non-protein nitrogen in the blood and so on have all been standardized, so far as
they are standardized, as the result of tests carried out on average people. A wide margin
of variation has been shown to exist, seeming to indicate, assuming that the experimental error of the test is small, that there is very great variation in the average.
Even if the average were quite uniform, it would still give us no idea as to what the
potential health of even the average might be.
In the first batch of recruits in the United States in 1941, fifty per cent were rejected. This indicates that the average health must be lower than the potential, and also
that the number of people in superabundant health must be extremely small. We know
that under conditions of good food, exercise, medical care and so on, great improvement
was made in the average health of the men not rejected, indicating that their potential
health was much greater than the state of health to which they had been accustomed.
In England, a group of four thousand people of all ages and sexes, going about their
ordinary duties of life, voluntarily presented themselves for examination. No selection
was made by the examiners. The group was, in some sense, artificial in that the locale
of the examination tended to exclude the very poor and the very rich, as well as the
very ill, but in general terms the group represented a cross section of middle class people
in average health.
Four hundred out of the four thousand people were found to be quite well, without
any disorder, without any discomfort. Three thousand six hundred out of the four
thousand were found to have some physiological defect, deficiency or aberration. Twelve
hundred actually felt definite symptoms of disease or unease, but twenty-four hundred
out of the four thousand, while having some observable disorder or other, were not conscious of any feeling of discomfort or unease; that is to say, twelve hundred out of the
four thousand were consciously unwell and twenty-four hundred out of the four thousand were unconsciously unwell. Of the twelve hundred who were consciously unwell,
none admitted the need of consulting a physician—their opinion may have been clouded
by economic considerations. The twenty-four hundred who were in a state of well-
feeling naturally thought they were in a state of well-being and consequently they did
not seek professional help.
The significance of these figures is tremendous. Thirty-six hundred people in this
particular average healthy group of four thousand needed technological medical attention but because of one of the major orthodoxies of our present medical system they had
not as yet come into the category of patients. Though needing medical care and though
medical care was available, they were not receiving it.
As we are organized at present, it is necessary that the patient himself shall be the
first to diagnose his own condition as one of disease. We make each patient the first
doctor on the case. Next, the patient himself must then decide whether his condition
warrants attention or treatment. He must then decide whether to treat himself, to
patronize a cult, or to hand himself over to a practising physician. All this before treatment can be commenced.
Periodic health examination has been suggested to remedy this situation but the anticipated results will not necessarily accrue if periodical health examination alone is carried out. I recently saw three cases of carcinoma of the breast in two days. One had
been examined by three doctors before the carcinoma, quite a large one, was noticed.
Another patient had known she had a tumour for over a year before she sought medical
advice. The third had been examined by six doctors, all of whom failed to notice an
ulcerating mammary carcinoma in the anterior axillary fold, because their attention
was directed by the patient's complaints to the lower abdomen.
Page Two Hundred and Seven
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Patients are not coming any earlier to the cancer institutes than they were ten years
ago, either here or in any other part of the country, despite all the publictiy that has
been given to the work the institutes do.
In those places where figures are obtainable, only one-half of the people who are
consciously diseased are found to be actually seeking treatment. Considerable time lag
obviously exists between the recognition of the disease by the patient and the stage at
which he seeks treatment. The diseases found in those who seek treatment early are the
same as those who seek treatment late. It is not a question of the nature of the disease
but of the patient's response to the unease he is experiencing.
A periodic overhaul as carried out at present, if performed on a national scale, would
prove to be of great benefit in eliminating sickness and in getting people back to minimum
health standards. It would not necessarily, however, bring about the condition whereby
each citizen might attain the maximum health in keeping with his potentialities for it.
For such a condition, as has been indicated above, he must be in mutuality or at peace,
not only with his body, but with bis family, his society and his state, in that order of
importance.
The patient who has been cured of a disease is not ^necessarily in a state of health.
Returning a patient to work before he has been restored to complete health, even though
he has been cured of his disease can only be considered unscientific, uneconomical and
unjustifiable.
The technological art of medicine may be compared with that of the pest exterminator in the orchard. This may prevent the trees from being damaged and may get rid
of the pests already established, but it does nothing towards improving the quality of
the fruits. That is the cultivator's task. To ensure the fruits and the trees reaching
their optimum quality is his aim. The physician should seek to cultivate the health of
his patients to such an extent and in such manner that they and their whole environment
shall be able to work in fruitful mutuality. This is an orthodoxy not yet developed. Its
adoption will mark the greatest advance yet made towards attaining maximum health
for the individual and also for his environment, for one cannot be affected without the
other.
The adoption of such an orthodoxy will necesssitate the development of a new specialty in medicine, one differing entirely from preventive medicine as we now understand it, approaching more closely, in fact, to that broadest and oldest of specialties—
which we call general practice.
The new specialty might be called that of diseases of the community and the doctor
might be called the community doctor.
What would be the training and the duties of such a doctor? Emerson once remarked to Thoreau that Harvard had taken on the teaching of all branches of learning.
Thoreau's reply was "Yes, all the branches but none of the roots." The training for the
practice of medicine in the past seems to have been of a similar nature. It is time we
looked to the roots.
The training of the community specialist would start with a basic course in biology,
so arranged as to develop the proper understanding of the full relationships of life in
general, its bionomic and environmental and hereditary phenomena.
The formal medical school training would be directed to the borderlands which lie
between health and disease in order to facilitate early recognition of predispositions or actual incipient physcial diseases and mental disorders, in the apparently perfectly healthy.
Therapeusis would need to be taught only insofar as was necessary to enable the
community doctor to refer clients to the proper specialists for care and treatment.
The normal biological life of the mother, the father and the child, and family would
form a major part of their training. Such matters as the value of maternal feeding to
the infant, the mother, the father, the family and society, would be given more stress
than the value of any particular feeding formula. Such questions as the biological advantages of conducting confinements at home or in the hospital would need to be considered.
Page Two Hundred and Eight
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mm The community doctor would help to keep the feet of the practising physician more
firmly on the ground than they are now.
How to perform the regular periodic complete examination of the family, the mother,
the father and the child would be a major part of the training. Equally important would
be their actions and inter-actions in the family unit. The community doctor would be
trained to see that the family unit learns how to travel along its course in life within
the limits normal for its members, taking care never to insist that they be held to a
pattern. It is impossible to make the human being adapt himself to a mould which is
ill-fitting and to expect him at the same time to conform with the mould and be a
rational individualist.
The art of developing opportunities for the outlet of all the potentialities of all the
individual members of a family in the family, and of all the families of a neighbourhood
in the neighborhood and of all the neighborhoods of a community in the community
must be learned. Moulds must be provided, it is true, but they must be sufficiently
numerous and sufficiently varied that each individual may find one to suit himself and
may feel free to leave it when he finds it doesn't fit or when he gets tired of it. Moulds
for the community and for the family must also be available, in the same way that the
cultivator makes available all the things that are necessary to allow the roots of the plant
to develop their potentialities for the purpose of producing fruit. The plant uses up
those things that are valuable to it; it must not be compelled to absorb things which
it cannot use. The community doctor, herefore, will be greatly concerned with making
available the proper environment for the development of his client's potenitalities without
attempting to dveelop them forcibly.
Special trainings of the intensive type should be made available for those clients who
wish for them. But such organizations as the Boy Scouts and the Girl Guides, which
have their uses, must be watched carefully lest attempts to cultivate leadership or proficiency among their members may interfere with the natural development of these characters. Such matters as developing the pack instinct, with its subjection of free will,
which seems inherent in boys, beyond its natural intensity or duration must be carefully guarded against.
Sufficient has been said to give some idea of the activities of the community doctor.
How will he acquire his clients? You will notice he has no patients.
In some respects his practice will develop in the same way as does that of the general
practitioner. He will wait until clients come. Unlike the health officer, he will have
no rights over the community, but since he is concerned with healthy clients he will
need an institution or centre devoted to healthy clients, just as the general practitioner
needs an institution devoted to the needs of diseased patients. This centre will need to
be as attractive in its particular way just as the hospital is in its. This comrqunity centre,
the word "hospital" being out of place, will neither need nor have beds. It will be more
comparable to an outpatients' department. The big difference will lie in the technological equipment. Equipment for exercise, amusement, education and social life will be
there. It will be available to anyone who joins the doctor's clientele, the condition of
joining being that the client will attend for regular health examinations. Subject
only to this, the whole of the technological facilities will be available to the client
and his family to help them to develop their potentialities for full health, just as the
armamentarium of the hospital is available to help the patient to overcome his disease.
But here again there is a marked difference. In the hospital, the patient is told what
he must do, and the doctors and nurses use the equipment on him. In the community
centre, no one will tell a client what he must do and he will use the equipment on himself. The example of other clients, the encouragement of interested friends, and so on,
will influence the client to use the advantages presented to him by the centre, and as his
capacity to use different forms of equipment, physical, social and mental, increases, his
further potentialities will become obvious and he will tend to go on and develop them
and with them his free will.
Page Two Hundred and "Nine
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The community doctor will need other helpers about his institution—nurses, social
service workers, instructors, and so on. Like the doctor ,they will need special instruction in the work which is to be undertaken, and particularly they will need to be trained
away from the present orthodox relationship between the doctor and the patient.
Before the war began, a start had been made on such a scheme in London, and the
work, though experimental, had been rather startingly successful.
I commend the development of such community health work in this country to your
hands, as the method whereby you may raise your patients up to enjoy their maximum
attainable health.
We have considered man in some phases of his relationship to the physician. We have
scouted the idea of the economic man, the legal man, the chemical and the physical man,
and have discarded the concept of man merely as an animal. We have attempted to portray him insofar as he concerns the physician, as a human being with free will—man and
member of the family, in the home, in the community, and in the state.
I am convinced that the next great steps in health progress are already indicated. The
task is ours to see that these steps are taken soon.
In drawing to a close this attempt to commemorate one of the most beloved physicians of all times, may I say that his writings indicate that he always considered man in
the completest sense. I feel that he would join with me in my request that the physician
should maintain the widest possible outlook on all matters of health.
The whole task of health production as well as protection is really ours. We know
it is vast, but we should remember the following words of the Babylonian Talmud:
"The day is short. The work is great. The reward is also great and the Master
praises. It is not incumbent on thee to complete the work but thou must not therefore
cease from it."
» • •> • • ••>••••••••»
BRItfS
CARDIOVASCULAR SYPHILIS — REQUESTS FOR DRUGS
It is the policy of the Division of V.D. Control to refer all requests for drugs for
cardiovascular syphilis to our specialist in cardiology. In order that apprporiate treatment may be outlined, the following information should be supplied to the department
when drugs are requested:
History of symptoms, physical examination, X-ray plates and screenings of the heart
and great vessels, electrocardiogram, urinalysis and the type and amount of treatment
already given.
If such examinations are not available in the locality where the patient resides, arrangements may be made for this examination to be done by the Vancouver Clinic. Enquiries should be addressed to the Director, Division of V.D. Control, 2700 Laurel Street,
Vancouver, B.C.
Page Two Hundred and Ten
a&aa VAGOTOMY
By DR. ROY HUGGARD
Much is being now written on this subject, and as time passes more results will be at
hand to assess.   A few remarks may not be out of place.
This procedure is of course based upon certain physiological concepts. Concerning
duodenal ulcers great stress is placed upon the role of hyperacidity in the causation of the
disease, and the neurogenic impulses arriving via the vagus nerve. None, at the present
state of knowledge, can know just what changes have occurred in the brain to bring
about this altered function. By the same token results are assessed in terms of low acidity
and clinical observation. It should, however, be stressed that this is by no means a "cure
all" and cases should be carefully selected for this procedure. As with many other operations not properly used, the usual crop of bad results inevitably follows, bringing disrepute upon an otherwise good procedure.
In our limited experience we have reserved this treatment for the following cases:
1. The so-called "intractable" lesion that breaks down as easily as it heals. These
are for the most part in the young age groups. As long as they have hospital treatment
they do well.   They break down under resumption of normal economic activity.
2. Stenosing lesions of the duodenum.
3. So-called "bleeding duodenal ulcer".
4. Marginal ulcer where previous surgery has been done, be it gastroenterostomy
or gastric resection.
5. Those cases that do not respond to any form of treatment whatsoever.
You will note we have omitted mention of gastric ulcer. At our present state
of knowledge we would shun these and rely, as usual, upon gastric resection. The relationship of gastric lesions to carcinoma is a matter of great doubt. Hence the basis of
this reasoning.
A good word about operative approach might be in order. Originally these cases
were done by the transthoracic route. Subsequent experience has demonstrated that
10% required further operative treatment in the form of pyloroplasty or gastroenterostomy to facilitate gastric emptying. Further, to operate blind as it were, and not
demonstrate the pathological changes, does not seem to be a very sound procedure. We
now reserve the transthoracic route for those cases who have had many abdominal
operations and would be most difficult via the abdomen, owing to much adherency and
distortion. That is, of course, dependent upon the fact that as far as one can tell
emptying at the stoma is satisfactory.
By choice, our approach is subdiaphragmatic and posterior gastroenterostomy is now
done as a routine. We have as yet been unable to decide which cases are sure to empty
and those that will not, hence the gastroenterostomy to be on the safe side.
The operative technique is not difficult.
An ample left paramedian rectus incision is made and the muscle fibres split, peritoneum opened. The duodenum is then examined to confirm diagnosis, as is also the stomach. With favorable findings a vagotomy is decided upon. Team work is essential and
the assistants should clearly understand the approach. The left coronary ligament is
grasped in a long curved forceps and sectioned by scissors. It is avascular, but care
should be taken to avoid injury to the phrenic vein coursing along the diaphragmatic
dome. After clearing the coronary ligament down to the diaphragm the left lobe of
the liver is easily retracted medially. The first assistant carries this out at the same
time retracting the left costal margin with his left hand. The second assistant at the
same time holds the fundus of the stomach gently and retracts it downward with his
left hand.    The oesophageal orifice comes into view, the operator palpating the oeso-
Page Two Hundred and Eleven
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phagus with its inlying tube. The lesser curve and greater curve angles are identified.
This is most important for it shows one what is stomach and what is oesophagus. With
syringe and long needle a small blister is raised, using water or saline, on the oesophagus
just above these angles in such manner as to lift the visceral peritoneum. This is incised
by scissors. From now on all dissection is done with the right index finger. No instrument should be used, because the oesophagus is thin and easily punctured. The left
nerve is easily picked up, for it is taut like a bow string, owing to the second assistant's
gastric traction. The nerve is isolated by finger dissection, two neurological clips applied
an inch or more apart and the intervening portion of nerve cut and removed. A similar
procedure is used for the posterior or right nerve, usually found on the posterior aspect
of the right half of the oesophagus. In some cases one or two further branches may be
isolated. These should be treated in like manner. Once these nerves are sectioned
great mobility of the oesophagus follows. By using the forefinger one can be reasonably
certain that a complete section has been accomplished. Having completed this stage,
posterior gastro-enterostomy is done in the usual manner and the abdomen closed.
The post-operative management is standard. Gastric suction is required for two
to four days. When emptying begins we return them to solid food as quickly as possible, being careful to avoid overloading. There may be some slight diarrhoea which
is not of any moment. Between the third and fifteenth day some peri-umbilical cramps
may be present. The singular fact regarding these patients is the striking sense of
well being. They become hungry, their "ulcer pain" vanishes and they experience a
complete change over so to speak. Some may have cardiospasm and cannot "burp"
but the passage of a Levine tube a time or two quickly handles this symptom. Their
post-operative acid values are very low as to degree and quantity, total and free.
I have not mentioned the insulin test, but intend to do so at some length when we
have some very definite data accumulated. At this time we have not sufficient experience, and some confusion exists in our findings.
In conclusion may it be said that the time factor will eventually settle the virtue
of vagotomy. Cases done elsewhere four years ago are standing up. It may well be that
a new physiological principle has been found that will contribute greatly to the treatment of this common affliction. We believe in boldness tempered with prudence and
caution. No evidence is at hand to suggest it to be a "cure all". It has indications and
contra-indications, and the physician and surgeon should function in team fashion at
all times in dealing with this disease.
NOTICE !
The Workmen's Compensation Board of British Columbia invites applications from physicians registered in B.C., for positions as full-time
Medical Officers ■with the Board. Consideration will be given to applicants interested in general administrative and medical duties, and
also to those interested in the Specialty of Physical Medicine.
Please apply to the Secretary, Workmen's Compensation Board, 411
Dunsmuir St., Vancouver, B.C., stating age, qualifications and experience, service if any, in the armed forces, salary expected, etc. Applications should be filed immediately and should be accompanied by letters
of reference and a recent photograph.
Page Two Hundred and Twelve THE PHYSIOTHERAPISTS AND MASSAGE
PRACTITIONERS ACT
In July , 1946, an Act was passed respecting the practice of Physiotherapy and Massage in British Columbia. All persons practising Physiotherapy or Massage are now required to be registered. This Act is divided into three Sections. Section 1—Chartered
Physiotherapists; those persons who practice Physiotherapy exclusively under the prescription, supervision or direction of a legally qualified Medical Practitioner, with standards of education as high as that required for membership in the Canadian Physiotherapy Association. Section 2—Physiotherapists; those persons practicing Physiotherapy
who are graduates of a school of Physiotherapy approved by the Provincial Secretary but
do not work under the direction of a Medical Practitioner. Section 3.—Those persons
practicing Massage only.
As this Act was considered necessary to the public welfare, the Canadian Physiotherapy Association with the aid of the Medical Profession helped in its drafting, so that
the high standards of Physiotherapy set by C. P. A. might not become lost. Members
are now classified as Chartered Physiotherapists, with this Section having its own Board
for the regulating of ethics, discipline, methods of practice, an dexamination of applicants for registration, etc. All those registered in this Section work under Medical prescription, and are called Chartered Physiotherapists and should use the letters C. P. after
their names.
So much reference has been made to the C.P.A. that a short resume of this Association should be in order. The Canadian Physiotherapy Association Incorporated was
founded in 1926 to form a Dominion wide organization to establish a standard of qualifications by means of a central examining board. To provide a bureau of information
and a Register available to the Medical Profession and the general public, and for the
improvement in knowledge of its members by lectures, post graduate courses, etc. To
promote active cooperation with the Medical Profession, Hospitals and Universities in
Canada, and to establish branches throughout the Dominion. There are now two schools
of Physiotherapy in Canada approved by the C.P.A., University of Toronto with a three
year course, and McGill University with a two year course and six months internship.
The curriculum includes the following subjects: Anatomy, Physiology, Chemistry
Physics, Kinesiology, Medical Gymnastics, Massage, Electrotherapy, Psychology, Pathology, Under-water exercises, Elementary nursing, treatment of patients in hospital and
other subjects.
Members of C.P.A. are employed in hospitals and clinics throughout Canada and
many are in private practice, working under Medical Prescription. Membership in C.P.A.
was a requirement for Physiotherapists serving in the Armed Forces during the war,
members holding commissioned rank. The Department of Veterans Affairs also requires
C.P.A. membership for Physiotherapists employed in the Department Hospitals.
British Columbia has its own branch of the Canadian Physiotherapy Association and
maintains a Register of its Chartered Members for the convenience of the Medical Profession.
CANCER DRESSINGS
Doctors throughout British Columbia will undoubtedly be interested in the new
service project of the members of the Order of the Eastern Star.
They are making several types of dressings to be used by patients suffering from
cancer. In Vancouver, the dressings are distributed through the British Columbia Cancer
Institute.
Information about this matter in other centres can be obtained from the local hospitals or by contacting a member of the local Chapter of the Order of the Eastern Star.
These dressings are primarily intended for patients who would find the purchasing a
financial strain.
Page Two Hundred and Thirteen
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Members of the Profession in British Columbia were sorry to learn of the sudden
passing of Dr. S. C. MacEwen, who died on June 18th. Dr. MacEwen, a graduate of
McGill University, was licensed to practise in this Province in 1909. He has for many
years been active in organized medicine and was, at one time, a member of the Council
of the College of Physicians and Surgeons. Deepest sympathy is extended to Mrs.
MacEwen and family in their bereavement.
We regret to report hte death of Dr. T. F. Saunders, who passed away in Shaughnessy
Hospital. Registered in British Columbia in 1907, Dr. Saunders was a veteran of
World War I and II, and was well known in Vancouver before retiring.
Members of the College of Physicians and Surgeons of British Columbia welcome
Dr. F. L. Whitehead, who has been appointed to the position of Executive Secretary of
the College. Dr. Whitehead graduated from Dalhousie University in 1935. He sreved
in the Royal Air Force from 1936 until 1946, and then practised in Parrsboro, N.S. Dr.
Whitehead is, at present, attending the Canadian Medical Association Annual Meeting,
being held in Winnipeg, and will assume hsi duties here the first of July.
Dr. Alfred J. Elliot, Professor of Ophthalmology, University of Toronto, one of the
speakers at the Vancouver Medical Association Summer School, formerly resided in
New Westminster, and he and Mrs. Elliot are visiting family and old friends while here.
Dr. Ethlyn Trapp, President of the British Columbia Medical Association, accompanied by Doctors D. A. Johnston, H. H. Boucher and W. W. Simpson, visited Prince
George and Prince Rupert. They spoke to meetings of the Medical Societies and returned
home with the feeling that they, as well as th doctors of the Central Interior and
Prince Rupert Medical Associations, had profited by the meetings.
We welcome Dr. D. B. Avison, who has returned to Vancouver after serving in
China with U.N.R.R.A. He is now Director of Unit No. 3 of the Metropolitan Health
Committee.
Dr. E. France Word is making a post-graduate tour of the Clinics in Chicago, the
Mayo Clinic at Rochester and the Medical School in Minneapolis.
Dr. P. H. Spohn is going to the St. Johns Hopkins Hospital at Baltimore for a year.
Dr. J. S. Daly has returned home after spending a month in eastern Canada and
the United States. While away he attended the Annual Session of the American College
of Physicians at Chicago.
Dr. J. G. McKenzie, formerly at Michel, is now practising in Prince George.
Dr. E. W. R. Best from Toronto is now with the Okanagan Health Unit at Vernon.
Dr. K. R. Blanchard, formerly at St. Joseph's Hospital in Toronto, is now practising
at Alert Bay.
Dr. W. E. French has left Vernon to go to the Toronto Western Hospital in Toronto.
Several doctors have left Vancouver to reside in other parts of the Province, among
them Dr. H. K. Atwood, now at Kelowna; Dr. C. H. Ployart at Port Mellon, and Dr.
H. G. Weaver who is now residing at Sea Island.
Page Two Hundred and Fourteen Members of the professions extend congratulations to Dr. and Mrs. E. H. Saunders
on the occasion of their 'Golden Wedding Anniversary'.
Congratulations to the following doctors and their wives on their recent good
fortune:
Dr. and Mrs. G. Blott, Nanaimo—a son.
Dr. and Mrs. E. Christopherson, Vancouver—a daughter.
Dr. and Mrs. J. R. Ibberson, Vancouver—a son.
Dr. and Mrs. A. K. Karsgaard of Landour, India—a daughter.
Dr. and Mrs. C. H. McKee, New Westminster—a son.
Dr. and Mrs. L. E. Ranta, Vancouver—a son.
Dr. and Mrs. G. C. Walsh, Montreal—a son.
We were pleased to see such a large attendance of doctors from out-of-town at the
Vancouver Medical Association Summer School, which took place at the Hotel Vancouver recently.   A complete list of those attending will be published in the next "Bulletin".
'Hi
Nutut $c
5Tff0m00tt
2559 Cambie Street
Vancouver, B.C.
ARTHRITIS and ECZEMA
of endogenous origin
claimed to be allergic, may be
favored or induced by calcium
and sulphur deficiency, impaired
cell action; and imperfect elimination of toxic waste.
LYXANTHINE ASTIER
administered per os, brings about
improved cell nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement.
Write for Information
Canadian Distributors
ROUGIER FRERES
350  Le  Moyne   Street,  Montreal
Page Two Hundred and Fifteen
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tirxsmsamiM
|   Breaks the vicious circle of perverted   1
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
musculature. Controls the utero-ovarian
1    circulation and thereby encourages a     *
^    normal menstrual cycle. j
m^ * MARTIN H. SMITH COMPANY    J0
$&&. ISO lAFAUTTf STRUT. NiW YORK, N. T. xd&
Full formula and descriptive
literature on request
Dosage:   l to 2 capsules
3 or 4 times daily.   Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule is cut in half at seam.
4. r
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TOTAL SERUM PROTEIN
and
ALBUMIN-GLOBULIN RATIO
Normal values are: Total Protein 6 to 8 gm.; Albumin 3.5 to 6 gm.,
and Globulin 1.4 to 3 gm. per 100 cc.
The globulin is precipitated out by treatment with sodium sulphate
for 3 hrs. at 37 degrees C. This is followed by Kjeldahl digestion and
Nesslerization.
K '*
Telephone
PAcific 4839
fllEDICRL LflBORflTORV
OF
Dr. P. S. RUTHERFORD
312 Vancouver Block,
Vancouver, B.C.
T»
■SdSBiSBfi
MB
OOfii LIVOGEN
WHOLE LIVER j
EXTRACT WITH
YEAST AND
VITAMIN B
COMPOUND
Each fluid ounce contains:
liquid Extract of Liver B.P J^ oz.
(equivalent to 4 oz. of fresh liver)
Concentrated Extract of Yeast      ..   88 grs.
Thiamine Hydrochloride
(Vitamin Bl) 1.2 mgm.
Riboflavine (Vitamin B2).. 1.6 mgm.
Pyridoxine Hydrochloride ..    2.0 mgm.
Nicotinic Acid 40.0 mgm.
The significance of pyridoxine in human
nutrition has not yet been established.
► In addition to measured proportions of the B group of vitamins,
Livogen contains all the anti-anaemic
principles of whole liver together with
all the essential nutrients of both fresh yeast and liver
including those factors the precise nature of which is
as yet undiscovered.
Containing no strychnine or other stimulating drugs,
Livogen may be taken by old and young alike.
Livogen is of great value, therefore, throughout
illness, convalescence and during any period of
restricted food intake.
Supplied in bottles of 4, 16 and 80 fluid ounces.
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THE BRITISH DRUG HOUSES
(CANADA)    LIMITED
TORONTO
CANADA
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of G-E Model R-39
X-Ray Units
Now in Service!
If you can picture in your mind's eye a two-mile
column of R-39 Units, placed end to end, you'll
have a good idea of the popularity of this particular
model, and the vast amount of diagnostic service
it is rendering daily in the offices of specialists, and
in clinics and hospitals everywhere.
Why the R-39's great popularity?
1. It is an all-round diagnostic unit, yet is so
compactly designed that it can be accommodated in a small floor space.
2. Has ample power (100 ma. and 85 kvp) for
general radiographic and fluoroscopic diagnosis.
3- Its unusual flexibility facilitates positioning
of the patient vertically, angularly, or horizontally.
4. Its double-focus genuine Coolidge tube serves
both over and under the table.
5- The simple-to-operate, refined control system
assures a consistently fine quality of work.
You, too, may find the Model R-39 ideally adaptable to your particular needs. Why not investigate,
by writing today for complete information. Address your nearest Victor office, Department 2616.
VICTOR X-RAY CORPORATION of CANADA, Ltd. distributors for general © electric x-ray corporation
TORONTO: 30 Bloor St, W. • VANCOUVER: Motor Trans. Bldg., 570 Ounsmuir St • MONTREAL: 600 Medical Arts Building • WINNIPEG: Medical Arts Building eniora
Penioral (Buffered Penicillin Wyeth) reaches the
patient Laboratory-Fresh. It is protected three
ways against moisture, arch enemy of penicillin.
MEANS
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Vwrf^
wga ■n-lj£T&mmm
KHI_ORA||s
»UfFEtE6 MNKiUiN
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• Vial is sealed air-tight until opening.
• Desiccant absorbs moisture after vial is opened.
• Blue indicator turns pink when excessive moisture threatens full potency of the penicillin.
• Added protection—expiration date on every vial.
Ektch vial contains an average
day's prescription
25,000 International Unit
tablets—Vials of 12
50,000 International Unit
tablets — Vials of 8
100,000 International Unit
tablets — Vials of 8
m^/yf
Registered Trade Mark
For assured
Potency —
Write PENIORAL
on your
Penicillin Q
JOHN WYETH & BROTHER (CANADA) LIMITED
WALKERVILLE - ONTARIO
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l/ie characteristic response
to Pyridium therapy
The prompt symptomatic relief provided by Pyridium is extremely gratifying to the
patient suffering from distressing urinary symptoms such as painful, urgent, and frequent urination, nocturia, and tenesmus.
Pyridium, administered orally in a dosage of 2 tablets t.i.d., will promptly relieve
these symptoms in a large percentage of ambulant patients, thereby permitting them
to pursue normal activities without undue discomfort.
Acting directly on the mucosa of the urogenital tract, this important effect of Pyridium is entirely local. It is not associated with or due to systemic sedation or narcotic
action.
Therapeutic doses of Pyridium may be administered with virtually complete safety
throughout the course of cystitis, pyelonephritis, prostatitis, and urethritis.
• LITERATURE ON REQUEST •
PYRIDIUM
(Phenylazo-alpha-alpha-diamino-pyridine mono-hydrochloride)
MERCK & CO. LIMITED
MONTREAL        •        TORONTO        •        VALLEYFIELD
mm ^
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NUTRA-ORTHO
is prescribed as a precoital
douche to be used especially during the fertile period.
It should be taken in a
recumbent position and
retained for several minutes. Following coitus the
female should remain recumbent for at least two
hours.
Available in removable
label prescription packages of three vials. When
dissolved in warm water
each vial makes a sufficient
solution for two douches.
Never contra-indicated.
NUIKA" UK I till is a physiologic glucose
vaginal douche powder. When examination
reveals no evident organic pathology or
deficiency to prevent conception, many
physicians prescribe Nutra-Ortho to help
counteract hostile genital secretions and
to promote post-coital sperm survival
and migration.
ORTHO PHARMACEUTICAL CORPORATION
(CANADA) LIMITED — TORONTO Hi'
1 v
l£
A, I
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rilk
M
For the Treatment of
VARICOSE ULCERS
DECUBITUS ULCERS
ABRASIONS • BURNS
INDOLENT WOUNDS
PILONIDAL SINUS
INTERTRIGO
Post phlebitic
eczema and ulceration
Photograph: H. S. Hay den, F.R.P.S.
II
GADOMENT"
Ointment No. 753 "ifibddF
Gadoment contains 70% non-destearinated cod liver oil in a
wax base. Carbolic acid 0.375% has been added as a
mild tissue anesthetic. Benzoin and zinc oxide are present
in small quantities for their soothing and drying factors.
DIRECTIONS:
Spread Gadoment on waxed or paraffined paper, cellophane
or tightly woven cloth (not gauze), lay it on the exposed area
and cover with suitable protection. Renew the dressing as
conditions require.
In the excision of pilonidal sinus a gauze pack saturated with
Gadoment is applied. The pack should be removed daily and
a fresh one applied.
ekadto &3ftM«t&@x.
Available in one  ounce
tubes and one pound jars.
MONTREAL
CANADA WW...
m&mTSmm
^sorption*
WmKmmm
INDICATIONS
SUPPXX*
S-87A
Digitoxin
Stearns
FOR  ACCURATE  DOSAGE   BY  WEIGHT
always constant
DIGITOXIN Stearns—the chief active constituent of Digitalis purpurea—Is a pure
microcrystalline compound with definite physico-chemical properties. Uniform in
composition, it is-standardized by weight—permitting the prescription of precise
dosages—obviating the confusion of "frog" or "cat" units.
Administered orally, Digitoxin Stearns is approximately one thousand times
■as potent, weight for weight, as Digitalis U. S. P.; 1 mg. of Digitoxin produces the
Same effect in man as 1 Gm. of digitalis.
'■ rapid and complete
DIGITOXIN Stearns is rapidly—and presumably completely—absorbed from the
gastro-infestinal tract... oral administration of the dose required is equally as
effective as intravenous.
t excellent
DIGITOXIN Steams is free of inert, therapeutically undesirable materials. Small
doses produce full cardiac effects with virtual freedom from nausea and vomiting.
Single dose therapy for full digitalization is clinically practicable.
? DIGITOXIN Steams—pure crystalline glycoside of Digitalis purpurea—is indicated
' in general in the treatment of those conditions which respond to digitalis leaf or
other drugs of the digitalis group . . . both for rapid digitalization and for
maintenance.
[Tablets of 0.1 mg. and 0.2 mg., bottles of 100.
Descriptive literature and a trial supply available on request
Pr5  m Qj?Co/rtf>am/o£'Camrdr.JJL
WINDSOR, ONTARIO
Detroit
•        New York       •       Kansas City       •       San Francisco
*       Sydney, Australia       *       Auckland, New Zealand
Atlanta
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flfoount pleasant TUnbertafcing Co. Xtb.
KINGS WAY at 11th AVE.
Telephone FAirmont 0058
W. E. REYNOLDS
VANCOUVER, B. C
EXCLUSIVE flfllBUUMCE
*! SERVICE    I :■
VANCOUVER: 13th Avenue and Heather Street        f Air. 0080
NEW WESTMINSTER: 814 London Street flUJ.  60
We Specialize in Ambulance Service Only
J. H. GRELLIN W. L. BERTRAND
mm THE MOST RECENT ADVANCE
IN OBSTETRICAL ERGOT
Indicated in Postpartum Haemorrhage
Postpartum Atony etc.
"Our experience  with Methergine has convinced us
that it is a useful, potent oxytocic of great value."
Roberts*
Ampoules of 1 cc. ( = 0.2 mg. of d-lysergic acid-d-l-hydroxybuty-
lamide-2)  for i.m., i.v., or s.c. injection.  Boxes of 6 ampoules.
H
* H- $|
i
*P. C. Roberts: W. Jnl. Surg., Obs. & Gyn. 52, 380,  1944
D. G. Tollefson: Ibid  52, 383.   1944
A. C. Kirchhof ef ah Ibid  52,  197,  1944
E. P. Farber: Am. J. Obs. & Gyn.      .     . 51,859,1946
•   •   •   •
SANDOZ
PHARMACEUTICAL DEPARTMENT
The WINGATE CHEMICAL Co. Ltd.,
Montreal
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a-
ESSENTIAL ADAPTABILITY
for
RADIOGRAPHY
1 FLUOROGRAPHY
! FLUOROSCOPY
Ease of operation is emphasized
in this smooth, quiet, motor-
driven tilt table. The welded
chassis and aluminum alloy base
present a unit of unequalled
strength and durability. Tilt
Table "B" permits a degree of
flexibility never before attained.
No projections hinder manipulations on the operating side of the
table.
The KELEKET Tilt Table "B"
Virtually a complete absenc
toe   obstructions  permits
close contact at the table.
Angles of tilt may be mind
adjusted from 15 degrees 1
delenburg position to verticil
Designed  to  meet  all reqi
ments of the exacting posit
so necessary for thorough
accurate radiological work,
Table "B" has proven to be d
pletelv adaptable.
The   new   KELEKET  Mulj
Exposure Tunnel assures peii
spot film procedure.
AVAILABLE ATTACHMENJ
Fully adjustable head clai
double roller compression bl
and foot rest.
Doctors and Institutions throughout America have  bailed the Keleket Tilt Table "B" as onA
of the most worthy members of the famous Keleket line of complete units.
H
b A V E
DO
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P © Rt
R 0.   TOR O f*T©   S
MONTREAL
QUEBEC   CITY
EDMONTON
VANCOUVER
CALGARY
W1NNI
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•M-WKCML v'&^sIrS
ATT
T&kJO
m&
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SRE IS
:.*S.v5
{A New Synthetic Antihistamine]
Agent for the treatment of
rfttenfcf
INDICATIONS
Hay Fever - Urticaria - Pruritus - Urticarial Dermatitis - Anaphylactic Reactions
Serum   Sickness   -   Vasomotor  Rhinitis
PRESENTATION
i   Neo-Antergan is presented in tubes
1 50 coated tablets each containing 0.
Ik Gm. of acid maleate of N-dimethyl-
amino-elhyl-N para-methoxy-
[ benzyl-amino-pyridine.
■mm
of
1
In the near future:
Neo-Antergan TableKv-05 Gm.
Neo-Antergan Ampoules 0.05 Gm.
OF      CANADA       llMITED-MO/VrP£>]Z
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4 r.
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ANNOUNCING
A\
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nOAAJL
3,4-bis-(m-methyl-p.proplonoxyphenyl) hexane
ORALLY POTENT SYNTHETIC ESTROGEN
Economic estrogenic therapy is now available to physicians
without the hazards of patient discomfort and imperfect relief
of menopausal symptoms.
OUTSTANDING ADVANTAGES
# Relieves menopausal symptoms promptly.
# Restores sense of well-being.
# Unpleasant reactions virtually unknown.
# Exceptionally economical.
Comprehensive clinical studies in outstanding medical centers
attest the estrogenic potency and clinical dependability of
Meprane. Prompt relief of menopausal symptoms was reported
in a large series of cases, patients usually experiencing partial
remission of symptoms during the first days of treatment. Un-
pleasant reactions are virtually unknown.
Dosage : In the menopause, initial therapy—3 tablets daily;
maintenance therapy—1 to 2 tablets daily.
PACKAGING: Boxes of 30 and 100, 1 mg. (1-65 gr.) tablets, individually wrapped. Literature and samples on request.
j\
SUphOA/UL • FOR  MENOPAUSAL WELL-BEING
REED & CARNRICK (CANADA) LTD.
TORONTO. ONTARIO. CANADA
J*    J
■warn Constant Carefulness
Oniy|l an understanding ^professional
skill 1|ould maintain the confidencllpf
the Medical Profession which we enjoy.
Phone MArine 4161
Leslie G. Henderson Gibb G. Henderson
MIOHT
GEORGIA PHARMACY
L. I M  I T E D
W.OSOKOIA
fTRilT
(HmUx & 1 atin a SJfit
ESTABUSHID IMS
VANCOUVER, B. C.
fc
North Vancouver, B. C.
Powell River, B.C.
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New Westminster, B. C.
For the treatment of
NEUROPSYCHIATRIG
DISORDERS
Rfference-4-B. C. Medical Association
For information apply-ijjtt&t
Medical Superintendent, New Westminster, %C
New Westminster 288
or 721 Medical-Dental Building, Vancouver, B. C.
PAcific 7823 PAcific 803 6
§§H11
>27
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