History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: November, 1953 Vancouver Medical Association Nov 30, 1953

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The Vancouver Medical Association
dr. j. h. MacDermot
Publisher and Advertising Manager
OFFICERS 1953-54
Dr. D. S. Munroe Dr. J. H. Black
President Vice-President
Dr. George Langley
Hon. Treasurer
Dr. E. C. McCoy
Past President
Dr. F. S. Hobbs
Hon. Secretary
Additional Members of Executive:
Dr. R. A. Gilchrist Dr. A. F. Hardyment
Dr. G. H. Clement Dr. Murray Blair Dr. W. J. Dorrance
Auditors: R. H. N. Whiting, Chartered Accountant
Eye, Ear, Nose and Throat
Dr. W. M. G. Wilson Chairman Dr. W. Ronald Taylor Secretary
Dr. J. H. B. Grant.
.Chairman Dr. A. F. Hardyment Secretary
Orthopaedic and Traumatic Surgery
Dr. W. H. Fahrni Chairman Dr. J. W. Sparkes Secretary
Neurology and Psychiatry
Dr. A. J. Warren Chairman Dr. T. G. B. Caunt Secretary
Dr. W. L. Sloan Chairman Dr. L. W. B. Card Secretary
Dr. D. W. Moffat, Chairman; Dr. R. J. Cowan, Secretary; Dr. W. F. Bie;
Dr. C. E. G. Gould ; Dr. W. C. Gibson ; Dr. M. D. Young.
Summer School
Dr. S. L. Williams, Chairman; Dr. J. A. Elliot, Secretary;
Dr. J. A. Irvine; Dr. E. A. Jones; Dr. Max Frost; Dr. E. F. Word
Medical Economics
Dr. E. A. Jones, Chairman; Dr. W. Fowler, Dr. F. W. Hurlburt, Dr. R. Langston,
Dr. Robert Stanley, Dr. F. B. Thomson, Dr. W. J. Dorrance
Dr. Henry Scott, Dr. J. C. Grimson, Dr. E. C. McCoy.
V.O.N. Advisory Committee
Dr. Isabel Day, Dr. D. M. Whitelaw, Dr. R. Whitman
Representative to the Vancouver Board of Trade:  Dr. J. Howard Black
Representative to the Greater Vancouver Health League: Dr. W. H. Cockcroft
Published  monthly  at  Vancouver, Canada.    Authorized  as  second   class   mail,  Post  Office  Department,
Ottawa, Ont.
Page 67 (suspension "sterile" and ointment)
curbs eye inflammation
combats eye infections
protects   injured   eyes
Cortomyd is the only ophthalmic preparation containing cortisone and sodium sulfacetamide.
It acts safely, rapidly, and is well
Cortomyd can be used for its
anti-inflammatory and anti-bacterial effects without interference with normal use of the eye.
Symptomatic relief is obtained
often in minutes, infection controlled frequently within hours.
1.5% (15 mg. per cc) cortisone
with 10% (100 mg. per cc)
sodium sulfacetamide (SODIUM
5 cc. dropper bottle. Ophthalmic
Suspension Sterile; Vs ounce tube
Ophthalmic Ointment.
\tmtMtf  «ra
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.
Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
Thursday, 9:00 a.m.—Medical Clinic.
12:00 noon—Clinicopathological Conference on Newborns.
Friday, 9:00 a.m.—Paediatric Clinic.
Saturday, 9:00 a.m.—Neurosurgery Clinic.
Regular Weekly Fixtures
2nd Monday of each month—2 p.m Tumour Clinic
Tuesday—9-10 a.m Paediatric Conference
Wednesday—9-10 a.m i Medical Clinic
Wednesday—11-12 a.m Obstetrics and Gynaecology Clinic
Alternate Wednesdays—12 noon Orthopaedic Clinic
Alernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion)
Friday—8  a.m. Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m Surgical Conference
Friday—9 a.m Dr. Appleby's Surgery Clinic
Friday—11  a.m. Interesting Films Shown in X-ray Department
Regular Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology. Monday, 11:00 a.m.—Psychiatry.
Wednesday, 10:45 a.m.—General Medicine. Friday, 8:30 a.m.—Chest Conference.
Wednesday, 12:30 p.m.—Pathology. Friday, 1:15 p.m.—Surgery.
2656 Heather Street
Vancouver 9, B.C.
MONDAY—9:00 a.m.-10:00 a.m.—Nose and Throat Clinic.
TUESDAY—9:00 a.m.-10:00 a.m.—Clinical Meeting.
10:30-12:00 noon—Lymphoma Clinic.
THURSDAY—11:00 a.m.-12:00 noon—Gynaecological Clinic.
DAILY—11:45 a.m.-12:45 p.m.—Therapy Conference.
Page 71 not...
each fablet contains:
*Bone Meal 5 gr.
Ferrous Sulphate 5gr.
Vitamin  A 500 I.U.
Vitamin  D 400 I.U.
Vitamin C --     25 mg.
Thiamin Mononitrate ------- 0.75 mg.
Riboflavin 0.75 mg.
Niacin 5.0    mg.
Potassium Iodide 0.5    mg.
Copper Carbonate   ------- 0.1    mg.
Manganese Glycerophosphate •    -    •      0.1    mg.
*Bone meal contains:
Calcium  __ „ 25%
Phosphorus -._ 11%
Fluorine    .0.25%
Dosage: One tablet two or three times daily after meals. Availability: Bottles of 100, 500,  1000.
Representatives: Mr. F. R. Clayden, 3937 West 34th Ave., Vancouver 13, B.C.
Mr. Vic Gamham, 3228 West 34th Ave., Vancouver 13, B.C.
Mr. R. W. Fisher, 340 Island Highway, R.R.1, Victiria, B.C.
Page 72 In this issue we publish a short article by an old friend of the Bulletin's, Dr. Frank
Hebb, from whose pen we have from time to time received stimulating and thought-
provoking offerings, well worth our reading and consideration.   This is no exception.
In the limited space at his disposal, as he says, it is impossible to cover the subject
at all adequately—we must fill in the gaps for ourselves, and we feel that many of our
readers will find pleasure and stimulation in doing so.
Dr. Hebb's main complaint, as we see it, is against the modern tendency, unfortunately increasing, towards standardization—not only in the employment of personnel and
so on, of which he speaks, but in our thinking generally, and in our attitude towards
Science and towards life in general. He does not like the passion for yardsticks, which
seem to appeal so much, not only to the unthinking, who find in them a great saving
of labour and a great convenience, but even to those whose scientific training should
teach them that there is no such thing as finality, except the finality of death.
Nor is he alone in this uneasiness, though it is difficult to avoid this tendency. In
ordinary life, we must have standards and measures of all kinds: it is hard to see how
business, education and so on could get along without them. But this is not, we think,
what Dr. Hebb means. These standards must be our servants and not our masters, and
we must use them merely for a temporary convenience. The danger is in feeling that
standards mean anything more than this. There are no absolute standards, in fact: and
we can never settle back and feel that when we have reached a certain point, we are at
the end of our search.
The greatest minds of history have been those who were never satisfied, and to
whom every new discovery, was merely a challenge to see if they could not prove it
untrue. The greatness of Einstein lies in the word "Relativity" which describes his
greatest contribution to the world of thought.
Dr. Hebb has pointed out justly some of the dangers of standardization. Probably
the worst is the danger of stunting growth, of blocking progress, of curbing that most
precious of human gifts, curiosity. In our schools, with their masses of scholars, in our
colleges with too many students to too few teachers, in our industries, the emphasis is on
conformity, and the unsatisfied discontented soul is an object of grave suspicion. And
yet, as De Nouy has said in his "Human Destiny", the progress of the race depends
upon these few dissatisfied and unsatisfied spirits, who through history have been the
torchbearers for human progress. As De Nouy says, and as physics shows, satisfaction
means inertia and ant-like uniformity, death.
There is nothing to be said against scientific research, as such. It is our one hope
of lifting the veils that hang between us and the truth, as far as science goes. But, as
L. J. Walshe, the well-known psychologist and psychiatrist says, research by itself is
dangerous, unless we have minds that can integrate the facts that we find out by
scientific research. He quotes Sherrington as an outstanding example, whose great gift
to medicine was that he integrated his physiological and anatomical knowledge into a
functional whole. We should never have had penicillin, if Fleming had merely been
content to note that germs were destroyed when exposed to dusty air, and had not
asked the eternal question "why?" It is this "why?" which distinguishes man from the
And lastly, Dr. Hebb puts an unerring finger on the real problem, when he says
that man is much more than a reasoning being, or a scientific inquirer: and that science,
as he quotes Max Planck, is expressing one side of man's nature, and only one side. The
great scientists admit, nay they insist, that man is much more than the sum of the parts
into which we can objectively analyse him.  He is body, mind and spirit, and no matter
Page 75 how we may shrink from facing the fact, the last named transcends the others—and
cannot be defined in standard terms: and we run the risk of eternal death when we fail
to see this, and what is more, we miss most of the meaning, and perhaps all the beauty
of life.
1201 Pendrell Street,
Vancouver, B.C.,
September 28th, 1953
The Editor, The Bulletin of the Vancouver Medical Association,
1807 West 10th Avenue
Vancouver, B.C.
In the interests of all unborn sons of Vancouver and of not a few of their prospective parents, may I, as a humble observer, be permitted to voice a protest against the
routine operation of circumcision?
Any thoughtful person, especially if he believes that he is resident in "God's own
country", must find it difficult to believe that the Creator could have made such a
botch of the organ par excellence, that about 90% of these finished members should
require correction, yet in Vancouver this percentage of circumcisions is being carried out
on infant boys, not always with wholehearted parental approval.
Gairdner (Brit. Med. J. 1949, 2, 1433) showed that the development of the prepuce
continued for the first few years of life, and that only 10% of prepuces would fail to
attain retractability by the age of three years, and that in most of the remainder correction could be obtained by gentle manipulation.
Denis Browne (Brit. Med. J. 1950, 1, 181) in support of Gairdner's teaching, said
that for many years he had performed fewer straightforward circumcisions than operations designed to correct or mitigate the results of previous attacks on the foreskin.
More recently a leading article in the British Medical Journal (1952, 2, 766) concluded as follows:
"When the medical profession has realized that circumcision in the first three years
of life is an unnecessary operation, the parents will soon be dissuaded from requesting
it. The matter is not important enough for a national propaganda campaign addressed to
the laity, who already suffer from a surfeit of exhortation. If those who teach paediatrics
to medical students and those who lecture to midwives would remember to condemn the
operation as a treatment for the non-retractable prepuce of the infant, routine circumcision would again be no more than a religious ritual and an anthropological
If carcinoma of the penis were a common condition (according to Dean (1935) J.
Urol., 33, 252, carcinoma of the penis forms 1.25 per cent of all malignant tumours
found in the male) and if the essential precursor were a retractable foreskin, rather than
filth, balanitis, or venereal disease, there might be a case for preventive routine circumcision. There appears to be no evidence however that carcinoma of the penis cannot be
prevented by the liberal use of soap and water. The rarer, but similar, carcinoma of the
umbilicus is said to be due to the irritation of retained umbilical sebaceous material and
its calcified fragments or calculi, and it is probable that routine excision of the umbilicus, or even of the deep type only, would give absolute protection; again there is
not the slightest reason for believing that soap and water would not be equally efficacious.
As a preventive of cancer however, there certainly seems to be more justification for
excision of a deep, and difficult to clean, umbilicus than of a normal retractable prepuce.
I have spoken to numerous parents in Vancouver whose baby boys were circum-
cized, not because they wished this to be done, but because they were led to believe that
it was desirable, and to a few who have incurred the displeasure of their doctors by
refusing to allow the operation to be performed.  Because of the frequency with which
Page 76
H the operation is being carried out on the newborn, meatal ulcers are a commonplace at
the Well Baby Clinics here. Gairdner, in the article already referred to, remarked that
it second to be no accident that during the years when the child is incontinent the
glans is completely clothed by foreskin, and that meatal ulcer is almost confined to cir-
cumcized male infants.
Last week I examined a six-year-old boy who has become so embarrassed and unhappy about his normal foreskin, since acquiring two circumcised foster brothers, that
his mother is giving serious consideration to the question of circumcision.
If routine circumcision is, as it seems to be, an unnecessary operation, then, in a
commimity where about 90% of boys are being circumcised, perhaps there is something
to be said for removal of the embarrassing, if not tight, foreskins of the odd 10% or so
who previously slipped through the net?
I am sir,
Yours truly,
W. B. LAING, M.B., Ch.B.
+ + +
Editor, Vancouver Medical Association Bulletin,
1807 West 10th,
Vancouver 9, B.C.
Dear Sir:
Re: V.O.N.
Occasionally a lack of continuity develops in the care of patients after they have
left hospital.  I wish to draw to the attention of the Profession in Vancouver the importance of notifying the V.O.N, promptly about discharge of patients from hospital where
the services of the Order are required.
This can be done by telephoning CEdar 4151 or by dropping a note in the mail.
The V.O.N, would appreciate receiving salient facts about the cases which would assist
in the nursing care.
Yours sincerely,
Medical Advisory Committee V.O.N.
+ + +
_L ^ ■_»/
Library Hours:
Monday to Friday - 9:00 a.m. - 9:00 p.m.
Saturday 9:00 a.m. - 1:00 p.m.
Recent Accessions:
Clinical Management of Behaviour Disorders in Children by Backwin and Backwin. 1953.
Standard Values in Blood by Errett C. Albritton (Ed.)  1952.
An Atlas of Surgical Exposures of the Extremities by Sam. W. Banks and Harold
Laufman. 1953.
Page 77 Histology by Arthur W. Ham. 2nd ed. 1953.
Bone Tomors by Lohis Lichtenstein.  1'52.
Surgery of the Pancreas by Cattell and Wayne. 1953.
Fourth Annual Conference on the Nephrotic Syndrome—Nationas Nephrosis Foundation Inc., N.Y. 1952.
Manual for Sanitary Inspectors by Robert D. DeFries.   1947.
The Control of Comunicable Diseases in Man. American Public Health Association. 7th
ed. 1950.
Surgical Forum.  Clinical Congress of the American College of Surgeons 1952.
Medical Library Association—1st Pacific Northwest Conference:
On October 10th, 1953, the Librarians attended the 1st Pacific Northwest Conference of Medical Librarians, which was held in Seattle. Mr. Alderson Fry, Librarian of
the Health Sciences Library, University of Washington, acted as host to the visiting
Librarians, who were about twenty-four in number.
During the conference, which was held in the Health Sciences building, Mr. Fry
discussed plans to decentralize library resources and to set up duplicate holdings in areas
considered unlikely to be targets in the event of an atomic attack.
The scheme would be organized by members of the Medical Library Association on
a voluntary basis. Those libraries designated would have first call on duplicate material
offered on exchange lists; this material to be immediately available to libraries suffering
losses due to enemy action.
A resolution was passed during the meeting to the effect that those members of the
Medical Library Association attending the conference wished to form a regional group,
subject to the approval of the Association. It was agreed that an annual meeting of the
group should be held in a central location, possibly Seattle.
A Thought for Christmas:
Misleto. VISCUM
"I think that Misleto is so well known, that it is needless to describe it. The
La tines call it VTSCUS, and VISCUS, and so is the Birdlime called that is made of the
berries.  The Misleto of the Oak is called VISCUS QUERCINI and so of the rest.
Nature and Vertues
Misleto is hot and dry in the third degree, the leaves do heat and dry; and are of
subtle parts; and questionless participates of the nature of that Tree it grows upon; as
that which grows upon the Oak partakes of the nature of he Oak, and therefore is
ascribed to JUPITER, and is most effectual. It is held to be very effectual for the
curing of the Falling Sickness, and is by some prescribed to be taken in Pills thus prepared, Rx Visci Quercini, seeds and roots of Piony, ana 3 ijs. Nutmeg, Anniseeds, ana
3 i, js Sacchari Buglossati 3 vii. make pills thereof.
GERRARD saith, being taken inwardly, it is mortal, I never did prove any of it,
but only the Birdlime upon Birds, and I am sure that hath proved mortal unto them."
(Extracts from "The British Physician or the Vertues of English Plants." Author unknown.  Circa 1700.)
October 15, 1953—POWER, Phillip George, P.M.Q. 87, R.C.A.F. St., Comox, B.C.
October 26, 1953—ROBINS, Richard Edward, No. 832 925 W. Georgia St., Vancouver,
British Columbia.
October 30, 1953—MOORE, Peter, Sydenham, 1201 8th Ave., New Westminster, B.C.
No thinking individual lacks due respect for the advances of engineering and the
laboratory. However, in this age of fascination with mechanics should anyone step over
the line into, say, the field of abstract thought or let him roam across the boundaries of
compartmentalized learning, he may then be looked upon as eccentric. Let him go
beyond the realm of specialization and fail to adhere to irreducible and stubborn facts
and he is classified as impractical. The practical man in other words, seems to have about
all the genius which this age can afford. The long and short of it is that modern man
has no need of a ghostly metaphysical world inhabited by beautiful theories. Like the
musical banks in Samuel Butler's EREWHON, they make a delightful noise but they
cash no cheques.
No modern doctor, however, wishes to return to the abstruse philosophical climate
of the Middle Ages. They had few or no statistics, which was an unquestionable handicap. But we, their successors, are also handicapped the moment we discount the value of
any convictions not directly correlated with factual data . . . Take for example one of
our most frequent pitfalls, that of "type-casting". It is a reliance on "the familiar" and
can be found wherever there is an obvious technical advantage in classifying human
beings. The extensive personnel testing of persons who apply for work in large-scale
industry illustrates the growing habit of "typing" people according to their superficial
attributes. There is no real harm of course in trying to determine people's special
capacities but inevitably the factors which are important to an employer of labour
assume greater importance than the human qualities of individuals. The tests are devised
to anticipate the probable dollars-and-cents value to a prospective employer of a man
or woman at a given occupation. Often, however, larger implications than the "skill"
or "temperamental traits" of the tested individuals are read into the results of these
tests. The psychology of the tests also, is largely in terms of fixed norms or values.
They seek to establish what a man is, not what he may be trying to become. Their
general effect on human beings therefore is in terms of "status-quo-ism".
This attitude is not only flourishing in many places but seems to be doing so with
the full consent of the psychologist. True, intelligence tests have been improved in recent
years; but they will become significant only when the results of the tests are given in
their proper context. The affirmation that A's intelligence quotient is higher than B's
tells us, as it stands, very little. But one must admit, that, imperfect as it is, it has done
something to give statistical form and content to the universally held conviction that
some people are stupider than others. Today, a lazy student who receives a failing grade
is likely to be diagnosed as maladjusted. Similarly, the "well-adjusted" personality rates
high in any listing of virtues. Then the term "well-integrated" personality is beginning
to appear on recommendations. It could be that well-adjusted people are those who never
give any trouble, well-integrated may mean only a person without any individuality or
ideas ... A story is told of a querulous psychologist who underwent 221 hours of psychoanalysis for a Rockefeller Foundation inquiry. During it the psychologist asked his
analyst "What is normality?" "I don't know," the analyist replied. "I never deal with
normal people." The psychologist persisted: "But suppose a really normal person came
to you? The analyst admitted: "Even though he were normal at the beginning of the
analysis, the analytic procedure would create a neurosis."
It seems to be a great mistake to divide people into sharp classes, namely, people
with such-and-such a knack or those without or into such-and-such type of personality.
These trenchant divisions are disturbing. Fortunately, however, psychology's and psychiatry's members are not all positivists. There are many among them who make metaphysical assumptions and are very cautious in keeping away from "Pointer-readings" and
who try to avoid the psychological straight-jacket method of labelling personality. Actually many of our modern psychologists and psychiatrists are beginning to penetrate some
of the basic mysteries of man's psychic life, and like true discoverers, some of them are
becoming men with sincerity of purpose—men with something to say, who insist on
Page 79 being heard. But obviously there are many shortcomings in this perennially absorbing
field and one keeps hoping that in the not too distant future some new method of
approach or technique of study will be added to the vast literature on the subject of
personality. If they fail, their failure is at least more admirable than the behaviour of
those who have not even tried.
In short, Medicine can never become an exact science unless all the variables can be
estimated and allowed for, unless the personal element can be eliminated and unless each
patient can be reduced to a standard form. As things are, the normal variations in
individuals have such a wide range that both the automatic interpretation of facts and
the mechanical prescription of treatment are prohibited. John Ryle wrote "variability is
one of the most distinctive and necessary attributes of life which admits of no constant
and no norm."
Only too often as medical practitioners our vision becomes so restricted that we
can see only a single means of curing ailments, a certain form of diet, a particular medicine, some electrical method of treatment, or an ingenious operation. Health entails,
after all, a balancing of all our functions as well as adjustments between ourselves and
the outside world. If this balance and adjustment is upset, it can rarely be restored by
the use of any single remedy . . . When Max Planck was invited to describe the role of
Science in human life he replied that Science was 'a constructed work of art expressing
a certain side of Man's Nature.' This definition acknowledged that there are many sides
to Man's Nature which cannot find expression in Science. We have not only a scientist
within us, but also a poet, an artist and even traces of a potential saint. It is for each
of us to discover how the growth of the less developed sides of our nature can be encouraged so that we may live life richly and well. Eric Gill once said that an artist is not
a special kind of man, but that every man is a special kind of artist. Indeed, too many
of us think of everything in terms of our own science and turn a blind eye to eveiything
else. There is a rather pathetic entry in Charles Darwin's diary—"My mind seems to
have become a kind of machine for grinding general laws out of large collections of
facts but why this should have caused the atrophy of that part of the brain alone, on
which the highest tastes depend, I cannot conceive . . . The loss of these tastes is a loss
of happiness, and may possibly be injurious to the intellect and more probably to the
moral character by enfeebling the emotional part of our nature."
One recalls medical school days, during which time we were required to burden our
memories with so large a number of relevant facts that we simply dare not take the risk
of taxing our minds with too much extra curricular reading or thinking, for fear lest it
crowd out some of the knowledge of importance. Pre-eminently this was a period in
one's life, eighteen to twenty-three years of age, when future tastes and interests are
formed . . . To-day it is heartening to find a decided step forward in some medical
schools where opportunity is given for the development of a more liberal education.
Deprived of this as a youth, a doctor remains limited as a man on account of the arduous
conditions of hospital and private practice which preclude the chance of repairing the
limitations which lack of an all-round education has imposed. In the August '52 issue
of the "Canadian Doctor" the editor has this to say: "The major concern of the doctor
of tomorrow will be to look upon a patient as a 'whole human being'. Unless we limit
ourselves to research in a special field we must be careful to avoid the development of
compartmentalized minds. It has never been enough for any doctor to confine himself
to the context of textbooks of medicine. At the present time we are more aware than
ever that artificial barriers to thought must be broken down, not only within the science
of medicine itself, but also where they tend to isolate medicine from related Arts and
Sciences. The ultimate goal after all is, as Myerson stated it, 'to understand Man'."
Science can satisfy many of our needs but not those of the Spirit. If our sense of
the meaning of things is not developing then we are not developing; for what is left of
a man when you leave out his ideas and feelings about the meaning of life? In medicine
we might do well to study the fact, the theory, the alternative and the ideal, i.e., stretch
the mind in all directions in order to avoid falling into unsuspected provincialisms of
opinion.   The modern sage — A.  N. Whitehead,  has  written that philosophy asks
Page 80 the simple question "What is it all about?" He defines speculative philosophy as the
endeavour to construct a system of general ideas "in terms of which every element
in our experience can be interpreted." This does not mean that there should be less
study of work and more study of thought, i.e., educational escapism, where education
becomes an end in itself . . . Rather, that we make a new and vigorous effort to foster
in ourselves a wise philosophy of the science and the art of medicine, in the hope that
there may result therefrom the greatest of all gifts that the physician can possess—
Lastly, this article is far too short for so vast and complex a subject and it goes
without saying that the task has been inadequately performed. However, I make no
excuses for attempting it ... A brief theory is better than no theory at all.
This mental hygiene division has been functioning for 14 years under the direction
of Dr. C. H. Gundry, and it was felt that readers of "The Bulletin" might like to know
more about its structure and function.
The present staff comprises two psychiatrists, two psychiatric social workers, and
two psychologists.
In the work of the Division, the goal of prevention is expressed in two ways: first,
through working directly with children and parents, and secondly, through education
of others who deal with children. Even in direct help, policy is directed towards making
the mental hygiene work an integral part of the total public health programme. Although help is given to the child mainly by advising the nurse, teacher, and parents,
more intensive treatment is provided in selected cases. This includes psychotherapy in
the playroom and social case work. Two children considered to be definitely psychotic
have shown encouraging progress over the past year and a half with this type of help.
On the more educational side of the work, close cooperation with the schools is promoted through the school nurse and case conferences.
In 1952, almost 300 new cases were seen—130 of these were referred by the school,
while 55 were referred by the private physician. More than half the cases were in the
6 to 10 year age group, with the remainder falling mainly into the pre-adolescent and
adolescent range. 18 pre-school children were seen, and more of these would be welcome
since more serious difficulties can often be prevented by helping children when they are
younger. In fact, limited attempts are being made at present to increase mental hygiene
service in the well baby clinics.
Prominent presenting complaints in 1952 included poor school progress, poor group
factors, anxious parents occurred frequently, and the style of parental care was often
critical. Treatment recommendations ranged from individual treatment at our own
clinics to general supervision by the public health nurse.
In recent years it has been encouraging that an increasing proportion of cases have
come on the initiative of the parents or on the advice of their physicians. Similarly,
the referrals have shown an increased emphasis on the child who needs help rather than
on situations where the child needs managing. However, it is recognized that these
categories may not be mutually exclusive.
This mental hygiene division serves the metropolitan area of Greater Vancouver
including Burnaby, Richmond, and the North Shore. Although the special role of this
Division is seen in cases in which liaison with the school is particularly important, the
opportunity to cooperate wth private physicians in the study and treatment of mental
hygiene problems is always appreciated.
1807 West 10th Ave., Vancouver, B.C.      Dr. G. Gordon Ferguson, Exec. Secy
OFFICERS  1953-1954
President—Dr. R. G. Large ___Prince Rupert
President-Elect—Dr. F. A. Turnbull Vancouver
Immediate Past President—Dr.  J.  A.  Ganshorn Vancouver
Chairman of General Assembly—Dr. G. C. Johnston Vancouver
Hon. Secretary-Treasurer—Dr. J. A.  Sinclair New Westminster
Dr. J.  F. Tysoe
Dr.  E. W. Boak
Dr. C. C. Browne
Prince Rupert and Cariboo
Dr. J. G.  MacArthur
New Westminster
Dr. J. F. Sparling
Dr.  D. G.  B. Mathias
Dr. S. C.  Robinson
Dr. A. S. UnderhHI
Dr.  Ross Robertson
Dr.  R. A. Gilchrist
Dr. J. Ross Davidson
Dr. R. A. Palmer
Dr. A. W.  Bagnall
Dr. P. O. Lehmann
Dr. Roger Wilson
Chairmen of Standing Committees
Constitution and By-laws » Dr. Carson Graham, North Vancouver
Finance Dr. J.  A.  Sinclair,   New Westminster
Legislation. Dr. J. C. Thomas, Vancouver
Medical Economics . Dr. P. O. Lehmann, Vancouver
Medical Education Dr. Charles G. Campbell, Vancouver
Nominations Dr.  R. G. Large,  Prince  Rupert
Programme & Arrangements Dr.  Myles Plecash,   Penticton
Public Health Dr. J. Mather, Vancouver
Chairmen of Special Committees
Archives Dr. J. H. MacDermot, Vancouver
Arthritis and Rheumatism Dr. F. W. B. Hurlburt, Vancouver
Cancer Dr.  Roger Wilson, Vancouver
Civil Defence Dr. John Sturdy, Vancouver
Ethics Dr. Murray Baird, Vancouver
Hospitals Dr. F. A. Turnbull, Vancouver
Industrial  Medicine Dr.  W.  S.  Huckvale, Trail
Maternal Welfare Dr. A. M. Agnew, Vancouver
Membership   Dr. L. Fratkin, Vancouver
Nutrition Dr. J.  F. McCreary, Vancouver
Pharmacy Dr. B. T. Shallard, Vancouver
Public Relations _ Dr. A. W. Bagnall, Vancouver
Advice in Prescribing for Social Assistance Cases
The last few years have seen a steady increase in the cost of prescribing drugs to
Welfare cases. This is to be expected in view of the increased coverage and the continuing utilization of these services by the public. In general, the rising cost of drugs
is a reflection of the increasing demands on the profession by the group of persons covered
by the service.
A Committee has been set up by the Canadian Medical Association—B.C. Division
in co-operation with the Government of British Columbia to ensure that all persons
receiving Social Assistance have access to drugs necessary for the treatment of any
disease condition. At the same time the Committee has undertaken to reduce, if possible,
wastage of drugs and the prescribing of unnecessarily expensive drugs.
The new 1953 edition of the B.C. Formulary has been expanded beyond the revision
of 1947 and contains all drugs which are considered necessary for the treatment of
Beginning January 1, 1954 the basis of prescribing for Social Assistance cases is the
1953 edition of the B.C. Formulary qualified by the following list of drugs which are
henceforth to be provided by authority of the Committee of the Canadian Medical Association—B. C. Division.   Therefore, drugs which were formerly not available to
Welfare cases are now to be made so.
The drugs requiring authorization are divided as follows:
GROUP (A)  can be obtained only by authority of the Committee.
to 7-61 inclusive
to 8-46 inclusive
to 8-98 inclusive
GROUP (B) can be obtained up to the amount of 16 capsules from any pharmacy.
Further prescriptions will be filled upon authorization of the Committee.
GROUP  (B)   6-30 to 6-50 inclusive.
GROUP (C) can be filled to the extent of one month's supply by any pharmacist.
Subsequent prescriptions will be filled by authority of the Committee.
10-60 to 10-75 inclusive
Prescriptions which are to go through the Committee should be attached to the
i special form provided which contains space for the diagnosis and reasons for the request.
These should be mailed to the Medical Services Division, Department of Welfare, 635
Burrard Street, Vancouver, B.C.
Property and business located in Vital Centre in B.C. Licensed for
medical and convalescent cases. Annual Gross Volume $51,000.00.
Only one other hospital similar in area. Established 20 years. Fully
equipped for pre and post operative cases. Established connection
between clinics and doctors, the facilities available to all Licensed
Practitioners in B.C. This hospital is now operated by a qualified
matron. The account show over $7,000.00 net profit in 1952 without
owners salary. Terms $22,500.00 down. Full price $49,500.00. For
further particulars contact Mr. B. Good, MArine 6421—night or day.
530 Burrard, Vancouver, B.C.
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health, Province of British Columbia
A. M. GEE, M.D.,
Director, Mental Health Services, Province of British Columbia
Since the discovery of streptomycin and the subsequent introduction of chemothera-'
peutic agents in the treatment of tuberculosis a tremendous experience has developd in
the use of these agents, which in a short period of time has entirely changed the concept
of the treatment of this disease. Where formerly the objective was to achieve arrest of
the disease through rest and collapse therapy, it is now the aim to eradicate tuberculosis
by antimicrobial therapy and pulmonary resection.
Having overcome the development of resistance of the tubercle bacillus to streptomycin through combined therapy with P.A.S. these agents are widely used and broadly
speaking the present indications for therapy are that if a patient needs treatment for
tuberculosis he should receive antimicrobials. Treatment is usually carried on for a
minimum of one year, but often continues for two years or longer.
Streptomycin—Toxic effects and drug fastness which were a major concern when
this agent was originally introduced have been greatly reduced and now are not of
serious consideration.
Streptomycin is now administered 1 gm. in 3.5 cc. of normal saline intramuscularly twice weekly for a period of one year.
P.A.S. is given by mouth in three gram doses repeated three or four times a day,
so that a total of 9 to 12 grams are given daily. This is given together with streptomycin
to prevent development of resistance of the tubercle bacillus to streptomycin. The combination of the two drugs is also more effective when given singly.
Dihydrostreptomycin is used in the same dosage as streptomycin and appears to be
equally effective against the tubercle bacillus. It can be used as a substitute for streptomycin except for intrathecal injections. Dihydrostreptomycin may cause permanent
auditory nerve damage with resultant deafness, but not usually in dosages of one gram
twice a week.
Isoniazid (isonicotinic acid hydrazide or I.N.H.). This chemotherapeutic agent
has been in use now for almost two years, and has proven to be effective against tuberculosis, possibly even more effective than streptomycin in the early responses up to one or
two months. However, in longer courses streptomycin and P.A.S. are more effective.
One of the serious weaknesses of isoniazid is that resistance develops rather quickly so
that its effective use is limited. Because of his isoniazid is always used in conjunction
with streptomycin or P.A.S. or both.
This is given orally 152 mgms. to 250 mgms. per day and is used in acute types of
tuberculosis or where streptomycin has failed or is not tolerated.
It should be pointed out that alergic reactions to streptomycin on the part of those
administering the drug are fairly common unless precautions are taken to avoid nebuliza-
tion of the solution.  Hands should be washed carefully after administering streptomycin.
Care should be taken not to squirt air through the syringe and if syringes are boiled after
streptomycin injections one should avoid steam from the sterilizer.   This should be
allowed to cool before opening.
* * *
A new Consultative Cancer Clinic was set up in Nanaimo on October 9, 1953,
to serve cancer patients in the upper island districts.
This is the tenth clinic in British Columbia, the others being at Prince Rupert,
Prince George, Cranbrook, Nelson, Trail, Penticton, Kelowna, Vernon and Kamloops.
By F. GORDON WESTGATE, B.A., M.D., F.R.C.S. (Eng.)
Congenital Haemolytic Jaundice or Congenital Haemolytic Anaemia, basically, is a
Mendelian dominant inherited abnormality of the structure of the red blood cells. It is
inherited without sex-linkage which means either sex can transmit the condition and
either sex can inherit it. In the year 1900 Minkowski first accurately described the condition and in the year 1907 Chauffard first discovered the presence of the increased
fragility of the red blood cells and for that reason this condition is sometimes referred
to as Minkowski's or Chauffard's disease.
A normal erythrocyte is biconcave and does not haemolyse unless exposed to saline
solutions less concentrated than .38%, but the red blood cells in this disease are spherical
in shape and haemolyse in less hypotonic solutions (stronger concentrations of saline)
than this—usually over .42% of saline.
It was once considered that spherocytosis and fragility of the red blood cells was
the primary abnormality conferred on the cell by the bone marrow, however, we know
that the immature red blood cells of the bone marrow and in the peripheral blood in
Congenital Haemolytic Jaundice are normal in size and shape at least. This suggests
that the spherocytes are formed not in the marrow but by the action of some agent in
the circulating blood. It is also known that spherocytes are not found exclusively in
Congenital Haemolytic Jaundice and Dameshek and Schwarz in 1940 showed that spherocytosis, and fragility could both be reproduced in animals by intravenous injections of a
haemolysin. However, normal red blood cells transfused to a patient with Congenital
Haemolytic Jaundice do not suffer lysis, so the haemolysin in this case cannot be one of
a non specific type that affects all red blood cells. This is different in the acquired type
of Haemolytic Aaemia, for normal red blood cells transfused into a patient with such a
condition survive only a short time. Also an acquired Haemolytic Anaemia patient's
red blood cells transfused into a healthy individual survive the normal length of time
whereas a Congenital Haemolytic Anaemia patient's red blood cells transfused into a
normal person are quickly destroyed.
What is the role of the spleen in this condition? Normally one of the main functions of the spleen is the elimination of red blood cells from the circulation. In Congenital Haemolytic Anaemia the red blood cells are abnormally susceptible to destruction
by the spleen and it is quite likely that the splenomegaly is a straight forward over-use
hypertrophy, and the spleen is acting in a normal manner, for splenectomy relieves the
anaemia without usually affecting the fragility of the red blood cells. There are other
theories postulated regarding the role of the spleen in this disease but as yet none have
been proven.
The signs and symptoms of this condition are explained by the destruction of the
abnormal red blood cells by the spleen. The life of a red blood cell in health is about
120 days. If its life span is curtailed appreciably anaemia will result unless the bone
marrow can overwork to compensate. The anaemia stimulates the blood-forming tissues
to produce the red blood cells at a faster pace, with the result that more immature cells
are thrown into circulation causing the reticulocytosis. This increased rate of red blood
cell destruction causes a rise in the plasma bilirubin, haemolysis being normally the main
source of this product. This is the "indirect reacting" bilirubin of the Van den Bergh
test. It has the protein molecule attached to it yet and is sometimes called bilirubin-
globin. It is not excreted by the kidneys and hence an "acholuric jaundice" develops—
literally, a jaundice without bile in the urine. This bilirubin is carried to the liver and
there the protein molecule is removed and it is excreted via the bile into the small
intestine where some of it is changed by bacterial action into urobilinogen.  Some of the
*From paper given to the Vancouver Medical Association at St.  Paul's Hospital on October 20,  1953.
Page 85 urobilinogen is absorbed into the blood and is excreted by the liver and the kidneys. If
the liver function is normal there should be a maintained ratio of excretion between thej
liver and the kidney but if the liver function is impaired a higher proportion of urobilinogen is excreted in the urine. The increased amount of bilirubin being excreted in|
the bile predisposes to the formation of biliary calculi and the obstruction to biliary
excretion by these small calculi along with the impaired nutrition of the liver cells
caused by the chronic anaemia are factors in the cirrhosis and liver damage, that threaten
these patients in later life.
A combination of haemolytic anaemia, reticulocytosis, spherocytosis, increased fragility, splenomegaly and jaundice occurs in no other condition.
One of the puzzles of this condition which remains to be solved is the occurrence
of Crises. A crisis is an acute and sudden onset of illness which occur early in childhood
or not until late in life. A patient in crisis presents with fever, headache, photophobia,
anorexia, abdominal pain, vomiting, pains in various muscles and severe anaemia. Often
there is a history of more than one member of the same family having a crisis within a
short space of time. What initiates the crises is not entirely known, although since the
anaemia varies with the rapidity of haemolysis versus hematopoiesis it is likely that one
factor would be the failure of the bone marrow to keep pace with the spleen. Quite
probably infection plays a part too, which would help explain the serial onset of the
crises in the same family.
The crises may be very severe and the younger the patient is when the first crisis
appears the more severe the disease is likely to be, and if they don't die there may be
developmental abnormalities or deformities such as tower skull, widening of the root
of the nose or palatal deformities.
Treatment is splenectomy. Other measures are of little value in this condition and
blood transfusions may be followed by severe reactions when the blood matchings show
no incompatibihty. Most authorities advise against splenectomy during the actual crises
although operation during this time has been advocated by some on the basis that
immediate post-operative rise in the red blood cell count is a life saver. Usually once
jaundice has set in it doesn't clear up completely until splenectomy has been performed.
The operation is best performed through a left para-median incision in order that
exposure of the bile ducts be possible, for in some 60% of cases stones are to be found
in the bile passages. If possible, splenectomy and removal of biliary calculi should be
done at the same operation. But if only one of these procedures can be performed at
that time splenectomy should be the first choice and the removal of the biliary calculi
should be done at a second operation. If the reverse is done and the spleen not removed
the patient may die from haemolytic crises post-operatively.
The spleen is usually moderately enlarged but can be enormous. As a rule adhesions
are not as troublesome as they may be in splenectomy for other reasons. While on the
subject of splenic adhesions I would like to say that many so called adhesions of the
spleen are actually cases of simple enlargement of the spleen retro-peritoneally thus
resulting in a loss of mobility. Slide No. 1 is taken from Gray's Anatomy Book and
will help to illustrate this point. It is a transverse section of the abdomen at the level
of the spleen and from it one can see that marked enlargement of the spleen will take
up the fold of peritoneum (which is marked). This fold of peritoneum is formed by
the reflection of the parietal peritoneum from lateral and posterior abdominal wall onto
the spleen and goes to form the posterior layer of lieno-renal ligament. The enlargement
of the spleen separates the two layers of the lieno-renal ligament and so is no longer
separated from the left kidney and the posterior abdominal wall. Thus the surgeon
when he is unable to put his fingers behind the spleen might feel that the spleen is
attached by adhesions to the diaphragm and posterior abdominal wall when actually his
fingers have reached the blind end of the peritoneal fold.
Page 86 Left gastroepiploic
artery (in gastro-
splenic lig.)
Slide No. 1
-■Falciform lig.
* %
/Lesser omentum (with
bile duel, portal v. and
hepatic artery)
Tail bladder
-Floor of aditus to
lesser sac
-inferior vena
Splenic artery (in
lienorenal ligament)
Lesser sac
The peritoneal cavity is shown in dark blue; the peritoneum and its cut edges in lighter blue.
The best approach to splenectomy is through the gastro-splenic omentum, ligating
the short gastric and gastro-epiploic vessels as close as possible to their attachment. At
this stage one might be thankful that a stomach tube had been passed pre-operatively,
for a bloated and distended stomach can make the operation more difficult. The spleen is
then retracted as far medially as is possible and the avascular lateral layer of lieno-renal
ligament is divided just at the point of its reflection onto the abdominal wall, allowing
the spleen to be delivered into the wound attached only by its pedicle. The arteries and
veins are dissected out and the tail of the pancreas carefully separated from the hilus of
the spleen.  Slide Nos. 2 and 3 show the operation at this stage.   Before ligation, % m.l.
Slide No. 2
Slide No. 3
Page 87 of 1/1000 adrenalin solution is injected into the splenic artery and after the spleen has
contracted the arteries and veins are tied off as close to the hilus as possible and the
spleen removed.
A search for spleneoli is then made. In 140 cases of splenectomy reported by the
Mayo Clinic in the years 1942-1944, 13.2% had accessory spleens all of these were in
the neighbourhood of the hilus and were less than one inch in diameter. Other common
sites for the occurrence of spleneoli are the greater omentum, along the course of the
splenic artery, and in the mesentery, but some have been found as far afield as the broad
ligaments of the uterus.
Wintrobe states that this is one disorder in which splenectomy is followed by uniformly beneficial and lasting results. The overall operative risk is in the neighbourhood
of 3.4% in good hands but the operative mortality rate is slightly higher in children.
After splenectomy there is a rapid rise in the red blood count and in the white blood
count. The thrombocyte count usually reaches its maximum at about 12-15 days postoperatively and this might raise the fear of intra-vascular clotting. The role of the
platelets in thrombosis is complex. When a platelet contacts a foreign surface its equilibrium is disturbed, and a small amount of thromboplastin is exuded; this reacts with
prothrombin of the plasma to form thrombin and by this means the platelet becomes
covered with a fine coating of fibrin. The platelet is made sticky and attracts other
platelets to cause an agglutination. Many factors influence thrombosis such as slowing
of the circulation, changes in the vessel wall and agglutination of the platelets, the
latter being increased by the presence of foreign particles in the circulation such as
staphyloccocci. The magnitude of the platelet count alone is not so very important in
the cause of thrombosis and it has been said that post-operative thrombosis is no more
common after splenectomy than after other operations. However, most surgeons entertain the idea of anticoagulant therapy when the platelet count reaches the vicinity of a
There have been cases of Congenital Haemolytic Jaundice, the signs and symptoms
of which have completely disappeared following splenectomy only to recur some months
or years later. Findings at a second laparotomy have shown the presence of a spleneolus
which had reached the dimensions of the spleen removed at the first operation. Removal
of this organ effected a cure.
The diagnosis of this condition when seen during a crisis and without history of
familial tendency can tax the brain of the most astute clinician. The discovery of an
enlarged spleen might be the most influential finding in the further investigations that
lead to the diagnosis. The treatment is splenectomy as soon as possible, and this offers a
90-100% cure.
AIRD, IAN: Textbook Companion in Surgical Studies.
ALLEN, H. E.:  The Spleen—Relation to Splenectomy and Haemolytic Disorders. Portland Clinical
Culetin No.  5—No. 4 March  1952. pp.  87-104.
EDWARDS, HAROLD: Practice and Consequences of Splenectomy. Lancet. October 6, 1951. Volume
2. pp. 601-606.
MILLER & HAGEDORN: Splenectomy Annals of Surgery. November, 1951. Volume 134. pp. 815-821.
WINTROBE: Textbook Congenital Haemolytic Jaundice.
WALKLING: Spleen and Splenectomy. Surgical Clinics of North America. December 1951. pp. 1793-
On 33-foot Comer Lot at  19th and  Dunbar is complete modem
medical office for rent.  Please contact Mr. Rots at
530 Burrard Street
MArine 6421
Page 88 We would like to include your district medical news in the "News and Notes''
column of the "Bulletin". Will you kindly write in some of the recent meetings, elections, births or marriages etc., and mail to Dr. J. L. McMillan, 1401 West Broadway,
Vancouver 9, B.C.
Dr. A. J. Brunet, formerly of Montreal, has been appointed medical superintendent
of St. Joseph's Hospital, Victoria.
Dr. R. S. Ruskin, formerly of Vancouver has opened a practice in Victoria.
Dr. J. E. Dalton is visiting in New Orleans, and will attend the medical convention
in Houston, Texas.
Dr. K. S. Alstad, Medical Director, Vancouver Island Chest Clinic, has taken a
post in Malaya, and Dr. R. Lane, formerly of Tranquille, B.C. has been appointed the
new medical director.
Dr. C. H. Borsman is associated with Dr. W. D. Marshall, Victoria.
Dr. D. G. Adams is now associated with Dr. G. M. Paul, Victoria.
Dr. J. D. Stenstrom, Victoria, attended the annual meeting of the Royal College
of Surgeons, Montreal, at which he presented a paper on "Carcinoma of the Lung".
Dr. J. F. Paquet, Associate Professor of Medicine—University of Oregon Medical
School, addressed the November meeting of the Victoria Medical Society.
Dr. R. E. Beck and Dr. David Mow at are now sharing offices in the Vancouver
Broadway Medical district.
Dr. J. D. Galbraith is now superintendent of the Indian Hospital at Sardis and
Dr. C. R. Howell is taking over Miller Bay Indian Hospital in Prince Rupert.
Dr. J. A. Hopkins has opened a urological practice in Vancouver.
Dr. Ralph McGregor of White Rock and Dr. Neil McNeill of Vancouver have both
Among those who have moved into the Hycrof t Medical Building on South Gran-
vill in Vancouver are: Drs. C. E. G. Robinson, H. Brooke, E. A. Campbell, J. B. Fen-
wick, W. H. Fahrni, C. S. Allan, Don Starr, E. J. Badre, A. Bogoch, K. A. Campbell,
C. C. Covernton, E. J. Curtis, C. A. Davidson, A. C. Frost, A. C. G. Frost, Maxwell
Frost, John W. Frost, C. E. Gould, Jack E. Harrison, Michael Turko, Archie Herstein,
G. E. Hilton, Leigh Hunt, F. W. Hurlburt, J. A. Irving, London Johnston, Ben Kanee,
C C. Kersten, G. J. Kirkpatrick and others to a total of fifty.
Dr. Ross Davidson is now working full-time for the Workmen's Compensation
Dr. C. Marion is now practising pediatrics in Ottawa.
Dr. L. H. Appleby has been appointed Vancouver head of Queen's Medical Centenary Fund.
Dr. Jack Naden supervised Red Feather collection from physicians this year.
Dr. W. Cave is now practising in West Broadway Medical District in Vancouver.
Dr. C. H. Gundry spent the summer promoting mental hygiene work in Southeast
Asia under the auspices of the World Health Organization.
Page 89 Dr. M. A. Menzies has recently joined the Metropolitan Health Cornmittee staff
as assistant psychiatrist following post-graduate work in Toronto where he obtained the
Diploma in Psychiatry from the University of Toronto and Certification with the Royal
College as a specialist in Psychiatry.
Dr. Hugh S. Ford to Anne Collison, both of Victoria.
Born to Dr. and Mrs. W. D. McKinlay, of Vancouver, a daughter.
Born to Dr. and Mrs. R. J. Payne, of Vancouver, a daughter.
Mount pleasant (Eljaprl
Kingsway at IIth Ave. — Telephone EAAerald 2161
Vancouver 10/  B.C.
flDt pleasant Tanbertafcino Co. Xtb.
Managed anal Distributed
by Investors Syndicate
of Canada Ltd.
Representatives from
Mutual '"
of Canada  Limited        -c
When you become a shareholder of Investors Mutual your investment
is spread over more than 100 widely diversified and carefully chosen
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