History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: November, 1952 Vancouver Medical Association Nov 30, 1952

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 T H E
i 0F       1
The Vancouver Medical Association
Publisher and Advertising Manager JSJ|2
OFFICERS 1952-53
Db. E. C. McCoy Dr. D. S. Munroe
President •  Vice-President
Dr. George Langley jm&
Hon. Treasurer
Additional Members of Executive:
Dr. G. R. F. Elliot Dr. F. S. Hobbs
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommer, Whiting & Co.
Dr. J. C. Grimson
Past President
Dr. J. H. Black
Hon. Secretary
Eye, Ear, Nose and Throat
Dr. J. A. Irving 1 Chairman Dr. W. M. G. Wilson Secretary
Dr. J. H. B. Grant. Chairman Dr. W. H. S. Stockton Secretary
Orthopaedic and Traumatic Surgery
Dr. A. S. McConkey -Chairman Dr. W. H. Fahrni Secretary
Neurology and Psychiatry
Dr. B. Bryson . Chairman Dr. A. J. Warren Secretary
|P|                        Radiology
Dr. R. G. Moffat Chairman Dr. H. Brooke \ Secretary
Dr. J. L. Parnell, Chairman; Dr. D. W. Moffat, Secretary;
Dr. A. F. Hardyment ; Dr. W. F. Ble ; Dr. R. J. Cowan ; Dr. C. E. G. Gould
Co-ordination of Medical Meetings  Committee
Dr. W. M. G. Wilson Chairman Dr. B. T. Shallard Secretary
Slimmer School
Dr. S. L. Williams, Chairman; Dr. J. A. Elliot, Secretary;
Dr. J. A. Irvine ; Dr. E. A.v Jones ; Dr. Max Frost ; Dr. E. F. Word
Medical Economics ||||
Dr. E. A. Jones, Chairman; Dr. G. H. Clement, Dr. W. Fowler,
Dr. F. W. Hurlburt, Dr. R. Langston, Dr. Robert Stanley, Dr. F. B. Thomson
Dr. W. J. Dorrance, Dr. Henry Scott, Dr. J. C. Grimson
V.O.N. Advisory^ Committee
DR. Isabel Day, Dr. D. M. Whitelaw, Dr. R. Whitman
Representative to the Vancouver Board of Trade: Dr. D. S. Munroe
Representative to the Greater Vancouver Health League: Dr. W. H. Cockcroft
Published  monthly  at  Vancouver,  Canada.    Authorized  as  second  class  mail,  Post  Office Department,
Ottawa, Ont.
Page -61 Announcing a New and
Specific Narcotic Antagonist-
potent and
Effect o/'Nalline on
respiratory depression caused by
57 milligrams of morphine.1
Nalline is a specific antidote for poisoning following accidental
overdosage with morphine and its derivatives, as well as meperidine
and methadone.
This new product, the Merck brand of iV-Allylnormorphine, rapidly
reverses respiratory depression. The respiratory minute volume
promptly increases and the rate increases two- or threefold.
A recent study2 of 270 parturient women indicates that Nalline may
be of value in obstetrics. Onset of breathing occurred significantly
sooner in infants from mothers (sedated with meperidine) who were
given Nalline 10 minutes prior to delivery.
Literature available
lEckenhoff, J. E., Elder, J. D., and King, B. D.,
Am. J.Med. Scs. 223:191,February 1952.ZEcken-
hoff, J. E., Hoffman, G. L., and Dripps, R. D.,
Annual Meeting of the American Society of Anesthesiologists, Washington, D. C, Nov. 8, 1951.
Solution of Nalline Hydrochloride
in 2-cc. ampuls containing 10 mg.
of active  ingredient, 5  mg./cc.
Nalline comes within the scope of the Opium and
Narcotic Drug Act and regulations made thereunder.
Research and Production
for the Nation's Health
MERCK & CO. Limit
Manufacturing Chemists
Founded 1898; Incorporated 1906
The Regular Monthly Meetings of the Vancouver Medical Association are
discontinued for the summer months, but will be resumed in October.
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.
Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference. ^i
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 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.
Wednesday, 10': 4 5 a.m.—General Medicine.
Wednesday, 12:30 p.m.—Pathology.
Monday, 11:00 a.m.—Psychiatry.
Friday, 8:30 a.m.—Chest Conference.
Friday, 1:15 p.m.—Surgery.
685 West Eleventh Avenue, ||§|j
Vancouver 9, B.C.
Monday—9 a.m. - 10 a.m -Ear, Nose and Throat Clinic
Tuesday—9 a.m. - 10 a.m Weekly Clinical Meeting of Attending Medical Staff
Tuesday—10:30 a.m. - 11:30 a.m 1 Lymphoma Clinic
Daily—11:45 a.m. - 12:15 p.m 1 Therapy Conference
Spring meeting—April 25th, 26th, 1952.
Page 63 Begislered Trade Mark
regularity PETROLAGAR has long been
recognized as efficient in helping to
establish regular "Habit Time."
ease PETROLAGAR is an aqueous suspension of mineral oil that readily
permeates intestinal contents, forming a soft, formed, yielding, easily
passed stool.
comfort PETROLAGAR affords the advantages of comfortable bowel
movement...no diminution of efficacy
if prolonged use is necessary.
When preferred,^ PETROLAGAR  can  be  given  thinned with
water, miljc or fruit juices—with which it mixes readily.
Supplied in bottles of 1 6 fl. ozs.
Page 64 We have been reading with great interest the Medical Ethics Number (September)
of the Ontario Medical Review, which has a series of articles on the question of medical
ethics. Among the contributors are the Principal of Queen's University, who writes on
Professional Ethics in general, and an eminent Ontario Q.C. who is also an M.D. and
Professor of Psychiatry in the University of Toronto, who writes on the Legal Aspect
of Medical Ethics—as well as several well-known medical writers.
The choice of subject is a timely one. Medical relationships, both with the public
and amongst doctors themselves, have changed considerably in the past quarter of a
century. Not that the fundamental principles of ethical behaviour have changed at
all; but the emphasis has altered in several respects. Modern trends towards specialism,
the evolution of prepaid medical plans, group practice, "clinics", so-called—all these
and many_ other things have to some extent created problems of public and intra-
professional relationships which make for difficulty and misunderstandings.
And so it is a good thing from time to time to review these relationships,, and
readjust them in the light of basic principles. It is not so easy always for the
individual practitioner, and especially for the younger practitioner, to determine for
himself and by himself the proper course in any given situation. We believe, and our
belief is based on a good many years of practice, and association with other medical
men, that the vast majority of doctors are determined to behave according to the
highest standards of ethics, both to their patients and to their fellow medical men—but
many of us are puzzled sometimes by particular problems which arise, and to which no
easy solution presents itself.
In the course of generations a Code of Ethics has grown into specific formulation,
and is there for our use. The Canadian Medical Association has published an admirably
concise and complete version, and this has, we believe, been adopted by all its Divisions
—certainly by its B.C. Division. Every candidate for registration in this Province
receives a copy, as does every interne in our hospitals, and it is available to every man.
In it are embodied the simple rules, simply expressed, by which we should govern ourselves. It will not meet every situation in so many words—but it is difficult to
conceive of a situation which would not be adequately met in some way by the
principles laid down in it. It is based on the experience of hundreds of years, and deals
with the ethical standards we should maintain in our dealings, not only with our
patients, but with each other.
Some of us may ask "Why do we need a Code of Ethics at all, when we are told
in its opening sentences that the Golden Rule is its basis, and the basis of all ethical
behaviour?   Surely, if we follow the Golden Rule, we need no other guide or standard?"
Quite right, but this begs a big question. It sounds so easy—"Do unto others as
you would that they should do unto you." Actually, the injunction represents" the
peak, the absolute perfection, of. human behaviour; and it is the hardest rule to follow
that anyone ever laid down.
An understanding of, and obedience to the Golden Rule, presupposes a complete,
adult, maturity of mind—not so common a thing as one would wish, and not so easy
to attain. It involves not only a high degree of personal integrity and Tightness of
behaviour, but, as well, a highly developed social consciousness and acknowledgment of
the rights of others. Last and hardest of all it involves the ability and willingness to
see things from the other person's point of view, the act of "empathy". It is, indeed, a
full Code of Ehics in a single phrase.
So it is not enough just to lay down the Golden Rule as a law which everyone
may follow and avoid error. Some help will be needed in the quest. So we shall do
well to read our Code of Ethics from time to time.
Page 69 A suggestion was made to us a while ago by a friend of ours whose opinion we
respect highly, that it might be a good thing to publish with each number of the
Bulletin a brief extract from our Code of Ethics. This seems to us an admirable
suggestion, and we promise to follow it—so this issue will contain such a short extract,
to be followed in future issues by others. Later, we hope to obtain from the Ontario
Medical Review permission to publish one or two of the articles to which we referred
above.   We are sure our readers will appreciate them as much as we did.
Communications to the Laity on Medical Subjects
All opinions on medical subjects which are communicated to the laity by any
medium, whether it be at a public meeting, the lay press, or radio, should be presented
as from some organized and recognized medical society or association, and not from an
individual physician. Such opinions should represent what is the generally accepted
opinion of the medical profession.
"Discussions in the lay press on disputed points of pathology or treatment should
be avoided by physicians; such issues find their appropriate opportunity in the professional societies and the medical journals." (British Medical Association's Decisions.)
"The practice of medical practitioners taking charge of columns in which answers
to correspondents on medical questions are printed, is highly detrimental to the public
interest and most improper from a professional point of view." (British Medical Association's Decisions.)
A physician acting in a public capacity, e.g. a Health Officer, may issue to the
public warnings or notices regarding public health matters under his own name.
Library Hours:
Monday to Friday 9:00 a.m. - 9:30 p.m.
Saturday 9:00 a.m. - 1:00 p.m.
Recent Accessions:
Thomson, Lowe & McKeown, The Care of the Ageing and Chronic Sick, 1951.
Coope, R., The Quiet Art: A Doctor's Anthology, 1952.
Davidson, M., Smithers, and Tubbs, O. S., The Diagnosis and Treatment of Intrathoracic
New Growth, 1951.
Wright, S., Applied Physiology, 1952.
Clayton, S. and Oram S.  (editors), Medical Disorders during Pregnancy, 1951.
Mcllwraight, T. R., The Bella Coola Indians, 1948.
Daland, G. A., A Colour Atlas of Morphologic Haematology, 1951.
Levine, S. L. et al (editors), Advances in Pediatrics, volume 5, 1952.
Hagedorn, H., Prophet in the Wilderness, The Story of Albert Schweitzer, 1949.
Smith, H. W., The Kidney, Structure and Function in Health and Disease, 1951.
Lever, W. F. , Histopathology of the Slun, 1949.
By August A. Werner, M.D. and Associates
The title suggests that this book contains a summary of recent advances in Endocrinology. This title is misleading, however. The book, instead, contains the biography
of the author, a self-made man who began his career in a meat market, became a postal
clerk and finally realized a lifelong ambition to become a doctor. He pioneered in the
field of endocrinology in the twenties when the subject lacked a firm scientific foundation, and the extracts lacked potency. However, carried along by an outstanding personality and unlimited enthusiasm Doctor Werner claimed spectacular results in the
treatment of the male and female climacteric, which he considered to be identical conditions,' and in involutional melancholia.
He was among the first to study endometrial changes observed in the castrate female
with theelin, and found relaxation in writing, poetry, which although lacking Shakespearian quality, gave great satisfaction to its author.
A collection of reprints of the author's papers is included, but as they are largely
out of date, this book may be of value to the medical historian but is of no value to
the student of endocrinology.
Vancouver Medical  Association
President Dr. E. C McCoy
Vice-President Dr. D. S. Munroe-
Honorary Treasurer ! Dr. G. E. Langley
Honorary Secretary Dr. J. H. Black
Editor , Dr. J. H. MacDermot
I would like to take this opportunity to submit a report on the activities in golf by
the Vancouver Medical Association this year.
It has been our most successful year to date with the largest participating entry
taking part. In the neighborhood of one hundred and twenty physicians played golf
this summer. Five tournaments were played, the first at Fraserview in April, 1952, the
Summer School at Quilchena in May, the University in June, Burquitlam in July and
the final wind-up at Quilchena in September. As well as this, a matched play against
the Seattle physicians was played at Shaughnessy on May 8th. 1952.
The wives of the young doctors ran a wind-up dance for this year, which was at
Stanley Park Pavilion. An excellent dinner was served and a grand evening was had
by all who attended, and it was a most happy occasion for the presentation of the
prizes for the year. We are very grateful to that group for this party and hope that it
can be repeated successfully each year.
Besides the prizes competed for during the season, the following cups were won:
The McDonald trophy for the two lowest gross scores of the year—Dr. M. Share. The
Joe Bilodeau trophy for the low gross of the year—Dr. H. W. Mcintosh. The Rams-
horn trophy, two lowest nets for the year—Dr. H. L. Patrick. In presentation of the
Ramshorn trophy this year, Dr. Dan McLellan, the original donator, had struck off a
bronze plaque replica of the cup as well as two further plaques for the inclusion of the
names of the winners since its original donation. As well as this, an etching was made
of the trophy and was presented to all the winners while the etchings remaining out
of one hundred struck off, should guarantee that these can be distributed to the winner
each year for one hundred years from the time* of the original donation.   These etchings
Page 71 are to be kept in the offices of the Vancouver Medical Association at the Academy
building. The George Worthington trophy donated year for the low net of the year—
Dr. H. L. Patrick. The Lockhart trophy, low net of the year for 18 and over handicaps—Dr. H. A. Kester. The Fisher & Burpe championship Flight Cup—Dr. S. A.
McFetridge, who also won a 15-lb. salmon for the same competition, the prize being
donated by Mr. Duncan Hamilton. The winner of the 1st flight competition—Dr. G. A.
McLaughlin, a shirt donated by Mr. Mackin of Cunningham Drugs. The 2nd flight
won by Dr. H. L. Patrick, a stethoscope donated by B. C. Stevens. The 3rd flight was
won by Dr. H. A. Kester, a driver donated by Ivor Williams Sporting Goods. (The
4th flight was won by Dr. McKenzie Morrison, an English putter donated by British
Drug Houses (Mr. Hooper).
At the end of the year, there was a balance of funds of $103.57. Most of this]
was accumulated at the meeting of the Vancouver-Seattle golfers, the expense of which}
was handled by the Vancouver group. Next year on our visit to Seattle, all expenses,,
there will be taken care of by the Seattle group.
It is hoped that by next year a larger turnout may be anticipated and that a closer,
regulation of handicaps of those who do not belong to regular clubs can be made, so
that the competition will be more keen.   We have at hand now, ten tournaments with
the scores accumulated which ought to help the committee in ariving at these handicaps.
Respectfully submitted,
D. E. STARR, M.D.,
The Twelfth Annual Meeting of the Medical Services Association will
be held at 8 p.m. on Monday, December 15th, 1952, in the Christmas Seals
Auditorium, Tenth Avenue and Willow Street, Vancouver, B.C.
The next concert of the Friends of Chamber Music will be held in the Ballroom,
Hotel Vancouver, January 19th, 1953. This will be the Budapest Quartette. On
February 25 th, the Mannes-Gimpel Silva Trio will appear in the Mayfair Room, Hotel
Vancouver. The last of the scheduled concerts will be that of the New Music
Quartette of New York for April 18 th, in the Ballroom, Hotel Vancouver.
Enquire for tickets to Dr. Fahrni, BA. 1410.
Beginning in January, 1953, all editorial material for publication
in the current issue of THE BULLETIN must be in the bands of the\
Editorial Committee on or before their monthly meeting which will
he held on the first Tuesday of each month.
From a paper delivered by Dr. E. N. C. McAmmond
before the Vancouver Summer School, June, 1952.
I suppose every specialist considers that his field is the most important in the total
practice of medicine, and that not nearly enough emphasis is placed upon it. You
have been listening to internists, to surgeons, to neurologists, specialists in urinary tract
diseases, oto-laryngologists, paediatricians, pathologists, and now a proctologist. It
may be that you are uttering the complaint heard on other occasions, "But he seems
to see only his own particular specialty and to lose track of the whole patient, thereby
ceasing to be practical."
I am going to do my utmost this morning to keep in mind the whole patient and
at the same time to be completely practical.
THE INDICATIONS DEMANDING IT? Let us start from a point at which we are
all in agreement:
anus, rectum, and colon, careful and complete proctologic examination is demanded.
Certain approximate statistics will quickly serve to confirm this conviction:
1—Cancer of the large intestine is the fourth most frequently found malignant
tumour in women, and is second only to carcinoma of the stomach in men.
2—Eighty percent of cancers of the bowel are in the sigmoid colon and the rectum.
3—Ninety percent of cancers of the sigmoid and rectum are visible through the
Surely if 80% of intestinal cancers (excluding the stomach) are presented in the
lower bowel, and 90% of these are actually visible to the naked eye, and incidentally
available for biopsy, then the direct examination of sigmoidoscopy is reasonable.
BARIUM ENEMA. We are all agreed that in a case of suspected malignant disease
of the colon we are justified in ordering a barium enema. However, I would argue
that if you have an indication for the performing of a barium enema, you have a far
weightier indication for performing a sigmoidoscopic examination; and further, one
should never demand a barium enema until he has first inserted the sigmoidoscope.
Radiologists in convention have repeatedly passed resolutions urging all practitioners to
refrain from sending them patients for bowel investigation until the procto-sigmoido-
scopic examination has been completed, and a number of university departments of
radiology refuse to give barium enemas until the physician or surgeon "has had a look".
This demand by the radiologist is reasonable and logical for a variety of reasons.
1—If eighty percent of carcinomas of the bowel are in the sigmoid and rectum,
and ninety percent of these are diagnosable with the naked eye, why do we
use an indirect method of diagnosis when a direct one is available? This is
comparable to attempting the diagnosis of a carcinoma of the tongue by means
of a barium swallow instead of looking directly into the oral cavity.
2—The area of the rectum and colon which is visible to the eye of the sigmoido-
scopist is largely a blind area to the X-ray investigator. No self-respecting
radiologist will risk his reputation by attempting to diagnose an early carcinoma
of the rectum (and frequently the lower sigmoid) by his particular technique,
because he is the first to admit that owing to the anatomical peculiarities he
cannot visualize in detail the wall of the rectum and lower sigmoid, (and yet
it is in this area that almost eighty percent of the malignant disease of the
bowel occur.)
3—The dangers of precipitating an obstruction in a stenosing lesion of the rectum
or colon, following the injection of barium are very real.    Most radiologists
Page 73 can tell of instances where they have forced an emergency operation for
intestinal obstruction because of their investigation a few hours previously.
These three reasons are sufficient to cause us to defer to the tender sensibilities
to asking for a barium enema.
UNDERTAKING THE TREATMENT OF ANY OF THE COMMON ANORECTAL DISEASES. Perhaps I should modify that statement somewhat, for frequently
it is necessary to mollify a patient's pain before submitting him to proctoscopy. However, no patient who has a minor ano-rectal complaint should be discharged from your
care until you have performed a sigmoidoscopic examination.
A few years ago Buie of the Mayo Clinic made the statement that just over 43%
of their cases of carcinoma of the rectum and sigmoid had had operations or treatment
for minor ano-rectal conditions within the previous eighteen months. What a tragedy
to be treating fissures and haemorrhoids, when a carcinoma is present a few inches
away. May I urge you to have a look along the full length of the sigmoidoscopically
visible bowel when treating diseases of the anus.
requisite. Bleeding is always a serious symptom until proven otherwise. Last week
in my office a patient told of how he had complained to his doctor one year previously
that he had some bleeding at the time of a bowel movement, and the doctor replied,
"I've had blood on the toilet tissue for years too. Just ignore it". On investigation
that patient proved to have neoplastic disease. Persistent change in bowel habit, recurrent bouts of crampy lower abdominal pain, or even minor complaints of etching,
soreness and anal pain, all require a careful and complete proctologic examination.
(V) CANCER PREVENTION—Many millions of dollars have been spent in the
United States on campaigns for the prevention of Cancer. Large Cancer Detection
Centres have been opened and are operating at a phenomenal cost. The authorities in the
State of California were horrified at the great expense, and have managed to reduce the
figure by placing this matter of Cancer Prevention in the safe hands of the General
Practitioner. The public have received with assurance the slogan "Every doctor's
office is a cancer detection centre." The cost of detection has been markedly decreased
and the efficiency of the work enhanced.
Cancer prevention in relation to the rectum and lower sigmoid centres around
the discovery of the pre-malignant adenomatous polyp. Some authorities believe that
one hundred percent of cancers of the rectum come from previously existing polyps.
I believe that this figure is too high; however there is much evidence, some direct, but
still convincing, that probably 75% of malignant growths of the large bowel develop
on the basis of polyps. This statement is made by Coffey, Professor of Surgery at the
Georgetown University Medical Center, Washington, D.C. His reasons for the claim
are summarized:
1—A striking parallelism exists in the distribution of polyps and cancer in the-
large bowel.    The site of predilection for both is in the lower sigmoid and
rectum—a location which is within reach of the sigmoidoscope.
2—Multiple cancers of the large bowel are common. The well known occurence
of multiple malignant lesions in 4.5% of cases indicates a multicentric focus
of origin, and strongly directs suspicion to the polyp.
3—Polyps occur frequently in association with cancer of the large bowel; indeed
in about 3 3 % of cases polyps are found elsewhere in the colon. This association
cannot be attributed to mere coincidence.
4—Cancer of the large bowel frequently assumes a tell-tale polypoid form, suggesting a relationship to the polyp.
Page 74 5—The development of cancer has been observed at the exact site of a previously
noted' polyp. In an impressive number of instances, the removal of a polyp
has been refused or inadvertently neglected only to find a frank ulcerating
carcinoma at the precise point several years later.
6*—Cancer has been found in two thirds of the cases of multiple or familial
polyposis. It is the conviction of most pathologists that if left untreated, one
hundred percent of cases of polyposis will develop cancer.
7—Microscopic  cancer or  czncer-in-situ, is  commonly  found in polyps which
appear grossly benign.    This fact offers very strong evidence of the polyp-
cancer sequence.
The above evidence would indicate that our task in the prevention of cancer in
the lower bowel is centred around the finding and eradicating of the adenomatous
polyp.    Unfortunately the majority of polyps are symptomless.    If we remember their
common yet silent occurence we shall appreciate the rationale of routine sigmoidoscopy.
(VI) ROUTINE SIGMOIDOSCOPY—In various university centres surveys have been
taken in outpatient clinics. Individuals who have had no indication whatever have
been submitted to sigmoidoscopic examination; the findings have been startling. All
centres report that over thirty percent of cases show significant abnormalities. Surely
a procedure that supplies a diagnosis in over 30% of cases cannot be called upon for
further justification for routine adoption.
Important as the finding of fissures, fistulae, and haemorrhoids may be, they are
of small significance when it has been shown that these routine investigations have
disclosed malignant polyps in 7-10% of cases and actual carcinomas in 1%-1.5%.
This means that attending our sessions today there are two or three carcinomas of the
rectum and sigmoid, which are chuckling merrily at the complete ignorance of their
owners. It means further that attending this Summer School are fifteen to twenty
premalignant lesions which could be removed by electro-desiccation, and the risk of
their causing malignant disease mitigated. Surely with this evidence we cannot be
charged with lack of balance when we urge that all patients over forty years of age
should have the advantage of a proctosigmoidoscopy when presenting themselves for
their annual physical examination.
WHAT ARE THE RISKED INVOLVED in sigmoidoscopy? In the hands of the
careless there are always risks. Andresen reports 94 cases of perforation collected from
the literature. However, to reassure us, Bochus tells of 75,000 successive examinations
without a mishap. If you should unfortunately cause a perforation, do not delay.
Perform an immediate laparotomy to repair the perforation, also using the antibiotics.
With immediate operation the mortality is almost zero, whereas with delayed treatment
it is sixty to seventy percent.
In summary we would urge you to use that sigmoidoscope:
1. In the investigation of suspected malignant disease.
2. Always PREGEDING a barium enema.
3. Before undertaking treatment of the common ano-rectal diseases.
4. In the investigation of complaints which could indicate serious bowel disease,
especially bleeding, change of bowel habit, lower abdominal pain, etc.
5. In the programme of Cancer Prevention.
6. In the annual routine "check-up" of all individuals over forty years of age.
It is not anticipated that you will return home and start sigmoidoscoping every
patient that comes into your office. However we do hope that you will never again
order a barium enema without first having performed a sigmoidoscopy and further, we
believe that the use of the sigmoidoscope should become as much a routine to the
practitioner as the use of the tongue depressor, the auriscope or the vaginal speculum.
Hippocrates reported an epidemic of mumps, but it was not separated from other
forms of parotitis until Robert Hamilton in 1761 noted the association with orchitis.^
The term "Epidemic Parotitis" is a most unsuitable synonym for mumps. It is
obviously a systemic disease, not local, with "complications," the virus having predilection for many highly specialized tissues. One can easily understand why tins
virus with a predilection for the salivary glands should also show a tendency to invade
the pancreas, because of the similarity of these structures. Also there exists a physiological relationship between the salivary glands and the sex organs which is worthy
of mention. There is seen in certain vertebrates; for example, during the mating
season a musky odour is emitted by the submaxillary glands of the crocodile and
pervades their haunts. The salivary glands of the camels enlarge during the breeding
Morbid Anatomy: Because of the low fatality there is little information available
concerning the pathological picture of the parotid. Experimentally however, the changes
consist of interstitial serous and fibrinous exudates, catarrhal inflammation of excretory
ducts, foci of hemorrhagic infiltration by leucocytes, an intense vascular congestion,
periglandular oedema and changes of early necrosis. In the testis, there is parenchymatous and interstitial inflammation.
Diagnosis: Mumps occurs usually in the winter and spring. During epidemics or
following a history of exposure, the diagnosis is relatively simple. It is only during
epidemics that cases can be diagnosed in which only the submaxillary glands are involved. The incubation period is seventeen to twenty-one days. There is usually a
low grade fever, occasionally a moderate lymphocytosis, and the pulse is often slow.
Orchitis or epididymo-orchitis: Occurs usually in the second week and is more
often unilateral. The incidence lies between 17 and 33 per cent. The occurrence of
orchitis without parotitis has been noted in epidemics. The inflammation is usually
in the testis and not the epididymis. Atrophy of the testicle is rather frequent, taking
place in 40 to 60% of cases. Impotence and sterility, although they do occur, are not
very common.   Strict bed rest does not diminish the incidence of orchitis.
Ovaritis: Occurs less frequently than orchitis. A woman may menstruate out of
time, and with mumps in pregnancy may abort during her convalescence.
Pancreatitis or Mumps Pancreatitis: Makes its appearance three to four days after
the first sign of salivary gland involvement, but it may occur somewhat later. There
is abdominal pain about the umbilicus or in the epigastrium, shooting through to the
back. Shock, nausea, vomiting and diarrhoea may be of frequent occurrence. There
may be a moderate fever with a leucocytosis. The abdomen is tender and a transient
hyperglycemia with glycosuria is noted infrequently.
Mumps Meningitis: All ages are affected. The symptoms occur at the end of the
first week of illness. In its most common form it is indistinguishable in its symptoms,
signs and spinal fluid findings, from pre-paralytic poliomyelitis, except by the circumstances of the association with the undoubted signs of mumps. The reported incidence
varies widely. This is partly due to the fact that some figures are based on clinical
findings only, whereas other investigations have entailed routine examination of the
cerebrospinal fluid and any degree of pleocytosis is accepted as evidence of meningitis.
One. may find 200 to 400 cells per cu. m.m. but it may be higher. Tlhe protein may
exceed 40 mgm. but it is usually normal. Meningitis may occur without parotitis and
it is certainly more frequent than is commonly recognized. It runs a benign course.
One should note that acute aseptic meningitis also occurs in Infectious Mononucleosis and
in infections due to many viruses capable of invading the central nervous system, e.g.j
Herpes Simplex, Herpes Zoster and Lymphogranuloma inguinale.
Mumps Meningoencephalitis: One may find hemiplegia, monoplegia, acute ataxia
and convulsions.    There is usually a history of contact.    The spinal fluid exhibits in-i
Page 76 creased pressure, is clear or slightly opalescent and shows a pleocytosis composed largely
of mononuclear cells. The prognosis is good. Deaths have been reported but they
occur rarely, less than one per thousand.
To further emphasize the systemic nature of this disease one may find in addition
to the above, thyroiditis, arthritis, nephritis, optic neuritis with blindness, transverse
myelitis, deafness, pneumonia and suppuration of salivary glands.
Exposed persons should be watched for three weeks. After mild cases a quarantine
of two weeks is considered sufficient—yet some patients have proved themselves carriers
for six weeks after their recovery.
Treatment: Bed rest.is desirable so long as fever or any swelling persists. There
should be ample fluids and the mouth kept scrupulously clean to avoid secondary
infection. Sedation as usual helps. The prophylactic use of the serum of a patient
convalescing from Mumps in doses of 2 to 8 cc. is effective if given before the seventh
day after exposure, propylthiouracil has been employed with apparently some success,
200 mgm. daily, a reduction in size of the parotid and some symptomatic relief being
noted. Aureomycin, half a gram or 500 mgm. every six hours for eight doses has With
some observers shown dramatic subjective and objective improvement in twenty-four
hours, but many who have not had such good luck with the antibiotics are skeptical.
Stilbcestrol has been tried in doses of 5 to 15 mgm. daily with somewhat doubtful
results. In meningo-encephalitis, lumbar puncture relieves headache. With orchitis,
surgical drainage of fluid by splitting the tunica in its whole length is often indicated
for relief of pain and prevention of pressure necrosis.
Finally, it would seem that A. Epidemic Parotitis is an unsuitable synonym for
Mumps. B. In no other disease are so many cells found in the spinal fluid without
symptoms of meningeal irritation. Clinical and sub-clinical involvement of the
Central Nervous System occuring in Mumps is generally not recognized and thus is
deserving of special emphasis.
This short but excellent summary by Dr. Hebb is based on a study of the literature
available on the subject, and will serve to remind us of the fact that Mumps is by no
means merely tfa disease of childhood", with nothing to worry about. The literature
contains very little about Mumps, and this survey covers a great deal of ground that\
has been rather neglected in the text-books and elsewhere. —Ed.
T. R. SARJEANT, M.D., F.R.C.S. (Eng.); F.R.C.S. (C).
The treatment of varicose veins has a bad reputation for not producing a lasting
cure. The chief reason for this failure is that the treatment is usually inadequate. The
treatment of varicose ulcers has even a Worse reputation and for exactly the same
reason. Varicose ulcers would probably be more effectively treated if they were called
"Stasis Ulcers". This statement sounds rather ridiculous and therefore should be
Venous stasis in the skin and subcutaneous tissues of the affected area of the leg
causes nutritional changes which are manifested by pigmentation, eczema, subcutaneous
fibrosis and frequently ulceration.   There are three sources of venous stasis—
1. Simple, primary varicose veins of the saphenous systems;
2. Incompetency of the perforating veins which connect the saphenous with the
deep system;
3. Incompetency of the deep veins.
Every swamp is fed either by a surface stream or by a spring coming from an
underground stream. Every stasis ulcer is fed either by a varicose saphenous vein which
is a surface stream, or by an incompetent perforating vein which is a spring from the
underground stream of the deep vein of the leg. To dry up the swamp, you must get
rid of the stream or spring feeding it.    The same holds true for the stasis ulcer.    All
Page 77 three causes or sources of venous stasis must be investigated and all sources present
must be eradicated if permanent cure of the ulcer is to be effected.
For these reasons it would be better to use the term "Stasis Ulcer" rather than
"Varicose Ulcer" so that you will be reminded to look for all three sources of venous
stasis instead of jumping to the conclusion that the obvious varicose saphenous vein
is the sole cause of the trouble.
The diagnosis of the sources of venous stasis is based on the history and the use of ^
Trendelenburg tests. One must enquire carefully for the history of deep phlebitis or
"milk leg" following pregnancy. One must differentiate between attacks of superficial
phlebitis and deep phlebitis associated with operations, injuries to the legs or even with
previous injections of varicose veins. Not enough attention is paid to the history in
these cases because it is a tedious history to take. However, it is time well spent, for
the correct method of treatment can depend on the crucial point of whether or not the
patient had a deep phlebitis many years before.
In my opinion the Trendelenburg test is the most satisfactory of the many tests
because it is an objective test. Like any other test it must be correctly donie and
correctly interpreted. The patient lies down and the leg is elevated to 45 degrees and
the veins milked free of blood; a rubber tourniquet is then applied around the
upper thigh and the patient immediately stands. From the moment of standing> the
examiner carefully observes the varicose veins below the tourniquet for exactly 30
seconds then the tourniquet is released. The tourniquet should be released by the
nurse so that the examiner's finger tips can remain on the veins and can sense the impulse
or increase of tension in the veins when the tourniquet is released.
It is called a singly positive test when the veins remain empty during the 30
seconds and then fill rapidly from above on release of the tourniquet. This implies that
the long saphenous vein alone is incompetent.
It is called a doubly positive test when the veins below the tourniquet become
moderately filled during the 30 seconds and then become more distended on release
of the tourniquet. The filling of the varicose veins during the 30 seconds means that
they are being fed by an incompetent vein below the level of the tourniquet and this
may be the short saphenous or a perforating vein. The additional filling on release of
the tourniquet is of course due to incompetence of the long saphenous vein.
The test should then be repeated with the tourniquet applied just above the
patella. This will rule out the presence of an incompetent perforating vein in the thigh
as the cause of the doubly positive test.
If the test is still doubly positive it is again repeated, applying the tourniquet
below the knee. If a singly positive test is now obtained it means that both the long
and short saphenous veins are incompetent. If a doubly positive test is obtained below
the knee it means that incompetent perforating veins are present and we know that
these may or may not be associated with an incompetency of the deep vein. The
decision as to whether the deep vein is also incompetent, that is, whether a post-
phlebitic syndrome is present, can be made from the history.
It is unnecessary to carry out any other form of clinical investigation, such as a
venogram, in order to diagnose the presence of one or all of the sources of venous stasis
causing the stasis ulcer.
The Trendelenburg test is said to be negative if the saphenous vein moderately fills
during the 30 seconds and does not become more tense or becomes even less tense on
release of te tourniquet. Obviously the valves of the veins must be competent in order
to produce these findings. (At the risk of confusion it should be mentioned that there
is an abnormal condition in which a jaegative test will be obtained, and that is during
the first few months following a deep phlebitis in a patient who has no varicose veins.
The explanation is that the deep veins are plugged during this early phase before
recanalization occurs and all the blood must return through the saphenous system.
However, as time passes, the over-distension of the saphenous system destroys its valves
rendering it incompetent and when this occurs a doubly positive test will then be
Page 78 obtained.    The  taking of  a  careful history  will  prevent misinterpretation of  the
Types of Stasis Ulcers:
1. Single, small, shallow ulcer of short duration—present for less than 2-3 months,
acutely tender, has shelving sides rather than steep, punched-out margins.
2. Multiple, small, deep, punched out ulcers clustered together in an indurated,
fibrosed ulcer-bearing area.   As one ulcer heals another recurs.
3. Large chronic ulcers remaining open for many months or years, healing with
bed rest but recurring with resumption of activity.
The basic principle of the treatment of any lesion is removal of the cause. Every
type of local treatment to the stasis ulcer, not combined with removal of the cause
of the venous stasis, will be only temporarily palliative.
Local treatment of the ulcer will, of course, be required when there is superficial
infection, or an associated cellulitis or when preparing the ulcer for definitive surgical
treatment. It should be explained to the patient that such treatment is only palliative
and that when it is discontinued the ulcer will recur unless complete surgical treatment
is carried out.
Palliative treatment of the ulcer should include:
1. Cleanliness—Healthy, clean granulation tissue is essential for the growth of
epithelium. Smothering the ulcer with any of the thousand ointments on the market
is a waste of your time and the patient's money. Grossly infected and sloughing ulcers
should first be cleaned up with compresses of 1:4 Dakin's solution. When the granulation tissue on the floor of the ulcer has become healthy and assumed a beefy red, finely
granular appearance the ulcer should merely be bathed night and morning with normal
saline and a simple dressing of white vaseline applied.
2. Be*d rest to remove stasis—Bed rest with the leg elevated along with cleanliness
is the quickest method of healing an ulcer or getting rid of complications because
venous stasis is obviously prevented.
3. Pressure bandage to combat stasis when ambulatory—If the patient refuses to
stay in bed an elastic bandage or elastic stocking should be worn to attempt to combat
stasis. A fairly thick pad of folded gauze or a rubber sponge should be applied over the
vaseline dressing on the ulcer in order to exert firm pressure upon the area. An Unna's
paste bandage or elastoplast may be used but these prevent the daily cleansing of the
ulcer and are better withheld until the ulcer has healed, if they are to be used at all.
Curative treatment must include:
1. Preparation of the ulcer for surgery—No surgery of any type, not even a
sapheno-femoral ligation in the groin, should be done in the presence of an infected
stasis ulcer. The ulcer need not be healed, but it must be clinically clean. When an
open ulcer is present there is always danger of infection, even in distant wounds, because
the lymphatics are loaded with bacteria. Therefore, one should not invite disastrous
infection by operating in the presence of gross infection. The palliative treatment
previously outlined should be carried on until the state of the ulcer is satisfactory.
2. Eradication of all sources of venous stasis—
(a) Incompetent Long and/or Short Saphenous Veins—The most satisfactory
method of dealing witi^ these veins is their complete removal by stripping. In the
case of the long saphenous vein one must also ligate the sapheno-femoral junction flush
with the common femoral vein and all the tributaries of the sapheno-femoral junction
must be ligated. During the next 2 to 3 months all the remaining varicose veins below
the knee should be obliterated by sclerosing injections.
(b) Incompetent Saphenous Veins along with Incompetent Perforating Veins—
The saphenous veins should be stripped. Incompetency of the perforating veins of the
thigh is actually quite rare, but if present, a longitudinal incision should be made at the
Page 79 suspected site of the perforating vein and it should be divided and ligated deep to the
deep fascia. The perforating veins of the leg are numerous and I defy anyone to predict
pre-operatively which veins are incompetent. It is therefore impossible to deal adequately with them by using multiple small incisions. They must be ligated beneath
the deep fascia and if even one incompetent vein is left intact the venous stasis will
not be adequately corrected and trouble will continue. A fasciotomy or sub-fascial
dissection of the entire posterior compartment of the leg must be done from the medial
border of the tibia around to the fibula. A long incision is made from the knee to
the medial malleolus, placed one finger's breadth behind the medial border of the tibia
which is approximately over the course of the long saphenous vein. The long saphenous
vein is totally excised and the deep fascia is split along the line of the incision. No
attempt should be made to remove varicose veins from the subcutaneous tissue along the
margins of the flaps for this may result in necrosis of the overlying skin. The fascia
is lifted from the muscles around to the fibula and all perforating veins encountered are
divided and ligated close to the muscles. This is not a procedure to be lightly undertaken, and to prevent necrosis the skin flaps must be handled very gently and the
technique of plastic surgery must be used.
(c) Incompetent Deep Veins or the Post-Phlebitic Syndrome—It is in this condition that all three sources of venous stasis are present. The saphenous veins must be
stripped, a fasciotomy must be done and the superficial femoral and popliteal veins must
be ligated. A discussion of this syndrome and its treatment is beyond the scope of this
paper. Suffice it to say that the entire venous system in the leg has become incompetent
and therefore adequate treatment can only be obtained by an extensive onslaught upon
the leg.
3. Surgical treatment of the ulcers
There is always an incompetent vein lying under the base of an ulcer and "feeding"
it.   This feeder must be eradicated in order to permanently cure the ulcer.
If a small, shallow ulcer of short duration overlies the long saphenous vein, it will'
heal rapidly if the vein is stripped from beneath the ulcer. If such an ulcer lies, say,
one inch posterior to the course of the long saphenous vein, it may be treated by stripping
the long saphenous, then subsequently injecting tributaries which are feeding the ulcer.
These methods will be successful only when a singly positive Trendelenburg test was
obtained, indicating that the saphenous vein alone was incompetent.
In the case of a truly chronic large or small ulcer, excision and skin graft of
the ulcer and ulcer-bearing area must be done.   This is necessary for two reasons:
(a) The chronic ulcer is practically always fed by an incompetent perforating
vein which of course must be ligated.
(b) The chronic venous stasis and chronic infection produce marked induration
and fibrosis of the subcutaneous tissue and deep fascia so that the ulcer has a very
dense fibrous base. This fibrous base is a very poor bed for a skin graft, even though
you may succeed in getting healthy granulation tissue to cover the base before grafting.
The correct treatment is wide excision of the ulcer-bearing area, removing the
whole area including the deep fascia en bloc. This excision will expose a base composed
of muscle, tendons and periosteum of the tibia. The subcutaneous tissue through which
the incision has been carried will often be found to be at least %" thick.
Having excised the ulcer and discarded the instruments used, a fasciotomy is then
done if a doubly positive Trendelenburg was obtained (as it was almost certain to be).
The incision is carried upwards to the knee from the upper limit of the defect produced
by excision of the ulcer. The fasciotomy wound is sutured, then a split-thickness graft
is taken from the thigh and applied to the ulcer defect. The graft is carefully applied
to the floor and to the steep, thick walls of the defect and held in place by a firm
pressure dressing. A light plaster cast is used to immobilize the ankle because movement of the tendons under the graft would prevent a good take. On the seventh day
the cast is bi-valved and the graft is dressed and from that time onward is treated in
the same manner as any other graft, including saline tub baths if desired.   The posterior
Page 80 half of the cast should be used to immobilize the ankle and the patient should not be
allowed to walk until the grafted area has completely healed, otherwise the graft may
melt away.   If this plan of treatment is followed, the results are excellent.
Very little time has been spent talking about the local treatment of a varicose
ulcer. This was intentional for the important feature is not the ulcer but rather the
venous stasis causing the ulcer. An ounce of prevention of venous stasis is worth a
pound of cure applied to the ulcer.
By DR. W. E. HARRISON, Vancouver
Thoracic Surgery antedates all other officially recorded surgery, as our earliest
fore-father Adam had a rib resection. Although the result of this operation is reported
to have caused considerable trouble through the ages, there is no record of any true
surgical complications resulting from it. However, this branch of surgery was not
practiced as extensively as many other branches until comparatively modern times.
One of the diseases to which it was first applied with any degree of success, is
pulmonary tuberculosis. It is my intention to outline the history and increasing
importance of surgery in tuberculosis, give an outline description of the common
procedures used, with their general indications, contra-indications and complications,
and make some mention of the relative safety of the procedures. Some attempt will
be made to evaluate results using Canadian figures.
Pulmonary tuberculosis has affected mankind as far back as records are available,
but no direct attack was made on it till the 19th century.
Advised pneumothorax
Advised collapse therapy
Reported  results of artificial pneumothorax
Advised removing ribs over diseased area
More radical rib removal
Advised 1st rib must be removed
Recognized   importance   of   removing   rib   in   paravertebral   area—the
beginning of modern thoracoplasty
Beginning of successful pulmonary resections  for  tuberculosis
In the surgical treatment of such a deliberating disease as tuberculosis, the preoperative evaluation and treatment is a most important point. The most careful
physical and laboratory investigation is necessary. Pulmonary function studies allow us
to estimate the working capacity of each lung separately and tell us the extent to which
we can carry our removal or inactivation of pulmonary parenchyma. The dietary
preparation is important. The fight against wound infection should start long before
the patient enters the operating room. Here, when this surgery was first started,
infection was a major hazard, but now, by prolonged careful special skin preparation,
and the most rigid technique in the operating room, infection has been practically
eliminated. Everything that can possibly add to the patient's bodily strength should
be done, and everything that can eliminate a hazard should be removed because these
patients have a small margin of safety anyway. In our institution, every surgical
patient is seen and examined by an expert internist who is also a well trained cardiologist, before any final decision is made as to the surgery to be attempted.
As regards parenchymal disease, the surgical treatment is almost entirely directed
toward the treatment of cavities or potential cavities in the lung itself. The commonest
method of attack is to attempt to collapse the cavities, and have them heal in this
manner, as by pneumothorax, pneumoperitoneum, phrenic paralysis, thoracoplasty, etc.
Page 81
de Cerenville
1940 Perhaps the second most common attack is by the removal of the lung tissue containing
the cavity or other active disease, by lobectomy, segmental resection, wedge resection
or pneumonectomy. In a few cases, an attempt is made to eliminate the cavity by
external drainage, hoping it will heal up from the base and obliterate itself either with
or without the aid of collapse therapy.
The treatment of pleural infection may be done by attempts to have the lung
re-expand and obliterate the pleural space by various irrigations, the use of fibrin
solvents, or by decortication or by collapse of the chest wall down onto the partially
collapsed lung by thoracoplasty. External drainage may be necessary at times if the
patient is very toxic.
This chart gives the various collapse procedures in general use. Pneumothorax,
while really a surgical procedure, has been so widely used, largely by physicians, that
it is now out of the surgeon's hands.
A. Pneumothorax—intraplural which may require Al to make it effective.
Al Pneumolysis—Closed (Jacobaeus)
B. Extrapleural Operations—Pneumothorax
—Various packs inserted to maintain space
C. Phrenicotomy—Temporary
D. Pneumoperitoneum
E. Intercostal Nerve Operations—1. Blocking
2. Section
F. Thoracoplasty—1. Simple rib removal
2. Combined with extrapleural separation of lung
3. Various methods of turning ribs to maintain collapse
4. Combined with scapulectomy
Complications do arise from time to time to increase its risks. Pleural adhesions
may be such as to make it ineffective. If not too extensive, these may be cut by closed
intrapleural pneumolysis, using a thoracoscope to see the adhesions and a cautery, and
either heat or high tension to cut the adhesions. In a few cases, the thorax may actually
be opened and the adhesions cut by this method. A pneumothorax should be maintained for 3 to 5 years usually, depending on the extent of the original disease and
particularly on the size of cavities which have been collapsed. However it is most
unwise to continue a pneumothorax which is not effective.
The extra pleural operations consist of removing one rib and creating an artificial
space between the parietal pleura and the chest wall, by separating them through a
layer of very soft areolar connective tissue. It was originally done by Tuffier in 1893,
since which time it has waxed and waned in popularity. The lung is collapsed away
from the chest wall. The space so created may be maintained with air, and usually is,
but also may be maintained by the introduction of various substances such as wax,
plastic balls, gauze or spongelike plastic materials. The space, being an artificially
created one, is not lined by epithelium, and may ooze considerable serum or blood and
is more prone to infection than an epithelial-lined space. There is almost always some
subcutaneous emphysema but this is of no consequence. After being in disfavour for
some years, this operation has been increasing in popularity in the past few years. The
most frequent complication, extra pleural tuberculosis empyema, has been much reduced
since the introduction of streptomycin.
Mortality is said to be less than 2%, and it offers over 70% chance of closing
cavities. It has the disadvantage of requiring constant medical supervision, and most
authorities believe it shoud be used only in careful selected cases.
Page 82 Phrenicotomy means the interruption of the impulses in the phrenic nerve. It has
a two-fold purpose—first to stop the piston-like up and down motion of the diaphragm
and second as the muscle atrophies, from loss of its nerve supply, it loses tone and
rises in the thorax reducing the volume of the lung.
Pneumoperitoneum collapses the lung by pressure from below the diaphragm from
air introduced. The diaphragm may be paralyzed by phrenicotomy on the worse side to
make the diaphragm rise more on that side.
Thoracoplasty is the mainstay of collapse therapy in patients who have not been
benefitted by reasonable trial of more conservative measures. According to figures
from Canadian Tuberculosis Association, in 1937, of the patients discharged from,
and deaths in tuberculosis sanatoria, 35% had thoracoplasty operations. In that
year there was a total of approximately 7000 discharges and deaths which makes a
total of 245 cases operated. In 1949, the last year for which figures are available, the
comparable figures are 9.3% or over 2l/z times as high a percentage, but the number of
combined deaths and discharges had reached 13,000, making a total of 1209 cases
treated or almost four times as many. On the other hand, mortality rate has been
greatly reduced. It is seldom over 2% in any institution so that there were only
approximately 24 operative deaths in 1949. It should offer the patient about an 80%
chance of control of his disease. This means a sputum in which no bacilli are present
on culture. Following the modern operation, deformity should not be noticeable in
either sex. This is largely due to careful pre- and post-operative physiotherapy and to
careful preservation of erector spina; muscles and to the infrequency of wound infection. The operation is usually divided into stages so that only a small part of the
chest wall is soft at any one time. More extensive removals are now being attempted,
using various ingenious methods to stabilize the soft chest wall. These appear to be
meeting with some success, thus diminishing the work for the nursing staff and
eliminating pain for the patient by making fewer operations necessary.,
It is most importnt to remember that all these methods do nothing at all to
eliminate the disease focus from the body, but simply attempt to put it in such a
position so it can more readily heal. For this reason it is necessary for the patient to
spend an adequate time at rest, so that his body can heal his disease well before he
attempts to return to normal life. To me this seems a most important point. The
patient has been through one or more operations of varying severity, which he knows
has been through one or more operations of varying severity, which he knows were
were done to treat his tuberculosis. Many times he does not realize that it is still
necessary for his body to heal the disease.
In most centres it is still generally accepted that where collapse therapy is likely
to be successful it is still the procedure of choice.
A. Monaldi suction
B. Cavernostomy
External drainage is reserved for patients with very large cavities who are unfit
for more radical operations. Monaldi suction is drainage through a tube inserted into
the cavity, with the application of intermittent suction.
Cavernostomy is the opening of a pulmonary cavity from the outside by various
methods.   This therapy is only used in desperate cases, unfit for other types of surgery.
A. Collapse procedures
B. Decortication
C. Drainage
Tuberculosis empyema constitutes a great problem. Every effort must be made
to obliterate the pleural space. The simplest method is to expand the underlying lung
if it is sufficiently healthy. This is done by various irrigations of bacteriostatic materials,
and also may include some fibrin liquefiers such as streptokinase.    Where the lung can
Page 83 not be expected to expand and take up the space, the chest wall can be put onto the
lung, usually by thoracoplasty. Where the lung is tightly bound down by a heavy
envelope of fibrin, decortication may be justified under the protection of streptomycin.
In a few cases where the patient is very toxic, and especially if there is a mixed tuberculosis and pyogenic infection, external drainage either by the closed or open method
may be necessary as a temporary expedient usually to be followed by thoracoplasty.
A. Phrenicotomy for persistent diaphragmatic pleurisy.
B. Intercostal injections or resections for chest wall pain.
C. External drainage of collections of pus.
In terminal cases, minor palliative surgery may be a kind thing to do to ease the
last few weeks of a suffering patient's life. W§£
A. Lobectomy C.    Segmental resection
B. Wedge resection D.    Pneumonectomy
Excisional therapy has become increasingly popular. The commonly accepted terms
are given on the chart. The main reason for its increasing use is its increasing safety
in tuberculosis, which in the opinion of most authorities is due to the use of antibiotics and chemotherapeutic agents. Forsee in Annals of Internal Medicine, 1951,
states that before 1945, the overall mortality for resection was 25%, and from 1947
to 1951 this was reduced to 4%. In the first one hundred resections done for tuberculosis in the Willow Chest Centre, there was an operative mortality of 3%, any
death occurring within six weeks of operation being considered an operative death.
The total mortality in the one hundred cases followed from six months to five and a
half years from operation was 14%. All but one of the deaths were due to advancing
1. Unsuccessful thoracoplasty
2. Hilar disease
3. Lower lobe disease
4. Tuberculoma
5. Stenosing bronchial disease
6. Tuberculosis bronchiectasis
7. Persisting cavity in spite of satisfactory pneumothorax
8. Totally destroyed lung
This chart gives the generally accepted indications for pulmonary resection in
pulmonary tuberculosis.
Block in 1881 attempted the first resection for pulmonary tuberculosis on a
living patient who died during the operation.|g In 1891 Tuffier performed the first
successful resection for pulmonary tuberculosis; in 1893 by Lawson, in 1895 by Doyen.
From 1895 to 1933 many efforts to perfect a technique were reported, and in 1933,
successful reports were made by Lilienthel, Graham, Freedlander and Rienhoff. In
1942 Thornton and Adams reviewed the literature and found 29 pneumonectomies for
tuberculosis with mortality rate of 46% and 51 lobectomies with mortality rate of
Resection by the old tourniquet technique was very hazardous and the operation
lost favour. With the development of the individual dissection and ligation technique,
largely since 1940, mortality and morbidity was much improved and the introduction of
streptomycin and P.A.S. still further reduced the hazards. The Overholt or face down
position is given some credit for the reduced mortality and morbidity.
Page 84 At first it was felt that it was very dangerous to cut across tissue actually or
potentially infected with tuberculosis, so only complete lobectomies or pneumonectomies
were attempted. However it has been shown by Chamberlain and others that segmental
and wedge resections are safe, so the tendency has been towards saving as much non-
infected lung parenchyma as possible.
There are still many complications to be treated, not the least of which is bronchopleural fistula from failure of the bronchial stump to heal, often because of tuberculosis
infection. Still, in a large percentage of cases, this method seems to offer the only
reasonable hope of cure and the risk seems worthwhile. In some places in selected
cases, resection is elected over collapse procedures. Whether this will gradually become
generally accepted or not, only a prolonged follow-up can determine. The question
of the necessity for permanent collapse procedures preceding or following the resection
to take up the extra space, is still not finally settled. In many places, following removal
of a large part of lung, collapse is done, usually a modified thoracoplasty for upper
lobectomies or pneumonectomies and phrenicotomy for lower lobes.
Figures for Canada obtained from Canadian T.B. Association
in Percentage of Total Discharges and Deaths Per Year
Pneumolysis '
Paraffin Pack
This  chart  gives  an  idea  of  the   trends  in  popularity   of   the  various   methods   used  in  treating
pulmonary tuberculosis, showing particularly the trend toward more excisional therapy.
Antibiotics have already been mentioned in passing but I feel that further emphasis
might be put on their importance. The U.S. veterans hospitals have supplied us with
many accurately controlled studies on their effectiveness and advised what dosages are
necessary. Dosages have been steadily reduced and results maintained. In the Canadian
T.B. Society report, use of streptomycin was first reported in 1947—.02% of cases
receiving it, and in 1949, the last year for which figures are available, 23.3% received
it. We have seen many cases with fresh post-operative spreads heal their spreads in
a few weeks under antibiotic therapy, spreads that without antibiotics would take
months for control if they were controlled at all.
Good anaesthesia plays such a role in any thoracic surgery, it should be credited
with a share of its increased importance in pulmonary tuberculosis. A constant
supply of high concentration of oxygen with adequate anaesthesia, with ability to force
oxygen   when   necessary,   has   been   obtained   with   intratracheal   and   intrabronchial
The removal of secretions from the tracheo-bronchial tree during and after
anaesthesia adds to the safety by preventing atelectasis and allowing oxygen to be
utilized.    The use of blood in large quantities has made possible the performing of
Page 85 operations on debilitated individuals with low blood volume that otherwise would be
contraindicated. The close measuring of blood loss during long operations permits
the accurate replacement of this loss during and immediately after the operation.
Improved x-ray pictures have made diagnosis more accurate and early, and
localization of the lesion has directed the therapy necessary. The tomograph or piano-
graph has picked up many unsuspected cavities and directed therapy toward closing
them at an earlier date.
Bronchoscopic instruments and technique have been improved and many more
men have become proficient in their use and so many bronchial lesions have been found,
and treatment modified to take care of these lesions.
There is no doubt of the increasing importance of surgery in tuberculosis. Perhaps
some figures from the B.C. Department of Tuberculosis Control might be of some
interest. I may say we feel that we tend to be on the conservative side here, so the
figures should not exaggerate the importance of this therapy. The more rapid turnover
and dimished mortality in my opinion, is due mainly to two factors, namely streptomycin and increasing use of surgery.
Deaths &
% of Deaths
T.B. Beds
to Total
Operations j
To attempt to look into the future of any type of therapy in these rapidly changing times is a hazardous thing to do. The pathology of tuberculosis in the lung
causing extensive fibrosis and cutting off blood supply to the area early in the disease,
seems to make it unlikely that in the near future, any antibiotics or chemotherapeutic
agent can be delivered in sufficient concentration by the blood to a well established
fibrotic tuberculosis lesion to sterilize it, so that it will probably be necessary to treat
these lesions, particularly where cavities exist, by surgical means for some time to
1. Surgery is playing an increasing role in the treatment of pulmonary tuberculosis.
2. Safety of surgery in pulmonary tuberculosis is increasing, owing to many factors, the
most important being the use of streptomycin.
3. It would appear that surgery is causing a more rapid turnover in T.B. institutions
and probably is diminishing the period of disability.
4. From the nature of the pathology in tuberculosis, and in spite of more effective
antibiotics, it is probably true that surgery will be necessary in well established
tuberculosis lesions for some time.
Eye, ear, nose and throat practice in Vancouver, B.C.
Long established. Offices in Vancouver Block with many other physicians.   Will sell whole or divided specialties.   Full equipment including slit lamp and bronchoscope.   Terms if desired.   Selling with a
view to retirement. Apply No. 115 - 736 Granville Street, Vancouver.
Page 86 ^Irtttsh Columbia Htutstott
Canadian Mtbxtnl Assortatum
1807 West 10th Ave., Vancouver, B.C.      Dr. G. Gordon Ferguson, Exec. Secy
President—Dr. J. A. Ganshorn.
President-elect—Dr. R. G. Large..
-Prince Rupert
Vice-President and Chairman of General Assembly—Dr. F. A. Turnbull Vancouver
Hon.  Secretary-Treasurer—Dr. W. R. Brewster New 'Westminster
Members of the
Dr. G. Chishofm
Dr. E. VV. Boak
Dr. C. C. Browne
Prince Rupert and Cariboo
Dr. R. G. Large
New Westminster
Dr. J. A. Sinclair
Dr. W. R. Brewster
Dr. A. S. Underhill
Dr. C. J. M. Willoughby
Standing Committees
Constitution and By-Laws.
Legislation _.
Medical Economics	
Medical Education	
Nominations 1	
Board of Directors
Dr. F. A. Turnbull
Dr. A. VV. Bagnall
Dr. F. P. Patterson
Dr. P. O. Lehmann
Dr. G. C. Johnston
Dr. Ross Robertson
Dr. R. A. Gilchrist
Dr. J. Ross Davidson
Dr. R. A. Palmer
Dr. J. McMurchy
 Dr. R. A. Stanley, Vancouver
 Dr. W. R. Brewster, New "Westminster
 -Dr. J. C.  Thomas, Vancouver
 Dr. P. O. Lehman, Vancouver
 i Dr. T. R. Sarjeant, Vancouver
 Dr. J. A. Ganshorn, Vancouver
Programme and Arrangements Dr. Harold Taylor, Vancouver
Public Health 1 Dr. G. F. Kincade, Vancouver
Special Committees
Arthritis and Rheumatism-
Civil Defence	
Hospital Service_
_Dr. F. W. Hurlburt, Vancouver
 Dr. Roger Wilson, Vancouver
-Dr. John Sturdy, Vancouver
Industrial Medicine—
Maternal Welfare	
Public Relations	
 Dr. J. C. Moscovich, Vancouver
 Dr. J. S. Daly, Trail
 Dr. A. M. Agnew, Vancouver
 Dr. E. C. McCoy, Vancouver
._Dr.  D.  M. Whitelaw, Vancouver
 Dr. G. C. Johnston, Vancouver
Yes, that is certainly what resulted when the news that the B.C. Division was in
favor of extra billing hit the newspapers. Not all the furore came from the laity, for
even a few of ourselves didn't completely understand the idea and were somewhat
perturbed by the bombshell; which just proves the point that medical public relations
must include dissemination of information to our own members. For when this extra
billing (incidently an unfortunate name) is fully understood, that it is really for the
benefit of M.S.A. and those members who play fair with M.S.A., and not for the benefit
of the doctor, the controversy rapidly dies down. No doubt you and your patients
saw the advertisement by M.S.A. and the B.C. Division explaining this, and we hope
Page 87 that a lot of you heard the broadcast on it, though it was in competition with the
U.S. elections. We hope the subject is now fully understood, but if you have any
doubts or feel you would have trouble explaining it to any layman who questioned you,
drop me a line c/o the Bulletin, at 1805 W. 10th Avenue, and if necessary we will
print further explanatory details.
Speaking of public relations, don't miss the article by Dr. Johnston immediately
following this, which I am sure you will find of great interest. Dr. Dorrance in his
article gives some of the objectives and problems of the radio programmes.
There have been occasional misunderstandings about S.A.M.S., and so the executive
secretary has written a little article which I think you will find of definite value.
We are hoping through these columns to give you some idea of post-graduate courses
available in the Pacific Northwest. Sorry we haven't many details for this issue, except
to state the University of California in San Francisco is giving Cardiovascular Diseases
and Electrocardiography, in the mornings and afternoons respectively, February 2-5,
inclusively. Each course costs $25.00 and can be taken separately or can be combined.
They follow this on the 6-7-8 with one on pulmonary function.
We wish you all a Merry Christmas and a Very Happy and Prosperous New Year.
GORDON JOHNSON, Chairman of the Public Relations Committee
A few short decades ago "Public Relations" was unheard of. Today it is the"
stock-in-trade of business, industry, governments, hospitals and even professions. The
remarkable growth of this specialty appears to be a direct result of the technical
changes of the past fifty years. At the turn of the century, and many years after,
Canada was essentially an agricultural nation, which means a nation of individuals in
the economic sense. More recently, as the result of technical advances, huge organizations came into being to utilize those scientific discoveries. Overnight the country
changed from a society of semi-rural individual workers, carrying on their own public
relations in their own way, to one of an industrial character, in which individuals lost
their identity and became a mere cog in a machine. Since these large bodies are
essentially remote and impersonal, they easily became the object of suspicion or downright hate. Public Relations had to be developed and employed to humanize them, to
give them a personality and to allay the doubts and suspicions.
To the medical profession today one sees the same reaction. The individual doctor
impresses his patient in varying degrees, with his personality and by his acts. In
return, and in proportion, he receives homage, respect and confidence. The profession
as a whole is the abstract, soulless and little understood monster, who raises the costs,
make£ the mistakes and fails to cure. And so, it needs public relations to make it
understandably human, approachable and, if possible, trusted and loved for its kindness
and good works.
Everyone agrees, I think, that in the first instance our efforts in public relations,
as a profession, should be to serve the public by giving them general information about
ourselves, and about general matters of health. Most would also agree that our
offerings in this respect should be entertaining, as well as instructive, and that misinformation and false impressions should be corrected promptly.
These efforts may not be enough, however. It may be necessary to defend ourselves
overtly in the political field. In our own generation we have seen the appearance of
a political technique which is characterized by noisy, disputatious distortions and a
complete disregard for the truth. It is designed to raise doubts and suspicions and to
appeal to the baser emotions of the uninitiated. It accuses and confuses and rouses
the bully and the mob. It is completely lacking in the courteous civility of the
cultured man. It tramples on the personal freedoms, so dearly achieved, and on the
humanities that distinguish us from the barbarian.
Page 88 We have seen it begin in Germany, with the screaming and baying of the mob
and end in the horrors and disgrace of Belsen and Buchenwald. We see it daily in
the communist world, with its senseless lies, its brutal purges and its swollen slave
camps. One hears it in the bestial snarls of the rabble witnessing the political executions in Peking and Shanghai. One doubts if this continent is immune, when the
leader of a few hundred thousand coal miners repeatedly intimidates the government
of one hundred and sixty millions of people.
In the past this technique was met with soothing words, placating speeches and
ever increasing concessions. In the international field we have seen boundaries changed
and whole nations sacrificed to satiate the insatiable and have paid dearly for our
folly. We are still willing to compromise both at home and abroad. , We have not
completely learned our lesson and appeasement is still not dead.
One would submit, therefore, that our public relations should not be entirely a
matter of gentle timid back patting. If we are right, we should say so in no uncertain
terms. We should be intolerant of those who distort the truth for political advantage
and we should openly expose them. This is not to suggest that our public relations
be provocative or tactless but that it should be honest, fearless and straightforward
"Beauty is truth, truth beauty,—that
is all
Ye know on earth, and all ye need
to know."
The B.C. Division of the Canadian Medical Association at it's annual meeting
held in September of 1952 ratified the development of a radio program. This radio
program is the result of a series of meetings held by the Public Relations Committee
which considered that they could improve public relations of the medical profession
through the development of the program. It will be known as the "Doctor's Viewpoint"
and will be broadcast by CJOR every Tuesday evening at ten fifteen o'clock. The
program will be sponsored by the B.C. Division with several things in mind. First it
provides a radio channel for public statements on policy, as the recent broadcast on extra
billing. It gives the profession an opportunity to guide the thinking of the public on
purely medical matters.
An example of this is the forthcoming broadcast on "The Miracle Drugs" which
will point out the problems of too much publicity for newer drugs before they have
been thoroughly tested. Thirdly, the radio series provides a weekly chance to talk
to people in a personal way. In general, the radio series plays an important part in
our public relations by attempting to remove the idea that Doctors do not speak out,
and by presenting an understandable series of talks and discussions on medical matters.
The program is to be in the form of a series of weekly programs presented each
Tuesday evening for the next six months, and during this period of time we hope to
establish a radio audience which probably will not be large at first but should grow
as the program becomes better known. We hope to develop a fan radio mail,
the public will ask questions or write in to the radio station asking questions, and
these will be answered the following week.
The programs have already commenced, the first was given on October 28 th and
this served as an introduction; the second program was given on November 4th and
the topic was extra billing; the third was given on November 11th and this dealt with
the general practitioner. The type of program which is best suited, we believe, is one
of questions and answers and this is what we are trying to develop. We hope that
within the next two months we should have a good idea as to the reception this program
is receiving, and by means of the radio fan mail to develop an idea as to the reaction
of the public. In the development of this program, it is the intention of the Corn-
Page 89 mittee to use various members of the medical profession, who are particularly well
informed on the subject with which the radio program will deal on that special evening.
An example of this, is the program on extra billing, at which Dr. Gerald Watson
of the M.S.A. and Dr. Peter Lehmann who is Chairman of the Economics Committee,
were used along with Mr. Dorwin Baird, the radio announcer, to carry on the theme
of extra billing, and how that extra billing applies to the public. A number of these
weekly programs are now in the process of development, and they will all deal with
subjects in which the medical profession and the public are together interested. The
idea in the development of the radio program, is to be of service both to the public and
to the medical profession. The service which could be performed, is to improve the
public relations between the medical profession and the public itself. It could also
be of service in establishing the feeling of fraternity between the various sections of
the medical profession, and between the various members of the B.C. Medical Division.
It can also perform a service in answering any questions which the public may ask,
and in the dissemination of knowledge regarding medical subjects, and in how to give
treatment of minor injuries along the line of first aid.
We hope that the pubic will avail themselves of the opportunity of writing to
the ra<Jio station, so that we may have an opportunity of answering some of their
questions. This radio program, the "Doctors' Viewpoint", through the series of radio
broadcasts in which we give a series of talks and discussions on medical matters, should
produce a feeling of friendliness and good will between the public and ourselves.
fy&i Ifoub Onj/Vimatiott
The Doctor's Responsibility under the S.A.M.S., more properly known as the
Canadian Medical Association—British Columbia Division, Social Assistance Medical
It seems expedient to review for all members, certain aspects of the agreement
held by the profession with the Government of British Columbia to supply medical
care, to those members of our community who are in receipt of a pension under the
following Acts, which automatically apply a means test—
Old Age Assistance Act
Blind Persons Allowance Act
Mothers Allowance Act
Social Assistance Act
Protection of Children Act
and the Old Age Security Act of Canada where a means test indicates further assistance
is necessary.
This medical care is paid for wholly out of Provincial revenues. It is important
for us to see that this money, which is contributed by the people of British Columbia,
is wisely spent, and that it accomplishes the purpose for which it is set aside. The
S.A.M.S. Board is a subcommittee of the Committee on Economics of the Association,
and they see that the money is wisely spent, and that distribution is fair among the
doctors. They will also, in conjunction with the Committee on Pharmacy, very soon
bring you information on the wise use of the drug benefits.
It is the second above note on our responsibility that it is specially desired to bring
to your attention at this time—"that the money accomplishes the purpose for which
it is set aside."
These underprivileged people need health care, and it is in the public interest
that it should be available to them. Their meagre financial circumstances are such that
the costs of medical care would be an impossible hazard. It is through S.A.M.S.
that they are relieved entirely from this cost.
Page 90 When a doctor accepts a patient with an S.A.M.S. health card, he agrees to do all
the necessary work and look solely to the S.A.M.S. for payment. It is never his
prerogative to seek extra payment or balance of payment from the patient. Our
agreement as published in News Letter No. 1, June, 1952, is clear and says in
l.(a)i—"without charge to the patient." It is also most unwise for a physician in
honouring the professional agreement to accept further payment even when offered.
Occasionally a physician will feel that a family can do better for their older folk
and he is unwilling to serve at the S.A.M.S. rate. If this is so, and providing there is
no moral reason to remain on the case, he must refuse to honour the S.A.M.S. card
and give the patient the opportunity to seek another physician. If the patient decides
to remain for care, the understanding between patient and doctor should be written,
and no account whatever will be sent to S.A.M.S.   It is all S.A.M.S. or no S.A.M.S.
It is wise to remember that the responsibility of applying the means test rests with
the Department of Welfare. Criticisms of the efficiency of the testing should not be
made lightly. The Board of Directors of the Association will only make enquiries
when such criticisms are formally presented by a member with some substantiating
The members of our Association who comprise the S.A.M.S. Board of Directors,
and who work so hard on our behalf are—
Dr. Ross Robertson, Chairman
Dr. L. S. Chipperfield
Dr. T. R. Blades
Dr. W. W. Simpson
They deserve our grateful thanks.
Dr. H. Scott
Dr. M. M. Baird
Dr. Howard Black
Mr. E. L. Deighton (Secretary)
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health, Province of British Columbia
A. M. GEE, M.D.,
Director, Mental Health Services, Province of British Columbia
The Crease Clinic has been designed primarily for the diagnosis and active treatment of the early and acute mentally ill. By an Act of the Legislature which governs
the Clinic, patients are admitted for a period of treatment not to exceed four calendar
months. For this reason only patients who are acutely ill, or who have been ill for a
comparatively short period of time and who may reasonably be expected to obtain
benefit from a short period of active treatment should be sent to the Crease Clinic.
The following types of patient are considered acceptable for admission to the
(a) Psychosomatic disabilities.
(b) Psychoneurotics.
(c) Early psychotics.
(d) Frank psychotics whose illness has not advanced to the chronic stages.
It is not considered that the following types of patient will receive benefit from
short term treatment, and therefore they should not be certified to the Clinic.
(a) Senile dementia.
(b) Arteriosclerotic dementia.
(c) Chronic Psychotics—e.g. markedly advanced schizophrenics.
Page 91 (d) Mental defectives.
(e) Drug addicts without psychosis.
(f) Alcoholics without psychosis.
Any patient entering the Crease Clinic requires some form of legal certification..
Actually there are two procedures for admission to the Clinic.
(a) Certification by two medical practitioners.
In this form of certification, one form "A" and two forms "B" are required. The
form "A" should be completed if possible by a near relative to the patient alleged to be
mentally ill. This form actually is an application for medical examination and
certification. These two forms "B" should be completed by two duly qualified medical
practitioners who are not related in any way to the patient and who are not themselves
in partnership. These three forms, duly completed, are sufficient authority for the
admission and detention of any patient in the Crease Clinic.
(b) Voluntary certification.
This form of certification should be used in those instances where the patient has'
good insight into his condition and where he is desirous of receiving treatment. In
this type of certification only one certificate is%necessary, a form "F". The patient is
required to fill out the top half of this form and the physician is required to complete
the bottom half. The patient should also complete a form "A" at this time as it
provides useful information pertaining to the patient and his particular problem.
These are the only two procedures of admission to the Crease Clinic and when the
necessary certificates are duly completed the patient may be admitted at any time.
The medical officer in charge of the Crease Clinic has the authority to refuse any
patient he does not consider suitable for treatment.
Dr. Allan E. Davidson, for some years Clinical Director of the Provincial Mental
Hospital and Crease Clinic, Essondale, B.C., was promoted to the position of Deputy;
Director of Provincial Mental Health Services, effective October 1, 1952.
Dr. Thomas G. B. Caunt, formerly Medical Superintendent, Provincial Home for
the Aged, has been promoted to the position of Medical Superintendent, Provincial
Mental Hospital and Crease Clinic, Essondale, B.C., replacing Dr. E. J. Ryan, who
died in July, 1952.
Dr. Gordon H. Stephenson of the Crease Clinic staff has been awarded a Mental
Health Grant Bursary for one year's post graduate study in Psychiatry. Dr. Stephenson is pursuing his post graduate studies at the University of Toronto and the Toronto
Psychiatric Hospital.
Dr. Laura I. M. Coleman has returned to the B.C. Provincial Mental Health
Services after two years post graduate study in London, England, and is on the staff
of the Child Guidance Clinic, Vancouver, B.C.
flDount pleasant TDmoertaktnn Co. Xtb.
Telephone: EMerald 2161
Page 92 !■
Dr. S. A. Dekaban has returned from London, England, to Vancouver.
Dr. R. H. Fraser has moved from Victoria to practise in Vancouver with Dr.
Dr. J. B. Lynch has moved from Esquimalt to Nanaimo.
Dr. W. S. Maddin has returned from New York to Vancouver, where he is now
employed in Venereal Disease control.
Dr. John Stefanelli has returned to Trail from Philadelphia.
Dr. Donald Walker is now practising at Vernon. His wife is the former Dr.
EXspeth Evans, whom he met while they were both internes at the Vancouver General
Dr. D. M. Whitely has resumed general practice in Victoria in Victoria after an
absence of two and half years in England taking a Fellowship in Surgery.
Dr. J. R. Naden of Vancouver has been appointed Chief Medical Officer of the
Workmen's Compensation Board.
Dr. G. B. Buffam of Victoria is taking a postgraduate course in Philadelphia and
Dr. D. R. Horton has taken over his practice.
Dr. Chris H. Moore of Victoria is taking a postgraduate course at the Mayo Clinic.
Dr. C. /. G. Mackenzie is in association with Dr. O. C. Lucas of Victoria.
Dr. R. D. Sargent is in association with the Drs. Kenning of Victoria.
Dr. J. L. Hefferman is in association with Drs. V. Smith and E. J. Nash of Victoria.
Dr. W. E. Hunt of Victoria has joined Dr. J. G. Patterson in general practice.
Dr. Merwyn Murray has joined the staff of Radiology at St. Joseph's Hospital,
Dr. S. P. Findlay, his wife and young son, have recently moved from Fraser Lake,
and are now living at Aldergrove. Dr. Findlay has opened offices at Aldergrove for
the practice of medicine, and is on the staff of the Langley Memorial Hospital.
Dr. A. C. Tanner is now practising in Whitehorse.
Dr. H. A. Muth is now with the Williams Clinic in Trail.
Dr. J. J. Sector is now practising in Vancouver Capitol Hill district.
Dr. Wm. T. Armstrong has moved from Vernon to Revelstoke, B.C.
Dr. T. J. Agnew has left Vancouver to practice in Prince George.
Dr. A. F. Balkany of Dawson Creek left to take post graduate studies in Toronto in
Public Health.
Dr. K. C. Boyce of Vancouver has returned from New York.
Dr. L. G. Cohen has opened offices at 1420 Commercial Drive.
Dr. J. P. B. Dale of Vancouver is taking post graduate work at Shaughnessy
To Dr. and Mrs. D. M. Boyd of Victoria, a daughter.
To Dr. and Mrs. E. J. W. Nash of Victoria, a daughter.
At the Annual Meeting of the Victoria Medical Society held on October 6th,
1952, the following officers were elected for the ensuing year: President, Dr. J. D.
Stenstrom; Vice-President, Dr. Gavin Chisholm; Honorary Secretary ,Dr. A. N. Reid;
Honorary Treasurer, Dr. W. A. Trenholme.
At this meeting Dr. D. M. Whiteley addressed the Society on "Medicine in
England To-day".
Page 93 new uniform oral dosage
in muscle spasm of
rheumatic disorders
in acute
in certain
neurologic disorders
The new, uniform oral dose for adults is 1-3 grams.
This may be repeated 3-5 times per day.
The first dose prescribed should be at the lower end of
the recommended dosage range (an occasional patient
may complain of side effects wherif large doses are given
at the start of Tolserol therapy). S' bsequent doses may
be adjusted to the needs of the individual patient.
Whenever possible, Tolserol should be given after
meals. When Tolserol is given between meals, it is
desirable that the patient first drink Yz glass of milk
or fruit juice.
Squibb Mephenesin.
Tablets, 0.5 Gm., bottles of 100; Elixir, 0.1 Gm. per cc,
16 oz. bottles; Intravenous Solution, 20 mg. per cc,
100 cc. ampuls.
Page 94


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