History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1941 Vancouver Medical Association Oct 31, 1941

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of the
Vol. vm
No. 1 —
With Which Is Incorporated
Transactions of the
Victoria Medical Society
Vancouver General Hospital
St. Paul's Hospital
In This Issue:
NEWS AND NOTTS   g^jgjj^     ^W^^^S^^^&^:       " SSBL
MEDICAL ECONOMICS  1      ^W     ^^^H^WW 14
'FAT EMBOUSM^^^^/jl^^fc^^M |^H|    BJuBBSl . 23
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M riBM
The Complete Vitamin B Complex
Medical men are becoming more certain that the Vitamin B Complex, as a
whole, instead of its separate factors, is necessary to human nutrition. A lack of
any one component is likely to be associated with a lack of the other components.
For example, in many cases of pellagra the administration of Nicotinic Acid has
brought to light an accompanying deficiency of Vitamin Bi and Riboflavin*.
Therefore, the administration of the whole complex is logical.
contains the five known members of the Vitamin B Complex, in the pure state.
These components are present as a suitably balanced, palatable combination in
standardized amounts.
Vitamin Bi (Thiamin Chloride)
Vitamin B2 (Riboflavin)
Nicotinic Acid
Vitamin Be (Pyridoxine)
250 International Units.
40 Bourquin-Sherman Units.
.75 mgm.
.1   mgm.
3.0   mgm.
63   micrograms
Pantothenic Acid (Filtrate Factor) 63   micrograms
SUGGESTED DOSAGE:—One to two teaspoonfuls four times a day, preferably taken
after food. Two teaspoonfuls will provide the daily requirement of Vitamin Bi.
Larger dose may be given where indicated.
Viplex E.B.S. is also available in tablet form:
S.C.T. No. 745—VIPLEX E.B.S.
Vitamin Bi (Thiamin Chloride)        .75 mgm. 250 International Units.
Vitamin B2 (Riboflavin) ;5   mgm. 200 Bourquin-Sherman Units.
Nicotinic Acid 10   mgm
Vitamin Be (Pyridoxine) 250   micrograms
Pantothenic Acid (Filtrate Factor) 250   micrograms
SUGGESTED DOSAGE:—Two to four tablets a day, preferably taken after food.
Where the Condition I* duo to
B Complex Deficiency:
Beriberi (Subclinical)
Cardiovascular Dysfunction.  (Where other signs
of B Complex deficiency are present)
Gastro-intestinal Hypotonicity
Neuritis (Of Pregnancy) (Alcoholic)
Seborrheic Dermatitis
For Prophylaxis:
Growing Children
Prevention of Malnutrition
E. B. S.
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical  Dental Building, Georgia Street, Vancouver, B. G.
Dr. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
OCTOBER,  1941
No 1
OFFICERS, 1941-1942
Dr. G. McDiarmid Dr. J. R. Nejlson Dr. D. F. Busteed
President Vice-President Past President
Dr. W. T. Lockhart Dr. R. A. Palmer
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Dr. Gordon Burke, Dr. Frank Turnbull
Dr. P. Brodie Dr. J. A. Gillespie Dr. G. H. Clement
Auditors: Messrs. Plommer, Whiting & Co.
Clinical Section
Dr.  Ross  Davidson Chairman
Eye, Ear, Nose and Throat
Dr. J. A. McLean Chairman Dr. A. R. Anthony Secretary
Pediatric Section
Dr. R. P. Kinsman Chairman Dr. G. O. Matthews Secretary
Dr. F. J. Buller, Dr. D. E. H. Cleveland, Dr. J. R. Davies,
Dr. A. Bagnall, Dr. A. B. Manson, Dr. B. J. Harrison
Dr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. G. A. Davidson.
Summer School:
Dr. H. H. Caple, Dr. W. W. Simpson, Dr. Karl Haig, Dr. J. E. Harrison,
Dr. H. H. Hatfield, Dr. Howard Spohn.
Dr. A. W. Hunter, Dr. W. L. Pedlow, Dr. A. T. Henry
V. O. N. Advisory Board:
Dr. W. C. Walsh, Dr. R, E. McKechnie II., Dr. L. W. McNutt.
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont.
Greater Vancouver Health League Representatives:
Dr. R. A. Wilson, Dr. Wallace Coburn.
Representative to B. C. Medical Association: Dr. D. F. Busteed.
Sickness and Benevolent Fund: The President—The Trustees. IjRfc
eraois, Vaccines, Hormones
Related Biological Products
Anti-Anthrax Serum
Anti-Meningococcus Serum
Anti-Pneumococcus Serums
Diphtheria Antitoxin
Diphtheria Toxin for Schick Test
Diphtheria Toxoid
Old Tuberculin
Perf ringens Antitoxin
Pertussis Vaccine
Vaccine Virus
Pneumococcus Typing-Sera
Rabies Vaccine
Scarlet Fever Antitoxin
Scarlet Fever Toxin
Staphylococcus Antitoxin
Staphylococcus Toxoid
Tetanus Antitoxin
Tetanus Toxoid
Typhoid Vaccines
(Smallpox Vaccine)
Adrenal Cortical Extract
Epinephrine Hydrochloride Solution (1:1000)
Epinephrine Hydrochloride Inhalant (1:100)
Epinephrine in Oil (1:500)
Solution of Heparin
Protamine Zinc Insulin
Liver Extract (Oral)
Liver Extract (Intramuscular)
Pituitary Extract (posterior lobe)
Prices and information relating to these preparations will be
supplied gladly upon request.
Toronto 5
Depot for British Columbia
Macdonalds Prescriptions Limited
Total Population-
Japanese Population—estimated
Chinese Population—estimated J
Hindu Population—estimated 	
stimated 272,352
Total deaths 231
Japanese deaths 3
Chinese deaths 9
Deaths—residents only 200
Male, 222;  Female, 221.
Deaths under one year of
Death rate—per 1,000 births-
Stillbirths (not included in above).
Rate per 1,000
Aug., 1940
July, 1941
Cases   Deaths
August, 1941
Cases   Deaths
Sept. 1-15,1941
Cases   Deaths
Scarlet Fever  6
Diphtheria  0
Chicken Pox  15
Measles  3
Rubella  4
Mumps  0
Whooping Cough  1
Typhoid Fever  1
Typhoid Fever Carrier  1
Undulant Fever    0
Poliomyelitis  0
Tuberculosis  37
Erysipelas  3
Meningococcus Meningitis  7
Paratyphoid Fever  0
Hospitals &
Private Drs.
<<  A   "
Another Product of the Bioglan Laboratories, Hertford, England
Stanley N. Bayne, Representative
Phone MA. 4027
Descriptive Literature on Request
Vancouver, B. C.
•i r
m ;
Page 1 ml
■Wit 1 *
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As the season for colds begins
Chest Colds
• With fall and winter just around the corner,
affections of the upper respiratory tract will
become more frequent. Antiphlogistine is an
ideal adjuvant to the general treatment of such
affections. When administered promptly, its
medicative and sedative warmth prove helpful
in the process of decongestion and repair.
Made in Canada
Founded 1898 . . .Incorporated 1906
Programme of the Forty-fourth Annual Session
Dr. W. D. Keith: "Safety in the Operation for Toxic Thyroid.
Dr. E. J. Curtis: "Meningococcus Meningitis."
r •
, N
December    2—GENERAL MEETING.
Dr. F. E. Saunders: "Sterility in the Female."
Brisk, racy GUINNESS STOUT has long
been prescribed as a tonic by leading
doctors in Great Britain. Literally thousands of them, from their own clinical
experience, have vouched for its therapeutic attributes.
Its restorative value during convalescence is famous. In cases of insomnia
Guinness promotes sound, restful sleep,
obviating the depressing after-effects of
most hypnotics, Guinness is a stimulating and appetizing food for older people.
Guinness has been brewed in Dublin
since 1759, and is the largest selling
malt beverage in the world. It is brewed
from only four ingredients, barley malt,
hops, Guinness yeast and spring -water.
It is matured over a year in oak vats
and bottle.
as thousands in Britain have testified
Unlike other stouts and porters, Guinness is unfiltered and
unpasteurized, and thus contains all its natural goodness including useful minerals and active yeast, a source of Vitamins B
and G. Foreign Extra Guinness is obtainable through all legal
outlets. Write for convenient 3" x 5" file card giving complete
analysis and indications to Representative, A. Guinness, Son &
Co., Limited, 501  5th Avenue, N.Y.C
Total solids 5.87  gm.
Etbyl alcohol   (7.9% by volume) 6.25 gm.
Total  carbohydrates 3.86 gm.
Reducing   sugars   as   glucose 0.66 gm.
Protein None
Total nitrogen 0.10 gm.
Asb 0.28 gm.
Phosphorus 38.50 mg.
Calcium 7.00  mg.
Iron    : 0.072  mg.
Copper       0.049 mg.
Fuel value 61 col.
'Vitamin Bi 6 Int. Units
"Vitamin G 33  Sherman Bourquin Units
1 ■<? 11 i
Page ifi!*
■  c
No. 81S—Each tablet contains:
Vitamin Bi... .3.3 mg.   (1,100 International Units)
Nicotinamide ..8.3 mg.
Riboflavin .. .0.15 mg. (60 Sherman-Bourquin Units)
Vitamin B&.. .0.15 mg.
with other Vitamin B Complex Factors as contained in
0.167   Gm.   (2.5  grains)   of  dried  brewers'   yeast.
Supplied in bottles of 36, 100, 500 and 1000.
The FACTORS of the Vitamin B complex may be
likened to the spokes of a wheel. Each is important i
but, by itself, generally insufficient. Vitamin B]
deficiencies rarely occur singly. An obvious lack
of one factor is usually accompanied to some ex- j
tent by a lack of the associated components. So itj
is advisable to administer all the factors, even
when treating an apparently specific deficiency.
In such instances, "Beminal" Tablets furnish a
highly potent, balanced and standardized preparation  of  the   complete   Vitamin   B   complex.
Other Ayerst preparations of Vitamin B complex are "Beminal" Concentrate,
"Beminal" Compound, "Beminal" Liquid, "Beminal" Granules and "Beminal"
Injectable. Individual products of Vitamin Bi, Nicotinamide, Nicotinic Acid,
Riboflavin and Pyridoxine are also available. Literature on request.
AYERST, McKENNA & HARRISON LIMITED      •      Biological and Pharmaceutical Chemists
We have seen a circular letter that is being widely sent to members of the laity by
the Chiropractor's Association of British Columbia. Our readers are aware that an investigation is being held, with Mr. Justice Sloan as Commissioner, into the workings of the
Workmen's Compensation Act of British Columbia. All interests concerned have been
given a full and fair hearing: and recommendations of all sorts have been made to the
Commissioner. Among these is an earnest plea for recognition of the chiropractic art as
a means of treatment of those who come under the Workmen's Compensation Act.
The precious document to which we refer, and which is published in this issue for
our readers to peruse at their leisure, urges its readers to support the Chiropractors' Association in their attempt to secure, before election, a promise of support from every candidate for the Legislature in the coming election and to commit their candidate to a
definite statement as to his position in this regard.
The chiropractors are within their rights in this matter, we suppose, though we can
hardly believe that a candidate will pledge himself to the support of some measure in
advance, till he has had ample opportunity to study the subject and hear both sides of
the case. But what we are really concerned to point out, is that they are on a very
wrong track as regards the medical profession. The question of who shall be allowed to
treat the sick is not for us to decide, and never has been. This is the function of the
Legislature, and it is for the purpose of control of this matter -that medical acts are in
force everywhere.
Where so many people err, is in supposing that the Medical Act is a monopolistic
measure, designed to protect one school of healing, and that we as a profession immediately and automatically represent any encroachment on what, in the egregious words
of Mr. Sturdy we "consider is our sacred right."
We, of course, know this is all tosh. The Medical Act was passed with one end in
view alone, to protect the sick public against abuse and exploitation by quacks and
charlatans, and to ensure that nobody should treat the sick who could not show a certain
minimum of training and qualification. That is its only purpose, and that is still its
purpose. It is not passed for our benefit, but for the regulation of the practice of the
healing art.
Chiropractors and other aspirants towards recognition of their "right" to treat the
sick, on an equality with the medical profession, always blame the said medical profession for their failure to obtain this recognition. Perhaps it would be unkind to suggest
that this failure is rather due to their own fault: to their lack of adequate training and
knowledge. Since it is the Legislature that does the refusing, we can only suppose that
the Legislature has not been satisfied that they are capable of meeting the requirements.
We feel sure that the Legislature will continue to insist on proof of such adequate training and knowledge. If and when any such group can provide such proof, we cannot
stop their practising, nor shall we try.
The Medical Act is a statute of the Government of British Columbia, and alterations in it can always be made, jregardless of what we think of them. Our duty is
merely to advise when called on to do so. Whether we object or not to the inclusion
of chiropractors is not the question here. It is for the Government of British Columbia,
instructed by its Legislature, to decide, after considering all the facts in the case. We
feel that the matter can safely be left to these bodies, who are charged with the preservation of public health, and the maintenance of high educational standards. jn*
** '< i'-,l
rF B'
The Chiropractor's Association of British Columbia
October 1, 1941.
Dear Fellow Workers:
Allow me to thank you on behalf of the Board of Chiropractors, for the splendid
co-operation rendered by you in connection with our appeal before the Royal Commission, for an Amendment to the Workmen's Compensation Act, to include the services
of Chiropractors on the same basis as Medical Practitioners. Numerous resolutions were
received, and when read by our Solicitor to Mr. Justice Sloan, occasioned considerable
surprise, particularly to the medical profession. They established without any question
the fact that Chiropractic is now universally recognized as a healing Science of tremendous value to industry.
During the fight for recognition of Chiropractic, extending over many years, I
came to know how very powerful and skilful are the methods employed by the Medical
Profession. We became recognized by the Government, and are now on the same basis
as medicine, but there is still one more hurdle to jump, and that is to make sure that
when the Compensation Act is amended, we will be included.
There is only one way to win this objective, and this action must be taken immediately, and every precious minute taken advantage of between now and October 21st,
the date of the election.
We must depend upon you, the Labor Unions. You have the organization and the
compelling power by votes. In this respect we are outnumbered. The votes of seventy
Chiropractors in B. C. without a powerful organization, means little compared to six
hundred and fifty well organized medical Doctors, representing, with their friends, etc.,
thousands of votes.
We must therefore take this question to the Political field. Candidates before election are interested chiefly in their own election, and are apt to make promises, only to
be forgotten after they are elected.
Our plan, therefore, is to pledge the candidates in public meetings, by asking them
if they will vote for the inclusion of Chiropractic in the Workmen's Compensation Act.
We are asking you to do this. Will you then send the information obtained, to our
Solicitor and Secretary, Mr. J. S. Burton, Credit Foncier Building, 850 West Hastings
Street, Vancouver, B. C, or to myself, Walter Sturdy, D.C., 401 Vancouver Block, 736.
Granville Street, Vancouver, B. C.
If pledged in public, the candidate will keep his promise, and will be present in the
House when the vote is taken, and no vote will be lost by lobbying, as was done for
fifteen years by the Medical Association prior to the passing of the Chiropractic Act.
We believe that it is the right of the sick and injured to choose whatever form of
healing they desire, but the medical men will put up a bitter fight to protect their
monopoly on what they consider is their sacred right
I beseech you to act at once. It can only be done before election. We will not
have the same power afterwards. If the Commissioner makes a report recommending the
inclusion of Chiropractic, this in itself does not mean the Act will be amended. It still
must be passed by the members of the House.
Thanking you, I am,
Very sincerely yours,
Chairman of the Legislative Committee.
Page 4 NEWS    AND    NOTES
Surg.-Lieut. and Mrs. D. M. Whitelaw are receiving congratulations on the birth of
a son, on September 3rd.
Dr. and Mrs. J. T. Lawson of New Westminster are receiving congratulations on the
birth on September 8 th of a daughter.
At the Annual Meeting of the North Shore Medical Society, held on September 9th,
the following officers were elected: President—Dr. W. G. Saunders of North Vancouver;
Vice-President—Dr. C. M. R. Onhauser of West Vancouver; Secretary-Treasurer—Dr.
G. A. McLaughlin of North Vancouver.
55" Sfr Si* 3&
Dr. Robert Mackenzie of Grantham's Landing has been assisting the doctors of the
Burris Clinic during the summer months.
Dr. J. S. Burris of Kamloops has just returned from a month's trip, during which
time he visited hospitals in Toronto and Montreal, and spent part of the time with relatives in the East.
•p *r w *s*
Dr. M. G. Archibald of Kamloops has left for Eastern centres and while away will
visit the old homestead in Musquodoboit, Nova Scotia.
■ if
f »i
Dr. John E. Hammett, Professor of Surgery at Polyclinic Hospital, New York, spent
a few days in the early part of September with Dr. Lyon H. Appleby.
Dr. R. W. Garner, President, and Dr. G. B. Helem, Honorary Secretary of
the Upper Island Medical Association wish it announced that the Annual
Meeting of that Association will be held at Qualicum on Wednesday, October
29th, 1941.
It has been arranged that Dr. J. R. Neilson of Vancouver will contribute
to the surgical programme, and Dr. Lee Smith of Vancouver will deal with
some phases of the subject of Urology.
It has been planned that golf will be played in the afternoon and following
dinner the clinical programme and annual business meeting will be held. The
time and place of the dinner, golf and other features will be announced by
letter to all members.
An excellent meeting is .planned and a large attendance urged.
Dr. L. Giovando of Nanaimo spent his vacation on a shooting trip in the Cariboo.
Congratulations to Dr. and Mrs. Gordon Brown of Cranbrook, who were married
Page 5
w« «>"'
m ti
Dr. and Mrs. Gordon Wilson of Trail attended the wedding of Dr. and Mrs. Gordon
Brown in Cranbrook and spent a week at Gray Creek on the way back to Trail.
Dr. C. Ewert of Prince George .has returned from a trip to the coast.
Dr. J. Bain Thorn of Trail has spent a short holiday at the coast.
We are glad to learn that Dr. W. K. Massey, formerly of Ashcroft, is progressing
The profession will be pleased that Dr. Evelyn Gee, late of the Vancouver General
Hospital, is getting along fairly well.
Dr. A. K. Haywood, Superintendent of the Vancouver General Hospital, attended
the forty-third annual convention of the American Hospital Association in Atlantic
City, September 15 th to 19th.
Textbook of Medicine, 5th ed., 1941, edited by Russell L. Cecil.
Surgical Clinics of North America, Symposium on Surgical Treatment of Cancer, Mayo
Clinic Number, August, 1941.
The Romance of Exploration and Emergency First-Aid from Stanley to Bird,  1934,
Published by Burroughs Wellcome & Co.
INFANTILE PARALYSIS, A Symposium delivered at Vanderbilt University, April,
1941, under the auspices of The National Foundation for Infantile Paralysis.
This book should be sought after by those who wish to be informed on the progress
made in the investigation of poliomyelitis.
The title "Infantile Paralysis" is used in spite of an effort by some to relegate the
term to the misnomers.
The size of the book commends itself. The subject matter is in the form of a
symposium of lectures given by well known authorities. It is an outcome of the efforts
of the National Foundation for Infantile Paralysis.
There are lectures under the titles of History, Etiology, Immunological and Serological Phenomena and Pathology. Such a compilation does not lend itself to laborious
reading in order to obtain the meat therein. There is, however, considerable repetition
of interlocking data in the various lectures.
The absence of a heading on symptomatology or clinical aspects of the disease might
be disappointing at first glance. However, a thorough perusal of these lectures will give
one a much more sound clinical acumen in respect to acute poliomyelitis.
By far the most important lecture to the practising physician is that on treatment
and rehabilitation.   This is indeed excellent.
E. Johnston Curtis, M.D., CM.
Page 6 l! '!
British  Columbia  Medical  Association
President Dr. C. H. Hankinson, Prince Rupert
First Vice-President Dr. A. H. Spohn, Vancouver
Second Vice-President Dr. P. A. C. Couslahd, Victoria
Honorary Secretary-Treasurer Dr. A. Y. McNair, Vancouver
Immediate Past President Dr. Murray Blair, Vancouver
Executive Secretary j Dr. M. W. Thomas, Vancouver
The annual business session of the British Columbia Medical Association was held
on Wednesday evening, September 17th, in the Social Suite of the Hotel Vancouver,
Vancouver, B. C.
Doctor Murray Blair presided.
The minutes of the 1940 Annual Meeting held at Nelson were read and adopted.
The reports of Chairmen of Standing Committees, which had been published in the
September Bulletin, were adopted.
Dr. Murray Blair reported on the work of the Divisional Advisory Committee. He
then introduced Surgeon-Commander A. G. Laroche, Senior Medical Officer of the
Naval Medical Services; Lieut.-Col. G. C. Kenning, District Medical Officer of this Military District, and Major Murray Baird. Major Baird addressed the meeting on, "The
Duties of a Regimental Medical Officer." Surgeon-Commander Laroche spoke on the
duties of a Medical Officer in the Navy, and mentioned the assistance given by the specialists in the other services. Colonel Kenning spoke briefly, thanking the Medical Association for all the assistance given in this Military District.
The report of the Nominating Committee was presented to the meeting by Dr. W.
A. Clarke, Chairman of that committee. On motion, nominations were closed. It was
then moved, seconded and carried that the Secretary be instructed to cast the ballot for
the following officers: President, Dr. C. H. Hankinson, Prince Rupert; First Vice-
President, Dr. A. H. Spohn, Vancouver; Second Vice-President, Dr. P. A. C. Cousland,
Victoria; Honorary Secretary-Treasurer, Dr. A. Y. McNair, Vancouver.
The election of five Directors-at-large placed the following on the Board of Directors: Doctors G. F. Amyot, Victoria; P. S. McCaffrey, Agassiz; H. McGregor, Penticton; A. H. Meneely, Nanaimo, and G. F. Strong, Vancouver.
Dr. A. J. MacLachlan was re-appointed Auditor.
Dr. G. S. Fahrni, President of the Canadian Medical Association, then addressed the
meeting, and he was followed by Dr. T. C. Routley, General Secretary of the C.M.A.
It was announced that the next Annual Meeting would be held at Jasper, in conjunction with the Annual Meeting of the Canadian Medical Association, and that of
the Alberta Division.
Doctor Blair thanked the members for the honour of being elected to the Presidency.
He also thanked Doctor Fahrni and Doctor Routley, and all the speakers who had taken
part in the meeting for their excellent contribution.
Doctor C. H. Hankinson was conducted to the Chair by Doctor Blair. Doctor
Hankinson thanked the retiring President, members of the Executive, and all connected
with the arrangements for the meeting, and asked for continuation of the support of the
members in the coming year.
Dr. Thomas Addis, San Francisco, Calif.
Dr. A. M. Agnew, Vancouver.
Dr. T. H. Agnew, Vancouver.
Dr. Alexander, Vancouver.
Dr. T. M. Ahlquist, Vancouver.
Dr. G. F. Amyot, Victoria.
Dr. W. F. Anderson, Kelowna.
Dr. L. H. Appleby, Vancouver.
Dr. J. W. Arbuckle, Vancouver.
Dr. T. F. H. Armitage, Vancouver.
Dr. F. M. Auld, Nelson.
Dr. A. W. Bagnall, Vancouver.
Dr. T. D.  Bain, Vancouver.
Major M. McC. Baird, Victoria.
Lt.-Col. S. G. Baldwin, Victoria.
Dr. Ian Balmer, Vancouver.
Dr. W. S. Barclay, Sardis.
Dr. W. T. Barrett, Victoria.
Dr. C. E. Battle, Vancouver.
Dr. W. E. Bavis, Port Renfrew.
Dr. A. N. Beattie, Vancouver.
Dr. C. H. Beevor-Potts, Duncan.
Dr. J. Becher, Vancouver.
Dr. L. G. Bell, Winnipeg, Man.
Dr. C. E. Benwell, Essondale.
Lieut. W. F. Bie, Vancouver.
Dr. R. D. A. Bisson, Vancouver.
Dr. Murray Blair, Vancouver.
Dr. E. W. Boak, Victoria.
Dr. E. Bolton, Vancouver.
Dr. A. W. Bowles, New "Westminster.
Dr. C. E. Brown, Vancouver.
Dr. Harold Brown, Vancouver.
Dr. C. C. Browne, Nanaimo.
Dr. F. M. Bryant, Victoria.
Dr. F. W. Brydone-Jack, Vancouver.
Dr. B. F. Bryson, Essondale.
Dr. F. J. Buller, Vancouver.
Dr. W. B. Burnett, Vancouver.
Dr. D. F. Busteed, Vancouver.
Dr. U. P. Byrne, Essondale.
Dr. E. A.  Campbell, Vancouver.
Dr. Bruce Cannon, New Westminster.
Dr. H. H. Caple, Vancouver.
Dr. R. S. P. Carruthers, Vancouver.
Dr. T. G. B. Caunt, Essondale.
Major M. R. Caverhill.
Dr. G. A. Cheeseman, Field.
Dr. Y. Peter Chen, Los Angeles, Calif.
Dr. L. S. Chipperfield, Port Coquitlam.
Dr. D. A. Clark, New Westminster.
Dr. W. A. Clarke, New Westminster.
Dr. W. B. Clarke, Vancouver.
Dr. J. W. Cluff, Vancouver.
Dr. Wallace Coburn, Vancouver.
Dr. R. B. Coglon, Yakima, Wash.
Dr. J. L. Coltart, Kamloops.
Dr. H. G. Coulthard, Vancouver.
Dr. P. A. C. Cousland, Victoria.
Dr. C. F. Covernton, Vancouver.
Dr. C. H. Cowgill, Huntington Park, Calif.
Lieut. F. E. Coy, Vancouver.
Dr. T. Dalrymple, Vancouver.
Dr. J. S. Daly, Trail.
Dr. A. E. Davidson, Essondale.
Dr. J. R. Davidson, Vancouver.
Dr. D. H. Davis, Bremerton, Wash.
Dr. C. E. Davies, Vancouver.
Dr. J. R. Davies, Vancouver.
Dr. F. Day-Smith, Vancouver. _
Dr. O. DeMuth, Vancouver.
Dr. A. N. Dobry, Vancouver.
Dr. W. A. Dobson, Vancouver.
Dr. C. E. Dolman, Vancouver.
Dr. W. J. Dorrance, Vancouver.
Dr. Victor Drach, Vancouver.
Dr. D. A. Dunbar, Vancouver.
Dr. F. C. Dunlop, Vancouver.
Dr. G. P. Dunne, Vancouver.
Dr. Roger Dunne, Vancouver.
Dr. A. P. Duryee, Everett, Wash.
Dr. Watson Dykes, Vancouver.
Dr. H. Dyer, North Vancouver.
Dr. M. R. Earle, Vancouver.
Dr. C. M. Eaton, Vancouver.
Dr. R. Elder, Vancouver.
Dr. R. J. Elvin, Vancouver.
Dr. E. D. Emery, Nanaimo.
Dr. W. F. Emmons, Vancouver.
Dr. J. M. English, Vancouver.
Dr. W. T. Ewing, Vancouver.
Dr. G. S. Fahrni, Winnipeg, Man.
Dr. Richard Felton, Victoria.
Dr. J. M. Fowler, Victoria.
Dr. A. Francis, New Denver.
Dr. G. H. Francis, Vancouver.
Dr. R. H Fraser, Vancouver.
Dr. J. Freundlich, New Westminster.
Dr. A. C. Frost, Vancouver.
Dr. E. H. Funk, Vancouver.
Dr. J. D. Galbraith, Sardis.
Dr. L. P. Gambee, Portland, Oregon.
Dr. M. R. Garner, Vancouver.
Dr. A. M. Gee, Essondale.
Dr. B. D. Gillies, Vancouver.
Dr. G. E. Gillies, Vancouver.
Dr. A. F. Gillis, Merritt.
Dr. M. Gorkin, Vancouver.
Dr. J. A. Gorrell, Vancouver.
Dr. H. C. Graham, North Vancouver.
Dr. W. L. Graham, Vancouver.
Dr. G. H. Grant, Vancouver.
Dr. J. H. B. Grant, Vancouver.
Dr. C. A. Graves, Steveston.
Dr. E. J. Gray, Vancouver.
Dr. I. B. Greene, Everson, Wash.
Dr. L. M. Greene, Smithers.
Dr. G. A. Greaves, Vancouver.
Dr. K. P. Groves, Vancouver.
Dr. W. R. S. Groves, Chemainus.
Dr. E. B. Gung, Vancouver.
Dr. A. Hakstian, Tranquille.
Dr. Alan B. Hall, Nanaimo.
Dr. B. J. Hallowes, Port Renfrew.
Dr. C. H. Hankinson, Prince Rupert.
Dr. J. E. Harrison, Vancouver.
Dr. W. E. Harrison, Vancouver.
Dr. R. deL. Harwood, Vancouver.
Dr. W. H. Hatfield, Vancouver.
Dr. R. Haugen, Armstrong.
Dr. F. J. Hebb, Vancouver.
Dr. Antoine Hebert, Vancouver. Dr. G. B. Helem, Port Alberni.
Dr. W. E. Henderson, Chilliwack.
Dr. C K. P. Henry, Montreal, Que.
Dr. Taylor Henry, Vancouver.
Dr. J. Herzog, Vancouver.
Dr. D. Hewitt, Vancouver.
Dr. C T. Hilton, Port Alberni.
Dr. F. S. Hobbs, Vancouver.
Dr. E. K. Hough, New Westminster.
Dr. C. G. Hori, Vancouver.
Dr. F. Inglis, Gibson's Landing.
Dr. J. M. Jackson, Essondale.
Dr. E. S. James, Vancouver.
Dr. S. Janowsky, Victoria.
Dr. E. A. Johnson, Vancouver.
Dr. N. H. Jones, Port Alberni.
Dr. E. A. Jones, Winnipeg, Man.
Dr. T. M. Jones, Victoria.
Dr. H. Kamitakahara, Vancouver.
Dr. W. W. Kennedy, Vancouver.
Lt.-Col. G. C. Kenning, Victoria.
Dr. Stuart Kenning, Victoria.
Dr. W. T. Kergin, Vancouver.
Dr. G. F. Kincade, Vancouver.
Dr. G. W. Knipe, Vancouver.
Dr. Roger  Knipe, Vancouver.
Dr. W. J. Knox, Kelowna.
Dr. U. G. Krebs, St. Petersburg, Florida.
Dr. J. W. Laing, Vancouver.
Dr. A. S. Lamb, Vancouver.
Dr. G. A. Lamont, Vancouver.
Dr. J. W. Lang, West Vancouver.
Dr. W. H. Lang, Vancouver.
Surg.-Com. A. G.  Laroch, Esquimalt.
Dr. J. T. Lawson, New Westminster.
Dr. C R. Learn, New Westminster.
Capt. D. R. Learoyd.
Dr. G. H Lee, Vancouver.
Dr. T. H. Lennie, Vancouver.
Dr. D. M. Lineham, Vancouver.
Dr. W. T. Lockhart, Vancouver.
Dr. Andrew Lowrie, Vancouver.
Dr. A. L. Lynch, Vancouver.
Dr. E. J. Lyon, Prince George.
Dr. T. K. McAlpine, Vancouver.
Dr. W. G. McClure, Vancouver.
Dr. E. C. McCoy, Vancouver.
Dr. J. H. MacDermot, Vancouver.
Dr. Alice McDonald, Vancouver.
Dr. J. MaKay Macdonald, Vancouver.
Dr. Colin McDiarmid, Vancouver.
Dr. E. H. McEwen, New Westminster .
Dr. S. G. MacEwen, New Westminster.
Dr. S. A. McFetridge, Vancouver.
Dr. H. B. McGregor, Vancouver.
Dr. F. G. McGuinness, Winnipeg, Man.
Dr. D. H. Mclntyre, Vancouver.
Dr. J. W. McKay, New Westminster.
Dr. H. A. MacKechnie, Vancouver.
Dr. R. E. McKechnie, Vancouver.
Dr. C. S. McKee, Vancouver.
Dr. G. E. McKenzie, Vancouver.
Dr. H. H. MacKenzie, New Westminster.
Dr. A. J. MacLachlan, Vancouver.
Lieut. C. G. G. Maclean, Vancouver.
Dr. Daniel McLellan, Vancouver.
Dr. E. C. McLeod, Vancouver.
Dr. L. Macmillan, Vancouver.
Dr. A. Y. McNair, Vancouver.
Dr. J. S. McNair, West Vancouver.
Surg. Lt.-Com. F. P. McNamee, Esquimalt.
Dr. R. G. D. McNeely, Vancouver.
Dr. Neil McNeill, Vancouver.
Dr. Thomas McPherson, Victoria.
Dr. H. Mallek, Vancouver.
Dr. Josephine Mallek, Vancouver.
Dr. A. B. Manson, Vancouver.
Dr. J. Margulius, New Westminster.
Dr. I. Martianoff, Vancouver.
Dr. G. O. Matthews, Vancouver.
Dr. A. H. Meneely, Nanaimo.
Dr. A. M. Menzies, Vancouver.
Dr. W. L. C. Middleton, Vancouver.
Dr. H. H. Milburn, Vancouver.
Dr. J. W. Millar, Vancouver.
Dr. G. A. Minorgan, Vancouver.
Dr. R. E. Mitchell, New Westminster.
Dr. Gerald Mraz, Vancouver.
Dr. D. W. Moffatt, Vancouver.
Dr. J. A. Montgomery, Vancouver.
Dr. George More, Duncan.
Dr. G. Morse, Haney.
Dr. J. Moscovich, Vancouver.
Dr. D. F. Murray, Vancouver.
Dr. J. R. Naden, Vancouver.
Dr. A. C. Nash, West Vancouver.
Dr. J. R. Neilson, Vancouver.
Dr. T. R. B. Nelles, Vancouver.
Dr. C. M. R. Onhauser, West Vancouver.
Dr. W. E. Ortved, Walkerville, Ont.
Dr. R. E. Page, Vancouver.
Dr. R. A. Palmer, Vancouver.
Dr. K. D. Panton, Vancouver.
Dr. J. Parnell, Vancouver.
Dr. N. J. Paul, Squamish.
Dr. Stanley Paulin, Vancouver.
Dr. W. L. Pedlow, Vancouver.
Dr. S. B. Peele, Vancouver.
Dr. Florence Perry, Vancouver.
Dr. S. C Peterson, Vancouver.
Dr. E. K. Pinkerton, Vancouver.
Dr. J. Piters, Vancouver.
Dr. H. H. Planche, Vancouver.
Dr. G. S. Purvis, New Westminster.
Dr. P. Ragona, Vancouver.
Dr. W. R. Read, Essondale.
Dr. H. W. Riggs, Vancouver.
Dr. J. H. Rivers, Vancouver.
Dr. F. N. Robertson, Vancouver.
Dr. W. A. Robertson, New Westminster.
Dr. A. O. Rose, Langley Prairie.
Dr. A. C Ross, New Westminster.
Dr. T. C. Routley, Toronto 2, Ontario.
Dr. Olive Saddler, Vancouver.
Dr. Wm. Sager, Burnaby.
Dr. E. S. Sarvis, Sumas, Wash.
Dr. F. E. Saunders, Vancouver.
Dr. W. G. Saunders, North Vancouver.
Dr. Dorothy Saxton, Vancouver.
Lieut.. G. D. Saxton.
Dr. Gustav Schilder, Vancouver.
Dr. A. B. Schinbein, Vancouver.
Dr. C. Seale, Vancouver.
Dr. G. E. Seldon, Vancouver.
Dr. R. A. Seymour, Vancouver.
Dr. Wm. Shaw, Vancouver.
Dr. D. R. Shewan, Vancouver.
Dr. J. W. Shier, Vancouver.
Dr. K. Shimo Takahara, Vancouver.
Dr. S. H. Sievenpiper, Vancouver.
Dr. W. W. Simpson, Vancouver.
Dr. A. C. Sinclair, Victoria.
Page 9 if lilt
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Dr. J. A. Smith/Vancouver.
Lt.-Col. G. E. Snell, Ottawa.
Dr. J. F. Sparling, Haney.
Dr. Howard Spohn, Vancouver.
Dr. R. A. Stanley, Vancouver.
Dr. D. E. Starr, Vancouver.
Dr. L. C. Steindel, Cloverdale.
Dr. L. F. Stephens, Vancouver.
Dr. R. G. Stevenson, Vancouver.
Dr. Boyd Story, Vancouver.
Dr. G. F. Strong, Vancouver.
Dr. J. A. Sutherland, Vancouver.
Dr. W. H. Sutherland, Vancouver.
Dr. F. Sypher, Vancouver.
Dr. R. Miller Tait, Vancouver.
Dr. R. C. Talmey, Vancouver.
Dr. R. H. Taylor, Vancouver.
Dr. J. Lyle Telford, Vancouver.
Dr. J. B. Thom, Trail.
Dr. J. C Thomas, Vancouver.
Dr. M. W. Thomas, Vancouver.
Dr. J. W. Thomson, Vancouver.
Dr. W. J. Thompson, Vancouver.
Dr. E. Therrien, West Vancouver.
Dr. Ethlyn Trapp, Vancouver.
Dr. W. A. Trenholm, Vancouver.
Dr. A. E. Trites, Vancouver.
Dr. Frank Turnbull, Vancouver.
Dr. S. E. C. Turvey, Vancouver.
Dr. G. A. Upham, Vancouver
Dr. C. H. Vrooman, Vancouver.
Dr. H. Wackenroder, Vancouver.
Dr. J. T. Wall, Vancouver.
Dr. R. A. Wallace, Vancouver.
Dr. W. C. Walsh, Vancouver.
Dr. R. A. Walton, Vancouver.
Dr. E. N. Ward, Vancouver.
Lt.-Col. W. P. Warner, Ottawa, Ontario.
Dr. W. G. Weaver, Vancouver.
Dr. J. W. Welch, Vancouver.
Dr. R. C. Weldon, Vancouver.
Dr. J. A. West, Vancouver.
Dr. J. D. Whkbread, Vancouver.
Dr. Harold White, Vancouver.
Dr. W. H. White, Penticton.
Dr. W. E. Wilks, Vancouver.
Dr. D. H. Williams, Vancouver.
Dr. L. R. Williams, Vancouver.
Dr. G. T. Wilson, New Westminster.
Dr. R. A. Wilson, Vancouver.
Dr. Robert Wilson, Vancouver.
Dr. Wallace Wilson, Vancouver.
Dr. W. A. Wilson, Vancouver.
Dr. A. L. Yates, Vancouver.
Dr. R. E. Ziegler, Vancouver.
This meeting, as everyone knows, lasted from September 16th- 18 th inclusive. On
the 19th we called, in our editorial capacity, to congratulate the Executive Secretary,
Dr. M. W. Thomas, on a notable accomplishment, in having staged a wonderful meeting. At the time we called, he was over in the Hotel Vancouver "cleaning up." Just
what this meant, we do not quite know—but he is a tidy and methodical man and we
are sure he would leave everything in apple pie order before he left. In any case we
could not find him, and when we called again the next day, he had gone for a fishing
trip, at least that is the way we understood it.
Dr. Thomas richly deserved a holiday and rest after the meeting. It was a splendid
meeting, and we heard this opinion expressed on all sides. The attendance was excellent,
355 in all. This would be a good attendance in peace-time — but -with our ranks
depleted as they are at present it is impossible for many men to leave their work, as they
cannot get relief or substitutes. So we can realize how very good this attendance was.
There are various factors in the success of a meeting. The first is, we suppose, the
Programme. This was very good indeed. The speakers were all good, and we only
regret that none of their papers were written, so that we could have secured them for
publication. The Programme Committee deserves our thanks' and appreciation for the
excellent list of speakers they secured. But this is only one part of the Programme. The
rest was equally important. Clinical meetings, group meetings, entertainment, public
meetings, dinners, etc., all these are essential parts of a well-rounded programme.
The public meeting seems to have been a great success.    Unfortunately, the writer
could not be there, but we understand hundreds had to be turned away.   The programme
here went most smoothly, and we heard very favourable comments from people who
were there, and we heard, too, an expression of opinion that we should have more of
these meetings.   Probably there is a lot in this.   It means a great deal of hard work, and
it means publicity well organized.    Speaking of publicity, there can be no doubt that
a major reason for the success of this meeting was the excellent co-operation of the
press.   We owe to the press of Vancouver our sincere thanks for their generous help, and
Page 10 the accuracy of their reporting.    This meeting was well advertised in advance, and the
public seems to have welcomed the idea of such a meeting.
The various forms of entertainment, dinners, golf and so on were, we thought, very
happily carried through, though in our opinion, the Golf Committee could have been
more accurate in some of their choices of winners—but let that pass. We appreciated
immensely the speech of Dr. Ewing of the Provincial Normal School, at the Annual
The next important factor in the success of a meeting is the location of it. Here
we were very fortunate indeed. The Hotel Vancouver gave us an admirable suite of
rooms, and all the arrangements worked together with compelte smoothness. Our exhibitors were particularly well pleased with the opportunities given them for meeting the
doctors, and showing their products. The exhibits were admirable, well arranged and
most interesting. The various representatives were kept busy all the time showing and
explaining things, and both sides profited by the method of display. This is so much
better than the old Peacock Alley of the old hotel, where exhibitors sat in a hushed,
almost religious stillness, waiting for doctors who never came to see their display.
Lastly, and perhaps most important, as a reason for the success of this meeting is
the staff and the staff work. We hardly need to say anything about this,—everyone
knows how good it is—but we are going to, anyway, just for the pleasure of saying it.
The best programme obtainable in the best quarters available, would be little or no
good, if it were not for the preliminary work, and constant vigilance and care, to keep
things going properly. And here we very sincerely congratulate Dr. M. W. Thomas.
We know something of the immense amount of work and enthusiasm he devoted to the
arrangement of this Programme, and to the running of the actual meeting. Committees
were all very good, and did very good work—but he had the actual detail of it to
carry out—and he did it without a slip. We feel that he deserves our thanks for his
Helping Dr. Thomas, too, were Mrs. Bender and Miss Smith, who have done so much
in other meetings to make everything run smoothly, and whose work on this occasion
was beyond praise. They were there early and late, to answer everyone's questions, and
solve everyone's problems—and their quiet,, efficient help was a large factor in the successful operation of the mechanics of the meeting.
Next year, the meeting will, we understand, be held at Jasper; and we expect most
of the events will be staged on the golf course, of which we hear so much. Our new
President, Dr. Hankinson, of Prince Rupert, will be in charge of proceedings. To him
we extend our congratulations, and offer our services in any capacity. The meeting
will be held in conjunction with that of the Canadian Medical Association, and should
be a notable event.
The appeal for subscriptions to this fund has met with a very cordial reception
throughout the Province. A number of medical men were asked to act as key men, to
make contact with the other practitioners of their area, and they responded most willingly and effectively. We would take this opportunity of thanking them all most sincerely for their help.
We have made it clear that there is to be no solicitation or pressure here—every man
knows now about the Fund, and knows what he can personally afford to do. Everyone
is in complete sympathy with, the project—and, considering the times, and the very
large number of calls on the remainder of one's income (after the Federal Government
and the Provincial Treasury and this War Fund, and that Charities Fund have taken
their toll) we feel that the response has been very good. The main thing is that as many
men as possible should make some contribution, and the amount doesn't matter at all.
Page 11
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We shall be sending another lump sum to Ottawa very soon, and would be glad if
anyone who intends to subscribe would let us have his cheque at once.
This Fund, we would remind our readers, is not closed, nor will it be until the war
is over, and the need for our help shall have happily passed. We would suggest that this-
should be reckoned as one of those Funds to which one makes an annual subscription:
because next year the need will be as great at least, as it is now: and we can perhaps do
even better next year than we have this. Meantime, we thank all those who have subscribed. —ED.
— ( Continued )
Andrew, F. W., West Summerland, B.C $20.00
Anonymous 10.00
Auld, F. M., Nelson, B.C.     —._ 20.00
Austin, W. E., Hazelton, B.C 10.00
Beech, Alan, Salmon Arm, B.C. 5.00
Burris, H. L., Kamloops, B.C 20.00
Burris, J. S., Kamloops, B.C j  2"5.00
Clark, D. A., New Westminster, B.C 25.00
Clarke, W. A., New Westminster, B.C 25.00
Darby, G. E., Bella Bella, B.C 2.00
Ellis, John P., Lytton, B.C 10.00
Garner, R. W., Port Alberni, B.C 10.00
Green, F. W., Cranbrook, B.C  20.00
Hankinson,  C  H., Prince  Rupert,  B.C 2.00
Helem, G. B., Port Alberni, B.C 10.00
Hilton, C. T., Port Alberni, B.C 50.00
Jones, N. H., Port Alberni, B.C 10.00
Lyons, O. O., Powell River, B.C $15.00
McGregor, Herbert, Penticton, B.C 25.00
Marlatt, C. R., Powell River, B.C. 15.00
Marteinsson, B. T. H, Port Alberni, B.C.. 10.00
Meneely, A. H, and Brown, C C,
Nanaimo,  B.C. 52.50
Miller, A. P., Port Alberni, B.C 10.00
Montgomery, J. A., Vancouver, B.C 25.00
Murison, J. A., Powell River, B.C 15.00
Naismith, A. G., Kamloops, B.C 15.00
Pitts, W. C, Port Alberni, B.C 10.00
Straith, P. L., Courtenay, B.C 25.00
Truax, Windsor, Grand Forks, B.C 10.00
Watson, G. L., and Hamer, H. E.,
Revelstoke, B.C.  _  25.00
Willoughby, C. J. M., Kamloops, B.C 15.00
A few points in routine hospital care.
Extreme carefulness in teachnique of catheterization, plus instillation of 1 oz. of
10% argyrol will prevent many cases of cystitis and pyelitis.
Waiting until the third day, then giving the patient a wallop with castor oil, or
cleaning only the lower part of the colon with an enema, is usually unnecessary and to
many patients undesirable, particularly when painful piles are present. Begin the first
day post-partum with x/z oz. liquid petrolatum and J4 oz. of aromatic cascara b.i.d. or
p.r.n.   By the third day the bowels should be functioning well.
Less post-natal nipple trouble will occur if less "hardening" or "softening" of the
nipples with alcohol or intment is done ante- partum. A daily rub with soap and water
and a rough face cloth is better treatment. The majority of cracked nipples do best if
softening ointments are not used. Pumping or a nursing shield, and touching the fissure
alone with the point of a needle dipped in 5 0 % silver nitrate, plus lead shields or tincture
of benzoin, produces best results.
If acute mastitis develops, a treatment dose of X-ray (up to 150-200 Roentgen
units) within twelve hours of onset will abort it. In recurrent mastitis, this treatment
is especially valuable. Ice will usualy terminate acute mastitis quickly, and is most
effective if the bag is separated from the skin by only one layer of cloth. If, after three
days of ice, the condition is still acute, a change is made to hot foments, and one will
expect suppuration.
To inhibit lactation, five doses of diethyl stiiboestrol 1.0 mg. given twice a day is
helpful. More effective and less toxic is diethyl stiiboestrol diproprionate. One 5.0 mg.
injection daily for two to three days and a final one on the fifth day, will make binding
of breasts and restriction of fluids, etc., unnecessary. Only colostrum appears and pain
is nil.  The chief objection is cost.
Page 12 Infection of an episiotomy may often be avoided if a subcuticular stitch is used to
close the perineal skin snugly. If infection occurs, infra red heat is indicated. If it
breaks down, hot foments, followed by Dakin's irrigation till the wound is clean, then
balsam Peru, plus adhesive strapping together of edges, will frequently give an excellent
result where one was despaired of.
The Library Committee has received permission from the Post Office authorities to
use a reduced postal rate, allowed to libraries when lending books to out-of-town members, within the Province.
Under this arrangement both the outgoing and return postage is prepaid by the
Library. This amount will be repayable to the Library but as the new rate is 5 c for the
first pound and lc for each additional pound or fraction of a pound in place of the
usual rate of 8c a pound, the entire amount will be considerably less than the cost of
mailing one way heretofore.
Special labels are being printed and at the time of mailing a return franked label will
be pasted on the reverse side of the wrapper The reverse side must then be used in
returning books to the Library, and the package will be delivered without further postage.
The Library Committee is indebted to the Post Office Department of Canada for
their courtesy and kind co-operation in completing these arrangements.
We have learned from the textbooks throughout the years the signs and symptoms
that lead to the ante-mortem recognition of advanced cancer. There is no need to
discuss these signs and symptoms other than to advise their complete abandonment as
guides in attempting to recognize early cancer.
Clinically, there is no similarity between the early and late stages of the disease.
Neither is there a single infallible guide to the early clinical recognition of cancer other
than the biopsy.   Even the experts are fooled clinically on the early cases.
Cancer is recognized early only by constantly adhering to the following rigid
1. The examination of every patient that is seen—that is the physician's job and must
not be shirked.
2. Constantly thinking of cancer during all examinations—cancer is one of the few
diseases that cannot afford to be overlooked for a month or so.
3. Careful consideration of all even slightly doubtful tumours or symptoms—it may
herald the early change from a benign to a malignant lesion.
4. When suspicious of a lesion do not risk a life by waiting to see—the patient too
often dies of cancer as a result.   Instead, BIOPSY EARLY AND SAVE A LIFE.
The above formula is simple and can readily be carried out no matter under what
circumstances the physician is practising. Failure to follow out this formula means that
the physician is shirking his work and is inviting death to overtake some of his patients.
Address by Dr. S. Cameron MacEwen
at the Session on Medical Economics, Annual Meeting of the B. C Medical Association,
September 16-18, 1941.
The Members of the British Columbia Medical Association have been informed
through the courtesy of the Bulletin and by the Executive-Secretary of the Council,
of the College, as to the operations and services of the Medical Services Association.
Previous to your last meeting, the plan was under consideration and a great deal of
work was done by the Committee on Economics of the Council, to try and bring into
operation a plan which would be acceptable to the doctors of the Province. The present
set-up was approved at your last Annual Meeting, and your plan became effective on
November 1st, 1940. Details have been incorporated into a booklet which has been
widely circularized, and each doctor has had a chance to study it at his leisure. I might
mention a few outstanding principles: :
1. Corporate Structure: :
The M-S-A is incorporated under the "Societies Act" and brings together along
industrial lines those interested in medical care by prepayment—employees, employers
and doctors. There are three classes of members—employee members, employer members and professional members. The employee members elect two directors, employer
members and professional members each elect one director. This representative board
of directors is elected by the membership at large and serves without pay. The M-S-A
is a non-profit service organization and all dues collected are used or held for providing
services to its beneficiary members and their dependents. No more than 10 per cent of
the dues may be used for administrative expenses.
2. Services:
Medical and surgical care include services rendered by any doctor of medicine in
the Province in the home, the doctor's office or the hospital, consultations, special medical
services, such as X-ray, diagnostic aids, and laboratory examinations and the services of
specialists. $35.00 is paid the doctor for obstetrical services when the mother has been
enrolled for 10 months, including pre-natal, confinement and post-natal care.
3. Reports :
A fundamental principle adhered to in the development of the M-S-A has been that
the paper-work to be required of physicians should be kept at a minimum. There are
only two reports for the doctors:
(a) Physician's First Report—which is the statement to be sent by the doctor notifying the M-S-A that a subscriber has requested services. This report- should be sent
immediately on the day that the doctor's services are first requested. Authorization
for expensive procedures including major surgery is required and provision is made in
this report for such requests from the office of the Association or the Director of Medical
Services or in the case of districts outside the lower mainland from the following Assistant Medical Directors, who have all agreed to serve, at least for the present, without
Dr. J. S. Daly, West Kootenay; Dr. C. H. Hankinson, Prince Rupert; Dr. W. J.
Knox, Kelowna; Dr. E. J. Lyon, Prince George (Central Interior); Dr. Thomas McPherson, Victoria; Dr. T. J. Sullivan, East Kootenay; Dr. Gordon James, Britannia
(b) Doctor's Final Report and Account—which is the itemized bill for services
rendered and should be sent on completion of the case.
4. Payment to Doctors:
Payments are made to the doctors, not to the subscriber, and are at the rate of
per cent of the Schedule of Minimum Fees of the College of Physicians and Surgeons.
Page 14 For the period of operation the estimates of costs have been adequate to discharge the
obligations of the M-S-A for medical, surgical and hospital care and to set aside a
reserve for contingencies of 12 per cent of the dues.
The Fee-For-Service method of payment has not occasioned any difficulty and our
experience shows that it can be controlled. However, our experience has been too short
to warrant any definite conclusions.
Continuity of the plan is assured. In a plan of this kind it is necessary that the
members have assurance that contracts will be fulfilled. This plan has that assurance
in that the plan is underwritten by the medical profession of British Columbia. Thus,
the subscribers are protected and we have no reason to regret our undertaking. In fact,
we are accumulating very valuable experience which may be of great help to us in the
5. Professional Membership:
Practically all doctors in active practice in British Columbia have signed applications
for professional membership. At this date 540 doctors have become professional members. We urge the few remaining doctors who have overlooked sending in their applications to do so. Doctors will readily understand that each employee inquires immediately whether the service of his or her doctor would be available. It is necessary to
publish for the information of prospective members a list of doctors who have signified
their willingness to provide services under the M-S-A.
6. Growth:
The growth of the M-S-A has not been rapid but in comparison with similar plans
in other places, we have made good progress. M-S-A's 600* subscribers compares with
the 600 which was the enrolment of the Associated Medical Services Incorporated of
Toronto for six months. This plan after three and a half years of operation now has
24,000 subscribers, and we understand that it is growing at the rate of 800 a month.
The California Physicians' Service and the Michigan Medical Service have had a similar
experience. The latest information we have is that the enrolment is 23,000 and 197,000
respectively. (There are 190,000 subscribers in the surgical plan, and approximately
7,000 subscribers in the complete medical and surgical plan in Michigan.)
Experience has shown that with a new development of this kind, progress is slow at
the start but after a fair number of groups have been enrolled the plans gather momentum. The known value of a plan and the "mouth to mouth" recommendation of its
participating members increase the volume. We find that the best prospects are those
who have talked to an employee or employer member or their own doctor.
Our growth has been very similar to the physician estabhshing his practice. We
have grown rapidly enough to warrant our continuance, and like the young physician,
we have had ample opportunity to deal very thoroughly with a number of problems,
many of which are new to us and require careful handling. . Such gradual growth is
always more stable than a mushroom process and in the end will result in a solid structure.   The plan is gradually being extended to the whole Province.
7. The Future:
The increased payroll deductions and higher living costs leave little for the payment
of medical care and may result in the neglect of health. On the other hand, during and
after a war, a greater interest is taken in health matters and it is well that we have a
means provided whereby our services are placed within the reach of those who are in
need of them.
There is no doubt that our plan requires an employer contribution, because generally
employees cannot be induced to pay more than about $2.00 a month for family care.
Since we entered the field of payroll deduction, in addition to deductions from wages for
Workmen's Compensation, Group Life, Group Sickness and Accident, Community Chest
*Now increased to 900 subscribers.
Page 15
■ -*+ jjrjh: ..■,*; m
.11 s
[ 1 H
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and in some cases Pension Plans, there have been 'WW Savings, War Services, National
Defence Tax of 5 «»</ 7 ^r c?»£ and Unemployment Insurance deductions. With the
strained labour situation, each employer has his own problems, yet there is a definite
interest in employee welfare plans. The employers realize that while Unemployment
Insurance, pensions and group insurance fill a need, the disaster of disabling sickness still
finds the wage-earner unprepared. The fear of ill-health and worry over doctors' and
hospital bills impair efficiency.
Most employers are receptive but we have not overcome the feeling of high cost that
is abroad. Comparisons are made with contract practice and plans with salaried doctors.
While the difference in services is appreciated, the spread in costs is too much to overcome. MANY OF THESE CONTRACTS AND APPOINTMENTS ARE ON A
BASIS EQUIVALENT TO POOR RELIEF COSTS AND ARE AN EMBARRASSMENT.   It is futile to attempt to replace these contracts while they are in existence.
Meanwhile, it has been suggested that leadership in the promotion of the M-S-A
should come from the family doctor. People are greatly influenced by what their doctor
tells them. I feel that the doctor does a favour to his employer friend when he brings
this plan to his attention. Healthy employees are more efficient employees and while it
is difficult to demonstrate this advantage in dollars and cents, we all know it to be a
In any group plan the responsibility for selection of the plan must be assumed by
those in a position to do so and since our plan requires the employer to pay part of
the contribution,' it is necessary that the employers be thoroughly sold on the advantages
of preventive services. It is the experience of the life insurance companies that when
the employer is sold on a group plan, contributes part of the cost and recommends the
plan to his employees, 75 per cent of the selling job is accomplished. No one is in a
better position than the employer's family doctor to recommend and point out to him
the advantages of a comprehensive medical service.
7.    Limited Service:
It has been suggested, from time to time, that we recommend services be cut, or in
other words, that we offer partial benefits for a price that employees think they can
afford. Any such partial service would have to be capable of a clear definition. The
only service that fills this requirement is one which would start with "cutting" or surgical care only.   There is no doubt that it would be popular for the following reasons:
(a) The total subscription rate might be about half the cost of medical and surgical
care, and even when hospital benefits are added, would be low.
(b) Surgical benefits are spectacular and appeal to the imagination.
(c) Surgical bills are always relatively large, and subscribers tend to think of the
large fees charged for abdominal surgical cases.
(d) Insurance company activity has popularized the surgical benefit in hpspitaliza-
tion expense policies.
(e) Surgical cases involve hospitalization and absence from gainful employment;
consequently are always catastrophic from the economic point of view.
Insurance companies offer this type of care with hospital group plans to employers
with 50 or more employees and if we offered a surgical plan we would be in direct competition with them. The California Physicians' Service is now offering a Surgical Plan
and the Michigan Medical Service has enrolled most of its subscribers under this type
of plan. While experience elsewhere has shown that a Surgical Plan is necessary, if the
general subscribing public is to be interested, we have not felt justified at this time in
recommending a Surgical Plan for the sake of gaining members.
9.    Hospital Service Plan:
The M-S-A has been approached by the Provincial Inspector of Hospitals, who is
carrying on negotiations with the hospital representatives and group plans with a view
of co-ordinating existing plans for hospital care, and possibly provide a means whereby
further interested groups may obtain the benefits of prepaid hospital care.    Some of the
Page 16
E H It IJ subscribers to the M-S-A desire hospital care and as the M-S-A has been the only means
I by which they can obtain it on a group basis, hospital care to a certain extent has been
■ added to medical and surgical care.   It has always been the policy of the M-S-A not to
offer hospital care in areas where hospital service plans are in operation, and that when
Ian acceptable agency is set up, it would withdraw from hospital care and would cooperate with the hospital organization insofar as it may be permitted to do so.
The proposal is tentative and will not include any provision for medical care.    All
of us will be glad to see the benefits of prepaid hospital care made available and we
j welcome these negotiations and trust that they may reach a speedy conclusion.   Pending
j any formal arrangements being made, the M-S-A contracts with subscribers must of
[ course continue without change.
10. Financial Assistance:
Apart from the 10 per cent for administration expense and registration fees, organization expense has been met from advances.   As the plan grows this organization expense
| will be liquidated as is customary from registration fees.   These advances are authorized
; by the Council of the College.   The expense has been kept at a minimum.
11. Other Medical Service Plans:
The other Associations operating approved plans similar to the Medical Services
Association and participating in the 25 per cent discount are:
B. C. Telephone Employees' Sick Benefit Association.
B. C. Electric Railway Company Office Employees' Medical Aid Society.
Vancouver School Teachers' Medical Services Association.
These Associations continue to enjoy the confidence placed in them under which
they undertake to pay the doctor directly and under which all doctors are included.
Other Associations are and may attempt to discount doctors' bills. These other
plans have not been approved for various reasons. We wish to repeat our warning to
all doctors not to accept any attempted discounting of accounts by such Associations.
The doctor may with propriety accept the payment tendered on account and bill his
patient for the balance. With these lay associations, their obligation is to their member
and they are not obliged to pay the doctor under their contracts.
I hardly need remind you that approval by the Committee on Economics signifies
that the Committee is satisfied that dues collected from beneficiary members are used
for the purpose of paying for services and that an Association to which approval is
given is not operated for profit.
Out of the above, our chief problems are:
(1) Enrolment of New Groups:
Up to the present a certain percentage of all employees must be enrolled before being
admitted to the M-S-A. It is true that a great many would join if individual applications were accepted but this would involve careful examination to prevent a large
percentage of poor risks and would increase the overhead in the matter of collections.
Mr. McLellan has done splendid work in enrolling the present membership, but it
is impossible for him to do all that should be done.
I feel that some method should be worked out that would interest both employers
and employees in the plan.
It has been proposed that the doctors be given a form which they will be asked to
complete, giving the names of employers to whom they are well known, and to whom
they would be willing to send a letter, the draft of which will be enclosed. The letters
will be prepared for the doctor's signature, mailed and followed up by the M-S-A. The
doctors obtain no personal advantage by doing this and they should have no hesitancy
Page 17
,- 'i.
ifi 1!
mm It*. 1*1,
K f
5," ;,*„ &*
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in informing the employer that they are paid on a scale comparable to the Workmen's
Compensation Board.
(2) Reports:
First Reports have been coming in well but it seems that the doctors get tired before
the Second Report and Account is due, or possibly they do not want their money.
(3) Authorization:
When the membership is small in numbers and therefore the receipts are not large,
it is vital that expenses should be kept at a minimuni. This particularly applies to the
above mentioned. We cannot give a luxury service, but aim to give a complete service.
In many cases the rule laid down for these services has not been observed. Often, perhaps, it has been because the doctor considered the service essential. In no case, so far,
has the service been refused, chiefly, because it seemed unfair to the member and also
because I felt that some doctors did not understand the implications of their thoughtlessness.
It is very easy to obtain authorization—through the office or by application to the
Director of Medical Services or Assistant Directors of Medical Services, as previously
listed, and I will have to insist that this rule be lived up to much more than in the past.
(4) Lay Organizations:
Several societies and particularly some casualty companies have capitalized on our
publicity. These societies offer quite a different type of service with the inference that
it covers the same benefits—first visits, etc.
More than that they arbitrarily make deduction of 25 per cent on doctors' accounts.
There are only four plans to which the medical profession has agreed to accept the
25 per cent discount. These are, M-S-A, B. C. Telephone, B. C. Electric Office Workers'
Association and the Vancouver School Teachers. I would particularly like suggestions
as to the best means to combat this arrogant assumption of unauthorized rates. As one
doctor expressed it to me, "I do not want to stick my neck out by refusing to accept
their cheque for the diminished amount unless I am sure all doctors will do the same."
(5)  Statistics:
I am unable to give the time to this work that should be given.
There are many
things I would like to do which would increase the value of the experiment. All forms
should be coded—the machinery is there—but it would take a considerable amount of
time. Until the time comes when a "full time" Director of Medical Services is on the
job some of these things will have to remain undone. Most of them can be attended to
later but it would simplify matters if they could be done as we go along.
To the Medical Profession, I wish to extend thanks for the co-operation it has given
us, and I may say that we have had no complaints from the doctors in almost a year of
operations and also not a single complaint from any insured member.
Thanks to the Bulletin for its courtesy in publishing all the material given to the
Editor, particularly to the Committee on Economics of the Council for the very considerable time given, both in the formative stages and in the frequent meetings since operations were begun. To Dr. M. W. Thomas, Executive Secretary of the College, who has
acted as representative of the doctors on the Board and who has given freely of his time,
and much appreciated advice. To those doctors who have made it possible to carry on
by their generous subscriptions. To our very efficient office staff, Mr. A. L. McLellan
and Miss Myers.
Page 18
H .It
College of Physicians and Surgeons
President Dr. Wallace Wilson, Vancouver
Vice-President : Dr. W. A. Clarke, New Westminster
Treasurer ! Dr. F. M. Bryant, Victoria
Members of Council—Dr. F. M. Auld, Nelson; Dr. F. M. Bryant, Victoria; Dr. W. A.
Clarke, New Westminster; Dr. Thomas McPherson, Victoria; Dr. H. H. Milburn,
Vancouver; Dr. Osborne Morris, Vernon; Dr. Wallace Wilson, Vancouver.
Registrar Dr. A. J. McLachlan, Vancouver
Executive Secretary Dr. M. W. Thomas, Vancouver
The following letter has been received from the Unemployment Insurance Commission and is of special interest to members of the profession.
Ottawa, Ontario,
September 17th, 1941.
College of Physicians and Surgeons,
Registrar's Office,
203 Medical Dental Buildnig,
Vancouver, B. C.
Dear Sirs:—
In answer to your letter of September 10th, we beg to advise that although nurses
are excluded as a whole, whether working in a Hospital or "on call", and are not considered to be insured persons, there are cases where they might be able to participate in
the insurance coverage and, therefore, enjoy the benefits which ordinarily accrue. It is
in the cases of Registered or duly qualified nurses, who are working in a Doctor's office
that there is a possibility of their being classified as insured persons. This is where the
duties of the individual are that of a receptionist or of a secretarial nature and so described by the employer, but if the Doctor wishes to describe her duties as being of a
professional nature and that she makes use of her professional skill during the working
day, then the individual is not an insured person and, therefore, excluded from the
coverage of the Act.
You thus may see that it is the description which the Doctors may give of the nature
of the duties of these assistants, that defines their insurability or non-insurability under
the Act.
Yours very truly,
Chief Inspector Insurance Revenue.
>i ,
Chairman, Blood Donor Clinic Committee, B. C. Div., Canadian Red Cross.
The Canadian Red Cross Society has undertaken the collection of blood for the establishment of blood banks for use in casualties amongst the fighting services of the
country. To accomplish this, Blood Donor Clinics have been established. Three of these
have been operating for some months in Ontario and the Red Cross policy is now to
establish a provincial clinic in each of the provinces. A provincial clinic in British
Columbia is being established in Vancouver and at a later date further extension will
likely take place.
Page 19
 L   ^BP-i.i   *■
y fc I The Vancouver clinic, which will open down town on November 1st, will handle
a minimum of 100 donors with usable serum per week. The set-up for such a project
is quite extensive, necessitating a donor list of several thousands, the appointments of
these donors and in the necessary blood group ratio, transportation for them to the clinic,
attending physicians, graduate nurses, and nursing auxiliaries for attendance in the rest
room. With one exception all this work is voluntary as is that of the donors. A trained
laboratory technician is on hand to receive the blood, which is transported to the laboratories, where under the direction of Dr. Dolman prelirninary treatment is received prior
to its being shipped to the Connaught Laboratories at Toronto for further processing.
It is then handed over to the Department of National Defence.
This whole scheme of operation is under the control of the Blood Donor Clinic Committee appointed by the B. C. Division of the Canadian Red Cross Society, and the
various phases of the work are divided into sections with a responsible head over each one.
A medical committee of three, representing the B ,C. Medical Association in Vancouver, has considered matters relative to the medical standards and examination of
donors and technique of obtaining blood. The chairman, Dr F. Turnbull, will be in
charge of obtaining medical personnel. The surgical representative, Dr. J. R. Neilson,
will direct the technique, the necessity of having a standard, safe and certain method
being obvious. Dr. W. Simpson, medical representative, will direct matters relative to
the health of donors.   In general, the following criteria will be followed:
Donations of blood will not be accepted from persons above sixty or under eighteen.
On admission to the clinic the donor's temperature and haemoglobin (Tallquist scale)
will be determined. No person with a temperature over 99° or a haemoglobin under
80% is acceptable. The medical examiner will enquire for any history of tuberculsois
or severe anaemia. If he has any reasonable doubt about the donor's health, judging from
general appearance, the offer of blood will be declined. The donor will likewise be
refused unless he (or she) has a good vein for venupuncture. The donor will sign a consent form, agreeing to donate 400 c.c. of blood and declaring himself in good health,
this form to be witnessed by the examining doctor. Before each donor leaves the clinic
he (or she) will be visited briefly by the medical examiner to ascertain that no untoward
reaction has occurred and to be discharged with thanks. Three months will be considered
a minimum time between donations of blood by the same donor.
A complete, simple, sterilized outfit is supplied for each bleeding. It consists of a
corked bottle, marked at the 400 c.c. level. Two short pieces of rubber tubing lead out
through the cork, one to a large bore, well sharpened phlebotomy needle, the other to
a piece of glass tubing containing a filter, which can be used for suction by mouth.-
Novocaine and a hypo set for local anaesthesia will be available and, while optional,
should be used in most cases. Facilities for scrubbing and sterilizing the operator's hands
between each phlebotomy will be available. All the general precautions of an operating
room will be observed within practical limits. One operator should be able to keep two
or three tables in continuous action. Graduate nurses will prepare the donors' arms,
and supervise proper compression of the vein after the phlebotomy.
1. The Provincial Laboratories, Hornby Street, Vancouver, will be responsible for
assembling sterile blood connection outfits. These outfits have been reduced to the
simplest essentials, for ease of handling, and to ensure niinimum cost.
2. Donors should refrain from consuming a fatty meal for at least 12 hours prior
to being bled. The fat layer which otherwise appears in the serum renders it unsuitable
for processing.   Fatty serum specimens wil have to be thrown away.
3 The serum will be separated in the Provincial Laboratories, samples being taken
from each specimen for Kahn and sterility tests, and also for determination of the blood
Page 20 4. Specimens of the various groups, having passed the requisite tests, will be pooled
In the Laboratories into large bottles, in proportionate amounts roughly corresponding to
the general distribution of the four blood groups, and will then be shipped to Toronto.
After processing in the Connaught Laboratories, University of Toronto, such pooled
jserum specimens have been found to yield a product which can be given without fear
[of reactions.
5. The process involves freezing of the serum, followed by its evaporation to a dry
powder under negative pressure.    This powder can be quickly reconstituted for trans-
| fusion purposes by adding to it an amount of distilled, sterile water equivalent to the
j initial volume of the serum.   The powder is readily soluble in water, hence the term
"lyophile" for the process used in its manufacture.
6. The glassware used in the collection of the blood, and in the separation, pooling,
and shipment of the serum, is being supplied by the Canadian Red Cross Society. Other
special laboratory apparatus required, e.g., an autoclave, centrifuge, and refrigerator, is
being purchased by the Provincial Laboratories from its Contingencies Vote. The salary
of one laboratory technician, who will work whole-time on this assignment in the Laboratories, is being met by the Red Cross. The services of all other laboratory personnel,
administrative, technical, and clerical, are on a voluntary basis.
7. The earliest probable date on which the Laboratories' sadly inadequate and
unsuitable accommodation can be sufficiently supplemented to permit a start to be made,
is November 1st, 1941.
* .*
C. E. Gould, M.D., and S. E. C. Turvey, M.D.
A seventy-six-year-old while male was admitted to the Vancouver General Hospital
in 1940, with a history of having collapsed suddenly while at the dinner table ten days
previously. Following this he was "stiff all over," and was unable to speak or care for
himself in any way. During the. next three or four days there was some regression of
these marked symptoms, although he remained bed-ridden, and his wife noted then that
there was weakness of his left arm and leg. His generalized symptoms then recurred, he
became incontinent and totally helpless, and was admitted to the hospital in a semicomatose condition.
His past history, obtained from his wife, went back twenty-one years to 1919, at
which time he sustained a severe head injury when he was caught between a heavy wagon
and the wall of a barn, and his "head was badly crushed." While not able to give a
very full or accurate history, his wife stated that he had never been the same since that
accident, the most outstanding difference being a personality change, insofar as he was
very irritable. About two years prior to admission there was onset of intermittent
twitching movements of both arms and both legs, and these had increased noticeably in
frequency and severity during the ensuing two years, so that in the two months prior
to the onset of his illness, these movements had made it very difficult for his wife to
sleep in the same bed at night.
On examination he was an elderly and poorly nourished white male, semi-comatose,
breathing stertorously, incontinent, and with generalized muscular rigidity and a moderate degree of opisthotonus.   There were marked signs of generalized arteriosclerosis, and
Page 21
I ft
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evidence of a bilateral broncho-pnumonia.    The  reflexes were equal and hyperactive
A tentative diagnosis of cerebral thrombosis was made, and because of his critical
condition, no further investigation was done, with the exception of blood examination,
which showed a normal white cell count and differential, a normal red cell count and
haemoglobin, a sedimentation rate of three millimetres in one hour, a blood calcium of
12.63 milligrams per on ehundred cubic centimetres, a CO2 combining power of 43.01,
and an N.P.N, of 37 milligrams per one hundred cubic centimetres.
Despite symptomatic treatment, he went steadily downhill, his temperature rose, his
respirations became rapid and laboured and finally of a Cheyne-Stokes character, his
generalized spasticity changed to a generalized flaccidity, and he died on the fifth day
after admission.
Post-mortem examination revealed the following conditions, as listed in the pathological diagnosis:
Bilateral bronchopneumonia and pulmonary embolus, right.
Multiple cerebral infarcts, small, left putamen, and large one, right putamen, due
to occlusion of lateral striate branches of the middle cerebral artery.
Cerebral arteriosclerosis.
Old bilateral subdural hemorrhage (21 years). _
Thrombosis periprostatic veins.
Adenoma with hypertrophy of prostate.
Myocardial degeneration with dilatation.
Old healed pyelonephritis, left.
Of particular interest, in view of his past history, was the finding of old bilateral
subdural hemorrhage, and the portion of the pathological report pertaining to this is
quoted in full (Doctor H. H. Pitts):
"The skull cap was removed in the usual manner and the dura reflected to reveal
a considerable amount of dirty brownish to reddish fluid material escaping from the
subdural space on both sides, possibly three-quarters of a pint being present in all,
evenly distributed on both sides as described below. It is accumulated over the
frontal lobes, extending up to partially overlie the anterior portion of the parietal
lobes and small part of the upper portion of the temporal lobes. This material is
enclosed in a rather tough, thin, reddish-brown membranous sac in each side, apparently composed of old organized blood clot. This membrane is fairly firmly adherent
to the undersurface of the dura, but may be stripped from it. It may be readily
removed from the underlying cerebral convolutions. There is no evidence of extravasation of this fluid beyond this site, and the base of the brain and posterior portion
are clean. A bilateral deformity of the brain is noted, however, due to pressure from
this fluid which has been exerted chiefly on the frontal lobes, as described. They
appear compressed so that on their mesial aspect they form a ridge which approaches
the skull, laterally the depression being more marked, extending out to normal outline, at the periphery of the accumulated fluid. These cerebral convolutions are not
flattened but have a fairly regular rounded outline. There is also no evidence of
softening of the cortex. The brain weighs twelve hundred and thirty grams (1230
grms.). The vessels at the base are beaded with atheromatous plaques but are patent.
On section of the brain, the convolutions in the frontal area appear possibly somewhat smaller than normal, but the cortex is of even width throughout. All of the
structures in the frontal lobes, however, appear somewhat smaller than normal.
Miscroscopic Findings:
A large number of sections were taken through the membranous sacs found
beneath the dura. The structure of the wall is seen to be composed of oedematous
fibrolastic or fibrous connective tissue, rather roughly arranged and abundantly supplied with thin-walled blood channels.    The somewhat irregular arrangement of the
Page 22
i= cells within this wall differentiates it from the adjacent dura. Adherent to its lining
in many instances, are small masses of calcified material, and scattered throughout its
substance are fairly numerous cells containing brownish pigment. These findings
are in keeping with the gross impression of old haemorrhage with organization and
encapsulation. Apart from the presence of the large mononuclear cells which contain pigment, very few inflammatory cells are seen. Although it is actually impossible to state from microscopical examination that this structure is of twenty-one
years' duration, it appears to be a possibility, especially in view of the clinical history."
It is presumed, therefore, that these bilateral subdural haematomata were of twenty-
one years' duration.
By R. L. Whitman, M.D.
Fat embolism is neither new nor is it uncommon, yet it is seldom diagnosed clinically
and only infrequently reported at autopsy. The condition is defined by Gauss as follows1 "Fat embolism is an acute circulatory disturbance caused by trauma, manifested
anatomically by the presence of fat globules within the vessels of the circulation and by
certain secondary changes which they produce; clinically it is recognized by the presence
of restlessness, dypnoea, delirium, coma and frequently death."
Except when medicated oils are injected directly into the circulation, fat embolism
always follows some antecedent condition. Amongst the primary causes listed are (1)
trauma to the osseous system, such as fractures, and (2) trauma to subcutaneous fat
and fatty viscera. One also finds such conditions as burns, poisons and even natural
causes of death given as primary causes. However, Vance, working in the Office of
the Chief Medical Examiner of New York City, conclusively demonstrated that a
serious degree of fat embolism is only found following physical trauma2.
First, let us consider the pathological basis of this condition. It is uncommon in
children for the following reasons: (1) their bones are more easily bent, and (2) the
bone marrow present is more cellular and less fatty than that of adults. In addition,
according to Landois2, the fat present in the bones of children is composed of the less
fluid oils, palmitin and stearin, with a smaller proportion of the more fluid olein.
In the age group twenty to fifty, the bone marrow contains the highest percentage
of olein which is quite fluid at body temperature.
Before fat embolism may follow as the result of physical trauma the three conditions
enumerated by Gauss1 must be present.
(1) The force must so injure the envelope of the fat cell that liquid fat is set
(2) The force must tear small veins in the vicinity of the fat.
(3) Some mechanism must be present which will drive the liquid fat into the
open ends of the torn veins and so introduce it into the general venous circulation.
The most frequent source of fat embolism is fracture of the shaft of a long bone.
Here many veins are torn across and in addition those within the haversian canals are
held open by their osseous framework. Added to these forces are the normal "sucking"
action of the veins and the increased tension due to haemorrhage and muscle spasm. All
these factors aid in the introduction of fatty globules into the venous circulation through
which they are quickly carried to all the organs of the body. Because of their rich blood
supply the lungs and nervous system are particularly affected.
The pulmonary system possesses a tremendous reserve capacity and therefore only
when meboli are numerous are clinical symptoms and signs evident. Microscopically
the lungs show multiple small congested areas surrounded by more crepitant better
aerated tissue. Tissues treated by special fat stains such as Sudan III show in many areas
capillaries occluded by spherical or ovoid fatty globules.    The surrounding alveoli are
■;%'■ Page 23 r *•
.ft ii
'iff i
fifilled with an oedematous coagulum containing numerous red blood cells, leucocytes I
and monocytes.
To reach the systemic circulation and more particularly the nervous system fat |
emboli must either pass through a patent foramen ovale or through the pulmonary capil-l
lary field. It has been clearly demonstrated that a severe degree of cerebral fat embolism j
can rise in the absence of a patent foramen ovale or any other similar channel2.
Fat emboli may lodge in any area of the central nervous system.   Thus we may have
embolism with infarction occurring in the cortex, basal nuclei, association tracts, spinal 1
cord or even spinal cord roots.    It follows, then, that clinically almost any neurological I
picture may result.
Clinically cases of fat embolism are commonly divided into two groups: the pul- I
monary and the systemic or cerebral group. However, no sharp line of demarcation can I
be drawn between these groups for symptoms of pulmonary and cerebral involvement I
are found in nearly all cases. One of the most important points in the diagnosis of fat j
embolism is the fact that there is always a latent period between the occurrence of the I
trauma and the appearance of signs and symptoms. This latent period may vary from ]
several hours to eight or nine days.
First let us consider the so-called "pulmonary fat embolism." Following the latent |
period signs and symptoms of respiratory embarrassment may come on suddenly or more I
gradually. Characteristic of this condition are the onset of dyspnoea, chest pain, cough j
often with blood tinged sputum and cyanosis. The patient is anxious and restless. The j
blood pressure is commonly lowered, the pulse fast and irregular, and signs of pulmonary ]
oedema are found throughout the lungs. If the degree of fat embolism is severe, signs J
and symptoms become more marked and finally Cheyne-Stokes respirations indicating I
an almost certainly fatal outcome appear.
Let us now consider the cerebral or systemic form of fat embolism.   Almost invariably it is preceded or accompanied by signs and symptoms of pulmonary fat embolism, j
Generally the latent period in cases of cerebral fat embolism is longer than in those I
of the pulmonary type.    Usually a period of time varying from forty-eight to sixty
hours has elapsed following the trauma.   This period, however, may be as short as four
hours or as long as nine days.   Signs of cerebral involvement such as insomnia, disorien- j
tation and a slight delirium are the first to appear.   Gradually coma makes its appearance I
and with this varying neurological signs are met.    Muscular rigidity, contractions and j
convulsions indicate cortical involvement.    Paralysis of various groups, even a hemi- j
plegia, may appear.    The coma gradually deepens and the patient becomes incontinent.
Finally if the degree of embolism is severe a profound degree of unconsciousness accompanied by Cheyne-Stokes respirations, again indicating a fatal outcome makes its appearance.
Two important signs indicative of a systemic fat embolism are not infrequently
found and must be repeatedly searched for if the diagnosis is to be established beyond j
doubt.    They are  (1)   multiple petechiae about the chest and shoulders and  (2)   the 1
presence of fat in the urine.
Briefly now, a few words concerning treatment.    Once the condition is established, j
treatment must of necessity be merely supportive.   It is far better to aim at preventing
the development of this complication and briefly, prevention aims at the following:
(1) Avoid unnecessary movement of traumatic cases.
(2) Avoid the application of tight casts, since they increase the pressure on the
liquid fat surrounding the fracture and thereby tend to force it into the venous |
The following case report illustrates a severe degree of cerebral fat embolism.
Mr. C. T., aged 50. Admitted March 25, 1941.
Dr. Frank Turnbull, Dr. J. R. Naden Died April 13, 1941.
The patient was struck by a car about 11 p.m., March 25, 1941.    He sustained a
compound comminuted fracture of the right tibia and fibula, multiple scalp lacerations
Page 24
!1 and abrasions of the extremities. He was deeply unconscious and in miderately severe
shock on admission. On examination at that time, the pulse was 88, respirations 28,
and blood pressure 70/50. Respirations were quiet, regular and moderately deep. Pupils
were moderately constricted, round and regular and reacted quickly to light. Both
eyes were deviated to the left. Tendon reflexes were physiological, abdominal reflexes
absent, and plantar reflexes doubtful.
Treatment: Routine shock treatment was given, the scalp sutured, and extension
applied to the right leg by means of boot traction and Buck's extension.
March 26, 1941: Pulse varied between 80 and 100. The patient roused when spoken
to but seemed dazed. He was very restless, frequently grinding his teeth, and had to
be kept in light restraint. He took fluids eagerly. Blood pressure was 140/80. He was
placed on Soludagenan, one ampoule every four hours, and Sodium phenobarbital pro re
March 28, 1941: General condition improved. Because of "pressure areas" which
were developing about the right ankle he was taken to the Operating Room and under
local anaesthesia a Kirschner wire was inserted through the right os calcis. Extension
and fixation were maintained by means of a Thomas splint and Buck's extension.
March 29, 1941: General condition worse. Temperature varied between 1012 (R)
and 1022 (R). The patient was cyanosed and dyspnceic. His pulse was irregular and
of poor quality. Respirations were Cheyne-Stokes, and he continually ground his teeth.
Multiple petechiae appeared about the anterior chest and in both axillae. There were
frequent twitchings of the left side of the face. A large amount of fat was found in
the urine.    Haemoglobin was 77%.
March 30, 1941: Definite fatty casts and globules found in urine.
April 2, 1941: Less restless. Haemoglobin was 68%. N.P.N, was 50 milligrams
per cent.
April 8, 1941: Fully conscious; still disorientated. Answered simple questions quite
well.   Temperature was 992 (R), pulse 80, and respirations 20.
April 13, 1941: Bright and talkative today. While expelling an enema he became
cyanosed and died in a few minutes.
Autopsy, as reported by Dr. H. H. Pitts:
Gross examination: "The brain weighs one thousand, five hundred and thirty grams
(1530 grms). Section through the brain shows a number of small petechial haemorrhages suggesting they are not recent, as they are of a somewhat darker appearance, and
here and there are slightly larger ones, about the size of a barley grain, which have a
faintly brownish yellow tinge suggesting that they are much older. These are in the
cortex and also in the white matter."
Microscopic Findings: "A number of sections were made through the lungs, brain
and kidneys by the frozen section method and stained with fat stains but no definite
fat emboli are seen at this time although apparently during life they were definitely
present as there was a considerable degree of lipuria."
Autopsy Diagnosis:
(1) Pulmonary embolism.
(2) Compound comminuted fracture of right tibia and fibula.
(3) Multiple fat emboli (old) of brain.
(4) Marked pulmonary congestion.
(5) Myocardial degeneration.
(6) Fatty infiltration of liver.
I wish to thank Dr. F. Turnbull for kindly permitting me to include this case.
Pathology of Fat Embolism—Archives of Surgery, 9, 593.
Significance of Fat Embolism—Archives of Surgery, 23: 426.
Page 25 mk.
•u "■•
if,   j; H
In the past a frequent complaint from mothers was the expense
incurred when the large bottle of antiricketic
was accidentally upset.
can't i4iill
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to  U
Remove both top and side caps.
Wipe dropper tip. Place forefinger firmly over top opening
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Oleum Percomorphum is_ best
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*Supplied only on the 50 c.c. size;
the 10 c.c. size is still supplied with the ordinary type of dropper.
More Economical Now Than Ever
Please enclose professional card when requesting samples of Mead Johnson products to cooperate in preventing their reaching unauthorized persons.


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